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Introduction: Altered DNA methylation pattern in sperms has been associated with infertility in males demonstrating defective spermatogenesis or low semen quality. Vitamin B-12, by affecting 1-carbon metabolism pathways, might alter the DNA methylation pattern. We aimed to study the correlation of serum vitamin B12 levels with aberrant DNA methylation in infertile male patients. Methods: A cross-sectional study was conducted on 17 oligozoospermic infertile males (WHO criteria, 2010) and 10 healthy fertile males. Serum vitamin B12 levels were estimated using the chemiluminescence method. Global methylation was determined using the ELISA system (Imprint Methylated DNA Quantification Kit, Sigma–Aldrich). The levels of global DNA methylation were calculated and compared relative to the methylated (100%) control DNA provided with the kit. Results: Mean serum vitamin B12 concentration in the control group was higher than that of the case group. This difference in serum vitamin B12 concentration in both groups was found statistically significant. Although the results of this study show that oligozoospermic men have relatively lower global DNA methylation as compared to normozoospermic control, the values could not reach a statistically significant level. A small positive correlation was found between serum vitamin B12 levels and percent methylation defect (r = 0.14) but was statistically insignificant. Conclusion: Our study concludes that oligozoospermic infertile males have a significant deficiency of vitamin B12 as compared to normozoospermic fertile males. This study did not find any significant difference in global DNA methylation between the two groups. The present study does not suggest any correlation between serum vitamin B12 level and percent DNA methylation.

Objective: To determine the effectiveness of the telemedicine-based pulmonary rehabilitation programme in COVID-19 pneumonitis. Design: Prospective intervention study. Setting: Rehabilitation outpatient department, Tertiary-Care institute. Participants: Consecutive sample of patients (N = 50) in recovered COVID-19 infection. Intervention: Six weeks of telemedicine-based pulmonary rehabilitation in recovered patients of COVID-19 infection. Outcome Measures: All patients were clinically assessed by six minutes walk test (6MWT), Modified Medical Research Council Scale (mMRC), 30s-STS and SF 36 at zero week and six weeks post-intervention. Statistical Analysis: Difference in means of pre- and post-intervention was compared using paired t-test. A P value

High thoracic epidural anesthesia in cardiac surgery as the sole anesthetic technique is used in a select groups of patients having severe pulmonary co morbidities. We describe a case series of three patients at high risk for post operative pulmonary complications where this technique was used along with dexmedetomidine infusion for conscious sedation in off pump coronary artery bypass grafting. Proper selection of patients, proper placement of the epidural catheter at the appropriate level and timing of catheter insertion and removal are of paramount importance.

Background: Mucositis, xerostomia, dysgeusia, trismus, radiation caries, osteomyelitis, and osteoradionecrosis are a few examples of radiotherapy (RT) complications, eventually distressing the patient's life. Objectives: To study the oral complications emerging due to RT and evaluate dental management of such complications before, during, and post-RT in oral cancer patients. Methods: Patients were evaluated on various parameters, which include the Oral Hygiene Index Simplified (OHI-S), Periodontal Index (PI), Gingival Index (GI), D – Decayed, M – Missing due to caries, F – Filled, T – permanent teeth (DMFT) Index, mucositis, xerostomia, dysgeusia, and interincisal distance before, during (10th session and last session), and 1 month after the last session of RT were evaluated and compared. Statistical Analysis: The following tests were applied: Chi-square test, analysis of variance (ANOVA) test, and standard deviation method. Results: P value

Purpose: To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India. Methods: A cross-sectional study was conducted among school-going children of age group 6–16 years of standard I–XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value

Context: Papilloedema is defined as optic disc oedema secondary to raised intracranial pressure (ICP). Grading the degree of oedema using only subjective, examiner-dependent and non-quantitative fundoscopic classification like Modified Friesen Clinical Scale (MFS), may be subject to errors even when used by experienced examiners. The use of spectral-domain optical coherence tomography (SD-OCT), a non-invasive imaging technique, for early identification of raised ICP even before the clinical appearance of papilloedema by quantifying the thickness of the peripapillary retinal nerve fibre layer (ppRNFL) is crucial for such patients. Aims: To evaluate the ppRNFL using SD-OCT in patients with papilloedema. Settings and Design: Hilly North Indian population, Prospective case-control study. Methods and Material: From January 2018 to December 2018, a total of 45 patients diagnosed with papilloedema were included. Age and sex-matched controls were recruited. Detailed demographic information and the history of study subjects were noted. All subjects underwent systemic and detailed ophthalmic examination. Disc photographs were graded as per Modified Frisen Criteria (MFS). SD-OCT of the optic nerve head was done to provide a mean peripapillary RNFL thickness parameters in the different quadrants of the disc in each eye. Statistical Analysis Used: For analysis, statistical software SPSS version 23 and appropriate statistical tests were applied. P value < 0.05 was considered significant. Results: The median age of presentation was 36 years (Range 10–68 years). The male to female ratio was 1:1.3. The mean ppRNFL thickness of both right and left disc in all quadrants was significantly higher in cases in comparison to controls (P-value < 0.05 is significant). The average ppRNFL thickness in all the quadrants of both eyes was significantly higher in the mild grade of papilloedema in comparison to controls (P-value < 0.05 is significant). Conclusions: SD-OCT can be ordered as a routine important non-invasive investigation in addition to basic fundoscopic examination in all patients with papilloedema or suspected to have papilloedema.

A 25-year-old female presented with sudden onset diminution of vision in the right eye (oculus dextrus [OD]) following blunt trauma after a sports injury. Ocular examination revealed best-corrected visual acuity (BCVA) of 20/30 in OD and fundus revealed commotio retinae, localized preretinal bleed, and a large choroidal rupture (CR). She was managed conservatively at that moment. Three months following trauma, she returned with further deterioration of BCVA (20/80) in OD. Optical coherence tomography angiogram (OCTA) confirmed the presence of choroidal neovascular membrane (CNVM). She was treated with single intravitreal ranibizumab injection. Repeat OCTA after 6 weeks showed the regression of CNVM. Her BCVA improved to 20/30 at 6 months of follow-up. In the index report, we present a unique OCTA guided the diagnosis of posttraumatic CR-associated CNVM and its successful management with single intravitreal ranibizumab.

Background: Insulin resistance (IR) is a pre-diabetic condition and has been reported in patients with acanthosis nigricans (AN) and acrochordon. AN and acrochordon are claimed to be cutaneous markers of IR. Aim: The purpose of this paper was to study the association of AN and acrochordon with IR. Methods: It was a cross-sectional hospital-based study. Both groups were assessed for IR by using homeostatic model assessment of insulin resistance (HOMA-IR) formula. Results: A total of 70 cases and an equal number of controls were studied. IR was observed more in cases (41.4%) compared to controls (17.1%) (P < 0.01). Mean HOMA-IR value was also significantly higher in cases (4.32 ± 4.44) compared to controls (2.27 ± 0.90) (P < 0.05). Limitations: Low number of cases and controls were taken in the study. Association with hyperlipidemia and metabolic syndrome was not elicited. Conclusions: AN and acrochordons were found to be associated with IR.

Background: Globally, ocular morbidities are one of the most underdiagnosed, underreported, and undertreated public health concern. Among estimated 39 billion blind in world, India shares major proportions, with majority of them living in rural population. In India, religious festivals like Kumbh Mela that involve mass gatherings are mainly attended by middle and elderly population who are usually susceptible to various ocular diseases. Therefore, we analyzed the data of our eye camp to document pattern and magnitude of ocular morbidities among pilgrims attending a mega religious festive event. Methods: In a cross-sectional, descriptive study, we included all those patients who participated in a mega eye camp “Netrakumbh” from January to March 2019 at Kumbh Mela, Prayagraj, India and were attended by voluntary ophthalmologist from All India Institute of Medical Sciences, Rishikesh. Presenting chief complaints and detailed history were collected from all participants. All patients underwent comprehensive eye examination including visual acuity, slit lamp biomicroscopic examination, tonometry, etc., Data were compiled and analyzed utilizing SPSS 22.0. Results: A total of 47142 eyes of 23571 persons of all age groups (range 5 years to 70 years) with approximate equal gender distribution attending the mega eye camp were examined. The most common ocular morbidity noticed after ocular examination was refractive error with underlying cause majorly as presbyopia, followed by cataract, after cataract, convergence insufficiency, lids, and adnexal disease, etc. Conclusions: This study highlights the changing pattern of common ocular morbidities presently among middle and elderly populations in developing countries like India.

Shone's anomaly is a very rare congenital cardiac malformation characterized by four serial obstructive lesions of the left side of the heart (i) Supravalvular mitral membrane (ii) parachute mitral valve (iii) muscular or membranous subaortic stenosis and (iv) coarctation of aorta. We report a unique presentation of Shone's complex in a 14-year-old adolescent male. In addition to the four characteristic lesions the patient had bicuspid aortic valve, aneurysm of sinus of valsalva, patent ductus arteriosus, ventricular septal defect, persistent left superior vena cava opening into coronary sinus and severe pulmonary artery hypertension. This case report highlights the importance of a strong clinical suspicion of the coexistence of multiple congenital cardiac anomalies in Shone's complex and the significance of a careful comprehensive echocardiography.

Objective: To analyze global DNA methylation along with DNA methyltransferases (DNMTs) expression at transcript level in patients with impaired spermatogenesis to dissect its role in pathophysiology of human male infertility. Method: The content of Global methylated cytosine (mC) was determined using ELISA system (Imprint Methylated DNA Quantification Kit, Sigma–Aldrich) in 31 testicular biopsies showing impaired spermatogenesis and 8 with normal spermatogenesis. Real-time reverse transcription-polymerase chain reaction was done to analyze DNMTs (DNMT1, DNMT3A, DNMT3B and DNMT3L) mRNA levels in biopsies with different testicular phenotypes. Results: There was significant increase in levels of global methylation in different impaired testicular phenotypes as compared to normal. Expression analysis revealed significantly increased expression of DNMT1 and its positive correlation with global DNA methylation. Conclusion: In conclusion, increased levels of global methylation in impaired cases might be the one of the contributing factors for aberrant gene expression in infertile patients.

Objective: To investigate –844C>T single nucleotide polymorphism (SNP) present in the promoter of cell death pathway gene FASLG with male infertile phenotype. Methods: Genotyping for SNP FASLG (rs763110) was done by polymerase chain reaction followed by analysis with specific endonuclease (PCR-RFLP). DNA sequencing was used to ascertain PCR-RFLP results. Results: FASLG –844C>T polymorphism, allele and genotype distribution did not differ significantly between patients and controls (OR: 1.03, 95% CI= 0.7638 to 1.3952, P=0.83). Thus SNP-844C>T of the FASLG gene is not associated with male infertility risk in the analyzed patients. Conclusions: Human male infertility is a complex disorder and thus other genetic or environmental factors may be contributing to the complex etiology, and further study in other region of Indian populations will verify whether it is associated with male infertility risk.

Determination of lipid content of any biological sample is essential for various kinds of studies related to pathogenicity and drug development. Thus, reliable methods for the quantitative extraction of lipids are of critical importance. The mycobacterial cell wall is largely composed of lipids. Commonly used methods to extract lipids, such as the Bligh and Dyer method or the Folch method, yield a low amount of lipids when applied to mycobacterial cells. This study presents an efficient modification of Chandramauli's method, a less known method developed at this institute earlier that is able to yield a considerably higher concentration of mycobacterial lipids.

Gastrointestinal symptoms such as dyspepsia, vomiting, diarrhea, hepatitis, gastrointestinal bleed, abdominal pain, subacute intestinal obstruction like presentation and acute abdomen are common in acute malaria. However, perforated duodenal ulcer (PDU) complicating acute malaria in a child is a rare occurrence and uncommonly heard of. The exact mechanism of duodenal ulcer perforation in malaria is not clear due to the paucity of reported cases, and it may be multifactorial in etiology. The treatment of PDU in children is similar to adults that is surgical by omental patch repair of the perforation. We present an unusual case of PDU in a pediatric patient of malaria. The search of English literature revealed only one more reported case of PDU associated with malaria.

Aortopulmonary window (APW) is an extremely rare cardiac malformation accounting for 0.2-0.6% of all congenital heart defects. In an acyanotic patient with clinical evidence of patent ductus arteriosus with large left to right shunts and systolic rather than continuous murmur one should keep in mind the possibility of APW. If not treated early in childhood or adolescence, they tend to develop pulmonary hypertension, which can be fatal in almost all cases. Few surviving adult patients have symptoms associated with severe pulmonary hypertension, making these cases inoperable. We document an unusual case presenting in the second decade.

Dentigerous cyst is caused by fluid accumulation between the epithelium and the crown of an unerupted tooth. It grows by expansion of the follicle and is attached to the neck of the tooth. The radicular cysts are inflammatory jaw cysts at the apices of teeth with infected and necrotic pulps. These arise from the epithelial residues in the periodontal ligament as a result of inflammation, usually following death of the pulp. We present a case of a cystic lesion creating dilemma between radicular and dentigerous cyst.

Shankhpushpi is a cognition boosting traditional ayurvedic brain supplement. Convolvulus pluricaulis (Convolvulaceae), Evolvulus alsinoides (Convolvulaceae), Clitoria ternatea (Papilionaceae), and Canscora decussata (Gentianaceae) are botanical claimants of Shankhpushpi. This investigation is to focus the identification of the compound based on biological marker differentiation of four botanical claimants of Shankhpushpi for their antioxidant evaluation on thin layer chromatography (TLC) by 2,2-diphenyl-1-picrylhydrazyl (DPPH) method. A rapid TLC-DPPH method was developed to identify and differentiate four botanical claimants of Shankhpushpi in terms of presence of β-carotene, rutin, scopoletin, chlorogenic acid, and mangiferin. C. pluricaulis shows presence of scopoletin; E. alsinoides shows presence of β-carotene, scopoletin, and chlorogenic acid; C. ternatea shows presence of β-carotene, scopoletin, and rutin; and C. decussata shows presence of β-carotene, scopoletin, and mangiferin. The order, they followed, based on their antioxidant potential is β-carotene < mangiferin < rutin < scopoletin < chlorogenic acid. Antioxidants are attributed for their beneficial role in age-related cognition decline. The proposed method provides an edge in terms of identification and quantification of antioxidant constituents in a multi-component system. This method may also provide application for identification of correct plant sources used in the name of Shankhpushpi in marketed ayurvedic formulation, food supplement, and extracts.

Background: This study was undertaken to compare the effects on intrauterine resuscitation by table tilt versus pelvic tilt position after spinal anaesthesia for Caesarian Section. Patients & Methods: Fifty ASA I and II patients who fulfilled the eligibility criteria were enrolled in the study and were divided into two groups: group W (Pelvic tilt with wedge under right hip and group L- (15 0 left lateral table tilt) and received spinal anaesthesia. The following parameters were recorded. Heart rate (HR), mean arterial pressure (MAP) at baseline, 2mins, 5 min and then 5 min thereafter. Mean height of block, Total no. of segments blocked, Onset Time of sensory block (in Minutes), ephedrine doses, incidence of hypotension & bradycardia, APGAR score at 1& 5 Minutes. Results : The decrease in MAP was much more in wedged position as compared to table tilt position also the incidence of hypotension was 40% in wedged position as compared to 12% in table tilt position. Mean height of block, Total no. of segments blocked, and boluses of inj. ephedrine used were more in the wedged position than in table tilt position. Conclusion: Wedge placement caused increased incidence of hypotension and higher blockade after spinal anaesthesia as compared to left lateral table tilt position, there was no adverse effects on foetus and patients tolerated wedge better than left lateral table tilt position. Also surgery was easier to perform after wedge placement.

Chilaiditi syndrome is a condition in which the colon or rarely the small bowel is interposed temporarily or permanently between the liver and the diaphragm. Usually it is an asymptomatic and incidental radiographic finding, but may present with a variety of symptoms. We report a case of Chilaiditi syndrome with small bowel interposition who presented with chest pain, initially suspected to be myocardial infarction. Further Investigations revealed normal cardiac functions and gas under the right hemidiaphragm suggestive of pneumoperitoneum. After careful inspection of radiograph it was found to be gas filled small bowel between liver and diaphragm, which was later confirmed by ultrasound examination. The patient was successfully managed conservatively.

The isolation of the essential oil of whole fresh leaves of Citrus lemon by steamdistillation is described. The chemical composition of the oil was investigated by meansof Gas-Liquid Chromatography (GLC), Column Chromatography (CC) and coupled GasChromatography-Mass Spectrometry (GC-MS). The 27 most important volatilecomponents were identified. The volatile components were identified by comparing theirretention times of GC chromatograph with those of literature. Further identification wasdone by GC- MS. The components of the oil, percentage of each constituent, their RIvalues and their Eight Peak Index were also summarized and reviewed with standardavailable literature.

People in Indian region often apply Shankhpushpi and other Sanskrit-based common name to Evolvulus alsinoides, Convolvulus pluricaulis, Canscora decussata, and Clitorea ternatea. These are pre-European names that are applied to a medicinal plant. Before the establishment of British rule, like the other books, ayurvedic treatises were also hand written. This might be one of the reasons due to which ayurveda could not stand parallel to the western medicine and an ambiguity is reflected in the interpretation of names and description of drugs found in the books like Charaka Samhita and Sushruta Samhita. The most widespread application of Shankhpushpi is for mental problems, but they have been considered for an array of other human maladies. The present investigation deals with the comparative pharmacognostical evaluation of four ethanobotanicals of Shankhpushpi. A comparative morphoanatomy of the root, stem, and leaves has been studied with the aim to aid pharmacognostic and taxonomic species identification. Various physicochemical, morphological, histological parameters, comparative high-performance thin-layer chromatography (HPTLC), and comparative high-performance liquid chromatography (HPLC), chromatogram of methanolic extract presented in this communication may serve the purpose of standard parameters to establish the authenticity of commercialized varieties and can possibly help to differentiate the drug from the other species. All the parameters were studied according to the WHO and pharmacopoeial guidelines.

The isolation of the essential oil of whole fresh leaves of Citrus lemon by steam distillation is described. The chemical composition of the oil was investigated by means of Gas-Liquid Chromatography (GLC), Column Chromatography (CC) and coupled Gas Chromatography-Mass Spectrometry (GC-MS). The 27 most important volatile components were identified. The volatile components were identified by comparing their retention times of GC chromatograph with those of literature. Further identification was done by GC- MS. The components of the oil, percentage of each constituent, their RI values and their Eight Peak Index were also summarized and reviewed with standard available literature.

Objectives: Management of pT 1 G 3 TCC of urinary bladder is always a dilemma for urologists due to its high recurrence & disease progression rate. We evaluated the role of conservative management for this subgroup with TURBT and intravesical immunotherapy; and delayed cystectomy for progressive disease with an aim to salvage bladder. Patients & Methods: Between Jan.1996 to Dec.2002, 66 patients (15%) of pT 1 G 3 , out of a total 440 patients of superficial bladder cancer treated in this department were subjected to low dose BCG (40mg) and Interferon 3 million IU intravesically with maintenance therapy after complete TURBT and followed up for average 60 months. The mean tumor free interval was 26 months & 18 months in superficial recurrences & muscle progression disease respectively. Delayed cystectomy being preserved only for disease progression patients and the mean period of delayed cystectomy was 24 months (18-30 months). Results: 19 patients (29%) had no tumor recurrence, 35 patients (53%) showed superficial recurrence and 12 patients (18%) progressed to higher stage at end of five year follow up thereby giving a disease progression free interval of 60 months in 82% of our patients. Five patients of disease progression group died due to metastatic disease process and 7 patients are alive after delayed cystectomy at the end of follow up. Side effects from intravesical therapy were confined to local irritative symptoms only. Conclusion: Our data only confirms the benefit of adjuvant intravesical low dose immunotherapy in management of pT 1 G 3 tumor after TURBT with bladder salvage in 82% of patients, simultaneously not compromising the survival rate.

Aim: To determine the surgical complications of open retropubic radical prostatectomy. Materials and Methods: Fifty-nine cases of localized prostate cancer underwent retropubic radical prostatectomy in our department in the last seven years. Standard technique of open retropubic radical prostatectomy as described by Walsh was used. During follow-up cancer control and quality of life indices (potency and urinary continence) were noted. Result: Postoperative recovery of all patients except one was excellent. This patient required cardio-respiratory support and nine units of blood transfusion. Forty-nine out of 52 patients were continent, two had stress incontinence and one was totally incontinent at one year. Bladder neck contracture was present in eight out of 52 patients at one year. Forty-five patients were impotent at one year with or without oral tablet sildenafil. Cancer control was present in 45 out of 52 cases. Seven cases had biochemical failure at one year. Conclusion: Though retropubic radical prostatectomy is the standard treatment for early prostate cancer it is not without complications. It has a steep learning curve. More number of cases and refinement in technique is required to achieve world-class results.

Objective: To identify the clinical, laboratory, and radiological markers that could predict a positive GeneXpert result in patients suspected of tuberculous meningitis. Methods: In this prospective, observational study, patients with tuberculous meningitis were systematically evaluated. Various clinical, laboratory [including cerebrospinal fluid (CSF) microscopy, culture, and GeneXpert], and neuroimaging factors were examined. All participants were administered anti-tuberculous treatment and corticosteroids. A six-month follow-up was done to evaluate the outcome. Results: Of the 116 patients studied, 54 (46.6%) tested positive for GeneXpert, while 62 (53.4%) were negative. Third cranial nerve involvement (OR 3.71, 95% CI 1.052-13.09, P=0.04) and the presence of basal exudates on neuroimaging (OR 5.22, 95% CI 2.03-13.42, P=0.001) emerged as independent predictive factors for a positive GeneXpert result. A positive CSF GeneXpert result (P=0.002) and drug resistance (P=0.004) were significantly linked to adverse outcomes. Additionally, a high score on the Medical Research Council stage III (OR 5.64, 95% CI 1.18-26.87, P=0.03) and elevated CSF cell counts (OR 1.002, 95% CI 1.00-1.001, P=0.03) were identified as independent predictors of poor prognosis. Conclusions: Third cranial nerve involvement and the presence of basal exudates were significant indicators of a positive GeneXpert result. MRC stage III disability and elevated CSF cell counts predicted poor outcomes.

Background: Skin conditions form a major bulk of diseases in the community. With a disproportionately low number of dermatologists in the country, and a greatly unequal distribution between urban versus rural areas, ineffective treatment and mismanagement of skin conditions are, however, commonplace. Objective: To develop standard treatment workflows (STWs) for certain skin diseases for use by clinicians at primary, secondary, and tertiary care centers. Methodology: Seven members, from various academic institutes across the country, were selected for formulation of the STWs. They were provided logistic and technical support by the ICMR, Department of Health Research (DHR), and WHO India office. Multiple rounds of online and physical discussions were performed to identify topics that would be most useful in the management of skin diseases for the health care personnel (HCP) and subsequently to frame the STW content. Results: The selected diseases included acne and rosacea, alopecia, bacterial skin infections, cutaneous adverse drug reactions, dermatophytosis, eczema/dermatitis, immunobullous dermatoses, psoriasis, scabies, varicella and herpes, vitiligo, and urticaria. There was one separate module on rational use of topical corticosteroids. The STWs for these conditions have been finalised and are available as physical posters in health centers and can also be accessed online and through mobile applications. Conclusion: Thirteen STW modules have been prepared with a view to optimize management of skin diseases at various levels of health care system of the country.

Introduction: Acute viral encephalitis syndrome including dengue encephalitis (DE) is an important tropical illness with a guarded prognosis. The cerebral blood flow may be affected in acute viral encephalitis. Transcranial Doppler (TCD) sonography can quantitatively determine intracranial vascular flow dynamics in acute viral encephalitis. Aim: We aimed to investigate the intracranial blood flow characteristics in patients with DE and compare with nondengue acute viral encephalitis patients. Materials and Methods: In this prospective study, all the cases of acute viral encephalitis including dengue were enrolled over 18 months and followed up at 3 months. TCD was performed to determine the mean velocity pulsatility index (PI) and resistive index (RI) across the middle cerebral artery, anterior cerebral artery, posterior cerebral artery (PCA), vertebral artery, and basilar artery and compared it among dengue versus nondengue group as well as outcome at 3 months. Results: Out of 39 patients, 19 were diagnosed with DE, whereas 20 patients suffered from the nondengue group. The elevated PI and RI in the left PCA were found to statistically significant (P = 0.001 and 0.008, respectively) in the DE group. There was no significant difference in any other TCD indices in any other vessel among both the groups. In addition, an initial low Glasgow Outcome Scale (GOS) and higher brain imaging abnormality were significantly associated with poor GOS of

Introduction: Despite recent advancements in hypertension management, a significant portion of the population in India still has uncontrolled blood pressure (BP), particularly post percutaneous coronary intervention (PCI). This paper fulfils the gap between post-PCI and hypertension management, ensuring hypertension is well-controlled before, during, and after PCI. Methods: Cardiologists (interventional, n = 256; noninterventional, n = 336) throughout India who treated hypertensive patients, post PCI were invited to participate in a survey and virtual meetings. The perception and practices in managing these patients and strategies to improve BP control were captured. Results: Out of 593 cardiologists, 57.5% opined that heart failure (HF) was more common in patients with hypertension indicated for PCI. The target BP after PCI for patients aged 65 years was recommended to be 121–130/80 mmHg by 39% of experts while 131–140/90 mmHg by 33.2% of experts, respectively, with a target heart rate of 60–80 bpm. Angiotensin II receptor blockers (ARBs) were considered the most effective antihypertensive agent in different comorbid conditions. Metoprolol and bisoprolol were the most preferred cardio-selective beta-blockers for both post-PCI and HF. A combination of ARBs and beta-blockers after the intervention was suggested in hypertensive patients with coronary artery disease and diabetes mellitus (57.0%), stroke (41.1%), and HF (44.9%). Conclusions: Managing BP and heart rate in patients with hypertension post-PCI is important. In monotherapy, ARBs followed by beta-blockers and angiotensin-converting enzyme inhibitors, were the most preferred antihypertensive agents in these patients with different comorbid conditions. While a combination of ARB and beta-blocker was preferred in patients with PCI and multiple comorbidities.

Background: Pulmonary rehabilitation (PR) is a well-recognized intervention in the management of individuals with chronic obstructive pulmonary disease (COPD) that is designed to improve patients’ physical and psychosocial conditions. The primary aim of the study was to determine the effect of PR on ultrasonography (USG) assessment of diaphragmatic excursion. Materials and Methods: The current study is a prospective, interventional study in COPD (Group D) patients. All subjects underwent 8 weeks of supervised PR. The baseline assessment with USG diaphragmatic excursion, quadriceps femoris (QF) thickness, biceps brachii (BB) thickness, mid-thigh circumference, mid-arm circumference, modified Medical Research Council score, 6-min walk distance, COPD assessment test score, and after 8 weeks of supervised rehabilitation same parameters observed. Results: About 25.71% of the study population was in the age group range of 45–55 years, 51.43% between 56 and 65 years and 22.86% within 66–75 years of the age group. Out of 35 patients, 15 (42.86%) were females and the rest 20 (57.14%) were males. A significant increase was found in the diaphragmatic excursion (cm) from (P < 0.0001), mid-arm circumference (cm) (P < 0.0001), BB thickness (cm) (P < 0.0001) (upper limb strength and endurance training), and mid-thigh circumference (cm) (P < 0.0001) along with QF thickness (cm) (P < 0.0001) (lower limb strength and endurance training). Conclusion: An 8-week physical and PR program in COPD patients can lead to an improved USG diaphragmatic excursion.

This systematic review aims to determine the incidence and prevalence of acute stroke in patients with sickle cell disease (SCD) and explore its clinical implications and outcomes. A comprehensive search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines to identify relevant studies published between 2013 and 2023. Databases including PubMed, Google Scholar, ResearchGate, ScienceDirect, and Wiley Online Library are searched. Inclusion criteria are applied to select studies involving human subjects, written in English, and reporting the association between acute stroke and confirmed cases of SCD. Study quality assessment and data extraction are performed by two independent reviewers using study-specific tools. A total of 9 studies met the inclusion criteria including 7 cohort studies, and two meta-analyses are included in the systematic review with a total of 24,480 participants. The prevalence of stroke in SCD patients varied across studies, ranging from 1.24% to 27.3%. The incidence rates of stroke showed significant variability, ranging from 0.31% to 31%. Long-term disabilities, recurrence, and reduced quality of life characterized the clinical outcomes of stroke in SCD patients. Mortality rates varied among studies, emphasizing the need for early detection and comprehensive care. The review provides valuable insights for health-care professionals, researchers, and policymakers involved in SCD care, emphasizing the importance of early detection, intervention, and comprehensive management to improve patient outcomes. Further research is needed to address knowledge gaps and understand the underlying mechanisms of stroke in SCD.

Introduction: In individuals with acquired immunodeficiency syndrome (HIV/AIDS), abdominal pathologies rank second in frequency only to pulmonary illnesses. An essential imaging method for assessing abdominal diseases is ultrasonography (USG). In this study, abdominal pathologies in HIV/AIDS patients were evaluated using USG, and their relationship to CD4 count was further examined. Materials and Techniques: 400 HIV+ subjects with aberrant abdominal USG participated in the current investigation. The subjects were assessed and graded as per the CD4 counts. Later the comparisons were drawn between the USG, and its relationship to CD4 count using SPSS 16.0 software, and all data were examined using appropriate statistical tools. Results: Men were over 60% of the 400 subjects. The average age of these subjects was 35.6 years; the range for this age group was 6 to 63 years. Spleen involvement was found on ultrasonographic examination in 45.1% of subjects, while liver and lymph node involvement was seen in 43.6% of subjects. Substantial correlations between CD4 counts and findings such as periportal & mesenteric lymphadenopathy, localized pancreatic lesion, splenic microabscess, splenomegaly, and hepatomegaly were found. One percent of individuals had lymphoma, which affected the retroperitoneal lymph nodes, pancreas, and liver. Conclusion: Present research demonstrates the significance of abdominal ultrasonographic examination in HIV+ patients. CD4 counts have a big impact on how an HIV/AIDS patient's differential diagnosis is determined. The interpretation of USG results in relation to CD4 levels may aid in accurate diagnosis.

Background: Neoplastic and infective brain lesions may present as imaging mimickers. This study aims to help differentiate between etiology of lesions based on diffusion tensor imaging (quantitatively and qualitatively). Method: DTI was performed in 50 patients (12 - metastases,13 - high grade glioma,13 - tuberculoma, 12 - Neurocysticercosis). Lesional and perilesional Fractional anisotropy (FA) and mean diffusivity (MD) values were calculated. Lesional and perilesional mean FA and MD values were compared by using Student's 't'-test. Result: Mean FA values in the perilesional area of neoplastic lesions were found to be significantly higher (0.17±0.12 vs. 0.08±0.02), P < 0.001) in comparison to infective lesions. Mean MD values in the perilesional area of infective lesions were found to be significantly higher (1.51±0.22 vs. 1.20±0.33x10-3mm2/sec, P < 0.001) in comparison to neoplastic lesions. Perilesional FA was found to be significantly higher and perilesional ADC to be significantly lower in High Grade Gliomas (HGG) when compared with Metastasis, Tuberculomas or Neurocysticercosis. Infective group showed significantly higher prevalence of displacement of white matter tracts (60%) and the neoplastic group showed significantly higher prevalence of the disruption (40%). Conclusion: FA and MD values from the lesion and from perilesional region are helpful in differentiating among brain lesions. Fiber tracking along with quantitative parameters is helpful in determining type of involvement of tracts, thus helping in prognostication.

Objective: The objective of this study was to seek the opinion of Indian health-care professionals (HCPs) about hypertension (HTN) care during coronavirus disease 2019 (COVID-19) era. Methods: HCPs' opinions (n = 2832) were recorded based on survey and round table meetings. Standard questionnaire consisting of nine questions pertaining to HTN care in COVID-19 was prepared, discussed, and evaluated by experts who treat patients with HTN during COVID-19 era. Results: Smoking/tobacco use, obesity, and comorbidities (diabetes/dyslipidemia) were ranked as the top three modifiable risk factors. A total of 37% and 33% of HCPs reported an increase in blood pressure (BP) during the lockdown period in 10%–20% and 20%–40% of hypertensive patients, respectively, who were on monotherapy. Around 35% of HCPs reported that 20%–30% of their patients with HTN showed uncontrolled BP (>150/100 mmHg). Dual-drug therapy in patients with uncontrolled BP was preferred by 56% of HCPs. Nearly 71% preferred dual combination for HTN management. In dual combination, 27% preferred angiotensin receptor blockers (ARBs) + diuretic, 26% preferred ARB + calcium channel blockers, and 18% preferred ARB + beta-blockers. The majority of HCPs (44%) consider that

Background: Guillain–Barré Syndrome (GBS) is an acute acquired autoimmune inflammatory disorder of peripheral nerves and roots. The pathogenesis is essentially an aberrant post-infectious immune response in a genetically susceptible host milieu. Single nucleotide polymorphisms (SNP) in genes encoding the inflammatory mediators like TNF-α, CD1A and CD1E can influence their expression and level and the susceptibility and clinical course of disease in GBS. Objective: We tried to study the susceptibility of single nucleotide polymorphisms of TNF-α and CD1 genes in Guillain–Barré Syndrome in Indian population and determine the association in terms of genotype, allele and haplotype distribution along with individual subtype, severity and clinical outcome. Methodology: In this case-control study, we investigated the single nucleotide polymorphism pattern in the promoter region of TNF-α (-308 G/A), TNF-α (-863C/A), CD1A and CD1E genes using real-time polymerase chain reaction in 75 GBS patients and analysed in comparison with 75 age and sex-matched healthy controls. Results: The findings revealed that the allelic distribution of TNF-α (-308 G/A) *A allele was associated with GBS (P value 0.04, Odds Ratio 2.03, 95% Confidence Interval 1.01–4.07). There was no association found with genotype, haplotype combination and other allele distribution for GBS in the study. CD1A and CD1E SNPs did not reveal any susceptibility for GBS. The subtype analysis did not reveal any statistical significance, except for CD1A *G allele with AMAN subtype (P value 0.026). The haplotypic combinations and mutant allele of TNF-α (-308 G/A), TNF-α (-863C/A), CD1A and CD1E were significantly associated with severe GBS in the study. However, there was no association of any SNP for mortality and survival of GBS in the study. Conclusion: TNF-α (-308 G/A)*A allele might confer genetic susceptibility for GBS in Indian population. CD1 genetic polymorphism could not be considered for susceptibility to GBS. TNF-α and CD1 genetic polymorphism did not affect mortality in GBS.

Background: Correlation between chest X-ray findings and drug resistance can provide valuable guide for physicians working at low-resource settings. Objective: To study tuberculosis (TB) drug sensitivity pattern as per the radiological presentation. Materials and Methods: A hospital-based prospective study was conducted among 67 newly diagnosed sputum-positive pulmonary TB patients who never took anti-TB treatment. They were subjected to history, systemic examination, radiology, and sputum smear examination. Ten patterns of chest X-ray were studied in the present study, which was not studied before. Chest X-ray radiology pattern was correlated with the drug resistance. Results: Isoniazid (INH) monoresistance was present in 11.9% of patients. 1.5% had rifampicin (RIF) resistance but no INH resistance. RIF and INH both resistance (multidrug-resistant [MDR]) was present in 7.5% of cases. Pattern Four was the most common radiological presentation in our patients being present in 20 (29.9%) patients. In this pattern, bacteria of 5.0% were RIF resistant. 15.0% were INH resistant, and 5.0% were both RIF and INH resistant (MDR). RIF resistance was most common in chest X-ray PA view with “Pattern Two” being present in bacteria of 21.42% of patients. Conclusion: Radiological patterns 2, 3, and 4 were highly correlated with the multidrug resistance, but it was not statistically significant. Patients' chest X-ray showing these patterns can be suspected to have MDR-TB and sent for further evaluation for early diagnosis and treatment of MDR-TB, which will give us good outcome. Further studies on this hypothesis should be conducted with bigger sample size to throw more light in this field.

Aluminum phosphide (ALP) poisoning is one of the most common and lethal poisonings with no antidote available till now. Inhalation or ingestion of ALP leads to the production of phosphine gas when exposed to moisture. We here report an adolescent female with alleged consumption of ALP available as celphos tablet, followed by severe metabolic acidosis and cardiogenic shock. Rapid timely initiation of venoarterial extracorporeal membrane oxygenation leads to intact neurological outcome and survival. Timely referral to higher center with extracorporeal life support facility is a key.

Background: Under the New Drugs and Clinical Trials Rules -2019 that came into force on 14th September 2019, all Ethics Committees (ECs) reviewing biomedical and health research should register with the authority designated by the Central Government of India. Study Objective: We investigated the status of registration of ECs in the Department of Health Research (DHR) to date. Materials and Methods: The data collection was started on 1 April, 2021 and was last updated on 10 April, 2022. The ECs registered with DHR were extracted from NAITIK online portal. The ECs were segregated according to the state and Union territories, medical colleges, dental colleges, and hospital and research institutes. Results: Total of 836 registered ECs were uploaded on the DHR website to date. Out of which, 822 (98.32%) were Institutional and 14 (1.67%) were independent. Among total ECs, 518 (61.96%) were in hospitals and research institutes, 231 (27.63%) in medical colleges, and 73 (8.73%) in dental colleges. 76 (9.09%) got the final certificate after completion of a provisional period of two years. Among 606 medical colleges and 316 dental colleges, 38.11% and 23.10% of colleges had registered ECs respectively. Maharashtra has the highest number with 129 (15.43%) registered ECs whereas Gujarat is number one (53.33%) in terms of percent registered ECs in medical colleges of particular states. Conclusions: Timely registration of ECs should be encouraged by the concerned stakeholders and try to make a robust mechanism for bringing transparency, uniformity, and accountability to the ECs across the states.

Since March 2021, cases with unusual clots, particularly cerebral venous sinus thrombosis and splanchnic vein thrombosis, have been reported worldwide following adenoviral vector-based coronavirus disease 2019 (COVID-19) vaccination. This entity has been termed vaccine-induced thrombotic thrombocytopenia (VITT). We report a 23-year-old healthy female who developed seizures, altered sensorium, and left hemiparesis, 20 days after receiving the first dose of adenoviral vector-based COVID-19 vaccine “Covishield™.” The patient had transient thrombocytopenia. The D-dimer level was 2460 ng/mL. Magnetic resonance imaging (MRI) demonstrated occlusion of M2 segment of the middle cerebral artery and cerebral infarction. Platelet factor-4 antibodies level was normal. Treatment with aspirin and antiepileptic drugs resulted in a remarkable recovery. This is the first Indian case report of ischemic stroke and transient thrombocytopenia following SARS-CoV-2 ChAdOx1 nCoV-19 vaccination. Our case had clinical features consistent with the diagnosis of probable VITT. Familiarity with VITT is crucial because timely treatment with non-heparin anticoagulants and intravenous immunoglobulin improves the outcome.

Background: In approximately 25% of peripheral neuropathy cases, diagnosis remains obscure. In India, leprosy continues to remain one of the most frequent causes of peripheral neuropathy. We, in this prospective evaluation, performed nerve biopsies in patients with peripheral neuropathy for early confirmation of the diagnosis. Materials and Methods: A total of 55 consecutive cases of peripheral neuropathy were included in this study. All patients were subjected to clinical and electrophysiological evaluation. Sural nerve biopsies were performed in all the patients. Result: After a nerve biopsy in 29 cases, we were able to identify the underlying cause of peripheral neuropathy. In 26 cases, the diagnosis remained obscure. The most frequent histopathological diagnosis was leprosy, which was seen in 20 cases. Other diagnoses were chronic demyelinating neuropathy (four cases), vasculitis (two cases), and amyloidosis in one case. In two biopsies, the findings were consistent with hereditary neuropathies. The demonstration of lepra bacilli was the most distinctive feature. In addition, foamy macrophages (100%) and granuloma (100%) formation, epineurial (83.3%) and endoneurial infiltration (69%) along with epineurial (87.5%) and perineurial thickening (77.3%) were also noted more frequently in leprosy-associated neuropathy. Conclusion: The nerve biopsies revealed that leprosy was the most common etiology in patients with peripheral neuropathy. In approximately 47% of the cases, even nerve biopsies failed to establish a confirmed diagnosis.

Rationale: The impact of COVID-19 in patients with autoimmune liver disease treated with immunosuppressive therapy has not been described so far. This case report describes the clinical course of a patient with autoimmune hepatitis (AIH) who developed COVID-19 and the features of cytokine syndrome leading to its deterioration in our intensive care unit. Patient’s Concern: A 28-year-old male presented with generalized anasarca for two weeks and chronic liver disease for 8 months. Diagnosis: AIH and Covid-19 with features of cytokine storm syndrome. Interventions: Intravenous furosemide, mannitol, syrup lactulose, steroids (prednisolone 40 mg), azathioprine 1 mg/kg body weight, rifaximin, vitamin K, and blood products. Outcomes: The patient had hepatic encephalopathy and AIH and died on the 10th day after admission despite ventilatory support, sustained low-efficiency hemodialysis, and resuscition. Lessons: The dramatic release of cytokines and the inflammatory-immune responses not only alter the pathophysiology but also affects the onset and severity of disease progression in patients with AIH.

Massive hemoptysis can lead to respiratory failure and life-threatening hypoxia in patients with underlying post-tubercular fibrocavitary disease. In the absence of urgent surgical interventions in a resource-poor country, interventional bronchoscopy and bronchial artery embolization (BAE) can be lifesaving in critical care management of such patients. We present a young male who required mechanical ventilation, emergency bronchoscopic intervention, and BAE, and showed recovery.