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What exactly does an embryologist do? is one of the most common question asked by patients and the possible answer could be that embryologist is the child’s first watchperson. The ability to grow embryos in laboratory environment was a huge scientific achievement. Scientists and Embryologists are involved in reproductive research and fertility treatment. The embryologist has a huge role to play in IVF/ICSI process and the contribution of embryologist is no less than infertility consultant. They might not be doctors, but they are highly trained medical professionals, holding a master’s degree or Ph.D. due to specialized nature of work. They are responsible for management and maintenance of laboratory used in creating embryos as well as monitoring those embryos. The important activities that embryologist does are maintaining the embryology lab (temperature, humidity, CO2 cylinder, diffusion gas and pH), oocyte screening during ovum pickup (OPU), incubation and checking of fertilization, embryo transfer, vitrification and embryo biopsy for pre-implantation genetic screening (PGS) or pre-implantation genetic diagnosis (PGD).

Objective : To compare the rate of sperm survival and motility through semen freezing and thawing during infertility treatment. Methodology: In this bidirectional observational study, we enrolled 31 patients who underwent semen analysis for infertility treatment at the Institute of Reproduction and Child Cares & IRCC IVF Centre, Panchkula, Haryana, from June 2020 to December 2020. Out of these patients, 21 (67.74 %) were considered for semen freezing and thawing. For the rest of the ten patients (32.25 %), sperm count and motility were not good, and we excluded them from this study. Semen freezing based upon sperm count and motility were done. We did semen thawing after two weeks of semen freezing and recorded the sperm survival and motility. Results: Post thaw sperm survival rate and motility was 37.66% compare to pre-cryopreservation (61.82%). The observed rate of sperm motility declining was 24.16 % after cryopreservation/freezing. Conclusion: The present study results concluded that sperm's cryopreservation results in a decrease in sperm motility. There is a need of finding more accurate and reliable methods to freeze and thaw semen.

Test tube baby is always a fascinating field of human reproductive biological science playing an important role in treating infertility. Poor semen quality is the major cause of infertility in human beings. Preparation of semen samples for intrauterine insemination (IUI) or in-vitro fertilization (IVF) is a key point in the success of test-tube embryo production. The study compared two different methods of semen preparation viz. double density gradient (DDG) and single density gradient (SDG) in patients seeking IUI / IVF treatment with their consent and permission of the hospital. Semen ejaculate from patients (n=100) was divided equally into two equal volume parts. One half of each sample was treated with DDG and another half with the SDG method of semen preparation. Results showed that sperm concentration was significantly higher (P>0.05) in SDG compared to DDG treated samples which were 58.65±181 and 49.89±180 Million/ml, respectively. Sperm motility of type-a and type-b both were significantly higher (P>0.05) in SDG compared to DDG treated samples which were 91.85± 3.15 and 68.85 ± 26.15. It is concluded that the single density gradient method is better than the double density gradient for semen ejaculates preparation during the treatment of male infertility using the in-vitro fertilization technique.

A grading system of human embryo is very important for embryo selection & predicting blastocyst formation from day - 1, day 2, & day – 3, were sequentially explained. We were designed a methods for grading of embryos from day – 1 (zygote as a pronuclear evaluation, PN), day – 2 (cleavage stage) and day - 3 (evaluation of developmental stage according to cell size and fragmentation) embryo according to cell size and degree of fragmentation and early compaction. In the first grading system pronuclear study and poly-spermy, Second grading system is based on the blastomere / cell number and the observation of fragmentation pattern and selection for embryo transfer, embryos vitrification and pregnancy outcome. Assessment of embryo quality in order to select the embryos that have higher chance to give pregnancy, it is critical goal in IVF cycle or assisted reproductive technologies. ET current trend in human infertility treatment with IVF / ICSI embryo transfer (IVF / ICSI ET) is to increase the chance of higher pregnancy and reduce the multiple pregnancies after multiple embryo transfer according to patient age and endometrium thickness as well as own ART Laboratory protocol. Morphological evaluation & grading of human embryo as a reliable and no-invasive method that provides valuable information & prediction of IVF/ICSI embryos which has developmental potential to reach till early compaction or blastocyst. This research paper describes the current status of morphological embryo evaluation from zygote to eight cell blastomeres or early compaction on late day 3. We found higher embryo development potential and early compaction during in-vitro embryo culture conditions and higher implantation rate in Grade A embryos in comparison transferred of Grade B embryos. Overall embryo development in-vitro and conceiving rate was seen 48.06 % after embryo transfer of both grades A and Grade B embryos in 233 patients in different age group with different endometrium thickness and multiple embryos transfer in one uterus depend on patient previous history. 935Embryos was selected from 2702 developing embryos for embryo transfer (ET) was performed in 233 patients. After this study we found implantation rate (IR) was 48.06% based on embryo quality, morphology and grade.

This study tries to elicit the unexplored nexus between the contraceptive failure and abortions in India’s most populous state Uttar Pradesh. Condom being the most used modern method contributes to 47% of all observed episodes in the calendar period. Of all accidental pregnancies occurred because of modern contraceptive failures, 35.2% terminated with induced abortions. Gross failure rate of modern methods is conspicuously higher for urban poor, uneducated women, and marginalized section of population living in urban area. From a total of 7496 episodes of all reversible methods, abortions are estimated as high as 29.2%, whereas for the traditional method it accounts for around 21%. The empirical evidence of induced abortions due to contraceptive failure put serious concern regarding unintended pregnancies and hence discourages fertility intentions among the potential couples.

Background. Aspergillus is an inherently ubiquitous, weakly pathogenic fungus causing opportunistic infections. It is very rarely localized in the larynx, although laryngeal Aspergillosis may develop in the immunocompromised patients including those with leukaemia and severe aplastic anaemia. Objective. The aim of the research was to explore the primary laryngeal Aspergillosis in an immunocompetent patient thru a case report. Methods. A case report of primary laryngeal Aspergillosis in an immunocompetent patient is presented. Results. A male patient of 40 years old, presenting with chronic worsening hoarseness, was found to have a smooth, white spheroid submucosal growth on left vocal cord with preserved bilateral cord movements on videostroboscopy. Histopathological examination of vocal cord growth revealed squamous epithelium containing septate hyphae with acute angle dichotomous branching pattern consistent with Aspergillus. Voice improved after a four-week course of oral itraconazole 200 mg/day. Post therapy follow up of 24 months was unremarkable. Conclusions. Primary laryngeal Aspergillosis develops in the immunocompetent patients. Iatrogenic, vocal abuse, occupation and lifestyle factors may be contributory. Optimal diagnosis and management mandates a high index of suspicion.

Introduction: Corona virus disease- 2019 is caused by severe acute respiratory syndrome- 2 (SARS-CoV-2), also known as Novel corona virus (2019-nCoV).The disease presentation ranges from asymptomatic to severe acute respiratory failure requiring intensive care support. There are multiple drugs, therapies, and vaccine trials underway. One such therapy is convalescent plasma. Passive immunity delivered as anti-corona virus antibodies from convalescent human plasma has promise of emerging as a therapeutic option in the treatment of SARS-CoV-2. Objective: The objective of the study is to determine the age and sex distribution of the recipients of the convalescent Covid 19 plasma among patients admitted at different hospitals in Ranchi, Jharkhand. Materials and Methods: A retrospective study was conducted at Department of blood bank, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand from July 28, 2020 to October 28, 2020 who received at least one convalescent plasma transfusion for hospitalized patients aged 18 years or older with moderately as well as severely ill or life-threatening COVID-19 disease within 21 days from the onset of their illness. Results: This study recorded greater number of male recipients with B Positive blood group. The convalescent plasma recipients were mostly old patients above 50 years of age.

Aims and Objectives: Use of mobile phones always raises the issue of health implications in humans.Gender differences in cognitive abilities have been reported as a neuropsychological feature for many years.So, it was planned to study the effect of electromagnetic waves (EMW) emitted from mobile phone (MP) oncognitive functions in males and females.Material and Method: The present study was conducted in 20 males and 20 female healthy subjects in theage group of 18 to 40 years using mobile phones for the last 5 years or more with per day exposure of at least30 minutes or more. Subjects with history of diseases of ear, eye and brain (neurological and psychological)or the presence of diabetes, hypertension and consumption of any drug were excluded.After explaining the whole procedure and seeking a written consent, the Trail making test A (TMT A), Trailmaking test B (TMT B) and TMT A + TMT B, Single letter cancellation test (SLC test) and the Playing cardtest (PC test) were performed before and after exposure to MP. Subjects were exposed to MP GSM Type,Samsung Model GT- N 7100, 902, MHz, SAR limit 2.0W/Kg, average power emitted 0.125 - o.25W/cm2for a period of 10 minutes. Statistical analysis was done by statistic package SPSS 20 using paired t test. Avalue of p

OBJECTIVES Type 2 diabetes (T2D)-associated cognitive impairment is highly prevalent especially among the geriatric population. Here, we investigate the role of exercise in T2D-associated cognitive decline in rats. METHODS T2D was induced using high-fat diet (15 days) followed by low-dose STZ (25mg/kg). The T2D animals were subjected to aerobic exercise on running wheel for 6 weeks. Effect of aerobic exercise on cognitive performance of T2D animals was measured using step-down and transfer latency tests. This was followed by the measurement of reduced glutathione levels in hippocampal homogenates. We also measured hippocampal AchE activity and levels of neuroinflammatory markers such as IL-1 β, TNF-α and MCP-1. Morphology and density of hippocampal neurons were also determined by histopathological studies. RESULTS Exercise led to the following changes in T2D animals. It led to decrease in fasting blood glucose level (

Introduction: Corona virus disease- 2019 is caused by severe acute respiratory syndrome- 2 (SARS-CoV-2), also known as Novel corona virus (2019-nCoV).The disease presentation ranges from asymptomatic to severe acute respiratory failure requiring intensive care support. There are multiple drugs, therapies, and vaccine trials underway. One such therapy is convalescent plasma. Passive immunity delivered as anti-corona virus antibodies from convalescent human plasma has promise of emerging as a therapeutic option in the treatment of SARS-CoV-2. Objective: The objective of the study is to determine blood group distribution among covid -19 convalescent plasma donors in the Department of blood bank, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. Materials and Methods:Aretrospective study was conducted at Department of blood st st bank, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand over a period of 3 months from 01 August to 31 October 2020 who have donated at least one unit of convalescent plasma. Results: This study recorded greater number of male donors with B Positive blood group. The convalescent plasma donors were mostly middle aged between 30 to 50 years of age.

Background: In contrast to old time in today’s world of competitive sports and vehicular accidents twisting injuries to knee joints causing ligament and meniscal tears are a common occurrence. Being a prime stabilizer of the knee joint anterior cruciate ligament is truly “crucial” for normal functioning and stability of knee. It is responsible for prevention of forward displacement of tibia on the femur as well as prevention of hyperextension and excessive internal rotation of tibia. Additionally it acts as restraint on valgus and varus stress in all degrees of flexion and fine-tunes the screw home motion as the tibia approaches terminal extension. Rupture of ACL, unless properly reconstructed, can have catastrophic consequences for knee stability. The methods of reconstruction of a ruptured ACL include intra-articular reconstruction, extra-articular reconstruction and combined intra-articular and extra-articular reconstruction. With advances in arthroscopy intra-articular reconstruction is fast becoming procedure of choice due to less morbidity and prospect of an early mobilization. Recent studies have shown that four stranded semitendinosus tendon graft have similar strength and stiffness characteristics as that of normal anterior cruciate ligament. We conducted this study to evaluate the result of arthroscopic reconstruction of anterior cruciate ligament with quadrupled semitendinosus autograft and complications associated with this procedure. Materials and Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 30 patients who had been admitted to our institute with pain, limp and instability due to anterior cruciate ligament rupture. Patients were enrolled on the basis of pre-defined inclusion criteria and any patient having any exclusion criteria was excluded from the study. X-Ray and MRI (if required) were done. Detailed history, thorough clinical examination and baseline investigations were done. All patients underwent ACL reconstruction by semitendinosus autograft. The outcome of arthroscopic reconstruction with quadrupled semitendinosus autograft and complications associated with this procedure were studied. The data was tabulated and analyzed using SPSS 16.0 version software. Results: This study consisted of 30 patients having been diagnosed with anterior cruciate ligament rupture. There were 27 men and 3 women with a M: F ratio of 1: 0.11. The most common age group involved was 31-35 years (30%) followed by 20-25 years (26.67%) and 26-30 years (16.67%). Road traffic accidents (46.67%) and Sports injuries (43.33%) were the predominant causes of ACL rupture. Most patients (26.67%) presented within 6 months of injury. Associated meniscal injuries were seen in 11 (36.67%) patients and medial meniscus (20%) was found to be involved more commonly than lateral meniscus (16.67%). Majority of the patients received 9 mm graft (60%). Most of the patients were discharged from hospital within 1 week (53.33%) while 9 patients (30%) needed to be kept in hospital for up to 2 weeks. Only 5 patients (16.67%) required hospitalization beyond 2 weeks. Pre-operative Tenger- Lysholm score was poor in majority of the patients (73.33%). Post-operatively at the time of 6 months follow up majority of the patients (66.67%) had an excellent Tenger-Lysholm score. No major complications were encountered in any of our patients. Minor complication like wound infection at the graft site (2/30), wound edge necrosis (2/30), foot drop (1/30), chemical burn under the tourniquet (1/30) and synovitis (1/30) were seen in some patients. All these complication resolved with proper management and no residual complications were seen in any of the patients. Conclusion: Arthroscopic reconstruction of ruptured anterior cruciate ligament by quadrupled semitendinosus autograft is associated with good functional results and excellent outcome. Minor complications associated with the procedure can be taken care of by appropriate management.

BACKGROUND Hyponatremia is the most common electrolyte imbalance encountered in hospitalized patients worldwide. Our study is designed to analyse aetiology, clinical presentations, associated co-morbidities, severity, rate of correction and clinical outcome of hyponatremia in diverse group of patients in ICU. The aim of the study was to evaluate the prevalence, aetiology, clinical features and effect of various factors on the outcome of hyponatremia in patients admitted in ICU. MATERIALS AND METHODS All indoor general medicine admissions in the department of medicine, Darbhanga Medical College, Laheriasarai, Bihar during Feb. 2017 to Feb. 2018 were screened for hyponatremia and patients requiring ICU care were studied. RESULTS In our study, 6% of total admission had hyponatremia. Hyponatraemic patients admitted in ICU showed varied clinical presentation such as nausea (70%), malaise (88%), drowsiness (38%), lethargy (62%), confusion (32%), altered sensorium (44%) and convulsion (4%). Average serum Na was 122 meq/L, average serum osmolality was 268 mosm/L, average Hb was 10.6 gm/dl. 33% patients had raised serum creatinine (>1.4 mg/dl). Lower GCS was associated with a significantly lower survival (p value = 0.004). There was no significant association between serum Na on admission and the duration of hospital stay (p value= 0.06). Overall mortality was 18/50 (36%) which was quite significant as compared to total ICU mortality (30%). Most of the mortality was due to sub-optimal correction of Na. CONCLUSION Hyponatremia is quite a common electrolyte disorder encountered in ICU setting. Most common cause is SIADH. Hyponatraemic patients who presented with altered sensorium had poor outcomes. Type of fluid used for correction had not so much influence over the outcome. Under correction of hyponatremia in first 24 hour had poorer outcome whereas overcorrection had no any survival benefit, rather it was associated with risk of CPM.

Introduction Doxorubicin is amongst the most widely prescribed chemotherapy drugs due to its effectiveness in cancer treatment. However, progressive treatment using doxorubicin severely increases the risk of congestive heart failure. Mechanistically, researchers have shown that doxorubicin (i) intercalates into DNA and disrupts topoisomerase-II-mediated DNA repair and (ii) generates free radicals which then causes damage to cellular membranes, DNA, and proteins. Ultimately these cellular insults induce cardiomyocyte (CM) death mediated by the tumour suppressor, p53. Currently, there are no clinically applicable preventative treatments for doxorubicin-induced cardiotoxicity and so, extensive research is being done in discovering a potential therapy. One such candidate is curcumin – a natural polyphenol compound non-toxic to humans. We have previously demonstrated that curcumin inhibits lysine acetyltransferase activity of p300, therefore reducing both histone and non-histone protein acetylation. To induce CM death, p53 requires acetylation by p300. Therefore, we hypothesize that curcumin protects against doxorubicin-induced CM death and cardiotoxicity via p300-mediated inactivation of p53. Methods Rat H9c2 cardiomyoblast cells were cultured and treated with a 2.5 μM dose of doxorubicin for 16 hours. One group of cells were pre-treated with curcumin (15μM) 4 hours prior to doxorubicin treatment, and controls were cultured with only diluent added. Following treatment, the cells were harvested for total protein. At end point, we performed immunoblotting to measure protein expression of key proteins involved in DNA damage (y-H2A.X, p53), and apoptosis (cleaved-Caspase 3). Results Our findings show that following doxorubicin treatment, p53 expression was significantly increased (p Conclusions Our data provides the first evidence that curcumin protects against doxorubicin-induced apoptosis in rat cardiomyoblast cells in vitro. Further studies are warranted in vivo to confirm the potential of curcumin as a cardio-protective drug. Curcumin is a natural compound with little to no side-effects in humans, therefore our finding may provide a novel therapeutic target and treatment approach for doxorubicin-associated cardiotoxicity. Acknowledgement/Funding Heart & Stroke Foundation of Canada

Mustard aphid, Lipaphis erysimi (Kaltenbach), is the most serious pest of Rapeseed-Mustard which is known to be responsible for a tremendous loss in yield and oil content, under various agro-climatic conditions of India. Information support on aphid occurrence and intensity is necessary for effective management by the farmers in the mustard-growing belt. In this study, an effort is made to develop forewarning model using the field data on aphid for 12 consecutive rabi seasons from 2003-2004 to 2014-2015 under different agro-climatic locations in India. Three main components of aphid-related stages were identified for which necessary forewarnings were needed to be issued: (1) severity, (2) the time of reaching the economic threshold level (ETL) for decision-making on pesticide application, and (3) time of occurrence of peak population. To address these, three different models were developed/used and validated using incident field dataset. Those field observations when the infestation level were below severe category (< 60) during rising phase of the aphid population were found to indicate highest R sqr. (0.82) for the model-I during validation. When model-II was used, 11 out of 14 locations (78.57%) stood validated. The assumptions made in model-III also got validated when humidity thermal ratio (HTR) of the week of peak population ranged between 1.5 and 4 (lowest among the weeks considered), and population reached severe category. The models showed better results during real-time validation in seasons 2016-2017 and 2017-2018, thus suggesting that these three models can be used to ascertain the severity, week of ETL, and week of peak aphid population for Brassica juncea varieties all over the mustard belt in India and can be operationalized spatially to forewarn against the aphid pest population in future under Gramin Krishi Mausam Sewa (GKMS) scheme.

A novel, single-stage Pressure Assisted Osmosis system capable of broad-spectrum removal of anionic and cationic contaminants from water is described in this article. The system has demonstrated a high removal efficiency of over 95 % for anions such as sulfate and cations such as calcium and magnesium. It has also demonstrated a removal efficiency of over 90 % for monovalent anions such as carbonate and chloride. The modular system is characterized by a high degree of process intensification. The portable set-up attempts to merge several parts like feed cells, membrane assembly, and external force media into one compact unit. Another design feature was the operational flexibility of mechanical force addition. The portable device demonstrated sustained solvent flux without the usage of electric power. The proof of the concept of experimental studies with real-time operational aspects like reverse salt diffusion is described in this work.

Aim: The aim of this study is to find out the effect of propofol and its combination with meperidine and pentazocine lactate on certain clinico-anesthetic profiles in dogs. Materials and Methods: 15 apparently healthy mongrel dogs of either sex of about 1 year of age were randomly divided into three groups of five dogs each. The animals of Group I were administered propofol intravenously alone “to effect,” whereas meperidine at 2 mg/kgb.wt. and pentazocine lactate at 2 mg/kg b.wt. were injected intramuscularly 15 min before propofol “to effect” in Groups II and III, respectively. Atropine sulfate at 0.04 mg/kgb.wt. was injected intramuscularly 20 min before each treatment. Rectal temperature, heart rate, respiration rate, and anesthetic indices were recorded before and at 5, 10, 20, 30, and 60 min of induction. Results: As compared to Group I, the animals of Groups II and III exhibited a significant decrease (p

This article presents the systematic review of the randomized, controlled trials comparing the effectiveness of nasogastric (NG) versus postpyloris (PP) feeding in critically ill surgical patients and other patients in intensive therapy unit (ITU). Twenty randomized trials recruiting 1496 patients were retrieved from the standard electronic databases. There were 760 patients in the NG feeding group and 736 patients in the PP feeding group. There was significant heterogeneity among trials. PP feeding in ITU patients was associated with lower gastric residual volume (odds ratio (OR), 3.95; 95% confidence interval (CI), 1.19, 13.14; z = 2.24; P

Osteoporosis remains an important cause of morbidity in β-thalassemia major. Although several factors have been implicated to play an important role in the pathogenesis of osteoporosis and several candidate gene polymorphisms have been found to regulate this process, its pathogenesis has not been completely elucidated. Deletion of a C in the fourth intron sequence 8 base before exon 5 (713-8delC) of transforming growth factor beta 1 (TGF-β1) gene which has been reported significantly higher in the osteoporotic group was studied for its prevalence and association with bone mineral density (BMD) in thalassemia major patients. The aim of this study was to find out the distribution of TGF-β1 (713-8delC) sequence variation and its relationship with BMD in thalassemia major patients. 713-8delC Sequence variation polymorphism was detected in 150 β-thalassemia major patients and their BMD was measured by dual-energy X-ray absorptiometry. Biochemical levels were estimated by enzyme-linked immunosorbent assay. We have found a remarkable incidence (90%) of osteopenia and osteoporosis among regularly transfused patients. We have found no association of 713-8delC variant of TGF-β1 gene with Z-score of BMD at lumbar spine (p = 0.061) and hips (p = 0.773). However, Cc genotype of TGF-β1 gene was found as a risk factor (odds ratio: 3.3) for low bone density in these patients.

Introduction: The potential risk of prolongation of treatment time in cervical cancer has been reported for many low-dose rate (LDR) studies, with an estimated loss of local control ranging from 0.3 to 1.6% per day of treatment prolongation. Since the treatment schedule for fractionated high-dose rate intracavitary brachytherapy (HDRICBT) is not directly comparable with that for LDR studies. Many studies are also present with different results. Aims: To evaluate the adverse effect of treatment prolongation for cervical cancer treated with HDRICBT. Methods and Materials: Hundred patients with biopsy proven squamous cell carcinoma of the cervix with stage IIB to IVA (according to FIGO classification) were entered into protocol using concurrent paclitaxel and radiation. Radiotherapy was conventionally administered: 50.4 Gy/28 fractions by external beam (whole pelvis) followed by HDR-ICBT, 4 fractions of 7 Gy each. Paclitaxel was administered on weekly basis at dose of 40 mg∕m 2 during entire course of external beam radiotherapy. Results: Treatment response was evaluated three months after the end of radiotherapy by means of clinical examination and ultrasonography. Complete Regression (CR) in 83%, partial response (PR) 14% and progressive disease 3%. At 26 months of median follow up 73 patients alive out of 58 patients are diseases free. Conclusion: The results of this study suggest that to achieve better treatment outcome, avoid treatment prolongation and overall treatment time should be less than 50 days.

For acceptance of any chemical agent as an endogenous chemical mediator of inflammation, the agent in question must fulfill some biological requirements which are (a) it should be ubiquitously present in tissues in inactive form, (b) it should be activated during process of inflammation whose increase should be identifiable, (c) it should induce or amplify some events of inflammation, (d) there must be some natural inhibitor of such active form in tissues, (e) it should be able to induce inflammatory reaction after exogenous injection, (f) such reaction should be inhibited by exogenous use of their antagonists, and (g) it should be amplified by use of agonists. Copper in its protein free or protein bound form are reported to act as pathogenic factor in inflammatory processes due to oxidative stress. But their role as endogenous chemical mediator of inflammation does not appear to be investigated thoroughly in light of abovementioned biological criterion of mediator. Present study aims at thorough exploration on role of free copper as endogenous chemical mediator of inflammation in light of above facts. It was done by estimation of total copper, protein-bound copper, and free copper along with estimation of free radical generation, increase in vascular permeability, and cellular infiltration during acute inflammatory reaction induced by carrageenan and concanavalin using chicken skin as test model. It was further evaluated by use of exogenous free copper in experimental model and their subsequent inhibition and amplification by chemical chelators of copper. Present study confirms that free copper fulfilled all the biological requirements for accepting it as an endogenous chemical mediator of inflammation.

This experiment was designed to assess the effect of chronic fenvalerate toxicity on tissue Cu concentration in goats and to explore the pathways responsible for it. A significant decrease in tissue Cu concentration of kidney, heart, and brain while an increase in the liver were recorded in fenvalerate intoxicated goats at 15 mg/kg b.w. orally daily for 270 days. Concentration of total Cu, protein-free Cu, and protein-bound Cu in the wet intestine of fenvalerate-treated goats revealed a significant decrease in Cu concentration of the intestine due to the decrease in trichloroacetic acid (TCA)-insoluble Cu, while TCA-soluble Cu remained almost unaffected. Rabbit duodenal loop technique was used to assess the relative absorption of nonisotopic copper in a living animal. This technique enabled to compare Cu absorption from the lumen of three closely associated loops, each receiving 100 µg of copper along with different doses (0, 15, and 30 µg) of fenvalerate. A significant dose-dependent decrease in Cu absorption from the lumen due to fenvalerate treatment was recorded. A decrease in total copper (TCA-insoluble fraction) suggested an interference in active transport of copper due to the inhibition of absorption of protein-bound copper. It was concluded that fenvalerate interfered in copper absorption mostly by inhibiting its active or mediated transport.

Aim : The association of central obesity, hyperinsulinemia, and dyslipidemia with higher grade advanced prostate cancer as determined by Gleason grading is not well understood. We evaluated the effect of central obesity waist hip ratio (WHR ≥ 0.9) and biochemical parameters associated with central obesity on Gleason grading in North Indian patients of prostate cancer presenting at advanced stages. Materials and Methods : A cross-sectional study was conducted among 50 nondiabetic patients having clinical stages III and IV prostate cancer. Gleason grading on core biopsy samples by histopathology was done and patients were divided in two groups-group1, Gleason score ≥8; group 2, Gleason score

Injury to the pancreas after blunt abdominal trauma is less frequent than that of other solid organs. The clinical presentation can be subtle resulting in delayed treatment with high morbidity and mortality. A seventeen years male presented with pain jaw and abdomen following fall from tree. He was haemodynamically stable with signs of mandible injury. Investigations revealed splenic contusion with moderate haemoperitoneum. Laparotomy revealed complete transection of distal third of body of pancreas. Pancreatic resection with splenectomy was performed. The case is being reported because of the unusual location of complete pancreatic transection resulting from a blunt trauma. A high degree of clinical suspicion with due consideration to the mechanism of injury is key to good outcome in these patients. Major ductal injury is the critical issue in the management and a number of therapeutic choices are available specific to the location of insult. Copyright © 2014, Indian Journal of Medical Specialities. Published by Reed Elsevier India Pvt. Ltd. All rights reserved.

Transmissible spongiform encephalopathies (TSEs) are a group of fatal neurodegenerative disorders associated with misfolding of prion protein, from PrPC to PrPSc. Different types of experimental studies have resulted in a better understanding of the pathogenesis of the prion diseases. Genetic and molecular properties of PrP isoforms have been explained but the conformational conversion of the PrPC isoform to the PrPSc isoform has not yet been entirely elucidated. However, a number of possible therapeutic agents have been tried and some have proven to be effective against TSEs but most have limitations in terms of toxicity and pharmacokinetics. Congo red (CR), anthracyclines, and polyanionic dextran sulfate have limited ability to cross the blood-brain barrier and may be toxic. The efficacy of polyene antibiotics seems to be restricted to certain scrapie strains. Tetrapyrroles and tetracyclines with low toxicities and favorable pharmacokinetics could be useful in preventing PrPSc accumulation. Compounds like branched polyamines, Cp-60, analogs of CR, quinacrine and chlorpromazine, beta-sheet breaker peptides and inhibitory peptides, active immunization using recombinant PrP and passive immunization with anti-PrP antibodies, have potential use as therapeutic agents but would need further research and clinical trials.

Thalassemia major is a genetic disorder and blood transfusion is critical for survival in these patients. Over the course of the past three decades, hyper transfusion therapy in these patients has shown has dramatically extended life expectancy and improved quality of life. Unfortunately, this type of therapy also increased the incidence of complications due to iron overload. The aim of this study was to assess bone mineral density (BMD) in patients with β-thalassemia major and to determine their biochemical and hormonal profiles that may affect BMD. A cross- sectional study was carried out in Sanjay Gandhi – PGIMS, a tertiary care hospital over period of 3 years on all β-thalassemia major patients above 7 years receiving regular transfusion. Patients with transfusion dependent anaemia other than β thalassemia major were excluded. Physical examination, laboratory tests and bone density measurements were performed. Then, the data were analyzed. The total number of children over 7 years of age with β-thalassemia major receiving regular blood transfusions during the study period was 150. Mean hemoglobin was 7.8±0.6g/dL and the mean serum ferritin level 5295±2736 ng/mL. Short stature was seen in 54.7% boys and 28.7% of girls. Prevalence of lumbar osteoporosis and osteopenia were 42.5% and 37.5%. Femoral osteoporosis and osteopenia were present in 32.5% and 55% of the patients. Impaired puberty, hypothyroidism, diabetes mellitus, hypoparathyroidism were observed in 26%, 18%, 7%, and 15%, of patients, respectively. Nearly 75% of patients had low bone mineral density. Bone mineral density was significantly associated with short stature (P=0.002), hypogonadism (P=0.006), hypoparathyroidism (P=0.038), hypothyroidism (P=0.044) and vitamin D deficiency (P 重型地中海贫血是一种遗传疾病，对于与这些患者，以输血的方式来保证他们的生存质量是至关重要的。在过去的三十年中，高输血量疗法的运用极大地延长了病人的寿命并且大幅提高了他们的生活质量。不幸的是，这种疗法由于铁元素过量，增加了其他并发症的发生率。 本研究的目标是评估β-重型地中海贫血患者的骨骼矿物质密度（BMD）并且确定患者的生理化学和荷尔蒙状况是否会对骨骼矿物质密度（BMD）造成影响。 Sanjay Gandhi-PGIMS,一家三级保健医院，针对所有七岁以上接受定期输血治疗的β-重型地中海贫血患者，作出了这项长达三年的跨部门的研究。依赖输血治疗的贫血患者而非β-重型地中海贫血患者被排除。我们对患者进行了体格检查，实验室测试和骨密度测试，并对研究数据进行了分析。 在这项研究中，七岁以上接受定期输血治疗的β-重型地中海贫血患儿总数是150人。其平均血红蛋白值为7.8±0.6/dL, 平均血清铁蛋白水平为5295±2736ng/mL。54.7%的男孩和28.7%的女孩身材矮小。患者中，腰椎骨质疏松和骨质缺乏患病率分别为42.5%和37.5%；股骨骨质疏松和骨质缺乏患病率分别为32.5%和55%；据观察，青春期受损，甲状腺功能减退，糖尿病，甲状旁腺功能减退的发生率分别为26%，18%，7%和15%。近75%的患者有低骨骼矿物质密度的症状。骨骼矿物质密度与以下因素有显著的相关性：身材矮小（P=0.002），性腺机能减退（P=0.006），甲状旁腺功能减退（P=0.038），甲状腺功能减退（P=0.044），维生素D缺乏（P

An 18-year-old female patient presented with lump hypogastrium since one month. Lump was initially small in size but increased progressively to attain the present size. She also complained of non-specific, non-localized abdominal pain which was chronic, dull aching in nature, and nonradiating. It was mild in severity with no aggravating or relieving factors. Bladder and bowel habits were normal. She had an irregular menstrual cycle of 30–60 days, 1–2 days duration and scanty flow. She had no history of previous medication or hospitalization. On examination, two discrete tender lumps, 7–9 cm in size and firm in consistency, and well-defined margins present in hypogastrium. Per vaginal examination could not be performed due to denial of consent due to virgin status. All laboratory investigations were within normal limit except hemoglobin which was 5.9 mg% and low T3 0.10 ng/ml (normal 0.7–2.0 ng/ml), low T4 1.2 lg/dl (normal 5.5–13.5 lg/dl), and high TSH 102 llu/ml (normal 0.3–5.0 llu/ml) levels. CA 125 and other tumor markers were within normal limits. Ultrasonography at the time of admission showed bilateral enlarged ovaries of size 15.22 9 8.26 cm(Rt. Ovary) and 11.82 9 6.24 cm (Lt. ovary) with multiple cysts of varying sizes in both ovaries, giving a classical ‘spoke wheel-like appearance.’ A diagnosis of bilateral ovarian cysts was made, and diagnostic laparoscopy was planned for further management. On pre-anesthetic cardiopulmonary evaluation, pericardial effusion was suspected. Hence, cardiology opinion was taken and subsequent echocardiogram revealed massive pericardial effusion. Then, on the basis of previous findings and echocardiogram put together, a diagnosis of spontaneous Singh A. (&), Senior Resident Singh K., Ex.Senior professor and Head Of Department Khandelwal R. G., Assistant Professor Choudhary P., Post Graduate Student Sharma V. K., Post Graduate Student Department of Surgery, J. L. N. Medical College, Ajmer 305001, India e-mail: dr.amit5280@gmail.com Dr. Amit Singh completed his M.B.B.S from Dr Sampurnanand Medical College, Jodhpur, 2005, and M.S in general surgery from Jawaharlal Nehru Medical College, Ajmer, 2011. Presently, he is Senior Resident at Jawahar Lal Nehru medical college, Ajmer. His keen area of interest is hepatobiliary and gastrointestinal surgery. He has many international and national publications. The Journal of Obstetrics and Gynecology of India (March–April 2015) 65(2):132–135

n 89-year-old woman presented to the emergency de-partmentwithvomitinganddistensionofabdomenwithnonspecific pain localized to the right lower quadrant of2-day duration. There was no significant medical or surgicalhistory. Physical examination revealed an emaciated womanwith distended, tender abdomen and hyperactive bowelsounds. Laboratory investigations were remarkable for leu-kocytosis with a neutrophilic predominance. Abdomen ra-diograph demonstrated small intestinal obstruction (Fig. 1)and ultrasound revealed dilated intestinal loops with as-cites. There was no pneumoperitoneum. Emergency mul-tidetectorcomputedtomography(CT)(SiemensSensation40; Siemens, Erlangen, Germany) was performed to eluci-date the etiology.

Background The surgeon is an important variable that influences outcome following colorectal cancer surgery. Operative training of suitable quality and quantity is essential if intersurgeon variation is to be reduced. The aim of this study was to examine the outcome of colorectal cancer surgery when a high proportion of the operations were performed by trainee surgeons. Methods A prospective 7-year (1989–1996) audit of 306 consecutive colorectal cancers referred to a single general surgeon with a colorectal interest was carried out. The outcome (anastomotic leakage, 30-day mortality rate, local recurrence and cancer-related survival) of operations performed by the consultant was compared with that of his trainees. Results Some 245 (92·5 per cent) of 265 patients undergoing laparotomy had a resection. Seventy (28·6 per cent) and 67 (27·3 per cent) of operations were performed by supervised and independent trainees respectively. There was no difference between the consultant, supervised and independent trainees for 30-day mortality rate (6·5, 6 and 4 per cent respectively), clinical anastomotic leakage rate (9, 2 and 5 per cent) and local recurrence rate (2, 3 and 7 per cent). There was no difference between the three groups for adjusted 5-year disease-related survival rates. Conclusion Properly supervised trainees can resect a high proportion of colorectal cancers without compromising immediate outcome or long-term survival. Presented in part to the annual meeting of the Association of Surgeons of Great Britain and Ireland, Bournemouth, UK, April 1997, and published in abstract form as Br J Surg 1997; 84(Suppl): 56

This study is aimed at assessing the impact of thermal and moisture stresses associated with observed intraseasonal and interannual variability in key climatic elements on the nature and extent of losses in growth and yield of soybean crop in central India through the use of CROPGRO model. The crops are found to be more sensitive to higher cumulative heat units during cropping season. The yields respond substantially to temporal variations in rainfall (associated with observed swings in the continuity of monsoon). Prolonged dry spells at critical life stages of the soybean crop are found to adversely affect crop development and growth and hence the yields at selected sites. We have also examined the plausible effects of future climate change on soybean yields in the selected region based on simulations carried out for doubled atmospheric CO2 level and with modified weather variables using the available seasonal projections for the future. Our findings on the response of elevated CO2 concentrations in the atmosphere suggest higher yields (50% increase) for soybean crop for a doubling of CO2. However, a 3°C rise in surface air temperature almost cancels out the positive effects of elevated CO2 on the yield. Soybean crops at selected site are more vulnerable to increases in maximum temperature than in minimum temperature. The combined effect of doubled CO2 and anticipated thermal stress (likely by middle of the next century) on soybean crop is about 36% increase in yield at the selected sites. A decline in daily rainfall amount by 10% restricts this yield gain to about 32%. Deficient rainfall with uneven distribution during the monsoon season could be a critical factor for the soybean productivity even under the positive effects of elevated CO2 in the future.

Signet ring cell carcinomas of the colon and rectum are well documented in the adult population, but the incidence is very low in the paediatric population. Signet ring cell carcinoma has more malignant potential, mostly present as advanced stage and carries very poor prognosis. We are describing a 10-year-old male patient who presented with acute intestinal obstruction; radiology revealed large bowel obstruction and was diagnosed metastatic primary signet ring cell carcinoma of rectum on biopsy. We have discussed the diagnostic work-up and the management of this rare entity. Due to the high mortality that can be caused by a delay in making the correct diagnosis, signet ring cell carcinoma of colorectum represents a special diagnostic and surgical challenge.

Background Some authorities recommend that colorectal cancer should be treated in specialist units but evidence that non-specialist units demonstrate comparatively poor results may be lacking. Methods Between 1987 and 1991, 267 patients were operated on by four general surgeons, none of whom was a specialist in colorectal surgery. Procedure-related complications, postoperative mortality and disease-related survival rates were analysed. Results There were four cases of intraperitoneal sepsis (1 per cent) and five of 189 patients (3 per cent) had clinical anastomotic dehiscence; there was no case of wound dehiscence. The postoperative mortality rate after elective and emergency surgery was 2 and 13 per cent respectively. The 5-year disease-related survival rate for curative and palliative surgery was 67 and 9 per cent respectively. There were no significant differences between the surgeons. Conclusion Disease-related variables such as early-stage disease and fewer patients presenting as emergencies may have a greater favourable influence on ultimate survival than surgeon-related variables.

Acute viral hepatitis (AVH) is usually a self-limiting illness. Diabetics are prone to develop liver diseases and liver regeneration is impaired in them. Natural course of AVH in diabetics has not been assessed and may be severe.Observational prospective study to evaluate natural course of AVH in patients with and without diabetes mellitus. Consecutive patients with AVH were included and categorized in to those with or without diabetes. Etiology, complications, mortality and recovery parameters of AVH were identified and compared between two groups.131 consecutive AVH between March 2007 and March 2009 were evaluated; 12 diabetics and 83 non-diabetics (n = 95) were included for analysis. Hepatitis E was the commonest cause (n = 55, 57.89%) in the whole cohort. However, Hepatitis B virus (HBV) as the etiology was significantly higher among diabetics than in non-diabetics (58.33% vs. 25.3%, P = 0.02). In contrast, hepatitis E was the etiology in 61.44% of non-diabetics. Frequency of severe hepatitis was significantly higher in diabetics than in non-diabetics (5/12; 41.67% vs. 9/83; 10.64%, P 0.005). 5 of 14 (36%) with severe hepatitis were diabetics. Liver failure and death occurred in 2 (16%) diabetics, while none among the non-diabetics had liver failure. Multiple variable logistic regression analysis revealed that acute hepatitis B (OR 4.7 (95% CI 1.34-16.47)) and diabetes (OR 4.0 (95% CI 0.96-16.47)) were associated with severe hepatitis.Patients with diabetes are at risk to contact HBV infection and severe hepatitis.

A liver abscess formation is a rare complication of a gallbladder perforation, with a cholecystohepatic communication. Niemeier, in 1934, classified free gallbladder perforations and generalised biliary peritonitis as an acute or a Type I gallbladder perforation, a pericholecystic abscess and localised peritonitis as a subacute or a Type II gallbladder perforation, and cholecystoenteric fistulas as chronic or Type III gallbladder perforations. We are describing a 50-year-old male patient who presented with right upper quadrant pain and was found to have an intrahepatic perforation of the gallbladder. Our patient had a Type II perforation. We have discussed the diagnostic work-up and the management of this rare entity. Due to the high mortality that can be caused by a delay in making the correct diagnosis, a gallbladder perforation represents a special diagnostic and surgical challenge.

There are an estimated 45 million carriers of β-thalassemia trait and about 12,000–15,000 infants with β-thalassemia major are born every year in India. Thalassemia major constitutes a significant burden on the health care system. The burden of thalassemia major can be decreased by premarital screening and prenatal diagnosis. The success of prenatal diagnosis requires proper knowledge of spectrum of β-thalassemia mutations. In present study, β-thalassemia mutations were characterized in 300 thalassemia cases from 2007 to 2010 using ARMS-PCR and DNA sequencing. The five most common mutations accounted 78.9% of the studied chromosomes that includes IVS1-5(G>C), Cod 41-42(-TCTT), Cod8-9(+G), Cod16(−C) and 619bp del. Though IVS1-5(G>C) is most common mutation in all the communities, the percentage prevalence were calculated on sub caste basis and found that IVS1-5(G>C) percentage prevalence varied from 25 to 60 in Aroras & Khatris and Thakur respectively. Interestingly Cod41-42(−TCTT) mutation which is the second commonest among the mutations reported was totally absent in Kayasthas and Muslim community. These findings have implications for providing molecular diagnosis, genetic counseling and prenatal diagnosis to high risk couples of β-thalassemia.

Bone disease comprising of low bone mineral density (BMD), bone pain, and fractures is a characteristic feature of thalassemia. Vitamin D receptors (VDRs - FokI, TaqI, and Bsml) polymorphisms are closely related to low BMD at the lumbar spine and hips which can be used as a useful genetic marker in predicting bone disease in these patients.To find out the status of VDRs gene polymorphisms and its effect on osteoporosis in thalassemia patients of North Indian origin.BMD was measured in 40 beta-thalassemia major patients by dual-energy X-ray densitometry (DXA). Serum vitamin D levels were estimated by enzyme linked immunosorbant assay. VDR gene polymorphisms (FokI, TaqI, and BsmI) were analyzed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method.About 80.6% cases were found to be vitamin D deficient. Z score of BMD of lumbar spine and hips were -2.31 ± 1.18 and -2.09 ± 0.89. Osteoporotic lumbar spine was observed in 42.5% cases of thalassemia. A positive correlation of vitamin D level was found with Z score of BMD of lumbar spine (r = 0.398, P value = 0.027). Polymorphisms of FokI and BsmI were found significantly correlated with BMD of lumbar spine. However, no association of BMD was observed with TaqI polymorphism.The present study showed a high prevalence of low BMD in thalassemia, suggesting that they should be targeted for DXA screening and osteoporosis prevention before permanent end organ bone damage occurs. The VDR genotyping can be used as additional test in individuals who are susceptible to osteoporosis so that early preventive measurements can be taken.

The Tharu tribe inhabits the Himalayan foothills from Nainital in the West to Darjeeling in the East, and utilize plants in the treatment of diseases and other disorders. The present study deals with the therapeutic uses of 63 plants used by the Tharus of the Nainital district, U.P., in health care. Local names, preparation of ethnomedicine, dosage and mode of administration have been provided by selected informants and experienced medicine men. The study has provided some interesting data concerning medicinal plants which may enable phytochemists and pharmacologists to determine their true therapeutic properties.

Disposition kinetics of levofloxacin was investigated after single dose intravenous administration at the dose of 10 mg/kg in six healthy and six mastitic Black Bengal lactating goats. Mastitis was induced in goats by coagulase positive Staphylococcus aureus . The maximum milk concentration was higher in mastitic goats (17.01 ± 0.67 μg/ ml) as compared to healthy (14.75 ± 0.95 μg/ml). The therapeutic milk concentration in mastitic goats (0.10 ± 0.00 to 16.61 ± 0.70 μg/ml) was maintained for 48 h, which was significantly longer than healthy goats (36 h). The t ½ β in plasma (5.08 ± 0.18 h) and milk (7.28 ± 0.09 h) of mastitic goats were significantly longer than healthy goats (4.04 ± 0.24 and 4.16 ± 0.76 h). The total body clearence in plasma of healthy goats (5.64 ± 0.78 ml/kg/min) was almost similar to mastitic goats (5.82 ± 0.44 ml/kg/min). The AUC milk /AUC plasma ratio (3.36) in mastitic goats indicated extensive penetration of levofloxacin from plasma to milk. The t 1/2 milk /t 1/2 plasma ratio was 1.43. The AUC/MIC ratio in plasma and milk of mastitic goats were 296 and 1014 respectively. Based on the plasma kinetic parameters, it was concluded that levofloxacin may be used for treatment of mastitis in goats.

Disposition kinetic studies of gati fl oxacin (GAT) was conducted after single i.v. dose (10 mg/kg) in six healthy and six mastitic Black Bengal lactating goats. Mastitis was induced by coagulase positive S. aureus . The concentration of the drug was estimated by HPLC. The maximum milk concentration was found to be signi fi cantly (p< 0.05) higher in mastitic goats (12.78 ± 3.11 μ g/ml) than healthy (9.17 ± 1.41 μ g/ml). The therapeutic milk concentration in mastitic goats (0.13 ± 0.05 to 12.41 ± 2.99 μ g/ml) was maintained for 48 h which was signi fi cantly (p

The pharmacokinetic study of diminazene aceturate (DMZ) was carried out in two separate groups of 4 e ach clinically healthy female Murrah buffalo calves aft er single dose i.v. (8 mg/kg) and i.m. (16 mg/kg) administrat ion. The mean free peak serum concentration of DMZ (CS max ) after i.v. (26.28±0.67μ g/ml) and i.m. (8.41±2.43 μ g/ml) a dmin- istrations were obtained at t max of 5 and 30 min respectively. The DMZ serum concentrations time data were best fi tted to the two compartment open model. The calculated s erum half life (t ½ β ) values of DMZ were 15.099±2.504 and 14.225±2.682 h after i.v. and i.m. administration r espec- tively. The mean values of total body clearance rat e of DMZ (ClB) after i.m. (3.785±1.119 ml/kg/min) was signif icantly higher (P

The present experiment was designed to study the pharmacokinetics of levofloxacin in six healthy cross bred female cow calves (4 to 6 months age) weighing between 40 to 80 kg. Plasma from blood was separated by centrifugation at 10,000 rpm. Quantitative estimation of levofloxacin was done by UV-VIS spectrophotometer at 286 nm. The mean maximum plasma concentration (Cpmax ) of levofloxacin in febrile calves (5.28 ± 0.32 µg/ml) did not differ significantly as compared with healthy calves (4.50 ± 0.22 µg/ml) after single dose (20 mg/kg) oral administration. The mean therapeutic plasma concentration ( Cpther ) of levofloxacin was maintained for longer period in febrile calves (10 h) as compared to healthy calves ( 8 h). The mean maximum urine concentration (Cumax) in febrile (40.86 ± 2.19 µg/ml) also did not differ significantly as compared with healthy calves (39.38 ± 2.43 µg/ml). No significant difference in various pharmacokinetic parameters of plasma was observed in healthy calves ( β = 0.23 ± 0.01/h ; t1/2 β = 3.00 ± 0.17 h and MRT = 4.66 ± 0.14 h ) and febrile calves ( β = 0.23 ± 0.01/ h; t1/2 β = 3.05 ± 0.16 h and MRT = 5.04 ± 0.14 h ) . The mean value of β, and t ½ β calculated in urine also did not differ between healthy and febrile calves. However, the value of MRT(3.79 ± 0.07 h) and ClB(1.65 ± 0.09 ml/kg/min) calculated in urine of febrile calves significantly(p < 0.05) differ to healthy calves(MRT = 3.15 ± 0.03 h;ClB = 2.09 ± 0.13 ml/kg/min). Based on kinetic profile levofloxacin may be given orally at the dose rate of 1.49 mg/kg B.W.at 8 h intervals in febrile calves.

A rare form of bilateral autosomal recessive polycystic kidney disease (ARPKD) was observed incidentally in a six month old hybrid Tamworth and Desi crossbred pig during necropsy examination in the Department of Pathology, Ranchi Veterinary College, Ranchi. Grossly, both kidneys showed cystic lesion of varying size all over the renal surface. Dorsal section of kidney showed presence of watery or mucoid content in the cystic cavities with scanty normal renal parenchyma in between cystic lesions. Microscopically, cystic lesions were lined by flattened epithelium indicating their tubular origin along with fibrosis in the interstitium. The end stage renal failure appears to be the cause of death in the present case. The case was diagnosed as a rare porcine polycystic kidney disease(PKD).

This study comprised 32 cases of peritonsillar obscess (PTA)constitutint 0.08% of ENT outdoor cases and 0.80% of indoor admission. Age ranged from 14 years to 58 years(mean 34.21 ± 10.25 SD years). Male predominance was seen in the ratio of 1.69:1. A triad of symptoms comprising pain, fever and peritonillar swelling was seen in 29 (90.62%) cases. Ipsilateral jugulodigastric lymphnode enlargement was the commonest sign present in all the cases. Bacterial culture was positive in 25 (78.12%) cases. Most common aerobic organism isolated was Group A beta hemolytic streptococcus (GABHS) seen on 10 (27.77%) cases. Anaerobic culture could be done in 22 cases only. It was positive in 11 (50%) cases. Commonest isolate was Peptostreptococcus seen in 4 (18.18%) cases.

A 28-year-old woman presented with fever and chills for 2 months and features of congestive heart failure for 20 days. She had undergone a medical termination of pregnancy of 8 weeks gestation 4 days prior to the onset of fever. Clinical examination revealed marked pallor, tachycardia, raised jugular vein pressure, long rumbling diastolic murmur in the tricuspid area, hepatosplenomegaly and fundal haemorrhage. She had normocytic anaemia with marked leucocytosis. Echocardiography demonstrated large mass in the right atrium (figure 1) which was reported as atrial myxoma by the radiologist. Figure 1 Echocardiographic study showing right atrial …