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The current investigation was undertaken to study the gill histopathologies due to infestation of helminth parasite, monogenetic trematode, Dactylogyrus vastator (Nybelin, 1924) in the Indian major carp, Catla catla. There were only symptomatic samples of diseased fishes comprised of fingerlings and adults of Catla catla collected and examined. Behaviour respond studied- partial suffocation, lethargic swimming and clinical sign observed as their gills were very pale in colour and had haemorrhagic and inflamed areas at the sites of parasite attachments. The significant histopathological lesions and changes were seen in the gills where the parasites were found attached to the lamellar tissues causing local erosions of the epithelium and hyperplasia of the secondary lamellar epithelium and fusion of adjacent secondary lamellae, vascular congestion leading to aneurysm besides, clumbing of the tips in secondary lamellae, congested gill showed accumulation of blood leading to swelling hypertrophy in secondary lamellae, autolysis of epithelium and secondary lamellae and severe edema and necrosis were observed in gill of C. catla. No changes were noticed in other organs of the affected fishes. In severe infestations the fishes showed growth retardation. The histopathological analysis for parasites in fish will be useful tool for fish health management.

Dengue is an arboviral infection of public health problems in tropical and sub-tropical countries transmitted to humans through the bite of an infected mosquito of the Stegomyia family. It varies in severity, ranging from influenza-like self-limiting illness to life- threatening, which if left untreated, are associated with mortality as high as 20%. Find out hematological and coagulation profile in dengue infected children aged 1 to 12 years and association of hematological and coagulation profile with dengue severity. It is an Observational Cross- sectional study done on 100 dengue patients aged 1 to 12 years during the study period from March 2019 –February 2020. Among 100 dengue fever, 85 (85%) were categorized as dengue fever (DF), 11(11%) DF with warning signs and 4 (4%) were cases of severe dengue (DHF/DSS) according to revised World Health Organisation 2009. The most common age of presentation was above 6 years and females were afflicted more with dengue fever.100% dengue patients presented with fever. Persisting vomiting, pain abdomen, hepatomegaly and hypotension indicate progression towards severe dengue. Raised Hb% and PCV, low to normal values of WBC as well as predominantly decrease in platelet was seen in severe dengue cases however, both ESR and CRP were normal. The Liver function test was deranged SGOT>SGPT in almost all of the dengue patients and it was 3 to 4 times maximally in DFW and SD. PT, APTT prolongation, increased D- dimer and hypofibrinogenemia associated with the severity of dengue fever. Dengue is a common viral infection that may have serious consequences especially in children. There is clear difference in pattern of change of both haematological and biochemical parameters in non-severe dengue fever and severe dengue fever. Rising trend of Hb%, PCV, decreasing value of platelet count, raised transaminases (SGOT>SGPT), elevated D- dimer, PT and APTT and hypofibrinogenemia can be used as predictor of entry into critical phase

Background: Aceclofenac is considered to the first line drug in the symptomatic treatment of rheumatoid arthritis, osteoartheritis and ankylosing spondylitis. The successful treatment of arthritis depend on the maintenance of effective drug concentration level in the body, for which a constant and uniform supply of drug is desired. The short biological half-life (about 4 hrs) and dosing frequency more than once a day as well as (70-80%) of dose is excreted by renal transport make aceclofenac an ideal candidate for formulation of niosomal gel. Methodology: The niosomal gel of aceclofenac in order to sustain the release of aceclofenac topically, decreases the side effect of GI disturbance by maintaining the concentration of the drug in the blood and decrease the renal excretion as well as frequency of dosing. Niosomal gel was prepared by coacervation phase separation method. Preformulation studies, structural analysis, in-vitro drug release study, mechanism of drug release kinetic and data analysis (zero order, first order and higuchi’s model), percentage entrapment efficiency and stability study were performed (n=3). Anti-Inflammatory study was performed for final optimized formulation. Result and conclusion: It is revealed from preformulation studies that materials obtained for study did not show any incompatibility. Particle size was determined in the range of 9.46±1.055 to 12.91±3.587μm by using an optical microscope with calibrated eyepiece micrometer. Scanning Electron Microscopy of niosomes was performed to observe surface morphology and percentage entrapment efficiency of niosomes were reported in the range of 63.49±0.265% to 78.55±0.425%. From release kinetic modelling, it was analysed that the drug was released from niosomes by a diffusion-controlled mechanism. Lastly, stability study of all formulations was done in two different temperature and anti inflammatory activity of final optimised formulation was compared with marketed formulation (Voveran Emulgel). Results shows that the aceclofenac Niosomal gel showed fair anti-inflammatory activity but it was not as good as the commercial product.

Thiazolidinedione derivative have Antihyperglycemic activity, they are agonists for the peroxisome proliferator-activated receptor (PPAR), which controls glucose synthesis, transport, and utilization via regulating the transcription of insulin-responsive genes. A number of novel insulin sensitizers are currently being researched. Several of these are derivatives of Thiazolidinedione, but others have different chemical structures. In this work, we created some new Thiazolidinedione derivative based on structure–activity relationship as closely as feasible. The Thiazolidine-2,4-Dione derivatives were manually developed and synthesized using the proper synthetic techniques, then tested in vitro for antihyperglycemic action using the Sucrose loading model (SLM) and the Alloxan induced diabetes model (AIDM). The newly synthesized Thiazolidine-2,4-Dione derivative was characterized using infrared (IR) and proton (H) nuclear magnetic resonance. In this study we found that Compound M-4 has a lot of antihyperglycemic action, thus it's a good idea to think about using it as a lead material for the creation of anti-diabetic drugs.

BACKGROUND Abnormal uterine bleeding is an important cause of morbidity in the female population, which can be attributed to several reasons. Trans-vaginal sonography and saline-infusion sonography are the mainstay of diagnosis and govern the further management of this condition. This study was conducted to evaluate the thickness and pattern of endometrium with transvaginal sonography and determine any abnormality in the uterine cavity which can be attributed to saline infusion sonography (SIS) in cases of abnormal uterine bleeding (AUB). METHODS The study was conducted among 122 women with complaints of abnormal uterine bleeding attending Outpatient Department and indoor cases of a tertiary care hospital over a period of twelve months. RESULTS The most common presenting complaint was heavy menstrual bleeding in 27.04 % cases. Maximum (44.26 %) cases had normal finding on transvaginal sonography; most common pathological finding was leiomyoma (22.31 %), and endometrial hyperplasia (15.5 %). More than one third (37.7 %) of patients had no abnormalities on saline infusion sonography; while 62.3 % had one or more pathologies; the most common lesion was fibroid in 25.4 % cases. Normal proliferative and secretary endometrium was found on histopathological examination in 50 % cases, while remaining half cases had one or more pathology, most common pathology detected was endometrial hyperplasia in 25.4 % cases. On trans-vaginal sonography (TVS), 11 cases of endometrial polyp were missed, which were detected after infusion of saline and confirmed by histopathological examination. The diagnostic indices of SIS were superior to TVS in diagnosis of any pathology. Sensitivity of TVS was 86.94 % and SIS was 91.94 %. Specificity of TVS (75.41 %) was greater than SIS (68.33 %). CONCLUSIONS TVS and SIS scanning techniques play a very important role in endometrial disorders in woman with AUB. KEYWORDS SIS, Transvaginal, AUB, Endometrium

This methodological paper explains the process of occupational therapy management of displaced persons due to disaster influence. It is yet to be part of the occupational therapy practice domain even in recent decades with the advancement in occupational therapy research evidence and development. It is based on the current knowledge and developments in occupational therapy client centered practice. This methodological and conceptual based study describes and illustrates the occupational therapy practice model of rehabilitating displaced persons due to disaster influence. The present paper explores the occupational therapy role in rehabilitating displaced persons through People’s Environmental Occupation, Ecology of Human Performance (EHP), and Occupational Therapy Practice Framework. These are integrated as a single conceptual model to describe how and process of occupational therapy practice area during the rehabilitation process of a displaced person(s). The paper finally presented a sequenced framework to guide occupational therapists practice in this new emerging practice area of rehabilitation. This study was developed based on three different theories to support the occupational therapy treatment process of a displaced person due to disaster of any nature. Its concept based without any statistical analysis.

Appearance of dentition is of concern to a large people seeking dental treatment. People are giving a lot importance to the red and white aesthetics i.e the teeth and the gums. Apart from just colour of these dental components, harmony within these structures is of utmost important which includes shade, shape and size of teeth along with gingival esthetics. Gingival esthetics includes gingival architecture along with its colour Principles of esthetics must be followed for beautiful result. With introduction of digital smile designing, work on improving smile became more predictable. Using the technology, it becomes easy to guide best esthetics possible. Communication with patient showing their future result is possible. Due to high cost and need for special software makes it impossible to use for every patients seeking for smile correction. This case report describes the conventional and innovative approach of smile designing using an acrylic guide for correcting dimensions of teeth and ginigival zenith postion. Gingival pigmentation was also corrected to obtain esthetically pleasing gingival. Proper mock-up of diagnostic cast following all the rules of esthetics was done to visualize the final outcome. With introduction of veneers, conservative tooth preparation with high esthetics gain has become popular for management of unesthetic teeth. Keywords: Smile design, Digital smile design, Mock up, Gingival zenith, Veneers.

In recent days, there is rapid shift in consumer’s life-style due to change in standard of living, work culture, hectic work schedule, and free-thinking and global perspective, as a consequence, fast foods impact our dietary pattern and routine food consumption. As fast food is generally considered rich in calorie, fat, sugar, salt and poor in other nutrients, it has contributed to rise of many non- communicable diseases, metabolic diseases such as obesity and over-weight, diabetes mellitus, hypertension and cardiovascular diseases among more common. The present study was conducted to find the factors affecting the choice of fast food (Indian Fast Food, IFF; Western Fast Food, WFF) among teenagers using questionnaire-cum-structured interview schedule. In response to the influence of nutritional information about fast foods on the teenager’s choice of fast food, in case of IFF, the response was rarely (girls, 30%, boys, 19.6%), sometimes (girls, 40.4%, boys, 45.6%), most of time (girls, 20%, boys, 20.8%), and always (girls, 9.6%, boys, 6.4%), while in case of WFF, the response was rarely (girls, 20%, boys, 19.2%), sometimes (girls, 45.2%, boys, 42.4%), most of time (girls, 17.2%, boys, 20.8%), and always (girls, 15.2%, boys, 6.4%). In response to query on awareness for chemicals and preservatives present in fast food, respondents considered fast food as a healthy food in case of IFF response was yes (girls, 61.2%, boys, 53.6%), and no (girls, 37.2%, boys, 49.2%); while in case of WFF Always (girls, 57.6%, boys, 46.4%) and no (girls, 37.2%, boys, 49.2%). Regarding having prior knowledge of nutritive value of fast foods, in case of IFF, the response was as follows, “Yes, it has high nutritive value” (girls, 40.4%, boys, 44.4%), and “Yes, it has low nutritive value” (girls, 22%, boys, 19.6%), “no I don’t know” (girls, 35.2%, boys, 26.8%); while in case of WFF, “Yes it is high in calorie” (girls, 17.6%, boys, 17.2%), “Yes it has low calorie” (girls, 35.6%, boys, 31.2%), and “ no I don’t know” (girls, 43.2%, boys, 45.6%). This valuable information would be useful for preparing strategies related to fast food consumption among teenagers and their social, health and economical issues.

Triple-negative breast cancer (TNBC) is the most aggressive and heterogeneous cancer subtypes. High rates of metastasis, poor prognosis, and drug resistance are the major problems associated with TNBC. The current chemotherapeutics eliminate only the bulk tumor cells (non-BCSCs) and do not affect breast cancer stem cells (BCSCs). The BCSCs which are left behind after chemotherapy is reported to promote recurrence and metastasis of TNBC. Death receptor-5 (DR-5) is exclusively expressed in TNBCs and mediates the extrinsic pathway of apoptosis. DR-5, therefore, can be exploited for targeted drug delivery and to induce apoptosis. Gamma-secretase mediated Notch signaling in BCSCs regulates its proliferation, differentiation, and metastasis. The endogenous ligand, Delta-like ligand 4 (DLL4), is reported to activate this Notch signaling in TNBC. Blocking this signaling pathway using both gamma-secretase inhibitors (GSIs) and DLL4 monoclonal antibody (mAb) may produce synergistic benefits. Further, the GSIs (DAPT, LY-411575, RO4929097, MK0752, etc.) suffer from poor bioavailability and off-target side effects such as diarrhea, suppression of lymphopoiesis, headache, hypertension, fatigue, and ventricular dysfunctions. In this hypothesis, we discuss Solid lipid nanoparticles (SLNs) based drug delivery systems containing GSIs and surface modified with DR-5 and DLL4 monoclonal antibodies (mAb) to effectivity target and treat TNBC. The delivery system is designed to deliver the drug cargo precisely to TNBCs through its DR-5 receptors and hence expected to reduce the off-target side effects of GSIs. Further, DLL4 mAb and GSIs are expected to act synergistically to block the Notch signal mediated BCSCs proliferation, differentiation, and metastasis.

A comparative study of Indian Fast Food (IFF) and Western Fast Food (WFF) consumption among teenagers (girls and boys) was formulated to understand the quality aspects and trends of consumption of fast food among teenagers. For this 250 boys and 250 girls (12-18 years) were randomly selected and interviewed. It was found that girls (87.6%) and boys (86.8%) liked fast foods nearly equally i.e. and largely consumed both IFF and WFF (girls, 62.4% and boys, 60.4%). Among the IFF, girls (45.2%) and boys (54.4%) liked chat, pokora, samosa, patties, panipuri and while out of WFF, pizza was liked mostly (girls, 30% and boys, 45.2%). IFF was consumed for its taste (girls, 27.6% and boys, 53.6%) while WFF, it was largely as alternative food for girls (31.6%) and taste for boys (43.2%). IFF was taken occasionally by girls and boys, 29.6% and 33.2%, respectively, while WFF was taken occasionally, girls, 24.8% and boys, 52%. The satisfaction with IFF among girls and boys was 50.8% and 60%, respectively, and WFF (girls, 9.2% and boys, 5.2%). Reason for satisfaction with IFF was its deliciousness (girls, 64.4% and boys, 59.6%) followed by taste of food is indianized (girls, 20.4% and boys, 22%) in case of WFF, it was deliciousness (girls, 54% and boys, 59.6%), comparatively cheaper (girls, 7.6%; boys, 10.8%), and as a status symbol (girls, 2.4%; boys, 3.6%). This study would be helpful in formulating the strategies related to fast food consumption by teenagers.

We report diagnosis of Neuronal Ceroid Lipofuscinosis Type 2 (CLN2), a rare, hereditary neurodegenerative disease of childhood, in a four and a half year old girl, the first child of non-consanguineous parents with no family history. Despite extensive efforts by the parents, her clinical condition remained undiagnosed and without management, until recently. Our published “Bottom-up Approach”, based on comprehensive and multidisciplinary clinical, pathological, radiographical and genetic evaluations, played key role in diagnosis of the disease. Detailed analyses involving Next Generation Sequencing confirmed a missense variation NC_00011.10:g.6616374C>T (NP_000382.3:p.Arg339Gln; rs765380155) in exon 8 of TPP1 gene. In silico analyses predicted it to be highly pathogenic. Further family screening (including her both unaffected parents and asymptomatic, one year old younger sister) of the identified variation through Sanger Sequencing, revealed a perfect autosomal recessive segregation in the family. This study is the first case report on classic CLN2 from Jammu and Kashmir-India. This study is also indicating the effectiveness of our “Bottom-up Approach” in understanding rare disorders in low resource regions and the importance of timely diagnosis. Like in the proband, had diagnosis been established a bit early, the family might have benefitted at least with reference to their second child through counselling programmes.

Seizure is a common problem in many paediatric patients. When seizures persist even after 24 hrs of anaesthetic treatment it is known as Super Refractory Status Epilepticus (SRSE). We report a 10 years old girl admitted with fever, altered sensorium and GTCS with a provisional diagnosis of viral encephalitis. In the line of SRSE infusion thiopental was also started after giving first line antiepileptic as per guidelines. Seizures persisted despite six anti-epileptic drugs, steroids and infusion anaesthetic. MRI brain was suggestive of T2W Flair hyperintensity in B/L hippocampal and Para-hippocampal gyrus and CSF and blood positive for Mumps IgM. This was suggestive of Mesial temporal sclerosis (MTS) which is the scarring and loss of neurons in the deepest portion of the temporal lobe due to oxygen starvation to the brain, head trauma, brain infection or without any apparent cause. Dramatic response was seen after 36-48 hours of IVIG administration.

Background: The objective of this study was to undertake an early economic evaluation to analyse the potential costs and benefits associated with adopting a high sensitivity troponin (hs-cTn) at the Point of Care (POC) in the emergency department (ED) diagnostic pathway for suspected Acute Coronary Syndrome (ACS) patients in line with National Institute for Health and Care Excellence (NICE) Diagnostics Guidance (DG15) and NICE Clinical Guideline (CG95) as practised in the NHS in England. Methods: A decision tree analysis was undertaken to compare the current 60 to 90 minutes turnaround time for the standard laboratory hs-cTn test with an expected 20-minute turnaround time for a POC hs-cTn test. Three routes through the chest pain pathway were modelled based on the hs-cTn pathway used in Oxford University Hospitals (OUH) NHS Foundation Trust. Sensitivity analysis was performed. Results: The results indicate that if a hs-cTn POC test is used to diagnose patients in routes 1 to 3 of the diagnostic pathway for suspected ACS patients at ED, it potentially saves per patient costs of £53.36 in Route 1, £76.72 in Route 2 and £64.72 in Route 3. Moreover, it can also help in easing the pressure at ED as it enables diagnosis to be made between 55 to 70 minutes earlier across the 3 pathway routes. A hs-cTn POC test also has potential in achieving a ‘rule-in’ diagnosis for patients to speed up the treatment pathway for improved prognosis. The sensitivity analysis results indicate that savings per patient increase as the turnaround time of the lab result goes from 60 minutes to 90 minutes in the standard care pathway.Conclusions: Use of a hs-cTn test at POC can save between £53.36 and £76.72 per patient in ED when compared to the standard laboratory test. When such a POC test is developed, an evaluation validating the accuracy of the device will be needed together with a study of its clinical performance in a health care setting. The study should include a formal economic evaluation with real-world data alongside an efficacy/effectiveness study.

Lactic acid bacteria (LAB) are known for their probiotic properties, but only a few strains produce riboflavin. We evaluated the probiotic properties of four riboflavin-producing strains of Lactobacillus plantarum (BBC33, BBC32A, BIF43, and BBC32B) by using in vitro assessment and carried out multivariate principal component analysis (PCA) to select the best strain. Safety, antioxidant, and exopolysaccharide-producing properties were also studied. Lact. plantarum BBC33 showed better probiotic potential, followed by strain BIF43. Lact. plantarum BBC32A degraded mucin and excluded as a potential probiotic candidate. Lact. plantarum BIF43, BBC33, and BBC32A tolerated simulated gastrointestinal conditions and their overnight cell-free culture supernatants (CFSs, pH 4.0–4.3) inhibited the growth of Escherichia coli AF10, Salmonella Typhi MTCC98, Bacillus cereus NCDC250, and Pseudomonas aeruginosa NCDC105. Lact. plantarum BIF43 and BBC33 did not degrade mucin, adhered to human epithelial colorectal adenocarcinoma Caco-2 cells (22–25%), and aggregated with indicators (30–50%). Moreover, both were non-hemolytic and sensitive to most antibiotics tested. Of the two selected strains, BIF43 showed better exopolysaccharides (EPS) producing phenotype. The CFSs of all strains showed high (85–93%) 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity. PCA confirmed the results obtained from in vitro probiotic experiments and supported the selection of Lact. plantarum BIF33 and BBC43, as potential probiotics.

α-synuclein (SNCA), a major component of Lewy body is a pathological hallmark of Parkinson's disease (PD). Mutations in the SNCA gene cause misfolding and aggregation of SNCA protein, which results in neurodegeneration. Several studies have established the neuroprotective benefits of β2-adrenoreceptor (β2AR) agonists in PD However, β2AR agonists are associated with peripheral side effects- tachycardia, palpitation, pulmonary edema, myocardial ischemia, and cardiac arrhythmia due to βARactivation in peripheral tissues. PD therapy with β2AR agonists, therefore, warrants a brain-specific delivery.This review highlights the SNCA mediated neurodegenerative pathways in PD and various treatment strategies under investigation to lower SNCA gene expression, primarily focusing on β2AR mediated pathway. The review also discusses the beneficial and side effects of β2AR agonists in PD treatment by reviewing clinical trials, epidemiological studies, and meta-analysis data. Here we depict the need to develop a novel drug delivery system to achieve brain-specific delivery of β2AR agonists to overcome peripheral side effects and also propose various nano delivery strategies to achieve the same.Brain targeted delivery of β2AR agonists via various nano delivery systems will significantly downregulate SNCA gene expression in PD and also overcomes peripheral side effects of β2AR agonists.

The present study was conducted to evaluate the physicochemical and anti-oxidative properties of cow, buffalo and goat urine samples in two different successive seasons (summer and winter). For the physicochemical study, pH, electrical conductivity (EC), total dissolved solids (TDS) was measured and for the antioxidant properties, FRAP, DPPH and ABTS level was evaluated by standard methods. The data set were executed through the independent ‘t’ test by using IBM SPSS software version 22.0. The results showed that the EC level in all the (except cow) was significantly pandlt;0.5 lower in the winter season than in the summer season. TDS level in buffalo was significantly pandlt;0.5 lower in the winter season than the summer season but significantly higher in the winter season of the goat urine sample. In the case of antioxidant markers, FRAP and DPPH levels were significantly pandlt;0.5 higher in the summer season in all the animals, but there were no significant changes in the case of ABTS in all the animal’s urine samples. From these results, it is concluded that in the study area, the stress in the summer season as heat stress prevails in dairy cows, buffalo and goats. From the overall findings, it may be concluded that urine could be a good biomarker to evaluate the status of livestock health.

Triple-negative Breast Cancer (TNBC) is the most aggressive and prevailing breast cancer subtype. The chemotherapeutics used in the treatment of TNBC suffer from chemoresistance, dose-limiting toxicities and off-target side effects. As a result, conventional chemotherapeutics are unable to prevent tumor growth, metastasis and result in failure of therapy. Various new targets such as BCSCs surface markers (CD44, CD133, ALDH1), signaling pathways (IL-6/JAK/STAT3, notch), pro and anti-apoptotic proteins (Bcl-2, Bcl-xL, DR4, DR5), hypoxic factors (HIF-1α, HIF-2α) and drug efflux transporters (ABCC1, ABCG2 and ABCB1) have been exploited to treat TNBC. Further, to improve the efficacy and safety of conventional chemotherapeutics, researchers have tried to deliver anticancer agents specifically to the TNBCs using nanocarrier based drug delivery. In this review, an effort has been made to highlight the various factors responsible for the chemoresistance in TNBC, novel molecular targets of TNBC and nano-delivery systems employed to achieve sitespecific drug delivery to improve efficacy and reduce off-target side effects.

Depression is multi-factorial in origin and results from intricate mechanisms with no single identifiable risk factor. The present study is a cross-sectional study, conducted among 808 participants aged 30–70 years from a single mendelian, largely vegetarian population from North India. Socio- demographic and depression status were assessed through standard interview schedule among recruited individuals. Chemi- luminescence Immunoassay technique by Immulite®1000 is used to analyse homocysteine, folate and vitamin B12 levels. Of the total studied subjects, 31.1% were found to be having depression with higher rate among females (35.7%) compared to males (24.6%) (p = 0.002). Hyperhomocysteinemia and folate deficiency were found to pose an increased risk for moderate/ severe depression, though not significant. Folate repletion was playing a compensatory role for vitamin B12 deficiency among depressed individuals. MTHFR C677T gene polymorphism was not associated with depression in the present study.

BACKGROUND Surgery and anaesthesia cause considerable distress and psychological consequences especially in paediatric patients. The need of the hour is to assess the efficacy of premedicant drugs given through different routes to sedate the child and alleviate stress of separation from parent and intravenous cannulation. The aim of the study was to assess efficacy of frequently administered drugs as preanaesthetic medications and pharmacologic adjuncts. MATERIALS AND METHODS A randomized double-blind clinical trial was conducted with a sample size 100 children, ASA Class I & II, aged between 2-4 years, scheduled for elective surgery after obtaining an informed written consent from the parents for the study. RESULTS The results of our study showed that intranasal ketamine is statistically better in terms of sedation, separation of child from parent and intravenous cannulation, statistically significant p value

Purpose: To report our 5-year experience with intra-arterial chemotherapy (IAC) in the intravitreal chemotherapy (IvitC) era. Methods: Retrospective review of retinoblastoma treated with primary unilateral IAC in the IvitC era (2012–2017). Results: There were 34 eyes treated with IAC alone versus 20 eyes treated with IAC plus IvitC for vitreous seeds. IAC (IAC alone vs. IAC plus IvitC) consisted of melphalan (41 vs. 10%) or melphalan plus topotecan (59 vs. 90%, p = 0.03). IvitC consisted of melphalan (60%) or melphalan plus topotecan (40%). Tumor control and globe salvage were achieved in 100% of group B and C eyes without IvitC. Despite more extensive vitreous seeds in the IvitC group (p < 0.01), comparison of IAC alone versus IAC plus IvitC revealed no difference in tumor control for group D (88 vs. 69%, p = 0.36) or group E (67 vs. 100%, p = 0.25) and no difference in globe salvage for group D (88 vs. 69%, p = 0.36) or group E (58 vs. 57%, p = 0.39). Conclusions: IAC is effective as primary therapy for unilateral group B, C, D, and E retinoblastoma. IvitC is an important adjuvant therapy to achieve comparable globe salvage rates for group D and E eyes with persistent active vitreous seeds.

A series of cross-linked sulfonated poly(ether ether ketone) (SPEEK) membranes were synthesised using six different molecular weight of poly ethylene glycol (PEG) [200, 400, 600, 3000, 6000, 10,000 Da] as cross-linkers to investigate the effect of cross-linker chain length on membrane morphology and properties. Membranes morphology were investigated by using atomic force microscopy (AFM) and small angle X-ray scattering (SAXS), which showed that there was formation of cluster like structure and hydrophilic-hydrophobic phase separation occurs after cross-linking that makes the membranes mechanically stronger and reduces its swelling in water at higher temperature. Membrane properties were found to be strongly dependent on the chain length of the cross-linkers. PEG-400 cross-linked membrane gave desirable properties in terms of overall membrane performance such as proton conductivity, mechanical strength, and membrane durability etc. The methanol permeability of the membrane is found to be lower than Nafion-117 up to 55 °C.

Inflammatory myofibroblastic tumour (IMT) of ovary is an uncommon benign neoplasm that can mimic malignancy. It often occurs in children and young adults. Lung is the most common site of IMT. Precise etiology is not known but recent reports suggested the role of benign reactive process in its pathogenesis. A 32 year old female patient presented to the gynaecology out patient department with complaints of lower abdominal pain and increased frequency of micturition with burning since 15 days. On per abdominal examination, an irregular lump of 18 weeks size with restricted mobility was palpable in suprapubic region. Laboratoratory investigations revealed normocytic normochromic anaemia with neutophilic leucocytosis and raised ESR. Her serum CA 125 levels were slightly raised (44.30 u/ml). Imaging studies showed an infiltrating mass in the pelvis. The patient underwent total abdominal hysterectomy with bilateral salpingo oopherectomy and omentectomy. Histopathological examination of which revealed IMT of right ovary with extension to right parametrium and adjacent bladder. As IMT is a mimicker of malignancy due to its infiltrative growth. Histopathological examination is mandatory for its diagnosis and treatment. Misdiagnosis can lead to unnecessary extensive debulking surgeries and even chemotherapy. Rarity of this entity in the ovary has made this case worth reporting. DOI: 10.21276/APALM.1285

Absolute lymphocyte count (ALC) has been associated with overall survival (OS) and event-free survival, but we do not know if ALC is associated with minimal residual disease (MRD) at the end of induction (EOI) and whether it can be used as surrogate marker in resource limited settings. Immunological differences between MRD-positive and MRD-negative B ALL patients at the EOI are not known at present. This prospective study evaluated the association of ALC and peripheral blood lymphocyte subset percentage at the EOI with MRD. ALC was done at baseline, day 8, and day 15 and at EOI. Assessment for MRD and peripheral blood lymphocyte subset was done at EOI. In 2-year study duration, 197 B cell acute lymphoblastic leukemia (ALL) patients were recruited out of which 150 were analyzed. Peripheral lymphocyte subset percentage was available for 58 patients. We found that ALC at baseline, day 8, day 15, and EOI was not associated with MRD. Day 8 ALC was significantly higher in poor steroid responders (day 8 blasts 1 × 10

Introduction: Leprosy also known as Hansen’s disease is one of the oldest disease known to mankind. It is a chronic infectious disease caused by Mycobacterium leprae. It still remains as a major public health problem facing India. Nearly, 60% of all world leprosy cases are reported from India. The spectrum of presentation of leprosy is very wide. Histopathology is an important tool in making a definitive diagnosis. The objective of the study is to describe the histopathological profile of leprosy in the state of Bihar. Aim: To study the histopathological spectrum of leprosy at a tertiary care centre of Bihar. Materials and Methods: A retrospective hospital-based study of clinically diagnosed leprosy cases was conducted over a period of 28 months (January 2015 to April 2017). Lesional skin biopsies obtained were fixed, processed and stained with Haematoxylin and Eosin (H&E) followed by Ziehl-Neelsen (ZN) staining. The lesions were classified on microscopy as per Ridley-Jopling classification. Results: A total of 200 cases were studied. Highest incidence was in the 11 to 30 years age group for both males and females. Males were more affected (M:F=2.4:1). Most common clinical feature was loss of sensation. The commonest reported histopathological type was borderline lepromatous (43%) followed by borderline (17%). Overall ZN staining was positive in 56 (28%) cases. Conclusion: The spectrum of presentation of leprosy is very wide and there is clinical overlap between different types of leprosy. Histopathology still remains the gold standard for early diagnosis and classification of the disease. Accurate diagnosis forms the backbone for appropriate treatment and preventing deformities and drug resistance.

AimsTo measure the standard of care provided to patients who had a natural and expected death whilst in secure care at Roseberry Park Hospital, Middlesbrough.Mallard ward is a low secure psychiatric ward for older aged men suffering from cognitive difficulties and significant physical comorbidity in addition to a severe and enduring mental illness. The patient population is such that it will remain the most appropriate placement for some patients until their death. It is vital that staff members on Mallard ward and indeed all parts of the Trust are aware of the priorities for care of the dying person and ensure that care is provided in accordance with these priorities.The Leadership Alliance for the Care of Dying People (LACDP), a coalition of 21 national organisations, published One Chance to get it Right – Improving people's experience of care in the last few days and hours of life in June 2014. This document laid out five priorities for care of the dying person focussing on sensitive communication, involvement of the person and relevant others in decisions and compassionately delivering an individualised care plan.MethodThe data collection tool was adapted from End of Life Care Audit: Dying in Hospital, a national clinical audit commissioned by Healthcare Quality Improvement Partnership (HQIP) and run by the Royal College of Physicians. Data were collected from both electronic and paper records. There were three natural and expected deaths in the last two years.ResultFor all three patients, there was documented evidence that they were likely to die in the coming hours or days.End of life care discussion was held with the nominated persons and not with the patients due to their lack of mental capacity.The needs of the patients and their nominated persons were explored in all three cases.All patients had an individualised care plan which was followed.The palliative care team supported the staff with the care of these patients.The care provided was largely consistent with the priorities listed.ConclusionThe national audit compares performance of only acute NHS Trusts with no data to reflect the performance of mental health hospitals. It is imperative that mental health services work in collaboration with physical health and palliative care services so they are able to continue providing a high level of care to this patient group. Clinicians and staff involved in the care of dying patients also need to be adequately trained.

Background: Hysterectomy is widely used for treating a variety of gynecologic conditions. Most hysterectomies are elective and are performed to treat benign indications. Hence the present study was undertaken to determine the benign indication of hysterectomy, choice of surgical approach, safety and clinical aspect of hysterectomy as a surgical procedure and to correlate the findings with histopathological reports of the specimen.Methods: The present series represents a clinical study of 120 cases of elective hysterectomies for benign lesions. Out of which 73 were done by abdominal and 47 by vaginal route. Finally, all operated specimen were subjected to histological examination.Results: The main indications for elective hysterectomy were leiomyoma 53 (44.2%), prolapse 47 (39.2%) and dysfunctional uterine bleeding 11 (9.2%). Type of operation performed were mainly total abdominal hysterectomy with bilateral salphingo-oophorectomy in 60% cases and vaginal hysterectomy with anterior and posterior repair in 38.3% cases. The mean duration of surgery and average blood loss was more in vaginal procedure (90 min and 100ml) compared to abdominal (70 min and 80ml) respectively. Vaginal hysterectomy was associated with less morbidity and a smoother convalescence than abdominal hysterectomy. In 81.2% cases of abdominal hysterectomies correspondence of indication with histopathological report (HPR) were found, in vaginal 74.5% cases corresponded their histopathological report with their symptoms and investigations. Associated adnexal pathology was found in 8.3% cases. There was no mortality during the whole study period.Conclusions: Hysterectomy for benign pelvic lesions is a safe procedure and an important component of health care for women.

Fibroids are smooth muscle benign tumors. They arise most commonly from the uterus but may also rise from extra uterine sites like broad ligament. Uterine fibroids are the most common myomas, while uterine cervix and intraligamentary fibroids are statistically less frequent. This case report of Pseudo broad ligament fibroid with extensive cystic degeneration is presented for its rarity and diagnostic challenges as they mimic pelvic adenexal tumors. Following is the case report of a 40 year old, P4L4, postmenopausal female admitted in the department due to a diagnosed solid lesion in the left adnexa. Patient was asymptomatic 3 months back when she noted gradual swelling and distention over the abdomen. On abdomen examination, a generalized mass was palpable with minimal ascites. On ultrasonography, a large heterogenous mass measuring 200X215 mm seen in pelvic region, arising from left adnexa and extending towards abdomen. During laparotomy, left sided fibroid was removed and sent for frozen section analysis. Histopathological reports revealed spindle cells arranged in fascicles and interlacing bundle with focal areas of myxoid degeneration. Huge pseudo-broad ligament leiomyoma with cystic degeneration may present diagnostic difficulties in differentiating ovarian malignancies even on ultrasound and MRI. This differential diagnosis must be considered prior to surgical management.

Highlights • This study examined long-term trends in antibiotic resistance on a national scale in India. • Colistin-resistant Klebsiella pneumoniae and Escherichia coli strains have emerged in India. • In 2014, the prevalence of carbapenem-resistant E. coli was11.5%, the highest reported to date globally., Summary Objective There have been no long-term studies on trends in antibiotic resistance (ABR) on a national scale in India. Using a private laboratory network, the ABR patterns of organisms most commonly associated with bacteremia, obtained from patients across India between 2008 and 2014, were examined. Methods A retrospective study of patient blood cultures collected over a 7-year period (January 1, 2008–December 31, 2014) was conducted. Data on the microorganism(s) identified and their antimicrobial susceptibility were obtained from SRL Diagnostics (Mumbai, India). Results Of 135 268 blood cultures, 18 695 (14%) had at least one identified pathogen. In addition to continual high rates of methicillin-resistant Staphylococcus aureus (MRSA; approximately 44.2%), high resistance to nalidixic acid among Salmonella Typhi (98%) was observed, and carbapenem resistance increased in both Escherichia coli (7.8% to 11.5%; p = 0.332) and Klebsiella pneumoniae (41.5% to 56.6%; p

The Govt. and non-Govt. organizations throughout the world has realized the importance of Breast feeding under the scheme of 'Health Care for All' and particularly through protection and promotion of Breast feeding. To the practice of Breast feeding is an universal process in recent years. There has been a global decline in the number of Breast feeding mothers. The present investigations was an attempt to evaluate the prevalence of Breast feeding practices in relation to their awareness, knowledge, income, source of knowledge and reason behind Breast feeding. The present study was to spot the variations of child rearing and awareness regarding the feeding practices in the Bhagalpur town - Raionale : (1) to evaluate their awareness and knowledge. (2) to assess the knowledge according to age, income and source of knowledge. Methodology: This study was conducted in different wards of Bhagalpur town. It was Hindu dominated but Muslims respondent were also present, in which slum population was also considered. Total number of 500 subjects were selected, but 96 schedule were rejected due to incomplete answers. Therefore only 404 cases were studied by the researcher. Data were analysed statistically according to the need. Tools for the study - Interview schedule was used for the study. Result : 52.94 per cent subjects in between age group of 21 to 25 yrs. belonged to middle income group. 2.04 per cent respondent belonged to the age group of 30 to 40 yrs. were higher income group. 81.18 per cent respondent's source of knowledge regarding Breast feeding was from neighbours and relatives. Only 4.47 per cent got the knowledge through medical advisor. 40.50 per cent respondents belonging to higher income group showed the reasons behind Breast feeding were healthy way. 32.7 per cent respondents belonging to lower income group highlighted about the natural and enough secretion of milk was the main reason. Some reason was followed by 29.16 per cent women belonging to middle income group.

Aim The objective of the present study was to understand the effect of dietary and lifestyle determinants on plasma homocysteine levels by combining the MTHFR C677T polymorphism in a rural North Indian population. Methods A total of 1634 participants were recruited under a major government sponsored research project through door to door survey. The participants (both men and women and aged 30–65 years) were recruited from a Mendelian population. Of these 1459 participants were considered for the present analysis, as they were neither on any kind of medication for high blood pressure, CAD, diabetes or any other disorder nor did they have any missing data. Informed written consent was obtained from all the participants. Data on dietary and other lifestyle factors was collected in face-to-face interview through structured interview schedules. 5 ml of intravenous blood was collected from all the participants for biochemical and molecular analysis. Homocysteine, folate and vitamin B12 analysis was estimated through Immulite 1000 by chemiluminescence technique. Genetic variation in the MTHFR C677T genotype was analyzed using PCR-RFLP technique. Result The prevalence of hyperhomocystenemia (Hyphcy), folate and vitamin B12 deficiency was found to be 69.92%, 32.53% and 57.86% respectively. 677 T allele of MTHFR was found to be associated with Hyphcy. Men had significantly higher levels of homocysteine, folate and vitamin B12 as compared to the women. Age was found to be positively associated with homocysteine levels among women. Lifestyle determinants were found to be associated with increased risk for Hyphcy among the men. Conclusion The findings reveal that there is high frequency of vitamin B12 levels deficiency and Hyphcy in the studied population. This is likely to contribute to increased susceptibility to numerous disorders. Therefore, it is the need of the hour that the general population is made aware of the benefits of consumption of vitamin B12 rich foods and the same is promoted in the population.

Background: Thrombocytopenia is often the most commonly encountered clinical condition in this routine practice. Etiological causes being numerous, often pose a challenge in evaluating and treating the patients. The objective of this study was to find out the different causes and clinical profile of fever with thrombocytopenia in children aged 1month to 14 year who were admitted in this set up.Methods: This was a prospective study done on 200 patients with thrombocytopenia admitted IMS AND SUM Hospital, BBSR with various complaints, during the period of 01 August 2017 to 01 August 2019. This study includes age group 1months to 14 years.Results: The highest incidence of thrombocytopenia belonged to the age group 11-14 years (22.5%) followed by 6-9 years (19.5%) and 3-6 years (18%). Incidence of thrombocytopenia was more in male child (58.5%) as compared to female child (41.5%). the most common cause of thrombocytopenia was dengue (50%), Scrub typhus (34%) septicaemia (17.5%) followed by malaria (10.5%). Among the infectious aetiology severe thrombocytopenia was seen more in dengue (25%) and scrub typhus (34.5%) but evidence of bleeding was seen more in sepsis (34.2%) even with higher platelet count which may be explained by associated multi organ failure.Conclusions: Infections like malaria, dengue, leptospirosis and septicaemia were the common causes of thrombocytopenia along with scrub typhus. Whenever thrombocytopenia is detected further investigations can help us in reaching a correct diagnosis in the majority of the cases so that appropriate treatment can be given and also to avoid unnecessary platelet transfusion to prevent transfusion related complications.

Background: The presence of neuropsychiatric symptoms (NPS) in older adults with no cognitive impairment confers a high risk of future cognitive decline. Mild behavioral impairment (MBI) is a syndrome characterized by the new onset of NPS after 50 years, which is sustained and impactful. We report the distribution of various domains of MBI in subjects with mild cognitive impairment (MCI) and subjective cognitive impairment (SCI) and the association between different blood markers in individuals with MBI. Materials and Methods: This cross-sectional study was conducted in the Memory clinic of the Department of Geriatric Medicine in a tertiary health center. The study duration was 1½ years. Subjects with MCI and SCI were screened for the presence of NPS and MBI. Patients with dementia, impaired activities of daily living, and psychiatric illnesses were excluded. The mild behavioral impairment checklist ascertained the presence of various domains. Levels of various blood markers were assessed. Results: In this study, 124 participants were included. The mean age of the population was 69.21 ± 6.64, 71.77% were male, and 28.23% were female. Fifty-one participants were diagnosed to have MBI. Among the MBI domains, impulse dyscontrol was most commonly involved (68.63%) followed by decreased motivation (60.78%). Low Vitamin D (85.71%; P = 0.005) and high serum triglyceride (50%; P = 0.044) were associated with MBI. Conclusion: NPS, especially impulse dyscontrol and decreased motivation, in participants without dementia, were common in the memory clinic setting. Vitamin D deficiency and high triglyceride levels were significantly associated with MBI.

Skin cancer is the most common malignancy worldwide, including malignant melanoma and Non-malignant melanoma. The progressive increase in the incidence of skin cancers is observed, mainly in cutaneous melanomas over the last few decades. UV exposure is the most common cause of skin cancer, which occurs due to mutations in the DNA of skin cells. The mutation in MAPK pathway was the main cause of the skin cancer, in which BRAF gene undergoes 75 somatic mutations. The mutation in DNA suppressed the tumor suppressor gene p53, inactivates DNA repair gene and causes mutation in proto-oncogene results in the formation of oncogene which promote the cell growth, cell proliferation and cell reproduction by affecting the process of apoptosis. Skin cancer can be prevented by healthy dietary intervention and regular physical activity. In the current review, we highlight recent global trends in the treatments of skin cancer which involve chemotherapy, radiotherapy, photodynamic therapy, biological therapy and surgery. These therapies show the effectiveness by improving the survival rate and quality of life.

Background With current modalities, cure rates of retinoblastoma are high and hence the number of survivors is increasing. However, data on quality of life (QOL) are minimal. Procedure We analyzed QOL in 122 retinoblastoma survivors using the PedsQLTM 4.0 generic core scale. The self-reported questionnaire was filled by children of more than 5 years of age who had completed treatment for more than 12 months. The questionnaire consists of 23 questions on physical, social, emotional, and school domains on a scale from 0 to 4. This was converted to a scale from 0 to 100, where higher values represented better QOL. The QOL was compared with 50 siblings. Factors predicting the QOL were assessed. Results The median age of retinoblastoma survivors was 98 months (range 60–247) and 68% were males. Overall QOL was significantly poorer in retinoblastoma survivors as compared with the controls. The emotional health domain of QOL was significantly affected. Difficulties in maintaining friendships and competing were reported in the social health domain. The school health domain showed significantly higher absenteeism. However, the physical health domain, including household work, exercise, and self-care, was similar in both the groups. Lower age at diagnosis (≤18 months) predicted better QOL (P = 0.05), whereas age at assessment, sex, IRSS stage, and previous surgery and radiotherapy were not predictive of poor QOL. Conclusions We found a significantly poorer QOL in retinoblastoma survivors with the psychosocial health domain being more affected than the physical domain. Age less than 18 months at diagnosis predicted better QOL.

Aim: The aim was to investigate antibacterial activity of Withania somnifera (Ashwagandha), an Indian traditional medicinal plant against Escherichia coli O78, a pathogenic strain. Materials and Methods: Two-fold serial dilutions of 20% aqueous W. somnifera root (WSR) extract were inoculated with E. coli O78 @ 1x10 7 colony forming units grown in nutrient broth. Following inoculation, turbidity optical density was measured by spectrophotometer at 600 nm in all the tubes at 0, 2, 4, 6 and 8 h of incubation at 37°C. Result: The results revealed that the maximum inhibition of bacterial growth was observed at 1:8 dilution of WSR extract. The highest dilution of the extract that showed inhibited growth of the test organism when compared with control was 1:16. Therefore, the minimum inhibitory concentration of aqueous extract of WSR is 1:16. Conclusion: It is concluded that WSR possessed good antibacterial activity, confirming the great potential of bioactive compounds and its rationalizing use in health care.

Health-related quality of life (HRQOL) in retinoblastoma survivors was assessed using parent proxy report of PedsQL(TM) 4.0 generic core scale. One hundred twenty-two parents of retinoblastoma survivors filled the questionnaire satisfactorily. This was compared with parent-reported HRQOL of 50 siblings. The median age of survivors was 98 (range, 60-247) months and male:female ratio was 2:1. The overall parent-reported HRQOL was significantly worse in survivors as compared to controls (74.4 ± 8.5 vs. 85.1 ± 4.6, P < 0.001). All health domains were significantly affected when compared with controls. None of the baseline and treatment-related factors predicted HRQOL.

Purpose – The prevalence of diabetes has increased manifold and now become a public health problem from being mild disorder. There is a need to discover more effective and safer antidiabetic agents by utilizing the rich heritage of medicinal plants. Tannins are polyphenols that are obtained from various parts of different plants belonging to multiple species and considered as potential drugs for the treatment of non-insulin-dependent diabetes mellitus. The paper aims to discuss these issues. Design/methodology/approach – The study was conducted in three phases: incorporation of Babul powder in biscuits: assessment of Glycemic Index (GI): suitability of Babul powder on diabetic subjects statistical analysis: area under curve (AUC) for increase in blood glucose was calculated by trapezoidal rule and means were tested for significance by paired t-test. Mean glucose levels of all subjects were calculated for each time point. p Findings – Tannins are polyphenols that are obtained from various parts of different plants belonging to multiple species. As an indigenous plant of Rajasthan, Babul contains high amount of tannin levels ranging from 18 to 27 percent in deseeded pods from ssp. indica, whereas ssp. nilotica reached up to 50 percent. Hence, Babul was selected as the source of tannin and subjected to diabetics for its suitability. The study concluded that Babul powder is effective in management of blood glucose levels even the simple sugars also and can be considered as suitable for diabetics. The active component for the purpose may be the presence of tannin in the Babul. Research limitations/implications – The study was conducted on limited number of subjects. A confirmation study is suggested on the diabetic population. Originality/value – The prevalence of diabetes is rapidly rising all over the globe at an alarming rate. Over few decades, the status of diabetes has changed from being considered as a mild disorder of the elderly to one of the major causes of morbidity and mortality affecting the youth and middle-aged people. Therefore, the present study focused on the development of tannin-based nutraceutical for incorporation in common foods and its health-promoting effect on diabetes.

Von Recklinghausen’s disease (VRD) is a hereditary disease that occurs because of mutation in NF1 gene located on chromosome 17. About 25% of VRD patients are reported to suffer from gastrointestinal lesions varying from hyperplasia of the gut neural tissue, endocrine tumors of the duodenum and the periampullary region, and gastrointestinal stromal tumors. Herein, we describe a case of ampullary neuroendocrine tumor with unique histology and immunohistochemistry in a 35-year-old male patient with VRD, detailed review of literature.

Background: Few structures of the human body are as unique as the hand. The hand needs to be mobile in order to position the fingers and the thumb. Coordination of the hand is required for performing tasks. The structures that form and move the hand require proper alignment and control along with adequate strength for normal hand function to occur. The thumb is a highly evolved structure of the hand and is an exemplary example of human evolution. It has gained attraction among researchers due to its uniqueness, clinical significance and associated variations in morphology. Aim ‐ The aim of this study was to observe variations among Abductor Pollicis Longus (APL), Extensor Pollicis Longus (EPL) and Extensor Pollicis Brevis (EPB). Methods: Upper limbs from twenty embalmed cadavers were studied in the Department of Anatomy and variations among the APL, EPL and EPB were documented. Results: Unilateral variations were noted among form and structure of APL, EPL and EPB. Bilateral variations were absent. All three muscles in all twenty specimens had same nerve supply. Conclusion: Variations among APL, EPL and EPB are clinically significant and may lead to obfuscations during hand and upper limb surgeries.

The sulfur–nitrogen donor ligands, thiosemicarbazones of 5-nitro-1H-indole-2,3-dione and 6-nitro-1H-indole-2,3-dione and 5-chloro-1H-indole-2,3-dione, have been prepared by the condensation of thiosemicarbazide with respective ketones in 1:1 molar ratio in ethanol medium. Lead and iron complexes were prepared by the reaction of lead(II) chloride and iron(III) chloride with the ligands in a 1:2 molar ratio, respectively. The newly synthesized complexes have been characterized by elemental analysis, melting point determinations, and UV, ESR, and IR spectral studies. In all the complexes, the monobasic bidentate nature of the ligand is evident. Based on analytical and spectral data, hexacoordinated structure for lead and pentacoordinated structure for iron complexes have been proposed. Antibacterial and antifungal studies of these compounds against various pathogenic bacterial and fungal strains have been carried out. One of the ligands and its metal complexes were screened for their antifertility activity. ...

The prevalence of protein energy malnutrition (PEM) is assessed about 70% among children under 5. The main reason behind is inadequacy of diet. The present study emphasizes on the management of malnutrition among children. For the purpose a supplementary product ladoo rich in energy and protein was prepared. It was fulfilling 1/3 of day's requirement of energy and protein. Effect of product in management of malnutrition was assessed by assessing changes in anthropometric measurement, dietary intake and presence of clinical signs of PEM among malnourished children after intervention. A pre-post test design was used to assess the effect of supplementary food. To select the 10 normal and 30 malnourished children a preliminary survey was conducted on one hundred five children (3–6 years) of village Bhesana, Jhadol block of Udaipur district (Rajasthan). Due to supplement the weight of children under the entire category increased significantly (p

Prevalence of vitamin B12 deficiency has increased in community in recent time. The present study was done to assess vitamin B12 status with respect to age and sex. Vitamin B12 assays were performed on 1512 individuals from a North Indian Lacto vegetarian community and further validated on a familial sample of 79 individuals. Individuals were considered to be deficient, if vitamin B12 levels were