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This paper demonstrates that signaling within the dorsomedial hypothalamus via the G proteins Gqα and G11α, which couple cell surface receptors to the stimulation of phospholipase C, is critical for regulation of energy expenditure, thermoregulation by brown adipose tissue and the induction of white adipose tissue browning.

Patella is the largest sesamoid bone. It is a triangular bone that lies within quadriceps tendon. Fractures of patella constitute approximately 1% of all skeletal injuries and occur in all age groups. There is always a need to salvage the fracture as it is an important functional structure in extensor mechanism of knee. Its report to evaluate the effectiveness and safety of anterior cerclage wire/tension band wiring technique using two or more cannulated cancellous screws in patients with transverse or transverse with comminuted patellar fractures. Material and Methods: This is a prospective study of 28 patients with transverse or transverse with comminuted fractures. All patients were treated with open reduction and internal fixation using multiple cancellous screws (more than two) and 18G stainless steel wire except two cases with TBW with k wire as per tension band principle. Result-There were 28 patients, 24(85.71%) males and 4(14.28%) females. The age group ranged from 22-60 years with mean age 38 years. The mode of injury was either direct or indirect trauma, fall (74%) followed by RTA (18%) and violent quadriceps contraction (8%). Transverse fractures were present in 60% patients and transverse fracture with comminution in 40% patients. Mean time to achieve union was 10.7 weeks (Range 8-12 weeks). Cases were followed up for 3 months, then at 6 months, thereafter 6 monthly and assessed for recovery of knee function. Study continued up to 12 months to 18 months. Mean ROM at the end of 3 months was 113.8° (90-130) and at final follow up this movement improved up to 125.4° (ROM 100-150). There was loss of reduction in one case, one case of infection and one case of nonunion. No case of implant failure was observed. The study was conducted in Department of Orthopaedics, Hi Tech Medical College, Rourkela and SB Medical College, Hazaribag. The results were graded according to the criteria given by Gaur et al. IJO May 1997. Conclusion: The criteria for surgery, open reduction and internal fixation with multiple cannulated cancellous screws with anterior cerclage was if ˃ 3mm displacement and ˃ 2mm articular step off was present. The screws provide rotation control of fragment and anchorage of cerclage wire. It provides additional compression across the fracture site. Open reduction and internal fixation with cannulated cancellous screws with anterior cerclage /TBW is a safe, reliable and reproducible method in the management of transverse or transverse with comminuted fractures, with less chances of implant failure and less soft tissue irritation.

Background and aims Large osteochondroma arising from chest wall and sternum is uncommon and presentation with airway compression is further uncommon. Methods Here we present a case of large chest wall osteochondroma as a part of hereditary multiple exostoses in a 9-year-old boy presented with a history of stridor and shortness of breath. The bony mass of the right chest wall was extending up to a suprasternal notch and compressing the trachea. Results The case was successfully managed by initial femoro-femoral cardiopulmonary bypass under local anesthesia before the induction of anesthesia to prevent respiratory collapse, followed by debulking surgery was done.

Background Perioperative pulmonary aspiration risk increases with increased preoperative gastric volume; hence traditionally, healthy children are kept fasted overnight before surgery. Current guidelines recommend 2-hours clear fluids fasting prior to anaesthesia. However, emerging evidence favours allowing 3 mL/kg clear fluids up to 1-hour before anaesthesia. We compared the gastric volume and gastric emptying time after ingestion of 3 mL/kg and 5 mL/kg of clear fluids. Methods The present study enrolled forty-four children, aged between 6 and 14 years. On the day of surgery, baseline gastric volume was estimated using ultrasound and patients were randomly allocated in to two groups of equal number i.e. Group 3 and Group 5 (patients received 3 mL/kg and 5 mL/kg 5% Dextrose respectively). Repeated gastric ultrasound was performed at every five-minutes until the gastric volume reached baseline levels. The primary objective of the study was to compare gastric emptying time. Secondary objectives included comparison of antral cross-sectional area (ACSA) and gastric volume. Results The demographic profile, preoperative fasting duration for clear fluids and baseline gastric volume were comparable between groups. In both groups, compared to baseline the ACSA and gastric volume increased significantly following fluid ingestion and then decreased exponentially to reach baseline within 1-hour. The median (IQR) (range)gastric emptying time (minutes) [35.0 (28.8, 40.0) (20.0 - 45.0) in group 3 and 40.0 (28.8, 45.0) (20.0 -50.0) in group 5] and emptying t1/2 (minutes) [17.0 (15.7, 21.5) (14.4 - 24.0) in group 3 and 18.6 (16.0, 22.0) (15.1 - 23.8) in group 5] were comparable [median difference -5 (95% CI -7.8 to 2.1) and-1.5 (95% CI -2.3 to 1.0) respectively] (p=0.16 and p=0.44 respectively). Conclusion As the gastric volume returned to baseline within 1-hour even after ingesting 5 mL/kg clear fluids, the preoperative fasting time can be reduced to 1-hour and healthy children undergoing elective procedure can be safely allowed to drink up to 5 mL/kg clear fluids.

The corona virus disease 2019 (COVID-19) pandemic sweeping across the world has severely strained health care resources (equipment and personnel) forcing us to rethink strategies to provide obstetric care while judiciously using resources. We describe the anaesthetic management of a mildly symptomatic, COVID-19 positive, 28-year-old second gravida with term pregnancy who was taken up for an elective caesarean section under subarachnoid block in a standalone maternity facility. Challenges encountered and modifications of standard procedures so as to optimize patient care and minimize exposure of health care professionals are also discussed.

Rapunzel syndrome is a rare type of trichobezoar with an extension of the hair into the small bowel. Clinical presentation is deceptive and vague, ranging from asymptomatic abdominal mass to gastrointestinal perforation. There are only few cases reported in literature, with the youngest age being 3 years. We present the case of a 3-year-old male child presenting with Rapunzel syndrome and features of subacute intestinal obstruction.

Aims: Aim of this study, was to analyse the effect of Body Mass Index on PEFR and sympathetic and parasympathetic activity and to find which obesity marker has got better correlation with the autonomic functions. Keywords: Body mass index (BMI), Obesity, PEFR, Sympathetic nervous function

Introduction: AKI in critically ill children has multiple etiologies. The primary objective was to study the, causes, management practices and outcomes of AKI in critically ill children as seen by Pediatricians and Pediatric residents in two cities in different parts of India. Methodology: A cross sectional survey using Questionnaire based module with 12 questions was distributed to all participants during a CME at two centers. Results: 50/59 (response rate 84.7%) responded. Only 40% had trained pediatric nephrologist at their centers. 35 (70%) said they saw 1 case of AKI per month. 19/20 at center A believed sepsis with MODS as commonest cause while at center B 14, 21/30 (69.3%) participants selected prerenal causes such as dehydration. Renal causes (14/20, 70%) were commonest indication for dialysis at center A while at center B it was sepsis with AKI. Acute Peritoneal dialysis with stiff catheter was chosen as commonest modality. Complete recovery, persistence of kidney injury, and mortality contributed equally to outcome at center A whereas 56% at center B chose complete recovery. Conclusions: Intrinsic renal causes like HUS are the most common causes of AKI in critically ill children requiring RRT (renal replacement therapy). Despite some advances in infrastructure and training most residents and pediatricians felt that peritoneal dialysis was the commonest modality.

Introduction: Heart attack in medical terminology is generally called as Acute Myocardial Infarction (AMI). When blood flow is abruptly cut-off to the heart muscle, it damages the myocardial tissue. This could be the consequence of blocked coronary arteries. The plaque formed due to the deposition of cholesterol and other fatty material over a period of time is the leading cause of this blockage. Aim: To assess the level of Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) in cardiac and non-cardiac chest pain and their association to Body Mass Index (BMI). Materials and Methods: The present study was an observational case-control type of study which included 100 subjects of age group 30-65 years from March 2019 to April 2020. Out of them 50 were non-cardiac chest pain individuals which were control and 50 Cardiac chest pain arrived within 6-8 hours of chest pain who suspected to be Myocardial Infarction (MI) from Emergency Department, Dhiraj General Hospital, Gujarat, India. BMI was calculated by height and weight. PT and aPTT analysis was carried out using STAGO-S.A.S. coagulation analyser. Results: There were increased levels of PT and aPTT (statistically significant) in AMI cases compared to corresponding age and sex matched controls (p

Malaria is a vector-borne disease caused by mosquitoes infected with protozoan parasites belonging to Plasmodium species. In humans, five different Plasmodium species can cause infection—Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium knowlesi, and Plasmodium ovale. Significant progress in malaria disease control has been made in the last two decades, with a 62% reduction in the mortality rate between 2000 and 2019. Despite this success, malaria still accounted for approximately 228 million cases, and 405,000 deaths in 2018. The emergence of resistance in Plasmodium against currently available drugs, in addition to widespread resistance in mosquitoes, highlights the need for the development of better therapeutic modalities with novel mechanism(s) of action to kill the parasite. New therapies could be developed by finding new drug regimens, the development of new derivatives of current antimalarial drugs, or repurposing of approved drugs used for other diseases. There is also an emerging interest in the development of host-directed therapies against severe forms of malaria, particularly anti-inflammatory compounds and natural products that act on host immunity, and biological therapeutics that can control parasite growth, with or without antimalarial drugs. Host-targeted interventions could also help to improve the efficacy of the only approved malaria vaccine “Mosquirix” and the design of more effective vaccines in the future based on protein, DNA, and mRNA. The next generation of therapeutic modalities not only must eradicate the drug-resistant parasite but also must possess broad-spectrum to target multiple strains. In this chapter, we discuss the recent advances in antimalarial therapies and the emerging area of biological therapeutic modalities.

The term infant is remarkably resistant to bleeding despite physiologically low levels of procoagulant proteins. However, because of their unique haemostatic systems, neonates are vulnerable to haemorrhagic disorders. The prevention of early vitamin K deficiency bleeding (VKDB) of newborn by oral or parenteral administration of vitamin K has been well established. However, rarely, a newborn can present with bleeding manifestations even after routine vitamin K prophylaxis at birth. A 2-day-old healthy male baby presented with catastrophic pulmonary haemorrhage with severely deranged coagulation profile even after receiving vitamin K prophylaxis at birth. His presentation, initial laboratory findings and course in the hospital were very much in favour of haemophilia B, but follow-up factor IX level and clinical exome sequencing did not confirm it. However, protein induced in vitamin K absence-II was found to be raised just before the discharge, and we concluded this case as a rare presentation of classical VKDB.

Malaria was described in ancient Chinese and Indian literature about 3000 years ago. It is a vector borne disease caused by apicomplexan parasites of Plasmodium species. In Sub-Saharan Africa, South-East Asia and Central America, malaria still poses major threat to human health. There is urgent need to develop potent therapeutics against malaria due to lack of effective vaccine and emergence of drug resistant forms of Plasmodium species. In the last decade, there is renaissance in developing RNA based prophylactic agents against cancer, metabolic and genetic disorders. Advances in RNA medicine may provide new solutions to diagnose and treat patients infected with drug resistant forms of invading pathogens causing diseases like tuberculosis, malaria and other viral infections. The role of RNA guided genetic manipulation system CRISPR-Cas based genomic editing has been used for gene drive against mosquito that transmits malaria parasite. This chapter focuses on current status of RNA based therapeutics and potential of RNA medicine against malaria.

Huntington’s disease (HD) is caused due to an abnormal expansion of polyglutamine repeats in the first exon of huntingtin gene. The mutation in huntingtin causes abnormalities in the functioning of protein, leading to deleterious effects ultimately to the demise of specific neuronal cells. The disease is inherited in an autosomal dominant manner and leads to a plethora of neuropsychiatric behaviour and neuronal cell death mainly in striatal and cortical regions of the brain, eventually leading to death of the individual. The discovery of the mutant gene led to a surge in molecular diagnostics of the disease and in making different transgenic models in different organisms to understand the function of wild-type and mutant proteins. Despite difficult challenges, there has been a significant increase in understanding the functioning of the protein in normal and other gain-of-function interactions in mutant form. However, there have been no significant improvements in treatments of the patients suffering from this ailment and most of the treatment is still symptomatic. HD warrants more attention towards better understanding and treatment as more advancement in molecular diagnostics and therapeutic interventions are available. Several different transgenic models are available in different organisms, ranging from fruit flies to primate monkeys, for studies on understanding the pathogenicity of the mutant gene. It is the right time to assess the advancement in the field and try new strategies for neuroprotection using key pathways as target. The present review highlights the key ingredients of pathology in the HD and discusses important studies for drug trials and future goals for therapeutic interventions.

Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatological disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes, resulting in exfoliation and possible sepsis and/or death. TEN is a disease of both children and adults, but TEN in early infancy is a rare event; in literature, only few cases in infants aged

Bladder rhabdomyosarcoma (RMS) in children, at presentation are often large, situated in close proximity to vital structures. This makes the surgical resection challenging. Hence, chemoradiotherapy is often used first. For those tumors which are amenable for resection, laparoscopy can serve as a better alternative. A 5-year-old boy presented with lump in the abdomen. MRI revealed a solid tumor of size 4.8 × 4.3 × 5.3 cms arising from dome of bladder. Tru-cut biopsy of the tumor showed features of RMS, after which VAC (Vincristine, Actinomycin-D, Cyclophosphamide) chemotherapy was started. By the end of two cycles of chemotherapy, patient required hospital admission multiple times due to chemotherapy toxicity. Review imaging of the tumor showed >60% reduction in size. Laparoscopic bladder preserving partial cystectomy was done. Post-operatively patient was discharged after six days. During follow-up, patient had no urinary symptoms. The resected specimen had tumor cells at inferior margin. Adjuvant chemotherapy course was completed. Two years after the surgery, patient remains free of recurrence. Laparoscopy serves as a good alternative to open surgery for bladder RMS surgeries. Laparoscopic bladder preserving surgery can be done with good access, limiting the operative morbidity. Patients can benefit from smaller scars and speedy post-operative recovery.

Background: Scrub typhus is an acute febrile illness caused by rickettsia Orientia tsutsugamushi. Rickettsial infections are grossly underdiagnosed in India because of their non-specific clinical presentation, low index of suspicion among clinicians, and lack of diagnostic facilities. Objective: Objective of the study is to study the clinical profile, complications, and outcome of pediatric scrub typhus. Materials and Methods: This prospective observational study was conducted in the Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India, over a period of 2 years from November 2013 to October 2015. Children up to 18 years of age with signs and symptoms compatible with scrub typhus along with serological confirmation were included in the study. Serological study was conducted using rapid immunochromatographic assay and/or immunoglobulin M enzyme-linked immunosorbent assay technique. Clinical presentation, laboratory findings, complications, and outcome of these children were recorded on a performa. The data were analyzed using SPSS version 20 for windows. Results: About 115 children were diagnosed as scrub typhus during the study period. All children presented with fever. Other common symptoms were myalgia (56%), vomiting (50.5%), abdominal pain (26%), headache (28%), facial puffiness (15%), and seizures (8.7%). Pallor was present in 48% of children. Other common signs were hepatomegaly (29%), splenomegaly (28%), hypotension (24%), edema (21%), oliguria (17%), maculopapular rash (10%), meningeal signs (10.4%), and conjunctivitis (3%). Thrombocytopenia (67%), anemia (51%), pleural effusion (23%), shock (16%), hepatitis (23%), acute kidney injury (17%), meningoencephalitis (10%), myocarditis (7%), and acute respiratory distress syndrome (7%) were the complications observed. Azithromycin, doxycycline or chloramphenicol were used for the treatment. Overall mortality rate was 12.2%. Conclusion: A high degree of suspicion and knowledge of geographical distribution of rickettsial diseases is crucial for its early diagnosis and favorable outcome. The presence of an eschar is a valuable clinical clue in the diagnosis of scrub typhus; however, its absence does not rule out the disease.

Nephrotic syndrome is associated with hypercoagulable states and a subsequent high risk of venous and rarely arterial thromboembolism. Although venous thromboembolism has been a recognised risk, prevalence of pulmonary embolism in patients with nephrotic syndrome is based on data from different case series. Here we report a 5 year old child with nephrotic syndrome who developed life threatening cerebral dural venous sinus thrombosis and pulmonary embolism within a month of disease onset.

Neuroblastoma is the most common solid tumor of infancy presenting clinically in a plethora of different and sometimes unpredictable ways with a wide range of symptoms. Young children can present with bluish skin metastases that may resemble bruising secondary to child abuse. Blueberry muffin baby had been reported to be a manifestation of either dermal erythropoiesis secondary to some congenital viral infections or neoplastic infiltrations. Among the neoplastic diseases, neuroblastoma has been the most common association with these subcutaneous skin metastases. Here, we report 2 months infant with neuroblastoma who presented with abdominal distension and multiple blueberry muffin nodules.

Urinary bladder and the rectum share a common embryological origin, and the anatomical proximity of these two organs suggest that a dysfunction in either may influence the function of the other. Although, the coexistence of bladder and bowel dysfunction has been previously reported in the literature, there are hardly any reports on coexistence of posterior urethral valve (PUV) with Hirschsprung's disease. Here, we report a case of a 20-month-old male child who was initially treated for PUV and was later found to have coexisting Hirschsprung's disease.

Pericardial cysts are rare mediastinal abnormalities, which are usually congenital but may also be acquired after cardiothoracic surgery. Pericardial cysts are most commonly located at the cardiophrenic angle or, rarely, in the posterior or anterior superior mediastinum. The majority of pericardial cysts are asymptomatic and are found incidentally on imaging studies. Our case was an 18-year-old female with a diagnosis of ostium secundum atrial septal defect (ASD). She was planned for surgical closure of ASD. On the opening of the pericardium, a pericardial cyst of around 3.0×2.0-cm size, filled with clear fluid, was found in the aorta–pulmonary artery groove. Marsupialization of the cyst was done followed by routine direct suture closure of ASD. Postoperative recovery was uneventful, and the patient was discharged on the third postoperative day. Histopathology of tissue confirmed our diagnosis. Our aim to present this case report is to show an incidental finding of the pericardial cyst at a rare location and to discuss its perioperative implications.

Background and Aims: India is a vast country with variable, nonuniform healthcare practices. A laryngoscope is an important tool during general anesthesia and resuscitation. The study aimed to determine the current practices of laryngoscope decontamination in India. Material and Methods: An online survey was conducted amongst 100 anesthesiologists to determine the common methods of laryngoscope decontamination adopted in their settings. The survey was done over 6 months after validating the questionnaire. Results: A total of 73 responses were received out of 100. The result of the survey revealed that there is no uniform technique of laryngoscope decontamination. There is marked variability in techniques followed not only among different institutions, but also within the same institution. Conclusion: There are no fixed protocols adopted for laryngoscope decontamination. Thus, there is a need to develop definitive guidelines on this subject, which can be implemented in India.

Jejunogastric intussusception is a potentially lethal complication of gastric surgery intussusceptions that can occur in any patient who has had a gastrojejunostomy. The diagnostic triad consists of high intestinal obstruction, left hypochondriac mass and hematemesis. On abdominal examination there may be left upper quadrant tenderness and guarding, and occasionally a mass may be felt. Often the mass is concealed by the rib cage and the guarding. Because the lesion is intraluminal, there is no peritoneal irritation and ileus is a late sign. This complication may occur at a variable period after original gastric operation. The treatment of acute variety of jejunogastric intussusception is prompt surgery. Delay in surgery beyond 48 hours is associated with an approximately 50% mortality.

Background: The human sacrum is a large, triangular shield-shaped bone formed by the fusion of five separate vertebrae along with the inter-vertebral discs. Gross morphology of sacrum shows a concave ventral surface, a convex dorsal surface and a triangular sacral canal. The sacral canal consists of an anterior wall formed by the fusion of the posterior aspect of the bodies of sacral vertebrae and the dorsal wall is formed by the fused laminae, spines and ossified ligamentum flava. Spina bifida is a developmental defect of sacral vertebrae, where the dorsal wall of sacral canal is partially or completely absent. The present study is an attempt to verify the incidence of complete agenesis of dorsal wall of sacral canal.Methods: Eighty six dry human sacra were collected from the undergraduate students and department of anatomy of three different medical colleges of Uttar Pradesh for the study of dorsal wall of sacral canal. Results: out of eighty six bones studied, two (2.33%) of the bones showed complete absence of the dorsal wall of the sacral canal.Conclusions: Complete agenesis of dorsal wall of sacral canal may lead to partial or complete failure of caudal epidural anaesthesia. Association between dorsal sacral agenesis and some other congenital malformations have also been reported by few authors. Anatomical knowledge of these variations of dorsal wall of sacral canal is important for anaesthetists, radiologists and spine surgeons.

Purpose: The aim of this study was to estimate the prevalence and causes of visual impairment (VI) and blindness and diabetic retinopathy (DR) in Siwan district, Bihar. Methods: A population-based cross-sectional study was done from January to March 2016 using the Rapid Assessment of Avoidable Blindness 6 (RAAB 6, incorporating DR module) methodology. All individuals aged ≥50 years were examined in 57 randomly selected clusters within the district. Results: A total of 3476 individuals were enumerated and 3189 (92%) completed examination. The overall prevalence of blindness and severe VI was 2.2% (95% confidence interval (CI): 1.6–2.8) and 3.4% (95% CI: 2.6–4.3), respectively. Untreated cataract was the leading cause of blindness (73%) and severe VI (93%). The cataract surgical coverage (CSC) at

The objective of the present study was to investigate the clinico-pathological changes and therapeutic evaluation of gamma-benzene hexachloride and cetrimide along with vit A, D3, E and H in Black Bengal goat infested Psoroptes cuniculi mange. The study was conducted on 14 Black Bengal goats; 6 clinically infested with Psoroptes mange (group I) and 8 healthy goats (group II). Haemato-biochemical profile viz., haemoglobulin concentration, packed cell volume, total leukocyte count, albumin and albumin globulin ratio revealed significantly (P

Cytomegalovirus (CMV) is the most important viral pathogen in renal transplant recipient and is associated with considerable morbidity and mortality. Following transplant CMV may lead to a broad spectrum of disease including encephalitis, retinitis, hepatitis, Pneumonitis, gastrointestinal ulcers and graft dysfunction. The risk of developing CMV disease depends on various factors including Serological status of donor and recipient, degree of immunosuppression, episodes of acute rejection and degree of graft function. For diagnosis of CMV disease pp65 antigen assay or molecular assay for nucleic acid test is used. For prevention of CMV disease in renal transplant recipients either antiviral prophylaxis or preemptive therapy is used. Both strategies having own sets of advantages and disadvantages. For treatment of established disease either intravenous ganciclovir or oral valganciclovir is used. In resistant cases foscarnet of cidofovir may be used.

Isolated high grade pancreatic injury is rare after blunt abdominal trauma. It is a rare entity to appreciate intra-operatively and a high index of suspicion should always be kept in mind to reach the diagnosis. We are presenting our experience of four cases with moderate to high grade isolated pancreatic injury which were managed in a lesser aggressive approach and had an uneventful outcome.

Alport syndrome (AS) is a type of inherited nephropathy characterized by hematuria, proteinuria, and progressive renal failure; often associated with extrarenal manifestations such as sensorineural deafness and anterior lenticonus. X-linked AS causes end-stage kidney disease in young male patients, sometimes without prominent clinical manifestation beforehand due to its heterogeneous phenotype. Here, we report a case of AS where ignorance of visual and auditory symptoms led to progression to end-stage renal disease.

Background: In children undergoing adenotonsillectomy, smooth recovery from anesthesia without any respiratory compromise and excessive sedation or pain is always desirable. In this placebo-controlled study, we examined the effect of single dose of dexmedetomidine on intraoperative hemodynamics and postoperative recovery profile such as emergence agitation (EA), pain, and sedation in children undergoing adenotonsillectomy. Methods: Sixty American Society of Anesthesiologists I or II children in the age group of 5–10 years, undergoing adenotonsillectomy were randomly assigned to receive dexmedetomidine 1 μg/kg (Group D) or volume-matched saline (placebo) (Group C), 10 min before induction of anesthesia. Intraoperative heart rate (HR) and mean blood pressure (MBP), duration of surgery, time to extubation, EA using Paediatric Anaesthesia Emergence Delirium (PAED) scale, level of sedation in postanesthesia care unit using Ramsay sedation score (RSS), and postoperative visual analog score (VAS) for pain were recorded and compared. Results: Dexmedetomidine group had lower HR and stable MBP, compared to the control group (P < 0.05). Postoperatively, the agitation score (PAED scale score) was statistically lower in Group D compared to Group C (13.84 ± 1.39; median 14 in Group C vs. 9.37 ± 1.33; median 9.5 in Group D; P < 0.001). All patients in Group C had PAED scale score >12, while only 6.67% of patients in Group D had PAED scale score of 12. The patients in Group D had higher RSS (2.62 ± 0.49 in Group D vs. 1.60 ± 0.50, P = 0.004); none of the patients were excessively sedated or had RSS >3. No significant difference was found in VAS score of the groups at all times, except at 0 h (P = 0.002). Time to extubation was significantly longer in the dexmedetomidine group (7.70 ± 1.62 min in Group D vs. 5.23 ± 1.91 min in Group C; P = 0.001). Conclusion: Premedication of dexmedetomidine at the dose of 1 μg/kg in children undergoing adenotonsillectomy resulted in favorable effect on intraoperative hemodynamics, significant decrease in postoperative EA without causing any excessive sedation, desaturation, or any other drug-related adverse events.

Filariasis caused by the nematode Wuchereria Bancrofti is a public health and socioeconomic problem in tropical and sub-tropical countries. The clinical manifestations depend upon the course of infection in the human host and the worm load. It is a rarity to document filarial worms in histopathology from the testes. We present a giant filarial scrotum of size 30 kg in weight. INTRODUCTION: Lymphatic filariasis is a major health problem in India with a large number of patients tending to be asymptomatic. Genital filariasis in India more commonly presents as a secondary vaginal hydrocele with an associated epididymo-orchitis. CASE REPORT: A 40y/M, from jhalda, farmer by occupation. No history of trauma associated. c/o: Scrotal swelling for 8yrs.patient gave history of progressive increase in the size of swelling from football size to present size. During initial period of disease patient sometimes had rise in body temperature, malaise and tenderness in the swelling but with progression of disease the all symptoms vanished. O/E: swelling is 38into 34cm in size, ovoid in shape, you can get above the swelling. The swelling was non-reducible. Coughing impulse is absent. Skin above the swelling was wrinkled, Penis was buried. Cord was thickened, testis not palpable. Swelling was oval in shape hard in consistency, non-tender, with no rise in local temperature, no translucency; reducibility. USG: suggest Filarial scrotal tumour With the patient in a modified lithotomy position, we excised the lymphedematous mass with a U-shaped incision. The neo-scrotum was made by anterior and posterior flaps. Both testes have been preserved. Reduction scrotoplasty has been done. A romovac drain was put in pouches prepared for the testicles. Postoperative period was uneventful mass was send for histopathological examination. Patient was followed for 6 month for recurrence.

Renovascular hypertension is among the most common causes of secondary hypertension. Fibromuscular dysplasia and atherosclerotic involvement of the renal artery are the commonest etiology behind renovascular hypertension. Its diagnosis requires a high degree of clinical suspicion followed by rationale investigations and their proper interpretation else it may be misdiagnosed as essential hypertension. The therapeutic approach of the patient with renovascular hypertension is currently a matter of great debate. In any case optimal medical therapy with antihypertensive, lipid-lowering, and platelet-inhibiting drugs should be instituted. Current evidence suggests that endovascular interventions may benefit a subset of patients with significant stenosis. Prospective, randomized and controlled studies with clearly defined clinical endpoints are needed to better define the absolute and relative indications of angioplasty in renal artery stenosis.

IgA nephropathy (IgAN) is the most common noninfectious glomerulonephritis worldwide. Most of the children and young adults with IgAN present with macroscopic hematuria during an upper respiratory or gastrointestinal illness. However, various atypical presentations including overt nephrotic syndrome and rapidly progressive renal injury have been reported. Here, we present a case of IgAN that presented with hypertensive encephalopathy with features of end-stage renal disease as the initial presentation.

Dense deposit disease (DDD), previously known as membranoproliferative glomerulonephritis type 2, is an extremely rare disease affecting two to three people per million. The rarity of this disease makes it difficult for clinicians to establish evidence-based clinical practices for its management. Here, we report a case of DDD who presented with features of acute nephritic syndrome and did not respond to most of the treatment options available in literature.

The authors report a case with life-threatening hyperglycemia and acidosis in a patient with no previous diabetic history following treatment with olanzapine. A 35-year-old woman with a history of bipolar affective disorder treated with olanzapine presented with severe diabetic ketoacidosis. She had no prior history of diabetes or risk factors for diabetes. Glycosylated hemoglobin (HbA1c) on admission blood sample suggested that long-term glycemic control had been poor. The authors postulate that treatment with olanzapine precipitated hyperglycemia, an elevated creatine kinase level, and a high amylase level. A concurrent urinary tract infection precipitated an episode of sepsis, which combined to precipitate life-threatening diabetic ketoacidosis. During her stay in the intensive treatment unit and subsequently in the medical ward, her blood glucose concentration was intensively monitored. She remains on insulin therapy, and her antipsychotic medication was changed to risperidone. Newer atypical antipsychotic drugs such as olanzapine have been introduced with the benefit of fewer extrapyramidal side effects. A number of these have reported metabolic side effects of uncertain etiology such as diabetic ketoacidosis and elevated creatine kinase. The authors believe that the diabetic ketoacidosis occurred in this patient, who had no previous history of diabetes mellitus. Blood glucose should be monitored in patients taking olanzapine, especially in those patients with risk factors for diabetes mellitus.

Background: Adult data have shown low tidal volume strategy to be beneficial to the outcome of acute respiratory distress syndrome (ARDS).There are little data regarding the effect of different tidal volume strategies on outcomes in children with ARDS. Aims and Objectives: The aim of this study was to learn the differences in outcomes from ARDS in children using low vs conventional tidal volumes. Methods: All patients with ARDS (aged 1 month to 16 years) admitted to the pediatric intensive care unit from March 98 to June 2004 were studied. Prospective data for low expired tidal volumes (6–8ml/kg) were collected from Jan 2001 to June 2004 (group 1). ARDS patients during March 1998 to December 2000, receiving conven­ tional tidal volumes (10–15 ml/kg) were used as retrospective control (group 2). Etiologies, PRISMIII scores, interventions, and outcomes data were recorded. Standard supportive therapy for ARDS was used in all children using conventional mechanical ventilation. Results: A total of 153 (4.67%) patients had ARDS as defined by standard criteria. Groups 1 and 2 had 78 and 65 patients, respectively, with comparable PRISMIII scores. Mortality was 23% (group 1) vs 36.9% (group 2) (P

Background: Acute myocardial infarction (AMI) is a significant cause of morbidity and mortality worldwide, which results from occlusion of coronary artery. Dyslipidemia is a major risk factor of AMI. C-reactive protein (CRP) is an acute phase protein, synthesized by hepatocytes in response to cytokines released into circulation by activated leukocytes and has been found to increase after AMI. The objective of the present study is to investigate lipid profile in AMI patients and correlate it with inflammatory marker i.e. CRP.Methods: The present study includes 150 AMI patients and 100 normal healthy individuals as controls. In all the cases and controls, serum lipid profile and inflammatory marker were measured by diagnostic kits supplied by ERBA.Results: The levels of lipid profile and inflammatory marker were significantly altered in the AMI cases compared to controls. We found significantly higher levels of total cholesterol, TG, LDL, VLDL, CRP and lower level of HDL in AMI compared to that of control subjects. We also found strong positive correlation of CRP with total cholesterol, triglyceride, LDL-C and VLDL-C and significant negative correlation with HDL-C in AMI patients.Conclusions: We found alterations in the lipid profile and inflammatory marker in AMI cases; hence, all the people should undergo regular check up including lipid profile evaluation and inflammatory marker such as CRP to decrease the incidence, morbidity and mortality from the disease.

Myiasis is an infection of live mammalian tissue by the larvae of dipterous flies and commonly found in the tropical and subtropical area. It usually infects domestic and wild animals, but rarely affects humans as well. Neonatal umbilical myiasis is an unusual occurrence with only a few reported cases in the literature. We report a case of an 8-day-old neonate from a rural area who presented with umbilical myiasis caused by larval form of Chrysomya megacephala.

Presence of platelet hyperserotonemia and effective amelioration of behavioral dysfunctions by selective serotonin reuptake inhibitors (SSRI) in autism spectrum disorders (ASD) indicate that irregularities in serotonin (5-HT) reuptake and its homeostasis could be the basis of behavioral impairments in ASD patients. SLC6A4, the gene encoding serotonin transporter (SERT) is considered as a potential susceptibility gene for ASD, since it is a quantitative trait locus for blood 5-HT levels. Three functional polymorphisms, 5-HTTLPR, STin2 and 3'UTR-SNP of SLC6A4 are extensively studied for possible association with the disorder, with inconclusive outcome. In the present study, we investigated association of these polymorphisms with platelet 5-HT content and symptoms severity as revealed by childhood autism rating scale in ASD children from an Indian population. Higher 5-HT level observed in ASD was highly significant in children with heterozygous and homozygous genotypes comprising of minor alleles of the markers. Quantitative transmission disequilibrium test demonstrated significant genetic effect of STin2 allele as well as STin2/3'UTR-SNP and 5-HTTLPR/3'UTR-SNP haplotypes on 5-HT levels, but no direct association with overall CARS score and ASD phenotype. Significant genetic effect of the markers on specific behavioral phenotypes was observed for various sub-phenotypes of CARS in quantitative trait analysis. Even though the 5-HT level was not associated with severity of behavioral CARS score, a significant negative relationship was observed for 5-HT levels and level and consistency of intellectual response and general impression in ASD children. Population-based study revealed higher distribution of the haplotype 10/G of STin2/3'UTR-SNP in male controls, suggesting protective effect of this haplotype in male cases. Overall results of the study suggest that SLC6A4 markers have specific genetic effect on individual ASD behavioral attributes, might be through the modulation of 5-HT content.

Objective : This study was carried out to detect the incidence of erythrocytic Glucose-6-Phosphate dehydrogenase (G-6-PD) deficiency, to compare the incidence of hyperbilirubinernia in G-6-PD deficient neonates as compared to G-6-PD normal neonates and to asses the usefulness of neonatal screening for G-6-PD deficiency.Method : In a retrospective hospital based study 2,479 male and female neonates consecutively born at Indraprastha Apollo hospital between July 1998 to June 2003 who were screened for G-6-PD levels were evaluated for the incidence of G-6-PD deficiency.Results : Incidence of G-6-PD deficiency was found to be 2.0%. Incidence in males was 283% and femle was 1.05%. The incidence of hyperbilirubinemia was found to be 32% in G-6-PD deficient neonates which was significantly higher than the incidence of hyperbilirubinemia in neonates with normal G-6-PD, which was 12.3% (P

Background: Vitamin D3 has been linked to everything as cancer, diabetes mellitus heart disease etc. One important function of vitamin D is on the beta cells of pancreas that secretes insulin. In cases of deficiency of vitamin D there is not only a decreased secretion of insulin but also increased insulin resistance as proved by various studies. Studies have also shown that treatment of vitamin D deficiency delays the development of insulin resistance & so diabetes mellitus. Methods: Our objective was to examine the association of serum 25-hydroxyvitamin D levels with type 2 diabetes mellitus & effects of vitamin D on it. Analysis were carried out on 200 patients (120 men & 80 women) aged about 35 or above conducted for 1 year in 2014. Diabetes mellitus was defined as fasting plasma glucose > 126mg% or current use of oral hypoglycaemic agents or insulin. Results: Compared to individuals with a sufficient serum 25(OH)D concentration >75nmol/L, the observed values are divided into 4 groups severe (