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Objective To assess adequacy of present means of clinical communication between physicians and (Covid-19) patients’ family members, to analyse their perspectives and recommend felicitous practices for virtual conversation during ongoing pandemic. Methods Cross-sectional questionnaire-based (20 questions) anonymous online survey was conducted including patient’s relatives (Group-1) and treating physicians (Group-2), through Google Forms. Results Response Rate was 82.5%. Group-1 and Group-2 included 155 and 204 respondents respectively. Group-1 preferred update by resident doctors (39%), twice a day (41.9%), daily case-summaries (80%) and hand-written document/electronic messages (53%,31%) as consent. Whereas Group-2 favored update by senior consultants (63%), daily one appraisal (55.9%) and scanned copies of hand written consent (81%) before high-risk procedures. The groups broadly agreed on the desired duration for a fruitful discussion (5–10 min) and designating one responsible person from the family for daily appraisal. Conclusion Use of modern techniques/technologies of communication (voice/video calls, texts) during the ongoing pandemic is acceptable to majority. Practice implications Study proposes a senior physician should communicate to a designated responsible family member at-least once a day for stable and twice a day for critical covid patients (more if patient’s health condition changes), either by voice or video calls for 5–10 min.

To find out the serum fibroblast growth factor 23 (FGF-23) levels in different grades of CKD, and the prevalence of abnormal left ventricular mass index (LVMI), carotid intima–medial thickness (cIMT), and central pulse wave velocity (cPWV) and the risk factors including FGF-23 for these abnormalities. Fifty-nine patients of CKD with G2 to G5, aged 2–18 y were included. The LVMI, cIMT, and cPWV were measured using standard techniques, and serum intact FGF-23 levels were estimated at enrollment. Median FGF-23 levels were significantly raised in all the grades of CKD than controls (p

Spinal epidermoid cyst is a rare entity. It may be congenital with associated spinal dysraphism such asspina bifida ,dermal sinus tract and other neural tube defects or acquired due to repeated lumbar puncture and trauma. Congenital spinal epidermoid cysts without spinal dysraphism are rare. Here we are reporting a rare and interesting case of thoracic extramedullary intradural epidermoid cyst with no associated features of spinal dysraphism or history of iatrogenic trauma in a young male patient. Keywords: Epidermoid, Cyst, Spinal dysraphism, Extramedullary, Thoracic

In “Rights of Persons With Disabilities (RPWD) Bill, Disability has been defined based on an evolving and dynamic concept and the types of disabilities have been increased from existing 7 to 21 and the Central Government will have the power to add more types of disabilities.1 The Speech and Language Disability and Specific Learning Disability have been added for the first time. Acid Attack Victims have been included.

Normal sexual behavior brings pleasure to oneself and one's partner involves stimulation of the primary sex organs including coitus; it is devoid of inappropriate feelings of guilt or anxiety and is not compulsive. Sexual functioning is influenced by a number of factors, mental illness being one of them. Sexual dysfunction in patients with OCD has mostly been studied independently or in gender-specific studies. These studies have reported significant dysfunction in different areas of sexual functioning. The aim of this study is an attempt to assess & compare the presence, prevalence & types of sexual dysfunctions (SD) in OCD mostly coming from rural background in a Tertiary Government Hospital in West Bengal. Our study revealed Sexual dysfunction was in 53.33% of the subjects. Orgasmic dysfunction was the most frequent dysfunction 20.51% in females (N=8), followed by problems in desire15.38%. However since the data were collected from a specific population, the degree to which they represent the general population cannot be commented upon. Key word : OCD, Sexual Dysfunction

Background and aims Both endoscopic and laparoscopic transmural internal drainage are practiced for drainage of walled-off necrosis (WON) following acute pancreatitis (AP) but the superiority of either is not established. Our aim was to compare transperitoneal laparoscopic drainage with endoscopic drainage using either lumen apposing metal stents (LAMS) or plastic stents tailored to the amount of necrotic debris in WON. Methods In a randomized controlled trial, adequately powered to exclude the null hypothesis, patients with symptomatic WON were randomized to either endoscopic or laparoscopic drainage. In the endoscopy group, two plastic stents were placed if the WON contained 1/3rd. Primary outcome was resolution of WON within 4 weeks without re-intervention for secondary infection. Secondary outcome was overall success (resolution of WON at 6 months) and adverse events. Results Forty patients were randomized: 20 to each group. Baseline characteristics were comparable between the groups. Primary outcome was similar between the groups [16 (80%) in laparoscopy and 15 (75%) in endoscopy group; p = 0.89]. The overall success was similar [18 (90%) in laparoscopy vs. 17 (85%) in endoscopy; p = 0.9]. Median duration of hospital stay was shorter in endoscopy group [4 (4–8) vs. 6 days (5–9); p = 0.03]. Adverse events were comparable between the groups. Conclusion Laparoscopic drainage was not superior to endoscopic transmural drainage with placement of multiple plastic stent or LAMS depending on the amount of necrotic debris for symptomatic WON in AP. The hospital stay was shorter with the endoscopic approach.

Objectives To evaluate the effects of submucosally administered platelet-rich plasma (PRP) on the rate of maxillary canine retraction. Levels of soluble receptor activator of nuclear factor-κb ligand (sRANKL) and osteoprotegerin (OPG) in the gingival crevicular fluid (GCF) were also measured over 2 months. Materials and Methods This split-mouth trial involved 20 sites in 10 subjects randomly assigned to PRP (experimental) side and control side. After alignment, the freshly prepared PRP was injected submucosally distal to the experimental side maxillary canine, and retraction was performed using NiTi closed-coil springs (150 g) on 0.019 × 0.025-inch stainless steel wire. The rate of canine movement was assessed using digital model superimposition at 0, 30, and 60 days. The OPG and sRANKL were assayed using enzyme-linked immunosorbent assay from GCF collected at 0, 1, 7, 21, 30, and 60 days. Results Twenty sites were analyzed using paired t test. The rate of tooth movement increased significantly by 35% on the PRP side compared with the control side in the first month (P = .0001) and by 14% at the end of the second month (P = .015). Using the Mann–Whitney U test, OPG levels were found to be significantly decreased on the 7th (P = .003) and 30th day on the PRP side (P = .01), while sRANKL became detectable by the third week postinjection on the PRP side (P = .069). Conclusions Submucosal injection of platelet-rich plasma significantly increased tooth movement during the 60-day observation period. Local injection of PRP significantly altered the levels of OPG and sRANKL in GCF.

Study objectives We aim to explore the mechanism of relationship between insomnia and liver metabolism by examining the gene × insomnia interactions. Methods Individual level genotypic and phenotypic data were obtained from the UK Biobank cohort. Regression analysis was first conducted to test the association of insomnia with plasma total bilirubin (TBil; n = 186,793), direct bilirubin (DBil; n = 159,854) and total protein (TP; n = 171,574) in UK Biobank cohort. Second, genome-wide gene-environment interaction study (GWGEIS) was conducted by PLINK 2.0, and FUMA platform was used to identify enriched pathway terms. Results In UK Biobank cohort, we found that TP (P Conclusion Our study results suggested negative associations between insomnia and DBil and TBil; and a positive association between insomnia and TP.

We aimed to explore the underlying genetic mechanisms of traumatic events during childhood affecting the risks of adult substance use in present study. Using UK Biobank cohort, linear regression model was first applied to assess the relationships between cigarette smoking and alcohol drinking in adults with traumatic events during childhood, including felt hated by family member (41,648–111,465), felt loved (46,394–124,481) and sexually molested (47,598–127,766). Using traumatic events as exposure variables, genome-wide by environment interaction study was then performed by PLINK 2.0 to identify cigarette smoking and alcohol drinking associated genes interacting with traumatic events during childhood. We found that the frequency of cigarette smoking was significantly associated with felt hated by family member (coefficient = 0.42, P –9), felt loved (coefficient = −0.31, P –9) and sexually molested (coefficient = 0.46, P –9). We also observed weaker associations of alcohol drinking with felt hated by family member (coefficient = 0.08, P = 3.10 × 10–6) and felt loved (coefficient = −0.06, P = 3.15 × 10–7). GWEIS identified multiple candidate loci interacting with traumatic events, such as CTNNA3 (rs189142060, P = 4.23 × 10–8) between felt hated by family member and the frequency of cigarette smoking, GABRG3 (rs117020886, P = 2.77 × 10–8) between felt hated by family member and the frequency of alcohol drinking. Our results suggested the significant impact of traumatic events during childhood on the risk of cigarette smoking and alcohol drinking.

Type 1 diabetes mellitus (T1DM) is an autoimmune ?-cell destruction, usually leading to absolute insulin deficiency, insulin resistance, or by a combination of both. Both the incidence and prevalence of diabetes T1DM is suspected to be high in India, but in the absence of nation-wide registry, the possibility of exact numbers is unsure. Till date, studies done among the population have seen prevalence more than the incidence of the disease, which has led to late screening and diagnosis of the disease within the community settings. India is already suffering from the burden of type 2 DM, in the process of screening those, patients with T1DM are somewhat getting ignored. Furthermore, cost associated with the treatment expenditure and social status of the people suffering from the disease too have a role to consider which has been totally side-lined in national programmes like National Program for Control of Diabetes, Cardiovascular disease, and Stroke (NPCDCS). There is also scarcity of data on the incidence of T1DM which could aid in formulating better policy avenues for the patients suffering from the disease. Reports on trends in T1DM are more commonly available from countries with better established public health surveillance systems and diabetes research infrastructure. From India, due to scarcity of data on T1DM, we had to rely on published literature of some major centers across the country. Results from the Indian Council of Medical Research (ICMR) first phase, till July 2011 which included 5546 patients found T1DM among 63.9% cases and predominately among children; at registration 11.1% had already developed chronic complication of T1DM. As India is already suffering from the burden of type 2 DM, during current management and treatment, the problem lies at various levels which needs to be addressed. We propose a setting based, life course approach for T1DM where every age group will have access to the health care system either directly or indirectly from intra-natal life till elderly age group through health approach based on scientific methods delivered through health system. In this regard a central registry having enumeration and provisioning of mandatory Insulin to all through a national policy being implemented by NPCDCS is what policy makers must take up at urgent bases if we want to bend the curve of rising T1DM and prevalence of overall diabetes in India.

Introduction: Bhutan’s healthcare approach in achieving the sustainable development goal 3 (SDG 3) has been largely through primary healthcare as enshrined in the universal health coverage (UHC). Bhutan has forged a unique primary healthcare model in which oral health is integrated in its primary care initiatives. The Oral Health program under the Department of public health was established in 1999 with clear line objectives. The program has achieved commendable successes over the years. However, with changing needs, enhancing and mainstreaming of oral health and dentistry in the country must be accorded a top priority. This is particularly important as the Oral Health Policy and service standards were drafted fourteen years ago in 2007. The 2021 World Health Orgnization (WHO) agreement “to provide basic oral health services to all”, to which Bhutan is signatory, needs to be strictly implemented. Therefore, oral health dialogue was conducted to deliberate on the oral health systems in the country with experts from the field who were from within and outside Bhutan. This oral health policy dialogue generated important themes such as strategic and competent workforce, capacity development, need to transform oral health services in more people centric ways and mainstreaming oral health in other health policies.

Background: Little information is available from India about the psychological impact of COVID-19 on helath-care workers. Aim: The current study aimed to evaluate the psychological issues among the health-care workers (HCW) during the COVID-19 pandemic. Materials and Methods: An online survey using Survey Monkey® platform was carried out to evaluate depression (using Patient Health Questionnaire-9), anxiety (using Generalized Anxiety Disorder Questionnaire-7), and other psychological issues (using a self-designed questionnaire). Results: The study sample comprised 303 participants with a mean age of 41.2 (standard deviation: 11.1) years. A majority of them were male (69%) and married (79.9%). Nearly half (46.2%) of the participants had either anxiety disorder or depression or both and 12.9% of HCW had suicidal behavior. Higher level of anxiety and depression scores were associated with being female, having undergone quarantine, directly involved in the care of COVID-19 patients, and younger age (

Background Psychiatric disorders are among the largest and fastest-growing categories of the global disease burden. However, limited effort has been made to further elucidate associations between socioeconomic factors and psychiatric disorders from a genetic perspective. Methods We randomly divided 501,882 participants in the UK Biobank cohort with socioeconomic Townsend deprivation index (TDI) data into a discovery cohort and a replication cohort. For both cohorts, we first conducted regression analyses to evaluate the associations between the TDI and common psychiatric disorders or traits, including anxiety, bipolar disorder, self-harm, and depression (based on self-reported depression and Patient Health Questionnaire scores). We then performed a genome-wide gene-by-environment interaction study using PLINK 2.0 with the TDI as an environmental factor to explore interaction effects. Results In the discovery cohort, significant associations were observed between the TDI and psychiatric disorders (p Conclusions Our findings suggest the relevance of the TDI to psychiatric disorders. The genome-wide gene-by-environment interaction study identified several candidate genes interacting with the TDI, providing novel clues for understanding the biological mechanism of associations between the TDI and psychiatric disorders.

The risk of oral cancer is strongly related to consumption of tobacco, smoking and drinking alcohol. N-acetyl transferases 1,2 are phase II metabolic enzymes, metabolize aryl and heterocyclic amines which are present in tobacco. NAT2 slows acetylator phenotype and the genotype is related to reduced ability to detoxify these xenobiotic that are carcinogenic to tissues. The aim of our study to determine the risk of oral cancer as well as oral precancerous lesions in North Indian population with polymorphisms in these two N-acetyl transferases 1,2 genes. A total of 250 patients with pre oral cancer, oral cancer and 250 healthy volunteers were genotypes for the NAT1 and NAT2 gene polymorphisms. Genotypes were identified by PCR and RFLP. Genotype frequencies were evaluated by Chi-square test and risk of disease was estimated by Odds ratio (OR) with 95% confidence interval. Our results showed that individuals with CT and TT genotypes of NAT1 C > T polymorphism were significantly lower risk of oral diseases (p value = 0.02, OR = 0.60 and p value = 0.04, OR = 0.58, respectively). For NAT2 C > T polymorphism, the TT genotype significantly increased the risk of OSMF (Oral Sub mucous Fibrosis) and Leukoplakia (p value = 0.001, OR = 4.16; p value = 0.002, OR = 4.38, respectively). In contrary, the CC genotype for NAT2 T > C polymorphism increased the risk of OSMF (p value = 0.01, OR = 3.00, 95% CI = 1.31–6.86). Our study concludes that the NAT1 polymorphism shows protective association with oral diseases and NAT2 polymorphism and haplotypes also influence the susceptibility to oral diseases in North Indian population subjects.

Background Pediatric facial injuries are common due to children's high level of activity which gradually decreases as age advances. Main etiology in cases of pediatric age group are self-fall, sports related injuries, interpersonal violence and lastly road traffic accident. Pattern and management of facial fracture in pediatric age group is different to that of adult population. Material and methods This study included 87 patients who had facial injuries and who reported at dental institute RIMS, Ranchi over a period of three years from 2017 to 2020. Initial assessment diagnosis and management were given to the patients. Results Self-fall accounted as the leading cause of fracture (47.1%). Most frequent age group with facial injuries were from 7 to 12 years age group (49.1%). Dentoalveolar pattern of facial fracture was most common accounting for (39.1%) followed by mandible fracture in 33.3%. Closed reduction of the fracture was the most common way of treatment. Open reduction and fixation was carried out in 3.4% patients. Conclusion Self-fall was the main etiology in our study and younger age group patients were more involved. Conservative treatment are generally given to pediatric age group, with open reduction in few cases on the basis of displacement. Close monitoring and follow up is mandatory in these age group.

Graphical abstract Transmission of novel coronavirus (SARS-CoV-2) in humans happens either through airway exposure to respiratory droplets from an infected patient or by touching the virus contaminated surface or objects (fomites). Presence of SARS-CoV-2 in human feces and its passage to sewage system is an emerging concern for public health. Pieces of evidence of the occurrence of viral RNA in feces and municipal wastewater (sewage) systems have not only warned reinforcing the treatment facilities but also suggest that these systems can be monitored to get epidemiological data for checking trend of COVID-19 infection in the community. This review summarizes the occurrence and persistence of novel coronavirus in sewage with an emphasis on the possible water environment contamination. Monitoring of novel coronavirus (SARS-CoV-2) via sewage-based epidemiology could deliver promising information regarding rate of infection providing a valid and complementary tool for tracking and diagnosing COVID-19 across communities. Tracking the sewage systems could act as an early warning tool for alerting the public health authorities for necessary actions. Given the impracticality of testing every citizen with limited diagnostic resources, it is imperative that sewage-based epidemiology can be tested as an early warning system. The need for the development of robust sampling strategies and subsequent detection methodologies and challenges for developing countries are also discussed.

This study evaluated the diagnostic role of cerebrospinal fluid leucine-rich alpha-2 glycoprotein (CSF LRG) concentration in children with acute bacterial meningitis, and its role in differentiation from aseptic meningitis. CSF LRG concentration was measured by ELISA Kit of 50 children with bacterial meningitis, 16 aseptic meningitis, and 20 children with normal CSF; control. CSF LRG was significantly elevated (p

Objective: The aim of this study is to determine the frequency of thyroid disorders in patients with type-I diabetes mellitus. Study Design: Descriptive Cross-sectional study. Setting: Jinnah Medical College Hospital, Karachi. Period: 3rd January 2018 to 3rd July 2018. Material & Methods: A total number of hundred patients having NIDDM taking insulin were included and thyroid hormones were measured. Results: Out of hundred patients, 57 were male and 43 were female. Mean age was 12 to 20 years. Thirty-four (34%) of patients had a family history of type-I diabetes. The mean (±SD) age of patients when the type-I diabetes first diagnosed was 12(±3.08) years. A total of 6% patients had a thyroid dysfunction. Thyroid antibodies were negative among patients with deranged thyroid hormones and ultrasound thyroid gland was also normal. Conclusion: There is significant association of thyroid disorders with type-I diabetes mellitus. Frequent screening was recommended in these patients.

A Prospective cross-sectional examination was completed so as to survey the solution design in pregnant ladies. Going to Antenatal in and Outpatient Department of a Tertiary Care Hospital. A cross-sectional investigation was led by looking into the antenatal consideration In & outpatient office case papers of 230 irregular pregnant ladies. The remedy design was surveyed and the medications were arranged dependent on the US FDA Risk Classification. Out of 230 solutions, just 177 remedies had medicates other than iron, folic corrosive and calcium lactate. In this examination the majority of the medications endorsed falls under class B (26.6%), a reasonable number of medications falls under classification A (16.60%) and C (16.60%) and a couple of medications fall under classification D (6.66%). No medications having a place with class X were recommended. The current examination uncovers that the medication use during pregnancy in and around Bapatla area was insignificant and the majority of the medications were recommended by their conventional names. Recommending by nonexclusive name is known to decrease the expense of medication treatment, defended drug treatment and maintains a strategic distance from disarray.

Numerical anomalies of renal arteries are frequently encountered at radiological investigations. Origin of main renal artery from abdominal aorta above the level of origin of celiac trunk and supplying normally positioned kidney is encountered occasionally. But ectopic supradiaphragmatic thoracic origin of main renal artery supplying a normally positioned kidney is extremely rare and reported only as case reports and till recently only ten such cases have been reported. Incidentally all cases reporting thoracic origin are right renal arteries. The present case report is an incidental observation of origin of main right renal artery from thoracic aorta at the level of upper part of body of T-12 vertebra in a male patient undergoing contrast enhanced CT for suspected lung pathology. The normally positioned right kidney was supplied by an accessory renal artery arising just below the level of origin of superior mesenteric artery. Our literature search has yielded 23 cases (excluding the present case) out of which 19 were thoracic right renal arteries and 4 thoracic left renal arteries. Additionally the present case was associated with the presence of variations of celiac and superior mesenteric arteries in the form of gastrosplenic and hepatomesenteric trunks. This association of variant gastrosplenic and hepatomesenteric trunks with thoracic origin of main renal artery is reported for the first time. Knowledge of such rare variations is crucial for radiologists, surgeons and urologists for better outcome of surgical and interventional procedures. KEY WORDS: Thoracic renal artery, Supradiaphragmatic renal artery, Ectopic renal artery origin, Hepatomesenteric trunk, Gastrosplenic trunk.

Background: Varicose veins primarily considered to be a cosmetic problem have been widely mistaken to be medically unimportant and given low priority for treatment. The associated pain, swelling, open ulceration and other morbidities increase cost of its management. The debilitation adds on to the time lost from work and wages. Aim: To study the aetiogenesis, pathology, presentation, complications, and management of varicose veins in the study populations. Methods: The current study followed a prospective observational study design among 60 patients visiting Meenakshi Medical College Hospital and Research Institute with symptoms and signs of varicose veins and clinically diagnosed as having varicose veins. Various presentations and complications and treatments were noted and finally followed up for minimum of 6 months. Results and Conclusion: It is found that varicose veins and their associated symptoms and complications constitute the most common chronic vascular disorders leading to surgical treatment. The incidence is on the rise. It is more common in middle- aged group and in males. Patients presented with spectrum of symptoms and signs, dilated and tortuous veins being more common presentations. Long saphenous system is the most common venous system affected. Ankle (lower perforator being the most common incompetent perforators. The outcome of cases of primary varicose vein depends on a thorough and complete clinical examination and duplex scan by an experienced radiologist. Operative line of treatment is a primary procedure in the management of varicose veins of lower Stripping of LSV up to knee and non-stripping of SSV is associated with less morbidity. Accurate assessment reduces the risk of recurrent varicose veins. There must be ample support from the Government so that even the poor will be benefited from the newer modality of treatment of varicose veins.

Introduction Pandemic caused by novel coronavirus has created an unprecedented situation of lockdown in India. This retrospective study was undertaken to evaluate the impact of COVID-19 restrictions on cases of maxillofacial trauma and its etiologic variation by comparing it with the previous year archived data. Materials and Methods Patients with maxillofacial fracture visiting during the lockdown period (Phase) were compared to the patient’s record during the same time period in the year 2019 (Control). They were subcategorised based on the etiology of trauma, i.e., road traffic accident (RTA), self-fall, physical assault and animal attacks. Age and gender variations were also assessed. Degree of significance was calculated using t test and p value obtained. Result Mean age of trauma patients during lockdown and control period was 32.66 and 27.93 years, respectively. Number of cases of overall trauma had significantly decreased. Cases of RTA and self-fall were 22 and 4 in lockdown compared to 135 and 16 during control phase. Cases of physical assault increased by 50%, i.e., from 9 to 6 on comparison of both the phases. Animal attack maxillofacial injuries were 2 in each group. Conclusion RTA and subsequent drop in numbers of maxillofacial trauma can be shown as the benefit of lockdown nonetheless on the other side increase in number of physical assaults also shows how isolation and restrictions have psychological negative impact on society.

Burn is the immense public health issue globally. Low and middle income countries face extensive deaths owing to burn injuries. Availability of conventional therapies for burns has always been painful for patients as well as expensive for our health system. Pharmaceutical experts are still searching reliable, cheap, safe and effective treatment options for burn injuries. Fusidic acid is an antibiotic of choice for the management of burns. However, fusidic acid is encountering several pharmaceutical and clinical challenges like poor skin permeability and growing drug resistance against burn wound microbes like Methicillin resistant Staphylococcus aureus (MRSA). Therefore, an effort has been made to present a concise review about molecular pathway followed by fusidic acid in the treatment of burn wound infection in addition to associated pros and cons. Furthermore, we have also summarized chitosan and phospholipid based topical dermal delivery systems customized by our team for the delivery of fusidic acid in burn wound infections on case-to-case basis. However, every coin has two sides. We recommend the integration of in-silico docking techniques with natural biomacromolecules while designing stable, patient friendly and cost effective topical drug delivery systems of fusidic acid for the management of burn wound infection as future opportunities.

The World Health Organization recommends 20 mg of zinc per day for 10 to 14 days for children with acute diarrhea; in previous trials, this dosage decreased diarrhea but increased vomiting.We randomly assigned 4500 children in India and Tanzania who were 6 to 59 months of age and had acute diarrhea to receive 5 mg, 10 mg, or 20 mg of zinc sulfate for 14 days. The three primary outcomes were a diarrhea duration of more than 5 days and the number of stools (assessed in a noninferiority analysis) and the occurrence of vomiting (assessed in a superiority analysis) within 30 minutes after zinc administration.The percentage of children with diarrhea for more than 5 days was 6.5% in the 20-mg group, 7.7% in the 10-mg group, and 7.2% in the 5-mg group. The difference between the 20-mg and 10-mg groups was 1.2 percentage points (upper boundary of the 98.75% confidence interval [CI], 3.3), and that between the 20-mg and 5-mg groups was 0.7 percentage points (upper boundary of the 98.75% CI, 2.8), both of which were below the noninferiority margin of 4 percentage points. The mean number of diarrheal stools was 10.7 in the 20-mg group, 10.9 in the 10-mg group, and 10.8 in 5-mg group. The difference between the 20-mg and 10-mg groups was 0.3 stools (upper boundary of the 98.75% CI, 1.0), and that between the 20-mg and 5-mg groups was 0.1 stools (upper boundary of the 98.75% CI, 0.8), both of which were below the noninferiority margin (2 stools). Vomiting within 30 minutes after administration occurred in 19.3%, 15.6%, and 13.7% of the patients in the 20-mg, 10-mg, and 5-mg groups, respectively; the risk was significantly lower in the 10-mg group than in the 20-mg group (relative risk, 0.81; 97.5% CI, 0.67 to 0.96) and in the 5-mg group than in the 20-mg group (relative risk, 0.71; 97.5% CI, 0.59 to 0.86). Lower doses were also associated with less vomiting beyond 30 minutes after administration.Lower doses of zinc had noninferior efficacy for the treatment of diarrhea in children and were associated with less vomiting than the standard 20-mg dose. (Funded by the Bill and Melinda Gates Foundation; ZTDT ClinicalTrials.gov number, NCT03078842.).

Posterior reversible encephalopathy syndrome (PRES) is a rare serious syndrome of central nervous system that can develop in both adults and children. It is characterised by acute onset of headache, confusion, seizures, or focal neurological deficits along with radiological abnormalities in the parietal and occipital lobes. In the past, this syndrome has been mainly described in adults but rare in children. However, it is not uncommon in paediatric nephrology. Hypertension, renal disease, immunosuppression, and chemotherapy of malignancies are triggers for PRES. Here, we report a case of 12 years old boy with steroid-sensitive nephrotic syndrome presenting as PRES.

Kidney and urinary stone disease (Nephrolithiasis and urolithiasis) are the condition where urinary stones or calculi are formed in the urinary tract. The problem of urinary stones is very ancient; these stones are found in all parts of the urinary tract, kidney, ureters, and the urinary bladder and may vary considerably in size. It is a common disease estimated to occur in approximately 12% of the population, with a recurrence rate of 70-81% in males and 47-60% in females. The treatment of kidney and urinary stone diseases such as a western (allopathy) medicine and surgery is now in trends. However, most people preferred plant-based (herbal) therapy because of the overuse of allopathic drugs, which results in a higher incidence rate of adverse or severe side effects. Therefore, people every year turn to herbal therapy because they believe plant-based medicine is free from undesirable side effects, although herbal medicines are generally considered to be safe and effective. In the present article, an attempt has been made to emphasize an herbal therapy is better than allopathic therapy for the management of the kidney and urinary stone disease.

Background: Type I tympanoplasty is a surgical technique used to restore the integrity of tympanic membrane as well as improve the hearing in inactive mucosal chronic otitis media. There are two main methods that are underlay and overlay in between both is interlay. The aim of the present study is to analyse and compare the results of the two most commonly used type I tympanoplasty techniques, underlay and the interlay technique in chronic otitis media with mucosal disease in large central perforation, in terms of graft uptake and hearing improvement. Subjects and Methods: This is a randomized prospective study of 100 cases of inactive mucosal chronic otitis media with total or large anterior central perforation between October2017 to September 2019 in Anugarah Narayan Magadh Medical College & Hospital, Gaya. Half had gone through Interlay and half by Underlay technique of Type I Tympanoplasy surgery. Results: The graft uptake rate in this study was 96% and 90% for Interlay and Underlay technique respectively. Postoperatively mean air bone gap maximally reduced in the Interlay technique. Conclusion: The present study showed that Interlay method had better graft uptake rate as well as hearing improvement in total and large anterior central perforation of inactive mucosal chronic otitis media than the Underlay technique.

Objective: The main objective was to carry out the observational study in migraine patients. Methods: A prospective observational study was conducted for 6 months in 415 migraine patients with the prior approval from the Institutional Ethical committee. A predesigned pro forma was used to collect data such as socio-demographics of the patients, different types of migraine, triggering factors, and prescription pattern. Results: Among 415 patients, the female patients (n=356, 86%) outnumbered male patients (n=95, 14%). The mean age of the study population was found to be 59±54 years. In our study, we found that migraine without aura (79%) was most common, followed by probable migraine without aura (13.3%), chronic migraines (5%), and migraine with aura (0.3%). Grading is done according to International Headache Society into 0, mild, moderate, and severe. Conclusion: Compared to migraine with aura, migraine without aura is mostly seen in females than males due to fluctuating hormone levels, rural area is most effected due to exposure to triggers. Management includes pharmacological and non-pharmacological. Pharmacological therapy included nonsteroidal anti-inflammatory drugs agents, Triptans, and prophylactic therapy, and adjunctive therapy also prescribed.

Breast cancer is among the foremost common malignancies and the second leading cause for cancer-related deaths in females. Varied treatment approaches are projected to cause a subject matter reduction in the fatality rate. Carcinoma treatment is highly challenging due to therapeutic resistance and reoccurrence. Several studies have revealed that bioactive compounds isolated from natural products such as plants, vegetables, and marine origins have a therapeutic and preventive role in breast carcinoma. Utilization of these bioactive agents in amelioration of cancer as complementary and alternative therapy increases day by day due to growing scientific shreds of evidence of the biomedical innovation and clinical trials. Due to the safe nature of these photochemical investigators are focusing on the investigation of lead compounds from traditional herbal medicine to discover new lead anticancer agents in the single pure compound. This review highlights the mechanism of action and future prospects of novel medicinal agents from botanical sources that have chemoprevention activity against breast carcinoma together with other types of body cancer. The major bioactive, which are used as a remedy for the prevention and treatment of breast cancer, is summarized and explored here.

Lysosomal storage disorders (LSDs) are relatively common slow progressive inborn error of metabolism encountered by clinicians. This work intends to highlight the more common LSDs, their clinical presentation, outcome, and mutation (wherever feasible) collected from the genetic clinic at tertiary care center in Eastern Uttar Pradesh. The data for analysis were collected retrospectively from genetic records from a follow-up clinic. All cases

Background and aims Brain abscess is a serious and dreadful disease presenting at tertiary centre. The objective of this study was to look into the clinical profile, predisposing conditions, microbiology and outcome of children suffering from brain abscess. Methods 30 children up to 18 years with clinical and imaging evidence of brain abscess were taken for study. Patients were stabilized as per unit protocol. Necessary investigations were carried out. Neuroimaging (CT or MRI) was used to confirm the diagnosis. All parameters (clinical, investigation, outcome) were recorded in predesigned performa. Neurosurgery consultation was sought in patients with multiple abscesses, posterior fossa abscesses, abscess with air-fluid level and causing midline shift. Results There were 16 males with 13 patients in age group (5-10 years). Mean duration of stay in hospital was 14.8 days. Most common predisposing factor was chronic suppurative otitis media (n-15). Typically, patients presented with fever, headache and seizures. On examination, motor deficits were the most common followed by signs of meningitis. Computerized tomography confirmed the diagnosis in most cases. Temporal lobe (n-11) was the commonest intracranial site for the abscess. Methicillin resistant staphylococcus and proteus mirabilis were the common pathogen isolated from blood and pus. Blood culture positivity rate was 16.7% and pus culture positivity rate was 25%. All cases were managed with intravenous antibiotics and aspiration (n-10) and excision (n-6). There were 5 deaths. There was complete immediate recovery in 13 cases with residual motor deficit in 12 cases. Conclusion Brain abscess is a rare but serious entity in children. Late diagnosis and improper management leads to poor outcome. Early surgical intervention is helpful. Threshold for diagnosis should be low in children with chronic ear infection and congenital heart diseases.

Cholecystectomy is one of the commonest general surgical procedures performed all over India. The risk of bile duct injury (BDI) during laparoscopic cholecystectomy is two to three times higher than during open cholecystectomy. The worldwide incidence of bile duct injury is 0.5% or 1 in 200 cases. BDI and its consequences result in significant morbidity and may even cause mortality. BDI increases the cost of treatment and is a common reason for a medicolegal suit against the surgeons. To minimize the incidence of BDI and to manage it timely and appropriately, a set of guidelines was deemed necessary by a group of senior surgeons during a Society of Endoscopic and Laparoscopic Surgeons of India (SELSI) meeting in 2016. Guidelines for “Safe Laparoscopic Cholecystectomy” and bile duct injury management formulated by other international societies are already available. The applicability of these guidelines to Indian subjects especially in small peripheral centers was limited. Hence, a decision was taken to form a set of guidelines for general surgeons with basic laparoscopic skills with little or no advanced laparoscopic skills. Those working in a solo practice, nursing homes, and small private hospitals at talukas or districts should have “Safe Cholecystectomy” guidelines and management of BDI suitable to their situation. These guidelines were formed after three consensus meetings and have been approved by a SELSI Expert Group.

Lymphangioma of the tongue is a rare lymphatic malformation, and various authors have reported the successful use of sirolimus for its treatment. However, the safety of sirolimus in children needs further evaluation so that those who do not respond are not necessarily exposed to its potential adverse effects. We hypothesised that assessment of lymphangiogenesis can be used to predict whether the patient will respond to sirolimus, so we organised a prospective study after ethics committee approval had been given. After clinical and histological diagnoses of lymphangioma of the tongue had been confirmed, 16 patients were given sirolimus 0.8mg/day in three divided doses. Clinical response was assessed and compared with lymphatic microvessel density (LMVD), which was calculated immunohistochemically using the monoclonal antibody D2-40 as the lymphatic endothelial marker. Nine patients responded well, five partially, and two failed to respond. Mean (SD) LVD among the good responders was 21.00 (3.74), whereas among non-responders it was 8.00 (4.24). There was a significant difference in mean LVD between good responders, partial responders, and non-responders (p=0.04). Sirolimus is effective in treating children with lymphangioma of the tongue, and lymphangiogenesis is a useful therapeutic predictive marker.

Patients undergoing Radiotherapy (RT) for Head and Neck carcinoma often suffer from side effects such as mucositis, xerostomia, pharyngitis, laryngitis and pain which are being managed symptomatically by mouthwashes of soda-salt, chlorhexidine or betadine. Among the side effects, oral mucositis is the most debilitating one. This comparative case study comprises of 4 patients undergoing RT. Here, 2 patients each are randomly allocated into two groups. One group received the existing prophylactic management i.e., Sodium bicarbonate-salt solution mouth wash and the other group received, Draksha-guduchyadi yoga for kavala (gargling). Both the sets of patients were asked to perform gargling, from the first day of radiation to 15 days thereafter. The effectiveness of both mouthwashes was compared for their healing potential on oral mucositis by RTOG grading. The reduction in mucositis was significant in the group which received Ayurvedic mouthwash compared to the other group. This study positively highlights the contribution of Ayurveda in cancer treatment especially in the field of quality of life., Highlights • Plant-based mouthwashes or gargles mentioned in Ayurvedic classics are effective in curbing the side effects of Radiotherapy. • It can alleviate the sufferings of lakhs of cancer patients, and even reduce the dropouts from radiation course. • Ayurveda can play key role in the multidisciplinary approach to cancer treatment with special emphasis in the aspect of quality of life.

Objective:To evaluate role of Diagnostic Nasal Endoscopy and CT scan in various Sinonasaldiseases with regards to diagnosis and surgical intervention. Patient and methods:This prospective study was carried out in Department of ENT, A.N.M.M.C.H., Gaya on 200 patients with clinical evidence of sinonasal disease who had presented between March 2016 to February 2019. All patients were evaluated with DNE using 0 degree 4mm endoscope and CT scan with 3 mm coronal cuts. Result: Female patients(56%) were more as compared to male(44%) with majority between 21 - 40 yrs. Most common finding on Diagnostic Nasal Endoscopy(DNE) was mucopurulent discharge in middle meatuswhile on CT Scan was maxillary sinusitis(60%). Sinonasal polyp detection was better with DNE.CT has better detection rate of anatomical variation of osteomeatal complex. Conclusion :DNE has become initial tool for diagnosis as it is cost effective and office based procedure. In patients where surgical intervention is required, CT scan has advantage as it provides detailed understanding of anatomical variations. So bothDNE and CT scan should be used in collaborative fashion. Source Of Support:Patients of A.N.M.C.H., Gaya. Conflict Of Interest:None.

Diabetic kidney disease (DKD) is a severe complication of type 1 diabetes (T1D), which lacks non-invasive early biomarkers. Although less explored, mRNAs in urinary extracellular vesicles (uEV) could reflect changes in the kidney transcriptome during DKD development. We performed genome-wide mRNA sequencing of >100 uEV samples from two T1D cohorts with 24-hour and overnight urine collections. Our uEV pipeline allowed reproducible detection of >10,000 mRNAs bearing overall similarity to kidney transcriptome. uEV from T1D DKD groups showed significant upregulation of 13 genes, prevalently expressed by proximal tubular cells within the kidney. Strikingly, six genes involved in cellular stress responses including protection against oxidative stress (GPX3, NOX4, MSRB, MSRA, HRSP12 and CRYAB) correlated with hyperglycemia and long-term changes in kidney function independent of albuminuria status. The study identified genes associated with glycemic stress in T1D DKD and confirmed the utility of uEV in capturing pathological gene expression signatures from kidney.

Scrub typhus is an important etiological agent in acute febrile illness in the post-monsoon season in tropical countries. It leads to dreaded complications if left untreated. Acute kidney injury is one such complication. Malaria, syphilis, and HIV have been associated with secondary nephrotic syndrome in pediatric age group. Scrub typhus has been reported only once with nephrotic syndrome. We report a case of scrub typhus-associated nephrotic syndrome with acute kidney injury in a five-year-old female with uneventful outcome