Port Site Obstructed Hernia in a Morbidly Obese Patient: A Case Report.

Indications for laparoscopic surgeries are increasing in the current era in view of the advantages they offer in terms of less perioperative morbidities, early mobilization, and better cosmesis. These benefits are perceived even more in obese women. However, there are special challenges in this population, associated with their body habitus, poor visibility, and perioperative anesthesia risks. Difficulty in port closure is one such problem encountered in these women causing inadequate rectus suturing and leading to port site hernia. We report a case of a 59-year-old morbidly obese lady who underwent a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection for carcinoma endometrium. The intraoperative course was uneventful. In the postoperative period, she developed acute obstruction due to port site herniation of the small bowel, which was not suspected till postoperative day five. This was due to an inaccurate assessment of her abdomen because of her body habitus. A CT scan was done in view of the non-resolving obstruction, which revealed herniation of a small bowel loop through the umbilical port. Immediate correction was resorted to under local anesthesia. Rectus sheath closure was done in the same sitting. The patient had a quick recovery after that and was discharged three days later. Rectus sheath closure should be done for all ports 10 mm or greater in diameter. There should be a low threshold to get cross-sectional imaging in postoperative obese women with non-resolving gastrointestinal symptoms.

Pre-COVID and COVID experience of objective structured clinical examination as a learning tool for post-graduate residents in Obstetrics & Gynecology-a quality improvement study.

OBJECTIVE: Due to its comprehensive, reliable, and valid format, the objective structured clinical examination (OSCE) is the gold standard for assessing the clinical competency of medical students. In the present study, we evaluated the importance of the OSCE as a learning tool for postgraduate (PG) residents assessing their junior undergraduate students. We further aimed to analyze quality improvement during the pre-coronavirus disease (COVID) and COVID periods. METHODS: This quality-improvement interventional study was conducted at the Department of Obstetrics and Gynecology. The PG residents were trained to conduct the OSCE. A formal feedback form was distributed to 22 participants, and their responses were analyzed using a five-point Likert scale. Fishbone analysis was performed, and the 'plan-do-study-act' (PDSA) cycle was implemented to improve the OSCE. RESULTS: Most of the residents (95%) believed that this examination system was extremely fair and covered a wide range of clinical skills and knowledge. Further, 4.5% believed it was more labor- and resource intensive and time-consuming. Eighteen (81.8%) residents stated that they had learned all three domains: communication skills, time management skills, and a stepwise approach to clinical scenarios. The PDSA cycle was run eight times, resulting in a dramatic improvement (from 30% to 70%) in the knowledge and clinical skills of PGs and the standard of OSCE. CONCLUSION: The OSCE can be used as a learning tool for young assessors who are receptive to novel tools. The involvement of PGs in the OSCE improved their communication skills and helped overcome human resource limitations while manning various OSCE stations.

Successful outcome after timely management of severe fetal anemia with intrauterine transfusion in female with bad obstetric history.

Development of severe fetal anemia due to red cell destruction in intrauterine life, most commonly implicated with hemolytic disease of fetus or newborn. Untreated cases lead to hydrops and even death of newborn. We are reporting a case of severe fetal anaemia successfully delivered after intrauterine transfusion. A 28-year-old female having bad obstetric history G10 P3600, came to our fetal unit at 23 + 4 weeks gestation. Middle cerebral artery peak systolic velocity (MCA PSV) value was 2.2 mom before 1st intrauterine procedure. Subsequent intrauterine session was planned at 1-2 week interval. After completion of 3rd intrauterine transfusion, MCA PSV value was 0.8 mom and baby was delivered at 32 + 1 week via lower segment cesarean section. Intervention at appropriate time, appropriate volume of selected unit and appropriate rate of transfusion definitely improves perinatal outcome.

Computational exploration of the dual role of the phytochemical fortunellin: Antiviral activities against SARS-CoV-2 and immunomodulatory abilities against the host.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections generate approximately one million virions per day, and the majority of available antivirals are ineffective against it due to the virus's inherent genetic mutability. This necessitates the investigation of concurrent inhibition of multiple SARS-CoV-2 targets. We show that fortunellin (acacetin 7-O-neohesperidoside), a phytochemical, is a promising candidate for preventing and treating coronavirus disease (COVID-19) by targeting multiple key viral target proteins. Fortunellin supports protective immunity while inhibiting pro-inflammatory cytokines and apoptosis pathways and protecting against tissue damage. Fortunellin is a phytochemical found in Gojihwadi kwath, an Indian traditional Ayurvedic formulation with an antiviral activity that is effective in COVID-19 patients. The mechanistic action of its antiviral activity, however, is unknown. The current study comprehensively evaluates the potential therapeutic mechanisms of fortunellin in preventing and treating COVID-19. We have used molecular docking, molecular dynamics simulations, free-energy calculations, host target mining of fortunellin, gene ontology enrichment, pathway analyses, and protein-protein interaction analysis. We discovered that fortunellin reliably binds to key targets that are necessary for viral replication, growth, invasion, and infectivity including Nucleocapsid (N-CTD) (-54.62 kcal/mol), Replicase-monomer at NSP-8 binding site (-34.48 kcal/mol), Replicase-dimer interface (-31.29 kcal/mol), Helicase (-30.02 kcal/mol), Papain-like-protease (-28.12 kcal/mol), 2'-O-methyltransferase (-23.17 kcal/mol), Main-protease (-21.63 kcal/mol), Replicase-monomer at dimer interface (-22.04 kcal/mol), RNA-dependent-RNA-polymerase (-19.98 kcal/mol), Nucleocapsid-NTD (-16.92 kcal/mol), and Endoribonuclease (-16.81 kcal/mol). Furthermore, we identify and evaluate the potential human targets of fortunellin and its effect on the SARS-CoV-2 infected tissues, including normal-human-bronchial-epithelium (NHBE) and lung cells and organoids such as pancreatic, colon, liver, and cornea using a network pharmacology approach. Thus, our findings indicate that fortunellin has a dual role; multi-target antiviral activities against SARS-CoV-2 and immunomodulatory capabilities against the host.

Lifestyle and Prevalence of Menstrual Disorders among Undergraduate Medical and Nursing Students: Can We Bring a Change?

Objectives: Menstruation is a normal physiological phenomenon, but sometimes the abnormalities and pain associated with it can severely affect the daily routine of women and may create a stressful environment for them. The objective of this study was to conduct a comparative evaluation of the pattern of menstruation, lifestyle and the outlook toward menstruation among undergraduate female medical and nursing students. Methods: It was a descriptive cross-sectional study conducted among the undergraduate medical and nursing students of a tertiary care Institute. A semi-structured questionnaire was used to collect the data. Of the 400 students approached, 188 completed the questionnaire. Results: The mean age of the participants was 21.23 ± 1.47 years. The mean age of menarche was 12.65 ± 1.24 years among the medical students and 13.69 ± 1.38 years among the nursing students (P < 0.05). Overall, the common menstrual abnormalities observed were dysmenorrhea (71.2%) and premenstrual syndrome (70.2%) followed by menstrual irregularity (14.8%). On correlating lifestyle with menstrual abnormalities, no significant association was found. However, the most common reason for college absenteeism in both groups was dysmenorrhea and fear of unexpected heavy bleeding. Conclusion: Despite having a medical background and knowledge about the physiology of menstruation, medical and nursing students do carry certain myths regarding menstruation which are being carried forward in society. Small roleplays in the OPD (Outpatient Department) area and public awareness lectures should be planned. They will not only develop confidence and better understanding among the students but also create social awareness.

Incidentally Diagnosed Type 2 Youssef's Syndrome with Migrated Postcesarean Postpartum Intrauterine Contraceptive Device.

Vesicouterine fistula (VUF) also called Youssef's syndrome is a rare and the least commonly encountered entity among genitourinary fistulae. Treatment options range from excision of the fistulous tract with hysterectomy and primary closure of the urinary bladder to fistula repair. Migrated postpartum intrauterine contraceptive device is one of the rarest causes for VUF. Here, we are describing a case of incidentally diagnosed VUF with Type 2 Youssef's syndrome with migrated postplacental (postcesarean) intrauterine contraceptive device, treated with uterus-sparing laparoscopic VUF closure.

Integrating resilience with functional ecosystem measures: A novel paradigm for management decisions under multiple-stressor interplay in freshwater ecosystems.

Moving beyond monitoring the state of water quality to understanding how the sensitive ecosystems "respond" to complex interplay of climatic and anthropogenic perturbations, and eventually the mechanisms that underpin alterations leading to transitional shifts is crucial for managing freshwater resources. The multiple disturbance dynamics-a single disturbance as opposed to multiple disturbances for recovery and other atrocities-alter aquatic ecosystem in multiple ways, yet the global models lack representation of key processes and feedbacks, impeding potential management decisions. Here, the procedure we have embarked for what is known about the biogeochemical and ecological functions in freshwaters in context of ecosystem resilience, feedbacks, stressors synergies, and compensatory dynamics, is highly relevant for process-based ecosystem models and for developing a novel paradigm toward potential management decisions. This review advocates the need for a more aggressive approach with improved understanding of changes in key ecosystem processes and mechanistic links thereof, regulating resilience and compensatory dynamics concordant with climate and anthropogenic perturbations across a wide range of spatio-temporal scales. This has relevance contexting climate change and anthropogenic pressures for developing proactive and adaptive management strategies for safeguarding freshwater resources and services they provide.

Spin-transition in [Fe(II)(L5)2][ClO4]2 [L5 = 2-[3-(2'-pyridyl)pyrazol-1-ylmethyl](1-methylimidazole)]: a further example of coexistence of features typical for disorder and cooperativity.

An iron(II) complex [Fe(L5)2][ClO4]2 of a new nonplanar tridentate ligand [L5 = 2-[3-(2'-pyridyl)pyrazol-1-ylmethyl](1-methylimidazole)] has been synthesized and its spin-transition properties have been investigated. X-ray structural analysis of the solvated compound [Fe(L5)2][ClO4]2.CH3CN at 100 K and at 298 K revealed a mononuclear Fe(II)N6 pseudooctahedron with the tridentate ligand in the meridional coordination mode. Magnetic susceptibility measurements revealed LS (1A1) <--> HS (5T2) transition starting above room temperature and remained incomplete even up to 350 K, however providing evidence for the hysteretic behaviour of the transition. Photo-magnetic measurements using a 532 nm laser revealed incomplete light-induced excited spin-state trapping (LIESST). Relaxation curves in the dark exhibited a stretched exponential shape, typical for broad distributions of relaxation times. The complete photo-magnetic data were modelled using a non-cooperative master equation including a tunnelling process with distributed parameters and accounting for the bulk absorption of light. We also measured the diffuse reflectance properties, with detailed investigation of the absorption spectra and discussed the obtained features with respect to structural properties, including the suggested presence of disorder.

Temperature-dependent interactions and disorder in the spin-transition compound [Fe(II)(L)2][ClO4]2.C7H8 through structural, calorimetric, magnetic, photomagnetic, and diffuse reflectance investigations.

The title compound [Fe (II)(L) 2][ClO 4] 2.C 7H 8 (L = 2-[3-(2'-pyridyl)pyrazol-1-ylmethyl]pyridine) has been isolated while attempting to grow single crystals of the spin-transition (continuous-type) compound [Fe (II)(L) 2][ClO 4] 2, published earlier ( Dalton Trans. 2003, 3392-3397). Magnetic susceptibility measurements, as well as Mossbauer and calorimetric investigations on polycrystalline samples of [Fe(L) 2][ClO 4] 2.C 7H 8 revealed the occurrence of an abrupt HS ( (5) T 2) <--> LS ( (1) A 1) transition with steep and narrow (2 K) hysteresis at approximately 232 K. The photomagnetic properties exhibit features typical for a broad distribution of activation energies, with relaxation curves in the shape of stretched exponentials. We performed a crystal structure determination of the compound at 120, 240, and 270 K. A noteworthy temperature-dependent behavior of the structural parameters was observed, in terms of disorder of both the anions and solvent molecules, leading to a strong thermal dependence of the strength and dimensionality of the interaction network. Additional data were obtained by diffuse reflectance measurements. We model and discuss the antagonistic effects of interactions and disorder by using a two-level cooperative mean-field approach which includes a distribution of barrier energies at the microscopic scale.

Anti-HIV activity of thiosemicarbazone and semicarbazone derivatives of (+/-)-3-menthone.

A series of thiosemicarbazones and semicarbazone derivatives of (+/-)-3-menthone have been synthesized and their anti-HIV activity evaluated against HIV-1(III(B))and HIV-2 (ROD). The studies revealed that maximum protection is offered by chloro-substituted derivatives 2 and 7 against HIV-1 (III(B)) and HIV-2 (ROD).