Effectiveness of sustained maximal inspiration along with transcutaneous electrical nerve stimulation in patients with malignant pleural effusion with intercostal drainage tube: a randomized controlled trial

Background: Malignant pleural effusion (MPE) is one of the most common causes of an exudative pleural effusion. It is the most common cause of a unilateral massive pleural effusion. Most MPE s are secondary to metastases to the pleura, most often from lung or breast cancer. Medical management includes aspiration of fluid with the insertion of a chest tube, which may be necessary to relieve dyspnea. Hypoventilation does occur in certain areas of the lungs because of pain and muscle guarding after intercostal drainage tube (ICD) tube placements in pleural effusion. Therefore, it is important to emphasize pain management and expansion of affected areas of the lungs and chest wall. SMI is the basic maneuver of incentive spirometry and is mainly given to prevent atelectasis and lung collapse in postoperative patients. TENS is a method of producing an electro-analgesic effect and is effective in providing post-operative pain control. Methods: The study design of the study was a randomized controlled trial. A total of 44 participants with a diagnosis of MPE with an intercostal drainage tube were included in this study. The study duration was 5 years with an intervention period of 2 weeks and the outcome measures were pulmonary functions and intercostal pain severity using the NRS Scale. Results: There was a significant improvement in pulmonary functions in the control group and a highly significant improvement in pulmonary functions in the experimental group after 2 weeks of interventions and pain severity (NRS) was significantly reduced in the experimental group only (p<0.001) Conclusions: This study concluded that sustained maximal inspiration (SMI) along with TENS significantly improves pulmonary functions and reduces pain at the site of ICD in patients with MPE.

Profitability of Zero Tillage Wheat in Rice Fallows under National Innovation on Climate Resilient Agriculture Project at Chhattisgarh Plain Zone Durg in India

The research evaluated the economics of producing wheat under national innovation on climate resilient agriculture adopted village named karga using zero tillage and conventional method, and it evaluated how much technology and inputs contributed to the higher productivity brought over by zero tillage (ZT). The study found that zero tillage technology is able to increase farmers' profitability and aid in resource conservation. The difference in gross returns between zero tillage and conventional tillage approaches has been divided into 45% related to zero tillage and the remaining due to changes in input costs. This shows that zero tillage practices resulted in better performance in Rabi 2022- 2023 seasons, with an average yield increase of 7.7%. Net income per ha was Rs. 12475 with a reduced cost of cultivation due to reduced number of irrigations and lessened sowing operations cost. Higher yield is due to timely sowing, healthy crop growth, good plant population and less effect of climatic hazard.

Acute respiratory distress syndrome in Plasmodium vivax malaria. A case-control study of comparison between ARDS and non-ARDS patients in P. Vivax malaria

Background: Plasmodium vivax was conventionally considered to be a benign parasite for centuries but in the recent years have proved to be a virulent parasite causing severe malaria. Acute respiratory distress syndrome (ARDS) is one of such severe complications with a significant morbidity and mortality. The objective of this study was to find the prevalence of ARDS and identify the associated factors that could potentially lead to ARDS in patients with vivax malaria. Methods: A retrospective case-control study was conducted at a tertiary hospital in New Delhi. 329 patients with an established diagnosis of Plasmodium vivax mono-infection were identified using hospital medical records, the associated factors were evaluated and compared to calculate the odds of developing ARDS. All patients were categorized into ARDS cases and non-ARDS controls. Results: The incidence of ARDS was 7% with a female sex predominance (60.86%). Mean urea (71.5 mg/dl), creatinine (2.7 mg/dl), and AST (97.8 units/l) elevation in addition to decreased hemoglobin (7.7 gm/dl) and platelets count (38,217 cells/µl) proved to be significantly associated with ARDS in our study. Conclusions: Plasmodium vivax is a virulent parasite and can cause severe malaria even in the setting of isolated infection. Cytokine mediated diffuse inflammatory response is a postulated pathophysiology causing ARDS.

Coronavirus Disease (COVID-19) Possible Transmission Routes and Alleviation Strategies

Coronavirus disease is a contagious respiratory ailment that has spread significantly around the world. Most cases of COVID-19 are spread from person to person by coming into contact with respiratory droplets that are released when an infected person coughs or sneezes. In this manuscript, we have highlighted the possible transmission of COVID-19 through food, water, air and paper. In the case of food, we have extensively covered the transmission of COVID-19 through meat, frozen foods, food packaging and food market along with the incidences worldwide. In the nextsection, we have highlighted the different components of air which are responsible for the transmission and also covered its relation with PM 2.5 incidence. The SARS-CoV-2 was isolated from sewage water/wastewater of various countries namely the United States, India, Australia, Netherlands and France signifying that wastewater can be a mode of virus transmission. The paper circulation by the infected COVID-19 patients can also be a virus conveyance route. It can be concluded that SARS-CoV-2 can therefore be transmitted indirectly through food via the workers involved in food packing or food marts.By following general safety precautions (wearing masks, using hand sanitisers, cleaning and disinfecting contact surfaces, and avoiding close contact), heating and using chemicals like ethanol (67-71%), sodium hypochlorite (0.1%) and hydrogen peroxide (0.5%) on environmental surfaces, along with vaccination, it is possible to reduce the spread of the SARS-CoV-2 virus.

Senescence in oral lichen planus as assessed by the immunohistochemical evaluation of senescence marker protein-30 (Regucalcin)

Background: Oral lichen planus is a T-cell-mediated chronic inflammatory disease affecting approximately 1% to 2% of the population, the etiology of which is currently unknown. The objectives of this study were to observe if senescence occurs in oral lichen planus, through the assessment of the immunohistochemical expression of a novel marker for senescence called Senescence marker protein-30 or regucalcin, and compare the expression to that in oral lichenoid reaction and non-specific inflammation. Subjects and Methods: The study material consisted of 30 cases of oral lichen planus, 15 cases of oral lichenoid reaction and 15 cases of non-specific inflammation. The number of positive cells in ten randomly selected high power fields were counted in the epithelium and the connective tissue separately and the mean was determined. Results: Mann–Whitney U test was used to statistically analyze if there was any significant difference in the expression of Senescence marker protein-30 between oral lichen planus, oral lichenoid reaction and non-specific inflammation. Even though a greater expression was seen in the oral lichen planus cases than oral lichenoid reaction, the difference in both the epithelium and connective tissue was not statistically significant. Conclusion: This study shows that in addition to the already known mechanisms like apoptosis and increased cell proliferation rates, the activated T-lymphocytes may also trigger a senescent change in the cells of oral lichen planus. As with the other mechanisms, this is also seen only in a small proportion of the cases.

An Unusual Case of DRESS Syndrome Presenting with Marked Leucocytosis.

Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a rare severe drug-induced idiosyncratic hypersensitivity characterized by maculopapular and/or erythrodermic eruption, fever, peripheral lymphadenopathy, eosinophilia or atypical lymphocytosis, and visceral organ involvement. The estimated incidence of this syndrome ranges from 1/1000 to 1/10,000 drug exposures. In this report, we describe a case of DRESS syndrome in a young female with a unique presentation. The DRESS syndrome can be difficult to diagnose as its clinical findings can mimic those of other systemic diseases. This case emphasizes the importance of incorporation of the patient’s clinical and medication history in the interpretation of hematological investigations.

Introduction Of ‘Case Based Discussions In Teaching Biochemistry And Its Impact On Learning Of Students

Background:When topics of clinical importance are taught by didactic lecture, knowledge gained is hardly retained till the clinical teaching starts in the later years. So, we introduced ‘Case Based Discussions’ while teaching Biochemistry. Material And Methods:Students of II semester were divided in three groups-Group A and B was taught ‘Liver function tests’ by Didactic Lectures. Group B and C were further subdivided and taught through Case Based Discussions in which students collaborated in a small group environment to work through paper-based cases. Students’ understanding of the topic was assessed using a test paper and written feedback was collected from the students in first year to know their perception towards two methods of teaching and then in final year toknow if CBD sessions were helpful in clinics. Result:Mean total marks obtained by students of Group B were higher than those obtained by group A and C. Students perceived CBD sessions more stimulating educationally than traditional lectures and also found them helpful in clinics. Conclusion:Traditional teaching along with CBD resulted in significantly better test scores of students and promoted a deeper understanding of the basic concepts of Biochemistry to relate and link to patient cases in clinics.

Development Of Bioanalytical Standardization Parameters Of Alocasia Indica Tuber By Hptlc Technique

Alocasia indica is perennial herb growing widely and used as traditional medicine in India, China and Bangladesh. The divine herb has potent medicinal values for the treatment of different type of illnesses. The HPTLC techniques were used to separate active components from ethanolic extract of tuber part of A. indica. This examination was intended to designed a HPTLC fingerprint profile of crude extract of the plant in ethanol. A HPTLC method for the isolation of various active constituents in A. indica ethanolic extract have been developed and solvent system for quercetin the mobile phase used was toluene: ethyl acetate: formic acid (5:2:1) and for analysis of β-sitosterol the mobile phase used was chloroform: ethyl acetate: formic acid (6:4:1) . In the present investigation, HPTLC fingerprint of extract of dried tuber part of A. indica have been performed and the results demonstrated that important information for standardization. The HPTLC system for routine quality control of present species can be used for ethanolic extract and serve in qualitative, quantitative and was appropriate for standardization of the plant.

A Comparison of the Reliability of the Patellar Tendon-Trochlear Groove (PTTG) Distance and the Tibial Tuberosity-Trochlear Groove (TTTG) Distance Measured on MRI

@#Introduction: An increased tibial tuberosity-trochlear groove (TTTG) distance is used for deciding a treatment plan in patello-femoral instability (PFI). The centre of the patellar tendon and the chondral trochlear groove can be directly visualised on MRI, and measured, giving the patellar tendontrochlear groove (PTTG) distance. A study was designed to compare the inter-rater and the test-retest reliabilities of PTTG and TTTG measurements in MRI of patients without PFI and in a group with PFI. Materials and Methods:This cross-sectional reliability study was done on archival MRI films of 50 patients without patellar instability and 20 patients with patellar instability. TTTG and PTTG distances were independently measured by two orthopaedic surgeons and two radiologists. A hybrid PTTG measurement with bony landmarks on the femoral side and the patellar tendon landmark on the tibial side, was used to estimate the influence of the differences in the femoral and tibial landmarks on the difference in reliabilities. The intra-class correlation coefficient (ICC) was calculated for all four raters, as well as separately for each rater. Results: The PTTG distance had a higher inter-rater reliability (ICC=0.86, 95% CI=0.79-0.92) compared to the TTTG distance (ICC=0.70, 95% CI=0.59-0.80) in patients without PFI. Similar trends were seen in patients with PFI (0.83 vs 0.66). The inter-rater reliability for the hybrid PTTG distance was found to lie in between the TTTG and PTTG. Conclusions:The MRI-based PTTG distance had better inter-rater reliability compared with the MRI-based TTTG distance.

Tale of a mermaid

Sirenomelia is a rare congenital anomaly characterized by the presence of a median single lower appendage. The affected fetus is popularly referred to as a “Mermaid baby,” due to the uncanny resemblance to the fictious fable character. The manifestation is a result of the merger of the lower limbs with variable fusion or complete absence of bones. Sirenomelia is universally fatal due to the associated lethal anomalies involving the internal organs, which are usually part of the VACTER or VACTERL complex. However, this sirenomelia-afflicted fetus is unique in being associated with VACTERL as well as congenital hydrocephalus.

A road less travelled: Clinical comparison of HIV seropositive and seronegative patients with cystoisosporiasis � An 11-year experience from a tertiary care centre in Northern India

Background: Cystoisospora is a well-known opportunistic enteric parasite among human immunodeficiency virus (HIV) seropositive patients but there is a paucity of data among HIV negative patients. This study investigated Cystosporiasis on both HIV positive and negative patients, with or without diarrhea, presenting to a tertiary care and super specialty center of northern India. Methodology: Oocysts of Cystoisospora were detected on light microscopy, by modified Kinyoun staining of stool specimens, over an 11-year study period. Results: Of the 10,233 stool specimens evaluated, Cystoisospora was detected in 64 patients, 37 (57.81%) of whom were HIV positive. Year-wise analysis showed an overall declining trend of cystoisosporiasis. Maximum cases were detected in May and June in HIV positive patients and February and September among HIV negative patients. Among HIV positive patients, the mean CD4 count was 152.04 � 81.12cells/?L, mean absolute eosinophil count (AEC) was 229.16 � 175.62 cells/?L and 12.5% patients had mild eosinophilia. Tuberculosis was the most common co-morbidity. Dual infections of Cystoisospora with Cryptosporidium and Giardia were also seen. Among HIV negative patients, eight had primary autoimmune disorders, seven were solid organ transplant recipients and the rest had chronic bowel diseases. The mean AEC was 485.47 � 414.88 cells/?L, with 14.81% patients showing mild and 11.11% showing marked eosinophilia. Dual infection with Giardia was seen. Recurrent cystoisosporiasis was noted, despite cotrimoxazole treatment in a single case. Conclusion: The epidemiology of cystoisosporiasis differs between HIV seropositive and seronegative patients in terms of year-wise and month-wise trends, co-infections and most importantly, AECs.

Prevalence, clinical & biochemical correlates of non-alcoholic fatty liver disease in overweight adolescents

Background & objectives: Non-alcoholic fatty liver disease (NAFLD) characterized by excessive accumulation of fat in the liver, which can progress to inflammation, and cirrhosis, has emerged as an important complication of obesity in adults as well as children. This study was undertaken to assess the prevalence of NAFLD and its correlation with clinical and biochemical parameters in overweight Indian adolescents. Methods: In this cross-sectional study, 218 overweight adolescents aged 10 to 16 yr and their parents were included. Measurements included anthropometry, ultrasonography to diagnose NAFLD, fasting glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lipids for adolescents and parents, and additional parameters of blood pressure, body fat percentage (BF%), fasting insulin, apolipoprotein C3, tumour necrosis factor-? and adiponectin for adolescents. The variables were compared between adolescents with and without NAFLD, and logistic regression analysis was performed. Results: Mean age and body mass index (BMI)SD score (SDS) were 11.9±1.6 yr and 2.3±1.1, respectively. NAFLD was seen in 62.5 per cent of the adolescents. The prevalence of NAFLD in the parents was similar among the adolescents with and without NAFLD, while BMI and waist circumference SDS, BF per cent, blood pressure (BP), ALT, AST, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) were significantly higher in the adolescents with NAFLD. On multiple logistic regression, abdominal obesity, HOMA-IR and BF per cent were independently associated with NAFLD with odds ratios (95% confidence interval) of 2.77 (1.40-5.47), 2.21 (1.16-4.21) and 2.17 (1.12-4.22), respectively. Interpretation & conclusions: NAFLD was noted among nearly two-thirds of the overweight adolescents. An independent association was observed between abdominal obesity, HOMA-IR and body fat percentage and NAFLD in overweight adolescents.

Pattern of Drug of Resistance in Previously Treated Pulmonary Tuberculosis with Line Probe Assay

Background: Tuberculosis is global health problem known since ancient times. Drug-resistant TB has been known from the time of anti-TB drugs were first introduced for the treatment of TB. The emergence of drug resistant tuberculosis particularly MDR TB has become significant health problem worldwide and an obstacle to effective tuberculosis control. Line Probe Assay (LPA) is a Nucleic Acid Amplification Test (NAAT) which provides rapid diagnosis of R and H resistance and yield results in 72 hours.Literature on drug resistant pattern in patients who are previously treated for tuberculosis and/or suspected MDR cases with Line Probe Assay method are not studied hence this study was carried out. Aims and objectives: To know the drug resistance pattern of Rifampicin and Isoniazid in previously treated pulmonary tuberculosis cases and correlating with the demographic characteristics of patients. Methods: This study was carried out in department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur in AFB smear positive patients of pulmonary tuberculosis who have previously taken treatment, before reporting at OPD/IPD. The exclusion criterion was new cases of pulmonary tuberculosis. Detailed history, examination and investigations were carried out. The diagnosis of active pulmonary TB was based sputum smear examination by Ziehl - Nelson staining method. Sputum smear positive cases were subjected to line probe assay to detect resistant pattern at RNTCP accredited laboratory (SMS Medical College and Hospital, Jaipur). Results: A total of 175 previously treated sputum smear AFB positive patients of pulmonary tuberculosis were taken in this study. Out of which 141(80%) were males and 34(20%) cases were females with male : female ratio 4:1 and maximum cases (43.4%) belonged to 31-45 age group with mean age 38 years. Majority of cases belonged to rural area and lower middle class group. More than 2/3rd cases were smokers (72%) among male. Out of 175 cases, 100(57.1%) cases were drug resistant, 75(42.8%) cases were drug sensitive. Line probe assay with regard to resistant pattern was highest in grade +3 sputum (100%) followed by grade +2(98%) and grade +1(96%), while least in scanty sputum positive cases (3%). Resistance to Isoniazid (H), Rifampicin(R) and Both (H+R) were seen in 27%, 14% and 59% respectively. Half of patients (56%) out of total resistance belonged to default category of previously treated pulmonary tuberculosis cases. Resistance to H (27 cases) were 62.5% in relapse, 33.3% in default and 11% in failure cases. Out of R resistance (14 cases), 63% and 37% were in relapse and default cases. Out of 59 cases of H+R resistance 65% belonged to failure category and 20% default and 15% relapse category. Conclusion: Line Probe Assay (LPA) provides accurate and rapid diagnosis of R and H resistance and is recommended for diagnosis of DR-TB in previously treated pulmonary tuberculosis patients.

Evaluation of macular ganglion cell analysis compared to retinal nerve fiber layer thickness for preperimetric glaucoma diagnosis

Purpose: To compare the diagnostic ability of the ganglion cell analysis (GCA) and retinal nerve fiber layer (RNFL) protocol on optical coherence tomography (OCT), to diagnose preperimetric glaucoma. Methods: A prospective, cross-sectional study of 275 adult patients including 47 early glaucoma (mean deviation better than -6.0 D), 150 glaucoma suspects (106 with suspicious discs and 44 ocular hypertensive (OHT), and 78 normal controls was done. Eligible participants were scanned with the spectral domain CirrusTM OCT (Carl Zeiss Meditec, Dublin, CA). Average peripapillary RNFL thickness and GCA measurements were obtained. Area under receiver operating characteristic (AROC) curves were used to evaluate discriminant value of both protocols to diagnose likely preperimetric glaucoma among glaucoma suspects. Results: Average RNFL and GCA were significantly thinner in glaucoma patients compared to glaucoma suspects and normal controls (P < 0.001). The RNFL was 92.26 ± 8.8 ? in normal controls, 87.9 ± 12.12 ? in glaucoma suspects and significantly thinner in POAG (70.29 ± 10.18 ?; P < 0.001). The GCA was 81.94 ± 6.17 ? in normal controls, 77.69 ± 9.03 ? in glaucoma suspects, and significantly thinner in POAG (69.36 ± 11.06 ?; P < 0.001). AROCs for discriminating glaucoma suspects from normal were modest, with no difference in AROC of average RNFL or GCA measurements (DeLong; P = 0.93). Average RNFL thickness had significantly greater AROC values than average GCA for discriminating glaucoma suspects (both suspicious discs and OHT) from glaucoma (P = 0.03 and 0.05, respectively. AROC for diagnosing glaucoma was significantly better (P = 0.02) for RNFL (0.88 ± 0.03) than GCA (0.77 ± 0.04). Conclusion: In the present time, GCA measurements, as provided by the SD-OCT, do not appear to outperform RNFL measurements in the diagnosis of preperimetric glaucoma.

Influences of Gender, Religion, Dietary Patterns, and Mixed-sex Education on Aggressiveness in Children: A Sociodemographic Study in Municipal Primary Schools of South Delhi

Background: Increasing antisocial and violent behaviors in adolescents and young adults present serious challenges for public health. Children with persistent high levels of aggressiveness are often associated with developing conduct disorders later in life. Early detection of highly aggressive children and sociodemographic risk-modifying factors are important for developing effective preventive strategies. Objectives: The present study was undertaken to assess levels of aggressiveness for detecting highly aggressive children in sample populations of primary school children in an urban setting and determine significant biosociocultural risk-modifying factors in this scenario. Methods: The study was conducted during August朣eptember, 2015 in 5 primary schools of South Delhi Municipal Corporation. Sociodemographic data on 2080 students were collected. Overall aggressiveness scores (OA-Scores) were estimated using a self-report questionnaire in Hindi. Results: Categorizing students according to their OA-Scores, the data revealed that highly aggressive children constituted 4.3% of the study population. Analysis showed significant influence of (a) gender: boys displayed higher levels of aggressiveness compared to girls; (b) dietary pattern: omnivores showed higher aggressiveness than vegetarians; and (c) school environment: boys in mixed-sex (coeducational) schools displayed lower aggressiveness than from single-sex schools. Statistically significant influences of religion (Hindu/Muslim) and family type (joint/nuclear) on aggressiveness profiles were not noticeable. Conclusions: Vegetarian diets and mixed-sex education act as protective factors in the development of aggressiveness in children, especially among boys. Extending investigations to populations differing in geography and cultural backgrounds are warranted to verify present results.

Role of Autologous Platelet Derived Growth Factor and Fibrin Rich Plasma in Management of Chronic Non-healing Ulcer–A Pilot Study.

Background and Objectives: Chronic non-healing ulcer (CNHU) develops due to infections, trauma or underlying any medical and surgical conditions. Ulcer that have failed to response all available mode of treatment for long duration are more likely to develop gangrene and infection prone to limb amputation. This is a major public health problem. None of the conventional treatments are anticipated to stimulate active wound healing. The objectives of this study is to test the efficacy of topically applied autologous platelet derived growth factors and fibrin rich plasma in active repair of chronic non healing ulcer. Methods: Patients having one or more ulcers who have been receiving conventional treatment for their at least for more than 6 months duration but showed no evidence of healing till date were included in this study. Total of 30 skin ulcers were registered, of which 15 patients did not return for follow up. Rest 15 patients were included as the study group. All ulcers were treated with autologous platelet derived growth factors and fibrin rich plasma enriched antibiotic ointment. We observed that 73.33% ulcers were complete healed & rest ulcers had signs of improvement. Results: The study group showed complete healing in 73.33% ulcers and average 80% improvement observed in each ulcer, after applying autologous platelet derived growth factors and fibrin rich plasma. Significant ulcer healing was observed in patients who were less than 40 years of age, had no history of addiction for any toxic substance, and had ulcer size less than 30 sq cm. Ulcer healing rate was also found to be higher in cases whose duration of ulcer was within one year and those who did not have any history of systemic diseases. Conclusion: This study clearly shows the efficacy of topically applied autologous platelet derived growth factors and fibrin rich plasma in management of chronic non-healing ulcer.