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Myasthenia gravis is a rare autoimmune disorder characterized by nicotinic acetylcholine receptor autoantibodies, affecting the neuromuscular transmission leading to progressive weakness. As this disease is seen in the reproductive age group, clinicians need to be aware of this condition and its multidisciplinary management which is the key to successful outcome. Myasthenia gravis especially when associated with pregnancy is a high-risk condition, that may affect both the mother and the fetus and may result in adverse outcome. The pregnancy course is unpredictable with MG.
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Streptococcus gallolyticus is a gram-positive microbe rarely isolated from cases of neonatal sepsis. Prompt identification, management and monitoring is necessary in such cases due to potential complications like meningitis and endocarditis. We report a preterm baby referred to us on day 18 of life with fever, respiratory distress and lethargy with seizure. Blood culture revealed S. gallolyticus subspecies pasteurianus with meningitis on cerebrospinal fluid examination. He was treated with 21 days of injectable vancomycin and teicoplanin. Baby had no neurological sequelae or other end organ complications. To the best of our knowledge, this is the first case report from eastern India describing sepsis secondary to this rare organism.
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Azoospermia is the absence of spermatozoa in two separate centrifuged semen samples. It is one of the major contributors of male factor infertility. Usually detected in the course of infertility evaluation. Many forms of azoospermia are amenable to medical treatment. Authors report a case series of 16 cases of infertility with Azoospermia which were managed in the Assisted reproductive technology centre of a tertiary care teaching hospital of the Indian Navy in Mumbai between Jun 2022 to Jul 2023. Out of the 16 cases 13 cases underwent surgical sperm retrieval by PESA/TESE. We could retrieve sperms in 11 cases. In 5 cases the retrieved sperms were motile and in 6 cases immotile sperms were obtained. ICSI done with both motile and immotile sperms resulted in fertilization. Our study shows that IVF-ICSI can produce successful fertilization even with Immature sperms or sperms obtained directly from the testicular tissue and IVF-ICSI allows for pregnancy in couple where the man has irreversible azoospermia as long as it is possible to recover sperm from the testes.
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Background: Vault prolapse usually follows vaginal or abdominal hysterectomy and is usually associated with cystocele, rectocele and enterocele. Diagnosis is made clinically but magnetic resonance imaging can better detect enterocele than clinical finding.Methods: It was a prospective study over 3 years, so women presenting with vault prolapse, in which grading of vault prolapse was made clinically and by pelvic organ prolapse quantification (POPQ). Magnetic resonance imaging was performed for all cases to quantify prolapse and compare findings of MRI and POPQ with intraoperative findings of prolapse.Results: Mean age, parity, BMI were 58.4 years, 3.5, 22.71kg/m2 respectively. Most patients (75%) had vaginal hysterectomy while 25% had abdominal hysterectomy. Symptoms were pressure in lower abdomen and perineum (55%), bulge and feeling of mass descending in perineum (100%) and chronic constipation (60%). The type of prolapse was cystocele (100%), rectocele (100%), vault prolapse (100%) and enterocele (45%). MRI had agreement with intraoperative findings in 65% cases in cystocele, 45% cases in vault prolapse, 50% in rectocele but had much higher agreement of 88.8% for enterocele. While POPQ had higher agreement with intraoperative findings for cystocele (80%), vault prolapse (98%), rectocele (80%) but had poorer agreement for enterocele (66.6%).Conclusions: This study demonstrated that MRI was inferior in diagnosis of cystocele, rectocele and vault prolapse than POPQ but was superior in identification of enterocele than POPQ.
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Background: The present study aimed to evaluate if postpartum gestational diabetes mellitus (GDM) screening can be performed during immediate post-delivery 72 hrs instead of six weeks postpartum for follow-up.Methods: Total 150 GDM patients were included. The sample size was calculated as 150 with Nimaster2.0 software. GDM patients are enrolled after meeting the exclusion criteria for the study. The GDM diagnosis was made by DIPSI test and treated as per guidelines. After delivery, the Dipsi test was done on PND-3 (PP1). Furthermore, all were kept on LSM irrespective of the glycaemic level DIPSI test was repeated in all Patients after 45 days (PP2).Results: All 150 patients had a DIPSI test on 3rd day post-partum (PP1) and repeat test at 45 days (PP2)., Of these, 60 patients (40%) showed negative DIPSI test on P1 and all remained in Group 1, with 63 patients having negative DIPSI test on PP2. 50 patients (33.3%) had blood glucose between 140-199 mg (Group 2) on PP1 and increased to 53 patients in PP2 in 45 days. 40 patients had diabetic (26.6%) value (Group 3) in PP1, and out of them 34 (22.6%) remained in group 3 in PP2 after 45 days post-partum.Conclusions: This pilot study shows that nearly 60% of the GDM patient have either IGT or diabetic value following delivery on 3rd day of PP1 and almost similar results in PP2. Hence, we can do the postpartum screening on the postpartum 3rd day and need not wait for 6 wks when more than 50% is lost for follow-up. This study shows among GDM 60% of them have underlying beta cell dysfunction.
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Objective: A simple, reliable, and rapid RP-HPLC method showing stability has been established to detect Doxepin Hydrochloride (DOX) with its degraded products. The proposed method has been validated for specificity, linearity, system suitability, accuracy, precision, robustness, LOD, and LOQ as per ICH guidelines. All parameters were found to be within the accepted limits, affirming the method's reliability.Methods: Analysis was conducted using RP-HPLC on a Phenomenex C18 Luna column (250 mm × 4.6 mm id, 5 µm) with a mobile phase comprising methanol, acetonitrile, and buffer (40:30:30, v/v/v) and a flow rate of 0.5 ml/min. The detection was performed with a UV detector set at 254 nm. Diverse methods have been employed to investigate forced degradation studies, including acid-base hydrolysis, photolysis, thermal degradation, and oxidation. These studies were conducted both in bulk and in capsule formulations of DOX.Results: The retention time (tR) of DOX was 2.92 minutes, and all parameters met acceptable limit values. The response exhibited linearity over a concentration range of 10 to 50 µg/ml (R2 = 0.9974). The percentage of DOX recovered from the pharmaceutical cream dosage form ranged from 97.67% to 101%. Sensitivity levels for the developed method were indicated by limit of detection (LOD) and limit of quantification (LOQ) values of 0.40–0.50 µg/ml. The proposed method was validated according to ICH guidelines.Conclusion: Hence, a simple, reliable, accurate, and precise HPLC method was developed, proving suitable for the analysis of DOX in both bulk and commercial formulations.
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Background: Women who have experienced pre-eclampsia (PE) may also face additional health problems in later life, as the condition is associated with an increased risk of death from 2-fold increased risk of long-term cardiovascular disease (CVD), hypertension, stroke, an approximate 5-12-fold increased risk of end-stage renal disease (ESRD), metabolic syndrome, and diabetes. Methods: Method was randomized controlled trial. Women with PE who delivered in PGIMER will be enrolled and will be allocated into experimental ad control group using a computer random table with allocation concealment. Enrolment will be done at the time of discharge; baseline assessment will be done 6 weeks and the intervention bundle will be implemented to the women in experimental group. The women in control group will receive routine care. Women in both the groups will be followed up at 6 months. Conclusions: This study aims to determine the effectiveness of “extended postpartum comprehensive health care bundle (EP CHC bundle)” on selected outcomes of women with preeclampsia at 6 months. The comprehensive health care bundle will be designed with the inputs from all stakeholders, has the potential to suit the dynamic nature of management of women with preeclampsia after delivery. CTRI registration number: CTRI/2021/04/032749 ON 12/4/2021
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Nephrotic syndrome is a common renal disorder with an incidence of 20 to 40 per million population in developed countries. Children with nephrotic syndrome are especially susceptible to infections such as cellulitis, spontaneous bacterial peritonitis, and bacteremia. However, septic arthritis is an extremely rare complication in nephrotic syndrome. A 6-year-old girl with steroid dependent nephrotic syndrome relapsed following mumps parotitis and developed swelling of the right knee with restricted movements. Ultrasonography (USG) and magnetic resonance imaging (MRI) were suggestive of septic arthritis. The child responded to intravenous Vancomycin and Ceftazidime. We present a rare complication of nephrotic syndrome as septic arthritis, previously reported only once.
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Background: Umbilical venous catheterization and umbilical arterial catheterization provides easy access for administering fluids, exchange transfusion, medications, parenteral nutrition, blood pressure monitoring and blood sampling in neonates. Objective was to know the common practices related to the placement and maintenance of umbilical catheters, along with the associated complications in the level 3 and 4 neonatal intensive care units in the USA.Methods: A questionnaire-based survey study was conducted among NICU practitioners across United States. Only one survey was sent to each NICU.Results: Among the survey respondents, 50.8% represented level 3 NICUs, while 49.2% represented level 4 NICUs. The maximum duration for both UVC and UAC use was commonly reported as up to 7 days. Birth weight was the predominant method (86.8%) used for calculating catheter length. X-rays were universally employed for position confirmation. Heparin was widely utilized through UVC (96.7%), with a concentration of 0.5 IU/ml (73.7%). In cases of malpositioned UVC, practitioners employed techniques such as inserting another catheter, utilizing twisting movements during insertion, adjusting the UVC to a low position, and replacing the malpositioned UVC with a peripheral intravenous line. Common complications associated with UVC included line occlusion, thrombosis, and infections, while poor extremity perfusion and thrombosis were reported with UAC. Most units allowed feeding even when patients had a UAC in place.Conclusions: Despite the presence of institutional policies in most NICUs, practitioners encountered several complications during the use of umbilical catheters.
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Sickle cell disease (SCD) is an inherited autosomal recessive haemoglobinopathy. Sickle cell beta thalassemia is a variant syndrome of SCD characterised by the compound heterozygosity for sickle and beta thalassemia genes. We present a case of 12 year old male child diagnosed case of sickle cell thalassemia at the age of 2 years with complaints of fever, yellowish discolouration of eyes and drowsiness. USG abdomen was done suggestive of splenomegaly, multiple ill-defined, heterogeneously hypo-echoic, areas scattered throughout the splenic parenchyma with no vascularity within likely representing as splenic micro-abscesses. Child was started on antibiotics covering anaerobic and gram-positive organisms (vancomycin, meropenem, amikacin and metronidazole). Currently child is doing well with huge relieve to his symptoms.
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A 10-year-old female was brought to emergency department with complaint fever, cold, and cough for 5 days followed by weakness of upper limb weakness more than Lower limb associated with inability to walk/stand, brought to emergency with altered sensorium. Nervous system: Confused and altered, tone is normal, power: 3/3 in upper limbs 2/2 in lower limbs and reflexes in bilateral knee brisk, bilateral plantar-extensor; On general examination revealed hypomimia, dysarthria and bilateral bradykinesia along with ataxic gait and pyramidal signs. Blood investigation were normal and diagnosis made by neuroimaging s/o: Bilaterally symmetrical abnormal signal in both postero-medial thalami, bilateral insular cortices, pons and bilateral middle cerebellar peduncles. It is extending into pons involving transverse pontocerebellar tracts and median pontine raphe nuclei giving 'Hot cross bun sign' (HCBS). During course of treatment child had autonomic disturbances. Child was treated with supportive medication and methyl-presdnisolone followed by oral steroid. Child had responded to treatment given and child has been discharged with no neurological deficit on oral medications. We concluded autonomic dysfunction in any patient presenting with acute onset of weakness with short duration must evaluate for MSA and institute appropriate treatment.
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Depression is one of the most common mental diseases characterized by mood disorders affecting around 322 million individuals in the world. Depression is a feeling of inadequacy, dejection, anhedonia, and decreased activity in any action. Previously acetyl-L-carnitine reported beneficial effects on lipid metabolism, neuroprotection, and some types of depression. Therefore, in the present study, we evaluated the combined effect of acetyl-L-carnitine and bupropion against experimental-induced depression. Albino rats were divided into different groups (each group contained six animals). Normal groups received saline (1 mL/kg, i.p.). The standard group received imipramine (20 mg/kg, i.p.). The ALC group received acetyl-L-carnitine (100 mg/kg, i.p.), and the BPR group received bupropion (20 mg/kg, i.p.). T I and T II groups received acetyl-L-carnitine (30 mg/kg, i.p.) + Bupropion (10 mg/kg, i.p.) and acetyl-L-carnitine (80 mg/kg, i.p.) + Bupropion (30 mg/kg, i.p.), respectively. Antidepressant effects were assessed by forced swim test and sucrose preference test. In both models, the combined effect of the drug produced a significant (p < 0.05) antidepressant action as compared to the depression control group. Based on the findings, the combined effect of acetyl-L-carnitine and bupropion had a better therapeutic effect to combat depression as compared to individual treatments.
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Background: Preservation of planet should be of utmost importance. All practicing dentists collectively produce an amount of waste which can turn out to be extremely harmful to the environment. Biomedical waste management and eco-friendly approach in dental practice should be leveraged for a better future. Aim was to assess the changing trends regarding biomedical waste management and eco-friendly approach in regular practice among dentists of Ahmedabad. Methods: A questionnaire-based study consisting of 17 questions was conducted among practicing dentists of Ahmedabad city. A total of 301 dentists voluntarily participated in the study. Results: Most of the practicing dentists (98.7%) were aware about the biomedical waste management categories and 90.4% were known to the colour coding system used for waste segregation and disposal. A standard method of mercury waste management and sharps disposal was practiced by 53.7% and 88.4% of total participants respectively. Most of the participants were using disposable suction tips (91.6%) and disposable syringes (98.9%). However, 71.6% and 28.4% participants were using autoclavable patient drape, head cap and mask. Conclusions: Comparison based on experience revealed that dentists with lesser experience are more prone to having eco-friendly choices. Comparison based on qualification revealed that paediatric dentists were having the least eco-friendly approach in regular practice compared to other groups. Concept of eco-friendly dentistry was familiar to majority of the dentists but, use of various eco-friendly alternatives were not preferred equally by all dentists.
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Objective: To develop a simple, accurate, precise and linear Reverse Phase High-Performance Liquid Chromatographic (RP-HPLC) method and verify for the quantitative estimation (Dissolution) of Bromelain in delayed-release tablets.Methods: The optimized RP-HPLC method for both acid and buffer stage dissolutions of delayed-release tablets uses Zorbax 300 SB-C8 column (150 mm X 4.6 mm; 3.5?), a mobile phase-A of 0.1% trifluoroacetic acid in water and a mobile phase-B of 0.1% Trifluoroacetic acid in Acetonitrile in the gradient proportion, flow rate of 1.0 ml/min, injection volume of 25 µl, detection wavelength of 280 nm using a UV/PDA detector, column temperature of 40 °C, sample tray/compartment temperature of 5 °C and a run time of 20 min.Results: The developed method gave Bromelain eluting at about 6 min. Bromelain exhibited linearity in the range 53.4-800.6 ?g/ml (r2=0.99992). The precision is exemplified by relative standard deviation of 1.3 and 2.3% for acid and buffer stages, respectively. Percentage recovery of the drug was found to be between 90.0 and 110.0 during accuracy studies.Conclusion: A simple, accurate, precise, and linear RP-HPLC method was developed and verified for the quantitative estimation (Dissolution) of Bromelain in tablets and hence this method can be explored for the analysis of Bromelain in tablets in various pharmaceutical industries.
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We conducted a systematic review and meta-analysis to examine the protective effects of botulinum toxin-A (Botox-A) on spasticity and nociceptive pain in individuals with spinal cord injuries (SCIs). PubMed, Embase, and Cochrane Library databases were searched from inception to July 2023. The primary outcome of interest was spasticity and nociceptive pain. We pooled the available data using the generic inverse variance method, and we used a fixed-effect/random-effects model. We then calculated standardized mean difference (SMD) and 95% confidence intervals (95% CIs) to estimate the effect size. A total of fourteen studies meeting the inclusion criteria comprised two randomized controlled trials, five pre-post studies, and seven case reports. Across the various study designs, the majority of trials were assessed to have fair to high quality. The meta-analysis shows that Botox-A significantly decreased spasticity (SMD, -1.73; 95% CI, -2.51 to -0.95; p<0.0001, I2=48%) and nociceptive pain (SMD, -1.79; 95% CI, -2.67 to -0.91; p<0.0001, I2=0%) in SCI patients. Furthermore, Botox-A intervention improved motor function, activities of daily living (ADL), and quality of life. Our study suggests that Botox-A may alleviate spasticity and nociceptive pain in SCI patients. Moreover, the observed improvements in motor function, ADL, and overall quality of life following Botox-A intervention underscore its pivotal role in enhancing patient outcomes.
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Background@#Palatal injections are often painful. We aimed to compare topical ice and 20% benzocaine gel for pre-injection anesthesia before greater palatine nerve block (GPNB) injections. @*Methods@#A randomized split-mouth clinical trial was conducted among patients aged 15-60-years needing bilateral GPNB injections. A total of 120 palatal sites from 60 patients were randomly allocated to Group A (topical ice) or Group B (20% benzocaine gel). Pain was evaluated using sound, eye, motor (SEM), and the visual analog scale (VAS) in both groups. Inferential analysis was performed using the Mann-Whitney U test. @*Results@#The mean age of the participants was 20.5 ± 3.9 years. The median VAS score for group A was 11 (Q1 - Q3: 5.25 - 21.75), which was slightly higher than the 10 (Q1 - Q3: 4.0 – 26.75) reported in group B. However, the difference was not statistically significant (P = 0.955). The median SEM score for group A and group B was 3.5 (Q1 - Q3: 3.0 – 4.0) and 4.0 (Q1 - Q3: 3.0 - 4.0), respectively, which was statistically insignificant (P = 0.869). @*Conclusion@#Using ice as a form of topical anesthetic for achieving pre-injection anesthesia before GPNB was as effective as 20% benzocaine gel.
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Abstract Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures.
Resumo O conhecimento das variações anatômicas dos ramos viscerais da aorta abdominal é uma informação importante para o planejamento de qualquer cirurgia nessa região. Neste relato, apresentamos um raro conjunto de variações de vasos viscerais ao redor dos rins, bem como uma breve revisão da literatura recente. No lado direito, foi observada uma artéria renal acessória originando-se distal à artéria renal principal. Não havia artéria suprarrenal média no lado direito, e havia duas artérias suprarrenais inferiores originando-se de um ramo da artéria renal direita. No lado esquerdo, a artéria testicular apresentava um curso arqueado anterior à veia renal esquerda, simulando uma variedade incomum do fenômeno do quebra-nozes. O rim direito era drenado por duas veias renais para a veia cava inferior. O conhecimento da coexistência de tais variações anatômicas complexas pode ser útil para os clínicos durante os procedimentos diagnósticos e terapêuticos.
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Kriging as a Geospatial interpolative delineation of optimal radial distance around existing rainfall stations with in the purview of flat land (1-3 %) watershed (Hti-2 4D7B3) situated in Krishna basin. The smaller (15 and 30 min) and medium (45 min to 1h 45 min) events of the were analyzed focusing on their distribution whereas events of longer duration (>2 h) analyzed with their depth across 14 gauging stations. Analysis of 14 gauged rainfall network stations and their corresponding rainfall data during 2014-2020 used to derive relationship between recurring events of classified duration (15 min to 2 h) vis-a-vis weighted influence of number and depth due to spatial morphology and limitations of watershed. The event vise rainfall network distribution of Huti-2 watershed found to be significantly uniform in number and depth within the radial distance upto 3 km around each station prevailed by strong coefficient of determinant (R2) more than 0.8.
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In the Kharif grain sorghum growing areas of Karnataka, the sorghum production suffers greatly due to weed problem, which offers limitations to crop. It was found that weed infestation become unmanageable throughout the growing period by the traditional methods of interculturing and manual weeding due to continuous and heavy rains during entire vegetative and early reproductive stages of Kharif sorghum. Hence, integration of herbicides with some cultural operations and use of pre-emergence, post-emergence herbicides in combination with mechanical methods can prove to be more successful. A field experiment entitled “Weed management in kharif grain sorghum” was conducted during Kharif 2019 at ARS, Hagari in deep black soil with neutral reaction (pH 7.50), organic carbon (5.5 g kg-1), available nitrogen (248.00 kg ha-1), available phosphorus (36.75 kg ha-1) and available potassium (312.00 kg ha-1). An experiment was laid out in Randomized Complete Block Design (RCBD) with three replications. There were fourteen treatments comprising of weed management practices. The dominant weeds observed in the experimental fields were among grasses Brachiaria reptans, while in broad leaved weeds, Amaranthus viridis and among sedges, Cyperus rotundus. Significantly lower population of grasses, sedges, and broad leaved weeds, weed dry weight, weed index (%) and higher weed control efficiency throughout the crop growth period was noticed in sequential pre-emergence application of atrazine 50 WP @ 0.50 kg a.i. ha-1 as PE fb 2,4-D Na Salt 80 WP @ 0.75 kg a.i. ha-1 as PoE at 25 DAS except weed free treatment. Atrazine 50 WP @ 0.50 kg a.i. ha-1 as PE fb 2,4-D Na Salt 80 WP @ 0.75 kg a.i. ha-1 as PoE at 25 DAS recorded significantly higher plant height, dry matter accumulation, leaf area, test weight, grain yield, straw yield, harvest index, gross return, net return and benefit cost ratio (160.8 cm, 183.4 gplant-1, 24.1 dm2 plant-1, 30.53 g, 4195 kg ha-1, 9891 kg ha-1, 29.80 %, Rs. 1,03,675ha-1, Rs. 71,636 ha-1and 3.24, respectively) except weed free and it was on par with atrazine 50 WP @ 0.50 kg a.i. ha-1 as PE fb IC at 25 DAS and HW at 25 DAS and IC at 40 DAS.
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A study was conducted to reveal the land capability and its suitability to crops in the semi-arid region of North-Eastern Karnataka state, India. Alternate crop plan was proposed with suitable interventions at soil phase level, based on the prevailing climatic regimes and soil-land limitations. Cadastral parcels of Medinapur sub-watershed overlaid on IRS-P6 LISS-IV merged Cartosat-1 satellite imagery was used for interpreting soil units. Soil profiles and morphological studies were made to classify entire sub-watershed (covering 4890.46 ha) into ten soil series and these soil series, further classified into 23 soil phase/management units. The results revealed that major area of 1163 ha (23.79%) covers the soil phase unit “KMLmC2” with deep (100-150 cm) clay textured, gently sloping (3-5 %) and moderately eroded (e2) lands. Two land capability classes (IIIes and IVes) were found in the study area with topography, soil erosion, texture, drainage and soil fertility as major limitation factors. Red gram (59.64%) and Sorghum (18.86%) covering maximum area in the sub watershed were assessed for crop suitability to land. To estimate the significance of crop suitability criteria to land, linear regression analysis was performed with assigned rank values of independent variables. Suitability of these crops was found that the 77.84 % of land was moderately suitable (S2) to redgram with limitations of rooting condition, erosion and topography, only depth showed significant contribution to redgram suitability with R2 = 0.744. Sorghum was highly suitable (S1) to 21.12 % of land and soil depth and pH were significantly contributing to suitability of sorghum with R2 = 0.746. The estimation of criteria for land suitability to Sorghum and Redgram was significant at 5 per cent level. In common soil depth resulted as major contributing factor in deciding land suitability to crops.