Beyond the pulse: unusual presentations of Takayasu抯 arteritis

Takayasu抯 arteritis (TA) a.k.a pulseless disease is a chronic inflammatory occlusive thrombo-aortopathy. It is a rare inflammatory disease affecting large arteries, often leading to significant diagnostic challenges, especially when presenting with atypical symptoms. This case report explores a patient, whose primary complaints were chest pain and no neurological or constitutional symptoms, diverging from the common presentations of diminished pulses or limb claudication. Advanced imaging, including CT Aortogram and interventions like cardiac angiography, played a crucial role in detecting vascular inflammation and stenosis, facilitating accurate diagnosis and management. The case underscores the importance of considering Takayasu arteritis in differential diagnoses, even with non-classical presentations. This present case demonstrates rare and unique presentation of TA where patient presents with myocardial infarction and cardiogenic shock and also explains the diagnostic dilemma of TA with such unusual presentation.

Effect of Integrated Nutrient Management on Growth and Yield of Barley (Hordeum vulgare L.)

During the Rabi season of 2018-19, a field experiment was undertaken at Vivekananda Global University's Research Farm in Jaipur to investigate the "Effect of Integrated Nutrient Management on Growth and Yield of Barley (Hordeum vulgare L.)." The experiment followed a randomized block design with three replications. The treatments consisting of nine treatment combinations viz., 100% RDF (T1), 100% RDF + vermicompost 2.5 t ha-1 (T2), 100% RDF + vermicompost 2.5 t ha-1 + Azotobacter (T3), 75% RDF (T4), 75% RDF + vermicompost 2.5 t ha-1 (T5), 75% RDF + vermicompost 2.5 t ha-1 + Azotobacter (T6), 50% RDF (T7), 50% RDF + vermicompost 2.5 t ha-1 (T8) and 50% RDF + vermicompost 2.5 t ha-1 + Azotobacter (T9) were applied to the barley var. RD-2035. The experimental results demonstrated that several integrated nutrient treatments greatly boosted barley growth, yield characteristics and yield, quality, and economics. With the application of 100% RDF + vermicompost 2.5 t ha-1 + Azotobacter (T3), the maximum plant height at 60 DAS and 90 DAS, total number of tillers at 60 DAS and 90 DAS, effective number of tillers, ear length, number of grains ear-1, grain yield, straw yield, biological yield, and nitrogen content in grain and straw of barley were obtained. However, the application of 100% RDF yielded the significantly largest net returns and B: C ratio of barley (T1).

Hypertrophic pachymeningitis: a rare manifestation of IgG4 related disease

Hypertrophic pachymeningitis (HP) is a rare form of diffuse inflammatory disease that causes thickening of the dura mater. It can involve the cranial or the spinal dura or both. An increasingly well-known symptom of IgG4-related illness, a fibroinflammatory syndrome that may affect almost any organ, is IgG4-related hypertrophic pachymeningitis (IgG4-RHP). It is estimated that IgG4-RHP may account for a high proportion of cases of hypertrophic pachymeningitis once considered idiopathic. Contrast magnetic resonance imaging (MRI) shows pachymeningeal enhancement. Serum IgG4 levels may be elevated but are normal in most patients. However, most patients have elevated cerebrospinal fluid (CSF) IgG4 index. Hence, CSF IgG4 index could serve as a less invasive diagnostic marker of IgG4-RHP. Confirmation of diagnosis is by meningeal biopsy that shows swirling “storiform” fibrosis with lymphocytic infiltrates, obliterate phlebitis and IgG4 positive plasma cells. This case highlights the diagnostic dilemma of IgG4-RHP as gold standard of diagnosis is meningeal biopsy which has many of its own limitations. CSF IgG4 index could be an alternate option for meningeal biopsy when the procedure is contraindicated or uninformative.

Effect of Herbicides and Nitrogen Levels on Phalaris minor and Its Impact on Nutrient Uptake in Wheat (Triticum aestivum L.)

In the agricultural research farm of Banaras Hindu University, Varanasi, a field research study was carried out during the winter (Rabi) season of 2018–19 to examine the impact of levels of nitrogen and herbicides on associated weeds and wheat production. Nine weed species, including Phalaris minor, Anagallis arvensis, Cynodon dactylon, Melilotus indicus, Chenopodium album, Vicia sativa, Medicago denticulata, Solanum nigrum, and Cyperus rotundus, were frequently seen infesting wheat fields. Among these, Phalaris minor was the major weed. Application of Sulfosulfuron (25 g ha-1) + 2, 4-DEE (750 ml ha-1) significantly recorded the lowest weed density and biomass and higher weed control efficiency. HW twice (30&60 DAS) in combination with 180 kg N ha-1 followed by application of Sulfosulfuron (25 g ha-1) + 2, 4-DEE (750 ml ha-1) in combination with 180 kg N ha-1 performed significantly with respect to reduction in density, the biomass of Phalaris minor, as well as increased weed control effectiveness. Nutrient uptake was significantly highest under HW twice plot (30&60 DAS) followed by application of sulfosulfuron (25 g ha-1) + 2, 4-DEE (750 ml ha-1). The overall intake of N, P, and K in wheat grain and straw increased when nitrogen levels were high (180 kg ha-1), but uptake of these nutrients was low when nitrogen levels were low, which was ascribed to reduced plant biomass (grain and straw) and a low proportion of these nutrients in the plant.

The Morphologicalanalysis Of Pterion In North Indian Population

Pterion is defined as an H-shaped small circular area formed by the junction of four bones: Frontal, Parietal, Temporal and Sphenoid on Norma lateralis of the skull. A 35 dry adult human skulls of unknown sex without any gross pathology or abnormalitywere taken for the study. Sphenoparietal was the commonest type of pterion observed on both the sides. Second most common type of pterion found in our study was stellate type. Stellate type of pterion was present only on right side of skull. The accomplishments of this study contribute to anatomical variations of the pterion, which are of interest to anthropologists, forensic pathologists and surgeons. This topic of study deserves further investigation in other populations from different geographical areas.

Origin of Right Coronary Artery (RCA): A Multidetector Computed Tomography (MDCT) Coronary Angiographic (CA) Study in North India

Introduction: Several clinical and pathological scenarios like hemodynamic procedures, cardiac surgery in heart trauma and arrhythmias from coronary occlusive disease management have importance of variations in the origin of Right Coronary Artery (RCA). The RCA presents a wide spectrum of morphological expressions regarding its sites of origin, course, branches, length, size and termination. RCA usually arises from the Anterior Aortic Sinus (AAS) and traverses through the right atrio-ventricular (AV) groove. Subjects and Methods: In the present study, Computed Tomographic (CT) coronary angiograms of 50 routine subjects of different age groups who came to the Department of Radiodiagnosis, King George’s Medical University UP, Lucknow in the year 2010- 2011 with known or suspected coronary artery disease, were analyzed. Coronary angiography (CA) was performed on a 64 slice Multidetector Computed Tomographic (MDCT) scanner, using retrospective electrocardiographic (ECG) gating. The incidence of different sites of origin of RCA was assessed. Results: In the present study, RCA originated from Anterior Aortic Sinus (AAS) in 47 (94%) subjects. In 3 (6%) subjects, RCA showed anomalous origin from Left Posterior Aortic Sinus (LPAS). These three subjects were males [3(9.38%)]. In all the subjects, the course of RCA was normal except three males having origin of RCA from LPAS. In these three males, the proximal part of RCA coursed between Right Ventricular Outflow Tract (RVOT) and aorta. Conclusion: Most common site for origin of RCA was AAS. Anomalous origin of RCA was seen only from LPAS. Anomalous origin of RCA was seen only in male subjects. In all subjects having anomalous origin of RCA from LPAS, RCA coursed between pulmonary trunk and ascending aorta.

Variation In Branch Free Length Of Renal Artery And Its Clinical Significans: A 64-slice Ct Angiographic Morphometric Study

Background: Length of renal artery is an important morphological parameter while performing surgeries in renalarea. The present study was conducted to evaluate variations in length of renal artery.Materials and Methods: The study was conducted in the department of anatomy and department of radiology ofKing George’s Medical University, Lucknow. 53 subjects (106 renal arteries), undergoing 64-slice CT angiographyfor different indications were included in the study group. The angiographic images of all the subjects in abdominalregion were analyzed for renal arteries and their length was measured utilizing computerized tools.Results: The length of main renal artery varied from 8.5mm to 54.8mm on the right side. On the left side minimumlength was 7.7mm and maximum length was 48.8mm. The average length of renal artery was 30.5±10.4 mm on theright side and 26.91±10.0 mm on the left side. There was great variation in the length of renal artery due tovariation in site of ramification.Conclusion: The variation of renal artery length is critically important for maintaining vascularity of kidney aftersurgery

The Study Of Nutrient Foramen Of Bones Of Arm And Forearm In Adults

The variation in presence of number of nutrient foramen is important in long bones as nutrient foramen gives passage for entrance of nutrient arteries in to the bone. The present study was conducted on total 114 dry human long bones in department of anatomy, Era's lucknow medical college, lucknow. . The aim of the study was to determine the number of nutrient foramen in long bones of upper limb. Ethical approval was procured from the institutional ethical committee. In our study 97.40% humerus bones show single nutrient foramen, and 2.60% humerus bones show double NF, and all the radius and ulna show the single NF. The results of our study is similar with previous studies. The importance of knowledge about NF is very use full in orthopedic surgeries and in micro vascular bone grafting.

The Morphologicaland Morphometric Study Of Suprascapular Notch And Its Variations

The Suprascapular notch is situated in the lateral part of the superior border of the scapula, just adjacent to the base of Coracoid process. The notch is bridged by the superior transverse scapular ligament (STSL) which some time ossifies and is attached laterally to the root of the coracoid process and medially to the limit of the notch. A number of variations occur in the shape of suprascapular notch, from a discrete notch to "J" shaped, "V" shaped, "U" shaped or "O" shaped (i.e. as a complete foramen). To study morphological and morphometric variations of suprascapular notch of Indian population. We studied 140 dried scapula bone and measurements of SSN were done using digital vernier calipers. We used the Rengachary classification for this study. The following measurements were The superior transverse diameter - maximum distance between superior most edges of suprascapular notch (SSN). The inferior transverse diameter - maximum distance between the edges of the curved arch at the base of the SSN. The results of our study were: J-shaped -28%, U-shaped-26%, V-shaped -15%, Partial-ossification-7%, Indentation-10%, Absent-9%, Complete ossification- 2%. Type IV supra scapular notch was found to be the most prevalent type amongst all shapes. We also found that the characteristics of the scapula (dimensions) are related to the characteristics of the supra scapular notch (type and dimensions) and there is a distinct difference between right and left side scapula.

PDA (Posterior Descending Artery) & Coronary Dominance-A MDCT Coronary Angiographic Analysis of Anatomic Variations and Clinical Importance

Introduction: There is considerable variation in the arterial supply of diaphragmatic surface of the heart. Diaphragmatic myocardial infarction is one of the more common consequences of coronary artery disease. The aim of this study was to assess the incidence of anatomic variants of origin and termination of Posterior Descending Artery (PDA) and to determine the type of coronary dominance in North Indian population. Subjects and Methods: This prospective study was carried out on 50 routine subjects of different age groups who came to the Department of Radiodiagnosis, King George’s Medical University UP, Lucknow in the year 2010- 2011 with known or suspected coronary artery disease. All the cases were investigated on a 64 slice Multidetector Computed Tomographic (MDCT) scanner, using retrospective Electrocardiographic gating. Endeavour was made to determine the incidence of sites of origin and termination of PDA as well as to determine the type of coronary dominance. Results: PDA arose from Right Coronary Artery (RCA) in 39 (78%) cases and from Left Circumflex (LCx) artery in 11(22%) cases. The PDA was found to terminate in the upper 1/4 of Posterior Inter-Ventricular Groove (PIVG) in 18 (36%) cases, in upper 1/2 of PIVG in 19 (38%) cases, in upper 3/4 of PIVG in 10 (20%) cases and at the apex of the heart in 1 (2%) case. None of the female had termination of PDA at the apex. Termination of PDA could not be determined in 2 (4%) cases. Right dominance was seen in 36 (72%) cases, Left dominance in 11 (22%) cases. and Co-dominance in 3 (6%) cases. Conclusion: Posterior descending artery most commonly terminated after traversing the upper half of posterior inter-ventricular groove. The incidence of left coronary dominance was more in females, it was approximately twice the incidence found in males. Co-dominance was observed only in male subjects.

Diagnosis In A Spit : A Short Review

Salivary diagnostics is a cost effective, minimally invasive procedure. This bio-fluid can be easily collected, transported and stored. There are a variety of conditions where saliva can be used as a diagnostic tool such as measurement of stress, enzyme levels, developmental disease biomarkers and cancer mutations. A number of studies have focused their attention on the assessment and monitoring of oncologic biomarkers in saliva. Modern techniques, chemicals and various equipment have made laboratory investigations of saliva easy and precise. Its clinical applications and analysis has made salivary diagnostics a useful tool in the field of Medicine and Dentistry. The methodology for diagnosis of oral and systemic diseases has been a subject of study by several researchers with the aim of increasing its use as a diagnostic tool.

In vitro synergistic effect of biosurfactant produced by Bacillus subtilis MTCC 441 against drug resistant Staphylococcus aureus.

Microorganisms are capable to produce a wide range of surface active metabolites which are known as biosurfactant. In the present study, the production of biosurfactant from Bacillus subtilis MTCC 441 and evaluation of its synergistic activities with known antibiotics against drug resistance Staphylococcus aureus were performed. Drops collapse grid method was developed for detection of biosurfactant production in the medium. The production of biosurfactant was done in previously defined Carvalho’s medium. The extraction of biosurfactant was done in chloroform: methanol (2:1 v/v) solvent. The synergistic activity of crude biosurfactant was determined by disc diffusion and minimum inhibitory concentration assay. The Staphylococcus aureus was found resistant against ampicillin-sublactum (10μg), ampicillin (25μg), and cloxacillin (5μg), which showed no zone of inhibition but in the combination of crude biosurfactant, the zone of inhibition were measured as 14 mm, 14 mm and 19 mm, respectively. The crude biosurfactant showed good synergy with most of the antibiotics used in the study. The results demonstrated that biosurfactant possesses considerable potentiality to break the resistance of the pathogen tested. In future, it can be used for the development of effective drug against resistant bacteria.

Community Knowledge, Attitude, Awareness and Protective Practices Regarding Malaria in Mewat and Rohtak Districts of Haryana, India.

Aim: Mosquito borne diseases especially malaria is a serious public health problem in the tropical and sub-tropical regions of the world especially the developing countries including India. Besides available key interventions to control the spread of vectors and vector borne diseases, there is a felt need for involving a suitable community approach based on knowledge, attitude, awareness, behaviour and protective practices to get the best results. Hence, the present study is an attempt to provide some inputs in this direction. Methodology: A community based cross-sectional survey was carried out in a highly malaria endemic cluster of six selected villages of Rohtak and Mewat region of Haryana to know the respondent knowledge about malaria and other mosquito-borne diseases, as much as their attitude, awareness and practices regarding the malaria and its control. The results obtained were processed and analyzed statistically by using STATA version 10 software. Results: The study revealed that about 52% of the respondents in Rohtak region and 42.68% in Mewat region committed that malaria is transmitted by mosquito bite which was directly correlated with the level of education. It was observed that high fever, chills and body pain were considered as the major signs/symptoms of malaria. Television followed by friends and relatives and health care provider’s acts as the major source of information about malaria and other mosquito borne diseases. Overall (76.2%) individuals from both study areas mentioned that malaria is a serious problem in their area but only 46.3% knew about various Government measures for the protection and treatment of malaria. Mosquito nets, mosquito coil and repellents were commonly used as protective practices by the respondents but the difference was not found significant except for mosquito net (P <0.05) in both the study areas. Conclusion: Promoting active community participation by improving current intervention strategies through information, education and communication regarding malaria and other mosquito-borne diseases may yield better results.

Profile of lung cancer in predominantly bidi smoking rural population of northern Himachal Pradesh.

Background. Lung cancer is a leading cause of morbidity and mortality among both genders. The histopathological patterns of lung cancer in different parts of India appear to be variable. Objective. To study the profile of lung cancer in northern Himachal Pradesh. Methods. Patients of all age groups and either gender with history and complaints suggestive of lung cancer were subjected to further investigations to study the histopathological types of lung cancer over a period of 14 months. Results. Out of 105 histopathologically confirmed patients with lung cancer (mean age 62.7±11.6 years; 96 males), 89.5% were “ever smokers” and 82.9% were “current smokers”; 92% of current smokers were bidi smokers. Most common presenting complaints were chest pain (46.7%) and cough (35.2%). Mean duration of longest presenting complaint was 64 days. The histopathological types included squamous cell carcinoma (37.1%), adenocarcinoma (36.2%), small cell carcinoma (8.6%), un-classifiable (16.2%), and other types (1.9%). Conclusions. Majority of the lung cancer patients in northern Himachal Pradesh were bidi smoking males from rural areas and the incidence of adenocarcinoma and squamous cell carcinoma is almost equal.

Risk factor Analysis and Angiographic Profiles in First 228 Cases Undergone Coronary Angiography in Cardiac Cath Lab of Dhaka Medical College Hospital.

Background: Coronary artery diseases are one of the major challenges faced by cardiologists. Control of certain risk factors for CAD is associated with decrease in mortality and morbidity from myocardial infarction and unstable angina. So, identification and taking appropriate measures for primary and secondary prevention of such risk factors is, therefore, of great importance. This retrospective study was carried at the newly set up cath lab in Dhaka Medical college. Materials and Methods: Total 228 consecutive case undergone diagnostic coronary angiogram from 10th January 2007 to31st January 2009 out of which 194(80%) were male and 34 (20%) were female. In both sexes most of the patients were between 41 to 60 years of age. Risk factors of the patients were evaluated. Results: In females commonest risk factor was Diabetes (58.8%) followed by dyslipidaemia (35.3%). In males commonest risk factor was hypertension (30.9%) followed by smoking (29.9%) and diabetes (28.3%). In males 44.3% patients presented with acute myocardial infarction followed by stable angina (43.3%); but in females stable angina was the commonest presentation (50.0%) followed by myocardial infarction (38.2%).CAG findings revealed that in males 33.5% had double vessel disease 26.8% followed by single vessel 26.8% and multivessel disease 25.3%. In females normal CAG was found in 35.5% followed by double vessel 23.5%, multivessel 20.6% and single vessel 20.6%. On the basis of CAG findings; in males 41.8% patients were recommended for CABG, followed by PTCA & stenting 26.3% and medical therapy 30.0%; where as in females 55.9% were recommended for medical therapy , followed by CABG 32.4% and PTCA & stenting11.8%. Conclusion: The commonest presentation of CAD was 4th and 5th decades in both sexes. Diabetes and dyslipidaemia were more common in females whereas hypertension and smoking were more common in males. Myocardial infarction and stable angina were most common presentation in both sexes though in males myocardial infarction was more common. In males the angiographic severity of CAD was more and they were more subjected for CABG in comparison to females.

A dose verification method for high-dose-rate brachytherapy treatment plans.

AIM: To evolve a fast dose verification method for high-dose-rate (HDR) brachytherapy treatment plans and to demonstrate its applicability in different clinical cases. MATERIALS AND METHODS: We developed a software tool in VC++ for the Varisource HDR unit for HDR dosimetry plan verification using TG-43 parameters. HDR treatment dosimetry of a number clinical cases using Varisource was verified by comparison with the treatment planning system (TPS). RESULTS: A number of different types of clinical cases treated by Varisource were evaluated. TPS calculated dose values and verification code calculated dose values were found to agree to within 3% for most of the dose calculation points. CONCLUSIONS: We have validated with clinical cases a fast and independent dose verification method of the dosimetry at selected points for HDR brachytherapy treatments plan using TG-43 parameters. This can be used for the verification of the TPS calculated dose at various points. The code is written to work with Varisource, but it can conceivably be modified for other sources also by using the fitted constant of the respective source.

Non-familial multiple keratoacanthomas in a 70 year-old long-term non-progressor HIV-seropositive man.

We describe here multiple keratoacanthomas in an Human Immunodeficiency Virus (HIV)-seropositive 70 year-old man. The patient had multiple epithelial tumors of the skin showing rapid growth, histopathological features of a keratoacanthoma and a conspicuous tendency toward spontaneous remission. A diagnosis of nonfamilial multiple keratoacanthoma was established. The patient had a CD4 count of 633 cells/microL. The HIV disease in our patient was of a nonprogressive nature with CCR5-positive T cells.

Calcifying pseudotumor of scrotum: a case report.

Calcifying fibrous pseudotumors of the testicular and paratesticular soft tissue are relatively rare. We would like to report the first documented case of calcifying fibrous pseudotumor of the tunica vaginalis in Indian medical literature. This is a case of a 55 year old male who presented with a painless scrotal mass of 10 years duration. Histological sections showed dense hyalinised bands of collagen with focal collections of plasma cells and lymphocytes. Multiple round to oval concentrically laminated psammomatous bodies were seen.

Oral ulcer as an unusual feature of visceral leishmaniasis in an AIDS patient.

Leishmaniasis, a globally prevalent parasitic disease, occurs in three forms, viz, visceral, cutaneous and mucocutaneous. It is transmitted by female Phlebotomus sandflies. Human immunodeficiency virus (HIV) infection is increasing worldwide and several reports indicate a rising trend of VL / HIV co-infection, modifying the traditional anthroponotic pattern of VL transmission. India is one of the countries having the largest burden of leishmaniasis; nevertheless, there are very few HIV / leishmania co-infection cases reported so far. We report a 35-year-old homemaker infected with the human immunodeficiency virus; she presented with an oral ulcer. The investigations carried out on her revealed that she was afflicted by visceral leishmaniasis and the oral ulceration was a part of the same. This is only the second such case from the Indian subcontinent and more significantly from a non-endemic area.