Vaginal Atresia with Cervical Agenesis, a Rare Congenital Malformation.

Congenital vaginal atresia and cervical agenesis is a rare congenital abnormality of the female genital tract. Here we report a case of 15-year old girl with primary amenorrhea with hematometra, presented with lower abdominal mass. She was symptomatic since 5 months and visited local hospital after 4 months of onset of her symptoms when it became severe, where diagnostic laparotomy was performed for suspected Adnexal mass. Intraoperatively adnexal mass was adhered with and extended up to the uterus with 16 weeks size of uterus. Abdomen was closed without any further intervention and was referred to higher center for needful. When she presented to Kathmandu Model Hospital, she was asymptomatic on her 5th post-operative day of laparotomy. We planned for surgical intervention after examination and investigation. Drainage with vaginoplasty with amnion graft with placement of mould was done.

COVID-19 Pandemic: An Experience of OBGYN Residents at Kathmandu Model Hospital.

COVID-19, a novel corona virus has affected the life of each and every individual worldwide. Nepal being the neighborhood country of china, though, we had a late case detection. But, since the month of July this virus has spread in an alarming manner in Nepal. Nepal being one of the developing countries, we lack in equipments, manpower resources and also in treatment centers. Looking into the devastating scenario of Covid 19 in China, Italy, New York, Brazil and our neighboring countries like India, Pakistan and Bangladesh is scary. We wondered how we were going to handle this pandemic if similar circumstances happened in our country too. At the same time being OBGYN residents, we all know pregnancy is very crucial and our patients have faced much difficulties to receive the maternal health services. In this manuscript, we have shared our experience regarding preparedness for COVID-19, management of positive cases and its effect in OBGYN trainee.

Misleading Diagnosis of Dysgerminoma in a Young Asymptomatic Patient.

Dysgerminomas account for approximately one third of all malignant ovarian germ cell tumors (tumors arising from ovarian germinal elements) and are the most common ovarian malignancy detected during pregnancy. They are the only germ cell malignancy with a significant rate of bilateral ovarian involvement that is 15-20 percent. They have a variable gross appearance, but in general are solid, pink to tan to cream colored lobulated masses. They have the best prognosis of all malignant ovarian germ cell tumor variants. Two thirds are stage I at diagnosis, and prognosis is excellent even for those with advanced disease due to exquisite tumor chemosensitivity. The 5 year disease specific survival rate approximates 99 percent. This is a case report of a huge ovarian dysgerminoma in a young unmarried lady that was quite asymptomatic. She underwent laparotomy with right ovarian cystectomy.

Pregnancy Complicated by Acute Pancreatitis with Ascariasis.

Ascariasis lumbricoides infections are common in tropical and sub-tropical countries. As it is one of the common causes for common bile duct obstruction. But in pregnancy is a rare entity. It may present with complications like acute pancreatitis. Here we present a case of 24 year female gravida 2 para 1 at 34 weeks of pregnancy presented with chief complain of pain over epigastric region radiating to back and associated with two episodes of vomiting, non bilious, not mixed with blood. Ultrasonography showed long tubular hyperechoic structure in gallbladder lumen most likely ascariasis and then she was diagnosed as a case of acute pancreatitis with alive ascariasis.

Comparative genome analysis reveals key genetic factors associated with probiotic property in Enterococcus faecium strains.

BACKGROUND: Enterococcus faecium though commensal in the human gut, few strains provide a beneficial effect to humans as probiotics while few are responsible for the nosocomial infection. Comparative genomics of E. faecium can decipher the genomic differences responsible for probiotic, pathogenic and non-pathogenic properties. In this study, we compared E. faecium strain 17OM39 with a marketed probiotic, non-pathogenic non-probiotic (NPNP) and pathogenic strains. RESULTS: E. faecium 17OM39 was found to be closely related with marketed probiotic strain T110 based on core genome analysis. Strain 17OM39 was devoid of known vancomycin, tetracycline resistance and functional virulence genes. Moreover, E. faecium 17OM39 genome was found to be more stable due to the absence of frequently found transposable elements. Genes imparting beneficial functional properties were observed to be present in marketed probiotic T110 and 17OM39 strains. Genes associated with colonization and survival within gastrointestinal tract was also detected across all the strains. CONCLUSIONS: Beyond shared genetic features; this study particularly identified genes that are responsible for imparting probiotic, non-pathogenic and pathogenic features to the strains of E. faecium. Higher genomic stability, absence of known virulence factors and antibiotic resistance genes and close genomic relatedness with marketed probiotics makes E. faecium 17OM39 a potential probiotic candidate. The work presented here demonstrates that comparative genome analyses can be applied to large numbers of genomes, to find potential probiotic candidates.

Genomic and physiological analyses of an indigenous strain, Enterococcus faecium 17OM39.

The human gut microbiome plays a crucial role in human health and efforts need to be done for cultivation and characterisation of bacteria with potential health benefits. Here, we isolated a bacterium from a healthy Indian adult faeces and investigated its potential as probiotic. The cultured bacterial strain 17OM39 was identified as Enterococcus faecium by 16S rRNA gene sequencing. The strain 17OM39 exhibited tolerance to acidic pH, showed antimicrobial activity and displayed strong cell surface traits such as hydrophobicity and autoaggregation capacity. The strain was able to tolerate bile salts and showed bile salt hydrolytic (BSH) activity, exopolysaccharide production and adherence to human HT-29 cell line. Importantly, partial haemolytic activity was detected and the strain was susceptible to the human serum. Genomics investigation of strain 17OM39 revealed the presence of diverse genes encoding for proteolytic enzymes, stress response systems and the ability to produce essential amino acids, vitamins and antimicrobial compound Bacteriocin-A. No virulence factors and plasmids were found in this genome of the strain 17OM39. Collectively, these physiological and genomic features of 17OM39 confirm the potential of this strain as a candidate probiotic.

Alterations in Sialylation Patterns are Significantly Associated with Imatinib Mesylate Resistance in Chronic Myeloid Leukemia.

BACKGROUND AND AIM: The study examined sialylation changes for their potential predictive value in assessment of imatinib mesylate (IM) resistance, alone and/or with BCR-ABL1 transcript variants among chronic myeloid leukemia (CML) cases. METHODS: A total of 98 CML cases (un-treated cases, IM non-responders and IM responders) were enrolled in the study. Total sialic acid (TSA) and total protein (TP) levels were estimated spectrophotometrically, the expression profiles of BCR-ABL1, ST3GAL1 and ST3GAL2 were evaluated using qRT-PCR assays and BCR-ABL1 transcript variants were identified through subjecting PCR products to agarose gel electrophoresis. RESULTS: The results manifested increase in e14a2 transcript and decrease in co-expression of both transcripts (e13a2 and e14a2) in IM non-responders than un-treated CML cases. Notably, TSA/TP ratio was higher, whereas ST3GAL1 and ST3GAL2 expressions were lower in un-treated CML cases and IM non-responders as against IM responders. Further, ST3GAL2 expression was lower in un-treated CML cases than IM non-responders. Receiver operating characteristic curves also proved their discriminatory efficiencies. Decisively, the rise in TSA levels and the fall in ST3GAL1 and ST3GAL2 levels were evidently related to CML progression and clinical indicators of treatment failure (high BCR-ABL1 ratio, high WBC count, high platelet count and low Hb levels). The alterations in TSA, ST3GAL1 and ST3GAL2 levels were remarkably associated with each other. CONCLUSIONS: The altered levels of TSA, ST3GAL1 and ST3GAL2 are, to a significant extent, associated with IM resistance in CML, which have clinical relevance in treatment monitoring and IM resistance treatment.

Compartment syndrome of the forearm: a systematic review.

In this systematic review, we examined the available evidence regarding compartment syndrome of the forearm. Applying our inclusion criteria, we found 12 articles for a total of 84 cases using the MEDLINE (Ovid) database. All were retrospective studies (level IV evidence). In this study, papers were analyzed for causes, diagnosis, treatment, methods of wound closure, functional outcome, and complications. The most common cause of compartment syndrome of the forearm in children was a supracondylar fracture, while in adults the most common cause was a fracture of the distal radius. The diagnostic criterion used was clinical assessment alone in 48%, and in 52%, a combination of measurement of intracompartmental pressure and clinical assessment was used. The intracompartmental pressure was measured using various techniques including a wick catheter, slit catheter, the Whitesides technique, and the Stryker compartment pressure measuring device. Fasciotomy was the preferred method of treatment (73%). In cases reporting wound management, postfasciotomy skin grafting was needed in 61% of the cases, whereas secondary closure was performed in 39% of the cases. Neurological deficit was the most common complication (21%).

Differential gene responses in different varieties of pomegranate during the pathogenesis of Xanthomonas axonopodis pv. punicae.

Bacterial blight (BB) caused by Xanthomonas axonopodis pv. punicae (Xap) is the major scourge in pomegranate cultivation leading to an extensive yield loss up to 60-80%. Hence, identifying a novel resistance source for BB is very necessary for developing a suitable management strategy. Host range analysis and cross-inoculation studies revealed that Xap is specific to pomegranate and there are no alternative hosts to the pathogen. Screening of 149 accessions recorded the varied disease resistance levels with mean disease severity of 30.67%. Accession lines IC318735, IC318724, and IC318762 exhibited maximum disease tolerance by exhibiting the lowest disease severity of 4.91, 5.66, and 6.82%, respectively. Comparative expression analysis of defence genes in IC318724 and IC318735 recorded significant upregulation of phenylalanine ammonia-lyase (PAL), callose synthase-3 (CS3), chitinase, pathogenesis-related protein-1 (PR1), and pathogenesis-related protein-10 (PR10), indicating these genes might be actively involved in conferring disease tolerance. Abiotic elicitors were tested to induce systemic resistance in agronomically superior and widely adapted variety Bhagwa for managing BB of pomegranate. Among the various elicitors tested; proline (600 ppm), gamma-aminobutyric acid (600 ppm), chitosan (600 ppm), ß-aminobutyric acid (200 ppm), laminarin (600 ppm), and eugenol (200 ppm) recorded maximum disease protection in prophylactic treatment with disease protection of 89.59, 88.59, 87.15, 86.08, 81.05, and 78.72%, respectively. Similar observations were recorded when these were applied as curative treatment. The present study will broaden our understanding of host-pathogen interactions during BB infection in pomegranate, also aid in developing ideal approach for developing effective disease management. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13205-021-02721-y.

Complex odontoma.

Odontomas are hamartomatous lesions or malformations composed of mature enamel, dentin, and pulp. They may be compound or complex, depending on the extent of morphodifferentiation or their resemblance to normal teeth. The etiology of odontoma is unknown, although several theories have been proposed. This article describes a case of a large infected complex odontoma in the residual mandibular ridge, resulting in considerable mandibular expansion.

Oxidative stress-mediated essential polyunsaturated fatty acid alterations in female infertility.

Prostaglandins are exclusively synthesized in vivo from cell membrane essential fatty acids and together are known to regulate many aspects of reproductive processes. The objective of the study was to examine whether disturbances in fatty acid profile as a result of increased oxidative stress could be one of the causes of female infertility. Forty-five infertile and 30 control women were enrolled via the Department of Obstetrics and Gynecology of Bharati Medical College Hospital, Pune, India. Essential polyunsaturated fatty acids, malondialdehyde (MDA; oxidative stress-marker) levels and antioxidants (vitamins E and C) were measured in both groups. Results show that plasma eicosapentaenoic acid and erythrocyte docosahexaenoic acid levels were reduced (p < 0.05) in infertile women as compared to controls. Likewise, levels of MDA, a peroxidative product of essential fatty acids, were increased (p < 0.05) and vitamin E concentrations were decreased (p < 0.05) in infertile women, suggesting that increased oxidative stress and consequent altered essential polyunsaturated fatty acids are associated with infertility. Our study indicates, for the first time, the cause and effect relationship between oxidative stress and membrane essential polyunsaturated fatty acids in infertile women. These data have important implications for the supplementation of a combination of omega-3 fatty acids and antioxidants in the successful management of female infertility.

Body form and nutritional status among adult males of different social groups in Orissa and Bihar States in India.

This paper aims to carry out a biological investigation of the body form and nutritional status of the major social groups of Orissa and Bihar States in India. For this, Cormic Index (CI) and Body Mass Index (BMI) have been computed using data on height, sitting height and weight, taken from adult males of age 18-62 years of various ethnic groups in these two states. The subjects have been classified on the basis of chronic energy deficiency (CED). It is found that a substantial proportion of the people with CED are in the grade II and grade III categories. ANOVA, t-tests, correlation and regression were carried out separately. The results reveal that in Orissa, Scheduled Tribes are shorter, lighter and have lowest mean values of BMI and Cormic Index compared to other groups, but in Bihar, though the Scheduled Tribes are shorter, Scheduled Castes are lower in weight and have the lowest mean values of BMI. There are significant differences in BMI as well as in CI between Scheduled Tribes of Orissa and Bihar. Scheduled Castes and Tribes of Bihar have the highest percentage of CED with 64.71% and 57.45%, respectively. Muslims of Bihar are also affected (52.95%), but overall prevalence of CED is lower in Orissa (49.11%) than in Bihar (54.62%). BMI and CI are highly correlated for each of the social groups in Bihar and Orissa.

Influence of socio-economic status and television watching on childhood obesity in Kolkata.

Obesity is fast becoming an epidemic among the urban children and it has its adverse effect on the status of health even during adulthood. In this paper an attempt is made to assess the percentage of obesity among 6-10 year children and assess the effect of different socio-economic variables and TV watching on childhood obesity. We restricted our study to primary school-going children who attended classes I-IV. The sample consisted of 5216 children from 20 different Bengali medium and English medium schools in Kolkata. Categorical logistic regression of obesity on the socio-economic factors namely type of medium school, religion, parent's education, duration of television watching etc., has been carried out. The categorical logistic regression shows the significant effect of some of the socio-economic or demographic variables including the duration of television watching on obesity. We have seen a positive association between obesity and TV watching and also between obesity and consumption of fast food. This calls for making the parents aware and taking action as early as possible.

Aryl-1H-imidazole[4,5f][1,10]phenanthroline Cu(II) complexes: Electrochemical and DNA interaction studies.

The reaction of aryl imidazo[4,5f] [1,10]phenanthrolines with Cu(NO3)2 lead to the formation of Cu(II) complexes of the type [Cu(L)(NO3)2] where L=PIP, 2-(phenyl) [4,5f] imidazo phenanthroline; HPIP=2-(2-hydroxyphenyl)imidazo [4,5f] phenanthroline and NIP=2-(naphthyl) [4,5f] imidazo phenanthroline. The interaction of these complexes with calf thymus DNA has been studied using viscosity measurements, UV-visible and fluorescence spectroscopy. Chemical nuclease activity of these complexes has also been investigated. All complexes cleave DNA via oxidative pathway involving singlet oxygen. Molecular docking studies revealed that these complexes bind to DNA through minor groove.

Novel ubiquitin neuropathology in frontotemporal dementia with valosin-containing protein gene mutations.

Frontotemporal dementia (FTD) with inclusion body myopathy and Paget disease of bone (IBMPFD) is a rare, autosomal-dominant disorder caused by mutations in the valosin-containing protein (VCP) gene, a member of the AAA-ATPase gene superfamily. The neuropathology associated with sporadic FTD is heterogeneous and includes tauopathies and frontotemporal lobar degeneration with ubiquitin-positive inclusions (FTLD-U). However, there is limited information on the neuropathology in IBMPFD. We performed a detailed, systematic analysis of the neuropathologic changes in 8 patients with VCP mutations. A novel pattern of ubiquitin pathology was identified in IBMPFD that was distinct from sporadic and familial FTLD-U without VCP gene mutations. This was characterized by ubiquitin-positive neuronal intranuclear inclusions and dystrophic neurites. In contrast to FTLD-U, only rare intracytoplasmic inclusions were identified. The ubiquitin pathology was abundant in the neocortex, less robust in limbic and subcortical nuclei, and absent in the dentate gyrus. Only rare inclusions were detected with antibodies to VCP and there was no biochemical alteration in the VCP protein. VCP is associated with a variety of cellular activities, including regulation of the ubiquitin-proteasome system. Our findings are consistent with the hypothesis that the pathology associated with VCP gene mutations is the result of impairment of ubiquitin-based degradation pathways.

Multi-functional reactively-sputtered copper oxide electrodes for supercapacitor and electro-catalyst in direct methanol fuel cell applications.

This work reports on the concurrent electrochemical energy storage and conversion characteristics of granular copper oxide electrode films prepared using reactive radio-frequency magnetron sputtering at room temperature under different oxygen environments. The obtained films are characterized in terms of their structural, morphological, and compositional properties. X-ray diffraction, X-ray photoelectron spectroscopy and scanning electron microscope studies reveal that granular, single-phase Cu2O and CuO can be obtained by controlling the oxygen flow rate. The electrochemical energy storage properties of the films are investigated by carrying out cyclic voltammetry, galvanostatic charge/discharge and electrochemical impedance spectroscopy tests. The electrochemical analysis reveals that the Cu2O and CuO electrodes have high specific capacitances of 215 and 272 F/g in 6 M KOH solution with a capacity retention of about 80% and 85% after 3000 cycles, respectively. Cyclic voltammetry and chronoamperometry are used to study the electrochemical energy conversion properties of the films via methanol electro-oxidation. The results show that the Cu2O and CuO electrodes are electro-catalytically active and highly stable.

His electrogram alternans reveal dual-wavefront inputs into and longitudinal dissociation within the bundle of His.

BACKGROUND: His electrogram (HE) amplitude and morphology changes were observed in our previous studies during transition from "fast" to "slow" atrioventricular nodal (AVN) conduction. This phenomenon and its significance for the dual-AVN electrophysiology are not well recognized and have not been studied. METHODS AND RESULTS: Experiments were performed on 17 healthy rabbit atrial-AVN preparations during standard programmed electrical pacing. HEs were mapped along the His bundle with roving surface electrodes, along with recording of cellular action potentials (APs). HEs recorded from the superior margin of the His bundle were of greater amplitude during basic beats and decreased substantially, by 42+/-19% (P<0.01), when premature A(1)A(2) shortened to 178+/-20 ms. In contrast, the HEs from the inferior margin increased dramatically, 2.9+/-1.7 times (P<0.01), during short A(1)A(2) and remained high until AVN block occurred. In addition, during long A(1)A(2), the superior HEs consistently preceded the inferior by 1.9+/-0.7 ms. In contrast, at short A(1)A(2), the superior HEs occurred 2.7+/-0.8 ms after the inferior. Cellular AP recordings demonstrated clearly the presence of and the transition between early (fast) and late (slow) excitation wavefronts that accompanied HE alternans. CONCLUSIONS: The morphological-electrophysiological evidence from the AV junction suggests that fast and slow wavefronts reach the His bundle differently, producing functional longitudinal dissociation into 2 domains. The characteristic HE alternans recorded from these domains are a new sensitive tool to determine the presence of distinctly different wavefronts and their participation in the conduction during reentrant or other arrhythmias. These findings provide further understanding of the mechanisms of dual-AVN electrophysiology.

Living anatomy of the atrioventricular junctions. A guide to electrophysiologic mapping. A Consensus Statement from the Cardiac Nomenclature Study Group, Working Group of Arrhythmias, European Society of Cardiology, and the Task Force on Cardiac Nomenclature from NASPE.

Current nomenclature for the atrioventricular (AV) junctions derives from a surgically distorted view, placing the valvar rings and the triangle of Koch in a single plane with antero-posterior and right-left lateral coordinates. Within this convention, the aorta is considered to occupy an anterior position, although the mouth of the coronary sinus is shown as being posterior. Although this nomenclature has served its purpose for the description and treatment of arrhythmias dependent on accessory pathways and atrioventricular nodal reentry, it is less than satisfactory for the description of atrial and ventricular mapping. To correct these deficiencies, a consensus document has been prepared by experts from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. It proposes a new anatomically sound nomenclature that will be applicable to all chambers of the heart. In this report, we discuss its value for description of the AV junctions, establishing the principles of this new nomenclature.

Conduction system findings in sudden death in young adults with a history of bronchial asthma.

OBJECTIVES: This study was conducted to determine whether there are any pathologic changes in the conduction system when death occurs suddenly in young adults with a history of bronchial asthma. BACKGROUND: There is a worldwide increase in sudden death, especially in young adults with a history of bronchial asthma. METHODS: We studied the conduction system by serial section examination in six male patients (16 to 23 years old) with a history of bronchial asthma who died suddenly. RESULTS: The sinoatrial node artery was narrowed in two patients, with chronic inflammatory cells in three; it was fibrosed in one. The atrioventricular (AV) node was within the central fibrous body in three patients and isolated by fat in one. The AV bundle was markedly fragmented in five patients and fibrosed in two. The right and left bundle branches showed fat, fibrosis and disruption in five patients. Increased fibrosis on the summit of the ventricular septum with patchy fibrosis was present in five patients, and inflammatory cells in the conduction system were found in one. CONCLUSIONS: 1) There are distinct pathologic findings in the conduction system of young adults with a history of bronchial asthma who die suddenly. 2) The significant findings appear to be a markedly fragmented bundle and changes in the sinoatrial node that are not found in normal healthy young adults. 3) The changes in the conduction system may create an arrhythmic event, and sudden death may occur in some persons during an altered physiologic state. 4) We hypothesize that bronchial asthma may be associated with an alteration in immune complexes that affects the conduction system in some patients.

Congenital abnormalities of the conduction system in sudden death in young adults.

The sudden death of four apparently healthy young people, three men aged 25, 24 and 21 years, respectively, and one woman aged 20 years, was investigated. The heart was of normal size in two and was slightly enlarged in two. The conduction system in all hearts was serially sectioned. In all hearts the His bundle showed loop formation. In two, the branching bundle was left-sided with the right bundle branch intramyocardial. In the other two, the His bundle was markedly fragmented. Two had myocarditis, and three had arteriolosclerosis of the summit of the ventricular septum. These findings suggest the following: autopsy may be otherwise normal or show minimal findings in cases of sudden death in young people, with significant abnormalities seen only in the conduction system. The common denominator in the conduction system may be a congenital abnormality of the His bundle (in two hearts it was fragmented, in two it was left-sided and there was loop formation in all). Acquired changes may be present, such as arteriolosclerosis of the summit of the ventricular septum (three cases), myocarditis (two cases), and fatty infiltration in the atria (all four cases), a congenital abnormality of the His bundle with or without other findings (congenital or acquired) may cause reentrant phenomena or increased automaticity, ventricular arrhythmias and sudden death.