Frequency of Hyponatremia in Adults with Acute Bacterial Meningitis

Bacterial meningitis is a life-threatening disease. Bacterial meningitis patients are prone to develop acute hyponatremia. In the central nervous system infection hyponatremia could be due to the Syndrome of Inappropriate Anti Diuretic Hormone secretion. The frequency of hyponatremia in adults with acute bacterial meningitis patients was seen in this study. This cross-sectional study was conducted in the Internal Medicine Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from February 2016 to July 2016. A total of 50 patients were enrolled in this study by purposive sampling. Among 50 acute bacterial meningitis patients, 33 (66%) were diagnosed as hyponatremic state. The mean serum sodium level of 33 hyponatremic bacterial meningitis cases was 130.66±2.95 mmol/L. Most of the cases (78.79%) were mild hyponatremic state (130 mmol/L-135 mmol/L) whereas 18.18% were revealed as moderate hyponatremia (125 mmol/L-129 mmol/L). Only 3.03% of cases were presented as severe cases (≤124 mmol/L). The result revealed that a large number of patients with acute bacterial meningitis were suffering from hyponatremia and in the majority of cases were mildly hyponatremic.

Reduction of nitrite to nitric oxide and generation of reactive chalcogen species by mononuclear Fe(II) and Zn(II) complexes of thiolate and selenolate

Comparative reactivity of a series of new Zn(II) and Fe(II) compounds, [(Py2ald)M(ER)] (E = S, R = Ph: M = Zn, 1aZn; M = Fe, 1aFe; E = S, R = 2,6-Me2-C6H3: M = Zn, 1bZn; M = Fe, 1bFe; E = Se, R = Ph: M = Zn, 2Zn; M = Fe, 2Fe), and [(Py2ald)M]22+ (M = Zn, 5Zn; M = Fe, 5Fe) is presented. Compound 1aZn could react with nitrite (NO2-) to produce [(Py2ald)Zn(ONO)] (3Zn), which, upon treatment with thiols and PhSeH (proton source), could regenerate either 1aZn/5Zn and 2Zn respectively, along with the production of nitric oxide (NO) where the yield of NO increases in the order tBuSH ≪ PhCH2SH < PhSH < PhSeH. In contrast to this, 1aFe, 2Fe and 5Fe could affect the direct reduction of NO2- in the absence of protons to generate NO and [{(Py2ald)(ONO)Fe}2-μ2-O] (8Fe). Moreover, 8Fe could regenerate 5Fe and 1aFe/2Fe upon treatment with 4 and 6 equiv. of PhEH (E = S/Se), respectively, along with the generation of NO. Finally, a comparative study of the mononuclear Zn(II) and Fe(II) compounds for the transfer of the coordinated thiolate/selenolate and the generation and transfer of reactive sulfur/selenium species (RES-, E = Se, S) to a series of organic substrates has been provided.

Hepatitis B Virus x Protein Increases Cellular OCT3/4 and MYC and Facilitates Cellular Reprogramming

Hepatitis B virus x (HBx) is a multifunctional protein coded by the Hepatitis B virus that is involved in various cellular processes such as proliferation, cell survival/apoptosis, and histone methylation. HBx was reported to be associated with liver "cancer stem cells." The stemness inducing properties of HBx could also facilitate the generation of pluripotent stem cells from somatic cells. It is well established that somatic cells can be reprogrammed to induced pluripotent stem cells (iPSCs) using a cocktail of transcription factors called Yamanaka's factors (YFs) (OCT4, SOX2, KLF4, and MYC). The reprogramming process proceeds step-by-step with reprogramming factor chromatin interactions, transcription, and chromatin states changing during transitions. HBx is a "broad spectrum trans-activator" and therefore could facilitate these transitions. We electroporated low passage and high passage (difficult to reprogram) fibroblasts using YFs with and without HBx and evaluated the reprogramming efficiency. We also investigated the tri-lineage and terminal differentiation potential of iPSC derived using HBx. We found that the addition of HBx to YF improves iPSC derivation, and it increases the efficiency of iPSC generation from "difficult or hard-to-reprogram samples" such as high passage/senescent fibroblasts. Further, we show that HBx can substitute the key transcription factor MYC in the YF cocktail to generate iPSC. The cellular levels of OCT3/4 and MYC were increased in HBx expressing cells. Our results have practical value in improving the efficiency of pluripotent stem cell derivation from "difficult to reprogram" somatic cells, in addition to providing some insights into the mechanisms of liver carcinogenesis in chronic hepatitis B. To conclude, HBx improves the reprogramming efficiency of YFs. HBx increases the cellular levels of OCT3/4 and MYC.

Atypical Presentations of Childhood Simple Partial Seizures: a Case Series

Childhood epilepsy can masquerade as a variety of psychiatric disorders or behavioural abnormalities. Differentiating between simple partial seizure and psychiatric disorders remains a challenge. We report on three children with simple partial seizure, each presented atypically with migraine, tingling sensations, and/or crying spells. When dealing with atypical symptomatology, clinicians should utilise a multidirectional, rather than unidirectional, diagnostic approach when making their diagnosis.

Understanding Conformational Changes in Human Serum Albumin and Its Interactions with Gold Nanorods: Do Flexible Regions Play a Role in Corona Formation?

The importance of protein-nanoparticle (NP) conjugates for biomedical applications has seen an exponential growth in the past few years. The protein corona formation on NPs with human serum albumin (HSA), being the most abundant protein in blood serum, has become one of the most studied protein analyses under NP-protein interactions as HSA is readily adsorbed on the surface of the NPs. Understanding the fate of the NPs in physiological media along with the change in biological responses due to the formation of the protein corona thus becomes important. We analyzed the HSA protein corona formation on gold nanorods (AuNRs) through different spectroscopic studies in addition to the effects of change in the protein concentration on the protein-NP interactions. Different imaging techniques such as high-resolution transmission electron microscopy, field emission scanning electron microscopy, and atomic force microscopy were used to determine the morphology and the dimensions of the nanorods and the protein-nanorod conjugates. Fourier-transform infrared data showed a reduction in the α-helix content and an increase in β-sheet content for the HSA-AuNR conjugate compared to the native protein. A decrease in steady-state fluorescence intensity occurred with instant addition of AuNR to HSA showing better and efficient quenching of Trp fluorescence for the lower concentration of protein. Time-correlated single photon counting results showed greater energy transfer efficiency and faster decay rate for higher concentrations of proteins. The circular dichroism study gives insight into the secondary structural changes due to unfolding, and a greater change was observed for lower concentrations of protein due to a thermodynamically stable protein corona formation. Surface-enhanced Raman spectroscopy (SERS) indicated the presence of aromatic residues such as Phe, Tyr, and Cys that appear to be close to the surface of the AuNRs in addition to hydrophobic interactions between AuNR and the protein. The disordered and flexible regions mapped onto HSA (PDB: 1AO6), predicted by the intrinsically disordered region predictors, point toward the interactions of similar residues with the nanorods observed from SERS and fluorescence studies. These studies could provide a clearer understanding of the interactions between HSA and AuNRs for possible biological applications.

An eco-friendly removal of Cd(II) utilizing banana pseudo-fibre and Moringa bark as indigenous green adsorbent and modelling of adsorption by artificial neural network

Heavy metal-contaminated water can be effectively treated using adsorbents made from abundantly available biomass. The present investigation was carried out to adsorb Cd(II) from synthetic solution by banana pseudo-stem (BP) and Moringa oleifera stem bark (MB). Adsorption efficiencies of both adsorbents were studied in the batch reactor by conducting experiments to determine the consequences of changes of pH, adsorbent dosages, initial Cd(II) concentrations, incubation time, and temperature. The process parameters were tuned to attain the highest possible removal percentage. The characterization of the adsorbents was performed by utilizing Fourier-transform infrared spectroscopy (FTIR), field emission scanning electron microscopy (FESEM), and energy-dispersive X-ray (EDX) for the fresh and metal-loaded adsorbents. Atomic absorption spectroscopy (AAS) was employed to calculate the amount of Cd(II) in an aqueous solution. The experimental data were entirely consistent with the pseudo-second-order model for BP and MB. The findings of the study illustrated the better adsorption efficiency of BP-derived adsorbent (≈ 99%) at optimum conditions over the MB (≈ 97%), and the corresponding adsorption capacities were 11.98 and 7.04 mg/g, respectively. The 4 (four) well-known isotherm models were attempted both in linear and non-linear forms. BP (R² =0.995) and MB (R² =0.994) were found to be best described by the Freundlich isotherm, which was selected based on the highest R² value. In thermodynamic studies, ΔH and ΔS were calculated for both the adsorbents. Cd(II) adsorption on BP and MB was endothermic, as evidenced by the positive ΔH. Finally, the prediction of the removal percentage was made by the artificial neural network (ANN) modelling. The present work developed regionally derived waste materials which are helpful for small-scale industrial units for their waste management in an economical and sustainable way.

Internet of Things Framework for Oxygen Saturation Monitoring in COVID-19 Environment

The pandemic/epidemic of COVID-19 has affected people worldwide. A huge number of lives succumbed to death due to the sudden outbreak of this corona virus infection. The specified symptoms of COVID-19 detection are very common like normal flu; asymptomatic version of COVID-19 has become a critical issue. Therefore, as a precautionary measurement, the oxygen level needs to be monitored by every individual if no other critical condition is found. It is not the only parameter for COVID-19 detection but, as per the suggestions by different medical organizations such as the World Health Organization, it is better to use oximeter to monitor the oxygen level in probable patients as a precaution. People are using the oximeters personally; however, not having any clue or guidance regarding the measurements obtained. Therefore, in this article, we have shown a framework of oxygen level monitoring and severity calculation and probabilistic decision of being a COVID-19 patient. This framework is also able to maintain the privacy of patient information and uses probabilistic classification to measure the severity. Results are measured based on latency of blockchain creation and overall response, throughput, detection, and severity accuracy. The analysis finds the solution efficient and significant in the Internet of Things framework for the present health hazard in our world.

The increasing trend and the seasonal variation in attendance of diffuse parenchymal lung disease patients presenting to a pulmonary clinic in Eastern India

Background:

Diffuse parenchymal lung disease (DPLD) is not an uncommon problem in clinical practice. Although the exact prevalence of DPLD in India is not known, the relative etiological distribution in DPLD in India has been reported. There has been no information as regards the seasonality of the disease.

Patients and Methods:

The archive of the Institute of Pulmocare and Research, Kolkata, was searched for the number of new patients registered at the outpatient department to a single consultant (practicing in the same style on appointment only) over years from 2009 to 2019. The attendance (absolute and relative) was arranged year wise and then month wise to look for the annual and seasonal trends, if any.

Results:

A total of 2226 patients were registered from 2009 to 2019. There has been a steady increase in both the absolute number (104 in 2009 to 204 in 2019) and the relative percentage of attendance (4.36% in 2009 to 6.9% in 2019) of new registration of DPLD patients over the years. Regarding seasonal variation, two consistent peaks in attendance have been observed as December–January and April–May over the years with dips in February and September; the first being more consistent then the latter.

Conclusions:

The increase in relative attendance in the DPLD patients over the years needs further investigation to establish a rising trends in incidence and prevalence of DPLD. The unequivocal trend in seasonal variation needs attention and further research.

Water quality assessment of the Ganges River during COVID-19 lockdown

Ganges River water quality was assessed to record the changes due to the nation-wide pandemic lockdown. Satellite-based (Sentinel-2) water quality analysis before and during lockdown was performed for seven selected locations spread across the entire stretch of the Ganges (Rishikesh-Dimond Harbour). Results revealed that due to the lockdown, the water quality of the Ganges improved with reference to specific water quality parameters, but the improvements were region specific. Along the entire stretch of Ganges, only the Haridwar site showed improvement to an extent of being potable as per the threshold set by the Central Pollution Control Board, New Delhi, India. A 55% decline in turbidity at that site during the lockdown was attributed to the abrupt halt in pilgrimage activities. Absorption by chromophoric dissolved organic matter which is an indicator of organic pollution declined all along the Ganges stretch with a maximum decline at the downstream location of Diamond Harbour. Restricted discharge of industrial effluent, urban pollution, sewage from hotels, lodges, and spiritual dwellings along the Ganges are some of the reasons behind such declines. No significant change in the geographic trend of chlorophyll-a was observed. The findings of this study highlight the importance of regular monitoring of the changes in the Ganges water quality using Sentinel-2 data to further isolate the anthropogenic impact, as India continues the phase-wise opening amidst the pandemic.

The interplay between spatial and heliconical orientational order in twist-bend nematic materials

The helical pitch formed by organic molecules, such as the α-helix of proteins, usually requires hydrogen bonding between chiral units and long-range positional order. It was recently found that certain liquid crystal oligomers can have a twist-bend nematic (NTB) phase with nanoscale heliconical structure without hydrogen bonding, molecular chirality or positional order. To understand the nature of this unique structure, here we present hard and resonant tender X-ray scattering studies of two novel sulfur containing dimer materials. We simultaneously measure the temperature dependences of the helical pitch and the correlation length of both the helical and positional order. In addition to an unexpected strong variation of the pitch with the length of the spacer connecting the monomer units, we find that at the transition to the NTB phase the positional correlation length drops. The helical structure was found not only in the NTB phase but observed even in the upper range of a smectic phase that forms just below the NTB state. The coexistence of smectic layering and the heliconical order indicates a layered (SmATB) phase wherein the rigid units of the dimers are tilted with respect to the smectic layer normal in order to accommodate the bent conformation of the dimers and the tilt direction rotates along the heliconical axis.

The Pattern of Lipid Profile in Patients with Chronic Kidney Disease

Dyslipidemia is a common problem in chronic kidney disease patients. Dyslipidemia in chronic kidney disease patients has been known to be a major risk factor of their cardiovascular disease and may contribute to progressive renal dysfunction. The result of the study might be of interest in improving preventive strategies and in management of dyslipidemia in chronic kidney disease patients. This cross sectional study was conducted to evaluate changes in lipid profile in patients with chronic kidney disease stage-3 to stage-5 patients and to correlate the biochemical abnormalities with progression of the disease in Mymensingh Medical College Hospital, Bangladesh from October, 2016 to April, 2017. In this study 200 patients were including and subjected to do complete blood count, erythrocyte sedimentation rate, random blood sugar, routine examination of urine, serum creatinine and fasting lipid profile. Two hundred (200) patients (134 males, 66 females) with the mean age were 50.5±12.43 years. 44.5% patients were in CKD stage-5, 37.5% patients were in CKD stage-4, 18% patients were in CKD stage-3. Mean value of Triglyceride (TG) was 194±47.20. Eighty nine percent (89%) patient had hyper-triglyceridemia and 11% had normal triglyceride level. It was statistically significant increased in triglyceride level (p<0.05). Mean value of High density lipoprotein cholesterol (HDL-C) was 34±6.10. Low HDL-C had in 87.5% patients, normal in 12.5% patients and was statistically significant reduction in HDL-C level (p<0.05). Low Density Lipoprotein cholesterol (LDL-C) mean was 113±35.6. High level of LDL-C had optimal/or near optimal in 47% patients, 39% patients had borderline high and 14% patients had that was not statistically significant (p>0.10). Total cholesterol (TC) mean was 212±45.3. In 38% patients had within desirable level, 62% patients had high level of Total cholesterol (TC). It was not statistically significant change (p>0.01).

Practical consensus recommendations on duration of adjuvant hormonal therapy in breast cancer

Optimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and duration of hormone therapy. Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). Expert oncologist discussed on the duration of adjuvant hormonal therapy for improvement of OS and quality of life of breast cancer patients by providing reduction in recurrence and mortality. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

A checklist of macrofungi (mushroom) diversity and distribution in the forests of Tripura, India

Abstract: The tropical region, which has the highest macrofungi diversity, has not been fully exploited instead of this is an important component of the global diversity. However, no work has been carried out to assess such diversity in Tripura. Since tropical forests are diverse in plant composition and structure, hence the objective of this study was to explore the mushroom species richness in Tripura, Northeast India with the aim of producing a checklist along with their present geographical distributions, key identification characters and valid photographs. Field surveys and collection of mushrooms were carried out in Tripura covering different sites during 2015–2018. Data on macrofungal diversity, distribution patterns and taxonomic identification were analyzed. A total of 217 wild mushrooms were documented from eight districts of Tripura, northeastern India. Out of 217 samples, 202 samples were identified up to the genus level, 125 samples were identified up to the species level.  A total of 76 genera belonging to 60 families and 25 orders were classified in this ecological study. The majority of macrofungi belong to the family Polyporaceae (30 nos), and order Agaricales (103 specimens). The wild macrofungi were collected from 56 sites of eight districts of this state and the maximum macrofungi diversity was recorded from Sepahijala District. Present findings also observed that the maximum wild fungi of this state grow on different plant parts. This is the preliminary study on documentation of wild macrofungi from eight districts of Tripura, northeastern India and it will be used as a reference database of wild mushrooms of this state, which will also help in future research work in different fields.

Acute Traumatic Cervical Central Cord Syndrome—Is Early Intervention Justified?

The clinical features suggestive of traumatic central cord syndrome (TCCS) were presented by Thorburn in his publication in 1887. Later in 1954, Schneider first mentioned the involvement of central cervical spinal cord after an acute cervical spine injury and described it as TCCS. This is generally caused due to an extreme hyperextension injury without vertebral damage and secondary to anteroposterior pinching or squeezing of the spinal cord. There exists a lot of controversy whether early surgical intervention is justified in these patients. It is to assess our own results that we decided to review 40 such cases treated by the senior author in the past 8 years. Twenty-four of these were managed with early surgical intervention (which we defined as within 48 hours), and 16 were treated conservatively. In all cases, the existence of fracture-dislocation, disc prolapse, as well as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and exact motor and sensory deficit were recorded. The numbers are too few, but there was definite evidence that patients with disc prolapse and fracture dislocation did better with surgery than with conservative treatment. Those with grade 0 power in the upper limbs however did significantly better with surgical treatment. Those with advanced pre-existing cervical spondylotic changes did better than those without these premorbid changes. However, the numbers are too small for meaningful statistical analysis. This is a retrospective study conducted as a pilot study to plan for a future randomized study, which is very necessary in our clinical practice. Currently, we still quote the pros and cons of surgical intervention to the relatives and go by their choice.

Impact of conventional retting of jute (Corchorus spp.) on the environmental quality of water: a case study

Production of quality jute fibre primarily depends on the retting process of jute. However, the quality of retting water is of great concern because of the scarcity of available water bodies for retting. A study conducted on physico-chemical and microbiological changes in retting water (pre- and post-retting) from four intensively jute-growing districts namely Nadia, North 24 Parganas, Hooghly and South Dinajpur of West Bengal, India, during jute retting. The post-retting water samples recorded lower pH (6.22 to 7.08) and higher EC (electrical conductivity) (0.509 to 0.850 ds/m) compared with pre-retting water samples (pH 6.63 to 7.44; EC 0.197 to 0.330 ds/m) collected from all the four districts under study. The biological oxygen demand (BOD) and chemical oxygen demand (COD) increased several folds in the post-retting water samples indicating very high microbial growth and activities and depleted oxygen level compared with pre-retting water. The Ca + Mg (calcium + magnesium) content in pre-retting water was high (24.15 to 36.60 ppm) which raised further (61.30 to 103.67 ppm) in post-retting water, while the bicarbonate content also increased and ranged between 2.72 and 6.81 me/l in post-retting water compared with its status in pre-retting water (1.30 to 3.15 me/l). The post-retting water was found to be a rich source of nutrients like nitrogen (N), phosphorus (P), iron (Fe), manganese (Mn), zinc (Zn) and copper (Cu) which increased substantially because of jute retting as compared with their status in pre-retting water. The population of pectinolytic, xylanolytic, cellulolytic and ligninolytic bacterial cfu (colony forming unit) increased by 1.5 times in post-retting water as compared with pre-retting water, because these specific bacterial population were involved in the degradation of pectin, xylan, cellulose and lignin during retting of jute. Thus, post-retting water can be judiciously used as a potent source of primary, secondary and micronutrients for succeeding crops besides having higher BOD and COD as a result of higher microbial growth related to jute retting.

Coenzyme Q10 ameliorates cadmium induced reproductive toxicity in male rats

This study aimed at investigating the protective role of CoQ10 against cadmium (Cd)-induced reproductive toxicity in male rats. Adult male Wistar rats were exposed to an acute dose of Cd (25 mg/kg bwt; Cd group), Cd+CoQ10 (25 mg/kg bwt Cd+10 mg CoQ10; Cd-Q10 group) and distilled water (control) in vivo for 15 consecutive days and semen quality was assessed. A significant reduction was noted in sperm concentration, progressive motility, morphology and DNA integrity in both Cd- and Cd-Q10 groups in comparison to control indicating Cd-induced testicular lipid per oxidation (LPO) and decline in indigenous antioxidant defense system as measured by total antioxidant capacity (TAC) (p<0.05). However, simultaneous co-administration of CoQ10 along with Cd (Cd-Q10 group) was able to improve sperm concentration, motility, progressive motility, morphology, DNA integrity, and testicular TAC as well as lower LPO compared to Cd group (p<0.05). Results indicate that used dose of CoQ10 is capable of moderately ameliorating reproductive toxicity of Cd by improving semen quality and reducing testicular oxidative stress.

"Psychiatric assessment of deaf and mute patients - A case series"

Deafness is negatively associated with higher distress, depression, somatization, and loneliness in patients of all age groups. The psychiatric presentation of patient also varies. Due to lack of proper communication, clinical approach often becomes quite difficult. We will be discussing various psychiatric presentations in 3 different deaf mute patients. We will also be highlighting the different clinical approach applied to all the patients. This case series might help in giving an insight into the psychiatric symptoms of deaf mute patients which might pave way for new diagnostic guidelines for future research and in clinical practice.

Primary Delusion and the Sociopolitical Milieu in India - A Case Report & Short Review

Delusion has always been a central topic for psychiatric research with regard to its etiology, pathogenesis, diagnosis, treatment, and forensic relevance. Among these, primary delusion seems to be the interest of many psychiatrists. Content of delusion has always been the area of interest of cultural psychiatry. We have tried to discuss the various aspects of primary delusion and also tried to explain how cultural and sociopolitical environment in a country like India can shape the formation of primary delusion and influence its psychopathology.

Infanticide by a mother with untreated schizophrenia

This case report describes a 30-year-old mother of four with a 6-year history of obvious paranoia and psychosis from a poor rural farming community in India. Her symptoms and social functioning deteriorated over time, but the family did not seek medical care until she killed her 3-month-old daughter while under the influence of command hallucinations. Subsequent treatment with antipsychotic medication resulted in control of her psychotic symptoms and greatly improved psychosocial functioning. This case is an example of one of the many negative consequences of a community’s failure to recognize and treat mental illnesses. The patient had severe symptoms that were obvious to all for 6 years prior to the infanticide, but the family’s lack of basic knowledge about mental illness, the lack of locally available mental health care, and the relatively high cost of care prevented family members from obtaining the treatment that almost certainly would have prevented the tragic death of her infant. Changing these three factors in poor rural communities of low- and middle-income countries is the challenge we must work together to address. Infanticide secondary to untreated mental illness is a glaring reminder of how urgent this task is.

Psychiatric presentation of childhood epilepsy: Case series and review

Childhood-onset epilepsy has a varied presentation and may have different etiological factors. A multiaxial diagnostic approach should be used before making treatment and management decisions for any individual patient. It is widely accepted that distinction among primary psychiatric disorders, epilepsy, and nonepileptic seizures is a challenge for physicians. This case series demonstrated the identification of three atypical presentations of seizures in children on the basis of detailed history taking and electroencephalogram findings, despite having normal findings in neurological examination and magnetic resonance imaging. We report three rare cases of atypical presentation in epilepsy in patients with symptoms of episodic hallucinations, rage attacks, and secondary enuresis. Clinically, the diagnosis of epilepsy can be strengthened by paying sufficient attention to detailed history and symptom spectrum of partial epilepsy.

Selective picomolar level fluorometric sensing of the Cr(vi)-oxoanion in a water medium by a novel metal–organic complex

Selective picomolar level fluorometric sensing of the Cr(vi)-oxoanion in a water medium has been achieved by a novel metal–organic complex.

Burden Assessment, Psychiatric Morbidity, and Their Correlates in Caregivers of Patients with Intellectual Disability

OBJECTIVE

Intellectual disability in a child places great stress on a family and caregiver and this leads to significant socio-occupational dysfunction and impaired quality of life for caregivers. This study aimed to assess socio-demographic characteristics, burden, and psychiatric morbidity of the caregivers of persons with intellectual disability, as well as to determine the variables that correlated with burden and psychiatric morbidity.

METHODS

An observational study was carried out in an outpatient psychiatric unit of a tertiary care teaching hospital in India from October 2014 to April 2015. A total of 100 caregivers of intellectually impaired individuals were assessed for burden and psychiatric morbidity.

RESULTS

In all, 39% of the caregivers had a high burden score, 46% perceived mild-to-moderate burden severity, and 15% perceived no to mild burden. Mild-to-moderate depressive symptoms were present in 23% and 16% had severe-to-extremely severe depressive symptoms. Mild-to-moderate anxiety symptoms were evident in 19% of caregivers and a further 19% had severe-to-extremely severe anxiety symptoms.

CONCLUSION

Routine assessment of burden and psychiatric morbidity in the caregiver will help to reduce their burden and thus help them care for their children more appropriately and efficiently.

Risk Factor Analysis for Oral Precancer among Slum Dwellers in Delhi, India

Background:

An outfall of urbanization in developing countries has been the mushrooming of slums where dwellers live in pitiable environmental conditions representing the lowest rung of social strata. This group is more vulnerable to practicing deleterious social habits, including tobacco and alcohol abuse.

Aim:

The present study was undertaken to understand the strength of association between risk factors suspected of causing oral precancer among slum dwellers in Delhi.

Subjects and Methods:

A house-to-house survey was conducted in an urban slum cluster situated in the heart of Delhi city by a single trained investigator who recorded oral mucosal lesions according to WHO criteria. Demographic details and history of suspected risk factors was recorded by personal interview of each subject. The obtained data was coded, cleaned, and analyzed manually. Chi-square test was applied and Odds’ ratios were calculated to analyze the association of risk factors with oral precancer. A statistically significant difference was set at 95% confidence interval.

Results:

A total of 479 subjects of both sexes were examined and 31 cases clinically diagnosed as having oral precancer, of which majority were leukoplakia. All cases except one reported practicing habits that are known risk factors for oral precancer, i.e., smoking/smokeless tobacco, chewing betel leaf/nut, and combination of these habits with alcohol. Association of oral precancer with smokeless tobacco was higher than that with smoking or chewing betel leaf/nut alone.

Conclusion:

Practicing combination of habits with alcohol was found to be the most strongly associated risk factor for oral precancer.

Obstetric Emergencies: Feto-maternal Outcome at a Teaching Hospital

Aims: This study was done to know the pattern of obstetric emergencies and its influence on maternal and fetal outcome. Methods: A descriptive study was carried out in the department of obstetrics and gynecology at Kathmandu Medical College Teaching Hospital from 1st June 2013 to 31st May 2014. Cases were categorized as early pregnancy emergencies (ruptured ectopic pregnancy, complications of abortion), ante-partum emergencies and intra-partum emergencies (antepartum haemorrhage, preeclampsia, eclampsia, preterm prelabor rupture of membranes, rupture uterus), post-partum emergencies (postpartum haemorrhage, retained placenta, placenta accreta, uterine inversion), puerperal emergencies (postpartum sepsis), fetal emergencies (cord prolapse, shoulder dystocia). Outcome noted were type of emergency, obstetric intervention done, maternal and perinatal morbidity and mortality. Results: A total of 80 (4.45%) obstetric emergencies occurred among 1796 deliveries .The most common obstetric emergencies were obstetric hemorrhage (62.5%), severe preeclampsia (23.5%) and preterm prelabor rupture of membranes (10%). The obstetric interventions done were cesarean section (43.75%), exploratory laparotomy (33.75%) and blood transfusion (40%). Obstetric emergencies were responsible for 66.6% of total maternal death and 24.56% of total perinatal death. Conclusions: In spite of best efforts, some obstetric emergencies do occur. Obstetric hemorrhage and severe preeclampsia are the frequent obstetric emergencies. Cesarean section, exploratory laparotomy and blood transfusion were the commonly performed interventions. A better outcome can be achieved by national policy of promoting utilization of antenatal care, institutional deliveries, skilled birth attendance at delivery, liberal blood transfusion and regular training of doctors and nurses. DOI: http://dx.doi.org/10.3126/njog.v9i1.11186 NJOG 2014 Jan-Jun; 2(1):37-40

Non-descent Vaginal Hysterectomy: Safety and Feasibility

Aims: To assess safety and feasibility of non-descent vaginal hysterectomy. Methods: A hospital based prospective study was conducted at the department of obstetrics and gynecology of Kathmandu Medical College Teaching Hospital from 1st January 2010 to 31st December 2011. All the patients undergoing non -descent vaginal hysterectomy for benign indication, without suspected adnexal pathology were included in the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size ,estimated blood loss, length of operation, complication and hospital stay were recorded. Results: A total of 50 cases were selected for non-descent vaginal hysterectomy. Among them 43 cases successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 40%. All patients were parous. Uterus size was <10 weeks in 27 cases and >10 weeks in 23 cases. Commonest indication was leiomyoma of uterus (63%). Mean duration of surgery was two hours. Mean blood loss was 205.26ml. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in three cases. In rest of four cases there was difficulty in reaching the myoma and transverse diameter was too large so as to prevent descent of the uterus. The most common complication was post –operative pain in 23% of cases. Febrile morbidity was present in 4.6% of cases. Blood transfusion was required in seven cases. Average duration of hospital stay was three days. Conclusions: Vaginal hysterectomy for benign gynecological causes other than prolapse is safe and feasible. For successful outcome size of uterus, size in all dimensions and location of fibroid should be taken into consideration.Today in the era of minimally invasive surgery, non descent vaginal hysterectomy needs to be considered and seems to be a safe option. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11134   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 14-16

Subcutaneous mycoses caused by Rhytidhysteron species in an immunocompetent patient

Subcutaneous mycoses are chronic fungal infections of the skin and subcutaneous tissues caused by variety of fungal agents and usually occur following trauma with vegetative matter. We report a case of subcutaneous mycoses caused by rare fungus belonging to the genus Rhytidhysteron, in an immunocompetent male who presented with a subcutaneous nodule on left foot. This unusual species was identified and confirmed by molecular methods.

GA-optimized feedforward-PID tracking control for a rugged electrohydraulic system design

Rugged electrohydraulic systems are preferred for remote and harsh applications. Despite the low bandwidth, large deadband and flow nonlinearities in proportional valves valve and highly nonlinear friction in industry-grade cylinders that comprise rugged systems, their maintenance are much easier than very sophisticated and delicate servocontrol and servocylinder systems. With the target of making the easily maintainable system to perform comparably to a servosystem, a feedforward control has been designed here for compensating the nonlinearities. A PID feedback of the piston displacement has been employed in tandem for absorbing the unmodeled effects. All the controller parameters have been optimized by a real-coded genetic algorithm. The agreement between the achieved real-time responses for step and sinusoidal demands with those achieved by modern servosystems clearly establishes the acceptability of the controller design.

Effect of Some Non Functional Surfactants and Electrolytes on the Hexavalent Chromium Reduction by Glycerol: A Mechanistic Study

Hexavalent chromium is a widespread environmental contaminant and a known human carcinogen. Kinetics of reduction of hexavalent chromium by bio-molecule glycerol in micellar media have been studied spectrophotometrically. The cytoplasmic reduction of hexavalent chromium to trivalent chromium occurs in micro-heterogeneous systems. In vitro, the micelles are considered to mimic the cellular membranes. The electron transfer processes occurring in the micellar systems is considered as model to obtain insight into the electron transport process prevailing in biological systems. Micellar media is also a probe to establish the mechanistic paths of reduction of hexavalent chromium to trivalent chromium. Effects of electrolytes common to biological system are studied to establish the proposed reaction mechanism strongly.

Stability-indicating Reversed-phase Liquid Chromatographic Method for Simultaneous Determination of Losartan Potassium and Ramipril in Tablets

A stability-indicating reversed-phase liquid chromatographic method has been developed and validated for simultaneous determination of losartan potassium and ramipril. Separations were achieved using a C(18) column with mobile phase consisting of acetonitrile and (0.2% v/v, pH 2.5) aqueous trifluoroacetic acid (45:55, v/v) in isocratic mode at 1 ml/min flow rate. Column effluent was monitored at 210 nm using a UV detector. The method was validated for selectivity, linearity, accuracy, precision, sensitivity and robustness. Novel microwave-assisted forced degradation technique was employed for evaluation of selectivity. The method demonstrated excellent linearity for losartan potassium and ramipril with regression coefficients of 0.9999 and 0.9998, respectively. The linearity range was found to be 62.5-5000 ng/ml and 125-10,000 ng/ml with the mean percentage recoveries of 100.36% (±2.27) and 100.16% (±3.33) for losartan potassium and ramipril, respectively. In a robustness study, a full factorial design revealed that the analytical response remains unaffected by small variations in the critical chromatographic factors. The method was found to be sensitive with quantification limits of 44.30 and 79.93 ng/ml for losartan potassium and ramipril. The method was successfully employed for the determination of losartan potassium and ramipril in commercially available and in-house prepared tablets.

Hip fracture patients in India have vitamin D deficiency and secondary hyperparathyroidism

SUMMARY

This study evaluated the parameters of bone mineral homeostasis including 25(OH)D and PTH in 90 Indian patients with hip fracture and 90 controls. Hypovitaminosis D, secondary hyperparathyroidism, and biochemical osteomalacia was present in 77, 69, and 50 % patients, respectively, significantly higher compared to controls. Vitamin D deficiency is an important risk factor for hip fracture.

INTRODUCTION

The prevalence of vitamin D deficiency is not well known in hip fracture patients from India. Therefore, the present study was conducted to evaluate the parameters of bone mineral homeostasis including 25(OH)D and intact PTH in hip fracture from North India.

METHODS

Ninety consecutive patients with hip fracture and similar number of age- and sex-matched controls were enrolled in the study. The fasting venous samples were analyzed for 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium, and phosphorus. Vitamin D deficiency was defined as serum 25-OHD of <20 ng/dl.

RESULTS

The mean age of hip fracture subjects was 65.9 ± 12.6 which was comparable in men and women. Majority of study subjects were women (70 women and 20 men). The serum 25(OH)D and calcium levels were significantly lower, whereas the intact PTH and ALP levels were significantly higher in patients compared to controls. There was significant negative correlation between serum 25(OH)D and PTH. In the hip fracture group, 76.7 % of the subjects had vitamin D deficiency, and 68.9 % had secondary hyperparathyroidism. In the control group, vitamin D deficiency and elevated PTH levels were seen in 32.3 and 42.2 %, respectively.

CONCLUSION

About three fourths of hip fracture patients have vitamin D deficiency, and two thirds have secondary hyperparathyroidism. Therefore, the serum 25-OHD level may be a useful index for the assessment of risk of hip fracture in India.

Experiences of gynecological laparoscopic surgeries in a teaching hospital

BACKGROUND

Laparoscopic surgery has revolutionised the field of gynaecological surgery. Presently, almost all gynaecological procedures can find an alternative laparoscopic or hysterescopic approach. The aim of the study was to share the early experience of gynecological laparoscopic surgeries performed at Kathmandu Medical College Teaching Hospital.

METHODS

A study was carried out at Kathmandu Medical College Teaching Hospital from 1st January 2009 to 16th August 2012. All the patients undergoing gynecological laparoscopic surgeries were analyzed for the indication, type of procedure and its complications.

RESULTS

Overall 300 patients successfully underwent laparoscopy during the study period of which diagnostic laparoscopy was in 115. Operative laparoscopy was in 185. Sixty five cases underwent laparoscopic cystectomy. Sixty cases underwent laparoscopic assisted vaginal hysterectomy (LAVH). Salpingectomy for ectopic pregnancy was done in sixteen cases. Twelve cases contemplated for laparoscopic cystectomy underwent laparotomy. LAVH was converted to abdominal hysterectomy in four cases and laparotomy was done in two cases because of bladder injury and primary hemorrhage (from vault). Of minor complications the most common was port site infection and post-operative nausea and vomiting.

CONCLUSIONS

Laparoscopic gynecological surgery has tremendous potential in Nepal. Most of the surgeries can be carried out safely and favorable outcome has been noted in all the cases undertaken.