Automated classification of hidradenitis suppurativa disease severity by convolutional neural network analyses using calibrated clinical images

BACKGROUND

The assessment of hidradenitis suppurativa (HS) severity requires detailed, and error-prone lesion counts. This proof-of-concept study aimed to automatically classify HS disease severity using machine learning of clinical smartphone images.

METHODS

777 ambient-light and size-controlled images were used to build a class-balanced synthetic dataset (n = 7675). Convolutional neural networks (CNN) were used for automated severity classification (scale 0-3), and to assess disease-dynamics. International Hidradenitis Suppurativa Severity Score System (IHS4) served as reference. A U-NET algorithm was implemented for automated localization of diseased skin.

RESULTS

CNNs were able to distinguish no/mild from moderate/severe disease with an overall prediction accuracy of 78% [receiver operating curve (AUC) 0.85]. Correct IHS4 classification was achieved with an overall accuracy of 72% (AUC 0.84-0.89). In addition, disease dynamics using IHS4 numerical values aligned with CNN outputs (NRMSE 0.262). The UNET algorithm localized lesions with a pixel accuracy of 88.1% and test loss of 0.42.

LIMITATIONS

Limitations in assessing tattooed and hairy skin. Limited number of patients with dark skin colour and Hurley I.

CONCLUSION

CNNs were able to distinguish no/mild from moderate/severe disease, classify disease severity over time, and automatically identify diseased skin areas and the skin phototype. This study breaks new grounds for fast, reliable, reproducible and easy-to-use HS severity assessments using clinical images.

Expert panel recommendations for topical hemostatic agent use in varied bleeding sites and situations during neuro-spine surgeries

Intraoperative bleeding poses a substantial challenge, particularly in neuro-spine surgeries leading to complications such as hematomas, infections, and hemodynamic instability. Despite their proven efficacy, use of topical hemostatic agents (THAs) lacks comprehensive published literature and guidelines particularly in the Indian setting. The present study provides the first-ever Indian expert panel recommendations for effective adjunct THA use in different intraoperative bleeding sites and situations in neuro-spine surgeries. A comprehensive approach, encompassing a literature review, followed by experience sharing in a meeting using a survey helped integrate expert opinions in the form of practical algorithms to guide THA selection. Our survey results revealed a strong inclination towards specific THAs, flowable gelatin + thrombin being choice of THA for difficult to access and problematic bleeding situations during tumor removal/resection, transsphenoidal hypophysectomy and skull-based procedures. Both oxidized regenerated cellulose (ORC)/Fibrillar and flowable gelatin + thrombin were recommended for continuous oozing. ORC/Fibrillar was preferred for arteriovenous and cavernous malformations. This expert-panel guidance on THA use aims to optimize hemostat use practices and improve surgical outcomes in neuro-spine surgery.

IGF-1 stabilizes goat sperm mitochondrial transmembrane potential and reduces dna fragmentation

BACKGROUND

Antioxidant present in sperm cells protects them from oxidative damage. However, sperm are more susceptible to peroxidative damages due to the loss of these enzymes during cryopreservation and their survival and fertility may be compromised. Insulin like growth factor-1 (IGF-1) has an antioxidant effect and could maintain sperm motility.

OBJECTIVE

To improve seminal parameters, mitochondrial membrane potential (MMP), oxidative status and DNA integrity of buck semen after freeze-thawing by fortification of goat semen diluent with various concentrations of IGF-1.

MATERIALS AND METHODS

Fifty ejaculates were collected and were extended with tris- citric acid- fructose diluent with 10% egg yolk and 6% glycerol with sperm concentrations of 1×108 mL-1. Post-cryopreserved sperm were assessed for motility and a range of other functional parameters.

RESULTS

In post-thaw semen sperm motility, live sperm count, acrosome integrity, hypo-osmotic swelling positive spermatozoa, malondialdehyde (MDA), protein carbonyl content (PCC), TUNEL positive sperm differed significantly (P<0.05) with the various concentrations of IGF-1 used. Sperm functional parameters post-thawing were significantly (P<0.05) better in 250 ng/mL IGF-1. IGF-1 protects against lipid peroxidation by lowering MDA and PCC production, thus reducing the harmful effect of reactive oxygen species. The kidding percentage using the artificial insemination technique was significantly higher ( i.e., 40%) in the group supplemented with 250 ng/mL of IGF-1 than in the non-supplemented group (i.e., 30%).

CONCLUSION

IGF-1 may be used to improve post-thaw semen quality and fertility as measured by actual kidding rate. Doi.org/10.54680/fr23610110312.

Single parent adoption in India: Mental health and legal perspectives and the way forward

Single parent adoption (SPA) is a relatively new construct worldwide and in India. The Ministry of Women and Child Development, Government of India, has laid down criteria for adoption in general and SPA in particular, in conjunction with the Juvenile Justice Act (Care and Protection of Children), 2015. There is scant literature on this topic of SPA, more so in India, that looks into the various psychological nuances of SPA from a mental health professional's (MHP) perspective. This review paper aims to assess SPA from the perspective of a MHP that will focus on its various legal nuances as well as the psychological connotations attached to it. For this, a search strategy was employed that included a thorough literature search from two databases (PubMed and Google Scholar) with relevant keywords related to the topic. The various legal issues pertaining to SPA in the current scenario, the psychological issues and challenges faced by single parents, the behavioral outcomes of adoptees who are adopted by single parents, and ways to deal with the various obstacles of SPA are discussed.

16 Horner Syndrome: Can it be Familial? Case series in a family and review of literature

Ophthalmic literature reveals vague and rare references to Horner syndrome on a hereditary basis. We present a case series of mother and son with Horner syndrome, which was confirmed pharmacologically. They noticed symptoms on the same side at a similar age and no serious pathology was found.Retrospective case review of notes:Case 1: An 11-year-old male presented with 6 week history of anisocoria, mild right ptosis, no heterochromia and no history of trauma or previous surgeries. The anisocoria was more noticeable in the dark, Horner syndrome was confirmed with apraclonidine test.Case 2: Mother of case 1, 50-year-old female diagnosed with right Horner syndrome at the age of 14 in Austria. The presenting features were anisocoria, a lack of sweating on the right side of her face. Diagnosis was reconfirmed pharmacologically.Case 1 was referred to paediatrics for a systemic examination which was normal. He was investigated with urinary catecholamines, MRI head and CT neck and thorax which were all normal. Case 2 was investigated in the past with a normal CT head.Horner syndrome results in the interruption of the oculo-sympathetic pathway and can indicate serious pathology in the head, chest or neck. Our cases demonstrate that familial presentation could indicate an idiopathic aetiology as it is unlikely to have pathological Horner syndrome in two first degree relatives.Our case series highlights the importance of eliciting a family history of Horner syndrome and examining the family members. Positive family history can reassure patients while awaiting results of investigations.

Transformation of HHV-8-negative idiopathic multicentric Castleman disease into diffuse large B-cell lymphoma: A case report from Nepal

Key Clinical Message

Idiopathic Castleman disease transforming into Diffuse Large B-cell Lymphoma has an aggressive course and can lead to mortality. Hence, early diagnosis and intervention are required.

Abstract

Idiopathic Castleman disease transforming into non-Hodgkin lymphoma has an aggressive course, poor prognosis, and high mortality rate. Hence, early diagnosis and intervention are necessary. In a developing country like Nepal, where infectious diseases, particularly TB, are high, concomitant infection worsens the disease course. It also poses a diagnostic challenge as the clinical presentation may be similar.

Management of mad honey intoxication with suspected anaphylaxis in Nepal: a case report

Consumption of mad honey can lead to intoxication. The exact incidence of mad honey-induced intoxication is unknown. Typically, the patients present with dizziness, nausea, syncope, and sinus bradycardia.

Case presentation

The authors reported the case of a middle-aged male patient who presented with blurring of vision, passage of loose stools, vomiting, and profuse sweating after ingestion of honey. He also had a history of loss of consciousness. On presentation, he was hypotensive and tachypneic with cold, clammy extremities. His ECG showed sinus bradycardia. The authors made a diagnosis of mad honey intoxication with suspected anaphylaxis. The authors treated him with intravenous normal saline, epinephrine, and atropine. He again developed hypotension and bradycardia in a few hours, for which hydrocortisone was administered, following which his heart rate was normalized in 2 h. Overall, the recovery time in our patient was 8 h. The patient was counseled to avoid consuming mad honey and did well on his monthly follow-up.

Discussion

Our patient had signs and symptoms suggesting intoxication following ingestion of mad honey with suspicion of anaphylaxis. Similar to other reported cases, the patient had sinus bradycardia and hypotension. Epinephrine and atropine were administered to treat hypotension and bradycardia, respectively. Also, refractory hypotension was managed by intravenous hydrocortisone. Usually, atropine and saline infusion are sufficient to manage these cases, and simultaneous use of epinephrine and atropine should be avoided unless indicated.

Conclusion

Our case highlighted the approach to diagnosing and treating mad honey intoxication with suspected anaphylaxis.

A single N-terminal amino acid determines the distinct roles of histones H3 and H3.3 in the Drosophila male germline stem cell lineage

Adult stem cells undergo asymmetric cell divisions to produce 2 daughter cells with distinct cell fates: one capable of self-renewal and the other committed for differentiation. Misregulation of this delicate balance can lead to cancer and tissue degeneration. During asymmetric division of Drosophila male germline stem cells (GSCs), preexisting (old) and newly synthesized histone H3 are differentially segregated, whereas old and new histone variant H3.3 are more equally inherited. However, what underlies these distinct inheritance patterns remains unknown. Here, we report that the N-terminal tails of H3 and H3.3 are critical for their inheritance patterns, as well as GSC maintenance and proper differentiation. H3 and H3.3 differ at the 31st position in their N-termini with Alanine for H3 and Serine for H3.3. By swapping these 2 amino acids, we generated 2 mutant histones (i.e., H3A31S and H3.3S31A). Upon expressing them in the early-stage germline, we identified opposing phenotypes: overpopulation of early-stage germ cells in the H3A31S-expressing testes and significant germ cell loss in testes expressing the H3.3S31A. Asymmetric H3 inheritance is disrupted in the H3A31S-expressing GSCs, due to misincorporation of old histones between sister chromatids during DNA replication. Furthermore, H3.3S31A mutation accelerates old histone turnover in the GSCs. Finally, using a modified Chromatin Immunocleavage assay on early-stage germ cells, we found that H3A31S has enhanced occupancy at promoters and transcription starting sites compared with H3, while H3.3S31A is more enriched at transcriptionally silent intergenic regions compared to H3.3. Overall, these results suggest that the 31st amino acids for both H3 and H3.3 are critical for their proper genomic occupancy and function. Together, our findings indicate a critical role for the different amino acid composition of the N-terminal tails between H3 and H3.3 in an endogenous stem cell lineage and provide insights into the importance of proper histone inheritance in specifying cell fates and regulating cellular differentiation.

Diagnostic Dilemma of Frozen Shoulder in Post CABG Patient: A Case Report

Frozen shoulder, also known as adhesive capsulitis, is a condition featured by stiffness and pain in shoulder joint. In this report, we present a case of 58 years old diabetic male patient with the history of coronary artery bypass grafting (CABG) 06 months back. He presented with persistent right shoulder pain for 05 months. Clinical examinations reveal restriction of the right shoulder joint movement in all directions and wasting of the right supraspinatus, infraspinatus and trapezius muscles. Both active and passive range of motions was restricted with painful right shoulder joint. Pain free abduction range was about 40 degrees in right shoulder. Plain X-ray of right shoulder joint and other relevant investigations show normal findings. Considering the clinical and laboratory findings decision was taken to treat the patient with exercise, pain killer and ultrasound therapy which were found to be optimistic.

Quantitative imaging of chromatin inheritance using a dual-color histone in Drosophila germinal stem cells

We detail a stepwise protocol for the investigation and quantification of chromatin features during asymmetric cell division (ACD) of Drosophila germline stem cells (GSCs). We describe the use of a dual-color histone to study the inheritance of new and old histones. We detail steps for imaging and analysis of sister chromatid condensation dynamics and nucleosome density changes. In addition, this protocol could be applied to identify stem cells, which can be challenging to identify in intact tissues. For complete details on the use and execution of this protocol, please refer to Tran et al. (2012), Ranjan et al. (2019), and Ranjan et al. (2022).

DPIO Function among Normal Hearing Middle-Aged Adults in Sudarshan Kriya Yoga Practitioners and Non-Practitioners

The cochlea, to function efficiently towards hearing, the oxygenated blood supply is a very essential component. Yoga, a practice that originated in ancient India, claims to facilitate physical, mental, and spiritual well-being. Sudarshan Kriya Yoga (SKY) is one such practice that focuses on breathing, therefore, regulating the oxygen circulation in our body. The benefits on practicing SKY have been reported to increase oxygenated blood supply to the respective cells or tissues. DPIO is a measure of cochlear growth function that reflects the basilar membrane function and is sensitive to even a small alteration in the amount of function. Therefore, to analyze if there is an increase in the hair cell function, we compare it between the SKY practitioners and a control group of 70 middle-aged adults (40-65 years old; 35 subjects in each group) who have their hearing sensitivity within normal limits through DPIO measure. Student 't' test was used to compare the mean difference between the two groups. The results revealed that there is a significant difference between both groups with respect to the DPIO amplitude (p-value ≤ 0.05). The study concludes enhanced amplitude on DPIO measure among individuals who practice SKY when compared to nonpractitioners of SKY.

Asymmetric Histone Inheritance: Establishment, Recognition, and Execution

The discovery of biased histone inheritance in asymmetrically dividing Drosophila melanogaster male germline stem cells demonstrates one means to produce two distinct daughter cells with identical genetic material. This inspired further studies in different systems, which revealed that this phenomenon may be a widespread mechanism to introduce cellular diversity. While the extent of asymmetric histone inheritance could vary among systems, this phenomenon is proposed to occur in three steps: first, establishment of histone asymmetry between sister chromatids during DNA replication; second, recognition of sister chromatids carrying asymmetric histone information during mitosis; and third, execution of this asymmetry in the resulting daughter cells. By compiling the current knowledge from diverse eukaryotic systems, this review comprehensively details and compares known chromatin factors, mitotic machinery components, and cell cycle regulators that may contribute to each of these three steps. Also discussed are potential mechanisms that introduce and regulate variable histone inheritance modes and how these different modes may contribute to cell fate decisions in multicellular organisms.

Gastrointestinal Lesions and Its Associated Factors in Adult Males With Iron Deficiency Anaemia: A Cross-Sectional Study From Tertiary Care Centre of North India

Background

Around 30% of the world's population suffers from iron deficiency anaemia (IDA). The standard evaluation for IDA involves upper and lower endoscopy, which allows for the confirmation of pathology of the gastrointestinal tract (GIT) induced due to IDA through iron malabsorption mechanism or loss of blood. Assessing the prevalence of lesions of GIT of significant nature among males having IDA, was the goal of our study.

Methods

Our cross-sectional study was conducted for two years and involved 152 males (adults) with confirmed cases of IDA from the Outpatient (OPD) and In-patient (IPD) in the present hospital. Following collecting consent (both informed and written in nature), patient-specific data was collected in a standardized form, and a blood sample was taken for laboratory testing. The analyses were done at a 5% level of significance; an association was considered significant if the p-value < 0.05.

Results

The average age of the study participants was 59.6 years. The commonest lesions reported were antral gastritis (9.9%) and H. pylori gastritis (7.2%) in upper GI; and haemorrhoid (9.2%) and anal fissure (3.9%) in lower GI. The overall prevalence of any GI lesions was 65.1%. The GI lesions were significantly associated higher among men with age > 50 years (73.7%). The presence of occult blood in stools (p < 0.0001) and parasites in stools (p=0.0001) were significantly related to the presence of GI lesions.

Conclusion

GI lesions are frequently detected in males with IDA. Whether it is symptomatic male or asymptomatic male with anaemia refractory to iron treatment, GIT should be evaluated in them.

Interrelationship of Metabolic Syndrome and Rheumatoid Arthritis in North Indian Population

Objective: The metabolic syndrome (MetS) may be responsible for occurrence of high frequency of cardiovascular disease in rheumatoid arthritis (RA) patients. An association between inflammatory activity of RA and MetS has also been speculated. This study was designed to see whether presence of MetS along with RA increases the severity of disease and to find the risk association of the disease severity markers of RA namely TNF-α, anti-CCP, RF, CRP and ESR with MetS. Methodology: 185 patients of RA (EULAR 2010) were recruited and assessed for MetS according to NCEP/ATP III criteria. Serum level of disease specific biomarkers of RA namely TNF-α, anti-CCP, RF, CRP and ESR were quantified in all patients and compared between RA with MetS and only RA patients. Cytokine TNF-α, anti-CCP, RF, and CRP were assayed through ELISA. Results: The prevalence of MetS among RA patients was 41.2%. The mean age of RA cases with MetS is significantly older (55.65yrs) with increased disease duration. The levels of TNF-α, anti-CCP, CRP and ESR along with EULAR & DAS score were significantly (p<0.05) high in RA with MetS. TNF-α showed maximum risk (OR=6.3; p=0.03) in development of MetS. Longer disease duration with high anti-CCP, CRP and DAS-28 were also contributing significantly in MetS development. Conclusion: A positive vicious cycle is working between the pathogenesis of RA and MetS through inflammatory cytokines and biomarkers. MetS in RA is associated with increased disease severity. Keywords: Rheumatoid arthritis, Metabolic syndrome, Biomarkers, Cytokine TNF-α, Disease severity

Cardiovascular Manifestations in Hyperthyroidism: A Cross-Sectional Study in a Tertiary Care Hospital in South India

Background

The involvement of the heart in hyperthyroidism patients has a considerable prognostic value and causes significant morbidity and mortality. However, very little research, particularly among the Indian population, has addressed the most critical cardiovascular symptoms of hyperthyroidism, so this study aimed to assess the cardiovascular manifestations of hyperthyroidism.

Method

The current cross-sectional investigation involved 140 newly diagnosed and untreated confirmed cases of hyperthyroidism of any etiology for nine months. A structured data collection schedule was used to collect patient-specific and pertinent information during OPD hours or after admission. T4, T3, and TSH were measured in 10 mL of blood from each patient. The information was entered into a Microsoft Excel spreadsheet. All tests were carried out with a 5% level of significance.

Results

The mean age of study subjects was 43.2 years. Females made up 85.0% of the subjects in the current study, while males made up 15.0%. The etiology of hyperthyroidism was primarily due to Grave’s disease (59.3%). Heat intolerance (67.9%) was the most typical presenting symptom among the patients. The most common cardiac symptom was palpitation among 76.4% of subjects in the present study. Upon clinical examination, 80.7% of subjects had tachycardia. The ECG showed atrial fibrillation (AF) in 17.9% of subjects. The echocardiogram (ECHO) findings revealed systolic dysfunction in 17.8% of subjects.

Conclusion

Since cardiovascular manifestations are common in patients with thyroid disease and may be the only manifestation of thyroid disease, it is suggested that all patients with thyroid disorders be checked for cardiovascular manifestations. In addition, thyroid function tests should be performed in all patients with unexplained cardiovascular disease.

Differential condensation of sister chromatids acts with Cdc6 to ensure asynchronous S-phase entry in Drosophila male germline stem cell lineage

During Drosophila melanogaster male germline stem cell (GSC) asymmetric division, preexisting old versus newly synthesized histones H3 and H4 are asymmetrically inherited. However, the biological outcomes of this phenomenon have remained unclear. Here, we tracked old and new histones throughout the GSC cell cycle through the use of high spatial and temporal resolution microscopy. We found unique features that differ between old and new histone-enriched sister chromatids, including differences in nucleosome density, chromosomal condensation, and H3 Ser10 phosphorylation. These distinct chromosomal features lead to their differential association with Cdc6, a pre-replication complex component, and subsequent asynchronous DNA replication initiation in the resulting daughter cells. Disruption of asymmetric histone inheritance abolishes differential Cdc6 association and asynchronous S-phase entry, demonstrating that histone asymmetry acts upstream of these critical cell-cycle progression events. Furthermore, disruption of these GSC-specific chromatin features leads to GSC defects, indicating a connection between histone inheritance, cell-cycle progression, and cell fate determination.

The Effect of Exercise Training on Body Composition, Insulin Resistance and High Sensitivity C-reactive Protein (Hs-CRP) in Women With Polycystic Ovary Syndrome: A Pilot Study From North India

Background

Polycystic ovary syndrome (PCOS) is defined as clinical or biochemical hyperandrogenism, oligo/amenorrhea, and polycystic ovaries with or without increased ovarian volume. The goal of this study was to assess the effect of a 20-week home-based aerobic exercise programme on body composition, insulin resistance, and hs-CRP levels in women with PCOS.

Methods

This 12-month prospective study included 60 female patients diagnosed with PCOS, aged 20 to 40 years. The participants were divided into 2 groups, one for the experiment and the other for the control. For each participant, the 12-hour fasting blood samples were taken on two occasions i.e., 24 hours before the first session and 48 hours after the last session to measure the fasting glucose, fasting insulin, and hs-CRP. The Statistical Package for Social Sciences (SPSS) was used to conduct the analysis, and an association was considered significant when the p-value was less than 0.05.

Results

In the present study, there was a dropout rate of 16.7% (5/30) in the study group and 23.3% (7/30) in the control group. The baseline characteristics were comparable (p>0.05) between the study group and the control group during the enrolment. The BMI (kg/m²) among the study group before the exercise programme was 22.8±1.8 and it was significantly reduced to 21.1±1.9 after the exercise programme (p<0.05). The HOMA-IR and hs-CRP (mg/L) levels among the study group before the exercise programme were 3.2±1.5 and 6.7±2.7 respectively, and these were significantly reduced to 1.9±1.6 and 4.2±1.3 respectively after the exercise programme (p<0.05). In contrast, paired T-test analysis showed no such significant difference (p<0.05) for all variables (Weight, BMI, Waist, Hip, fasting glucose, Fasting insulin, and hs-CRP) among the control group during the study period.

Conclusion

In a group of female PCOS patients, a 20-week home-based aerobic exercise programme reduced weight, BMI, HOMA-IR, and hs-CRP. Although more research on the effects of aerobic exercises in PCOS is needed, these findings support aerobic exercise's effectiveness in reducing inflammation and enhancing insulin sensitivity in these patients.

Knowledge, Attitude and Practice about Hearing Impairment among the parents of children posted for Cochlear Implantation

INTRODUCTION

Audition is essential for communication, and it is vital for the normal cognitive development of children. Hence, if a child has a hearing impairment, it would significantly impact the child's speech and language development, competence, and emotional wellness. Most children with hearing impairment are advised to go for amplification devices or cochlear implantations for communication through oral modality. There are numerous factors upon which the rehabilitation programs' outcomes depend; one critical aspect that influences habilitation/rehabilitation is parents' knowledge regarding hearing impairment, their attitude towards it, and their practice. Therefore, it needed to assess the parental knowledge, attitude, and practice among parents of children with hearing impairment.

METHOD

The study used a cross-sectional study design and a convenient sampling method to recruit the participants. It was a timebound study; all the cases were recruited as participants during the study period.

RESULTS

The developed questionnaire has good reliability and validity. The questionnaire was administered to 38 parents to assess their knowledge, attitude, and practice towards their children's hearing impairment. The study's finding revealed that the overall parental knowledge, attitude, and practice towards their children's hearing impairment was found to be good.

CONCLUSION

The developed questionnaires in Hindi have good reliability and validity to assess parental knowledge, attitude, and practice about hearing impairment among parents of children with hearing impairment.

Development, Validation and Reliability of a Questionnaire to Assess Awareness, Knowledge, and Practice about Hearing Impairment Among School Teachers

BACKGROUND

Hearing impairment is the most common congenital anomaly. It is well known that teachers are the corner pillar for inclusive education.

OBJECTIVE

The study aimed to develop a tool that evaluates awareness, knowledge, and practice about Hearing impairment among Teachers and to validate, and test the reliability of the questionnaire.

METHODS

A cross-sectional study design and convenient sampling was used to recruit 82 participants. The questionnaire was developed after a familiarity check from Kannada language experts then it was intended for content validation by 6 experts in the field of Audiology. The finalized questionnaire was filled by participants and tested for internal consistency and test-retest reliability.

RESULTS

In the current study finalized questionnaire consisted of 50 questions. The scale content validation index (S-CVI) was shown to be good with 0.944 S-CVI. The internal consistency showed moderate-good internal consistency in the independent section and very high overall reliability with a value of 0.898. Further test-retest reliability showed no significant difference (p>0.05) in independent and overall scores of test and retest sessions, respectively. Individual domain and total score intraclass coefficients revealed 'high' test-retest reliability.

CONCLUSION

The currently developed questionnaire in the Kannada language to assess teachers' awareness, knowledge, and practice about hearing impairment showed high reliability and validity, making it an efficient tool to assess the gaps between regular school teachers on children with hearing impairment.

Assessment of Maternal and Fetal Outcomes in Pregnancy Complicated by Fibroid Uterus

Background

The study aims to assess maternal and fetal outcomes in pregnancy complicated by a fibroid uterus.

Materials and methods

Sixty-four adult women patients with fibroids in age range of 25-45 years were selected. Fetal and maternal outcomes were recorded.

Results

Thirty-four patients were in the age group of 25-35 years, and 50 were aged 35-45 years of age. Primigravida was seen in 52 and multigravida in 32. The common types were intramural in 40, submucosal in 16, pedunculated in seven, and subserosal in 21 cases. Size >5 cm was seen in 38 and 2 cm-5 cm in 46 patients. Common symptoms were preterm labor pain in 50, abdominal pain in 12, and urinary tract infection (UTI) in 22 cases. The common sites were the anterior wall fibroid in 42, posterior wall in 22, and lateral wall in 20 cases. Complications reported in our study were premature rupture of membranes (PROMs) in 12, threatened preterm in 11, associated infertility in five, intrauterine growth retardation (IUGR) in two, malpresentation in seven, postpartum hemorrhage (PPH) in four, preterm labor in six, and abruption in eight cases. The difference was observed to be significant (P<0.05). 

Conclusion

Common complications were PROM, threatened preterm, associated infertility, IUGR, malpresentation, PPH, preterm labor, and abruption.

A cluster of children with facial nerve palsy in a high prevalence area for COVID-19

BACKGROUND

COVID-19 is a disease of varying presentation and neurological sequelae of the disease are being studied. Following a cluster of paediatric facial nerve palsy (FNP) cases in an area of South Wales with a high prevalence of COVID-19, we conducted an opportunistic study to determine whether there has been an increase of incidence of FNP and if there is an association between the FNP and COVID-19 in children.

METHODS

We performed a retrospective review of the incidence of FNP between 2015 and 2020 across two hospitals within the health board. The incidence was compared with that in 2020 including a cluster of six children in 14 weeks, presenting to Royal Glamorgan Hospital between June and October.

RESULTS

There were 48 cases of children with FNP across both hospital within the study years. Seven (7) cases in 2020. The incidence was not statistically different in comparison to other years. Five out of six of these children in 2020 had antibody testing for COVID-19. All serology testing (100%) returned negative for SARS-CoV- 2 antibodies.

CONCLUSIONS

In high prevalence area for COVID-19, cases of children with FNP have not shown a commensurate increase. we have found no causal link between COVID-19 and FNP in children. While this is a small study, larger cohort studies are needed to support this finding. As new strains of COVID-19 are being reported in UK, South Africa and Brazil, physicians need to continue to be vigilant for consistent pattern of signs and symptoms, especially in children.

A recent surge of fulminant and early onset subacute sclerosing panencephalitis (SSPE) in the United Kingdom: An emergence in a time of measles

BACKGROUND

Subacute Sclerosing Panencephalitis (SSPE) is a fatal progressive neurological disorder following measles infection.

METHODS

Cases were collated from Paediatric Neurology centres in the UK over 24 months from 2017 to 2019 and represent all cases referred to the National Viral Reference Department (VRD). Diagnosis was established with detection of a raised measles index, demonstrating intrathecal measles antibody production.

FINDINGS

Six children presented with SSPE over two years, with median age five years (range 2-7 years) and median latency period three years (range 2-6 years). The majority were exposed to measles during infancy. Atypical features were common, including visual impairment, focal and generalised tonic-clonic seizures, headache, vomiting and movement disorders. EEG demonstrated typical features in five cases, though not always at presentation. Initial MRI was normal in four cases, with two showing focal and widespread white matter changes. Antiviral and immunomodulatory treatment led to minimal or no improvement. All progressed to cognitive regression, seizures and neurological decline within six months.

INTERPRETATION

These cases demonstrate the highest incidence of SSPE in the UK since 2000, all progressing to acute fulminant disease, following younger age of onset, short latency period and atypical presentations. Recent global surges in measles cases raise the importance of clinician awareness of SSPE as a potential diagnosis in children with neurological regression. Herd immunity remains the key protective mechanism for infants and groups that cannot be vaccinated. Health care providers, educators and governments must ensure resources continue to target effective education and access to immunisation programmes, the only means to combat this devastating and fatal condition.

A Cluster of Children with Facial Nerve Palsy in High Prevalence Area for COVID-19

OBJECTIVES

COVID-19 is a disease of varying presentation and neurological sequelae of the disease are being studied. Following a cluster of paediatric facial nerve palsy (FNP) cases in an area of South Wales with a high prevalence of COVID-19, we conducted an opportunistic study to determine whether there has been an increase in incidence of FNP and if there is an association between the FNP and COVID-19 in children.

STUDY DESIGN

A retrospective cohort study. Using the case series from 2020 and comparing it with previous years.

METHODS

We reviewed the incidence of FNP between 2015-2020 across two hospitals within the health board. The incidence was compared with that in 2020 including a cluster of six children in 14 weeks, presenting to the Royal Glamorgan Hospital between June and October.

RESULTS

There were 48 cases of children with FNP across both hospital within the study years. Seven (7) cases in 2020. The incidence was not statistically different in comparison to other years.Five out of six of these children in 2020 had antibody testing for COVID-19. All serology testing (100%) returned negative for SARS-CoV- 2 antibodies.In high prevalence area for COVID-19, cases of children with FNP have not shown a commensurate increase. we have found no causal link between COVID-19 and FNP in children. While this is a small study, larger cohort studies are needed to support this finding.

CONCLUSION

As new strains of COVID-19 are being reported in UK, South Africa and Brazil, physicians need to continue to be vigilant for consistent pattern of signs and symptoms, especially in children.

Status of Beta Defensin-1 and its Effect on Post-thaw Semen Fertility Gene Expression in Indian Goat Breed

BACKGROUND

Defensins are antimicrobial peptides and uniformly spans the entire sperm surface and is not exclusive to a specific domain. Goat β-defensin-1 helps in initiation of motility and capacitation of sperm.

OBJECTIVE

To know the status of β-defensin-1 in blood, semen and its effect on post thaw fertility gene expression in Indian goat breeds.

MATERIALS AND METHODS

Semen was extended and divided for estimation of β-defensin-1 and cryopreserved having different concentrations of β-defensin-1.

RESULTS

Bet defensin-1 concentration (pg/mL) in neat semen, sperm pellet and seminal plasma was significantly higher (P< 0.05) in goat breed Barbari followed by Jamunapari and Jakhrana. β-defensing-1 was also high in Jakhrana blood followed by Barbari and Jamunapari. The post thaw motility, live sperm, acrosome intactness and hypo osmotic swelled sperms were significantly higher (P< 0.05) with 10 ng/mL β-defensin in the semen dilutor.

CONCLUSION

Beta defensin (10 ng/mL) in semen dilutor may be used as immuno-modulator to get better post thaw quality suitable for artificial insemination.

Effect of Sudarsankriya yoga practices on P300 amplitude and latency

The cognitive ability which was perceived as a constant trait, is now understood to be upgraded by adaptive and extended training. Yoga practices are known to sharpen the intellect and enhance concentration. In the initial period of practicing yoga as an alternative/supporting tool to medical line of treatment, it is essential to investigate effect of yoga on cognitive ability using objective method, in order to establish evidences. Hence, aim of this study was to explore the effect of regular practice of sudarsankriya yoga on auditory event related potential (P300) by recording and comparing peak latency and amplitude. The participants were divided into three groups with Group I and Group II participants practicing sudarsankriya yoga for more than 36 months and less than 36 months respectively. Group III were non-practitioners with no prior practice of any form of yoga. Twenty participants in each group with a total of 60 participants between 40 to 65 years of age were recruited for the study. Results revealed a significant difference for mean latency and amplitude between three groups. Findings of the current study suggest that sudarsankriya yoga practices slows down the process of aging effect or maintains on cognitive ability in adults.

Super-Resolution Live Cell Imaging of Subcellular Structures

There has long been a crucial tradeoff between spatial and temporal resolution in imaging. Imaging beyond the diffraction limit of light has traditionally been restricted to be used only on fixed samples or live cells outside of tissue labeled with strong fluorescent signal. Current super-resolution live cell imaging techniques require the use of special fluorescence probes, high illumination, multiple image acquisitions with post-acquisition processing, or often a combination of these processes. These prerequisites significantly limit the biological samples and contexts that this technique can be applied to. Here we describe a method to perform super-resolution (~140 nm XY-resolution) time-lapse fluorescence live cell imaging in situ. This technique is also compatible with low fluorescent intensity, for example, EGFP or mCherry endogenously tagged at lowly expressed genes. As a proof-of-principle, we have used this method to visualize multiple subcellular structures in the Drosophila testis. During tissue preparation, both the cellular structure and tissue morphology are maintained within the dissected testis. Here, we use this technique to image microtubule dynamics, the interactions between microtubules and the nuclear membrane, as well as the attachment of microtubules to centromeres. This technique requires special procedures in sample preparation, sample mounting and immobilizing of specimens. Additionally, the specimens must be maintained for several hours after dissection without compromising cellular function and activity. While we have optimized the conditions for live super-resolution imaging specifically in Drosophila male germline stem cells (GSCs) and progenitor germ cells in dissected testis tissue, this technique is broadly applicable to a variety of different cell types. The ability to observe cells under their physiological conditions without sacrificing either spatial or temporal resolution will serve as an invaluable tool to researchers seeking to address crucial questions in cell biology.

Patterns of calcium channel (TRPV6) expression in rabbit gut epithelium

<p>The present study was undertaken to explore the immunohistochemical localisation of TRPV6 calcium channels in rabbit gut epithelium that are actively involved in calcium absorption. To undertake the research, twelve apparently healthy adult female rabbits with a body weight between 1.0 to 1.5 kg were procured, acclimatised and divided into two groups: control and test. Both groups were kept on same feed along with exogenous calcium supplementation in test group animals only. The serum calcium level revealed that normally a high value of serum calcium is maintained in the rabbit as compared to other mammals, thus indicating that the homeostatic mechanism might be poorly developed. Immunohistochemistry and reverse transcription polymerase chain reaction analysis revealed that the caecum was the site of maximum calcium absorption in rabbit, followed by the duodenum and jejunum. The expression pattern of TRPV6 protein/mRNA was weaker in test group animals than in the control group, indicating that the channel was functional in low calcium concentration in the gut.</p>

Extending Horizon of Robotic Surgery to Bladder-Preserving Approach for Vesical Paraganglioma: Rare Case with Unusual Presentation

Background: Vesical paraganglioma is rare and accounts for <0.1% of all urinary bladder tumors. They are mostly functional because of secretion of catecholamines and clinical presentation may mimic like a hyperfunctioning adrenal pheochromocytoma. They are easily misdiagnosed as urothelial malignancy and adequate perioperative attention is not provided. Case presentation: We hereby report a case of 55-year-old Indian lady with silent vesical paraganglioma at anatomically difficult location of bladder neck managed with robot-assisted excision of mass and bladder preservation. Conclusion: Surgery is the mainstay of the treatment that requires total excision of mass. However, minimally invasive bladder-preserving approach should be always kept as an option, if feasible. Robot assistance can help in bladder preservation even in difficult anatomic locations.

Cauda Equina Syndrome: A Review of 15 Patients Who Underwent Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) Under Local Anaesthesia

INTRODUCTION

To analyse the results of Cauda Equina Syndrome (CES) operated by Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD).

MATERIAL AND METHODS

The study is a retrospective series of 15 patients operated by PTELD. Bladder dysfunction was classified as incomplete CES (CESI) and complete CES retention (CESR). Bladder / motor recovery rate and its timing, Oswestry Disability Index (ODI), Visual Analogue Score (VAS), patient satisfaction index, and sexual dysfunction were used to measure the outcome objectively. Additionally, in CESR patients, post-void residual (PVR) urine was measured by sonography. Complications and technical problems were noted.

RESULTS

There were ten patients of CESI and five patients of CESR. The average follow-up was 20.33(12.05) months. Bladder symptoms recovery was 100%, and motor recovery was 80%. VAS for back pain recovered to 0.53(0.52) from 8(2.39). VAS for leg pain recovered to 0.13(0.35) from 9.20(1.32). ODI improved to 6.07(2.85) from 77.52(13.20). The time to the recovery of bladder function was 1.47(1.55) days. All CESR patient's abnormal PVR urine was normalised at five weeks post-operative. No complications were reported. However, five technical executional problems occurred.

CONCLUSION

PTELD can be considered for CES treatment due to its substantial and quick recovery advantages. However, more evidence support is needed to make it a practice recommendation.

Management of complex non union of tibia using rail external fixator

INTRODUCTION

Management of the complex non union of tibia is a challenging task due to infection, bony gap, deformity, poor bone quality and poor soft tissue cover at fracture site. The limb reconstruction system (LRS) or Rail fixator has emerged as a viable option for the treatment of the same as it can address most of all above problems. It is more patient friendly and easier to apply in comparison to Ilizarov ring fixator.

MATERIAL AND METHODS

Twenty two patients (17 males and 5 females) with complex non union of tibia underwent thorough debridement and resection of non viable bone followed by bone transport to fill the gap and then lengthening (8 patients) or acute docking & lengthening (14 patients) by the use of rail fixator. The average time to union, bone gap filled, lengthening achieved, treatment index were measured. The bone and functional outcome assessment was done by ASAMI score. The complications were classified according to Paley's classification.

RESULTS

Union without residual infection was achieved in 20 (90.1%) patients while 2 patients had failure. As per ASAMI criteria bone results were excellent in 12 (54.5%), good in 5 (22.7%), fair in 3 (13.6%) and poor in 2 (9.1%). Functional results were excellent in 11 (50%), good in 5 (22.72%), fair in 4 (18.18%) and failure in 2 (9%). Mean treatment duration was 8.2 months (range 7-19 months). Mean follow up duration was 11.3 months (range - 8.3 to 22 months). Average lengthening achieved was 4 cm (0-9 cm). Treatment index was 2.1 month/cm.

CONCLUSION

The monolateral rail fixator is simple, effective, easier to apply and more patient compliant with acceptable functional and radiological outcome.

Temporal Dynamics of COVID-19 Outbreak and Future Projections: A Data-Driven Approach

Long-term predictions for an ongoing epidemic are typically performed using epidemiological models that predict the timing of the peak in infections followed by its decay using non-linear fits from the available data. The curves predicted by these methods typically follow a Gaussian distribution with a decay rate of infections similar to the climbing rate before the peak. However, as seen from the recent COVID-19 data from the US and European countries, the decay in the number of infections is much slower than their increase before the peak. Therefore, the estimates of the final epidemic size from these models are often underpredicted. In this work, we propose two data-driven models to improve the forecasts of the epidemic during its decay. These two models use Gaussian and piecewise-linear fits of the infection rate respectively during the deceleration phase, if available, to project the future course of the pandemic. For countries, which are not yet in the decline phase, these models use the peak predicted by epidemiological models but correct the infection rate to incorporate a realistic slow decline based on the trends from the recent data. Finally, a comparative study of predictions using both epidemiological and data-driven models is presented for a few most affected countries.

"Is there a difference in treatment outcome of tuberculosis patients: Rural Healthcare Providers versus Community Health Workers?"

Introduction:

Rural healthcare providers (RHCPs) are the first point of contact for majority of patients in rural parts of India. A total of 75 RHCPs were trained and engaged in Hazaribagh to identify presumptive tuberculosis (TB) patients (PrTBPs) and refer them for diagnosis. Patients diagnosed with TB were initiated on directly observed treatment short course (DOTS) under the programme. Based on patients' choice, the treatment providers were either RHCPs or community health workers (CHWs). In this paper, we aim to compare the treatment outcomes of TB patients who received DOTS from RHCPs with CHWs.

Method:

This is a retrospective cohort study using secondary data routinely collected through project and Revised National TB Control Programme.

Results:

Over the period of 24 months, 57 RHCPs continued to be engaged with project and a total of 382 referrals were made out of which 72 (19%) were diagnosed with TB. Based on choice made, 40 (55%) of TB patients chose RHCPs and 32 (45%) CHWs as their treatment provider. The mean successful treatment completion rate was 87% in the RHCP group compared with 81% for CHWs (P value 0.464). The percentages of unsuccessful outcomes were similar for both groups.

Conclusions:

Our study demonstrates the process to engage RHCPs in TB prevention and care. The study highlights community preference for RHCPs as DOT provider who can produce similar TB treatment success rates as that of CHWs identified by programme.

Asymmetric Histone Inheritance in Asymmetrically Dividing Stem Cells

Epigenetic mechanisms play essential roles in determining distinct cell fates during the development of multicellular organisms. Histone proteins represent crucial epigenetic components that help specify cell identities. Previous work has demonstrated that during the asymmetric cell division of Drosophila male germline stem cells (GSCs), histones H3 and H4 are asymmetrically inherited, such that pre-existing (old) histones are segregated towards the self-renewing GSC whereas newly synthesized (new) histones are enriched towards the differentiating daughter cell. In order to further understand the molecular mechanisms underlying this striking phenomenon, two key questions must be answered: when and how old and new histones are differentially incorporated by sister chromatids, and how epigenetically distinct sister chromatids are specifically recognized and segregated. Here, we discuss recent advances in our understanding of the molecular mechanisms and cellular bases underlying these fundamental and important biological processes responsible for generating two distinct cells through one cell division.