Duodenal perforation with Ascaris lumbricoides in a child: A case report

Gastrointestinal infestation with Ascaris lumbricoides is common in temperate and tropical countries. Although heavy worm infestation produces wide range of acute abdominal complications, duodenal perforation in association with ascariasis, especially in children, is rarely reported. We report a case of 5-year-old girl with duodenal perforation secondary to ascariasis

Scrub typhus in children: Clinical profile and complications at a Tertiary Care Teaching Hospital in Uttarakhand

Background: Scrub typhus is an acute febrile illness caused by rickettsia Orientia tsutsugamushi. Rickettsial infections are grossly underdiagnosed in India because of their non-specific clinical presentation, low index of suspicion among clinicians, and lack of diagnostic facilities. Objective: Objective of the study is to study the clinical profile, complications, and outcome of pediatric scrub typhus. Materials and Methods: This prospective observational study was conducted in the Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India, over a period of 2 years from November 2013 to October 2015. Children up to 18 years of age with signs and symptoms compatible with scrub typhus along with serological confirmation were included in the study. Serological study was conducted using rapid immunochromatographic assay and/or immunoglobulin M enzyme-linked immunosorbent assay technique. Clinical presentation, laboratory findings, complications, and outcome of these children were recorded on a performa. The data were analyzed using SPSS version 20 for windows. Results: About 115 children were diagnosed as scrub typhus during the study period. All children presented with fever. Other common symptoms were myalgia (56%), vomiting (50.5%), abdominal pain (26%), headache (28%), facial puffiness (15%), and seizures (8.7%). Pallor was present in 48% of children. Other common signs were hepatomegaly (29%), splenomegaly (28%), hypotension (24%), edema (21%), oliguria (17%), maculopapular rash (10%), meningeal signs (10.4%), and conjunctivitis (3%). Thrombocytopenia (67%), anemia (51%), pleural effusion (23%), shock (16%), hepatitis (23%), acute kidney injury (17%), meningoencephalitis (10%), myocarditis (7%), and acute respiratory distress syndrome (7%) were the complications observed. Azithromycin, doxycycline or chloramphenicol were used for the treatment. Overall mortality rate was 12.2%. Conclusion: A high degree of suspicion and knowledge of geographicaldistribution of rickettsial diseases is crucial for its early diagnosis and favorable outcome. The presence of an eschar is a valuable clinical clue in the diagnosis of scrub typhus; however, its absence does not rule out the disease

Is scar tenderness a reliable sign of scar complications in labor?

Background: Cesarean section has come a long way from being a risky & restrictive surgery to one that is safe and quick. Due to a rise in the rates of primary caesarean section globally, repeat cesarean section has also become very common. The chief concern during labor with scarred uteri is that of scar rupture which can have devastating fetal and maternal consequences, including mortality. Several studies monitoring for the features of scar rupture like abnormal cardiotocography (CTG), severe abdominal pain persisting between contractions, acute onset scar tenderness, hematuria or abnormal vaginal bleeding, maternal tachycardia or shock, cessation of uterine activity and loss of station of the presenting part exist with the exception of scar tenderness which has not been evaluated separately in any study. The present prospective observational study was undertaken in a tertiary care hospital to evaluate the sensitivity and specificity of scar tenderness as a sign of scar complications in labor. Methods: 78 women with one previous cesarean delivery in spontaneous labor at term undergoing trial of scar were monitored for progress of labor and observed for vaginal bleeding, scar tenderness, maternal pulse and blood pressure every 30 minutes. Scar tenderness was elicited by pressing below and behind the pubic symphysis in between uterine contractions while engaging the woman in conversation and noting for a visible wince. Fetal heart rate auscultation was done as per protocol. Trial of scar was terminated for scar tenderness, unexplained maternal tachycardia, fresh vaginal bleeding, fetal heart rate abnormalities and non-progress of labor.Results: The sensitivity and specificity of scar tenderness as a predictor of scar complications was 92.3% and 3.8%, while accuracy was 33.3%. The likelihood ratio of a positive sign of scar tenderness being associated with scar complications in labour is 1.48. Maternal tachycardia was not a significant predictor of scar complications in labour (p value=0.2). Past history of D&E has relative risk of 2.85 for scar complications.Conclusions: Scar tenderness is a sensitive sign of scar complications and should continue to be elicited for all women undergoing trial of labor after previous caesarean

Synthesis of some new 2-(pyrazol-l-yl)-4-(pyrimidin-5-yl)thiazoles

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Prolonged adrenal insufficiency after unilateral adrenalectomy for Cushing′s Syndrome

The contralateral healthy adrenal in patients undergoing unilateral adrenalectomy for Cushing′s is known to be suppressed temporarily and forms the basis of peri and postoperative steroids. We present four cases of Cushing′s who had prolonged adrenal insufficiency with continued requirement for steroids for periods ranging 1-4 years after unilateral adrenalectomy for Cushing′s. We further review literature regarding the recovery of the hypothalamo pituitary adrenal axis postsurgery in patients with Cushing′s syndrome

Sustainable tourism progress: a 10-year bibliometric analysis

AbstractSustainability in tourism has become one of the concerns of the travel industry. More research is required to establish a scientific basis for Sustainable Tourism (ST). In order to develop the field structure on sustainable tourism from 2013 to 2023, the study examines the existing situation using bibliometric analysis. The ‘Scopus’ database was explored on the ‘sustainable tourism’ theme in order to achieve the goal. The original search yielded a total of 701 papers, which were subsequently filtered to 619 documents. For the articles relating to ST, the most cited papers, significant authors, co-citation of references, and sources were all looked into. This study found that research into sustainable tourism has grown recently. Three research with 1512 citations were found by the authors, and they also found two publications with over 500 ‘Scopus’ citations. The study highlights the gap and identifies the conceptual sub-domains, such as biodiversity, economic, environmental issues, and local community engagement, which might be crucial in subsequent studies