Case report on necrotizing fasciitis following episiotomy

Necrotising fasciitis (NF) is an extremely rare but near fatal bacterial soft tissue infection, complicating the operative wounds. Here is a case report of Necrotising fasciitis in episiotomy wound in low socioeconomic, poorly nourished and anaemic women. A 39 years old, second gravida, delivered normally with medio-lateral episiotomy under local anaesthesia. On postnatal day four, patient developed high grade fever and on examination episiotomy was found to be unhealthy and gaped. She was started on broad spectrum antibiotics empirically but the cellulitis rapidly progressed to vulva, then to the bilateral thighs and extended till knees. Bilateral lower limb Doppler ultrasonography was done to rule out deep vein thrombosis which showed no abnormality. USG abdomen revealed huge pus collection in the lower abdomen. Under anaesthesia, surgical exploration was done, pus was drained followed by wound debridement and pus sent for culture and sensitivity. Pus and blood culture showed growth of Klebsiella pneumoniae, so started on appropriate antibiotics. Patient started recovering, when the wound was healthy, secondary suturing of episiotomy wound done. She was discharged on post-natal day 27 after full recovery. Early diagnosis and aggressive timely management are the corner stone to avoid morbidity and mortality of NF

Internet Addiction and Its Correlates among College Students of Surat City: A Cross Sectional Study

Introduction: The number of internet users in 2018 was 4.021 billion, increased 7 percent year-on-year. More than nine-tenths of Indian teens use Internet. Due to social distancing norms put forward due to COVID-19 dependency and availability of Internet usage has increased.Objective: To assess the extent of Internet addiction and determine its predictors among college students of Surat city. Method: A cross sectional study was conducted from March-September 2021 among 400 first- and second-year students selected by systematic random sampling from four colleges selected purposively. Outcome variables were Young’s Internet addiction Test and Duke Health Profile Score which were assessed in terms of mean score. Univariate analysis was done, followed by t-test, ANOVA and Pearson Correlation to establish associations. Predictors were determined by Binary Logistic Regression.Results: Around one-tenth (12.8%) participants were seen with no Internet addiction, with majority being mildly (44.8%) and moderately (36.5%) addicted. Severe addiction was seen in around one out of twenty participants (6.1%). Social networking (32%) and education (34.5%) were the major reasons for use of Internet. Higher pocket money (aOR=4.3), greater monthly internet expenditure (aOR=2.8), ownership of internet enabled mobile phone (aOR=3.9), lying down posture while accessing internet (aOR=4.8) and evening (aOR=2.2) or night time (aOR=8.7) of internet access were significant predictors for Internet addicts. Conclusion: In this study more than four fifth of the college students had Internet Addiction even at young age. Physical, Mental, Social and General health were significantly negatively correlated with internet addiction

FoxO suppresses endoplasmic reticulum stress to inhibit growth of Tsc1-deficient tissues under nutrient restriction

The transcription factor FoxO has been shown to block proliferation and progression in mTORC1-driven tumorigenesis but the picture of the relevant FoxO target genes remains incomplete. Here, we employed RNA-seq profiling on single clones isolated using laser capture microdissection from Drosophila larval eye imaginal discs to identify FoxO targets that restrict the proliferation of Tsc1-deficient cells under nutrient restriction (NR). Transcriptomics analysis revealed downregulation of endoplasmic reticulum-associated protein degradation pathway components upon foxo knockdown. Induction of ER stress pharmacologically or by suppression of other ER stress response pathway components led to an enhanced overgrowth of Tsc1 knockdown tissue. Increase of ER stress in Tsc1 loss-of-function cells upon foxo knockdown was also confirmed by elevated expression levels of known ER stress markers. These results highlight the role of FoxO in limiting ER stress to regulate Tsc1 mutant overgrowth

Public expenditure on Non-Communicable Diseases & Injuries in India: A budget-based analysis.

BackgroundResource allocation decisions for disease categories can be informed by proper estimates of the magnitude and distribution of total spending. In the backdrop of a high burden of Non-Communicable Diseases and Injuries (NCDI) in India, and a paucity of estimates on government spending on NCDI, this paper attempts to analyse public sector expenditure on NCDI spending in India.MethodsVarious recent budget documents of the Centre and States/Union Territories have been used to extract expenditure on NCDI. The aggregates thus arrived at have been analysed to estimate aggregate and state level per capita spending. State level spending have been compared against disease burden using DALYs. Patterns of spending on NCDI across states were also analysed together with state level poverty to observe possible patterns.FindingsThe total spending on NCDI by the government is low at less than 0.5% of GDP. NCDI spending is little more than one-fourth of total health spending of the country and most spending takes place at the state level (80%). The Ministry of Health and Family Welfare's share in Central spending on NCDI is around 65%, and currently it spends 20% of its total health spending on NCDI. The gap between spending and DALYs is the most for the economically vulnerable states. Also, the states with high poverty levels also have low per capita expenditure on NCDI.InterpretationIndia does not depend on donor funding for health. It will have to step up domestic funding to address the increasing disease burden of NCDIs and to reduce the high out-of-pocket expenditure on NCDI. Policies on NCDI need to focus on UHC, service integration and personnel gaps

tpHusion: An efficient tool for clonal pH determination in Drosophila

Genetically encoded pH indicators (GEpHI) have emerged as important tools for investigating intracellular pH (pHi) dynamics in Drosophila. However, most of the indicators are based on the Gal4/UAS binary expression system. Here, we report the generation of a ubiquitously-expressed GEpHI. The fusion protein of super ecliptic pHluorin and FusionRed was cloned under the tubulin promoter (tpHusion) to drive it independently of the Gal4/UAS system. The function of tpHusion was validated in various tissues from different developmental stages of Drosophila. Differences in pHi were also indicated correctly in fixed tissues. Finally, we describe the use of tpHusion for comparative analysis of pHi in manipulated clones and the surrounding cells in epithelial tissues. Our findings establish tpHusion as a robust tool for studying pHi in Drosophila.ISSN:1932-620

Vaginal leiomyoma: MRI features with pathologic correlation

We present a rare case of vaginal leiomyoma presenting as prolapsed vaginal mass in a 45 years old woman. The leiomyoma was found to arise from the right lateral vaginal fornix with a vascular stalk. MRI showed homogenous hypointense signals on T1W1 and iso to hyperintense signals on T2W1 images with moderate heterogenous enhancement on post contrast images. It was enucleated via vaginal route and the histopathological examination confirmed the diagnosis of vaginal leiomyoma

Ascending infection causing pyomyoma in a young woman

Pyomyoma is a very rare complication of uterine fibroid, but is associated with high morbidity and mortality. We report a case of pyomyoma in a young lady caused by an ascending infection. She presented with chronic fever. CT scan showed the presence of gas inside the pyomyoma. An exploratory laparotomy was performed followed by drainage of pus. She responded well to the treatment. Although rare, pyomyoma should be suspected in patients with leiomyoma, unexplained fever, abdominal pain and no other apparent source of infection