Ethics and professional development: a primer for doctors in training

While dealing with colleagues, patients and relatives of patients, doctors have to practice ethical behavior. This paper describes some basics on etiquette, ethics, people management skills, team work, politeness, etc which will give doctors 3 C’s: Competence, Confidence and Compassion, which in turn will enable doctors ascend rapidly in health care organizations. It is suggested that principles of etiquette and ethics be acquired by medical students while in training itself so that they can implement them and use them from day one in the hospital they join. Whether these principles should be part of medical curriculum is a matter to be decided by appropriate authorities

Palliative care in medical outliers with heart failure

Medical outliers are the patients who present to medical practices without health insurance or with serious co-morbidities needing prolonged hospital stay. Palliative care is part of standard guidelines for management of heart failure. But in medical outliers suffering from heart failure, palliative care should begin more early than it is recommended in standard guidelines because of financial reasons. It is suggested that guidelines be framed also for medical outliers with heart failure. It will be useful for patients of heart failure in resource-poor countries too

Mycophenolic acid: a drug with a potential beyond renal transplantation

Mycophenolic acid is an anti-metabolite immunosuppressant. It inhibits the enzyme inosine monophosphate dehydrogenase, which is essential for purine synthesis. It is indicated in prevention of rejection after renal transplantation. It is one of the few drugs, which were discovered more than a century ago and still in active use. This review discusses the other current and potential uses of the drug

CHIP_QC, COMPUTATIONAL PLATFORM FOR MULTIVARIATE EPIGENETIC STUDIES AND ITS APPLICATION IN UNCOVERING ROLE OF POLYCOMB DEPENDENT METHYLATIONS STATES

ABSTRACT During my PhD tenure, I have been involved in developing a user-friendly cross-platform system capable of analyzing epigenomic data and further use it in understanding the role of the Polycomb Repressive Complex 2 (PRC2) in genome regulation. From current trending in epigenetics research, we can sense increasing ease of high throughput sequencing and greater interest towards genome wide epigenomic studies. As a result of which we experience an exponential flooding of epigenetic related data such as Chromatin immunoprecipitation followed by sequencing (ChIP-seq), and RNA sequencing (RNA-seq) in public domain. This creates an opportunity for crowd sourcing and exploring data outside the boundaries of specific query centered studies. Such data has to undergo standard primary analysis, which with the aid of multiple programs has been stabilized courtesy to the scientific community. Further downstream, out of many, genome wide comparative, correlative and quantitative studies have proven to be critical and helpful in deciphering key biological features. For such studies we lack platforms, which can be capable of handling, analyzing and linking multiple interdisciplinary (ChIP-seq/RNA-seq) datasets with efficient analytical methods. With this aim we developed ChIP_QC, a user-friendly standalone computational program with an ability to support numerous datasets with high/moderate sequencing depth for performing genome wide analysis. First, using ENCODE project (Consortium, 2012) data, we illustrated few applications of the program by posing different biological scenarios and showed the comfort with which some known observations can be verified and also how it can be helpful in deducing some other novel observations. Second, we were interested in understanding the functionality of the products generated through catalytic activity of PRC2. It is known that Lysine 27 of histone H3 (H3K27) undergoes posttranslational modification (PTM) and methylation is one such dominant PTM. Methylation on H3K27 can be either mono/di/tri-methylation form. Out of all three forms, it is very well demonstrated that trimethylation of H3K27 (H3K27me3) is PRC2 dependent and at the same time its role in gene repression is well characterized, but functional roles of other forms of methylation on H3K27 are still poorly characterized. For understanding this, we used mouse embryonic stem cells (mESC) as model system of our study and we were able to provide an extensive characterization of other forms of methylation, highlighting their differential deposition along the genome, their fundamental role in transcriptional regulation, and their indispensability during differentiation program. Using ChIP_QC and with other computational methods along with experimental evidences, our data demonstrated that the monomethylation of Lys27 (H3K27me1) is required for correct transcription of genes and positively correlates with trimethylated Lys36 (H3K36me3); on the other hand dimethylated Lys27 (H3K27me2), that we identified to be the principal activity of PRC2, prevents firing of non cell type specific enhancers

Propellar flap: safe, reliable option for coverage of exposed tendo achilles

Background: Stable skin cover over exposed tendo achilles is absolutely essential for proper healing and recovery of tendo achilles function. Exposed tendo achilles can be a result of open injuries, repair of closed TArupture, complications after repair like suture dehiscence, skin necrosis, infection, delayed exposure and recurrent rupture. Various methods have been described for coverage of repaired tendo achilles like distally based skin flaps, advancement flap, free tissue transfers and islanded flaps. This study describes the usefulness of islanded propeller flap for stable skin cover over tendo achilles.Methods: Over a period of 4 years from March 2012 to August 2016 with total cases were 6, all male patients between 16 to 56 years of age were included in the study. Method of tendo achilles repair/reconstruction was planned, based on individual case requirement. All patients underwent islanded propeller flap for coverage of exposed tendo achilles. All cases were followed up for at least 1 year.Results: All flaps except one case survived and on follow up the function of tendo achilles was excellent with stable, supple, healthy skin overlying the tendon. Tendoachilles strength was assessed by asking the patient to stand on toes.Conclusions: Islanded propeller flap cover over tendoachilles provides a stable, reliable, single stage procedure with good aesthetic appearance.

New Liquid Holdup, Load Point and Flooding Velocity Models in Different Regions of Operations for a Structured Packed Column

Scope and Method of Study: Liquid holdup of structured packed column affects the pressure drop, flooding velocity, and HETP. For this reason, liquid holdup was used as an important model parameter by different researchers such as Billet (1999) and SRP (1995). However, despite its importance, the amount of work available on liquid holdup is much less in the open literature. When the performance of available literature models were evaluated using the experimental data from the open literature, the literature models were not properly capturing the effect of packing geometry and operating conditions. The main reason for the lack of performance is because a majority of these liquid holdup models were adopted from the random packing. So there is a clear need for liquid holdup models to be developed for a structured packed column using an experimental structured packed column. In the present work, new liquid holdup models were developed in different regions of operation using experimental data of a structured packed column. Furthermore, these new liquid holdup models were used in developing new load point and flood point models. Findings and Conclusions: A brief summary of the new models is presented below:* Both OkState preloading and flooding liquid holdup models were developed using a film thickness model.* An OkState loading liquid holdup model was developed using vapor kinetic energy term.* An OkState load point model was developed using dimensional analysis.* An OkState flooding velocity model was developed using the Wallis equation and also liquid holdup flooding term as the main model parameterOverall multiple models were developed using packing geometrical area and packing void fraction as the main model parameters. These new models were properly capturing the effect of operating conditions and packing geometry on the experimental conditions than any of the literature models. The current models will be useful in improving the pressure drop and HETP models of a structured packed column.Chemical Engineerin

Trends in drug usage among elderly with cardiovascular diseases

Background: Cardiovascular disease (CVD) is a common health problem in the world and a major cause of premature morbidity and mortality in the elderly. Various combinations of drugs are used for the management of CVD. Hence, the present study was conducted to analyze the drug usage trends in elderly with CVDs.Methods: A retrospective cross-sectional descriptive study was conducted for a period of 6 months in an outpatient department at a tertiary care teaching hospital. The medical records of elderly (age ≥60 years) patients with CVDs were reviewed. Drug prescribed mainly for hypertension, ischemic heart disease (IHD), congestive cardiac failure (CCF) were included along with drugs used for other co-morbidities. The results were analyzed using descriptive statistics.Results: Of 234 elderly patients, 124 (53%) were males and 110 (47%) were females. Hypertension was found in 208 (88.9%) patients, 66 (28.2%) had IHD and 4 (1.7%) had CCF. Drugs used for CVDs were beta blockers (BB) (30.77%), calcium channel blockers (CCB) (39.32%), angiotensin receptor blockers (ARB) (24.36%), angiotensin converting enzyme inhibitors (ACEIs) (20.94%) and diuretics (16.67%). Nitrates were prescribed for 66 (28.20%) patients and antiplatelet agents such as aspirin and clopidogrel were prescribed in 80 (34.19%) patients. Diabetes mellitus was found in 114 (48.7%) patients, 26 (11.1%) had bronchial asthma, followed by hyperlipidemia (3.8%), arthritis (3.8%), cerebrovascular accident (1.7%), and peripheral neuropathy, retinopathy and hypothyroidism was noted in 2 (0.9%) patients each.Conclusion: Among the antihypertensive groups CCBs were the most commonly used followed by BB, ARBs and ACEIs. Among these antihypertensive agents amlodipine, losartan, atenolol and enalapril were most commonly used. Commonly used antidiabetic agents were metformin and glimepiride

Eisenmenger syndrome in a patient with ventricular septal defect: a case report

Eisenmenger Syndrome (ES) represents Pulmonary Arterial Hypertension (PAH) associated with Congenital Heart Defects (CHD). Although patients survive until their third or fourth decades of life, the symptoms include dyspnea, cyanosis, fatigue, dizziness, and syncope. In addition, cardiac arrhythmias, a late complication are causing sudden death in patients with ES. Treatment options have been limited; however, recent successes have been achieved with the use of therapies targeted against the pathophysiological pathways that underlie PAH. The dual endothelin receptor antagonist and prostacyclins demonstrated to improve hemodynamics of the patients. This is the case of a 16 year old young female with ventricular septal defect that was admitted with increasing shortness of breath and cyanosis with clubbing which are clinical features of Eisenmenger syndrome. She was medicated with Furosemide, Sildenafil which improved her functional status