A rare case of serologically diagnosed overlap syndrome presents as an idiopathic inflammatory myositis without any overlapping features

Overlap syndrome is a rare inflammatory rheumatic condition that shares features suggestive of at least two distinct autoimmune diseases with a reported prevalence of less than 34/100,000 persons and an incidence of less than 20/million/year. One example of an overlap syndrome is the presence of dermatomyositis or polymyositis with other autoimmune afflictions such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), or Sjogren’s syndrome. We present a case report of a 22-year-old male presented with progressive weakness in both upper and lower limbs without any other significant complaints. On investigation, serology revealed antibodies suggestive of overlap syndrome, which on further investigations, categorized as idiopathic inflammatory myositis (IIM). This shows that overlap syndrome, as an IIM, is one of the differential diagnoses in patients presenting with progressive extremity weakness involving both extremities even if there is no involvement of any sensory function

Induction of labour after 37 weeks of pregnancy using foley’s catheter: traction versus non-traction method

Background: Cervical Foley’s catheter used now a days for induction of labour alone as well as a combined with cerviprim gel. The objective of the study was to assess the effectiveness of 750 cc traction on Foley catheter with no traction for labour induction in >37 weeks pregnancy.Methods: A randomized controlled trial performed on pregnant women at >37 weeks who were admitted for induction of labour with unfavourable cervix. They were randomly assigned into two groups, Foley’s with 750 cc traction and without traction. The primary outcomes were improvement in Bishop Score, number of favourable cervix following induction and the mode of delivery. The secondary outcomes were neonatal outcome, and maternal infection.Results: A total of 80 pregnant women were randomized into traction group (n=46) and non-traction group (n=34). Traction group had significantly (p=0.0462) higher number of vaginal delivery compared to non-traction group. Participants were comfortable using both methods. There was no difference in neonatal outcomes and risk of maternal infections in both groups.Conclusions: Application of traction did result in more vaginal delivery

Hysteroscopy today: is it yet a conventional diagnostic technique in abnormal uterine bleeding?

Background: To assess the efficacy of hysteroscopy over dilatation and curettage in diagnosis of abnormal uterine bleeding. Methods: A total of 51 women in reproductive and peri- menopausal age group (19-55 years) with complaints of abnormal uterine bleeding were enrolled in the study. All the patients underwent hysteroscopic examination followed by D&C/histopathological evaluation. Hysteroscopic findings were compared against histopathological findings.Results: Majority of patients belonged to 36-40 years of age group. Majority (40%) presented within 6 months of complaints. Hysteroscopically, 46% had abnormal findings 12% had cervical polyps, 12% fibroid polyps, 18% endometrial polyps, 2% had adhesions (Ashermann’s syndrome) and 2% had a forgotten intrauterine contraceptive device. On histopathology (D&C) 64% cases had normal/proliferative/atrophic endometrium, 12% had hyperplasia and 6% had polyp.Conclusions: Hysteroscopy provided additional information for some of the pathologies which would otherwise be undiagnosed by HPE.

Impact of shorter MDR tuberculosis regimen drugs on heart rate variability in MDR tuberculosis patients at tertiary care hospital

Background: Tuberculosis is major cause of death in India. Analysis of heart rate variability is one of the most popular methods of autonomic nervous system evaluation. Shorter MDR-TB regimen drugs affect both central nervous system as well as peripheral nervous system. Existing research suggests that active pulmonary tuberculosis causes ANS dysfunction. So, by HRV measurement impact of shorter MDR-TB regimen drugs on autonomic dysfunction can be correlated. Aim of the current investigation was to evaluate effect of shorter MDR-TB regimen drugs on cardiac autonomic regulation in MDR-TB patients with respect to heart rate variability as a parameter.Methods: Fifty newly diagnosed MDR-TB patients of either gender on shorter MDR- TB regimen were enrolled in this study after taking consent. After 20 minutes rest, ECG was taken by “physiopac digital polygraph” software for 5 minutes. Two follow-up HRV assessments were done on 2nd month and 4th or 6th month of treatment. HRV was calculated by root mean square deviation of successive differences between adjacent RR intervals (RMSSD) and low frequency and high frequency ratio.Results: Repeated measures ANOVA showed no statistically significant difference in HRV parameters between baseline, 2 months and 6 months groups. So, sympathetic and parasympathetic modulation in terms of HRV remains unchanged during treatment of MDR-TB with shorter MDR-TB regimen drugs.Conclusions: Shorter MDR-TB regimen drugs don’t have any significant impact on HRV in MDR- TB patients, No correlation was observed between HRV and heart rate in MDR-TB patients

Nevirapine induced Stevens-Johnson syndrome: a case report

Stevens-Johnson syndrome (SJS) is a severe mucocutaneous skin reaction with extensive necrosis and detachment of the epidermis. Nevirapine is one of the high risk agents implicated in development of SJS. Here, we present a case of 27 years old male with HIV infection who was diagnosed to have SJS following administration of nevirapine

Prevalence of Methicillin Resistance Staphylococci (MRS) from Neonatal Septicemia and Comparative Evaluation of Newer Rapid Latex Agglutination Method with Conventional Methods for diagnosis of MRS

Background & Aims: Neonatal septicemia is a major cause of neonatal mortality in developing countries. Rapid treatment with antimicrobials is very crucial for essential outcome. Methicillin Resistance Staphylococcus (MRS) are important cause of nosocomial infection, which causes septicemia especially in neonates. They are frequently resistance to other antibiotics also. So, rapid, sensitive and specific procedures are required urgently to initiate timely treatment. This study was undertaken to perform comparative evaluation of conventional methods with rapid agglutination method in diagnosis of MRS and to estimate the prevalence of MRS among neonatal septicemia cases. Materials and Method: This study was done in one of the major tertiary care hospitals in Ahmedabad, Gujarat. All the blood samples collected from the patients with sign and symptoms of septicemia, from January 2012 to July 2012, were cultured and identified by standard microbiological method. MRS detection was done by conventional methods and latex agglutination method. Results: Staphylococcus coagulase negative constituted 61.96% and S.aureus 4.33% of total bacterial isolates. Methicillin resistance in S.aureusand in CONS, was 44.44% and 25.91% respectively. Prevalence of MRS among neonates was 32.72%. The sensitivity and specificity of oxacillin disk was 68% and 100% respectively for detection of MRS. Latex agglutination test method shows sensitivity and specificity of 100% for detection of MRS. Conclusion: Along with cefoxitin disc diffusion method, latex agglutination method is to be used for early diagnosis & treatment and forprevention of over use of vancomycinfor methicillin resistant staphylococci

Reliability of Bell’s Test Conducted with Virtual Reality

Cancellation tasks are commonly used assessment tools to detect unilateral neglect. Bell’s Test, one of the most commonly administered cancellation tasks, requires individuals to quickly and accurately identify “bells” randomly placed in an array of symbols. The reliability of Bells Test conducted with a paper and pencil is well established. A newly developed, commercial software application, allows Bell’s Test to be administered in fully immersive virtual reality environment. PURPOSE: The purpose of this study was to measure the reliability of the Bell’s Test using a virtual reality (VR) system and to establish the level of agreement between the pen-paper and VR administration. METHODS: Fourteen apparently healthy individuals between the age of 24 – 73y volunteered (47.9±20.7y; 166.0±5.2cm; 77.5±16.3kg). Subjects were excluded if they had a history of concussion or had perceptual or visual deficits. Participants completed Bell’s Test a total of four times. The first time, it was completed with a pen-paper (PP). Then, participants completed an initial assessment in VR (VRbase); the same test was administered again in VR one-hour (PostVR1hr) and one-week (PostVR1wk) post baseline. Realization time, total time, and the number of errors committed in the right and left field of view were recorded. Cronbach’s alpha was computed on realization and total time in all VR conditions. Additionally, an ANOVA with repeated measures was used to determine differences in PP, VRbase, PostVR1HR, and PostVR1Wk. The Holms-Sidak method was used to identify pairwise differences. Alpha was set at pa priori. RESULTS: Reliability for realization time for the Bell’s test conducted in VR was acceptable (α=0.79). There was, however, a significant difference between trials (F=6.65; p=0.013). VRbase (29.25±8.11s) was significantly different than PostVR1HR (15.52±4.30; p=0.006). and VRpost1wk (21.24±5.89s; p=0.01). Additionally, PP realization time (15.31±4.25s) was significantly different than PostVR1HR (p=0.02) and PostVR1WK (p=0.03). Reliability for total time for the Bell’s test conducted in VR was good. (α=0.82). There was not a significant difference between the trials (F=4.34; p=0.06) for VRbase(24.1±6.7s), PostVR1HR (45.44±12.6) or VRpost1wk(p=0.06). However, there was a significant difference found in PPtotal time taken and VR1wk with the (p=0.03). The average number of left side omitted bells was 0.50±0.65; 0.07±0.26; 0.07±0.26; 0.14±0.36 for PP, VRbase, Post VR1HR, and PostVR1WK; respectively. The number of bells omitted on the right side was 0.50±0.85, 0.21±0.57, 0.14±0.36, for 0.14±0.36 for PP, VRbase, PostVR1HR, and PostVR1WK; respectively. CONCLUSION: These data indicate that the reliability of the Bell’s Test for the realization time is acceptable, and the total time reliability was good in the virtual reality system. Healthy individuals performing the Bell’s Test in VR show slight improvements one hour after baseline, but there was no difference after one week. More data are needed within different age groups to determine reliability in young and older individuals. Additionally, future studies are required to determine the reliability of Bell’s Test in VR for individuals suffering from neurological injuries or diseases

Extraction and Partial Characterization of Collagen from Different Animal Skins

Collagen is a wonder triple helix fibrous protein. Basically, it connects and supports other bodily tissues, such as skin, bone, tendons, muscles and cartilage. In fact, it makes up about 25% of the total amount of proteins. Collagen possesses great tensile strength. In the present investigation, three methods of collagen extraction were employed. Out of which the method of George and Chandrakasan (1996) proved to be a better method for collagen extraction in chicken and human skins. Regarding Goat and Buffalo skins, collagen was extracted using TCA method wherein the extracted fibrous protein got hydrolyzed, getting denatured therefore, a definite band pattern was not obtained. By comparing the electrophoretic profile of various animal skins, a definite band pattern can be obtained which will indicate differences in collagen structure thereby facilitating species and generic differentiation

Effects of Supervised Exercise-based Telerehabilitation on Walk Test Performance and Quality of Life in Patients in India with Chronic Disease: Combatting COVID-19

Background: The world is currently undergoing a pandemic, caused by the SARS-CoV-2 virus (COVID-19). According to the World Health Organization, patients with chronic illnesses appear to be at the highest risk for COVID-19 associated sequelae. Inability to participate in outpatient-based rehabilitation programs and being home-bound can increase the risk for and potential worsening of chronic health conditions. This study evaluated the short-term effects of telerehabilitation on patients’ walk test performance and health related quality of life (HRQoL).  Methods: 47 patients (23 cardiovascular, 15 pulmonary, 9 oncology) participated in the telerehabilitation program. At baseline and following a 1-month intervention, patients had their 6-minute walk test distance (6MWTD) and HRQoL assessed. Average daily step counts were measured by the PACER App. Conclusion: Our results indicate that a short-term, supervised virtual telerehabilitation program had significant positive effects on 6MWTD and HRQoL in cardiac, pulmonary and oncology patients during COVID-19

IgG4-related disease: a review with an Indian perspective

IgG4-related disease (IgG4-RD) is a recently discovered (2003) complex disease, manifesting in various organs with symptoms mimicking other diseases. Progression of the disease leads to organ failure and hence early diagnosis is an urgent requirement in these patients. There is scarcity in reporting of IgG4-RD globally and in India. The aim of the study was to generate awareness on the epidemiology, diagnosis, and practice trends for IgG4-RD in India and globally, and to aid Indian physicians in early diagnosis of IgG4-RD in patients. Additionally, the evidence currently available in the Indian subpopulation has been evaluated. A preliminary literature search was performed using the PubMed database with the keywords including ‘IgG4-related disease’ in the title and abstract to obtain the relevant data. In total, PubMed identified 2071 publications comprising world-wide studies published in the English language before 30 April 2021. Studies were filtered region-wise by adding ‘India’ to the search strategy and total 60 publications were identified. The relative newness of IgG4-RD and the ensuing paucity in literature limits diagnosis by clinicians. Awareness of the disease among Indian clinicians would improve understanding of the disease and development of a country-specific consensus-based management guideline might lead to better prognosis in Indian patients with IgG4-RD