A Rare Case of Webbed Penis in an Alleged Accused of Sexual Assault

Background: Webbed penis is a rare congenital anomaly of penis which can be presented in late childhood or adolescence. It can be present in isolation or can also occur in combination with hypospadias, chordee, and micropenis.Case Report: A 42-years old unmarried male, working as tailor was brought by police with alleged history of sexual assault with 6 years old girl. On examination of penis and scrotum, the penoscrotal fusion extending from the preputial skin to the scrotal wall was seen suggestive of simple type, grade-03 webbed penis.Conclusion: In cases of alleged accused of sexual offences having webbed penis without having any other penile deformity will not to be considered as legitimate cause of impotency

Perception and attitudes of medical students toward communication, chronic disease and death

Background: Medical students of today’s world found difficulty in communication when they faced with dying patients, how they would feel, what are their perception about caring of patients with chronic disease. These are often unspoken and neglected issues.Methods: It was a cross-sectional comparative questionnaire based survey of the 2nd year medical students and interns. Students were evaluated using a questionnaire consisting of 15 Likert type statements.Results: Completed questionnaire received from 89 out of 100 students. All students strongly agreed upon the commutation with patients. Interns (37.03%) were strongly disagreed (p=0.001) on not curing the patient is a failure of doctors. Interns (32.58%) were significantly more likely to be less worried (p<0.01) about death of the patient and to indicate cancer is a non-curable disease (p<0.001) when compared to 2nd MBBS. Students from both the groups distressed, while communicating with dying patients and relatives of dying patients.Conclusion: Perception of students regarding caring of chronically ill-patients and death related issues needs improvement. We believe that integrating different teaching strategies and training programs regarding this issue should begin at early stages of undergraduate medical curriculum

Assessing resource and infrastructure disparities to strengthen Indian dairy sector

The present study reveals the resource and infrastructure disparities of dairy development in India. The relative progress of the states in dairying was measured by multitude of developmental indicators. To get a lucid picture, a composite Dairy Progressiveness Index (DPI) with 20 indicators was developed for 16 states of India. Principal Component Analysis (PCA) was employed for the construction of DPI. As per the indices score, Punjab, Kerala, Haryana, Goa and Gujarat were categorized as highly dairy progressive states. Tamil Nadu, Rajasthan, Maharashtra, Andhra Pradesh, Karnataka and Uttar Pradesh were categorized as moderate dairy progressive states while West Bengal, Himachal Pradesh, Bihar, Madhya Pradesh and Odisha states were grouped as least dairy progressive states. The study implicates the strong need to develop organized marketing network along with reforms in dairy cooperatives as well as producer companies in Punjab, Haryana, Himachal Pradesh, Bihar, Madhya Pradesh and Odisha. Since fodder, pasture and irrigation resources in Himachal Pradesh, Andhra Pradesh, Madhya Pradesh, Odisha, Kerala and Gujarat are poor, policy intervention like restriction on export of oilseed cake and ban on harvesting using combine harvester without straw ripper, establishment of fodder bank network could address the fodder scarcity. Transfer of technologies such as hydroponics, azolla, silage, urea treatment, use of mineral mixtures to field in resource poor states need attention. Poor genetic potential in the low performing states demand proper breeding strategies, conservation and spread of elite indigenous breeds such as Sahiwal, Gir and Tharparkar. Improvement in veterinary infrastructure would reduce the imbalanced progress. The policy interventions on identified gaps would pave even development of dairy farming and reduce future demand gap

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

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Research PaperThe present study reveals the resource and infrastructure disparities of dairy development in India. The relative progress of the states in dairying was measured by multitude of developmental indicators. To get a lucid picture, a composite Dairy Progressiveness Index (DPI) with 20 indicators was developed for 16 states of India. Principal Component Analysis (PCA) was employed for the construction of DPI. As per the indices score, Punjab, Kerala, Haryana, Goa and Gujarat were categorized as highly dairy progressive states. Tamil Nadu, Rajasthan, Maharashtra, Andhra Pradesh, Karnataka and Uttar Pradesh were categorized as moderate dairy progressive states while West Bengal, Himachal Pradesh, Bihar, Madhya Pradesh and Odisha states were grouped as least dairy progressive states. The study implicates the strong need to develop organized marketing network along with reforms in dairy cooperatives as well as producer companies in Punjab, Haryana, Himachal Pradesh, Bihar, Madhya Pradesh and Odisha. Since fodder, pasture and irrigation resources in Himachal Pradesh, Andhra Pradesh, Madhya Pradesh, Odisha, Kerala and Gujarat are poor, policy intervention like restriction on export of oilseed cake and ban on harvesting using combine harvester without straw ripper, establishment of fodder bank network could address the fodder scarcity. Transfer of technologies such as hydroponics, azolla, silage, urea treatment, use of mineral mixtures to field in resource poor states need attention. Poor genetic potential in the low performing states demand proper breeding strategies, conservation and spread of elite indigenous breeds such as Sahiwal, Gir and Tharparkar. Improvement in veterinary infrastructure would reduce the imbalanced progress. The policy interventions on identified gaps would pave even development of dairy farming and reduce future demand gap.Not Availabl

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Productive and reproductive performance of cattle and buffaloes reared under farmers’ management in differential dairy progressive states in IndiaThe productive and reproductive performances of dairy animals have direct effect to milk production and profitability of dairy enterprise. The present study was carried out to analyse the productive and reproductive performance of cattle and buffaloes reared under farmers’ management in three states of differential dairy progress in India. Haryana, Maharashtra and Odisha states were purposively selected from highly, moderately and least dairy progressive states, respectively. The total sample size was 900 containing 300 dairy farmers from each state. The finding shows that the productive and reproductive performances of buffalos in Haryana are better than Maharashtra and Odisha. The productive and reproductive performances of Crossbred were found better in Haryana as well as Maharashtra than Odisha. In Haryana, very few farmers reared Indigenous cattle but the performances were better than Maharashtra and Odisha. The better performance of Haryana may be due to being home track of elite Murrah buffalo, Tharparker and Sahiwal breeds of Indigenous cattle, agro-climatic situations, veterinary services and managerial skills of dairy farmers. To improve the productive and reproductive performance of dairy animals in the moderately progressive (Maharashtra) and least progressive (Odisha) states efforts shouNot Availabl