Unusual presentation of twisted ovarian cyst

Ovarian torsion (also termed as adnexal torsion) refers to partial or complete rotation of the ovary and a portion of fallopian tube along its supplying vascular pedicle. It occurs commonly in reproductive age group; more on the right side (60%) and often presents with acute lower abdominal pain lasting for few hours and up to 24 h, accounting for 2.7% of acute gynecological conditions. It is one of the devastating conditions, hampering blood supply of ovary which may lead to total necrosis of ovarian tissue and complications, if not diagnosed and managed in time. Hence, we present a case on a twisted ovarian cyst in postmenopausal woman with unusual symptomatology leading to delayed diagnosis and loss of an ovary

Evaluating the efficacy of low-dose hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) along with fentanyl for subarachnoid block in patients undergoing medical termination of pregnancy and sterilization: A prospective, randomized study

Background: Spinal anesthesia using low doses of local anesthetics with opioids is emerging as a useful technique for day care surgeries. Levobupivacaine, a lesser toxic enantiomer of bupivacaine, has now been increasingly used in various gynecological surgeries. However, its use has not been demonstrated in medical termination of pregnancy (MTP) with sterilization (a kind of day care surgery). This study was performed to compare analgesic and anesthetic effectiveness of low-dose hyperbaric 0.5% levobupivacaine and hyperbaric 0.5% bupivacaine in combination with fentanyl in spinal anesthesia in patients undergoing MTP with sterilization. Methods: A comparative, randomized, double-blind study was conducted in 90 patients scheduled to undergo elective MTP with sterilization. Group levobupivacaine (L) (n = 45) received 7.5 mg (1.5 mL) of 0.5% isobaric levobupivacaine + 1 mL of 5% dextrose and fentanyl 25 mcg (0.5 mL), while group bupivacaine (B) (n = 45) received 7.5 mg (1.5 mL) of 0.5% hyperbaric bupivacaine + 1 mL of normal saline and fentanyl 25 mcg (0.5 mL). They were compared with respect to onset and duration of sensory and motor block, time to reach highest sensory level, time to two segments' regression, and total duration of analgesia. Results: Sensory and motor block onset and time to achieve highest level of sensory block were significantly delayed in group L (P < 0.05). Duration of sensory block and duration of analgesia was longer in group L than group B. Motor block duration was significantly shorter in L group (88.4 ± 12.4 min in group L and 133.9 ± 28.1 min in group B). Both groups were comparable in terms of hemodynamic parameters and adverse effects. Conclusion: This study suggests that 7.5 mg of 0.5% levobupivacaine usage in spinal anesthesia provides longer duration of analgesia and better sensory blockade with minimal motor block when compared with 0.5% bupivacaine along with fentanyl and may be a better alternative to bupivacaine in day care surgeries

Female sexual dysfunction in patients with endometriosis: Indian scenario

Background: Female sexual dysfunction (FSD) in Indian women is often overlooked due to cultural beliefs and considered as social taboos. Sexuality is an important and integral part of life. There are many causes of sexual dysfunction, but the prevalence of FSD in endometriotic patients is still underdiagnosed. Materials and Methods: Study design - Cross-sectional observational study conducted at tertiary care center, from June 2015 to March 2016. Sample size - Fifty-one patients in reproductive age group (18-47 years) who were diagnosed with endometriosis on diagnostic laparoscopy were included. Methods - FSD was assessed with a detailed 19-item female sexual function index questionnaire. All six domains of sexual dysfunction, i.e., desire, arousal, lubrication, orgasm, satisfaction, and pain were studied. Exclusion - Patients with other gynecological, medical or surgical history were excluded. Results: Out of 51 patients with endometriosis, 47.06% of patients had sexual dysfunction. With the increase in staging of endometriosis, sexual dysfunction prevalence is also rising. FSD was 100% in patients with severe endometriosis as compared to 33.33% in minimal endometriosis. Conclusion: Every individual deserves good sexual life. The sexual dysfunction associated with endometriosis should also be taken into consideration while managing these patients

Pregnancy outcome in renal transplant recipients: Indian scenario

Background: Pregnancy in renal transplant recipient is a high risk pregnancy, associated with increased risk of graft rejection and other complications. Many pregnancies have been reported, still there is limited data on optimal counseling and clinical management of these patients. Objectives: To study maternal and fetal outcomes in renal transplant recipients. Material and methods: Study design: This is a retrospective observational study conducted at tertiary health center in Ahmedabad, from 2004 to 2014. Sample size: There were 3016 renal transplant recipients out of which 2507 were males and 509 were females. Among 509 females, 211 recipients were in reproductive age group (20–40 years) who were included in the study. Out of 211 recipients, 113 (53.5%) had complete family, 46 (21.8%) did not tried for pregnancy, 33 (15.63%) were lost to follow up, 16 (7.58%) patients conceived and 3 (1.41%) were infertile. Method: Maternal and fetal outcomes were studied and patients were followed up till 2 years of postpartum. Exclusion criteria: Unmarried, divorcee and widow patients were excluded. Results: There were 16 patients who had conceived, out of which 8 patients had abortions, 6 patients had full term deliveries and 2 patients had preterm delivery. Two patients developed newly diagnosed gestational hypertension from 20 weeks of gestation. One patient had graft rejection 2 months post abortion and one had cholestasis of pregnancy from 7 months of gestation. On follow up, one patient expired 1 year after abortion due to tuberculosis meningitis and one patient (10 months post abortion) is on intermittent hemodialysis since 3 months, after 1.5 years of renal transplant. Conclusion: These patients are at risks for developing many complications during pregnancy, out of which graft rejection is most grievous one. However, with proper peritransplant and periconceptional counseling regarding optimal time for pregnancy, these patients can have good pregnancy outcome

Jobs Justice Climate: Redevelopment Proposals for North Dekalb Mall and The Gallery at South Dekalb

This studio report presents socio-economic, energy, water, and transportation benchmarks of existing conditions and compares them to the projected performance of urban design proposals developed by four teams of MSUD, M.Arch, and MS.HPB students. It was presented to Dekalb County Commissioners Terry, Johnson, and Rader in April, 2021.Hypothetical redevelopment and reinhabitation urban design proposals are presented for both shopping malls to help the local DeKalb County Commissioners and their constituents envision and discuss options of what change might look like guided by Green New Deal goals

NaV1.1 and NaV1.6 selective compounds reduce the behavior phenotype and epileptiform activity in a novel zebrafish model for Dravet syndrome

Dravet syndrome is caused by dominant loss-of-function mutations in SCN1A which cause reduced activity of Nav1.1 leading to lack of neuronal inhibition. On the other hand, gain-offunction mutations in SCN8A can lead to a severe epileptic encephalopathy subtype by over activating NaV1.6 channels. These observations suggest that Nav1.1 and Nav1.6 represent two opposing sides of the neuronal balance between inhibition and activation. Here, we hypothesize that Dravet syndrome may be treated by either enhancing Nav1.1 or reducing Nav1.6 activity. To test this hypothesis we generated and characterized a novel DS zebrafish model and tested new compounds that selectively activate or inhibit the human NaV1.1 or NaV1.6 channel respectively. We used CRISPR/Cas9 to generate two separate Scn1Lab knockout lines as an alternative to previous zebrafish models generated by random mutagenesis or morpholino oligomers. Using an optimized locomotor assay, spontaneous burst movements were detected that were unique to Scn1Lab knockouts and disappear when introducing human SCN1A mRNA. Besides the behavioral phenotype, Scn1Lab knockouts show sudden, electrical discharges in the brain that indicate epileptic seizures in zebrafish. Scn1Lab knockouts showed increased sensitivity to the GABA antagonist pentylenetetrazole and a reduction in whole organism GABA levels. Drug screenings further validated a Dravet syndrome phenotype. We tested the NaV1.1 activator AA43279 and two novel NaV1.6 inhibitors MV1369 and MV1312 in the Scn1Lab knockouts. Both type of compounds significantly reduced the number of spontaneous burst movements and seizure activity. Our results show that selective inhibition of NaV1.6 could be just as efficient as selective activation of NaV1.1 and these approaches could prove to be novel potential treatment strategies for Dravet syndrome and other (genetic) epilepsies. Compounds tested in zebrafish however, should always be further validated in other model systems for efficacy in mammals and to screen for potential side effects

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4&nbsp;% presented with RS, while 13.6&nbsp;% had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7&nbsp;% vs RS: 37.5&nbsp;%). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1&nbsp;% vs. RS 32.0&nbsp;%), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders