Case Report: Uncontrolled Anasarca: Capillary Leak Syndrome

INTRODUCTION Capillary leak syndrome (CLS) is a rare clinical disease that causes edema, hypoproteinemia, episodic hypotension, dyspnea, hyponatremia, and weight gain that can be life threatening1. Although the underlying pathology is currently unknown, CLS is thought to be secondary to a systemic process associated with hyperpermeability of the body\u27s microcirculation, resulting from a diffuse and severe disruption of the endothelium and causing generalized edema and often acute respiratory distress2

Synaptic proteins promote calcium-triggered fast transition from point contact to full fusion.

The molecular underpinnings of synaptic vesicle fusion for fast neurotransmitter release are still unclear. Here, we used a single vesicle-vesicle system with reconstituted SNARE and synaptotagmin-1 proteoliposomes to decipher the temporal sequence of membrane states upon Ca(2+)-injection at 250-500 μM on a 100-ms timescale. Furthermore, detailed membrane morphologies were imaged with cryo-electron microscopy before and after Ca(2+)-injection. We discovered a heterogeneous network of immediate and delayed fusion pathways. Remarkably, all instances of Ca(2+)-triggered immediate fusion started from a membrane-membrane point-contact and proceeded to complete fusion without discernible hemifusion intermediates. In contrast, pathways that involved a stable hemifusion diaphragm only resulted in fusion after many seconds, if at all. When complexin was included, the Ca(2+)-triggered fusion network shifted towards the immediate pathway, effectively synchronizing fusion, especially at lower Ca(2+)-concentration. Synaptic proteins may have evolved to select this immediate pathway out of a heterogeneous network of possible membrane fusion pathways.DOI:http://dx.doi.org/10.7554/eLife.00109.001

IN VITRO ANTIOXIDANT PROPERTIES AND TOTAL PHENOLIC AND FLAVONOID CONTENTS OF RUMEX VESICAIUS L.

Objective: The aim of the study was to investigate the total phenolic and total flavonoids contents and evaluate the antioxidant potential of different solvent extracts of Rumex vesiarius L.Methods: The antioxidant potential of the hexane, ethyl acetate and methanol extract by using FRAP, LPO and Peroxidase assays and free radical scavenging by using DPPH and ABTS were determined. These activities were determined by using standard protocols with some modifications. Aluminium chloride colorimetric method was used to estimate TFC (total flavonoid content) and TPC (total phenolic content) was measured by Folin-ciocalteu method.Results: Among the test extracts methanol extract exhibited strong antioxidant activity than that of hexane and ethyl acetate. Free radicals, DPPH and ABTS were significantly inhibited by methanol extract of leaf and fruit (IC50 174.91±17.96 μg/ml and 526.791±91.85 mM min-1g-1DW), whereas methanolic extract of leaves showed good antioxidant potential using FRAP (306±14.8 mM min-1g-1DW) and LPO (30.57±5.65 MDA g-1DW) methods, while Peroxidase was were strongly inhibited by ethyl acetate extract of flower (0.624±0.013 mM min-1g-1DW). The maximum total phenolic and total flavonoids content was observed in leaves (0.53±0.31 mg GAE/gm DW and 2.15±0.72 mg QE/gm DW).Conclusion: The present investigation suggested that methanol extracts of Rumex vesicarius has significant antioxidant activity. These results clearly indicate that R. vesicarius is effective against free radical mediated diseases. These crude extracts can further purify and may be considered as a new source for antioxidant pharmaceutical compounds.Â

An unusual cause of edema in a child with congenital heart disease post Fontan procedure

Protein Losing Enteropathy Post Fontan procedure. Protein Losing Enteropathy (PLE) is an uncommon cause of edema in children with congenital heart disease. Protein-Losing Enteropathy may be defined as excessive loss of proteins across the intestinal mucosa and is due to either a primary gastrointestinal abnormality or secondary to cardiac disease. Protein-losing enteropathy (PLE) is a rare complication of the Fontan palliation for functional single-ventricle. Although PLE occurs in about 3.5% of patients post-Fontan, it confers marked morbidity and high mortality within 5 years of diagnosis. The pathogenesis of Fontan-related PLE is not completely understood, and it is unclear why it develops in some patients post-Fontan and not others. We describe a child with Double Inlet Right Ventricle who had undergone Fontan procedure, and presented to us with generalised oedema. The child had hypoproteinaemia, the common causes for which were ruled out and was diagnosed as Protein Losing Enteropathy (PLE) related to his surgical intervention. Though, not frequently encountered it should be kept in mind as one of the causes of anasarca

Interventions to reduce caesarean section rates at government medical college and hospital Aurangabad, India

Background: Caesarean sections are effective in saving maternal and infant lives, but only when they are performed for medically indicated reasons, The Objective of this study was to reduce caesarean Section rate at GMCH, Aurangabad and to improve overall birthing experience with respectful maternity care.Methods: The caesarean sections done at GMCH Aurangabad were audited using Robson`s Ten Group classification system to identify the major contributors to the overall CS rate. The following clinical and non-clinical interventions were applied dynamically to control the caesarean section rates. Clinical Interventions were changes in protocols regarding induction of labour, Intermittent auscultation as opposed to continuous electronic foetal monitoring in low risk cases, use of a partogram, encouragement of different birthing positions, promoting TOLAC to reduce the secondary CS rate. Nonclinical interventions include encouragement of DOULA (birth companion), ante-natal counselling of the expectant mothers, training of healthcare staff for respectful maternity care and use of evidence based clinical practice guidelines with mandatory second opinion for every non recurrent indication of CS. Auditing of caesarean section using Robson classification.Results: In this study there has been steady decline in LSCS rates from 33% to 26.9%. On analysis with Robson classification, group 5 (previous LSCS) made largest contribution of 36.9% followed by Group 1, 2, 10 each contributed 18.01%,13.2% and 11.2% respectively. Group 6 to 10 account for 23%. Various birthing positions lowered use of oxytocics from 33 % to 19% as well lowered episiotomy rates with greater success in vaginal delivery.Conclusions: Modification of induction protocols have reduced the primary LSCS rates and successful VBAC using FLAMM score was helpful in reducing the repeat caesarean Sections. Various birthing positions, DOULA gave greater success in vaginal delivery. LSCS rates in mothers with breech, multiple or oblique/transverse lies were largely unmodifiable. Limiting the CS rate in low-risk pregnancies by individualizing every labour and not to set a time limit as long as mother and baby are closely monitored

Effectiveness of distributed form of constraint induced movement therapy to improve functional outcome in chronic hemiparesis patients

Background:Upper limb hemiparesis is among the most common deficits after stroke that leads to disability. Learned nonuse develops due to over-reliance on the less affected limb for the functional activities. However for many stroke patients, participation in a traditional, more intense CIMT may be problematic, given the required practice intensity and the duration of the restraint schedule. So it is necessary to evaluate the effects of distributed form of Constraint Induced Movement Therapy (dCIMT) in improving functional outcome and quality of life in patients with chronic hemiparesis.Methods:36 hemiplegic patients following stroke were included. The experimental group was given dCIMT for 5sessions/week for 4 consecutive weeks in addition to conventional therapy while the control group received only conventional therapy. The outcome measures were motor activity log, wolf motor functional test and nine hole peg test.Results:The results of within group analysis for both the experimental group (Group-A) and control group B showed highly significant improvement on all the 3 outcome measures with P <0.0001.But the difference in the improvement of group-A compared to group-B was highly significant on the MAL and NHPT (P <0.0001) whereas it was not significant for WMFT performance score but highly significant for WMFT duration (U=23).Conclusion:dCIMT is an effective measure in improving the upper extremity motor function in terms of the quality and amount of use & speed and co- ordination. Thus improves the functional level and the quality of life of the patients with chronic stroke.

Real-world observational study to capture practice pattern of controlled ovarian stimulation in the in vitro-fertilization and embryo transfer or intracytoplasmic sperm injection-2

Background: The objective of the study was to evaluate the practice patterns of controlled ovarian stimulation (COS) in patients who underwent in vitro-fertilization and embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI).Methods: In REAL-COS (REAL-world observational study to capture practice pattern of COS in IVF-ET/ ICSI cycle) study, data was collected by 138 clinicians across India between April 2021 and March 2022 in a retrospective manner.Results: Data of 1651 subfertility female patients were evaluated. The mean (SD) age was 31.8 (3.9) years and majority (77.8%) of the patients were aged <35 years. Obese patients constituted 28.1% of the total population. The majority (79.5%) of the patients had primary subfertility and the polycystic ovarian syndrome (PCOS) was the most (27.8%) common cause of subfertility. Nearly equal percent of patients were treated with frozen or fresh embryo transfer. Most (~96%) of the patients received GnRH antagonist protocol wherein cetrorelix acetate was the most common drug (98.7%) while ~4% patients received GnRH agonist protocol wherein luprorelin was the most common one (83%). The most commonly used gonadotropin was recombinant follicle stimulating hormone alone therapy (rFSH, 49.2%). Majority (51.8%) of the patients were initiated at 225 IU dose of gonadotropin for COS. For ovulation trigger, human chorionic gonadotropin (hCG) was used in majority (59%) of the cases. Treatment with rFSH alone therapy resulted in max mean no. of oocytes and mean metaphase-II oocytes as compared with other treatments.Conclusions: This real-world observational study reports primary subfertility as the major reason for IVF-ET/ICSI in the study population. The GnRH antagonist protocol was followed by most of the clinicians participating in this study. rFSH was the most commonly used gonadotropin. rFSH alone therapy yielded the greatest number of oocytes and metaphase II oocytes versus other treatments

Real-world observational study to capture demographic details of newly diagnosed type 2 diabetes mellitus

Background: To understand the demographic profile of newly diagnosed type 2 diabetes mellitus (T2DM) patients and to evaluate the glycaemic status and initial treatment choices in this subset of T2DM patients.Methods: The ROD-IT-2 study was a real-world, retrospective, cross-sectional, observational study conducted at various centres across India between April 2021 and March 2022. The study outcomes included epidemiology, comorbidities, and management strategies preferred by Indian clinicians in these patients.Results: Data from 29,550 newly diagnosed T2DM patients were analyzed. The mean age of patients was 53.3 years, and majority were males (65%). Majority of patients (63.85%) were aged 40 to 60 years. More than half (53.11%) of the patients were either overweight (36.65%) or obese (16.76%). The mean glycated hemoglobin (HbA1c) was high (8.4%). Most (88.5%) patients had cardio-renal comorbidities. Hypertension was the most common comorbidity (45.7%) followed by dyslipidemia (32.1%). Chronic kidney disease (CKD) was also present in 31.2% patients. In the present study, 9.2% patients presented with microvascular complications at the time of diagnosis. Majority of newly diagnosed patients (79.7%) were treated with combination therapy. In patients who were prescribed dual drug combination therapy, metformin + dipeptidyl peptidase-4 inhibitor (DPP4i) was the preferred combination (42.71%)  followed by metformin + sulfonylurea (31.37%).Conclusions: ROD-IT-2 study showed that mean HbA1c levels in T2DM patients still remain high in our population and cardio-renal comorbidities remain prevalent in newly diagnosed patients. Indian clinicians were found to prefer the combination therapy in newly diagnosed T2DM patients

Recent trends in the pattern and long-term management strategy of patients diagnosed with acute coronary syndrome in India: an observational study

Background: The understanding of demographic patterns and the real-world management practices for patients with acute coronary syndrome (ACS) will facilitate optimizing the management strategies for ACS based on the patient’s clinical profile and the associated risk factors in Indian patients. Hence, this study determined the demographic details and the treatment patterns in Indian patients with ACS.Methods: The RECent trends in the pattern and lOng-term management stRategy of patients Diagnosed with acute coronary syndrome in India (RECORD ACS-2) study was a real-world, retrospective, cross-sectional, observational study conducted at various centres across India between 2021 and 2022. The study outcomes included the demographic profile and therapeutic management in patients with ACS.Results: A total of 9945 patients with a mean age of 59 years were included. The ACS was commonly observed in the age group of 41-70 years with highest incidence in the age group of 51-60 years. The ST-elevation myocardial infarction (STEMI) was most common (53.2%) presentation. Hypertension (37.2%) and dyslipidemia (29.3%) followed by diabetes (21.3%) were the most common comorbidities. Single vessel disease was the most common angiographic feature (58%). Percutaneous coronary intervention was the most preferred management strategy (57%). Ticagrelor was the most preferred loading (68.3%) as well as maintenance (71.2%) P2Y12 inhibitor in ACS patients. Most of the patients (81.8%) had received high intensity statin therapy for the secondary prevention of the disease.Conclusions: The prevalence of ACS was high between 51-60 years of age, more so in males, smokers, and physically less active patients. Associated comorbidities were hypertension, dyslipidemia and diabetes. Incidence of STEMI was high, and more than half of the patients underwent PCI. Ticagrelor was the most preferred P2Y12 inhibitor in ACS patients for loading as well as maintenance therapy

Aftermath of pulmonary tuberculosis : computed tomography assessment

Purpose: Pulmonary tuberculosis (PTB) has clinically significant sequelae, even after recommended treatment completion. It is important to recognise these sequelae for accurate assessment of severity and treatment planning, if indicated. Material and methods: We retrospectively analysed contrast-enhanced computed tomography (CT) scans of chest of 100 patients with previous history of treated pulmonary tuberculosis, excluding those with active pulmonary disease. CT findings were analysed based on parenchymal, airway, pleural, mediastinal, and vascular sequelae of PTB. Results: Parenchymal sequelae included fibrosis with architectural distortion and volume loss (90%), cavities (21%) (with aspergillomas noted in 19% of these cases), and tuberculomas (54%). Airway involvement was noted as bronchiectasis (77%) and bronchial stenosis (4%) but none with broncholithiasis. Mediastinal sequelae included lymph node calcification (74%), fibrosing mediastinitis (1%), and pericardial tuberculosis (2%). Pleural sequelae included pleural thickening (22%), with 40.9% of these patients showing calcifications, and one patient with chronic chylous pleural effusion. Vascular sequelae included Rasmussen aneurysms (4%), enlarged bronchial arteries (3%), and systemic bronchial collaterals in 1% of our patients. Conclusions: PTB has multiple appalling sequelae, which require due attention and appropriate treatment in symptomatic cases. Radiological evaluation forms an integral part in patient assessment and decision making