Giant congenital nevus

A 17-year-old boy presented with painful swelling of the front of his chest after a roadside brawl. He had been born with a birthmark on his chest that had grown steadily to its present size. We noted a giant (32-by-21-cm), circular, well-defined, spongy, hairy, jet-black congenital melanocytic nevus occupying the lower chest and epigastrium (Panel A). The nevus was warm to the touch and mildly tender. Multiple satellite lesions over the trunk, face, limbs, palms, and lower back (Panel B, arrow) were present. No neurologic deficits were identified. Congenital nevi, which are benign proliferations of melanocytes in the dermis, epidermis, or both, occur in 1 to 2% of newborn infants. If the nevus is greater than 20 cm in diameter, it is classified as giant. Satellite lesions are often found in patients with giant congenital nevi. Giant congenital nevi may cause cosmetic problems, undergo malignant transformation, or be a part of the rare syndrome of neurocutaneous melanosis, which is characterized by congenital melanocytic nevi and melanotic neoplasms of the central nervous system. The patient's symptoms improved with oral antibiotic therapy. Despite discussion of the risk of subsequent melanoma, the patient and his parents declined surgical resection of the giant nevus

Planned versus emergency cesarean delivery with previous one cesarean section: a prospective observational study

Background: Women presents with previous history of cesarean section (CS) is a ‘high risk pregnancy’ and requires regular antenatal check-ups. Planned CS at term done for perinatal interest. Post cesarean pregnancy admitted through emergency required direct CS, for those not fit for vaginal birth as per different guidelines. Main objective of this study is to know neonatal and maternal outcome at term for planned versus emergency CS with previous one CS.Methods: Planned or emergency CS were done in 1003 pregnant women at term with previous one CS and outcome of both neonatal and maternal were noted. Emergency CS done in failed VBAC women were excluded from the study.Results: Planned CS before onset of labor were done in 22.93% and emergency CS in 77.07% in the present study. A significant number of women has undergone planned CS in cephalo-pelvic disproportion (45.21%), contracted pelvis (24.34%) and fetal growth restriction (6.95%) where P=0.000. Scar tenderness (20.18%), fetal distress (16.04%) and cephalo-pelvic disproportion (15.52%) were major indications for emergency CS. Maternal complications in the emergency CS group were pyrexia (P=0.000) and blood transfusion, required in 1.81% (P=0.000). There were two maternal death and hysterectomy required in 0.38% in the emergency CS compared to 1.30% in the planned CS (P=0.274). Neonatal complications were significant(P=0.018) in the emergency CS group. Common complications were jaundice (2.84% versus 1.73%, P=0.489), sepsis (0.25% versus 0.86%, P=0.487) and early neonatal death (2.97% versus 0.86%, P=0.119) in emergency CS compared to planned CS.Conclusions: Neonatal morbidity and mortality were significant in the emergency CS, compared to planned CS. Pyrexia and blood transfusion were significant maternal morbidity in the emergency CS group

Pattern & correlates of neurocognitive dysfunction in Asian Indian adults with severe obstructive sleep apnoea

Background & Objectives: No published data are available on neurocognitive dysfunction in Asian Indians with obstructive sleep apnoea (OSA). We therefore, studied the pattern and correlates of neurocognitive dysfunction in Indian adults with severe OSA. Methods: Fifty patients aged 25-65 yr with severe OSA (apnoea-hypopnoea index>30) and 25 age, sex, and education level-matched normal controls were studied. Both groups were administered a standardized battery of neurocognitive tests. Results: Patients with severe OSA had significantly impaired performance on tests of alertness, working memory, response inhibition, problem solving, and executive function. However, the difference in executive function between the groups disappeared after adjusting for delayed information processing. The test scores did not correlate with apnoea-hypopnoea index, arousal index, or Epworth sleepiness score. However, the percentage of time spent at <90 per cent oxygen saturation had a weak correlation with the number of stroop errors (Spearman's rho=0.64; P=0.033), number of trials required (rho=0.05; P=0.02), and perseverative errors on Wisconsin card sorting test (rho=0.36; P=0.02). Interpretation & Conclusions: Our results suggested that delayed information processing rather than impaired abstract thinking was probably the cause of impaired performance on composite tests of neurocognitive function in patients with severe OSA

Dynamics of socio-economic factors affecting climate vulnerability and technology adoption: Evidence from Jodhpur district of Rajasthan

Climate change and extreme weather fluctuations are the most threatening challenges to the farming communities especially in semi-arid tropics. The paper investigates socio-economic factors affecting vulnerability and adoption of innovations using micro-level survey data of 100 systematically selected farmers in the Jodhpur district of Rajasthan, India. The results reveal that higher income, irrigation and provision of seeds reduce climate vulnerability to a great extent. Several farm level strategies have been adopted by the farmers against climate induced stress, including change in cropping pattern, reduction in irrigation usage, use of drips and sprinklers and water conservation. In case of pearl millet cropping system, we found that adoption of wide row spacing is significantly influenced by the level of the farmer’s education, land size category, climate awareness and trainings programs. The study suggests that diversified crop sequence involving pearl millet-wheat-cluster bean-barley-onion, farmers’ adoption of suitable adaptation strategies and climate resilient technologies will improve with better awareness, education and farm governance with regard to climate change. Moreover, technologies especially indigenous ones suitable to the local contextual needs must be developed or fine-tuned and disseminated for reducing climate-induced vulnerability

Clinical Characteristics of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in North Indian Population of HIV/AIDS Patients Receiving HAART

Background & Objective. IRIS is an important complication that occurs during management of HIV-TB coinfection and it poses difficulty in diagnosis. Previous studies have reported variable incidence of IRIS. The present study was undertaken to describe the pattern of TB-associated IRIS using recently proposed consensus case-definitions for TB-IRIS for its use in resource-limited settings. Methods. A prospective analysis of ART-naïve adults started on HAART from November, 2008 to May, 2010 was done in a tertiary care hospital in north India. A total 224 patients divided into two groups, one with HIV-TB and the other with HIV alone, were followedup for a minimum period of 3 months. The diagnosis of TB was categorised as ‘‘definitive” and ‘‘probable”. Results. Out of a total of 224 patients, 203 completed followup. Paradoxical TB-IRIS occurred in 5 of 123 (4%) HIV-TB patients while 6 of 80 (7.5%) HIV patients developed ART-associated TB. A reduction in plasma viral load was significantly (P = .016) associated with paradoxical TB-IRIS. No identifiable risk factors were associated with the development of ART-associated TB. Conclusion. The consensus case-definitions are useful tools in the diagnosis of TB-associated IRIS. High index of clinical suspicion is required for an early diagnosis

Loss of genetic diversity and inbreeding in Kashmir red deer (Cervus elaphus hanglu) of Dachigam National Park, Jammu & Kashmir, India

BACKGROUND: Hangul (Cervus elaphus hanglu), the eastern most subspecies of red deer, is now confined only to the mountains in the Kashmir region of Jammu & Kashmir State of India. It is of great conservation significance as this is the last and only hope for Asiatic survivor of the red deer species in India. Wild population of free ranging hangul deer inhabiting in and around Dachigam National Park was genetically assessed in order to account for constitutive genetic attributes of hangul population using microsatellite markers. RESULTS: In a pool of 36 multi-locus genotypes, 30 unique individuals were identified based on six microsatellite loci. The estimated cumulative probability of identity assuming all individuals were siblings (P(ID) sibs) was 0.009 (9 in 1000). Altogether, 49 different alleles were observed with mean (± s.e.) allelic number of 8.17 ± 1.05, ranging from 5 to 11 per locus. The observed heterozygosity ranged between 0.08 and 0.83, with mean 0.40 ± 0.11 and the inbreeding coefficient ranged between −0.04 and 0.87 with mean 0.38 ± 0.15. Majority of loci (5/6) were found to be informative (PIC value > 0.5). All loci deviated from Hardy-Weinberg equilibrium except Ca-38 (P > 0.05) and none of the pairs of loci showed significant linkage disequilibrium except the single pair of Ca-30 and Ca-43 (P < 0.05). CONCLUSIONS: The preliminary findings revealed that hangul population is significantly inbred and exhibited a low genetic diversity in comparison to other deer populations of the world. We suggest prioritizing the potential individuals retaining high heterozygosity for ex situ conservation and genetic monitoring of the hangul population should be initiated covering the entire distribution range to ensure the long term survival of hangul. We speculate further ignoring genetics attributes may lead to a detrimental effect which can negatively influence the reproductive fitness and survivorship of the hangul population in the wild

Allelic dimorphism of Plasmodium vivax gam-1 in the Indian subcontinent

BACKGROUND: Genetic polymorphism is an inevitable component of a complex organism especially in multistage infectious organisms such as malaria parasites. Understanding the population genetic structure of the parasites would provide valuable information for effective malaria control strategies. Recently, the development of molecular tools like PCR has made analysis of field samples possible and easier and research on Plasmodium vivax has also been strengthened. Not many reports are available on the genetic polymorphism of P. vivax from the Indian sub-continent. This study evaluates the extent of diversity in field isolates of India with respect to Pvgam-1. METHODS: A study was designed to assess the diversity of Pvgam-1 among field isolates from India, using a nested PCR assay. Field isolates were collected from different regions of the country and the observed variability was confirmed by sequencing data. RESULTS: Both Belem and Chesson type alleles were present either exclusively or in mixed form among isolates of all 10 study sites. The Belem type allele was predominant, occurring in 67% of isolates. The proportion of isolates showing the mixed form (both Belem and Chesson type alleles occurring together in the same isolate) was about 13 overall (up to 38.5% in some isolates). Sequencing of the PCR-amplified Belem and Chesson type alleles confirmed the PCR results. Among the 10 study sequences, 11 polymorphic sites and four singleton variations were observed. All the nucleotide substitutions were non-synonymous. CONCLUSION: Study shows limited diversity of Pvgam-1 marker in Indian isolates with well representation of both Belem and Chesson type alleles

Plasmodium vivax lineages: geographical distribution, tandem repeat polymorphism, and phylogenetic relationship

Background: Multi-drug resistance and severe/ complicated cases are the emerging phenotypes of vivax malaria, which may deteriorate current anti-malarial control measures. The emergence of these phenotypes could be associated with either of the two Plasmodium vivax lineages. The two lineages had been categorized as Old World and New World, based on geographical sub-division and genetic and phenotypical markers. This study revisited the lineage hypothesis of P. vivax by typing the distribution of lineages among global isolates and evaluated their genetic relatedness using a panel of new mini-satellite markers. Methods: 18S SSU rRNA S-type gene was amplified from 420 Plasmodium vivax field isolates collected from different geographical regions of India, Thailand and Colombia as well as four strains each of P. vivax originating from Nicaragua, Panama, Thailand (Pak Chang), and Vietnam (ONG). A mini-satellite marker panel was then developed to understand the population genetic parameters and tested on a sample subset of both lineages. Results: 18S SSU rRNA S-type gene typing revealed the distribution of both lineages (Old World and New World) in all geographical regions. However, distribution of Plasmodium vivax lineages was highly variable in every geographical region. The lack of geographical sub-division between lineages suggests that both lineages are globally distributed. Ten mini-satellites were scanned from the P. vivax genome sequence; these tandem repeats were located in eight of the chromosomes. Mini-satellites revealed substantial allelic diversity (7-21, AE = 14.6 +/- 2.0) and heterozygosity (He = 0.697-0.924, AE = 0.857 +/- 0.033) per locus. Mini-satellite comparison between the two lineages revealed high but similar pattern of genetic diversity, allele frequency, and high degree of allele sharing. A Neighbour-Joining phylogenetic tree derived from genetic distance data obtained from ten mini-satellites also placed both lineages together in every cluster. Conclusions: The global lineage distribution, lack of genetic distance, similar pattern of genetic diversity, and allele sharing strongly suggested that both lineages are a single species and thus new emerging phenotypes associated with vivax malaria could not be clearly classified as belonging to a particular lineage on basis of their geographical origin