Prevalence of diphtheria in a tertiary care hospital of Western part of India – A clinicoepidemiological study

Background: Diphtheria, a very common vaccine-preventable disease, is still persistent in India without much decline in the past decade. Objective: The objective of this study was to study the clinicoepidemiological profile of diphtheria in children up to 12 years of age, their outcome in tertiary care hospital of Western Gujarat. Materials and Methods: This prospective observational study was conducted among 164 children admitted in the tertiary hospital of Western Gujarat, who were diagnosed with during the period of July 2016–August 2018. Results: It was observed that the highest prevalence of diphtheria was seen in the age group of 5–9 years. There was slight male preponderance with 1.5:1. The majority of patients were referred from rural areas. Immunization status was the most determining feature as 68 patients out of the study population were unimmunized at the time of admission. Conclusion: The rise in the prevalence in more advanced age group of 8–12 years might be due to waning immunity and emphasizes on the need for increasing primary immunization coverage along with both booster doses in areas having less adequate health-care facilities or poor access

Nonsteroidal Management of Accidental Extrusion of Sodium Hypochlorite beyond Apex

Sodium hypochlorite is often used as an intracanal irrigant in root canal treatment for removal of organic debris. It is also used for its ability to dissolve pulpal tissues, removal of organic debris from smear layer. Despite its safe properties, serious complications can result from inadvertent use. The present case report discusses the inadvertent effects and management of accidental extrusion of concentrated NaOCl and nonsteroidal management. Extrusion of NaOCl beyond the root canal can occur when there is iatrogenic widening of the apical foramen, lateral perforation, or wedging of the irrigating needle. Injudicious use of the irrigant should be avoided to prevent the NaOCl accidents. This report demonstrates destructive effect of concentrated NaOCl solution on soft tissues and subsequent management of the case

Exploring Chickpea Germplasm Diversity for Broadening the Genetic Base Utilizing Genomic Resourses

Legume crops provide significant nutrition to humans as a source of protein, omega-3 fatty acids as well as specific macro and micronutrients. Additionally, legumes improve the cropping environment by replenishing the soil nitrogen content. Chickpeas are the second most significant staple legume food crop worldwide behind dry bean which contains 17%–24% protein, 41%–51% carbohydrate, and other important essential minerals, vitamins, dietary fiber, folate, β-carotene, anti-oxidants, micronutrients (phosphorus, calcium, magnesium, iron, and zinc) as well as linoleic and oleic unsaturated fatty acids. Despite these advantages, legumes are far behind cereals in terms of genetic improvement mainly due to far less effort, the bottlenecks of the narrow genetic base, and several biotic and abiotic factors in the scenario of changing climatic conditions. Measures are now called for beyond conventional breeding practices to strategically broadening of narrow genetic base utilizing chickpea wild relatives and improvement of cultivars through advanced breeding approaches with a focus on high yield productivity, biotic and abiotic stresses including climate resilience, and enhanced nutritional values. Desirable donors having such multiple traits have been identified using core and mini core collections from the cultivated gene pool and wild relatives of Chickpea. Several methods have been developed to address cross-species fertilization obstacles and to aid in inter-specific hybridization and introgression of the target gene sequences from wild Cicer species. Additionally, recent advances in “Omics” sciences along with high-throughput and precise phenotyping tools have made it easier to identify genes that regulate traits of interest. Next-generation sequencing technologies, whole-genome sequencing, transcriptomics, and differential genes expression profiling along with a plethora of novel techniques like single nucleotide polymorphism exploiting high-density genotyping by sequencing assays, simple sequence repeat markers, diversity array technology platform, and whole-genome re-sequencing technique led to the identification and development of QTLs and high-density trait mapping of the global chickpea germplasm. These altogether have helped in broadening the narrow genetic base of chickpeas

Acute Febrile Encephalopathy in Children: A Prospective Study of Clinical Features, Etiology, Mortality, and Risk Factors from Western India

Introduction: Acute febrile encephalopathy (AFE) in children is a medical emergency and could be a manifestation of many systemic and central nervous system pathologies. The clinical features of AFE are nonspecific and etiological spectrum variable depending on the studied population. Materials and Methods: A prospective, observational study was carried out including children aged between 1 month and 12 years with AFE admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in Western India. The primary objective was to assess the clinical presentation and etiology of AFE while the secondary objectives were to correlate the clinical and etiological findings and to determine the risk factors associated with mortality. Results: Out of the ninety children with AFE included in this study, male:female ratio was 1.2:1; most of them were aged between 1 and 5 years and came with a history of <7 days (82.2%). All of them had altered sensorium, about 2/3rd had seizures and 47.8% having a Glasgow Coma Score (GCS) <8. Etiology remained elusive in about 40% of the cases, and viral infections were the most common among the ones with an identifiable cause. A variety of morbidity (shock, disseminated intravascular coagulopathy, respiratory failure, etc.) and high mortality (40%) was observed with risk factors associated with mortality being GCS <8, the presence of raised intracranial pressure, shock, and respiratory failure. Conclusion: AFE, though a rare diagnosis in children, is associated with significant morbidity and high mortality in a developing country like India

A Hospital Based Clinical Study on Corneal Blindness in a Tertiary Eye Care Centre in North Telangana

Background: Worldwide there are nearly 2.7 million blind people due to corneal disease which is a major causes of blindness in the world today and remains second only to cataract. Aim & Objective: The present hospital based retrospective study was undertaken to estimate the prevalence of corneal blindness in patients attending tertiary eye care center in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar. Material and Methods: A hospital-based study was conducted over a period of 1 year from August 2014 to August 2015. Participants were patients attending outpatient department of Chalmeda Anand Rao Institute of Medical Sciences. Detailed history was taken and comprehensive ocular examination including Snellen E-chart for visual acuity, slit lamp bio microscopy, contact tonometry, posterior segment evaluation through B-scan and dilated retinal evaluation when indicated was performed at out patient department. Results: Overall, 33,566 patients were examined. Proportion of corneal blindness was 3.9% (CI-95% 3.6% - 4.3%). The proportion increased with age in elderly patients (5.7%) and was higher among the females (5.2%) compared to males (2.8%). The most common cause of corneal blindness in our study was ocular trauma which was 59.5%. Conclusion: The study ?findings demonstrate that currently ocular trauma, corneal ulceration, infectious keratitis, postsurgical bullous keratopathy, and corneal degenerations are responsible for the major burden of corneal blindness among the patients attending outpatient department

Profiling of Home/On the way mortality found SARS-COV-2 positive in Rajasthan during the current season-Away mortality found SARS-COV-2 positive in Rajasthan during the current season-April to July 2020 For Strategic Interventions

Background: First case reported from this empowered action group state&nbsp; on 2.3.20 from international tourist after which state&nbsp; saw an staggered spurt in COVID 19 cases along with rising mortality. Rajasthan was one of the foremost affected state bearing the frontal attack likewise geographicaly extensive states MP &amp;Gujrat. Making indespensable for&nbsp; converting information into evidence for timely identification of causal drivers &amp;revising strategies in pandemic inferno. Objective:To sketch out the mortality profile with respect to demographic and clinical progression with an aim to identify the groups,this virus conspicuously pickedup with a perspective to control some of the avoidable factors.Methods:We analyzed the epidemiological data in 56 RT-PCR confirmed deaths of COVID 19 patients who were brought dead that occurred between 1stApril 2020 and 31stJuly 2020 over a period of 120 days throughout Rajasthan by community surveys . A 3 member team of sector health workers(ASHA/ANM/Medical officer ) were constituted for verbal autopsy of deceased kith/kin after informed consent &amp; 3 weeks after death . A written format for detail discussion with family members was pre hand given which later culminated into a single page dossier for identification of level of delays that lead to a death &amp; actionable points from team itself. These delays were&nbsp; classified into 6 broad categories i.e L1-Delay in seeking health care , L2-delay in availing transport facility, L3- Delay in getting optimum treatment , No Delay,Non COVID Death &amp; cause unknown .Later inspired by the positive feedback impact government facility death review mechanism was also institutionalized steerheaded by medical education department to enrich the available knowledge of prevention &amp; treatment. Results:Atotal of 650 patients died during four months period from 2 March to 5 July out of which 56 brought dead mortality cases presenting with COVID (+) post expiry were analyzed. 26 deaths occurred in the 30-60 years of age group. The mean age being 46.48 years. Males had a marginally increased mortality rate (F: M-1:1.43). The mean time of onset of symptoms to hospitalization was 7.8 days. Thirty Nine&nbsp; (71%) patients were from urban areas, whereas 7(13%) belonged to rural areas.Only 23.52 % patients presented within 24 - 48 hours whereas 33% presented within aday of onset of symptoms&amp; 25.49 % presented within 4-7 days wheras 17.64% had no symptoms .On economic status front 84% belonged to Non Below Poverty line (NBPL) &amp; rest were BPL .Educational status was 34% were 5th pass,23% uneducated ,20 % 8th pass &amp; rest 11&nbsp; % were 10th pass &amp; graduate.77% deaths were without any associated cause of death. Based on initial rounds of facility level reviews 66.9% succumbed within 5 days of hospitalization, despite starting for hospital in advance .56.86% had predisposing risk factors. Conclusion: On the way/home &nbsp;mortality of 8.06% was found out of total some 694 (April-July-20) which was low&nbsp; as house to house survey conducted &amp;community&nbsp; awareness campaigns thru health worker helped in sensitization of general public . As&nbsp; acorollary of this analysis the authors are of the opinion that a rejig of the existing guidelines to identify and treat influenza like illness be made available at the national level. What factors promote rapid progression especially in a group without any predisposing risk condition should form&nbsp; the focus of&nbsp; future studies. As&nbsp; risk group individuals formed&nbsp; a major chunk of deaths, the need to vaccinate this group should form a scaffold on which future directions and interventions have to be builtup to combat the morbidity and mortalit

Self-nanoemulsifying drug delivery system (SNEDDS) mediated improved oral bioavailability of thymoquinone: optimization, characterization, pharmacokinetic, and hepatotoxicity studies

Thymoquinone (TQ) is an antioxidant, anti-inflammatory, and hepatoprotective compound obtained from the black seed oil of Nigella sativa. However, high hydrophobicity, instability at higher pH levels, photosensitivity, and low oral bioavailability hinder its delivery to the target tissues. A self-nanoemulsifying drug delivery system (SNEDDS) was fabricated using the microemulsification technique to address these issues. Its physicochemical properties, thermodynamic stability studies, drug release kinetics, in vivo pharmacokinetics, and hepatoprotective activity were evaluated. The droplet size was in the nano-range (< 90 nm). Zeta potential was measured to be -11.35 mV, signifying the high stability of the oil droplets. In vivo pharmacokinetic evaluation showed a fourfold increase in the bioavailability of TQ-SNEDDS over pure TQ. Furthermore, in a PCM-induced animal model, TQ-SNEDDS demonstrated significant (p < 0.05) hepatoprotective activity compared to pure TQ and silymarin. Reduction in liver biomarker enzymes and histopathological examinations of liver sections further supported the results. In this study, SNEDDS was demonstrated to be an improved oral delivery method for TQ, since it potentiates hepatotoxicity and enhances bioavailability