A retrospective study on the surgical management and outcome of congenital diaphragmatic hernia in neonates

Background: Congenital diaphragmatic hernia is a developmental disorder in the anatomy of the diaphragm, which can range from the presence of a thin sac to the frank absence of part of the diaphragm. It results in protrusion of abdominal contents in the chest. CDH once considered as a surgical emergency is no longer a valid dictum. But definitive management of CDH is the surgical correction of defect. Study the demographics, presentation, diagnosis, and surgical outcomes of congenital diaphragmatic hernia (CDH) repair without significant associated congenital anomalies at a tertiary care institute. Methods: This was a retrospective study over 3 years from January 2021 to December 2023. Data was collected and noted from the medical records department. Patient’s clinical data in terms of demography, presentation, radiology, preoperative condition, timing of surgery after admission, intra-operative findings and post-operative course (including postoperative complications, duration of NICU stay, the incidence of sepsis, and need of inotropes), etc. Results: Most patients were male (85%). Among the total cohort, 70% were born outside the tertiary care institute and were referred from peripheral hospitals. Respiratory distress was the predominant complaint (85%). Congenital diaphragmatic hernia (CDH) was incidentally discovered in 5% of neonates. The majority of patients (70%) underwent surgical intervention between the 3rd postnatal day and up to one week. Left-sided herniation was observed in 90% of cases. An identifiable hernial sac was found in 18% of patients, with part or the entirety of the stomach being the most frequently encountered herniated viscera. Conclusions: Congenital diaphragmatic hernia (CDH) presents as a significant congenital anomaly in the pediatric surgery domain. Hidden mortality in case of CDH leads to underreporting of the actual incidence of the condition. The success of surgical intervention depends on a myriad of factors, encompassing patient-specific attributes and surgical methodologies. However, instances devoid of overt congenital anomalies and featuring stable preoperative physiological parameters typically yield satisfactory surgical outcomes, with favorable results.

Social Tourism Entrepreneurship as tool for Development of rural areas: a case study of Himalayan region of Jammu & Kashmir, India

The promotion of rural tourism has been suggested as a way to promote local economic, social, and cultural renewal. The importance of entrepreneurship in the tourism sector is growing. Since entrepreneurs may be vital in the growth of rural communities, especially those in less industrialized regions, they are frequently confronted with a variety of social issues. Finding new sources of revenue and employment possibilities for them is essential. There is no doubt that entrepreneurial businesses help the host community and the nation\u27s economy. Kashmir\u27s rural areas have certain unique characteristics that can be turned into enticing tourist destinations. This study accesses rural tourism entrepreneurship as a strategy for economic development in the Kashmir valley, examines the literature on rural tourism and rural tourism potential. The Kashmir valley poses huge potential for rural tourism and there is a big gap in the development of these destinations. Low-income and disadvantaged communities might benefit from tourism because of its capacity to spur economic growth. Due to a lack of enough infrastructure, rural areas find it difficult to fully benefit from tourism

Simple, sensitive and rapid determination of linifanib (ABT-869), a novel tyrosine kinase inhibitor in rat plasma by UHPLC-MS/MS

An overall model for sulfur self-retention in ash during coal particle combustion is developed in this paper. It is assumed that sulfur retention during char combustion occurs due to the reaction between SO2 and CaO in the form of uniformly distributed non-porous grains. Parametric analysis shows that the process of sulfur self-retention is limited by solid difussion through the non-porous product layer formed on the CaO grains and that the most important coal characteristics which influence sulfur self-retention are coal rank. content of sulfur forms. molar Ca/S ratio and particle radius. A comparison with the experimentally obtained values in a FB reactor showed that die model can adequately predict the kinetics of the process, the levels of the obtained values of the SSR efficiencies, as well as the influence of temperature and coal particle size.U radu je prikazan razvijeni model zadržavanja sumpora u pepelu tokom sagorevanja uglja. Pretpostavka modela je da se zadržavanje sumpora tokom sagorevanja koksnog ostatka odigrava usled reakcije SO2 i CaO koji je u obliku ravnomerno raspoređenih zrna. Parametarska analiza je pokazala da je proces zadržavanja sumpora kontrolisan difuzijom kroz formirani sloj čvrstog produkta na zrnima CaO, kao i da su rang uglja, sadržaj formi sumpora molarni Ca/S odnos i veličina čestice važne osobine uglja koje utiču na proces. Poređenje sa eksperimentalnim rezultatima dobijenim u reaktoru sa fluidizovanim slojem je pokazalo da model može adekvatno da predvidi kinetiku procesa, efikasnost zadržavanja sumpora u pepelu, kao i uticaj temperature i veličine čestice uglja

Gabapentin Toxicity and Role of Dialysis; Case Series and Literature Review

Gabapentin is frequently used as an analgesic in patients with chronic kidney disease (CKD). It is excreted exclusively through kidney, and therefore impairment in kidney function could lead to gabapentin accumulation and hence toxicity. We present our experience of 3 cases with Gabapentin toxicity who were managed according to the severity of symptoms. Case 1: A 32-year-old male was found lying unconscious after consuming around 12,000 mg of gabapentin and had respiratory depression, rhabdomyolysis, and acute kidney injury (AKI). Patient was managed with supportive care and hemodialysis (HD). Case 2: A 64-year-old male CKD Stage 5 (5D) patient with diabetic neuropathy was started on gabapentin 300 mg daily by his primary care physician 1 week back. Patient started to feel sleepy and developed altered sensorium and myoclonus. Discontinuation of gabapentin and a session of HD led to dramatic improvement in patient’s status. Case 3: A 70-year-old female diabetic patient with CKD Stage 3 and had diabetic neuropathy. Her neuropathic symptoms had improved with gabapentin 300 mg twice daily, but lately patient was feeling sleepy during the day and was confused. Discontinuation of the drug led to improvement in symptoms. Gabapentin is a relatively safe medication, but in certain clinical scenarios, particularly in impaired renal functions, can lead to severe complications. Moreover, it per se can rarely lead to rhabdomyolysis and AKI. Clinical suspicion and timely decontamination are needed, and sometimes dialytic therapy may be needed

Physical health perspective and mental subnormality of a child with Hunter’s disease

Hunter’s disease or mucopolysaccharidosis (MPS II) is a rare X-linked recessive disorder caused by deficiency or malfunctioning of the lysosomal enzyme iduronate-2-sulfatase (IDS), leading to progressive accumulation of glycosaminoglycans in almost all cell types, tissues and organs which result in permanent, progressive cellular damage that affects the appearance, physical abilities, organ and system functioning and, in most cases, mental development. The common clinical presentations include facial dysmorphism, pulmonary dysfunction, hepatosplenomegaly, and skeletal defects including joint stiffness and contractures, cardiomyopathies, and neuropsychiatric manifestations. We present this case of MPS II with clinical presentation including coarse facies, short stature, and mental retardation. The diagnosis was confirmed by demonstrating the deficiency of IDS in plasma. We report this case to highlight the clinical features and to specify the mental and physical health perspective of a child with Hunter’s disease. Mental subnormality includes progressive cognitive deterioration that is not manageable with enzyme replacement therapy. Hence, the patient should undergo regular assessment and should be trained accordingly

Sitagliptin induced splenic infarcts

  Sitagliptin belongs to the class of dipeptidyl pepti­dase-4 (DPP-4) inhibitors. DPP-4 inhibitors are remark­ably well tolerated oral antihyperglycemic drugs with an adverse effect profile similar to that of placebo. No adverse effects have been reported even with overdose of sitagliptin in suicide attempts. We present here case summary of a 35-year-old female with type 2 diabetes mellitus and major depressive disorder who presented with multiple splenic infarcts after ingestion of sitag­liptin 700 mg and metformin 14 g with suicidal intent. To the best of our knowledge, there are no published reports of splenic infarcts as an adverse event of sit­agliptin. (Clin Diabetol 2017; 6, 6: 215–217

Life style patterns and adherence to pharmacotherapy after acute coronary syndrome: one year follow up study from a tertiary care center in Kashmir, India

Background: Acute coronary syndrome is the leading cause of cardiac mortality and morbidity world over. Modification of life style pattern and adherence to pharmacotherapy plays a vital role in primary and secondary prevention of coronary events. This study was aimed at assessing the penetration of life style modifications and adherence to pharmacotherapy after acute coronary event in our population.Methods: Acute coronary syndrome patients enrolled in the study were examined, interviewed and all the demographic and clinical data was recorded at index event and at 3, 6 and 12 month intervals.Results: A total of 260 patients were enrolled in the study and followed for 12 months. Mean age of patients was 55.6±8.27 years. Males 78.6% and females 21.5%. Hypertension was risk factor in 67.7%, diabetes in 26.2%, smoking in 63.8%, BMI ≥25 in 67.3% and family history of coronary artery disease in 8.8% of the cases at index event. Uncontrolled hypertension was observed in 30.11%, 38.63% and 44.88% patients at 3, 6 and 12 months follow up. Uncontrolled diabetes at 3, 6 and 12 months was found in 58.82%, 66.17% and 73.52% patients. 5.42%, 15.06% and 21.08% cases continued to smoke at 3, 6 and 12 months respectively. Drug non-compliance overall was noted in 9.61%, 17.69% and 23.84% cases at 3, 6 and 12 month follow up.Conclusions: This study highlights the under prevalence of modifiable risk factor change in practice and drug non-compliance after an acute coronary event

Correlation between preoperative axillary ultrasound and histopathology of resected lymph nodes in patients with carcinoma breast

Background: Axillary Ultrasound is an important tool in assessing regional lymph node status in women who are node negative clinically as many of them will prove to have axillary lymph node involvement on histopathology. The aim of the present study was to establish the role of axillary ultrasound in preoperative assessment of lymph node status in women with carcinoma breast and to correlate the findings of axillary ultrasound with the histopathology of resected axillary nodes.Methods: Forty patients (all women) were included in this study and the preoperative axillary ultrasound was done to know the status of axillary lymph nodes and the findings were correlated with histopathological findings of the resected nodes.Results: The sensitivity of axillary ultrasound was found to be 66.67%, specificity was 87.5%, accuracy 75%, positive predictive value (PPV) of 88.89% and negative predictive value of 63.4%.Conclusions: Axillary ultrasound is very important tool in assessing preoperative axillary lymph node status in patients with carcinoma breast. It is also important in assessment after inadequate axillary dissection and for follow up of non-treated axilla