Showing papers by "Apollo Hospital, Indraprastha published in 2018"

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

Abstract: Background Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. Methods and findings We assessed 3,964 children (with almost equal number of boys and girls distributed in 2–<6 and 6–9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6–9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2–<6 year olds ranged from 2.9% (95% CI 1.6–5.5) to 18.7% (95% CI 14.7–23.6), and for any of nine NDDs in the 6–9-year-old children, from 6.5% (95% CI 4.6–9.1) to 18.5% (95% CI 15.3–22.3). Two or more NDDs were present in 0.4% (95% CI 0.1–1.7) to 4.3% (95% CI 2.2–8.2) in the younger age category and 0.7% (95% CI 0.2–2.0) to 5.3% (95% CI 3.3–8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5–11.2) and 13.6% (95% CI 11.3–16.2) in children of 2–<6 and 6–9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6–9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. Conclusions The study identifies NDDs in children aged 2–9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.

Publication trends and knowledge mapping in 3D printing in orthopaedics.

Abstract: Purpose Three dimensional (3D) printing, also called ‘rapid prototyping’ and ‘additive manufacturing’ is considered as a “second industrial revolution.” With this rapidly emerging technology, CT or MR images are used for the creation of graspable objects from 3D reconstituted images. Patient-specific anatomical models can be, therefore, manufactured efficiently. These can enhance surgeon's understanding of their patients' patho-anatomy and also help in precise preoperative planning. The 3D printed patient-specific guides can also help in achieving accurate bony cuts, precise implant placement, and nice surgical results. Customized implants, casts, orthoses and prosthetics can be created to match an individual patient's anatomy. The 3D printing of individualized artificial cartilage scaffolds and 3D bioprinting are some other areas of growing interest. We aim to study the publication trends in 3D printing as applied to the field of orthopaedics. Materials and methods A literature search was performed to extract all papers related to 3D printing applications in orthopaedics and allied sciences on the Pubmed, Web of Science and SCOPUS databases. Suitable keywords and boolean operators (“3D Printing” OR “3-dimensional printing” OR “3D printed” OR “additive manufacturing” OR “rapid prototyping”) AND (‘‘Orthopaedics” OR “Orthopaedics’’) were used, in May 2018. Search was attempted in Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Database of Abstracts of Review of Effectiveness (DARE) databases, using keywords 3d printing orthopaedics. A similar search was repeated in pubmed and SCOPUS to get more specific papers. No limits were set on the period or evidence level, as 3D printing in orthopaedics is relatively new and evidence available is usually limited to low-level studies. Trends in a publication on these topics were analyzed, focussing on publications, type of research (basic science or clinical), type of publication, authors, institution, and country. Some citations received by these papers were also analyzed in SCOPUS and Web of Science. MS Excel (2008 - Mac version) and VOS Viewer1.6.8 (2018- Mac version) software were used to analyze the search results and for citation mapping respectively. We also identified top 10 most cited articles in the field. Results An increasing trend in publications in 3D printing-related work in orthopedic surgery and related fields was observed in the recent past. A search on Pubmed using the above strategy revealed 389 documents. A similar search revealed 653 documents on SCOPUS, many (314) of which were from an engineering background and only 271 were related to medicine. No papers were found in the Cochrane database. Search on TRIP database revealed 195 papers. A similar search revealed 237 papers on orthopedic applications on Pubmed and 269 documents on SCOPUS, whereas a search on Web of Science revealed only 23 papers. Publication trends were then analyzed on data derived from SCOPUS database. Overall, most papers were published from China, followed by United States, United Kingdom, and India. Conclusion There has been an upsurge of interest in 3D printing in orthopedic surgery, as is evident by an increasing trend in research and publications in this area in the recent years. Presently, 3D printing is in a primitive stage in the field of orthopedic surgery as our knowledge is still insufficient, and costs and learning curve are somewhat high. However, looking at latest publication trends, we are enthusiastic that it holds the key to future in orthopaedics and trauma cases.

Surgical approaches for open reduction and internal fixation of intra-articular distal humerus fractures in adults: A systematic review and meta-analysis.

Abstract: Background A number of surgical approaches have been described for open reduction and internal fixation (ORIF) of intra-articular distal humerus (IDH) fractures in adults. However, there is no consensus as to which approach is better in terms of functional outcomes and complications. The purpose of this study was to determine whether the functional outcomes and types and rates of complications are influenced by the choice of surgical approach for ORIF of IDH fractures (AO/OTA types 13 B & C). Methods A systematic review of literature was performed using the PubMed, EMBASE and Cochrane Database of Systematic Reviews databases. Studies, both prospective and retrospective and comparative or non-comparative, dealing with surgical approaches for ORIF of IDH fractures in adult patients were included. Conference abstracts, studies looking primarily at the results of internal fixation rather than the surgical approach, those including extra-articular distal humeral fractures, pediatric distal humeral fractures ( Results 11 studies were included in the qualitative analysis, of which 5 were comparative studies and 6 were non-comparative. Quantitative analysis was performed on two sets of two studies, each set comparing the Bryan and Morrey or the triceps-split approach to the olecranon osteotomy approach, and revealed no significant differences in the Mayo Elbow Performance Score, range of motion and rates of complications. The overall methodological quality of the studies included in the review was low. Conclusions High-quality evidence on surgical approaches for ORIF of IDH fractures in adults is lacking. Evidence from low-quality studies indicates that there is no difference in the functional outcomes or complication rates when comparing the Bryan and Morrey or triceps-split to the olecranon osteotomy approach. Future research in the form of high-quality randomized controlled trials is needed to determine which approach is superior in terms of functional outcomes and complications.

Renal Allograft Dysfunction: Evaluation with Shear-wave Sonoelastography

Abstract: Shear-wave sonoelastography showed significant differences among stable allograft, acute allograft dysfunction, and chronic allograft dysfunction and may evolve as an additional tool for routine evaluation of patients with renal allograft.

INASL Guidelines on Management of Hepatitis B Virus Infection in Patients receiving Chemotherapy, Biologicals, Immunosupressants, or Corticosteroids.

Abstract: Hepatitis B Virus (HBV) reactivation in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids is emerging to be an important cause of morbidity and mortality in patients with current or prior exposure to HBV infection. These patients suffer a dual onslaught of illness: one from the primary disease for which they are receiving the culprit drug that led to HBV reactivation, and the other from HBV reactivation itself. The HBV reactivation not only leads to a compromised liver function, which may culminate into hepatic failure; it also adversely impacts the treatment outcome of the primary illness. Hence, identification of patients at risk of reactivation before starting these drugs, and starting treatment aimed at prevention of HBV reactivation is the best strategy of managing these patients. There are no Indian guidelines on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids for the treatment of rheumatologic conditions, malignancies, inflammatory bowel disease, dermatologic conditions, or solid-organ or bone marrow transplantation. The Indian National Association for Study of the Liver (INASL) had set up a taskforce on HBV in 2016, with a mandate to develop consensus guidelines for management of various aspects of HBV infection, relevant to India. In 2017 the taskforce had published the first INASL guidelines on management of HBV infection in India. In the present guidelines, which are in continuation with the previous guidelines, the issues on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids are addressed.

Recommendations for the Early Management of Acute Ischemic Stroke: A Consensus Statement for Healthcare Professionals from the Indian Stroke Association:

Abstract: As per the National Vital Statistics Report, cerebrovascular disease (stroke) in the US has now dropped down to the fifth leading cause of death after chronic lower respiratory diseases and accidents while in India it is 2nd leading cause of death. More than 795,000 people suffer from stroke and almost 130,000 patients die because of stroke each year in the United States while in India over 1.5 million stroke occur every year. Loss of these patients from the work force and 8

Computed tomography based 3D printed patient specific blocks for total knee replacement

Abstract: Objectives 3D printing is an emerging technology and its use in orthopaedics is being explored. We discuss the role of computed tomography based 3D printed patient specific jigs in total knee replacement. We also discuss the various advantages of 3D printed patient specific jigs and the future scope of their use in total knee replacement. Methods A search of English literature was done and articles discussing the role of CT scan based 3D printed patient specific jigs in total knee replacement were included in the study. Results The role of 3D printed jigs in total knee replacement have been found in the prediction of femoral valgus angle, component sizing and in retained hardware. They have shown promise with studies suggesting they might improve the overall mechanical alignment of the knee. There are studies which have also studied the combined role of patient specific instruments with navigation. Conclusion 3D printed jigs hold promise in total knee replacement. Their use in total knee replacement in the presence of retained hardware is useful for the surgeon. They have also showed promise in improving prediction of component sizing and improving mechanical alignment of the knee. Further studies with longer follow up and larger sample size will help in establishing their role in total knee replacement.

Current status of top 10 nutraceuticals used for Knee Osteoarthritis in India.

Abstract: Knee Osteoarthritis (OA) is a progressive degenerative joint disease affecting the quality of life of the elderly population. There is considerable evidence that nutraceuticals from natural herbs may play a significant role in inflammation and joint destruction in OA. We review the current status of some of the commonly used nutraceuticals in Indian market - Boswellia, Aflapin, Chondroitin sulphate, Glucosamine sulphate, Collagen peptide, Curcumin, Fish Oil, Ginger, Green tea, and Rosehip extract. We have summarized their mechanism of action, biological effects, toxicities and efficacy in the management of Knee OA. These supplements have been found to be effective in knee OA in various studies. No serious side effects have been reported for any of these supplements. Overall, our study identifies and support the use of these nutraceuticals to provide symptomatic relief to patients with knee OA and justify their use as an adjunct therapy for the management. More good quality trials are needed to provide definitive answers to questions related to their efficacy and safety for OA prevention and treatment.

Impact of Glycemic Levels in Type 2 Diabetes on Periodontitis.

Abstract: Aim: The aim is to study the effect of glycemic level in Type 2 diabetes and cardiovascular risk factors on periodontal health. Materials and Method: Type 2 diabetic and nondiabetic patients in the age group of 35–80 years (n = 1700) were recruited for the study. Periodontal examination included as follows: Probing depth, clinical attachment level (CAL), gingival recession, and bleeding on probing. Periodontitis was diagnosed based on the CAL levels and diabetes was diagnosed based on glycated hemoglobin (HbA1c) levels. Body mass index, total cholesterol, triglyceride, and low-density lipoprotein (LDL) were assessed for cardiovascular risk. Patients were characterized into two groups as follows: diabetic (n = 1235) and nondiabetic (n = 465). Sociodemographic variables included were: age, sex, obesity, smoking, duration of diabetes, and periodontitis were assessed. SPSS version 20.0.1.0 was used for all the statistical assessments. Conclusion: HbA1c and lipid levels were statistically significant with the severity of periodontitis (odds ratio [OR] [95% confidence interval [CI]: HbA1c 1.34 [1.019–1.21]; Total cholesterol 1.01 [1.03–1.42]; triglycerides 1.01 [1.01–1.14]; LDL 1.028 [1.08–1.71]). Smoking and obesity were also found to be significantly associated with the presence of periodontitis [OR (95% CI): smoking 1.35 (1.10–1.67); obesity 1.23 (1.73–2.05)]. The study concluded that uncontrolled HbA1c levels and elevated cardiovascular risk factors significantly increase the severity of periodontitis in Type 2 diabetes mellitus.

Kidney-Paired Donation to Increase Living Donor Kidney Transplantation in India: Guidelines of Indian Society of Organ Transplantation - 2017.

Abstract: The Indian Society of Organ Transplantation clinical practice guideline document is designed to provide information and assist decision‐making in relation to kidney‐paired donation (KPD). It does not intend to define a standard of care. Variations in practice will inevitably occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to a clinical situation. The working group acknowledged the lack of high‐quality evidence on the issue from India, on which to base our recommendations.

Practical consensus recommendatons for Paget's disease in breast cancer.

Abstract: Paget's disease of the breast is a rare type of cancer of the nipple-areola complex and that is often associated with an underlying in situ or invasive carcinoma. Diagnosis and treatment of Paget's disease is controversial. Expert oncologists discuss on the update on the approaches of Paget's disease diagnosis and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Single Nucleotide Polymorphism-Based Noninvasive Prenatal Testing: Experience in India

Abstract: Noninvasive prenatal testing (NIPT) has revolutionized prenatal screening for chromosomal aneuploidies in some countries. Its implementation has been sporadic in developing countries. Given the genetic variation of the people in different countries, we evaluated the performance of the SNP-based NIPT in India . The Panorama™ NIPT was performed in 516 pregnancies, which had tested intermediate-to-high risk on conventional first and second trimester screening. Results were confirmed either by invasive diagnostic testing or by clinical evaluation after birth. Of 511 samples analyzed, results were obtained in 499 (97.7%). Of these, 480 (98.2%) were low risk and 19 were high risk. A sensitivity of 100% was obtained for detection of trisomies 21, 18, 13 and sex chromosomal abnormalities. The specificity ranged from 99.3 to 100% for abnormalities tested. Taken together, the positive predictive value for trisomies 21, 18, 13 and monosomy X was 85.7%. The average fetal fraction was 8.2%, which is lower than the average observed elsewhere. This is the first report of detailed experience with NIPT in India and demonstrates comparable performance in all aspects of testing to the results elsewhere.

A comparison of ketamine + midazolam to propofol for procedural sedation for lumbar puncture in pediatric oncology by nonanesthesiologists-a randomized comparative trial

Abstract: BACKGROUND Both ketamine-midazolam and propofol are frequently used in pediatric oncology units for procedural sedation. However, there are no prospective, randomized comparative trials (RCT) comparing the two groups when the procedure is performed by nonanesthesiologists. OBJECTIVE To compare ketamine + midazolam (group A) and propofol (group B) as sedative agents for intrathecal chemotherapy with regard to efficacy, side effects, time to induction, time to recovery, and smoothness of recovery. METHODS A partially-blinded RCT was conducted between August 2015 and March 2017 after gaining institutional ethics committee approval. Children aged 1-12 years requiring intravenous sedation for intrathecal chemotherapy were included. Patients were allocated to two treatment arms using computer-generated randomization tables, after obtaining written consent. The initial doses used were: ketamine 2 mg/kg, midazolam 0.2 mg/kg, and propofol 2.5 mg/kg, as per standard recommendations. The patient, parents, and person analyzing the data were blinded. Time to sedation, dose required, depth of sedation, vital parameters, time and smoothness of recovery, and emergence phenomena were documented. RESULTS We enrolled 152 patients (76 each in group A and B). Nine patients had a failure of sedation (all in group B). Mean time to sedation and recovery was shorter in group B (P < 0.001). Transient drop in saturation was more frequent in group B, without statistical significance (P = 0.174). Mean depth of sedation was greater in group A (P < 0.001). Emergence symptoms were more frequently experienced in group A (P < 0.001). CONCLUSIONS Ketamine-midazolam combination is safer and more effective. Propofol is faster in onset and recovery, and has smoother emergence with poor efficacy at recommended initial doses.

Double Dose Plateletpheresis: A Savior to Shrinking Donor Pool and Platelet Inventory Management.

Abstract: The double dose plateletpheresis (DDP) is considered to be a cost effective way of preparing platelets, owing to the low incidence of infectious complications and by also minimizing allogeneic donor exposure to the patients. We aimed at collecting DDP at our center and study its effect on donor hematological parameters, evaluate the product quality and the adverse donor reactions thereafter. Double Dose Platelet was collected from 160 eligible apheresis donors on Amicus cell separator (Fenwal, Inc. Three Corporate Drive Lake Zurich, IL, USA). The donor hematological parameters, product yield, adverse effects on the donors, collection efficiency (CE) and collection rate of the machine were noted. A total of 160 DDPs were collected. The total blood volume processed to achieve the yield of 6.0 × 1011 was 3673.5 ± 276.56 mL. The average yield achieved was 6.14 ± 0.26 × 1011. The average run time was 68.05 ± 6.25 min. Total ACD used was 408.33 ± 33.81 mL. We observed significant relation of pre-donation donor platelet count and platelet yield (p < 0.001). The CE was 78.09 ± 5.15%. There was a significant drop in the post DDP platelet count (p < 0.01) causing no adverse effect. Fourteen donors (8.75%) experienced mild citrate related adverse events. DDP does not lead to major adverse effects and post DDP hematological parameters are also within the acceptable range. It also helps to maintain apheresis platelet inventory, reduce donor exposure, reduce donor requirement and reduce the cost of the product.

Practical consensus recommendations regarding the management of HER2 neu positive metastatic breast cancer

Abstract: Metastatic breast cancer (MBC) is cancer that has spread from the breast to another part of the body or has come back in another distant location. Treatment options for MBC depend on several factors, including where the cancer has spread, the patient's overall health, and the levels of hormone receptors and HER2 in the tumour. Over-expression of HER2 is generally considered to be a negative prognostic feature because it accompanies an increase in breast cancer mortality. However, the development of agents that specifically target HER2 has improved the management of patients with these tumours.[7],[8],[9],[10] This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of these agents and the management of HER2 positive MBC for the benefit of community oncologists.

Meeting report, “First Indian national conference on cervical cancer management - expert recommendations and identification of barriers to implementation”

Abstract: In India, cervical cancer accounts for almost 14% of all female cancer cases. Although poverty continues to cast a wide net over the Indian subcontinent, the preceding three decades have borne witness to improvements in nutrition and sanitation for many citizens. However, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. Treatment of cervical cancer is stage-specific and depends on the patient’s age, desire to preserve fertility, overall health, the clinician’s expertise, and accessibility to resources. There is a paucity of uniform treatment protocols for various stages of cervical cancer in India. Considering all these parameters, a need to optimize treatment paradigms for the Indian population emerged. Three expert panel meetings were held in different regions of India from 2016 to 2017. They were comprised of 15 experts from across the country, and included surgical oncologists, radiation oncologists, and medical oncologists. The panel members reviewed the literature from both national and global sources, discussed their clinical experience and local practices and evaluated current therapeutic options and management gaps for women diagnosed with cervical cancer. This article summarizes the expert opinion from these meetings. It discusses the available resources and highlights the current therapeutic options available for different cervical cancer stages: early stage disease, locally advanced tumors, recurrent/persistent/metastatic cancer. An Indian consensus governing treatment options emerged, including guidelines for use of the only approved targeted therapy in this disease, the anti-angiogenesis drug, bevacizumab. The panel concluded that given the availability of state-of-the-art imaging modalities, surgical devices, radiotherapeutics, and novel agents in several population-dense urban centers, a uniform, multi-disciplinary treatment approach across patient care centers is ideal but not realistic due to cost and a paucity of third party payors for most Indian citizens. Preventative strategies including visual inspection with acetic acid to screen for precursor lesions (i.e., cervical intraepithelial neoplasia) with immediate referral for cervical cryotherapy and possible large-scale roll-out of the HPV vaccine in the near future can be expected to reduce mortality rates significantly in this country.

Minimum-intensity projection images in high-resolution computed tomography lung: Technology update.

Abstract: Chest physicians need to be aware about MinIP images, as these are increasingly being used for the evaluation of a wide range of lung diseases in HRCT study of lungs MinIP images highlight the areas with reduced CT attenuation in the lung parenchyma This allows prompt and early diagnosis of cystic lung diseases or airway, vascular or parenchymal disorders, which manifest with hypoattenuation, mosaic attenuation or air trapping MiniP images are therefore useful for accurate pre-operative planning and disease monitoring

Practical consensus recommendations on management of triple-negative metastatic breast cancer.

Abstract: Patients with breast cancer along with metastatic estrogen and progesterone receptor (ER/PR)- and human epidermal growth factor receptor 2 (HER2)-negative tumors are referred to as having metastatic triple-negative breast cancer (mTNBC) disease. Resistance to current standard therapies such as anthracyclines or taxanes limits the available options for previously treated patients with metastatic TNBC to a small number of non-cross-resistant regimens, and there is currently no preferred standard chemotherapy. Clinical experience suggests that many women with triple-negative metastatic breast cancer (MBC) relapse quickly. Expert oncologist discussed about new chemotherapeutic strategies and agents used in treatment of mTNBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Native valve endocarditis, fusarium and end-stage renal disease.

Abstract: We would like to report a case of invasive Fusariosis involving the native mitral valve and complicated by septic thromboembolism. The patient was a known case of end-stage renal disease on maintenance haemodialysis and did not have any of the known risk factors for invasive Fusariosis like neutropaenia, severe T cell immunodeficiency, postsolid organ transplant recipients, posthaematopoietic stem cell transplant recipients and patients who received cytotoxic and/or high-dose corticosteroid therapy.

Practical consensus recommendaton for adjuvant bone-modifying agents in breast cancer.

Abstract: Bone-modifying therapy is a primary research interest in breast cancer. Several features contribute to the importance of the bone environment in the management of breast cancer. Firstly, bone metastases represent the most common site of breast cancer metastases and secondly, the emergence of cancer treatment-induced bone loss (CTIBL) among breast cancer survivors and patients is of increasing concern. In the adjuvant setting, bisphosphonates can be given to prevent and treat tumor therapy-induced bone loss in premenopausal and postmenopausal women and, owing to their beneficial effect on bone turnover, have also been evaluated for prevention of bone metastases occurrence. Expert oncologists discusses on the update on the approaches of Bone-modifying Agents and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Unusual surgical emergency in a patient of dengue haemorrhagic fever: spontaneous rectus sheath haematoma leading to abdominal compartment syndrome.

Abstract: Abdominal compartment syndrome (ACS) is an uncommon complication of dengue haemorrhagic fever (DHF), described so far only in association with fluid refractory shock and high-volume resuscitation. We describe an unusual case of ACS in a patient of DHF where raised intra-abdominal pressure was due to spontaneous rectus sheath haematoma causing external compression. Early recognition of the haematoma, constant vigilance and timely decision for surgical intervention could salvage the patient with complete recovery of organ function.

Omics and Edible Vaccines

Abstract: Molecular farming provides an unprecedented approach for the production of metabolites or proteins of medicinal value from plants used previously only in agricultural setting. These plants act as protein factories that can synthesize a variety of proteins free from pathogens such as plasma proteins, growth factors, and vaccines. This method provides a novel, tempting, inexpensive, easy, and safe alternative to other techniques of protein or antigen production. With the advent of transgenic plants, it is possible to produce unlimited amounts of subunit vaccines (for oral use/edible and of parenteral use), protein used for pharmaceutical/medicinal purpose, recombinant proteins, antibodies, and industrial enzymes. Plants have numerous advantages over the production systems on account of scalability, safety, and are economic; for example, less cost of production is involved for Hepatitis B nucleocapsid antigen using transgenic tobacco. Biopharming or molecular farming provides an important resource for cheaper drug production used in the treatment of cancer, heart diseases, and infectious diseases. The pharmaceutical products are manufactured by genetically engineered plants that are extracted and purified, also known as pharmaceuticals produced by plants. Edible vaccines are cheaper in cost, easy to administer mostly by oral route, fail-safe, and are acceptable by society especially in developing countries. These vaccines are targeted to provide systemic as well as mucosal types of immunity. It has been predicted that in future children may get their immunization by munching on foods instead of getting enduring shots. The production of edible vaccines consists of the process of introducing the selected genes of desired quality into plant to induce these altered or transgenic plants to produce the encoded proteins in a natural way. These vaccines provide safer alternatives and help in reduction of cost of production and shipping and also decrease the potential hazards associated with conventional vaccines. However, becoming a reality and readily availability of edible vaccine is challenged by many problems of technical, regulatory, and nonscientific issues, which should be ruled out and rectified. This chapter provides insight into the current scenario and future applications of this new preventive modality.

Adjuvant therapy in poor ovarian response – Where do we stand?

Abstract: In the current era, there is an ever increasing incidence of poor ovarian response. Many strategies have been studied and hypothesized for the management. Androgens have been widely used and studies in the management of Poor ovarian response. The two prime androgens used in poor ovarian response are Dehydroepiandrosterone [DHEA], Androstenadione and testosterone. Use of Growth hormone, recombinant luteinizing Hormone and vasoactive substances have been analyzed based on the current evidence.

Umbilical cord blood hematology in relation with maternal anemia: a preliminary study

Abstract: Objectives: The aim of this study was to observe any umbilical cord blood hematological changes in relation to maternal anemia. Methods: We conducted a cross-sectional study on 220 neonates and their mothers from August 1, 2015, to July 31, 2016, in collaboration with the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal, India. Immediately after vaginal delivery of baby, umbilical cord was clamped and blood was collected in EDTA vials and analyzed using automated hematoanalyzer. Results: Neonates of non-anemic mothers had significantly higher level of hemoglobin concentration than neonates of anemic mothers. Total leukocyte count (TLC) was slightly higher in neonates of non-anemic mothers as compared to neonates of anemic mothers. Platelet count was slightly higher in neonates of anemic mothers as compared to non-anemic mothers, but platelet crit, mean platelet volume, and platelet cell distribution width were slightly higher in neonates of non-anemic mothers than neonates anemic mothers. Conclusions: It was a preliminary study. A similar type of the study must be conducted in future to comprehend the effect of various other factors affecting delivery such as maternal anemia, diet, and environment on blood parameters of newborns.

Adjuvant conundrum in central mucoepidermoid carcinoma of the mandible: case presentation and literature review.

Abstract: The cornerstone modality of treatment of central mucoepidermoid carcinoma (CMEC) of the mandible is surgery, optimally, an en bloc resection with/without segmental or hemimandibulectomy Notwithstanding the documentation of a survival benefit in few case reports with the addition of postoperative radiotherapy in carefully selected high-risk patients, there does not exist a clearly defined consensus regarding the role of adjuvant radiotherapy We report the case of a 49-year-old man who presented with right lower jaw swelling which on imaging was found to be a multiloculated lesion causing bony expansion and cortical destruction of the mandible and was diagnosed with CMEC after radiological and histopathological criteria were met He underwent right hemimandibulectomy and histopathology showed squamous and mucinous cells with positive mucicarmine staining and characteristic immunohistochemistry markers confirming the diagnosis of CMEC He subsequently underwent adjuvant radiotherapy and is disease free 5 years since treatment completion