Jawaharlal Nehru Medical College, Belgaum (JNMC) is a constituent medical school of KLE University. It is located at Belgaum in Karnataka state. The college was earlier affiliated to the state unitary Rajiv Gandhi University of Health Sciences.
The perforation of prepyloric gastric ulcer is a surgical emergency that carries a high morbidity burden, but the rate of occurrence of double prepyloric perforation is extremely low, which thus presents both diagnostic and operative challenges. The presented case is of a 57-year-old male from India, who presented with a five-day history of abdominal pain, nausea, vomiting, and constipation. Cultural Extended Focused Assessment with Sonography for Trauma (E-FAST) and clinical examination indicated peritonitis with intra-abdominal fluid, thus warranting emergency exploratory laparotomy. During the intraoperative period, about 800 mL of purulent fluid was drained and 2 cm and 1.5 cm adjacent prepyloric perforations were detected along the lesser curvature. The patient had severe intraoperative malnutrition, which was manifested through cachexia, depleted omental fat, and hypoalbuminaemia and required a surgical approach based on his compromised physiological reserve. The perforations were primarily closed and then a gastrojejunostomy with feeding jejunostomy was done to provide sufficient gastric bypass and postoperative nutritional support. Histopathologic examination of the patient revealed gastric ulceration with mucosal denudation, fibrinous exudate, bacterial colonies, and inflammatory infiltration, which were consistent with perforation. The patient responded to antibiotics, analgesia, and enteral feeding, which was achieved through jejunostomy, with a gradual improvement in the clinical condition. Oral intake was then started and tolerated. After four weeks, the feeding jejunostomy was removed, and the patient also remained asymptomatic on follow-up. The case of double prepyloric ulcer perforations is quite rare, and it highlights the necessity of immediate surgical intervention and an individual approach to patients with poor nutritional status. Reporting of such cases is significant to provide insights into optimal operative decision-making in complex cases of upper gastrointestinal perforation.
BackgroundParkinson’s disease (PD) is the second most prevalent neurological disorder, characterized by motor symptoms such as tremor and rigidity due to the degeneration of dopaminergic neurons in the substantia nigra. This study investigates the formulation of quercetin, a natural bioflavonoid with potent antioxidant and anti-inflammatory properties, as niosomes for intranasal delivery to enhance its bioavailability and therapeutic potential for PD.MethodsThe niosomal formulation was optimized for critical parameters including particle size, entrapment efficiency, and zeta potential. Male Wistar rats were utilized to assess the effects of quercetin-loaded niosomes on motor function, dopaminergic neuron protection, and oxidative stress alleviation.ResultsThe optimized niosomal formulation exhibited a particle size of 195 nm, a polydispersity index (PDI) of 0.29, a zeta potential (ZP) of −30.63 mV, and an entrapment efficiency (EE) of 82.77%. In vivo evaluations conducted using the haloperidol-induced PD model revealed significant enhancements in behavioural, biochemical, and histopathological outcomes when compared to both disease controls and the standard treatment group. Additionally, short-term stability tests confirmed the robustness of the formulation.ConclusionThe findings suggest that the quercetin-loaded niosomal formulation offers improved drug delivery and efficacy, indicating its potential as a superior treatment option for PD compared to conventional dosage forms. This approach may pave the way for enhanced therapeutic strategies targeting the neurodegenerative processes underlying Parkinson’s disease.
Background: The study aims to explore the burden and trends of prostate cancer (PC) in India at the state level from 1990 to 2021, using data from the Global Burden of Disease (GBD) 2021 study. Methods: The health metrics including age-standardised incidence rates (ASIR), prevalence rates (ASPR), disability-adjusted life years (ASDR), and mortality rates (ASMR) per 100,000 for PC were analysed across Indian states and union territories. Join point regression analysis was employed to identify significant changes in these metrics over time. Projection of ASIR were done using auto-regressive integrated moving average (ARIMA) model. Results: The age-wise distribution of PC showed increased in ASIR, ASPR, ASDR, ASMR among older age, majorly in the 75-79 years age group. From 1990-2021, the average annual percentage change (AAPC) in ASIR, ASPR, ASMR and ASDR increased by 157 %, 278 %, 76 % and 58 % respectively. Projections indicate a further rise in ASIR to 9.15 per 100,000 by 2031. The join point analysis showed the highest annual percentage change (APC) between 1992 and 1995 period in all health metrics. Despite Gujarat state showing the highest total percentage change in all health metrics when considering regional variations, Delhi and Kerala still remain the highest overall.
INTRODUCTION:Aortic valve neocuspidization (AVNeo) using fixed autologous pericardium, also known as the Ozaki technique, is an effective therapy for treating aortic valvulopathies. It serves as an alternative to complex aortic valve repair, offering better hemodynamics compared to biological or mechanical valve replacement, without the need for lifelong anticoagulation. OBJECTIVES:To evaluate the immediate and early outcomes of our initial experience with the AVNeo procedure in a spectrum of aortic valve diseases. METHODS:In this retrospective cohort study, seventeen AVNeo procedures were performed between March 2023 and October 2023 at our center. All patients completed one year of follow-up. Outcomes were assessed by echocardiographic evaluation postoperatively and at one year, including complications and mortality. RESULTS:Patient age ranged from 7 to 77 years (mean 35.2 ± 22.4 years), with 3 females among the 17 patients. Aortic valve morphology was bicuspid in 6 (35.3 %) and tricuspid in 11 (64.7 %) patients. Twelve patients had aortic stenosis as the primary pathology, and five had moderate to severe aortic regurgitation. In aortic stenosis patients, the preoperative mean peak gradient was 82.3 ± 20.3 mmHg, and mean gradient was 48.9 ± 18.5 mmHg. Postoperatively, mean peak gradient reduced to 9 ± 5.3 mmHg, and mean gradient to 16.7 ± 9.1 mmHg. Two patients required conversion to prosthetic valve replacement for progressive aortic regurgitation. There was no mortality at one year, though one patient developed severe aortic regurgitation. CONCLUSION:AVNeo is a feasible, reproducible procedure with favorable early outcomes, low pressure gradients, and mild regurgitation at one year. It is a cost-effective option, particularly in resource-limited settings like India.
OBJECTIVE:Asthma poses a significant health burden in South Asia, with increasing incidence and mortality despite a global decline in age-standardized prevalence rates. This study aims to analyze asthma trends from 1990 to 2021, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across South Asia. The study also assesses the impact of risk factors like high body mass index (BMI), smoking, and occupational exposures on asthma outcomes. METHOD:We extracted asthma data from the Global Burden of Disease database for South Asia (1990-2021). Joinpoint regression analysis was used to assess temporal trends in asthma burden. Total Percentage change (TPC) in age-standardized rates of incidence, mortality, and DALYs were calculated. Data were stratified by gender, and the contribution of risk factors was evaluated. RESULTS:Asthma-related mortality in South Asia decreased by 37%, from 27.78 per 100,000 (1990) to 17.54 per 100,000 (2021). The Maldives showed the most significant reduction in mortality (78.31%), while Bangladesh recorded a 47.44% reduction in prevalence and a 62.64% decrease in DALYs. High BMI, smoking, and environmental risks contributed significantly to DALYs, with environmental factors playing a major role in countries like Afghanistan (20.73%) and Bhutan (18.58%). Females, particularly those over 20, experienced higher asthma-related DALYs than males. CONCLUSION:Asthma burden in South Asia has reduced over the past three decades, yet the absolute number of cases continues to rise, driven by population growth and environmental risk factors. Targeted interventions addressing risk factors and healthcare disparities are essential for further reducing asthma burden.
