ABSTRACT:Budd-Chiari syndrome (BCS) is a rare hepatic vascular disorder characterized by hepatic venous outflow obstruction with an incidence of 1-2 per million population annually. While dengue fever is primarily associated with hemorrhagic complications, thrombotic events are rarely reported. To our knowledge, this represents the first documented case of BCS occurring in association with dengue fever. A 22-year-old male from a rural area presented with a 4-day history of abdominal pain, fever, vomiting, and loose stools. Physical examination revealed hepatomegaly, ascites, and mild dehydration. Laboratory investigations confirmed dengue IgM positivity with thrombocytopenia (104,000/mm3) and elevated liver enzymes. Thrombophilia screening revealed deficiencies in protein C, protein S, and antithrombin III. Imaging studies, including ultrasonography, computed tomography with contrast, and color Doppler, demonstrated hepatic vein thrombosis, inferior vena cava narrowing, and caudate lobe hypertrophy, establishing the diagnosis of BCS. Upper gastrointestinal endoscopy revealed grade II esophageal varices consistent with portal hypertension. During admission, the patient also developed severe bilateral lower limb pain refractory to strong analgesics, and nerve conduction studies confirmed sensory polyneuropathy in both lower limbs. The patient was managed with supportive care and careful anticoagulation therapy using low-molecular-weight heparin (LMWH), followed by warfarin 4 mg daily. Despite initial thrombocytopenia, anticoagulation was successfully initiated with close monitoring for bleeding complications. The patient showed an excellent clinical response, with complete resolution of hepatic vein thrombosis, normalization of liver function, and resolution of ascites at follow-up. At 6-month follow-up, repeat thrombophilia assays performed after stopping warfarin and bridging with LMWH revealed normal levels of protein C, protein S, and antithrombin III, indicating no true inherited deficiency. This case highlights a novel association between dengue fever, BCS, and sensory polyneuropathy in a patient with apparent but transient thrombophilia. Early recognition, appropriate anticoagulation, and careful neurological evaluation can lead to favorable outcomes despite concurrent thrombocytopenia.
BACKGROUND:Type 2 diabetes mellitus (T2DM) is associated with an increased risk of urinary tract infections, including asymptomatic forms like asymptomatic bacteriuria or asymptomatic pyuria (ASP). However, the association between ASP (defined as elevated urinary leukocyte count without symptoms) and glycemic control remains unclear. Hence, this study was conducted to determine the prevalence of ASP in patients with T2DM and evaluate its association with glycemic parameters and urinary abnormalities. METHODS:This retrospective cross-sectional study included 2843 T2DM patients attending the endocrinology outpatient department of a tertiary care center between June 2018 and May 2020. Data on urine microscopy, fasting plasma glucose, postprandial plasma glucose (PPG), and glycated hemoglobin (HbA1c) were analyzed. ASP was defined as >10 leukocytes per high-power field in urine. RESULTS:The prevalence of ASP was 14.98%, significantly higher in females than males (30.7% vs. 6.87%, P < 0.0001). Patients with ASP were older and had significantly higher PPG and HbA1c levels compared to those without ASP. Nitrituria, proteinuria, and glucosuria were also more frequent in the ASP group. Among patients with available urine cultures (n = 84), 61.9% showed significant bacterial growth, predominantly Gram-negative organisms, with Escherichia coli being the most common isolate (69.2%). A notable proportion of isolates exhibited multidrug resistance. CONCLUSIONS:ASP is present in approximately 15% of T2DM patients, with higher prevalence in females and association with poor glycemic control and urinary abnormalities. Given the substantial proportion of culture positivity and antimicrobial resistance, further studies are needed to clarify the clinical significance and management implications of ASP in T2DM.
BACKGROUND:Acute coronary syndrome (ACS) is a major global cause of morbidity and mortality. Early identification of high-risk patients is crucial for guiding treatment. Von Willebrand factor (VWF) antigen, a marker of endothelial activation and platelet adhesion, plays a role in ACS-related thrombosis. This study evaluated the ability of VWF antigen to predict major adverse cardiovascular events (MACE) and mortality in patients with ACS. MATERIALS AND METHODS:In this prospective study conducted at a tertiary care hospital, VWF antigen levels were measured using an enzyme-linked immunosorbent assay in 121 patients with ACS. Demographic data, cardiovascular risk factors, clinical presentation, angiographic findings, and treatment were recorded. Patients were monitored for MACE (defined as a composite of heart failure, angina, myocardial infarction, stroke, acute decompensated heart failure, and death) at 4 weeks and 3 months. RESULTS:The mean age of the 121 patients was 58.2 ± 11.8 years; 69.4% were male. At 1 month, MACE occurred in 7.6% of patients, and mortality occurred in 2.5%. At 3 months, MACE occurred in 34.8% of patients and mortality occurred in 3.5%. The median VWF antigen levels were significantly higher in patients with MACE at 3 months than in those without (31.90 [interquartile range (IQR): 27.70-33.50] vs. 12.30 [IQR: 6.00-30.20], P < 0.0001). VWF antigen levels were higher among patients who died, but the difference was not statistically significant (P = 0.243). A multivariate Cox regression analysis identified VWF antigen levels >26.75 as an independent predictor of MACE at 3 months (adjusted Hazard ratio: 3.82, 95% confidence interval: 1.89-7.72, P < 0.001). ROC analysis for this cutoff demonstrated good predictive performance (AUC: 0.788, sensitivity: 85.0%, specificity: 69.33%). CONCLUSION:Elevated admission VWF antigen levels were significantly associated with an increased incidence of MACE at 3 months and emerged as an independent predictor of adverse outcomes in patients with ACS. VWF antigen may be a useful biomarker for early risk stratification and identification of high-risk patients who require closer monitoring.
BACKGROUND:The decision to perform systematic lymphadenectomy in endometrial carcinoma (EC) depends heavily on preoperative staging. We investigated the utility of diffusion-weighted imaging (DWI) and quantitative apparent diffusion coefficient (ADC) mapping to noninvasively predict the presence of EC and its histological tumor grade. MATERIALS AND METHODS:This prospective case-control study included 30 women with histopathologically confirmed EC (cases) and 30 women with normal endometrium (controls). Participants underwent 3.0T pelvic magnetic resonance imaging, including DWI (b-values: 0, 500, and 1000 s/mm2). Mean ADC values were calculated using manually delineated regions of interest and correlated with final surgical histopathology. RESULTS:The mean ADC value was significantly lower in the EC group (0.89 ± 0.29 × 10-3 mm2/s) compared to the control group (1.70 ± 0.37 × 10-3 mm2/s) (P < 0.001). Receiver operating characteristic curve analysis identified an optimal upper-threshold ADC cutoff of 1.16 × 10-3 mm2/s, yielding 100% sensitivity, 86.7% specificity, and 94.6% accuracy for malignancy. Crucially, mean ADC values demonstrated a statistically significant inverse correlation with histological tumor grade, decreasing sequentially from Grade 1 (1.04 ± 0.15 × 10-3 mm2/s) to Grade 2 (0.84 ± 0.37 × 10-3 mm2/s) and Grade 3 (0.82 ± 0.29 × 10-3 mm2/s) (P = 0.015). CONCLUSION:Quantitative ADC mapping is a highly accurate, noninvasive biomarker for EC. The established cutoff reliably distinguishes malignancy, while the inverse correlation between ADC values and tumor grade provides critical preoperative intelligence to guide the extent of surgical staging.
ABSTRACT:Vici syndrome is a rare autosomal recessive multisystem disorder caused by biallelic mutations in the EPG5 gene. It is classically characterized by agenesis of the corpus callosum, oculocutaneous hypopigmentation, combined immunodeficiency with recurrent infections, cataracts, and cardiomyopathy. We report the case of a newborn born to consanguineous parents, with a family history of a sibling death of unspecified cause, presenting with hypopigmentation, generalized hypotonia, agenesis of the corpus callosum, severe recurrent infections, developmental delay, and cleft palate. The infant also developed transient functional renal failure in the context of severe dehydration, which resolved completely after fluid resuscitation. Brain magnetic resonance imaging confirmed complete agenesis of the corpus callosum. Molecular genetic testing for suspected Vici syndrome is currently in progress. This case highlights the importance of considering Vici syndrome in neonates born to consanguineous parents presenting with agenesis of the corpus callosum, hypopigmentation, and recurrent infections. Transient renal failure may be an additional manifestation. Early recognition is essential for appropriate clinical management and genetic counseling.
BACKGROUND:Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and nonmotor deficits. Emerging evidence suggests a role of the renin-angiotensin system (RAS) in neurodegeneration, making it a potential therapeutic target. AIM:To evaluate the neuroprotective effects of RAS-modulating drugs such as captopril, perindopril, and losartan in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced model of PD. METHODS:An experimental in vivo study was conducted using Swiss albino mice (n = 6 per group). Parkinsonism was induced using MPTP (25 mg/kg). Animals were divided into six groups: vehicle control, negative control, standard control (levodopa + benserazide), and three treatment groups receiving captopril (20 mg/kg), perindopril (5 mg/kg), and losartan (90 mg/kg). Behavioral assessments included actophotometer, rotarod, grip strength, hole board, tail suspension, forced swim, and elevated plus maze tests. Data were expressed as mean ± standard deviation and analyzed using analysis of variance. RESULTS:MPTP significantly impaired motor and behavioral parameters, as evidenced by reduced locomotor activity (21.17 ± 2.70 vs. 286.50 ± 8.77), decreased rotarod performance, and increased immobility time in depression models. Treatment with RAS modulators significantly improved these parameters (P < 0.05). Losartan (274.67 ± 11.15) and captopril (267.33 ± 16.01) showed greater improvement in locomotor activity compared to perindopril. Similarly, all treatments reduced immobility time and improved anxiety-related behavior in the elevated plus maze. CONCLUSION:RAS modulators demonstrated significant neurobehavioral protection in MPTP-induced Parkinsonism, suggesting their potential as adjunct therapeutic agents in PD.
BACKGROUND:Bicytopenia is defined as a reduction in any two of the three major blood cell lineages and may result from a wide spectrum of infectious, nutritional, hematological, and systemic disorders. Early identification of the underlying etiology is essential for appropriate management. AIMS:To study the etiological spectrum, hematological profile, clinical presentation, and patterns of bicytopenia among patients attending a tertiary care Center. MATERIALS AND METHODS:The study analyzed the clinical and hematological profile of 110 patients with bicytopenia. Patients were categorized based on age, gender, hematological parameters, etiologies, symptoms, and type of bicytopenia. Statistical analysis was performed using the Chi-square test. RESULTS:Patients in the study had a mean age of 41.5 ± 15.42 years with female predominance (54.5%). Viral fever, including dengue, was the leading cause (23.6%), subsequently nutritional deficiency (13.6%) and sepsis (11.8%). Leukopenia with thrombocytopenia was the most common type of bicytopenia (37.3%). Fever was the predominant presenting symptom (48.2%). The type of bicytopenia showed a significant association with of underlying etiology (P < 0.0001). CONCLUSION:Bicytopenia is associated with diverse etiologies ranging from transient infections to serious hematological disorders. Infectious diseases and nutritional deficiencies constituted the major causes in the present study. Recognition of hematological patterns along with systematic clinical evaluation can aid in early diagnosis and timely management.
BACKGROUND:Propolis is a resinous natural product produced by honeybees and is known for its diverse phytochemical composition and biological activities. Its bioactive constituents and potential use in the green synthesis of nanoparticles have attracted increasing interest for antimicrobial and anticancer applications. OBJECTIVES:To evaluate the phytochemical composition, antibacterial activity, and anticancer potential of ethanol and acetone extracts of propolis and to investigate the synthesis, characterization, and biological activities of propolis-mediated silver nanoparticles (AgNPs). MATERIALS AND METHODS:Propolis collected from Melaka, Malaysia, was extracted with ethanol and acetone using Soxhlet extraction. The extracts were subjected to qualitative phytochemical analysis and thin-layer chromatography. Antibacterial activity against Bacillus cereus and Enterococcus faecalis was evaluated using the well diffusion method. Anticancer activity against MDA-MB-231 breast cancer cells was assessed using the MTT assay. AgNPs were synthesized using the propolis extracts through a green synthesis approach and characterized using ultraviolet-visible (UV-Vis) and Fourier-transform infrared (FTIR) spectroscopy. The antibacterial and anticancer activities of the synthesized AgNPs were subsequently evaluated. RESULTS:Phytochemical analysis revealed the presence of flavonoids, phenolic compounds, and terpenoids in both extracts, whereas alkaloids were detected only in the ethanol extract. The acetone extract demonstrated antibacterial activity against B. cereus, with inhibition zones ranging from 10 to 13 mm at the tested concentrations, whereas no inhibition was observed against E. faecalis. The ethanol extract showed no inhibitory activity against either bacterial strain. Both propolis extracts exhibited concentration-dependent anticancer activity against MDA-MB-231 cells, with IC₅₀ values of 183.14 μg/mL and 192.61 μg/mL for the ethanol and acetone extracts, respectively. Propolis-mediated AgNPs were successfully synthesized and characterized by UV-Vis and FTIR spectroscopy. The AgNPs also demonstrated concentration-dependent anticancer activity, with IC₅₀ values of 127.23 μg/mL for ethanol-derived AgNPs and 141.72 μg/mL for acetone-derived AgNPs. CONCLUSION:Ethanol and acetone extracts of propolis contain bioactive phytochemicals and exhibit anticancer activity, while the acetone extract demonstrated antibacterial activity against B. cereus. Green synthesis of propolis-mediated AgNPs enhanced the anticancer activity of the extracts, supporting their potential for further investigation in biotechnological and therapeutic applications.
Abstract Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease primarily affecting exocrine glands, with less frequent but significant extraglandular manifestations. Among these, inflammatory myopathy (IM ) is rare, particularly in biopsy-proven cases. We report the case of a 63-year-old female with a history of hypertension, type 2 diabetes mellitus, and chronic statin use who presented with progressive, symmetric proximal muscle weakness of 8 months’ duration. Neurological examination revealed flaccid weakness without sensory involvement. Laboratory evaluation showed markedly elevated creatine phosphokinase levels and positive anti-HMG-CoA reductase and anti-Ro52 antibodies. Magnetic resonance imaging of the thighs demonstrated diffuse myoedema. Muscle biopsy revealed myonecrosis, myophagocytosis, and lymphocytic infiltration, consistent with IM. Schirmer’s test and salivary gland biopsy confirmed the diagnosis of pSS. IM may rarely occur in pSS and can be easily overlooked in the context of long-term statin use. A high index of suspicion, combined with detailed immunologic workup and tissue biopsy, is essential for accurate diagnosis and timely immunosuppressive therapy.
ABSTRACT:Distal radius fractures are common injuries and displaced or unstable patterns frequently require operative stabilization. Volar locking plating remains the predominant method for many unstable distal radius fractures; however, selected radial column or radial styloid-dominant patterns may be amenable to fragment-specific fixation. We report a displaced distal radius fracture treated using a modified Kocher-style dorsolateral wrist exposure with cannulated compression screw fixation augmented by a distal radius T-plate. A 45-year-old, right-hand-dominant, male manual laborer presented after a fall on an outstretched hand with acute right wrist pain, swelling, deformity, and painful restriction of wrist motion. Radiographs and computed tomography evaluation showed a displaced extra-articular distal radius fracture with a dominant radial styloid/lateral fragment, minimal comminution, intact ulna, and congruent distal radioulnar joint. Open reduction and internal fixation was performed through a 5-cm dorsolateral modified Kocher-style approach. The fracture was anatomically reduced, buttressed with a distal radius T-plate, and compressed using a 3.0-mm cannulated compression screw placed from the radial styloid across the fracture line under fluoroscopic guidance. The postoperative course was uneventful. At 6 weeks, radiographs showed early callus and maintained alignment, with approximately 60° of active wrist flexion and 60° of extension without pain. At 3 months, radiographs showed union with trabecular bridging, clinically symmetrical wrist range of motion, grip strength comparable to the contralateral side, and return to manual work. At 1-year follow-up, the patient remained asymptomatic without tendon irritation, neurovascular deficit, implant prominence, loss of reduction, or need for implant removal. This case suggests that, in carefully selected distal radius fractures with a large radial styloid/radial column fragment and limited comminution, a modified Kocher-style dorsolateral approach with cannulated compression screw fixation and T-plate augmentation may provide stable reduction while avoiding a standard volar exposure. This technique is not proposed as a replacement for volar locking plating; rather, it may be considered as a selected alternative when fracture morphology permits direct fragment-specific compression and buttress support. The single-case design and absence of prospectively recorded patient-reported outcome scores limit generalizability.
ABSTRACT:We report a case of a 43-year-old male diagnosed with moderate noncommunicating hydrocephalus, in a human immunodeficiency virus-positive patient. The patient presented with progressive memory loss, and was eventually managed with ventriculoperitoneal shunting. This case report discusses the diagnostic challenges and multidisciplinary approach required in immunocompromised patients presenting with neurological symptoms.
BACKGROUND:Gastric carcinoma is the fifth-most common cancer worldwide and the third-leading cause of cancer-related deaths, with a 5-year survival rate of approximately 20%. Human epidermal growth factor receptor 2 (HER2) overexpression occurs in 10-30% of gastric and gastroesophageal junction adenocarcinomas and acts as a key prognostic and predictive biomarker, similar to breast cancer. Encoded by the ERBB2 gene, HER2 is a transmembrane tyrosine kinase receptor that promotes cell proliferation, survival, and differentiation via phosphoinositide 3-kinase/AKT and mitogen-activated protein kinase pathways. In gastric cancer, HER2 expression is often heterogeneous and incomplete, which complicates diagnostics and is linked to aggressive features such as intestinal histology, advanced stage, and poor survival. HER2 positivity rates show geographic variation (12.5-13.8% in Euro-Latin American cohorts) and higher prevalence in proximal tumors and chromosomal instability-high subtypes. AIM:The aim of this study was to assess HER2 expression via immunohistochemistry (IHC) in gastric carcinoma and correlate it with clinicopathological parameters and survival outcomes. MATERIALS AND METHODS:Retrospective analysis of 55 histologically confirmed gastric carcinoma cases (2022-2025) at a tertiary care hospital. HER2 scoring followed Hofmann et al. criteria for gastric cancer. Associations used Chi-square, odds ratio (OR), and multivariate logistic regression; survival via Kaplan-Meier and Cox regression. RESULTS:HER2 positivity (IHC 3+) occurred in 12.7% (7/55) cases, significantly linked to intestinal-type histology (OR 4.2, P = 0.02), higher grade (P = 0.01), advanced stage (P < 0.001), lymphovascular invasion (P = 0.03), and lymph node metastasis (P = 0.004). HER2-positive cases exhibited a median survival of 18 months versus 26 months for negatives (P = 0.002, log-rank); HER2 remained an independent prognosticator (hazard ratio 2.8, 95% confidence interval 1.4-5.6, P = 0.003). CONCLUSION:HER2 overexpression portends aggressive behavior and inferior survival in gastric carcinoma, similar to findings in advanced cohorts with nodal metastasis (76.5%). Routine HER2 testing is imperative for prognostication and trastuzumab eligibility, despite resistance challenges.
INTRODUCTION:Severe acute malnutrition (SAM) continues to be one of the most important preventable causes of under-five morbidity and mortality in low- and middle-income countries, particularly in South Asia, a significant proportion of which is contributed by India. Nutritional rehabilitation centers (NRCs) deliver standardized care for children with SAM using guidelines derived from the World Health Organization (WHO); however, there is a paucity of data regarding their functioning in Karnataka and Southern India. AIMS AND OBJECTIVES:This study aimed to assess the clinico-epidemiological profile, identify risk factors, and evaluate the treatment outcomes of SAM children admitted to NRC in Kalaburagi. MATERIALS AND METHODS:This was a retrospective record-based cross-sectional study conducted among all under-five children admitted with SAM at the NRC of a tertiary care center in Kalaburagi. Data were collected from the available medical records of 150 admitted children, and analysis was performed using SPSS version 20. RESULTS:Out of the 150 cases analyzed, 51% were boys, with the majority (72%) belonging to the 1-24-month age group. Laboratory findings revealed a high burden of anemia, with 44% of children having moderate-to-severe anemia. Overall, 88% of the children achieved a weight gain of more than 5 g/kg/day prior to discharge. Around 80% of admitted SAM children were discharged with an improvement in their grade of malnutrition. CONCLUSION:Hospital-based management of SAM children in NRC with adherence to the updated WHO standard guidelines has helped in reducing mortality and morbidity among undernourished children.
BACKGROUND/AIMS:MicroRNA-429 (miR-429), a member of the miR-200 family, has been implicated in epithelial-mesenchymal transition and tumor progression, yet its clinicopathological significance in breast cancer remains unclear. This study aimed to evaluate serum miR-429 expression in treatment-naïve breast cancer patients and correlate its levels with detailed histopathological variables, molecular subtype, treatment response, and outcome. MATERIALS AND METHODS:In this prospective study, serum samples from 49 invasive ductal carcinoma (IDC- no special type [NST]) patients and 49 age-matched healthy controls were analyzed by quantitative real-time polymerase chain reaction. Clinicopathological data (tumor grade, receptor status, lymphovascular invasion [LVI], nodal status, mitosis, tumor-infiltrating lymphocytes, necrosis, and subtype) and treatment response (Response Evaluation Criteria in Solid Tumors [RECIST] v1.1) were recorded. Resection specimens were evaluated for residual cancer burden (RCB). RESULTS:Mean serum miR-429 levels were significantly lower in cases than controls (0.92 ± 0.53 vs. 1.24 ± 0.55; t = 2.892, P = 0.005). Receiver operating characteristic analysis showed an area under the curve of 0.649 (95% confidence interval: 0.540-0.758; P = 0.011) with 67.3% sensitivity and specificity at a cut-off of <1.005. Higher miR-429 expression was significantly associated with LVI (37.5% vs. 0%, P = 0.021). Trends toward higher mitotic activity (≥6 mitoses/10 hpf: 62.5% vs. 25.0%, P = 0.094) and greater nodal involvement (50.0% vs. 20.0%, P = 0.096) were noted in the high-expression group. No significant associations were observed with grade (P = 0.190), receptor status (estrogen receptor P = 0.354; progesterone receptor P = 0.614; HER2 P = 0.579), molecular subtype (P = 0.852), RCB (P = 0.418), or RECIST response (P = 0.627). At follow-up, 42 patients (85.7%) were doing well, 5 (10.2%) had died, and outcomes were not significantly related to miR-429 (P = 0.351). CONCLUSION:Serum miR-429 is downregulated in breast cancer and correlates significantly with LVI, suggesting a role in invasive biology. While diagnostic utility is modest, its integration into multi-microRNA panels may enhance predictive accuracy. Larger, multi-institutional, subtype-stratified studies are needed for validation.
ABSTRACT:Spinal stenosis most commonly occurs at L4-5, with 91% of patients experiencing nerve compression at this location. It results from a degenerative process that begins in the intervertebral disc, as viable cell counts, water, and proteoglycan content decrease in the nucleus pulposus. The disc height decreases as the nucleolus pulposus degenerates and the annulus fibrosus bulges. Stenosis is generally classified by descriptive elements, such as etiology (i.e., degenerative or congenital), location (i.e., central, lateral recess, foraminal, or extraforaminal), and severity of narrowing on advanced imaging (mild, moderate, or severe). The primary case study in this case report is LSCS, where the researchers explored the patient's problems and nursing care. Mr. A (68 years old) was admitted to the 6th floor (Surgery) ward with complaints of low back pain that had been felt for the past 7 months. Pain scale 6-7 (NRS), felt intermittent, sometimes disturbing sleep during the day or night. The pain radiates from the waist to the left leg. The patient is bedridden and cannot walk, and only gets up to a body elevation position of 30 ° for 7 months. The client experienced a decrease in extremity muscle strength. The results of the MRI examination showed the patient had lumbar spinal canal stenosis. The nursing problems experienced by Mr. A were resolved after 6 days of nursing intervention. The patient showed a decrease in pain to a scale of 2-3 (mild pain), improved physical mobility, decreased falls, and decreased knowledge deficit.
INTRODUCTION:Pulmonary arterial hypertension (PAH) is relatively uncommon yet life-threatening morbidity in neonates and infants. South Asian countries including India may record a relatively higher incidence of pediatric PAH. The etiology of pediatric PAH is heterogeneous, and little evidence is available on the clinical spectrum of pediatric PAH from low- and middle-income countries. This descriptive study aims to describe the incidence and underlying causes of pediatric PAH at a tertiary care referral center in coastal Karnataka, India. MATERIALS AND METHODS:This is a retrospective study which involved complete enumeration of pediatric PAH cases admitted at a tertiary care referral center in coastal Karnataka between January 2018 and December 2021 after prior approval from the Institutional Ethics Committee. Clinical data were retrieved from the electronic medical records. RESULTS:The center documented a total of 165 cases of pediatric PAH, with an incidence of 1.19% among the total neonatal intensive care unit admissions within the study period. Persistent fetal circulation was the most common sub-classification (77.44%), with underlying inherited metabolic disorders (30%), infectious pathologies, and malnutrition being the final diagnosis in this group. Neonates subclassified under neonatal cardiac failure majorly showed underlying cardiac anomalies (80%), while 4% of the cases were attributed to other causes including hyperbilirubinemia-induced encephalopathy and COVID-induced multisystem inflammatory syndrome, viral endocarditis, etc. CONCLUSIONS:Inherited metabolic and cardiac anomalies, antenatal and postnatal maternal morbidities, nutritional deficiencies, and secondary infections are the major causes of neonatal and infantile PAH. Multilevel screening could substantially reduce the incidence and the morbidities associated with infantile PAH.
OBJECTIVES:Perinatal oral health care is essential for the well-being of both women and fetal health. Oral health care involves both professional and self-care. Depression or stress during the perinatal phase can reduce oral hygiene maintenance and need intervention to facilitate oral health care. The present study aimed to evaluate the effects of independent and combined depression and stress on oral self-care behaviors of perinatal women in a tertiary hospital. MATERIALS AND METHODS:A total of 1234 women in the first or second trimester of pregnancy were enrolled in the interprofessional pregnancy oral health care unit. The enrolled subjects completed the depression scale, Perceived Stress Scale-10, and a self-report on oral self-care during pregnancy and 2+ years following birth. RESULTS:Depression and stress were negatively associated with frequency of toothbrushing and flossing. Further, the frequency of toothbrushing and flossing was not associated with time. About one-fourth of the participants reported toothbrushing twice daily. However, a very low level of flossing was reported among the participants. CONCLUSION:The perinatal period needs interventional strategies to promote oral hygiene. Oral health education and collaboration with the medical team can help in oral health improvement.
BACKGROUND:The management of hemodynamic instability in critically ill pediatric patients represents one of the most challenging aspects of intensive care medicine. The appropriate selection, timing, and titration of fluid therapy, inotropic and vasoactive agents can significantly impact patient outcomes, making the development and implementation of standardized protocols an essential aspect of quality care. MATERIALS AND METHODS:This prospective observational study was carried out in the pediatric intensive care unit (PICU) among children aged 1 month to 14 years admitted to the PICU and requiring inotropic agents, after approval from the institutional scientific and ethics committee. A comprehensive evaluation of each enrolled patient was done and documented in a standardized case record form. Demographic and clinical details, including history, comorbidities, examination findings, diagnosis, type of shock, and laboratory parameters were noted. Details of inotropic agents used in each individual patient were documented. Response to therapy and outcome measures such as duration of inotropic support, need for escalation to multiple agents, time to achieve hemodynamic stability, success of weaning attempts, length of PICU stay, mechanical ventilation requirements, mortality, presence of multiorgan dysfunction, and use of steroids were noted and analyzed statistically. RESULTS:A total of 100 children (aged 1 month to 14 years) admitted to the PICU and requiring inotropic support were enrolled. Infants (<1 year) (35%) constituted the largest proportion of the study population, followed by children aged 1-5 years (33%). Respiratory symptoms with fever were the most common presenting complaints (28%), followed by gastrointestinal manifestations (24%). Comorbidities were present in 38% of patients, with cardiac conditions being the most prevalent. Hypovolemic shock was the most common type observed (44%), followed by septic shock (41%) and cardiogenic shock (18%). Fluid resuscitation practices in this study were consistent with international recommendations, with most patients receiving one or two boluses. Adrenaline was the most commonly used first-line inotrope (63%), although noradrenaline was preferentially used in septic shock and adrenaline in cardiogenic shock. More than half of the patients (56%) required escalation to a second inotrope. The use of complex combination therapy was significantly associated with mortality (P < 0.001); among nonsurvivors, 62.5% received combination therapy, compared with only 19.1% of survivors. In septic shock, early initiation and timely escalation of inotropic therapy were associated with improved hemodynamic stabilization. Mechanical ventilation was required in 59% of patients, and multiorgan dysfunction syndrome (MODS) was observed in 21%. The duration of PICU stay was influenced by the number of inotropes required, with prolonged stays associated with higher inotropic support. De-escalation of inotropic support was guided by clinical improvement and hemodynamic stability. Steroids were used selectively in 22% of patients. The overall mortality rate was 32%. Key predictors of adverse outcomes identified in this study included the requirement for multiple inotropes, the need for mechanical ventilation, and the presence of MODS. CONCLUSIONS:Protocol-based management of pediatric shock has been shown to improve outcomes. The findings of this study reinforce the importance of early recognition, timely intervention, and individualized, protocol-driven management in improving outcomes in pediatric shock.
ABSTRACT:Gyrate atrophy is a rare autosomal recessive chorioretinal dystrophy caused by ornithine aminotransferase deficiency, resulting in toxic accumulation of plasma ornithine and progressive retinal degeneration. We describe a 20-year-old male, born to consanguineous parents, who presented with progressive diminution of vision, nyctalopia, and peripheral visual field loss. Fundus examination revealed sharply demarcated, scalloped areas of midperipheral chorioretinal atrophy with relative macular sparing. Optical coherence tomography demonstrated cystoid macular edema, whereas plasma ornithine levels were markedly elevated. The patient was treated with dietary protein restriction and pyridoxine supplementation, with biochemical improvement and stabilization of visual function. Early recognition, metabolic monitoring, and evaluation of pyridoxine responsiveness may delay visual deterioration and improve visual prognosis in gyrate atrophy.
