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Objective: To evaluate morphine's risk-benefit profile in the treatment of acute heart failure. Method: Different electronic databases, including PubMed, MEDLINE, Cochrane Library, and Google Scholar, as well as clinicaltrails.gov, were searched for articles published between 2012 and 2022. The risk of bias in the present study was evaluated by employing randomized controlled trials (RCTs) checklist that assesses the effectiveness of new interventions through random assignment of participants to different treatment groups. The twopart tool was used to address the five specific domains such as selection bias, performance bias, detection bias, attrition bias, and selective reporting bias. Evaluation of the quality of diagnostic accuracy studies was conducted using the RevMan software (version 5.4), a quality assessment tool. Results: A total of 13 studies were included in the present review, in which there were 5 retrospective studies, 3 randomized-control studies, 2 prospective studies, 1 multicenter pharmacodynamics study, 1 multicenter cardiac magnetic resonance imaging study, and 1 open-label, cross-over study. The mortality of acute heart failure patients treated with morphine was higher compared to those without morphine. Conclusions: Acute heart failure patients who do not receive morphine have a lower mortality rate compared to those who receive morphine. Considering the adverse effects, including mortality associated with morphine, there is a pressing need for further research to explore alternative and effective treatment options in acute heart failure. [ABSTRACT FROM AUTHOR]

Background: Allogeneic hematopoietic stem cell transplantation activity is growing globally as one of the curative treatment options for many hematological diseases. A stem cell transplant registry plays an important role in such treatment. Setting up a functional stem cell donor registry is quite challenging with several issues such as resources, donor recruitment, donor attrition, ethnicity, lack of support, and impact of coronavirus disease 2019 (COVID-19). Aim: The aim of the current study was to present the experience of a resource-constrained registry in India as well as the effect of COVID-19 on its operations. Settings and Design: The present study was a descriptive study which was designed to study the functioning of a resource-constrained registry from north India. Materials and Methods: The study data for the period of 2012--2020 pertaining to donor recruitment, number of searches, number of matched donors, number of transplants performed, and donor attrition was collected from the registry software "Prometheus." Statistical Analysis: Descriptive statistics such as frequency and percentage was used. Results: During the past 9 years of operation, the registry has faced several issues pertaining to lack of funds, donor recruitment, donor attrition, and COVID-19 has exacerbated their pain points significantly. The registry has recruited a total of 20,093 donors, of which only 7794 have been human leukocyte antigen typed, with the remaining samples awaiting funding. Out of this small number of typed donors, registry has performed 15 matched unrelated donor transplants for Indian and international patients. As a result of COVID-19, donor attrition was on the rise and showed a peak in 2020. During the year 2020, the number of searches, donor recruitment camps, and donors all decreased considerably. Conclusion: The establishment and operation of a stem cell transplant registry necessitate extensive planning and resources. The resource-constrained registries face a number of issues pertaining to effective functioning and future developments. The external support and awareness for the cause can help minimize the pain points of these registries. [ABSTRACT FROM AUTHOR]

Background: Mechanical bowel preparation (MBP) includes cleansing of intestine from its contents by giving oral preparations before surgery to clear fecal material from bowel lumen. It had many proposed advantages that lacked evidence. Recently, due to many notable side effects, the use of MBP had been questioned. This study was performed to compare the surgical outcome with MBP and without MBP in ileostomy closure surgeries. Materials and Methods: The study was conducted on 80 patients who had ileostomy for more than 3 months. They were randomly divided into two groups of 40, each using computer-generated randomization. Group A patients received MBP on the evening before elective ileostomy closure while Group B patients did not receive any MBP. Postoperatively, patients were kept in the ward and monitored for any complications and total duration of stay in hospital. Results: The mean postoperative duration of paralytic ileus after ileostomy closure surgery with bowel preparation is 4.1 ± 1.4 days. Without bowel preparation, it is 3.9 ± 1.5 days (P > 0.05). The number of patients with anastomotic leak is 3 (7.5%) in the bowel preparation group and 3 (7.5%) in the group without bowel preparation (P > 0.05). Wound infection is present in 7 (17.5%) patients in the bowel preparation group and 10 (25%) patients in the group without bowel preparation. The number of patients needing surgical intervention in the course of management is 2 (5%) in Group A (with MBP) and 3 (7.5%) in Group B (without MBP). The mean duration of hospital stay with bowel preparation is 10.6 ± 3.6 days and without bowel preparation is 10.8 ± 3.5 days (P > 0.05). Conclusion: The above study concludes that there is no influence of MBP on surgical anastomosis in ileostomy closure surgeries. [ABSTRACT FROM AUTHOR]

We present an extremely rare association of anal canal duplication with sacrococcygeal teratoma Altman's Type IV. A 3-year-old female child presented with anal discharge, itching, and vague perineal pain. On examination, a small second opening of 5 mm in size and 2.5 cm in length was located just posterior to the normal anus at 6 'o'clock position. The lumen ended blindly without connection to the normal anorectum. Ultrasound and radiological investigations were normal. During excision of the duplicated tract, it was seen arising from a presacral mass which was completely excised along with coccygectomy. Biopsy was confirmed mature teratoma and anal canal duplication. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism (PHPT) is a disease characterized by excessive secretion of parathormone. During the disease, bone loss occurs, particularly depending on the resorption of the skeletal system. One of the complications of PHPT is fibrotic, cystic bony changes which are called a brown tumor (BT). Skeletal manifestations in the form of BTs are rare, and according to literature studies, it occurs in <2% of patients suffering from any form of HPT. As it is a rare disease and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present the case of a 35-year-old man who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fibrous dysplasia but turned out to be a case of PHPT. [ABSTRACT FROM AUTHOR]

Context: A new indigenous recombinant human chorionic gonadotropin (r-hCG) has been developed in India with a comparable pharmacological profile to that of Ovitrelle® (Merck Serono). Aims: This study aims to compare the efficacy and safety of the new r-hCG with that of Ovitrelle for induction of ovulation in women undergoing intrauterine insemination (IUI). Settings and Design: Randomized (2:1), multicenter, open-label, equivalence clinical trial conducted in India. Subjects and Methods: A total of 217 women, aged 20-37 years, undergoing IUI were administered the new r-hCG (test) 250 mcg or Ovitrelle 250 mcg (comparator) after ovarian stimulation with gonadotropins. The ovulation rate was compared as the primary outcome. In addition, pregnancy rates, incidence of adverse events (AEs), and development of immunogenicity were assessed. Statistical Analysis Used: The ovulation and pregnancy rates were compared using Chi-squared test with statistical significance at P < 0.05. Results: With 144 women in the test group and 73 in the comparator group, the ovulation rate (85.4% vs. 78.1%; P = 0.17) and pregnancy rate (serum ß hCG test) (11.8% vs. 12.3%; P = 0.91) were similar in both groups. A total of 15 AEs were reported (11 in the test r-hCG group and 4 in the comparator group) in 11 women; none of these were serious, and all were judged to be unrelated to the study drug. No subject developed immunogenic reaction to the test drug. Conclusions: The new preparation of r-hCG was equivalent to the conventional preparation of r-HCG in the induction of ovulation in patients undergoing IUI. [ABSTRACT FROM AUTHOR]

The knee joint, surrounding ligaments, and extensor mechanism (quadriceps and patellar tendon), given their superficial nature, are easily accessible and accurately assessed with high-resolution musculoskeletal (MSK) ultrasound. Its bedside availability, lower cost than magnetic resonance imaging (MRI), and its high sensitivity in the detection of a small effusion, synovitis, and Baker's cyst, together with its ability to be used for needle guidance in invasive procedures, make ultrasound a highly desired diagnostic tool. In this article, we will focus on common rheumatologic indications of MSK ultrasound in the knee and discuss scanning technique and sonographic findings. Transducer positioning and essential sonographic bony landmarks will be reviewed and scanning in two orthogonal planes (both long and short axis of the structure) will be emphasized. With advances in technology, cost reduction, and easy availability, it is expected that more and more clinicians will be utilizing ultrasound in their clinics in management and treatment of rheumatologic diseases. The diagnostic ability of MSK ultrasound is based on an operator's training and experience, the patient's habitus and aptly chosen clinical indications. A good grasp of anatomy, sound ultrasound technique, and knowledge of limitations of ultrasound modality is essential for a safe ultrasound practice. It is also important to keep in mind that ultrasound provides limited information about internal structures such as meniscus and cruciate ligament pathologies and it has a complementary role with MRI. [ABSTRACT FROM AUTHOR]

Recent advances in musculoskeletal (MSK) ultrasound and transducer technology have enabled increased utilization of high-quality ultrasound in rheumatology clinics and by the bedside as an adjuvant to the clinical examination of the hip. Ultrasound is also an integral part of image-guided joint aspirations, injections, biopsies, and bursa injections. In this article, we will focus on basic ultrasound scanning technique and findings related to common rheumatologic pathologies of the adult symptomatic hip. Transducer positioning and essential sonographic bony landmarks will be reviewed and scanning in two orthogonal planes (both long and short axes of the structure) will be emphasized. Common hip pathologies such as synovitis, joint effusion, bursitis, greater trochanter pain syndrome, and hamstring pathology will be discussed. The reader will also be made aware of limitations of ultrasound in the evaluation of hip and emphasize the complementary role of ultrasound with other imaging modalities (radiographs, computed tomography, and magnetic resonance imaging). The diagnostic ability of MSK ultrasound is based on an operator's training and experience, the patient's habitus, and aptly chosen clinical indications. A good grasp of anatomy, sound ultrasound technique, and knowledge of limitations of ultrasound modality are essential for a safe ultrasound practice. A long-standing commitment of time and resources is needed to become competent and comfortable in scanning. Where possible, the training should be inbuilt into the postgraduate training. It is best that a rheumatologist adopts a career plan of learning, inclusive of MSK ultrasound, relevant to rheumatology. [ABSTRACT FROM AUTHOR]

Sepsis and septic shock affect anywhere between 100 and 1000/100,000 person-years and 19 per 100,000 person-years depending on the cohort studied, with mortality rates ranging between 20% and 50%. The recently updated Sepsis 3.0 consensus definitions state that sepsis is an infection accompanied by life-threatening organ dysfunction caused by a dysregulated host response. Given the pivotal role of cytokine production in sepsis and post major surgery, it follows that removal of these substances may attenuate the response particularly in the early phase of sepsis. [ABSTRACT FROM AUTHOR]

Postkidney transplant infectious complications are always challenging due to atypical organisms, varied presentation, and the balanced treatment to avoid rejection. They are often fatal if not diagnosed and treated in time. High clinical suspicion and decreasing immunosuppression are the important points to remember. This is a case report of postkidney transplant recipient with disseminated cryptococcal infection. The patient improved with functioning graft with appropriate antifungal treatment. [ABSTRACT FROM AUTHOR]

Summary Background/Introduction Gastric teratoma is an extremely rare tumor, almost exclusively benign, accounting for < 1% of all teratomas in infants and children. Purpose/Aim This work aimed to study the clinical presentation, investigation modalities, intraoperative findings, histopathological types, and surgical outcome of gastric teratoma in children. Methods A retrospective study was performed from 1993 to 2013 in two pediatric institutes. Results There were eight patients with gastric teratoma and all of them were male. Seven (87.5%) patients presented in infancy, out of which four (50%) patients were neonates, while one (12.5%) patient was a toddler. The manifestations were as follows: a palpable abdominal mass in seven (87.5%), abdominal distension in five (67.5%), anemia in four (50%), respiratory distress in three (37.5%), gastric outlet obstruction with recurrent vomiting in three (37.5%), and abdominal pain, anorexia, and melena in one (12.5%) each. Ultrasonography showed a solid cystic mass with mixed echogenicity in all the patients, while calcification was seen in seven (87.5%) cases. Computed tomography, which was performed in four (50%) patients, clinched the preoperative diagnosis. A growth was present on the posteroinferior wall near the greater curvature in seven (87.5%) cases, while in one (12.5%) patient, it was arising from the lesser curvature. Excision of the tumor was performed in all patients. Histopathology was mature type in six (75%) cases, and immature Grade 1 and 2 in one (12.5%) each. Complications were seen in five (62.5%) cases, and one (12.5%) mortality was observed in our series. All other patients were doing well in the postoperative period. Conclusion Gastric teratoma is almost always benign and has predilection for male sex. It commonly presents as a palpable abdominal mass. Complete surgical excision is curative. Close observation is recommended for Grade 2 and 3 immature teratomas. The prognosis is excellent. [ABSTRACT FROM AUTHOR]

Summary Background/Introduction Hydatid disease is relatively uncommon in children. The liver and lungs are most commonly involved, while involvement of other sites in the body is unusual. Purpose(s)/Aim(s) To study the presentation of hydatid disease in children, evaluate the risk factors, and derive appropriate management recommendations for prevention of recurrence and disease control. Methods This was a retrospective study performed from April 2006 to April 2014 in three pediatric institutes. Results There were 18 cases of hydatid disease in children; their age ranged from 7 to 16 years, and the male to female ratio was 8:1. All 18 patients were from a rural background or a farming community and of low socioeconomic status. Cattle rearing was common to the households of all patients. Nine (50%) patients had isolated liver hydatid cyst and three (16.7%) had isolated primary lung hydatid cyst. Two (11.1%) patients had multiple cysts with lung and liver involvement, while four (22.2%) had unusual presentation, i.e., primary hydatid cyst of the spleen in three (16.7%) and primary hydatid cyst of the brain in one (5.5%). All cases were managed surgically and there was no recurrence in any of our patients. Conclusion Hydatid disease is not rare in the pediatric age group. The liver and lung are commonly involved, but it may also present as primary disease in unusual sites like the spleen and brain. Proposed risk factors are rural background, farming community, low socioeconomic status, cattle rearing, lack of supply of potable water, and male sex. Intrinsic defects in the filter mechanism of the liver and lungs, dissemination through enteric lymphatic channels, and patency of the ductus arteriosus in early infancy are the proposed causes of unusual presentation of hydatid disease in children. During cyst removal, spillage of the contents must be avoided to prevent recurrence. Community-based measures are recommended for prevention and disease control. [ABSTRACT FROM AUTHOR]

Background: Idiopathic gingival enlargement is a rare condition characterized by massive enlargement of the gingiva. It may be associated with other diseases/conditions characterizing a syndrome, but rarely associated with periodontitis. Case Description: This case report describes an unusual clinical form of gingival enlargement associated with chronic periodontitis. Clinical examination revealed diffuse gingival enlargement. The lesion was asymptomatic, firm, and pinkish red. Generalized periodontal pockets were observed. Radiographic evaluation revealed generalized severe alveolar bone loss. Histopathological investigations revealed atrophic epithelium with dense fibrocollagenous tissue. Lesions healed successfully following extraction and surgical excision, and no recurrence was observed after 1 year follow-up but recurrence was observed at 3 and 5-years follow-up. Clinical Implications: Successful treatment of idiopathic gingival enlargement depends on proper identification of etiologic factors and improving esthetics and function through surgical excision of the over growth. However, there may be recurrence. [ABSTRACT FROM AUTHOR]

Abstract: Success in root canal treatment is achieved after thorough cleaning and shaping followed by the complete obturation of the root canal system. Such treatment may be performed in root canal systems that do not comply with the normal anatomical features described in standard textbooks. Supernumerary root is a developmental condition which is not uncommon and may involve any tooth. These case reports describe successful endodontic management of maxillary second molar with an extra palatal root and an anomalous mandibular second molar with a supernumerary root in between mesial and distal roots. [Copyright &y& Elsevier]

Abstract: Gingival enlargement is a well-documented and extensively researched condition in the field of dentistry but the diagnosis of this condition is complicated by a variety of inter-related factors in its etiology and progression. Hence, the identification of these factors and precise diagnosis forms the key to proper treatment planning. A case report of a 42-year-old man is illustrated with a localized gingival enlargement in the posterior right mandibular region, which posed quite a challenge in the diagnosis and treatment. [Copyright &y& Elsevier]

Stem cell transplant (SCT) is the “standard of care” for several malignant disorders such as leukemia as well as nonmalignant disorders such as thalassemia and aplastic anemia. In SCT, family (usually a sibling) is screened for human leukocyte antigen (HLA)-matched related donor (MRD), and failing this, matched unrelated donor (MUD) transplants are considered. There are seven major steps involved in the process of MUD SCT, while the patient is prepared for receiving the SCT in parallel after achieving remission. Here, we report the timelines involved in MUD SCT along with a case report and review of literature. [ABSTRACT FROM AUTHOR]

The article discusses verrucous carcinoma of the finger in a female adult patient. Topics covered include symptoms experienced by the patient, results of the patient's cutaneous and routine blood examinations, characterization of verrucous carcinoma, the types of verrucous carcinoma and the uniqueness of the case.

Introduction: There is a need to reassess the significance of myoedema in evaluation of overt hypothyroidism in the current day clinical practice. It is commonly checked for by licking across the biceps belly expecting a transient mound at the points of tactile stimuli with mild pressure. Aim and Objective: To assess elicitation of myoedema in overt hypothyroidism (defined arbitrarily as TSH >50 mIU/L in primary hypothyroidism and fT4 <0.6 ng/dl in secondary hypothyroidism). Results: The 28 primary overt hypothyroid (OH) patients were divided into three groups as mild, moderate, and severe depending on TSH levels as those with 50-100, 100-150, and >150 mIU/L. Myoedema was elicited in 8 of 13 in the severe OH group, in 2 of 7 in moderate OH group and in 1 of 8 in the mild OH group. In the group of secondary hypothyroidism, myoedema was elicitable in one of two patients. The odds ratio for presence of both myoedema and clinical features of myopathy in a group of overt hypothyroid patients with TSH >150 mIU/L as compared to <150 mIU/L was 17.5. Similarly, the odds ratio for the presence of only myoedema was 6.4 while the odds ratio for presence of only clinical features of myopathy was 3.67. While the odds ratios involving presence of myoedema neared statistical significance, that with the presence of clinical features of myopathy alone did not. Conclusion: Examination for eliciting myoedema is useful when evaluating a case of overt hypothyroidism. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate antinociceptive property of the leaf extract of Delonix elata (Linn.). Methods: Antinociceptive activity was evaluated by abdominal writhing and tail flick methods in Swiss albino mice. Acetyl salicylic acid was used as standard drug. Results: A dose dependent significant (P<0.01) antinociceptive activity was observed in three different concentrations 100, 200 and 300 mg/kg. Among them dose at 300 mg/kg, significantly (P<0.01) inhibited (74.94%) the nociception induced by acetic acid but less effective than the standard reference (84.06%). Tail-flick test showed that the extract at the doses 300 mg/kg showed efficient results when compared to the other two doses (100 and 200 mg/kg) with increase in the latency to response of tail to the thermal stimulation. Conclusions: The significant antinociceptive activity of the leaf extract is due to the presence of a single active constituent in higher levels or due to the combined effect of more than one phytoconstituent. This investigation supported the ethnomedicinal claims of Delonix elata. [Copyright &y& Elsevier]

Aim: To study the pattern of presentation and outcome of patients with IgA nephropathy in our center. Materials and Methods: Medical case records of patients who had biopsy proven Ig A Nephropathy between 2001 and 2007 were retrospectively analyzed for the features at presentation and follow up along with the outcome, including the current status. Patients who were lost to follow up for more than a year were excluded from the study. Results: Total number of patients: 106; patients selected: 35; age 37.2 (22-71) yrs; males 26(74%), proteinuria nephrotic 15(42.8%), nonnephrotic 20(57%); macrohematuria 6(17%), microhematuria 22(62.8%); renal Failure at presentation 25(71.4%), at follow up 24(68.5%). Renal Biopsy: minimal change 5(14%), mesangial hypercellularity 20(57%), sclerosis 11(31.4%), crescent 1(2.8%), interstitial inflammation 15(42.8%), interstitial fibrosis 2(5.7%). Follow up: patient survival 28(80%) mortality 4 (11.4%). Cause of death: sepsis 3, renal failure 2 Conclusions: Proteinuria is the commonest presenting feature and it was nephrotic in 42% of patients. 71% had renal failure at presentation. Mesangial hypercellularity and interstitial inflammation were the commonest light microscopy findings. [ABSTRACT FROM AUTHOR]