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Near peer learning is an educational practice in which children interact with their peers or friends attain educational objectives. In simpler terms children involved in this type of learning are seniors and juniors of the same school or college. Learners are more comfortable and relaxed, and ready to learn when teacher is their peer, whom they know and understand. At the same time, it develops communication skill, leadership skills and confidence of public dealings in the teacher peer. In recent days, near peer teaching and learning becoming popular as learning methodology in schools and colleges. It involves students exposed to similar circumstances, from same educational programme, but at different levels. Research question of the study is ‘Is Near Peer learning effective on improving knowledge and habit making regarding prevention of waterborne diseases among primary school children?’ This study was carried out systematically to assess the effectiveness of structured Near Peer learning, where a senior student teaches regarding prevention of waterborne diseases to junior students. Here the subject selected for structured near peer learning is “prevention of waterborne diseases”. Elder children of age group 13-14 years taught their near peers of age group 9-10 years, regarding prevention of waterborne diseases with special attention on improving personal hygiene and hand hygiene. The researcher assessed the effectiveness of structured Near peer learning regarding prevention of water borne diseases, in increasing the knowledge and improving the habits related to Personal hygiene and Hand washing, among primary school children. An evaluative research approach with one group pre test post test design was adopted. In the study, 4 students of 13-14 years age group were selected and researcher taught them regarding prevention of waterborne diseases. 40 primary school children of age group 9-12 years, constituting both boys and girls were also selected through convenient sampling technique. Then one elder child taught 10 younger children regarding same. Pretest and post test done. The questionnaire used were, demographic proforma, knowledge questionnaire, and checklist. Mean pretest was 9.925 and mean post test knowledge was 15.6 Mean pretest for practice was 33.5 and mean post test for practice was 42.07. Hand washing mean pretest practice score was 7.075 and post test was 10.095. There was significant association between pre test scores regarding knowledge and practice and education of child, occupation of father and age of child. P_value

The writers describe a case of big ovarian mucinous cystadenocarcinoma aggravating a young pregnancy in a young woman. Ovarian mucinous adenocarcinoma is an uncommon type of ovarian tumour that develops from the ovary's surface epithelium.A 25-year-old woman with abdominal distension presented to the hospital 9 days after giving birth. USG findings reveal a massive solid cystic mass beginning from the pelvis and extending up to the epigastrium, measuring 36 x 14 cm.MRI pelvis shows a heterogeneous hyperintense solid cystic mass lesion with a bunch of grapes appearance in the intraperitoneal space, extending cranially up to the epigastrium and caudally into the pelvis, causing anterior uterus displacement. Also, the bowel loops are displaced to the back. The lesion is cystic with a solid component and multiple internal echoes for the most part.

Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive neurodegenerative disease resulting in death in 2 to 4 years in most cases. There are several clinical subtypes of ALS depending on the degree of upper and lower motor neuron involvement, and recognition of these subtypes is important because certain subtypes have better prognosis. Without a reliable biomarker, ALS is a clinical diagnosis supported by laboratory investigations. The etiology of ALS remains unknown. However, mutations in certain genes cause ALS in about 5–8% of cases and understanding molecular pathogenetic pathways in these cases may pave a way for effective therapies. There is currently no cure or meaningfully effective therapy for ALS. Supportive and palliative measures in multidisciplinary ALS clinics are exceedingly important to maintain and improve the quality of life in patients with ALS. This chapter summarizes the clinical features and management of ALS.

Background: The SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt. Methods: Hospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India covering a total of 202,986 hospital births, December-2018 through to May-2021. We calculated incidence rates (with 95% Confidence Intervals (CIs)) per 1000 hospital births, case-fatality and rate ratios (RR) with 95% CIs. Linear regression was used to examine the association between the Government Response Stringency Index (GRSI) for India and changes in hospital births, incidence and case-fatality. Results: There was a significant decrease in hospital births per month during the pandemic period with a 4.8% decrease per 10% increase in the GRSI scores (p

Background Cervical cancer is the most common cause of death among women in developing countries. India has the highest age standardized incidence in South Asia at 22. An attempt was made to know the impact of cancer screening programmes in place since 1975 in India, and to do cytological screening in symptomatic women. Material and methods 200 women in the age group of 21–65 years who attended Gynaecology Outdoor Patient Department (OPD) who consented to participate were screened by Pap smear testing. Women who were pregnant, and known or treated case of cancer cervix were excluded from the study. Pap smears were made with conventional method. Results None of the women had Pap smear testing in their life earlier. Only 5% women knew that the tests are available that can detect cervical cancer. All the women were married and in stable marital relationship. Mean age was 38.6 years. Most of the women were parous, had poor socio-economic status and had never used tobacco in any form. Vaginal discharge was the commonest complaint followed by inter-menstrual bleeding. 56% smears were reported as NILM, 32.5% inflammatory, 1.5% had other non-specific findings. ASC-US was in 1%, LSIL in 5.5% and HSIL in 2.5% women. Overall sensitivity and specificity for detection of LSIL were 76.9% and 96.2% and those for detection of HSIL were 66.6% and 97.6%. Conclusions Pap smear is highly sensitive and specific method in detecting pre-cancerous lesions of cervix. Community needs to be enlightened about Pap test through diffuse educational activities.

A 34-year-old man presents with recurrent episodes of acute reversible muscle weakness, soreness, pain, cramps and myoglobinuria with elevated creatine kinase. Symptoms were triggered by fasting, sustained long duration exercise and viral infection. A metabolic myopathy was suspected. Genetic testing showed a homozygous pathogenic variant in CPT2 gene resulting in deficiency of Carnitine Pamitoyl transferase II, an enzyme in the carnitine cycle. The cycle plays a vital role in transport of long chain hydrophobic fatty acids from the cytosol into the mitochondrial matrix for the production of energy via β-oxidation. Carnitine Pamitoyl transferase II deficiency is the most common inherited disorder of lipid metabolism affecting the skeletal muscle of adults. It is also the most frequent cause of hereditary myoglobinuria across all ages. Our case presents an analysis of important clinical features of carbohydrate and lipid metabolism disorders. It highlights how thermolability of the mutant enzyme, rather than its actual deficiency, explains triggering of muscle symptoms by prolonged exercise, infections, febrile episodes, or exposure to cold.

Background There is a paucity of good quality evidence regarding the best therapeutic option for acute control of blood pressure during acute hypertensive emergency of pregnancy. Objective We sought to compare the efficacy of intravenously administered hydralazine and oral nifedipine for acute blood pressure control in acute hypertensive emergency of pregnancy. Study Design In this double-blind, randomized, controlled trial, pregnant women (≥24 weeks period of gestation) with sustained increase in systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥110 mm Hg were randomized to receive intravenous hydralazine injection in doses of 5, 10, 10, and 10 mg and a placebo tablet or oral nifedipine (10 mg tablet up to 4 doses) and intravenous saline injection every 20 minutes until the target blood pressure of 150 mm Hg systolic and ≤100 mm Hg diastolic was achieved. Crossover treatment was administered if the initial treatment failed. The primary outcome of the study was time necessary to achieve target blood pressure. The secondary outcomes were the number of dosages required, adverse maternal and neonatal effects, and perinatal outcome. Results From December 2014 through September 2015, we enrolled 60 patients. The median time to achieve target blood pressure was 40 minutes in both groups (intravenous hydralazine and oral nifedipine) (interquartile interval 5 and 40 minutes, respectively, P = .809). The median dose requirement in both groups was 2 (intravenous hydralazine and oral nifedipine) (interquartile range 1 and 2 doses, respectively, P = .625). Intravenous hydralazine was associated with statistically significantly higher occurrence of vomiting (9/30 vs 2/30, respectively, P = .042). No serious adverse maternal or perinatal side effects were witnessed in either group. Conclusion Both intravenous hydralazine and oral nifedipine are equally effective in lowering of blood pressure in acute hypertensive emergency of pregnancy.

Summary A study was conducted to assess the growth performance and nutrient utilization of cross-bred calves serially infected with Fasciola gigantica and/or supplemented with deoiled mahua seed cake (DMSC) during pre-patent period of infection. Twenty healthy cross-bred (Holstein Friesian × Haryana) male calves aged 6–7 months with an initial average live weight of 79.6 ± 2.71 kg were divided into four treatment groups (CON, CON-INF, DMC and DMC-INF) of five animals each following randomized block design. DMSC was included in the concentrate mixture of DMC and DMC-INF groups at 100 g/kg level. Animals of groups CON-INF and DMC-INF were given an infection of 200 metacercariae (mc) of F. gigantica as serial infection dose of 50 mc twice weekly over a period of 2 weeks. A metabolism trial at 40–49 days post-infection and growth trial of 145 days duration were conducted. The average daily gain (ADG) and feed conversion ratio (FCR) were significantly (p

To compare staples with subcuticular sutures for skin closure in emergency Cesarean sections (CS). One hundred and thirty women (undergoing emergency CS without previous abdominal delivery) were randomly assigned to either staples or subcuticular skin closure (monocryl 3-0). Primary outcome of the study was cosmetic outcome [as assessed by patient and independent observer: Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS), respectively], 6 weeks post-operative. Secondary outcomes were wound complications, operating time, post-operative pain (visual analogue scale day 3 post-operative and patient assessment of pain in scar 6 weeks post-operative), and duration of hospital stay. 112 women were available for evaluation of scar 6 weeks post-operative. Cosmetic result of staples was significantly better than subcuticular sutures (PSAS and OSAS: p value 0.022 and 0.000, respectively), with significantly lesser duration of surgery (24 vs. 32 min: p value 0.000) and comparable post-operative pain (pain on day 3 and 6 weeks post-operatively: p value 0.474 and 0.179, respectively) and wound complications (p value 0.737). However, duration of stay in hospital was increased (6 vs. 3 days: p value 0.001). Staples are the method of choice for skin closure in emergency CS as they are significantly better than subcuticular sutures with respect to cosmesis and duration of surgery. Post-operative pain and wound complications are comparable in two groups. However, staples are associated with significantly increased duration of hospital stay. Trial registered in clinical trial registry CTRI: REF/2013/05/005087.

Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility.Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3-7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle. Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards.Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, significant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups.Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.

Background: Cancer of the cervix is one of the most common cancers among women in India. The study aimed to detect the predictive accuracy of cytology and colposcopy in cervical cancer screening among Himachali married women who had a high risk for cervical cancer. Materials and Methods: This was a hospital-based cross-sectional study. Two hundred nonpregnant married women with a high risk for cervical cancer and attending the gynecology clinic of a tertiary care center of Himachal Pradesh were included in the study over a period of 1 year. A detail clinical history was taken, and examination was performed in all the cases. Papanicolaou (Pap) smears for cytological examination were taken in all the cases. Colposcopy was performed in all the cases, and cervical punch biopsy was taken in all the women with suspicious lesions on colposcopy. Bethesda classification system (2001) and the WHO classification of tumors of the uterine cervix (2003) were used for reporting cytology and histopathology, respectively. Results: The mean age of the women in the study is 38.6 ± 6.2 years. Pap was reported as negative for intraepithelial lesion or malignancy in 88.5%, inflammatory in 32.5%, low-grade squamous intraepithelial lesion (LSIL) in 5.5%, high-grade SIL (HSIL) in 2.5%, and atypical squamous cells of undetermined significance in 1%. In the current study, the diagnostic accuracy of Pap smear and colposcopy for LSIL was 79.4% and 73.5%, respectively. The diagnostic accuracy of Pap smear and colposcopy for HSIL was 100% and 91.3%, respectively. Conclusion: This study has established the utility of Pap smear cytology and colposcopy as a screening tool for the detection of normal as well as abnormal lesions while analyzing cervical pathology in patients with high risk of cervical cancer.

Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease in adults. The biologic basis of ALS remains unknown. However, ALS research has taken a dramatic turn over the past 4 years. Ground breaking discoveries of mutations of genes that encode RNA processing proteins, and demonstration that abnormal aggregates of these and other proteins precede motor neuron loss in familial and sporadic ALS, have initiated a paradigm shift in understanding the pathogenic mechanisms of ALS. Curiously, some of these RNA binding proteins have prion-like domains, with a propensity to self-aggregation. The emerging hypothesis that a focal cascade of toxic protein aggregates, and their consequent non-cell-autonomous spread to neighborhood groups of neurons, fits the classical temporo-spatial progression of ALS. This article reviews the current research efforts toward understanding the role of RNA-processing regulation and protein aggregates in ALS.

In one carbon reaction, tetrahydrofolate works as cofactor for the synthesis of glycine, serine, methionine, purines and thymidylate. Folate or vitamin B9 is not synthesized in humans therefore plants are the main source of this essential vitamin. Deficiency of vitamin B9 may cause severe health consequences like birth defects, megaloblastic anemia, cardiovascular disorders, cancers, etc. To recover folate intake worldwide in the daily diet it is essential to engineer genetically universal food plants with intrinsic capacity to synthesize folate. In this review, we have precised recent advances in determination, biosynthesis enzymes, transport and compartmentation of folate.

The OHVIRA syndrome classically occurs in the setting of uterine didelphys or more rarely, a septate uterus with incidence in various case series is 0.1-3.8%. Renal agenesis is the most commonly reported urologic anomaly. The typical patient with this rare condition usually presents after menarche with nonspecific symptoms of recurrent pelvic pain or dysmenorrhea but both of our patients had atypical presentation. Sonography is frequently the initial imaging modality for evaluation of suspected Mullerian duct anomalies, MR imaging is an excellent modality for evaluating the frequently complex Mullerian duct anomalies. Treatment invariably requires surgical intervention in the form of excision of vaginal septum to relieve obstruction. In addition to relief of pain due to obstruction, surgery also reduces chances of pelvic endometriosis due to retrograde menstrual seeding. We are reporting these cases being their atypical presentation in adulthood life.

A study was conducted to assess the growth performance and nutrient utilisation of crossbred calves trickle infected with Fasciola gigantica ( F. gigantica ) and/or supplemented with deoiled mahua ( Bassia latifolia ) seed cake (DMSC) during patent period of infection. Twenty healthy crossbred (HF X Haryana) male calves aged 6–7 months with an initial average live weight of 79.59±2.71 kg were divided into four treatment groups (CON, CON–INF, DMC and DMC–INF) of 5 animals each following randomized block design. DMSC was included in the concentrate mixture of DMC and DMC–INF groups at 100 g/kg. Animals of groups CON–INF and DMC–INF were given an infection of 200 metacercariae (mc) of F. gigantica as trickle infection dose of 50 mc twice weekly over a period of two weeks. A metabolism trial at 105–114 days post infection (DPI) and growth trial of 172 day duration were conducted. Calves under CON–INF exhibited significantly lower ( P P P >0.05) by trickle infection with F. gigantica . However, higher urinary excretion of nitrogen and lower ( P P P P P F. gigantica trickle infected crossbred calves.

A study was conducted to evaluate the effect of condensed tannins and saponins from deoiled mahua seed cake (DMSC) on the development of fasciolosis. Fifteen male buffaloes were randomly divided into three groups of five each and were orally infected with Fasciola gigantica metacercaria at 800 per animal. DMSC was included in the concentrate mixture of group 2 (M5) and group 3 animals (M10) at 5 and 10%, respectively and group 1 remained as the non-supplemented control (C) group. Hypo-albuminemia, hyper-globulinemia and decrease in Albumin:Globulin (A:G) ratio were the significant features in C and M5 group. The group M10 was characterised by higher haemoglobin and packed cell volume and lower plasma total protein concentration, antibody response and faecal egg count than C and M5 group. This combined with higher plasma albumin, creatinine and lower globulin concentration in group 3 animals were conclusive of lower intensity infection as compared to other groups. It is concluded that condensed tannin and ...

Genetic neuromuscular diseases are caused by defective expression of nuclear or mitochondrial genes. Toxic mutant protein may cause cell death, and thus, strategies that reduce mutant gene expression may provide therapeutic benefit. Synthetic antisense oligonucleotide (ASO) has been known to recognize cellular RNA and control gene expression. In recent years, advances in ASO chemistry, creation of designer ASO molecules to enhance their delivery and safety, and design of clinical trials to judge therapeutic efficacy have ushered into an era of plausible application of ASO technology to treat currently incurable neuromuscular diseases. The US Food and Drug Administration has recently approved two ASO therapies in genetic neuromuscular diseases. This brief overview examines the recent advances in ASO technology, evolution, and use of synthetic ASOs as therapeutic platform, and the mechanism of ASO action by exon-inclusion in spinal muscular atrophy and exon-skipping in Duchenne muscular dystrophy, with attention to their advantages and limitations.

To investigate the role of "mifepristone" for induction of labor (IOL) in pregnant women with prior cesarean section (CS).In this retrospective study, all pregnant women with prior CS who received oral mifepristone (400 mg) for IOL (as per clear obstetric indications) [group 1] were compared with pregnant women with prior CS who had spontaneous onset of labor (SOL) [group 2], with respect to incidence of vaginal delivery, CS, duration of labor, and various maternal and fetal outcomes.During the study period, 72 women received mifepristone (group 1) for IOL and 346 had SOL (group 2). In group 1 after mifepristone administration, 40 (55.6 %) women had labor onset, and 24 (33.3 %) women had cervical ripening (Bishop Score ≥ 8) within 48 h. There were no statistically significant differences with respect to duration of labor (p value: 0.681), mode of delivery (i.e., normal delivery or CS-p value: 0.076 or 0.120, respectively), or maternal (blood loss or scar dehiscence/rupture uterus), or fetal outcomes (NICU admission) compared to women with previous CS with SOL (group 2). However, the need of oxytocin (p value 0.020) and dose of oxytocin requirement (p value 0.008) were more statistically significant in group 1.Mifepristone may be considered as an agent for IOL in women with prior CS.

Although genetic and inherited disorders are individually rare, they collectively affect about one in 17 individuals in Western population 1 . Genetic abnormalities at conception are more common and many of them become incompatible for embryo survival. In fact, chromosome abnormalities in embryo account for about 50% first trimester pregnancy losses. Most of these genetic abnormalities are numerical chromosome aberrations and recurrence risk of numerical chromosome abnormalities in subsequent pregnancy is low. However, neurological developmental abnormality among survivals with chromosomal aberrations, such as trisomy 21 (Down syndrome), is almost universal.

We examined the clinical characteristics of patients who underwent initial dual energy X-ray absorptiometry (DXA) testing at a primary care facility from 2000 to 2013, and whether these factors changed over time in accordance with Canadian clinical practice guidelines. The burden of osteoporosis remains high and largely unchanged and clinical practice guidelines are not being followed, overall. This study examined the clinical risk factors, therapeutic health behaviors, and bone mineral density (BMD) status of patients who underwent initial DXA testing at a primary care facility in Saskatchewan, Canada, and whether these factors changed over time from 2000 to 2013 in accordance with Canadian clinical practice guidelines. We conducted a retrospective cross-sectional medical chart audit of 800 patients 50 years of age and older who underwent their first DXA test to assess BMD status. Data was extracted from 2000 to 2013 and further stratified into four periods (2000–2001, 2002–2006, 2007–2009, and 2010–2013; n = 200 each period) based on the years when practice guidelines were implemented. Extracted data included BMD outcomes, clinical risk factor indicators for DXA testing, and recommendations for therapeutic health behaviors outlined in the clinical practice guidelines. There were no differences in BMD status across the four time stratas (p = 0.430). Overall, most clinical risk factors had little change over time. The number of males screened significantly increased over time (p

Background A viral etiology of amyotrophic lateral sclerosis (ALS) has been proposed because of the selective vulnerability of motor neurons to certain viruses. During the last 20 years, at least 19 cases of ALS or ALS-like disease have been reported in HIV-1 (HIV) seropositive individuals. Objective To describe two cases of clinically definite ALS in patients with HIV infection and to review the previously reported cases of HIV-associated ALS syndrome. Setting A multidisciplinary ALS center and Neuro-AIDS clinic at a tertiary care university hospital. Patients/Design We investigated and prospectively monitored two patients who had developed clinically definite ALS by El Escorial criteria several years after acquiring the HIV infection. The previously reported cases of ALS or ALS-like disease in patients with HIV infection were reviewed for comparison and contrast with the characteristics of sporadic ALS. Results The clinical course of ALS in our two HIV seropositive individuals mirrored that of classical sporadic ALS. A review of previously described 19 patients with ALS syndrome revealed clinically definite ALS in 4 cases and clinically probable or possible ALS in 15. ALS commenced at different stages of the HIV disease; in 7 patients, HIV infection was discovered contemporaneously with diagnosis of ALS. CD4 + T cell count ranged from 2 to 560 cells/mm 3 . Three (1 definite ALS) of the fatal cases were studied at autopsy and all exhibited pathology outside the motor neuron pool. Unlike our patients, 7 of 8 patients with HIV-associated ALS syndrome receiving HAART demonstrated at least partial recovery of their motor deficit. Conclusions ALS-like syndrome can occur in association with HIV infection; however, the causal relationship remains uncertain. Patients with ALS syndrome related to HIV infection are generally younger in age and often demonstrate pathology outside the motor neuron system. Patients with HIV-associated ALS syndrome may improve following antiretroviral therapy. An aggressive HAART regimen to reduce viral load should be pursued in all such cases.

The nosologic boundary of neuropathic scapuloperoneal syndrome (Davidenkow's syndrome) remains ill defined and its genetic basis is unknown. A case of Davidenkow's syndrome with the monochromosomic 17p11.2 deletion that often is associated with hereditary neuropathy with liability to pressure palsies (HNPP) is described. The other allele at chromosome 17p11.2 locus was of normal length, and direct sequencing of the coding region of the peripheral nerve protein-22 gene in this allele revealed no additional mutation. The deleted allele in the proband was inherited from the paternal line in which the affected members had a late onset Charcot-Marie-Tooth type 1 clinical phenotype. This observation suggests that the rare Davidenkow's syndrome is clinically related to HNPP and its genotype could be a chromosome 17p11.2 deletion.

The objective of this cross-sectional study was to evaluate the accuracy of the calcaneal quantitative ultrasound (QUS) and the Osteoporosis Self-Assessment Tool (OST) in identifying older women with osteoporosis as defined by dual-energy X-ray absorptiometry (DXA), and to establish optimal cutoffs to determine risk. We assessed bone mineral density of the femoral neck and lumbar spine using DXA and subsequent calcaneal QUS and OST measurements in 174 women aged 50-80 years. Pearson product correlation coefficients between QUS, OST, and DXA parameters were calculated. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) and optimal thresholds for QUS and OST were defined based on sensitivity, specificity, and likelihood ratio analysis. The ability of calcaneal QUS to identify women with a T-score ≤-2.5 at the femoral neck (AUC = 0.892) consistently outperformed a T-score ≤-2.5 at the lumbar spine (AUC = 0.696) and OST at both the femoral neck and lumbar spine (AUC = 0.706-0.807). Stiffness index cutoff values that fall between 65 and 78 were found to warrant DXA screening, with a cutoff65 indicating high likelihood of osteoporosis. Further prospective research is needed to examine the gender-related differences of QUS and OST diagnostic performance and their usefulness in clinical practice.

To determine the success rate of trial of labor after cesarean (TOLAC) in rural India.The present prospective observational study enrolled pregnant women attending Dr Rajendra Prasad Government Medical College, Kangra, India, in 2013. Eligible women had a previous low-segment cesarean delivery and had a singleton pregnancy with cephalic presentation. Women in labor were managed as per the institutional protocol.In total, 482 women were included. TOLAC led to a vaginal delivery in 383 (79.6%) women. Overall, 2 (0.4%) women had scar rupture, and 4 (0.8%) had scar dehiscence. Fetal death was recorded in one woman with scar rupture, for whom peripartum hysterectomy was necessary. Blood loss was significantly lower among the 316 women with normal vaginal delivery than among the 99 who underwent cesarean (P0.001). Blood transfusion was required in 2 (0.6%) women with normal vaginal delivery and 2 (2.0%) with cesarean delivery (P=0.05). The proportion of neonates who had to be admitted to intensive care did not differ significantly by mode of delivery (P=0.06).Under strict supervision, TOLAC is a reasonable option even in rural India.

Rotaviral enteritis has emerged as a major cause of morbidity and mortality in piglets during their post-natal life. The present study was carried out to examine high-mobility group box 1 (HMGB1) protein, acute phase response and oxidative stress indices in the serum of suckling piglets suffering from enteritis with or without association of porcine group A rotavirus infection. The present investigation utilized 23 clinical cases with signs of acute enteritis and 12 more healthy piglets of a similar age group as control animals. Out of 23 enteritis cases, 12 cases were found to be positive for porcine group A rotavirus infection as confirmed by reverse transcription-polymerase chain reaction (RT-PCR) using specific primers for group A rotavirus, and the rest were found negative. The acute enteritis cases in piglets were associated with an elevated level of HMGB1 protein and serum haptoglobin and ceruloplasmin suggestive of an acute phase response. Among the oxidative stress indices, the concentrations of malondialdehyde (MDA) and nitric oxide (NO) in serum were significantly increased. A pronounced drop of total antioxidant capacity and the activity of antioxidant enzymes such as catalase and superoxide dismutase in the serum of piglets suffering from acute enteritis compared to healthy ones were also noticed. The alterations in HMGB1 protein, acute phase response and oxidative stress indices were more pronounced in cases with the involvement of porcine rotavirus as compared to rotavirus-negative cases. It is concluded that HMGB1 protein, markers of oxidative stress and acute phase proteins might play an important role in the aetiopathogenesis of porcine diarrhoea caused by rotavirus and might be true markers in diagnosing the conditions leading to the extension of the prompt and effective therapeutic care.

Mitochondria differ from other subcellular organelles in that they contain their own DNA (mitochondrial DNA [mtDNA]). In mitochondrial disorders, not only does energy failure in tissues and organs result, with a variety of clinical symptoms, but the metabolic block at the end of the anaerobic glycolysis can also lead to excessive pyruvate and lactate accumulation. Lactic acidosis, therefore, can be a manifestation of mitochondrial dysfunction. Symptomatic hyperlactatemia associated with antiretroviral therapy is linked to the mitochondrial respiratory-chain impairment in HIV disease. The recent availability of antiretroviral drugs has substantially reduced HIV-associated mortality and morbidity through decreased viral burden and immune restoration. Mitochondria are the site of generation of most of the cellular ATP pool. The conversion of one molecule of glucose to pyruvate or lactate is associated with the net formation of two molecules of ATP. Nucleoside analog reverse transcriptase inhibitors (NRTI)-related mitochondrial toxicity appears to be the major factor responsible for hyperlactatemia and lactic acidosis in patients with HIV disease. All metabolic acidoses have profound effects on the respiratory, cardiac, and nervous system. It seems essential to discontinue all antiretroviral drugs at the time of NRTI-associated lactic acidosis (NALA) diagnosis; however, surviving patients often need to continue antiretroviral therapy.

This chapter describes the different methods used to perform magnetic resonance spectroscopy (MRS) studies of patients with HIV infection, reviews the major findings from the studies, and identifies future directions for clinical studies that may further elucidate the pathophysiology of HIV-associated brain injury, as well as discusses issues to consider in treatment monitoring. MRS studies have been performed in both adult and pediatric patients with HIV infection, using localized MRS and MRS imaging (MRSI) techniques and long TEs and short TEs, and before or after antiretroviral treatment. The majority of the studies used localized spectroscopy techniques (either point resolved spectroscopy (PRESS) technique or the stimulated echo acquisition method) and evaluated one to three brain regions. Limited by magnetic-susceptibility problems in evaluating the frontal brain regions, many of the earlier localized MRS studies evaluated the parietal or the occipital brain regions. Improvements in MRS techniques, such as adjustments of the slice order, allow the assessment of the frontal lobe and subcortical brain regions. Prior to highly active antiretroviral therapy (HAART), several longitudinal MRS studies reported changes in metabolite ratios or levels in HIV patients during antiretroviral treatment. Levels of inflammatory markers, such as the chemokine macrophage chemoattractant protein 1 (MCP-1), were found to be higher in patients with HIV-associated dementia than in those who were neuroasymptomatic. Additionally, both in vivo and ex vivo MRS studies in animal models of AIDS (e.g., simian immunodeficiency virus (SIV) and feline immunodeficiency virus (FIV)) should provide additional insights into the pathophysiology of HIV-associated dementia.

To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS).In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I-IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I-IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I-IV).Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS (p = 0.440) and inter-delivery interval (p = 0.062) had no statistically significant correlation with thickness of LUS.Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.

Pelvic organ prolapse during pregnancy is extremely rare. Limited cases (less than 30) have been reported since 1980. From a very benign presentation of heaviness in perineum, it can present as uterine rupture with fetal and maternal mortality. No standard guidelines of care have been established for this rare presentation. There is gross variation in management ranging from conservative measures, laparoscopic surgery to cesarean section followed by peri-partum hysterectomy and abdominal sacral colpopexy. This case series report five cases of pelvic organ prolapse during pregnancy and outlines an approach of watchful expectancy with favorable maternal & fetal outcomes.

Acute fulminant fungal sinusitis is characterized by acute symptoms and rapid progress with a mortality rate of 60-80%. A large number of survivors have permanent neurological, visual and cosmetic disabilities. This clearly underscores the need of early recognition of this disease in at risk population in order to start urgent treatment. The at-risk population of diabetics, AIDS and other immunosuppressed is likely to increase, as will the incidence of acute fulminant fungal sinusitis. In the present study we have reviewed nine cases of acute fulminant fungal sinusitis to determine clinical presentation, related radiological picture and optimum treatment. Most common presenting features were fever, headache, facial swelling and proptosis. Many patients presented with blindness, facial paralysis and meningitis. Predisposing causes were uncontrolled diabetes with ketoacidosis in four out of six cases, post renal transplant immunosuppression and leukemia. All patients were treated with amphotericin B or liposomal amphotericin B (AmBisome). Diagnosis was confirmed by biopsy and culture of sinus mucosa, soft tissues of cheek, or orbit. Mucor (Zygomycetes) was identified on culture or histopathology in all cases. Surgical debridement was performed in seven cases. Six out of nine patients survived but morbidity was high: only two patients survived without any permanent disability.

Peripheral neuropathy is common in human immunodeficiency virus type-1 (HIV-1) infection. Peripheral neuropathies complicate all stages of the HIV-1 disease and cause considerable morbidity and disability in HIV-1 infected individuals and acquired immunodeficiency syndrome (AIDS) patients. Whereas symptomatic neuropathies occur in approximately 10% to 15% of HIV-1-infected patients overall, pathologic evidence of peripheral nerve involvement is present in virtually all end-stage AIDS patients. There are 6 major clinical types of HIV-associated neuropathies that are regularly seen in large HIV-1 clinics. Distal sensory polyneuropathy (DSP) is the most common among the HIV-1-associated neuropathies. DSP generally occurs in later stages of HIV-1 infection and it follows an indolent and protracted clinical course. The dominant clinical features in DSP include distal pain, paresthesia and numbness in a typical length-dependent fashion with proximal to distal gradient. Whereas toxic neuropathies--secondary to certain antiretroviral agents--are clinically similar to DSP, their temporal relation to neurotoxic medication helps distinguish them from other HIV-1-associated neuropathies. DSP and toxic neuropathy may coexist in a single patient. Acute and chronic inflammatory demyelinating polyradiculoneuropathies (AIDP and CIDP) produce global limb weakness. AIDP may occur at seroconversion and it can therefore be the initial manifestation of HIV-1 infection. CIDP generally occurs in the mid to late stages of HIV-1 infection. Progressive polyradiculopathy (PP) occurs in patients with advanced immunodeficiency and is generally caused by the opportunist cytomegalovirus (CMV) infection. Mononeuropathy multiplex (MM) in early stages of HIV-1 infection is immune mediated, whereas in advanced AIDS it is caused by the CMV infection. Finally, subclinical autonomic nervous system involvement is common in all stages of HIV-1 infection. Because HIV-1-associated neuropathies are diverse in their etiology and pathogenesis, a precise clinical diagnosis is required to formulate a rational therapeutic intervention.

There is an imperative need for the early diagnosis of amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) in the current era of emerging treatments. When evaluating the patient with ALS/MND, the neurologist must consider a number of other motor neuron disorders and related motor syndromes that may have clinical features resembling ALS/MND. The revised Airlie House-El Escorial diagnostic criteria have been established through the consensus of experts meeting at workshops. However, by definition, using these criteria a patient is likely to have fairly advanced disease at the time of a definitive ALS/MND diagnosis. The reasons for the difficulty in making an early ALS/MND diagnosis are several. No surrogate diagnostic marker currently exists for ALS/MND. ALS/MND at its onset is heterogeneous in clinical presentation, its clinical course is variable, and several clinical variants are recognized. In addition, certain motor syndromes, such as monomelic amyotrophy, postpolio muscular atrophy, and multifocal motor neuropathy, can clinically mimic ALS/MND. Therefore, not only may the diagnosis of ALS/MND be clinically missed in the early stages, but worse, the patient may be wrongly labeled as having ALS/MND. The diagnosis of ALS/MND requires a combination of upper motor neuron (UMN) and lower motor neuron (LMN) involvement. Motor syndromes in which the deficit is restricted to the UMN or LMN through the entire course of the disease are described as atypical MND in this review. Approximately 5% of patients with ALS/MND have overt dementia with a characteristic frontal affect. ALS/MND with parkinsonism and dementia is rare outside the western Pacific region. The clinical course of motor disorder in these overlap syndromes does not differ from that in typical ALS/MND.

The clinical course of the primary experimental Fasciola gigantica infection was investigated in riverine buffalo calves of the Murrah breed. Nine male calves aged 12–15 months were randomly assigned to two groups of five (Group I) and four (Group II) animals. Each animal in Group I, was orally infected with 1000 metacercariae (mc) of F. gigantica, whereas Group II animals did not receive any infection dose and served as uninfected controls. No clinical signs of fasciolosis were observed until the sixth week post-infection (PI). Group I animals, however, developed recognised symptoms of acute fasciolosis, comprising apyrexic inappetance, anemia, poor weight gain, diarrhoea and sub-mandibular and facial oedema, respectively, from 5, 6, 8, 16 and 17 weeks PI. The signs were intermittent in nature and of variable duration. The prepatent period was of 92–97 days (mean 95.2 ± 3.1). One of the five infected animals died on Day 147 PI. At necropsy, 36.8 ± 11.0% of the infection dose was recovered as adult fluke population. The gross lesions were primarily biliary in nature. Group II, the uninfected controls, throughout the study period of 165 days PI, did not show any symptom and were negative for F. gigantica. The study demonstrated that the onset of adverse effects of F. gigantica on the growth and health of the infected host was mainly noted during late prepatency much before coprological prediction and diagnosis. The significance of preventive therapy against fasciolosis during prepatency has been stressed in endemic areas.

Sialorrhea is frequently a socially disabling symptom in patients with bulbar amyotrophic lateral sclerosis (ALS). In this open-label prospective study, we report the effect of botulinum toxin A (Botox) injection into the parotid glands in 10 patients with bulbar ALS and socially disabling sialorrhea. We applied three different outcome measures to determine the effect of Botox therapy on sialorrhea. Botox significantly improved the degree of sialorrhea and a drooling impact score and, by inference, the quality of living, in over half of the patients with bulbar ALS and severe sialorrhea. The beneficial effect of Botox lasted for at least 2 months in those who responded. No major adverse effects were noted. Local injection of a small dose of Botox into the parotid glands can control sialorrhea and potentially improve living quality in some patients with bulbar ALS.

Although isolated lower motor neuron disease has been reported as a paraneoplastic complication, it has not been previously described, in association with anti-Hu antibody. We report a 51-year-old man in whom weakness heralded the presence of a small-cell cancer of the lung. His neurological disorder was characterized by an unremitting progression of limb, neck, and chest wall weakness and wasting that commenced and remained predominant in the upper limbs. Electrophysiological studies demonstrated widespread denervation and examination of a muscle biopsy specimen showed evidence of acute and chronic denervation. High titers of anti-Hu antibody were detected in the serum and cerebrospinal fluid. Neither objective measures of strength nor titers of anti-Hu antibody responded to corticosteroids, cyclophosphamide, intravenous immunoglobulins, or plasmapheresis. Death from the complications of motor neuron disease ensued 23 months after the onset of weakness. Autopsy revealed tumor in the lung and on pleural and peritoneal surfaces. There was a loss of anterior horn cells in the spinal cord. Despite the absence of symptomatic cerebellar disease, a decrease in the number of Purkinje cells was also detected.

Prion diseases or transmissible spongiform encephalopathies are fatal neurodegenerative diseases characterized by the aggregation and deposition of the misfolded prion protein in the brain. α-synuclein (α-syn)-associated multiple system atrophy has been recently shown to be caused by a bona fide α-syn prion strain. Several other misfolded native proteins such as β-amyloid, tau and TDP-43 share some aspects of prions although none of them is shown to be transmissible in nature or in experimental animals. However, these prion-like “prionoids” are causal to a variety of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. The remarkable recent discovery of at least two new α-syn prion strains and their transmissibility in transgenic mice and in vitro cell models raises a distinct question as to whether some specific strain of other prionoids could have the capability of disease transmission in a manner similar to prions. In this overview, we briefly describe human and other mammalian prion diseases and comment on certain similarities between prion and prionoid and the possibility of prion-like transmissibility of some prionoid strains.