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To find out the serum fibroblast growth factor 23 (FGF-23) levels in different grades of CKD, and the prevalence of abnormal left ventricular mass index (LVMI), carotid intima–medial thickness (cIMT), and central pulse wave velocity (cPWV) and the risk factors including FGF-23 for these abnormalities. Fifty-nine patients of CKD with G2 to G5, aged 2–18 y were included. The LVMI, cIMT, and cPWV were measured using standard techniques, and serum intact FGF-23 levels were estimated at enrollment. Median FGF-23 levels were significantly raised in all the grades of CKD than controls (p

This study evaluated the diagnostic role of cerebrospinal fluid leucine-rich alpha-2 glycoprotein (CSF LRG) concentration in children with acute bacterial meningitis, and its role in differentiation from aseptic meningitis. CSF LRG concentration was measured by ELISA Kit of 50 children with bacterial meningitis, 16 aseptic meningitis, and 20 children with normal CSF; control. CSF LRG was significantly elevated (p

Background and AimWDR13 - a WD repeat protein, is abundant in pancreas, liver, ovary and testis. Absence of this protein in mice has been seen to be associated with pancreatic β-cell proliferation, hyperinsulinemia and age dependent mild obesity. Previously, we have reported that the absence of WDR13 in diabetic Leprdb/db mice helps in amelioration of fatty liver phenotype along with diabetes and systemic inflammation. This intrigued us to study direct liver injury and hepatic regeneration in Wdr13−/0 mice using hepatotoxin CCl4.MethodsMice were injected with CCl4 twice a week for 8 consecutive weeks. Controls were injected with vehicle (olive oil) similarly. After the last injection, mice were given a 10-days of recovery period and then sacrificed for physiological and molecular analyses.ResultsIn the present study we report slower hepatic regeneration in Wdr13−/0 mice as compared to their wild type littermates after CCl4 administration. Interestingly, during the regeneration phase, hepatic hypertriglyceridemia was observed in Wdr13−/0 mice. Further analyses revealed an upregulation of PPAR pathway in the liver of CCl4-administered Wdr13−/0 mice, causing de novo lipogenesis.ConclusionsThe slower hepatic regeneration observed in CCl4 administered Wdr13−/0 mice, may be linked to liver hypertriglyceridemia because of activation of PPAR pathway.

Posterior reversible encephalopathy syndrome (PRES) is a rare serious syndrome of central nervous system that can develop in both adults and children. It is characterised by acute onset of headache, confusion, seizures, or focal neurological deficits along with radiological abnormalities in the parietal and occipital lobes. In the past, this syndrome has been mainly described in adults but rare in children. However, it is not uncommon in paediatric nephrology. Hypertension, renal disease, immunosuppression, and chemotherapy of malignancies are triggers for PRES. Here, we report a case of 12 years old boy with steroid-sensitive nephrotic syndrome presenting as PRES.

The Coronavirus outbreak is a rapidly evolving pandemic, placing unprecedented strain on health-care systems. COVID-19 presents challenges for management of children with renal diseases, especially those receiving long-term immunosuppressive medications, including renal transplant recipients and those with chronic kidney disease and acute kidney injury requiring dialysis. Our preparedness for managing this vulnerable group of children is the need of the hour. The purpose of this article is to provide guidance to caregivers and health care personnel involved in management of children with renal diseases and to ensure patient well-being, while protecting staff from infection.

Ultrasonogram-guided fine needle aspiration cytology of the axillary lymph nodes using a 7–12 MHz linear transducer was carried out on 102 breast cancer patients in whom there was no clinically palpable lymph node in the axilla. Ultrasound was able to visualize an axillary node in 55 patients (54%) while in 47 patients (46%), no node was visualized. USG-guided FNAC on the 55 patients found 9 (16%) patients to be positive for metastases, 27 (49%) to be negative, and 19 (35%) in whom an inconclusive or inadequate sample was reported. On correlation with post-modified radical mastectomy (MRM) histopathology, the preoperative USG-guided FNAC had a sensitivity of 60%, specificity of 100%, and an overall diagnostic accuracy of 58%. It can be concluded that patients with a positive for malignancy USG-guided FNAC report on the axilla should be treated as such. Patients who have a negative for malignancy or inconclusive/inadequate FNAC report or in patients in whom no axillary node is visualized on USG should undergo a sentinel node biopsy procedure for further evaluation of the axilla.

Dear Editor, Rising and remerging pathogens are worldwide difficulties for open health.1 Coronaviruses are wrapped RNA infections that are dispersed extensively among people, different warm-blooded creatures, and flying creatures and that cause respiratory, enteric, hepatic, and neurologic diseases.2, 3 Six coronavirus species are known to cause human illness like 229E, OC43, NL63, and HKU1, SARS – CoV and MERS – CoV.4 Given the high predominance and wide circulation of coronaviruses, the huge hereditary decent variety and successive recombination of their genomes, and expanding human–creature interface exercises, novel coronaviruses are probably going to develop intermittently in people attributable to visit cross-species contaminations and incidental overflow events.5, 6 On January 30, World Health Organization (WHO) pronounced the ebb and flow flare-up that began in Wuhan, China as a Public Health Emergency of International Concern, while prescribing against movement or exchange interruptions to and from China.7 The progressing pandemic of coronavirus ailment 2019 (COVID-19) is brought about by extreme intense respiratory disorder coronavirus 2 (SARS-CoV-2).8 As of 12 April 2020, in excess of 1,777,515 instances of COVID-19 have been accounted for in more than 200 nations and regions, bringing about in excess of 108,862 passings.

Lysosomal storage disorders (LSDs) are relatively common slow progressive inborn error of metabolism encountered by clinicians. This work intends to highlight the more common LSDs, their clinical presentation, outcome, and mutation (wherever feasible) collected from the genetic clinic at tertiary care center in Eastern Uttar Pradesh. The data for analysis were collected retrospectively from genetic records from a follow-up clinic. All cases

Background and aims Brain abscess is a serious and dreadful disease presenting at tertiary centre. The objective of this study was to look into the clinical profile, predisposing conditions, microbiology and outcome of children suffering from brain abscess. Methods 30 children up to 18 years with clinical and imaging evidence of brain abscess were taken for study. Patients were stabilized as per unit protocol. Necessary investigations were carried out. Neuroimaging (CT or MRI) was used to confirm the diagnosis. All parameters (clinical, investigation, outcome) were recorded in predesigned performa. Neurosurgery consultation was sought in patients with multiple abscesses, posterior fossa abscesses, abscess with air-fluid level and causing midline shift. Results There were 16 males with 13 patients in age group (5-10 years). Mean duration of stay in hospital was 14.8 days. Most common predisposing factor was chronic suppurative otitis media (n-15). Typically, patients presented with fever, headache and seizures. On examination, motor deficits were the most common followed by signs of meningitis. Computerized tomography confirmed the diagnosis in most cases. Temporal lobe (n-11) was the commonest intracranial site for the abscess. Methicillin resistant staphylococcus and proteus mirabilis were the common pathogen isolated from blood and pus. Blood culture positivity rate was 16.7% and pus culture positivity rate was 25%. All cases were managed with intravenous antibiotics and aspiration (n-10) and excision (n-6). There were 5 deaths. There was complete immediate recovery in 13 cases with residual motor deficit in 12 cases. Conclusion Brain abscess is a rare but serious entity in children. Late diagnosis and improper management leads to poor outcome. Early surgical intervention is helpful. Threshold for diagnosis should be low in children with chronic ear infection and congenital heart diseases.

Scrub typhus is an important etiological agent in acute febrile illness in the post-monsoon season in tropical countries. It leads to dreaded complications if left untreated. Acute kidney injury is one such complication. Malaria, syphilis, and HIV have been associated with secondary nephrotic syndrome in pediatric age group. Scrub typhus has been reported only once with nephrotic syndrome. We report a case of scrub typhus-associated nephrotic syndrome with acute kidney injury in a five-year-old female with uneventful outcome

Infants with acute kidney injury (AKI) who are critically ill often will have multiorgan dysfunctions. Objective of the present study was to find out mortality, recovery of kidney function at discharge and at 3 months, and to determine risk factors for mortality. Fifty-two infants (24 newborns and 28 postneonatal) with AKI were included. Staging was done as per Kidney Disease Improving Global Outcomes classification. Patients were subjected to medical treatment and peritoneal dialysis (PD), wherever indicated. Kidney function tests were performed at admission, discharge, and at 3 months follow-up. Median age of neonates was 8 days and postneonatal infants were 4.5 months. Stage 1, 2, and 3 AKI were present in 14 (26.9%), 16 (30.7%), and 22 (42.3%) cases, respectively. PD was required in 22 (42.3%) infants, and significantly higher in postneonatal than in neonates (57.1% vs. 25%, p

Steroid-resistant nephrotic syndrome (SRNS) patients with genetic mutations most commonly have histology of focal segmental glomerulosclerosis (FSGS) and do not respond to immunosuppressive drugs. We report the molecular screening results of 18 pediatric SRNS cases presented to our nephrology clinic. Three pathogenic variants have been detected, two previously reported and one novel variant. The reported pathogenic variants have been detected in NPHS1 and NPHS2 genes. A novel pathogenic variant has been detected in the inverted formin 2 gene (INF2) gene. We did not detect any variant of the WT1 gene. There were 13 males. Mean age of study participants at enrollment was 69 months. There were 12 cases of primary SRNS. The mean duration from onset of symptoms to SRNS diagnosis was 13 months. FSGS and minimal change disease (MCD) were present in the same number of cases. The response rate (complete or partial) to immunosuppressive drugs was seen in only one patient in the genetic SRNS group (n = 3), while the response rate in nongenetic cases (n = 15) was 80%. Two nonresponders in the genetic SRNS group had FSGS for histopathology and pathogenic variants (NPHS2 and INF2). The other three nonresponders in the nongenetic SRNS group had both FSGS (n = 1) and MCD (n = 2) histopathology. There were two deaths in the study cohort of the nongenetic SRNS group. This study highlights the screening of the SRNS cohort by a panel of extended genes rather focussing on the three most common genes (NPHS1, NPHS2, and WT1). This further confirms the molecular etiology of SRNS in three cases and extends the list of pathogenic variants of genetic SRNS in the North Indian population. This is the first study in the eastern part of Uttar Pradesh in India.

The present chapter focused on wound healing agents of herbal and natural origin. Anatomical and physiological details of wound and wound healing process are not described in this chapter due to space constraints. Concise lists of wound healing agents of natural origin with a brief information about scientific name/identification, parts used, and formulation of listed wound healing agents are described in this chapter. But natural wound healing agents are not limited to these names only; there would be many more agents having same properties, either being described in ancient literature or being used by traditional/local healers. The description given in this chapter is based on scientific literature-based evidences. The soothing fact about natural wound healing agent is that during in vivo studies, different plants have shown marvelous potential for wound healing.

Vascular malformations are nonneoplastic expansions of blood vessels that arise due to errors in angiogenesis. Here we report loss-of-function mutations in ELMO2, which translates extracellular signals into cellular movements, as causative for autosomal recessive intraosseous vascular malformation (VMOS) in five different families. Individuals with VMOS suffer from life threatening progressive expansion of the jaw, craniofacial and other intra membranous bones caused by malformed blood vessels that lack a mature vascular smooth muscle layer. Analysis of primary fibroblasts from an affected individual showed that absence of ELMO2 correlated with a significant down regulation of binding partner DOCK1, resulting in deficient RAC1-dependent cell migration. Unexpectedly, elmo2-knockout zebra fish appeared phenotypically normal, suggesting human-specific ELMO2requirements in bone vasculature homeostasis or genetic compensation by related genes. The genetic basis for vascular malformations is incredibly complex. The great deal of phenotypic variability within known gene mutations suggests that we do not fully comprehend the exact genetic contribution to syndromes. However, further investigation will allow us to identify at-risk patients in the hopes of preventing the more severe sequelae of the syndromes. Furthermore, in-depth knowledge of the molecular basis of these lesions will provide ample opportunity to develop tissue-targeted therapy.

Urinary tract infections (UTIs) are considered to be the most common infections worldwide, having an incidence rate of 40−60% in women. Moreover, the prevalence of this disorder in adult women is 30 times more than in men. UTIs are usually found in many hospitals and clinical practice; as disorders, they are complicated and uncomplicated; in uncomplicated cases, there is no structural or functional abnormality in the urogenital tract. However, obstruction, retention of urine flow and use of catheters increase the complexity. There are several bacteria (e.g., E. coli, Klebsiella pneumoniae, Proteus vulgaris, etc.) successfully residing in the tract. The diagnosis must not only be accurate but rapid, so early detection is an important step in the control of UTIs caused by uropathogens. The treatment of UTIs includes appropriate antimicrobial therapy to control the infection and kill the causal microbes inside the body. A long-time usage of antibiotics has resulted in multidrug resistance causing an impediment in treatment. Thus, alternative, combinatorial medication approaches have given some hope. Available treatments considered Homeopathic, Ayurvedic, Unani, and other herbal-based drugs. There are new upcoming roles of nanoparticles in combating UTIs which needs further validation. The role of medicinal plant-based nanotechnology approaches has shown promising results. Therefore, there must be active research in phyto-based therapies of UTIs, such as Ayurvedic Biology.

Albumin is the major protein excreted in urine in patients with nephrotic syndrome (NS). However, low-molecular-weight proteins including some binding proteins are also excreted. Thyroid hormone and its binding globulins are excreted in urine in excess in nephrotic syndrome. Therefore, it has been postulated that patients with nephrotic syndrome may show hypothyroidism, subclinical or overt. In this prospective observational study, patients of idiopathic nephrotic syndrome aged 1–40 years of both gender were included. Serum T3, T4 and TSH were assayed at diagnosis and repeated at 12 weeks or at remission whichever was earlier. Renal biopsy was performed as required. Among 100 patients taken for analysis (42 children, 58 adult), 30 cases were of first episode, 40 were of frequent relapse/steroid-dependent NS, and 30 patients had steroid-resistant NS (SRNS). Three (3%) cases had overt hypothyroidism and 18 (18%) patients had subclinical hypothyroidism. Most hypothyroid cases belonged to SRNS subgroup. Mean Serum T3, T4 and TSH values showed significant improvement in remission in comparison to nephrosis state (P

Objective In varicose veins, increased levels of inflammatory markers are indicators of endothelial damage and increased procoagulant activity. These findings support the assumption that the constitution of blood in varicose veins differs from that of systemic blood. The purpose of the study was a correlative study of blood constituents in varicose veins and peripheral veins (normal vein) in same individual with varicose vein which was done by comparing the level of concentration of interleukin-6, fibrinogen, haemoglobin from blood of varicose veins and normal peripheral vein (antecubital vein). Method Using citrated plasma samples withdrawn from arms and legs of same patient and plasma obtained by centrifugation of citrated venous blood at 5000 r/min for 10 min was used for correlation. Serum concentration of interleukin-6 and fibrinogen were determined by human enzyme-linked immunosorbent assay Kit for both interleukin-6 and fibrinogen, which is based on the standard sandwich enzyme-linked immunosorbent assay technology. This assay employs a monoclonal antibody specific for human interleukin-6 coated on a 96-well plate. Result Expressed as median (interquartile range) in pg/mL, leg samples from patient having varicose vein has significantly increased interleukin-6 in cases as compared to controls ( p value of Conclusion Blood withdrawn from the site of varicose vein appears to have significantly increased concentration of interleukin-6, fibrinogen and haemoglobin when compared to same patient’s antecubital blood sample supporting the hypothesis that inflammation is increased in tissues drained by varicose vein.

Coumarins (warfarin, acenocoumarol, phenprocuomon) are well known agents that are prescribed for prevention of thromboembolic episodes in pregnant women who are on mechanical heart valves prosthesis. It acts as double edge sword as fetus is unnecessarily exposed to teratogenic effect of drug. Warfarin is well studied drug in terms of its tetratogenic dose, period of exposure, fetopathic effects. Acenocoumarol is well known teratogen but its effect and lethal dose on fetus is less reported. We report a neonate who was exposed to acenocoumarol throughout intra uterine life. Neonate showed all features of coumarin embryopathy (flat facial profile, depressed nasal bridge, short columella, skeletal stippling, short distal phalanges in hand) and cephalhaematoma in addition. We also summarised the clinical findings of all the cases reported so far of acenocoumarol embryopathy. Acenocoumarol has same teratogenic potential as of warfarin. Doses causing embryopathy remained unexplored field. Clinicians need to document properly so that scientific data can be generated as ethical issues arises in head to head trial of these drugs.

To detect Cytotoxic T- Lymphocyte Antigen-4 (CTLA4) single nucleotide polymorphisms (SNPs) at +49A/G (rs231775) and -318C/T (rs5742909) positions in children with idiopathic nephrotic syndrome (INS) and also assay urinary soluble CTLA4 (sCTLA4) levels in children with minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS) and steroid sensitive nephrotic syndrome (SSNS) in remission. The study included 59 patients of INS (MCD-23, FSGS-15 and SSNS in remission-21) and 35 healthy controls. The CTLA4 SNPs profiling was done in peripheral blood mononuclear cells and urinary sCTLA4 level was assayed by ELISA kit. Although frequency of homozygous +49 GG (rs4553808) genotype (26.3% vs. 11.4%; p = 0.231) and G allele (52.6% vs. 40%; p = 0.216) were found to be higher in INS as compared to controls, the differences were statistically non-significant. Genotypes GG, AG, AA and alleles A and G frequencies were comparable among MCD, FSGS and controls. SNP at −318 C/T (rs5742909) did not show homozygous TT genotype both in INS as well as controls. Median urinary sCTLA4/creatinine level was significantly higher in MCD as compared to FSGS (p = 0.027), SSNS in remission (p = 0.001) and controls (p = 0.003). The positive associations of +49 GG genotype and G allele in patients with nephrotic syndrome were not observed. The frequencies did not differ significantly among MCD, FSGS and controls. Urinary sCTLA4 level was significantly increased in MCD; suggesting its possible role in the pathogenesis of disease.

Introduction Childhood tuberculosis (TB) is now a global priority. With the advent of Xpert MTB/RIF, more TB cases in children are being reported. This study was undertaken to evaluate the performance of Xpert in diagnosis of pulmonary and extra-pulmonary TB in children. Methods Specimens from 171 suspected TB cases in children aged

Introduction: Children with idiopathic nephrotic syndrome (INS) are steroid responsive but have relapses in subsequent non-treatment period. The objective of the present study was to analyze the factors which could predict relapses in these children.Material and Methods: Forty patients of INS aged 1-14 years of both gender were enrolled over one year period and followed for six months after treatment of initial episode of Nephrotic Syndrome.Results: The median age of children was 4.5 years and male to female ratio 1.9:1. There were 24(60%) relapses and 16(40%) non-relapses. The relapses had significantly higher mean total leukocyte count, serum urea, potassium and cholesterol than non-relapses. It was also observed that the median age of onset in relapses was significantly lower than non-relapses (p

BACKGROUND Corneal infections are one of the predominant causes of ocular concern worldwide especially in agriculture based developing countries. The aim of the study is to evaluate the aetiology and risk factors associated with keratomycosis in Western Region of Uttar Pradesh. MATERIALS AND METHODS This cross-sectional study was carried among 62 clinically suspected cases of fungal keratitis from March 2014 to February 2016 in the Department of Microbiology of Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, after approval of Institutional Ethical Committee. The patients were analysed for predisposing factors and clinical characteristics. The corneal scrapings were examined by 10% KOH mount and were cultured on Sabouraud dextrose agar. The fungal aetiologies were identified by colony morphology, lactophenol cotton blue mount, slide culture and other standard tests. RESULTS Of 62 clinically suspected cases of keratomycosis, 29 (45.83%) were culture positive and 33 (53.22%) cases were positive on direct microscopy for fungal elements. The most common predisposing factor was found to be traumatic inoculation of vegetative matter to the eye (41.38%), followed by inoculation of dust among brick workers (24.13%), prolonged use of corticosteroid (13.79%), use of contact lenses (13.79%) and severe diabetes mellitus (8.89%). The commonest fungi secluded were Aspergillus species (61.5%) followed by Fusarium species n=6/29 (20.67%), Penicillium species n=4/29 (13.79%), Candida albicans n=2/29 (6.90%), Curvularia species n=2/29 (6.90%) and Mucor species n=2/29 (6.90%). CONCLUSION Incidence of keratomycosis is on higher side in this region. It should be considered while diagnosing corneal infection especially in rural area as early diagnosis can help in the management of keratomycosis and hence its complications.

Triple negative breast cancer (TNBC) is characterized by absence of estrogen and progesterone receptors (ER and PR) expression and lack of amplification of HER2 gene expression. It accounts for 15–20% of all breast cancer worldwide. The aim of the study was to determine the prevalence of TNBC patients visiting Surgery Department of Banaras Hindu University and correlate various clinico-pathological parameters vis-a-vis non-TNBC patients. TNBC accounted for 64/196 (32.6%) of all breast cancer patients. TNBC patients presented at a younger age (49 versus 55 years) compared to non-TNBC patients. TNBC patients had a higher chance of lymph node involvement (84 versus 75%), more grade III lesions (64 versus 50%), higher chance of lympho-vascular invasion (62.5 versus 45.5%) compared to non-TNBC patients. On follow-up of 36 months, the incidence of locoregional recurrence was 26.5% and distant metastasis 17.2% among TNBC patients compared to 16.6 and 12% respectively for non-TNBC patients. None of the TNBC patients developed bone metastasis which was seen in 7 of the non-TNBC patients. Stage for stage TNBC tumors had a worse histological profile and higher incidence of locoregional and distant metastases compared to non-TNBC patients. Although the prevalence of TNBC in our study was three times higher than reported worldwide yet their biological behavior is by and large similar to those reported worldwide.

To assess prevalence of behavioral problems in children with epilepsy. This was a cross-sectional study of children with epilepsy, and normal controls enrolled between July 2013 to June 2015. Child Behavior Checklist (CBCL) was used as a tool to assess the behavior based on parents reported observation. There were 60 children with epilepsy in 2-5 years and 80 in 6-14 years age groups, and 74 and 83 unaffected controls, respectively. Mean CBCL scores for most of the domains in children of both age groups were significantly higher than controls. Clinical range abnormalities were mainly detected in externalizing domain (23.3%) in 2-5 years, and in both internalizing (21.2%) and externalizing (45%) domains in children of 6-14 years. Younger age of onset, frequency of seizures and duration of disease had significant correlation with behavioral problems in both the age groups. Antiepileptic drug polytherapy was significantly associated with internalizing problems in older children. Age at onset, frequency of seizures and duration of disease were found to be significantly associated with occurrence of behavioral problems.

Urinary neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-beta-D-glucosaminidase (NAG), and interleukin 18 (IL-18) were found to be useful for early detection of acute kidney injury (AKI). The objective of this study was to determine the predictive ability of biomarkers for mortality and variation in levels in relation to different stages of AKI, need for dialysis, etiologies, and with duration of hospital stay.Urinary NGAL, NAG, and IL-18 levels were measured in 50 children with AKI and 30 age- and gender-matched healthy controls. AKI was classified as per pediatric Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria.Median NGAL, NAG, and IL-18 values were significantly increased in AKI patients compared with controls (p 0.001), with significant increase among risk, injury, and failure stages. Nonsurvivors had significantly higher median levels of NGAL (p = 0.008) and NAG (p = 0.018) than survivors. NGAL had highest area under the curve (AUC) at 0.750 [confidence interval (CI) 0.580-0.920], followed by NAG at 0.724 (CI 0.541-0.907), with sensitivity and specificity of 75 % each; and IL-18 (AUC 0.688, CI 0.511-0.864), with sensitivity 62.5 % and specificity 70.8 %, for predicting mortality. Values were significantly higher in patients who required peritoneal dialysis (PD) than in those in whom it was not indicated. Levels were comparable among different etiologies. Only NGAL level was found to be a significant risk factor associated with longer duration of hospital stay.Urinary NGAL and NAG had modest predictive ability for mortality. Children requiring dialysis had significantly raised levels, and the NGAL level had significant association with duration of hospital stay.

CONTEXT Spectrum of fungal keratitis continues to change with geographical location and season. Microbiological and epidemiological data provide guidelines to the treating physician facilitating chances of successful treatment. PURPOSE To report microbiologic and epidemiologic profile of 119 culture-positive cases of fungal keratitis treated at a tertiary centre in North India. SETTINGS AND DESIGN All cases reporting directly or referred to the OPD of Eye Department of Rohilkhand Medical College and Hospital, Bareilly, India, diagnosed and treated as fungal keratitis during a 3-year period between March 2012 and Feb 2015. METHODS Retrospective analysis of clinical and microbiological data of 119 culture-positive cases of fungal keratitis. Demographic features, risk factors, clinical course and laboratory findings were reviewed. RESULTS All patients were residents of 11 adjoining districts of Northern India. Of the 119 patients, 76 (63.8%) were males (male: female ratio 1.79:1). 81(68%) patients were in young productive age group of 20-45 years. 87 (73%) were rural based. Ocular trauma with vegetative material, especially sugarcane leaf or dust falling in eyes were the chief precipitating factors; n = 89 (74.7%). Microbiologically Fusarium was the predominant isolate, 64 cases (53.7%), followed by Aspergillus 34(28.6%) and Candida 11(9.2%). 2 cases of Alternaria and Curvularia and solitary cases of Acremonium and Scedosporium were reported. 4 strains remained unidentified. Mode of injury had a causal relation with fungal aetiology. Majority of Fusarium infections were caused by vegetative injuries 39(61%). Of these, 15(23.4%) were attributed to sugarcane leaves. Soil/dust fall in eye or Surma application were responsible for bulk of Aspergillus infections; 21(61.7%). Candida infections were sporadic with a higher presenting age (Mean av 51.2 years) and a frequent association with topical steroid usage, (8 of 11 cases). Aspergillus infections were predominant in the hot and humid months of June to September; 25 of 34 cases (73.5%). Fusarium infectivity remained largely constant over the year with bimodal spurt during harvesting seasons. A wet KOH mount was effective for early diagnosis with a sensitivity of 89%. CONCLUSION Microbiological data of reviewed cases reveal a high preponderance of filamentous fungi as the aetiological agent, with Fusarium and Aspergillus species alone accounting for 82% of infective pathology in this rural belt of North India.

BACKGROUND Urinary tract infection (UTI) is a common infection in pregnant women. It is responsible for range of complications causing perinatal and maternal morbidity and mortality. AIM To assess the associated risk factors, aetiology and their antibiogram of UTI among pregnant women. METHODOLOGY This is a cross-sectional study carried out in Department of Microbiology & Department of Obstetrics from March 2015 to February 2016. The patient details and risk factors were recorded. Midstream & catheter urine specimens from pregnant women with symptoms of UTI were collected and sent for routine microscopy, culture and sensitivity. RESULTS In 550 pregnant women, 122(22.18%) had significant bacteriuria and 72(17.72%) had low colony count UTI. The most affected number age group was 25-35 years (58.85%) followed by 15-25 years. Of the associated risk factors, multiparity 45.31%, low socioeconomic status 42.18%, anaemia 39.06% etc. were important. Escherichia coli was most frequently isolated with a percentage of 29.14%, followed by Klebsiella species (17.49%), S. aureus (14.34%) etc. Other isolated micro-organisms included Enterococci, Proteus mirabilis, Citrobacter, Pseudomonas, Acinetobacter species. The antibiotics with more than 50% sensitivity against Gram-negative isolates were Imipenem (74.7%), Levofloxacin (73.17%), Ciprofloxacin (69.10%), Amikacin (57.72%), Amoxiclav (55.28%), and Cefoperazone/Sulbactam (50.40%). The antibiotics for Gram-positive isolates were Linezolid (88.46%), Cefoxitin (78.84%), Teicoplanin (69.23%) and Vancomycin (65.22%). CONCLUSION We found associated risk factors such as multiparity, low socioeconomic status, etc. E. coli was the most common bacteria isolated in our setting. Therefore, pregnant women should be assessed for associated risk factors and evaluated for the pathogenic organism during their regular follow-up. The drug sensitivity should be taken into consideration with their side effects related to pregnancy.

Post operative pain management is the key factor to decide the outcome of the patient. TAP block is relatively newer method for management of postoperative pain after abdominal surgery. Technique involves the injection of local anesthesia into the plane between the internal oblique and transversus abdominis muscle and thus giving pain relief. The technique when performed under ultrasound guidance improves the yield. TAP block provides good analgesia between T10 and L1 level hence very useful for lower abdominal and gynecological procedures. This significantly reduces the analgesic requirement in postoperative period and hence reduces the side effects of analgesics.

Introduction: Malnutrition is a common problem in developing countries and often associated with co-morbidities. The present study was undertaken with objectives of to find out the comorbidities in children with severe acute malnutrition (SAM).Materials and Methods: This was a hospital based study carried in 77 children with SAM, diagnosed on the basis of WHO criteria.Results: The age group of children was 1- 5 years (median age 23 months) with about 39% between 1- 2 years. There were 38 males (49.3%). Low maternal education (60%), overcrowding (60%), lower- middle socioeconomic status (87%) were some of the predisposing factors observed. Pneumonia (51%), acute gastroenteritis (21%) and bacterial meningitis (8%) were common co- morbidities found. Associated abnormal laboratory parameters found were anemia (60%), leucocytosis (38%), hyboalbuminemia (36%) hyponetremia (31%), and hypokalemia (17%).Conclusion: Presence of infections and biochemical abnormalities require urgent attention in SAM cases and appropriate treatment in a hospital setting to improve their survival.J Nepal Paediatr Soc 2015;35(2):99-102

Background : Cholelithiasis is one of the most common problems encountered in surgery department. Symptoms may be acute or chronic. Chronic symptoms are usually dyspeptic. Dyspeptic symptoms are also present in other upper (Gastro intestinal) GI pathologies. UGIE is investigation of choice for definitive diagnosis of upper GI pathologies. Upper GI endoscopy and endoscopist still are not easily available in rural or small towns, CHC or district hospital in India. So it is not easy to perform routine upper GI endoscopy in all patients of cholelithiasis with dyspepsia in these set ups. Endoscopy also gives economic burden to the poor patients. So our study questioned is it really necessary to perform upper GI endoscopy in all patients of cholelithiasis presenting with dyspepsia and to identify the various common UGI pathologies seen on UGIE in all cholelithiasis patients with dyspepsia in rural population. Methods: Present study was carried out in department of surgery in UP Rural Institute of Medical Science and Research, Saifai, Etawah (U.P.) during January 2014 to august 2015. 100 patients admitted under IPD were taken for the study, considering the exclusion and inclusion criteria. Results: In our study, it was found that, dyspepsia with gall-stones was commonly seen in females in 30-60 year age group in rural patients. Patients presenting with dyspepsia and gall-stones in rural setup should be directly treated surgically. As in our study at three month postoperatively 99% showed no any type of dyspeptic symptom. Conclusions: Routine pre-operative upper GI endoscopy could not be recommended in all (for our study population as well) patients with gall-stone disease who present with dyspepsia as at the end of 3 months postoperatively 99% patients were symptom free in our study. If symptoms persists even after surgery now patient can be considered for upper G.I. endoscopy to rule out other causes of dyspepsia.

Background: Birth asphyxia is the third leading cause of neonatal deaths in developing countries. The present study was an attempt to find out the various risk factors associated with mortality in these cases. Methods: This was a retrospective hospital based analysis of data in neonates with birth asphyxia admitted during the period February 2010 to January 2011. The demographic profile and outcome were recorded. Results: Of 285 neonates, there were 212 (74.4%) outborn and 73 (25.6%) cases were inborn. Male were 207 (72.6%) and female were 78 (27.4%). One hundred eighty eight (66%) came from rural area. Two hundred sixty six (93.3%) were full term and 19 (6.7%) were preterm. Thirty two (11.2%) were delivered at home and 253 (88.8%) were institutional delivery among which 54 (18.9%) babies were born by caesarean section while 215 (75.4%) were by normal vaginal delivery and 16 (5.6%).were instrumental delivery. Thirty eight (13.3%) were found to be normal while clinical signs of HIE were present in 247(86.7%) babies, out of those 48 (16.8%) babies were in stage I, 136 (47.7%) in Stage II and 63 (22.1%) in stage III of HIE. Fifty nine (20.7%) babies died during the hospital stay. The babies who were born at home (p=0.028, OR=2.472, 95% CI 1.104-5.536), prematurity (p=0.024, OR=3.154, 95% CI 1.166-8.528) and shock at the time of admission (p=0.035, OR=2.261, 95% CI 1.061-4.821) had higher risk of mortality. Conclusions: Thus unsupervised delivery at home, prematurity and presence of shock at admission affected the outcome in these babies. Therefore, institutional delivery with facility to care preterm baby and immediate treatment of complications are needed for better survival .

Spectrum of renal disease varies in different ethnic population, geographical location, and by environmental factors. The purpose of this study was to find out the clinical spectrum and occurrence of different pediatric renal diseases at a teaching hospital in the Eastern part of Nepal. All cases of renal diseases from one month to 15 years of age, attending the pediatric renal outpatient department and/or were admitted to the wards during the period of February 2012 to January 2013, were included in the study. Detailed clinical and laboratory evaluations were performed on all patients. Diseases were categorized as per standard definitions and managed with hospital protocols. Renal diseases accounted to be 206 cases (6.9%) of total annual pediatric admissions, of which (58%) were male and (42%) female. Acute glomerulonephritis (AGN) was the most common disorder (37.7%) followed by nephrotic syndrome (26.1%), urinary tract infection (21.3%), acute kidney injury (AKI) (17.9%), obstructive uropathy (1.9%), chronic kidney disease (CKD) (1.2%), and others. In AGN group, the most common cause was post-infectious glomerulonephritis (PIGN) (32.9%) followed by lupus nephritis (4%) and Henoch-Schonlein purpura nephritis (0.8%). Urine culture was positive in (9.22%) and the most common organism was Escherichia coli (57.9%). The causes of AKI were urosepsis, septicemia, and AGN (18.9%) each, followed by dehydration (13.5%). Mortality was found in 5% of cases and the etiologies were AKI in (72.7%), PIGN (18.1%), and CKD (9%). Renal diseases are a significant problem among children and are one of the common causes of hospital admission. These patients need comprehensive services for early identification and management.

Background: Infections pertaining to mankind particularly those affecting the periodontal tissues are of serious concerns worldwide and are increasing on a global scale particularly in the tropical and subtropical countries like India. The clinical presentation, though very typical of periodontal infection, is often confused with other oral infection, making laboratory diagnosis and confirmation necessary. The management of periodontal infections needs personal hygiene, awareness of infection, proper diagnosis and medication. The present study was undertaken to demonstrate the oral spirochete (Treponema denticola) from periodontal pathogens suffering from periodontal disease.Methods: A total of 55 clinically diagnosed selected patients of periodontal infection attending the outpatient Department of Periodontics, V. K. Institute of Dental Science, KLE University, Belgaum were studied. Dental plaque was taken as specimens from the patients were processed by modified Fontana staining and observed in microscope. Results: A total number of 55 plaque samples were stained by modified Fontana staining technique. 30 cases were positive and 25 cases were negative. Males were affected more as compared to the females and the age group ranging from 15 to 65. Farmers were more affected compared to other occupation.Conclusions: Microscopic method by modified silver nitrate staining can be a very useful screening method for evaluation of oral spirochetes in a clinical setting if used judiciously keeping in mind the variables that can affect the results.

Type I diabetes, though contributes to only 5–10% of total diabetes cases, is a rising concern in today’s world. Our previous studies have shown that the absence of WDR13 in mouse results in pancreatic β-cell hyper-proliferation. Also, amelioration of the diabetic phenotype on introgression of Wdr13-null (Wdr13-/0) mutation in genetically diabetic mice (Leprdb/db) [type II diabetes] was observed. It was thus, interesting to see the role of WDR13 in streptozotocin-mediated diabetes in mice, a model for type I diabetes. Wdr13-/0 mice along with its wild type (Wdr13+/0 mice) littermates were administered streptozotocin intraperitoneally for 5 consecutive days. Blood glucose levels and body weights of these mice were monitored for subsequent 5 weeks and then they were sacrificed for physiological and histological analyses. Results showed that Wdr13-/0 mice exhibited higher serum insulin levels, better glucose clearance and significantly higher number of proliferating β-cells; reiterating the finding that absence of WDR13 helps in β-cell hyper-proliferation and recovery from diabetes; further underscoring WDR13 as a key target molecule for diabetes treatment/amelioration.

Background: Objectives of the study were to find out the ability of urinary neutrophil gelatinase- associated lipocalin (NGAL) as a biomarker to differentiate between steroid resistant nephrotic syndrome (SRNS) and steroid sensitive nephrotic syndrome (SSNS), and also to observe variation in levels, if any, between focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) in SRNS patients.Methods: The study included 63 patients of idiopathic nephrotic syndrome (19 SSNS in relapse, 19 SSNS in remission and 25 SRNS), aged 2.5-16 years, along with 17 controls. Urinary NGAL was measured by ELISA and the values were normalised with urinary creatinine.Results: Median urinary NGAL/creatinine level was significantly raised in SRNS as compared to SSNS relapse, SSNS remission and controls (p 18.3 ng/mg had sensitivity of 84%, specificity of 97.4% and area under the curve of 0.935 (p< 0.001, 95% confidence interval 0.871-0.998) to differentiate SRNS from SSNS patients. Median urinary NGAL/creatinine value was significantly raised in children with FSGS as compared to MCD (p=0.003) in SRNS patients. It had significant positive correlations with duration of illness (r=0.342, p=0.006), urine protein creatinine ratio (r=0.594, p< 0.001) and negative correlation with serum albumin (r=0.470, p

The exact etiopathogenesis of febrile seizures (FS) is unknown. The present study was conducted to evaluate the cerebrospinal fluid (CSF) zinc (Zn), magnesium (Mg), copper (Cu) and gamma-aminobutyric acid (GABA) levels in children with FS. The study subjects included 20 cases of FS, 26 patients of encephalitis and 22 children of fever with meningismus. The Zn, Mg and Cu levels in CSF and serum were analyzed by atomic absorption spectrophotometry and GABA was estimated by paper chromatography method. The mean CSF Zn, Mg and Cu values were significantly decreased in FS in comparison to encephalitis and fever with meningismus cases ( P P P 37.9°C) had significantly decreased levels of CSF ( P P

Background Acute kidney injury (AKI) in P. falciparum malaria infection is an important morbidity in children. The purpose of the present study was done to observe the renal involvement, associated morbidities and outcome. Methods Out of 156 patients with severe P. falciparum malaria, diagnosed on the basis of compatible clinical presentations and positive malarial parasites in the peripheral blood smear and/or histidine rich protein 2 antigen, 31 had AKI at presentation and were analyzed. Results Of 31 (19.9%) patients with AKI, 4 were classified at risk, 11 injury, and 16 failure stage, as per pRIFLE criteria (pediatric version of RIFLE [R = risk, I = injury, F = failure, L = loss E = end-stage kidney disease]). Mean age of children with AKI was 7.7 ± 3.2 years. A significantly higher proportion of patients with AKI had hypoglycemia (41.9%), pulmonary edema (32.2%), and disseminated intravascular coagulation (DIC) (29.0%) compared to those without AKI (18.4%, 4.8%, and 3.2%, respectively). Twelve patients (38.7%) required peritoneal dialysis (PD), 8 (25.8%) died, and all were in failure stage. The non-survivors had significantly higher blood urea ( p = 0.005) and serum creatinine levels ( p = 0.042), lower glomerular filtration rate ( p < 0.001), longer duration of illness ( p = 0.003), and oliguria/anuria ( p = 0.001) than survivors at admission. On logistic regression analysis, the disseminated intravascular coagulation (DIC), jaundice and parasite density (≥ 3+) were found to be significant factors contributing to mortality in children with AKI. Conclusions Acute kidney injury in falciparum malaria is one of the severe systemic complications. Duration of illness and presence of comorbidities adversely affected the outcome.

Aims: To study the diagnoses and survival of neonates receiving mechanical ventilation. Study Design: Prospective observational study.

Background Bacterial vaginosis (BV) is highly prevalent among women especially in reproductive age group but it is found also in other age groups. Bacterial vaginosis is a great health concern in India because of its complications. Most of the healthcare centers in India are not well-versed in advance diagnostics for BV. Aim To assess the utility of conventional methods for diagnostic evaluation of BV in the patients of different age groups. Materials and methods In this 1 year cross-sectional study, the vaginal swabs were collected from women with signs and symptoms of BV like complaints of vaginal discharge, odor, itching, back ache, etc. attending the department of obstetrics and gynecology of a tertiary care hospital in Western UP. These specimens are subjected to vaginal pH determination and are sent to department of microbiology for Gram stain, wet-mount and whiff test. Amsel's criteria were used for confirming BV. Results A total of 206 women included in the study, n = 63 (29.61%) were found to be having BV based on Amsel's criteria. The mean age of the females were found to be 30.77 years. The most affected age group was found to be 26 to 35 years, n = 33 (54%). The vaginal pH was significantly higher in n = 61 (29.61%) women with BV. Vaginal discharge was prevalent in n = 108 (52.43%) women. Presence of clue cells and positive whiff test were found to be in n = 63 (30.58%) and n = 61(29.61%). Conclusion The characteristics of vaginal discharge, vaginal pH determination, clue cells and whiff test is relatively easier conventional methods for diagnosis of women with BV where better facilities are lacking. These tests are suitable for screening women with BV and in formulating the treatment to check the complications. How to cite this article Mishra PP, Prakash V, Agrawal L, Premi HK. Diagnosis of Bacterial Vaginosis by Conventional Methods in the Patients at a Tertiary Care Hospital. Int J Adv Integ Med Sci 2016;1(1):1-3.