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Heart failure secondary to isolated pulmonary artery vasculitis is rarely described in children. We describe a 10-year-old child who presented with right heart failure symptoms, severe pulmonary hypertension, and bilateral branch pulmonary artery stenosis secondary to isolated pulmonary artery vasculitis. (Level of Difficulty: Advanced.), Central Illustration

Purpose of review Cognitive behavioral therapy (CBT) with exposure and response prevention is the first-line treatment for obsessive-compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD). We review here recent developments in CBT and related therapies in treating OCD and related disorders. Recent findings Superiority of CBT over medications in treating OCD is being questioned by some recent meta-analyses, nonetheless CBT continues to be the mainstay of treatment. Web-based therapies have been shown to be beneficial in treating at least mild-to-moderately ill patients. Mindfulness-based CBT, intensive residential treatment and Bergen 4-day concentrated exposure are also proving to be useful in treating OCD. Large well designed studies have demonstrated the efficacy CBT over supportive therapy in treating BDD. Research on the efficacy of CBT in treating hoarding disorder is accumulating. Summary Efficacy of web-based CBT has a potential public health importance in that CBT may now become accessible to all and benefit at least mild-to-moderately ill patients who form most of the clinically ill sample. Similarly, efficacy of Bergen 4-day concentrated exposure will have a huge public health implication if the findings can be replicated in other centers across the world.

Context: IUGR is one of the most common pregnancy complications which substantially increase risk of adverse neonatal outcome. The sequelae of IUGR include stillbirth, neuro-developmental delay in childhood and high risk of diseases like hypertension, diabetes in adulthood. Therefore, IUGR in pregnancy warrants intensive antepartum fetal surveillance to ensure optimal perinatal outcome. Aims: To evaluate the tests of antepartum fetal surveillance like AFI, BPS and Doppler ultrasound, alone and in combination for predicting adverse perinatal outcome in pregnancy with IUGR. Materials and Methods: This was a prospective observational study done on 100 pregnant IUGR women > 34weeks of gestation, at a tertiary care centre in Karnataka, from June 2017 till December 2018. They were monitored by tests of fetal surveillance like Amniotic Fluid Index (AFI), Bio Physical score (BPS) and Doppler ultrasound. Tests done within 48 hours before labour and its relation to perinatal outcome were assessed. Continuous data such as age, height, weight were described by mean and standard deviation. The sensitivity specificity, positive and negative predictive value were calculated for each test. Results: The statistical difference between the normal and abnormal tests of antepartum fetal surveillance in relation to perinatal outcome was significant. Diagnostic accuracy of Doppler was 67%, BPS and AFI was 69%. In case of combination of findings of BPS and Doppler, the accuracy rose to 75%. Conclusions: Biophysical profile was most reliable diagnostic method than Doppler in predicting adverse outcome. Sensitivity increased when BPS and Doppler was combined which is beneficial in predicting perinatal outcome. Keywords: Antepartum fetal surveillance, Doppler, Biophysical score, Amniotic fluid index, Perinatal outcome, IUGR

Introduction Intramuscular paromomycin monotherapy to treat visceral leishmaniasis (VL) has been shown to be effective for Indian patients, while a similar regimen resulted in lower efficacy in Eastern Africa, which could be related to differences in paromomycin pharmacokinetics. Methods Pharmacokinetic data were available from two randomized controlled trials in VL patients from Eastern Africa and India. African patients received intramuscular paromomycin monotherapy (20 mg/kg for 21 days) or combination therapy (15 mg/kg for 17 days) with sodium stibogluconate. Indian patients received paromomycin monotherapy (15 mg/kg for 21 days). A population pharmacokinetic model was developed for paromomycin in Eastern African and Indian VL patients. Results Seventy-four African patients (388 observations) and 528 Indian patients (1321 observations) were included in this pharmacokinetic analysis. A one-compartment model with first-order kinetics of absorption and elimination best described paromomycin in plasma. Bioavailability (relative standard error) was 1.17 (5.18%) times higher in Kenyan and Sudanese patients, and 2.46 (24.5%) times higher in Ethiopian patients, compared with Indian patients. Ethiopian patients had an approximately fourfold slower absorption rate constant of 0.446 h–1 (18.2%). Area under the plasma concentration-time curve for 24 h at steady-state (AUCτ,SS) for 15 mg/kg/day (median [interquartile range]) was higher in Kenya and Sudan (172.7 µg·h/mL [145.9–214.3]) and Ethiopia (230.1 µg·h/mL [146.3–591.2]) compared with India (97.26 µg·h/mL [80.83–123.4]). Conclusion The developed model provides detailed insight into the pharmacokinetic differences among Eastern African countries and India, however the resulting differences in paromomycin exposure do not seem to explain the geographical differences in paromomycin efficacy in the treatment of VL patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-021-01036-8.

While medicating cats, veterinarians have to very cautious else they can face serious adverse effects. Cats are different from other animals with respect to metabolism. Various drugs like antibiotics, Non-steroidal anti-inflammatory drugs (NSAIDs), anti-parasitic etc. are causing adverse effects in cats. The prescribed drugs may cause acute poisoning even at therapeutic doses. This review aims at providing information to clinical veterinarian, pet owner to be cautious while administering of drugs in cats. The adverse effects of contraindicated drugs are summarised here for accurate use of drugs and to avoid acute poisoning leading to death.cat, toxicity, glucuronidation

Introduction: The objective of this study was to determine the etiology of acute undifferentiated fevers (AUF) in hospitalised children with in a tertiary care centre in North India. The various causes of acute undifferentiated fevers included dengue, malaria, scrub typhus, enteric fever, leptospirosis and Chikungunya. The clinical spectrum and therapeutic outcome of these cases was also studied. Methods: This retrospective study was conducted over a period of 6 months from June 2019 to December 2019. The clinical information of 126 children who tested positive for any of the causes of AUF namely dengue, malaria, scrub typhus, enteric fever, chikungunya and leptospirosis was obtained from the Paediatrics Department. The information was recorded in a predesigned proforma. Various tests performed for the diagnosis of these illnesses were noted. They included dengue NS1 antigen ELISA and IgM ELISA, peripheral blood smear (PBS) for malarial parasite and rapid malarial antigen detection test (RMAT), scrub typhus IgM ELISA, leptospira IgM ELISA, and Chikungunya IgM ELISA. Results: The diagnosis of AUF were dengue (55.5%; 70/126), malaria (19%; 24/126) and scrub typhus (19%; 24/126), enteric fever (4.7%;6/126) and Chikungunya (1.5%; 2/126). The most common presenting symptom was fever or pyrexia followed by myalgia, generalised aches and pains in the body and vomiting. Commonly observed complications included thrombocytopenia, hepatitis and shock. Conclusions: Dengue, malaria and scrub typhus are the major causes of AUF in the hospitalised children with dengue being the most prevalent infection. The study further emphasises the need to develop a systematic approach to the diagnosis of AUFs. This should be using a combination of clinical, epidemiological and laboratory parameters, which will be very useful for developing a relevant action plan for treatment and prevention of such fevers in any hospital setup.

Human papilloma virus (HPV) is capable of causing varieties of dermatological conditions differing in morphology, histopathology and site of occurrence. Plane wart is one of the morphological varients accounting for approximately one fifth of HPV lesions. Treatment of plane warts is difficult and recurrence quite common .The objective of our study is to compare the efficacy and safety of 5% 5 –fluorouracil (5 FU),0.5% tretinoin and electrosurgery in the treatment of plane wart. Seventy five patients 38 males and 37 females were included in this randomized controlled comparative trial .Patients were age and sex matched and divided into three groups, GROUP A : Patients treated with 5% 5-Fluorouracil ,GROUP B:Patients treated with 0.5% tretinoin and GROUP C : Patients treated with electrodessication .While topical treatments were applied once nightly for 4 weeks(5% 5-fluorouracil for four hours and tretinoin overnight), radiodessication was done at first visit only.Result and conclusion:While radiofrequency showed faster results , results were more consistent with least recurrence in 5-FU and fair recurrence with .05% tretinoin.

Objectives: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. Methods: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. Results: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. Conclusion: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.

INTRODUCTION: Latarjet procedure is commonly performed for recurrent anterior shoulder instability with glenoid side bone loss. Classic Latarjet procedure can be performed using specially designed drill guides, jigs, or by freehand technique. Here we have described a technical note on classic Latarjet procedure performed with freehand technique utilizing simple rulers and caliper. The functional and radiological outcomes of our patients have also been analysed. MATERIAL AND METHODS: 149 open classic Latarjet procedures were performed using our technique between March 2015 and July 2018. The mean age of the patients was 32.95 years (Range 22–59 years). The functional outcome of the patients was measured using Western Ontario Shoulder Instability (WOSI) and Oxford Shoulder Instability Score (OSIS) at 2 years of follow-up. Screw and graft positioning were studied in 24 consecutive patients with a postoperative computed tomography (CT) scan. RESULTS: There was no incidence of recurrent subluxation or dislocation post-surgery. Mean OSIS score increased from 15.63 ± 3.20 preoperatively to 42.44 ± 3.88 postoperatively (p value

Objectives To evaluate the efficacy of lumbo-peritoneal shunt (LPS) in patients of idiopathic intracranial hypertension presenting with visual symptoms. Methods Between Apr. 2014 and Mar. 2018, 70 patients of Idiopathic Intracranial Hypertension (IIH) underwent treatment at our institution. Patients were evaluated for neurological and ophthalmological status and were subjected to LPS depending on their symptoms. Results Mean opening pressure was 29.97 ± 5.33 cm of water and mean Body-Mass Index (BMI) was 26.51 ± 3 and the two were significantly correlated (p-value 0.006). All patients with visual symptoms (23) underwent LPS and others (47) were managed medically. All patients with LPS and 25 of medically managed patients improved, while 22 medically-managed patients required LPS due to deterioration in visual symptomatology. The proportion of patients showing complete resolution of features of IIH was significantly different between the three groups. Of the 7 patients with shunt extrusion/migration, only 2 required revision. Conclusion LPS is an equally effective and more technically familiar modality for treatment of IIH for neurosurgeons and should be offered to asymptomatic patients with objective visual signs. Shunt extrusion/migration may not always warrant revision due to “mini-shunt” that drains Cerebro-Spinal Fluid (CSF) through shunt tract even after extrusion.

Central infusion of Ang II (angiotensin II) has been associated with increased sympathetic outflow resulting in neurogenic hypertension. In the present study, we appraised whether the chronic increase in central Ang II activates the paraventricular nucleus of the hypothalamus (PVN) resulting in elevated sympathetic tone and altered baro- and chemoreflexes. Further, we evaluated the contribution of HIF-1α (hypoxia-inducible factor-1α), a transcription factor involved in enhancing the expression of N-methyl-D-aspartate receptors and thus glutamatergic-mediated sympathetic tone from the PVN. Ang II infusion (20 ng/minute, intracerebroventricular, 14 days) increased mean arterial pressure (126±9 versus 84±4 mm Hg), cardiac sympathetic tone (96±7 versus 75±6 bpm), and decreased cardiac parasympathetic tone (16±2 versus 36±3 versus bpm) compared with saline-infused controls in conscious rats. The Ang II-infused group also showed an impaired baroreflex control of heart rate (−1.50±0.1 versus −2.50±0.3 bpm/mm Hg), potentiation of the chemoreflex pressor response (53±7 versus 30±7 mm Hg) and increased number of FosB-labeled cells (53±3 versus 19±4) in the PVN. Concomitant with the activation of the PVN, there was an increased expression of HIF-1α and N-Methyl-D-Aspartate-type1 receptors in the PVN. Further, Ang II-infusion showed increased renal sympathetic nerve activity (20.5±2.3% versus 6.4±1.9% of Max) and 3-fold enhanced renal sympathetic nerve activity responses to microinjection of N-methyl-D-aspartate (200 pmol) into the PVN of anesthetized rats. Further, silencing of HIF-1α in NG108 cells abrogated the expression of N-methyl-D-aspartate-N-methyl-D-aspartate-type1 induced by Ang II. Taken together, our studies suggest a novel Ang II-HIF-1α-N-methyl-D-aspartate receptor-mediated activation of preautonomic neurons in the PVN, resulting in increased sympathetic outflow and alterations in baro- and chemoreflexes.

Introduction: Ki-67 is a nuclear protein. It is a proliferation marker that has an essential function in tumorigenesis due to its positive connection with tumor expansion. Aim: The aim of this study was to evaluate the articulation of Ki‑67 as prognostic marker in various grades of oral epithelial dysplasia (OED) and in oral squamous cell carcinoma (OSCC). Materials and Methods: A total of 100 histologically affirmed samples of normal oral mucosa (NOM), OED, and OSCC were divided into three groups—Group I (10 samples of normal oral mucosa), Group II (45 samples of OED), Group III (45 samples of OSCC). Routine hematoxylin and eosin and immunohistochemical staining with Ki-67 monoclonal antibody were carried out in all the samples. Results: Within Group I, articulation of Ki-67 was constrained to the basal layers. In Group II, cells showing positive expression of Ki-67 were available in the basal, suprabasal, and spinous layers. Cells showing positive expression of Ki-67 among well-differentiated OSCC were presented mainly in the periphery of the tumor nests; in moderately differentiated OSCC, cells were located in both peripheral and part of a center of the tumor nests; and in most cases of poorly differentiated OSCC, cells were diffused. Statistically significant difference in positive expression of Ki-67 was appreciated between three groups. Conclusion: Ki-67 antigen may perhaps be used as a marker for the histological reviewing of OED and OSCC. With the increase in the severity of OED, cells showing positive expression of Ki-67 also increased.

BACKGROUND In this study, we determined the safety, tolerability, efficacy and compliance of ‘Positeve’ melt-in-mouth tablets, an oral iron preparation along with micronutrients crucial for healthy blood cells and women’s health. The tablets were administered to young girls and non-pregnant women as part of daily dietary supplementation in maintaining an anaemia free status as determined by measuring the haemoglobin status pre- and post-intervention. METHODS A prospective study was conducted (July 2019 - November 2019) at Divakars Speciality Hospital, Bengaluru, India. One hundred and seven subjects were enrolled as per the inclusion criteria. Baseline Hb levels were measured and additional measurements were recorded at the completion of the study period i.e. 6 weeks. A daily dose of melt-in-mouth tablets delivering 11.5 mg of elemental iron and 100 mcg of folic acid (along with other micronutrients) was administered to the study participants, once daily, after meals, for a period of 6 weeks. RESULTS Of the 107 enrolled, 7 dropped out and were not available for follow up. Of the 100 study subjects, 58 women took Positeve melted mouth tablets regularly; 42 women were noted to be partially compliant. In 59 subjects, there was a haemoglobin raise of 0.1 g/dL - 0.6 g/dL. By applying students paired t test we could see that the difference was found to be statistically significant. In 32 subjects, there was a drop of 0.1 g/dL - 0.7 g/dL. In 4 subjects, it did not make any difference in their Hb level. No major side effects or anaphylactic reactions were noted during study period. CONCLUSIONS The findings of the study suggest that Positeve melt-in-mouths by Hlthistyl is safe and well tolerated and helps in maintaining iron sufficiency among young girls and non-pregnant women. The elemental iron formulated along with crucial micronutrients is suggested to be effective in the supplementary treatment of IDA among the young girls and non-pregnant women. Compliance is found to be better with minimal adverse effects.

Obsessive-compulsive disorder (OCD) is a common mental illness that has a lifetime prevalence of 2–3% and often runs a chronic course with waxing and waning of symptoms [1]. OCD is associated with ...

Background: Recent clinical studies demonstrate that SGLT2 (sodium-glucose cotransporter 2) inhibitors ameliorate heart failure (HF). The present study was conducted to assess the expression and function of renal SGLT2 and the influence of enhanced renal sympathetic tone in HF. Methods: Four weeks after coronary artery ligation surgery to induce HF, surgical bilateral renal denervation (RDN) was performed in rats. Four groups of rats (Sham-operated control [Sham], Sham+RDN, HF and HF+RDN; n=6/group) were used. Immunohistochemistry and Western blot analysis were performed to evaluate the renal SGLT2 expression. One week after RDN (5 weeks after induction of HF), intravenous injection of SGLT2 inhibitor dapagliflozin were performed to assess renal excretory responses. In vitro, human embryonic kidney cells were used to investigate the fractionation of SGLT2 after norepinephrine treatment. Results: In rats with HF, (1) SGLT2 expression in the proximal tubule of the kidney was increased; (2) the response of increases in urine flow, sodium excretion, and glucose excretion to dapagliflozin were greater; and (3) RDN attenuated renal SGLT2 expression and normalized renal functional responses to dapagliflozin. In vitro, norepinephrine promoted translocation of SGLT2 to the cell membrane. Conclusions: These results indicate that the enhanced tonic renal sympathetic nerve activation in HF increases the expression and functional activity of renal SGLT2. Potentiated trafficking of SGLT2 to cell surface in renal proximal tubules mediated by norepinephrine may contribute to this functional activation of SGLT2 in HF. These findings provide critical insight into the underlying mechanisms for the beneficial effects of SGLT2 inhibitors on HF reported in the clinical studies.

Cerebrospinal fluid (CSF) is a symmetric flow transport that surrounds brain and central nervous system (CNS). Congenital hydrocephalusis is an asymmetric and unusual cerebrospinal fluid flow during fetal development. This dumping impact enhances the elasticity over the ventricle wall. Henceforth, compression change influences the force of brain tissues. This paper presents a mathematical model to establish the effects of ventricular elasticity through a porous channel. The current model is good enough for immediate use by a neurosurgeon. The mathematical model is likely to be a powerful tool for the better treatment of hydrocephalus and other brain biomechanics. The non-linear dimensionless governing equations are solved using a perturbation technique, and the outcome is portrayed graphically with the aid of MATLAB.

Aims: Hypertension increases the risk of heart disease. Hallmark features of hypertensive heart disease is sympathoexcitation and cardiac mitochondrial abnormality. However, the molecular mechanisms for specifically neurally mediated mitochondrial abnormality and subsequent cardiac dysfunction are unclear. We hypothesized that enhanced sympatho-excitation to the heart elicits cardiac miR-18a-5p/HIF-1α and mitochondrial unfolded protein response (UPRmt) signaling that lead to mitochondrial abnormalities and consequent pathological cardiac remodeling.Methods and Results: Using a model of neurogenic hypertension (NG-HTN), induced by intracerebroventricular (ICV) infusion of Ang II (NG-HTN; 20 ng/min, 14 days, 0.5 μl/h, or Saline; Control, 0.9%) through osmotic mini-pumps in Sprague-Dawley rats (250–300 g), we attempted to identify a link between sympathoexcitation (norepinephrine; NE), miRNA and HIF-1α signaling and UPRmt to produce mitochondrial abnormalities resulting in cardiomyopathy. Cardiac remodeling, mitochondrial abnormality, and miRNA/HIF-1α signaling were assessed using histology, immunocytochemistry, electron microscopy, Western blotting or RT-qPCR. NG-HTN demonstrated increased sympatho-excitation with concomitant reduction in UPRmt, miRNA-18a-5p and increased level of HIF-1α in the heart. Our in silico analysis indicated that miR-18a-5p targets HIF-1α. Direct effects of NE on miRNA/HIF-1α signaling and mitochondrial abnormality examined using H9c2 rat cardiomyocytes showed NE reduces miR-18a-5p but increases HIF-1α. Electron microscopy revealed cardiac mitochondrial abnormality in NG-HTN, linked with hypertrophic cardiomyopathy and fibrosis. Mitochondrial unfolded protein response was decreased in NG-HTN indicating mitochondrial proteinopathy and proteotoxic stress, associated with increased mito-ROS and decreased mitochondrial membrane potential (ΔΨm), and oxidative phosphorylation. Further, there was reduced cardiac mitochondrial biogenesis and fusion, but increased mitochondrial fission, coupled with mitochondrial impaired TIM-TOM transport and UPRmt. Direct effects of NE on H9c2 rat cardiomyocytes also showed cardiomyocyte hypertrophy, increased mitochondrial ROS generation, and UPRmt corroborating the in vivo data.Conclusion: In conclusion, enhanced sympatho-excitation suppress miR-18a-5p/HIF-1α signaling and increased mitochondrial stress proteotoxicity, decreased UPRmt leading to decreased mitochondrial dynamics/OXPHOS/ΔΨm and ROS generation. Taken together, these results suggest that ROS induced mitochondrial transition pore opening activates pro-hypertrophy/fibrosis/inflammatory factors that induce pathological cardiac hypertrophy and fibrosis commonly observed in NG-HTN.

BackgroundStimulation of non-crying neonates after birth can help transition to spontaneous breathing. In this study, we aim to assess the impact of intact versus clamped umbilical cord on spontaneous breathing after stimulation of non-crying neonates.MethodsThis is an observational study among non-crying neonates (n=3073) born in hospitals of Nepal. Non-crying neonates born vaginally at gestational age ≥34 weeks were observed for their response to stimulation with the cord intact or clamped. Obstetric characteristics of the neonates were analysed. Association of spontaneous breathing with cord management was assessed using logistic regression.ResultsAmong non-crying neonates, 2563 received stimulation. Of these, a higher proportion of the neonates were breathing in the group with cord intact as compared with the group cord clamped (81.1% vs 68.9%, pConclusionsStimulation of non-crying neonates with intact cord was associated with more spontaneous breathing than among infants who were stimulated with cord clamped. Intact cord stimulation may help establish spontaneous breathing in apnoeic neonates, but residual confounding variables may be contributing to the findings. This study provides evidence for further controlled research to evaluate the effect of initial steps of resuscitation with cord intact.

Ayurveda is the age-old science of healing which encompasses the scriptures of Acharyas like Charaka, Sushruta, and Vagbhata etc. What differentiates Ayurveda from other Pathy is its supreme objective that is to help maintain the health of healthy individual and cure of diseases of a patient. Shotha (edema) is dealt in Ayurveda by different names such as Shotha, Shopha, Shvayathu, Utsheda, samhata etc. In Charaka Samhita, Chikitsa sthana chapter- 12 Shvayathu chikitsa, Acharya Agnivesh questioned the great sage- Lord Atreya about the etiology, sign and symptoms and treatment of Shvayathu roga regarding which the Lord Atreya explained in detail about the disease. Although, Shotha has been documented in Charaka Samhita, Sushruta Samhita, Ashtanga sangraha but the profound essence of pathogenesis is found in Madhava nidana (700 AD) which is influenced by the Brihat trayees. In clinical practice, many patients come with the symptom of hasta-pada Shotha (swelling of the limbs) and without the proper knowledge of Ayurvedic literature, it is very much difficult for an Ayurvedic practitioner to differentiate them as whether it is a symptom of disease or prodromal symptom or complication of a disease etc. This paper is an honest effort on differentiating hasta-pada Shotha in different diseases or conditions.

Introduction Childhood pneumonia is a major cause of mortality worldwide while household air pollution (HAP) is a major contributor to childhood pneumonia in low and middle-income countries. This paper presents the prevalence trend of childhood pneumonia in Nepal and assesses its association with household air pollution. Methods The study analysed data from the 2006, 2011 and 2016 Nepal Demographic Health Surveys (NDHS). It calculated the prevalence of childhood pneumonia and the factors that cause household air pollution. The association of childhood pneumonia and HAP was assessed using univariate and multi-variate analysis. The population attributable fraction (PAF) of indoor pollution for causing pneumonia was calculated using 2016 NDHS data to assess the burden of pneumonia attributable to HAP factors. Results The prevalence of childhood pneumonia decreased in Nepal between 2006 and 2016 and was higher among households using polluting cooking fuels. There was a higher risk of childhood pneumonia among children who lived in households with no separate kitchens in 2011 [Adjusted risk ratio (ARR) 1.40, 95% CI 1.01–1.97] and in 2016 (ARR 1.93, 95% CI 1.14–3.28). In 2016, the risk of children contracting pneumonia in households using polluting fuels was double (ARR 1.98, 95% CI 1.01–3.92) that of children from households using clean fuels. Based on the 2016 data, the PAF for pneumonia was calculated as 30.9% for not having a separate kitchen room and 39.8% for using polluting cooking fuel. Discussion for Practice Although the occurrence of childhood pneumonia in Nepal has decreased, the level of its association with HAP remained high.

Introduction Temporal contusions are common in patients with head injuries and require close monitoring due to the propensity of these patients to deteriorate rapidly and fatally. This study attempts to introduce a radiological grading system for temporal lobe contusions and analyse its prognostic value so as to better identify patients at risk of deterioration. Methods The study was conducted as a cross-sectional observational study from April 2011–March 2017 on 42 patients with temporal lobe contusion. Each patients was graded according to the proposed system from a minimum of four to a maximum of 13 and then further grouped in three grades – grade 1 (score = 4), grade 2 (score 5–7) and grade 3 (score > 7) – and their clinical course was closely observed. Results The minimum and maximum scores observed were four and 11 respectively. The proposed grading system has statistically significant correlation to the Glasgow Coma Scale ( p-value Conclusion The proposed temporal lobe contusion grading system is a good radiological tool to predict the clinical course of patients and thereby identify patients at higher risk of delayed deterioration.

Aim The aim of this study was to identify the incidence, risk factors and outcome associated with meconium aspiration syndrome (MAS). Methods An observational study was conducted in 12 public hospitals in Nepal from 1 July 2017 to 29 August 2018. All babies born within the study period were included in the study. Babies who were diagnosed as MAS were designated as outcome. Data were analysed with bivariate analysis followed by multiple regression analysis. Results The overall incidence of MAS was 2.0 per 1000 livebirths. Babies born at post-term gestation (adjusted odds ratio (AOR) = 2.41; 95% confidence interval (CI): 1.05-5.55), nulliparity (AOR = 2.26; 95% CI: 1.20-4.28), instrumental delivery (AOR = 4.79; 95% CI: 2.52-9.10) and caesarean delivery (AOR = 3.67; 95% CI: 2.29-5.89) were significantly associated with MAS. Babies with MAS had a 10-fold risk for pre-discharge mortality (odds ratio = 9.87; 95% CI: 5.81-16.76). Conclusions The findings in this study are consistent with that reported in other studies. MAS has a high risk of neonatal mortality. Thus, monitoring during pregnancy and labour is necessary for early identification of high-risk conditions associated with MAS. Strengthening of newborn care services is essential to curtail mortality.

Introduction: Loricrin is usually observed in abundance in keratinizing epithelium in response to mechanical stress, which may be associated with development and malignant transformations in conditions such as oral submucous fibrosis (OSMF). Therefore, understanding of various molecular mechanisms associated with difference in gene expressions between OSMF and that of normal oral tissue is important. Aim: The aim of this study was to evaluate of the efficacy of loricrin as a diagnostic marker in patients with OSMF. Materials and Methods: Fifty formalin-fixed paraffin-embedded tissue blocks were obtained from the archives of the department. The study sample was grouped into two groups of normal mucosa (group I; n = 20) and OSMF (group II; n = 30) specimens. The study tissues were immunohistochemically stained with loricrin antibody and were further graded on basis of staining intensity. Results: Loricrin immunostaining was observed significantly more in OSMF cases and even in stratum granulosum in comparison to normal mucosa. Conclusion: Loricrin can act as an early indicator and a prognostic marker for detection of deleterious changes within epithelium in OSMF.

Background Assessing the natural history of oral mucosal lesions with both lichenoid and epithelial dysplastic features through a systematic review of published literature. Methods Scopus, PubMed, and Web of Science were searched for oral mucosal lesions showing both lichenoid and epithelial dysplastic features from original studies using the keywords “oral lichenoid dysplasia; oral epithelial dysplasia (OED) with lichenoid features; oral lichen planus (OLP) with dysplastic features; oral lichenoid lesions (OLL) with dysplastic features”. Results The search yielded 152 articles (PubMed-84, Scopus-32, Web of Science-36). Among these only 5 studies complied with the selection criteria including the provision of sufficient clinical and histopathological data. Out of these 5 studies, 181 cases were described to exhibit both lichenoid and epithelial dysplastic features. The most common diagnostic criterion employed was of van der Meij et al. Although some studies accepted the presence of epithelial dysplasia in OLL, most rejected the notion of epithelial dysplasia in OLP and designated such lesions as an OLL or oral lichenoid dysplasia. The few studies which accepted the presence of epithelial dysplasia in OLP rendered a diagnosis of OLP with dysplasia. Conclusions The review shows that several diagnoses were used for lesions with similar clinicopathological features and distinct clinicopathological entities were designated similar diagnosis. These diagnostic variations are the primary cause for the discrepancies in the prevalence and malignant transformation rates of these enigmatic entities which in turn often leads to erroneous treatment.

Transfusion-transmitted malaria in neonates is uncommon entity. Here we report a case of severe malaria in a term neonate after exchange transfusion successfully treated with intravenous artesunate.

Objective: Anomaly scan at the second trimester provides the detail anatomical study of fetus. Any structural or morphological defects detected prenatally guides the parents and doctors for further counseling. The main objective of this study was to detect the fetal congenital anomalies in high risk patients at 18-22 weeks and highlight the effectiveness of prenatal ultrasound examination. Materials and Methods: This was a hospital based descriptive study done during the period of 2017 January to 2019 January in the department of Radiology, ultrasound unit, Pokhara Academy of Health Sciences, Nepal. Pregnant women who were first examined and evaluated by the Obstetrician during the ante-natal check up (ANC) either by asking the patient history or by mother age or any symptoms or chance of being abnormalities or high risk patients during that time frame (18-22 weeks) were enrolled for the study. Maternal age, parity, any history of previous anomalies, previous history of miscarriage/Intra Uterine Fetal Demise ( IUFD) or any exposure to radiation or drugs, history of other disease were recorded during the filling of consent form. High risk patients were identified by the Obstetrician and anomaly examination was prescribed at second trimester (18-20 weeks). Descriptive analysis was done using SPSS 20. Results: There were two hundred and twenty four patients who had undergone anomaly (targeted fetal anatomy) examination which were referred for “anomaly scan” from the gynaecology and obstetrics department during that period. Among all the cases, fourteen cases had anomalies detected during the scan (18-22 weeks). Out of which seven cases had central nervous system related anomalies, two cases had skeletal deformities (dysplasia), two case had urinary tract related anomalies, one had lungs related anomalies and one had single umbilical artery with polyhydroamnios associated with duodenal atresia and one case had malformation of lymphatic system ( cystic hygroma ) Conclusion: Our study revealed that ultrasound scan performed between 18-22 weeks of pregnancy is effective in diagnosing major fetal abnormalities in the high-risk patients.

Introduction The nutritional status in the first 5 years of life has lifelong and inter-generational impacts on individual’s potential and development. This study described the trend of stunting and its risk factors in children under 5 years of age between 2001 and 2016 in Nepal. Methods The study used datasets from the 2001, 2006, 2011 and 2016 Nepal Demographic Health Surveys to describe the trend of stunting in under 5-year children. Multiple logistic regression analysis was carried out to assess the risk factors for stunting at the time of the four surveys. Results The nutritional status of under 5-year children improved between 2001 and 2016. Babies born into poorer families had a higher risk of stunting than those born into wealthier families (AOR 1.51, CI 95% 1.23–1.87). Families residing in hill districts had less risk of stunting than those in the Terai plains (AOR 0.75, CI 95% 0.61–0.94). Babies born to uneducated women had a higher risk of stunting than those born to educated women (AOR 1.57, CI 95% 1.28–1.92). Discussion Stunting among under-5-year children decreased in the years spanning 2001–2016. This study demonstrated multiple factors that can be addressed to decrease the risk of stunting, which has important implications for neurodevelopment later in life. We add literature on risk factors for stunting in under-5-year children.

Introduction: Cervical cancer is one of the common cancers in women and is a major public health problem all over the world. It has significant contribution to high mortality and morbidity. Preinvasive lesions spontaneously regress to normal, remain stable for a long time or progress to higher degree of dysplasia followed by carcinoma cervix. Materials and Method This was a hospital based retrospective study where 456 patients’ records were reviewed. Pap smear was used as the screening tool for the detection of precancerous lesion among the women visiting Western Regional Hospital (WRH), Department of obstetrics and gynecology. Results: Among 456 patients screened, most of them were in the age group of 30-39 years (42.8%) and were of parity 3 (42.8%). Most of them had no risk factors for carcinoma cervix (54.4%). Early marriage accounted for the highest risk of developing precancerous lesion (32.7%). There were no carcinoma detected by Pap smear. The test was negative in 68.9%, Low-grade Squamous Intraepithelial Lesion (LSIL) was detected in 5.9% and 2.9% had High-grade Squamous Intraepithelial Lesion (HSIL). Pap smear was sent for screening purpose in asymptomatic women (37.1%) and among the symptomatic patients vaginal discharge was the most common indication of pap test (34.6%). Conclusion: A Pap smear is reliable, simple, non-invasive, cost effective, and easy screening tool for detection of precancerous lesions in a woman.

Liposomal amphotericin B (LAmB) is recommended for treatment of Indian visceral leishmaniasis (VL), with a cure rate of more than 95% in the Indian subcontinent. A prospective observational study of 1,143 subjects was performed with a longer follow-up than prior studies (12 months) to evaluate the long-term effectiveness and safety of LAmB for the treatment of VL. Patients received a single dose of 10 mg/kg LAmB and were evaluated for initial cure at day 30 and final cure at 6 and 12 months to see the response to the therapy. Furthermore, predictors of relapse were also calculated. At day 30, the initial cure rate was 100%; however, at 6 months and 12 months, cure rates were 97.0% and 94.2% by per-protocol analysis and 96.9% and 93.9% by intension-to-treat analysis, respectively. Fever was the most common adverse event (AE). There were no deaths and serious AEs. Male gender, weight less than 30 kg, and spleen size more than 4 cm at the start of the treatment were significant risk factors of relapse. Liposomal amphotericin B was found to be very effective and safe in the treatment of VL. A longer follow-up period of 12 months is recommended to pick up late relapses.

Glucagon-like peptide-1 (GLP-1), an incretin hormone, has diuretic and natriuretic effects. The present study was designed to explore the possible underlying mechanisms for the diuretic and natriuretic effects of GLP-1 via renal nerves in rats. Immunohistochemistry revealed that GLP-1 receptors were avidly expressed in the pelvic wall, the wall being adjacent to afferent renal nerves immunoreactive to calcitonin gene-related peptide, which is the dominant neurotransmitter for renal afferents. GLP-1 (3 μM) infused into the left renal pelvis increased ipsilateral afferent renal nerve activity (110.0 ± 15.6% of basal value). Intravenous infusion of GLP-1 (1 µg·kg−1·min−1) for 30 min increased renal sympathetic nerve activity (RSNA). After the distal end of the renal nerve was cut to eliminate the afferent signal, the increase in efferent renal nerve activity during intravenous infusion of GLP-1 was diminished compared with the increase in total RSNA (17.0 ± 9.0% vs. 68.1 ± 20.0% of the basal value). Diuretic and natriuretic responses to intravenous infusion of GLP-1 were enhanced by total renal denervation (T-RDN) with acute surgical cutting of the renal nerves. Selective afferent renal nerve denervation (A-RDN) was performed by bilateral perivascular application of capsaicin on the renal nerves. Similar to T-RDN, A-RDN enhanced diuretic and natriuretic responses to GLP-1. Urine flow and Na+ excretion responses to GLP-1 were not significantly different between T-RDN and A-RDN groups. These results indicate that the diuretic and natriuretic effects of GLP-1 are partly governed via activation of afferent renal nerves by GLP-1 acting on sensory nerve fibers within the pelvis of the kidney.

Glucagon-like peptide-1 receptor (GLP-1R) agonists, widely used to treat type 2 diabetes, reduce blood pressure (BP) in hypertensive patients. Whether this action involves central mechanisms is unknown. We here report that repeated lateral ventricular (LV) injection of GLP-1R agonist, liraglutide, once daily for 15 days counteracted the development of hypertension in spontaneously hypertensive rats (SHR). In parallel, it suppressed urinary norepinephrine excretion, and induced c-Fos expressions in the area postrema (AP) and nucleus tractus solitarius (NTS) of brainstem including the NTS neurons immunoreactive to dopamine beta-hydroxylase (DBH). Acute administration of liraglutide into fourth ventricle, the area with easy access to the AP and NTS, transiently decreased BP in SHR and this effect was attenuated after lesion of NTS DBH neurons with anti-DBH conjugated to saporin (anti-DBH-SAP). In anti-DBH-SAP injected SHR, the antihypertensive effect of repeated LV injection of liraglutide for 14 days was also attenuated. These findings demonstrate that the central GLP-1R signaling via NTS DBH neurons counteracts the development of hypertension in SHR, accompanied by attenuated sympathetic nerve activity.

Introduction: Globally, there is a discrepancy between demand and availability of organs for transplantation. Transplantation is done from a living donor as well as a brain-dead/deceased donor. However, the World Health Organization (WHO) encourages deceased donor transplantation, since there is no risk to the donor. Although, the Transplant Act of Nepal 2016 opened the doors for deceased donor organ transplantation, the rate of transplantation from deceased donors is very low. Thus, this study assesses factors associated with willingness for deceased organ donation among post-graduate students of law, medicine, and mass communication streams. Methods: A total of 9 colleges, 3 from each specialty were selected via lottery method. The total sample size calculated was 440. Self- administered questionnaire was used to collect the data. 170, 140 and 130 forms were distributed in law, medicine and mass communication respectively via convenient sampling. Multivariate analysis among the variables that had p- value

Leishmaniasis is a vector-borne neglected tropical disease which manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and mucocutaneous leishmaniasis (MCL). The current drugs are toxic, duration of treatment is long, there is regional variation in efficacy, and emergence of resistance is common.This manuscript is based on literature derived from PubMed and reviews the current and emerging medications for the treatment of leishmaniasis. A single dose of liposomal amphotericin B (L-AmB) and multidrug therapy are the best options for VL in the Indian subcontinent (ISC), while a combination of pentavalent antimonials and paromomycin remains the treatment of choice for VL in Africa where efficacious and safe regimens are needed for HIV-VL coinfection. L-AmB at a total dose of 18-21 mg/kg is the recommended regimen for VL in the Mediterranean region, South America and for HIV-VL coinfection. Treatment of CL varies from observation, local or systemic therapy depending on severity of lesions, etiological species and its potential to develop into mucosal leishmaniasis.The monitoring of single-dose L-AmB and combination therapy in the ISC is essential. Effective short-course combination therapy is needed for the treatment of post-kala-azar dermal leishmaniasis and HIV-VL. Better evidence for treatment is still needed along with safer and shorter treatment options for CL and MCL.

Introduction: Gliomas are the most common brain tumors in adults originating from the glial cells. Glioblastoma multiforme is the most malignant and frequent among all gliomas. In recent years, the antibody Mindbomb Homolog-1 (MIB-1) has evolved as a measure of the proliferative nature of the glial tumors. This study aims to investigate the MIB-1 index value as an independent prognostic factor in high-grade gliomas and its correlation with outcome and survival. Materials and Methods: Mean MIB-1 index was determined in 51 high-grade glioma tissue samples in formalin. Its correlation with outcome by assessing the clinicoradiological parameters and median survival of patients in months were assessed. Survival analysis was studied by using the Kaplan–Meier bivariate analysis and Cox proportional ratio. Results: Preoperative Karnofsky Performance Score, WHO-PS, Neurological Performance Scale, and Mini–Mental Status Examination (MMSE) were statistically significant with respect to outcome and survival, whereas tumor factors such as size and perilesional edema were not. In particular, midline-crossing tumors and deep-seated tumors were significantly associated with high MIB-1 index and by correlation with outcome. There were significantly higher number (P < 0.0001) of patients with Grade IV tumors, with an MIB-1 index value above an arbitrary cutoff of 10% compared to Grade III tumors. In addition, median survival period of patients with low MIB-1 index was longer irrespective of tumor grade. Conclusion: Significant correlation between high-grade glioma and MIB-1 index suggests MIB-1 index to be a good prognostic tool, with MIB-1 index and midline-crossing variables being independent prognostic parameters.

The countries in the Indian subcontinent have reported a dramatic decline in visceral leishmaniasis (VL) cases. However, the presence of the parasite reservoir in the form of post-kala-azar dermal leishmaniasis (PKDL), a dermal sequel of VL, is a hurdle in attaining VL elimination. Presently employed clinical specimens for the diagnosis of PKDL include skin biopsy specimens and slit skin smears. In this study, the use of blood as a clinical specimen was investigated in different manifestations of PKDL in India. This is a bicentric study (National Institute of Pathology, Indian Council of Medical Research [ICMR], New Delhi, and Institute of Medical Sciences [IMS], Banaras Hindu University, Varanasi), with 215 participants (120 PKDL patients and 95 controls). Highly sensitive quantitative real-time PCR (Q-PCR) and field-deployable loop-mediated isothermal amplification (LAMP) were employed using blood samples for diagnosis. Promising sensitivities of 77.50% (95% confidence interval [CI], 69.24 to 84.05%) for Q-PCR and 70.83% (95% CI, 62.16 to 78.22%) for LAMP were obtained for the diagnosis of PKDL. Further, enhanced sensitivities of 83.33% (95% CI, 71.28 to 90.98%) and 77.78% (95% CI, 65.06 to 86.80%) for Q-PCR and LAMP, respectively, were recorded for the detection of macular cases. The study revealed an inverse correlation between the parasite load estimated in slit and blood samples, thereby favoring the use of blood for the diagnosis of the macular variant, which may be missed due to scant parasite loads in the slit. This study is the first to propose the promising potential of blood as a clinical specimen for accurate diagnosis of PKDL, which would aid in fast-tracking VL elimination.

Multiple lines of investigations suggest the presence of cortical inhibition aberrations as central to the phenotypic manifestations of severe mental disorders. Transcranial Magnetic Stimulation (TMS) combined with electromyography can characterize these inhibitory processes in the motor cortex with satisfactory temporal precision. We examined TMS-evoked short- (SICI) and long-interval intracortical inhibition (LICI) and cortical silent period (CSP) as markers of GABAA- (SICI) and GABAB-mediated (LICI and CSP) cortical neurotransmission in symptomatic individuals with mania (n = 40), schizophrenia (n = 76), unipolar depression (n = 86), and OCD (n = 43), and compared them against similar recordings in healthy subjects (n = 125). We hypothesized transdiagnostic GABAA deficits across all the clinical groups and diagnosis-specific GABAB alterations in mania (increased) and OCD (decreased). After controlling for potential confounder variables (gender, education, benzodiazepine prescription, and motor threshold) using the ANCOVA, we observed no significant group difference in SICI (F = 1.04, P = 0.38), but a significant group effect in LICI (F = 16.29, P

The severe disease outbreak COVID-19 pandemic impacted public health and safety and the educational systems worldwide. For fear of the further spread of diseases, most educational institutions, including Bangladesh, have postponed their face-to-face teaching. Therefore, this study explores public university student's perceptions towards online classes during the COVID-19 pandemic in Bangladesh. Data were collected among students of Islamic University, Kushtia, Bangladesh, through an online survey. The study followed both a qualitative and quantitative approach, where the survey technique was used as an instrument of data collection. Results showed that most students were facing difficulty participating in virtual classes and could not communicate with their friends correctly during online classes. They faced challenges in online schooling, and the majority of the students preferred conventional types of learning to virtual classes and did not understand the content of virtual classes easily. The study also explored that most students did not feel comfortable in online classes. Still, considering the present pandemic situation, they decided to participate in online classes to continue schooling. Besides, the study discovered that female students showed better real perceptions than male students regarding online classes, and urban students have more optimistic appreciation than rural students. Moreover, laptop or personal computer users showed more positive perceptions towards online education than mobile users. Furthermore, Broadband/ Wi-Fi users have more positive perceptions than mobile network users. These findings would be an essential guideline for governments, policymakers, technology developers, and university authorities for making better policy choices in the future.

Introduction Increased mortality is thought to be associated with an elevated troponin in addition to co-morbidities and age. International studies have demonstrated that troponin is an independent predictor of mortality in COVID-19 patients but to our knowledge this has not been assessed in a UK hospitalised population. We performed a single-centre retrospective observational study investigating the association between troponin positivity in patients hospitalised with COVID-19 and increased mortality in the short term. Methods All adults admitted with swab-proven RT-PCR COVID-19 to Homerton University Hospital (HUH) from 04.02.20 to 30.04.20 were eligible for inclusion. We retrospectively analysed data collected from the physical and electronic patient records (EPR) including demographic and biochemical data (e.g. serum high sensitivity Troponin I). Data was analysed according to the primary outcome of death at 28 days during hospital admission. Troponin positivity was defined above the upper limit of normal according to our local laboratory assay (>15.5ng/l for females, >34 ng/l for males). Univariate and multivariate logistical regression analyses were performed to evaluate the link between troponin positivity and death. Results The total number of adults with swab-proven RT-PCR COVID-19 to HUH from the date of the first positive swab to 30th April 2020 was 402. Mean length of stay for all patients was 9.1 days(SD 12.0). Table 1 shows selected demographics. This is a highly comorbid population with modest ethnic minority representation. Mean age was 65.3 years for men compared to 63.8 years for women. In those with a positive initial troponin, there was a high burden of mortality at 28 days post-admission. Mortality in troponin positive and negative patients is shown in table 2. A chi-squared test showed that survival of COVID-19 patients was significantly higher in those with a negative troponin (p = 3.23 x10-10) compared to those with a positive troponin. A Mann Whitney U test showed that initial troponin was significantly higher in those who died (p = 2.24 x10-12) compared to those who were alive. Mean initial troponin was 89.8 (95% CI 43.1 – 136.5). In the multivariate logistical regression, lung disease, age, troponin positivity and CPAP were all significantly associated with death, with an AUC of 0.8872, sensitivity of 0.9004 and specificity of 0.6292 for the model. Within this model, troponin positivity was independently associated with short term mortality (OR 3.23 , 95% CI 1.53-7.16, p=0.00278). Conclusions We demonstrated an independent association between troponin positivity and increased short-term mortality in COVID-19 in a London district general hospital. The mechanisms implicated in myocardial injury in COVID-19 are not fully understood but are likely multi-factorial. Conflict of Interest Nil

IntroductionDeep brain stimulation (DBS) of bilateral anteromedial subthalamic nucleus (amSTN) has been found to be helpful in a subset of patients with severe, chronic and treatment-refractory obsessive–compulsive disorder (OCD). Biomarkers may aid in patient selection and optimisation of this invasive treatment. In this trial, we intend to evaluate neurocognitive function related to STN and related biosignatures as potential biomarkers for STN DBS in OCD.Methods and analysisTwenty-four subjects with treatment-refractory OCD will undergo open-label STN DBS. Structural/functional imaging, electrophysiological recording and neurocognitive assessment would be performed at baseline. The subjects would undergo a structured clinical assessment for 12 months postsurgery. A group of 24 healthy volunteers and 24 subjects with treatment-refractory OCD who receive treatment as usual would be recruited for comparison of biomarkers and treatment response, respectively. Baseline biomarkers would be evaluated as predictors of clinical response. Neuroadaptive changes would be studied through a reassessment of neurocognitive functioning, imaging and electrophysiological activity post DBS.Ethics and disseminationThe protocol has been approved by the National Institute of Mental Health and Neurosciences Ethics Committee. The study findings will be disseminated through peer-reviewed scientific journals and scientific meetings.

Online users today are provided with a variety of customization tools to build their own information environment. A growing number of public health messages reach their target audiences via these digital venues. Given the deeply personal and individualized nature of customized environments, do online users show lesser reactance to persuasive health messages? Or, are they more likely to show reactance because they feel intruded upon? We conducted a 2 (Customization: present vs. absent) × 2 (Message threat: high vs. low) experiment (N = 145) to find out. Data showed that interface customization increases the sense of control and sense of identity among users. Sense of control is positively associated with threat to freedom of action, causing more affective reactance. In contrast, a sense of identity is negatively associated with anger toward the persuasive message. Theoretical and practical implications for online health campaigns are discussed.

PURPOSE: Lateral epicondylitis or lateral elbow tendinopathy is a common condition which needs to be addressed appropriately. This condition usually responds well to non-operative treatment. However, an orthopaedic physician needs to be aware of the recalcitrant cases and equip surgical armamentarium to provide adequate care. METHODOLOGY: The literature search was performed on PubMed, Medline and Google scholar using the keywords Tennis elbow, recalcitrant, thorntons technique, surgical options, for this narrative review. CONCLUSION: This article focuses on the causes for recalcitrant tendinopathy and review of its surgical options.

Background: Canine cardiovascular problems are commonly seen in veterinary medicine. Cardiac abnormalities in canine can be diagnosed by various means like electrochardiography, radiography, blood pressure measurement, echocardiography and biomarkers like troponins and peptides specific for heart.Methods: The present study was conducted to evaluate different biomarkers such as cardiac troponin T (cTnT), atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) for the diagnosis of cardiac diseases in comparison to echocardiography in canine. A total of 40 cases were included in the study, out of which 26 cases found to be positive for cardiac affections as confirmed by echocardiographic examination. Result: The serum concentration of cTnT and BNP were found significantly (P less than 0.05) elevated in dogs having cardiac as well as cardiac along with renal affections. ANP values were significantly (P less than 0.05) increased in dogs having both cardiac and renal diseases as compared to dogs with cardiac diseases only. Biomarkers like cTnT, ANP and BNP were compared with echocardiography (gold standard). The BNP was having the highest sensitivity (88.46%) and specificity (78.57%) as compared to cTnT and ANP. From the study, it is concluded that BNP can be used as suitable biomarker than cTnT and ANP for the diagnosis of cardiac diseases in canine. It can be used as a biomarker for cardiac diseases under field conditions where facilities for echocardiography are not available.

Skin is the largest organ of the human body extending the first line of defense against temperature variation, chemicals, microorganisms, and mechanical impacts. Damage to skin affects its functioning, working capacity, and self-esteem. Maintaining skin integrity is needed for its proper functioning. Effective cure and management of skin in cases of accidental plant poisoning are necessary for individuals and the whole society. Herbal remedies are known to heal skin injury since time immemorial. With modern know-how of drug development, these plant and phytochemicals can be used against mechanical injury, contact dermatitis, and photosensitization caused in accidental plant poisonings. Scientific methods to prove its efficacy by understanding its mechanism will lead to the development of newer, safer drugs for the natural healing process in accidental plant skin poisoning.

Vietnam's close proximity to China where the COVID-19 outbreak started made it one of the countries expected to have widespread transmission of the virus. However, the country opposed this expectation and attained low spread of COVID-19 infection due to its proactive approaches in containing the disease. As of March 11, 2021, Vietnam has a total of 2529 confirmed cases, equivalent to 26 cases per one million population-compared to the global rate of 15,223 cases. The low-cost model approach used by Vietnam in dealing with previous public health issues, tackle the importance of a strategic public health system, good governance, and citizen cooperation in the fight against COVID 19 pandemic. This paper aims to analyze Vietnam's achievement in its early and continued success in combating COVID-19 by taking into account various aspects of its health system and experience on outbreaks that have previously occurred and how these can be applied to current COVID-19 responses.

Objective The present study is a large case series evaluating the benefits of transcranial direct current stimulation (tDCS) in treatment-resistant obsessive compulsive disorder (OCD). Methods We reviewed the charts of 32 patients with treatment-resistant OCD who received 10–20 sessions of anodal pre-SMA tDCS. Results Overall, 9 (28 %) showed at least partial response to tDCS at the end of 10–20 sessions [responders = 8 (25 %), partial responders = 1 (3%)]. Two out of three partial responders at the end of 10 sessions had response at the end of 20 sessions. Conclusions tDCS may benefit a proportion of patients with treatment-resistant OCD.

Introduction: Diastolic dysfunction and cardiac hypertrophic remodeling are hallmark features of heart failure with preserved ejection fraction (HFpEF) in humans. However, an ideal animal model that mimics all these basic clinical features of HFpEF remains to be developed. Methods: Male Sprague-Dawley rats (250-300 g) were subjected to central infusion of either Angiotensin II (Ang II at 20 ng/min, 0.5 μl/h, i.c.v) or isotonic saline (0.5 μl/h, i.c.v) through osmotic mini-pumps for 14 days. Echocardiography was used to measure systolic (ejection fraction) and diastolic functions (E/A and E/E’ ratio) at day 14. Mean arterial pressure (MAP), heart rate (HR), left ventricular pressure (LVP), changes in ±dP/dt, and cardiac responses to isoproterenol (ISO) were also measured in anesthetized rats. Results: Central infusion of Ang II in rats resulted in increased sympathoexcitation and mean arterial pressure. Concomitantly, there was decreased E/A ratio (AngII: 1.2 ± 0.1 vs. Cont: 1.5 ± 0.1) and increased E/E’ ratio (AngII: 14.3 ± 0.8 vs. Cont: 12.9 ± 0.6), indicating diastolic dysfunction. Ejection fractions were comparable between the groups (AngII: 67 ± 2% vs. Cont: 69 ± 5%). Ang II infused rats demonstrated increased heart to body weight ratio (AngII: 4.5 ± 0.5 vs. Cont: 2.9 ± 0.1), cachexia (AngII: 235 ± 18 g vs. Cont: 331 ± 11 g), hypertrophy (AngII: 46 ± 5 μm/unit area vs. Cont: 36 ± 7 μm/unit area), and fibrosis (AngII: 5.2 ± 0.5 intensity/unit area vs. Cont: 2.6 ± 0.4 intensity/unit area). At the same time cardiac contractile responsiveness to ISO (0.5 μg/kg) was significantly lower for negative dP/dt in Ang II rats (AngII: -6998 mmHg/s vs. Cont: -11675 mmHg/s), which is indicative of abnormal diastole or relaxation. However, positive dP/dt response to ISO was similar in the two groups, indicating preserved systolic function in the Ang II group. Conclusions: Central Ang II infusion in rats shows sympathoexcitation, diastolic dysfunction, and pathological cardiac hypertrophy and fibrosis mimicking abnormalities seen in patients with HFpEF. This model of cardiac dysfunction in rats may represent a suitable platform to investigate the underlying mechanisms of HFpEF.