Search

A novel series of 4-morpholino-5,8,9,10-tetrahydropyrimido[4,5–b]quinolin-6(7H)-one has been synthesized by an extremely effective, straightforward and clean methodology for one-pot multicomponent condensation reaction (MCRs) utilizing polyphosphoric acid as a catalyst in conjunction with acetic acid. The three-components 4-amino-6-morpholinopyrimidine, cyclohexane-1,3-dione and various aromatic aldehydes resulted in the synthesis of high-yielding compounds, to gauge their in vitro antimalarial activity toward P. falciparum 3D7 strain cultures. The compounds demonstrated outstanding inhibition with IC50 values ranging from 0.62 to 0.84 μg/mL. Compounds 3c and 3e exhibited the most significant action with IC50 values of 0.62 μg/mL which is also supported by in silico ADME and molecular docking study. These newly synthesized pyrimido[4,5–b]quinolines aim to enhance antimalarial drugs, potentially opening up new routes in pharmaceutical chemistry.

Self-compacting concrete (SCC) has been versatile over compaction of concrete by manual or mechanical vibrators. Compaction of concrete by traditional methods generates delays and imparts additional costs. Further, much research has been done on the effects of fiber on traditional concrete, but it has rarely been on SCC. Here, fiber-reinforced SCC was prepared by adding glass and steel fibers to study the effect of fibers on fresh properties like workability and hardened properties like compressive, split tensile and flexural strength. Geometrically similar reinforced specimens with 1.0% and 1.5% flexural reinforcement were also prepared to understand the flexural behavior of reinforced SCC with and without fibers. It was observed that the addition of fibers reduced workability and increased mechanical properties like compressive, split tensile, flexural strength, first crack load, ultimate load, and energy absorption capacity. It was also observed that as the size of specimens increased, the ductility factor decreased.

Firearm deaths continue to be a major public health problem, but the number of non-fatal firearm injuries and the characteristics of patients and injuries is not well known. The American College of Surgeons Committee on Trauma, with support from the National Collaborative on Gun Violence Research, leveraged an existing data system to capture lethal and non-lethal injuries, including patients treated and discharged from the emergency department and collect additional data on firearm injuries that present to trauma centers. In 2020, Missouri had the 4th highest firearm mortality rate in the country at 23.75/100,000 population compared to 13.58/100,000 for the US overall. We examined the characteristics of patients from Missouri with firearm injuries in this cross-sectional study. Of the overall 17,395 patients, 1,336 (7.7%) were treated at one of the 11 participating trauma centers in Missouri during the 12-month study period. Patients were mostly male and much more likely to be Black and uninsured than residents in the state as a whole. Nearly three-fourths of the injuries were due to assaults, and overall 7.7% died. Few patients received post-discharge services.

Objectives The Field Triage Guidelines (FTG) support emergency medical service (EMS) decisions regarding the most appropriate transport destination for injured patients. While the components of the algorithm are largely evidenced-based, the stepwise approach was developed with limited input from EMS providers. FTG are only useful if they can easily be applied by the field practitioner. We sought to gather end-user input on the current guidelines from a broad group of EMS stakeholders to inform the next revision of the FTG.Methods An expert panel composed an end-user feedback tool. Data collected included: demographics, EMS agency type, geographic area of respondents, use of the current FTG, perceived utility, and importance of each step in the algorithm (1: physiologic, 2: anatomic, 3 mechanistic, 4: special populations). The American College of Surgeons Committee on Trauma (ACS COT), in partnership with several key organizations, distributed the tool to reach as many providers as possible.Results 3958 responses were received (82% paramedics/emergency medical technicians, 9% physicians, 9% other). 94% responded directly to scene emergency calls and 4% were aeromedical providers. Steps 2 and 3 were used in 95% of local protocols, steps 1 and 4 in 90%. Step 3 was used equally in protocols across all demographics; however, step 1 was used significantly more in the air medical services than ground EMS (96% vs 88%, p

Learning manual small-incision cataract surgery (SICS) is essential for ophthalmic surgeons as it provides an alternative to phaco-emulsification in complicated cases. Nearly 10% of ophthalmic surgeons are left-handed. Left-handed surgeons do face more difficulties because of their laterality, which have been highlighted in various surveys even in other surgical specialities. Surgical training programs, residency programs, and fellowships have traditionally been designed considering the right hand as the dominant hand. Left-handed surgeons (LHSs) are at disadvantage as they are trained by right-handed surgeons (RHSs), which may result in more initial intra-operative errors. Intra-ocular lenses are also designed such that dialing into the bag is relatively difficult for LHSs. Developing customized training modules for LHSs can help them overcome the laterality challenges and enhance their surgical capabilities. In this article, we herein present a brief description of the SICS technique for LHSs, elaborating the crucial steps and customized maneuvers that, if performed differently, may make surgeries easier for them.

Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion: Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

Introduction: Neonatal hyperbilirubinemia is one of the most common problem encountered during the neonatal period. Phototherapy is a widely accepted, cheap, non-invasive relatively safe and effective method of treatment for neonatal hyperbilirubinemia. Aim: To compare the efficacy of Light Emitting Diode (LED) phototherapy vs Conventional Phototherapy for treatment of neonatal hyperbilirubinemia in healthy term neonates. Materials and Methods: A quasi experimental study was conducted in Neonatal Intensive Care Unit and Post-natal wards in a tertiary care hospital affiliated to Medical College and Hospital, Ahmedabad, Gujarat from July 2018 to April 2019 with a sample size of 135 in each group. They were assessed clinically by Kramers method just before initiation of phototherapy, then using Transcutaneous Bilirubinometer (TCB) Total Serum Bilirubin (TSB) level was measured. Bilirubin assessment by these methods were done for every neonate before initiation of phototherapy and then again repeated after 24 and 48 hours of phototherapy. Data was collected and analysed in Microsoft (MS) excel Statistical Package for the Social Sciences (SPSS) 0.26. Chi-square test was used for comparison. Results: In the present study, 158 (58.51%) babies were male and 112 (41.48%) babies were female. Initially, LED was found to be better than Compact Fluorescent (CFL) conventional phototherapy on comparing the average fall in the serum bilirubin level from baseline during the first 24 hours however no such difference in the efficacy between the two light sources was seen after a period of 48 hours. Total 9 (6.66%) patients developed rebound hyperbilirubinemia after completion of conventional phototherapy whereas 14 (10.37%) developed rebound hyperbilirubinemia after completion of 48 hours of LED phototherapy. Conclusion: LED and conventional phototherapy were equally efficacious in managing non haemolytic hyperbilirubinemia in healthy term neonates.

Sacral chordoma is a rare condition requiring multidisciplinary approach for management. Here, we report a 72-year-old male patient who was diagnosed with sacral chordoma with L2–L3 disc herniation and L5–S1 degenerative spondylolisthesis and L1 body fracture. The patient was first managed by discectomy L2–L3 with D12–L3 decompression and fixation. Sacral chordoma excision was done 10 months later. The chordoma was excised by anterior laparoscopic resection and mobilization of tissues from the tumor followed by posterior sacrectomy with L5–S1 decompression and extension of fixation in a single stage. Proline mesh was used to support the colon posteriorly. This was further complicated by proximal junction fracture due to fall which was further managed by proximal extension of the rod-screw construct. The patient became symptom free without any radiotherapy or chemotherapy and is able to walk independently, two years following the primary surgery without recurrence of tumor.

Despite increased pre and postoperative care including screening procedures, improvement in the operating room environment, and controlled prophylactic antibiotic therapy, the health burden of Surgical Site Infections (SSIs) in India is far more escalated than that in developed countries. SSIs ranging from superficial skin infection to life threatening septicemia affect one third of the patient population undergoing surgery, thereby contributing to morbidity and mortality. One of the most dominant bacterial species that causes SSIs is Staphylococcus aureus, wherein Methicillin Resistant S.aureus (MRSA) alone contributes to a significant increase in both the cost and the length of hospitalisation along with an increased mortality rate among patients with SSIs. The rising resistance pattern among pathogens coupled with the concerns over the tolerance and safety of currently available agents against MRSA limits treatment options available for patients with SSIs. Levonadifloxacin and its oral prodrug alalevonadifloxacin are novel benzoquinolizine anti‑MRSA agents which have recently been approved in India to tackle gram positive ‘super-bugs’. Herein, the aim of this review article was to collate the possible factors contributing toward SSIs, its implications on health and economy, antibiotic resistance, possible preventive measures, and the need for new antimicrobial agents.

Percutaneous Gastrostomy (PEG) tube is an endoscopic-guided procedure to provide enteral nutrition, medications and/or fluids to patients with oral or esophageal pathologies. PEG tubes are a relatively safe intervention but commonly known to have complications like insertion site infection, tube leakage, and tube blockage. This was an unusual case in which the PEG tube was discovered to be obstructing the third part of the duodenum after migration resulting in mechanical gastric obstruction with septic shock and severe hemodynamic instability. PEG induced gastric obstruction is often misdiagnosed during a triage due to the atypical presentation of this condition leading to aggressive management, testing and consultations. PEG dependent patients have rapidly increased over the years and a complete physical examination of the PEG site should be performed by all physicians in order to prevent related complications.

Objective: The study was conducted to compare the use of less soluble volatile anesthetics (Desflurane and Sevoflurane) as alternatives to Propofol for maintenance of general anesthesia in providing a more rapid emergence from anesthesia. Methodology: For the study 90 cases of ASA 1 and 2 physical status scheduled for laparoscopic surgery were randomly divided to one of three anesthetic groups by the chit method. Total 90 adult patients of ASA I and II between the age group of 18 – 70years of either sex posted for elective daycare laparoscopic were selected for the study. They were randomly divided into three groups Group 1 received Desflurane, Group 2 received Propofol and Group 3 received Sevoflurane. Results: There were total 30 patients in each group. In group of Desflurane and group of Sevoflurane least fall in blood pressure than group of Propofol. So Propofol causes maximum fall in blood pressure as compare to Desflurane and Sevoflurane. Following to vaporizer turn off the immediate recovery is seen in Desflurane group of patient. While delayed eye opening seen in Propofol group of patient and intermediate eye opening seen in Sevoflurane group. Conclusion: Desflurane provides faster recovery from anesthesia in patients undergoing laparoscopic surgeries than Sevoflurane and Propofol. However all three groups were hemodynamically stable during the intraoperative period.

Aim: Gingivitis is a common periodontal condition affecting most of the population of the world. Beneficial results have been achieved by researchers with use of antibiotics as an adjunct to phase I therapy. This study was done to evaluate the therapeutic effectiveness of Ornidazole containing gel as an adjunct to scaling in comparison with scaling alone. Materials and Method: Total 30 subjects of both the sexes diagnosed with chronic generalized gingivitis were recruited for the study. A split mouth study was conducted where scaling was done on the control site & scaling along with Ornidazole gel application was done on the test site. Modified gingival index and plaque index were recorded at baseline, 2 weeks and 4 weeks. Results : This clinical study showed statistically significant improvement in gingival status of all the patients. For both the groups significant difference in mean score (0.52) of modified gingival index was observed but there was no significant difference in mean plaque score between two sites. Conclusion: The result showed that scaling alone can improve the gingival status; however additional benefits can be obtained when antimicrobial gel is used as an adjunctive therapy.

Fraud in medical publishing has risen to the national spotlight as manufactured and suspect data have led to retractions of papers in prominent journals. Moral turpitude in medical research has led to the loss of National Institute of Health (NIH) grants, directly affected patient care, and has led to severe legal ramifications for some authors. While there are multiple checks and balances in medical research to prevent fraud, the final enforcement lies with journal editors and publishers. There is an ethical and legal obligation to make careful and critical examinations of the medical research published in their journals. Failure to follow the highest standards in medical publishing can lead to legal liability and destroy a journal’s integrity. More significant, however, is the protection of the medical profession’s trust with their colleagues and the public they serve. This article discusses various techniques and tools available to editors and publishers that can help curtail fraud in medical publishing.

Overactive bladder (OAB) is a common, costly, and treatable condition in older persons. There is a wide array of available antimuscarinics for the treatment of these conditions; however, their side effect profile and the limited number of studies that evaluate their effect in the elderly curb their use. This review article focuses on OAB and its treatment, with special attention to the use of antimuscarinics in the elderly.

The most common cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although the incidence has remained stable, the neonatal mortality for this disorder has improved due to early diagnosis and intensive neonatal care, thanks in part to the widespread use of prenatal ultrasound evaluations. In fact, the most common reason for the diagnosis of posterior urethral valves presently is the evaluation of infants for prenatal hydronephrosis. Since these children are often diagnosed early, the urethral obstruction can be alleviated rapidly through catheter insertion and eventual surgery, and their metabolic derangements can be normalized without delay, avoiding preventable infant mortality. Of the children that survive, however, early diagnosis has not had much effect on their long-term prognosis, as 30% still develop renal insufficiency before adolescence. A better understanding of the exact cause of the congenital obstruction of the male posterior urethra, prevention of postnatal bladder and renal injury, and the development of safe methods to treat urethral obstruction prenatally (and thereby avoiding the bladder and renal damage due to obstructive uropathy) are the goals for the care of children with posterior urethral valves[1].

Ureterosciatic hernia (USH) is a rarely described entity and is an extremely rare cause of refractory flank pain. We report the diagnostic dilemma, and sequential endourological and finally the successful robotic management of one such symptomatic USH in an elderly woman who had presented with ipsilateral refractory flank pain, hydroureteronephrosis, and compromised renal function. We have also reviewed the current literature regarding the etiopathogenesis, presentation, diagnosis, and management of USHs. To the best of our knowledge, this is the first such case to describe the robotic-assisted laparoscopic management of a case of USH.

A 55-year-old woman, with history of cataract surgery 1 year back, presented with features of ocular inflammation for last 3 months. She had no history of any other intraocular surgery. On examination, anterior segment showed frothy material in the inferior angle with moderate anterior chamber reaction (cells+/flare+) and sulcus intraocular lens with large posterior capsule rent. Fundoscopy showed multiple, small to medium-sized transparent bubbles of perfluorocarbon liquid (PFCL) with membranes in the vitreous cavity. Ultrasonography confirmed the presence of PFCL in the vitreous cavity. Pars plana vitrectomy with anterior chamber wash was done which led to good visual recovery. To conclude, retained PFCL can cause late onset fibrinous inflammation after a quiescent period but surgical intervention may lead to good visual outcome.

Mucormycosis is rare in clinical practice. Most infections are acquired by inhalation; other portals of entry are traumatic implantation and ingestion in immunocompromised host. Mucormycosis is life threatening infection in immunocompromised host with variable moratlity ranging from 15 -81% depending upon site of infection. General treatment principles include early diagnosis, correction of underlying immunosuppression and metabolic disturbances, adequate surgical debridement along with amphotericin therapy. We describe surgical site mucormycosis extended to involve large bowel in elderly diabetic patient.

Introduction: Malaria continues to be a great health problem in some of the most populated areas of the world & continues to cause significant morbidity and mortality worldwide. The hematological abnormalities that have been reported to consistently with malaria are anemia, thrombocytopenia, atypical lymphocytosis and infrequently disseminated intravascular coagulation. Methodology: This cross sectional study was conducted in central hospital laboratory of a tertiary care hospital of Surat, Gujarat. The laboratory confirmed cases of malaria from August to October, 2012 were included in the study. Hematological profile of different spices of malaria was compared. Results: The difference in mean platelet count according to severity of infection was highly statistically significant according to ANOVA test both for P.Vivax and P.Falciparum. Platelet counts show decreasing trend according to severity of infection. Difference in the mean haemoglobin level and mean platelet counts of P.Vivax cases and P.Falciparum cases was also statistically significant. Conclusion: The low level of platelet can be used as predictor of severity of the infection. And thus, prediction of the hematological changes enables the clinician to establish an effective and early therapeutic intervention in order to prevent the occurrence of major complications.