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Background: Thyroid dysfunction evaluation during pregnancy is important for the mother’s health, obstetric outcomes, and the child’s cognitive development. This study is conducted to know various thyroid disorders that can occur during antenatal and their impact on mother and fetus outcomes. Materials and Methods: This observational research was conducted over two years at a tertiary center in Western Rajasthan, India. Seven hundred and seventy-two low-risk singleton pregnant patients who met the inclusive criteria were recruited. The estimation of T3, T4, and TSH was done along with a routine investigation in antenatal women. Antenatal having abnormal thyroid profiles were then analyzed for mother and fetus problems. Results: The prevalence of thyroid dysfunction in antenatal women is 16.5%. Subclinical hypothyroidism (SCH) was seen in 12.5% of cases, overt hypothyroidism in 3.36%, and subclinical hyperthyroidism in only 0.51% of cases. Anti-TPO was positive in 46 (41.44%) women with hypothyroidism and 1 (25%) with hyperthyroidism. Compared to euthyroid women, women with overt hypothyroid (19.23% vs 3.1%, P = 0.002) and subclinical hypothyroid (9.27% vs 3.1%, P = 0.003) were found to be associated with a higher risk of hypertensive disease. Concerning fetal outcomes. There was a high risk for preterm (12.37% v/s 4.9%, P = 0.004) and fetal growth retardation (FGR) in patients with SCH (7.21% v/s 3.1%, P = 0.04). Conclusion: Considering the significant influence of thyroid disorders on mother and fetus outcomes, the screening for thyroid during pregnancy should be considered universally, particularly in developing countries with high prevalent rates, such as India.

Background: Sick neonate score (SNS) is a simple clinical score that requires minimal basic equipment and expertise. It is utilized for the prediction of mortality among neonates. Objective: The objective of this study was to study the correlation of SNS with mortality and duration of hospital stay of admitted neonates. Methodology: This hospital-based observational descriptive study was conducted in a tertiary care hospital in Jaipur, Rajasthan. A total of 404 outborn transported neonates were enrolled. Baseline characteristics and SNS were recorded and analyzed. Categorical data were presented in numbers and percentages, whereas continuous data in mean and standard deviation. The Chi-square test and unpaired t-test were used for analysis. Receiver operating characteristics curve analysis was used to estimate the cutoff value of SNS determining the mortality and duration of hospital stay of the patient. Results: Out of 404 neonates 243 (60%) were tachypneic, 242 (59%) had oxygen saturation 7 days. Conclusion: SNS has a good negative correlation with mortality. Neonate with SNS ≤8 either expired early or was discharged with a higher duration of hospital stay.

Brain-targeted gene delivery across the blood-brain barrier (BBB) is a significant challenge in the 21st century for the healthcare sector, particularly in developing an effective treatment strategy against Alzheimer’s disease (AD). The Internal architecture of the brain capillary endothelium restricts bio-actives entry into the brain. Additionally, therapy with nucleic acids faces challenges like vulnerability to degradation by nucleases and potential immune responses. Functionalized nanocarrier-based gene delivery approaches have resulted in safe and effective platforms. These nanoparticles (NPs) have demonstrated efficacy in protecting nucleic acids from degradation, enhancing transport across the BBB, increasing bioavailability, prolonging circulation time, and regulating gene expression of key proteins involved in AD pathology. We provided a detailed review of several nanocarriers and targeting ligands such as cell-penetrating peptides (CPPs), endogenous proteins, and antibodies. The utilization of functionalized NPs extends beyond a singular system, serving as a versatile platform for customization in related neurodegenerative diseases. Only a few numbers of bioactive regimens can go through the BBB. Thus, exploring functionalized NPs for brain-targeted gene delivery is of utmost necessity. Currently, genes are considered high therapeutic potential molecules for altering any disease-causing gene. Through surface modification, nanoparticulate systems can be tailored to address various diseases by replacing the target-specific molecule on their surface. This review article presents several nanoparticulate delivery systems, such as lipid NPs, polymeric micelles, exosomes, and polymeric NPs, for nucleic acids delivery to the brain and the functionalization strategies explored in AD research.

Introduction: Being diagnosed with breast cancer or receiving surgery, radiation or chemotherapy as a treatment modality in itself is seen as a traumatic experience for many women. This emotional distress is in turn associated with reduced quality of life and can pose a negative influence on compliance with treatment. Ultimately leading to an elevated risk of mortality which is also seen as the sixth vital sign in cancer care. Aim & Objectives: The purpose of our study is to estimate the prevalence of depression and anxiety in breast cancer patients and their correlation with socio-demographic factors. Materials and Methods: A cohort of 140 breast cancer patients registered in the Department of Radiation Oncology, SMS medical College, Jaipur from January 2022 to December 2022 were recruited and interviewed with a structured questionnaire including socio-clinical and demographic factors and PHQ-2 and GAD-2 scales. Results: Prevalence of depression among patients were 37.9% (53/140) and almost one third (33.6%, 47/140) of cases had anxiety. Around two thirds (69.3%, 97/140) cases had stage III breast cancer, followed by stage II in 23 (16.4%) cases and 20 (14.3%) cases had IV stage breast cancer. The place of residence, educational status, employment status, accompanying person and marital status emerged as significant predictors of depression risk, while age group, marital status and financial status were found to have statistically significant association with elevated anxiety symptoms. Conclusion: This study shows that prevalence of anxiety and depression in breast cancer patients is high and patients from rural areas, single, low monthly income, younger age group and low education level were more prone. Therefore, special care and support and often referral to psychiatry department may be required in such group of patients.

Objective Due to its comprehensive, reliable, and valid format, the objective structured clinical examination (OSCE) is the gold standard for assessing the clinical competency of medical students. In the present study, we evaluated the importance of the OSCE as a learning tool for postgraduate (PG) residents assessing their junior undergraduate students. We further aimed to analyze quality improvement during the pre-coronavirus disease (COVID) and COVID periods. Methods This quality-improvement interventional study was conducted at the Department of Obstetrics and Gynecology. The PG residents were trained to conduct the OSCE. A formal feedback form was distributed to 22 participants, and their responses were analyzed using a five-point Likert scale. Fishbone analysis was performed, and the ‘plan-do-study-act’ (PDSA) cycle was implemented to improve the OSCE. Results Most of the residents (95%) believed that this examination system was extremely fair and covered a wide range of clinical skills and knowledge. Further, 4.5% believed it was more labor- and resource intensive and time-consuming. Eighteen (81.8%) residents stated that they had learned all three domains: communication skills, time management skills, and a stepwise approach to clinical scenarios. The PDSA cycle was run eight times, resulting in a dramatic improvement (from 30% to 70%) in the knowledge and clinical skills of PGs and the standard of OSCE. Conclusion The OSCE can be used as a learning tool for young assessors who are receptive to novel tools. The involvement of PGs in the OSCE improved their communication skills and helped overcome human resource limitations while manning various OSCE stations.

Introduction: HIV infection is considered as one of the leading infectious cause of pulmonary arterial hypertension (PAH) and it exhibits higher rate of development of this condition than general population. The prevalence of HIV associated PAH has not been established accurately and varies based on factors such as geographical distribution, gender, duration of HIV and ART etc. This study aims to estimate the prevalence of PAH in HIV infected patients who are on first line ART and to study the association of PAH with CD4 count and viral load. Methods: This cross-sectional study was conducted on 150 HIV positive patients who visited medical OPD and ART centre, JLN medical college and hospital, Ajmer and were above 18 years of age and were on first line ART. PAH was identified through transthoracic doppler echocardiographic screening and systolic pulmonary artery pressure (sPAP) estimation of more than 35 mmHg was used to diagnose PAH. Result: In this study, out of 150 patients, PAH was diagnosed in 12 patients and hence the prevalence of PAH came out to be 8 % (95 % CI: 3.65; 12.34). Significant association of PAH has been observed with viral load (p value = 0.04). While no significant association has been found between PAH and CD4 count. Conclusion: PAH in HIV patients was found to be 8% which is considerably higher than the already established global prevalence. Hence, PAH should be an important consideration for clinicians in differential diagnosis of dyspnea in HIV patients.

Background: Cervical carcinoma is the fourth most common cancer and leading cause of cancer related deaths in women worldwide. Brachytherapy is an important part in the treatment of cervical cancer. Delivering HDR Intracavitary Brachytherapy in the Covid-19 era is challenging. Objective: To compare the dosimetry and treatment outcomes between two fractionation schedules of 9Gy in 2 fractions v/s 7Gy in 3 fractions of high dose rate Brachytherapy in patients with locally advanced carcinoma cervix. Methods: A randomized observational study was carried out on 80 histopathologically proven squamous cell carcinoma patients of cervix. All patients were treated with EBRT 50Gy in 25 fractions over a period of 5 weeks (2Gy/#) with concurrent weekly cisplatin 30mg/m2. After assessing fitness for brachytherapy, patients in the study arm received HDR intracavitary brachytherapy in 9Gy for 2 fractions v/s 7Gy for 3 fractions in the control arm. Results: The median time of follow-up was 14 months for the study (range 7 – 20 months). Local control rate was 89.75% for study arm and 92.30% for control arm. One year disease free survival in the study arm was 76.92% as compared to 74.35% in the control arm. Median disease-free survival was better in the study arm (14 months v/s 12 months) with a trend of significant benefit. Rectal and bladder toxicities were comparable in both the arms. Median dose to ICRU bladder and rectal point, and EQD2 dose in both arms were not found to be statistically significant. Conclusion: Both the regimes were found to be safe. Disease response and toxicities were also similar in both the arms. There was a better patient compliance with 9Gy for 2 fractions schedule in view of lesser number of fractions resulting in less hospital visit in the Covid-19 pandemic.

Objective The study was conducted to determine the frequency of alloimmunization to various blood group antibodies in pregnant women, and the risk of hemolytic disease in the fetus and newborn. Methods All antenatal women, irrespective of the period of gestation or obstetric history, were included, whereas those taking anti-D immune-prophylaxis or with a history of blood transfusion were excluded. Antibody screening and identification were performed using a Bio-Rad ID microtyping system. Results Of 2,084 antenatal females, 1,765 were D-antigen positive and 319 D-antigen negative. Sixty-five (3.119%) women alloimmunized. Out of 54 (2.591%) who had sensitized to D-antigen, 11 (0.527%) also sensitized to other antibodies. These 11 alloantibodies identified included: anti-M (n=6; 9.23%), anti-C (n=1; 3.076%), anti-E (n=1; 1.538%), anti-e (n=1; 1.538%), anti-Lewis (a) (n=1; 1.538%), and unspecified antibodies (n=1; 1.538%). Multiple antibodies were seen in four patients that combined: anti-D and anti-C (n=2; 3.076%), anti-e and anti-c (n=1; 1.538%), and anti-D and anti-G (n=1; 1.538%). Conclusion The rate of alloimmunization in D-antigen-negative women was high. Apart from this, the alloimmunization rate in women with bad obstetric history was very high, at 8.1%. In developing countries such as India, universal antenatal antibody screening, though desirable, may not be justified at present, as the cost and infrastructure required would be immense because of the lower alloimmunization rates in RhD antigen-positive women. However, it is necessary to impose properly formulated protocols to screen pregnant women with bad obstetric history.

Primary congenital glaucoma (PCG) occurs worldwide and has a broad range of ocular manifestations. It poses a therapeutic challenge to the ophthalmologist. A proper diagnostic evaluation under anesthesia is advisable for all children who do not cooperate for an office examination. Medical therapy only serves as a supportive role, and surgical intervention remains the principal therapeutic modality. Angle incision surgery such as goniotomy or trabeculotomy ab externo is the preferred choice of surgery in the Caucasian population. Primary combined trabeculotomy-trabeculectomy with or without antifibrotic therapy is the preferred choice in certain regions such as India and the Middle East where the disease usually presents with severe forms of corneal edema along with megalocornea. In refractory cases, trabeculectomy with antifibrotic therapy or glaucoma drainage devices are available options in the armamentarium. Cycloablative procedures should be reserved for eyes with poor visual potential. Myopia is common among children with PCG, and appropriate optical refractive correction in the form of glasses or contact lenses should be provided. Amblyopia therapy should be instituted to ensure overall visual development in the early developmental years. Low-vision rehabilitation services should be provided to children with vision impairment. Long-term follow-up is mandatory and carers of children with PCG should be counseled and educated about this need. Regardless of the visual outcomes, clinicians should emphasize the need for education of these children during the clinic visit. The overall goal of the management should be to improve the overall quality of life of the children with PCG and their carers.

Background: The recent increase in the cesarean section (CS) rate worldwide has led to global concerns and vaginal birth after CS (VBAC) as an effective way to reduce the CS rate. In this study, our main aim was to know about various factors that help women make their preferred mode of delivery following a previous CS. Material and Method: This was a questionnaire-based study conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Jodhpur, among 200 women with previous one lower segment CS (LSCS). Results: Elective repeat cesarean delivery (ERCD) was found to be more among uneducated women and those who had complications in their previous babies. The most common reason for opting for ERCD was fear of labor pains. Women who were counseled by senior doctors were more likely to opt for a trial of labor after cesarean section (TOLAC). Conclusion: Improving the education levels of mothers, counseling about advantages associated with vaginal birth, counseling by senior obstetrician, and information regarding labor analgesia can decrease CS rates.

Background: Present study compares two high-dose-rate intracavitary brachytherapy (ICBT) planning methods using two-dimensional orthogonal radiography and three-dimensional computed tomography (3D-CT) with regard to dose to target volume and organs at risk (OAR) in carcinoma cervix. Methodology: ICBT plans for 22-patients were compared using 2D planning and three-dimensional computed tomography (3D-CT) planning techniques. 2D treatment plans were generated using 2D-orthogonal images and dose was prescribed at Point A while 3D-CT plans were generated using 3D-CT images after contouring target volume and organs at risk. In 2D planning rectal and bladder doses were assessed as per ICRU-38 and in 3D planning, 0.1cc, 0.2cc, 0.5cc and 1cc doses of bladder and rectum were evaluated. Doses to target and organ at risks (rectum and bladder) were compared for each planning method. Results: Mean dose received by D90, D95 and D100 was 8.05±1.59Gy, 7.19±1.43Gy and 4.79±0.93Gy respectively. ICRU bladder and rectal point doses were 5.19±1.36Gy and 5.03±0.36Gy respectively. Mean dose received by bladder D0.1cc, D0.2cc, D1cc, D2cc and D5cc was 2.38±0.80, 2.22±.75, 1.85±0.64, 1.51±0.64 and 1.29±.49 times higher than ICRU bladder reference point dose. Similarly mean dose received by rectum D0.1cc, D0.2cc, D1cc, D2cc and D5cc was 1.49±0.27, 1.43±.25, 1.25±0.23, 1.09±0.21 and 0.93±.21 times higher than ICRU rectal reference point dose. Conclusion: This study demonstrates suboptimal target coverage and underestimation of dose to OAR by 2-dimensional radiography when actual dose estimation was done by 3-dimensional brachytherapy planning for the same brachytherapy session.

Purpose of study: To evaluate the efficacy and safety of oral pilocarpine concomitantly with radiation treatment for the prevention of radiation induced xerostomia in Head and Neck cancer patients. Material and methods: A prospective randomized study was carried out on 60 histopathological proven squamous cell cancer patients of Head and neck region. All patients received a total radiation dose of 66Gy /33 fraction/6.2 weeks (2Gy/fraction, 5 days/ week) on Telecobalt machine with or without concurrent chemotherapy. The concurrent chemotherapy eligible patients received, weekly chemotherapy courses using cisplatin 30 mg/m2. Patients in the study group received oral pilocarpine 5.0 mg three times a day starting 3 days prior to start of radiotherapy and continued for 3 months post radiotherapy. Patients were evaluated on subjective basis based on Zimmerman Questionnaire and EORTC QLQ HN 35. The statistical analysis was done by Paired sample T test. Results: The average Zimmerman Xerostomia score for all parameters combined was as follows: First assessment -100mm vs 100mm; Second assessment -50mm vs 45mm; Third assessment -59mm vs 52mm; Fourth assessment -64mm vs 57mm, Fifth assessment -71mm vs 68. As per QLQ-HN 35 questionnaire used for assessment of quality of life of patients in both groups, we observed that better scores were obtained in the pilocarpine group in comparison to control group. Conclusion: In the present study, the effectiveness of Pilocarpine given during and 3 months post radiotherapy was observed in terms of better compliance during radiation treatment. Most of the patients had less subjective symptoms with lesser grades of toxicities observed during various phases of assessment post RT.

Mature cystic teratoma is a benign ovarian tumor that usually presents in reproductive-age females. This tumor usually presents with pain abdomen, bloating, and a lump. Hereby, we describe a case of an ovarian dermoid presented with features of intestinal obstruction secondary to ileo-dermoid fistula formation. A 55-year-old postmenopausal female presented with lower abdominal pain, nausea, vomiting, and the feeling of a lump in the abdomen. On evaluation and imaging, it was diagnosed as a large ovarian dermoid (with malignant transformation) with multiple fistulous communications with ileal loops. The patient was managed by laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy, bowel resection, and anastomosis. The patient was discharged in good condition. The rupture of malignant ovarian dermoid followed by enterodermoid fistula formation and intestinal obstruction is rare. Complete cytoreduction and bowel repair should be considered for optimal results.

Vaginal vault dehiscence leading to bowel evisceration is a rare but potentially lethal surgical emergency. Various aetiologies have been reported in the literature, but the condition is most commonly seen after hysterectomy in post-menopausal women. Prompt reduction of the bowel is necessary to prevent ischaemic complications. Although most cases in the past have been managed by exploratory laparotomy, the condition may be managed laparoscopically if the prolapsed bowel is viable, giving the benefit of minimally invasive surgery to the patient. A hybrid approach of laparoscopic bowel reduction and per vaginal repair of the vault is technically simple and can be performed even by non-expert surgeons in an emergency setting.