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In India's current economic situation, women's entrepreneurship is gaining traction. It has been hailed as a significant step forward in the country's fight against poverty. In India, there is a list of successful businesses in both the social and monetary spheres. They are doing a fantastic job. The growing presence of women in the business world as entrepreneurs has resulted in a shift in the country's business and monetary development sector qualities. Women-led groups are doing an outstanding job in the public light encouraging others and expanding job opportunities across the country. Regardless, a manageable growth of women business visionaries is required to advance a reasonable development in the country. This study develops a model that addresses the various elements that are essential for the development of women business visionaries in India. What India requires is a well-organized, all-encompassing technique in which the general people and the government share equal responsibility for the growth of women business visionaries.

Introduction: A 37 years old female was diagnosed with Adenomyosis and heavy bleeding during menstrual cycle. She had a history of irregular menstrual cycle and lower abdominal pain. The prescribed medicines did not help her much. So she did not take medication. She decided to take help from Yoga Prana Vidya (YPV) Trained Healer. This paper presents the case of Adenomyosis treated successfully with Yoga Prana Vidya Healing protocol. Methods: This is the case study method with detailed analysis of medical records of patient’s health condition pre and post YPV healing treatment applied as alternative medicine. This is the case of a 37 years old female diagnosed with Adenomyosis in December 2020. Initial symptom was bleeding got started after one week of completion of menstrual cycle. A Gynaecologist advised to get the Ultrasound done which diagnosed Adenomyosis. The doctor prescribed Hysteroscopic D&C followed by Mirena insertion. She used to have painful menstrual cycle with heavy flow every month. Results: Analysis of the patient’s health condition and medical case documents pre and post treatment shows that she got cured with Yoga Prana Vidya (YPV) healing method for Adenomyosis. Conclusion: This case study documents the evidence on the effective use of YPV in treating Adenomyosis and heavy bleeding during menstrual cycle. There is ample scope to conduct further research on the application of YPV as alternatively effective and low cost medicine for various medical conditions.

Introduction: India possibly carries the highest burden of antimicrobial resistant typhoidal salmonellae in the world. We report on the health-care ecosystem that produces data on antimicrobial resistance (AMR) testing and the resistance patterns of typhoidal Salmonella isolates in the city of Ahmedabad. Materials and Methods: Through municipality records and internet searches, we identified 1696 private and 83 public laboratories in the city; 4 medical colleges, 4 health-care institution attached laboratories, and 4 corporate laboratories (CLs) were performing culture and antibiotic sensitivity testing (AST), but only 2 medical colleges and 1 CL shared their data with us. There was considerable variation in culturing and sensitivity testing methodology across laboratories. Results: Out of 51,260 blood cultures, Salmonella isolates were detected in only 146 (0.28%). AST was conducted on 124 isolates, of which 67 (54%) were found resistant. Multidrug resistance was absent. Concurrent resistance to more than one antibiotic was very high, 88%, among the 67 resistant isolates. Ciprofloxacin resistance varied widely between the private and public sector laboratories. Notably, isolates from the private sector laboratory showed complete resistance to azithromycin. Conclusions: High resistance to ciprofloxacin and azithromycin observed in Ahmedabad may be due to the increased use of these two antibiotics in the public and private sectors, respectively. The need of the hour is to identify a representative sample of laboratories from both the public and the private sectors and encourage them to participate in the national AMR surveillance network.

Introduction: Widal test has been used extensively for the sero-diagnosis of Enteric fever in India, however, its accuracy and reliability are debatable. We studied widal testing and widal positivity rates in the entire city of Ahmedabad for the diagnosis of Enteric Fever. Methods We screened all 1700 possible diagnostic laboratory facilities, in Ahmedabad, in the public and private sector. We performed telephonic surveys for the initial filtering of facilities that could be conducting widal testing. It was followed by physical visits to probable facilities to confirm testing methods and preservation of reports of widal testing. We followed a systematic process for screening and selection of 23 laboratories, which conducted widal tests and had reliable data. While 14 laboratories refused to share data, data provided by three of them were inappropriate and couldn’t be used. We finally analyzed data from four large public hospitals, one private trust hospital and one corporate laboratory for variable periods in a span of 15 years (2000 – 2015). Result: The Widal testing rate was found to be 8.7% and widal positivity as 12.5% in a sample of 1.2 million clinically suspected in-patients. In 15 years, the private hospital had admitted 1/10th as many cases as all the public hospitals together. However, the widal testing and positivity rates were similar in both. We observed a lower proportion of widal positivity among children below 12 years and a disproportionate, but insignificant, gender distribution of widal positivity. Conclusion: This study indicates that the widal test, which is meant to be an initial screening test, is widely used in the city. We propose linkage of testing and reporting of widal with other more reliable and accurate tests such as Typhidot and blood culture in order to strengthen our knowledge of enteric fever epidemiology in India.

In recent years an increasing number of novel opioids have appeared on the illicit drug market and have been linked to the growing opioid crisis in the United States. It is suspected that synthetic-opioid-related deaths are underestimated since many laboratories either use a screening method that is not specific and sensitive enough for these compounds or testing is not performed for fentanyl and its related analogs in general. We describe a method for the analysis of 19 of the most current novel opioid drugs quantitatively in whole blood and serum, and 17 analytes qualitatively in urine using solid phase extraction with liquid chromatography-tandem mass spectrometry (LC-MS/MS). The limit of detection was determined to be at a minimum 0.25 ng/mL for beta-hydroxythiofentanyl, 0.05 ng/mL for butyryl/isobutyrylfentanyl, AH-7921, 2-furanylfentanyl, 4-ANPP, and U-47700; 0.025 ng/mL for MT-45, para-methoxybutyrylfentanyl, 4-methylphenethyl acetyl fentanyl, U-50488, acrylfentanyl, valerylfentanyl, and carfentanil; and 0.0125 ng/mL for para-fluorofentanyl, ortho-fluorofentanyl, para-fluorobutyrylfentanyl/FIBF, and alpha-methylfentanyl. The lower limit of quantitation was determined to be 0.1 ng/mL for all analytes except AH-7921, U-47700, U-50488 which were 0.05 ng/mL and beta-hydroxythiofentanyl which was 0.5 ng/mL. The method was validated successfully according to a Scientific Working Group in Forensic Toxicology (SWGTOX) compliant approach. This method was applied to the analysis of 2758 samples between October 2016 and September 2017. It was determined that 4-ANPP, furanylfentanyl, and carfentanil were the 3 most prevalent fentanyl related compounds detected: 56.1% of cases were positive for 4-ANPP, 44.5% were positive for furanylfentanyl, and 25.2% cases were positive for carfentanil.

Pilomatricoma is a relatively uncommon benign tumor derived from the matrix of hair follicles. Multiple pilomatricomas may arise sporadically or in association with other disease entities. These entities include myotonic dystrophy type-1, a multisystem disorder that confers increased susceptibility to developing neoplasms, as well as familial adenomatous polyposis-related syndromes (including Gardner syndrome) and others. Here we present two case reports of multiple pilomatricomas that were initially misidentified clinically. We discuss pilomatricoma as a differential diagnosis of multiple skin nodules, its association with myotonic dystrophy in one of two patients, and describe its distinguishing microscopic features. We emphasize the importance of screening patients with multiple pilomatricomas for various syndromes that predispose to malignancy.

Study Objective Endometriosis of the urinary system accounts for less than 1% of all endometriosis, wherein bladder endometriosis is the most common. Bladder endometriosis is defined as endometriosis infiltrating the detrusor muscle and represents 85% of urinary tract endometriosis 1 , 2 . Segmental bladder resection/partial cystectomy is the bladder-preserving surgery and offers the complete removal of bladder endometriotic nodules 3 , 4 . Laparoscopic/robotic excision increases the chances of complete removal of nodules but may lead to inadvertent removal of excess bladder wall and increase the risk of complications, especially in cases of large lesions in close proximity to ureteric orifices. Thus, simultaneous laparoscopy and cystoscopy offers the most effective way of complete resection of bladder endometriotic nodules, relieving symptoms and minimizing intraoperative and postoperative complications and recurrence rates in patients 5 , 6 , 7 , 8 , 9 , 10 , 11 . This article with accompanying video describes the systematic approach and step-by-step surgical excision of a bladder endometriotic nodule in a patient with frozen pelvis. Design Step-by-step surgical excision of a bladder endometriotic nodule by simultaneous cystoscopy and laparoscopy. (Canadain Task Force classification: level III) Setting Jyoti Hospital and Minimum Invasive Surgery Center, Ahmedabad, India. Patient A 41-year-old women, P2L2, presented with cyclical dysmenorrhea, dysuria, and chronic pelvic pain. Informed consent was obtained from the patient, and the local institutional board provided the approval. Intervention Simultaneous cystoscopy and laparoscopy. Measurements and Main Results A preoperative assessment was done with transvaginal ultrasonography with a partially full bladder that showed an intravesical 3-cm endometriotic nodule along with chocolate cysts of the ovary and adenomyosis of the uterus. A simultaneous cystoscopy by a urologist and laparoscopy by a gynecologist was performed. On cystoscopy the nodule was seen away from both the ureteric orifices. The nodule was marked cystoscopically with a monopolar needle and laparoscopically with bipolar scissors. Laparoscopy began with a full inspection of the abdomen, pelvis, and adhesions. Dissection started from the left round ligament, and both paravesical spaces were dissected gently, keeping the bladder partially full. Good uterine manipulation helped to delineate vaginal fornices during dissection. Dissection continued over the isthmus, and bladder was gently separated from the isthmus. The bladder was partially filled with methylene blue and intentionally cut opened to excise the demarcated bladder nodule with a monopolar hook, taking a disease-free margin of 5 mm [12] . Two stay sutures were taken at both the lateral angles of the bladder, and suture ends were brought outside the abdomen to facilitate closure of the bladder transversely. After mobilization of the bladder, both uterine vascular bundles were desiccated with bipolar and laparoscopic hysterectomy. Vaginal closure was done away from bladder stitches. The patient was discharged on day 3 with catheter and DJ stents. On day 21, 3-dimensional computed tomography cystogram showed adequate bladder volume. Catheter and DJ stents were removed, low-pressure cystoscopy showed a smooth stitch line with mucosa over it and no residual endometriosis. The patient was found to have no symptoms at the 2-year follow up. Conclusion The video demonstrates the feasibility of simultaneous laparoscopic and cystoscopic approach for excision of a bladder endometriotic nodule. Marking the nodule by simultaneous cystoscopy and laparoscopy before excision helps in removing the disease completely and avoiding unnecessary normal bladder wall excision, thus reducing the risk of recurrence and resultant small bladder symptoms.

Multiple intracellular and extracellular regulatory factors affect transcription of the tyrosine hydroxylase (TH) gene encoding the rate-limiting enzyme in the biosynthesis of the neurotransmitters dopamine, norepinephrine and epinephrine. Short chain fatty acids like butyrate are known to alter TH gene expression, but the mechanism of action is unknown. In this report, transient transfection assays identified the proximal TH promoter to contain sufficient genetic information to confer butyrate responsiveness to a reporter gene. Deletion studies and gel shift analyses revealed that the promoter region spanning the cAMP response element is an absolute requirement for transcriptional activation by butyrate. The branched short chain fatty acid valproate is used for seizure control in humans. Significantly, it has a similar aliphatic structure to butyrate, and it was found to have similar effects on TH in PC12 cells. Site-directed mutagenesis indicated that the effects of both fatty acids were mediated through the canonical CRE. Butyrate treatment also resulted in CREB phosphorylation without changing CREB protein levels. The increased phosphorylation of CREB correlated with accumulation of TH mRNA. The adenylate cyclase inhibitor dideoxyadenosine blocked both CREB phosphorylation and accumulation of TH mRNA. The data are consistent with the conclusion that butyrate induces post-translational modifications of pre-existing CREB molecules in a cAMP/PKA-dependent manner to alter TH transcription. These results support the role of butyrate as a novel exogenous regulatory factor in TH gene expression. Our data delineate a molecular mechanism through which diet-derived environmental signals (e.g. butyrate) can modulate catecholaminergic systems by affecting TH gene transcription.

Mycetoma is a chronic, granulomatous disease of the skin, and subcutaneous tissue, which sometimes involves muscle, bones, and neighboring organs. It is characterized by tumefaction, abscess formation, and fistulae with discharge of grains from sinuses. Mycetoma can be caused by various species of fungi (eumycetoma) and aerobic actinomycetes (actinomycetoma), which occur as saprophytes in soil or plants. A tentative diagnosis sufficient to initiate treatment may be made on the basis of grain color. For instance, melanoid grains are always caused by fungi and ochroid or pale grains by actinomycetes. Although this is not the thumbrule, there are exceptional reports too. As trauma favors infection, most lesions are on the foot and lower leg but they may occur anywhere on the body mimicking actinomycosis. However, lab investigations and culture are important tool to differentiate apart from the clinical picture. We are reporting atypical case with unusual site of presentation (perineum and thigh) of mycetoma.

BACKGROUND: Despite their well noted therapeutic benefits for heart failure (HF), angiotensin-converting enzyme (ACE) inhibitors may be underprescribed and underdosed among older nursing home patients. OBJECTIVES: To assess the use of ACE inhibitor therapy in older (≤70 years) nursing home residents with systolic heart failure (HF). DESIGN: A cross-sectional, retrospective analysis. SETTING: Five long-term care facilities in Providence, Rhode Island. SUBJECTS: Adults aged 70 years or older with left ventricular (LV) ejection fractions ≤40%. MEASUREMENTS: New York Heart Association (NYHA) class, comorbid diseases, and cardiac medications with logistic regression analysis to clarify their bearing on the prescription of ACE inhibitors. RESULTS: Of the 819 nursing home residents who were evaluated, 119 (24 men, 95 women) fulfilled exacting entry criteria, i.e., heart failure signs/symptoms and documented LV systolic dysfunction. Forty-one of these 119 (35%) older persons were receiving ACE inhibitor therapy, predominantly in doses (≤50 mg captopril/day or ≤5 mg enalapril/day) less than those of proven therapeutic efficacy. Compared with older residents not receiving ACE inhibitors, those receiving ACE inhibitors included fewer with NYHA Class I HF (0 vs 21%, P = .017), more men (58 vs 28%, P ≤ .01), and more people with hypertension (61 vs 35%, P ≤ .01). In contrast, diuretics were prescribed more frequently among those not receiving ACE inhibitors (83 vs 56%, P ≤ .001). CONCLUSIONS: ACE inhibitors are underprescribed and underdosed among elderly nursing home patients carefully screened to include systolic HF and no contraindications to the medication. ACE inhibitors are particularly underused in those elderly with NYHA Class I HF and in those receiving diuretics.

Synovial sarcoma is very rare and highly malignant tumour of the head and neck. Only 3 cases of synovial sarcoma have been treated 1980-1997 in Kasturba Medical College, Manipal. Treat-ment involved extensive surgical resection of the tumour (with neck dissection in two cases); and post- operative radiotherapy and chemotherapy in one case. Behaviour of the tumour was followed up till August 1997. It remains in our experience that synovial sarcoma, though a tumour or poor prognosis if treated by adequate tumour resection and adjunctive radiotherapy and chemotherapy, has good patient survival.

Invasive mycotic infections can be effectively treated if rapid identification of fungus is obtained. We reported a case of coinfection byAspergillusandRhizopussp. involving nose, paranasal sinuses, orbit, and brain in a 68-year-old known hypertensive male. He was presented to ENT OPD with history of fever and intermittent headache since fifteen days along with history of right-sided nasal obstruction and proptosis since seven days. CT scan of brain and paranasal sinuses showed findings of pansinusitis with cellulitic changes in right orbit. MRI confirmed the same along with features of intracranial extension with focal meningitis in right frontotemporal region. Laboratory parameters did not conclude much except for leucocytosis and hyponatremia. Patient was taken for endoscopic debridement from nose and paranasal sinuses, and tissue was sent for microbiological and histopathological examination. Minced tissue was processed, and after 48 hrs of incubation two types of growth were identified, one was yellowish, granular, and powdery consistent withAspergillussp., and another was cottony and woolly consistent withRhizopussp. LCB mount confirmed presence ofAspergillus flavusandRhizopus arrhizus. Patient responded to therapy with IV amphotericin B and surgical debridement. On discharge patient's condition was good.

In this paper we introduce a new algorithm for multi-focus image fusion based on edge information of the source images and K-mean segmentation. The basic idea is to extract the edge information of the source images, divide the images into blocks and then select the blocks with higher edge information to construct the resultant fused image. The pixels in the unallocated blocks of the fused image are then selected from the source images by recursive K-mean segmentation and comparison of the corresponding segments of the source images. The major achievement of this algorithm is its excellent sharpness, clarity, superior edge preservation with minimum fusion artifacts.

We report a case of retained uterine fundus after vaginal hysterectomy that was subsequently removed at laparoscopy. The patient had undergone vaginal hysterectomy 8 years previously and came to our hospital with abdominal pain. Examination revealed a supravesical mass. Laparoscopy was performed and showed the uterine fundus with its cornual attachments. The mass was excised and sent for histopathologic analysis, which confirmed that it was uterine tissue. Retained uterine tissue or myoma tissue has been reported, usually after morcellation. However, to our knowledge, our case is only the second reported case of retained fundus after complete vaginal hysterectomy. Because of adhesions, it is possible that the uterus was not completely removed. In such cases, laparoscopic assistance is extremely useful.

Solitary myofibroma is a recently described benign neoplasm of the skin or superficial soft tissue and it represents the adult counterpart of infantile myofibromatosis. This new clinicopathological entity is being recognized increasingly. A case of solitary myofibroma occurring in the pinna of a 50-year-old woman is presented. Such a lesion occurring in the pinna of an adult has not been reported in the literature.

Ectopic thyroid is an uncommon embryological aberrationcharacterized by the presence of thyroid tissue at a site other than in its usual pretracheal region. Usually it occurs along the path of descent of the developing thyroid primodium from the foramen caecum, commonest being lingual followed by sublingual and in the anterior midline of neck at, or below, the level of the hyoid bone. It is unusual for lingual thyroid to present simultaneously with another ectopic thyroid; reported here are two such cases.

Vault dehiscence and evisceration of peritoneal contents is a rare complication following total hysterectomy. A 43-yearold lady presented with history of something soft coming out per vaginum. She underwent total laparoscopic hysterectomy 2 months back for 16-week fibroid uterus. The surgery was uneventful, vaginal vault was sutured laparoscopically with no 1 polyglactin, interrupted figure of eight sutures. She was discharged after 48 h with uneventful recovery and subsequently presented with mass protruding per vaginum. Speculum examination showed loops of small bowel protruding in the vagina (Fig. 1). She was hospitalized and scheduled for reduction of the prolapsed bowel with vault repair. On examination under anaesthesia, there was complete dehiscence of the vaginal vault with loops of small bowel protruding through the defect. To maintain the pneumoperitoneum vagina was blocked using a simple vaginal tampon soaked in betadine solution (Fig. 2) [1]. On Laparoscopic evaluation the entire vault was deficient. There were no bowel, bladder or omental adhesions to the vault. The prolapsed ileal loops were seen just at the vault, with healthy pink colour and regular peristalsis. On giving Trendelenburg’s position the reposition was smooth. After confirming that the vault was free of any adhesions, the vault was closed vaginally using interrupted no 1 Polydioxone II sutures (Fig. 3). Patient was discharged on the third post-operative day and is asymptomatic at 6-month follow-up. Vaginal vault dehiscence with evisceration posthysterectomy can occur up to few weeks to even few years after hysterectomy. The commonest organ to eviscerate is small bowel, particularly terminal ileum. Several factors which may contribute to weakness of vaginal apex are poor surgical techniques, post-operative wound haematoma and cuff infection, post-menopausal status, any activity resulting in increased intra-abdominal pressure, early resumption of sexual activity, chronic steroid administration, history of previous radiotherapy in cases of radical hysterectomy [2] and systemic illness like diabetes mellitus and immunecompromised status [3].

Endoscopic endonasal dacryocystorhinostomy [EDCR] is considered to be a superior alternative technique to the conventional external dacryocystorhinostomy [DCR], both in primary and secondary cases. It is of particular value in children and young adults as it avoids an external scar. Sixteen cases of chronic dacryo-cystitis were treated by the endoscopic technique, including 8 revision cases of failed external approach. In all cases except one, a patent nasolacrimal fistula was noted, with a success rate of 93.7%. The authors share their experience in EDCR and review the relevant literature.

A 38-year-old woman who had had pelvic heaviness for 1 month was admitted for laparoscopic myomectomy. She had 2 children, both delivered by cesarean section. Clinical examination revealed a pelvic mass measuring up to 24 weeks in size. Ultrasonography revealed a bulky uterus with a posterior wall myoma measuring 15!7 cm. Laparoscopy revealed a 15-cm left cornual pedunculated myoma that was vascular and had large feeder vessels arising from the omentum. The myoma occupied the entire pouch of Douglas. Another 2-cm posterior wall intramural myoma was also observed.

Effects of Intrauterine Exposure to Cocaine, Opium and Methadone on Gut Myoelectrical Activity of Neonates

Developmental Delay in Normal Gastric Wave Pattern Formation in Neonates Measured by Electrogastrography

The objectives of the study were to accumulate information on provision, acceptability, and nutritional adequacy of meals provided, and to compare the nutritional content both with the recommended daily allowance figures and with the nutritional content of meals provided for the children's indigenous counterparts.