Wandering spleen or hypermobile spleen results from the elongation or maldevelopment of the spleen’s suspensory ligaments. It is a rare clinical entity that mainly affects children. Among adults, it is most commonly found in females of active reproductive age. It may present as an asymptomatic mass in the abdomen, or it may present with intermittent abdominal discomfort because of torsion and spontaneous detorsion of the spleen. We present the case of a 37-year-old female who had features of intestinal obstruction with mass per abdomen. Exploratory laparotomy showed an infarcted spleen. A total splenectomy was performed.

A rapid and sensitive ultra-performance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS) method was developed and validated for the estimation of 17-desacetyl norgestimate in human plasma using solid-phase extraction technique. 17-desacetyl norgestimate D6 was used as the internal standard. Simple gradient chromatographic conditions and mass spectrometric detection enabled accurate and precise measurement of 17-desacetyl norgestimate at sub-picogram levels. The proposed method was validated for a linear range of 20–5000 pg/mL with a correlation coefficient Z 0.9988. The intra-run and inter-run precision and accuracy were within 10%. The overall recoveries for 17-desacetyl norgestimate and 17-desacetyl norgestimate D6 were 96.30%and 93.90%, respectively. The total run time was 4.5 min. The developed method was applied for the determination of the pharmacokinetic parameters of 17-desacetyl norgestimate following a single oral administration of a norgestimate and ethinyl estradiol 0.250 mg/0.035 mg tablets in 35 healthy female volunteers.

AIM: To evaluate anti cataract effect of phyllanthus niruri (PN) both in vitro and in vivo galactose induced cataract.METHODS: Aqueous extract of PN was evaluated against galactose-induced cataract both in vitro and in vivo. Galactosaemic cataract was induced in rats by feeding 300g/L galactose diet. PN was administered orally at three-dose levels 75, 150 and 300 mg/kg of body weight. Rat lenses were subjected to osmotic stress in vitro by incorporating galactose (30mmol/L) in the culture medium. The effect of PN (720 and 880μg/mL) on the glutathione (GSH) and polyols levels was studied.RESULTS: PN significantly delayed the onset and progression of cataract in vivo. In addition to the delay in reaching various stages of development of cataract, stage IV did not develop with lower doses till the completion of experimental period. Lenses treated with PN 880μg/mL concentration showed higher levels of GSH and decreased levels of polyols in vitro. In vivo, 75mg/kg significantly delayed the onset and progression of cataract as compared to control.CONCLUSION: PN delayed the process of cataracto-genesis in the experimental models. However, further study is required to extrapolate the use in human beings for the prevention of cataract.

Difficult femoral nonunion takes account of infective nonunion and aseptic gap nonunion. Limb length discrepancy and nonunion need to be tackled simultaneously. Conventionally Ilizarov ring fixator is in vogue but it has some limitations. To overcome these, monorail fixator is an effective alternative. Persistent good results can be obtained if we can get a perfect anatomical alignment and good regeneration.
External Fixators ; Femoral Fractures ; surgery ; Fracture Fixation ; instrumentation ; Fractures, Ununited ; surgery ; Humans ; Ilizarov Technique

A joint time–frequency localized three-band biorthogonal wavelet filter bank to compress Electrocardiogram signals is proposed in this work. Further, the use of adaptive thresholding and modified run-length encoding resulted in maximum data volume reduction while guaranteeing reconstructing quality. Using signal-to-noise ratio, compression ratio (C(R)), maximum absolute error (E(MA)), quality score (Q(s)), root mean square error, compression time (C(T)) and percentage root mean square difference the validity of the proposed approach is studied. The experimental results deduced that the performance of the proposed approach is better when compared to the two-band wavelet filter bank. The proposed compression method enables loss-less data transmission of medical signals to remote locations for therapeutic usage.
Electrocardiography ; Joints ; Methods ; Signal-To-Noise Ratio

Choriocarcinoma occurs mainly in the gonads, but an extragonadal origin has been reported, albeit infrequently. Primary hepatic choriocarcinoma (PHC) is a rare malignancy, with only 11 cases reported. Most cases reported were in males, with none reported in pregnant females. A 23-year-old primigravida presented with a large liver lesion involving the right lobe of the liver at 28 weeks of pregnancy. Preoperative imaging was suggestive of hepatocellular carcinoma. She underwent a non-anatomical resection of the liver lesion. Surprisingly, her postoperative histopathology revealed a diagnosis of PHC. Her blood workup showed elevated beta human chorionic gonadotrophin. She underwent a termination of her pregnancy at 32 weeks. Before initiating adjuvant chemotherapy four weeks after surgery, a whole-body PET scan revealed multiple bi-lobar liver and pelvic deposits. After a multidisciplinary team discussion, she was started on adjuvant chemotherapy. She is currently under regular follow-up, seven months post-surgery. PHC, one of the vascular lesions of the liver, poses a diagnostic and therapeutic challenge, warranting a multidisciplinary approach.

Elbow dislocation with concomitant diaphyseal fractures of radius and ulna has been reported rarely. This injury could be included in Monteggia equivalent lesions based on the mechanism of injury, radiographic pattern and method of treatment as described by Bado. We report a rare case of Monteggia equivalent lesion in an adult with unclear mechanism of injury. The possible mechanism of injury, its management and the follow-up results were described. An attempt to solve the controversy regarding whether labeling it as type 1 or type 2 was made.
Adult ; Elbow ; Humans ; Joint Dislocations ; Monteggia's Fracture ; Radius ; injuries ; Radius Fractures ; therapy ; Ulna

STUDY DESIGN: Prospective study. PURPOSE: To verify the feasibility and safety of outpatient microscopic lumbar discectomy (MLD) in a developing country. OVERVIEW OF LITERATURE: Outpatient MLD is advantageous in terms of cost effectiveness and avoidance of nosocomial infections. Safety of outpatient MLD has been well established in the developed nations of North America and Europe. There is no published study of outpatient MLD from the rest of the world, especially in developing countries. METHODS: Fifty-eight consecutive patients undergoing outpatient MLD with a median follow-up time of 12 months (range, 6–21 months) were included in this study. Simultaneous patient counseling was done by a surgical and anesthetic team preoperatively and pre-discharge. We collected and analyzed data pertaining to the demography, socioeconomic status, perioperative parameters, complications, and outcome assessment scores of the patients. RESULTS: The average patient age was 37.8±9.6 years (39 males, 19 females). Unilateral discectomy was performed in 55 patients, and bilateral discectomy in three. The majority (80.3%) of the patients were classified to lower middle (III) or upper lower (IV) class on the Modified Kuppuswamy Scale. The average operative time was 41.0±8.4 minutes with an average blood loss of 42.6±14.9 mL. The average postoperative stay was 5.5±0.7 hours and the successful discharge rate was 100%. Complications noted were postoperative nausea (n=8), urinary retention (n=2), meralgia paresthetica (n=3), delayed wound healing (n=2), and recurrence (n=1). The successful outcome rates were Visual Analog Scale (VAS) score leg pain, 93.1%; VAS score back pain, 89.6%; Oswestry Disability Index score, 91.3%; return to activities of daily living, 94.8%; return to work, 79.3%; patient satisfaction rate, 82.7%; and overall success rate, 88.4%. CONCLUSIONS: Outpatient MLD can be safely performed with success, even in the setting of a developing country, if the prerequisites of appropriate patient selection, arduous adherence to outpatient surgery protocol, competent surgical/anesthetic team, and infrastructure needed for conduction of microsurgery are met.

OBJECTIVES: This goal of this study was to shed light on the ecological context as a potential determinant of the infant mortality rate in nine high-focus states in India. METHODS: Data from the Annual Health Survey (2010-2011), the Census of India (2011), and the District Level Household and Facility Survey 3 (2007-08) were used in this study. In multiple regression analysis explanatory variable such as underdevelopment is measured by the non-working population, and income inequality, quantified as the proportion of households in the bottom wealth quintile. While, the trickle-down effect of education is measured by female literacy, and investment in health, as reflected by neonatal care facilities in primary health centres. RESULTS: A high spatial autocorrelation of district infant mortality rates was observed, and ecological factors were found to have a significant impact on district infant mortality rates. The result also revealed that non-working population and income inequality were found to have a negative effect on the district infant mortality rate. Additionally, female literacy and new-born care facilities were found to have an inverse association with the infant mortality rate. CONCLUSIONS: Interventions at the community level can reduce district infant mortality rates.
Censuses ; Education ; Family Characteristics ; Female ; Health Surveys ; Humans ; India* ; Infant ; Infant Mortality* ; Infant* ; Investments ; Literacy ; Socioeconomic Factors ; Spatial Analysis

Purpose: This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of parents or caregivers of children suffering from migraines at a tertiary care center in North India. Methods: We conducted a cross-sectional study involving 100 parents or caregivers, using convenience sampling. A 20-item questionnaire was administered in English and also translated into the local language (Hindi). The study included children with migraines who visited the pediatric outpatient department within a 6-month period (December 2022 to May 2023). Results: Over 60% of caregivers were aware of the chronic nature of the illness, its triggering factors, the role of family history, and the importance of lifestyle modifications. However, only 46% understood the pathophysiology of the illness, and 53% were aware of the medication used for childhood migraines. More than 85% of caregivers believed that recurrent headaches necessitate a doctor’s consultation, may require regular visits for optimal treatment, and were willing to alter their child’s lifestyle to prevent headaches. However, a significant percentage of caregivers (47%) practised self-medication for their children’s headaches. Most caregivers believed that lifestyle modifications and avoiding triggers were the best treatments for migraines. There were significant associations (P<0.05) between the level of education and responses to questions related to migraine definition, prophylaxis, treatment, investigations, lifestyle modifications, and screen time. Conclusion Most participants were well-educated on migraine, and their KAP regarding migraine prevention and treatment were generally adequate. However, the practice of self-medication without professional guidance is a significant concern.