Acute promyelocytic leukemia (APML) is considered to be sensitive to all-trans-retinoic acid (ATRA) which acts as a differentiating agent. ATRA is considered to be a well-tolerated agent and is known to achieve complete remission in acute promyelocytic leukemia. However, a few cases on long term all-trans-retinoic acid (ATRA) use can develop pseudotumor cerebri. Out of 32 patients with APML who were treated in our Centre over a 4-year-period, we encountered 6 patients who developed ATRA-related pseudotumor cerebri while on maintenance treatment. The patients ranged from 12 to 40 years of age. 3 patients complained of unbearable headache, 2 of diplopia and 1 of gross reduction in visual acuity. CT scans and MRI did not reveal any intracranial lesions. Cerebrospinal fluid (CSF) examination was normal with CSF manometry revealing a high CSF pressure (average of 345mmH2O). Fundoscopy revealed papilledema in 5 patients and optic atrophy in 1 patient. The patients were successfully managed with decrease dose/discontinuation of ATRA, use of acetazolamide, corticosteroids and therapeutic CSF drainage.

OBJECTIVETo assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondylar fractures of the humerus in children.

METHODSWe prospectively followed 52 children who presented with Gartland type 3 displaced supracondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing (n=23), followed by fall from height (n=20), road traffic accidents (n=5) and fall from standing height (n=2). In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn's criteria.

RESULTSLateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn's criteria, 90.4% patients showed satisfactory results.

CONCLUSIONLateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Bone Wires ; Child ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; surgery ; Male ; Prospective Studies

The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019(COVID-19)pandemic has almost collapsed the health care systems especially in the developing world.Given the disastrous outbreak of COVID-19 second wave in India,the health system of country was virtually at the brink of collapse.Therefore,to identify the factors that resulted into breakdown and the challenges,Indian healthcare system faced during the second wave of CO VID-19 pandemic,this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization(WHO).Applying integrated review approach,we found that the factors such as poor infrastructure,inadequate financing,lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India.Although health system in India faced these challenges from the very beginning,but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic.To sum-up given the likely future challenges of pandemic,while healthcare should be prioritized with adequate financing,strong capacity-building measures and integration of public and private sectors in India.Likewise fiscal stimulus,risk assessment,data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.

Poultry farming not only provides high nutritious food but also creates employment opportunity for rural masses. Documented evidences elaborates that helminth parasitism is most deciduous problem of chickens especially in developing world. Ascaridia (A.) galli, a nematode of small intestine, has been considered as the most common and important parasite of chicken. The present study was carried out to investigate prevalence and severity of A. galli in White Leghorn layers (housing type: battery cage and deep litter, 50 each) and Fayoumi-Rhode Island Red crossbred (male and female: 50 each) flock rearing at Government Poultry Farm, Dina, Punjab, Pakistan. Two hundred faecal samples were examined by using standard parasitological and McMaster egg counting technique. The overall prevalence was 24.5% at farm, 13% in White leghorn layer (battery cage=2%, deep litter=24%) and 36% in Fayoumi-Rhode Island Red (male=34%, female=38%). It was also observed that White leghorn layer rearing in deep litter had more severe infection (EPG=1920) of A. galli compare with battery cages birds (EPG=500). Parasite prevalence was significantly related with sex (P<0.05) in Fayoumi-Rhode Island Red and male birds had less number of average parasites (0.34±0.47) as compared to females (0.38±0.490). Additionally, female birds were under serious threat of infection (EPG=2270) compared with its counterpart (EPG=1250). Given the high infection rates, particular attention should be paid to management and provision of feed supplement to White leghorn layer housing in deep litter and female bird of Fayoumi-Rhode Island Red crossbred.

Background/Aims: This study aimed to study the endoscopic yield, appropriateness, and complications of pediatric endoscopy performed by adult gastroenterologists in an adult endoscopic suite. Methods: This a retrospective study in which records of all the patients less than 18 years of age who underwent endoscopy in the last 5 years were studied. The indications of endoscopy in children were categorized as appropriate or inappropriate per the latest guidelines by American Society for Gastrointestinal Endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Positive endoscopic yield was defined as the presence of any abnormality on endoscopy. Results: Among the total of 822 children (age <18 years), the most common indications were variceal surveillance/eradication in 157 (19.1%), followed by dyspepsia in 143 (17.4%), upper gastrointestinal (UGI) bleeding in 136 (16.5%), recurrent abdominal pain in 94 (11.4%), unexplained anemia in 74 (9%), recurrent vomiting in 50 (6.08%), chronic refractory gastroesophageal reflux disease in 34 (4.1%) and others; 780 out of 822 endoscopic procedures (94.9%) done in children were appropriate as per the guidelines. The endoscopic yield was 45.8%, highest in patients with UGI bleeding (71.3%), followed by variceal surveillance (54.8%), recurrent vomiting (38%), dyspepsia (37.8%), and recurrent abdominal pain (36%). Minor adverse events occurred in 7.3% of children. Conclusions Pediatric endoscopy performed by an experienced adult gastroenterologist may be acceptable if done in cooperation with a pediatrician.

Aims: This study was aimed to screen indigenous medicinal plants for their antibacterial potential against methicillin-resistant Staphylococcus aureus (MRSA). Methodology and results: Three indigenous plants (Nigella sativa, Zingiber officinale and Calotropis procera) and thymoquinone were screened for antibacterial activity against MRSA, isolated from septic wounds of patients admitted to Mayo Hospital Lahore, Pakistan. Isolated bacteria were screened for methicillin and cefoxitin resistance by the Kirby-Bauer method, followed by mecA gene-specific polymerase chain reaction (PCR). Confirmed MRSA was processed for antibacterial activity of plant extracts and thymoquinone followed by cytotoxicity assay of plant extract having least minimum inhibitory concentration (MIC) value. Out of total samples (n=100), S. aureus (29%), MRSA (26%) and vancomycin-resistant S. aureus (VRSA) (21.7%) isolates were recovered based on morphology, biochemical profile and antibiotic susceptibility testing. Nigella sativa showed the highest antibacterial activity (10.06 ± 6.53 mm) against MRSA followed by Z. officinale (4.06 ± 3.72 mm) and C. procera (3.65 ± 3.33 mm) in comparison to standard thymoquinone (17.93 ± 10.14 mm). The least MIC value recorded was for Z. officinale at 36.89 ± 3.75 μg/mL. Zingiber officinale was the most effective antibacterial agent, followed by N. sativa and C. procera and non-toxic for eukaryotic cells at all tested concentrations (1500 μg/mL to 2.92 μg/mL). Conclusion, significance and impact of study It was concluded that Z. officinale may be used as an effective alternative for treating septic wound infection in local or topical preparations. As pathogenic S. aureus is becoming life-threatening among antibiotic-resistant bacteria and traditional plants are in used for centuries to treat septic wound infections.
Plants, Medicinal ; Methicillin-Resistant Staphylococcus aureus--isolation & ; purification ;

Aims: This paper presents the report on biodiesel and biogas production at a laboratory scale from Scenedesmus strain. Methodology and results: Previously isolated and identified Scenedesmus were grown in 10 Liter flask using BG-11 media at 16 h light and 8 h dark cycle. Oven-dried biomass (20 g) from 16-day-old culture of Scenedesmus was finely grounded and subjected to lipids extraction by chloroform-methanol-NaCl mixture. Microalgal lipids (6 mL) were subjected to transesterification by using NaOH leading to the production of 5 mL biodiesel and 4 mL of glycerin. Biodiesel was rich in methyl esters of linoleic acid, phosphorothioc acid and dodecanoic acid, as shown by gas chromatography-mass spectrometry (GC-MS) analysis. Oven-dried microalgae (2 g) without lipid extraction and leftover biomass (2 g) after lipid extraction were subject to biogas production through anaerobic digestion. Biogas (34, 27 and 19 mL) were recorded respectively in oven-dried whole biomass; lipid extracted biomass and control over a period of 15 days of anaerobic digestion. Conclusion, significance and impact of study It was concluded that water bodies are rich in diverse algae, especially Scenedesmus sp., and this algae can be cultured to produce biodiesel and biogas. But the lipid accumulation potential of microalgae requires special treatment and lipid extraction methods are not up to the mark, which is a major bottleneck in biofuel production from microalgae.
Biofuels ; Scenedesmus--isolation & ; purification