Background: Anterior cerebral artery is an important terminal branch of internal carotid artery. It forms the anterior component of circle of Willis along with the anterior communicating artery. Circle of Willis is known for the frequent variations. The knowledge of anatomical variations in anterior cerebral artery is of considerable help to clinicians. Method: Morphology and variations of the anterior cerebral arteries and the anterior communicating artery were studied in 112 formalin preserved brain. Results: Variations were found in 31.3% (n=35). Variations of the segments in relation with size, course, communications and terminations of the anterior cerebral artery (ACA) were noted. These were divided into different groups like hypoplasia, aplasia, duplication and fenestrations. The mean diameter and length of the proximal segment of the anterior cerebral artery (A1) was 3.2 mm and 15.7 mm, anterior communicating artery (ACoA) was 2.4 mm and 3.3 mm and distal segment of the anterior cerebral artery (A2) was 2.5 mm and 42.1 mm respectively. Conclusion: Variation of anterior cerebral artery is common in this study of Indian human cadavers.

Thirty-two adult female ASA I patients (American Society of Anesthesiologists' grading) undergoing voluntary termination of pregnancy (VTP) under general anaesthesia were randomly divided into three groups. Patients received 0.6 mg/kg pentazocine intravenously five minutes prior to induction of anaesthesia along with either isotonic saline, or promethazine 0.5 mg/kg or metoclopramide 0.2 mg/kg. Anaesthesia was induced with intravenous thiopentone and maintained with nitrous oxide in oxygen and boluses of thiopentone. Vomiting and sedation were scored at the end of anaesthesia, one hour later and at the time of discharge. The mean vomiting score was comparable in the three groups. Though the mean dose of thiopentone used was significantly less in the promethazine group, the sedation scores and the duration of stay in the clinic were comparable in all the groups. It is concluded that promethazine and metoclopramide in the doses used are ineffective as antiemetic agents in outpatient gynaecological patients.
Abortion, Induced ; methods ; Adult ; Ambulatory Surgical Procedures ; methods ; Analysis of Variance ; Anesthesia, General ; adverse effects ; Chi-Square Distribution ; Dilatation and Curettage ; methods ; Female ; Humans ; Metoclopramide ; administration & dosage ; therapeutic use ; Pregnancy ; Promethazine ; administration & dosage ; therapeutic use ; Statistics, Nonparametric ; Vomiting ; etiology ; prevention & control

The EXIT (Ex utero intrapartum treatment) procedures have been, with a high degree of success, employed to treat a myriad types of fetal airway obstruction most commonly neck masses such as cystic hygroma and lymphangioma with ample plan including prenatal diagnosis by ultrasound scan or MRI. Before the advent of EXIT, formal documentations had been published with descriptions of intubation during intrapartum period and fetal airway protection either during normal or operative delivery. We report a 28-year-old gravida 2 para 1 who was referred to our Maternal Fetal Medicine (MFM) unit at 26 weeks and 3 days gestation with a foetal neck mass. We present a case of an successful EXIT procedure performed in the Lloyd Davies position with the hips abducted and flexed at 15 degrees as is employed during gynecologic laparoscopy surgery minus the Trendelenburg tilt. Both mother and baby are well. The benefits of this position are discussed.

The research aimed to evaluate the anti-Shigella and antacid activities of the methanolic extract of Limnophila indica.

Nuclear factor κB(NF-κB)is a ubiquitous regulator of the signalome and is indispensable for various biological cell functions.NF-κB consists of five transcription factors that execute both cytoplasmic and nuclear signaling processes in cells.NF-κB is the only signaling molecule that governs both pro-and anti-apoptotic,and pro-and anti-inflammatory responses.This is due to the canonical and non-canonical components of the NF-κB signaling pathway.Together,these pathways orchestrate cancer-related inflammation,hyperplasia,neoplasia,and metastasis.Non-canonical NF-κB pathways are particularly involved in the chemoresistance of cancer cells.In view of its pivotal role in cancer progression,NF-κB represents a potentially significant therapeutic target for modifying tumor cell behavior.Several phy-tochemicals are known to modulate NF-κB pathways through the stabilization of its inhibitor,IKB,by inhibiting phosphorylation and ubiquitination thereof.Several natural pharmacophores are known to inhibit the nuclear translocation of NF-κB and associated pro-inflammatory responses and cell survival pathways.In view of this and the high degree of specificity exhibited by various phytochemicals for the NF-κB component,we herein present an in-depth overview of these phytochemicals and discuss their mode of interaction with the NF-κB signaling pathways for controlling the fate of tumor cells for cancer-directed interventions.

Purpose: Trauma is a common cause of death worldwide and head injury is the most common form of trauma presented at the Emergency Department. Physiological scores are better for predicting outcome than anatomical scores. To reduce mortality rates, this study compared the capacity of the revised trauma scores (RTS) and the Glasgow coma scale- age- pressure (GAP) scores to predict the survival of patients and effectively channel resources. Methods: An observational study of head trauma patients aged 12 to 80 years was performed at a tertiary care center (N = 500). We noted demographic information, RTS and GAP trauma scores, and outcomes in terms of mortality or survival at 24 hours, 48 hours, and 7 days. Results: Of the 500 patients who were enrolled, 414 (82.8%) survived 24 hours, 373 (74.6%) survived 48 hours, and 265 (53%) survived after 7 days. Using the Receiver Operating Characteristic curve, the RTS score was a significantly better predictor of survival in patients with head trauma than the GAP score at 24 hours (p = 0.044) and 48 hours (p = 0.049) of admission. The results were not significantly different at 7 days (p = 0.240). Mortality or survival outcomes were not significantly different between the RTS and GAP scores (p = 0.373). Conclusion RTS appears to be a better early predictor for mortality (within 48 hours of admission) than the GAP score. The RTS was more effective in directing the triage of patients which improved survival rates in head trauma patients.

Management of congenital hyperinsulinemia of infancy (CHI) is challenging. A 4-month-old female infant with persistent hypoglycemia and elevated insulin levels was diagnosed with CHI. Gallium-68 DOTANOC positron emission tomography/computed tomography (PET/CT) scan (⁶⁸Ga-labeled [1,4,7,10-tetraazacyclododecane-N,N’,N’’,N’’’-tetraacetic acid]-1-NaI3-octreotide) demonstrated focal disease in the body of the pancreas. Genetic studies indicated paternal inheritance, making focal disease likely. She was started on diazoxide therapy with partial improvement in blood glucose levels. Due to a suboptimal response to diazoxide and the likelihood of focal disease amenable to surgery, a laparoscopic subtotal pancreatectomy with preservation of the head of the pancreas was performed. The biopsy demonstrated diffuse hyperplastic pancreatic islet cells on immunohistochemistry, indicative of diffuse rather than focal disease. Paternal inheritance is a recognized indicator of focal disease. Gallium-68 DOTANOC PET/CT scan is the only available imaging modality in South India as ¹⁸F-L-dihydroxyphenylalanine (DOPA) PET/CT scan is not available at present. A laparoscopic approach reduces the postoperative recovery time and morbidity in such patients. The absence of ¹⁸F-L-DOPA PET/CT scan and the limited supply of diazoxide makes the management of this complex condition more challenging in developing countries.
Biopsy ; Blood Glucose ; Congenital Hyperinsulinism* ; Developing Countries* ; Diazoxide ; Electrons ; Female ; Head ; Humans ; Hyperinsulinism ; Hypoglycemia ; Immunohistochemistry ; India ; Infant ; Insulin ; Islets of Langerhans ; Pancreas ; Pancreatectomy ; Positron-Emission Tomography and Computed Tomography ; Wills

Purpose: The purpose of this study was to determine the pattern of human leukocyte antigen (HLA)-DQ genotype in children diagnosed with celiac disease (CD) (biopsy proven), and to compare this with a control group; and secondarily, to correlate HLA genotypes with clinical profiles of CD. Methods: This cross-sectional comparative observational study included 26 controls and 52 patients diagnosed with CD who presented at Sir Padampat Mother and Child Health Institute, Jaipur, from May, 2017 to October, 2018. HLA DQ genotype was assessed for each patients and correlated with clinical profiles. Results: HLA DQ2/DQ8 genotypes were significantly more common in CD (present in 100.0% cases) than in controls (23.1%) in Northern India (Rajasthan). When HLA DQ2.5 and DQ8 were present together, individuals had significantly more atypical presentations and severe findings on duodenal biopsy. Similarly, patients with the HLA DQ 2.5 genotype were also predisposed to more severe endoscopic findings, while HLA DQ2.2 predisposed them to less severe biopsy findings. HLA DQ8 was significantly associated with later age at diagnosis (>5 years) and shorter stature. The highest HLA DQ relative risk (RR) for CD development was associated with HLA DQ2.5 and DQ2.2 in combination, followed by HLA DQ2.5 and DQ8 in combination, while HLA DQx.5 and HLA DQ2.2 together had the lowest risk. Conclusion HLA DQ2/DQ8 genotypes are strongly associated with pediatric CD patients in northern India. These genotypes and their combinations may be associated with different clinical presentations of CD, and may help predict severity of CD.

Dinucleotide repeat polymorphism based genetic analysis is a powerful approach to gain insight into rare genetic events like germline mosaicism and de novo mutations. The loss of heterozygosity of polymorphic dinucleotide loci at "deletional hotspot" of dystrophin gene can provide direct evidence of carrier status in female relatives of affected DMD patients with overlapped exonic deletions. We have used 4 STR loci of the central deletional hotspot of the dystrophin gene for genetic analysis in sporadic unrelated DMD families. Twenty-nine mothers of sporadic deletional cases were analysed and their carrier status was determined. Eighteen of them showed heterozygosity in the deleted loci suggesting the occurrence of de novo mutations. In 9 cases, the carrier status was indeterminate while 2 showed germline mosaicism. Our observations reiterated the importance of STR analysis in determining the status of mothers of sporadic deletional DMD cases in order to provide proper genetic counselling.
DNA Mutational Analysis ; Dystrophin/*genetics ; Female ; Germ-Line Mutation/genetics ; Haplotypes/genetics ; Heterozygote Detection ; Human ; Male ; Mosaicism/genetics ; Muscular Dystrophy, Duchenne/*genetics ; Mutation/*genetics ; Pedigree ; Sequence Deletion/genetics

INTRODUCTIONWith advances in interventional catheterisation, transcatheter device closure of atrial septal defect (ASD) is now a feasible option to open heart surgery, especially in patients with isolated ASD. We aim to compare the outcomes, benefits and costs between device closure versus standard open-heart surgery for ASD in Singapore.

MATERIALS AND METHODSThis is a comparative study between 2 cohorts with isolated secundum ASDs who underwent closure of ASD either by surgery or device, at the Department of Paediatrics, National University Hospital (NUH). The clinical outcomes, complications, length of stay and total costs incurred were compared.

RESULTSSurgical patients were at slightly greater risk of developing complications (RR=1.33; 95% CI, 0.30 to 5.95) than the device group. The median length of inpatient stay for the surgical group was significantly longer than that for the device group. Seventy percent of the patients in the device group did not need to be in ICU while 40% of patients in the surgery group stayed 2 or at least 3 days in ICU (P <0.001). The mean cost per successful procedure was $1511 (95% CI, -352 to 3375) higher for the device group patients despite a shorter length of stay in hospital.

CONCLUSIONSWe concluded that transcatheter device closure is an effective and safe alternative to surgery in the treatment of suitable ASDs. Despite the high cost of the device, direct and indirect benefits for the patients and their families, who undergo device occlusion include less morbidity, better cosmesis, shorter length of stay in hospital, faster recovery and shorter time taken to resume normal activities.

Adolescent ; Adult ; Child ; Child, Preschool ; Cohort Studies ; Confidence Intervals ; Feasibility Studies ; Female ; Health Care Costs ; Heart Septal Defects, Atrial ; economics ; surgery ; therapy ; Humans ; Intensive Care Units ; economics ; statistics & numerical data ; Length of Stay ; Male ; Retrospective Studies ; Risk ; Risk Factors ; Septal Occluder Device ; economics ; Singapore ; Treatment Outcome ; Young Adult