Background: Many benefits are associated with early antenatal booking which include but are not limited to accurate dating, early detection of medical and obstetrical disorders that could make the pregnancy a high-risk pregnancy and affect its outcome, and objective assessment of maternal baselines such as identifying pre-existing risk factors, taking weight, blood pressure, blood sugar level and urinalysis. If done early, it may provide a picture of the pre-pregnancy condition of the woman. Aim: In the time period and setting looked at in this research, it was found that majority of the mothers booked late, however reasons for booking late were not sought as this was only a quantitative retrospective cohort study. From the outcomes measured, it was seen that anaemia was the most significant outcome associated with late bookers. PPH was also found to be significant amongst late bookers however other statistical analysis deemed it insignificant. Results The results of this study found that majority of the women (76,58%) booked late. Of these, women who booked late fell in the 15 to 25 age range, were of I-taukei ethnicity, were married, did domestic duties, attended secondary level of education and were multiparous. The most significant pregnancy outcome that was associated with late booking was found to be anaemia. The remaining outcomes were found to be insignificant.

DEMOGRAPHIC PROFILE, SUBSTANCE USE TRENDS AND ASSOCIATED PSYCHOTIC DISORDERS AMONG VETERANS WITH MENTAL HEALTH CONDITIONS: A RETROSPECTIVE COHORT STUDY OF US VETERANS Background: Amphetamine and other substances induced psychotic disorder and associated suicidal risk among hospitalized US veterans is not clear. Aims: To understand the demographic profile, substance use trends, psychotic disorders and suicide attempts in veterans hospitalized with acute Mental Health Conditions (MHC). Methods: Veterans Affairs Informatics and Computing Infrastructure Database (ICD) and codes were used to identify veterans hospitalized with MHC diagnosis between 1999 and 2022. Laboratory records used to determine types of substances used hospitalization frequency, all-cause mortality, suicide attempts and suicide outcomes. SAS was used for statistical analysis. Results: Among veterans with MHC, psychosis, manic-bipolar and PTSD were common diagnosis. Psychosis was comparatively less among males above 50 years of age, but prevalent among Hispanics. In general, substances use was significantly higher, and amphetamines were most used, followed by cannabis codeine, morphine, cocaine, barbiturates, fentanyl, and PCP among veterans with MHC. Amphetamine induced psychotic disorder persisted in 22.28% and other substance induced psychotic disorder persisted in 77.72% of veterans hospitalized with MHC. Psychosis was associated with higher rates of hospitalization, suicide attempts, and suicide death. Conclusions: Among US Veterans with MHC, amphetamine was most used substance associated with higher rates of psychotic disorders, hospitalization, suicide attempts, and death. ASEAN Journal of Psychiatry, Vol. 25 (7) July, 2024; 1-11.

Bilateral distal anterior cerebral artery (DACA) aneurysms also called “kissing aneurysms” or “mirror aneurysm” are extremely rare, accounting for only 0.2% of all intracranial aneurysms. There have only been a few examples of mirror DACA aneurysms reported in the literature. Here, we report a rare case of mirror DACA aneurysm in a middle aged female with its successful clipping. Patient was admitted with severe headache and altered sensorium. Computed tomography (CT) head was suggestive of anterior inter-hemispheric hematoma. Digital subtraction angiography (DSA) was done which was suggestive of two distal anterior cerebral artery aneurysms located at same anatomical position. It was treated through microsurgical clipping. Mirror image DACA aneurysms are rare occurrence. All patients with ruptured DACA aneurysms should have angiography with 3D reconstruction studies. This aids in determining the aneurysm’s morphology and planning treatment accordingly.

Humans ; Fasciitis, Necrotizing/diagnosis* ; Prospective Studies ; Organ Dysfunction Scores ; Prognosis

One of the most significant medical advancements in human history is the development of vaccines. Progress in vaccine development has always been greatly influenced by scientific human innovation. The main objective of vaccine development would be to acquire sufficient evidence of vaccine effectiveness, immunogenicity, safety, and/or quality to support requests for marketing approval. Vaccines are biological products that enhance the body’s defenses against infectious diseases. From the first smallpox vaccine to the latest notable coronavirus disease 2019 nasal vaccine, India has come a long way. The development of numerous vaccines, driven by scientific innovation and advancement, combined with researcher’s knowledge, has helped to reduce the global burden of disease and mortality rates. The Drugs and Cosmetics Rules of 1945 and the New Drugs and Clinical Trials Rules of 2019 specify the requirements and guidelines for CMC (chemistry, manufacturing, and controls) for all manufactured and imported vaccines, including those against coronavirus infections. This article provides an overview of the regulation pertaining to the development process, registration, and approval procedures for vaccines, particularly in India, along with their brief history.

Post-traumatic internal carotid artery pseudoaneurysm (ICA PSA) is a rare occurrence with high mortality rates, and with the advent of endovascular therapy, its treatment has shown drastic improvement in clinical as well as radiological outcomes. Here we are describing our experience with the CGuard embolic protection system (InspireMD, Tel Aviv, Israel) for the treatment of post-traumatic left ICA PSA in a 49-year-old male. New improved biomechanics and navigability have proven it to be a safe and efficient treatment modality for ICA PSA. However, a multicentric large-scale randomized trial is recommended to support this modality.

Severe alcoholic hepatitis has very high short term mortality and corticosteroids have been the mainstay of treatment for decades. Patients with Lille score >0.45 are considered non-responders to steroids and have poor outcome. Recently Orthotopic Liver Transplantation (OLT) is being increasingly used as rescue treatment for these patients, without waiting for 6 months of abstinence. Liver transplant is the only rescue treatment which can potentially provide long term benefit for patients who are steroid non-responders. However, with scarcity of organs being a concern, all patients of severe alcoholic hepatitis cannot be chosen for transplantation in an arbitrary way. There is a need for development of predictive tools and objective protocols to select patients who can justify the use of precious liver grafts. With a stringent criteria for selection of patients receiving the graft, liver transplantation in severe alcoholic hepatitis can become a viable rescue therapeutic option conferring significant survival advantage of both short- and long-term basis. The optimal criteria for selection will also prevent misuse of the liver donor pool as well as to prevent mortality in salvageable patients. Further research needs to be done to identify subset of patients which are at low risk of recidivism and also cannot be managed with pharmacotherapy alone. We reviewed the current knowledge on role of OLT in patient with acute severe alcoholic hepatitis in the present review.
Adrenal Cortex Hormones ; Alcoholics* ; Drug Therapy ; Fibrosis ; Hepatitis, Alcoholic* ; Humans ; Liver Diseases, Alcoholic ; Liver Transplantation* ; Liver* ; Mortality ; Steroids ; Tissue Donors ; Transplants

BACKGROUND: Most of the people associated with tailoring occupation in Nepal are still using mechanical sewing machine as an alternative of new technology for tailoring. Common peroneal nerves of both right and left legs are exposed to strenuous and chronic stress exerted by vibration and paddling of mechanical sewing machine. METHODS: The study included 30 healthy male tailors and 30 healthy male individuals. Anthropometric variables as well as cardio respiratory variables were determined for each subject. Standard Nerve Conduction Techniques using constant measured distances were applied to evaluate common peroneal nerve (motor) in both legs of each individual. Data were analyzed and compared between study and control groups using Man Whitney U test setting the significance level p ≤ 0.05. RESULTS: Anthropometric and cardio respiratory variables were not significantly altered between the study and control groups. The Compound muscle action potential (CMAP) latency of common peroneal nerves of both right [(11.29 ± 1.25 vs. 10.03 ± 1.37), P < 0.001] and left [(11.28 ± 1.38 vs. 10.05 ± 1.37), P < 0.01] legs was found to be significantly prolonged in study group as compared to control group. The Amp-CMAP of common peroneal nerves of both right [(4.57 ± 1.21 vs. 6.22 ± 1.72), P < 0.001] and left [(4.31 ± 1.55 vs. 6.25 ± 1.70), P < 0.001] legs was found significantly reduced in study group as compared to control group. Similarly, the motor nerve conduction velocity (MNCV) of common peroneal nerves of both right [(43.72 ± 3.25 vs. 47.49 ± 4.17), P < 0.001] and left [(42.51 ± 3.82 vs. 46.76 ± 4.51), P < 0.001] legs was also found to be significantly reduced in study group in comparison to control group. CONCLUSION: Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left common peroneal nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.
Action Potentials ; Humans ; Leg ; Male ; Nepal ; Neural Conduction ; Occupations ; Peroneal Nerve* ; Vibration*

A 17-year-old girl presented with complaints of headache and decreasing vision of one month's duration, without any history of fever, weight loss, or any evidence of an immuno-compromised state. Her neurological examination was normal, except for papilledema. Laboratory investigations were within normal limits, except for a slightly increased Erythrocyte Sedimentation Rate (ESR). Non-contrast computerized tomography of her head revealed complex mass in left frontal lobe with a concentric, slightly hyperdense, thickened wall, and moderate perilesional edema with mass effect. Differential diagnoses considered in this case were pilocytic astrocytoma, metastasis and abscess. Magnetic resonance imaging (MRI) obtained in 3.0 Tesla (3.0T) scanner revealed a lobulated outline cystic mass in the left frontal lobe with two concentric layers of T2 hypointense wall, with T2 hyperintensity between the concentric ring. Moderate perilesional edema and mass effect were seen. Post gadolinium study showed a markedly enhancing irregular wall with some enhancing nodular solid component. No restricted diffusion was seen in this mass in diffusion weighted imaging (DWI). Magnetic resonance spectroscopy (MRS) showed increased lactate and lipid peaks in the central part of this mass, although some areas at the wall and perilesional T2 hyperintensity showed an increased choline peak without significant decrease in N-acetylaspartate (NAA) level. Arterial spin labelling (ASL) and dynamic susceptibility contrast (DSC) enhanced perfusion study showed decrease in relative cerebral blood volume at this region. These features in MRI were suggestive of brain abscess. The patient underwent craniotomy with excision of a grayish nodular lesion. Abundant acid fast bacilli (AFB) in acid fast staining, and epithelioid cell granulomas, caseation necrosis and Langhans giant cells in histopathology, were conclusive of tubercular abscess. Tubercular brain abscess is a rare manifestation that simulates malignancy and cause diagnostic dilemma. MRI along with MRS and magnetic resonance perfusion studies, are powerful tools to differentiate lesions in such equivocal cases.
Abscess ; Adolescent ; Astrocytoma ; Blood Sedimentation ; Blood Volume ; Brain Abscess* ; Brain* ; Choline ; Craniotomy ; Diagnosis, Differential ; Diffusion ; Edema ; Epithelioid Cells ; Female ; Fever ; Frontal Lobe ; Gadolinium ; Giant Cells, Langhans ; Granuloma ; Head ; Headache ; Humans ; Lactic Acid ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Necrosis ; Neoplasm Metastasis ; Neurologic Examination ; Papilledema ; Perfusion ; Perfusion Imaging ; Weight Loss

Adult ; Aneurysm, Dissecting ; diagnostic imaging ; Humans ; Male ; Multidetector Computed Tomography ; Pulmonary Artery