A 5-month-old male child was admitted with cough and fever, during which excessive bleeding occurred from a venipuncture site. Born from a third-degree consanguineous marriage, the child was developmentally normal. Routine blood tests showed a slightly elevated white blood cell count due to infection, while coagulation studies revealed prolonged PT and APTT. A mixing study indicated no inhibitors.Advanced testing showed normal levels of fibrinogen and factor VIII, but a significantly low factor V level (2.2%), indicating moderate factor V deficiency. The child received fresh frozen plasma (FFP) transfusions as needed and has been thriving with regular follow-ups. Genetic counseling was provided to the parents, who also had abnormal coagulation profiles but no bleeding tendencies. Genetic testing was offered but not pursued due to financial constraints. This case highlights the importance of awareness of inherited bleeding disorders in consanguineous families and the need for supportive management and counseling.

A 5-month-old male child was admitted with cough and fever, during which excessive bleeding occurred from a venipuncture site. Born from a third-degree consanguineous marriage, the child was developmentally normal. Routine blood tests showed a slightly elevated white blood cell count due to infection, while coagulation studies revealed prolonged PT and APTT. A mixing study indicated no inhibitors.Advanced testing showed normal levels of fibrinogen and factor VIII, but a significantly low factor V level (2.2%), indicating moderate factor V deficiency. The child received fresh frozen plasma (FFP) transfusions as needed and has been thriving with regular follow-ups. Genetic counseling was provided to the parents, who also had abnormal coagulation profiles but no bleeding tendencies. Genetic testing was offered but not pursued due to financial constraints. This case highlights the importance of awareness of inherited bleeding disorders in consanguineous families and the need for supportive management and counseling.

A 5-month-old male child was admitted with cough and fever, during which excessive bleeding occurred from a venipuncture site. Born from a third-degree consanguineous marriage, the child was developmentally normal. Routine blood tests showed a slightly elevated white blood cell count due to infection, while coagulation studies revealed prolonged PT and APTT. A mixing study indicated no inhibitors.Advanced testing showed normal levels of fibrinogen and factor VIII, but a significantly low factor V level (2.2%), indicating moderate factor V deficiency. The child received fresh frozen plasma (FFP) transfusions as needed and has been thriving with regular follow-ups. Genetic counseling was provided to the parents, who also had abnormal coagulation profiles but no bleeding tendencies. Genetic testing was offered but not pursued due to financial constraints. This case highlights the importance of awareness of inherited bleeding disorders in consanguineous families and the need for supportive management and counseling.

A 5-month-old male child was admitted with cough and fever, during which excessive bleeding occurred from a venipuncture site. Born from a third-degree consanguineous marriage, the child was developmentally normal. Routine blood tests showed a slightly elevated white blood cell count due to infection, while coagulation studies revealed prolonged PT and APTT. A mixing study indicated no inhibitors.Advanced testing showed normal levels of fibrinogen and factor VIII, but a significantly low factor V level (2.2%), indicating moderate factor V deficiency. The child received fresh frozen plasma (FFP) transfusions as needed and has been thriving with regular follow-ups. Genetic counseling was provided to the parents, who also had abnormal coagulation profiles but no bleeding tendencies. Genetic testing was offered but not pursued due to financial constraints. This case highlights the importance of awareness of inherited bleeding disorders in consanguineous families and the need for supportive management and counseling.

Objectives: Post-coronavirus disease 2019 (COVID-19) symptoms were widely reported.However, data on post-COVID-19 conditions following infection with the Omicron variant remained scarce. This prospective study was conducted to understand the prevalence, patterns, and duration of symptoms in patients who had recovered from COVID-19. Methods: A prospective study was conducted across 11 districts of Delhi, India, among individuals who had recovered from COVID-19. Study participants were enrolled, and then returned for post-recovery follow-up at 3 months and 6 months interval. Results The mean age of study participants was 42.07 years, with a standard deviation of 14.89 years. The majority of the participants (79.7%) reported experiencing post-COVID-19 symptoms. The most common symptoms included joint pain (36.0%), persistent dry cough (35.7%), anxiety (28.4%), and shortness of breath (27.1%). Other symptoms were persistent fatigue (21.6%), persistent headache (20.0%), forgetfulness (19.7%), and limb weakness (18.6%). The longest duration of symptom was observed to be anxiety (138.75±54.14 days), followed by fatigue (137.57±48.33 days), shortness of breath (131.89±60.21 days), and joint pain/swelling (131.59±58.76 days). At the first follow-up visit, 2.2% of participants presented with abnormal electrocardiogram readings, but no abnormalities were noticed during the second follow-up. Additionally, 4.06% of participants exhibited abnormal chest X-ray findings at the first follow-up, which decreased to 2.16% by the second visit. Conclusion: The most frequently reported post-COVID-19 symptoms were joint pain, dry cough, anxiety and shortness of breath. These clinical symptoms persisted for up to 6 months, with evidence of multi-system involvement. Consequently, findings highlighted the need for long-term follow-up during the post-COVID-19 period.

Methods: The study included 60 patients graded American Society of Anesthesiologists I and II and scheduled for thoracolumbar spine surgery involving >3 vertebral levels. The patients were divided into two groups: group KD (ketodex) and group F (fentanyl). The primary objective was to compare the postoperative analgesic requirements among the groups. The secondary objectives included a comparison of the intraoperative anesthetic requirements, postoperative pain scores, hemodynamic parameters, side effects of the study drugs, and the duration of post-anesthesia care unit stay of both the groups. Results: Ketodex use prolonged the mean time to first rescue analgesia (22.00±2.30 hours vs. 11.69±3.02 hours, p <0.001) and reduced the requirement of rescue analgesics in the first 24 hours postoperatively compared to fentanyl use (70.00±8.16 μg vs. 113.31±36.65 μg, p =0.03). The intraoperative requirement of desflurane was comparable between the groups (p >0.05). The postoperative pain scores were significantly lower in the group KD than in group F at most timepoints (p <0.05). Patients in group KD had a shorter post-anesthesia care unit stay than group F did (p <0.001). Conclusions Low-dose ketodex could be a safe substitute for fentanyl infusion when employed as an anesthetic adjuvant for patients undergoing thoracolumbar spine surgeries involving >3 vertebral levels to achieve prolonged analgesia without any opioidrelated side effects.

For decades, the gut has been thought to play an important role in sepsis pathogenesis. Sepsis is a serious life-threatening, chronic condition of an infection caused by dysregulated host immune response in most of the intensive care unit patients. Probiotics have dual roles in polymicrobial sepsis i.e. probiotics may induce sepsis in many cases and may prevent its prognosis in many cases. Experimental evidence from both pre-clinical and clinical studies have demonstrated that probiotic therapy ameliorates various inflammatory mediators such as tumor necrosis factor, interleukin-10 (IL-10), IL-6, etc., in septicemia. In addition, probiotic use was also found to reduce the severity of pathological conditions associated with irritable bowel disorder and prevent development of endocarditis in septicemia. On contrary, probiotic therapy in neonatal and athymic adult mice fail to provide any beneficial effects on mortality and sepsis-induced inflammation. Importantly, in few clinical trials probiotic use was found to aggravate sepsis by promoting inflammatory cascade rather than suppressing it. This review discusses various studies regarding the beneficial or harmful effects associated with probiotic therapy in sepsis.
Animals ; Humans ; Inflammation ; Mice ; Probiotics/therapeutic use* ; Sepsis/therapy* ; Tumor Necrosis Factor-alpha

Objectives: Menstrual hygiene management (MHM) in developing countries is linked to human rights, social justice, and the education and empowerment of young girls. The objective of this study was to assess menstrual hygiene practices and their determinants among adolescent girls,including school dropouts, and the effects of pad distribution programs in urban resettlement areas of Delhi, India. Methods: A cross-sectional study was conducted from March 2019 to February 2020 in urban resettlement colonies and 2 villages of Delhi among 1,130 adolescent girls aged 10 to 19 years, who were interviewed face to face. Results: In total, 954 participants (84.4%) used only disposable sanitary pads, 150 (13.3%) used both sanitary pads and cloths, and 26 (2.3%) used only cloths (n = 1,130). Most school-going girls utilized the scheme for pad distribution, but only two-thirds of the girls who were out of school utilized the scheme. In the adjusted analysis, girls with lower educational status, those who had dropped out of school, and those from the Muslim religious community were more likely to use cloths for MHM. Conclusion More than 4 out of 5 adolescent girls in Delhi in low-income neighborhoods preferred sanitary pads for MHM. The government free pad scheme reached near-universal utilization among school-going girls (97%), but the subsidized pad scheme for girls who did not attend school was insufficiently utilized (75%).

The use of aromatherapy for the reduction of anxiety levels during dental treatment procedures has been well established in the literature; however, there is limited evidence regarding its efficacy. The present meta-analysis is an attempt to assess the association between the use of aromatherapy and anxiety levels among dental patients.A comprehensive search was conducted across Medline, Scopus, Web of Science, EBSCO host, Cochrane databases, and Google Scholar for studies evaluating aromatherapy and anxiety level among dental patients. PRISMA guidelines were followed for the meta-analysis. Randomized and cluster-randomized trials comparing aromatherapy with controls were included. The random-effects model was used to assess the mean differences in anxiety levels of patients visiting dental OPD. The significance value was set at P < 0.05. Six studies were identified that met the requirements for inclusion. Aromatherapy was significantly associated with reduction in patient anxiety levels during dental treatment (pooled mean difference: -3.36 [95% CI, -3.77 – -2.95, P = 0.00001). Low heterogeneity was noted between studies (I2 = 1%, P = 0.41) analyzed in the meta-analysis. High certainty of the evidence was obtained from the association between the use of aromatherapy and dental anxiety. This meta-analysis suggests that aromatherapy is effective in reducing dental anxiety. When used judiciously, the results of this work should encourage the use of aromatherapy to reduce patient anxiety levels during dental procedures

Purpose: Intensity-modulated radiotherapy (IMRT) provides higher dose to target volumes and limits the dose to normal tissues. IMRT may be applied using either simultaneous integrated boost (SIB-IMRT) or sequential boost (SEQ-IMRT) technique. The objectives of this study were to compare acute toxicity and objective response rates between SIB-IMRT and SEQ-IMRT in patients with locally advanced head and neck cancer. Materials and Methods: Total 110 patients with locally advanced carcinoma of oropharynx, hypopharynx, and larynx were randomized equally into the two arms (SIB-IMRT vs. SEQ-IMRT). Patients in SIB-IMRT arm received dose of 66 Gy in 30 fractions, 5 days a week, over 6 weeks. SEQ-IMRT arm’s patients received 70 Gy in 35 fractions over 7 weeks. Weekly concurrent cisplatin chemotherapy was given in both arms. Patients were assessed for acute toxicities during the treatment and for objective response at 3 months after the radiotherapy. Results: Grade 3 dysphagia was significantly more with SIB-IMRT compared to SEQ-IMRT (72% vs. 41.2%; p = 0.006) but other toxicities including mucositis, dermatitis, xerostomia, weight-loss, incidence of nasogastric tube intubation and hospitalization for supportive management were similar in both the arms. Patients in SIB-IMRT arm showed better treatment-compliance and had significantly less treatment-interruption compared to SEQ-IMRT arm (p = 0.028). Objective response rates were similar in both the arms (p = 0.783). Conclusion Concurrent chemoradiation with SIB-IMRT for locally advanced head and neck cancer is well-tolerated and results in better treatment-compliance, similar objective response rates, comparable incidence of mucositis and higher incidence of grade 3 dysphagia compared to SEQ-IMRT.