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.

Background: High blood glucose levels in diabetes lead to vascular inflammation which accelerates atherosclerosis. Herein, Morin was orally administered in male Wistar rats, at the dose of 40 mg/kg for 28 days, and on the 27th and 28th day, ISO was administered to designate groups at the dose of 85 mg/kg s.c., to induce myocardial infarction. Results: Free radical generation, including ROS, in diabetes following ISO administration, leads to the activation of both intrinsic and extrinsic pathways of apoptosis. Morin significantly (p ≤ 0.05) reduced oxidative stress (GSH, MDA, SOD), cardiac injury markers (CK-MB, LDH), inflammation (TNF, IL-6), and apoptosis (Bax, ­BCl 2 , Caspase-3). In addition, it also reduced insulin and blood glucose levels. Akt/eNOS, Nrf2/HO-1, MAPK signaling pathways, and Insulin signal transduction pathways were positively modulated by morin pre-treatment. Conclusions Morin attenuated oxidative stress and inflammation and also modified the activity of various molecular pathways to mitigate cardiomyocyte damage during ISO-induced MI in diabetic rats.

Gestational trophoblastic diseases are histologically different types of tumors originating from the placenta with an incidence of 0.2–5.8/1000 pregnancies. Ectopic pregnancy is the implantation of the fertilized ovum outside the uterine cavity, and a 0.64% incidence is reported. Ectopic cornual pregnancy and molar pregnancy are rare cases, and a combination of these two rare entities occurring simultaneously is even rare and very few cases have been reported in the literature. A cornual pregnancy refers to the implantation and development of a gestational sac in one of the upper and lateral portions of the uterus, whereas an interstitial pregnancy is a gestational sac that implants within the proximal, intramural portion of the fallopian tube that is enveloped by the myometrium. We present one of the rare combinations of molar pregnancy and cornual/interstitial ectopic pregnancy in a 30‑year‑old G3 P1 who presented with a triad of amenorrhea, vaginal bleeding, and abdominal pain. Laparotomy was done in view of an ultrasound which was suggestive of a well‑defined complex thick‑walled lesion of size 3.2 × 3.3 with a gestational sac and no cardiac activity in the right fallopian tube/adnexa suggesting tubal ectopic pregnancy. Beta‑human chorionic gonadotropin (β‑hCG) levels were done and noted to be as high as 9998 mIU/mL. Intraoperatively, a cornual ectopic pregnancy was found with no hemoperitoneum which was excised. Histopathology showed chorionic villi with variable size and hydropic change, myxoid stromal changes, and cistern formation with polar trophoblastic proliferation, based on which a diagnosis of molar pregnancy was made. Although ultrasonography and higher than usual serum β‑hCG levels are diagnostic of uterine molar pregnancy, they do not yield a proper diagnosis in ectopic molar pregnancy, hence, making it difficult to distinguish between an early ectopic molar pregnancy from a nontrophoblastic tubal pregnancy. The final diagnosis is usually made only after histopathology. A high degree of clinical suspicion of cornual pregnancy followed by histopathological examination of the products of conception is the standard for arriving at an appropriate diagnosis. Serial serum β‑hCG level follow‑up is recommended to rule out its malignant potential.
Pregnancy, Cornual ; Pregnancy, Ectopic ; Hydatidiform Mole

With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, healthcare professionals (HCPs) have experienced high levels of stress and anxiety because of the high risk of infection for themselves and their families. This has led to acute sleep problems for HCP. This study was designed to assess the anxiety and sleep quality of HCPs during the COVID-19 pandemic. Methods: This cross-sectional study analyzed 370 HCPs employed at All India Institute of Medical Sciences Patna over 3 months, using the standard Generalized Anxiety Disorder 7-item scale (GAD-7) for suspected GAD and the Pittsburgh Sleep Quality Index for sleep quality. Results were tabulated and multivariable binomial logistic regression analysis was done to determine the predictors of poor sleep. Significance was attributed to p<0.05. Results: Of the 370 HCPs screened, 52 (14.1%; 95% confidence interval [CI], 10.8%–18.1%) were found to have GAD and 195 (52.7%; 95% CI, 47.5%–57.9%) were found to be poor sleepers. The presence of any addictive habit (adjusted odds ratio [AOR], 1.833; 95% CI, 1.12–2.8), unprotected contact with COVID-19 cases (AOR, 1.902; 95% CI, 1.1–3.3), and the presence of GAD (AOR, 5.57; 95% CI, 2.5–12.4) were found to be predictors of poor sleep quality among HCPs. Conclusion: A significant proportion of HCPs were found to have suspected GAD and were poor sleepers. This highlights the need for measures to confront this problem.

Tissue engineering is a research domain that deals with the growth of various kinds of tissues with the help of synthetic composites. With the culmination of nanotechnology and bioengineering, tissue engineering has emerged as an exciting domain. Recent literature describes its various applications in biomedical and biological sciences, such as facilitating the growth of tissue and organs, gene delivery, biosensor-based detection, etc. It deals with the development of biomimetics to repair, restore, maintain and amplify or strengthen several biological functions at the level of tissue and organs. Herein, the synthesis of nanocomposites based on polymers, along with their classification as conductive hydrogels and bioscaffolds, is comprehensively discussed. Furthermore, their implementation in numerous tissue engineering and regenerative medicine applications is also described. The limitations of tissue engineering are also discussed here. The present review highlights and summarizes the latest progress in the tissue engineering domain directed at functionalized nanomaterials.

Methods: Clinical and radiological features of 18 patients with CV junction abnormalities were analyzed between March 2017 and February 2019 at Sawai Man Singh Medical College, Jaipur, India. Dynamic computed tomography (CT) of the CV junction and CT angiographies of the neck with respect to the vertebral artery course at the C1–C2 joints were obtained and studied. Customized 3D models of the CV junction were then made based on the CT data, and rehearsal of the surgical procedure was performed using the 3D model one day prior to performing the actual procedure. Results: Seventeen patients had congenital-type AAD, whereas one patient had posttraumatic AAD. Improvements in neck pain and myelopathy were seen in all patients at the follow-up, as analyzed using the Visual Analog Scale and the Japanese Orthopedic Association Scale score, respectively. There were no cases of malpositioning of screws or any direct vertebral artery injury, although in one patient, the distal flow in the dominant vertebral artery was cut off as it got compressed between the bony arch and the screw head. Conclusions Compared to computer-generated images, 3D-printed models are a more practical approach for dealing with complex CV junction abnormalities. They provide surgeons with deep insights into the complex bony anomalies as well as variations in the vertebral artery courses, thereby improving surgical outcomes.

BACKGROUND/AIMS: Although symptoms related to the pelvic floor, such as pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS), are common in patients with chronic constipation (CC), its impact is not clear. Our aims were to investigate the following (1) compare pelvic floor symptom related dysfunction in irritable bowel syndrome with constipation (IBS-C) and functional constipation (FC), and (2) symptom correlation with findings on anorectal manometry (ARM) and balloon expulsion test. METHODS: This was a retrospective analysis of patients with CC undergoing ARM. IBS-C and FC were diagnosed by Rome III criteria. Pelvic Floor Distress Inventory (PFDI-20) was used to measure pelvic floor symptom distress. Constipation Severity Scale was used to assess constipation severity. RESULTS: A total of 107 patients underwent ARM (64 FC, 43 IBS-C). The overall PFDI-20 score in IBS-C was higher compared with FC patients (118.0 vs 79.2, P = 0.001). In those with IBS-C, POP, LUTS, and colorectal symptoms subscales were all higher compared with FC patients (P < 0.05 for each). On multivariable regression, IBS-C (P = 0.001) and higher constipation severity (P = 0.001) were both independently associated with higher PFDI scores. ARM parameters and abnormal balloon expulsion test did not correlate with PFDI scores. CONCLUSIONS: Compared with FC patients, those with IBS-C have significantly higher distress from pelvic floor specific symptoms including POP and LUTS. Higher abdominal pain among IBS-C patients did not entirely explain these findings. A diagnosis of IBS-C and higher constipation severity correlated with PFDI-20 scores, but dyssynergia did not.
Abdominal Pain ; Arm ; Ataxia ; Constipation ; Defecation ; Diagnosis ; Humans ; Irritable Bowel Syndrome ; Lower Urinary Tract Symptoms ; Manometry ; Pelvic Floor ; Pelvic Organ Prolapse ; Retrospective Studies