Though Noradrenaline infusion is showing promising results for management of spinal anaesthesia-induced hypotension, there are very few studies that evaluated intermittent intravenous (i.v) bolus dose of inj. Noradrenaline. So, we aimed to compare intermittent i.v. bolus of phenylephrine and noradrenaline in management of spinal anaesthesia-induced hypotension in elective LSCS.This randomized controlled study was conducted in obstetrics operation theatre from August 2022 to April 2023. Intermittent I.V. bolus dose of Phenylephrine (Group A) was compared with intermittent I.V. bolus dose of Noradrenaline (Group B). Data regarding baseline heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), hypotension, bradycardia, total number of bolus doses of study drugs required, intraoperative nausea and vomiting, neonatal Apgar score at one and 5minute, and umbilical cord blood gas analysis at birth were collected and analyzed using standard statistical tests.HR at 9 minute, 12 minutes, 15 minutes, and 20 minutes after spinal anaesthesia was significantly lower in group A than in group B. No statistically significant difference was found between the groups in terms of SBP, DBP, MAP, APGAR score at one and five minutes, UA pH, UA PO2, UA PCO2, UA HCO, UV pH, UV PO2, UV PCO2, UV HCO. Incidence of nausea and vomiting was higher in group A than in group B (P-value = 0.006).Thoughintermittent I.V. bolus of both Phenylephrine and Noradrenaline are equally efficacious in management of spinal anaesthesia-induced hypotension during elective LSCS, inj. Noradrenaline is a better option with fewer adverse effects.

Background: De Quervain (DQ) tenosynovitis is a frequent source of wrist pain amongst middle-aged adults. Steroid injections are recommended after conservative methods fail, despite unclear mechanisms. The effectiveness of platelet-rich plasma (PRP) for DQ is not well-studied. To address this gap, we conducted a randomised controlled trial comparing the efficacy of PRP and corticosteroid (CS) injections for treating DQ. Methods: This prospective, randomised and open-label trial was conducted at a tertiary care hospital in India. Adult patients aged 18-60 were randomly assigned to receive either ultrasound-guided triamcinolone acetonide injections or autologous PRP in the first extensor compartment. Outcomes were measured at baseline and at 1, 4 and 12 weeks using the VAS and quick disabilities of arm, shoulder and hand (QuickDASH) questionnaires. Results: Eighty-six age- and sex-matched patients, with an average disease duration of 14 weeks in both groups, were enrolled. Both the CS and PRP groups demonstrated a significant reduction in pain scores and improvement in functions at 1, 4 and 12 weeks. However, between the groups, the degree of improvement in pain was more in CS group at 1 week and similar improvements between the groups at 4 and 12 weeks. Regarding hand function, the CS group exhibited notable at 1 and 4 weeks based on the QuickDASH scale. Yet, by the 12th week, hand function improvements were comparable between both groups. Conclusions: This study suggests that PRP is equivalent to CS in reducing pain in DQ tenosynovitis. Hand function improved more significantly in the CS group at 1 and 4 weeks post-injection. Both PRP and CS are safe and equally effective treatments for DQ. Level of Evidence: Level I (Therapeutic).

Mitochondrial CPT1-mediated fatty acid β-oxidation (FAO) critically contributes to the accelerated metastatic expansion of triple negative breast cancer (TNBC). Hence, inhibition of FAO through active CPT1 targeting could be a promising therapeutic approach in anti-TNBC therapies. Herein, we strategically synthesized a pyrene chain end labelled copolymer bearing biotin pendants, CP4, that actively targets CPT1 and efficiently blocks FAO in metastatic TNBC. Following the comprehensive characterization and synthesis of CP4, in silico negative docking score and Ramachandran plot analyses confirmed its on-target binding potential to CPT1. As a result, CP4 disrupts mitochondrial membrane potential, generates excessive ROS, and restricts excessive ATP production by impairing mitochondrial respiration, glycolytic function, and FAO. Subsequently, CP4 suppressed FA uptake and regulated FAO-associated gene expressions, exhibiting successive metastatic growth inhibition and apoptosis induction. Also, in an animal model, CP4 demonstrated active binding to CPT1, as evidenced by the significant depletion of CPT1A expression in tumor and liver tissue, akin to the specific CPT1-targeted drug. This active targeting of CPT1 has further consolidated the healing of altered lipid and oxidative stress, resulting in remarkable tumor regression, highlighting CP4 as a promising anticancer therapy focused on mitochondrial FAO, advancing future breast cancer treatments.

To evaluate the role of serum procalcitonin (PCT) as a diagnostic tool to differentiate bacterial sepsis from flare-ups during febrile episodes in children with known rheumatic disorders compared to other inflammatory markers like C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Previously diagnosed patients with known rheumatic disorders presenting in emergency or outpatient departments with febrile episodes were included in the study. Blood samples were collected upon admission to test for signs of infection, including serum PCT levels with routine laboratory and radiological tests. Patients with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) were stratified using the Juvenile Arthritis Disease Activity Score (JADAS-27) and SLE Disease Activity Index (SLEDAI) respectively. Patients without bacterial focus with high disease activity were included in the flare-up group and the rest in the sepsis cohort. The diagnostic value of PCT was calculated using receiver operating characteristic (ROC) curve analysis. In the study (N=73), 41 (56.2%) patients were previously diagnosed with JIA and 28 (38.3%) had SLE. 38 patients had definite evidence of sepsis and 35 had disease flare-ups as per respective disease activity scores. There was a significant difference in PCT and CRP among the flare-up and sepsis groups. For detecting sepsis, the area under curve (0.959), sensitivity (94.7%), and specificity (74.3%) of PCT at a cut-off of 0.275 ng/mL were significantly better than those of CRP. PCT is a better diagnostic test than CRP or ESR during febrile episodes in differentiating flare-ups from infection and PCT >0.275 ng/mL indicates bacterial infection with good specificity and sensitivity in children with low disease activity.

The retrospective study by Lew et al (2022) examined the rising hospitalization rates for chronic pancreatitis (CP) and its association with pancreatic ductal adenocarcinoma (PDAC), revealing significant ethno-racial disparities and risk factors. Overweight black men aged 40-59 years and white men over 40 years with higher incomes showed an elevated risk of PDAC among CP patients. The study, which included 14.2 million admissions from 2016-2017, found that 2.6% of adult patients were diagnosed with CP, with white males being the majority. Multivariate regression analysis identified men, black individuals, those aged 40-59 years, and individuals with a body mass index (BMI) between 25 and 29.9 as having an increased risk for CP. Moreover, 0.78% of CP patients also had PDAC, with older age and BMI being significant risk factors for developing PDAC in CP patients. The study also highlighted disparities in healthcare access and utilization among different socioeconomic and ethno-racial groups, which may impact the risk and outcomes of CP and PDAC.

Pancreatic cancer (PanCa) is a catastrophic disease, being third lethal in both the genders around the globe. The possible reasons are extreme disease invasiveness, highly fibrotic and desmoplastic stroma, dearth of confirmatory diagnostic approaches and resistance to chemotherapeutics. This inimitable tumor microenvironment (TME) or desmoplasia with excessive extracellular matrix accumulation, create an extremely hypovascular, hypoxic and nutrient-deficient zone inside the tumor. To survive, grow and proliferate in such tough TME, pancreatic tumor and stromal cells transform their metabolism. Transformed glucose, glutamine, fat, nucleotide metabolism and inter-metabolite communication between tumor and TME in synergism, impart therapy resistance, and immunosuppression in PanCa. Thus, a finer knowledge of altered metabolism would uncover its metabolic susceptibilities. These unique metabolic targets may help to device novel diagnostic/prognostic markers and therapeutic strategies for better management of PanCa. In this review, we sum up reshaped metabolic pathways in PanCa to formulate detection and remedial strategies of this devastating disease.

Crisaborole might emerge as a potential long-term therapeutic option in not only paediatric patients, but also adult patients with mild to moderate atopic dermatitis. Our pilot study, carried out on a cohort of Indian patients, emphasizes the safety, reliability and efficacy of this novel molecule on atopic dermatitis.

Objectives- Fate of STEMI patients on optimum medical therapy who remains asymptomatic following MI within 24 hours ,electrically and haemodynamically stable regarding their clinical status , LV function, with totally occluded infarct related artery. Methods-100 patients whose angiography performed 3 to 28 days after ST segment elevation myocardial infarction, showed total occlusion of the infarct-related artery with poor or absent ante grade flow,were put on optimum medical therapy in absence of contraindication and follwed up for 6 months. Results- At 1st month among 100 patients 46 ( 46% ) patients were asymptomatic.43 (43%)patients were presented with shortness of breath on exertion (SOBE) and rest 11(11%)had both chest pain and shortness of breath. In subsequent visit at 6 months 46 % patients were asymptomatic and rest presented with SOBE, none of them presented with significant chest pain Conclusion- In spite of optimum medical therapy patients with total occlusion of IRA and non viable myocardium developed progressive remodeling. Collateral flow is not adequate to prevent remodeling.Remodeling causes gradually progressive HF symptoms.If the patient has not developed new coronary lesion patients usually didn’t present with chest pain, shortness of breath was predominant symptoms in follow up in this group of patients.