Abnormalities in midgut rotation occur during the physiological herniation of midgut between the 5th and 10th week of gestation. The most significant abnormality is narrow small bowel mesentery which is prone to volvulus. This occurs most frequently in the neonatal period, less commonly midgut malrotation presents in adulthood with either acute volvulus or chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge. We report a case of a 17-year-old male patient who presented with 10-year history of nonspecific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed with midgut malrotation following computed tomography of abdomen. The patient was treated with a laparoscopic Ladd's procedure and at 3 months he was gaining weight and had stopped vomiting. A laparoscopic Ladd's procedure is an acceptable alternative to the open technique in treating symptomatic malrotation in adults. Midgut malrotation is a rare congenital anomaly which may present as chronic abdominal pain. Abdominal CT is helpful for diagnosis.

Non-communicable diseases like cardiovascular diseases, cerebrovascular diseases, diabetes mellitus, and cancer are very common causes of death worldwide. Therefore, the need to search for novel, affordable, and easily accessible biomarkers and risk factors for non-communicable diseases continues, which can predict the future risk of having these diseases with greater accuracy and precision. In this context, among available biomarkers, high-sensitivity C-reactive protein (Hs-CRP) is considered to be the best-suited marker. Various drug intervention trials demonstrated positive results in reducing Hs-CRP in individuals with raised levels. Numerous pharmacological and non-pharmacologic interventions in the form of lifestyle modifications, exercise, and cessation of smoking are being investigated to study their effect on reducing serum C-reactive protein (CRP) levels.This review article discusses the role of Hs-CRP and its isoforms in the pathogenesis of various disease conditions, factors affecting its serum concentration, its prognostic value, and its comparison with other risk factors. Further, its clinical significance in chronic inflammatory and degenerative diseases of the nervous system and other common non-communicable diseases, including recent advances in the management of various diseases, has also been discussed.

Background. Frailty is a reversible age-related condition characterised by declines across multiple physiologic systems and associated with an increased risk of mortality or unplanned hospitalisation. We developed and validated a new frailty index that is easy to apply in elderly people in rural India and has predictive accuracy for all-cause mortality at 6 and 12 months. Methods. 1000 participants aged >60 years who were admitted to a geriatric unit of a rural hospital for screening or treatment of any illness were recruited for development and validation of the Frailty Index in Rural Elderly-Mental status, Activities of daily living, Depression, and Events (FIRE-MADE), which combines the Cumulative Deficits Model and the Comprehensive Geriatric Assessment Model and takes into account of four domains: physical, cognitive, psychosocial, and functional. Results. The FIRE-MADE score increased with age and was higher in men than in women. Higher FIRE-MADE score was associated with higher rates of mortality and unplanned hospitalisation. In multivariable analysis, predictors for mortality were Mini-Mental State Examination, activities of daily living, ischaemic heart disease, history of stroke, and polypharmacy. In Kaplan-Meier survival analysis, 4.9%, 7.1%, and 16.7% of participants with mild (FIRE-MADE score, 0.3-0.4), moderate (0.5-0.6), and severe (>0.7) frailty died at the end of 1 year. The cutoff values for mortality and unplanned hospitalisation were 0.32 and 0.27, respectively, with the area under the receiver operating characteristic curve for the severity being 0.883 and 0.794, respectively. Compared with the Longitudinal Aging Study Amsterdam frailty index score in predicting mortality and unplanned hospitalisation, the FIRE-MADE score had positive predictive values of 88.89% and 88.89%, respectively, and negative predictive values of 65.93% and 41.10%, respectively. Association between the two indices was strong. Conclusions. FIRE-MADE is easy to apply in clinical practice as a screening tool to detect frailty in elderly people in rural India.

To study right ventricular function and pulmonary artery pressure in patients with mild-moderate COPD by 2D echo Doppler. METHODS: This observational cross sectional study was carried out in JNMC, Wardha. 100 subjects with COPD in our hospital were interviewed. Detailed history and physical examination done and all patients were subjected to pulmonary function test (PFT) and categorised as per GOLD Criteria. The patients so selected were subjected to 2D ECHO Doppler examination. Hence, right ventricular (RV) systolic function was calculated with the help of Tricuspid Regurgitation (TR) jet, Pulmonary Regurgitation (PR) jet and Tricuspid Annular Plane Systolic Excursion (TAPSE). RESULTS: The mean age of present study population was 53.45±15.73 years. In the present study, males account for 74%, with a male: female ratio of 2.84:1 which was comparable to other study groups. 61 patients in the study group were smokers of which 53 patients had moderate COPD. This proves importance of smoking as a risk factor. Out of 100 patients 20% had mild COPD and 80% had moderate COPD. Study of PASP by TR jet with the use of 2D ECHO showed mild PASP in 68 patients out of 100 while moderate PASP in remaining 32 patients, while there were no patients with severe PASP. Study of TAPSE by 2D ECHO showed that 80 patients had abnormal TAPSE value while 20 patients had normal value. CONCLUSION: The study explains the incidence of pulmonary hypertension in mild-moderate COPD patients. Thus if subjected to ECHO, RV systolic function and pulmonary hypertension can be detected in early course of disease and hence early intervention may predict decreased morbidity and favourable outcome in patients of COPD.

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Anaemia (particularly iron deficiency) is of important concern in patients with chronic kidney disease (CKD) as it reflects the outcome of the disease. Current recommendations for the use of intravenous iron (IV) therapy in the management of anaemia in such patients are limited. This study highlights the comparison of oral to intravenous iron in patients with chronic kidney disease. Materials and methodsThis is a prospective case-control study comparing intravenous iron to oral iron in chronic kidney disease patients admitted to the Medicine Department of Acharya Vinoba Bhave Rural Hospital, in central India from October 2018 to October 2020. A total of 150 patients were divided into two groups of 75 each, one receiving oral iron (ferrous sulfate 325 mg tablets) and the other intravenous iron (IV iron sucrose). ResultsSerum iron, serum ferritin, and transferrin saturation (TS) showed increased levels in the IV iron group than in the oral iron group. In the IV group, a statistically significant increase was found in haemoglobin levels after therapy among all stages of kidney disease (p<0.05) while the same was not reported in the oral iron group. ConclusionIV iron sucrose therapy had been found to be effective, well-tolerated, and more successful than oral iron treatment in chronic kidney disease patients as far as the parameter of iron deficiency anaemia is concerned.

Background:The anemia not only negatively affects physical function but also the cognition, mood, and quality of life in adult patients due to hypoxic condition as per its severity. This study has been planned to investigate the cross-section association of anemia with cognitive function in neurologically intact patients.Methods:In this study, a total 200 subjects were enrolled out of which 100 were cases and 100 age and sex matched controls. Mini-mental status examination (MMSE) and short portable mental status questionnaire (SPMSQ) scales were used to assess cognition in all the subjects.Results:This study showed that there was a significant correlation between the anemia and the cognitive skills in the neurologically intact patients.Conclusion:The cognitive functions were strongly related to hemoglobin levels as seen by low MMSE score and higher SPMSQ error in those with low hemoglobin levels compared with those with higher hemoglobin levels.