Use of CDR-sob and ADAS-cog score to check protective role of Non-steroidal AntiInflammatory Drugs in Alzheimer Disease: A Systematic Review and Meta-Analysis

Background Alzheimer’s disease is the major neurodegenerative disease, affecting more than two third cases of dementia in the world. NSAIDs are widely used anti-inflammatory analgesic agents representing 7.7% of worldwide prescription of which 90% are in patients over 65 year old. Based on mixed findings by different RCTs, a systematic review and meta-analysis on CDR-sob and ADAS-cog score was conducted to develop the better understanding on the protective role of Non-steroidal anti inflammatory drugs (NSAIDs) in AD. Methods Data base search was Pubmed, WebScience and Embase. RCTs investigating the effect of NSAIDs on AD or test scores assessing cognitive function in people without AD at baseline were included. Two indicators ADAS-cog score, and CDR-sob are used. Total 09 studies are included in the present Metaanalysis. Results For ADAS-score pooled the pooled summary effect size was calculated using random effect model was -0.03 with 95% C.I -0.13 to 0.07, which was statistically insignificant (p-value =0.44). For CDRsob score difference, the pooled the pooled summary effect size was calculated using random effect model was -0.09 with 95% C.I -0.29 to 0.11 which was statistically insignificant (p=0.3812).For CDR-sob score, the pooled summary effect size was calculated using random effect model was 0.21 with 95% C.I -0.09 to 0.51, which was statistically insignificant (p-value = 0.1741). Conclusion Present Meta analysis shows that NSAIDs in general are not effective in treatment of AD. They also have no protective effect against development of AD on their sustained use.

Recent trend of multi-drug resistance in Pseudomonas aeruginosa.

Objective: Continuous emergence of resistance among Pseudomonas aeruginosa strains to common antimicrobial drugs have been documented world-wide. This study investigated the recent trend of antimicrobial resistance patterns of P. aeruginosa among the patients in mid & far western region of Nepal. Materials and Methods: The study was conducted on 917 patients with suspected P. aeruginosa infections, attending outpatient and inpatient departments of Nepalgunj Medical College and teaching Hospital, Banke, Nepal from September 2011 to January 2014. Specimens were collected from pus/wound, sputum, urine, tracheal aspirates, central venous catheter tip, broncho-alveolar lavage fluid, catheters and vaginal swabs and processed for isolation and identification of P. aeruginosa following the standard microbiological methods. The disc diffusion test was used to determined antimicrobial resistance patterns of the recovered isolates at the central Laboratory of Microbiology. Results: One hundred ninety four isolates were identified as P. aeruginosa. Resistance to Chloramphenicol (74.23%), Ceftriaxone (69.56%), Cefepime (57.22%), Cefoperazone-Salbactum (54.12%) and Co-trimoxazole (53.02%) was observed. All the isolates were susceptible to Imipenem. 48 (24.74%) of P. aeruginosa isolates were multi-drug resistant to >3 classes of antibiotics. Among 194 isolates, 88 (45.36%) were from the patients of 21-40 years age group, which was statistically significant (P<0.05) compared to the other age groups. Conclusions: The study revealed the presence of drug resistant strains of P. aeruginosa in Nepal. High levels of antibiotic resistance of many of the isolates might be due to antibiotic abuse. Therefore, we recommend judicious use of antibiotics by the physicians to curb the increasing multi-drug resistance of P. aeruginosa strains in Nepal.

Vancomycin‑resistant Enterococcus faecium: Report of two cases.

Vancomycin‑resistant Enterococci (VRE), especially Enterococcus faecium has emerged as an important nososcomial pathogen and represents a serious threat to patients with impaired host defense. Early detection of patients colonised or infected with VRE is an essential component of any hospital program designed to prevent nosocomial transmission of this organism. The authors report two cases of VRE isolated from blood and surgical site pus of two neonates admitted in the same neonatal unit, highlighting that early detection, prompt and appropriate infection control measures were keys to successful containment of this dreaded pathogen.

Bilateral glandular odontogenic cyst of the maxilla: A rare case report and review of literature.

The glandular odontogenic cyst (GOC) is a recently recognized rare developmental odontogenic cyst having an aggressive behavior and accounts for 0.012 to 1.3% of all jaw cysts. In 1992, the World Health Organization recognized this cyst as glandular odontogenic cyst (GOC). Clinically, GOC usually presents as a painless, slow-growing swelling that tends to affect the anterior part of the jaws. Many authors have suggested that the cyst mainly occurs in 4th and 5th decades and presents as an expansion of jaws with or without pain or Paraesthesia. The dental professionals must be aware of the clinical significance of this lesion as the aggressive nature of the lesion has been reported and at least 25% to 55% recur following curettage. Hence the treatment of choice is excision rather than enucleation in order to obviate recurrence. Here, we report a case of bilateral GOC in the anterior region of the maxilla, in a 29-year-old male patient, which is very unusual as it is the first bilateral case to be reported in the literature.

Comparison of the routine Papanicolaou staining technique with the rapid, economic, acetic acid, Papanicolaou (REAP) technique.

Background: The universal stain for oral cytological screening for precancer and cancer of oral cavity is Papanicolaou stain which has been used in different laboratories with many modifications. Objectives: To assess the superiority of staining of smears by REAP technique compared to PAP technique. Material and Methods: 100 smears were collected from 50 patients. One set of smears were stained with conventional PAP technique and the other set with the REAP technique. In the REAP technique, the ethanol bath in the pre Orange G6, post Orange G6 and post EA50 stages is replaced by 1% acetic acid; Tap water is used instead of Scott’s tap water and hematoxylin is pre heated in water bath to 60°C for rapid penetration. Methanol is used for final dehydration. The two sets of smears are observed by two independent observers and assessed for the optimal and suboptimal nuclear and cytoplasmic staining. The results are compared and analyzed statistically. Results: Good cytoplasmic transparency and optimal nuclear details were seen in REAP stained smears compared to the conventional PAP smears. The cost involved in REAP method was lesser compared to conventional PAP technique. REAP technique took 3 minutes for completion compared to PAP technique that involves a minimum of 20 minutes. Conclusion: REAP technique produces better stained smears that are cost effective and involve minimal time for mass screening of oral cancer as compared to conventional PAP smears.

Mixed pulmonary infection in an immunocompromised patient: A rare case report.

Patients who are immunocompromised are predisposed to a variety of common and uncommon pulmonary infections. We report a case of mixed pulmonary infection by drug resistant tuberculosis with a nocardiosis in a 49-year-old man who was a known case of chronic obstructive pulmonary disease, on prolonged corticosteroid use with diabetes mellitus. Chronic use of corticosteroids is a predisposing factor for opportunistic infections, such as nocardiosis or tuberculosis. Since such a mixed infection is rare, maybe a combined approach to therapy early in the course of disease would be effective in such cases.

Accidental intestinal myiasis caused by genus Sarcophaga.

Myiasis of different organs has been reported off and on from various regions in the world. We report a human case of intestinal myiasis caused by larvae of Sarcophaga. A 25 - year - old male presented with symptom of passage of live worms in stool. Following diagnosis and treatment the patient improved completely with cessation of maggots in stool.

Pulmonary hydatidosis: an unusual cause of haemoptysis.

A 28-year-old female patient was referred to us with complaints of massive haemoptysis and cough with expectoration, of two years' duration. Her chest radiograph, computed tomography scan and video-bronchoscopy revealed a cystic lesion in the right upper and lower zones of the lungs. Aspiration from the cyst fluid was grossly hemorrhagic and full of inflammatory cells. On digestion of the fluid with potassium hydroxide, it showed plenty of hooklets and scolices of Echinococcus granulosus. An intact brood capsule was also seen. Diagnosis of hydatidosis was further confirmed by a positive serological and therapeutic response to albendazole.

Germ cell tumour of testis.

Germ cell tumour, though rare, represents most common malignancy among young men aged between 15 to 35 years. In 1990's dramatic improvement has taken place in survival rate of testicular tumours (from 10% in 1970's and 90% in 1990's). This has been possible because of effective diagnostic techniques, accurate monitoring with biological markers and use of effective platinum based combination chemotherapy in its management. The most significant improvement in survival rate has occurred in advanced stage germ-cell tumours. Seminomas are sensitive to radiation therapy and NSGCT (Non Seminomatous Germ Cell Tumours). are effectively treated by combination chemotherapy of 3 drugs of which Bleomycin is most expensive and many patient can not afford it and so compliance is poor. In the present series we have tried only 2 drug regimen consisting of Platinum and Etoposide (PE). Since January 1992 to December 1994, 40 cases of testicular tumours were treated. 16 cases received PEB regimen and 24 cases were treated by PE regimen of which only 6 cases in the former and 20 cases in the later group completed the scheduled course. Patients were given 6 cycles of PE regimen (inj. Platinum 20 mg/m2 D1-D5, VP-16 (ETOPOSIDE), 100 MG/M2 1.V. D1-D5) repeated every three weeks. Final evaluation was done in June 1996. 17/20 (85%) patients on PE regiment exhibited complete regression of the disease by the end of June 1996, I was lost to follow up, and 2 of them had the disease in progressive stage and were considered for another regimen. 18 months disease free survival was 85%. Table I. Royal Marsden Staging System Stage I: Disease econfined to testes Stage II: Intradiaphragmatic node involvement A: Less than 2 cm B: 2-5 cm C: Greater than 5 cm Stage III: Supradiaphragmatic node involvement Stage IV: Extralymphatic disease Lung, Liver, Bone etc.

Clinico-epidemiological profiles of post-kala-azar dermal leishmaniasis in Varanasi.

Twenty-seven cases of Post Kala-Azar Dermal Leishmaniasis (P. K. D. L.) were detected in an endemic focus of Kala-azar in Sujabad village in Varanasi Distt. Male-Female ratio of cases was 4.4:1. Majority (66.6 per cent) of cases had macular lesions. Histopathology of one case showed Leishmania donovani (L. D.) bodies. Densities of sand fly were more in pockets where P. K. D. L. cases were detected. All the 13 cases, which were treated with sodium antimony gluconate, responded well to therapy.

Serum and tissue sodium/potassium changes in estrogen treated female albino rats.

Five control and ten estrogen treated albino rats were studied for changes in sodium and potassium in serum, heart, muscle, uterus and brain. The serum levels of sodium depleted significantly in the estrogen treated rats. Of the tissues studied, only uterus and brain had significantly sodium retention effect. The potassium levels on the other hand decreased significantly, both in serum and tissues following treatment with estrogen.