Drug adherence to anti-tubercular treatment during COVID-19 lockdown in Haldwani block of Nainital district

Background: India saw one of the stringent lockdowns during the COVID-19 pandemic. In the wake of this period, the normal functioning of medical services was affected. People were reluctant to seek medical attention and notification of Tuberculosis dipped. The aim of the study was to estimate the proportion of non-adherence to anti-tubercular treatment and to identify the factors affecting the non-adherence to treatment. Methods: A retrospective community-based study was conducted among 284 tuberculosis patients. They were interviewed using a pre-designed questionnaire consisting of WHO dimensions of non-adherence and lockdown related questions. Results: The proportion of non-adherence to treatment was found to be 5.3%. Factors like chronic diseases, depression, without knowledge on how the disease is transmitted and that medication can be discontinued once the symptoms subsided, alcohol consumption, and trouble accessing medicine were found to be the determining factors in non-adherence to the treatment. Conclusions: Non-adherence to anti-tuberculosis treatment in our study was low but the various dimensions of adherence along with lockdown related factors had significant impact on it. To further minimize non-adherence during emergency like the lockdown due to COVID-19 pandemic, corrective measures must be explored and implemented.

Isolation And Structure Elucidation Of Isoquercitrin From Hygrophila Salicifolia (ACANTHACEAE)

Hygrophila salicifolia is an erect herb (family: Acanthaceae). It has many medicinal uses like diuretic and anti inflammatory in traditional systems of medicine. Till date no data available for its standardisation therefore isolation of phytoconstituent was done from methanolic extract of Hygrophila salicifolia. Besides a known flavonoid, Isoquercitrin was isolated for the first time from a Hygrophila species, namely Hygrophila salicifolia (Acanthaceae). Its structure was established on the basis of its spectroscopic data.

Supercilliary madarosis in an Indian male with Chronic Myelogenous Leukemia Treated with Dasatinib - A case report.

Dasatinib, a second generation multi-target tyrosine kinase inhibitor (TKI) is active against many imatinib-resistant BCR-ABL mutant forms, Src, and c-Kit tyrosine kinases. While skin hypopigmentation is a well recognized adverse effect of first generation TKIs; it has rarely been reported with dasatinib. We report a rare case of diffuse cutaneous hypopigmentation and bilateral supercilliary madarosis induced by dasatinib. A 51 year-old Indian male with no co-morbidities and with history of chronic myelogenous leukaemia with complex variant of Philadelphia translocation and E 225 V mutation in P loop domain of bcr-abl transcript who was initiated on imatinib followed by dasatinib as a part of treatment. After 5 months of treatment with dasatinib, he developed supercilliary madarosis bilaterally. Cutaneous side effects may adversely affect patient’s quality of life and, therefore, require prompt attention to prevent long-term complications or suboptimal outcomes due to poor compliance.

Incidence of thyroid dysfunction in antenatal women and its effect on fetomaternal outcome

Background: Thyroid dysfunction is the second most common endocrine disease in pregnant women. Hypothyroidism is a more common dysfunction encountered in pregnancy. Aim: To study the incidence of thyroid dysfunction in antenatal cases and its effect on fetomaternal outcome. Materials and methods: Total 50 cases of pregnancy with thyroid disorder were selected. Detailed history was taken and full clinical and general examination was performed using a predesigned proforma including clinical feature suggestive of thyroid dysfunction. Serum TSH, T3, T4, fT3, fT4 was measured by CLIA (Chemiluminescence Immunoassay) in all the cases as initial hormonal screening investigations. Results: The overall percentage in our study was 15.97% and out of this 74% was without any symptom i.e. subclinical and only 26% had symptoms. Caesarian section rate was (30% v/s 0%), 18% with subclinical hypothyroidism were detected. In controls, 9% with subclinical hypothyroidism were detected. The most common complication associated with hypothyroidism was abortion (14%) and PIH (16% v/s 56%) hyperemesis gravidarum (9% v/s 3%) and hemorrhage in early pregnancy (22% v/s 8%) We also observed that hypothyroidism is associated with more complications even if it is subclinical (42%). Conclusion: The study concludes that thyroid dysfunction in pregnancy is often significantly associated with maternal complications most commonly abortions, anemia, preterm labour and abruption. Higher caesarean rates are also observed among hypothyroid mothers. Low Apgar scores, increased NICU admissions, low birth weight mainly due to prematurity are usually noted in the Joshi K, Bhatt M, Saxena R. Incidence of thyroid dysfunction in antenatal women and its effect on fetomaternal outcome. IAIM, 2016; 3(11): 136-142. Page 137 neonate. The early administration of treatment and maintenance of a normal level of thyroid hormones significantly minimize the risk of maternal and fetal complications.

Biofilm as a virulence marker in Candida species in Nosocomial blood stream infection and its correlation with antifungal resistance.

Nosocomial blood stream infections (BSI) due to fungi especially Candida is increasing steadily. A two year prospective study was conducted in the S.C.B. Medical College with an aim to evaluate the species distribution, antifungal susceptibility and biofi lm formation of Candida spp. isolated from nosocomial BSIs. 34 Candida spp. were isolated from 359 blood cultures. Antifungal susceptibility was performed by microbroth dilution technique and both visual and spectrophotometric method were used for biofi lm detection. C. tropicalis was the common spp. isolated followed by C. parapsilosis and others. Most (92%) of the isolates were susceptible to Amphoterecin-B and highest resistance was observed against Flucytosine (37%) and Fluconazole(35%). Biofi lm production and antifungal resistance was observed more in nonalbicans Candida spp.

Determination of cilostazol and its active metabolite 3,4-dehydro cilostazol from small plasma volume by UPLC-MS/MS / 药物分析学报

A simple, rapid and sensitive ultra performance liquid chromatography-tandem mass cilostazol and its pharmacologically active metabolite 3,4-dehydro cilostazol in human plasma using deuterated analogs as internal standards (ISs). Plasma samples were prepared using solid phase extraction 18 (50 mm ? 2.1 mm, 1.7 mm) column. The method was established over a concentration range of 0.5–1000 ng/mL for cilostazol and 0.5–mL for 3,4-dehydro cilostazol. Intra-and inter-batch precision (%CV) and accuracy for the analytes were found within 0.93–1.88 and 98.8–101.7% for cilostazol and 0.91–2.79 and 98.0–102.7% for the metabolite respectively. The assay recovery was within 95–97% for both the analytes and internal standards. The method was successfully applied to support a bioequivalence study of 100 mg cilostazol in 30 healthy subjects.

Assessment of free radical-mediated damage in head and neck squamous cell carcinoma patients and after treatment with radiotherapy.

Reactive oxygen species (ROS) produced as a part of cellular metabolism can interact with biological macromolecules such as DNA, proteins and lipids and interfere with their normal functions, leading to the loss of cellular viability. ROS have been implicated in many pathophysiological conditions including cancer. In the present study, the damage caused by ROS and the effect of radiation in head and neck squamous cell carcinoma (HNSCC) patients were assessed in the erythrocytes by analyzing the superoxide dismutase (SOD) and catalase (CAT) activities, and levels of total thiols (T-SH) and malondialdehyde (MDA, a marker for lipid peroxidation). Blood samples were collected before the start of treatment and after the completion of radiotherapy. Both SOD and CAT activities were decreased in untreated patients, but elevated in patients after treatment. The T-SH levels were also depleted in untreated HNSCC patients, but elevated non-significantly after radiation therapy (p>0.05). The levels of MDA showed a significant increase in both untreated patients and after radiation therapy when compared with normal subjects (p<0.05). Thus, the present study indicated that the free radical-mediated damage was aggravated in untreated HNSCC patients, but the levels of antioxidants returned to baseline or nearly so after the treatment with radiation therapy.

Bilateral subthalamic nucleus stimulation for Parkinson's disease.

High frequency stimulation of the subthalamic nucleus (STN) is known to ameliorate the signs and symptoms of advanced Parkinson's disease. AIM: We studied the effect of high frequency STN stimulation in 23 patients. METHOD: Twenty-three patients suffering from severe Parkinson's disease (Stages III-V on Hoehn and Yahr scale) and, particularly bradykinesia, rigidity, and levodopa-induced dyskinesias underwent bilateral implantation of electrodes in the STN. Preoperative and postoperative assessments of these patients at 1, 3, 6 and 12 months follow-up, in "on" and "off" drug conditions, was carried out using Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging, England activities of daily living score and video recordings. RESULTS: After one year of electrical stimulation of the STN, the patients' scores for activities of daily living and motor examination scores (Unified Parkinson's Disease Rating Scale parts II and III) off medication improved by 62% and 61% respectively (p<0.0005). The subscores for the akinesia, rigidity, tremor and gait also improved. (p<0.0005). The average levodopa dose decreased from 813 mg to 359 mg. The cognitive functions remained unchanged. Two patients developed device-related complications and two patients experienced abnormal weight gain. CONCLUSION: Bilateral subthalamic nucleus stimulation is an effective treatment for advanced Parkinson's disease. It reduces the severity of "off" phase symptoms, improves the axial symptoms and reduces levodopa requirements. The reduction in the levodopa dose is useful in controlling drug-induced dyskinesias.

Palliative treatment of advanced non small cell lung cancer with weekly fraction radiotherapy.

Various hypofractionated radiotherapy schedules of radiotherapy have been tried in patients of advanced NSCLC with no conclusive superiority of either a more protracted low dose per fraction schedule or a rapid course of large fraction size. Present study evaluates the role of weekly high dose radiotherapy for the palliation of various intrathoracic symptoms like cough, chest pain, hemoptysis, dyspnoea. A total of 47 patients of advanced non-small cell lung cancer were treated with four weekly fraction of 5 Gy to a total dose of 20 Gy. Mean age at presentation was 53 years. Majority of patients had stage III disease. Pain relief was seen in 77% (23/30) patients with complete relief in 57%; haemoptysis was completely relieved in 77% patients (17/22); and cough was relieved in 68% (19/28) patients. Complete relief from dyspnoea was seen in only 5/12 (42%) patients whereas 2/12 (17%) patients had partial response. The present regime of 20 Gy in four weekly fractions was well tolerated by the patients without any identifiable acute toxicity and was simple and convenient to the patients, who traverse a long distance for radiotherapy in India. To conclude, weekly schedule af EBRT provide effective palliation of various intrathoracic symptoms in the patients with advanced NSCLC.

Effect of induction-delivery and uterine-delivery on apgar scoring of the newborn.

Very short or prolonged induction-delivery interval (i.e. less than 5 minutes or more than 15 minutes) and uterine-delivery interval of more than 90 seconds has a definite effect on the apgar scoring of a newborn especially when general anaesthesia is administered as compared to regional anaesthesia for caesarean section.

Difficult intubation--when can we predict it?

Anaesthetists at times encounter difficult intubation in an apparently normal individual in spite of using the best possible positioning and most profound relaxation. This study was carried out to find out the most simple and easy measurement that may predict a difficult intubation. The study was conducted in three groups of patients of twenty each. The first group consisted of patients in whom intubation was easy. Second group consisted of anticipated difficult intubation. Cases in whom very difficult intubation was encountered were analyzed retrospectively and were included in third group. An attempt has been made to predict difficult intubation with the roentgenographic study of lateral view of mandible along with the measurement of distance from chin to thyroid cartilage. Of all the parameters, ratio of effective mandibular length to posterior mandibular depth and distance from chin to thyroid cartilage were found to be important to predict difficult intubation.

"Steroid responsive pure red cell aplasia".

A young female with pure red cell aplasia with brisk response to prednisolone therapy is described. The patient has remained in remission on a small dose of prednisolone for 10 months.

Comparative study of oral and intramuscular atropine sulphate as a premedicant in paediatric age group.

The use of atropine sulphate in the paediatric age group as a premedicant orally in a dosage of 0.02 mg/kg body weight 70 minutes prior to surgery was found to be as effective as atropine sulphate given intramuscularly 35 minutes prior to surgery in a dosage of 0.01 mg/kg body weight. This avoids the unpleasant memory of needle prick; The duration of effect as studied in the normal healthy children not subjected to surgery was found to be 2 1/2-3 hours.