Pharmacological evaluation of Atremisia annua for Antinociceptive Activity in rats.

Pain has been defined by International Association for the Study of Pain as an obnoxious sensory and emotional incident allied with actual or potential tissue damage. Artemisia annua (Asteraceae) is native to China . Its ancient Chinese name, Qing Hao, literally means “green herb A. annua L. is a source of both essential oil (1.4 – 4.0 %) depending on chemotype, and other substances such as sesquiterpene lactones, flavonoids, polyalkynes and coumarins. The essential oil composition has been studied thoroughly and about 60 components have been identified; camphor, artemisia ketone, germacrene D and 1,8-cineole, are usually the main components.The professed medical uses of artemisia annua include treatment for malaria, infections, fever, inflammation, bleeding, headaches and cancer, particularly some lung and thyroid cancers. The ethanolic extract of aerial parts of Artemisia annua (200mg/kg) was found to be effective against chemical as well as thermal stimuli. So the results are in agreement with the traditional use of plant as analgesic agent.

Assessment of the current practice regarding Diarrhea Management by pharmacists/chemist in Moradabad.

Diarrhea is one of the GIT disorders that create discomfort of normal life. Diarrhea is defined by the World Health Organization as having 3 or more loose or liquid stools per day or as having more stools than is normal for that person. It may be due to infection by viruses, Bacteria and parasites etc. Generally in small cities large number of diarrheal patients visit chemist shop and took medicine with or without advice/precaution from over the counter. Present study deal with specific aim focus on evaluating the role of Pharmacist/Chemist in management of diarrhea. Pharmacist helped in out in managing diarrhea to some extent by prescribing drugs either in single or combinations form but they don’t know about the which patients to test, what tests to order, what accurate medical treatments to use, and what steps to take in case of acute as well as in chronic case of diarrhea.

Pulmonary carcinosarcoma masquerading as a cryptic disseminated malignancy.

Pulmonary carcinosarcoma is an aggressive rare malignant tumor comprising a mixture of carcinoma and sarcoma components containing differentiated mesenchymal elements, such as malignant cartilage, bone, and skeletal muscle. We report a case which presented with unusual clinical features and proved cryptic until death. At autopsy, it was a stage IV lung malignancy and histopathology revealed a carcinosarcoma comprising an adenocarcinoma and an osteosarcoma with metastasis to the heart, lymph nodes, and both adrenals. To our knowledge, this is the first case of this subtype with metastasis to the heart. The present case had an unusual clinical presentation and its elusive nature towards diagnosis despite dissemination is noteworthy and unique in the literature.

Hyponatremia and hypernatremia: disorders of water balance.

Total body water and tonicity is tightly regulated by renal action of antidiuretic hormone (ADH), reninangiotensin-aldosterone system, norepinephrine and by the thirst mechanism. Abnormalities in water balance are manifested as sodium disturbances--hyponatremia and hypernatremia. Hyponatremia ([Na+ < 136 meq/ l]) is a common abnormality in hospitalized patients and is associated with increased morbidity and mortality. A common cause of hyponatremia is impaired renal water excretion either due to low extracellular fluid volume or inappropriate secretion of ADH. Clinical assessment of total body water and urine studies help in determining cause and guiding treatment of hyponatremia. Acute and severe hyponatremia cause neurological symptoms necessitating rapid correction with hypertonic saline. Careful administration and monitoring of serum [Na+] is required to avoid overcorrection and complication of osmotic demyelination. Vasopressin receptor antagonists are being evaluated in management of euvolemic and hypervolemic hyponatremia. Hypematremia ([Na+] > 145 meq/l) is caused by primary water deficit (with or without Na+ loss) and commonly occurs from inadequate access to water or impaired thirst mechanism. Assessment of the clinical circumstances and urine studies help determine the etiology, while management of hypernatremia involves fluid resuscitation and avoiding neurological complications from hypernatremia or its correction. Frequent monitoring of [Na+] is of paramount importance in the treatment of sodium disorders that overcomes the limitations of prediction equations.

Organizing an effective continuous medical education session.

Maintenance of professional competence remains an exercise of lifelong learning and an essential requirement for evidence -based medical practice. Physicians attend continuing medical education (CME) programs to update their knowledge. Often CME programs remain the main source of updating current information. CME organizers have considerable responsibility in determining appropriate curriculum for their meeting. Organizing an effective CME activity often requires understanding of the principles of adult education. Prior to deciding on the curriculum for a CME, course organizers should conduct needs assessment of physicians. CME planners need to be organize activities that would consistently improve physician competence. CME sessions that are interactive, using multiple methods of instructions for small groups of physicians from a single discipline are more likely to change physician knowledge and behavior. Effectiveness of a CME program should be evaluated at a level beyond measuring physician satisfaction. CME planners need to incorporate methods to determine the course attendees improvement of knowledge, skills and attitudes during the CME activities. Pre and post test of physicians using multiple choice questions form a useful method of assessment. Course organizers would need to ensure that the questions are appropriately constructed to assess the ability to use knowledge in real life situations.

Clinical applications and update on evidence-based medicine.

Despite an agreement on the definition of evidence-based medicine (EBM), there remains considerable debate around what constitutes an evidence-based care. In the current review, we discuss the clinical application of EBM including challenges in retrieving relevant medical information, critically reviewing the data and applying it to the patient. Also discussed are the techniques and issues surrounding patient-physician communication. Among the current updates in EBM we highlight the '5S' model of retrieving best evidence, use of hand held devices for point of care information and describe future directions and use of computer based decision support, ehealth, electronic medical records and evidence based management to improve quality of health care. Several methods are described to enhance risk communication and evidence-based practice.

Diagnosing acid-base disorders.

Diagnosis and management of acid-base disorders ranks high among the medical problems that intimidate many physicians. In practice, acid-base disorders can be approached very systematically as they can be easily diagnosed when certain rules are applied. Using a four step process including, 1) determination the serum pH, 2) calculation of the serum anion gap, 3) estimating the degree of compensation, 4) calculation of the excess anion gap, the reader will be able solve any complex acid-base problem. In this review we describe a practical stepwise approach to identify and resolve issues involving acid-base disorders.

Clinical approach to breast disorders: A primer for internists.

Women with breast disorders often present first to their internists for evaluation. A delay in accurate diagnosis could often result in worsening of prognosis for the patient. Common diagnostic problems include evaluation of a breast lump, nipple discharge and breast pain. Internist now has a choice of several diagnostic modalities to evaluate breast disorders. An evidence-based approach to common breast symptoms and advances in breast diagnostic techniques has been described to enable early diagnosis of breast cancer, thereby reducing the need for intensive treatments and improve patient satisfaction and clinical outcome.

Literature search using PubMed: an essential tool for practicing evidence- based medicine.

Efficient literature search is essential to the practice of Evidence-Based Medicine. PubMed provides free access to one of the largest searchable biomedical databases. Efficient literature search using PubMed requires a good understanding of the available search strategies and tools. In this article we present a step-by-step approach for performing literature search using PubMed. Several PubMed tools including 'Single Citation Matcher', 'Clinical Queries', 'Clipboard', 'Field Tags', and 'Cubby' are highlighted using case based scenarios.

Preoperative evaluation for non-cardiac surgery.

Internists are frequently consulted to perform preoperative risk assessments on patient undergoing non-cardiac surgery. Physicians need to assess the cardiac risk associated with the surgery, identify the patient's unique risk profile, recommend appropriate preoperative testing and make suitable recommendations. By a focused history-taking, physical examination, and application of current evidence-based guidelines in cardiac risk assessments, patients at high risk for complications at surgery can be identified and additional work-up suggested. Effective preoperative recommendation includes an assessment of risk (cardiac and non-cardiac), recommendations on medication adjustment, thrombo-embolic prophylaxis, and use of perioperative beta blockers. Prompt communication with the surgeon often enhances the quality of medical consultation and ensures compliance.

Understanding medical uncertainty: a primer for physicians.

Many decisions in General Medicine have to be made in the paucity of well-researched information. Despite the existence of evidence-based guidelines, physicians may perceive obstacles in implementing these in clinical practice. Intolerance to uncertainty may result in a tendency to perceive ambiguous situations as sources of threat. Variability in treatment, choice of medical specialty, increased personal anxiety, increased test ordering tendencies, decrease comfort with geriatric and psychological problems have been correlated with intolerance to uncertainty. Various Instruments and scales are currently available to measure physician's uncertainty. Quantitative and qualitative techniques of managing uncertainty include shared decision-making, meticulous history-taking and evaluation, exclusion of worrisome diagnosis, ability to critically appraise current literature and establishing trust with patient.

Left sided cervical and thoracic malignant extra-adrenal pheochromocytoma.

Extra-adrenal Pheochromocytomas are rare entities. High index of suspicion among diastolic hypertensives followed by screening test for 24-hour urinary catecholamine level helps in diagnosis. 123I MIBG scintigraphy is specific for tumour localisation and surgical debulking of tumour or 131I MIBG therapy are alternative modes of treatment.

Induced liver tumour further support to a genetic marker with its high correlation with chorioallantoic membrane phenotypes in selected layer lines.

The conventional chorioallantoic membrane (CAM) phenotype assay was conducted using 11-day-old embryonatic eggs of white Leghorn strains, each inoculated with 0.2 ml of subgroup A Rous sarcoma virus (RSV) and subgroup C RSV separately containing 10(3)pfu ml(-1). Eggs were further incubated for hatching. Harvesting of CAMs for counting of pocks and monitoring chicks for liver tumour (LT) mortality during 4 weeks of post-hatching period were followed. The conversely associated phenotype (CAP) incidence i.e. CAM(+) LT(-) and CAM(-) LT(+) was observed in all three lines for both subgroup A and C virus infection. The LT deaths of chicks in all strains occurred within 21 days post-hatch irrespective of virus subgroups. The regression analysis of %LT death (transformed data) distributed within pock count range (PCR) basis was performed. The regression coefficients (b(i)'s) were found to be non-significant, indicating that %LT death did not correlate with number of particles that entered the cells because the chicks that had at least 25 pock counts in CAMs died with few exceptions. This study upheld the view that the CAM phenotypes (S and R) under the control of a pair of alleles, a(s) and a(r) at the tva locus and c(s) and c(r) at the tvc locus as reported extensively. Because of a high correlation coefficients between CAM and LT phenotypes [S and LT(+)] in respect of subgroup A (r = 0.72) and subgroup C (r = 0.81) infection, it is obvious that one could postulate a pleiotropic control of the two traits by the tva and tvc genes, respectively. Indeed fitting a 4-allele model in both tva and tvc locus, suggesting that CAPs are the indicator for nullifying the conventional 2-allele model proposed for the induced tumour expression phenotypes by leukosis sarcoma viruses.

Diverse manifestation of arrhythmogenic right ventricular dysplasia in a family.

Arrhythmogenic right ventricular dysplasia (ARVD) is a cardiomyopathy of unknown cause associated with life-threatening arrhythmias. The purpose of this case report is two-fold: (i) To highlight the utility of a definite set of diagnostic criteria encompassing structural, histologic, electrocardiographic, arrhythmic and genetic factors in establishing diagnosis of ARVD in institutions like ours which are handicapped by lack of magnetic resonance imaging (MRI) and endomyocardial biopsy facilities, (ii) to present diverse arrhythmic manifestations in a single family.

Correlation and modulation of Ehrlich ascites tumor growth with tumor-plasma IgA.

Plasma IgA level of Ehrlich ascites tumor bearing mice showed correlation with progress of tumor growth. In PAGE analysis total plasma IgA separated into 3 major bands corresponding to mol. wt. > or = 669,000 daltons, identical to 443,000 daltons and between 443,000 and 150,000 daltons. All the three bands increased gradually with progress of tumor growth upto day 14 and then declined on day 16. Total plasma IgA isolated by anti-IgA affinity chromatography when adoptively transferred to mice inhibited tumor growth. Affinity-purified plasma IgA separated into three major peak fractions after Sephadex G-200 column chromatography which corresponded with the bands of IgA on PAGE analysis. Three Sephadex G-200 IgA fractions when adoptively transferred to tumor-bearing mice showed effect different from total IgA. High mol. wt. IgA fraction (> or = 669,000 daltons) inhibited tumor growth whereas medium mol. wt. fraction (identical to 443,000 daltons) enhanced tumor growth. The low mol. wt. IgA fraction (< 443,000 and > 150,000 daltons) had no significant effect on tumor growth. The high mol. wt. IgA fraction enhanced tumor killing ability of peripheral blood lymphocytes (PBL) and peritoneal macrophages of tumor bearer in vitro. Medium mol. wt. IgA fraction inhibited tumor-killing ability of PBL in vitro but had no significant effect on peritoneal macrophages. The low mol. wt. IgA fraction showed a mild enhancing effect on tumor-killing ability of PBL but had no significant effect on peritoneal macrophages. The results established importance of IgA in tumor growth regulation and its therapeutic potentiality. The results indicated that tumor growth modulation by tumor plasma IgA is also mediated by its effect on cellular anti-tumor immune factors of the host.

Clinicopathologic study of lupus nephritis.

Needle biopsies of kidney were done in 35 cases of systemic lupus erythematosus (SLE) with renal lesions. The lupus nephritis were classified according to WHO classification and were correlated with response to therapy and prognosis. Detailed clinical features, routine haematological, biochemical tests (e.g., serum urea, creatinine, total protein and albumin, cholesterol, etc), examination of urine (degree of proteinuria and cells) and occurrence of various auto-antibodies e.g., antinuclear antibody (ANA), anti double stranded DNA (anti DsDNA) by enzyme immunoassay (EIA) method, LE cells and rheumatoid factor (RF) were studied in all cases. Clinically hypertension was present in 19 (54.3%) cases and nephrotic range of proteinuria was detected in 20 (57.2%) cases. ANA was found in 31 (88.5%) cases, anti DsDNA 24 (68.5%) and LE cells were detected in 25 (71.5%) cases. RF was detected in 2 (5.7%) cases. Histologically the most frequent lesions were class IV occurring in 15 cases (42.8%) with initial complete remission achieved only 4 cases by immunosuppressive therapy. Active lesions were also most frequent in this class. Class III lesions were found in 8 (22.8%) cases with 6 cases had complete remission. The best prognosis was noted in class II cases with 4 out of 5 (14.3%) cases had complete remission. Class V lesions were found in 6 (17.2%) cases with complete remission achieved in 3 cases. Only one patient presented with class VI lesion. RF positive cases had milder renal lesions.