Pregnancy outcome after first trimester vaginal bleeding

Background: First trimester vaginal bleeding is one of the most common complications in pregnancy threatening its proper development and successful outcome.Methods: A case-control study was conducted from October 2016 to April 2018 in the department of obstetrics and gynecology SKIMS.200 cases with vaginal bleeding in first trimester were taken for study. Out of the cases, number of patients who had abortion, ectopic, molar pregnancy or continued their pregnancy beyond 20 weeks was noted. Those who continued their pregnancy were compared with 130 controls for complications developing later in pregnancy.Results: There was significantly higher incidence of PIH (15.4% of cases, 6.9% of controls, p value = 0.005) and abruption (7.7% and 1.5% among cases and controls respectively with p-value of 0.034) among cases than controls. Mean gestational age at delivery in cases was 35.6±3.63 weeks while in controls it was 38.5±1.94 weeks (p value <0.001). Mean birth-weight of the neonates in cases was 2.16±0.78 kgs while in controls was 3.05±0.53 kgs (p value <0.001). IUGR occurred in 9.2% of cases and 3.1% of controls (p value 0.039). There was significantly higher neonatal ICU admission rate in cases than controls (p value 0.019).Conclusions: Patients with first trimester vaginal bleeding are at increased risk for spontaneous loss and adverse pregnancy outcome.

Sideroblastic anaemia as a diagnostic filch point of melas [myoencephalopathy, lactic acidosis and stroke like episodes]

Sideroblastic anaemia includes a heterogeneous group of conditions characterized by decreased heme synthesis and mitochondrial iron overload. It is diagnosed by the presence of ringed sideroblasts in the bone marrow aspirate and association of this form of anemia with various mitochondrial dysfunction disorders can be a catch point to reach an ultimate diagnosis in these disorders as reported in this case of myoencephalopathy, lactic acidosis, and stroke-like episodes [MELAS] syndrome

Sideroblastic Anaemia-A Hitherto Unrceognized cause of unexplained Anaemia

Objective: To assess the clinicopathological heterogeneity of sideroblastic anemia disorders characterized by the presence of ring sideroblasts in the bone marrow

Study Design: Descriptive study

Place and Duration of Study: Study was conducted at department of Pathology, Combined Military Hospital Kharian, from Apr 2014 to Oct 2016

Material and Methods: A total of ten patients diagnosed as having sideroblastic anemia [SA] on cytomorphological basis were included in the study. After clinical examination of the patients, blood samples were analyzed on Sysmex KX21 Haematology analyzer. Blood and bone marrow aspiration slides were stained with leishman's stain to study red cell morphology and aspects of haematopoiesis. Assessment of iron stores was done using Perl's staining technique. Data was collected and analyzed using SPSS 16.0 version

Results: Age range of the SA patients varied from 14-65 years and male to female ratio was 1.3:1. Clinical features included weakness, malaise, easy fatigability, fever, bleeding complications, pallor, splenomegaly and syndrome specific features in 2 patients. MCV ranged from 66 fl to 94 fl. Dimorphic red cell morphology which is considered an important feature of SA was not observed in any patient. Other cytopenias were also noticed. Dysplasia was observed in 4 patients. One patient was confirmed as having secondary SA due to lead poisoning

Conclusion: Clinicopathological features of SA are variable and it is inappropriate to associate SA with any specific age group, gender, red cell indices or morphology. Prompt recognition of SA with its accurate categorization and specific treatment can avoid undue suffering of the patients as well as their relatives

Isolation and preliminary evaluation of Mulva Neglecta mucilage: a novel tablet binder

ABSTRACT The aim of this study was to evaluate binding potential of Mulva neglecta mucilage (MNM) with subsequent comparison to PVP K30. Eight batches of Diclofenac sodium tablets were prepared by wet granulation technique keeping different concentrations (4, 6, 8 & 10% w/w) of Mulva neglecta mucilage (extracted from leaves of Mulva neglecta) and PVP K30 as standard binder. The granules of formulated batches showed bulk density (g/mL) 0.49 ± 0.00 to 0.57 ± 0.00, tapped density (g/mL) 0.59 ± 0.01 to 0.70 ± 0.01, Carr's index 09.27 ± 0.95 to 19.65 ± 0.59, Hausner's ratio 1.12 ± 0.00 to 1.24 ± 0.01 and angle of repose 30.37 ± 2.90 °C to 36.86 ± 0.94 °C. Tablets were compressed to hardness 7.50 to 7.95 kg/cm2. The tablets showed 0.39 ± 0.02 to 0.39 ± 0.01% friability and 7:20 to 14:00 min disintegration time. Granules and post-compression evaluation revealed that parameters assessed were all found to be within the pharmacopoeial limits. The results (hardness, disintegration and dissolution) proved that Mulva neglecta mucilage has better binding capacity for preparation of uncoated tablet dosage form as compared to PVP K30. Among all the formulations, MN-1 to MN-4 showed slow release as compared to PV-1 to PV-4 and thereby Mulva neglecta mucilage exhibited satisfactory drug release phenomenon tablets of diclofenac sodium.

RESUMO O objetivo deste estudo foi avaliar o potencial de ligação de mucilagem de Mulva neglecta (MNM), com posterior comparação ao PVP K30. Oito lotes de comprimidos de diclofenaco de sódio foram preparados pela técnica de granulação úmida, mantendo diferentes concentrações (4, 6, 8 e 10% w/w) de mucilagem de Mulva neglecta (extraída de folhas de Mulva neglecta) e PVP K30 como ligante padrão. Os grânulos de lotes formulados mostraram densidade aparente (g/mL) 0.49 ± 0.00-0.57 ± 0.00, densidade compactada (g/mL) 0.59 ± 0.01-0.70 ± 0.01, índice de Carr 09.27 ± 0.95-19.65 ± 0.59, a relação de Hausner 1.12 ± 0.00-1.24 ± 0.01 e ângulo de repouso 30.37 ± 2.90 °C a 36.86 ± 0.94 °C. Os comprimidos foram prensados à dureza de 7.50-7.95 kg/cm2. Os comprimidos apresentaram 0.39 ± 0.02-0.39 ± 0.01% friabilidade e 7:20-14:00 min de tempo de desintegração. A avaliação de grânulos e pós-compressão revelou que todos os parâmetros estavam dentro dos limites da farmacopeia. Os resultados (dureza, desintegração e dissolução) provaram que a mucilagem de Mulva neglecta tem maior capacidade de ligação na preparação da forma de dosagem de comprimido não revestido em relação à PVP K30. Entre todas as formulações, MN-1 e MN-4 mostraram liberação lenta em comparação com PV-1 e PV-4 e, assim, a mucilagem de Mulva neglecta exibiu liberação do fármaco satisfatória para os comprimidos de diclofenaco de sódio.

Diagnostic dilemmas in intraductal papillomas of the breast - experience at Sultan Qaboos University Hospital in the Sultanate of Oman

The aim of this retrospective study was to correlate the significance and accuracy of the colour of nipple discharge and breast ultrasound imaging in the diagnosis of intraductal papilloma. This is a retrospective study of 34 patients who underwent 36 microdochectomies in Sultan Qaboos University Hospital [SQUH] in the Sultanate of Oman, over a 4 year period of January 2009 till December 2012. The confounders considered were patient age, physical examination findings, nipple discharge cytology result, ultrasound results and biopsy report following microdochectomy. Comparisons analysis, charts and graphs were made using the SPSS software [version 20]. The mean age of the patients was 44 [27-73] years old. Twenty-seven out 36 [75%] patients had presented with nipple discharge, 14 out 27 [52%] had blood stained nipple discharge and 13 [48%] with coloured discharge [yellow, brown and green], 9 patients had no discharge. The final histopathology showed intraductal papilloma 13 [36%], duct ectasia 18 [50%], DCIS 1 [2.7%], fibrocystic disease 3 [8.3%] and LCIS 1 [2.7%]. Thirteen out of 36 had intraductal papilloma on final histopathology. The correlation between blood stained discharge and final histopathology of intraductal papilloma was insignificant [p=0.44]. Nipple discharge is irrelevant to the diagnosis of intraductal papilloma. Spontaneous nipple discharge regardless of color is to be referred to breast surgeon and to be assessed with triple assessment. Surgery remains the mainstay of treatment

To study the influence of different grades of Ethylcellulose ether derivative polymer Ethocel[registered] and co-excipient on drug release profile of controlled release matrix tablet of acarbose

The aim of the study presented is to formulate and evaluate Acarbose controlled release matrix tablets by means of different grades of polymer Ethocel and different co-excipients with the intention to see their effects on drug release profile during in vitro dissolution studies. Controlled release dosage forms is gaining rapid popularity due to its positive aspect of reduction in dosage frequency and curtailing side effects. Controlled released tablets of Acarbose were prepared by direct compression method, using Ethocel[registered sign] Standard 7 Premium and Ethocel[registered sign] Standard 7 FP premium polymer. The effect of co-excipients including hydroxypropyl methylcellulose [HPMC], Carboxymethyl cellulose [CMC] and starch on the drug placing 30% lactose were also examined. In-vitro studies were carried out with the help of phosphate buffer [PH 7.4] as dissolution medium. Drug release mechanism was assessed by applying various kinetic models. Similarly / dissimilarity factor f[2]/ f[1] were applied for determination of dissolution profile of the test and reference formulations. Physiochemical characteristics were in the USP satisfactory limits. Conventional Acarbose tablet released 97% of the drug within 2 hrs. Ethocel[registered sign] Standard 7 premium and Ethocel[registered sign] standard 7 FP released 59.9% and 47.01% of the drug within 6 and 99.9% and 97% within 24 hours, respectively. This effect possibly has been aceived owing to the smaller particle size of the Ethocel[registered sign] Standard 7 FP premium which show evidence of anomalous, nonfickian release kinetics. Co-excipients like HPMC, CMC and starch augment the drug release rates from the matrices which may be attributed to their hydrophilic nature. Ethocel[registered sign] Standard 7 Premium and Ethocel[registered sign] Standard premium 7 FP polymers show a promising response in fruitful production of controlled release tablets by direct compression method

Evaluation of Prunus domestica gum as a novel tablet binder

To evaluate binding potential of Prunus domestica gum in tablets formulations. Six tablet batches (F-1B to F-6B) were prepared by wet granulation method, containing Avicel pH 101 as diluent, sodium diclofenac as model drug using 10, 15 and 20 mg of Prunus domestica gum as binder and PVP K30 was used as standard binder. Magnesium stearate was used as lubricant. Flow properties of granules like bulk density, tapped density, Carr index, Hausner’s ratio, angle of repose as well as physical parameters of the compressed tablets including hardness, friability, thickness and disintegration time were determined and found to be satisfactory. The FTIR spectroscopic analysis showed that the formulation containing plant gum is compatible with the drug and other excipients used in tablets formulation. Hence the plant gum has role as a potential binder in tablets formulations. The dissolution profile showed that tablets formulations containing Prunus domestica gum 15 mg/200 mg of total weight of tablet as binder showed better results as compared to PVP K30.

Para avaliar a propriedade aglutinante da goma Prunus domestica em formulações de comprimidos, seis lotes (F-1B para F-6B) foram preparados pelo método de granulação úmida, contendo Avicel pH 101 como diluente e diclofenaco de sódio como fármaco modelo, usando 10, 15 e 20 mg de goma de Prunus domestica como agente aglutinante e PVP K30 como aglutinante padrão. O estearato de magnésio foi utilizado como lubrificante. Propriedades de fluxo dos grânulos, como a densidade, índice de Carr, razão de Hausner, ângulo de repouso, bem como parâmetros físicos dos comprimidos, incluindo o tempo de dureza, friabilidade, espessura e desintegração foram determinados e se mostraram satisfatórios. A análise espectroscópica no FTIR mostrou que a formulação contendo goma vegetal é compatível com o fármaco e outros excipientes utilizados na formulação dos comprimidos. Assim, a goma vegetal tem papel potencial como aglutinante em formulações de comprimidos. O perfil de dissolução das formulações que contêm 15 mg/200 mg do peso total do comprimido em goma de Prunus domestica como aglutinante mostrou melhores resultados comparativamente ao PVP K30.

Mucinous breast cancer with solitary metastasis to humeral head: a case report

Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.

Development of novel diclofenac potassium controlled release tablets by wet granulation technique and the effect of co-excipients on in vitro drug release rates

The aim of the present study was the formulation and evaluation of controlled release polymeric tablets of Diclofenac Potassium by wet granulation method for the release rate, release pattern and the mechanism involved in drug release. Formulations having three grades of polymer Ethocel [7P; 7FP, 10P, 10FP, 100P, 100FP] in several drugs to polymer ratios [10:3 and 10:1] were compressed into tablets using wet granulation method. Co-excipients were added to some selected formulations to investigate their enhancement effect on in vitro drug release patterns. In vitro drug release studies were performed using USP Method-1 [Rotating Basket method] and Phosphate buffer [pH 7.4] was used as a dissolution medium. The similarities and dissimilarities of release profiles of test formulations with reference standard were checked using f2 similarity factor and f1 dissimilarity factor. Mathematical/Kinetic models were employed to determine the release mechanism and drug release kinetics

Formulation and in vitro evaluation of ofloxacin-ethocel controlled release matrix tablets prepared by wet granulation method: influence of co-excipients on drug release rates

Being controlled release dosage forms, tablets allow an improved absorption and release profiles of Ofloxacin. The fact that drugs with fine particles size can be compressed well after wetting, so in our research studies Ofloxacin controlled release matrix tablets were prepared by wet granulation technique. In order to investigate the potential of Ethyl cellulose ether derivatives as a matrix material, Ofloxacin formulations with different types and grades of Ethocel were prepared at several drug-to-polymer ratios. The method adopted for in vitro drug release studies was USP Method-1 [rotating Basket Method] by Pharma test dissolution apparatus using phosphate buffer 7.4 pH as a dissolution medium. Various Kinetic models were employed to the formulations for the purpose of determination of release mechanism. A comparative study was performed between the tested Ofloxacin-Ethocel formulations and a standard reference obtained from the local market. FI dissimilarity factor and f2 similarity factor were applied to the formulations for the checking of dissimilarities and similarities between the tested formulations and reference standard

Effect of lithium metal on the chemical status of glutathione [GSH] present in whole blood [especially in plasma and cytosolic fraction in human blood]

Lithium remains a mainstay in the acute and prophylactic treatment of bipolar affective disorder. It is used in the augmentation of antidepressant treatment and, less frequently, in the augmentation of antipsychotic treatment of schizophrenia. It is reported to have specific anti-suicidal effects. Thus the effect of Lithium was interesting to study on the glutathione [GSH] level in vivo conditions. Ellman's method has been used to see the effect of lithium on glutathione [GSH] level in whole blood. The time dependent effect of Lithium on the chemical status of glutathione [GSH] was determined in the whole blood [Plasma and cytosolic fraction] of human. The concentration of Glutathione was drastically decreased. The decrease in the glutathione level was concentration and time of interaction dependent, probably due to oxidation of glutathione [GSH] to corresponding disulphide [GSSG]. In this paper the effect of Lithium on the Thiol/GSH level was discussed in vitro, which in principal may present a model of in vivo reaction

Left sided amyand's hernia

Appendicitis within an Amyand's hernia is a rare clinical entity in itself and becomes especially more rare if it occurs in the left inguinal region. We report this rare case of Amyand's hernia where the appendix was found along with gangrenous ceacum during surgery for strangulated left inguinal hernia in an adult, who underwent resection, anastomosis and simple repair for his hernia

Torsion of an epiploic appendix pretending as acute appendicitis

Torsion of an epiploic appendix is a rare surgical entity. Its unusual symptomatology, wide variation in physical findings and the absence of helpful laboratory and radiological studies makes it very difficult to diagnose pre-operatively. This is a report of this rare entity found in a patient upon diagnostic laparoscopy performed for suspected acute appendicitis

Eosinophilic cholecystitis: an infrequent cause of cholecystectomy

Eosinophilic cholecystitis is a rare condition with obscure etiology. They are diagnosed histopathologically on resected specimens. We report a similar case confirmed on histopathology of a 49 years old diabetic lady who underwent routine elective cholecystectomy for chronic cholecystitis due to gall stones. The rarity of the condition prompted us to report this entity

Sternal bronchogenic cyst: a rare condition

Bronchogenic cyst is a congenital developmental abnormality of the embryonic foregut usually formed as a result of an accessory lung bud becoming isolated from the rest of the tracheobroncheal tree. Usually a solitary extra pulmonary cyst, it's a benign condition, found most commonly in the mediastinum with rare occurrence on the skin or subcutaneous tissues.We report a case of cutaneous bronchogenic cyst that occurred in the skin over the manubrium sterni of four years old boy. The diagnosis was made by the histopathological findings which revealed ciliated and mucin-producing pseudo stratified columnar epithelium of respiratory type