Can the Pirani Score Predict the Number of Casts and the Need for Tenotomy in the Management of Clubfoot by the Ponseti Method?

@#Introduction:We assessed the role of the Pirani score in determining the number of casts and its ability to suggest requirement for tenotomy in the management of clubfoot by the Ponseti method. Materials and Methods:Prospective analysis of 66 (110 feet) cases of idiopathic clubfoot up to one year of age was done. Exclusion criteria included children more than one year of age at the start of treatment, non-idiopathic cases and previously treated or operated cases. Results: The initial Pirani score was (5.5±0.7) for the tenotomy group and the initial Pirani score was (3.3±1.6) for the non-tenotomy group. There was a significant difference between the initial Pirani score for the tenotomy and the nontenotomy group with t= -7.9, df= 64 p<0.0001. The tenotomy group had a significantly higher number of casts (four to seven) compared to non-tenotomy group (two to five) t=-10.4, df=64, p<0.0001. Spearman’s rank correlation coefficient was significant and confirmed positive correlation between the initial Pirani score and the number of casts required to correct the deformity (r = 0.931, p<0.0001). Conclusion: Initial high Pirani score suggests the need for greater number of casts to achieve correction and probable need for tenotomy. The number of casts required in achieving complete correction increases with increase in the initial Pirani score. The initial high hindfoot score (2.5-3) signifies the probable need of a minor surgical intervention of percutaneous tendoachilles tenotomy. Based on the initial Pirani score, parents can be informed about the probable duration of treatment and the need for tenotomy.

Comparative Study Of Efficacy Of Palonosetron With Dexamethasone Versus Granisetron With Dexamethosone In Laproscopic Abdominal Surgeries For Control Of Post Operative Nausea And Vomiting.

Background & Aim: This study was carried out to demonstrate the efficacy and compare a dose of Granisetron with Dexamethasone and Palonosetron with Dexamethasone for prophylaxis against postoperative nausea and vomiting. Aim is to study the effectiveness of palonosetron and granisetron with aims of evaluating the efficacy of palonosetron and granisetron with dexamethasone in prevention of postoperative nausea and vomiting and to study associated adverse effects. The study was carried out in Civil Hospital, Ahmedabad with prior permission of ethical committee of the hospital. Methodology: This study was designed to evaluate the efficacy and compare a dose of study drugs in 60 patients of either sex and age ranging from 18 to 60 years and physical status ASA risk I or II undergoing general anaesthesia for various laparoscopic surgical procedures. Patients were divided into 2 groups(n=30), assigned to receive granisetron 1mg plus dexamethasone 8mg i.v and palonosetron 0.075mg plus dexamethasone 8mg i.v. A standard general anaesthesia technique and post operative analgesia were used throughout our study. The groups were compared with regards to the incidence of complete response, mean PONV score, mean nausea VDS scores and requirement of rescue anti emetics drug at various intervals (0-6,6-24,24-72hrs). Differences in continuous variables (age and duration of anaesthesia) across two dosage groups were compared using analysis of variance (ANOVA) test which is a parametric statistical test. Differences in categorical variables (gender, presence of complete response, use of rescue anti-emetics) across two dosage groups were compared using chi square test. Differences in ordinal variables (PONV scores and 4-point verbal descriptive nausea scores) across two dosage groups were compared using non-parametric Kruskal Wallis one-way analysis of variance. Mann Whitney U test was used to conduct sub-group analyses for comparing PONV scores and 4-point verbal descriptive nausea scale scores between two given groups. McNemar's test was done to compare differences in rates of complete response in a given dosage group across different time periods of assessment. Results: Our study results shows clear superiority of palonosetron with dexamethasone as a prophylactic drug for the prevention of PONV than that of granisetron with dexamethasone. Conclusions: Due to its longer duration of action, a single dose of palonosetron with dexamethasone before induction is effective in preventing PONV for upto 72 hours and hence can be termed as a prophylactic drug for PDNV also. It’s optimal and effective dose is 0.075mg i.v. with minimal side effects.

Antioxidant and Radical Scavenging Properties of β-Carotene on Cisplatin Induced Cardiotoxicity.

Objective: To investigate the protective role of β-Carotene against cisplatin induced cardiotoxicity in male albino rats. Methods: Various biochemical parameters such as Creatine kinase-MB, Lactate dehydrogenase (LDH), Alkaline phosphatase (ALP), Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Triglycerides (TG) and Total cholesterol (TC) are being assessed. Also the levels of the in vivo antioxidants such as Reduced glutathione (GSH), Catalase (CAT), and Malondialdehyde (MDA) in the post mitochondrial supernatant of heart were measured. In addition, the histopathological studies were performed to study the protective activity of β-carotene. Results: Cisplatin administration has shown the elevated levels of the cardiac markers and diminished the endogenous antioxidant levels when compared with the normal rats. β-carotene treatment showed the inhibitory effect on the free radicals showing decreased levels of the cardiac markers like CK-MB, LDH, AST, ALT and ALP. The β-carotene treated rats showed significant (p<0.001) decrease in lipid peroxidation in both prophylactic and curative groups when compared to the cisplatin group. Also showed a significant (p<0.05, p<0.001) increase in the levels of GSH in prophylactic and curative group respectively when compared with the cisplatin group. Both prophylactic and curative groups have shown a significant (p<0.001) increase in the levels of CAT. Further, the histopathological studies confirm the protective effect of β-carotene. Conclusion: These findings justify the biological and traditional uses of β-carotene as confirmed by its promising radical scavenging activity against cisplatin induced cardiotoxicity.

Serum 25-Hydroxy Vitamin D, Calcium,Phosphorus and Alkaline Phosphatase Levels In Healthy Adults Above the age of 20 Living in Potheri Village of Kancheepuram District , Tamilnadu.

Medical fraternity believed that Vitamin D deficiency is rare in southern part of tropical country like India. This study is aimed to determine the serum vitamin D, calcium, phosphorus and alkaline phosphatase levels in healthy subjects around Potheri, kancheepuram district of Tamilnadu. Total of 81 subjects above the age of 20, out of which 50 males and 31 females were recruited for the study. Institutional ethical committee clearance was obtained. After getting informed consent from each subject, a preformed questionnaire containing the details about socioeconomic status, religion, dietary habits , sun light exposure and skin color were filled. Venous blood was drawn to test vitamin D, calcium, phosphorus and alkaline phosphatase levels in the serum. Among 81 subjects, 73.91% had Vitamin D deficiency. Serum Vitamin D was not significantly correlated with serum phosphorus, serum alkaline phosphatase, skin color and living condition. But there exists positive correlation between serum calcium, sun light exposure with Vitamin D levels whereas socio economic status had a negative correlation. Adequate sun light exposure, fortification of food and oral intake of 800IU-1000IU Vitamin D daily are the best options to combat the Vitamin D deficiency.

Macrovascular and Microvascular Complications in Newly Diagnosed Type 2 Diabetes Mellitus.

Objectives: To study the prevalence and clinical profile of microvascular and macrovascular complications in newly diagnosed type 2 diabetes mellitus patients in and around Bellary, Karnataka. Study design: The study was an observational cross-sectional study of 100 newly detected type 2 diabetics attending Dept. of Medicine (outpatient/inpatient), VIMS combined hospitals, Bellary, from October 2012 to June 2013 (9 months) who matched the inclusion criteria. Material and methods: Cases were screened for vascular complications as per ADA criteria, data tabulated and analyzed. Statistical analysis: SPSS software package was used for analysis. Statistical significance was defined as a p value <0.05. Results: The mean age of presentation was 54.05 ± 13.24 with male:female ratio of 1.6:1. The prevalence of diabetic retinopathy, nephropathy, neuropathy, cardiovascular, cerebrovascular and peripheral vascular disease was 20%, 37%, 16%, 26%, 8% and 11%, respectively; retinopathy, nephropathy and coronary artery disease screening being significant (p < 0.05). Conclusion: There was a significant correlation between prevalence of diabetes and increased waist circumference and body mass index. There was high prevalence of coronary artery disease, nephropathy and retinopathy in South Indian population at diagnosis. Screening for all cases of diabetes at diagnosis for complications is recommended.

Prescribing pattern of antibiotics for post-tuberculous bronchiectasis treated in a tertiary care hospital.

The present study aimed at assessing the prescription pattern of antibiotics used for the treatment of patients diagnosed with post-tuberculous bronchiectasis in a tertiary care hospital. A prospective study was carried out at Government General Hospital located in Kakinada, Andhra Pradesh during April 2011 to June 2011. A total of 120 in-patient prescriptions were analyzed and data was collected on a standard documentation form. Patients who are in the age group of 20 to 80 years were included in the study. The data collected was analyzed for the prescribing patterns of antibiotics based on the demographic profile of patients. The study results showed that among 120 patients, male patients were 92 (76.7 %) and female were 28 (23.3%), indicating higher incidence of the disease in male than female. Out of 120 prescriptions, 108 prescriptions contained double antibiotics, 12 were found with single antibiotic and 6 prescriptions with triple antibiotics. A total of seven different classes of antibiotics were prescribed either alone or in combination. Gentamicin was found in 90 (75.0%) prescriptions, ciprofloxacin in 76 (63.3%) and cefotaxime in 26 (21.7%) prescriptions. It was found that aminoglycosides, cephalosporins and fluoroquinolones were most commonly used in the hospital practice for the treatment as well as management of tuberculosis complications and associated post-TB bronchiectasis.

Simple Spectrophotometric Method for Estimation of Raltegravir Potassium in Bulk and Pharmaceutical Formulations.

A simple, rapid, precise, and economical spectrophotometric method has been developed for quantitative analysis of Raltegravir Potassium (RALP) in tablet formulations. The stock solution of RALP was prepared in water. The standard solution of RALP in water showed absorption maxima at 331.6 nm. The drug obeyed Beer–Lambert’s law in the concentration range of 1–100 μg/mL with coefficient of correlation (R2) was 0.9999. It showed coefficient of variation below 2 % in intra-run and inter-run precision. The recovery was obtained with values close to the 100 % of theoretical at three different concentrations. The results of analysis have been validated as per ICH guidelines. The method can be adopted in routine analysis of RALP in bulk and tablet dosage form and it involves water as a solvent and no complex extraction techniques.

Crystal violet stain as a selective stain for the assessment of mitotic figures in oral epithelial dysplasia and oral squamous cell carcinoma.

Background: Assessment of mitotic figures (MFs) is routinely practiced as prognostic indicator in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC), but identification of MFs poses a problem in terms of staining characteristics. Aim: To evaluate effectiveness of crystal violet stain for staining of MFs and its comparison with hematoxylin and eosin (H and E) stain. Materials and Methods: Study sample includes archival tissues embedded in paraffin blocks diagnosed as OED (n = 30) and OSCC (n = 30). The control group comprised of tissue specimen from oral mucosa of healthy volunteers (n = 30). Two serial sections of each tissue specimen were stained separately with H and E stain and 1% crystal violet stain. The stained sections were observed under microscope for identification and counting of MFs. Data obtained was statistically analyzed by using the Man-Whitney U test. Results: A significant increase in number of MFs was observed in OED and OSCC in comparison with normal oral mucosa. There was a highly significant increase in number of MFs in crystal violet stained tissue sections when compared with H and E stain. Metaphase is the most commonly observed phase of mitosis in crystal violet stain when compared with H and E stain for all three groups. Conclusion: Crystal violet stain can be considered as selective stain for mitotic figures.

Case of Phthiriasis palpebrarum with blepheroconjunctivitis.

A 70-year-old woman came to ophthalmology outpatient department with complaints of repeated episodes of itching, redness and watering in both eyes of 3 months duration. She was treated with antibiotics elsewhere but had no improvement. Slit lamp examination showed lice and nits anchored to the eyelashes. Light microscopic examination of the matted eye lashes and crusts further helped in identification of the ectoparasites as Phthirus pubis (Pubic louse or Crab louse) with typical morphology.

Evaluation of effects of different concentrations of lead, alcohol and vitamin E on protein carbonyl content of brain tissue in rats.

The lead treatment was characterized by increase (28%) in protein carbonyl content 5.19, but the increase was not significant. In alcohol treated rats, the protein content was 5.52nmol/gram of brain tissue of rat. The increase (36%) was significantly higher when compared to lead treated rats. The protein carbonyl content (6.39nmol/gram) was further increased in rats coexposed to alcohol and lead, and the values ranged from 5.40 to 8.20 nmol/gram. The percent increase in protein carbonyl content was 57% in rats coexposed to alcohol and lead. Thus, the magnitude of deleterious effects of oxidative stress on protein oxidation is more significant in combined treatment group when compared to lead alone treated rats and alcohol alone treated rats. The lead treatment was characterized by a significant increase (37%) in protein carbonyl content (6.19nmol/gram). In alcohol treated rats, the increase in protein carbonyl content (6.79nmol/gram) was more marked (51%) when compared to lead treated rats. The protein carbonyl content was significantly increased (73%) in rats coexposed to alcohol and lead, and the values ranged from 6.80 to 8.56 nmol/gram (7.76nmol/gram).

Effect of Lead, Alcohol and Vitamin E on Protein carbonyl content in rats.

Protein carbonyl content assay was conducted among eight groups of animals treated with lead, alcohol and vitamin E in individuals and in combination at two, four and eight weeks of duration. In two weeks of treatment, lead treated rats recorded 2.45 nmol/grams. In alcohol treated rats, it was recorded 2.60 nmol/gram of protein carbonyl content in liver tissue. Compared to control, it was recorded 2.01 nmol/gram. In vitamin E treated with lead and alcohol, protein carbonyl content was recorded 3.02 nmol/gram of tissue. In four weeks of duration, lead treated rats recorded 2.64 nmol/gram of tissue and in alcohol treated rats, protein carbonyl content was 2.87 nmol/gram and in lead with alcohol and vitamin E treated rats, protein carbonyl content was 3.29 nmol/gram. In eight weeks of treatment, maximum protein carbonyl content was recorded in lead with alcohol treated rats compared to control.

Antifungal activity of bioactive compound of seeds of Psoralea corylifolia L. against seed borne Fusarium species of maize.

Antifungal activity of bioactive compound 2H-Furo[2,3-H]-1-benzopyran-2-one isolated from seeds of Psoralea corylifolia L. were tested against eight Fusarium species of maize seeds at 100- 1000ppm concentration. F. moniliforme, F. oxysporum, F. semitectum and F. solani were completely inhibited at 600ppm concentration. F. equiseti, F. lateritium and F. proliferatum were completely inhibited at 700ppm concentration and F. graminearum was inhibited at 800 ppm concentration. Significant inhibition was also observed from 100-500ppm concentration in all the test fungi. Compared to synthetic fungicide Thiram recorded significant antimicrobial activity than Captan tested at 2000ppm concentration. Minimum Inhibitory Concentration (MIC) was also determined for all the species of Fusarium tested. In dry mycelia weight analysis, the mycelia growth all the species of Fusarium were completely inhibited at 500-650 ppm concentration of the bioactive compound.

In vitro evaluation of aqueous seed extract of Psoralea corylifolia L. on seed germination and seedling vigour of maize.

Aqueous seed extract of seeds of P.corylifolia were evaluated for seed germination and vigour index at 10, 20, 30, 40 and 50% concentration for 3,6, 12 and 24hours of treatment in maize seeds. Maximum and significant activity was observed in 20% concentration at 12hours of duration and recorded 88.0% germination and 1398.5 vogour index. Compared to control, it was recorded 72.1% germination and 1010.1 vigour index. In 30 and 40% concentration at 12 hours of duration, significant activity was recorded. In 6 hours of duration, moderate activity was observed in 10, 20, 30 and 40% concentration. No significant activity was observed in 3 hours and 24 hours duration at 10, 20, 30, 40 and 50% concentration of aqueous seed extract.

Neonatal Umbilical Myiasis with Sepsis.

The authors report a 9-day old neonate from a rural area with umbilical myiasis caused by fly larvae of Cochliomyia hominivorax. The blowfly causing this infestation belongs to the family Calliphoridae (Diptera) and the genus Cochliomyia that usually infests only open wounds of animals. The new-world screw-worm fly Cochliomyia hominivorax, is an obligate ectoparasite of domestic and wild animals, and in some cases may affect humans. This is the rare reported case of neonatal umbilical myiasis with sepsis in the world literature.

Phytoplankton as index of water quality with reference to industrial pollution.

In this paper Shannon-Weaver (SI-3.58-4.07, SII-3.1-3.72, SIII-1.64-2.25, SIV-2.54-2.95 and SV-3.09-3.23) diversity index was applied to surface phytoplankton to study the water quality status of river Bhadra receiving Mysore paper mill and Iron and steel mill effluent. A total of 45 species of phytoplankton belonging to 5 classes were recorded and study indicated that the phytoplankton diversity (Chlorophyceae-19 species, Bacillanophyceae-16 species, Cyanophyceae-07 species, Euglenophyceae-2 species and Chrysophyceae-1 species) did not reveal the same type of water quality (water temperature 24.62-27.32 degrees C, pH-7.08-7.25, electrical conductivity-67.49-201.94 micromhos/cm, dissolved oxygen-4.13-5.98 mgl(-1), chloride-12.30-40.85 mgl(-1), calcium-6.49-23.74 mgl(-1), total hardness 28.98-76.65 mgl(1), magnesium-4.69-15.92 mgl(-1), total alkalinity-77.26-86.53 mgl(-1), BOD-1.88-4.01 mgl(-1), COD - 16.53-45 mgl(-1), phosphate-0.001-0.53 mgl(-1), sodium-2.70-7.46 mgl(-1) and potassium-2.37-7.88 mgl(-1)). The investigation emphasized the need of phytoplankton community as index of water quality polluted by industrial effluents at the downstream stretch of the Bhadra river.

Trace metal levels in the organs of finfish Oreochromis mossambicus (Peter) and relevant water of Jannapura lake, India.

Trace metal levels in the body organs of finfish, Oreochromis mossambicus (Peter) and relevant water was studied in Jannapura lake, located five kilometers from Bhadravathi town, Karnataka, India, during 2004-05. Lead, Copper and Cadmium accumulation was higher in muscles than in gills while, Zinc, Nickel and Cobalt accumulation was maximum in gills followed by muscles. The metals present in the highest concentration were in the order of Pb > Cu > Zn > Cd > Ni > Co in the water samples. The higher concentration of various metals in water and Pb, Ni in fish muscle and Ni in gill samples was probably due to the addition of untreated sewage, geological weathering and agricultural runoff from the surrounding areas. On the basis of results obtained, it is predicted that if the present situation of water pollution continues in future, survival of fish population and other aquatic animals will be extremely difficult.

In vitro antiviral activity of bael (Aegle marmelos Corr) upon human coxsackieviruses B1-B6.

The in-vitro antiviral activity of a series of compounds in samples extracted from various parts of the Indian holy tree, Bael (Aegle marmelos corr.) were evaluated for their efficacy against human coxsackieviruses B1-B6. The inhibitory concentrations (IC50) for leaves (L1 and L2) stem and stem bark (S1, S2, S3 and S4) fruit (F1 and F2micro) root and root bark (R1 and R2) and pure compound, the marmelide were 1000 microg/ml (for L1 and L2), 1000 microg/ml (for S1, S2, S3 and S4), 1000 microg/ml (for F1) and 500 microg/ml (for F2) 250 microg/ml (for R1) and 500 microg/ml (for R2) and 62.5 microg/ml for marmelide respectively by plaque inhibition assay at 96 hrs. On the other hand, the corresponding value for Ribavirin, a standard antiviral drug, was 2000 microg/ml for the same viruses at the same time period. These concentrations did not exhibit any toxicity to Vero cells, the host subtoxic concentrations were 5000 microg/ml for leaf and stem fractions 2000 microg/ml for fruit fractions 500 and 1000 microg/ml for root fractions 250 microg/ml for marmelide and 2000 microg/ml for Ribavirin. The cytotoxic concentrations were 8000 microg/ml for leaf and stem compounds 4000 mg/ml for fruit; 1000 microg/ml and 2000 microg/ml for root 500 microg/ml for marmelide and 4000 microg/ml for ribavirin at 96 hrs. These were also confirmed by trypan blue dye exclusion test and further passaging of cells. Additionally pretreatment of host cells, virus inactivation, yield reduction and effect of time of addition assays against coxsackievirus B3 suggested that marmelide was most effective as a virucidal agent besides interfering at early events of its replicative cycle like adsorption, penetration, at various steps in single cycle growth curve and effect of time of addition.