A rare case report on rheumatoid arthritis with pleuro-parenchymal fibroelastosis

Pleuroparenchymal fibroelastosis(PPFE) is a recently characterised type of interstitial lung disease that begins in the upper lung zones and extends to the entire lung. To date, the aetiology is unknown. However, the cause of PPFE in the current case report is rheumatoid arthritis. The symptoms are dyspnoea and dry cough. Pneumothorax is a common complication that occurs at the time of presentation or subsequently in the progression of the disease. It usually occurs in > 40% of ex-smokers with restrictive patterns in the pulmonary function test. Interstitial fibrosis appears pathologically as a thick consolidation insomepreserved alveolar septal outlines and a markedly abrupt contact with thenormal residual lung. Undiagnosed PPFE casescan be misdiagnosed as sarcoidosis, atypical idiopathic pulmonary fibrosis, or other unclassifiable interstitial pneumonia. The current case report will address the rare outline of Rheumatoid arthritis with PPFE.

Outcome of transcutaneous retrobulbar injection of liposomal amphotericin B in post-COVID-19 rhino-orbito-cerebral mucormycosis: Our experience

Purpose: To assess the outcome and response of transcutaneous retrobulbar injection of amphotericin B (TRAMB) in post?coronavirus disease of 2019 (COVID?19) rhino?orbito?cerebral mucormycosis (ROCM) and to establish a scoring system in guiding treatment modalities. Methods: An interventional, prospective study was done on 82 eyes of post?COVID?19 ROCM from May 2021 to July 2021. A comprehensive multi?departmental evaluation along with detailed ophthalmic examination, laboratory investigations, and radiological examination was done. Scoring points were given to each symptom, sign, and radiological features of orbit and the total score was taken. Based on these scores, severity of disease was grouped into A, B, and C corresponding to mild, moderate, and severe orbital ROCM. One milliliter of reconstituted liposomal amphotericin B was given to all patients every alternate day as three doses. Efficacy of these injections was assessed in all groups, even though other treatment modalities like orbital debridement and exenteration were considered for moderate and severe cases. Patients were followed up for a period of 8 weeks. Results: Out of 82 eyes, symptomatic improvement was seen in a major proportion (72%) of patients. A statistically significant improvement in scores was noted in group A (93% improved) with a P value of 0.002, while 68.4% showed improvement in group B (P?value? 0.0001). Group C with severe disease showed minimal improvement in post?injection scores of 41% (P?value 0.086), necessitating surgical intervention. No serious adverse effect of the drug or procedure was noted. Conclusion: Significant improvement in scores of groups A and B highlights TRAMB as an effective and safe treatment modality in mild to moderate ROCM. It is an effective adjunct in severe cases, along with other interventions. Also, the scoring system helps in assessing the severity and guiding in management strategies.

Effects of Nebulized Dexamethasone Versus Nebulized Ketamine on the Attenuation of Post-operative Sore Throat Following Endotracheal Intubation

Background: General anesthesia (GA) with endotracheal intubation is a frequent cause of airway mucosal trauma whichresults in the post-operative sore throat (POST), with an incidence of 21–65%. Although minor and self-limiting complication,it produces significant discomfort and annoyance to the patient. This study was aimed to compare the efficacy of nebulizeddexamethasone versus ketamine in preventing POST.Materials and Methods: After approval from the institutional ethics committee and written informed consent, 100 patients ofthe American Society of Anesthesiologists physical status 1–2, aged between 20 and 60 years of either sex, undergoing GAwith endotracheal intubation were included in this prospective, randomized, and double-blind study. Patients were randomizedinto two groups of 50 each (n = 50); Group D: Patients received dexamethasone 8 mg (2 ml) with 3 ml of normal saline (totalvolume of 5 ml) for nebulization and Group K: Patients received ketamine (preservative free) 50 mg (1 ml) with 4 ml of normalsaline (total volume of 5 ml) for nebulization. After 15 min of nebulization, induction was done, POST assessment was done at0, 2, 4, 6, 12, and 24 h post-extubation. The severity of POST was graded on a 4-point scale (0–3).Results: The total incidence of POST was 19% in this study. Five patients (10%) in dexamethasone group and 14 patients(28%) in ketamine group experienced POST (Fisher’s exact test, P = 0.039). Reduction in the incidence and severity of POSTin the dexamethasone group when compared to ketamine group at 2, 4, 6, and 12 h postoperatively is statistically significant(P < 0.05*).Conclusion: Pre-operative single dose of nebulized dexamethasone 8 mg effectively attenuates POST in patients followingGA with endotracheal intubation compared to nebulized ketamine 50 mg without any detrimental effects.

Role of Magnetic Resonance Imaging in rotator cuff pathologies

Background: Stability to the shoulder joint which has great range of motility, is provided by the rotator cuff, the coraco-acromial arch and the glenoid labrum along with the capsule and glenohumeral ligaments. The common disorders involving the rotator cuff tendons include impingement, tendinopathies and tears. Magnetic Resonance Imaging (MRI) has good spatial resolution for identifying tendon edema and tears in the rotator cuff. Aim and objectives: To describe the MRI characteristics of rotator cuff pathologies. To describe the rotator cuff pathologies in terms of age, gender, symptomatology and predisposing factors among the study population. Materials and methods: The study was performed in the Department of Radiodiagnosis, NRI General Hospital, Chinakakani, Guntur from September 2015 to August 2017 and comprises of 100 patients with suspected rotator cuff pathologies who were referred for MRI shoulder. Results: The age distribution of patients with rotator cuff abnormalities was in the range of 21 and 74 years. The most commonly affected was supraspinatus tendon followed by subscapularis and infraspinatus tendons. Among the rotator cuff abnormalities the frequently encountered finding was tendinosis followed by partial tears. Conclusion: Magnetic Resonance Imaging is very useful in depicting rotator cuff disease in patients with painful, weak or stiff shoulder for prompt and accurate diagnosis.

Development and Validation of RP-HPLC Method for the Determination of Amlodipine.

The present paper describes a simple isocratic RP-HPLC method for the determination of Amlodipine in tablet dosage form. Best symmetric peak shape was obtained with column Zodiac C18 column (250 mm x 4.6 mm, 5μ) at 245nm with retention time of 5.53min. The mobile phase used was Methanol: Water: Acetonitrile 60:20:20 (v/v/v) with flow rate of 1.0 ml/min. The method for estimation of Amlodipine in tablet dosage form was found to be linear, accurate, precise, sensitive and selective. The linearity range was from 60μg/ml to 210μg/ml. Method was found to be highly sensitive as LOD and LOQ were found to 0.4μg/ml and 1.3μg/ml. The repeatability and reproducibility were within the range i.e. less than 2%. The %recovery values were found to be in the range of 98.82-100.93%. The percentage of assay was calculated for market formulation was 99.19%.

Modification of mercury-induced biochemical alterations by Triticum Aestivum Linn in rats.

The present investigation has been undertaken to evaluate role of Wheat grass extract in modifying mercuryinduced biochemical alterations in albino rats. Mercuric chloride 5 mg/kg body weight i.p. was given on 11, 13 & 15th day of the experiment. Wheat grass extract (400 mg/kg) and Quercetin (10 mg/kg) were administered 10 days before mercuric chloride administration and continued up to 30 days after mercuric chloride administration. The animals were sacrificed on 1, 15 and 30 days, the activity of serum alkaline and acid phosphatase and the iron, calcium, BUN, creatinine, SGPT, SGOT, total bilirubin, total protein levels were measured. Tissue lipid peroxidation content, glutathione (GSH) level, anti-oxidant enzymes- CAT and GR were measured. Hematological indices were also estimated. Mercury intoxication causes significant increase (P<0.001) in calcium level, acid phosphatase, BUN, creatinine, SGOT, SGPT, total bilirubin, lipid peroxidation content and significant decrease in iron level, alkaline phosphatase, total protein, and CAT, GR and glutathione level. Wheat grass extract pre- and post-treatment ameliorated mercury-induced alterations in terms of biochemical and hematological parameters. Concomitant treatment of Wheatgrass extract with Mercury showed prominent recovery and normal architecture with mild residual degeneration in the tissues. Thus from present investigation, it can be concluded that Wheat grass extract pre- and post-treatment with HgCl2 significantly modulate or modify mercury-induced biochemical alteration in albino rats.

Estimation of total Length of Humerus from Its Fragments in South Indian Population.

Aim: To obtain the lengths of the humeral segments and compare with total length of humerus in South Indian population, That helps in estimating the stature of individual using standard regression formulae and to compare these data with the study conducted in other countries for the use in forensic and archeological studies. Materials and Methods: 150 (75 left and 75 right) adult, fully ossified, dry and processed humerii were taken to analyze the morphometric details of the humeral segments which were measured using osteometric board and scale. The length of six different segments namely, from most proximal point in the head to most distal point of the circumference of the head (segment-1), from most distal point of the circumference of the head to the convergence of two areas of muscle attachment (segment-2),the convergence of two areas of muscle attachment to the deltoid tuberosity (segment-3), from deltoid tuberosity to upper margin of the olecrannon fossa (segment- 4), from upper margin of olecrannon fossa to lower margin of olecrannon fossa (segment-5), from lower margin of olecrannon fossa to most distal point on the trochlea (segment-6) and maximum length of humerus were measured to the nearest millimeter. Results: The values obtained in mm (mean±S.D) in total length of humerus segments -1,2,3,4,5 and 6 were recorded. The proportion of segments to the total length was also calculated which will help for the stature estimation using standard regression formulae. Conclusion: This study helps in forensic, anatomic and archeological fields in order to identify unknown bodies as well as for the orthopedic surgeons for the treatment of proximal and distal humerus fractures for their reconstruction in case of extensive damage to those parts of the humerus.

Carrier detection in Duchenne muscular dystrophy using molecular methods.

Background & objectives: Duchenne and Becker muscular dystrophies are X-linked allelic disorders which are caused by mutations in the DMD gene. Carrier analysis in DMD is complicated due to the heterozygous nature of the X chromosome. Several techniques have been tried for carrier analysis in families where the mutation is identified including quantitative multiplex PCR (qmPCR), Southern blot, and now multiplex ligation-dependent probe amplification (MLPA). Linkage analysis is used in cases without identifiable mutations. The present study was undertaken to determine the status of probable carriers in families where the DMD deletion/duplication has been identified for the affected index cases. Methods: Carrier status was present in 150 probable carriers from 110 apparently unrelated families where the patients’ mutations were known. Of these 110 families, 100 were deletions, 9 duplications and 1 point mutation. Multiplex ligation-dependent probe amplification (MLPA) was used to assess the copy number changes and direct sequencing was used for the case with the point mutation. Results: Of the 150 cases, 49 were found to be carriers. Among the sporadic cases, it was observed that the rate of de novo mutations was very high (71%) as compared to the hereditary cases (29%), which was higher than the calculated rate (30%). It was observed that this difference was more apparent in deletion mutations than in duplications. Interpretation & conclusions: Identifying the DMD carrier rates in the families with unidentified deletions and duplications and where the causative mutation could be small insertions/deletions or point mutations could throw more light into this observation. MLPA was found to be useful in detecting copy number changes in DMD carriers and this could be the method of choice for DMD carrier analysis, when the mutation is detected in the affected child.

Hypolipidemic activity and HPTLC analysis of Ixora coccinea L. Leaves.

The present research was made to investigate the potential hypolipidemic effect of Ixora coccinea. Hypolipidemic activity is screened by inducing hyperlipidemia with the help of atherogenic diet in wistar albino rats and serum levels of biochemical parameters such as total cholesterol, triglycerides, LDL, VLDL and HDL cholesterol were determined. Atherogenic index shows the measure of the atherogenic potential of the drugs. Ethanol extract showed significant (p< 0.05) hypolipidemic effect by lowering the serum levels of biochemical parameters such as significant reduction in the level of serum cholesterol, triglyceride, LDL, VLDL and HDL level which was similar to the standard drug Atorvastatin. Ethanol extract exhibited significant atherogenic index and percentage protection against hyperlipidemia. Preliminary phytochemical analysis revealed the presence of phytoconstituents such as alkaloids, tannins, flavonoids, carbohydrates, protein and amino acids and reducing sugars which is further confirmed by HPTLC (high performande thin layer chromatography). The overall experimental results suggests that the biologically active constituents such as flavonoids, alkaloids, tannins and glycosides in the ethanol extract, of Ixora coccinea, may be responsible for the significant hypolipidemic activity and the results justify the use of Ixora coccinea as a significant hypolipidemic agent.

Percutaneous tracheostomy.

The purpose of this review is to discuss the various techniques of percutaneous tracheostomy and to assess their safety and efficacy profile, indications and contraindications, early and late complications. Literature was reviewed from Medline and MD Consult databases. Early techniques by Sheldon, toye and Schachner have been abandoned due to their high complication rates. Percutaneous dilational tracheostomy using the Ciaglia kit (Wiliam Cook Europe Bjaeverskov) and a Griggs kit (Portex PDT kit, POrtex, Hythe, Kent, UK) has been used most often. Griggs guide Wire Dilator Forceps kit (SIMS, Portex, Hythe, Kent, UK) is the next most common in use but its long-term studies are few. Fantoni (TLT set, Mallinckrodt Medical) and PercuTwist device (Riisch, Kernen, Germany) are two new techniques currently under study. Percutaneous dilational tracheostomy and conventional surgical tracheostomy are still competing methods to provide an airway for intensive care patient requiring assisted ventilation. Review of literature shows that percutaneous tracheostomy is safe, cost-effective and compares favourably with the open surgical tracheostomy. Many intensive care units now use the percutaneous tracheostomy as a procedure of choice. Percutaneous tracheostomy has a learning curve and requires appropriate case selection and meticulous attention to the technique by all those who want to use this method.

A new parasite of the genus cucullanus nematoda cucullanidae from the fish arius thalassinus ruppel

Se describe una nueva especie parasitaria, cucullanus baylisi, del intestino de arius thalassinus de Bheemeli. La presente especie difiere de todas las especies conocidas reportadas de varias partes del mundo por tener un gran número de papilas caudales sésiles. Estas especies se parece estrechamente a C. theraponi por tener elevadas estructuras de la cloaca, ausencia de ciego intestinal y ventosa preanal, pero difiere en la presencia de espículas subiguales, estrechas aletas caudales, localización del anillo nervioso y papilas cervicales, tamaño del gubernaculum, forma de la cola, medidas y gran número de papilas caudales sésiles. Por lo tanto, se describe y se agrega una especie al género cucullanus y se denomina cucullanus baylisi

Streptoverticillium acido-carbonicum sp. nov.

A new species of Streptoverticillium assignable to biverticillate series, isolated from coal mine soil, Kothagudem (A. P.) is described. It grows from pH 4.5-6.0 with an optimum at pH 5.0 and temperature 37 degrees C. Its growth characters on differential media and utilization of carbon compounds are presented.

Radioimmunoassay of polypeptide hormones using immunochemically coated plastic tubes.

A method has been developed for immobilisation of antisera on fresh plastic tubes through an immunochemical bridge. This type of immobilisation has been shown to be more consistent than direct adsorption on plastic. Such immunochemically coated antisera on plastic tube has been used in the development of a noncentrifugation radioimmunoassay. This assay system has been found to be technically as sound as the conventional method.