A novel case of left atrial and right lung mass turned out to be unconventional metastasis of uterine leiomyosarcoma with a review of literature

Uterine leiomyosarcoma (ULMS) is a rare malignancy arising from the myometrial smooth muscle wall, and cardiac metastases are extremely rare. Metastasis to the heart is a very unusual finding, and atrial metastasis is even rarer. Here, we report a case of a 45 year old woman who presented with dyspnea and pleural effusion and had a significant history of hysterectomy done for ULMS. Magnetic resonance imaging revealed a left atrial mass, which was resected and revealed to be a metastasis of leiomyosarcoma on histopathology and immunohistochemistry. Metastatic ULMS may rarely present as a left atrial mass with acute clinical presentation. Detailed clinical history and accurate diagnosis are vital for further management.

Cost analysis of antiamoebic drugs marketed in India: An observational study

Background: Amebiasis is a common recurring infection of the gastrointestinal tract caused by Entamoeba histolytica, affecting 15% of Indian population, related to poor sanitation and socioeconomic condition. No studies have been performed yet on cost analysis of antiamoebic drugs. Aim and Objective: The aim of the study was to analyze cost variations of different brands of antiamoebic drugs marketed in India. Materials and Methods: It was an observational and analytical study in which maximum and minimum costs in rupees per 10 tablets/capsules of each antiamoebic drug in same strength, manufactured by different pharmaceutical companies in India, were obtained from the Current Index of Medical Specialties (October 2021–January 2022), Drug Today (October 2021–January 2022), and Indian Drug Review (Issue 5, 2021). Cost ratio and % cost variation were calculated for each antiamoebic drug. Results: Metronidazole 200mg had highest cost ratio of 12.1 and 1110.73% cost variation, while Diloxanide furoate 500 mg had lowest cost ratio of 1.69 and 69% cost variation. Among fixed dose combinations, Tinidazole + Norfloxaxin (600 + 400) mg had highest cost ratio of 17.89 and 1689% cost variation, while Metronidazole + Norfloxacin (600 + 400) mg had lowest cost ratio of 1.21 and 21.22% cost variation. Conclusion: Our study showed significant cost variation in different brands of the same antiamoebic drugs. To lessen economic burden and to improve adherence to treatment, it is desirable for physicians to prescribe cheaper brands/generic drugs, to meet the health-care needs of patients. Furthermore, the government should make regulations to decrease cost variation of different brands of same antiamoebic drugs.

Analysis of COVID-19-related clinical trials registered in the Clinical Trial Registry of India in 2020: A descriptive study

Background: COVID-19 caused immense morbidity and mortality worldwide and was declared a pandemic on March 11, 2020, by the World Health Organization. Lack of effective treatments directed researchers to various interventional strategies, such as development of new drugs or vaccines, drug repurposing models, and AYUSH formulations, for prophylaxis and treatment of COVID-19. Aim and Objectives: The information obtained from registered COVID-19 trials for the year 2020, will help to identify the various aspects for therapeutics and types of study designs used for achieving different objectives, so as to guide researchers for similar future projects. Materials and Methods: A descriptive, observational study was conducted on COVID-19-related clinical trials registered in Clinical Trials Registry of India during calendar year 2020. The details were noted in a predesigned pro forma and evaluated. Results: Of the 946 registered trials, majority were single center (82.76%), interventional (50.7%), randomized (73.1%), open-labeled (61.9%), and prospective in nature (96%). Our study revealed that 40.16% trials used modern medicine while 26.53% used AYUSH formulations. The psychological impact of COVID-19 pandemic was studied in 121 trials, of which 118 trials showed negative impact on the mental well-being. Conclusion: Our study provides thorough insight about the on-going research in our country, especially about various drug repurposing strategies and government supported AYUSH interventions. This may act as a foundation for future investigators to identify any lacunae in the current studies, helping them to diversify their objectives accordingly, so as to encourage quality research in our country.

Analysing The Correlation Of Lipid Profile Pattern In Chronic Rheumatic Heart Disease (RHD) Patients

Background:The global burden of ARF and RHD is significant, and is predominantly found in populations living in low-resource settings. This study was conducted with a view for analysing the lipid profile variation in patients with chronic Rheumatic Heart Disease (RHD) and correlating the same. The early management of RHD has to be started to prevent further cardiac complications. To date no hypothesis is established on the relation between the Lipid Profile and RHD. This study would be beneficial to Indian cardiologists in defining the optimal treatment by the choice of antibiotic therapy and Lipid lowering agents like Statins.Material And Methods:It was a cross-sectional study carried out on the patients visiting Cardiology Out Patient Department (OPD) at a tertiary care hospital in Ahmedabad and who were diagnosed with Rheumatic Heart Disease (RHD).The blood lipids levels of thepatients were evaluated with current classification schemes and treatment levels for hyperlipidemia based on the National Cholesterol Education Panel’s (NCEP) Adult Treatment Program-3 (ATP-III) guidelines.Result:Total 89 patients were included in the study. 76 patients were associated with dyslipidaemia and 13 patients had normal lipid values. As far as total cholesterol levels were concerned, 23 out of 76 patients (30.26%) had above target levels for total cholesterol. Also 46 patients out of 76(60.52%) had raised triglycerides levels and 47 patients (61.84%) had raised LDL levels. As far as HDL levels were concerned, 38 out of 76 patients (50.00%) had below desirable levels. The frequency of deranged LDL is higher as compared to HDL, triglycerides and total cholesterol levels. If these values are to be co-related to the disease, then LDL as a lipid parameter stands most significant.Conclusion:Morbidity and mortality in RHD is very high in Indian patients and one of the determinants of the cardiovascular morbidity is the increased lipid levels. The frequency of deranged LDL is higher as compared to HDL and total cholesterol levels in these patients. This study was planned to evaluate an entirely novel hypothesis that RHD is an independent risk factor for Atherosclerosis and CAD. The exact reason behind the occurrence is unknown but it can be environmental or genetic. RHD and Dyslipidaemia might engulf younger patients. The study is also aimed at evaluating all lipid parameters with RHD.

Allergic Drug Reactions: How Do The Dermatologists Of Vadodara City Perceive And Contribute To Pharmacovigilance Program?

Background:The pharmacovigilanceisimperativein defining safety profile of the drug.As cutaneous Adverse Drug Reactions (ADRs) are very common, dermatologists’ contribution to pharmacovigilanceprogram of India (PvPI) is important. This study was conducted to know dermatologists’ perception about ADRs; their awareness and participation inPvPI. Material and Methods:A Prospective, cross-sectionalsurvey was conductedamongst dermatologists, approaching via Whatsappor during academic meetings. Pre-validated questionnaire including their demographic details, perception of risk of allergic reactions, awareness of PvPI and ADRs reporting was utilized. Data analysis was done with Microsoft Excel and Graph Pad prism software. Results:Out of 73 dermatologists, 44 responded the survey (Coverage rate 60%).Highest and lowest risk amongstantimicrobials for ADRswas perceived for sulphonamides and cephalosporins respectively. Amongstnon-antimicrobials, it was Non-steroidal anti-inflammatory drugs (NSAIDs) and local anaesthetics respectively. Awareness about PvPI was seen in 94% and 38% of dermatologists working in an institute and in a private set up respectively. Amongst them, 78% and 18% had ever reported ADRs to PvPI. Conclusions:Sulphonamides and NSAIDs were perceived to have higher risk ofADRs. Limited number of dermatologists have contributed to national ADR database amongst the ones who are aware of PvPI.

Design And Development Of Rilpivirine Nanoparticle Containing Chitosan Using Ionic Gelation Method For Hiv Infections

Objective: The primary objective of the current research was to prepare rilpivirine loaded Nanoparticles containing Chitosan using the ionic gelation method for HIV infections. Methods: The nanoparticles of rilpivirine were prepared using the ionic gelation technique. Further, nanoparticles were characterized by Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), scanning electron microscopy (SEM) and in vitro drug release. Results: The optimized nanoparticles were found with a particle size of 130.30±5.29 nm (mean±SD) and entrapment efficiency (% EE) of 77.10±0.50%. Scanning electron microscopy technique exposed spherical particles with uniform size. It was observed that the nanoparticles created showed the absence of the crystalline nature of the drug and its switch to the amorphous state. Results showed that more than 45% of the pure drug is released in 50 min and after 90 min almost about 95% of the drug is released. Conclusion: The research study concluded that the in vitro release profile of nanoparticles was found to be sustained up to 24 hr. Sustained release of the rilpivirine could improve patient obedience to drug regimens, growing action effectiveness.

Clinical profile and outcome of acute pancreatitis and necrotizing pancreatitis.

Background: Acute pancreatitis includes a wide spectrum of disease, from mild self limiting symptoms to a fulminant process with multiple organ failure and high mortality. Around 20% of the patients of acute pancreatitis develop acute severe pancreatitis in the form of extensive pancreatic or peripancreatic fat tissue necrosis with associated peripancreatic collection. These patients run a protracted clinical course with high morbidity and mortality. Material and methods: Clinically, radiologically and by blood investigated, diagnosed 40 patients ofacute pancreatitis were prospectively evaluated for the clinical outcome with respect to presence or absence of pancreatic necrosis and severity in terms of CTSI. Results: 24 patients had acute pancreatitis without necrosis (Group A) whereas 16 patients had necrosis including >30% of gland (Group B). The rate of organ dysfunction and mortality (0% versus 25%) rate of was significantly higher in the group B. Multi organ failure (MOF) was present in 4.17% of group A and 20.84% of group B patients. 80% patients were managed conservatively, who all survived and 20% patients underwent surgical intervention of whom 50% survived. Conclusion: CECT is the modality of choice to diagnose acute pancreatitis, presence or absence of necrosis, to stage the severity of pancreatic necrosis, depict severity of inflammatory processes and local complications. Patients with pancreatic necrosis with transient end organ dysfunction can be treated conservatively with favorable outcome. The need for intervention should be individualized and based on the clinical condition of patient.

Effectiveness of a program designed to expose medical student to the rural community and support system in healthcare, in a medical college.

Background: It is felt that medical training should largely be made in close proximity of public health & social environment compared to a tertiary care hospital. The package of training could include an exposure to the rural community because a fresh graduate doctor does not have concept of broad community healthcare needs. Aims & Objectives: The aim of the study was to assess the effectiveness of a program designed to expose medical student to the rural community and support system in health. Methods: The study was conducted in December 2008 among 96 medical student of 7th semester. This was a quasi- experimental design with before and after intervention assessment. Assessment was made based on presentations on comparisons of mock village scenario Vs real village experience. A structured questionnaire was used to assess change in knowledge. Results: The mean of the test scores in communication skill and knowledge (based on presentations) in average mock village scenario were 45.94 and improved to 53.56 after real village stay. There was an improvement of 7.62(16.6 %, p<0.001).The mean pre and post village stay score in knowledge based on questionnaire was 56.02 and 67.12 respectively with an improvement of 11.1 (19.81%, p<0.001). The programme was also found to be interesting to the students and villagers. Conclusions: A village stay programme to teach undergraduate student in a field setting to expose them to various parameters of practice of primary health care can help them understand the contextual needs of the society.

Prostate cancer disease characteristics for foreign-born South Asian men living in the United States.

INTRODUCTION: We report the largest known cohort of South Asian (SA) men treated by radical prostatectomy living in the United States. Our objective was to characterize this sub-population and compare them to our wider cohort of prostate cancer patients treated with radical prostatectomy in the United States. MATERIALS AND METHODS: All patients who underwent radical prostatectomy at two high-volume United States academic institutions at separate geographic locations between 1990 and 2011 were identified. Demographic data, pre-operative Prostate Specific Antigen (PSA), biopsy Gleason score, pathology Gleason score, pathology Stage, margin status, and node status were collected. In addition to SA men, African American (AA) men were identified and used for comparative analysis as a high-risk cohort. RESULTS: A total of 69 SA men were identified in Cohort 1 and 24 men were identified in Cohort 2. When comparing SA men against the entire cohort, no significant difference was found for age, year of surgery, biopsy Gleason score, or path Gleason score for either cohort. However, significant differences were found in pre-operative PSA (P = 0.01), pathologic stage (P<0.01), and positive node status (P = 0.04) for SA men in Cohort 1. Whereas in Cohort 2, SA men had a significantly higher proportion of positive surgical margins (P = 0.04). In all significant comparisons, characteristics were worse in SA men and similar to that of AA men. CONCLUSIONS: SA men have worse pathologic disease profiles when compared to the general population of men undergoing radical prostatectomy. SA men living in the United States have pathologic disease profiles that are comparable to AA men.

Drug Prescription Pattern in Pregnant Women Attending Antenatal Out Patient Department of a Tertiary Care Hospital.

Aims: Pregnant women requiring medication represent a challenge to healthcare providers to avoid any teratogenic risk to fetus. The purpose of this study was to provide information about the drug use among pregnant women in a tertiary care hospital, Mumbai, India. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynecology and Department of Pharmacology, Seth GSMC & KEM Hospital, between July 2011 and December 2011. Methodology: A cross sectional study was conducted by reviewing the antenatal care Outpatient department case papers of 760 random pregnant women. Demographic profile, detailed medical history and drug intake in current pregnancy was noted. The prescription pattern was assessed and the drugs were classified based on the US FDA Risk Classification. Results: Out of 760 women, one third (33.18%) women were anemic. Majority drugs were prescribed for the treatment of upper respiratory tract infection, vaginal discharge fever with chills, nausea and vomiting. The average number of drugs per prescription was 2.27. Only 4% drugs were prescribed by their brand name and 96 % by generic name. Iron, folic acid and calcium were prescribed to all pregnant women. Majority of the patients were prescribed Category A and B drugs. No patient was given Category X drugs. Conclusion: Findings of our study showed that all pregnant women were provided with prophylactic iron and folic acid therapy. The occurrence of contraindicated medicines was desirably low, thereby minimizing overall risk to developing fetus. Thus prescribing pattern observed in our study sets a good example, as selection of drugs was rational in most of the cases.

Tetany: Possible adverse effect of bevacizumab.

Background: Bevacizumab a recombinant humanized monoclonal antibody was approved in 2004 by US FDA for metastatic colorectal cancer. It is reported to cause potentially serious toxicities including severe hypertension, proteinuria, and congestive heart failure. Aim: To correlate adverse event tetany with the use of bevacizumab. Materials and Methods : World Health Organization's Uppsala Monitoring Centre, Sweden, for reporting of adverse drug reactions from all over the world, identified 7 cases with tetany-related symptoms to bevacizumab from four different countries. These 7 patients reported to UMC database developed adverse events described as musculoskeletal stiffness (1), muscle spasm (1), muscle cramps (1), lock jaw or jaw stiffness (4), and hypertonia (1), with hypocalcaemia. Results: After detailed study of the possible mechanism of actions of bevacizumab and factors causing tetany, it is proposed that there is a possibility of tetany by bevacizumab, which may occur by interfering with calcium metabolism. Resorption of bone through osteoclasts by affecting VEGF may interfere with calcium metabolism. Another possibility of tetany may be due to associated hypomagnesaemia, hypokalemia, or hyponatremia. Conclusions: Tetany should be considered as a one of the signs. Patient on bevacizumab should carefully watch for tetany-related symptoms and calcium and magnesium levels for their safety.

Drug Utilization and Cost Analysis for Common Skin Diseases in Dermatology OPD of an Indian Tertiary Care Hospital - A Prescription Survey.

Introduction: Epidemiology of skin diseases has been studied and evaluated occasionally. In view of high incidence of skin diseases and economic burden that it poses, there is a need to evaluate the present epidemiology and prescribing pattern of skin disorders. Objective: To assess common skin conditions, drug utilization patterns and cost analysis in Dermatology Out patients Department (OPD) of Tertiary Care hospital. Methodology: After taking Ethics committee’s permission, prescriptions of 600 patients attending Dermatology OPD were audited. The prescriptions were analyzed for common skin conditions drug utilization and cost analysis. Results: The common skin conditions found were Pyoderma and Scabies while common classes of drugs prescribed were antiallergics, antifungals and steroids. Drugs prescribed by Generic name were 16.6% and Brand names were 83.4%. It was revealed that 30% of total drugs dispensed from hospital pharmacy and 70% from outside pharmacy. Average hospital and outside pharmacy costs were INR19.40 and INR116.20, respectively. The outside pharmacy cost of prescription (Spearman’s Rho = -0.130, p < 0.01) as well as cost paid by the patients (Spearman’s Rho = 0.408, p < 0.001) had a negative correlation with the socioeconomic score as the drugs were prescribed irrespective of the socioeconomic class. Conclusion: The dermatological prescription analysis gives a message to the prescribing physician to achieve rational and cost effective medical care. The drugs which are made available in the hospital pharmacy should be based on clinical evidence generated from meta-analysis of drug studies, pharmacoepidemiology and pharmacoeconomic studies. There is dire need for physicians training with regards to rational use of drugs and pharmacoeconomics. Hospital should make essential drugs available with continuous monitoring to improve the prescribing pattern. The limitation of this study is that the actual direct costs and indirect costs were not studied. It opens the scope for further study in this area.

Biodegradation of phenol by native microorganisms isolated from coke processing wastewater.

The present investigation was undertaken to assess the biodegradation of phenol by native bacteria strains isolated from coke oven processing wastewater. The strains were designated ESDSPB1, ESDSPB2 and ESDSPB3 and examined for colony morphology Gram stain characters and biochemical tests. Phenol degrading performance of all the strains was evaluated initially. One of the strains namely ESDSPB2 was found to be highly effective for the removal of phenol, which was used as sole carbon and energy source. From an initial concentration of 200 mg l-1 it degraded to 79.84 ± 1.23 mg l-1. In turn the effect of temperature (20 to 450C), pH (5 – 10) and glucose concentration (0, 0.25 and 0.5%) on the rate of phenol degradation by that particular strain was investigated. Observations revealed that the rate of phenol biodegradation was significantly affected by pH, temperature of incubation and glucose concentration. The optimal conditions for phenol removal were found to be pH of 7 (84.63% removal), temperature, 300C (76.69% removal) and 0.25% supplemented glucose level (97.88% removal). The main significance of the study is the utilization of native bacterial strains from the waste water itself having potential of bioremediation.

Noise pollution in residential areas of Jharsuguda Town, Orissa (India) and its impact.

In this paper, an attempt has been made to study noise levels in different residential areas of Jharsuguda town in western Orissa (India). Minimum, maximum, L10, L50 and L90 noise levels have been computed. It was found that noise levels in the residential areas exceed the standards set by the Central Pollution Control Board, India. Vehicular traffic, with air horns of loud noise, was found to be the main reason for these high noise levels. Strict measures need to be taken to reduce and control the noise pollution.

A correlation of secondary aerosol (nitrate and sulfate) with respirable particulate matter (RPM) in ambient air at different traffic junctions of Vadodara city.

The correlation study of secondary aerosol (nitrate and sulfate) with RPM in ambient air at different traffic junctions of Vadodara city is reported. RPM was analyzed using Ion Chromatography technique and measured the level of nitrate and sulfate in ambient air. The correlation studies of these particulates with RPM have been established. The average concentration of sulfate and nitrate in ambient air was found 35.74 microg/m3 and 24.22 microg/m3, which ranged of 5.33-84.69 and 1.93-77.86 microg/m3 respectively. The correlation of RPM and SO4 (r = 0.813, P<0.01), RPM-NO3 (r = 0.5549, P<0.01) and SO4-NO3 (r = 0.6133, P<0.01) were found significant. The presence of sulfate and nitrate in RPM is 8.25% and 5.60% . The pH of water extract of RPM averaged 6.81, which ranged 6.17-7.28. Regression analysis result showed that the relationship between RPM-SO4 was significantly (R2=0.66215) correlated. This indicate that probably the secondary aerosols such as nitrate and sulfate in excess may cause irritation and increasing lung disease.

Gastric bacterial overgrowth accompanies profound acid suppression.

BACKGROUND: Suppression of gastric acid may lead to gastric colonization by aerobic and anaerobic bacteria, and consequent clinical manifestations. The risk is likely to be higher with poor environmental hygiene. AIMS: To study the effect of short-term acid suppression with omeprazole on gastric bacterial flora. METHODS: Twenty-five ambulatory patients with acid-peptic diseases underwent clinical assessment and gastric juice collection (for pH and culture) prior to start of therapy with 20 mg omeprazole daily, on days 7 and 14 of therapy, and 7 days after omission of therapy (day 21). RESULTS: Eighteen patients completed the study. The median gastric pH was 1.8, 7.5, 7.5 and 3.4 on days 0, 7, 14 and 21 respectively. Positive gastric cultures were obtained in 13 of 25, 17 of 21, 18 of 18 and 14 of 18 patients on respective study days, with median colony counts of 1.5 x 10(4), 7.5 x 10(5), 8.7 x 10(7) and 7.3 x 10(4) cfu/mL respectively. Three patients developed self-limiting diarrhea during therapy and two more immediately after discontinuing therapy. CONCLUSIONS: Gastric colonization is common with short-term profound acid-suppression, and may cause diarrhea. Acid suppressive therapy should be used with caution especially in patients with poor environmental hygiene.

Carotid sinus syndrome associated with carcinoma of the pyriform fossa.

A patient who developed syncope due to carotid sinus syndrome is described. The patient was suffering from carcinoma of the pyriform fossa for the past one year and received radiotherapy in the region of the neck for the same. Demand pacing was ineffective in alleviating syncopal episodes. The patient responded to oral administration of an anticholinergic (belladonna) and a sympathomimectic agent (orciprenaline).

Pulmonary function status of shopkeepers of Ahmedabad exposed to autoexhaust pollutants.

The study deals with evaluation of pulmonary function status (VC, FEV1% and FEF25-75%) in Ahmedabad shopkeepers stationed near different traffic junctions and relating them with the levels of oxides of nitrogen (NOx) near these junctions categorised as Heavy, Medium and Low polluted area junctions. The pulmonary function test (PFT) values of heavy polluted and medium polluted area shopkeepers is compared with low polluted area shopkeepers. The influence of smoking habits and duration of exposure over PFT values was seen. The prevalence of airway obstruction in shopkeepers was compared with USA population. The results indicated significant impairment in FEV1% and FEF25-75% value in high polluted area shopkeepers where NOx level is much higher than TLV value. In medium polluted area, where NOx level is slightly higher than TLV value, shopkeepers demonstrated significant impairment in FEF25-75%. Smoking is found to have an additive effect. A linear increase in the prevalence of pulmonary impairment with increasing duration of exposure was evidenced. Shopkeepers exhibited higher prevalence of impairment in both smokers and non-smokers than USA population attributing it to the effect of autoexhaust pollutants. This study also denoted that FEF25-75% is an early indicator of obstruction in smaller airways which is the primary site of deposition of inhaled pollutants.

Systolic time intervals in rheumatic mitral stenosis.

Thirty two patients with pure mitral stenosis and twenty normal subjects were studied by M-Mode Echocardiography and systolic time intervals. Preejection period (PEP) was increased in 62 percent of patients in New York Heart Association (NYHA) Class III and IV, compared to 42.9 percent of cases in NYHA class I and II. Left ventricular ejection time (LVET) was abbreviated in 87.5 percent cases in NYHA class III and IV, and in 58.3 percent of cases in NYHA class I and II. PEP/LVET ratio was significantly increased (p less than 0.01) in mitral stenosis (0.42) compared to normal subjects (0.33) while calculated left ventricular ejection fraction (EF) was significantly lower (p less than 0.01) in mitral stenosis (60%) compared to normal subjects (71.55%). It is hypothesized that a rigid "mitral complex" immobilises the posterobasal area of the left ventricle in mitral stenosis thereby impairing left ventricular contraction.