2D Echocardiographic Findings, NT-ProBNP Levels, and Outcomes in Dyspnoeic Patients: Results from the Pro-BNP Investigation of Dyspnoea in the Emergency Department- a Single Centre Experience

Background: Dyspnoeic in the emergency department with multiple co-morbidities is a diagnostic challenge. Approximately 15-20% of acute dyspneic in the Emergency Department due to ADHF (acute decompensated heart failure) are misdiagnosed. B-type peptide (BNP) and its amino-terminal fragment (NT-proBNP) accurately identify HF in dyspnoeic patients. In the general population with dyspnoea, plasma pro-BNP concentrations are increased in left ventricular dilatation, hypertrophy, systolic dysfunction, or diastolic dysfunction but are unaffected by pulmonary dysfunction. Aims and Objectives: To study the relation between NT pro-BNP & echocardiographic findings in acute dyspnoeic patients, and the relation between NT pro-BNP and In-hospital Mortality. Materials and Methods: Source of data- Patients admitted to the Emergency Room or cardiac intensive care unit with a history of acute dyspnea in a tertiary cardiac care center in south India, meeting inclusion & exclusion criteria, were studied. Results: The study population is predominantly constituted of the elderly population. The most common co-morbid condition was hypertension. The present study uses an NT pro BNP level of 900pg/ml as the cut-off level. 78 patients were positive for the test. Echocardiography showed that 58% had LV systolic dysfunction, 60% had diastolic dysfunction. 42 patients had EF >55%, 10 patients between 55-45%, 33 patients between 44-30% and 15 patients had EF < 30%. Mortality rate was 6% in the whole study population. However, Mortality was seen in only NT pro-BNP positive group it was not statistically significant (p=0.46). Conclusions: NT pro-BNP correlates well with the worsening of LV systolic function; as the EF decreases, NT pro-BNP increases. Increase in NT pro-BNP levels has to be interpreted in the clinical context, and it is not a substitute for echocardiography for assessing cardiac abnormalities and dysfunction.

Comparison Of Anaesthetic Efficacy Of Inferior Alveolar, Gow-Gates And Vazirani-Akinosi Technique In Dentoalveolar Surgery

Background:Inferior alveolar nerve block has been widely used to anaesthetise the mandibular teeth. The other alternatives include the Gow-Gates and the Vazirani-Akinosi technique. This study aims to compare these three techniques of anaesthesia for posterior mandibular dentoalveolar surgery.Material & Method:Thirty subjects were equally distributed into three groups receiving the specific injection technique assigned to the group. The injection technique was performed using 3.6ml of 2% lignocaine with 1: 200000 adrenaline and clinical parameters such as onset of anaesthesia, pain in the injection site, extent of soft tissue anaesthesia and success rate of each block was assessed. Visual Analogue Scale was used to assess the pain experienced by the patient during theextraction procedure.Results:It was noted that the time taken for the onset of anaesthesia was the same in all the three groups. Vazirani-Akinosi group patients experienced significantly more pain on injection and during extraction of the tooth. Greaterextent of soft tissue anaesthesia was seen with the Gow-Gates technique when compared to the other two techniques. Conclusion:Gow-Gates technique demonstrated better efficiency when compared to the inferior alveolar or the Vazirani-Akinosi technique.

Morphological Comparative Study Of Human Renal Arteries In Cadavers And In Computed Tomography Scans

Background:The kidneys are vital organs of urinary system. The primary function of the urinary system is removal of metabolic waste from the body. The blood supply of any organ reflects its functional importance. This is true with the kidneys and its blood supply too. The right and left kidneys receive their blood supply from the lateral branches of the abdominalaorta, that is respectively from the right and the left renal arteries. These renal arteries are known to exhibit variations. These variations are encountered routinely during the dissection of cadavers. The knowledge of such variations is important for the clinicians and the surgeons. The recent advances in radiological techniques (CT scan) allow study of arterial system with good precision. This study is therefore planned with an aim to study and compare morphology of human renal arteries in cadavers andusing Computed tomography scans in living individuals. Material And Methods:The study was conducted on 36 formalin fixed cadavers and on 36 computed tomographic(CT)angiograms of renal arteries.The parameters measured included mode of termination and the branching pattern of renal arteries. Statistical analysis of the data was carried out to find out the mean and standard deviation (SD).Result:68.5% to 86.1%peri hilar mode of termination and 13.8% to 31.4% hilar mode of terminationwas found in cadavers. While both type of mode of termination in CT angiogramswas found to be around 44.4% to 55.5%. In cadavers as well as in CT angiograms43.7%to 70% was P1 branching pattern.Conclusion:The mode of termination of renal artery in cadavers was peri hilar in 77.4% and hilar in 22.5% cases and in CT study mode of termination of renal artery was peri hilar in 50% and hilar in 50%.The branching pattern of renal artery in case of peri hilar division in majority of cases is P1 that is posterior artery was the first branch of renal artery.

Indian Spices Enhance the Activities of Antibiotics against Human Pathogens Synergistically.

Background: Bacterial pathogens are considered aspredominant cause of human diseases throughout theworld. Until recently, antibiotics were considered aspromising agents against most bacterial pathogens butrecent reports suggest that there is growing resistance tocommonly used antibiotics creating a global healthcareproblem. Aim and Objectives: To investigate thesynergistic antibacterial potential of three differentantibiotics including Vancomycin, Clindamycin andCefotaxime with three popular Indian spices namelyCinnamomum zeylanicum (Dalchini), Trachysparmumammi (Ova) and Syzygium aromaticum (Clove) againsthuman pathogens Staphylococcus aureus,Enterococcus faecalis, Escherichia coli and Klebsiellapneumoniae. Material and Methods: Fourier-transformInfrared (FTIR) spectroscopy analysis was performedto detect molecular changes occurring while synergisticexposure of antibiotics and spices on pathogenicmicrobes. The addition of spices extracts showedenhanced activity of antibiotics against the pathogenshowever degree of antibiosis was varied according tobacterial species. Inhibition Zones (IZ) ranged from 0.0-34 mm. The highest IZ of 34.33 mm was found againstS. aureus where a combination of Cefotaxime and C.zeylanicum were applied. The synergy of spice extractswith antibiotics revealed an increase in the bactericidalactivity of standard antibiotics against pathogens. FTIRspectral analysis showed that, microorganisms showingresistance to antibiotics (Vancomycin and Clindamycin), alters important functional groups of antibioticsmight be resulting in decreased antimicrobialperformance. FTIR spectra's revealed common bands inantibiotics and spices such as nitroamines, aromaticphosphorus, benzene, bromide, carboxylic group,aliphatic esters, sulphonamides, primary alcohols,aliphatic ether, acid anhydride conjugate ring withketone and azo compounds, aromatic ethers, sulphonilchloride, sulphoamide etc. Interestingly, there wasincreased antimicrobial response for synergism whendecreased concentration of antibiotics and increasedconcentration of spice extracts were used. Conclusion:This investigation suggests that, spice extract could beused independently and in combination to elevate theperformance of antibiotics which addresses the issue ofdrug resistance in human pathogens.

Method Development And Validation Of Selective And Highly Sensitive Method For Determination Of Apixaban In Human Plasma Using Liquid Chromatography-Tandem Mass Spectrometry

Objective: The present research work aims to develop and validate a selective and highly sensitive method for the determination of apixaban in human plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Methods: 200 µl of sodium heparin plasma samples were acidified and clean-up was performed by using solid-phase extraction (SPE). Apixaban 13C D3 was used as an internal standard (deuterated) to lower the relative matrix effects and a single step SPE was employed for sample clean up. 10 µl of SPE eluent was loaded onto Hypersil Beta Basic C18, 100×4.6 mm, 5 µ column for highly selective chromatographic separation using an isocratic mobile phase. 2 mmol ammonium acetate in water and acetonitrile were delivered by using a quaternary low-pressure gradient pump without premixing at a minimum flow rate of 0.50 ml/min. Results: LC-MS/MS method was successfully developed and validated to demonstrate the lowest detection limit of 0.05 ng/ml and a linear dynamic range from 1-250 ng/ml with r2>0.99. Method development and validation results proved that the method is selective and highly sensitive for the determination of apixaban in human plasma using LC-MS/MS. Conclusion: Current method can be applied for both therapeutic drug monitoring (TDM) and pharmacokinetic (PK) study analysis.

Health issues among transgenders in urban Pondicherry

Background: Transgender is an umbrella term for people whose gender identity and expression does not conform to the norms and expectations traditionally associated with the sex assigned to them at birth. Aim & Objectives: To study the health problems among the transgenders, to study the health seeking behaviour of the transgenders, to study the social stigma and discrimination faced by the transgenders and to study the sexual behaviour among the transgenders. Settings and Design: It is a community based, descriptive, cross-sectional, study design done among 121 transgenders (TGs) registered under a Non-Government Organization. Methods and Material: A convenience sampling was undertaken. A pre-designed, pre-tested and self-administered, semi-structured questionnaire in local language was used. Statistical analysis used: Proportion, mean, standard deviation, Kruskal-Wallis & Mann-Whitney test were applied using EpiData and chi-square test was applied using MS Excel. Results: The common places of discrimination faced by the Transgender were public bathrooms for 36 (29.8%), school for 36 (29.8%) TGs and in bus for 29 (24.0%) TGs. 57 (47.1%) had sexual relationship with more than one partner. Tobacco chewing was the commonest form of substance abuse found among the distressed transgenders. (p=0.007). Conclusions: Lower per capita income, no fixed job status; low education status, prevalent health problem of knee joint arthritis, were the main findings among the transgenders. Substance abuse of alcohol and consumption of tobacco products were high and an association was found between products of tobacco consumption to their psychological distress.

CdS nanocrystals as fluorescent probe for detection of dolasetron mesylate in aqueous solution:Application to biomedical analysis / 药物分析学报

A simple and straightforward method for the determination of dolasetron mesylate (DM) in aqueous solution was developed based on the fluorescence quenching of 3-Mercaptopropionic acid (MPA) capped CdS quantum dots (QDs). The structure, morphology, and optical properties of synthesized QDs were characterized by using UV-Vis absorption spectroscopy, fluorescence spectroscopy, transmission electron microscopy (TEM) and dynamic light scattering (DLS) measurements. Under the optimum conditions, the MPA-CdS QDs fluorescence probe offered good sensitivity and selectivity for detecting DM. The probe provided a highly specific selectivity and a linear detection of DM in the range of 2–40 μg/mL with detection limit (LOD) 1.512 μg/mL. The common excipients did not interfere in the proposed method. The fluorescence quenching mechanism of CdS QDs is also discussed. The developed sensor was applied to the quantification of DM in urine and human serum sample with satisfactory results.

Effect of feeding graded doses of Citrinin on clinical and teratology in female Wistar rats.

Citrinin is the one of the well-known mycotoxins, which is possibly spread all over the world. The graded doses of citrinin (1, 3 and 5 ppm CIT in feed) in female Wistar rats 10 weeks prior to mating, during mating and during organogenesis resulted in resorptions and post implantation losses, decreased fetal body weights and crown-rump lengths in fetuses of all groups. Various developmental anomalies recorded in fetuses of treated rats included gross (wrist drop, curled tail, stretched forelimb, subcutaneous haematoma), skeletal (incomplete ossification of skull bones, incomplete fusion of vertebral bodies, complete and partial agenesis of sternaebrae, metacarpals, metatarsals and phalanges, fused ribs and swing out ribs) and visceral (internal and external hydrocephalus, cerebellar hypoplasia, microphthalmia, roundening of heart, contracted kidneys, dilated renal pelvis and cryptorchid testes). The results suggest that CIT has adverse effects on fetal development which may be due to the longer bioavailability of citrinin in the animals.

Hypolipidemic and antioxidant activity of ethanolic extract of Symplocos racemosa Roxb. in hyperlipidemic rats: An evidence of participation of oxidative stress in hyperlipidemia.

Hypolipidemic and antioxidant activity profiles of ethanolic extracts of Symplocos racemosa (EESR) were studied by triton-WR1339 (acute) and high fat diet induced (chronic) hyperlipidemic rat models. In both the models, a significant increase in total cholesterol (TC), triglycerides (TG), very low density lipoproteins (VLDL), low density lipoproteins (LDL) and decrease in high density lipoproteins (HDL) in serum were observed. EESR (200 and 400 mg/kg) and simvastatin (10 mg/kg) administered orally reduced the elevated serum lipids (TC, TG, VLDL, LDL), restored the decreased HDL and improved the atherogenic index. In high fat diet induced hyperlipidemic model, EESR treatment prevented the increased formation of malondialdehyde (MDA) in liver, restored the depleted liver antioxidants, glutathione, superoxide dismutase, catalase significantly. The increased liver cholesterol, HMG-CoA reductase activity and body weight of hyperlipidemic rats were significantly reduced by EESR treatment. The EESR inhibited HMG-CoA reductase, a rate limiting enzyme in cholesterol biosynthesis, thereby causing hypolipidemic effects. EESR treatment also improved histoarchitecture of hepatocytes in hyperlipidemic rats. Experimental findings demonstrated anti-hyperlipidemic and antioxidant activity of EESR, which may be directly or indirectly related to its antioxidant activity. The hypolipidemic activity of EESR may be due to the presence of flavonoids phenolic compounds, phenolic glycosides and steroids.

Epidemiological Assessment of Goiter.

Research Question: 1. What is the magnitude of problem of Goiter? 2. What is the level of iodised salt consumed by school children at school & home? Objectives: 1. To find out incidence of Goiter. 2. To find out level of iodised salt consumed by school children at school & home. Study Design: Cross-sectional study. Settings: School & houseto- house survey of urban & rural area of Raichur district. Participant: School children & general population of both sexes. Sample size: 45173. Statistical analysis: Proportion & Chi-squared test. Results: Total population covered 45173 in five talukas. Males were 23463 & females 21730, adult population 16404, children more than 15 yrs were 28769 & school population was 24984. School boys were 14269 & girls 10715. Highest prevalence of goiter found in Raichur taluka i.e. 5.68% and lowest in Lingsur taluka i.e. 0.86%. Over all prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases). Higher prevalence has been reported among females in age group of 10- 14 yrs 5.25% & 15-19 yrs 4.66% compared to other age groups of village population. School children in Raichur district revealed the prevalence of Goiter 3.66%. Conclusion: Prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases), which is less compared to the National figures. The people are consuming the iodated salt and ban on non-iodated salt may be effectively implemented in study region.

A case report of evans syndrome.

Evans Syndrome (ES) is the rare simultaneous or subsequent development of immune thrombocytopenia purpura (ITP) and autoimmune hemolytic anemia (AIHA). It portends a poorer prognosis and a more aggressive line of management than either condition presenting alone. Here we report a case of a young female who presented with both bleeding and acute decompensated anemia. Although she was successfully treated, mystery still shrouds the etiology, pathophysiology, as well as line of management of this rare and enigmatic disease.

Operational feasibility of establishing community reporting systems.

BACKGROUND: In developing countries the absence ofa credible disease surveillance system results in an inappropriate response to an outbreak. Since a functioning and responsive disease surveillance system cannot be provided immediately, some interim surveillance system for early detection of outbreaks is needed to institute a prompt response. This operational research study was conducted to assess the feasibility of establishing community reporting systems involving women self-help groups and members of Panchayati raj institutions through syndromic surveillance at the community level. METHODS: Reporting was initiated from 8 villages in 4 gram panchayats of Begunia block of Khurda district in Orissa during May and June 2005. Members of women self-help groups and Panchayati raj institutions were trained on structured reporting guidelines. In congruence with the state disease surveillance system, weekly reporting was started for comparison where feasible. RESULTS: Completeness of reporting was better achieved by women self-help groups (91.6%) than members of Panchayati raj institutions (66.6%). Data capture was more complete as compared with the existing disease surveillance system. Illnesses among women were better captured and greater ownership of the public health service was noted. CONCLUSION: Establishing community reporting systems using women self-help groups and members of Panchayat raj institutions for disease surveillance in India is a feasible option.

Management of temporo-mandibular joint ankylosis in growing children.

Although temporo-mandibular joint (TMJ) ankylosis is one of the most common pathologies afflicting the facial skeleton, it is also the most overlooked and under-managed problem in children. The TMJ forms the very cornerstone of cranio-facial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Impairment of speech, difficulty in mastication, poor oral hygiene, rampant caries and acute compromise of the airway pose a severe psychologic burden on the tender minds of children. The aim of this article is to present an overview of efficient management strategies, based on a case report, so as to increase its awareness among all dental surgeons involved in the treatment of children.

Reactive fibrous hyperplasia associated with a natal tooth.

A natal tooth is that which is present in the oral cavity at the time of birth. Fibrous hyperplasia is a non-specific reactive lesion of soft tissues of unknown etiology usually associated with trauma or local irritation. Natal teeth can occur as an isolated dental finding, but many times they are associated wilh syndromes and developmental disturbances. This is a rare case, where in a natal tooth has led to the formation of a reactive fibrous hyperplasia in a four and half month old infant, a relationship not reported previously.

"Moebius syndrome": a case report.

Moebius syndrome is an extremely rare disorder characterized by a lifetime facial paralysis, involving sixth and seventh cranial nerves with malformations of orofacial structures and the limbs. In this case, an 8 year old girl with Moebius syndrome is presented, clinical findings are described and management aspects are discussed. Early dental evaluation and parental counselling as a part of preventive dental regimen can go a long way in providing complete psychosocial rehabilitation for such physically disabled children.

Labial talon cusp on permanent central incisor: a case report.

Talon cusp is a supernumerary crown structure, a developmental disturbance in the shape of teeth that causes various diagnostic, functional and esthetic problems. Some synonyms for talon cusp are dens evaginatus of anterior teeth, interstitial cusp, tuberculated tooth, odontoma of the axial core type, evaginated odontoma, enamel pearl, supernumerary cusp etc. The lingual location on incisors, which frequently affects occlusion, is pathognomonic of the talon cusp. This report describes a rare odontogenic, isolated anomaly rather than an integral part of any disorder, a case of talon shaped cusp projecting from the labial surface of a maxillary permanent central incisor.

Herniation of the buccal fat pad into the oral cavity: a case report.

An interesting lesion is presented, wherein a tiny traumatic perforation of the buccal mucosa and buccinator muscle forced a large portion of the buccal fat pad to extrude into the oral cavity. Such a situation can alarm any clinician & reinforces the importance of careful history taking and thorough examination, before treating patients.

Congenital muscular dystrophy--a case report.

A rare case of congenital muscular dystrophy with unique oro-facial manifestations is presented. Dental considerations and successful management techniques are discussed.

Role of liquid membrane phenomenon in biological actions of ACE inhibitors, captopril and lisinopril.

The liquid membrane phenomenon in angiotensin converting enzyme (ACE) inhibitors namely, captopril and lisinopril has been studied. Hydraulic permeability data have been obtained to demonstrate the existence of the liquid membrane in series with a supporting membrane generated by the ACE inhibitors. Data on the transport of the relevant permeants in presence of the liquid membrane formed by ACE inhibitors indicate that liquid membrane phenomenon is likely to play a significant role in the action of ACE inhibitors.