Effect of Mycobacterium w on IL-6 and Oxygen Requirement in COVID-19

The efficacy and safety of heat-killed Mycobacterium w (Mw) in severe COVID-19 were evaluated. Twenty-five hospitalized patients (mean age, 52.9 ± 13.1 years) with severe COVID-19 and having multiple comorbidities were intradermally injected with 0.3 mL of Mw daily for three consecutive days. Changes in leukocyte and platelet counts; C-reactive protein (CRP), interleukin-6 (IL-6), serum creatinine, and liver enzyme levels; and oxygen saturation were compared before and after treatment. An ordinal scale assessed the clinical response. There were significant improvements in the IL-6 level and oxygen saturation following treatment (p < 0.001). There were marked improvements in the platelet count, CRP level, serum aspartate transaminase level, and ordinal scale score. Eighty percent of patients who were on oxygen support were successfully shifted to room air within 5.6 days of treatment and discharged. No systemic adverse events were noted. Thus, Mw treatment could be a promising therapeutic modality in severe COVID-19.

A Cross Sectional Study to Estimate Occupational Stress among Higher Secondary School Teachers in Thalassery, Kerala

Background: Changing norms have overburdened the educators. Our study aims to assess the levels of occupational stress among higher secondary school teachers and demographic, academic characteristics and relevant factors influencing it. Methodology: Cross sectional study was conducted in Thalassery block of Kannur district, Kerala. The block comprised of 38 schools with 516 teachers. Overall, 484 teachers participated in the study. Modified 慚anual for teacher抯 occupational stress scale� questionnaire was used. Results were analyzed using Chi square test, 憈� test and one way ANOVA. Results: Males were 155 (32%) and females were 329 (68%). The mean age was 40.6 years. Four-fifth (81%) were from government and one-fifth (19%) were from private schools. Majority, 268 (55%), of teachers were found to have mild occupational stress. While, 171 (35%) had moderate stress and 45 (9%) had severe occupational stress. Stress was linked to vast syllabus, time constraint, outside interference, students� behavior, poor infrastructure and favoritism from authorities. Increased teaching experience and rising position in school were significantly associated with stress. Conclusion: All higher secondary school teachers in Thalaserry block of Kannur, Kerala felt occupational stress. Majority (55%) had mild stress, 35% had endured moderate and 9% suffered severe stress.

Efectos del tratamiento homeopático individualizado en la hipertensión esencial de estadio I: ensayo aleatorizado, simple ciego, controlado con placebo / Effects of Homeopathic Treatment Individualized in Hypertension Stage I Essential: Randomized Trial, Single Blind, Placebo controlled

Fundamentos: la hipertensión arterial es el cuarto principal factor de riesgo de muerte e incapacidad, así como el responsable de más de 1.6 millones de fallecimientos en la India. Los informes de casos clínicos, los estudios observacionales y los ECA evidencian los efectos de los medicamentos homeopáticos en la hipertensión. Objetivos: los resultados de este estudio se añaden a la evidencia de la eficacia del uso de los medicamentos homeopáticos individualizados en la hipertensión de estadio I. Materiales y métodos: Se ha realizado un ensayo aleatorizado, simple ciego y controlado por placebo entre octubre de 2013 y marzo de 2018. El parámetro primario fue evaluar los cambios en la presión sistólica (PS) y la presión diastólica (PD) mensualmente durante tres meses. 217 pacientes de los 2,127 pacientes examinados cumplieron los criterios de selección y fueron aleatorizados para recibir un medicamento en potencias Q (o potencias LM) más indicaciones para la modificación del estilo de vida (MEV) (116 pacientes) o bien placebo + MEV (101 pacientes). La modificación del estilo de vida incluyó actividad física y dieta como parte de la pauta terapéutica. El análisis fue de intención de tratamiento. Resultados: Las mediciones ANOVA repetidas entre los grupos mostraron una diferencia estadística significativa (Lambda de Wilks 0.85, F=12.12, dF=213, P=0.0001) tanto en la PS como en la PD a favor de la Homeopatía individualizada. La prueba t independiente post hoc mostró una reducción media significativa de la PS [diferencia media 7.12 mmHg, IC del 95%; CI 4.72 a 9.53, P=0.0001] y un descenso medio de la PD [diferencia media 5.76 mmHg, IC del 95%: 4.18 a 7.23, P=0.0001] a favor del grupo con Homeopatía más MEV. Los medicamentos más utilizados fueron: Sulphur (n=24), Natrium muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) y Phosphorus (n=10). Conclusiones: Se ha constatado que la Homeopatía individualizada junto con la MEV fue más eficaz que el placebo junto con la MEV en los pacientes que sufren hipertensión en estadio I. Se precisan más ensayos en un marco estricto. (AU)

Background: Hypertension (HTN) is a leading risk factor for death and disability and responsible for over 1.6 million deaths in India. Clinical case reports, observational studies and randomised controlled trials show the effects of homoeopathic medicine in HTN. Objectives: The results of this study will add to the evidence of effectiveness of individualised homoeopathic medicine in Stage I HTN. Methods: A single-blind, randomised, placebocontrolled trial was undertaken from October 2013 to March 2018. The primary outcome measure was to evaluate the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) every month for 3 months. Of 2,127 patients screened, 217 patients who fitted the inclusion criteria were randomised to receive either homoeopathic Q potencies (or LM potencies) plus lifestyle modification (LSM)=116 or placebo + LSM=101. LSM included physical activity and diet as part of the treatment regimen. Analysis was by intention to treat. Results: Repeated-measure ANOVA between the groups showed statistically significant difference (Wilk lambda 0.85, F=12.12, df=213, P=0.0001), in both SBP and DBP favouring Individualised Homoeopathy (IH) along with LSM. Post hoc independent t-test showed a significant mean reduction in SBP (mean difference 7.12 mmHg, 95% confidence interval [CI] 4.72-9.53, P=0.0001) and DBP (mean difference 5.76 mmHg, 95% CI: 4.18-7.23, P=0.0001) favouring Homoeopathy plus LSM group. Sulphur (n=24), Natrum muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) and Phosphorus (n=10) were the most useful medicines. Conclusion: IH in LM potency along with LSM was found effective over placebo along with LSM in the patients suffering from Stage I HTN. Further trials in rigorous setting are warranted. (AU)

Calcarea carbonica treatment rescues lipopolysaccharide-induced inflammatory response in human mononuclear cells via downregulation of inducible cyclooxygenase pathway / 中西医结合学报

OBJECTIVE@#Prolonged use of nonsteroidal anti-inflammatory drugs is associated with severe side effects and toxicity. Therefore, we studied the anti-inflammatory role of Calcarea carbonica which had minimal toxicity at the low doses.@*METHODS@#THP-1 human mononuclear cells were treated with C. carbonica to evaluate the 50% cytotoxicity concentration (CC) and 50% effective concentration (EC). Cell survival was evaluated in lipopolysaccharide-stimulated C. carbonica-treated cells. Nitric oxide (NO) and tumor necrosis factor-α (TNF-α) were measured to evaluate the anti-inflammatory activity of C. carbonica. Cyclooxygenase-2 (COX-2) protein expression was determined by Western blotting analysis, and the interaction of C. carbonica with the COX-2 protein was evaluated using molecular docking simulation.@*RESULTS@#The CC and EC of C. carbonica were found to be 43.26 and 11.99 µg/mL, respectively. The cell survival assay showed a 1.192-fold (P = 0.0129), 1.443-fold (P = 0.0009) and 1.605-fold (P = 0.0004) increase in cell survival at 24, 48 and 72 h after initiating C. carbonica treatment, respectively. C. carbonica-treated cells showed a reduction in NO levels by 2.355 folds (P = 0.0001), 2.181 folds (P = 0.0001) and 2.071 folds (P = 0.0001) at 24, 48 and 72 h, respectively. The treated cells also showed a reduction in TNF-α levels by 1.395 folds (P = 0.0013), 1.541 folds (P = 0.0005) and 1.550 folds (P = 0.0005) at 24, 48 and 72 h, respectively. In addition, a 1.193-fold reduction (P = 0.0126) in COX-2 protein expression was found in C. carbonica-treated cells. The molecular docking showed interaction of C. carbonica with the phenylalanine 367 residue present in active site of Cox-2.@*CONCLUSION@#C. carbonica exhibited anti-inflammatory properties in lipopolysaccharide-stimulated cells by significantly reducing NO production and TNF-α level through downregulation of the COX-2 protein. This effect is probably mediated through interaction of C. carbonica with the phenylalanine 367 residue present in active site of Cox-2.

Calcarea carbonica treatment rescues lipopolysaccharide-induced inflammatory response in human mononuclear cells via downregulation of inducible cyclooxygenase pathway / 中西医结合学报

OBJECTIVE@#Prolonged use of nonsteroidal anti-inflammatory drugs is associated with severe side effects and toxicity. Therefore, we studied the anti-inflammatory role of Calcarea carbonica which had minimal toxicity at the low doses.@*METHODS@#THP-1 human mononuclear cells were treated with C. carbonica to evaluate the 50% cytotoxicity concentration (CC) and 50% effective concentration (EC). Cell survival was evaluated in lipopolysaccharide-stimulated C. carbonica-treated cells. Nitric oxide (NO) and tumor necrosis factor-α (TNF-α) were measured to evaluate the anti-inflammatory activity of C. carbonica. Cyclooxygenase-2 (COX-2) protein expression was determined by Western blotting analysis, and the interaction of C. carbonica with the COX-2 protein was evaluated using molecular docking simulation.@*RESULTS@#The CC and EC of C. carbonica were found to be 43.26 and 11.99 µg/mL, respectively. The cell survival assay showed a 1.192-fold (P = 0.0129), 1.443-fold (P = 0.0009) and 1.605-fold (P = 0.0004) increase in cell survival at 24, 48 and 72 h after initiating C. carbonica treatment, respectively. C. carbonica-treated cells showed a reduction in NO levels by 2.355 folds (P = 0.0001), 2.181 folds (P = 0.0001) and 2.071 folds (P = 0.0001) at 24, 48 and 72 h, respectively. The treated cells also showed a reduction in TNF-α levels by 1.395 folds (P = 0.0013), 1.541 folds (P = 0.0005) and 1.550 folds (P = 0.0005) at 24, 48 and 72 h, respectively. In addition, a 1.193-fold reduction (P = 0.0126) in COX-2 protein expression was found in C. carbonica-treated cells. The molecular docking showed interaction of C. carbonica with the phenylalanine 367 residue present in active site of Cox-2.@*CONCLUSION@#C. carbonica exhibited anti-inflammatory properties in lipopolysaccharide-stimulated cells by significantly reducing NO production and TNF-α level through downregulation of the COX-2 protein. This effect is probably mediated through interaction of C. carbonica with the phenylalanine 367 residue present in active site of Cox-2.

Antibiotics sensitivity and resistant pattern in tribal region of Chhattisgarh, India: a retrospective observational study

Background: Antimicrobial resistance (AMR) is the biggest health care problem globally, it is responsible for the high rate of mortality worldwide which was commonly observed in developing countries. We tried to find the incidence of antimicrobial resistance in the tribal region of Chhattisgarh, India.Methods: It was an institutional based retrospective observational study. Out of 3389 samples from inpatient and outpatient department, a total number of 1676 cultured proven micro-organism were isolated from Jan 2017 to Dec 2018. SPSS v23 was used for descriptive analysis.Results: More than 75% of the samples collected from the inpatient department in which surgical IPD were significantly higher. The commonest isolated were Staphylococcus aureus followed by Escherichia coli, then Klebsiella species. Amoxycillin-clavulanic acid was resistant to the majority of microorganism followed by 3rd generation cephalosporins then Co-trimoxazole.Conclusions: Antimicrobial resistance was higher even in the tribal region. The incidence of AMR is increasing at an alarming rate. Microorganism targeted antimicrobial therapy with the use of narrow-spectrum antibiotics and avoidance of broad-spectrum antibiotics will possibly overcome the antimicrobial resistance. There is also a need to strengthen laboratory or microbiology department to produce an accurate report to combat antimicrobial resistance.

A world health organization core drug use indicator based prescription study in the dermatology outpatient department of a tertiary care teaching hospital of central South India

Background: Irrational prescribing is a universal problem that may lead to inadequate response to medication therapy, poor patient compliance and increased adverse drug reactions ultimately leading to frequent hospital admissions. Hence this study was done to assess the drug utilization pattern using WHO core drug use indicators so that the recommendation can be made towards the rational prescribing.Methods: A sample of 3650 prescriptions was analysed prospectively to assess the drug utilization patterns in the dermatology OPD of a tertiary care teaching hospital of central south India.Results: The average number of drugs per prescription was 2.74 whereas 79.26% drugs were prescribed by generic names. Percentage of encounters with an antibiotic prescribed was 18.68%. Regarding use of injections, 3.26% prescriptions contains one or more injections. Percentage of drugs prescribed from essential drugs list was 78.37%. Average consultation time was lower (2.9 minutes) than recommended.Conclusions: The data from the present study indicates that prevalence of polypharmacy, inadequate consultation and dispensing time along with poor patient’s knowledge are the areas of medication therapy to be improved. Availability of essential drugs and key drugs in stock should be improved to achieve rational therapeutic goal. Further, continued medical education regarding the rational prescribing will definitely improve the standards of health care delivery.

To estimate the serum level of N-terminal pro-brain natriuretic peptide levels in acute coronary syndrome

Background: Acute coronary syndromes caused by a sudden blockage of a coronary artery. According to degree and location of the blockage, it ranges from unstable angina to non–STsegment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI), and sudden cardiac death. The levels of serum cardiac markers get elevated during myocardial necrosis in ACS. B-type natriuretic peptide (BNP), cardiac neurohormone, and its Nterminal fragment (NT-proBNP) are synthesized and secreted from the ventricular myocardium. It is well known that the stimulus for their release is the increase in left ventricular wall stress. Aim and objectives: To estimate the serum level of N-terminal pro-Brain natriuretic peptide levels in acute coronary syndrome, to assess the levels of NT-pro-BNP and its relationship between STEMI, NSTEMI and Unstable angina patients. Materials and methods: The study included 40 patients admitted in the medicine ward of RMMCH. The study period was from January 2018- July 2018. Patients with acute coronary syndromes were identified over a period according to the criteria and were included in the study. The patients were completely evaluated and their serum NT-pro BNP levels were noted. Killips Class was recorded if the patient was in acute MI. In NSTEMI, STEMI and unstable angina, TIMI scoring was also calculated. Results: The common age of the patients was 51 to 60 years (50%). In the age group of 41 to 50 years, 30% was observed. In the age category of 31 to 40 years, 20% was observed. The mean age was 49.10 years. There was 55% of patients with NT pro BNP > 500 in the age category 51- 60 years whereas only 16.7% in this range in the age category 41 to 50 years and again only 8% Mohamed Yasar Arafath, K. Babu Raj. To estimate the serum level of N-terminal pro-brain natriuretic peptide levels in acute coronary syndrome. IAIM, 2019; 6(1): 8-15. Page 9 in the age category 30 to 40 years. The Majority of 30 to 40 years had NT pro-BNP of 100 to 500 (62.5%). In the age category of 41 to 50 years, 50% had NT Pro BNP of 100 to 500 while only 35% was in this range in the age group of 51-60 years. In the age category of 41 to 50 years, 33.3% had NT pro-BNP of < 100 whereas only 10% of 51 to 60 years had NT pro-BNP of < 100 and in the age category of 30 to 40 years, no one had NT pro-BNP of <100. The chi-square test of association was insignificant. Cardiac enzymes (Troponin T and CKMB) was elevated for the majority of the patients (N=27, 67.5%). Cardiac enzymes (Troponin T and CKMB) were normal for only 32.5% of the patients. The correlation of TIMI score with NT pro-BNP was peak positive i.e. if NT pro-BNP is higher, TIMI score was also higher and vice versa but the correlation was insignificant (r=2.54, p = .64). Conclusion: Even though the study is done in patients without clinical signs of heart failure, the levels of NT-proBNP had an inverse relationship with Ejection Fraction. Low NT-proBNP levels at the time of admission rule out high-risk patients or patients with heart failure.

Cystatin-C as a potential risk factor for acute myocardial infarction with normal renal function

Background: Myocardial Infarction accounts for 20% of all medical emergency admissions and has the highest risk for adverse effects and deaths. Risk of CAD could be prevented by various strategies and most of the developed countries could reduce the incidence and mortality related to CAD especially Myocardial Infarction by various preventive methods. Cystatin-C thus acts as an independent risk factor for Myocardial Infarction and heart failure. Aim and objective: To estimate the Serum level of Cystatin-C in Acute Myocardial Infarction with normal renal function Materials and methods: The study included 40 patients admitted in the medicine ward of RMMCH. The study period was from February 2018- July 2018. Patients with acute coronary syndromes were identified over a period according to the criteria and were included in the study. Primary complaints like angina, dyspnea, symptoms of cardiac failure were recorded. Risk factors for coronary artery disease like diabetes mellitus, systemic hypertension, smoking, hyperlipidemia, renal failure, and other complaints if any were noted. Clinical examination included a detailed general examination including vital signs and systemic examination of cardiac, respiratory, gastrointestinal, and nervous systems. 2 ml of blood was withdrawn from all patients within 12 hours of onset of symptoms for measuring Cystatin-C. Results: The common age was 52 to 59 years (47.5%) and 45 to 51 years (45.0%). The mean age of the study patients was 51.10 ±5.47 years. The majority of the patients had ST-elevated MI (N=27, 67.5%). Among STEMI, 14 patients were AWMI (N=14, 51.9%) IWMI- STEMI was identified in 18.5% patients. Likewise, posterior wall MI-STEMI was the diagnosis for 18.5% and Inferior-lateral- Bharat Lochan, K. Babu Raj. Cystatin-C as a potential risk factor for acute myocardial infarction with normal renal function. IAIM, 2019; 6(1): 1-7. Page 2 STEMI was the feature for 11.1%. The mean Cystatin-C for STEMI was 1.24 + 0.26 whereas it was 1.38 ± 28 for NSTEMI. The difference was statistically insignificant (t=1.46, p=151). The overall Cystatin-C Mean was 1.29 ± .27, which was higher than the normal level. The correlation of CystatinC with LV function is poor (r = .181, p=26). The relationship was weakly positive and insignificant. That was when Cystatin ‘C’ was more, LV function was less and vice-versa. The correlation of Cystatin-C with TIMI was negative i.e. when Cystatin was more, TIMI was less and vice-versa but the relationship was poor (r=.126, p = .44) and insignificant. Conclusion: Cystatin-C plays an important role in the pathogenesis of Acute Myocardial Infarction, and one of the mechanisms is thought to be that Cystatin-C facilitates the progress of atherosclerosis by regulating inflammation. Cystatin-C is less influenced by age, gender, and muscle mass and thus may be a better indicator of cardiovascular risk especially Myocardial Infarction.

A clinical study of incidence, risk factor profile, and prognosis in cases of posterior circulation stroke

Background: The etiology of posterior circulation ischemia has been thought to be primarily due to local arterial atherosclerosis (large artery disease) and penetrating artery disease (lacunes). However, there is increasing evidence that cardiogenic embolization is more common than previously suspected and is responsible for 20-50% of posterior circulation strokes. Aim and objective: To study the clinical manifestations, risk factor profile, and prognosis in this sample of patients. Materials and methods: 54 cases of posterior circulation strokes, admitted to the Department of Medicine, Rajah Muthiah Medical College, and Hospital, Chidambaram, during the period from September 2016 to October 2017, who fulfilled the inclusion criteria, were taken up for the study. Results: Out of 54 patients, 48.1% had hypertension, 37.0% had diabetes, 37.0% had tobacco abuse, 37.0% had alcohol abuse, 40.7% had dyslipidemia, 7.4% had TIA/Stroke, 11.1% had RHD, 27.8% had IHD and 7.4% had MVP as predisposing factors. Majority of the patients had hypertension as a risk factor followed by dyslipidemia. Many patients had multiple predisposing factors. 46.3% had their consciousness impaired, 59.3% had speech disturbances, 13.0% had cranial nerve involvement, 55.6% had motor disturbances, 13.0% had sensory disturbances, 48.1% had cerebellar signs, 37.0% had nystagmus and 44.4% had fundal changes. Majority of the patients had speech disturbances on clinical examination. Conclusion: Majority of the patients had Hypertension (48.1%) as a risk factor followed by Dyslipidemia (40.7%). Many patients had multiple predisposing factors. There is an increased K. Babu Raj, B. Nageswaran. A clinical study of incidence, risk factor profile, and prognosis in cases of posterior circulation stroke. IAIM, 2018; 5(9): 28-33. Page 29 association between coronary artery disease and posterior circulation strokes in our study (27.8%). Infratentorial lesions (50%) were more common than supratentorial lesions (38.9%) and both combined (11.1%). The mortality associated with posterior circulation strokes in our study is 16.7%. Majority of the patients had no disability (22.2%) or slight disability (18.5%).

Study of hypoglycemia in elderly diabetes mellitus

Background: The etiology of diabetes in India is multifactorial and includes genetic factors coupled with environmental influences such as obesity associated with rising living standards, steady urban migration, and lifestyle changes. It is a chronic disease, and as it prolongs it has many serious effects on multiple organs of the body. Keeping a view of the above-said problem, there arises a need for rigorous control of diabetes mellitus. However, rigorous control of diabetes leads to more incidence of hypoglycemia in elderly diabetic patients. Hypoglycemia has serious complications leading to various morbidity and mortality. Aim and objective: To study the risk factors associated with the development of hypoglycemia in elderly diabetic patients, to study about the symptoms occurring during the hypoglycemic episodes. Materials and methods: The study included 100 patients: Group –A 50 diabetics and Group B controls. Age and sex-matched diabetic patients >60 years admitted during the same period in RMMCH. Details of the hypoglycemic episode (symptoms, severity, glucose level, risk factors identified, treatment and outcome), comorbidities, polypharmacy, alcohol use and assessment of functional status Assessment of the functional status was done using Katz score. Results: Functional status of patients were assessed with KATZ index only 10 out of 50 study patients had poor (Katz score=0) functional status. 52% patients had their episodes during night time. 34 patients (68%) had come to the hospital with hypoglycemia and the rest of the patients developed hypoglycemia in-hospital stay. 70% of patients had symptoms and 30% had no symptoms. Neuroglycopenia was predominant in most patients. Conclusion: Asymptomatic hypoglycemia was common in the elderly diabetics. In symptomatic patients, neuroglycopenic symptoms were more commonly encountered than autonomic symptoms. K. Babu Raj, R. Prabhakaran. Study of hypoglycemia in elderly diabetes mellitus. IAIM, 2018; 5(9): 14-20. Page 15 The mean duration of diabetes mellitus was longer in the group of study patients with no symptoms of hypoglycemia as compared to patients who were symptomatic for hypoglycemia.

A study of ocular movements and pupillary changes in acute stroke patients

Background: Cerebrovascular disease or stroke rank first in frequency and importance, among all the neurological diseases of adult life. It is the third most common cause of death in the world. Different neuroanatomical pathways are involved in the control of pupil, the integrity and the functionality of these neurological pathways can be often be ascertained through the analysis and interpretation of pupillary behavior. This makes the pupil size and the pupillary light reflex an important factor to be considered in many clinical conditions. Aim and objective: To study the ocular movements and pupils in acute stroke patients with its clinical correlation and imaging. Materials and methods: The study sample included was 50 patients with acute stroke confirmed by CT/MRI findings of both sexes and who belonged to the age group of 20 to 80 years from RMMCH. A detailed clinical history was taken for these patients who were included in this study. All these patients were examined thoroughly with particular importance to ocular movements and pupils. Results: Of the 50 patients, 16 patients were having an altered level of consciousness(32%), 30 patients were having speech disturbances(72%), 18 patients were having gaze paresis(36%), all the patients who were included in the study were having facial palsy (100%), Of the 18 patients with abnormal pupillary findings, there were 9 patients (18%) with dilated pupils which were not reacting to light during the first 12 hours, i.e. from the time of admission, 9 patients (18%) with round, constricted pupils, sluggishly reacting to light and 32 patients (64%) did not show any changes in the pupils. Of the 20 patients (40%) with abnormal ocular movements, the commonly observed ocular changes in the study sample were 3rd nerve palsy, 6th nerve palsy, multiple cranial nerve palsies, conjugate eye deviation to the side of the lesion, nystagmus on left lateral gaze, horizontal nystagmus on lateral gaze to the side of lesion. K. Babu Raj, G. Arul Venkadesh. A study of ocular movements and pupillary changes in acute stroke patients. IAIM, 2018; 5(8): 9-16. Page 10 Conclusion: The Anterior circulation stroke (78%) was more common than the Posterior circulation stroke (22%) in our study group. Although the abnormal pupillary changes and ocular movements were very common in posterior cerebral artery territory infarcts, the incidence of abnormal pupillary changes and ocular movements was more common in posterior cerebral artery territory (50%) and also in middle cerebral artery territory (45%) in our study group.

A study on clinical profile of acute coronary syndrome in type 2 diabetes mellitus patients with relevance to HbA1c

Background: Cardiovascular disease (CVD) has emerged as the dominant chronic disease in many parts of the world. At the beginning of the twenty-first century, CVD accounts for nearly half of all deaths in the developed world and 25% in the developing world. Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Vascular diseases account for most morbidity and mortality in patients with DM. Aim and objectives: To study the clinical profile of type 2 diabetic patients presenting with Acute Coronary Syndrome (ACS) with reference to HbAlc level. Materials and methods: After selecting appropriate samples for the study based on the inclusion criteria, a detailed history was elicited and clinical examination was done as per the proforma. The necessary investigations were done as per the proforma. The clinical profile of these patients was then analyzed and correlated with reference to HbAlc level and statistical analysis performed using paired’ test. Results: The prevalence of microvascular diabetic complications was high with nephropathy amounting to 62% and retinopathy amounting to 58%. Neuropathy was not documented. About 32% of patients were free of microvascular complications. Other macrovascular diabetic complications were not documented. Among complications of ACS, 24% developed hypotension and no other complication was noted. Remaining 76% did not suffer any complications. No mortality was documented. Patients with systolic dysfunction constituted 82% and diastolic dysfunction 66%. The percentage of patients with HbA1c >7% constituted 62% which was very high and only 32% of patients had their HbA1c level in the control range. K. Babu Raj, G. Sivachandran. A study on clinical profile of acute coronary syndrome in type 2 diabetes mellitus patients with relevance to HbA1c. IAIM, 2018; 5(8): 1-8. Page 2 Conclusion: A majority of diabetic patients developing acute coronary syndrome have poor glycaemic control as reflected by their HbAlc levels. The coronary event is likely to occur sooner after the detection of diabetes if good glycaemic control is not achieved. Exercise, in the form of regular day to day activities, does not achieve satisfactory glycaemic control and cannot prevent the development of adverse complications of diabetes.

Electrochemical determination of an anti-hyperlipidimic drug pitavastatin at electrochemical sensor based on electrochemically pre-treated polymer film modified GCE / 药物分析学报

An electrochemically pretreated silver macroporous (Ag MP) multiwalled carbon nanotube modified glassy carbon electrode (PAN-Ag MP-MWCNT-GCE) was fabricated for the selective determination of an anti-hyperlipidimic drug, pitavastatin (PST). The fabricated electrochemical sensor was characterized by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). The fabricated electrode was employed in quantifying and determining PST through differential pulse adsorptive stripping voltammetry (DPAdSV) and CV. The electrode fabrication proceeded with remarkable sensitivity to the determination of PST. The effect of various optimized parameters such as pH, scan rate (ν), accumulation time (tacc), accumulation potential (Uacc) and loading volumes of Ag MP-MWCNT suspension were investigated to evaluate the performance of synthesized electrochemical sensor and to propose a simple, accurate, rapid and economical procedure for the quantification of PST in pharmaceutical formulations and biological fluids. A linear response of PST concentration in the range 2.0×10?7–1.6×10?6 M with low detection (LOD) and quantification (LOQ) limits of 9.66 ± 0.04 nM and 32.25 ± 0.07 nM, respectively, were obtained under these optimized conditions.

Evaluation of efficacy of photodynamic therapy as an adjunct to nonsurgical periodontal therapy in treatment of chronic periodontitis patients: A clinico-microbiological study.

Background and Objectives: Photodynamic therapy (PDT) is a local noninvasive treatment modality without side effects caused by antibiotics. The aim of this study was to evaluate the efficacy of adjunctive use of PDT with scaling and root planing as compared with SRP alone in the treatment of chronic periodontitis. Subjects and Methods: Twenty participants with chronic periodontitis having probing pocket depths (PDs) of ≥5 mm were selected for the study. Patients were randomly divided into control group and test group with ten patients in each group. Full-mouth SRP was performed in both the groups, followed by PDT in test group. Assessment of plaque index (PI), gingival index (GI), PD, and clinical attachment level (CAL) was done at baseline and after 3 months. Microbiological assessment of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola was done by polymerase chain reaction (PCR) at baseline and 3 months after the therapy. Results: There was a significant reduction in PI, GI, PD, CAL, and microbiologic parameters in test group, following SRP and PDT, when compared with SRP alone in control group. Conclusion: PDT in conjunction with SRP has shown additional improvement in periodontal parameters when compared to SRP alone and has a beneficial effect in chronic periodontitis patients.

Wound healing and antimicrobial activity of two classical formulations of Laghupanchamula in rats.

Background: Wounds affect a large number of patients and seriously reduce the quality of life. The wound as a medical problem was first discussed by Maharshi Agnivesha in Agnivesha Samhita (later known as Charaka Samhita) as Vrana. Laghupanchamula denotes a combination of the roots of five herbs. However, in Ayurvedic classics, besides four common herbs viz. Kantakari, Brihati, Shalaparni and Prinshniparni, the fifth one is either Gokshura (LPG) or Eranda (LPE), and both formulations have been documented to have wound healing (Vrana) activity. Objective: The present study was undertaken to determine the in vivo wound healing activity and in vitro antimicrobial activity of 50% ethanolic extract of Laghupanchamula containing Gokshura (LPGE) and Laghupanchamula containing Eranda (LPEE) in rats with acute toxicity in mice. Materials and Methods: LPGE and LPEE (1000 mg/kg) was administered orally, once daily for 10 days (incision wound model) or for 24 days (excision wound model) in rats. LPGE and LPEE was studied for its in vitro antimicrobial and in vivo wound breaking strength (WBS) (incision model) and rate of contraction, period of epithelization and histology of skin (excision model). Results: LPGE and LPEE showed antimicrobial activity against skin pathogens, enhanced WBS, rate of contraction, skin collagen tissue formation and early epithelization period with low scar area indicating enhanced healing with histological evidence of more collagen formation in skin tissues. LPGE and LPEE also showed anti‑bacterial activity and seemed to be safe. Conclusion: Use of both formulations in Laghupanchamula for their wound healing and anti‑microbial activities is thus authenticated.

Brachiocephalic Trunk and Left Common Carotid Artery Arising from Aortic Arch as a Single Trunk.

Branches of aortic arch usually are brachiocephalic trunk, left common carotid artery and left subclavian artery from right to left direction. Arch of aorta show more variations in branching patterns. One among which is origin of only two branches in which brachiocephalic trunk and left common carotid artery arise together as a common trunk and other branch is left subclavian artery. The variations occur due to abnormal development of arch of aorta. During routine dissection of superior mediastinum of thoracic region, we have found the left common carotid artery and brachiocephalic trunk was arising from the arch of aorta as a common trunk. These kinds of variations are very rare and knowledge of which is very important for neck surgeons, cardiologists and interventional radiologists while doing surgeries and instrumentation procedures.

A rare case of toxic optic neuropathy secondary to consumption of neem oil.

A 35-year-old female was referred to our hospital with bilateral loss of vision of two days duration. She gave history of consumption of about 150 ml of neem oil five days back. Examination revealed no perception of light in both eyes. Both pupils were dilated and sluggishly reacting to light. Her fundus examination showed bilateral hyperemic, edematous discs and also edema extending along the superior and inferior temporal vascular arcade. Magnetic resonance imaging (MRI) scan showed bilateral putaminal regions with altered signal, hypointensities in T1-weighted images, hyperintensities on T2-weighted, images and hyperintense on Fluid Attenuation Inversion Recovery (FLAIR) images suggestive of cytotoxic edema due to tissue hypoxia. Her vision improved to 20/200 in both eyes with treatment after two months. This is the first case report of such nature in the literature to the best of our knowledge.

Healing effect of terminalia chebula fruit extract on trinitrobenzene sulfonic acid induced colitis in rat.

The present study aims to evaluate healing effect of 50% ethanolic extract of Terminalia chebula fruit pulp (TCE) on trinitrobenzene sulfonic acid (TNBS, intra-colonic route) induced colitis in rats. TCE (600 mg/kg, oral) was studied in TNBS-induced colitis for its effects on fecal output, food and water intake and body weight changes, histology, antibacterial activity and levels of free radicals (nitric oxide and lipid peroxidation), antioxidants (superoxide dismutase; catalase and reduced glutathione) and acute inflammatory marker (myeloperoxidase) in colonic tissue. TNBS administration increased colonic mucosal damage and inflammation (macroscopic and microscopic) and stool output but decreased body weight which was reversed by TCE treatment. TCE showed significant antibacterial activity and enhanced the antioxidants but decreased free radicals and myeloperoxidase activities affected in TNBS colitis. Thus, Terminalia chebula dried fruit pulp extract healed colitis by promoting antioxidant status and decreasing intestinal bacterial load, free radicals and myeloperoxidase responsible for tissue damage and delayed healing.