Inhaled iloprost as an add-on therapy for advanced pulmonary arterial hypertension: An Indian perspective

BACKGROUND Pulmonary arterial hypertension (PAH) is a progressive disease with high morbidity and mortality. Risk stratification and initiation of dual or triple combination therapy has a better clinical response, especially in high-risk patients. Unfortunately, prostacyclin analogues are not marketed in India; hence, the use of these medications is limited. We report the benefits and difficulties of using iloprost inhalation in patients with advanced PAH in India. METHODS In this prospective observational study, we included patients with group 1 PAH. Inhaled iloprost was initiated as an add-on therapy for patients who had clinical, echocardiographic or laboratory deterioration on dual oral medications. Patients with clinical instability were excluded. All patients underwent thorough clinical evaluation, detailed echocardiogram and laboratory investigations. Patients were started on inhaled iloprost 2.5 ?g six times daily and closely followed up. The dose was escalated if necessary. On follow-up, clinical echocardiographic and laboratory evaluation was done on all patients. RESULTS Fourteen patients (11 women) with a median age of 32 years (2–66 years) with group 1 PAH were started on inhaled iloprost as an add-on therapy. Improvement in clinical parameters, WHO functional class, echocardiographic-derived right ventricular function, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were observed in 10 of 14 patients. A median increase of 31% (4.2, 106%) in the distance travelled during 6-minute walk test, a median increase of 45% (–20, 120%) in right ventricular fractional area change, a median increase of 27% (–16.7, 60%) in tricuspid annular peak systolic excursion and a median decrease of 36.7% (–69.6, 17.2%) in NT-pro-BNP levels were observed after initiation of medication. Three patients had progression of symptoms and were then referred for lung/heart–lung transplant. One patient developed progression of symptoms after an excellent initial response and transitioned to subcutaneous treprostinil. Improvement in clinical, echocardiographic and laboratory features allowed us to successfully perform surgical Potts shunt in 2 patients. The medications were well tolerated with minimal and transient side-effects. There were no deaths. CONCLUSION Inhaled iloprost can be used with acceptable benefits and minimal side-effects in patients with PAH.

To Study Association of Sociodemographic Factors with Awareness and Practices Pertaining to Complementary Feeding in Six Months to Two Years old Child Attending Immunization Clinic in a Tertiary Care Hospital of a Medical College in Urban Area

National Guidelines on Infant and Young Child Feeding should become an integral part of nation-wide Integrated child development Services (ICDS) and the Reproductive and Child Health (RCH) Programme. These need to be effectively operationalized through the programme managers and field functionaries of these on-going programmes. This can happen only when they are practically oriented to the correct norms of IYCF. Methods: A cross sectional study of complementary feeding practices amongst mothers of children aged six months to two years in an urban setting. The place of study is an immunization clinic in a tertiary care hospital of a medical college located in urban area. Study population comprised of mothers of children aged six months to two years attending an immunization clinic. Study was approved by college Institutional Ethics Committee. Mothers who met the inclusion criteria, attending the immunization clinic, from the selected tertiary care hospital of a medical college were selected by systematic random sampling and interviewed. Data analysis done with the using Microsoft excel. Results: Out of 154 mothers, 51.3% of the mothers were in the age group of 25-34 years followed by 47.4% of the mothers in the age group less than 25 years and only 1.3 % of the mothers were more than 35 years of age. Mean age ± SD of the mothers was 25.26 ± 3.73 with the youngest and the oldest mother being 19 and 39 years old respectively. Among the respondents by religion, majority (80.5%) were Hindus followed by 15.6 % Muslims and only 3.9% were Christians. Conclusion: Time of complementary feeding initiation varied according child’s gender, predominant caregiver of the child, mother’s parity and socio economic status of the family, which were found to be statistically significant.

A Study of Complementry Feeding Practices amongst Mothers of Children Aged Six Months to Two Years Attending an Immunisation Clinic

Introduction: Infant and young child feeding indicators havebeen developed by the World Health Organization (WHO), toguide and monitor the feeding practices of young children. TheWorld Health Organization (WHO) recommends exclusivebreast feeding (EBF) for the first six months of life, with theaddition of complementary feeds (CF) at six months withcontinued breast feeding until at least the age of two years.Study aimed to find out the complementary feeding practicesamongst mothers of children aged six months to two years.Material and Methods: A cross sectional study ofcomplementary feeding practices amongst mothers of childrenaged six months to two years in an urban setting. Therefore atotal of 154 subjects were taken into the study. The study wasconducted from Jan 2014 – Sep 2015.Result: Among the studied children, 59.7% were males and40.3% were females. Almost more than half of the childrenwere in the age groups of more than 9 months and only 18.2%were in the age group 6 – 8 months.Conclusion: This study suggested that accurate informationand education should be given to mothers and caregiversabout appropriate breast-feeding and complementary feedingpractices to prevent malnutrition and improve the health statusof the children

EBV reactivation mimicking a lymphoproliferative disorder associated with ruxolitinib therapy for myelofibrosis

No abstract available.

Abdominal Sonography: Evaluation of Image Quality in Patients with Varying BMI Using Tissue Harmonic Imaging and Standard Sonography

Background: The study was conducted at the Department of Radiodiagnosis and Imaging, Army Base Hospital Delhi Cantt on 200 patients (114 females, 86 males) with varying age and BMI (Body Mass Index) from year 2005 to 2009. Methods: Abdominal sonography was done using standard B mode using HDI 5000 (Philips/ATL) system. This equipment awarded a U.S. patent for Tissue Harmonic Imaging (THI).The study was done using broadband curvilinear 2 to 5 MHz (C 5-2) transducer. This transducer can be used for both standard conventional B-mode (CUSS) and tissue harmonic imaging (THI). Results: Correlation was done for BMI of the study population and was found that greater percentage of lesionswere seen better THI in patients having BMI >25. The p value was < 0.05 (significant). Conclusion: Out of the 258 positive findings assessed for total image quality in THI in comparison to CUSS the p value was < 0.001 (significant).

Clinicopathological Study of Juvenile Nasopharyngeal Angiofibroma; a Single Institution Study in a Tertiary Care Hospital In Odisha

Background: Aim- To study the presenting features correlates them with radiological finding & the management of JNA. Methods: A prospective study was done on 30 patients who were clinically &radiologically diagnosed as Juvenilenasopharyngeal angiofibroma &treated in department of ENT & HNS SCB Medical College Cuttack during the period of 1.8.2015 to 30.10.2017. All patients are examined & after stabilisation, CECT of nose and PNS done. Staging was done according to clinical &radiological finding by FISCH staging system. Patients were treated by surgical excision by various approaches. Most common procedure done is endoscopic guided excision by medial maxillectomy with lateral rhinotomy approach. Excised tissues send for HP study & patients are followed up for a period of one year. Results: All the patients in our study were males. Majority (70%) are in 11-18 yr age group with mean age of presentation 17.13yr. Most common presenting feature is epistaxis with progressive nasal obstruction. Palatal bulging & hearing loss is the commonest extra sinonasal manifestation. Hollman miller sign found in 50% of cases. Maximum patients presented in stage-2 disease. Post operatively 1 death occurred due to blood transfusion reaction. All patients HP study report is found to be nasopharyngeal angiofibroma. Conclusion: JNA is a benign tumour & should be suspected in all cases of adolescent male presented with epistaxis & progressive nasal obstruction. CECT, has a definite role in diagnosis, staging & plan of management of JNA & should be done within 1 wk prior of surgical management. Ram-Haran sign which is found most of cases of early stage, help in early diagnosis of JNA & can be a diagnostic criteria for JNA. Endoscope assisted external approach, is definitely beneficial in total disease clearance.

Diphenylmethyl selenocyanate attenuates malachite green induced oxidative injury through antioxidation & inhibition of DNA damage in mice.

Background & objectives: Malachite green (MG), an environmentally hazardous material, is used as a non permitted food colouring agent, especially in India. Selenium (Se) is an essential nutritional trace element required for animals and humans to guard against oxidative stress induced by xenobiotic compounds of diverse nature. In the present study, the role of the selenium compound diphenylmethyl selenocyanate (DMSE) was assessed on the oxidative stress (OS) induced by a food colouring agent, malachite green (MG) in vivo in mice. Methods: Swiss albino mice (Mus musculus) were intraperitoneally injected with MG at a standardized dose of 100 μg/ mouse for 30 days. DMSE was given orally at an optimum dose of 3 mg/kg b.w. in pre (15 days) and concomitant treatment schedule throughout the experimental period. The parameters viz. ALT, AST, LPO, GSH, GST, SOD, CAT, GPx, TrxR, CA, MN, MI and DNA damage have been evaluated. Results: The DMSE showed its potential to protect against MG induced hepatotoxicity by controlling the serum alanine aminotransferase and aspartate amino transferase (ALT and AST) levels and also ameliorated oxidative stress by modulating hepatic lipid peroxidation and different detoxifying and antioxidative enzymes such as glutathione-S-transferase (GST), superoxide dismutase (SOD), catalase (CAT), and also the selenoenzymes such as glutathione peroxidase (GPx) and thioredoxin reductase (TrxR) and reduced glutathione level which in turn reduced DNA damage. Interpretation & conclusions: The organo-selenium compound DMSE showed significant protection against MG induced heptotoxicity and DNA damage in murine model. Better protection was observed in pretreatment group than in the concomitant group. Further studies need to be done to understand the mechanism of action.

Anti-tumour promoting activity of diphenylmethyl selenocyanate against two-stage mouse skin carcinogenesis.

Epidemiological, clinical and experimental evidence collectively suggests that Se in different inorganic and organic forms provides a potential cancer chemopreventive agent, active against several types of cancer. It can exert preventive activity in all the three stages of cancer: initiation, promotion and progression. Literature reports revealed that organoselenocyanates have more potential as chemopreventive agents than inorganic forms due to their lower toxicity. In our previous report we showed chemopreventive efficacy of diphenylmethyl selenocyanate during the initiation and pre- plus post-initiation phases of skin and colon carcinogenesis process. The present study was undertaken to explore the anti-tumour promoting activity of diphenylmethyl selenocyanate in a 7,12-dimethylbenz (a) anthracene (DMBA)-croton oil two-stage skin carcinogenesis model. The results obtained showed significant (p<0.01) reduction of the incidence and number of skin papillomas, precancerous skin lesions, along with significant (p<0.01) elevation of phase II detoxifying enzymes (GST, Catalase and SOD) and inhibition of lipid peroxidation in liver and skin. Thus, the present data strongly suggest that diphenylmethyl selenocyanate also has the potential to act as anti-tumour promoter agent in a two-stage skin carcinogenesis mouse model, pointing to possible general efficacy.

Inhibition of DMBA-croton oil two-stage mouse skin carcinogenesis by diphenylmethyl selenocyanate through modulation of cutaneous oxidative stress and inhibition of nitric oxide production.

Selenium, an essential micronutrient, plays important roles against different diseases, including several types of cancer. In the present study, antioxidative and chemopreventive properties of a synthetic organoselenium compound, diphenylmethyl selenocyanate, were evaluated with a 7,12-dimethylbenz (a) anthracene - croton oil induced two-stage mouse skin carcinogenesis model. The compound was administered orally to carcinogen-treated mice at two different non-toxic doses, 2mg/kg. b.w. and 3mg/kg. b.w. Significant inhibition in the incidence of papilloma formation (53-80%) as well as in the cumulative numbers of papillomas per papilloma bearing mouse were observed in the treated groups as compared to the carcinogen control group. The compound was also found to upregulate significantly different phase II detoxifying enzymes such as glutathione-S-transferase (p<0.01) and superoxide dismutase (p<0.01) in skin cytosol when measured after 15 days and also after 12 weeks of the first 7,12-dimethylbenz (a) anthracene treatment. Lipid peroxidation measured with reference to thiobarbituric acid reactive substances in skin microsomes was significantly inhibited (p<0.05) in a dose dependent manner by diphenylmethyl selenocyanate. Considerable inhibition of the level of nitric oxide production in peritoneal macrophages was observed after 12 weeks (p<0.05). Thus the compound appears to exert chemopreventive activity in terms of papilloma formation, which may be through modulation of cutaneous lipid peroxidation, the phase II detoxifying enzyme system and nitric oxide production.