Metabolic risk factors in first acute coronary syndrome (MERIFACS) Study

Objectives: In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. Methods: This is a prospective caseecontrol observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n ¼ 2153) were compared with matched controls (n ¼ 1210). Results: Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (p < 0.0001), diabetes - 42.6% vs 12.7% (p < 0.0001), smoking - 28.3% vs 9.3% (p < 0.0001) and elevated LDL-C - 70.2% vs 57.9% (p < 0.0001). MRF: High BMI - 54.7% vs 55.1% (p ¼ 0.84), increased waist: hip ratio 79.5% vs 63.6% (p < 0.0001), high HbA1c - 37.8% vs 14.9% (p < 0.0001), low HDL-C - 56.2% vs 42.8% (p < 0.0001) and elevated triglycerides - 49.7% vs 44.2% (p ¼ 0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (p < 0.001), diabetes - 4.7 (p < 0.001), high LDL-C - 3.3 (p < 0.001) and smoking6.3 (p < 0.001). MRF: High waist: hip ratio - 2.4 (p < 0.001) high HbA1c - 3.2 (p < 0.001), low HDL-C 2.2 (p < 0.001) and elevated triglycerides - 0.878 p ¼ 0.17. Conclusion: In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF

Do it yourself smartphone fundus camera – DIYretCAM.

This article describes the method to make a do it yourself smartphone‑based fundus camera which can image the central retina as well as the peripheral retina up to the pars plana. It is a cost‑effective alternative to the fundus camera.

Microarchitecture of the Palatine Tonsil in Sheep (Ovis aries) / Microarquitectura de la Tonsila Palatina en Oveja (Ovis aries)

The tissue pieces of palatine tonsil were collected from different postnatal age groups of sheep from the Corporation Slaughter House, Perambur, Chennai. The palatine tonsil consisted of a surface epithelium, capsule, tonsillar lobes, crypts, crypt epithelium and tonsillar follicles. The surface epithelium over the palatine tonsil was made up of non-keratinized stratified squamous epithelium in all the postnatal age groups studied. The palatine tonsil was clearly demarcated from the surrounding structures by a distinct connective tissue capsule and one septa dividing the tonsil into two lobes. The surface epithelium was invaginated into the substance of the tonsil to form primary and secondary crypts in each lobe. The crypt epithelium covered the regions of lymphoid follicles became lymphoepithelium. The macrophages were also observed in the epithelium. In the areas of lymphoepithelium the basement membrane was interrupted since lymphocytic infiltration was heavy into the epithelium. Numerous secondary tonsillar follicles with germinal centers separated by interfollicular areas were observed in the palatine tonsil. The tonsillar follicles consisted of a mantle zone, which was heavily populated with small darkly stained lymphocytes. These mantle zones were always oriented towards the crypts. The tonsillar follicles of young sheep showed many medium and small sized lymphocytes, lymphoblasts and also reticulocytes. The reticular cells usually appeared larger than lymphocytes and had a more abundant and organized cytoplasm with vacuoles.

Fueron recolectadas piezas de tejido desde la tonsila palatina de ovejas con diferentes edades postnatales, desde la Corporación Slaughter House, Perambur, Chennai. La tonsila palatina consistía en un epitelio de superficie, cápsula, lóbulos de las tonsilas, criptas, epitelio de las criptas tonsilares y folículos. El epitelio superficial sobre la tonsila palatina estaba compuesto, en todos los grupos estudiados, de epitelio escamoso estratificado no-queratinizado. La tonsila palatina se delimitó claramente de las estructuras circundantes por un tejido conectivo capsular y un septo dividiendo la tonsila en dos lóbulos. El epitelio superficial se invaginó dentro de de la tonsila para formar criptas primarias y secundarias en cada lóbulo. El epitelio de las criptas cubrió las regiones de folículos linfoides transfomándose en linfoepitelo. También se observaron macrófagos en el epitelio. En las áreas de linfoepitelo la membrana basal estaba interrumpida por la infiltración linfocitaria y fue mayor en el epitelio. Fueron observados numerosos folículos tonsilares secundarios con centros germinales separados por áreas interfoliculares. Los folículos tonsilares consistían en una zona del manto que estaba densamente poblada con pequeños linfocitos intensamente teñidos. Estas zonas del manto se orientaron siempre hacia las criptas. Los folículos tonsilares de las ovejas jóvenes mostraron muchos linfocitos de tamaño medianos y pequeños, linfoblastos y también reticulocitos. Las células reticulares usualmente aparecían más grandes que los linfocitos y tenían un citoplasma más abundante y organizado con vacuolas.

Knowledge, attitude and practice of patient medication counseling among drug dispensers in North West Ethiopia.

Patient medication counseling on dispensing of medicines should give the patient clear and complete instructions on how to take or use drugs. The way drugs are taken by the patient is often influenced by the way drugs are dispensed and the type of information given during dispensing. The objective of this study was to assess drug dispensers’ knowledge, attitude and practice of patient medication counseling in drug retail outlets of Gondar and Bahir Dar towns. A cross-sectional study was conducted on patient medication counseling by using a self-administered semi-structured questioner. The questionnaire was distributed to dispensers to fill in their home or at their free time and collected in the next day. Data were analyzed using SPSS for windows version 16.0. Forty (62.5%) of the dispensers believe that patient counseling is a shared responsibility of pharmacy professionals and physicians. Only 29.7% of the dispensers always update their knowledge on drugs and their most frequent source of drug information on drugs were leaflets. Forty nine (76.6%) of dispensers respond as they know the formal way and the information included in patient counseling. Lack of adequate knowledge on drugs and up-to-date drug information was major factor that prevent dispensers from counseling patients. Most of the dispensers are not accessible to up-to-date drug informations. The dispensers give less counseling. Lack of knowledge and update drug information was the major barrier of patient medication counseling dispensers faced. Formal education should include patient counseling and continuous training should be given to increase dispensers’ knowledge on patient counseling. Up to date and relevant drug information sources should be given to dispensers.

Assessment of patterns of drug use by using World Health Organization's prescribing, patient care and health facility indicators in selected health facilities in Southwest Ethiopia.

The objective of the study was to assessing patterns of drug use by using World Health Organization prescribing, patient care and health facility indicators in Southwest Ethiopia. A cross sectional study was carried out in four randomly selected health facilities. Retrospectively the prescription papers analyzed according to WHO guideline. Prospectively 35 patients from each of the four health facilities were interviewed at the outpatient pharmacy while drugs were dispensed to assess the patient care indicators. The average number of drugs per prescription ranging from 1.98 to 2.24. The mean consultation time spent between the prescriber and patient were range from 5.47 to 6.50. The mean pharmacy dispensing time was 1.23 minutes to 1.25minutes. The average number of drugs prescribed was in the range of 1.80 to 2.88. Two of the health facilities had a copy of Ethiopian essential drug list (EDL), 2(50%) had a copy of standard treatment guideline for health centers and only 1 (25%) of the health facility had a copy of drug formulary. The pattern of prescription in terms of generic name and polypharmacy was near to optimal. The pattern of antibiotics and injection prescribing appears appropriate when compared with the world health organization guideline. However, there is a need to improve patients’ knowledge on dispensed drugs.

Evaluation of antidiabetic and related actions of some Indian medicinal plants in diabetic rats

OBJECTIVE@#To evaluate antidiabetic activity of chloroform extracts of Acacia arabica bark, Benincasa hispida fruit, Tinispora cordifolia stem, Ocimum sanctum areal parts and Jatropha curcus leaves.@*METHODS@#The chloroform extracts of Acacia arabica bark, Benincasa hispida fruit, Tinospora cordifolia stem, aerial part of Ocimum sanctum and Jatropha curcus leaves were evaluated at different doses (250 and 500 mg/kg body weight.) for antidiabetic potentials in alloxan induced diabetic albino rats. The extracts were administered for two weeks in different groups whereas tolbutamide (80 mg/kg body weight) was used as reference standard throughout study.@*RESULTS@#The result of present study showed test compounds significantly decreases elevated level of serum glucose and also caused to reverse the cholesterol, triglyceride, HDL and LDL values when compared to untreated diabetic rats.@*CONCLUSIONS@#Our finding indicates that different test extracts were able to ameliorate the derangements in lipid metabolism caused by diabetes mellitus in alloxan induced diabetic rats towards normal level.

Effect of sewage water on seed germination and vigour index of different varieties of groundnut (Arachis hypogaea L.).

The study has been focused on the investigation on ground nut (Arachis hypogea) fields influenced by sewage water. Sewage water sampled in and around Mysore city and analyzed forphysicochemical parameters. Different concentrations such as 1, 5, 10, 25, 50, 70 and 100% of sewage water on seed germination and vigour index of Arachis hypogea verities such as DH - 2 - 30, ICJS - 11, JL - 24, K - 134, TMV - 2 and VRI - 2 were studied. From the recorded observation it is concluded that the sewage water diluted to 25% concentration for irrigation of groundnut enhances germination percentage and vigour index in K- 134 variety which is more susceptible than other tested varieties.

25 gauge vitrectomy under topical anesthesia: a pilot study.

AIMS: To evaluate the safety and efficacy of transconjunctival 25 gauge vitrectomy under topical anesthesia. SETTINGS AND DESIGN: A pilot study of consecutive cases which underwent 25 gauge vitrectomy under topical anesthesia. MATERIALS AND METHODS: Seven eyes of 7 patients underwent 25 gauge vitrectomy under topical anesthesia with a pledget soaked in anesthetic, for vitreous hemorrhage (2 eyes), retained cortex (1 eye) and postoperative endophthalmitis (4 eyes). Subjective pain and discomfort were graded from 0 (no pain or discomfort) to 4 (severe pain and discomfort). Patients underwent an immediate postoperative assessment, followed by day one and one week postoperative evaluation. RESULTS: All patients had grade 0 pain during the surgery. Five patients had grade 2 pain during the placement of the sclerotomies. None of the patients required any sedation during the procedure. No inadvertent eye movements were noted during surgery. Except one patient, none required postoperative analgesics. Five eyes had a favorable outcome. No eyes in this pilot study had any procedure-related complications. CONCLUSION: With appropriate case selection, topical anesthesia is a safe and effective alternative to infiltrative anesthesia for 25 gauge vitrectomy. A larger series of patients with a longer follow-up is required to validate the findings of this pilot study.

Digital video recording and archiving in ophthalmic surgery.

Currently most ophthalmic operating rooms are equipped with an analog video recording system [analog Charge Couple Device camera for video grabbing and a Video Cassette Recorder for recording)]. We discuss the various advantages of a digital video capture device, its archiving capabilities and our experience during the transition from analog to digital video recording and archiving. The basic terminology and concepts related to analog and digital video, along with the choice of hardware, software and formats for archiving are discussed.

Evaluation of naked eye single tube red cell osmotic fragility test in detecting beta-thalassemia trait.

The Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) was applied to 4 groups of subjects: (i) Normal; (ii) Proven beta-thalassemia trait carriers; (iii) Iron deficiency anemia; and (iv) other hemoglobinopathies, to evaluate its effectiveness as a screening test for beta-thalassemia minor. The test was successful in detecting 105/110 subjects with beta-thalassemia trait. The sensitivity of the test was 95.5% and specificity was 87%. The predictive value of the positive test was 70.5% and that of the negative test was 98.3%. NESTROFT was also positive in 9/17 subjects with HbS trait, in 3/3 subjects with HbD trait and in 1/1 subjects with HbE trait. The test proved to be simple, cheap, easy to perform and adaptable for field surveys, coming close to an ideal screening test for beta-thalassemia minor.

Empyema of gall bladder in a child with homozygous sickle-cell disease

A 13-year-old boy with homozygous sickle-cell (SS) disease followed from birth in a cohort study of sickle-cell disease developed empyema of the gallbladder after a known 3-year history of gallstones. At this age, gallstones occur in 30%of cohort study children with SS disease but this is the first patient with specific symptoms

Anterior chamber intra ocular lens implantation.

The role of A.C. IOL in modern implant surgery has become somewhat debatable, since, the choice procedure to day is undoubtedly an ECCE with a PC lens implant preferably in the capsular bag. Even so, anterior chamber lens implantation has its definite indications. As such it is necessary for the implant surgeon to be familiar with the latest technique in this modality of surgery as well. Many of the complications of earlier rigid model AC IOLs were mainly due to defective lens design. With the advent of new generation flexible one-piece PMMA AC lenses, many of these complications have been eliminated. A.C. IOL implantation, although less frequently done now, has its own legitimate place in modern IOL surgery.