A comparative study of cholecalciferol and vildagliptin on fasting blood glucose level of streptozotocin-nicotinamide-induced Type 2 diabetic albino rats

Background: The lack of vitamin D deficiency has been found to be closely associated with many health problems such as metabolic syndrome, cancer, cardiovascular disease, and type 2 diabetes. This interest has also arisen due to the identification that most cells, along with the pancreatic beta-cells, incorporate the vitamin D receptor. Aims and Objectives: In this study, we tested the potential anti-diabetic effect of cholecalciferol, one of the vitamin D analogs, alone or in combination with vildagliptin in type 2 diabetic rats. Materials and Methods: Type 2 diabetic model rats were induced by intraperitoneal injection of streptozotocin followed by nicotinamide. Rats were assigned into five groups each of six rats divided as follows: Normal (non-diabetic) control (Group A), untreated diabetic group receiving the vehicles only (Group B), cholecalciferol-treated group (Group C), vildagliptin-treated group (Group D), and group receiving a combination of cholecalciferol and vildagliptin (Group E). The treatment course lasted for 1 month. For the estimation of fasting blood sugar, the rats were kept deprived of food overnight and were allowed free access to water. Blood samples were collected from the tail of rat with the help of glucometer. Statistical analysis was performed using SPSS version 20 software. One-way ANOVA test was used to compare the effect of drugs on different group. Post hoc analysis was done using Turkeys HSD (honestly significant difference) test. Differences were considered significant at (P < 0.05). Results: Mean FBS value of vitamin D, vildagliptin, and their combination was 181.50 mg/dl, 95.0 mg/dl, and 84.83 mg/dl on day 28. It showed that the combination of both drugs acquired much closer value of FBS as compared to normal non-diabetic control group and thus achieved normal glucose level more effectively. Furthermore, coadministration showed greater fall in fasting blood glucose at the extent of 61.15% as compared to 56.45% by vildagliptin and 17% by cholecalciferol alone on day 28. Conclusion: Therefore, it may be suggested through this study that vitamin D has blood glucose lowering property and coadministration of vitamin D and vildagliptin potentiate the action of each other.

Safety of photodynamic therapy involving optic nerve head

We present a case of large peripapillary polypoidal choroidal vasculopathy treated with standard-fluence photodynamic therapy (PDT) as other treatment options were unsuccessful or not justified. Due to large lesion size, treatment spot included part of optic disc also. PDT resulted in regression of polyp and visual improvement (from 20/300 to 20/20) without any collateral damage to optic nerve as evidenced by visual-field test and visual-evoked potential with a follow-up till 2 years. This case highlights the role of PDT as a safe alternative for treatment of large peripapillary lesion, even though the treatment spot encompasses part of the optic nerve head.

Curious case of retrolental mass: An unusual tele-screening artifact

We are presenting a case of premature baby born at 32 weeks of gestation who was under regular follow-up with our retinopathy of prematurity (ROP) tele-screening team. During final follow-up at 41 weeks of postconceptional age, anterior segment image captured with RetCam showed a retrolental mass lesion in right eye resembling retinoblastoma or medulloepithelioma. The baby was referred to our base hospital for further evaluation, where a detailed examination showed no retrolental lesion or intraocular mass. This is the first case where imaging artifact, despite use of high-quality imaging system by well-trained staff, during ROP tele-screening appeared like a retrolental mass lesion and resulted in false-positive referral.

Rebound inflammation after an intravitreal injection in Vogt朘oyanagi朒arada syndrome

A 43-year-old male with chronic Vogt朘oyanagi朒arada syndrome (VKH) presented with subfoveal choroidal neovascular membrane (CNVM) in the right eye with no evidence of active inflammation. He underwent intravitreal bevacizumab and dexamethasone injections. Postinjection he developed fresh keratic precipitates and exudative retinal detachment (RD). He received two more bevacizumab injections with oral corticosteroids and immunosuppressants causing resolution of exudative RD with scarred CNVM. We report this case to highlight that intravitreal injection may act as a trigger for rebound inflammation in VKH patients and may require anti-inflammatory drugs to be started even in the absence of an active inflammation.

C-MAC videolaryngoscope improves the laryngoscopic view in Mallampati class 2 and 3 patients

Objective: We aimed to compare C-MAC videolaryngoscope [VLC] with Macintosh laryngoscope with regard to the laryngoscopic view, the need for external laryngeal manipulation, requirement of airway adjuncts like stylet, time required to complete the tracheal intubation and the hemodynamic changes in Mallampati class 2 and 3 patients

Methodology: Sixty patients who were admitted for elective surgery requiring general anesthesia with endotracheal intubation were randomly allocated to proceed with endotracheal intubation using the conventional Macintosh laryngoscope [Group A] or the C-MAC VLC [Group B]. Following a standardised general anesthetic protocol, time for intubation, laryngoscopic view, need for external manipulation, and hemodynamic parameters during and after intubation were registered during study period

Results: It was observed that C-MAC VLC improves the laryngoscopic view in predicted difficult airway setting, and thus reduces the need for external laryngeal manipulation and the use of stylet. However, the hemodynamic stress response was significant with C-MAC VLC than Macintosh laryngoscopy. There was significant reduction in time taken for intubation with conventional Macintosh laryngoscope when compared with C-MAC® VLC. The median total intubation time for the Macintosh and C-MAC® VLC were 23.8 and 35.33 sec respectively [p = 0.000]

Conclusion: C-MAC® videolaryngoscope improves laryngoscopic view in difficult airway settings compared to the conventional Macintosh laryngoscope, but at the cost of prolonged time taken for intubation and increased hemodynamic stress response. Large scale studies may be required to determine the ultimate success of intubation with this new tool

Effect of Body Mass Index (BMI) on Peak Expiratory Flow Rate in young adults

Background: Obesity has become one of the major health issues in India. WHO defines obesity as “A condition with excessive fat accumulation in the body to the extent that the health and wellbeing are adversely affected”. Obesity results from a complex interaction of genetic, behavioral, environmental and socioeconomic factors causing an imbalance in energy production and expenditure. Peak expiratory flow rate is the maximum rate of airflow that can be generated during forced expiratory manoeuvre starting from total lung capacity. The simplicity of the method is its main advantage. It is measured by using a standard Wright Peak Flow Meter or mini Wright Meter. Aim: The aim of the study is to see the effect of body mass index on Peak Expiratory Flow Rate values in young adults. Materials and methods: A correlational study was done 40 healthy individuals with age of 18-35 year old. Subjects having cardio or pulmonary condition were excluded. Then according to body mass index (BMI) normal (group A) and obese (group B) individuals were included. Where, BMI - normal: 18.5-22.9 kg/m2 and obese: 25 kg/m2 onwards. Then in sitting position all the individuals were given three trials for PEFR and best of all was taken. Results: Group A: BMI mean -18.74±1.11and PEFR mean - 395±116.8, Group B: BMI mean - 28.7±1.12 and PEFR mean - 309±46.4. According to spearman’s correlation Group A, r= 0.456 and p=0.022 also in Group B r=0.097 and p=0.342. Conclusion: There was weak correlation in between BMI and PEFR.

Sialolipoma of parotid gland, a rare benign tumor.

Sialolipoma is a rare tumour found within both major and minor salivary glands. A total of 35 sialolipoma cases have been reported 18 within major salivary gland and 17 within minor salivary gland. Major gland sialolipoma most often are presented in the parotid gland (77%) and those from minor salivary glands were often seen in the palate (41%). All lesions were well circumscribed and contained mature adipose tissue admixed with benign salivary gland component. Treatment is surgical excision. We report a case of 52 years old male who presented with the complaint of swelling in the left parotid region for 22 years duration. Apart from cosmetic reason he has no other complain. All specific investigations done were inconclusive and suggested a benign tumor. Histopathological examination after superficial parotidectomy suggested sialolipoma.

Unicentric Castleman’s disease presenting as retroperitoneum lump.

Castleman disease is a rare lymphoproliferative disorder, also known as giant lymph node hyperplasia or angiofollicular lymph node hyperplasia. Clinically, Castleman disease is of two types: localised/unicentric type and multicentric/systemic type. Unicentric or localised Castleman disease affect a single lymph node or group of lymph nodes. The multicentric type affects two or more groups of lymph node in different part of the body. It can also affect organs containing lymphoid tissue. Histologically it is classified as hyaline vascular variant, plasma cell variant and a mixed variant. Clinical symptoms may vary from asymptomatic to symptomatic lymphadenopathy accompanied by fever, anaemia fatigue, abdominal or thoracic pain and weight loss. There is no specific test to diagnose Castleman disease. We report a case of 16 years old male who presented with a painless lump in left lumbar region without any constitutional symptoms. CECT suggested a retroperitoneal lump with calcification. Laparotomy was done and complete excision of mass done. Histopathological examination of excised tissue suggested Castleman disease of hyaline vascular variant. After six month of follow up, the patient has no complain.

Knowledge, attitude and practice of cervical cancer screening in women visiting a tertiary care hospital of Delhi.

Background: Cervical cancer being a major cause of morbidity and mortality in women in developing countries, its awareness is essential. Aim: The aim of this study is to assess the knowledge, attitude and practices of women regarding the basic screening test for detection of cancer cervix. Settings and Design: Population based cross-sectional study. Materials and Methods: Cross-sectional prospective study was conducted. Information from consenting participants (450) was collected using structured questionnaire. Answers were described in terms of knowledge, attitude and practice and their respective adequacy with respect to Papanicolaou (Pap) test, the most common test used for early detection of cervical cancer. Adequacy was compared between the categories of socio demographic and clinical variables. Statistical Analysis: The data collected was analyzed using statistical package (SPSS version 18.0). Adequacy was compared between the categories of the control variables by χ2 test with a 5% significance level. Results: Knowledge, attitude and practices regarding Pap test were adequate in 32.7%, 18.2% and 7.3% of women respectively. Major impediment to adequate practice was lack of request by physician. Knowledge, attitudes and practices were found to increase significantly with increasing age and education. Conclusion: Effective information, education and communication strategies are required to improve the level of awareness of public. Health-care professional should be proactive in imparting knowledge at every opportunity.

Generation of transgenic mesenchymal stem cells expressing green fluorescent protein as reporter gene using no viral vector in caprine.

Mesenchymal stromal cells (MSC) are multipotent cells that can be derived from many different organs and tissues. While there are many ways to label and track cells each with strengths and weakness, the green fluorescent protein (GFP) is a reporter gene commonly employed. In the present study, caprine MSC were collected from bone marrow and cells were characterised with MSC specific markers. Passage 10 (P10) MSC cells were transfected using plasmid vector containing GFP as reporter gene with different concentrations of DNA and lipofectamine. Six different concentrations of DNA and lipofectamine as 1 µg DNA: 2 µL lipofectamine, 1 µg DNA: 2.5 µL lipofectamine, 1.2 µg DNA: 2.2 µL lipofectamine, 1.2 µg DNA: 2.5 µL lipofectamine, 1.5 µg DNA: 2.5 µL lipofectamine, 1.5 µg DNA: 3 µL lipofectamine were used. After 24 h and 48 h of transfection, caprine MSC were observed under florescent microscope. Highest transfection rate indicating green flourecscent MSC were found when the cells were transfected with 1.2 µg DNA: 2.2 µL lipofectamine and 1.5 µg DNA: 2.5 µL lipofectamine than other combinations. These cells have been propagated beyond 4th passage maintaining GFP expression. The results indicated that stable GFP positive MSC cells can be generated using the above protocol. These cells are being used for transplantation studies.

Anesthetic management of congenital broncho-esophageal fistula in an adult.

Broncho-esophageal fistula (BEF) are quite rare in adults, more so the congenital variety. The common causes of BEF in adults include infections, trauma, and malignancies. We report a rare case of congenital BEF manifesting in adulthood with repeated pulmonary infections. We emphasize mainly on the preoperative preparation and perioperative management of this patient. It is essential to have a high index of suspicion to diagnose congenital BEF in adults. Anesthesiologists play an important role in successful management of these cases.

Pattern of childhood neuronal migrational disorders in Oman

To record the pattern of different neuronal migrational disorders [NMD] and their associated neurological conditions. The data were collected at the Child Neurology Services of Sultan Qaboos University Hospital, Oman, from January 1993 to September 2006 from all children with psychomotor delay and epilepsy, who underwent brain imaging [mostly MRI]. The MR imaging was used for the diagnosis of a neuronal migration anomaly. There were 86 cases of NMD. Corpus callosum agenesis and lissencephaly/pachygyria formed the major group. There were 48 cases of corpus callosum agenesis, and 16 cases of lissencephaly/pachygyria. Other disorders were 10 cases of heterotopias, 5 schizencephaly, 3 holoprosencephaly, 2 polymicrogyria, and one each of hemimegalencephaly, and hydranencephaly. Developmental delay was the most common associated finding noted in 80 [93%] cases. Sixty-seven [77.9%] cases had motor deficit. Forty out of 86 [46.5%] cases had epilepsy. Partial/partial complex seizures were the most common at 13 out of 40 [32.5%]. Syndromic seizures were seen in 11 out of 40 [27.5%] cases. The seizures were controlled in only 3/40 [7.5%] cases. The NMD constitute a significant number of child neurology patients with psychomotor delay and intractable epilepsy. Exogenic and genetic factors affecting the early embryonic and fetal development from sixth to twenty-sixth weeks of gestation result in NMD. Recent genetic studies are defining the underlying mechanism and these studies will help in early diagnosis and possible prevention of NMD

Critical illness myopathy.

Critical illness myopathy is one of the causes for failure to wean from ventilator. Although associate factors of dyselectrolytemia is to be ruled out and other causes for failure to wean is to be ruled out before diagnosing critical illness myopathy. Several factors play role in development of this condition. Here we present a case report of a post partum patient where we had encountered failure to wean despite several attempts and at last was successfully weaned and discharged from intensive care unit.

Traumatic rupture of the right hemidiaphragm:diagnosis aided by computerized tomography and image reformation: a case report

Traumatic rupture of the diaphragm [TRD] poses a challenge to both radiologists and surgeons. They are uncommon and occur following blunt abdominal or lower thoracic trauma. The right side involvement is less common than the left side and is easily missed. Spiral computed tomography [Spiral CT] with image reformation is very useful in the diagnosis of TRD and in identifying associated injuries. Early diagnosis and repair reduces mortality and morbidity. We present the case of a 16 year old boy who was involved in a high speed traffic accident with blunt injury to his thorax and abdomen. He was referred from a peripheral hospital in Oman for further management at Sultan Qaboos University Hospital. A spiral CT scan of thorax and abdomen with image reformation helped in the early diagnosis and management of the traumatic rupture of his right hemidiaphragm

Curcuma longa as feed additive in broiler birds and its patho-physiological effects.

Broiler birds (Vencob chicken of 3 days old) when given feed mixed with powdered rhizome of Curcuma longa (CL; @ 1 g/kg) for 42 days of age, showed significant decrease in serum uric acid and albumin as compared to control, whereas significant increase was recorded in the level of serum total protein and globulin. Level of serum glucose, alkaline phosphatase, aspartate amino transferase and calcium showed no significant variation between the two groups. Micronutrient assay revealed significantly higher level of manganese, zinc, iron and copper in treated group as compared to control group. HA/HI test revealed better humoral response against RD vaccine in CL administered birds. Haematological study showed significantly higher haemoglobin and absolute neutrophil count in treated group. Addition of CL as feed additive also resulted in better growth rate, feed consumption and F:C efficiency in the treated birds. Thus, it could be concluded that powdered CL might be a useful feed additive, since it enhanced the F:C efficiency and had nephroprotective properties.

Enhanced erythrocytic lipid peroxides level in rabbits after repeated parental administration of iron.

An experiment was conducted in rabbits to evaluate the possible involvement of oxidative stress in iron-overload animals. Ten adult female New Zealand white rabbits were divided into 2 equal groups with 5 animals each. Group II animals received intramuscular iron dextran injections (120 mg/kg body wt/day) on alternate day for 14 days (8 injections), while Group I animals did not receive any iron supplementation to serve as negative controls. The blood samples were collected by cardiac puncture before the start of iron dosing and thereafter, at weekly intervals for 28 days. The samples were processed to measure blood iron concentration, packed cell volume, erythrocytic lipid peroxide (LPO) level, superoxide dismutase (SOD) and catalase (CAT) activities. The blood iron concentration showed a rising trend following repeated iron administration, and the mean level recorded on day 14 was significantly higher than respective day 0 value. LPO level remained significantly higher from day 14 onwards till the end of the observation period of 14 more days after cessation of iron adminstration. Erythrocytic superoxide dismutase activities showed a transient significant rise on day 7, and thereafter, showed a declining trend, but remained statistically comparable to respective day 0 or corresponding value of the control animals.

Oesophageal manometry in noncardiac chest pain.

Chest pain of oesophageal origin is an important differential diagnosis in patients with cardiac chest pain. A preliminary survey of 40 patients with noncardiac chest pain (NCCP) revealed oesophageal motility disorder in 47.5%; achalasia cardia being the most frequent disease (47.3%). 15.8% of these patients with motility disorder had features of progressive systemic sclerosis and another 15.8% had non specific oesophageal motility disorder (variants). Compared to barium swallow, oesophageal manometry was found to be superior in the diagnosis of oesophageal motility disorder.