Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars:a randomized controlled trial

Background@#Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. @*Methods@#This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. @*Results@#The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. @*Conclusion@#Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.

Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars:a randomized controlled trial

Background@#Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. @*Methods@#This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. @*Results@#The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. @*Conclusion@#Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.

A Comparative Study of Automated v/s Manual Measurement of Blood Pressure

Measurement of blood pressure accurately is imperative in the diagnosis and monitoring of a wide range of clinical conditions. The mercury sphygmomanometer discovered more than 100 years ago, has since been used as the gold standard to record blood pressure. Using the mercury sphygmomanometer requires adequate training and practice, whereas the automated devices are convenient and easier to use. We wanted to compare the readings taken by the manual mercury and the digital sphygmomanometer and determine the variations in the readings if any. MethodsThis cross-sectional study was done in 148 apparently healthy medical students (males n=58, females n=90) (Fig. 1). Written informed consent was taken and the procedure was carried out. Questionnaires were provided to obtain demographic data from students. Blood pressure was recorded in the dominant arm using Pulse Wave 300 NISCO mercury sphygmomanometer, and OMRON HEM-7130 digital sphygmomanometer in the sitting, standing and recumbent posture. Three readings were recorded in each position with an interval of 2 mins., between each recording. The mean of the systolic and diastolic blood pressured was compared between the mercury and digital sphygmomanometer for variations if any. Data was analyzed using IBM SPSS version 22. P value of ≤ 0.05 was considered significant. ResultsIn our study out of the 148 participants 58 were males and 90 were females. The overall mean systolic blood pressure recorded using the mercury sphygmomanometer was found to be 107.59 ± 11.62 mmHg; mean diastolic blood pressure was found to be 68.83 ± 8.91 mmHg; overall mean systolic blood pressure recorded using the digital sphygmomanometer was found to be 107.72 ± 13.36 mmHg and overall mean diastolic blood pressure was found to be 71.4 ± 9.62 mmHg. ConclusionsIn our study no statistically significant difference was found between the BP measurements recorded using the mercury and digital sphygmomanometer (Table. 1, 2). Mercury sphygmomanometer still remains the gold standard in recording blood pressure, and those who are unskilled in recording BP using the standard method could utilize the digital device as it is easier and more convenient.

Effect of Cold Pressor Test (CPT) on Pulse Rate and Blood Pressure amongst Individuals with and without Family History of Hypertension.

It is an established fact that primary and secondary hypertension and related cardiovascular disorders have a familial predisposition. We also know that essential hypertension is the most common amongst hypertensives. The aim of our study was to find out effect of cold pressor test (CPT) on heart rate and blood pressure amongst individuals with and without family history of hypertension. MethodsPresent study was undertaken using within group design consisting of measurements at basal and CPT and the parameters studied were pulse rate and Blood pressure. ResultsIn our study we found that in males with family history of HT (n=15), the mean basal pulse rate was 78.33 beats/min and following CPT it increased to 85.73. Similarly, in males without family history of HT (n=18) mean basal pulse rate was 77.28 beats/min and following CPT it increased to 86.72 beats/min. In both cases it was statistically significant. But it is observed that in case of females with family history of HT (n= 20) mean basal pulse rate was 80.9 beats/min and following CPT it increased to 89.1. Similarly, in Females without family history of HT (n=26) mean basal pulse rate was 77.15 beats/min and following CPT it increased to 84.73 beats/min and in both these cases, it was statistically significant. In males with family history of HT (n=15), mean basal SBP was 115.13 mmHg and following CPT increased to 123.93 and this was statistically significant and the mean DBP was 74.67 mmHg and following CPT it increased to 79.82 mmHg and it was not statistically significant. In males without family history of HT (n=18) mean basal SBP was 114.67 mmHg and following CPT it was increased to 122.89 mmHg and increase was statistically significant and mean DBP was 74.44 mmHg and following CPT it increased to 76.33 mmHg and this increase was not statistically significant. In females with family with family history of HT (n=20) the mean SBP was 114.2 mmHg and following CPT it increased to 121.9 mmHg and it was statistically significant and the mean DBP was 73.75 mmHg and following CPT it increased to 78.80 mmHg and it was not statistically significant. In females without family history of HT (n= 26) the mean basal SBP was 108.23 mmHg and following CPT it increased to 117.08 mmHg and the mean basal DBP was 69.92 mmHg and following CPT it was increased to 76.69 mmHg this increase in both the cases was statistically significant (table 1,2). In both the groups, none of the subjects was found to be hyperreactive to either systolic or diastolic blood pressure when they were subjected to CPT. ConclusionsIn both the groups, subjects were found to be hyporeactive or normoreactive to either systolic or diastolic blood pressure when they were subjected to CPT. But increase in basal blood pressure response is known to be due to CPT.

Study of Effect of Shavasana on Handgrip and Cold Pressor Test on Heart Rate and Blood Pressure in Young Adults.

Shavasana or a corpse pose is the final pose of a yoga flow. When practiced regularly it is known to restore the body and mind. Aim of our present study was to investigate the effects of shavasana on handgrip and cold pressor test on heart rate and blood pressure in apparently healthy young adults. In today’s world all of us are under constant stress and majority of individuals with sedentary lifestyle suffer from hypertension and each of us react differently to varied internal and external stimuli.METHODSFor convenience, we took 300 apparently healthy medical students of both sexes in the age group of 18 to 22 years and a comparative study was carried out among them. Their basal pulse and BP were recorded from dominant hand. For Hand Grip Test (HGT) handgrip dynamometer (INCO) was used by left hand, and pulse and BP from right hand was recorded and similarly Cold Pressor Test (CPT) was carried out by immersing left hand up to wrist joint in cold water mixed with ice cubes to maintain temperature at 40C and pulse and BP was recorded from right hand. Shavasana was performed for 15 minutes by lying down on the wooden couch, with eyes closed and lying on back, keeping arms six inches away from the body and legs and feet “drop” open and palms facing upwards and concentrating on their breathing, after which pulse and BP was recorded. This was carried out for a period of 30 days.RESULTSData was collected and analysed using paired ‘t’ test and paired differences were calculated using 95% confidence interval of the difference and p value of < 0.05 was taken as scientifically significant. In our study we found that there is significant decrease in basal pulse rate, when compared with CPT, immediately and after performing shavasana for a period of one month, and there was significant increase in pulse rate following HGT (p< 0.001) (table 1 and graph 1). Compared to basal, SBP and DBP, it was observed that there is significant decrease; immediately and after performing shavasana for one month and significant increase with HGT and CPT was observed (p<0.001) (table 1 and graph 1).CONCLUSIONSThere is a significant decrease in basal pulse rate, when compared with CPT, immediately and after performing shavasana for a period of one month, and there was significant increase in pulse rate following HGT (p< 0.001) (table 1 and graph 1). Compared to basal, SBP and DBP it was observed that there is significant decrease; immediately and after performing shavasana for one month and significant increase with HGT and CPT was observed (p<0.001) (table 1 and graph 1).

Comparative performance of Cerebral Perfusion Ratio as compared to MCA PI and UA PI in prediction of adverse perinatal outcomes in intra uterine growth restricted fetuses

Background: Intra uterine growth restriction (IUGR) is a common clinical sign seen due to chronic foetal hypoxemia and is considered a major contributor of perinatal morbidity and mortality. The aim of the present study was to determine and compare the sensitivity and specificity of umbilical artery pulsatility index (UA PI), middle cerebral artery (MCA) PI and cerebral perfusion ratio (CPR) in predicting adverse and poor perinatal outcomes in fetuses with IUGR.Methods: The study included 100 pregnant women with post 24 weeks of gestation with clinical history of IUGR.  Doppler examination parameters, including waveforms and measurements, of the umbilical artery, middle cerebral artery were recorded. The Cerebral Perfusion Ratio (CPR) was calculated from MCA PI and UA PI and a final comparison of accuracy of Doppler indices was done with perinatal outcome.Results: The sensitivity of the UA PI was higher (49.3%) than that of the MCA PI (43.6%) and the CPR (37.7%). The specificity of the CPR was higher (87.1%) than that of the MCA PI (83.9%) and the UA PI (74.2%).Conclusions: From the findings of the study, it can be concluded that UA PI is the most sensitive and CPR is the most specific parameter in predicting adverse perinatal outcomes in IUGR fetuses. Thus, in addition to pulsatility indices, CPR should be used as a tool for surveillance and included in the routine reporting formats of obstetric Doppler studies.

Development of validated stability indicating RP-HPLC method for the estimation of glecaprevir and pibrentasvir in bulk and pharmaceutical dosage form

A novel, selective, precise, and sensitive stability indicating Reverse Phase-High Performance Liquid Chromatography(RP-HPLC) method has been developed and validated for simultaneous estimation of Glecaprevir (GLE) andPibrentasvir (PIB) for bulk and pharmaceutical dosage form. The chromatographic separation was accomplished ona Denali C18 column (150 mm × 4.6 mm, 5 µm) by using mobile phase buffer (pH 4.8) and acetonitrile in the ratio of60:40 v/v. An injection volume of 10 µl was used via manual rheodyne and the solute was detected at a UV wavelengthof 260 nm. The mobile phase was pumped at an ambient temperature of 30°C with a flow rate of 1 ml/minute. Theretention time of GLE and PIB were found to be 2.13 and 3.46 minutes, respectively. The Q2b validation of theproposed analytical method revealed several features; linear regression analysis data showed good linearity over theconcentration range 25–150 µg/ml for GLE and 10–60 µg/ml for PIB with r2 of 0.999 in both the cases and the meanrecovery of them were found to be 100.33% and 100.47%, respectively. The accuracy and precision aspects expressed<2% relative standard deviation value along with adequate robustness. The acid, alkali, neutral, dry heat, UV, andphoto-degradation studies demonstrated the formation of various degradation products. The proposed analyticalmethod proved to be suitable for the routine simultaneous analysis of both the drugs in bulk and tablet formulations.potential, morphology, encapsulation efficiency, and stability of microcapsules. The characterization results from eachformulation reported that the ratio of mangosteen peel extract and maltodextrin at level 50%:50% (MP3) producedmore proportional characteristics than other treatments. The formulation of mangosteen peel extract with maltodextrinat a balanced ratio could be used as an alternative supply and processing of functional food.

Comparative evaluation of induction with propofol vs induction with sevoflurane for insertion of laryngeal mask airway in children

Background: There is increasing use of laryngeal mask airway in children because of ease of insertion and minimal disturbances in cardio respiratory system and lesser risk of airway injury during perioperative period as compared to endotracheal tube. It is also simple, well-tolerated, safe, reusable, cost effective method of airway management in paediatric patients. Intravenous propofol (1%) is a preferred induction agent for LMA insertion till date, while sevoflurane, a halogenated volatile inhalational, non-irritating anaesthetist agent with pleasant odour is also suitable for inhalational induction of children. This study was carried out to study and compare clinical efficacy of propofol and sevoflurane for laryngeal mask airway (LMA) insertion in children undergoing short surgical procedures.Methods: In this study, total 100 children of ASA grade I/II of either sex with age group 3-8 years, weighing between 10-20 kg were enrolled. They were induced with either sevoflurane (group S) or intravenous propofol (group P) 3 mg/kg. Then appropriate size LMA was inserted. Various parameters like jaw relaxation and ease of insertion attempts required hemodynamic changes were noted and compared in two groups.Results: In group P, 94% patients and groups S, 90% patients had full jaw relaxation. The LMA insertion was easy in 98% patients in groups P and 94% patients in groups S. In 98% patients of groups P and 96% patients in groups S, LMA was inserted successfully in first attempt. The mean time required for LMA insertion was 19.16±5.29 seconds in groups P and 20.8±6.39 seconds in groups S. Both the groups were comparable with respect to haemodynamic changes observed which were transient and clinically not significant though statically significant.Conclusions: Both the groups showed comparable and satisfactory LMA insertion conditions, hence both can be routinely used for induction of anaesthesia in children.

Study of correlation between clinical profile, CD4 count and total lymphocyte count in HIV infected patients at rural tertiary care institute

Background: India is a country with low HIV prevalence, yet it has the third largest number of people living with HIV/AIDS. Availability of antiretroviral medications is improving, making it is important to develop feasible strategies for the management of antiretroviral therapies in resourcelimited settings. Aim and objectives: To study clinical profile of HIV infected patients with special respect to total lymphocyte count (TLC) and CD4 count and study the correlation between Total Lymphocyte count (TLC) and CD4 count in HIV infected patients. Materials and methods: An observational study was conducted on patients admitted in general medicine ward at the tertiary care hospital, fulfilling inclusion and exclusion criteria, for duration of 24 months. The detailed history and examination findings of the patients were recorded. To analyse the data we used statistical software SPSS 16.0 was used. Results: Fever was the most common symptom reported. CD4 counts corresponded to various opportunistic infections. The Pearson correlation of TLC with CD4 counts was 0.388 i.e. moderate correlation at p<0.05 (0.005) and this showed the statistical high significance between TLC and CD4 count. Conclusion: TLC is a widely available and inexpensive parameter, which can be used in place of CD4 count, for monitoring immune status in HIV infected individuals. TLC values may be useful, but less sophisticated and less costly methods of determining CD4 counts such as microvolume Siddheshwar V. Birajdar, Sanjay S. Chavan, Deepak R. Patil. Study of correlation between clinical profile, CD4 count and total lymphocyte count in HIV infected patients at rural tertiary care institute. IAIM, 2018; 5(2): 135-140. Page 136 fluorimetry and ELISA techniques be evaluated and made available for use in resource-limited settings

Simple Spectrophotometric Method for Estimation of Raltegravir Potassium in Bulk and Pharmaceutical Formulations.

A simple, rapid, precise, and economical spectrophotometric method has been developed for quantitative analysis of Raltegravir Potassium (RALP) in tablet formulations. The stock solution of RALP was prepared in water. The standard solution of RALP in water showed absorption maxima at 331.6 nm. The drug obeyed Beer–Lambert’s law in the concentration range of 1–100 μg/mL with coefficient of correlation (R2) was 0.9999. It showed coefficient of variation below 2 % in intra-run and inter-run precision. The recovery was obtained with values close to the 100 % of theoretical at three different concentrations. The results of analysis have been validated as per ICH guidelines. The method can be adopted in routine analysis of RALP in bulk and tablet dosage form and it involves water as a solvent and no complex extraction techniques.

Aquasomes: A novel drug carrier.

Aquasomes are one of the most recently developed delivery system for bioactive molecules like peptide, protein, hormones, antigens and genes to specific sites. Aquasomes are spherical in shape with 60–300 nm particles size. These are nanoparticulate carrier systems but instead of being simple nanoparticles these are three layered self assembled structures, comprised of a solid phase nanocrystalline core coated with oligomeric film to which biochemically active molecules are adsorbed with or without modification. These structures are self assembled by non covalent and ionic bonds. The solid core provides the structural stability, while the carbohydrate coating protects against dehydration and stabilizes the biochemically active molecules. The delivery system has been successfully utilized for the delivery of insulin, hemoglobin, and enzymes like serratiopeptidase etc. This reviews the principles of self assembly, the challenges of maintaining the conformational integrity and biochemical activity of immobilized surface pairs, the convergence of these principles into a single functional composition and its application in various fields of pharmacy.

Frequency of group A rotavirus with mixed G and P genotypes in bovines: predominance of G3 genotype and its emergence in combination with G8/G10 types

The present study describes the genotypic distribution of rotaviruses (RVs) in an Indian bovine population with unexpectedly higher proportions of G3 alone or in combination of G8/G10. PCR-genotyping confirmed that 39.4% (13/33) of the prevalent RVs were the G3 type while 60.6% (20/33) were dual G3G10 or G3G8 types. P typing revealed that 93.9% (31/33) of the samples were P[11] while 6.1% (2/33) possessed a dual P[1]P[11] type. Sequence analysis of the VP7 gene from G3 strains viz. B-46, 0970, and BR-133 showed that these strains had sequence identities of 90.5% to 100% with other bovine G3 strains. The highest identity (98.9% to 100%) was observed with RUBV3 bovine G3 strains from eastern India. The G3 strains (B-46, 0970, and BR-133) showed 97.5% to 98.8% sequence homologies with the Indian equine RV strain Erv-80. Phylogenetic analysis demonstrated that G3 strains clustered with bovine RUBV3 and J-63, and equine Erv-80 G3. Overall, these results confirmed that the incidence of infection by RVs with the G3 genotype and mixed genotypes in the bovine population was higher than previously predicted. This finding reinforces the importance of constantly monitoring circulating viral strains with the G3 genotype in future surveillance studies.

Sporotrichoid nocardiosis with cutaneous dissemination.

Dissemination of primary cutaneous nocardiosis is a rare event. A 37-year-old man working as farmer presented with multiple painful suppurative nodular and ulcerative skin lesions over left lower extremities, in a linear pattern, with duration of five months and single painful nodule over right elbow since last three months. We found the presence of beaded filamentous bacteria in Gram stain smear and partial acid fast stain, from the smear taken from pus. Patient responded well to cotrimoxazole therapy. Hence, we confirm our diagnosis of sporotrichoid pattern of cutaneous nocardiosis with dissemination to other cutaneous area.

Kaposi's sarcoma: A presenting sign of HIV.

Kaposi's sarcoma (KS) is a multifocal cutaneous and extra cutaneous vascular proliferative disorder. In India, there are only a few cases of HIV-associated KS in published literature. A 26-year-old married man presented with asymptomatic elevated skin lesions over the face, trunk, both upper limbs and lower limbs with a duration of one-and-a-half months. Cutaneous examination revealed multiple violaceous papules and nodules, on the face (right upper and lower eyelids, upper lip), trunk and proximal part of both limbs. Oral cavity showed erythematous plaques, two in number, on the hard palate. Skin biopsy showed proliferation of thin walled capillaries with formation of slit like spaces, spindle cell proliferation, abundant extravasation of RBCs and moderately dense inflammatory infiltrate in the dermis. Thus a clinical diagnosis of cutaneous KS was confirmed. On testing with ELISA for HIV, the patient was for the first time diagnosed as HIV reactive. Thus KS was the presenting manifestation of HIV disease.

Refractory hyperkalaemia due to trimethoprim, successfully treated with fludrocortisone.

We report a case of intractable hyperkalaemia in an elderly patient with myeloma, who received conventional dose of trimethoprim-sulfamethoxazole and hyperkalaemia resolved following therapy with fludrocortisone. We recommend monitoring of serum potassium in high-risk patients receiving conventional doses of trimethoprim-sulfamethoxazole for 5 or more days.

Spinal cord response to altered fractionation and re-irradiation: radiobiological considerations and role of bioeffect models.

The aim of radiation oncologist is to implement an uncomplicated loco regional control of cancer by radiation therapy. The bioeffect of a physical dose depends on the nature of the tissue, fractionation scheme, dose rate and treatment time. The transformation of absorbed dose into a bioeffect dose is controlled by treatment variables and the radiobiological characteristics of the relevant tissue. Various bioeffect models have been proposed to predict the biological effect of radiotherapy treatments. Dale has proposed extrapolated response dose (ERD) equations for external beam therapy, intracavitary brachytherapy and interstitial brachytherapy. Within the context of the LQ model, the parameter which quantifies the overall biological effect on a given tissue is the biologically effective dose (BED) which is obtained by applying repopulation correction to ERD (Orton). Thames proposed the total effect (TE) concept based on the incomplete repair LQ model which accounts for the biological effect of a fractionated course of radiotherapy. Spinal cord myelitis limits the dose to tumours in the head and neck, thoracic and upper abdominal regions resulting in reduction of tumour control probability. Radiation myelopathy is one of the most devastating complications of clinical radiotherapy. Treatment techniques that are designed to minimize the risk of spinal cord injury are likely to underdose the tumour consequent failure to control the disease. Since radiation myelopathy results in severe and irreversible morbidity, it is important to establish the tolerance dose of the spinal cord. A number of patients have recently been reported to have developed radiation myelopathy following hyperfractionated accelerated radiotherapy. As the survival rates of patients increase, radiation oncologists are more frequently faced with the problem of treatment of late recurrence or second tumours situated within or close to previously treated site. A rationale for taking a decision in treating in such a condition is even more complex than the original condition and requires knowledge of the kinetics of decay of occult injury of the previous treatment. To test the validity of ERD, clinically reported data of altered fractionation to the spinal cord for 7 patients reported by Wong et al, Saunders et al and Bogaert et al, were analysed, ERD values were calculated and compared with compiled clinical literature data of 3233 patients for the incidence of spinal cord myelitis reported by Cohen and Creditor, Wara et al, Abbatucci et al and Jeremic et al for conventional fractionation. ERD values were estimated with alpha/beta of 2.5 Gy for the conventional and altered fractionation data. To test the validity of TE concept for clinical data of re-irradiation tolerance of the spinal cord, the data of the 22 patients compiled by Nieder et al were used. Clinical data compiled from the literature of Cohen and Creditor, Wara et al, Abbatucci et al and Jeremic et al, were used for comparison.

Multisegmental cervical ossification of the posterior longitudinal ligament: anterior vs posterior approach.

AIMS: To determine the surgical approach in patients with multisegmental (four or more segments) OPLL of the cervical spine. METHODS AND MATERIALS: Data of 27 patients who had undergone either an anterior (corpectomy with excision of OPLL and interbody fusion = 14 patients) or posterior approach (laminectomy = 12, laminoplasty = 1 patient) for the multisegmental cervical OPLL was analyzed retrospectively. The patients in each group were statistically similar in respect to preoperative factors such as age, duration of symptoms, preoperative modified Japanese orthopedic association score, OPLL thickness, effective canal diameter, and antero-posterior cord compression ratio. The clinical outcome was assessed by the Harsh grading system and recovery rate was assessed by Hirabayashi method. RESULTS: There was no statistical difference in the outcome, and recovery rate. Nine patients developed complications after anterior approach in contrast to one after posterior approach. CONCLUSIONS: In patients with multisegmental cervical OPLL, there was no significant difference in the short-term recovery rate and outcome between two groups. The immediate postoperative complications were less in patients who had undergone posterior approach. From our analysis, it appears that the posterior approach is probably the preferred method of treatment in a multisegmental OPLL in absence of preoperative kyphosis.

Superior sagittal sinus thrombosis and Budd-Chiari syndrome due to paroxysmal nocturnal hemoglobinuria managed with transjugular intrahepatic portosystemic shunt: a case report.

BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoietic cells, is associated with complement-mediated hemolysis and a hypercoagulable state. Thrombotic complications in this disease are associated with reduced survival. We report a patient with PNH complicated by intracranial venous thrombosis and Budd-Chiari syndrome, who was managed with transjugular intrahepatic portosystemic shunt. CASE PRESENTATION: A 26-year-old man presented with thrombosis of the superior sagittal and right sigmoid sinuses. Initial investigations did not reveal any underlying cause. Nine months later, he developed hepatic venous thrombosis. At this time, Ham test was positive. Flow cytometry confirmed the diagnosis of PNH. The patient was treated with transjugular intrahepatic portosystemic shunt; one episode of stent blockage one month later was managed successfully with balloon dilatation and restenting. CONCLUSION: PNH should be considered in patients with unexplained venous thrombosis. Thrombosis in these patients needs to be managed with prolonged anticoagulation. For Budd-Chiari syndrome in patients with underlying PNH, transjugular intrahepatic portosystemic shunt may be a good option but caution is needed to prevent stent occlusion.

Montelukast - evaluation in 6 to 14 years old children with persistent asthma - pediatric montelukast study group.

OBJECTIVE: The suffering of children with asthma as a persistent illness is present in approximately 10% of the total population. The prevalent treatment regimens available has been the inhaled coticosteroids and short acting bronchodialators. Though the therapies are rational and well accepted but at the cost of side effects on chronic use. The changing definitions and guidelines with regard to asthma have given a classified slot to newer treatments like leukotriene receptor antagonists (LTRAs). The aim of the present study was to study the efficacy and tolerability of montelukast in the treatment of Indian pediatric patients aged 6 to 14 years with chronic asthma. METHODS: It was a prospective, open, non-comparative multicentric study. 881 Children (Mean age 11.83+/- 3.12 years) were included. Patients fulfilling the inclusion criteria were given one mouth dissolving 5 mg montelukast tablet daily in the evening for 30 days. RESULTS: There was an overall improvement in all the efficacy parameters. The daytime total asthma score decreased from 9.55 +/- 1.52 to 3.59 +/- 2.10. The average number of asthma attacks over the last 4 weeks decreased from 1.14+/- 1.19 to 0.28+/-0.57. The number of nocturnal awakenings fell from 1.54+/-0.78 to 0.43+/-0.54. FEV1 (L) [Predicted] improved by 21.18%). PEFR (L/min.) improved by 34.69%). Approximately 45% physicians rated the treatment as excellent, 30% as very good, 18% as good, 7% as fair and none as poor. CONCLUSION: Montelukast administered once daily improved efficacy end-points and was well tolerated in pediatric patients with chronic persistent asthma establishing itself as a valuable treatment option to current asthma therapies in 6 to 14 years old patients.

Retro-peritoneal plasmacytoma: a case report and review of literature.

Solitary Extramedullary Plasmacytoma (EMP) is an uncommon neoplasm. When diagnosed, head and neck region is its most likely location. Rarely, it may occur in the retro-peritoneum. We report a 44 year old man with solitary extramedullary plasmacytoma in the retro peritoneum (RPEMP). The patient did not show response to three cycles of VAD chemotherapy. Thereafter Surgical excision of the mass was performed successfully. This is probably the first case report from Indian subcontinent.