A rare prostatic tumour masquerading clinically as benign prostatic hyperplasia

Prostatic tumours are usually benign. Malignant tumours are usually adenocarcinoma. Rare benign prostate tumours include inflammatory myofibroblastic tumours, which can be found in various body parts and are frequently identified in the lung or abdominal cavity of children and young adults. Inflammatory myofibroblastic tumours of the urinary tract present more often in kidneys. Prostatic inflammatory myofibroblastic tumours are sporadic and rare. Presenting 44 years old male with complaints of gross hematuria for 15 days with recurrent urine retention. Per rectal examination revealed, grade II prostate enlargement was firm in consistency. PSA was mildly raised (4.4 ng/ml). Ultrasound abdomen showed enlarged prostate (volume -40 cc) with irregular margins and heterogeneous echo texture showing increased flow on colour Doppler. Transrectal ultrasound (TRUS) showed a well-defined irregular heterogeneously echoic mass in the transitional zone, but TRUS biopsy showed no malignancy. After TURP, prostate chip examination showed inflammatory myofibroblastic pseudotumour of the prostate. Di?erentiation of inflammatory myofibroblastic prostate tumours from malignant tumours through imaging and laboratory tests is di?cult. A case of prostatic inflammatory myofibroblastic tumour observed after transurethral resection of the prostate to treat prostate hyperplasia in a 44-year-old man is presented in this report.

Pharmacognostical, Pharmaceutical and Microbiological Analysis of Mrudwika Sharkara

Draksha (Mrudwika) is best among all fruits as per Ayurveda. It is also indicated in different diseases as a medication and used in diets in fresh and dry forms. Draksha is a fruit that is only available during certain times of the year. Sharkara dosage form of it can be prepared to make that is palatable. Draksha is used in dry form i.e., Munakka (Mrudwika, raisins). Commonly, Munakka, Kismis, and Currants are three varieties with slight differences in their characteristics and nutritional content. They own property in Mridu Rechana, Vatahara, Pittahara, Brimhana, Vrishya, and Rasayana. For health promotion, disease prevention, and a wide range of Vata, Pitta, and Raktaja Vyadhis and Apatarpana Vyadhis, Draksha should be regularly incorporated into diet in either dry or fresh form. In the present study, an attempt has been made to develop pharmacognostical and pharmaceutical standards for Mrudwika Sharkara for assurance of quality of herbal compounds pharmacognostical and pharmaceutical analysis should be done. Methods: Mrudwika Sharkara was subjected to microscopic evaluation for pharmacognostical study, analysis physic-chemical analysis includes specific gravity, pH value, reducing sugar, non-reducing sugar and total sugar and high Performance thin layer chromatography (HPTLC). Mrudwika Sharkara was assessed for microbiological which include smear examination and culture study. Results: Pharmacognostical study showed the presence of certain identifying characters of Mrudwika and Sharkara. In pharmaceutical study, preliminary physico-chemical analysis showed specific gravity is 1.160, pH value is 4, reducing sugar 21.1%, non reducing sugar 48%, total sugar content 69.1%. HPTLC analysis showed eight spots in 254nm and six spots in 366nm. From date of preparation 23/06/21 to 18/10/22 no fungal contamination was found in Mrudwika Sharkar Conclusion: Present work was carried out to standardize the formulation Mrudwika Sharkara in terms of its identity, quality and purity. All of the preparation's active ingredients were identified by pharmacognostic and physicochemical examination. Self life of Mrudwika Sharkara showed that the quality of syrup in standard condition.

Tuberculosis Case Notification by Registered Private Medical Practitioners in Kolkata: A Mixed-Methods Study

Background: Under?notification of tuberculosis(TB) cases remains a persistent problem that impedes accurate estimation of the disease burden. India’s private health sector contributes to only one?fourth of the total TB notifications. Objectives: The present study was conducted among registered private practitioners in Kolkata to assess their knowledge, attitude and practice on TB notification, to find the socio?demographic and work-related factors associated with it, to identify the barriers faced by them in notifying TB cases and to elicit suggested solutions in overcoming these barriers. Materials and Methods: It was an observational study, cross-sectional in design following explanatory sequential mixed?methods approach conducted among 426 private practitioners in Kolkata Municipal Corporation area over 2 years (July 2019–October 2021). Quantitative data were analyzed using SPSS 25.0 with suitable descriptive and inferential statistics. Qualitative data were analyzed using Atlas.ti 7.1 and data were represented in the form of themes, codes, and verbatims. Results: Out of 426, 295 (69.2%) of the study population had adequate knowledge, 385 (90.4%) had positive attitude and only 115 (27.0%) had satisfactory practice. Lack of awareness, inadequate communication, and breaching patient confidentiality were the main barriers identified. Suggested solutions to improve engagement of private sector were organizing more continuing medical educations, active case finding, and acknowledgement to private practitioners on notification. Conclusion: Private practitioners had adequate knowledge on TB notification, their attitude was very positive but practice was poor. Training and sensitization of private practitioners on notification are recommended with feedback from both ends.

Disparity in Relation to Covid-19 Preventive Behaviour and Associated Myths among Rural and Urban Residents of Lucknow: A Community Based Study

Introduction: For curbing Covid-19 disease, adequate knowledge, attitude, and practices of both rural and urban population for Covid-19 disease prevention is required along with busting of the associated myths. Objectives: To assess the Knowledge, Attitude and Practices of urban and rural residents of Lucknow district regarding covid-19 preventive behaviour and associated myths. Methodology: A community-based study was conducted among 420 rural and 421 urban residents of Lucknow. Multistage random sampling was done to select the study subjects. A pre-designed pretested semi-structured questionnaire was used to collect the information regarding the Knowledge, Attitude and Practices of the residents for covid19 disease causes, prevention, and treatment. Further, KAP scoring was done to compare the two groups. Results: The mean age of the rural and urban residents was 31.48 ± 12.05 and 30.93 ± 11.96 years respectively. Only 40.4 % urban and 25.5 % rural people had correct knowledge about social distancing (p<0.0001). Knowledge regarding quarantine for covid-19 disease prevention was less among the urban residents (64.6%) as compared to rural (70.5%) (p=0.035). More than one-third (37.6%) of the rural resident believed in the myth that alcohol can prevent the covid-19 disease (p=0.003). 68.8 and 70.5 percent rural and urban residents had positive attitude towards the Indian government’ efforts in curbing the disease. Majority of the urban (90%) and rural (87.6%) residents wore mask when they went out. Only one-fourth of the urban (24.7%) and rural (22.9%) had correct practices for the duration of hand washing. Conclusion: The knowledge was more among the urban people, attitude and practices were almost similar among both the rural and urban residents while myths were more observed among the rural residents.

Clinical spectrum of AKI in chronic liver diseases

Introduction: Acute kidney injury (AKI) is a heterogeneous syndrome of different aetiologies, and often multifactorial. Occurrence of Acute kidney injury in patients with chronic liver disease is frequent finding which makes prognosis of CLD even poorer. Material and methods: A prospective cohort observational study on 100 adult patients of chronic liver disease with AKI conducted over a period of 24 months from August 2016 to August 2018 at Sri Aurobindo medical college and postgraduate institute. Detailed clinical examination and biochemical tests were done. Univariate and multivariate logistic regression (odds ratio) analyses were used. Result: 87% are males and 13 % are females. The most common cause of cirrhosis is alcoholic 77% followed by hepatitis Bvirus related 10%, unknown etiology 7%, hepatitis C 3%, NASH 2%, Wilson 1. The most common sign of decompensation of liver is jaundice 78% followedby ascites 70%, hepatic encephalopathy 37% and upper GI bleed 30%. Distribution of child class as a prognostic indicator showed the maximum no. ofpatients found in class C 56% followed by class B 34% and class A 10%. Conclusion: Acute kidney injury is very common in chronic liver disease patient in our hospital and majority of them have intrinsic cause of AKI

Molecular Docking Study Of Six Pyrimidine Derivatives As Egfr (EPIDERMAL Growth Factor Receptor) And Ca Ix (CARBONIC Anhydrase Ix) Inhibitor

Objective: The present study was carried out to discover whether these pyrimidine derivatives have the potential to be used as epidermal growth factor receptor (EGFR) and carbonic anhydrase (CA) IX inhibitors through structure-based in silico study. Methods: Docking was performed on 6 pyrimidine analogs; cetuximab and curcumin were taken as reference drug. The structure of the target protein retrieved from the RCSB Protein databank and the protein-ligand docking was performed using Pyrx AutoDock wizard with MGL tools 1.5.6 by using Lamarckian algorithm. Results: All the compounds have shown lower binding energy and inhibition constant (Ki) value than reference drug cetuximab and curcumin. Out of the 6 inhibitors analyzed vkh has shown minimum binding energy against the target protein EGFR and CA IX respectively. Smaller Ki value shows stronger interaction. The scoring value of the interaction of vkh i. e-10.74 and-9.93 Kcal/mol and Ki 13.17ɳM and 53.04ɳM against the target protein EGFR and CA IX respectively while the reference drug cetuximab has shown binding energy-6.09 Kcal/mol with Ki value 34.44 µM and curcumin has shown binding energy-6.02 kcal/mol with Ki value 38.60 µM. Conclusion: It can be concluded that the molecule vkh could have potential to be used as an EGFR inhibitor and CA IX inhibitor.

PHYSICOCHEMICAL AND HPTLC ANALYSIS OF PIPPALIMULA (ROOT OF Piper longum LINN.)

Pippalimula (root of Piper longum Linn.) is the spice of Indian cuisine having immense therapeutic properties. The study was conducted to evaluate Physicochemical, phytochemical analysis and HPTLC analysis using specific solvent system for Pippalimula. Material and Methods: Fine powder of Grade I Pippalimula (root of Piper longum Linn.) and alchoholic extract were obtained and subjected to phytochemical analysis and chromatographic study. Discussion: Physicochemical analysis of the root was carried out. HPTLC analysis of the methanolic extract of the root powder was performed with Toluene: Ethyl acitate 9:1.(v/v) Conclusion: HPTLC analysis of root of Piper longum Linn.can provide standard analysis with selected solvent system and can be used as a reference for the authentication and quality control of the drug. The study will provide referential information for the correct identification of the crude drugs.

Adrenal tumors: An experience of 10 years in a single surgical unit.

INTRODUCTION: Most of the adrenal masses are discovered incidentally by imaging techniques for reasons unrelated to adrenal diseases. Treatment is based on various factors such as, nature of adrenal mass, age of presentation, size of tumor, and the functional status of tumor. We report a series of 14 consecutive cases of adrenal tumors treated in a single surgical unit in our hospital. AIM: The aim of this study was to evaluate the clinical profile and outcome of treatment of adrenal tumors treated in a surgical unit. MATERIALS AND METHODS: It is a retrospective study data of 14 cases of adrenal tumors treated in a single surgical unit in University Hospital over 10 years have been analyzed. Various parameters such as gender, age, size of tumor, functional status, histopathology, type of management, and outcome have been reviewed. RESULTS: A total of 14 patients with adrenal masses were seen over a 10 year period (1997‑2006). All were referred cases, either from endocrinology or medicine wards. There were seven female and seven male patients. Mean age of patients was 48.6 years (range 14‑60 years). Mean size of tumor was 8.0 cm (5.9 cm for benign tumors and 9.7 cm for malignant tumors). There were six cases of adrenal carcinoma, four cases of adrenal myelolipoma, two cases of pheochromocytoma, and one each case of adrenal hyperplasia and histoplasmosis. There were only two functional tumors. All, except two malignant cases were treated operatively. A total of 5 year survival was 100% in benign cases and 27% in malignant tumors. CONCLUSION: Adrenal tumors need to be assessed for their functional status and malignant potential prior to treatment. Surgical excision is usually curative for benign lesion. Among malignant tumors the benefits of surgery depend on local extent and metastatic status of tumors.

Basilic vein aneurysm mimicking as arterio venous malformation.

Venous aneurysm is saccular or fusiform dilatation of vein, usually congenital origin. Among acquired variety post intravenous cannulation leading to venous aneurysm is extremely rare entity. Non invasive diagnostic procedure MRI and duplex scanning are very useful modality for anatomical localization of the aneurysm. Although an ascending venogram is an invasive test and should take a backseat for diagnosis of such aneurysm. Symptometic case needs surgical management. Anatomical delineation is an important pre requisite for planning surgery. Aneurysmorrhaphy preserves the affected venous segment because it does not produce luminal compromise.

Pharmacognostical and Pharmacochemical Parameters of Tablet Sutashekhara Rasa – Without Gold .

Tablet Sutashekhara Rasa (TSR) is an Ayurvedic, herbo-metal formulation prescribed widely for several conditions such as Acid peptic disorders, Pain in abdomen, Haemorrhage, Mental disorders etc. On analysis of pharmcodynamics of this compound it is basically Pitta corrective drug. Ardhavabhedaka (Migraine) is also one of the clinical morbidity which is manifested by vitiated Pitta/Rakta along with Vata. The available treatment in modern medicine is use of NSAIDs, Beta-blockers etc. with only temporary relief. TSR being a Pitta corrective is used in a clinical study with new indication in Ardhavabhedaka (Migraine). Till date there is no data available regarding evaluation ofTSR. Present study an attempt to develop newer approaches for the quality control and standardization of TSR. The samples were subjected to organoleptic, physicochemical analysis and Chromatographic (HPTLC) examination by optimizing the solvent systems. The phrmacognostical study of ingredients of TSR shows the presence of Sceleriform vessel, Lignified stone cells, Bottle necked shapedstone cells etc. Pharmaceutical analysis showed that the Average weight of tablet 276mg, Average hardness of tablet 2.05 Kg/cm2 , Loss on drying 4.7904% w/w, pH value 7 and High Performance Thin Layer Chromatography at 254nm and 366nm resulted into 6 spots

A comparative study on different market samples and standard samples of Shalaparni through physicochemical methods and near infrared spectroscopy.

Dashmoolais one of the most important groups explained in Mishrakagana. One of which, Shalaparni is a potent drug used single as well as in various formulations mentioned in classics. Adulteration in Dashmoolaplants is a very big issue now days and this is because of the lack of availability of the original drugs. In this study market samples of Shalaparni (Desmodium gangeticum DC.) collected from the different part of India; compared with the standard Shalaparni authenticated sample which was collected from the natural source; by using physicochemical parameter and near infrared spectroscopy. Results were statistically processed by PCA. The results show that there is no similarity found outbetween the standard drug and market samples of Shalaparni which were collected from different regions of India. The market samples were observed for different adulterated material having poor quality.

Micro evolution of bitter taste domain drugs.

Ayurveda classified the drugs in various ways and one of which the classification is based on Rasa (taste) dominancy. Rasa is essential to identify drugs and to know its therapeutic application. In this study the drug has been selected according to Charaka classification of Tikta Rasa (bitter taste) drugs with an aim to find out the similar characters among all the drugs having bitter Rasa dominancy. Till date there is no data available regarding the pharmacognostical evaluation in concern bitter taste. For the first time selected five bitter drugs are subjected to various pharmacognostical evaluation, result reveals that Organoleptic characters of all five drugs give bitter taste, microscopic evaluation revealed that presence of starch grain, vessels, fiber , brown content are dominant in all five raw drug and all the five powder subjected to alkaloid test by using dragondroff reagent and give positive result for alkaloids.

Immunomodulatory activity of guduchi ghana (aqueous extract of tinospora cordifolia miers).

In the present work, Guduchi Ghana (concentrated form of aqueous extract of Guduchi) was prepared according to the method described in classical text – Sidhdha Yoga Samgraha and the other sample of aqueous extract was purchased from the market for the assessment of the immunomodulatory activity. It was done by haemagglutination antibody titre method for humoral immunity and footpad swelling method for cell mediated immunity on wistar albino rats. Results of present studies suggest that Guduchi Ghana prepared by classically was found to possess significant immunostimulatory action on immune system but market sample of it exhibited significant immunosuppression effect in dose dependent manner when compare with control group at a dose of 50 mg/kg orally.

Comparitive Pharmacognostical and Phytochemical Evaluation of Brihat and Laghu Gokshur.

Laghu Gokshur (Tribulus terrestris) and Brihat Gokshur (Pedalium murex) are well known drugs used in Ayurveda as diuretics. These are classified under mishrak varga as ‘Dashmoola’ in Ayurveda and in chemotaxonomy as Saponin glycosides. The objective of the work is to find out the diagnostic tool to identify the two varieties of Gokshur. The powder was studied for macroscopic, microscopic and physicochemical parameters. For HPTLC Stationary phase was Pre-coated silica gel GF 254 and mobile phase was Toluene: Ethyl acetate: Formic acid (7:2:1 v/v/v). The plate was scanned and quantified at 254 nm for Diosgenin.Results shows that microscopic characters like trichomes, stomata and crystals show some difference in the two varieties while physicochemical parameters show difference in extractive values. Phytochemical screening also shows similar findings. HPTLC analysis carried out using Diosgenin as reference standard revealed the presence of steroidal Saponin “Diosgenin”. Quantitative estimation for Saponins found marked variation in the two varieties, where Laghu gokshur had 16% of Saponins while Brihat gokshur had 13% Saponins. The study can be used as a diagnostic tool for identification of these two varieties of Gokshur.

Biological behavior and disease pattern of carcinoma gallbladder shown on 64-slice CT scanner: A hospital-based retrospective observational study and our experience.

Purpose: The aim of this diagnostic observational study was to assess the spread and biological behavior of gallbladder cancer using 64-slice computerized tomography (CT) scanner in this particular geographic belt (eastern Uttar Pradesh, western Bihar, and northern Madhya Pradesh provinces of North India). Indians are ethnically and culturally different from their Western counterparts among whom the incidence of this disease is comparatively low. Subjects and Methods: After systemic examination, all patients (87) were subjected to ultrasonographic examination. All cases were histopathologically proven. Confirmed cases were subjected to volumetric CT examination of abdomen and pelvis, plain, post contrast and delayed phase. Results: Majority of the cases were adenocarcinoma. There was female preponderance with majority belonging to fifth and sixth decades. Commonest presentation was diffuse, irregular, enhancing wall thickening in 49.4%. Majority had invasion of liver parenchyma (74.7%). Cholelithiasis was seen in 48.3% cases. Invasion of biliary radicals was high (13.8-18.4%). Eleven cases had invasion of portal vein and tumor thrombus, with hepatic artery invasion in one case. In two cases, both hepatic artery and portal vein invasion was seen. Portal and peripancreatic nodal metastasis was seen in 58.5%. Distant metastasis was reported. Conclusion: Few studies involving the Indian population have attempted to use multi-row detector CT to define the biological behavior of carcinoma gallbladder. The opinion whether the pathology is operable or non-operable can reasonably be given. This large-scale, single-center study gives insight about the epidemiology and biological behavior of carcinoma gallbladder.

Pharmacognostical and physicochemical analysis of Tamarindus indica Linn stem.

Tamarindus indica Linn. fruits (Chincha) are extensively used in culinary preparations in Indian civilization. Its vast medicinal uses are documented in Ayurvedic classics and it can be used singly or as a component of various formulations. Besides fruit, the Kasta (wood) of T. indica L. is also important and used to prepare Kshara (alkaline extract) an Ayurvedic dosage form. Pharmacognostical and physicochemical details of Chincha Kasta are not available in authentic literature including API (Ayurvedic Pharmacopoeia of India). The study is an attempt in this direction. T. indica L. stem with heartwood was selected and morphological, microscopic and physicochemical standardization characters along with TLC fi nger print, and fl uorescence analysis were documented. Transverse section of stem showed important characters such as phelloderm, stone cells layer, fi ber groups, calcium oxalate, crystal fi bers, and tylosis in heartwood region. Four characteristic spots were observed under UV long wave, in thin layer chromatography with the solvent combination of toluene: ethyl acetate (8:2). The study can help correct identifi cation and standardization of this plant material.

Primary high-grade testicular leiomyosarcoma.

We herein present an extremely rare occurrence of primary intratesticular leiomyosarcoma. A 65-year-old patient presented with painless enlargement of the right testis. A high inguinal orchiectomy was done. Histopathological examination of the excised mass was consistent with high-grade leiomyosarcoma. Pertinent literature is reviewed and the importance of excluding the germ cell tumor and the paratesticular neoplasm is emphasized.

Granulomatous hepatitis following open heart surgery with cardiopulmonary bypass.

BACKGROUND: Cardiopulmonary bypass (CPB) initiates an inflammatory cascade, predisposing the patient to a number of infections. The stress of surgery and anaesthesia further expose the patient to a variety of non-infectious complications. We report a group of patients who developed granulomatous disease after open heart surgery. METHODS: We retrospectively analysed a subset of patients who developed a syndrome of fever, jaundice and hepatomegaly after open heart surgery. We recruited age- and sex-matched controls who underwent open heart surgery during the same period (July 2002-July 2004). Details of demographic profiles, diagnostic evaluation and drug treatment were noted and compared between the two groups using the SPSS software. RESULTS: Five patients were identified to have the specific syndrome of high grade intermittent fever with jaundice and hepatomegaly with investigations revealing an intrahepatic cholestasis. A detailed evaluation revealed granulomas in tissue specimens of the bone marrow and/or liver in these patients. An extensive evaluation for an alternative aetiological agent was non-contributory. CONCLUSION: We found granulomatous hepatitis in 5 patients following open heart surgery and they were given conventional antituberculous therapy to which they responded. It is possible that in these patients, tuberculosis was re-activated from a dormant focus due to a period of transient immunodeficiency caused by an extracorporeal circulation.