Tissue Clock Beyond Time Clock: Endovascular Thrombectomy for Patients With Large Vessel Occlusion Stroke Beyond 24 Hours / 대한뇌졸중학회지

Background@#and Purpose Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). @*Methods@#This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). @*Results@#Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P<0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0–2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P<0.001), and better discharge NIHSS (P<0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P<0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence. @*Conclusion@#In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients’ age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.

A Comparison of the Postoperative Analgesic Efficacy of Two Different Doses of Caudal Clonidine as Adjunct to Caudal Bupivacaine in Infraumbilical Surgeries in Younger Children.

Managing peri operative pain in smaller children is challenging but beneficial. Caudal epidural block with local anaesthetic and adjuvant in proper dose can significantly prolong the duration of analgesia while avoiding dose related side effects of both the drugs. We selected clonidine as adjuvant to bupivacaine in caudal blocks for perioperative pain management in 80 children during infra umbilical surgeries performed under general anaesthesia. MethodsThe children were randomly allocated into two groups, Group A (n=40) and Group B (n=40). Group A received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 1 μg/Kg in 1 mL normal saline and Group B received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 0.5 μg/Kg in 1 mL normal saline, after inhalational anaesthesia. Heart rate, blood pressure, respiratory rate, oxygen saturation, sedation score, Bromage score and pain score were monitored and recorded peri-operatively. Time to first rescue analgesic at pain score of 12, total number of rescue analgesic doses required, and side effects were also recorded. Data was analysed using appropriate statistical tests. ResultsGroup B patients had significantly higher heart rates, systolic and diastolic blood pressures, respiratory rates and pain scores compared to Group A patients at 50 mins post operatively. The requirement of rescue analgesics in Group B was earlier and higher than Group A. Group A patients remained haemodynamically stable and pain free for longer period. There was no significant difference in side effects between the groups. ConclusionsAddition of 1 μg/Kg clonidine to caudal epidural bupivacaine improves the quality and prolongs the duration of postoperative analgesia compared to addition of 0.5 μg/Kg clonidine without causing significant side effects.

Relationship Of Perioperative Hyperglycemia And Postoperative Infection In Elective Abdominal Surgery In Non Diabetic Patient

BACKGROUND: Postoperative infections are common in surgical patients leading to increased morbidity and mortality. Patients are susceptible to stress-induced hyperglycemia following operation, independent of the diabetic status. Perioperative hyperglycemia in critically ill surgical patients increases the risk of postoperative infections and its consequences. Despite 30 million operations performed in United States and much more in India each year, the clear association between perioperative blood glucose (BG) level and postoperative infection (POI) remain ill-defined for the majority of surgery patients. AIM: To identify the relationship of perioperative hyperglycemia and post-operative infection in elective abdominal surgery in non diabetic patients. MATERIAL AND METHODS: This is a prospective, observational study of 150 patients who were non diabetic and underwent an elective abdominal surgery. The primary outcome of interest was POI, defined as the occurrence of 1 or more reports of pneumonia, wound infections, urinary tract infections, and sepsis in the first 30 days after surgery and one year after surgery in case of use of prosthesis. The primary predictor of interest was peri-operative hyperglycemia, defined as the RBS of >150mg/dl in the perioperative period (just prior to surgery and within 12 hr and within 24 hr after the skin closure). In the study 500 patient were screened for perioperative hyperglycemia out of which only 150(30%) patient had RBS>150mg/dl in perioperative period. RESULTS AND CONCLUSIONS:There was significant change in RBS in the perioperative period. The overall incidence of POI in 150 cases of Elective Abdominal Surgeries was 7.33%. Wound infection was observed in 7 cases (4.66%) and 4 cases (2.66%) had respiratory complication. Risk factors like old age, contaminated wound, higher ASA grade and increased duration of surgery are associated with increased POI.The most common complication was wound infection

Disposition kinetics of omeprazole in healthy female volunteers in Pakistan

Omeprazole [OMP] a proton pump inhibitor is widely used to suppress gastric acid secretions of parietal cells of stomach and metabolized predominantly by CYP2C19. The objective of the present study was to investigate the pharmacokinetics and dosage regimen of OMP, after its single oral administration in eight healthy adult female subjects. Blood samples were collected at different time intervals after oral administration and their pH was measured. Plasma concentration of OMP was determined by high performance liquid chromatography [HPLC] system equipped with UVvisible Detector. The concentration versus time data was used to compute the pharmacokinetic parameters with the help of computer software programme MW/PHRAM APO version 3.02.Peak plasma concentration was [Cmax] 0.38 +/- 0.04 microg/ml achieved at 2.07 +/- 0.22 hrs. The elimination half-life [t1/2beta] was1.82 +/- 0.42 hrs. Volume of distribution [Vd] in the present study was 0.40 +/- 0.07 l/kg with total body clearance [ClB] 0.19 +/- 0.02 l/hr/kg and area under the curve [AUC] 1.89 +/- 0.23 microg.hr/ml. The pharmacokinetic properties which are different from the literature after oral administration of 20 mg OMP in eight healthy female volunteers may be due to the variations of environment and genetic variation between Pakistan and drug manufacturing of foreign countries

Clinical profile and outcome of paraphenylene diamine poisoning

Objective: To determine the clinical presentation, complications, and outcome of paraphenylene diamine [PPD] poisoning in patients presenting to Nishtar Hospital, Multan. Study Design: Descriptive study. Place and Duration of Study: Medical Unit II and III, Nishtar Hospital, Multan, from April 2015 to September 2016

Methodology: All adult patients admitted with history of paraphenylene diamine ingestion were evaluated for clinical features, complications, and outcomes on a pre-designed proforma

Results: Out of 122 patients, 95 were females [77.9%] and 101/122 patients had ingested the poison with an intention of suicide or self harm [82.8%]. The mean age of presentation was 23.21 +/-8.2 years. Cervico-facial edema was the chief presenting complaint, seen in 116/122 [95%] of patients, with median of 2 [interquartile range=3] for time of onset after ingestion of poison. Tracheostomy was needed in 95/116 [82%] patients with cervico-facial edema. Other common complaints were dark urine in 95/122 [77.9%] and pain in limbs in 98/122 [80.3%] patients. Rhabdomyolysis was evident in 91/122 [74.5%] patients at admission. Acute kidney injury developed in 37/122 [30.3%] patients. Among these, 16 [43.2%] patients required haemodialysis. Myocarditis was diagnosed in 33/122 [27%] patients. The median for hospital stay was 9.50 days [interquartile range=6.25]. The mortality was 34/122 [28%]. Ventricular arrhythmias were the commonest cause of death in 25/34 [73.5%], followed by renal failure in 5/34 [14.7%], asphyxia in 2/34 [5.88%], and aspiration pneumonia in 2/34 [5.88%] patients

Conclusion: Paraphenylene diamine is an emerging domestic poison in Pakistan, with a high morbidity and mortality

Renal clearance and urinary excretion of omeprazole in healthy female volunteers in Pakistan

Omeprazole is a widely prescribed proton pump inhibitor to treat various gastric acid hyper secretion disorders. The present study was designed to evaluate the renal clearance and urinary excretion of omeprazole in eight healthy female volunteers to increase the understanding of the contributing factors such as demographics variability in the renal clearance and urinary excretion of omeprazole under indigenous conditions. The urine and blood samples were collected 0.5, 1, 1.5, 2, 3, 4, 6, 8 hours after oral administration of enteric coated omeprazole [20 mg] and drug concentration in the samples was determined by High Performance Liquid Chromatography [HPLC] with C18 column and UV detector. Urinary excretion and renal clearance of omeprazole was calculated and data was statistically analyzed by using regression/correlation technique. Endogenous creatinine was also measured by reagent kit available in the market. The results indicate that mean diuresis was 0.0172+/-0.0029 ml/min/kg. While the mean values of renal clearance of creatinine and omeprazole were 1.315+/-0.103 and 0.066+/-0.0042 ml/min. kg, respectively. Whereas, clearance ratio was 0.055+/-0.007 which indicates back diffusion. The cumulative percentage of dose excreted was 6.71+/-0.358. A significant [p<0.05] negative correlation [r= -0.457] between clearance ratio and urine pH of omeprazole reflecting glomerular filtration reabsorption of drug at kidney tubular level while significant [p<0.05] negative correlation [r= - 0.681] between clearance ratio and plasma concentration of omeprazole indicates the involvement of active tubular secretion of drug. It can be concluded that during glomerular filtration, omeprazole diffuse back/reabsorption. Therefore, Urinary excretion of omeprazole in indigenous healthy female subjects was observed to be lower than given in the literature values

Anatomical outcome following indocyanine green assisted internal limiting membrane peeling for stage 3 and 4 macular hole surgery

Objective: To evaluate the anatomical success of stage 3 and 4 macular hole surgery after removal of internal limiting membrane [ILM] with the help of Indocyanine green [ICG]

Study Design: An experimental study

Place and Duration of Study: LRBT Tertiary Care Eye Hospital, Karachi, October 2015 to August 2016

Methodology: Twenty patients with stage 3 and 4 macular hole [confirmed by spectral domain optical coherence tomography] underwent standard 3 ports pars plana vitrectomy. Staining of ILM was performed with the help of 0.5% ICG to aid in visualization. ILM was removed by using intraocular forceps in circular fashion. Finally, gas fluid exchange with internal tamponade of SF6 20% was performed. Postoperative face down posture was maintained for seven days. Patients were followed-up for 8 months and assessment of macular hole closure was done using SD-OCT

Results: After a follow-up of 8 months, macular hole was closed in 17 eyes [85%] and vision had improved in 6 patients. Postoperative complications included cataract, hyphema and vitreous hemorrhage

Conclusion: Surgery for stage 3 and 4 macular hole with ILM peeling has high anatomical success rate. Final visual acuity is dependent on preoperative macular hole stage and visual acuity at presentation

Identification of ofloxacin-resistant mycobacterium tuberculosis by PCR-RFLP and sequencing

This study was planned to verify the resistance frequency of Ofloxacin [OFX] against Mycobacterium tuberculosis by polymerase chain reaction restriction fragment length polymorphism [PCR-RFLP] technique and sequencing. Total 366 clinical samples of suspected TB patients were collected from various localities of central Punjab. All of them were found positive by ZN [Zeihl-Nelsen] staining method. Among them, 108 [29.5%] were found negative and 258 [70.5%] positive on PCR based study. The cases not responding to ATT were further characterized by proportion method and by PCR-RFLP to establish the drug resistance. Selected drug resistant case were further sequenced to confirm the results of amplified RFLP. The results showed that out of 118 drug resistant cases, 06 [5.08%], 03 [2.54%] were found resistant to OFX by drug susceptibility testing and PCR-RFLP respectively. The two strains were selected for sequencing procedure. The strain-79 showed point mutation at four points, at codon 70, 71, 76 and 78. The sequence of strain- 81 showed mutation at codon 95.PCR-RFLP is a useful molecular technique for the rapid detection of mutations and may be used to diagnose drug resistance but it should be confirmed by sequencing before starting 2[nd] and 3[rd] generation treatment because the restriction site is the cornerstone of PCR-RFLP and mutation may be occurring elsewhere

Genetic polymorphism of UDP-glucuronosyltransferase [UGT2B15] and glucuronidation of paracetamol in healthy population

Inter individual variability in polymorphic UDP-glucuronosyltransferase [UGT2B15] has been associated with varied glucuronidation level. The present project was designed to determine the genetic polymorphism of UDP-glucuronosyltransferase [UGT2B15] and glucuronidation of paracetamol in healthy [male=59 and female=50] population. The association between genotype [UGT2B15] and phenotype [paracetamol glucuronidation] has been evaluated. According to trimodal model, genotypes and phenotypes were categorized as fast, intermediate and slow glucuronidators. Presence of wild type allele illustrated a UGT2B15 genotype as fast glucuronidator. The glucuronidation status was investigated by HPLC analysis of paracetamol. Ratio of paracetamol glucuronide to paracetamol was determined with two antimodes at glucuronidation ratio of 0.3 and 1.8. In our study, 7% and 12% of population was distributed as slow glucuronidators by phenotype and genotype, respectively and association between phenotype and genotype was good for analysis of glucuronidation status as displayed by kappa value [0.792]

Effect of hormonal contraceptives on serum lipids: a prospective study

To estimate the effects of using hormonal contraceptives on serum lipoprotein levels. Lipid profile was measured at baseline and afterward at 3, 6, 9 and 12 months. 1391 Pakistani females taking COCs, DMPA, or non hormonal [NH] contraceptives. The results were calculated by repeated measure ANOVA subsequent to tukey's post hoc test for the multiple comparisons. Statistical examination revealed that differences in lipid profile were significant [p <0.001] among all treated group in comparison with control. DMPA also caused significant rise in Castelli index-I and Castelli index-II as compared to COCs group and control group. This study demonstrated raise in total cholesterol [TC] and triglycerides [TG] as well as very low density lipoprotein [VLDL-C] and low density lipoprotein cholesterol [LDLC]. Whereas, an obvious decrease was observed in high density-lipoprotein cholesterol [HDL-C] in the DMPA-treated group. We concluded that, this inductive study specifies atherogenic cardiovascular risk in women using DMPA on long term basis

Urgent ureteroscopies in acute ureteric colic requiring intervention

Background: Urolithiasis, in general, constitutes a significant volume of the daily clinical activities in our institution

Objective: To evaluate the outcome of ureteroscopies performed in patients admitted acutely with symptomatic ureteric calculi compared with elective ureteroscopies

Design: A retrospective review

Setting: Department of Urology, King Hamad University Hospital, Bahrain

Method: All ureteroscopy [URS] procedures performed for symptomatic ureteric calculi between 1 January 2013 to 31 December 2013 were reviewed. These procedures were divided into two groups: urgent URS and elective URS group. Both groups were comparable in personal and stone characteristics

Result: One hundred ninety-five procedures were performed on 167 patients. One hundred twenty-seven [65.1%] procedures were urgent and 68 [34.9%] were elective. The cohort included 131 males and 36 females with a mean age of 41.5 years, a range of 19 to 74. One hundred fortynine [76.4%] procedures were performed on male patients, while 46 [23.5%] were performed on female patients. The mean stone size for patients undergoing urgent URS was 7.7 mm and 8.3 mm for elective procedures; approximately one-third of patients had more than one stone. Eighty-one stones in the urgent group were distally located; fifty-seven were in the elective group. The most common indication for urgent URS was pain refractory to injectable analgesia. LASER was used in 182 [93.3%] procedures, 179 [91.7%] procedures were urgent. Seventeen [8.7%] complications were documented for urgent URS and 8 [4.1%] for elective cases, no statistical significance, P value = 0.74

Conclusion: Urgent URS procedure is a safe and cost effective option compared with Elective URS. It should be the preferred option when resources and expertise are available

Comparison of fistulectomy with fistulotomy in low fistula in Ano

Objective: To compare the outcomes in terms of healing after fistulotomy and fistulectomy for low lying fistulae in ano

Study design: Cross sectional analytic

Place and Duration of study: Department of Surgery, Surgical Unit I, Jinnah Postgraduate Medical Centre Karachi, from June 2013 to May 2015

Methodology: Patients of both genders between 12 to 60 year of age with clinical diagnosis of fistula in ano were included in the study. Pain was assessed on visual and analog scale [VAS] Hospital stay was also recorded. All were followed for four week for any complications

Results: During the study period 120 patients were enrolled. Out of these 60 patients had fistulotomy and 60 underwent fistulectomy for fistula in ano. Male predominated with male to female ratio of 3:1. Swelling [86.6%], discharge [37%] and itching [27%] were the common symptoms. The mean duration of hospital stay was 3 +/- 1 day. Postoperative wound healing and pain assessed by VAS, were high in fistulectomy group. All patients recovered during follow up except one who continued to complain incontinence from fistulectomy group

Conclusion: Fistulotomy yielded better results as compared to fistulectomy for the treatment with low fistula in ano

Osteopoikilosis; a rare incidental spotted bone disease on CT

Osteopoikilosis is a benign, asymptomatic, sclerosing bone dysplasia with an autosomal dominant trait. The disease is characterized by diffuse symmetrical small round and ovoid radiopacities in the juxta-particular region of cancellous bone. We reported a rare case of a middle aged female presented with abdominal distension, whose radiological work up revealed an incidental osteopoikilosis

Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature.

Protective potential of trachyspermum ammi seeds in gentamicin-induced nephrotoxicity in rabbit model / Potencial de protección de las semillas trachyspermum ammi en la nefrotoxicidad inducida por la gentamicina en modelo de conejo

Nephrotoxicity is one of the most important side effects and therapeutic limitations of aminoglycoside antibiotics, especially gentamicin. Gentamicin-induced nephrotoxicity involves free radical generation, reduction in antioxidant defense mechanism and renal dysfunction. A number of crude herbal extracts have potential to ameliorate gentamicin-induced nephrotoxicity due to presence of various antioxidant compounds. Therefore the goal of current study was to evaluate the protective activity of T. ammi seeds aqueous extract against gentamicin-induced nephrotoxicity in albino rabbits. The results showed that gentamicin caused severe alterations in serum biochemical parameters and kidney markers along with severe alterations in kidney tissues. However, T. ammi extract, when given along with gentamicin, reversed the severity of gentamicin-induced nephrotoxicity by normalizing the indicators of kidney function e.g. serum urea, creatinine, blood urea nitrogen, albumin and serum electrolyte parameters indicating the nephroprotective potential of T. ammi. Similarly the extract has ability to augment the endogenous antioxidant enzymatic machinery by increasing the activity of antioxidant enzyme catalase and by reducing the total oxidant status. Nephroprotective potential was further confirmed by the histopathological examination. Nephroprotective potential might be due to the presence of antioxidative polyphenolic compounds in aqueous extract of T. ammi seeds.

La nefrotoxicidad es uno de los efectos secundarios más importantes limitaciones terapéuticas de los antibióticos aminoglucósidos, especialmente gentamicina. La nefrotoxicidad inducida por gentamicina implica generación de radicales libres, la reducción en el mecanismo de defensa antioxidante y la disfunción renal. Una serie de extractos de hierbas crudas tienen potencial para mejorar la nefrotoxicidad inducida por gentamicina debido a la presencia de varios compuestos antioxidantes. Por lo tanto, el objetivo del presente estudio fue evaluar la actividad protectora del extracto acuoso semillas de T. ammi contra la nefrotoxicidad inducida por gentamicina en conejos albinos. Los resultados mostraron que la gentamicina causó graves alteraciones en los parámetros bioquímicos séricos y los marcadores de riñón, junto con alteraciones severas en los tejidos renales. Sin embargo, el extracto de T. ammi, cuando se administra junto con la gentamicina, invierte la gravedad de la nefrotoxicidad inducida por gentamicina por la normalización de los indicadores de la función renal, por ejemplo, urea sérica, creatinina, nitrógeno ureico en sangre, albúmina y los parámetros de electrolitos séricos que indican el potencial nefroprotector de T. ammi. Del mismo modo, el extracto tiene la capacidad para aumentar la maquinaria enzimática antioxidante endógena mediante un aumento de la actividad de la enzima antioxidante catalasa y reduciendo el estado total de oxidante. El potencial nefroprotector fue confirmado por el examen histopatológico. El potencial nefroprotector podría ser debido a la presencia de compuestos polifenólicos antioxidantes en el extracto acuoso de semillas de T. Ammi.

Histopathological evaluation of gastro protective effect of Berberis vulgaris [Zereshk] seeds against aspirin induced ulcer in albino mice

The present study was carried out to investigate the antiulcer activity of Berberis vulgaris [Zereshk] seeds in albino mice. After acclimatization, animals were divided into six equal groups. Aspirin 150mg/kg was used to induce gastric ulcer in all groups except normal control. Omeprazole 20mg/kg was used as synthetic anti ulcer drug in study. Three dose levels of B. vulgaris seed powder 300mg/kg, 600mg/kg and 900 mg/kg were used respectively orally. Histopathological analysis was carried out to evaluate the gastroprotective activity of B. vulgaris seed powder. Results of the study showed that in case of aspirin treated mice gastric luminal mucosa villi were decreased in height or were absent. In the glandular region there was connective tissue proliferation and also infiltration of cells. Similar infiltration of cells was present on muscularis mucosa. In esophageal region tumor cells were present. However three dose levels of B. vulgaris significantly reduced thetissue proliferation, infiltration of cells and sloughing induced by aspirin. Highest dose of B. vulgaris [900mg/kg] showed similar results as synthetic antiulcer drug omeprazole

Significance of sonographic characterization and fnac of small size thyroid nodules

The purpose of this study is to determine the accuracy of various ultrasound characteristics of small size thyroid nodules in the predication of malignancy and the usefulness of ultrasound guided FNAC of these nodules. Experimental / analytic study. This study was carried out at Radiology Department Services Hospital, Lahore from October 2011 to September 2012. This study was conducted on 70 patients, in whom 76 thyroid nodules 4mm to 10mm in size were biopsied. Diagnostic ultrasound was performed with high frequency linear probe for the evaluation of following ultrasound characteristics, internal structure, echogenicity, margins, posterior acoustic shadowing, height to width ratio, halo around the nodules, calcifications and vascular flow on Doppler scan. Each character was correlated with the results of FNAC to determine the accuracy of the feature in the prediction of malignancy. Out of 76 FNACs of 4mm to 10mm size thyroid nodules 8 [10.5%] biopsies did not yield significant cytological specimen. Another 8 [10.5%] specimen were classified as indeterminate so no further analysis was done. The rate of malignancy among nodules on final diagnosis was 20%. The most accurate sonographic features associated with malignancy were posterior acoustic shadowing [88.3%], taller than wider [83%], Halo around the nodule [80%] and calcification [70%]. Small size thyroid nodules are associated with significant risk of malignancy. Certain sonographic characteristics can be used to measure the risk of malignancy. FNAC of these nodules can be safely and accurately performed with high diagnostic rate

Cefixime; disposition kinetics and bioavailability comparison of two formulations of cefixime in healthy adult male subjects

Cefixime is a third generation and orally acting cephalosporin. It is a cell wall synthesis inhibitor and is well stable to presence of beta lactamase enzymes. Environmental and genetic differences play a greater role in disposition kinetics of a drug. To determine disposition kinetics of cefixime in local population and to evaluate the bioequivalence of multinational and national brands of cefixime. 2013-2014. Institute of Pharmacy, Physiology and Pharmacology, University of Agriculture, Faisalabad. In present study disposition kinetics and bioequivalence of two brands of cefixime, cefspan and ceforal-3, were investigated in 10 adult healthy male subjects after a single oral dose of 400 mg capsule of each with a 7 days washout period. After blood sampling, plasma concentration of cefixime was determined by HPLC method. For computing disposition kinetic parameters, one compartment open model was applied. Mean values of disposition kinetic parameters; t1/2 Beta 5.01 and 4.72 hours, Vd 1.10 and 1.29 L/kg and CI[B] 0.16 and 0.21 L/hr/kg of cefspan and ceforal-3, respectively, were found non significantly [P 0.05] different. Similarly mean values of bioavailability parameters; AUC 36.58 and 32.99microg.hr/mL, AUMC 282.95 and 264.13 microL/g.hr[2]/mL and MRT 7.79 and 7.83 hours of cefspan and ceforal-3, respectively, remained non significantly [P > 0.05] different. All the parameters were compared by paired t-test. Relative bioavailability was found to be within the range 80-125% which is acceptable for bioequivalence. The test formulation, ceforal-3, was found bioequivalent to the reference formulation, cefspan

Prevalence and factors affecting nasobronchial allergy among university students In Ajman, UAE

Objectives: The study was conducted to explore the most common allergens and common symptoms of naso-bronchial allergies and to determine the prevention and management practices of students with naso-bronchial allergies

Materials and methods: A cross sectional survey was conducted among 186 students of Gulf Medical University in Ajman, U.A.E. A standardized self- administered questionnaire was used to find out the prevalence of naso-bronchial allergies, allergens, aggravating factors/ relieving factors, medications and preventions. Data were analyzed using SPSS-21

Results: The majority of the students that participated in the questionnaire were of Arab and Asian ethnicity, mostly unmarried, of age group <20. 60 [30%] had some form of allergy. And 18.5% of the candidates had Naso-bronchial allergies. The leading type of Allergens was Dust accounting for 70% of the participants followed by exposure to tobacco smoke around 50-60%; and food and pollen with a rate of 31% and 30% respectively. Majority had symptoms of sneezing and runny nose followed by nose block, sore throat and throat irritation. Most of them had significant maternal history of nasobronchial allergy. 40.5% of the participants also confirmed that they had consulted a physician for their allergy in the past, while the rest 59.5% did not consult a physician. Majority of the candidates confirmed the use of nose spray and anti-histamine drugs for allergies. For the prevention methods of NBA majority of the candidates claimed to have avoided dust and sand as a prevention method, followed by keeping house clean and ventilated

Conclusion: A larger study can be conducted to estimate the prevalence of naso bronchial allergies. And awareness should be spread to address the underlying allergen, so that it can aid people to plan better methods of preventions and help them to avoid exposure to factors which aggravate the condition

Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review

Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases.