Multi-factorial risk stratification in Acute Coronary Syndrome

Background: ST elevated myocardial infarction (STEMI), non-ST elevated myocardial infarction (NSTEMI) and unstable anginas (UA) are continual spectrum of coronary artery disease (CAD).These are terminal events arising as a result of coronary artery atherosclerosis and superimposed thrombosis.Materials and methods: A prospective study in which a total of 91 patients of either sex aged 20 to 60 years were recruited, of which 30 were STEMI, 31 were NSTEMI/ unstable angina and 30 were age and sex matched healthy controls. Patients with following complaints of maximum 24 hours duration were registered in the emergency department and were included in the study (ACC/AHA Guidelines, 2002).Results: In the present study, 91 subjects were recruited from medical emergency department. All of the subjects were meeting the inclusion criteria. Of the total 91 subjects 30 were of STEMI (Group 1),15 were of NSTEMI (Group 2), 16 were of unstable angina (Group 3) and 30 were controls (Group4).Conclusion: In patients of ACS, MPO is raised as compared to controls. Also in complicated ACS,irrespective of other risk factors, MPO was significantly raised as compared to controls and can beused to predict immediate clinical complication. There is no significant association between MPO, hs Chowdhury P, Pandey V, Avasthi R, Kandukuri MK, Giri S, Sharma S. Multi-factorial risk stratification in Acute Coronary Syndrome. IAIM, 2016; 3(1): 36-45.Page 37 CRP and CK-MB when taken together to predict complications. TIMI risk score is a simple prognostication scheme that categorizes a patient's risk of death and ischemic events and provides a basis for therapy.

Unusual causes of fungal rhinosinusitis: A study from a tertiary care centre in South India.

Purpose: The frequency of mycotic infections of the nose and paranasal sinuses has been increasing over the past three decades. Apart from the common causes of fungal rhinosinusitis such as Aspergillus species and Penicillium species, there have been reports of rare and unusual fungi isolated from India and other countries. Objective: The objective of this study is to fi nd out the prevalence of fungal infections of the nose and paranasal sinuses caused by unusual fungal isolates at a tertiary care teaching hospital in South India. Materials and Methods: Duration of the study period was from April 2009 to March 2010. Specimens were collected from the nose and paranasal sinuses of all clinically and radiologically diagnosed cases of rhinosinusitis. All the clinical specimens were processed by standard methods for fungal culture. This included initial screening by 10% potassium hydroxide, inoculation of the specimen onto Sabouraud dextrose agar and incubation at 25°C and 37°C, followed by slide culture and other special techniques wherever necessary. Histopathological examination was also performed for the specimens. Results: A total of 60 specimens were received for fungal culture from cases of rhinosinusitis during the period, out of which 45 showed no growth. There were nine cases of Aspergillus fl avus, 1 each of Aspergillus fumigatus and Penicillium species. The rest four specimens grew rare fungal isolates, i.e. Acremonium sp., Scedosporium apiospermun, Cladosporium cladosporioides and Lasiodiplodia theobromae. Histopathological fi ndings were also positive for these four cases. Conclusion: Apart from the common causes, unusual fungal pathogens were isolated from cases of rhinosinusitis during the study period, which is in accordance with similar reports from other parts of India and some other countries.

A review of Candida species causing blood stream infection.

The incidence of candidemia has been on a rise worldwide. The epidemiology of invasive fungal infections in general and of candidemia in particular has changed in the past three decades because of a variety of factors like the AIDS epidemic, increased number of patients receiving immunosuppressive therapy for transplantation and the increasing use of antimicrobials in the hospital setups and even in the community. The important risk factors for candidemia include use of broad-spectrum antimicrobials, cancer chemotherapy, mucosal colonization by Candida species, indwelling vascular catheters like central venous catheters, etc. More than 90% of the invasive infections due to Candida species are attributed to five species-Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis and Candida krusei. However, the list of new species of Candida isolated from clinical specimens continues to grow every year. Early diagnosis and proper treatment is the key for management of candidemia cases.

Mini-open reduction and intramedullary interlocking nailing of fracture shaft of tibia without an image intensifier.

Intramedullary interlocking tibial nailing is usually performed using an image intensifier. But being expensive, it is not available in the most of the hospitals of resource-poor countries of the world. The purpose of this study is to analyze the results of interlocking nailing without the use of an image intensifier. This is the retrospective study of 55 diaphyseal tibial fractures treated with minimally open reduction and internal fixation with interlocked intramedullary nail fixation. The proximal locking of the nail with the screws was made using external jig and for the distal locking direct visualization of the hole was carried out. There were 15 females and 40 males. The average age in years was 32 with a range of 18 to 64 years. The surgical approach was medial parapatellar. The average follow up period was 4 months. This period ranged from 3 months to 14 months. The union time in an average was 4 months. The complication mainly was distal screw loosening leading to valgus deformity and shortening in 1 case. It is, therefore, concluded that interlocking intramedullary nailing can be performed with proximal and distal locking accurately without the use of an image intensifier.

Achieving distal locking without an image intensifier.

The tibia is commonly fractured bone frequently caused by high energy trauma leading to the complications and major disabilities. Different types of intramedullary nails have been employed by surgeons over 500 years. Today, the intramedullary interlocking tibial nailing is the leading modality of treatment because of its biomechanical advantage over the other modalities. This procedure is done in the advanced centers under the C-arm image intensifier. Yet, there is no facility of C- arm image intensifier in the operation theatre at the tertiary level public hospitals in Nepal. Most of the peripheral hospitals do not have portable X- ray facility. The purpose of this study was to study the success rate of distal locking in the intramedullary nailing of tibial shaft fractures with the aid of distal aiming device (DAD). The distal locking were done in 65 tibial shaft fractures. In this technique the distal hole was directly visualized after proper drilling. All the distal locking could be done without image intensifier. So this technique can be useful where the imaging facilities are not available and even in the advanced centers to avoid radiation hazards.

Effect of Ovaprim doses and latency periods on induced spawning of Clarias batrachus: observation on larval deformity.

Induced spawning of C. batrachus was conducted at different Ovaprim dose and latency period combinations to observe the deformed larvae among the hatchlings. For the purpose, four doses of Ovaprim (0.5, 1.0, 1.5 and 2.0 ml/kg body weight) and five latency periods (11, 14, 17, 20 and 23 hr) were considered in 20 different combinations. There were no deformed larvae in the females injected with all four doses and stripped at 11 hr latency, as the eggs did not hatch. The percentage of deformed larvae (4-7%) did not vary significantly at 1.0-2.0 ml dose level in combination with 14-17 hr latency periods. While increasing the latency period beyond 17 hr at 1-1.5 ml dose level, the percentage of deformed larvae increased significantly and touched as high as 11%. The results indicated that 1-1.5 ml dose in combination with 14-17 hr latency are suitable to reduce the deformed larvae among the hatchlings during induced spawning of C. batrachus.

Effects of polyherbal formulation 'ImmuPlus' on immunity and disease resistance of Indian major carp, Labeo rohita at different stages of growth.

A series of experiments were performed to determine the impact of polyherbal immunomodulatory formulation 'ImmuPlus' (AquaImmu) on growth, immunity and disease resistance of rohu (Labeo rohita), one of the Indian major carp at different stages of growth. Rohu larvae were fed on plankton, ImmuPlus-mixed compound feed, and plankton plus ImmuPlus-mixed compound feed (ImmuPlus added at three dose levels of 0.25, 0.50, and 0.75 g/kg feed) from 4th day of hatching to 14th day. ImmuPlus-mixed diets enhanced growth of larvae, survival and disease resistance against Aeromonas hydrophila challenge, compared to only plankton-fed group. In two other experiments, advanced rohu larvae and fingerlings were fed with ImmuPlus-mixed compound feed (at 0, 0.5, 1.0 and 2.0 g/kg) for 15, 30 and 45 days. At the end of 45 days for advanced larvae and 30 days for fingerlings, the fish fed with ImmuPlus at 1.0 g/kg level showed significantly higher growth and disease resistance against A. hydrophila challenge. In a separate experiment, juveniles of rohu were fed with 1 g/kg of ImmuPlus incorporated feed for 15 and 30 days. At the end of the trial, the ImmuPlus fed fish showed enhanced non-specific immunity (as measured through nitroblue tetrazolium reduction assay, serum lysozyme activity, serum haemolysin titre and resistance against A. hydrophila challenge in non-vaccinated fish as well as specific immunity levels (as measured through bacterial agglutination titre against A. hydrophila in vaccinated fish). Incorporation of ImmuPlus at 1 g/kg level in the diet of rohu may be beneficial for enhancing disease resistance.

Immunomodulation by 'Immuplus (AquaImmu)' in giant freshwater prawn, Macrobrachium rosenbergii (De Man).

ImmuPlus, a polyherbal commercial formulation was used to modulate the immune system of commercially important giant freshwater prawn M. rosenbergii. The prawns were fed with basal diet supplemented with ImmuPlus at 1g/kg feed for 4 weeks. Results showed that the phenoloxidase activity (PO), haemagglutination and lysozyme activities were significantly elevated in ImmuPlus-fed prawn up to 3 weeks of feeding and declined after 4 weeks of feeding. The total protein level in ImmuPlus-fed prawn raised up to 2nd week of feeding. Incorporation of ImmuPlus at the rate of 1g/kg feed in the diet of prawn for 3 weeks may be beneficial in raising the immune status of prawn.

Seminoma in hybrid catfish [Clarias batrachus (Linnaeus) female x Clarias gariepinus (Burchell) male].

Spontaneous testicular tumors, seminoma, were noticed in four male hybrid catfish (C. batrachus female x C. gariepinus male) after the age of two years. The hybrids showed massive abdominal swelling with catchectic body and free lobulated, encapsulated tumors (> 325 g) within the serosanguinous fluid-filled peritoneal cavities. The tumor cells were large and polyhedral with prominent centrally located nuclei. Other vital organs appeared normal. It seems to be the first report of seminoma in hybrid catfish and possibly of genetic cause.

Effects of angiotensin converting enzyme inhibitor on renal function in patients of membranoproliferative glomerulonephritis with mild to moderate renal insufficiency.

AIM: To determine the effect of enalapril, angiotensin-converting-enzyme inhibitor (ACE-I) on progression of renal insufficiency in primary membranoproliferative glomerulonephritis with mild to moderate renal insufficiency. METHOD: Thirty patients with histopathologically proved MPGN having hypertension (grade I and II of JNC-VI criteria of hypertension) and mild to moderate impairment of renal function (creatinine clearance varying from 30-80 ml/min, significant albuminuria and serum creatinine 1.2-3.0 mg/dl) were initially treated with diuretics and 3-blockers to bring down BP < 140/90 mm Hg. These patients were then randomly divided into three groups of 10 each, group I--Control; group II--Nifedipine and group III--Enalapril. In group II and III Nifidepine 30 mg/day and in group III Enalapril 10 mg/day respectively were added in addition and treatment was continued for nine months. These patients were followed up monthly for drug efficacy, side effects and any adverse drug reaction. RESULTS: Out of 30, 28 patients completed the study. At the end of nine months of treatment the patients of control group revealed significant increase in serum creatinine (1.65 +/- 0.38 to 2.17 +/- 0.31 mg/dl), blood urea (34.0 +/- 3.9 to 40.0 +/- 3.1 mg/dl), and 24 hours albuminuria (3.6 +/- 0.6 to 4.2 +/- 0.6 gm) and decrease in creatinine clearance (60.3 +/- 13.3 to 37.5 +/- 11.8 m/min); however, in enalapril group there was decrease in serum creatinine (1.72 +/- 0.45 to 1.24 +/- 0.58 mg/dl), blood urea (34.6 +/- 4.7 to 28.1 +/- 6.7 mg/dl) and 24 hours albuminuria (3.3 +/- 1.0 to 1.6 +/- 1.1 gm) and increase in creatinine clearance (56A +/- 15.8 to 77.1 +/- 23.5 ml/min). The patients on nifedipine showed statistically nonsignificant changes in creatinine clearance, blood urea and serum creatinine; while albuminuria increased from 3.0 +/- 1.3 to 3.9 +/- 0.4 gm/24 hours (p < 0.01). The blood pressure was well controlled in all patients. None of the patient had side effects leading to withdrawal of drugs. No adverse drug reaction was noted. CONCLUSION: ACE-I (enalapril) provided protection against the progression of renal insufficiency in patients of MPGN having hypertension with mild to moderate renal impairment. The renoprotective effects of ACE inhibitor (enalapril) is associated with substantial decrease in albuminuria.

Antipyretic activity of Nelumbo nucifera rhizome extract.

Antipyretic activity of methanolic extract of rhizome of N. nucifera was studied on normal body temperature and yeast induced pyrexia in rats. Yeast suspension (10 ml/kg, s.c.) increased rectal temperature after 19 hr of administration. The extract, in doses of 200, 300 or 400 mg/kg (po) produced significant dose dependent lowering of normal body temperature and yeast provoked elevation of body temperature in rats. The effect produced was comparable with the standard antipyretic drug, paracetamol (150 mg/kg, i.p.).

Calcium induced alterations in structural and functional role of phospholipids in Microsporum gypseum.

The effect of calcium on the structural and functional aspects of phospholipids in Microsporum gypseum was examined. Cells grown in presence of calcium exhibited increased content of phospholipids and enhanced synthesis of phospholipids as monitored by the incorporation of [32P] orthophosphoric acid. The rise in the levels of phospholipids was found to be due to increased synthesis of fatty acids as observed from [14C] acetate incorporation studies. The rise in the levels of phospholipids were reflected in the subcellular fractions also. Change in the phospholipid composition increased the fluidity of the membrane as is evident from fluorescence polarization studies using 1-anilinonaphthalene-8-sulfonate (ANS) and 1,6-diphenyl-1,3,5-hexatriene (DPH). The increased membrane fluidity was consistent with the enhanced uptake of [3H] proline in calcium grown cells.