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Hypoxia is a condition deprived of oxygen at tissue level, is known to be linked to oxidative stress and inflammatory cytokines. Hippophae rhamnoides L., commonly called Seabuckthorn, being rich in flavonoids, is reported to reduce oxidative stress. It is hypothesized that aqueous extract of H. rhamnoides relieves adverse changes in rat heart induced by continuous sub-acute hypobaric hypoxia. Exposure to continuous hypobaric hypoxia for seven days resulted in elevated levels of malondialdehyde, decrease in reduced glutathione, glutathione peroxidase and superoxide dismutase activities with concomitant increase in NFkB expression in rat heart. The levels of pro-inflammatory cytokines, TNFα and IL6 and TGFβ1, AKT and ERK were found to be decreased. The expression levels of JAK1 were reduced while STAT3 and STAT6 levels were found increased following hypoxia exposure. The treatment of rats with aqueous extract of H. rhamnoides significantly attenuated hypobaric hypoxia induced oxidative stress, increased TNFα and IL6 and deactivated NFҡB activity. H. rhamnoides treatment augmented expressions of JAK1, AKT and ERK proteins. Overall, results of this study indicate that the aqueous extract of Hippophae rhamnoides helps in inducing tolerance to rat heart at extreme altitude faster by optimizing tissue oxidative stress, preventing inflammatory response and configuring JAK1/ERK/AKT and STAT3/STAT6, at least to certain extent.
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context: Cerebral venous sinus thrombosis (CVST) previously believed to be an uncommon cerebrovascular event, accounting for0.5–1% of cases of stroke, affecting 1.32/100,000 person/year. CVST is a disease of young adults (<50 years old) predominantlyand is diagnosed based on clinical suspicion with confirmatory neuroimaging.Aims: This study aims to prospectively evaluate the Hounsfield unit (H.U) value of cerebral venous sinus on non-contrastcomputerized tomography (NCCT) scan and to assess its predictive value in diagnosing cerebral venous thrombosis and toevaluate whether standardizing venous sinus H.U value measurements to those of the corresponding internal cerebral arterywould improve diagnostic accuracy.Materials and Methods: In our study, a total of 80 clinically suspected case of CVST were included and NCCT head scan was donethen confirmed by M.R. venography (gold standard). Of 80 cases, a total of 38 cases were diagnosed as CVST on M.R. venographywhich was considered as Group B and rest 42 cases were normal on M.R. venography which was considered as Group A.Statistical Analysis: Average HU and H:H ratio were compared using two-tailed t-test, and linear regression analysis wasused to assess correlation between hematocrit (HCT) and HU.Results: Linear regression analysis showed positive correlation between HCT with computed tomography attenuation (HU)among both the groups (P < 0.005). H:H ratio (HU/HCT) for cutoff point of 1.645 had sensitivity of 71.1%, 97.6% specificity,and 96.4% PPV. A cutoff value of 1.335 for standardized measurement with internal carotid arteries (ICA) had 71.1% sensitivity,81% specificity, and 77.1% PPV.Conclusion: We conclude that average HU, H:H ratio, and standardized with ICA were the best predictor for sinus thrombosis.
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Background: The thyroid gland is located in the anterior part of neck, spanning between C5 and T1 vertebra and is located anterior to the thyroid and cricoids cartilage of larynx and first three tracheal rings. Ultrasonography has been widely used for diagnosis of thyroid disease it is highly regarded for its ease of use, real-time capability, portability and low cost.Methods: The current observational study was conducted in Department of Radiology, Dr. BRAM Hospital, Pt. JNM Medical College, Raipur, India. Consecutive sampling method was used for the study. All the cases coming to radiology department during the study period were taken as study subjects.Results: Of the normal subjects, author found 107 normal thyroid subjects and 53 patients were categorized into cases with diffuse non-nodular thyroid swelling groups. Of the diffuse thyroid swelling group about 85% of the study population is between 20-50 years of age group, 13.2% were <20 years of age and one patient is >50 years of age. Females to male ratio for diffuse thyroid disease is 3.4:1.Conclusions: Ultrasound elastography (USE) is a newly developed non-invasive method to evaluate and compare the elasticity of the thyroid gland and other organs like liver, prostate, parotid, breast pathologies. Its use is based on the principle that pathological changes in a tissue also changes its elasticity.
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Pulmonary complications are common in cardiac surgical patients. Limited respiratory reserves along with the pain associated with sternotomy add to the morbidity. Patients undergoing cardiac surgery who have had a pneumonectomy done before can be even more challenging to manage perioperatively due to a single-functioning lung. We present a case of a postpneumonectomy patient who underwent off-pump coronary artery bypass grafting. Perioperative optimization of lung function tests was stressed upon including the chest physiotherapy and early mobilization. Preoperative thoracic epidural catheter was inserted for postoperative pain and other proven benefits of thoracic epidural in coronary artery disease patients. We could conclude from our experience that proper optimization of lung function tests and meticulous pain management along with fast-tracking are keys to the management of such patients.
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Background: Acute kidney injury previously known as acute renal failure, is characterized by the sudden impairment of kidney function resulting in the retention of nitrogenous and other waste products normally cleared by the kidneys. Acute Kidney Injury is usually manifested as multiorgan failure syndrome and extracorporeal support may also target fluid overload and heart failure, extracorporeal CO2 removal for combined kidney and lung support, albumin dialysis for liver support. Haemodialysis is more effective than peritoneal dialysis for management of Acute Kidney injury as Peritoneal dialysis is associated with clearance limitation and difficulties with fluid removal and is thus rarely used in adults in developed countries.Methods: The study was conducted in the Department of Medicine, Pt. J.N.M. Medical College and Dr. B.R.A.M. Hospital, Raipur (CG), India, from 2010 to 2012. All patients of both the sexes who were diagnosed as a case of Acute Kidney Injury due to Acute Gastroenteritis and Malaria and who were advised for Hemodialysis were included in the study. In our study, 32 patients of Acute Kidney Injury were included. The criteria used for AKI in the study was RIFLE criteria. Hemodialysis was done in all the cases. Quantitative variables are reported as means±SD and qualitative variables as percentage. Factor(s) determining outcome of AKI were tested by univariate analysis using “fisher’s exact test”. All variables with a P value <0.05 in the univariate analysis were defined statistically significant.Results: Out of 32 patients of Acute Kidney Injury in our study, 50% (n=16) were of Malaria associated AKI cases and other 50% (n=16) patients were of Acute Gastroenteritis associated AKI in which 87.5% males,12.5% Females were of Malaria and 75% male,25% Female were in AGE associated AKI. Maximum number of patients presented with features of AKI within first 3days of disease onset i.e. 56.25% (n=9) of malaria patients and 68.75% (n=11) of AGE patients. Mortality due to MOD was more common in Malaria patients as compared to AGE patients. AGE associated AKI patients had different level of deranged SOFA score.Conclusions: Acute kidney injury due to acute gastroenteritis differs from other causes of AKI by frequent occurrence of hypokalemia. Early diagnosis and prompt management can restore the kidney function.
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School children often encounter traumatic injuries like a crown fracture. They create serious functional, esthetic and psychological problems. Achievement of promising restoration that preserves its aesthetics and strength is the greatest desire for both children and their parents and is a challenging task for the dentist. The restorative options in these cases usually include composite resin and porcelain laminate veneers. This article describes treatment of a paediatric patient with porcelain laminate veneers for restoring unaesthetic maxillary anterior teeth.
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Objective: Acute kidney injury (AKI) is a commonly encountered postoperative complication after cardiac surgery especially in high risk patients. AKI though seen more commonly after conventional on pump coronary artery bypass surgery (CCABG), is not uncommon after off pump coronary bypass surgery (OPCAB). Various biomarkers have shown promise over last one decade as an early marker for predicting AKI postoperatively. NGAL is one such biomarker whose concentration is increased in urine after any nephrotoxic and ischemic insult. The objective of this study was to assess the role of urine NGAL in predicting AKI after OPCAB in patients with increased risk of developing AKI. Design: A prospective cohort study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty patients. Materials and Methods: study was approved by the hospital research ethics committee. 80 patients posted for OPCAB with an increased risk of developing AKI defined as having a Cleveland Clinic Foundation Acute renal failure scoring System score of ≥6 were included in the study. Patients with coronary angiography (CAG) within 48 hrs prior to surgery, pre-existing AKI, preoperative renal replacement therapy (RRT) and CKD stage 5 were excluded. Urine NGAL level before the start of surgery baseline and at 4 hrs post surgery were done. Renal function tests were assessed on the day of surgery (4 hrs post surgery) and on the next three days. Result: Seven patients developed AKI as defined by acute kidney infection network (AKIN) and risk injury failure loss end stage (RIFLE) criteria for AKI. NGAL value at 4 hrs in patients who developed AKI was significantly higher than in those patients who did not develop AKI (P < 0.05). Conclusion: urine NGAL is an early biomarker of acute kidney injury in patients undergoing OPCAB surgeries. However, large multicentre studies may be needed to confirm it.
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The synchronous occurrence of tuberculosis and carcinoma in breast is unusual. The simultaneous occurrence of both the diseases can complicate the neoplastic disease. The diagnosis and treatment of tuberculosis in a patient with cancer assumes importance as it can prevent high mortality in patients with co-existent disease and thereby create problems in treatment decision. Axillary lymph node enlargement in breast cancer patient is not always caused by metastatic tumour of the breast even in the ipsilateral axillary nodes. We present here six case reports as an example of tuberculous axillary lymphadenitis co-existing with invasive ductal carcinoma of the breast. Accurate diagnosis has helped in down-staging carcinoma of the breast and also in identifying curable disease.