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INTRODUCTION Brachial cleft cyst is the most common cause of cystic lesion in the neck in younger population. But in patients above 40 years of age, about 80% of the cystic neck lesions were reported to be malignant. The incidence of such type of metastasis from Waldeyer's ring accounts for 33-62%. A 60 year old male presented with aCASE REPORT painless swelling in the left side of the neck for 8 months. Clinical features, imaging and FNAC favoured infected brachial cyst. Excision biopsy showed metastatic carcinomatous deposits with high mitotic index. Panendoscopy with tonsillectomy done. Biopsy of left tonsil showed moderately differentiated squamous cell carcinoma. Then adjuvant Radiotherapy was given to the patient and on 6th month follow up, patient had no features of recurrence.CONCLUSION For any cystic neck lesion in an adult, metastatic disease must be considered as a differential diagnosis. And for proven malignant cystic cervical lymph node, a primary malignancy involving Waldeyer's ring should be suspected. Initially imaging and FNAC may be taken. If FNAC is inconclusive, excision biopsy may be done. Then depending upon the biopsy finding, pan endoscopy with guided biopsies and tonsillectomy may be done
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Background@#Accessory infraorbital foramen (AIOF) can change the normal course of emerging branches of the infraorbital nerve and blood vessels exiting the infraorbital foramen (IOF). This study aimed to examine the AIOF, number of foramina, and their position in relation to IOF using cone-beam computed tomography (CBCT). @*Methods@#We performed a retrospective CBCT assessment of hospital records between January 2018 and August 2022. The CBCT of 507 patients were examined to extract information on the prevalence, number, position, linear distance from the IOF, and diameter of AIOF in relation to demographic factors. Descriptive statistics were used to evaluate the prevalence of AIOF. Mean and standard deviation were used to calculate the linear distance and diameter of the AIOF, respectively. The AIOFs, its distribution, and number were compared between sexes and sides using the chi-square test. The independent t-test and Mann–Mann-Whitney test were used to compare the mean difference between the sexes and sides. Statistical significance was set at P < 0.05. @*Results@#In this current study, the prevalence of AIOF was 7.1% (36 of the 507 patients). Additionally, the current study examined the number of foramina using a single foramen on each side and double foramina located bilaterally at a distance from the AIOF to the IOF. The mean AIOF diameter was also studied, and the AIOF position with respect to the IOF on CBCT was superomedial or inferomedial. There were no statistically significant associations between any of the parameters assessed in this study when comparing sex and sides. @*Conclusions@#A greater number of patients with AIOF presented with a single foramen and unilateral occurrence, without a statistically significant difference. The AIOF was most commonly located superomedial to the IOF.
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Pleuroparenchymal fibroelastosis(PPFE) is a recently characterised type of interstitial lung disease that begins in the upper lung zones and extends to the entire lung. To date, the aetiology is unknown. However, the cause of PPFE in the current case report is rheumatoid arthritis. The symptoms are dyspnoea and dry cough. Pneumothorax is a common complication that occurs at the time of presentation or subsequently in the progression of the disease. It usually occurs in > 40% of ex-smokers with restrictive patterns in the pulmonary function test. Interstitial fibrosis appears pathologically as a thick consolidation insomepreserved alveolar septal outlines and a markedly abrupt contact with thenormal residual lung. Undiagnosed PPFE casescan be misdiagnosed as sarcoidosis, atypical idiopathic pulmonary fibrosis, or other unclassifiable interstitial pneumonia. The current case report will address the rare outline of Rheumatoid arthritis with PPFE.
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Aims and objectives: AIM of this study was to observe and correlate clinical and laboratory profile of patients with adrenal mass. The objective was to study clinical and laboratory profile of patients with adrenal mass with the secondary objective to establish the etiological diagnosis with adrenal mass Methods: This observational study was carried out at tertiary care government hospital in north India from Jul 2020 to June 2022. Based on prevalence 4.4 of the disease as per previous study sample size for 95% confidence level & 5% precision works out 43. The inclusion Criteria were patients detected to have adrenal mass or symptoms related with adrenal mass. The exclusion criteria were any pre-existing known malignancy other than adrenal gland. Subsequent to enrolment the demographic data, clinical data, laboratory data, hormonal assays and radiological data was recorded as per predesigned proforma. The adrenal CT imaging protocol consists of three phases together are used for calculating absolute percentage washout and/or relative percentage washout to differentiate lipid-poor adenomas from primary carcinoma and metastases. Results: The mean age was 39± 15.41. Majority of patients were males 35(77.8%). 86.7% subjects had no comorbidity, 7.9 % had HTN. 6.7% patients were noted to have clinical cushings whereas in 4.4% subject acanthosis nigricans and goiter was seen. On Overnight dexamethasone suppression test, 16/45 patients were observed with value higher than <2.01 ug/dl, similar was the case with low dose dexamethasone suppression test. There was a significant rise in the mean plasma free metanephrine and urinary metanephrine noted in 12/ 45 patients. The minimum size of adrenal mass detected in the USG abdomen was 2.5 cm. The minimum size of adrenal mass detected in the CT abdomen was 1.21 cm. There is a significant association noted between absolute percentage washout (APW) outcome and hormonal activity with p-value <0.001. Conclusion: 6.7 % had features of cushing's disease and 4.4 % had acanthosis nigricans. On hormonal assays elevated metanephrine levels were seen in 26% subjects. On hormonal assays of ONDST and LDDST 35.5 % subjects were seen with elevated levels. Other hormonal assays aldosterone, renin and ACTH were normal. CECT was sensitive to identify a small adrenal mass up to 0.633 cm. 34 % of adrenal mass were hyper functional and 2 % were found malignant in this study.
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Background: The price of medicine in India has always been a point of discussion in public domain. The price range of the same drug is very large with more than 100% difference between various brands available in different settings. Aims and Objectives: To assess the price of different drugs at Jan Aushasdhi (JA), AMRIT and Private Chemist and to compare the prices of these three outlets so that the issues. Material and Methods: This institution-based cross-sectional study was carried out from May 2019 to June 2019. A pretested proforma was prepared to compare the prices of 284 different medicines in Jan Aushadhi, AMRIT and private chemist shops. The collected data were entered in an Excel spreadsheet and presented in Proportions, percentages, and mean. Results: The price of 284 medicines were compared from JA (Median(IQR)- 15.18(18.75) INR) and Private chemist shop (Median(IQR)-88(111.5) INR) while 249 medicine from AMRIT (Median(IQR)-61.05(78.33) INR). Although the majority of the AMRIT drugs are cheaper than the chemist shop except for 31% of Antipsychotic drugs, 26.6% of antihypertensives, 25% of respiratory drugs, 25% of steroids, 21.9% of antibiotics. Conclusion: We concluded that JA is providing drugs cheaper than AMRIT and Private chemist . The prices of medicines offered at AMRIT are lower than market pricing but they are costlier when compared to JA prices.
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This study aims to assess the preventive measures and self?protective rights of employees at the workplace. A survey has been conducted in a steel and power industry of Angul district of Odisha (India) using a semi?structured interview schedule to assess the determinants of occupational hazards. Occupational health practices among 425 male workers were assessed from the steel and power industry using the population proportion to sample technique (PPS). Respondents from the higher educational background, skilled workers, Hindu religious group, general category, and employees with high?household income were significantly associated (P < 0.05) with self?protective rights at the workplace. Industrial workers are considered a vulnerable group with respect to the power of self?protective rights in the industry. The factors such as job insecurity, financial hardship, less education, and unskilled profession make them vulnerable, which forces them to settle with a lower level of rights at the workplace.
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Abstract Gout is a form of metabolic arthritis originated on grounds of increased accumulation of monosodium urate (MSU) crystals in joints. Current study focuses on anti-arthritic activities of β-carotene on MSU crystal-induced gouty arthritis rats in comparison with the non-steroidal anti-inflammatory drug, indomethacin. The evaluation was done by taking into account paw oedema, lysosomal enzymes, anti-oxidant enzymes, lipid peroxidation, serum biochemical parameters (uric acid, creatinine), serum cytokines (TNF-α, IL-1β) and histopathological studies. After the induction of MSU crystals, the lysosomal enzymes were increased, antioxidant enzymes were reduced, lipid peroxidation increased and paw volume increased. β-carotene treated at a dose of 10 mg/kg of body weight stabilizes lysosomal enzymes, increases anti-oxidant enzymes, regulates lipid peroxidation and decreased paw volume. The drug β-carotene potentially influences anti-inflammatory effects in arthritic group which is evident from the reduction in the elevated levels of inflammatory cytokines, TNF-α and IL-1β. Current study is an evidence of anti-inflammatory and anti-oxidant effects of β-carotene against MSU-crystal induced gouty arthritis rats.
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Tramadol, a synthetic codeine analogue having a weak ? receptor agonist action has been widely used for relief of mild to moderate pain. Most commonly, tramadol addiction or abuse is reported among doctors or people with previous history of drug abuse. However, rare cases of tramadol dependence have been described in patients without prior substance abuse history. We are describing one such case of a 35-year-old male who presented with history of using injection tramadol regularly for three years where there was no prior history of drug abuse but who was prescribed tramadol for medical reason. The frequency of one ampule of tramadol increased from once in two to three days to almost daily up to 12-14 ampules/day. The management was a serious challenge. We admitted the patient for inpatient detoxification. He required tramadol injections to manage his withdrawal symptoms, along with lorazepam and clonidine which were gradually tapered over a period of 14 days. This case highlights that tramadol dependence though very rare but still can happen in a patient without substance abuse history. Also, the physician should be aware of the abuse potential of tramadol and should keep in mind short and judicious prescription, and educating the person regarding the risk of abuse can help to minimise this debilitating and sometimes fatal addiction.
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Mucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most important species causing Mucormycosis is Rhizopus arrhizus (oryzae). Identification of the agents responsible for mucormycosis is based on macroscopic and microscopic morphological criteria, carbohydrate assimilation and the maximum temperature compatible with its growth. The incidence of mucormycosis is approximately 1.7 cases per 1000 000 inhabitants per year. Clinical diagnosis of mucormycosis is difficult, and is often made at a late stage of the disease or post-mortem. We present here a series of five cases of different types of mucormycosis that were reported in our hospital till date. Of which three patients had good recovery and other two had a fatal outcome. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection or debridement as part of source control-and appropriate anti-fungal therapy. Liposomal amphotericin B is the drug of choice for this condition. The overall rate of mortality of mucormycosis is approximately 40%.
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Introduction: Commonly used polymethyl methacrylate (PMMA) denture base material cannot be considered as ideal due toinferior thermal and mechanical properties.Aim: The aim of the study was to evaluate and compare the thermal conductivity, flexural strength, and surface hardness ofheat cure acrylic resin incorporated with 10 wt.% and 15 wt.% alumina and conventional denture base resin.Materials and Methods: A total of 108 specimens were prepared. Specimens were divided into three main groups. Group Aspecimens were disk shaped (50 mm × 5 mm) and used for measuring thermal conductivity. Groups B and C specimens wererectangular shaped (65 mm × 10 mm × 3 mm) and were used for measuring flexural strength and surface hardness, respectively.Each group was further divided into three subgroups (1, 2, and 3) depending on the concentration, namely, PMMA without filler(control), PMMA + 10 wt.% of Al2O3, and PMMA + 15 wt.% of Al2O3 containing 12 samples each. Thermal conductivity wasmeasured using a modified guarded hot plate apparatus. Flexural strength was assessed with a three-point bending test usinga universal testing machine. Hardness testing was conducted using a Vickers Hardness Tester. The results were analyzedusing one-way ANOVA followed by post hoc comparison by Tukey’s method.Results: Mean values of thermal conductivity were (in W/mK) 0.190, 0.231, and 0.275 for subgroups A1, A2, and A3, respectively.The mean flexural strength values were (in MPa) 56.62, 66.73, and 74.24 for subgroups B1, B2, and B3, respectively. Meanvalues of surface hardness was calculated to be (in HV) 15.17, 16.51, and 17.91 for subgroup C1, C2, and C3, respectively.There was statistically significant improvement in thermal conductivity, flexural strength, and surface hardness after incorporationof alumina and the increase was in proportion to the weight percentage of alumina filler.Conclusion: Incorporation of alumina into heat cure denture base resin significantly improved the thermal conductivity, flexuralstrength, and surface hardness.
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Purpose: To identify the pattern of uveitis at a tertiary eye center in the central India and to compare with other reported studies. Methods: This prospective observational study was undertaken with all new uveitis cases attending the uvea clinic between January 2016 and September 2017. A standard clinical protocol and detailed investigations were done to find out the specific cause of uveitis. Results: A total of 210 patients with uveitis were evaluated. Anterior uveitis (47.1%) followed by intermediate uveitis (31.90%) were the most common type of uveitis in this study. Specific etiology of uveitis could be established in a majority of cases of uveitis (51.91%), except in intermediate uveitis group where the cause was mostly idiopathic (77.61%). Conclusion: Tuberculosis (46.29%) and viral etiology (38.88%) were the most common forms of infective uveitis (25.71%), whereas spondyloarthropathy (27.27%) and traumatic cause (14.54%) were the most common in the noninfective group of uveitis (26.19%).
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Introduction: Metronomic chemotherapy (MC) is an emerging therapeutic option in clinical oncology and it may prove usefulat least in metastatic head and neck squamous cell carcinoma (HNSCC) patients. To develop rational therapeutic strategies,it is important to identify molecular targets that are linked to the pathogenesis of HNSCC.Aim: The aim of the study was to assess the effect of oral MC on changes in quality of life (QOL) in advanced/recurrent HNSCCpatients.Materials and Methods: Patients with advanced, metastatic, and recurrent HNSCC patients who are not amenable to localtreatment with surgery, radiotherapy, and chemotherapy were included in the study. QOL assessed with the European organizationfor research and treatment of cancer (EORTC) QLQ-C30 and QLQ-H&N 35 questionnaires.Results: In this study, 50 patients were included, 37 patients (74%) become pain-free at the end of 6 months. A decreasedpain grade was observed in another 13 patients (26%). Mean QLQ-C 30 score at the time of presentation was 68.67, 75.35at 2 months, 81.26 at 4 months, and 85.38 at the end of 6 months. Mean QLQ-H&N 35 score at the time of presentation was61.53, 72.16 at 2 months, 76.43 at 4 months, and 81.69 at the end of 6 months. In subgroup analysis, both QLQ-C30 andQLQ-H&N 35 significantly correlated with disease progression.Conclusion: The use of oral metronomic therapy with methotrexate and celecoxib significantly improves the QOL and improvespain control in patients with advanced/recurrent HNSCC
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Background: Perforation peritonitis is a commonly encountered surgical emergency and it is defined as inflammation of theserosal membrane that lines the abdominal cavity and the visceral organs. The aim of this study is to analyze the demographicpattern and site of perforation of non-traumatic hollow viscus perforation peritonitis in Vindhya region.Materials and Methods: A total of 209 cases were studied with hollow viscus perforation peritonitis admitted in the surgicalwards in Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa (MP), India, in the period fromJune 1, 2018, to May 31, 2019. All necessary investigations were carried out. X-ray, Ultrasonography abdomen, and bloodinvestigations were done. The patient underwent emergency exploratory laparotomy and a careful record of pre-operative andpost-operative findings was made and was carefully filled in the pro forma. All the patients were advised to attend the surgicaloutpatient department for follow-up.Results: Of 10,887 patients admitted to Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa(MP), India, from June 1, 2018, to May 31, 2019, in which non-traumatic hollow viscus perforation peritonitis was diagnosedin 209 patients (1.9%), among which most of the patients were male (177) and rest were female (32). Most of the patientsbelonged to the low-socio-economic status of 21–40 years of the age group. From this study, the duodenum was found to bethe most common site of perforation, followed by stomach.Conclusion: Patients were admitted in the Department of Surgery, Shyam Shah Medical College and Sanjay Gandhi HospitalRewa, the Vindhya region in the Madhya Pradesh, patients diagnosed as a case of non-traumatic hollow viscus perforationperitonitis were included in the study. The majority of the patients of the perforation peritonitis belonged to 21–40 years ofage group. 41–60 years of age group was the second most common age group of patients who presented with perforationperitonitis with a male-to-female ratio of 5.5:1. The most common site of perforation was duodenum followed by gastric andappendicular and the least common site of perforation was colon.
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Background: Rhinosporidiosis is a chronic inflammatory granulomatous disease caused by the organism Rhinosporidiumseeberi. This causal organism was once believed to be a sporozoan, but is now considered to be a fungus. The disease ispresent all over the world except in Australia. However, it is endemic only in India and Sri Lanka; more than 95% of reportedcases are from these two countries. The most common site of manifestation of rhinosporidiosis in man is the nose accountingfor about 70% of cases. Surgical excision remains the mainstay of treatment today even though dapsone and ketoconazolehave been tried to some extent in preventing recurrence after surgery.Aim of the Study: The aim of the study was to study the prevalence, distribution, clinical behavior, results of various forms oftreatment and to provide a baseline clinical data and to supplement information for ongoing studies in the field of rhinosporidiosis.Materials and Methods: A total of 20 patients diagnosed as rhinosporidiosis, who attended the ENT Outpatient Department ofMedical College Hospital, Calicut, during the period from December 1998 to November 1999. Detailed history was recorded andpatients were subjected to thorough otolaryngological examination. Special attention was given to the site of lesions and type ofattachment. Details were also collected with particular reference to bathing habits, occupation, contact with animals, and occurrenceof similar illness in the family or in the neighborhood. Investigations included regular blood and urine and blood grouping. All thepatients underwent surgical excision of the lesions. The diagnosis was confirmed by histopathological examination of specimenobtained postoperatively. 100 mg of dapsone was administered daily (50 mg daily in children), 6 days a week, for a period of 6 months.All patients were reviewed for follow-up at the end of 1 month, 2, 4, and 6 and 9 months and on completion of a year after surgery.Observations and Results: In this study, the average age of patients suffering from rhinosporidiosis was 30.6 ± 2.80 years and theage varied between 8 and 52 years. The sex incidence was as follows: Males 17 (85%), females 3 (15%). Male predominance wasseen in this series and the male to female ratio was 5.66:1. Most of the subjects suffering from rhinosporidiosis were manual laborers7 (35%) out of 20, of which 2 (10%) were agricultural workers. The other major group was students accounting for 5 (25%) out of20 cases. The external appearance of the nose was normal in all patients. Partial nasal obstruction was seen in 13 cases (65%),on the left six, on the right five, and bilateral two cases. The total obstruction was seen in 5 cases (25%) – left two, right two, andbilateral one. Both nasal cavities were patent in only two cases. The vestibule showed the presence of mass in four cases (20%).Conclusions: Rhinosporidiosis is not an uncommon disease encountered in day-to-day ENT practice. The occurrence of thedisease does not bear any relation to the occupation of the patient. The maximum incidence of rhinosporidiosis is seen inthe age group of 21–30 years and males predominate. Rhinosporidiosis is more common in the rural population. There is asignificant association between dip baths in ponds and the occurrence of disease.
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Background: Dengue is a self-limiting, vector-borne disease transmitted by Aedes mosquito, causing a major public health threat globally. The objective of this study is to assess the clinical profile and outcome of the dengue infection in children less than 14 years of age September 2018 to August 2019 at the Pediatric Department of S.V.S. Medical College, the tertiary care hospital in Mahabubnagar, Telanagana.Methods: Prospective study of 82 hospitalized children of <14 years with the diagnosis of dengue illness. Children with diagnosis of dengue were classified further in to two groups as per WHO guidelines, Non-severe dengue fever (probable dengue, dengue with warning signs) and 'Severe Dengue' (Dengue Haemorrhagic Fever and/or Dengue Shock Syndrome (DHF/DSS). A separate questionnaire form used for documenting clinical history, laboratory parameters. Haematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done. Children were managed as per WHO protocol. The outcomes of the cases were mentioned as discharge, left against medical advice and death.Results: A total of 82 children with dengue were divided in to 55(67%) non severe dengue and 27(33%) severe dengue with males 56(68.2%) and females 26(31.7%). The most common age of presentation was between 6-10 years 34(41.5%). Fever 73(89%) was the most common presenting symptoms. Pleural effusion and hepatomegaly were the commonest clinical findings 28(34.1%) each, which were more among the severe dengue patients. Gall bladder edema 29(35.3%) was the most common ultra-sonogram finding. Significant elevation of transaminases (SGOP, SGPT) was seen in 39(47.5%). Severe thrombocytopenia was observed in 22(26.8%) children. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a global problem. Presenting features include high grade fever, vomiting, abdominal pain, skin rash. Early recognition of symptoms and proper management can reduce the mortality.
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Background: Perforation peritonitis is a commonly encountered surgical emergency and it is defined as inflammation of the serosal membrane that lines the abdominal cavity and the visceral organs. The objective of this study is to predict a correlation between post-operative outcomes in perforation peritonitis patients with reference to the history of nonsteroidal anti-inflammatory drugs (NSAIDs) use. Materials and Methods: A total of 209 cases were studied with hollow viscous perforation peritonitis admitted in the surgical wards in Sanjay Gandhi Memorial Hospital associated with S. S. Medical College, Rewa (M.P.), India, in the period from June 1, 2018, to May 31, 2019. All necessary investigations were carried out. X-ray, ultrasonography abdomen, and blood investigations were done. Patient underwent emergency exploratory laparotomy and a careful record of pre-operative and post-operative findings was made and was carefully filled in the pro forma. All the patients were advised to attend surgical OPD for follow-up. Results: Most of the patients (73.2%) of perforation peritonitis had a history of NSAID intake, out of which 81.6% recovered from the disease while mortality rate in perforation peritonitis associated with NSAID use was found to be 18.4%. Those patients with no history of NSAID use (26.8%) had a mortality rate of 9% while 91% of patients of perforation peritonitis were recovered from the disease. Conclusion: In this study, it is concluded that the outcome of the patients of the perforation peritonitis is not dependent on the history of NSAIDs use, but NSAIDs abuse is one of the etiological factors in the pathogenesis of the perforation peritonitis
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Introduction: Computed tomography (CT) scan is an accurate tool for the detection of injuries in a trauma setting and is able to find the injuries that were occult in chest X-ray (CXR). In past years, the utility of CT scan was limited to severe trauma injuries but now is used in less severely injured trauma patients. The study aimed to compare the efficacy of CXR and chest CT scans in patients with chest trauma. Materials and Methods: The present study was conducted in the Department of Surgery of Medical Institute. For the study, we prospectively view the previous medical records of the patients who were admitted in our surgical ward for blunt chest trauma and received both CXR and high resolution CT chest scans. A total of 95 patients were included in the study. Data regarding the study were collected. Results: Out of 95 patients, 79 were males and 16 females. The mean age of the patients was 32.42 years ranging from 2 to 90 years. The most common cause for blunt trauma to the chest according to our results was a road traffic accident. We observed that CT scan is more accurate as compared to CXR in the detection of certain cases such as sternum fracture, rib fracture, scapula fracture, lung contusion, hemothorax, and pneumothorax. Conclusion: Chest CT scan is highly sensitive in the detection of thoracic injuries following blunt chest trauma. In day-to-day practice, CT scan is better in visualizing as sternum fracture, rib fracture, scapula fracture, lung contusion, hemothorax, and pneumothorax
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This study was performed with an objective of developing and validating an UV-spectroscopic method for estimating contents of prulifloxacin in simulated intestinal fluid (SIF) i.e. phosphate- buffer media with a pH of 6.8 as per ICH guidelines. The λmax for prulifloxacin in phosphate- buffer media pH 6.8 was found to be 272 nanometer. The calibration curve of drug followed linearity in-between 1-9 μg/ml concentration range and correlation co-efficient value was found equal to 0.9995. We tested this proposed method onto the bulk and marketed pharmaceutical formulation (tablets) also in order to find out contents of drug. Using developed method for estimation of prulifloxacin in SIF, drug was found to be in-between 101.91 and 104.02 % in marketed tablets which shows a good agreement with that of the claimed level. Accuracy of developed method was established through recovery experimentation, performed for three spiked percent concentrations- 75%, 100%, and 125%. The % recovery was found to be in between 97.27 and 101.82%. Low values of % RSD supported accuracy as well as the reproducibility of developed method. Precision of developed method was established by good in-limit intraday and interday experimental variations and through repeatability tests. Values of % RSD less than 2 confirmed about precision of developed method. The ruggedness of the developed method was validated by performing drug estimation by two different performers. This proposed spectroscopic method has proved to be a rapid and successful method for routine analysis of prulifloxacin in simulated intestinal fluid.