Study of risk factors associated with adverse outcome in a severe coronary artery disease (syntax score >22) with different therapeutic strategies

Background: The specific question of whether PCI or surgical treatment offers any advantage over MT in patients with stable angina and multivessel disease remains unanswered. Objective of our research was to study various risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease.Methods: This was prospective observational study carried out in a tertiary care center from July 2014 to July 2016. A total of 98 subjects undergoing different therapeutic strategies were followed up. Risk factors which interferes the outcome of various therapeutic procedures in coronary artery disease (CAD) were studied.Results: There was a significant difference in mean SYNTAX score (P = 0.003), urine micro albumin levels (P=0.006), and body mass index (0.046) between those who had MACE and who did not have MACE.Conclusions: The urine micro albumin >30 mg/l and highest SYNTAX score were significantly associated with MACE at 1 year in subject with severe CAD.

Prevalence of goitre among school children in Belgaum District.

Objective. A school survey was conducted to estimate the prevalence of goitre among schoolchildren in Belgaum district. Methods. A cross-sectional study was conducted in primary, middle and high schools of villages selected. All the children of the selected schools were examined for the presence of goitre and the salt samples obtained from their homes were tested for iodine content. Results. Overall prevalence of goitre was 16.7%. Prevalence of palpable goitre was 16.4 % and visible goitre was very low (0.3%). Higher prevalence was found among females (21.1%) when compared to that of male children (12.8 %). Prevalence of goitre increased significantly with advancement of age until 16-yr. 72.1 % children were consuming rock salt and only 27.9 % were consuming powdered salt at their homes. Estimation of Iodine content in the salt samples showed that 68.7 % of the sample had inadequate iodine content. Prevalence of goitre was significantly high among children who consumed rock salt (16.2%) as compared to those who used powdered salt (11%). Conclusion. Strict implementation of salt codization and marketing in rural area is desired. Also health education programme be showed.

Primary HIV-1 infection--a "window of opportunity" for healthcare providers.

The diagnosis of primary HIV-1 infection (PHI) is often missed and requires a high index of suspicion and a thorough knowledge of laboratory methods. We report the case of a young promiscuous male who presented with fever, rash and neurological symptoms 8 weeks after unprotected sexual exposure. Clinical and laboratory investigations showed the presence of leucopenia and thrombocytopenia with elevated transaminases, and a normal cerebrospinal fluid analysis, while CNS imaging revealed a vasculitis-like involvement of the corpus callosum. Symptoms resolved spontaneously over 3 weeks. Fourth generation ELISA with p24 antigen assay was positive with high HIV-1 RNA load while Western-Blot was negative, thus confirming the diagnosis of PHI. The patient was subsequently started on antiretroviral therapy (ART) and showed undetectable viral load after 8 weeks of therapy. We present the differential diagnoses which need to be entertained as well as the pros and cons of very early ART intervention.

Nevirapine-induced fulminant hepatitis.

Nevirapine induced hepatotoxicity is known but fatality is rare. We report a case of a young individual who developed nevirapine (NVP) induced fatal hepatitis without apparent risk factors or preceding rash. Exacerbation of underlying silent chronic liver dysfunction possibly contributed to the fatal outcome. This case stresses the need for careful evaluation, regular monitoring and prompt omission of drug on suspicion of hepatotoxicity.

Prevalence of goitre among school children in coastal Karnataka.

OBJECTIVE: A cross sectional study was conducted in the rural field practice area of Department of Community Medicine, KMC, Manipal to find out the prevalence of goitre among school children in the age group of 8-10 years. METHODS: A total of 722 children were selected from the study population by the method of probability proportion to size (PPS) stratified sampling giving due representation to both Government and private schools. Children were clinically examined for the presence of goitre and graded according to WHO guidelines. Urine and salt samples were collected from subsample to estimate the urinary iodine excretion level and iodine content in the salt respectively. RESULTS: Over all prevalence of goitre was 30 percent. Prevalence among males was 28.8 percent and among females it was 31.2 percent. In the both sexes goitre rate increased with the advancement of age. Prevalence of grade I and grade II goitre was 29.4 and 0.6 percent respectively. Prevalence of goitre was significantly higher among children who had urinary iodine excretion level less than optimum (<10 mcg/dl). Estimation of iodine content in the salt sample revealed that 48.3 percent of samples had adequate iodine content (>=15 ppm). There was significant increase in the goitre rate as the iodine content in the salt decreased (p=0.01). CONCLUSION: Prevalence of goitre among school children was high and therefore constituted a public health problem in this region.

In vivo radioprotective effect of Moringa oleifera leaves.

Radioprotective property of Moringa oleifera leaves was investigated in healthy adult Swiss albino mice. Animals were injected (ip) with 150 mg/kg body weight of 50% methanolic extract (ME) of M. oleifera leaves, as a single dose, or in 5 daily fractions of 30 mg/kg each, and exposed to whole body gamma irradiation (RT, 4 Gy) 1 hr later. Five animals from each group were sacrificed at 1, 2 and 7 days after treatment. Bone marrow protection was studied by scoring aberrations in metaphase chromosomes and micronucleus induction in polychromatic erythrocytes and normochromatic erythrocytes. Pretreatment with a single dose of 150 mg/kg ME significantly reduced the percent aberrant cells to 2/3rd that of RT alone group on day 1 and brought the values to normal range by day 7 post-irradiation. A similar effect was also seen for the micronucleated cells. Fractionated administration of ME (30 mg/kg x 5) gave a higher protection than that given by the same dose administered as a single treatment. ME also inhibited the Fenton reaction-generated free radical activity in vitro in a concentration dependent manner. These results demonstrate that pretreatment with the methanolic leaf extract of M. oleifera confers significant radiation protection to the bone marrow chromosomes in mice and this may lead to the higher 30 day survival after lethal whole body irradiation.

Use of percutaneous endoscopic gastrostomy in acute dysphagic stroke

Background Percutaneous endoscopic gastrostomy [PEG] is a widely used method for insertion of gastrostomy tube for patients with dysphagia due neuromuscular disorders. Aim: this article highlights the role of PEG for such patients, how safe, effective then standard gastrostomy in providing long-term nutritional support for patients with dysphagic stroke. Over a four-year period [1995-1998], 27 patients had percutaneous endoscopic gastrostomy performed for neuromuscular dysphagia. A Wilson Cook [24G] gastrostomy tube was used and it was inserted with Ponsky-Gauderer pull technique. All the patients tolerated the procedure will. Stroke [81%] was the most common indication for PEG. Major gastroscopic finding was found in eight patients [29%]. Minor complication was seen in only three patients [11%]. PEG Feeding is safe, simple and effective procedure with no serious side effects. Patients and their relatives accept PEG better than nasogastric tube feeding. However, the ideal timing at which to institute gastrostomy feeding after dysphagic storke is still not clear

Radiosensitization of a mouse melanoma by withaferin A: in vivo studies.

The radiosensitizing effect of a plant withanolide, withaferin A, on the B16F1 mouse melanoma was studied in vivo. Treatment of 100 mm3 tumours with 10 to 60 mg/kg withaferin A intraperitoneally produced a dose dependent increase in growth delay and volume doubling time. Injection of 30-50 mg/kg withaferin A, followed by 30 Gy local gamma irradiation, significantly enhanced the tumour response. No systemic or local adverse reactions were noted in these groups. The drug was most effective when injected intraperitoneally 1 h before irradiation. However, neither the individual agents nor their combination could produce any complete response (tumour cure). Melanoma is a relatively radioresistant tumour. The present results indicate that the radiation response of this tumour can be significantly enhanced by pretreatment with withaferin A.

Evaluation of anti-tumor efficacy of injectable Centchroman in mice bearing Ehrlich ascites carcinoma.

Anti-tumor efficacy of Centchroman formulated as niosomes and gel implant was evaluated in Swiss albino mice bearing Ehrlich ascites carcinoma at 10 mg/kg body weight dose given subcutaneously. Median day of death, percentage increase in host life span and changes in body weight were studied. Centchroman significantly (P < 0.05) increased the median day of death both in free and formulated systems. Also, injectable formulations exhibited a significant (P < 0.05) increase in host life span compared to free drug, hence, enhanced anti-tumor efficacy against Ehrlich ascites carcinoma.

Antitumor and antifertility activities of plumbagin controlled release formulations.

With a view to increase efficiency and reduce toxicity of Plumbagin, an attempt was made to formulate plumbagin as a controlled release preparation using various carriers and test for their antitumor and antifertility activities. Niosomes and albumin microspheres were used as carriers. In vitro data showed promising results for these formulations thus they were taken up for in vivo assessment. Given at a dose of 5 mg/kg, ip the albumin microspheres showed promising antitumor and antifertility activity when compared to the niosomes on control. Animal survival data also indicated slight improvement in survival rate and thus antitumoral activity. Also, an interesting point was that the antifertility activity was affected through an antiovulatory action as seen from histopathological studies.

Radiosensitizing effect of plumbagin on mouse melanoma cells grown in vitro.

Mouse melanoma cells were treated with plumbagin, a naphthoquinone, from the plant Plumbago rosea at 0.5 microgram/ml (PI) for 60 min either alone or followed by 2 Gy gamma radiation (RT). Response to the different treatments was assessed by following the cell growth up to 5 days post treatment. PI alone produced a significant decrease in the cell count on days 3 and 4, whereas RT treatment significantly enhanced the growth inhibitory effect when compared to RT or PI alone. These findings suggests the radiosensitizing effect of PI on mouse melanoma cells in vitro, supporting the earlier in vivo findings.