Etiology and Outcome of Community-Acquired Acute Kidney Injury in Pediatric Inpatients

Objective: To estimate the etiology, outcome, and risk factors for mortality in children with community-acquired acute kidney injury (CA-AKI). Methods: Between October, 2020 and December, 2021, consecutive hospitalized children aged 2 mo-12 years with a minimum 24 hours of stay, and at least one serum creatinine level measured at or within 24 hours of hospitalization were prospectively enrolled. CA-AKI was labelled in children with an elevated serum creatinine level at admission and subsequent fall during hospitalization. Results: Of 2780 children, 215 were diagnosed as CA-AKI (7.7%, 95% CI 6.7-8.6). Diarrhea with dehydration (39%) and sepsis (28%) were the most common causes of CA-AKI. 24 children (11%) died during hospitalization. Requirement of inotropes was an independent predictor of mortality. Out of 191 children discharged, 168 (88%) had complete renal recovery. At 3 months, out of 22 children without complete renal recovery, 10 progressed to chronic kidney disease (CKD), with 3 becoming dialysis dependent. Conclusions: CA-AKI is common in hospitalized children, and is associated with increased risk of progression to CKD, especially in those with incomplete renal recovery.

Identification of Probable Urinary Tract Infection in Children Using Low Bacterial Count Thresholds in Urine Culture

Objectives: To assess the proportion of children, symptomatic for urinary tract infection (UTI), with urine culture showing single bacterial species >104 CFU/mL, and to compare patient and disease characteristics between children having low counts (from >104-105 CFU/mL) and those with counts >105 CFU/mL. Methods: Prospective observational study, enrolling symptomatic children aged 1 month to 12 years. Mid-stream clean-void or catheter collected urine were cultured. Children with single species >104 CFU/mL were scheduled for imaging studies, following age criteria of Indian Society of Pediatric Nephrology guidelines. The main outcome was proportion with single bacterial species >104 CFU/mL in urine culture. Results: Of 216 children (132 males) with median (IQR) age of 24 (12, 48) months, 38 (17.6%) showed single species growth >104 CFU/mL. Of these, 29 (13.4%) were diagnosed as UTI at cutoff >105 CFU/mL, and an additional 9 (4.2%) were found to have ‘probable low-count UTI’ (from >104 to 105 CFU/mL). One child in the latter group had bilateral hydroureteronephrosis, vesico-ureteral reflux and renal scarring. There was largely no difference in parameters between children with low counts and those with counts >105 CFU/mL. Conclusion: An additional proportion of symptomatic children with probable urinary tract infection and possible underlying urological abnormalities may be identified by lowering bacterial colony count cutoff to >104 CFU/mL, in clean-voided and catheter-based urine samples.

Biliary adenofibroma: a precursor lesion of intrahepatic cholangiocarcinoma

ABSTRACT Biliary adenofibroma (BAF) is an uncommon liver tumor with a high propensity for malignant transformation. The histomorphology of BAF with malignant transformation can show a spectrum of changes ranging from benign, dysplastic to frank malignancy. Thus, the diagnosis of BAF imposes the pursuit of dysplasia/ malignancy focus. We presented a case of intrahepatic cholangiocarcinoma arising from BAF in a 49-year-old woman with detailed histomorphology. We also performed a PubMed database search and tabulated all previously reported cases of BAF with dysplasia/ malignant transformation. A statistic comparison of age, sex ratio, size of the tumor, and survival following complete resection between BAFs with and without dysplasia/ malignancy from the retrieved data is presented. Our analysis did not highlight any statistically significant difference between BAFs with and without dysplasia/ malignancy in age, sex ratio, tumor size, and survival following complete surgical resection. Our study highlights the histopathology and immunohistochemistry of a case of BAF with malignant transformation and highlights the importance of this diagnosis in management. Further longitudinal studies on a larger cohort of patients are required to validate our findings.

Incidence of Genital Organ Abnormalities in Female Genitalia of Marwari Goats

The present study was conducted to record various gross genital abnormalities of female genital organs in Marwari goats. A total of 115 genital organs were collected from municipal and local abattoir of Bikaner city, randomly. Slaughtered genital organs were segregated in 3 groups viz. healthy non pregnant, pregnant and abnormal groups based on their visual observations. The incidences of various gross genital abnormalities were recorded. Out of total 115 genitalia collected, 80 were found to be grossly normal (69.56%).The percentage of pregnancy wastage was 11.30% (13 out of 115). Over all 22 (19.13%) genitalia had abnormalities. The common genital abnormalities found were uterine infections (18), ovarian cyst (3) and parovarian cyst (1), respectively. All these genital disorders are causes a big damage to reproductive health of goat and if they are not diagnosed or treated early then they cause infertility.

Preterm General Movements in Prediction of Neurodevelopmental Disability and Cerebral Palsy at Two Years: A Prospective Cohort Study

Background: A neurological assessment before discharge from the NICU would enable early targeted intervention to mitigate the risk and severity of cerebral palsy (CP) and neurodevelopmental disability. Objective: To assess the accuracy of general movements (GM) in the preterm and fidgety movement periods in predicting neurodevelopmental disability and cerebral palsy in very preterm infants (?32 weeks gestational age) at 18-24 months corrected gestational age. Study design: Prospective cohort study Participants: One hundred and seventy very preterm infants, mean (SD) gestation 29.8 (1.32) weeks, and birthweight 1215 (226) g. Outcomes: Infants underwent GM assessments in the preterm period (31-36 weeks post-conception age) and fidgety movement period (8-18 weeks post term age). Neurodevelopmental outcomes were assessed in 127 children using the Griffiths Mental Developmental Scales-2. Results: Nine children had neurodevelopmental disability (two infants with cerebral palsy and seven with global developmental delay. The relative risk (95% CI) for neurodevelopmental disability was 1.46 (0.31-6.89) with preterm movements and 6.07 (0.97 – 38.05) with fidgety movements. Sensitivity and specificity values for the prediction of neurodevelopmental disability were 33% and 64% in the preterm period and 25% and 92% in the fidgety movement period, respectively. The sensitivity and specificity values for prediction of CP were 50% and 63% in the preterm period and 100% and 93% in the fidgety movement period, respectively. Conclusion: Preterm movements showed lower sensitivity and specificity than fidgety movements in predicting later CP and neurodevelopmental disability in preterm infants.

Assessment of anti-inflammatory activity of Tridax procumbens in wistar rats

Background: Tridax procumbens Linn. is a spreading herb found throughout India. Tridax procumbens is known for several potential therapeutic effects like antiviral, antioxidant, anti-infective, wound healing, insecticidal and anti- inflammatory, hepatoprotective, and antidiabetic. Novel therapies for inflammation are essential to overcome the adverse effects of existing anti-inflammatory drugs. Thus, this study was designed to evaluate anti-inflammatory activity in the experimental animal. Objective: To evaluate anti-inflammatory efficacy in experimental animal Materials and Methods: Tridax procumbens plant leaves were taken for the study. The Plant extraction was prepared by using the Soxhlet apparatus. The ethanolic extract was used as a test drug. Indomethacin and Dexamethasone were used as control drugs. Wistar rats weighing 150g to -200g were used in the study. Results: At dosages of 200 and 400 mg kg-1 , the ethanolic leaf extracts of Tridax Procumbens demonstrated substantial anti-inflammatory activity against Irish Moss-triggered inflammation. After 3 hours, 400 mgkg-1 showed a significant reduction in inflammation (48 percent), with the impact increasing after 3 hours (52 percent). The anti-inflammatory efficacy of Tridax Procumbens ethanol (EtOH) extracts was substantial and comparable to that of indomethacin (10 mg/kg). Tridax procumbens ‘s Ethanol (EtOH) leaf extract at a dose of 200 and 400 mgkg-1 , demonstrated considerable anti-inflammatory action. The average weight of granulomatous surrounding tissue in the threading was considerably smaller in the Tridax procumbens extraction group after 7 days than in the comparison group. The 400 mg kg-1 dose was shown to be the most effective of the two. the greatest reduction in the production of granuloma tissue. Tridax procumbens at doses of 200 mg/kg and 400 mg/kg resulted in substantial reductions in granuloma weights of 38.16 ± 0.04 (7.4 percent inhibition) and 34.58 ± 0.04 (16.1 percent inhibition), respectively. The lower dose of 400 mg/kg resulted in a little lesser reduction in granumola weight than the conventional medication dexamethasone (28.92 ± 0.04). (29.8 percent inhibition). Conclusion: The present study concludes that Tridax Procumbens possess anti-inflammatory effects in animal models.

Clinico-Etiologic Profile of Macroscopic Hematuria in Children: A Single Center Experience

Objective: To study the demographic, clinical and etiological profile of macroscopic hematuria in children presenting to a tertiary care hospital. Methods: This prospective observational study, conducted between January, 2018 and December, 2019, enrolled children aged 3 months to 12 years, presenting with gross hematuria. Results: Of the 62 children (44 males) enrolled, (mean (SD) age of 7.3 (2.6) years), glomerular hematuria was seen in 59.7%. Post-infectious glomerulonephritis was the commonest etiology of glomerular hematuria; hypercalciuria and renal calculi predominated among non-glomerular hematuria. After a median (IQR) follow up of 8 (6,14.2) months, microscopic hematuria persisted in 10 (7, glomerular hematuria) children. The median time to resolution of gross as well as microscopic hematuria tended to be longer in glomerular etiologies. Conclusion: Majority of children with gross hematuria had glomerular etiologies, thus requiring monitoring and follow-up.

Adult diffuse hepatic hemangiomatosis

Abstract Diffuse hepatic hemangiomatosis (DHH) is an uncommon vascular lesion, though hemangiomas are the commonest benign tumors of the liver. The etiology is largely unknown to date; however, its association with giant cavernous hemangiomas (GCH) has been reported in the literature. We present herein, the case of a 37-year-old hypothyroid woman with abdominal fullness for 2 months. The contrast-enhanced computed tomography revealed multiple well-encapsulated lesions involving the liver lobes and was diagnosed as giant cavernous hemangiomas. Most of them, except the deep-seated ones, were enucleated. Histopathological examination highlighted the presence of GCH with irregular margin, replacement of hepatic parenchyma, and presence of multiple micro-hemangiomas suggesting the possibility of DHH further substantiated by retrospective radiological assessment. No extrahepatic vascular lesion was noted, and the post-operative recovery and follow-up were uneventful. Adult DHH is an uncommon entity. The diagnosis of DHH and its distinction from GCH are important from the management and prognostic point of view as recurrence, extrahepatic manifestations, features of consumption coagulopathy, and death from the complications are not uncommon.

Occult papillary carcinoma of thyroid presenting as cervical lymphadenopathy in a young male: case report

Papillary carcinoma of thyroid accounts for 80% of all thyroid malignancies. They tend to have a female preponderance and present in the 4th to 5th decade of life, as a slow growing midline mass. Cervical metastases are common, blood borne being rare. We present a case of a 29 years old who presented with cervical lymphadenopathy that was secondary to an occult papillary carcinoma of thyroid. Patient underwent total thyroidectomy with bilateral neck node dissection for the same.

Isolation, Identification and Antibacterial Activity of Endophytic Bacteria from Leaves of Acacia catechu

Drug resistance in bacteria is becoming an alarming problem in recent years. Post-antibiotic era is not so far. The need for novel antibiotics, chemotherapeutic agents and agrochemicals are utmost. Endophytes are microorganisms that reside in the tissues of living plants which are relatively unstudied and are potential sources of novel natural products for exploitation in medicine, agriculture and industry. The endophytes of medicinal plants participate in biochemical pathways and produce novel bioactive compounds. The aim of the study was to isolate, identify and to assess antibacterial activity of endophytic bacteria from leaves of Acacia catechu. 18 endophytic bacteria had been isolated and identified by sequencing 16S rRNA gene. The isolated endophytic bacteria were identified as Bacillus humi. Considerable in vitro antibacterial activities against a panel of human pathogenic microorganisms (Staphylococcus aureus, Streptococcus pyogenes, Bacillus cereus, Klebsiella pneumoniae, Salmonella Typhimurium and Escherichia coli) were recorded. Among 18 isolates, 15 isolates had shown inhibitory activity against Staphylococcus aureus and Salmonella Typhimurium and 10 isolates had shown inhibitory activity against Klebsiella pneumoniae

Antibiotic Use Evaluation in Genitourinary Tract Infections in Female Patients at a Tertiary Care Hospital.

Genitourinary tract infections are some of the most common infections in females. These problems are a challenge in terms of diagnosis and treatment. The present study was conducted to evaluate the prescribing pattern in three of the most common types of female genitourinary tract infections.METHODSA prospective and observational study was conducted on genitourinary tract infections in female patients at the gynaecology outpatient department in a tertiary care university hospital.RESULTSMajority of the infected female patients were in 26 - 35 years age group (31.8%) followed by 36 - 45 years age group (25.9%). The common infection noticed was urinary tract infection (42.2%), followed by pelvic inflammatory disease (32.2%) and vaginitis (25.5%) in infected female patients. The types of antibiotics prescribed for urinary tract infection were aminoglycosides, fluoroquinolones, cephalosporins and penicillins. The commonly prescribed antibiotics for pelvic inflammatory disease were tetracyclines, azoles, fluoroquinolones and cephalosporins, and for vaginitis azoles and aminoglycosides. The most commonly prescribed class of antibiotics for urinary tract infection, pelvic inflammatory disease and vaginitis were fluoroquinolones (11.8%), azoles (11.8%) and aminoglycosides (15.7%), respectively. Oral route was the preferred mode of administration (71%), followed by rectal (suppositories, 17.2%) and topical (cream, 11.8%).CONCLUSIONSYoung married women in this urban Indian community have a high prevalence of genitourinary tract infections but seldom seek treatment. Education and outreach are needed to reduce the stigma, embarrassment and lack of knowledge related to genitourinary tract infections

Evaluation of Autologous Platelet Rich Plasma Injection in the Treatment of Rotator Cuff Tendinopathy

Background: Rotator cuff tendinopathy (RCT) is a significantsource of disability and loss of work. As commonly usedsubacromial corticosteroid injection for treatment of chronicrotator cuff tendinopathy has adverse effects especially inelderly people, new treatment options such as Platelet-RichPlasma (PRP) can be considered for managing of thispathology. The aim of the present study was conducted toevaluate the effectiveness of autologous platelet rich plasmainjection in the treatment of rotator cuff tendinopathy.Materials and Methods: The present study was conductedamong adults of age 30-70 years over the period of 1 year fromFeb 2018 to Jan 2019. The primary outcome measure for allparticipants was a score on a 0–10 visual analog scale (VAS)assessing current resting pain at baseline and at 8, 12, and 52weeks. Demographics and information about duration of RCTpain and prior therapies for RCT were collected. Eachparticipant underwent a single injection of PRP. In-personassessment occurred at 2, 8, and 12 weeks and by phone at52 weeks. Statistical analysis was done using SPSS 21software. P values less than .05 were considered statisticallysignificant for main and interaction effects.Results: In the present study total sample size was 46 inwhich 32 were males and 14 were females. VAS score wasevaluated for the treatment of Rotator cuff Tendinopathy atbaseline, 8 week, 12 week, 52 weeks after the injection ofautologous platelet rich plasma. The result shows that VASscore was less after 8 weeks and after 12 weeks and 52 weeksit was almost same.Conclusion: Our study concluded that pain was less in thepatients of Rotator cuff Tendinopathy after the injection ofautologous platelet rich plasma.

Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome / Incidência e fatores de risco para infecções graves em crianças hospitalizadas com síndrome nefróticas

ABSTRACT Introduction: Children with nephrotic syndrome are at increased risk of infections because of disease status itself and use of various immunosuppressive agents. In majority, infections trigger relapses requiring hospitalization with increased risk of morbidity and mortality. This study aimed to determine the incidence, spectrum, and risk factors for major infections in hospitalized children with nephrotic syndrome. Methods: All consecutive hospitalized children between 1-12 years of age with nephrotic syndrome were enrolled in the study. Children with acute nephritis, secondary nephrotic syndrome as well as those admitted for diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion were excluded. Results: A total of 148 children with 162 admissions were enrolled. Incidence of major infections in hospitalized children with nephrotic syndrome was 43.8%. Peritonitis was the commonest infection (24%), followed by pneumonia (18%), urinary tract infection (15%), and cellulitis (14%), contributing with two thirds of major infections. Streptococcus pneumoniae (n = 9) was the predominant organism isolated in children with peritonitis and pneumonia. On logistic regression analysis, serum albumin < 1.5gm/dL was the only independent risk factor for all infections (OR 2.6; 95% CI, 1.2-6; p = 0.01), especially for peritonitis (OR 29; 95% CI, 3-270; p = 0.003). There were four deaths (2.5%) in our study, all due to sepsis and multiorgan failure. Conclusions: Infection remains an important cause of morbidity and mortality in children with nephrotic syndrome. As Pneumococcus was the most prevalent cause of infection in those children, attention should be paid to the pneumococcal immunization in children with nephrotic syndrome.

RESUMO Introdução: Crianças com síndrome nefrótica apresentam maior risco de infecções devido ao próprio status da doença e ao uso de vários agentes imunossupressores. Em grande parte, as infecções desencadeiam recidivas que exigem hospitalização, com risco aumentado de morbidade e mortalidade. Este estudo teve como objetivo determinar a incidência, o espectro e os fatores de risco para infecções graves em crianças hospitalizadas com síndrome nefrótica. Métodos: Todas as crianças hospitalizadas consecutivamente entre 1 e 12 anos de idade com síndrome nefrótica foram incluídas no estudo. Crianças com nefrite aguda, síndrome nefrótica secundária, bem como aquelas admitidas para biópsia renal diagnóstica e infusão intravenosa de ciclofosfamida ou rituximabe foram excluídas. Resultados: Foram cadastradas 148 crianças com 162 internações. A incidência de infecções graves em crianças hospitalizadas com síndrome nefrótica foi de 43,8%. A peritonite foi a infecção mais comum (24%), seguida por pneumonia (18%), infecção do trato urinário (15%) e celulite (14%), contribuindo com dois terços das principais infecções. Streptococcus pneumoniae (n = 9) foi o organismo predominantemente isolado em crianças com peritonite e pneumonia. Na análise de regressão logística, a albumina sérica < 1,5gm / dL foi o único fator de risco independente para todas as infecções (OR 2,6; 95% CI, 1,2-6; p = 0,01), especialmente para peritonite (OR 29; IC95% 3 -270, p = 0,003). Houve quatro mortes (2,5%) em nosso estudo, todas devido a sepse e falência de múltiplos órgãos. Conclusões: A infecção continua sendo uma importante causa de morbimortalidade em crianças com síndrome nefrótica. Como o Pneumococo foi a causa mais prevalente de infecção nessas crianças, deve-se atentar para a imunização pneumocócica em crianças com síndrome nefrótica.

Prediction of Severe Acute Kidney Injury using Renal Angina Index in a Pediatric Intensive Care Unit

Objectives: To determine the proportion of children in a pediatric intensive care unit with apositive Day 0 Renal angina index who develop severe acute kidney injury (AKI) on Day 3;and to compare the predictive ability of the index with that of individual markers of renal injury,for the development of severe acute kidney injury. Design: Observational study. Setting:Pediatric intensive care unit of a tertiary-care hospital. Participants: Consecutive children, 1month to 12 years, admitted in Level 3 pediatric intensive care unit for a minimum of 8 hours,having weight and intake-output records, were eligible. Children known to have chronickidney disease or already in stage 2/3 acute kidney injury/dialysis were excluded.Procedure: Day 0 Renal angina index was calculated from the product of Risk Group score(Pediatric intensive care admission/Ventilation and inotropy) and Renal Injury score (fluidoverload over previous 8 hours or the % fall in estimated creatinine clearance from baseline).Renal angina index ≥8 was considered positive. Main outcome measure: The proportion ofchildren with positive Day 0 Renal angina index who develop severe AKI (Kidney DiseaseImproving Global Outcomes (KDIGO) ≥ Stage 2) on Day 3. Results: Of 162 enrolled children(median (IQR) age 10.5 (3,39) months), 86 (53%) had positive Renal angina index. On Day 3,a higher proportion of children with positive index developed severe AKI, compared tonegative group (RR 95.5; 95% CI 21.7,420.5; P<0.001). Day 0 positive Renal angina indexhad a sensitivity, specificity, positive predictive value and negative predictive value of 96.9%,75.5%, 72% and 97.4% respectively, for predicting severe AKI on Day 3. The ReceiverOperating Characteristic curve of Day 0 renal angina scores showed AUC of 0.90 (95% CI0.85, 0.95), better than the AUC obtained from either Day 0 serum creatinine or Day 0 percentfall in estimated creatinine clearance from baseline. Conclusion: Day 0 Renal angina indexpositivity is a promising tool to identify critically ill children with impending severe AKI.

Beneficial role of Avocado oil orally used in Osteoarthritis: experience in a tertiary care hospital of Bihar, India

Background: Osteoarthritis is the most common type of joint disease. It represents a heterogeneous group of conditions resulting in common histopathologic and radiologic changes. It is a degenerative disorder arising from biochemical breakdown of articular (hyaline) cartilage in the synovial joints.Methods: Total of 90 patients were randomly selected from outdoor and indoor of Orthopaedics department (IGIMS Patna). Study was done in Department of Pharmacology & Orthopaedics at IGIMS Patna. Three groups A, B and C were taken. Each group was consist of 30 patients of both sexes and age groups between 18 to 65 years. Group A was received Multivitamin with Exercise. Group B was received NSAIDS only. Group C was received Avocado oil orally along with Exercises as Muscle strengthening exercises of Quadriceps, Hamstrings, Abductor and Adductor muscles of thigh. We had compared pain thresholds among all these three groups with the help of Visual analogue scale and Oxford Knee score.Results: After 3 months of treatment the patients belonging to group C showed better response as compared to group A and B. When we compared pain threshold among group A, B and C on the basis of Oxford Knee score group C had occupied maximum score, which meant satisfactory joint functions and did not require any formal treatment. we also compared average visual analogue scale and average oxford knee score, Group C showed better response.Conclusions: Avocado oil is a food supplement and does not contain any side effects as compared to NSAIDS [Non-steroidal anti inflammatory drugs], glucosamine sulfate, chondroitin sulfate, sulfasalazine etc so avocado oil can be used for long duration in case of osteoarthritis.

Profile of Acute Kidney Injury in Hospitalized Children with Idiopathic Nephrotic Syndrome

Objective: To determine the incidence, risk factors and outcome of acute kidney injury (AKI)in hospitalized children with nephrotic syndrome. Methods: All consecutive hospitalizedchildren (aged 1-14 years) with diagnosis of nephrotic syndrome between February 2016 andJanuary 2017 were enrolled for the study.Children (aged 1-14 years) with features ofnephritis, underlying secondary causes of nephrotic syndrome as well as children admittedfor diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion wereexcluded. Results: A total of 73 children (81 admissions) were enrolled; incidence of AKI was16% (95% CI, 9-23). On multivariate logistic regression analysis, furosemide infusion wasobserved as an independent risk factor for acute kidney injury (OR 23; 95% CI, 3-141;P<0.001). Out of 13 children with AKI, three died. Conclusions: Acute kidney injury inhospitalized children with nephrotic syndrome has high risk of mortality. Children receivingfurosemide infusion should be closely monitored for occurrence of acute kidney injury.

Somatic Mutations in Circulating Cell-Free D-Loop Region of Mitochondrial DNA: A Study from North-East India

Head and neck Squamous cell carcinoma (HNSCC) is highly prevalent in Northeast India. The widespread use of tobacco exposure is a known risk factor, makingmitochondrial DNA (mtDNA) more susceptible to damage by oxidative stress incomparison to nuclear DNA. Mitochondrial dysfunction being a hallmark of cancer, thestudy aims to evaluate liquid biopsy involving circulating cell-free mitochondrial DNA(cfmtDNA) as an early diagnostic marker by reducing the dependability over tumor tissuebiopsy specimen. A total of 50 HNSCC cases reported at Cancer Hospital, Guwahati MedicalCollege from January 2018 to August 2018 were included in this study. Cell-free DNA wasisolated using QIAamp Circulating Nucleic Acid Kit. PCR based amplification ofmitochondrial D-loop, followed by direct sequencing. Our result indicated the presence ofsomatic mutations (73(A/G), 93(G/A), 146(T/C) and 207 (G/A)). Polymorphism was alsoobserved in the sequences (263A>G, 275G>A, 318T>C, 16034T>C, 16257C>A and16519T>C) upon comparison with reference sequence. Analysis of c-tract region showedthe presence of an additional cytosine nucleotide at position 309.Identifying somaticmutations in cfmtDNA using liquid biopsy approach will certainly minimize thedependency of clinicians and molecular biologist over the availability of tumor tissuespecimens. The identified somatic variations from our study will help in theimplementation of preventive measure. Therefore, our study provides an early mtDNAdiagnostic marker using liquid biopsy approach.

Hyponatremic-Hypertensive Syndrome in Ovarian Paraganglioma

Background: Hyponatremic-hypertensive syndrome (HHS) is characterized bycombination of polyuria, polydipsia, hypertension, hyponatremia and hypokalemia inassociation with unilateral renal artery stenosis. Case characteristics: A 10-year- old girlpresented with polyuria, polydipsia, hypertension, hyponatremia, hypokalemia andproteinuria. Ultrasonography with doppler study revealed bilateral normal renal arteries.Completed tomography of abdomen detected a left adnexal mass, which was laterconfirmed as ovarian paraganglioma on histopathology. Outcome: After tumor excision,polyuria subsided and blood pressure normalized. Message: Hyponatremic-HypertensiveSyndrome does not always result from unilateral renal artery stenosis. High index of clinicalsuspicion with appropriate imaging technique may clinch rare endocrine causes ofhypertension, like paraganglioma.

Cost variation analysis of proton pump inhibitors available in Indian market

Background: In now days proton pump inhibitors are prescribing more and more by Indian physicians not only in peptic ulcer,gastroesophageal reflux disease, gastritis but also along with non steroidal anti-inflammatory drugs to overcome the side effects as gastric irritation and discomfort by non steroidal anti inflammatory drugs.There are many brands of PPI drugs available in Indian market. Costly drugs can lead to economic burden which results in decreased compliance or even non-compliance. Non 朿ompliance leads to incomplete treatment which tends to increase morbidity.Increase in the patient medication cost was found to associated with decreased adherence to prescription medication.Hence this study was done to assess the cost variation of proton pump inhibitors [PPI] drugs.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition Drug Today April to June 2018 Vol-1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of 10 tablets/capsules was calculated in case of oral drug and the cost of one 1 vial or ampoule was noted in case of injectable drug. At last the cost ratio and percentage cost variation of various brands was compared.Results: Percentage variation in cost for proton pump inhibitors marketed in india was found to be tablet/capsule Esomeprazole [20mg]:141.17, tablet/capsule Esomeprazole [40mg]:196.29, capsule/tablet Omeprazole[20mg]: 569.53, Tablet/capsule Pantoprazole[40mg]: 248.8, tablet /capsule Rabeprazole[20mg]: 815.78, capsule/tablet Lansoprazole[30mg]: 173.33, Inj. Esomeprazole [40mg] 1 vial: 81.81, Inj. Omeprazole[40mg] 1vial: 47.95, Inj. Pantoprazole[40mg] 1vial: 66.66, Inj.Rabeprazole [20mg] 1vial: 176.625.Conclusions: Tablet Rabeprazole[20mg] shows highest cost ratio and percentage cost variation as 9.15 and 815.78. While Inj. Omeprazole[40mg] 1 vial shows lowest cost ratio and percentage cost variation as 1.47 and 47.95.

Efficacy and safety of topical 2% dorzolamide and 0.5% timolol in cases of open angle glaucoma in a tertiary care hospital of East Singhbhum: an observational, prospective and comparative study

Background: Present study was undertaken to evaluate and compare the efficacy and side effects of 2% dorzolamide and 0.5% timolol in patients with open angle glaucoma.Methods: There were 60 randomly selected patients were equally divided into Group I (n=30) and Group II (n=30). Further both groups were divided into IA (n=10), IB (n=20), IIA (n=10) and IIB (n=20). 2% Dorzolamide hydrochloride in Group IA and IIA and 0.5% Timolol maleate in Group IB and IIB was administered for 24 weeks. Patients were evaluated for general and ocular examinations on day of enrolment and then at the end of 1st, 4th, 8th and 24th week. Adverse effects of the drug during study period were also noted. Mean±SD, t value, p value and comparison between groups were analysed by graph pad software.Results: At the end of 24 weeks difference in mean reduction of IOP was not significant with 6.2±1.85mm Hg (Right eye) and 5.55±1.68mm Hg (left eye) and 4.72±2.97mm Hg (Right eye) and 5.37±1.24mm Hg (left eye) in Group IA and Group IIA respectively. At the end of 24 weeks difference in mean reduction of IOP was not significant with 5.06±1.62mm Hg (Right eye) and 4.40±1.96mm Hg (left eye) and 4.30±1.41mm Hg (Right eye) and 4.12±2.08mm Hg (left eye) in Group IB and Group IIB respectively. Fall in both systolic and diastolic blood pressure in both the groups were significant. Both drug regimens were well-tolerated, and no serious drug-related adverse effects were reported.Conclusions: Dorzolamide was more efficacious for reduction of intra ocular pressure, well-tolerated, had low allergic response and had a favourable ocular, cardiovascular and respiratory safety profile than Timolol.