Non Hodgkin’s Lymphoma Misdiagnosed As Tuberculosis: A Case Report

Non-Hodgkin’s Lymphoma is a heterogeneous group of malignancies characterized by an abnormal clonal proliferation of T-cells, B-cells or both. Sometimes, tuberculosis and lymphoma presentation can share common symptoms and features. A 37-year-old male patient was admitted in the hospital with complains of shortness of breath associated with cough, loss of appetite, generalized weakness and weight loss since two months. There were no palpable peripheral lymph nodes present anywhere in the body. The patient had no personal or family history of tuberculosis. The chest X-ray showed bilateral mild pleural effusion with confluent radio opacities in both lung fields. Pleural fluid biochemistry showed increased Adenosine deaminase level with increased protein and low sugar. Antitubercular drugs were started after initial diagnosis of tuberculosis. After non improvement in symptoms fine needle aspiration cytology (FNAC) was done from spleen which showed finding suggestive of non- hodgkins lymphoma

A Prospective Study of Clinical Profile, Predisposing Factors and Management of Deep Venous Thrombosis

Introduction: Deep venous thrombosis (DVT) of lower limbsis one of the most common cause for the majority of deathscaused by pulmonary embolism. Deep vein thrombosis is theformation of blood clots in the deep veins which commonlyaffects the leg veins such as the calf veins, femoral vein, orpopliteal vein or veins of the pelvis. The aim of the studywas to evaluate clinical profile of patients in form of age,sex, etiological factors of deep venous thrombosis in ourinstitute. Also study risk the factors in patients of deep venousthrombosis.Material and Methods: Study was a prospective studywhich was conducted on 108 symptomatic patients of deepvein thrombosis which were proved by colour dopplerultrasonography. All patients who were more than 18 years ofage and either sex were taken into study.Results: In our study 37.03% of the patients were malesand 62,97% were females with majority belonging to 21-30 years of age group (33.82%). In this study the youngestpatient was 20 years old female and the oldest patient was96 years old female. Male: Female ratio was 1:1.7. The leastcommon age group affected is extreme of age i.e. ≥ 20 yearsand > 60 years of age in both sexes. The most common limbaffected is left lower limb 62 patients (57.40) and right limbinvolvement is seen in 39.81% of patients. Bilateral lowerlimb DVT is present in two patients and one patient was upperlimb DVT. Predisposing factors associated with thrombosisin deep veins maximally seen in 46 patients in 42.59% due tounknown cause. Pregnancy and post-partum was the secondmost common predisposing factor associated with DVTwhich is seen in 33 patients in 30.55%. Thrombosis due toorthopaedic trauma is seen eight patients only. Chronic illnessand malignancy was present in 19.44% of patients.Conclusion: It is very important for accurate diagnosis ofDVT to prevent potentially fatal complications like pulmonaryembolism (PE) and pulmonary hypertension. Also it is veryimportant to avoid anticoagulants therapy with associated riskof bleeding in patients of misdiagnosed and negative colourdoppler findings. Because clinical features are nonspecific;hence new strategies were evolved for diagnosing thiscondition.

Role of adenosine deaminase in monitoring tubercular pleural effusion

Background: Tuberculosis is a common cause of pleural effusion especially in countries like India. ADA (adenosine deaminase) is predominantly an enzyme, that catalyses the conversion of adenosine to ionosine. Usually patients with tuberculous pleural effusion have ADA level >40 U/L.Methods: This is a prospective, observational study conducted in Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati from September 2016 to September 2017. 45 patients with pleural fluid ADA levels >40 U/L were selected with diagnosis of tubercular pleural effusion. Pleural fluid was analysed for cytological, biochemical and microbiological parameters along with ADA and malignant cell cytology. Anti-tubercular treatment (ATT) was started and pleural fluid ADA level were repeated after 15 days of ATT.Results: Pleural fluid ADA levels before the start of ATT intake and after 15 days of ATT intake were statistically analysed. Among 45 patients, 38 were male and 7 females. Mean age of the patients was 45.42±16.43 years. Mean pleural fluid ADA level before starting ATT was 64.49±31.78 U/L. After 15 days of ATT intake mean pleural fluid ADA level was 36.11±10.42 U/L, p value was statistically significant (p<0.05).Conclusions: Pleural fluid ADA significantly decreased after 15days of initiation of anti-tubercular treatment. Pleural fluid ADA can be a useful tool as a follow up biomarker in cases of tubercular pleural effusion

A questionnaire-based study on knowledge and attitude towards counterfeit medication among the doctors in tertiary care hospital

Background: Counterfeit drugs are a global problem and suffered almost all developing and developed countries worldwide. In India, it is a major problem which results life threatening issues as well as financial loss on health system. So, we conducted a cross sectional questionnaire-based study on knowledge and exposure to counterfeit drugs of doctors at SHKM Govt. Medical College, Nuh, Haryana, India.Methods: A structured questionnaire was distributed to 100 registered doctors. The questionnaire was based on knowledge, attitude and its consequence on the heath system by the practices of counterfeit medication.Results: There were Twenty questionnaires excluded from the study due to incomplete information. Only 57.77% (46/80) subjects having the knowledge of questionnaire correct meaning of counterfeit drug. However, almost 90% (72/80) subjects were aware about its dangerous effects. More than 50% of the subjects have suggested that modern technology is capable to control counterfeiting of the medicine.Conclusions: Counterfeit drugs create a people health hazard and waste to consumer income. The proper knowledge, awareness and modern technological approaches are the devices may helpful in diminution of counterfeit medication practices.

Evaluation of vitamins/tonics prescribing pattern in tertiary care teaching hospital and private sector

Background: Rational use of drugs had been great concern by the government as well as public during the past several years. Monitoring of prescriptions studies could identify the associated problems and provide feedback to the prescribers, so as to create awareness about the irrational use of drugs. This study was conducted to evaluate the prescribing pattern of Vitamins/Tonics in government sector and private sector.Methods: This prospective study was designed to obtain statistical data on the prescribing pattern of Vitamins/tonics in patients of S.V.B.P. Hospital Meerut and other associated hospital/ clinics. The total study sample size was of 614 prescriptions. Out of these 439 prescriptions were from government sector, 175 prescriptions from private sectors.Results: Percentages of prescription with Vitamins/ Tonics were 35.76 and 48.57 in government and private sectors respectively and these differences are statistically significant. Percentage of drug prescribed as Vitamins/ Tonics of the total drugs was 8.68 and 10.19, in government and private sector respectively and these differences are statistically not significant. Vitamins/ Tonics were the most frequently prescribed drugs 16.52% and 17.14% in obs./ Gynae in both the sectors respectively, and least number of Vitamins/ Tonics 1.06% and 3.2% were prescribed in cardiology in both the sectors.Conclusions: The study indicates a big scope for enhancing the prescribing pattern of Vitamins/Tonics and minimizing the use of irrational Vitamins/Tonics, due to the fact most of the times it抯 not needed, and it only put financial burden on Patients.

Effect of lamotrigine, levetiracetam & topiramate on neurobehavioural parameters & oxidative stress in comparison with valproate in rats.

Background & objectives: Though newer antiepileptic drugs are considered safer than conventional antiepileptics, the effects of lamotrigine, levetiracetam and topiramate on neurobehavioural functions are yet to be established. This study evaluated neurobehavioural parameters and oxidative stress markers in brain tissue of rats treated with lamotrigine, levetiracetam and topiramate compared to sodium valproate . Methods: Five groups of male Wistar rats were treated respectively with normal saline (control), sodium valproate (370 mg/kg), lamotrigine (50 mg/kg), levetiracetam (310 mg/kg) and topiramate (100 mg/kg) for 45 days. Neurobehavioural parameters were assessed using elevated plus maze (EPM), actophotometer, rotarod, passive avoidance and Morris water maze (MWM) at baseline and at the end of treatment. Oxidative stress parameters [malondialdehyde (MDA), reduced glutathione (GSH) and superoxide dismutase (SOD)] were estimated in rat brain at the end of treatment. Results: Valproate and lamotrigine showed no significant effect on learning and memory in passive avoidance and MWM tests. However, levetiracetam and topiramate reduced retention memory significantly as compared to control (P<0.01) and lamotrigine (P<0.05) groups. Performances on EPM, rotarod and actophotometer were not significantly different between the groups. In comparison to control group, MDA was higher in the levetiracetam and topiramate (360.9 and 345.9 nmol/g of homogenized brain tissue, respectively) groups. GSH and SOD activity were significantly reduced by valproate and levetiracetam treatment. Lamotrigine did not induce significant oxidative stress. Interpretation & conclusions: Long-term and therapeutic dose treatment with levetiracetam and topiramate significantly impaired learning and memory, which was not seen with valproate and lamotrigine in rats. Levetiracetam, topiramate and valproate augmented oxidative stress, whereas lamotrigine has little effect on it. These antiepileptic drugs are used in clinical practice, hence pharmaco- vigilance studies are required to evaluate their safety profile.

Lesions of Tongue : A Five Year Experience.

Context: Tongue lesions are quite common and affect both genders and all age groups. However, very few studies concentrate on the histopathological spectrum of tongue lesions, usually including them as a part of oral cavity lesions. No such study has been published from the newly formed state of Uttarakhand. Aim: A retrospective review of histopathology of various types of tongue lesions in different age groups of both genders, amongst cases reported in the department of pathology. Methods and Materials: Study included a total of 121 cases of tongue lesions reported in the histopathology section over a duration of five years, from July 2004 to June 2009. Result: In this study, the most common lesions were malignant (58.7%), followed by benign lesions (33%) and pre-malignant lesions (8.3%). The most common site for tongue lesions was base of tongue (52.8%). Common age groups affected were 41- 50 years (27.2%) and 51-60 years (28.0%). The most common clinical presentation was growth and induration. Overall males were affected more than females; with Male:Female ratio of 3.3:1. Conclusions: The commonest tongue lesion in this study was moderately differentiated squamous cell carcinoma among the malignant lesions whereas chronic inflammation was the commonest out of non-malignant lesions. Tongue may show some less common tumours like schwannoma and hemangioma etc.

Modified Approaches for Colon Specific Drug Delivery System: A Review.

The colon is a site where both local and systemic delivery of drugs can take place. Local delivery allows topical treatment of inflammatory bowel disease. However, treatment can be made effective if the drugs can be targeted directly into the colon, thereby reducing the systemic side effects. This review mainly describes the primary approaches for CDDS (Colon Specific Drug Delivery) namely prodrugs, pH and time dependent systems, and microbially triggered systems, which achieved limited success and had limitations as compared with newer CDDS namely pressure controlled colonic delivery capsules. Oral administration of different dosage forms is the most commonly used method due to flexibility in design of dosage form and high patient acceptance, but the gastrointestinal tract presents several formidable barriers to drug delivery. In oral colon-specific drug delivery system, colon has a large amount of lymphoma tissue (facilitates direct absorption in to the blood), negligible brush boarder membrane activity, and much less pancreatic enzymatic activity as compared with the small intestine. Colon-specific drug delivery has gained increased importance not just for the delivery of the drugs for treatment of local diseases associated with the colon but also for its potential for the delivery of proteins and therapeutic peptides. Different approaches are designed based on prodrug formulation, pH-sensitivity, time-dependency (lag time), microbial degradation and osmotic pressure etc to formulate the different dosage forms like tablets, capsules, multiparticulates, microspheres, liposomes for colon targeting. The delivery of drugs to the colon has a number of therapeutic implications in the field of drug delivery. In the recent times, the colon specific delivery systems are also gaining importance not only for local drug delivery of drugs but also for the systemic delivery of protein and peptide drugs. This review updated the research on different approaches formulation and evaluation of colon-specific drug delivery.

Gum Arabic Enhances Paracellular Transport of Water in Amphibian Everted Small Intestinal Segments.

Gum Arabic (GA) is known for its proabsorbent activity in normal intestine as well as in animal models of diarrhea. The aim of the study was to find the effect of GA on intestinal transport of water and possible route of absorption in frog everted gut sacs. D-Mannitol was used as a marker of paracellular transport to find the route of absorption. Everted gut sacs (n=4,5) were placed in Ringer containing GA (2.5 g/L) with or without D-Mannitol (0.5 g/L), incubated for 1 hour and analysed for change in weights of the sacs and D-Mannitol uptake. There was significant increase in uptake of water and D-Mannitol in the presence of GA compared to controls (P<0.05).Gum Arabic improves water uptake by the intestinal mucosa, possibly by opening the paracellular pathways.

Myocardial Infarction Associated with Plasmodium Falciparum Malarial Infection.

Cardiac functions are almost well preserved in malarial infection. We report a rare case with fatal complication of myocardial infarction in patient with delayed diagnosis of Plasmodium falciparum infection. The authors therefore, suggest that every case of fever especially if associated with risk factor for cardiovascular disease should be immediately investigated for malaria so as to prevent this grave complication. This is even more important for people living in malarial endemic areas.

Antioxidant potential of the root of Vetiveria zizanioides (L.) Nash.

Vetiveria zizanioides, an aromatic plant commonly known as vetiver has been used for various ailments. The essential oil of vetiver root has been shown to possess antioxidant activity. However, antioxidant potential of spent root extract has not been reported. Hence, in the present study, ferric reducing, free radical scavenging and antioxidant activity of two genotypes namely KS1 and gulabi of V. zizanioides L. Nash root were investigated using in vitro assays - the ferric reducing antioxidant power (FRAP), 1,1-diphenyl-2-picrylhydrazyl (DPPH), total phenolic content (TPC), total antioxidant capacity (TAC) and reducing power (RP). KS1 genotype showed higher FRAP values, DPPH inhibition, TPC and RP potential compared to gulabi and the antioxidant activity increased with the concentration of the extract (10-1000 microg/mL). A significant protective effect of cv KS1 (100 microg/mL) extract was also observed in reduced glutathione (GSH) and malondialdehyde (MDA) concentrations of erythrocytes subjected to oxidative stress by tert-butyl hydroperoxide (t-BHP) and hydrogen peroxide (H202). The cv KS1 showed better antioxidant activity, compared to cv gulabi indicating the possibility of exploring the presence of different phytoconstituents in the two varieties.

Effect of oral glutamine administration on oxidative stress, morbidity and mortality in critically ill surgical patients.

OBJECTIVE: To examine the effect of enteral administration of glutamine in patients with peritonitis or abdominal trauma. METHODS: In a prospective, interventional, observer-blind, randomized clinical trial, 120 patients, aged 18-60 years, were randomized to receive either enteral glutamine 45 g/day for 5 days in addition to standard care (n=63; group A) or standard care alone (n=57; group B). Surgical intervention was done as needed. RESULTS: The two groups were comparable for sex and severity of illness scores. Following treatment, serum malondialdehyde (MDA) levels in group A increased from 4.4 (8.0) to 7.2 (4.8) mmol/mL, whereas those in group B decreased from 3.9 (4.9) to 3.1 (5.0) mmol/mL; these changes were not statistically significant. Reduced glutathione levels increased from 0.03 (0.04) to 0.06 (0.12) mg/g Hb (p=0.032) after treatment in group A and from 0.03 (0.03) to 0.05 (0.04) mg/g Hb (p=0.001) in group B. Infectious complications were equally frequent in the two groups (group A: 44; group B: 37; p=0.571). Survival rate and duration of hospital stay were also comparable in the two groups. CONCLUSION: Enteral glutamine supplementation offers no advantage in patients with peritonitis or abdominal trauma.

Angioplasty of degenerated saphenous vein grafts--role of covered stents.

To study the safety and efficacy of covered stents in angioplasty of saphenous vein grafts a retrospective study was carried out among 12 consecutive cases admitted at the cardiology unit of Nizam's Institute of Medical Sciences during last 3 years. Angioplasty of saphenous vein grafts is a challenging task due to the different nature of the disease in vein grafts compared to the native coronary arteries. The lesions in vein grafts are more often diffuse and have considerable loose atherothrombotic material that is prone for distal embolisation, resulting in slow flow/no reflow and myocardial damage. Use of covered stents for saphenous vein grafts appears to be feasible and safe.

Assessment of trace elements leaching of coal combustion residues from Bokaro Thermal Power Station.

The leaching behaviour of coal combustion residues (CCRs) viz. fly ash, bottom ash and pond ash from Bokaro Thermal Power Station (BTPS), Jharkhand was investigated by open column percolation experiment. The study aims to determine the long-term leaching of trace/ heavy elements CCRs from BTPS. The results ofpotentiometric analysis ofleachates reflected that CCRs are slightly acidic to alkaline but overall on the long-term basis these are alkaline in nature. From the long-term leaching study of approximately two years, it has been revealed that of the twenty three elements those were analysed by open column percolation experiments, only Ca, Mg, Na and K were found to be leaching throughout the study period though their concentrations reduced considerably with time. Other elements such as Mn, Fe, Cu, Zn, Pb found to leach at significant concentration levels for sometime but found to be absent on long-term basis. Elements such as As, Cr, Cd, Ni, Al, Co, B etc. were not found in the leachate. Conclusion of this study is that CCRs from BTPS are environmentally benign with respect to leaching of trace elements.