A comparative histological analysis of early and late graft dysfunction in different time zones following living donor liver transplantation

Background: Liver biopsy plays a crucial role in evaluating allograft dysfunction. Comprehensive analysis of the histological spectrum of complications, particularly rejection, in different time zones is lacking. Aim: To evaluate the histological spectrum of rejection, in four time zones, in a large Living donor liver transplant series. Patients and Methods: Retrospective analysis of 313 biopsies for the last 10 years of living donor liver transplantation (LDLT) recipients. 123 of which had rejection as diagnosis, were redistributed in four time zones [1-early (<3), 2-intermediate (3–6), 3 and 4-late (6–12 and > 12) months] and were assessed for sixteen histological parameters. Results: Biopsies in time zone 1 (26.5%), 2 (20.7%), 3 (24.6%), and 4 (28.1%)] were nearly equal. Multiple coexistent complications existed in 12% of the cases. Rejection diagnosed in time zone groups: 1 = 22 (17.9%), 2 = 27 (22%), 3 = 36 (29.3%), and 4 = 38 (30.9%). Portal inflammation mixed type (P < 0.000), portal vein (P = 0.001) and hepatic vein endothelialitis (P < 0.000), portal eosinophils (P = 0.001), and lymphocytic bile duct damage (P = 0.01) were most pronounced in group 1. Perivenulitis without hepatic vein endothelialitis was observed (P = 0.03) in groups 3, whereas bile duct atypia (P = 0.01) and duct loss (P < 0.000) were observed in group 4. Multiple episodes of rejection displayed significant association with central perivenulitis (P = 0.002) and bile duct loss (P < 0.001). Conclusions: Histological analysis in large series of LDLT recipients highlights the spectrum of complications in different time zones. Late acute and chronic rejection occurred as early as 3 months posttransplant. Central perivenulitis and bile duct atrophy were associated with repeated episodes of rejection and deterioration.

A study on prescription pattern and safety profile of antimicrobial agents in medicine department of tertiary care hospital

Background: Antimicrobial agents (AMAs) are an integral part of management of diseases in the department of general medicine, and a wide range of antimicrobials are used for prevention, prophylaxis, or treatment of various infectious diseases. Systematic studies regarding the pattern of AMAs use may help in improving the quality of patient care by evidence-based practices and also in formulating effective antimicrobial usage guidelines. Aim and Objectives: The objectives of this study were as follows: (i) To analyze the prescribing trends of Antimicrobials in Medicine wards of a Tertiary Care Hospital; (ii) to assess safety profile of AMAs; and (iii) to analyze extraneous factors influencing AMAs prescription. Materials and Methods: The prospective analysis of Antimicrobial prescriptions of Medicine wards for the period of July 2018–August 2019. The class of AMAs, formulation, dose, route of administration, frequency, and duration of administration and their safety was assessed using the WHO indicators. Results: The most frequently used AMAs were third generation cephalosporin (Ceftriaxone) and it was frequently combined with metronidazole. The choice of initial AMAs was empirical, which was later changed depending on the clinical response. The AMAs were effective in preventing or controlling infections and well tolerated without any serious adverse reactions or drug interactions. Conclusions: The rational use of AMAs is necessary to control worldwide emergence of antibacterial resistance, side effects, and to reduce the cost of treatment.

The Great Imitator - Disseminated Tuberculosis Presenting as Baker’s Cyst: A Case Report

@#Tuberculosis is known to be a great mimicker, and it can present in a myriad of ways, which often result in an incorrect diagnosis. In a country that is endemic to tuberculosis, the presentation can take many forms ranging from tumour to trauma. We present a case of Baker’s cyst that was provisionally diagnosed as pigmented villonodular synovitis (PVNS) of the knee and eventually turned out to be tuberculous arthritis. A 46-year-old male presented with an insidious swelling on the posterior aspect of his knee for one year. Magnetic resonance imaging was suggestive of PVNS as the likely diagnosis. The patient presented 21 days later with a foot drop. On following-up with further investigations, he was found to have a lesion at the level of the L4-L5 spine. Chest radiograph changes were suggestive of tuberculosis. A synovial biopsy of the knee was done, and the tuberculosis culture report was positive. The patient was started on anti-tubercular treatment and then operated on, with arthroscopic synovectomy and posterior open cyst excision. The histology report was positive for tuberculous synovitis. The patient completed the course of antitubercular drugs and had physiotherapy. He demonstrated a clinically and radiologically healed disease at the final follow-up with a good functional outcome. Clinicians must have a high index of suspicion for tuberculosis, especially in endemic areas. Getting a chest radiograph is recommended in every case. Early diagnosis with the appropriate treatment will give a good functional outcome for the patient.

Design And Development Of Nanostructured Lipid Carrier Containing Triamcinolone Acetonide

Objective: The aim of present study was to prepare nanostructured lipid carriers (NLCs) based Triamcinolone acetonide (TA). Methods: Nanostructured lipid carriers (NLCs) consisted of solid lipid and liquid lipid are a new type of lipid nanoparticles, prepared by using solvent diffusion and high pressure homogenization methods, which offer the advantage of improved drug loading capacity and release properties. Glyceryl monostearate selected as the solid lipid, capmul MCM C8 as the liquid lipid, polyvinyl Alcohol (PVA) as the surfactant. NLCs dispersion was characterized by particle size analysis, zeta potential, scanning electron microscopy (SEM), differential scanning calorimetry, and an in vitro release study. Results: Optimized NLCs loaded with TA were exhibited spherical shape with particle size 286.1 nm, polydispersity index 0.317, zeta potential-21.9 mV and entrapment efficiency 86.19% respectively. The result of differential scanning calorimetry (DSC) showed that drug was dispersed in NLCs in a crystalline state. In vitro release studies revealed that drug release of optimized batch was 8.34 % and 88.84% at 1h and 8h respectively. The release kinetics of the optimized NLCs best fitted the peppas-korsmeyer model. Furthermore, morphological investigations by SEM showed that optimized batch exhibit a spherical shape and a smooth surface. Conclusion: Thus, the results indicated that successfully prepared TA-loaded NLCs and could potentially be exploited as a carrier with improved drug loading capacity and sustained drug release. The present results demonstrated that these systems could be a promising platform for inflammatory diseases, in particular for psoriasis topical therapy.

An unusual case of hepatic lymphoma with multiple epithelial malignancies

Primary hepatic mucosa-associated lymphoid tissue lymphoma (MALToma) is a rare entity. Its coexistence with other malignancies is even rarer. Only few case reports of its association with other malignancies mostly gastric and colon cancer have been published. We report a case of primary MALToma of liver in an unusual setting of dual solid malignancy.

Oral Hygiene status of Leprosy Patients from Raichur district, South India

Patients with leprosy may not be commonly reporting to the dental professionals. This study describes the oral hygiene status of the leprosy patients from a developing district of South India. A descriptive crosssectional study was conducted to assess the oral hygiene status of leprosy patients in Raichur district, Karnataka. A total of 225 patients were examined during 2012 as a part of the study. These are patients who registered at Raichur and Mudgal leprosy centres during this period for leprosy treatment. Oral Hygiene Index – Simplified was recorded according to the criteria given by Greene and Vermillion in 1964. Data was analyzed using SPSS version 16.0 software package. Male : female ratio was 2:1 and age of these patients ranged from 6-80 years, mean 33.25 ± 15.49 years. The mean Debris Index-Simplified score was 1.94 ± 0.66; mean Calculus Index-Simplified score 2.08 ± 0.64 and the mean Oral Hygiene Index-Simplified score was 4.02 ± 1.22. Percentage of leprosy patients with poor oral hygiene increased with increasing age. There was also association with habits of pan chewing, smoking, alcohol use and cleaning practice of not using tooth brush or neemstick. No relationship could be found with broader classification of leprosy, socio-economic status and other parameters. Patients with good and fair oral hygiene reported of lower dental problems than those with a poor oral hygiene. Lack of association with socioeconomic status and type of leprosy suggests a general awareness problem but this issue deserves in depth studies. The current study among leprosy patients in Raichur district is the first kind of study from this area which highlights the poor plight of these patients with respect to their oral hygiene status. Periodic surveys and interventions in terms of awareness campaigns among the leprosy patients as well as care providers and community in general will be useful. Orientation of health systems accordingly will be required to bring desired changes in the situation.

Potential of Microbispora sp. V2 as biocontrol agent against Sclerotium rolfsii, the causative agent of southern blight of Zea mays L (Baby corn)–in vitro studies.

The study was undertaken with the aim of exploring novel and beneficial agro activities of rare actinomycetes like Microbispora sp. V2. The antagonistic activity of Microbispora sp. V2 was evaluated as a biocontrol agents against Sclerotium rolfsii, a soil-borne fungal plant pathogen. The methodology performed for evaluation of biocontrol agent was in vitro evaluation assay which comprised of three tests viz., cellophane overlay technique, seed germination test and Thiram (fungicide) tolerance of Microbispora sp. V2. The isolate was found to inhibit the fungal pathogen Sclerotium rolfsii to 91.43% in cellophane assay. In seed germination assay, Microbispora sp. V2 treated seeds resulted in 25.75% increased germination efficiency, as compared to seeds infected by Sclerotium rolfsii. The isolate Microbispora sp. V2 could tolerate 1000 µg mL-1 of Thiram (fungicide). The in vitro assay studies proved that Microbispora sp. V2 can be used as antifungal antagonist and thus posses’ great potential as biocontrol agent against southern blight caused by Sclerotium rolfsii in Zea mays L (Baby corn) which causes large economical losses.

Design and Development of Ultrasound-based Wheelchair.

A wheelchair is a most commonly used machine in hospitals for patients, mainly those patients who cannot move or walk or who work with great difficulty. A patient on wheelchair has to depend on another person required to control the motion and direction of the wheelchair to avoid obstacles on their path since the patient is not in a condition to control the wheelchair himself. This makes the patient on the wheelchair dependant.1 The prototype of ultrasound-based wheelchair allows patient on the wheelchair to be self-dependant and the wheelchair itself controls the motion by avoiding obstacles in its path. This wheelchair is mainly designed for handicapped people (blind, limp patients mainly) for their domestic purposes. Ultrasoundbased wheelchair avoids obstacles on its path using ultrasound sensors.2 Once an obstacle is detected, the microcontroller gives signal to the motors of the wheel to perform appropriate actions as per the developed algorithm. The designed prototype causes no inconvenience to the patient and allows patient to move within the house or a specified hospital environment. The design cost of ultrasound-based wheelchair prototype is Rs 7000.

Can combination metronomic therapy overcome chemoresistance in cholangiocarcinoma: A literature review.

Cholangiocarcinoma (CCa) is relatively resistant to chemotherapy as well as radiation therapy, and complete resection is the main curative therapy for these patients. The prognosis for patients with unresectable intrahepatic CCa (iCCa) is extremely poor. A 55‑year‑old woman presented at our hospital with abdominal pain. After evaluation, she was diagnosed to have multifocal iCCa. She did not opt for standard chemotherapy and therefore received oral metronomic therapy with a combination of celecoxib, etoposide, and cyclophosphamide for a total of 30 months. Presently, she is 57 months post diagnosis and 27 months post cessation of all treatment and continues to be in complete radiological remission. In the present report, we review the literature and discuss whether metronomic scheduling of biologic agents and anticancer drugs will be able to overcome chemoresistance and improve the outcome in cholangiocarcinoma. References for the review were identified through searches of Pubmed for the last 10 years as well as searches of the files of the authors themselves. The final list was generated on the basis of originality and relevance to this review.

Assessment of local anesthetic activity of lignocaine by simultaneous administration of potassium channel agonists nicorandil in albino rats.

There are reports about a possible weak local anaesthetic activity of nicorandil, a potassium channel agonist (PCA). In addition, modification of local anesthetic activity of lignocaine by PCA is not clearly defined. The objective of the present study is to evaluate local anesthetic activity of nicorandil and to evaluate the influence of nicorandil on the efficacy and duration of local anesthesia by lignocaine. A total number of 84 albino rats of either sex were divided into 14 groups of 6 animals each. Two methods, sciatic nerve blockade and tail clip method were applied for the study. Control group received 0.2ml normal saline, whereas the study group received 0.2ml of 1% drug solution (lignocaine or nicorandil) combined with 0.9% sodium chloride. The results showed weak local anaesthetic activity with the higher dosages of nicorandil (10 mg/kg, 100mg/kg). Combination of nicorandil (1mg/kg, 10mg/kg and 100mg/kg) and lignocaine (5mg/kg) yielded synergistic results like decreased onset latency and prolonged reaction time. To conclude unquestionably there are multiple mechanisms involved for causation of local anesthetic effect by drugs like lignocaine. PCAs like nicorandil will influence the activity of these drugs as observed in the present study. Mechanism of this may be complex. Nicorandil may increase the plasma membrane permeability to potassium causing hyper polarization and moves the membrane potential away from the threshold required to generate an action potential.

Fatal rabies despite post-exposure prophylaxis.

Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.

Quantitative Analysis of Gallstones in Libyan Patients

Gallstone disease is one of the major surgical problems in the Libyan population; it is probably related to diet; especially excessive consumption of meat. The study was conducted to determine the composition of gallstones and their possible etiology in a Libyan population. The chemical composition of gallstones from 41 patients (six males and 35 females) was analyzed. The stones were classified into cholesterol; pigment; and mixed stones (MS). Cholesterol stones (CS) showed a significantly higher cholesterol content than pigment stones (PS) (p=0.0085) though not significantly higher than MS. Their phospholipid content and inorganic phosphates were higher than in the other types of stones and oxalate content was significantly elevated in comparison with MS (p=0.0471). In MS; the cholesterol; bile acids; and bilirubin were intermediate between cholesterol and PS; whereas triglycerides were significantly more than PS (p=0.0004). Bilirubin (0.0001) and bile acids (p=0.0009) were significantly higher than CS (p=0.0001). However; they contained the lowest amounts of sodium; potassium; magnesium; and oxalate. In PS; bilirubin (p=0.0001) was significantly higher than both groups. Bile acid content was significantly higher than CS (p=0.0001) but not significantly more than MS. They showed the highest values of calcium; sodium; potassium; magnesium; and chlorides compared to the other types of stones. High levels of cholesterol in stones and dyslipidemia associated with mixed as well as cholesterol gallstones suggest an etiological association and efforts to reduce dietary fat among the Libyan population may lead to decreased cholesterol and mixed gallstones

Primary malignant melanoma of left buccal mucosa with metastasis in thyroid: a case report.

Primary oral malignant melanomas are rare with an incidence of .2 to 8% of all melanomas. Less than 1% of them arise on buccal mucosa. Grossly they arise as a black macule with irregular borders & are commonly of mucosal lentiginous type. They appear at a higher stage and are aggressive with a 5 yr survival rate of 10-25%. 39% of metastasis in thyroid occur from skin (melanomas) and melanomas produce a thyroid mass while the original source remains occult. We report a case of oral malignant melanoma of left buccal mucosa for its rarity and its spread to cervical lymph nodes and thyroid.

Transcutaneous absorption of oil in preterm babies--a pilot study.

This study was conducted to determine transcutaneous absorption of oil in preterm neonates. A mixture of coconut oil and Meadowfoam oil which contains unique fatty acids, which acted as marker fatty acids was applied to the skin of babies. One mL blood was collected before and one hour after post oil application. Both pre and post oil application serum samples were hydrolysed and derivatised with 2-phenyl hydrazine hydrochloride in order to detect fatty acids by HPLC analysis on C-8 column. None of the pre oil application serum sample showed the presence of the marker fatty acids. The post oil application serum sample of all the 12 babies showed the presence of marker fatty acids of Meadowfoam oil which indicates transcutaneous absorption of oil in preterm babies.

Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women.

AIMS OF STUDY: To study effect of yoga on the physiological, psychological well being, psychomotor parameter and modifying cardiovascular risk factors in mild to moderate hypertensive patients. METHODS: Twenty patients (16 males, 4 females) in the age group of 35 to 55 years with mild to moderate essential hypertension underwent yogic practices daily for one hour for three months. Biochemical, physiological and psychological parameters were studied prior and following period of three months of yoga practices, biochemical parameters included, blood glucose, lipid profile, catecholmines, MDA, Vit. C cholinesterase and urinary VMA. Psychological evaluation was done by using personal orientation inventory and subjective well being. RESULTS: Results showed decrease in blood pressure and drug score modifying risk factors, i.e. blood glucose, cholesterol and triglycerides decreased overall improvement in subjective well being and quality of life. There was decrease in VMA catecholamine, and decrease MDA level suggestive decrease sympathetic activity and oxidant stress. CONCLUSION: Yoga can play an important role in risk modification for cardiovascular diseases in mild to moderate hypertension.

Renal artery involvement in patients of coronary artery disease undergoing coronary angiography--a prospective study.

METHODS: We prospectively studied the angiographic incidence of renal artery stenosis in 1000 consecutive patients who underwent coronary angiography for clinically suspected coronary artery disease since December, 1998. Selective renal arteriography was performed in all the patients (mean age 57 years, 74.6% males) after coronary angiography. RESULTS: Systemic arterial hypertension was present in 52%, 29.1% were smokers, 21% had diabetes and 31.2% had hypercholesterolemia. Significant coronary artery diseases was found in 849 (84.9%) patients. Of the total patient cohort, 103 (10.3%) patients had renal artery disease; 78 (7.8%) had insignificant stenosis (> 50%) and significant renal artery stenosis (< 50%) was identified in 25 (2.5%) patients. Three had bilateral renal artery stenosis. Comparisons were made between renal artery stenosis and risk factor profile. There was no statistically significant association between renal artery stenosis and parameters like diabetes mellitus, hypertension, smoking, lipid levels and serum creatinine. CONCLUSION: In our study, the absolute number of cases with significant renal artery stenosis is small, so no statistical analysis could be performed to demonstrate the relationship of presence of renal artery stenosis with severity of CAD. However patients with severe coronary artery disease or having multiple risk factor showed a trend towards increased prevalence of renal artery stenosis, hence renal angiography should be done for this subset of patients.

Effect of yogic practices on subjective well being.

Forty eight healthy volunteers who participated in the practice of yoga over a period of 4 months were assessed on Subjective Well Being Inventory (SUBI) before and after the course in order to evaluate the effect of practice of yoga on subjective feelings of well-being and quality of life. A significant improvement in 9 of the 11 factors of SUBI was observed at the end of 4 months, in these participants. The paper thus, reiterates the beneficial effects of regular practice of yoga on subjective well being.

An investigation into the effect of solidification shrinkage on distortion of casting and flexure strength of various solders for base metal alloys. A laboratory study.

This study was undertaken to determine the distortion due to solidification shrinkage and to evaluate the flexure strength properties of soldered joints between combination of three commercially available base metal alloys and solders. Ninety rectangular bars were cast using three commercially available alloys for soldering (30 bars of each alloys). Ten bars of each alloy were soldered using electrical soldering unit and solder recommended by respective manufacturers, twenty bars (ten pairs each) were soldered using other solders. Length between the references markings on the specimen were measured using a vernier caliper and travelling microscope to check the possible solidification shrinkage. The specimens were then subjected to flexure strength evaluation using a universal testing machine. Statistical comparison of dimensional changes due to solidification shrinkage and flexure strength evaluation of soldered joints was done using analysis of variance test. Recommended Ni-Cr solders showed less shrinkage compared to that of the Co-Cr solders from the tested specimens and superior flexure strength was found in Co-Cr alloy specimen (P value P > .001) soldered with Co-Cr alloy solders.

Medical and socio-economic aspects of long term therapy of open angle glaucoma.

Hundred patients of open angle glaucoma (OAG) who were on any one of the three drugs pilocarpine, timolol and epinephrine--for an average period of 3.3 years were chosen. Proforma regarding socio-economic status and the patients' reaction to long-term medication were recorded. Though the objective and subjective effects of long term medication were negligible the financial constraints were considerable. More than 70% patient would prefer laser's and surgery because of the cumbersome schedule and financial burden. The visit to the clinic was a time consuming process suggesting a lack of adequate glaucoma follow-up at the peripheral level. The study reflects a need for reorientation of glaucoma management.