Case report of a successful term pregnancy following renal transplantation

Pregnancy with renal disease is associated with high risk for both mother and fetus with adverse outcomes. Criteria for considering pregnancy in renal transplanted patients include good post-transplant health for 2 years, stable allograft function with a serum creatinine <1.5 mg/dl, absence of rejection, control of blood pressure, absence of proteinuria. Authors report a case of 26-year-old, primigravida had renal transplantation done in NRI Medical College and treated with immunosuppressive therapy with tablets Tacrolimus 1mg twice daily, Azathioprine 50mg twice daily, Prednisolone 10mg once daily and continued till delivery. Developed gestational hypertension treated with tablet Amlodipine 5mg once daily. Elective caesarean section done for contracted pelvis. Post-natal period was uneventful and discharged on immunosuppressive therapy and contraceptive advice. Post-renal transplantation pregnancy should have multidisciplinary approach for. With close medical and obstetric follow up, successful outcome for both mother and infant is possible.

Enhanced S-cone syndrome: Clinical spectrum in Indian population

Purpose: Enhanced S-cone syndrome (ESCS), a rare disorder, is often misdiagnosed as other forms of retinal degenerations, which have a poorer prognosis than ESCS. The aim of this study is to report the varied clinical features of ESCS and distinguish it from other similar disorders. Methods: We retrospectively scrutinized the records of patients with confirmed diagnosis of ESCS and analyzed the findings. Results: We included 14 patients (age range 4–39 years) who were confirmed to have ESCS according to pathognomonic electroretinography (ERG) showing reduced photopic, combined responses, and 30 Hz flicker with reduced L, M cone responses and supernormal S cone responses. The disease presented in the 1st decade with night blindness and was almost stationary or minimally progressive. Mid-peripheral fundus changes in form of nummular pigmentary alterations, yellow punctate lesions, and macular schisis were noted. The vision ranged from 6/6 to 6/36 with follow-up ranging from 1month to 22 years. Conclusion: ESCS shows varied clinical features ranging from unremarkable fundus to pigment clumping and atrophic lesions. It has good prognosis with patients mostly maintaining their vision. ERG is diagnostic. More awareness and knowledge about this entity can help to differentiate it from other forms of night blindness.

A questionnaire based study on the knowledge, attitude and the practices of pharmacovigilance among the postgraduate students at a tertiary care hospital in south India

Background: Adverse drug reactions (ADRs) are common cause of morbidity in the practice of medicine. Pharmacovigilance is the science of detection, assessment and understanding and prevention of adverse effects or any drug related problems. Post graduates are perhaps the first to notice ADRs in outpatient/inpatient setup as they spend most of the time bedside. Thus, this study was conducted to assess the knowledge, attitude and practices (KAP) of postgraduates about Pharmacovigilance.Methods: A prevalidated and pretested questionnaire with 20 questions related to KAP of pharmacovigilance is administered to postgraduate students after obtaining their consent. All the completed and returned questionnaires were analysed for results using appropriate statistics.Results: 180 pretested questionnaires were distributed among postgraduates out of which, 122 were returned from postgraduates of all major medical and surgical allied departments. 90.2 % defined pharmacovigilance correctly, 83.6% thought reporting ADRs is a professional obligation, while only 65.6% knew regarding the existence of national pharmacovigilance program. 58.4% have experienced ADRs, of which only 24.6% reported ADR to pharmacovigilance centre. Major reasons for under reporting are lack of time to report and difficulty to decide whether ADR has occurred or not.Conclusions: In this study, the knowledge and attitude related to Pharmacovigilance is good amongst postgraduates, but practical implementation in reporting of ADRs is poor. Sensitization programs on pharmacovigilance practice in tertiary care hospitals and regular review meetings to ensure ADR reporting to pharmacovigilance centre will strengthen the health care setup.

Study of Surgical Management Varicose Veins in a Tertiary Care Institution

A total of 98 patients of both sexes aged between 30 and 65 years having varicose veins were studied with the involvement of 49 (50%) left leg, 41 (41.8%) right leg, and 8 (8.16%) both limbs were included in the study. The clinical manifestations were 27 (27.5%) had pain, 25 (25.5%) had dilatation of veins, 22 (22.4%) had ulceration, 8 (8.16%) had edema, 5 (5.10%) had itching and pigmentation, 6 (6.12%) had cramps, and 5 (5.10%) had heaviness legs. The occupation of the patients was as follows: 19 (19.3%) were farmers, 17 (17.3%) were shopkeepers, 21 (21.4%) were hotel/bar waiters (attenders), 14 (14.2%) were bus conductor, 16 (16.3%) were mason, and 11 (11.2%) were traffic police. The types of the involvement of venous system were 49 (50%) long saphenous venous system, 33 (33.6%) long saphenous and perforators, 9 (9.18%) had short saphenous system, and 7 (7.14%) had both long and short saphenous. The surgical procedures were 45 (45.9%) saphenofemoral flush ligation and ligation of constant tributaries, 33 (33.6%) ligation of perforator veins in addition to flush ligation, 6 (6.12%) ligation of saphenopopliteal flush ligation, 4 (4.08%) saphenofemoral and saphenopopliteal flush ligation with stripping of long and short saphenous vein, 8 (8.16%) flush ligation of saphenopopliteal with stripping of short saphenous, and 2 (2.04%) flush ligation of saphenopopliteal junction along with ligation of subfascial perforators.

Effects of IL-10 and glucose on expression of OPG and RANKL in human periodontal ligament fibroblasts

The effects of interleukin-10 (IL-10) and glucose on mRNA and protein expression of osteoprotegerin (OPG), and its ligand, receptor activator of nuclear factor-κB ligand (RANKL), were investigated in human periodontal ligament fibroblasts (HPDLFs). Primary HPDLFs were treated with different concentrations of IL-10 (0, 1, 10, 25, 50, and 100 ng/mL) or glucose (0, 5.5, 10, 20, 30, and 40 mmol/L). Changes in mRNA and protein expression were examined using the reverse-transcription polymerase chain reaction (RT-PCR) and Western blot analysis, respectively. After IL-10 treatment, mRNA and protein levels of OPG were increased, while mRNA and protein levels of RANKL were decreased (P<0.05), both in a concentration-dependent manner. Glucose stimulation had the opposite concentration-dependent effect to that of IL-10 on OPG and RANKL expression. IL-10 upregulated OPG expression and downregulated RANKL expression, whereas high glucose upregulated RANKL and downregulated OPG in HDPLFs. Abnormal levels of IL-10 and glucose may contribute to the pathogenesis of periodontal disease.

A study of correlation of expression of ER, PR and HER2/neu receptor status with clinico-pathological parameters in breast carcinoma at a tertiary care centre.

Background: In English literature it is documented that the expression of ER and PR is low in Asian countries when compared to that of Western countries. HER2/neu over expression is uniform throughout the world. Studies have shown that triple-negative breast carcinomas are aggressive, likely to spread beyond the breast and recur after treatment. Aims and objectives: To correlate the expression of ER, PR and HER 2/neu with clinico-pathological parameters in infiltrating ductal carcinoma and other variants of breast carcinoma. To determine the clinicopathological parameters in triple negative cases. Methods: This is a prospective study for a period of two years in the Department of Pathology, Andhra Medical College, a tertiary care centre. We received 111 mastectomy specimens during this period out of which 52 patients were funded under Arogyasri and were subjected for ER, PR, HER2/neu receptor study. Results: In the present study total cases analyzed were 52. Infiltrating ductal carcinoma was 41/52 (78.84%) and other variants were 11/52 (21.15%). In our institute infiltrating duct cell carcinoma (NOS) type was the commonest type of carcinoma breast with significant group occurring in less than 45 years of age, 95 % of women were multipara with two or more children and triple negative tumors being 54.83%.In infiltrating ductal carcinoma ER, PR positive expression has no association with age and size of tumor. Their expression was higher in grade 1 tumors 83.3%.The ER,PR negative expression was more in size of tumor being greater than 2 cm; (92.5%),positive lymph nodes (51.8%) and stage II and stage III tumors (96.2%). HER2/neu negative expression was seen in 51.61% of cases. Triple negative receptor expression was seen in 54.83% of infiltrating ductal carcinoma. In the English literature medullary carcinoma is negative for HER2/neu expression but in the present study in 2 cases the expression for HER2/neu was positive. Conclusion: In the present study significant group occurred in less than 45 years of age presenting in advanced stage of the disease. Triple negative cases were seen in 54.8% cases of infiltrating duct cell carcinoma indicating bad prognosis.

Application of Box-Behnken Design for the Optimized Production of Lactic Acid by Newly Isolated Lactobacillus plantarum JX183220 Using Cassava (Manihot esculenta Crantz) Flour.

Aim: The present study aimed at optimization of Lactic acid production using new isolate, Lactobacillus plantarum JX183220 with cassava flour (Manihot esculenta Crantz) in semi-solid fermentation by Response Surface Methodology. Study Design: Box-Behnken design of Response Surface Methodology was used. Place: Department of Chemical Engineering and Biotechnology, ANITS, Visakhapatnam. Materials and Methods: Lactobacillus plantarum JX183220 isolated from goat milk was used for the production of Lactic acid using cassava flour (CF) in semi-solid fermentation. Different fermentation parameters such as incubation time, inoculum volume, pH, temperature, substrate concentration (cassava flour), and Calcium carbonate concentration were initially optimized in preliminary studies. The substrate concentration, temperature and pH were chosen as potential variables and further optimized using Box-Behnken design of Response Surface Methodology. A second order polynomial regression model was fitted and was found adequate with a high coefficient of determination, R2 (0.9913). Validation experiment was carried out at optimum conditions of the parameters as determined from the model. Results: The preliminary experiments revealed that maximum production of lactic acid by Lactobacillus plantarum JX183220 was observed on 4th day of incubation with 2% inoculum and 0.3% Calcium carbonate. Optimization using Box -Behnken design of RSM resulted in maximum Lactic acid production of 18.3679 g/100 g of cassava at optimum conditions of substrate concentration, 1.225%; Temperature, 36.39°C and pH 6.43. These results were confirmed by validation experiment. Conclusion: Optimum parameters for the direct conversion of cassava flour starch to Lactic acid by new isolate, Lactobacillus plantarum JX183220 were determined. Box Behnken design of RSM was found to be convenient tool with 15 runs for optimizing lactic acid production. The lactic acid production could be further enhanced by saccharification and fermentation in future studies.

A Rare Clinical Presentation of Primary Pulmonary Hypoplasia with Tuberculous Pleural Effusion.

Primary pulmonary hypoplasia is rare in adulthood. It is characterized by decreased number or size of bronchi, vessels and alveoli. We present a case of unilateral pulmonary hypoplasia in 44-old-year male smoker who presented with right pleural effusion. His chest X-ray revealed an inhomogenous opacity on the left side with bronchiectatic changes and right minimal pleural effusion. Fiberoptic bronchoscopy revealed blind end bronchi in left upper lobe and computed tomography pulmonary angiography revealed hypoplastic lung with cystic bronchiectasis on the left side and hypoplastic left pulmonary artery. It was not associated with any other congenital anomalies. In addition to symptomatic management, he was started on anti-tuberculous treatment for tuberculous pleural effusion and kept under follow-up.

Grass pea consumption & present scenario of neurolathyrism in Maharashtra State of India.

Background & objectives: Neurolathyrism is a non progressive motor neuron disorder engendered by the prolonged over-consumption of  Lathyrus sativus  (grass pea) seeds which contain a neurotoxic amino acid, β-N oxalyl- L-α, β-diaminopropionic acid (β-ODAP). It is characterized by spastic paraparesis in the hind limbs. The present study was conducted in 105 households (HHs) of Gondia district in Maharashtra, India, where grass pea is cultivated and consumed to assess the health implication of its consumption. Methods: aA cross-sectional survey was carried out in 105 HHS in five villages and grass pea samples were collected for β-ODAP estimation. Amino acid analysis was also done, neurolathyrism cases were identified by snowball sampling method and neurological examination was carried out. Results: The study revealed that 61 per cent of population was consuming this pulse as a part of diet. β-ODAP concentration in grass pea was high in Bora village (1254.5 ± 528.21 mg %) and less in Malgaon village (413.6±415.79 mg %). The nutritional status of the people was within the normal range (BMI 18± 3.40 kg/m2) in the surveyed households. Consumption of grass pea was observed to be less than 25g. Conclusions: The cases of neurolathyrism declined in all the studied villages due to reduced β-ODAP exposure through Lathyrus sativus consumption, however, the grass pea was cultivated and consumed in Gondia district of Maharashtra State.

In Vitro Study of Antimicrobial Activity in Marine Algae Caulerpa Taxifolia and Caulerpa Racemosa (C. Agardh).

The present study was carried out to investigate its antimicrobial potentiality of the algae such as Caulerpa taxifolia, Caulerpa racemosa (C. Agardh) were studied against both Gram-positive, Gram- negative and fungal pathogens. For microbiological testing of the different crude algal extracts (Hexane, Chloroform, Methanol and water) was determined by the well diffusion method.The zone of inhibition was measured for all the Crude extracts revealed a wide range of antimicrobial activity against tested pathogens. The overall antimicrobial activity assessed from the above results indicates the presence of active constituents in the extractions of Seaweeds which can be exploited for the production of lead molecules which are use of in pharmaceutical industry.

Barriers to follow-up for pediatric cataract surgery in Maharashtra, India: How regular follow-up is important for good outcome. The Miraj Pediatric Cataract Study II.

Background: Regular follow up and amblyopia treatment are essential for good outcomes after pediatric cataract surgery. Aim: To study the regularity of follow‑up after cataract surgery in children and to gauge the causes of poor compliance to follow up. Subjects: 262 children (393 cataracts) who underwent cataract surgery in 2004-8. Materials and Methods: The children were identified and examined in their homes and a “barriers to follow‑up” questionnaire completed. Demographic data collected, visual acuity estimated, and ocular examination performed. Statistical Analysis: SPSS version 19. Results: Of the 262 children, only 53 (20.6%) had been regularly following up with any hospital, 209 (79.4%) had not. A total of 150 (57.3%) were boys and the average age was 13.23 years (Std Dev 5 yrs). Poor follow up was associated with the older age group (P < 0.001), less education of mother (P = 0.012), father’s occupation (P = 0.031), how much money spent on travel (P = 0.033) and was it paid or free surgery (P = 0.001). It was not related to gender, numbers of children in family, ordinal status of child, and social strata. Distance and cost were major barriers, as was the inability of the eye care center to communicate the importance of follow up. A prospective follow‑up visit showed that 93 children needed Nd: YAG LASER capsulotomy, 5 needed low vision aids, 4 contact lens, and 162 a change of spectacles. The average visual acuity improved in 150 (38.8%) eyes >1 line with regular follow‑up. Conclusion: Regular follow‑up is important and improves vision; eye care practitioners need to take special efforts to ensure better follow‑up.

Giant pleomorphic adenoma of parotid gland.

Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenomas are the most common benign neoplasms of the parotid gland. The vast majority are 2-6cms in size, when resected. Untreated pleomorphic adenomas can enlarge in size and weigh several kilograms. There are only few cases of giant pleomorphic adenomas reported in the literature. Here we present one of such case.

Synthesis, Characterization and Antimicrobial Activities of Schiff bases of 2-amino-4-(O-chloroanilino)-1, 3-thiazole.

A novel series of schiff bases of 2-amino-4-(o-chloro anilino)-1, 3-thiazole (3a-3j) were synthesized and screened for their antibacterial and antifungal activities. The structures of these compounds were ascertained by UV, IR, 1H NMR, mass spectra and elemental analysis. The antibacterial activity of the synthesized schiff bases were evaluated against Gram positive bacteria such as Staphylococcus aureus, Bacillus subtilis and Gram negative bacteria like Escherichia coli and Klebsiella pneumonia. All the compounds had shown moderate to significant antibacterial activity amongst them; compound 3e exhibited more significant activity against the tested bacteria. The antifungal activity was screened against two strains of fungi such as Candida albicans and Aspergillus niger. Similar to antibacterial activity compound 3e exhibited significant antifungal activity. The standard drugs Amoxycillin and Amphotericin B were used to screen antibacterial and antifungal activity at 10μg/ml respectively. Interestingly compound 3e had shown more prominent inhibitory activity against the tested bacteria and fungi.

Klippel-Trenaunay syndrome / Síndrome de Klippel-Trenaunay

Klippel-Trenaunay syndrome (KTS) is a rare congenital, vascular disorder affecting one or more limbs. The syndrome is characterized by capillary malformations, soft tissue or bony hypertrophy and varicose veins or venous malformations. We present a case of this disorder in a twelveyear old boy who had an enlarged right lower limb with varicosities. Investigations revealed extensive superficial and deep venous varices, with dilatation of the right common iliac and external iliac veins. Klippel-Trenaunay syndrome should be suspected in a child presenting with capillary haemangioma and an enlarged limb.

El síndrome de Klippel-Trenaunay (KTS) es un raro trastorno congénito vascular que afecta a una o más extremidades. El síndrome se caracteriza por malformaciones capilares, hipertrofia ósea o del tejido suave, y várices o malformaciones venosas. Presentamos un caso de este trastorno en un muchacho de doce años que tenía una extremidad inferior derecha agrandada con varicocidades. Las investigaciones revelaron varices superficiales y várices venosas profundas, con dilatación de las venas ilíacas comunes derecha y las venas ilíacas externas. El síndrome de Klippel-Trenaunay se debe sospechar en un niño que se presenta con hemangioma capilar y agrandamiento de un miembro.