Scrub Typhus Presenting as Subdural Hemorrhage with Normal Platelet Counts: A Rare Case Presentation

Scrub typhus is a common zoonotic disease with high case fatality rate. The clinical presentation of this disease may vary from acute febrile illness, thrombocytopenia, gastrointestinal manifestations, coagulopathy to neurological manifestations. The common neurological manifestations are meningitis and meningoencephalitis, whereas subdural hemorrhage, cerebrovascular accident, i.e., intracerebral hemorrhage, infarct, subarachnoid hemorrhage, etc. are among rare neurological presentations. Scrub typhus-induced neurological disease should be investigated to provide a timely and appropriate diagnosis and to reduce the mortality in complicated scrub typhus infection. Here we report a case of scrub typhus complicated with subdural hemorrhage admitted in our hospital.

Study on stereoacuity and associated factors in school children aged 7 to 14 years

Purpose: The study aimed to estimate the prevalence of subnormal stereoacuity in school children and to assess the factors associated with it. Methods: In this prospective cross?sectional study, a total of 2,376 school children without amblyopia and manifest squint were screened by the titmus fly test, Snellen chart, tests for heterophoria, anterior segment examination, and fundoscopy. Children with a manifest squint, amblyopia (best?corrected visual acuity [BCVA] <6/18), and history of ocular trauma or surgery, and one?eyed children were excluded. Cycloplegic refraction was done in children with uncorrected or undercorrected refractive errors, and stereoacuity was assessed again with spectacle correction. Results: The prevalence of normal stereoacuity by titmus fly test was 93.18% with correction of refractive errors. Girls had slightly better stereopsis compared with boys. The subnormal stereoacuity was significantly associated with refractive error (P < 0.00001, significant at P < 0.05), unilateral refractive error (P < 0.00001, significant at P < 0.05), bilateral refractive error (P < 0.00001, significant at P < 0.05), anisometropia (P < 0.00001, significant at P < 0.05), ametropia (P < 0.00001, significant at P < 0.05), lower BCVA (P < 0.00001, significant at P < 0.05), hyperopia (P < 0.05, significant at P < 0.05), and heterophoria (P = 0.014, significant at P < 0.05). The subnormal stereoacuity was positively correlated with the magnitude of refractive error of the eyes. Conclusion: This study underlines the significant impact of identification and correction of refractive errors and squints in school children. The measurement of stereoacuity will be of immense importance and must be included in the screening programs for children

Le Fort I maxillary osteotomy in a Jehovah’s Witness patient: strategies for minimizing blood loss and maximizing safety / 대한악안면성형재건외과학회지

Background@#The Watch Tower Society, the main governing organization of the Jehovah’s Witness (JW) faith, introduced the doctrine to refuse blood in 1945 and has been enforcing it since 1961. A member can be expelled for accepting prohibited blood components. Many reconstructive surgeries place patients at an increased risk for blood loss. There have been attempts at reducing the rate of transfusions in craniofacial surgery, even in patients not opposed to it.PresentationA 15-year-old female patient, who refused blood transfusion due to her faith, presented with a class III malocclusion, transverse maxillary constriction, and a lateral open bite. Surgery was deferred until the patient reached 18 years of age and had undergone preoperative orthodontics. A two-piece Le Fort I osteotomy was performed. Erythropoietin, oral iron, and tranexamic acid were used to minimize intraoperative blood loss. @*Conclusion@#Here we discuss preoperative and intraoperative management strategies to ensure a transfusion-free environment for patients with religious objections to blood transfusions undergoing operations with increased bleeding risk.

Hepatitis B virus and hepatitis C virus co-infection among outdoor patients and indoor patients of tertiary care institute, Bathinda, Punjab, India

Background: Hepatitis virus infections have many serious consequences like chronic hepatitis, fulminant hepatitis, liver cirrhosis, hepatocellular carcinoma and liver cancer. Serological test is thus necessary to identify hepatitis virus in the body. An observational study was conducted with an objective to detect hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) antibodies by rapid card tests and to find the prevalence of co-infection with hepatitis B and hepatitis C viruses from January 2019 to June 2019.Methods: Blood samples were received from patients irrespective of age and sex, constituted the material for the present study. All samples were tested on hepacard and tri-dot card for the detection of hepatitis B virus and hepatitis C virus and results were interpreted as per Clinical Laboratory Standards Institute guidelines.Results: Out of 3488 samples, 254 samples were positive for hepatitis virus infection. Out of these 254 samples positive for hepatitis viruses, 22 (0.6%) patients were positive for hepatitis B virus and 232 (6.6%) patients were positive for hepatitis C virus. Only 2 (0.7%) of these patients showed co-infection with both viruses.Conclusions: Male patients showed more positivity of hepatitis virus as compared to females. Patients were more from outpatient department (OPD) as compared to inpatient department (IPD). Hepatitis virus infection was found to be highest in the age group 21-40 and lowest in the age group above 80 years. Both the co-infected patients were males and from IPD.

Always, better and control - vital, essential, desirable matrix analysis of the drug store of a tertiary care teaching hospital of North India

Background: Substantial improvement can be brought about in the hospital inventory and drug expenditure by inventory control techniques. These include ABC (always, better and control), VED (vital, essential and desirable) and ABC-VED matrix analysis. The objective of the study was to categorize the drugs based on cost and criticality and identify those which require stringent managerial control.Methods: ABC analysis according to drug expenditure, VED analysis according to criticality of the drugs,  ABC-VED matrix analysis to classify drugs into category I, II and III was done for drug store of a tertiary care teaching hospital of North India for the period of April, 2018 to March, 2019.Results: The total number of the drug items used by the drug store was 315. The total drug expenditure was Rs. 9,61,29,859. By ABC analysis, it was found that 15.24%, 22.54% and 62.22% items belonged to A, B and C category respectively, accounting for 70%, 20% and 10% of Annual Drug Expenditure (ADE). VED analysis showed that 31.11%, 60.32% and 8.57% were V, E, and D category items respectively, accounting for 30.44%, 57.12% and 12.44% of ADE. By ABC-VED matrix analysis, 42.86%, 52.38% and 4.76% items were category I, II and III items respectively, accounting for 78.91%, 20.15% and 0.94% of ADE.Conclusions: The study depicted the items belonging to category I which requires top managerial control, also the items belonging to categories II and III which require control by middle and lower managerial level respectively.

Evaluation of anti-inflammatory activity of ethanolic extract of Gmelina arborea in experimental acute and sub-acute inflammatory models in wistar rats

Background: Inflammation is a complex reaction to various injurious agents such as infections, trauma, foreign bodies, tissue necrosis, physical and chemical agents, that consists of vascular responses, migration and activation of leukocytes and systemic reactions. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are currently the most commonly prescribed drugs for treating pain and inflammation. The traditional NSAIDs usually cause various adverse effects on long term use. Gmelina arborea Linn (Gambhari) belongs to family Verbenaceae. The roots, leaves, flowers, fruits and bark are used for treating different ailments as anthelmintic, analgesic, anti-pyretic, antidiabetic, antimicrobial, diuretic and other common disorders.Methods: The study was carried out by using inflammatory models in wistar rats. The anti-inflammatory activity of G. arborea was compared with standard drug aspirin. The study parameters for acute inflammation was assessment of reduction in inflammation & the percentage inhibition of the paw edema. The parameter for the sub-acute inflammation was percentage inhibition of the dry granuloma weight.Results: The low and high dose of G. arborea root extract significantly showed the anti-inflammatory activity when compared to control group. The high dose of G. arborea extract showed comparable results in parameters like reducing inflammation, percentage inhibition of paw edema and dry granuloma weight in acute carrageenan paw edema and sub-acute inflammation cotton pellet granuloma models with standard aspirin treated group.Conclusions: Since G. arborea root extract was having all the qualities required for anti-inflammatory drug. However, no clear inference can be drawn at this stage and hence we consider the work for further extensive research.

Evaluation of analgesic activity of sodium valproate and ethanolic extract of Vitex negundo in experimental analgesic models in wistar rats

Background: NSAIDs and opioids are commonly prescribed medications to relieve pain of multiple aetiologies with no effect on the level of consciousness of the patient. They interfere with the mode of transmission of the pain message. A widely prescribed antiepileptic drug, sodium valproate has been used in various non-epileptic conditions like migraine prophylaxis and in the treatment of bipolar disorder because of the multiple mechanisms by which it acts. Vitex negundo has been investigated for antipyretic, analgesic, anti-inflammatory, anticonvulsant, hepatoprotective and bronchial relaxant. Very few studies have been done to evaluate its analgesic activity and no study was done on analgesic activity with the combination of modern drug. The more important point to be noted is that Vitex negundo is a natural product and therefore unlikely to cause adverse effects when compared to the traditional drugs used to treat pain. The aim of the present study was to evaluate of analgesic activity of sodium valproate and docosahexaenoic in experimental analgesic models in wistar rats.Methods: For analgesic activity, a total of 36 adult Wistar albino rats were taken and divided into six groups of six rats each. Group I was control (distil water 1ml/kg), Group II received intraperitoneal injection of diclofenac sodium (10mg/kg), Group III, IV were injected intraperitoneal sodium valproate 200, 400mg/kg with distil water respectively and Group V, VI were given sodium valproate 200, 400mg/kg (intraperitoneal) plus EEVN 400mg/kg (orally) respectively. Analgesic activity was assessed using hot plate, tail flick and acetic acid writhing models.Results: Present study revealed that sodium valproate at higher doses (400mg/kg) used either alone along with EEVN (400mg/kg) showed statistically significant analgesic activity in comparison to control in various experimental models for assessing pain.Conclusions: Combination of sodium valproate along with EEVN has shown promising analgesic activity.

Evaluation of antidiabetic activity of Tinospora cardifolia in alloxan induced diabetes in albino wistar rats

Background: The objective was to evaluate the antidiabetic activity of Tinospora cardifolia in alloxan induced diabetes in albino rats in comparison with a currently used oral hypoglycaemic glibenclamide.Methods: there were 24 rats with FBS in the range 80-115 mg/dl were selected for the study. Four groups each containing six rats, were induced diabetes with alloxan (150mg/kg). The diabetic control group (0.5ml normal saline), Standard control group (5mg/kg glibenclimide), Test group I (200mg/kg T. cardifolia) and test II group 400mg/kg T. cardifolia). FBS was recorded on 1, 3, 7, 14, 21 and 28th day using glucometer. Data was analysed by using one way ANOVA and posthoc Tukey’s test SPSS 21Version.Results: Extract of Tinospora cardifolia showed dependent hypoglycaemic action in both low dose (200mg/kg) and high dose group (400mg/kg). Hypoglycaemic action with high dose of Tinospora cardifolia is comparable to that of standard drug glibenclamide.Conclusions: This study demonstrates the hypoglycaemic action of T. cardifolia in diabetic rats. T. cardifolia can be a therapeutic potential to treat type 2 diabetes mellitus.

Evaluation of the antipeptic ulcer activity of the seed extract of sesame (Sesamum indicum) in stress induced peptic ulcers in rats

Background: The peptic ulcers can be developed inside the inner lining of the stomach (gastric ulcer) or the small intestine (duodenal ulcer). Around 10% population of the world is suffering from the peptic ulcer disease. From the ancient times there is a reference about herbal extracts like Sesame indicum for the treatment of various diseases. The aim of the study is Evaluation of the anti-peptic ulcer activity of the seed extract of sesame (Sesamum indicum) in stress induced peptic ulcers in rats.Methods: The study was carried out by stress-induced ulcer model in wistar rats. The antiulcer activity of S. indicum (0.5, 1mg/kg p.o. for 7 days) was compared with standard drugs (pantoprazole). The studied parameters were mucin content, gastric volume, pH, total acidity, free acidity, ulcer index, size and number.Results: The low and high dose of S. indicum extract significantly reduced gastric mucosal lesion, mucin content, volume of gastric juice, gastric pH, free and total acidity when compared to positive control group. The high dose of S. indicum extract showed comparable results in parameters like effect on mucin content, gastric volume, pH, free acidity and total acidity with standard group. The statistical significant changes noted only in ulcer size, number and index.Conclusions: Although the high dose S. indicum (1mg/kg) group showed significant gastric protection against ulcer induced by cold restraint method. However, no clear inference can be drawn at this stage and hence there is a need for further extensive research.

A study on pattern of initial and acquired drug resistance for isoniazid and rifampicin in A.F.B. positive sputum smears of pulmonary tuberculosis patients at a Medical College in North Eastern Uttar Pradesh, India

Background: Despite availability of good quality anti-tubercular drugs and its administration through Directly Observed Therapy Short Course (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP), tuberculosis remains a major cause of morbidity and mortality in India. The emergence of drug resistance necessitates the timely detection of susceptibility of anti-TB drugs. This can help in appropriate modification in treatment strategies.Methods: A total of 50 patients of pulmonary TB with AFB positive sputum smears attending the OPD of TB and Chest department of B.R.D. Medical College, Gorakhpur were included. Patients were grouped based on history into new (cat-I) and previously treated patients (cat-II). Cat-II patients were further subdivided into defaulter, treatment failure and relapse groups. The culture and DST of AFB positive sputum smears of these patients was done in VersaTREK™®. At the end of study, patients were grouped according to age, sex, category and drug sensitivity pattern for Isoniazid (INH) and Rifampicin (RIF) viz mono resistance (resistance to either INH or RIF) or multi drug resistance (M.D.R.) and the resultant data were analysed.Results: Of the total 50 patients included in this study, 18 (36%) patients were sensitive to both the drugs INH and RIF, of which 11 (22%) were of cat-I and 7 (14%) of category-II. Twenty-two (44%) patients were resistant to INH only of which 8 (16%) were of cat-I and 14 (28%) of cat-II. One (2%) case of cat-I showed resistance to RIF only, while M.D.R. type of resistance is seen in 1 (2%) patient of cat-I and 8 (16%) patients of cat-II. Pattern of resistance to both INH and RIF together (i.e. M.D.R. type) showed significant difference between cat-I and cat-II.Conclusions: Most of the patients showing resistance to INH, RIF or both INH and RIF (M.D.R.) belonged to category-II (previously treated) patients.

Anterior segment ischemia following Hummelsheim procedure in a case of sixth nerve palsy.

A, 46‑year‑old Indian male, known hypertensive presented with left esotropia of 25 prism diopters (PD) after head injury in a roadside accident 9 months back. The deviation was constant in nature and was associated with complaints of diplopia in left lateral gaze. Traumatic sixth nerve palsy was diagnosed. The patient underwent left medial rectus recession of 5 mm and a split‑tendon transposition of the left superior and inferior recti to the lateral rectus insertion (Hummelsheim procedure). On the first postoperative day, the patient developed corneal edema and anterior chamber reaction of flare 2+ and cells 2+. The pupil was semi‑dilated and was sluggishly reacting to light. Anterior segment ischemia was diagnosed, which was managed with topical and systemic steroids.

Role of Free Radicals and Common Antioxidants in Oral Health, an Update.

Free radicals have been implicated in the etiology of large number of major diseases. They can adversely alter many crucial biological molecules leading to loss of form and function. Such undesirable changes in the body can lead to diseased conditions. Antioxidants are compounds which destroy the free radicals in the body, thereby preventing against harmful oxidation- reduction reactions. Antioxidants are critical for maintaining optimum health and wellbeing. The best sources are fruits and vegetables which provide a variety of antioxidants like Vitamins A, C, E & carotenoids. As in every medical field, the usage of antioxidants is becoming more frequent in dentistry also. It can help adjunct treating the progress of oral problems such as periodontitis or gingivitis or progression of potentially malignant disorders to malignancy. Thus, a greater consumption of fruits and vegetables should be encouraged as they are the natural sources of these chemopreventive antioxidant along with other protective factors packaged by nature. This review focuses on commonly used effective antioxidants in different oral and dental pathologies as a new generation adjunctive remedy.

Scanning the macula for detecting glaucoma.

Background: With the advent of spectral domain optical coherence tomography (SDOCT), there has been a renewed interest in macular region for detection of glaucoma. However, most macular SDOCT parameters currently are thickness parameters which evaluate thinning of the macular layers but do not quantify the extent of area over which the thinning has occurred. We therefore calculated a new macular parameter, “ganglion cell complex surface abnormality ratio (GCC SAR)” that represented the surface area over which the macular thickness was decreased. Purpose: To evaluate the ability of SAR in detecting perimetric and preperimetric glaucoma. Design: Retrospective image analysis. Materials and Methods: 68 eyes with perimetric glaucoma, 62 eyes with preperimetric glaucoma and 165 control eyes underwent GCC imaging with SDOCT. SAR was calculated as the ratio of the abnormal to total area on the GCC signifi cance map. Statistical Analysis: Diagnostic ability of SAR in glaucoma was compared against that of the standard parameters generated by the SDOCT soft ware using area under receiver operating characteristic curves (AUC) and sensitivities at fi xed specifi cities. Results: AUC of SAR (0.91) was statistically signifi cantly bett er than that of GCC average thickness (0.86, P = 0.001) and GCC global loss volume (GLV; 0.88, P = 0.01) in diff erentiating perimetric glaucoma from control eyes. In diff erentiating preperimetric glaucoma from control eyes, AUC of SAR (0.72) was comparable to that of GCC average thickness (0.70, P > 0.05) and GLV (0.72, P > 0.05). Sensitivities at specifi cities of 80% and 95% of SAR were comparable (P > 0.05 for all comparisons) to that of GCC average thickness and GLV in diagnosing perimetric and preperimetric glaucoma. Conclusion: GCC SAR had a bett er ability to diagnose perimetric glaucoma compared to the SDOCT soft ware provided global GCC parameters. However, in diagnosing preperimetric glaucoma, the ability of SAR was similar to that of soft ware provided global GCC parameters.

Moyer's Mixed Dentition Predictable Values Correlation Among Hindu Children of Bhopal City.

Context: Prediction values based on a particular race cannot be considered as universal. It requires revision according to developing malocclusion and relative size of the tooth. Aim: To evaluate the applicability of Moyer’s mixed dentition analysis with derivation of regression equation for Hindu children of Bhopal city; Materials and methods: The mesio-distal width of permanent mandibular incisors, maxillary and mandibular canine and premolars were measured for 200 children of 12-16 years of age using digital vernier caliper; Statistical analysis: Student’s ‘t’ test was applied to compare the actual and predicted values and linear regression equations were derived for prediction of tooth size. The correlation between the sums of the canine, premolars in both arches and mandibular incisors was done by using coefficient of correlation (r). The Student’s unpaired t test was applied to compare the tooth dimensions between male and female;Results: Moyer’s prediction values was not an accurate method to estimate tooth dimensions in the present study sample. The mesio-distal crown dimensions in both the arches were larger in males compared to the females ;Conclusion: Statistically significant difference was present between predicted values of Moyer’s table and the values obtained in present study sample. So uses of newly devised regression equations are recommended for prediction of the combined mesiodistal width of canines and premolars in Hindu populations of Bhopal city.

Evaluation of vaccine candidate potential of ΔaroA, ΔhtrA and ΔaroAΔhtrA mutants of Salmonella enterica subspecies enterica serovar Abortusequi in guinea pigs.

Salmonella enterica subspecies enterica serovar Abortusequi (S. Abortusequi), a host adapted Salmonella causes abortions, still births and foal mortality in equids. Though known since more than 100 years, it is still a problem in many of the developing countries including India. There is dearth of really good vaccine affording immunity lasting at least for one full gestation. In search of a potential vaccine candidate, three defined deletion mutants (ΔaroA, ΔhtrA and ΔaroAΔhtrA) of S. Abortusequi were tested in guinea pig model for attenuation, safety, immunogenicity, humoral immune response, protective efficacy and persistence in host. The ΔhtrA and ΔaroAΔhtrA mutants were found to be safe on oral inoculation in doses as high as 4.2×109 cfu/animal. Also through subcutaneous inoculation ΔaroAΔhtrA mutant did not induce any abortion in pregnant guinea pigs. All the three mutants did not induce any illness or death in 1-2 week-old baby guinea pigs except ΔhtrA mutant which caused mortality on intraperitoneal inoculation. Inoculation with mutants protected against challenge and increased breeding efficiency of guinea pigs. After >4.5 months of mutant inoculation, guinea pigs were protected against abortifacient dose of wild type S. Abortusequi and mother guinea pigs also conferred resistance to their babies to the similar challenge. Early humoral immune response of S. Abortusequi mutants was characteristic. Faecal excretion of ΔaroA and htrA mutants was detected up to 45 days of inoculation in guinea pigs while ΔaroAΔhtrA mutant could not be detected after 21 days of inoculation. The results indicated that the double deletion mutant (ΔaroAΔhtrA) was the most effective and safe candidate for vaccination against S. Abortusequi through mucosal route of inoculation.

Displaced Tibial Plateau Fractures: Is There A Role Of Conservative Treatment In The Present Scenario.

This retrospective case series includes 92 closed tibial plateau fractures treated by operative (66 patients) and conservative (26 patients) methods at our institution.The means and mean differences of grades of the objective variables of extensor lag and range of motion and articular step were better in the surgically treated patients (p value <0.05), while those of axial alignment and side to side instability did not show any statistical significance. An average articular step of more than 1.6 mm significantly deteriorated the functional outcome.Achieving articular congruity is the most important factor for the successful outcome of tibial plateau fractures. Operative treatment in the presence of adequate expertise and infrastructure gives satisfactory results. Type V and VI fractures are highly unstable fractures and need to be treated by more stable fixation in the form of dual plating and/or locked compression plating. The variables like extensor lag, range of motion and radiological articular step directly correlate with the functional outcome of tibial plateau fractures. The conservative treatment should only be accepted as last option in case of displaced tibial plateau fractures.

Serum Zinc and Copper Levels in Aplastic Anemia.

Mean serum zinc and copper levels were measured in pediatric patients with idiopathic aplastic anemia. Zinc levels were significantly lower in patients compared to controls and correlated with severity of disease. Serum copper levels were significantly higher in patients. There was no correlation with severity of disease. Cu/Zn ratio also correlated with severity of disease.

Premedication with midazolam nasal spray: an alternative to oral midazolam in children

Midazolam is a water soluble benzodiazepine which is frequently administered by intravenous and oral routes in our institution. Its nasal spray has become recently available. To compare the efficacy of midazolam administered orally and by intranasal spray, with the specific objective of assessing their efficacy in terms of acceptability to the patients, whether they achieve a satisfactory sedation score, and the overall ease of inducing general anesthesia. Sixty healthy children of ASA grade I or II, aged 2-6 years who were undergoing elective surgery of approximately 30 minutes duration, were assigned to receive midazolam premedication in a randomized controlled trial. They were divided into 2 groups of 30 patients each. Group I: 30 patients received midazolam orally [parenteral solution mixed in honey]. Group II: 30 patients received a commercially available midazolam nasal spray. The study shows that children better accepted the drug when administered orally than when administered intranasally, although satisfactory sedation scores at 10 and 20 minutes were better in the nasal spray group than in the oral group [i.e., 6 [20%] vs. 0 [0%] at 10 min and 16 [53.3%] vs. 13 [43.3%], respectively]. Satisfactory ease of induction scores [24 [80%] vs. 13 [43.3%]], recovery times [11.63 +/- 4.19 minutes vs. 25.20 +/- 9.36 minutes], and post-anesthesia recovery scores were better in the nasal spray group [group II] than in the oral group [group I]. On the basis of our study, we conclude that nasal midazolam spray is acceptable and is a good alternative to oral midazolam as premedication in the pediatric population

Evaluation of a novel, non contact, automated focal laser with integrated [NAVILAS[restricted] ] fluorescein angiography for diabetic macular edema

To evaluate the procedural experience and complications of a novel integrated laser delivery system [NAVILAS; OD-OS Teltow, Germany] that combines automated laser delivery with color fundus photography, fluorescein angiography [FA], fundus autofluorescence [FAF] and infrared imaging with a frequency doubled YAG laser. This prospective study evaluated surgical experience with the NAVILAS automated photocoagulation system for the treatment of patients with diabetic macular edema [DME]. Subjective assessment of the accuracy of laser spot placement and postoperative complications were documented. Twelve patients [7 males, 5 females] were enrolled in this pilot study. Five patients were phakic and 7 were pseudophakic. Image overlays and the tracking system allowed accurate delivery of laser spots of varying size, duration and power. None of the patients reported any pain and tolerated the procedure well. No complications were reported in the study. In this pilot study, the NAVILAS system allowed accurate laser spot placement with no complications in patients with DME. However a larger sample with longer follow up is required to determine the safety of this procedure

Anti-oxidant treatment in obstructive sleep apnoea syndrome.

Purpose. To investigate whether oral intake of N-acetylcysteine (NAC) is a treatment option in patients with obstructive sleep apnoea syndrome (OSAS). Methods. Twenty patients with OSAS were enrolled in the study. After polysomnography (PSG), they were randomly assigned to receive a placebo (n=10) and NAC (n=10). A repeat PSG was done after the treatment period of 30 days. Fasting venous samples were collected for various biochemical analysis. Results. In the patients of NAC group, compared to their baseline values, slow wave sleep as sleep percent time (27.9±2.7 vs 42.3±4.2; p<0.01) and sleep efficiency (90.8±1.3 vs 94.4±1.5; p<0.05) improved considerably. The apnoea-hypopnoea index (61.2±8.5 vs 43.1±8.6; p<0.05), apnoea related arousals (22.2±7.6 vs 11.6±4.7; p<0.05), longest apnoeic episode duration (seconds) (54.9±7.1 vs 37.8±5.6; p<0.01), oxygen desaturation events per hour (51.8±7.7 vs 37±7.8; p<0.01) and epworth sleepiness score (16.6±0.8 vs 9.2±0.9; p<0.001) decreased significantly. The relative snore time (%) (10.2±2.9 vs 4.9±1.9; p<0.01), number of snore episodes (63.8±23.9 vs 28.2±9.9; p<0.05) and duration of longest snore episode (min) (2.5±0.7 vs 0.6±0.1; p<0.05) also decreased significantly. Such responses were not evident in the placebo group. N-acetylcysteine produced significant decrease in lipid peroxidation and increase in total reduced glutathione. Conclusions. Oral NAC administration appears to have a therapeutic potential in the treatment of OSAS. It is proposed that long-term treatment with NAC in patients with OSAS may reduce their dependency on continuous positive airway pressure therapy.