Lamivudine plus tenofovir versus lamivudine plus adefovir for the treatment of hepatitis B virus in HIV-coinfected patients, starting antiretroviral therapy

Background: Combination of tenofovir disoproxil fumarate (TDF), lamivudine (3TC) and efavirenz (EFV) is preferred in the treatment of HIV/hepatitis B virus (HBV) coinfection. We postulated that a HBV active nucleoside reverse transcriptase (RT) inhibitor/nucleotide RT inhibitor backbone of adefovir dipivoxil (ADV) +3TC would be as effective as TDF +3TC for the Indian population. Objective: ADV + 3TC could be an alternative option for these HIV/HBV coinfected individuals, preserving the dually active TDF + 3TC as second-line nucleoside backbone following failure of the first-line ART. Materials and Methods: This randomised control trial (CTRI/2012/03/002471) was carried out at the ART Centre of Calcutta School of Tropical Medicine, India. Seventy-eight (39 on each arm) treatment-naïve HIV/HBV coinfected patients were randomised to receive either the combination of lamivudine + tenofovir + EFV or lamivudine + adefovir + zidovudine + EFV and followed up for 120 weeks. Results: Median age of the study participants was 36 years (21–62), majority were male (61/78; 78.2%) and heterosexually (39/78; 50%) infected. Baseline characteristics were identical in both arms. There was no statistically significant difference in median aspartate aminotransferase (37 vs. 29.5 U/L), alanine aminotransferase (ALT) (36 vs. 34.5 U/L), ALT normalisation rate (80 vs. 70%), AST to platelet ratio index (0.45 vs. 0.33), CD4 count (508 vs. 427 cells/mm3), HBV DNA suppression (81.8 vs. 70%), hepatitis B e antigen loss (9 vs. 5%), hepatitis B surface antigen seroclearance rate (6.06 vs. 18.75%) and death (3 vs. 3) at 120 weeks between TDF (n = 33) and ADV (n = 32), respectively. Conclusions: Adefovir plus lamivudine is an effective alternative of tenofovir plus lamivudine in long-term HBV treatment outcome in HIV/HBV coinfected patients.

trans-4,4'-Dihydroxystilbene (DHS) protects PC12 cells from oxidative damage but induces reactive oxygen species-mediated apoptosis in SHSY-5Y cell line.

Polyphenols can exert both, antioxidant and pro-oxidant properties, depending on cell types as well as their concentrations. Hence, it was of interest to examine if the naturally occurring resveratrol analog, trans-4,4'-dihydroxystilbene (DHS) also exert both these activities in a biphasic or cell-specific manner. In this study, we established the cytoprotective action of DHS against hydrogen peroxide (H2O2)-induced apoptotic death of the PC12 cells. DHS reduced mitochondrial membrane permeabilization and deactivated reactive oxygen species (ROS)-mediated caspase-3 activation in the H2O2-treated PC12 cells. However, it induced apoptosis in the human neuroblastoma SHSY-5Y cell line by destabilizing mitochondrial membrane, augmenting ROS and activating caspapse-3. DHS showed better activity than resveratrol in both the chosen models.

A Rare Case Report on Benign Recurrent Intrahepatic Cholestasis.

Benign recurrent intrahepatic cholestasis is an inherited and occasionally sporadic disease presents as recurrent episodes of obstructive jaundice without any obstruction in billiary channel with intervening symptom free periods. Here we are presenting a case of 20-year-old male with a recurrent jaundice and pruritus who later diagnose as BRIC.

Nebulization by Isotonic Magnesium Sulphate Solution with Salbutamol Provide Early and Better Response as Compared to Conventional Approach (Salbutamol Plus Normal Saline) in Acute Exacerbation of Asthma in Children.

Asthma attacks are serious respiratory problem that can be lethal when not treated appropriately. Till today the main stay of therapy is short acting ß2-agonist. Unfortunately in acute asthma episodes this is not enough to relieve the bronchospasm and reduce dyspnea. The shortcoming of ß2-agonist therapy has resulted in the use of a variety of other treatment in the management of acute asthma. The use of magnesium sulphate is one of the recent treatment options. This study was done to compare the efficacy of nebulized salbutamol with magnesium sulphate versus salbutamol with normal saline in the treatment of acute exacerbation of asthma in children. This randomized controlled trial was carried out among 60 patients with acute exacerbation of bronchial asthma fulfilling the inclusion criteria, admitted in the department of Paediatrics, Mymensingh Medical College Hospital over a period of one year from January 2009 to December 2009. They were distributed randomly, 30 patients received nebulized salbutamol (0.15mg/kg; minimum dose 2.5mg) with 2.0 ml of isotonic magnesium sulphate solution and another 30 patients received the same dose of salbutamol with 2.0 ml of normal saline on 3 occasions at 20 minute intervals. With single dose of nebulization in the magnesium sulphate with salbutamol group, by 20 minute almost all 26 (86.7%) patients achieved at least 60% of predicted PEFR. Within 20 minute from control group none could achieve 60% of predicted PEFR. After second dose of nebulization control group started achieving 60% of predicted value. Regarding response criteria, with second dose of nebulization, at 40 minute 16 (53.3%) patient from magnesium sulphate with salbutamol group showed good response (PEFR>70% predicted). But within the first 40 minutes, none could show good response in control group. With 3rd dose of nebulization all from magnesium sulphate group showed good response but even at 60 minute, 5 (16.7%) patients in control group failed to be included as good responder. In conclusion, nebulization by isotonic magnesium sulphate solution with salbutamol provide early and better response as compared to conventional approach (salbutamol plus normal saline) in acute exacerbation of asthma in children.

Nutritional Profile of Some Tropical Fruits in Bangladesh: Specially Anti-Oxidant Vitamins and Minerals.

Objective: Fruits and vegetables are important for the daily diet as these contain micronutrients, fiber, potassium, folate, Vitamin C, vegetable proteins, carotenoids and polyphenols, which act as antioxidants within the body as well as bio-functional components. The aim of the study is to establish nutritional profile specially antioxidant vitamins and minerals of tropical fruits in Bangladesh. Methodology: Nutritional composition and physico-chemical properties, such as pH, titratable acidity, moisture, total soluble solid, crude fibre, total carbohydrate, total protein, total fat, total energy, vitamin C, beta-carotene, ash, sodium, potassium, iron, zinc, copper, manganese, phosphorus, calcium and magnesium content of ten tropical fruits namely Blackberry, Java apple, Jack fruit, Pineapple, Carambola (Star fruit), Golden apple, Mango, Melon, Monkey jack, Star gooseberry were determined according to standard methods. Results: Results of this study suggest that the tropical fruits of Bangladesh were excellent source of antioxidant vitamins and minerals like vitamin C, beta- carotene, iron, zinc, copper and manganese. These fruits were also good source of potassium, phosphorus, calcium and magnesium but poor source of protein and fat and sodium. Conclusion: Present study strongly suggests that star gooseberry, monkey jack, pineapple and golden apple were antioxidant vitamins and minerals enriched tropical fruits.

An epidemiological study on risk factors of diabetes mellitus among patients attending a medical college hospital in Kolkata, West Bengal.

Two hundred and thirty cases of diabetes mellitus were selected in a case-control fashion by applying systemic random sampling technique taking 20% of the patients attending the diabetic clinic of Calcutta National Medical College during the period from January to June, 2003 to find out association and risks of some socio-economic and demographic factors with the occurrence of diabetes mellitus. Controls were selected from the patients admitted in the department of surgery in the same period. Factors like physical activity, socio-economic status, residential status, family history and obesity have shown statistically significant association with diabetes. For physical activity the estimated relative risk is maximum in case of sedentary worker where the odd's ratio was 9.4. So far other factors are concerned the estimated relative risk of diabetes was 5.1 in case of urban population, 6.2 in case of positive family history, 2.5 in case of upper and upper middle classes, and 2.4 in case of obesity in comparison to their respective reference category.

Right myocardial bridge on CT coronary angiography.

Myocardial bridging is a condition where the coronary artery traverses through the myocardium. Although it is not an uncommon finding in left anterior descending coronary artery (LAD), recently we came across a very rare case of right coronary artery (RCA) traversing through the right myocardium on CT coronary angiography.

Recent trend in the treatment of dysfunctional uterine bleeding.

Dysfunctional uterine bleeding (DUB) is defined as excessive uterine bleeding with no demonstrable organic cause either genital or extra-genital. Management of DUB should be individualised. The general measures, conservative approach, radical therapy and surgery as treatment modalities, as practised have been detailed here.

Role of paucibacillary leprosy in the transmission of disease.

The objective of this study was to establish that paucibacillary leprosy also carried increased risk of infection to the community. All members of 100 families with an index paucibacillary case were clinically, bacteriologically and immunologically examined. The "comparison" group was sampled from suspect register. Fifty-six cases occurred among 944 contacts of index paucibacillary cases; of these, four were multibacillary and 52 were paucibacillary. In the "comparison" group, two contacts out of 760 developed paucibacillary leprosy. This difference, between the two groups, was statistically significant. All the 56 cases in the index case families were under 20 years of age; and 50 of them were aged under 15 years. Male/female ratio was 2.1:1. Of the 56 cases, 28 shared the same bed with the index patient, 20 shared the same room and eight lived in the same house. Lepromin positivity rate was higher in "comparison" families (92.2%) than in index case families (74.6%), the difference being statistically significant (x = 6.09, P < 0.001). Contacts of index case families, therefore, were immunologically at higher risk than contacts of "comparison" families.

Ultrasonography in acute flank pain.

In 58 patients with acute recurrent or persistent flank pain, straight x-ray (kidney, ureter, bladder region) detected stones in the urinary tract in 50 cases (86.2%), whereas ultrasonography detected stones in the urinary tract in 55 patients (94.8%). Ultrasound also detected unilateral hydronephrosis in 20 patients (34.48%). The presence of calculus was subsequently proved by intravenous urography/surgery or spontaneous passage. Ultrasonography is safe, quick, reliable and most effective diagnostic tool in such cases in rural areas. Intravenous urogram should be reserved for cases which need surgical intervention.

Electron microscopic characteristics of actinomycetic agents having aetiological association with human leprosy and epizootic ulcerative syndrome of fish.

The transmission electron microscopic (TEM) studies of the human leprosy derived chemoautotrophic nocardio-form (CAN) bacteria and EUS derived CAN bacteria showed presence of double contoured cell-walls consisting of an electron transparent and a dense layer. The fibrillar structures on the surface of these CAN bacterial cells also suggested their similarity to the human tissue derived Mycobacterium leprae cells. These EM studies further revealed mycelial and coccoid bodies in all these bacteria as was observed originally.

Antipyretic activity of Nelumbo nucifera rhizome extract.

Antipyretic activity of methanolic extract of rhizome of N. nucifera was studied on normal body temperature and yeast induced pyrexia in rats. Yeast suspension (10 ml/kg, s.c.) increased rectal temperature after 19 hr of administration. The extract, in doses of 200, 300 or 400 mg/kg (po) produced significant dose dependent lowering of normal body temperature and yeast provoked elevation of body temperature in rats. The effect produced was comparable with the standard antipyretic drug, paracetamol (150 mg/kg, i.p.).