Effect of megaloblastic anemia on hemoglobin A2 and diagnosis of ?-thalassemia trait

Context: ?-thalassemia trait is usually diagnosed by raised hemoglobin A2 (HbA2). The presence of megaloblastic anemia can cause an increase in HbA2 and create a diagnostic dilemma. Here, we have analyzed the effect of vitamin B12 and folic acid supplementation on HbA2 and diagnosis of ?-thalassemia trait in cases of megaloblastic anemia with raised HbA2. Materials and Methods: Cases of megaloblastic anemia with raised HbA2 on high-performance liquid chromatography (HPLC) were supplemented with vitamin B12 and folic acid. Post-treatment evaluation was done after 2 months. Cases showing adequate hematological response were subjected to statistical analysis. Based on post-treatment HbA2 value, the cases were diagnosed as normal, borderline raised HbA2, or ?-thalassemia trait. Pre- and post-treatment values of red cell parameters and HbA2 were analyzed. Results: There was a significant decrease in HbA2 value after vitamin B12 and folic acid supplementation. The diagnosis was changed in 70.97% of the cases after treatment. The chance of inconclusive diagnosis was decreased from more than 50% to less than 10%. Pre-treatment mean corpuscular volume (MCV) and HbA2% showed a significant difference between the thalassemic and normal groups. Conclusions: Megaloblastic anemia can lead to false-positive diagnosis of ?-thalassemia trait on HPLC. Repeat HPLC should be done after adequate supplementation of vitamin B12 and folic acid in cases of megaloblastic anemia with raised HbA2. Red cell parameters are not helpful to suspect ?-thalassemia trait in presence of megaloblastic anemia. However, HbA2% on HPLC can be a useful parameter to suspect or exclude ?-thalassemia trait in cases of megaloblastic anemia.

Metabolic adverse drug reactions in geriatric patients in Odisha

Background: Geriatric patients are at a greater risk of developing adverse drug reaction (ADR) because of changed metabolic activity and renal status associated with aging. As most of the elderly patients suffer from multiple chronic diseases (Diabetes, Hypertension, Arthritis, constipation, peptic ulcer disease, etc.), they are under polypharmacy and the risk of ADRs is exacerbated by multiple medications. Metabolic ADRs include weight gain, hypoglycemia, hyponatremia, hypokalemia, and the endocrinal abnormality are the frequent cause of hospital admission in geriatric patients. Most metabolic ADRs due to drugs are treatable. There are few such studies conducted in India regarding metabolic ADR in geriatric patients. Hence, this study aims to evaluate the metabolic ADRs encountered in geriatric patients with the following objectives in Odisha. Aim and Objectives: The prevalence and spectrum of metabolic ADRs in geriatric population were studied. The causality assessment, severity assessment, and preventability were done using standard scales. Materials and Method: This was a prospective and observational study conducted from September 2016 to September 2018 in Department of Pharmacology in collaboration with Department of Geriatric Medicine and Department of Medicine of SCB Medical College and Hospital. All geriatric patients (?60 years) with ADR, reporting to the above departments, were included in the study. The detailed information of type of ADRs and its characteristics was filled up in Suspected ADR Reporting Form designed by Indian pharmacopeia commission version 1.3. The incidence and spectrum of metabolic ADRs were observed. Their causality, severity, and preventability were evaluated by the WHO-UMC System, Hartwig’s Severity Scale, and Schumock Thornton Preventability Scale, respectively. Result: A total of 236 ADRs were reported in 2 years, out of which 28.8% were metabolic ADRs. Metabolic ADRs were more reported in young old patients and often encountered ADR was hypoglycemia 73.5% due to use of oral anti diabetics. About 29% of the metabolic ADRs had a causal relation of probable association. About 94.2% were moderate in severity and 89.7% metabolic ADRs could be probably preventable. Conclusion: There was a probable causal association of metabolic ADR with the drug used and they were moderate verity. The metabolic ADRs found in our study can be preventable with appropriate means.

Predict the hospitalization in COVID-19: Magic is in the air

Background: Although pathogenesis and pattern of disease are still not completely understood, tactical management of overcrowding of hospitals and rational usage of resources is the need of the hour. Aims and Objectives: The study objectives were as follows: Finding of correlation between various attributes of COVID; evaluation of the association of common characteristics with hospital stay; prediction of cooccurrence of different symptoms; calculation of odds ratio of prolonged hospitalization due to various symptoms; and estimation of the rate of prolonged hospitalization due to different symptoms and comorbidities. Materials and Methods: Retrospective data of 6918 COVID-19-positive cases from SCB Medical College and Hospital, India, were obtained from the hospital records from March 2020 to January 2021. The patients’ age, gender, symptoms, and comorbidities were analyzed against their hospital stay using R software (version 4.0.2). Results: Elderly patients (>65 years) had a higher rate (91.22%) of prolonged hospital stay as compared to others (47.61%). Frequently observed symptoms (in decreasing order) were fever (73.93%), cough (67.52%), myalgia (62.11%), dyspnea (49.59%), dizziness (47.38%), and anosmia (44.10%). The risk of prolonged hospitalization was highest with dyspnea [odds ratio: 2.29 (95% confidence interval: 2.07–2.52)], followed by diarrhea [odds ratio [OR] 1.98 (confidence interval [CI] 1.77–2.21)], fever [OR 1.89 (CI 1.69–2.10)], anosmia [OR 1.86 (CI 1.69–2.05)], and dizziness [OR 1.46 (CI 1.32–1.60)]. The rate of hospitalization for more than 7 days was highest with diabetes (86.80%) followed by respiratory illnesses (71.85%) and hypertension (71.28%). Conclusion: These findings can help manage patients based on their symptoms and comorbidities before admission.

The Design And Development Of Carvedilol Gastroretentive Floating Drug Delivery Systems Using Hydrophilic Polymers And In Vitro Characterization

Objective: The primary aim of the present examination was to create carvedilol phosphate floating tablets using factorial designs and for retention in the upper portion of the gastrointestinal (GI) tract to sustain the dissolution where the solubility of carvedilol phosphate is more in an acidic medium. Methods: The floating tablets of carvedilol phosphate were ready to employ different concentrations and a combination of these polymers of Na-alginate, Carbopol 934P, and sodium carboxymethyl cellulose (NaCMC) with lubricants magnesium stearate by direct compression technique. In the present experiment, involved sodium bicarbonate and citric acid as a gas-producing agent. Fifteen formulations structured and judged for pre-compression components like the angle of repose, bulk and tapped density, Hausner’s ratio, compressibility index, and post-compression factors are weight uniformity, hardness, drug content, friability, in vitro buoyancy, dissolution studies, and Fourier transforms infrared spectroscopy (FTIR). Results: The drug released 90.02% in 12 h by combining NaCMC (7.5 mg) and Na-alginate (7.5 mg) in the formulation F14 towards the achievement of sustained release. Batch F14 selected as optimized, as provided desired zero-order release profile as well as floating lag time 20 s and total floating time>12 h, and the mechanism of drug release observed (n = 1.098, super case-II transport). Conclusion: From the results fulfilled that all the preparation found to be within the pharmacopeia limits and was the best dosage form to treat moderate heart failure and hypertension. The in vitro dissolution profiles of all formulations placed into various kinetic models, the statistical parameters like slope, regression coefficient and intercept determined. The gastro-retentive dosage form to maintain the sustain drug delivery, which would improve the maximum therapeutic efficacy and patient compliance.

Formulation And Evaluation Of Controlled Release Maintenance Dose Loaded Niosomes Of Anti-Hypertensive Drug

The present study was aimed to formulate, comparatively evaluate and optimize multiple lipid drug carriers of valsartan for oral controlled release to overcome the problems associated with the drug such as bioavailability, to reduce the dosage regimen, half life and to determine the appropriateness of niosomal formulation as a drug carrier. Ether injection method was chosen for the formulation of physically and chemically stable niosomes of valsartan. The formulation and process parameters were optimized by manufacturing placebo niosomes. Than drug loaded niosome was prepared by varying the concentration of span 60. The prepared nine formulations were evaluated for various parameters. Placebo niosomes were evaluated for appearance, odour, texture, creaming volume, pH and changes after 15 days. The medicated nine formulations were evaluated for organoleptic properties (appearance/color, odour), pH, total drug content, entrapment efficiency, mean particle size and polydispersibility index, zeta potential and In-vitro drug release. All formulations were off-white in color, odourless, and fluid in nature. It was stable and did not show sedimentation. The pH was found to be in the range of 4.6-5.4. Drug content was found in the range of 89.13 to 99.52. The Entrapment efficiency was found in range of 79.05 to 98.24. The mean vesicle size of drug loaded niosomes of the different batches ranged between 2.52-3.42μm. The polydispersvity index was in the range of 0.325 to 0.420 which indicates a narrow vesicle size distribution. The values of zeta potential were in the range of -20.29 mV to -30.55 mV which indicates that niosome had sufficient charge and mobility to inhibit aggregation of vesicles. All the nine formulations shows constant drug release in controlled manner up to 24 h. Formulation V7 was considered to be the best formulation as the % drug content (99.52 ± 0.97), % entrapment efficiency (98.24 ± 1.50) and % drug release at the end of 24th h (98.55) were high for V7. The optimized formulation V7 showed higher degree of correlation coefficient (r2) 0.9805 which indicates process of constant drug release from dosage form. The present study concludes that the prepared niosome is a convenient and efficiency carrier for the delivery of antihypertensive drug. Besides this, it provided controlled delivery of drug.

Spectrophotometric Method Development And Validation For Simultaneous Estimation Of Nebivolol Hydrochloride And Valsartan In Bulk And Combined Pharmaceutical Dosage Form In Release Media

A simple, rapid, precise, accurate and sensitive spectrophotometric method has been developed for the simultaneous estimation and validation of Nebivolol Hydrochloride (NEB) and Valsartan (VAL) in pure and combined tablet dosage forms. Pure drug samples of NEB and VAL were dissolved in 67 mM Phosphate buffer pH 6.8 with 0.5 % sodium dodecyl sulphate (SDS) and found to have absorbance maxima at 280 nm for NEB and 250 nm for VAL, respectively. The linearity lies between 10-70 μg/ml for NEB and 10-60 μg/ml for VAL in this method. The correlation coefficient (r2) was found to be 0.9965 for NEB and 0.9960 for VAL. The % recoveries obtained were 95.65 % – 109.85 % for NEB and 97.42 % – 101.43 % for VAL. The % RSD found 0.271 %-1.490 % for intraday and 0.334 %-1.917 % for interday for NEB and 0.188 %-0.944 % for intraday and 0.392 %-1.197 % for interday for VAL. The limit of detection and limit of quantitation for NEB were found to be 4.608 μg/ml and 13.965 μg/ml respectively and the limit of detection and limit of quantitation for VAL were found to be 4.348 μg/ml and 13.178 μg/ml respectively. Simultaneous calibration of both drugs in 67 mM Phosphate buffer pH 6.8 with 0.5 % SDS shows that λmax of one drug does not interfere on the λmax of other drug. Recovery study was performed to confirm the accuracy of the method. The results of analysis have been validated statistically by recovery studies as per International Conference on Harmonization guidelines. The method showed good reproducibility and recovery with % RSD <2. Hence, this proposed method was found to be rapid, specific, precise, accurate and can be successfully applied for the routine analysis of NEB and VAL in pure and combined tablet dosage form.

Evaluating the effect of monocrotophos and glyphosate on microbial population and certain important exoenzyme activities in soil

Aim: The study aimed to evaluate the effects of various concentrations of organophosphate agrochemicals, namely monocrotophos and glyphosate on soil chemical parameters, microbial population and activities of certain vital exoenzymes e.g. invertase, amylase, cellulase, dehydrogenase and protease at 7 days interval over an incubation period of 84 days. Methodology: Three concentrations of monocrotophos (1.0 g kg-1 soil-low T1, 2.0 g kg-1 soil-medium T2, 3.0 g kg-1 soil-high T3) and glyphosate (0.1 g kg-1 soil-low T1, 0.15 g kg-1 soil-medium T2, 0.2 g kg-1 soil-high T3) were applied to soil. Soil pH, electrical conductivity, organic carbon (OC), available nitrogen, phosphorous and potassium (NPK) were assessed. Bacterial and fungal population along with activities of exoenzymes were also studied. Data were analysed using two way ANOVA and Duncan's multiple range test (DMRT). Results: Significant variations (p<0.05) of chemical parameters, except P and K, in treated soil between concentrations and time over the incubation period were observed. Microbial population and exoenzymes showed significant variations (p<0.05) in response to agrochemical treatments. Invariably, lower microbial load and enzyme activities were noticed in treated soil relative to control. Interpretation: The study indicated that monocrotophos and glyphosate at recommended and elevated concentrations in soil could adversely impact microbial growth. Inhibited microbial population culminated in lower exoenzyme activity

Brodie’s Abscess of Posterior Ilium with Gluteal Syndrome, an Unusual Cause of Paediatric Low Back Pain: A Case Report

Brodie’s abscess is a variety of subacute osteomyelitis with a long duration of presentation and intermittent pain. It usually involves the metaphyseal region of long bones of the lower limbs. Brodie’s abscess of pelvic bone is very rare. Involvement of posterior ilium with gluteal syndrome is extremely unusual and can be easily missed or misdiagnosed. We present a 9-year old boy who reported to us with intermittent low back pain of three months duration without any other constitutional symptoms. Clinically, there was mild tenderness over the posterior ilium. Computed tomography showed a lytic lesion in the posterior ilium with a breach in the outer cortex. MRI and bone scan were suggestive of inflammatory pathology. Keeping infective, tubercular and benign bone tumors as differential diagnoses, open biopsy and curettage were done. Staphylococcus aureus was cultured and histopathology was suggestive of osteomyelitis. The patient received appropriate antibiotics for six weeks. He was asymptomatic till 18 months of follow up without any recurrence. We present this case because of its rarity and unusual presentation as gluteal syndrome and low back pain, and its resemblance to other pelvic and sacroiliac joint pathologies which are often missed or misdiagnosed in paediatric patients.

Knowledge regarding snake bite in rural Bengal – Are they still lingering on myths and misconceptions.

Introduction: Snake bite is a very common problem in rural India which even today leads to a large number of deaths. This is because the uninformed community members take recourse to harmful traditional healing measures which cause loss of vital time which is very important for the survival of the patient. Objectives: To assess the knowledge of the study population on snake bite and to elicit any association of this knowledge with their demographic and socioeconomic characteristics. Material and methods: An observational, cross-sectional study was done in a village in the Singur Block of Hooghly district of West Bengal. The head of the family or in his absence the senior most members was interviewed with a pre-designed, pre-tested schedule. Results: Farming was the occupation of the majority (36%) followed by business (20.6%) and service (17.7%). 45% belonged to the social class I and II (modified B.G. Prasad) while 39% were in the social class IV and V. Only 58.85% of the study population were aware that the incidence of snake bite can be reduced. 68% were aware of immobilisation of the affected part was the initial first aid measure and only 4% had the correct knowledge that application of collar was unnecessary and harmful. . Correct knowledge on the availability of specific treatment was present among 85.1% and 77.1% knew where specific treatment is available. Education OR 2.51 (1.26 – 5.00), Occuption OR 4.44 (2.35-8.40), PCI OR 2.05 (1.12-3.76) were significantly associated with good knowledge. Conclusion: There is a paucity of knowledge on different domains of snakebite. Hence dissemination of correct knowledge is necessary to remove their misconceptions.

Effect of Ovaprim doses and latency periods on induced spawning of Clarias batrachus: observation on larval deformity.

Induced spawning of C. batrachus was conducted at different Ovaprim dose and latency period combinations to observe the deformed larvae among the hatchlings. For the purpose, four doses of Ovaprim (0.5, 1.0, 1.5 and 2.0 ml/kg body weight) and five latency periods (11, 14, 17, 20 and 23 hr) were considered in 20 different combinations. There were no deformed larvae in the females injected with all four doses and stripped at 11 hr latency, as the eggs did not hatch. The percentage of deformed larvae (4-7%) did not vary significantly at 1.0-2.0 ml dose level in combination with 14-17 hr latency periods. While increasing the latency period beyond 17 hr at 1-1.5 ml dose level, the percentage of deformed larvae increased significantly and touched as high as 11%. The results indicated that 1-1.5 ml dose in combination with 14-17 hr latency are suitable to reduce the deformed larvae among the hatchlings during induced spawning of C. batrachus.

Seminoma in hybrid catfish [Clarias batrachus (Linnaeus) female x Clarias gariepinus (Burchell) male].

Spontaneous testicular tumors, seminoma, were noticed in four male hybrid catfish (C. batrachus female x C. gariepinus male) after the age of two years. The hybrids showed massive abdominal swelling with catchectic body and free lobulated, encapsulated tumors (> 325 g) within the serosanguinous fluid-filled peritoneal cavities. The tumor cells were large and polyhedral with prominent centrally located nuclei. Other vital organs appeared normal. It seems to be the first report of seminoma in hybrid catfish and possibly of genetic cause.

Prevalence of dental caries and treatment needs among children of Cuttack (Orissa).

An epidemiological investigation was carried out to know the prevalence of Dental Caries amongst 1257 children in the age group of 5, 8, 11 & 15 years respectively attending schools in the city of Cuttack, Orissa. The examination was carried out under natural light and dental caries was diagnosed according to W.H.O. Criteria 1983. The point prevalence of dental caries was recorded to be 64.3% with an average DMFT of 2.38. The prevalence of caries showed a pattern of occurrence i.e. prevalence consistantly increased from 5 years to 8 years age group and subsequently decreased at 11 years and 15 years age. Regarding treatment needs, 63.6% children required dental treatment for various reason and it is in accordance with dental caries prevalence of different age group.

Role of duodenal bile crystal analysis in idiopathic pancreatitis.

BACKGROUND/AIM: The aim of this study was to find out the incidence and clinical use of duodenal bile crystal analysis in patients presenting with idiopathic pancreatitis. MATERIALS AND METHODS: Sixty consecutive patients with acute pancreatitis were studied. They were divided into two subgroups (known and unknown causes). Sixty patients were used as controls and divided into 3 subgroups (n = 20 each). The patients of acute pancreatitis with severe or life threatening complications or those requiring surgical interventions were excluded. Bile samples from both groups were analyzed for presence or absence of crystals. RESULTS: The maximum age incidence of acute pancreatitis was in the fifth decade (41-50 years). The M/F ratio was 3.6:1. Recurrent acute pancreatitis was observed in 26.6% cases (20% idiopathic vs. 6.6% known aetiology). Twenty-five percent of the control sub group (n = 20) cases of cholelithiasis without history of pancreatitis had positive microcrystals in their bile sample. In patients with idiopathic pancreatitis (n = 18), 7 cases (11.6%) had crystals in the bile. In those with known causes of pancreatitis (n = 42), 33 cases (55%) had positive crystals in the bile. CONCLUSION: Thirty percent of our patients had idiopathic acute pancreatitis with a high rate of clinical recurrence (20%). Duodenal bile crystal analysis detected 7 cases of microlithiasis out of 18 cases in this group and suggested an aetiology. This procedure should be used more often.