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Background: Reproduction is the basic expectation of human life. There is worldwide increase in incidence of infertility due to many factors such as delaying child-bearing, increase in lifestyle disorders, and stress to achieve personal and professional goals. The incidence varies between 5 and 15%. Aims and Objectives: The aims of this study were to evaluate the factors responsible for infertility using diagnostic hysterolaparoscopy among the patients attending tertiary care hospital. Materials and Methods: It was a prospective study conducted from December 2018 to May 2022 in Obstetrics and Gynecology Department of GCS Medical College, Ahmedabad. Around 150 patients were included in study. All patients of primary and secondary infertility whose hormonal profile was normal were included in the study. Results: In the present study, primary infertility was present in 73% of cases where as 27% were having secondary. Majority (43%) of patients of the primary infertility belonged to age 26–30 years and 29% of secondary infertility cases were in the age group 31–35 years. Tubal factors were highest (32%), followed by ovarian factors (29%), peritoneal factors (11%), and uterine factors (9%). Among tubal factors, bilateral block was present in 19% and unilateral tubal block in 11%; among ovarian factors, polycystic ovary syndrome was highest (18%) and in peritoneal factor, endometriosis was seen in 6%. In uterine factors, fibroid was present in about 8% of cases. Conclusion: Diagnostic hysterolaparoscopy provides reliable information in evaluation of infertility and determining various causes such as tubal, ovarian, peritoneal, and uterine.
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Background:High flow nasal cannula is a newer modality of treatment for hypoxemic respiratory failure. Present study is conducted to evaluate demographic characteristics, co-morbidities and outcome parameters of patients on High flow nasal cannula. Material And Methods:In retrospective observational study all patients on High flow nasal canula with covid-19 were evaluated for demographic characteristics and outcome with comorbidities during study period.Result:Maximum number of patients belongs to age group 51-60 years. Highest mortality was in the age group of 61-70 years.Conclusion:The High flow nasal cannula therapy may provide important newer modality and helpful in patients with respiratory failure.
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Aim: The present study was carried out to identify and explore novel areas of semiochemical based pest management like oviposition deterrents.Methodology: The oviposition deterrents were identified from larval faecal pellets of pink bollworm using methanol as solvent and analysed in GC-MS. Three fatty acids were identified and evaluated for oviposition deterrent effect. Results: In the present study, three major compounds namely; oleic, linoleic and palmitic acids were identified for the first time from larval faecal pellets of pink bollworm. Their oviposition deterrent effect was confirmed in bioassays carried out with different concentrations of identified compounds. The avoidance index (Ai) 0.78 ± 0.05 and per cent effective deterrency (PED) 87.42% was recorded in oleic acid at highest concentration followed by linoleic acid (Ai: 0.77 ± 0.03; PED: 86.61%) in reducing the egg laying by conspecific female. This clearly showed the role of these compounds as oviposition deterrent. Interpretation: The compounds, oleic and linoleic acids evaluated in laboratory showed oviposition deterrent effect on female pink bollworm reducing egg laying considerably. However, further field studies need to be conducted to validate these observations.
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Hypertension, often referred to as ‘The silent killer’, is christened so, as it is seldom preceded by any warning signs or symptoms. With the new ACC/AHA guidelines lowering the Blood Pressure (BP) threshold values, it has resulted in a 140% relative increase in the hypertension prevalence in India, which is 3 times higher than that of in United States. Imidazoline receptor agonists control BP effectively with minimal adverse effects of sedation and mental depression that are usually associated with centrally acting antihypertensives. While having a low affinity to the α2-adrenergic receptors, these new generation centrally acting antihypertensive agents are highly selective for imidazoline receptor. Moxonidine, a second-generation centrally acting antihypertensive drug having selective agonist activity on imidazoline I1 receptors and minor activity on imidazoline α2 adrenoceptors, reduces the activity of Sympathetic Nervous System (SNS) by activating I1 imidazoline receptors in Rostral Ventrolateral Medulla (RVLM). Studies of moxonidine have shown equal effectiveness in lowering BP like other well-established antihypertensive drugs such as nifedipine, atenolol or angiotensin-converting enzyme inhibitors, with minimal adverse events. At doses of 0.2-0.6 mg, moxonidine induces satisfactory BP reduction in patients with mild-to-moderate essential hypertension. In patients with mild-to-moderate hypertension, moxonidine (0.2-0.4 mg o.d.) significantly decreased Systolic Blood Pressure/Diastolic Blood Pressure (SBP/DBP), respectively, by 19.5/11.6 mmHg. In obese, non-controlled hypertensive patients, there is a 14% and 13.5% reduction in the mean SBP and DBP, respectively, from the baseline value after moxonidine treatment and during the follow-up with an additional reduction in body weight, plasma leptin levels and Body Mass Index (BMI) (p<0.01). Thus, moxonidine could be considered as a therapeutic option in obese patients with metabolic syndrome.
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Chronic stable angina (CSA) is an incapacitating disorder. The pain can hinder the routine chores of an individual and significantly impact one’s quality of life (QoL). However, the good news is that this can be treated and the QoL can be improved. The key to apt management lies in the accurate early diagnosis of this condition, followed by a detailed evaluation and accordingly planned management, which should be regularly revised and be backed by an adequate follow-up. OPTA-OPtimal Treatment for chronic stable Angina-is an educational initiative to assist the clinicians in India with screening and diagnostic tools, strengthened by updated guideline-directed management to ensure satisfactory patient outcomes. OPTA aims to improve clinical outcomes by providing optimized pharmacotherapy for patients with stable angina. This expert consensus document intends to provide information for better understanding of the condition by clinicians and to ensure an early, accurate diagnosis, followed by optimal management of angina. For better clinical and practical understanding of Indian clinical scenario, the most commonly encountered patient profiles are briefly described here. These inputs and an extensive literature review were blended to develop the recommendations for clinicians across the country. An attempt is made to include clinical recommendations that meet the needs of the majority of patients in most circumstances in the Indian scenario. However, the ultimate judgment regarding individual case management should be based on clinician’s discretion. This expert consensus document is not a substitute for textbooks and/or a clinical judgment.
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Return of blood flow after periodic ischemia is often accompanied by myocardial injury, commonly known as lethal reperfusion injury (RI). Experimental studies have shown that 50% of muscle die of ischemia and another 50% die because of reperfusion. It is characterized by myocardial, vascular, or electrophysiological dysfunction that is induced by the restoration of blood flow to previously ischemic tissue. This phenomenon reduces the efficiency of the present modalities used to combat the ischemic myocardium. Moreover, despite an improved understanding of the pathophysiology of this process and encouraging preclinical trials of multiple agents, most of the clinical trials to prevent RI have been disappointing and leaves us at ground zero to explore newer approaches.
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A selective, sensitive and precise assay based on solid phase extraction and liquid chromatography–tandem mass spectrometry (LC–MS/MS) was developed for the simultaneous determination of amiloride (AMI) and hydrochlorothiazide (HCTZ) in human plasma. Sample clean-up with 250 μL of plasma was done on Phenomenex Strata?-X extraction cartridges using their labeled internal standards (AMI-15N3 and HCTZ- 13C,d2). Chromatography was performed on Hypersil Gold C18 (50 mm×3.0 mm, 5 μm) column using acetonitrile with 4.0 mM ammonium formate (pH 4.0, adjusted with 0.1% formic acid) (80:20, v/v) as the mobile phase. Detection was carried out on a triple quadrupole API 5500 mass spectrometer utilizing an electrospray ionization interface and operating in the positive ionization mode for AMI and negative ionization mode for HCTZ. Multiple reaction monitoring was used following the transitions at m/z 230.6/116.0, m/z 233.6/116.0, m/z 296.0/204.9 and m/z 299.0/205.9 for AMI, AMI-15N3, HCTZ and HCTZ-13C,d2, respectively. Calibration curves were linear (r2≥0.9997) over the concentration range of 0.050–50.0 and 0.50–500 ng/mL for AMI and HCTZ, respectively, with acceptable accuracy and precision. The signal-to-noise ratio at the limit of quantitation was ≥14 for both the analytes. The mean recovery of AMI and HCTZ from plasma was 89.0% and 98.7%, respectively. The IS-normalized matrix factors determined for matrix effect ranged from 0.971 to 1.024 for both the analytes. The validated LC–MS/MS method was successfully applied to a bioequivalence study using 5 mg AMI and 50 mg HCTZ fixed dose tablet formulation in 18 healthy Indian volunteers with good reproducibility.
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A sensitive and selective method has been proposed for the simultaneous determination of amlodipine (AML), valsartan (VAL) and hydrochlorothiazide (HCTZ) in human plasma by liquid chromatography–tandem mass spectrometry (LC–MS/MS). The analytes and their deuterated analogs were quantitatively extracted from 100 μL human plasma by solid phase extraction on Oasis HLB cartridges. The chromatographic separation of the analytes was achieved on a Chromolith RP18e (100 mm × 4.6 mm) analytical column within 2.5 min. The resolution factor between AML and VAL, AML and HCTZ, and VAL and HCTZ was 2.9, 1.5 and 1.4, respectively, under isocratic conditions. The method was validated over a dynamic concentration range of 0.02–20.0 ng/mL for AML, 5.00–10,000 ng/mL for VAL and 0.20–200 ng/mL for HCTZ. Ion-suppression/enhancement effects were investigated by post-column infusion technique. The mean IS-normalized matrix factors for AML, VAL and HCTZ were 0.992, 0.994 and 0.998, respectively. The intra-batch and inter-batch precision (% CV) across quality control levels was ≤ 5.56% and the recovery was in the range of 93.4%–99.6% for all the analytes. The method was successfully applied to a bioequivalence study of 5 mg AML + 160 mg VAL + 12.5 mg HCTZ tablet formulation (test and reference) in 18 healthy Indian males under fasting. The mean log-transformed ratios of Cmax, AUC0–120h and AUC0-inf and their 90% CIs were within 90.2%–102.1%. The assay reproducibility was demonstrated by reanalysis of 90 incurred samples.
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A selective, sensitive and precise assay based on solid phase extraction and liquid chromatography–tandem mass spectrometry (LC–MS/MS) was developed for the simultaneous determination of amiloride (AMI) and hydrochlorothiazide (HCTZ) in human plasma. Sample clean-up with 250 μL of plasma was done on Phenomenex Strata?-X extraction cartridges using their labeled internal standards (AMI-15N3 and HCTZ- 13C,d2). Chromatography was performed on Hypersil Gold C18 (50 mm×3.0 mm, 5 μm) column using acetonitrile with 4.0 mM ammonium formate (pH 4.0, adjusted with 0.1% formic acid) (80:20, v/v) as the mobile phase. Detection was carried out on a triple quadrupole API 5500 mass spectrometer utilizing an electrospray ionization interface and operating in the positive ionization mode for AMI and negative ionization mode for HCTZ. Multiple reaction monitoring was used following the transitions at m/z 230.6/116.0, m/z 233.6/116.0, m/z 296.0/204.9 and m/z 299.0/205.9 for AMI, AMI-15N3, HCTZ and HCTZ-13C,d2, respectively. Calibration curves were linear (r2≥0.9997) over the concentration range of 0.050–50.0 and 0.50–500 ng/mL for AMI and HCTZ, respectively, with acceptable accuracy and precision. The signal-to-noise ratio at the limit of quantitation was ≥14 for both the analytes. The mean recovery of AMI and HCTZ from plasma was 89.0% and 98.7%, respectively. The IS-normalized matrix factors determined for matrix effect ranged from 0.971 to 1.024 for both the analytes. The validated LC–MS/MS method was successfully applied to a bioequivalence study using 5 mg AMI and 50 mg HCTZ fixed dose tablet formulation in 18 healthy Indian volunteers with good reproducibility.
ABSTRACT
A sensitive and selective method has been proposed for the simultaneous determination of amlodipine (AML), valsartan (VAL) and hydrochlorothiazide (HCTZ) in human plasma by liquid chromatography–tandem mass spectrometry (LC–MS/MS). The analytes and their deuterated analogs were quantitatively extracted from 100 μL human plasma by solid phase extraction on Oasis HLB cartridges. The chromatographic separation of the analytes was achieved on a Chromolith RP18e (100 mm × 4.6 mm) analytical column within 2.5 min. The resolution factor between AML and VAL, AML and HCTZ, and VAL and HCTZ was 2.9, 1.5 and 1.4, respectively, under isocratic conditions. The method was validated over a dynamic concentration range of 0.02–20.0 ng/mL for AML, 5.00–10,000 ng/mL for VAL and 0.20–200 ng/mL for HCTZ. Ion-suppression/enhancement effects were investigated by post-column infusion technique. The mean IS-normalized matrix factors for AML, VAL and HCTZ were 0.992, 0.994 and 0.998, respectively. The intra-batch and inter-batch precision (% CV) across quality control levels was ≤ 5.56% and the recovery was in the range of 93.4%–99.6% for all the analytes. The method was successfully applied to a bioequivalence study of 5 mg AML + 160 mg VAL + 12.5 mg HCTZ tablet formulation (test and reference) in 18 healthy Indian males under fasting. The mean log-transformed ratios of Cmax, AUC0–120h and AUC0-inf and their 90% CIs were within 90.2%–102.1%. The assay reproducibility was demonstrated by reanalysis of 90 incurred samples.
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A sensitive and rapid liquid chromatography-tandem mass spectrometry (LC– MS/MS) method has been developed for the simultaneous determination of lisinopril (LIS) andhydrochlorothiazide (HCTZ) in human plasma using their labeled internal standards (ISs). Sample pre-treatmentinvolved solid phase extraction on Waters Oasis HLB cartridges using 100 μL of plasma, followed by liquidchromatography on Hypersil Gold C18 (50 mm×3.0 mm, 5 μm) column. The analytes were eluted within 2.0 min usingacetonitrile-5.0 mM ammonium formate, pH 4.5 (85:15, v/v) as the mobile phase. The analytes and ISs wereanalyzed in the negative ionization mode and quantified using multiple reaction monitoring. The methodshowed excellent linearity over the concentration range of 0.50–250.0 ng/mL for both the analytes. Theintra-batch and inter-batch precision (% CV) was ≤5.26% and their extraction recoveries were in the range of 96.6% –103.1%. Matrix effect evaluated in terms of IS-normalized matrix factors ranged from 0.97 to 1.03 for boththe analytes. The validated method was successfully applied to determine the plasma concentration of the drugsusing 10 mg lisinopril and 12.5 mg hydrochlorothiazide fixed dose formulation in 18 healthy Indian volunteers.
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A rapid and sensitive ultra performance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS) method is described for determination of letrozole in human plasma. Following solid phase ex-traction (SPE) of letrozole and letrozole-d4 on Orochem DVB-LP cartridges, chromatography was per-formed on Acquity UPLC BEH C18 (50 mm ? 2.1 mm, 1.7 mm) column using methanol-0.1%formic acid in water (85:15, v/v) as the mobile phase. Detection was carried out on a triple quadrupole mass spec-trometer with an electrospray source, operated under positive ionization mode. Quantitation of letrozole and letrozole-d4 was done using multiple reaction monitoring (MRM) following the transitions at m/z 286.2-217.0 and m/z 290.2-221.0, respectively. The calibration plots were linear through the con-centration range of 0.10–100 ng/mL (r2Z0.9990) using 100 mL human plasma. The extraction recovery of letrozole ranged from 94.3% to 96.2% and the intra-batch and inter-batch precision was r 5.2%. The method was successfully applied to a bioequivalence study of letrozole after oral administration of 2.5 mg tablet formulation to 16 healthy postmenopausal Indian women. The assay reproducibility was also established through incurred sample reanalysis (ISR) of 74 subject samples.
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An improved and reliable ultra-performance liquid chromatography/tandem mass spectrometry (UPLC–MS/MS) method has been developed and validated for the determination of lercanidipine in human plasma. Plasma samples with lercanidipine-d3 as an internal standard (IS) were prepared by solid phase extraction on Phenomenex Strata-X cartridges using 100 mL of human plasma. Chromatographic analysis was performed on UPLC BEH C18 (50 mm ? 2.1 mm, 1.7 mm) column under isocratic conditions. Linear calibration curves were obtained over a wide dynamic concentration range of 0.010–20.0 ng/mL. Matrix effect was assessed by post-column infusion, post-extraction spiking and standard-line slope methods. The mean extraction recovery was 4 94%for the analyte and IS. Inter-batch and intra-batch precision (%CV) across five quality controls was o 5.8%. Bioequivalence study was performed with 36 healthy sub-jects after oral administration of 10 mg of lercanidipine and the assay reproducibility was evaluated by reanalysis of 133 incurred samples.
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Thrombotic thrombocytopenia purpura (TTP) is a rare hematological disease and only 20%–30% of patients present with classic pentad. About 20% of patients with TTP are resistant to plasma exchange. We have described a 28-year-old female patient with TTP who did not have classic pentad of TTP. We ruled out all other differential diagnosis. She was refractory to plasmapheresis and was treated successfully with rituximab. It was thus concluded that on the basis of the literature review, rituximab should be considered in TTP patients who fail to respond after 7–14 days of standard treatment with daily plasmapheresis and glucocorticoids.
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Background & objectives: Endemic fluorosis resulting from high fluoride concentration in groundwater is a major public health problem in India. This study was carried out to measure and compare the prevalence of dental fluorosis and dental caries in the population residing in high and normal level of fluoride in their drinking water in Vadodara district, Gujarat, India. Methods: A cross-sectional study was conducted in Vadodara district, six of the 261 villages with high fluoride level and five of 1490 with normal fluoride level in drinking water were selected. The data collection was made by house-to-house visits twice during the study period. Results: The dental fluorosis prevalence in high fluoride area was 59.31 per cent while in normal fluoride area it was 39.21 per cent. The prevalence of dental caries in high fluoride area was 39.53 per cent and in normal fluoride area was 48.21 per cent with CI 6.16 to 11.18. Dental fluorosis prevalence was more among males as compared to females. Highest prevalence of dental fluorosis was seen in 12-24 yr age group. Interpretation & conclusions: The risk of dental fluorosis was higher in the areas showing more fluoride content in drinking water and to a lesser degree of dental caries in the same area. High fluoride content is a risk factor for dental fluorosis and problem of dental fluorosis increased with passage of time suggesting that the fluoride content in the water has perhaps increased over time. Longitudinal studies should be conducted to confirm the findings.
Subject(s)
Dental Caries/epidemiology , Dental Caries/etiology , Fluorosis, Dental/epidemiology , Fluorosis, Dental/epidemiology , Fluorosis, Dental/etiology , Groundwater/chemistry , Humans , India , PrevalenceABSTRACT
Pulmonary drug delivery has attracted tremendous scientific and biomedical interest in recent years and has progressed considerably within the context of local treatment for lung diseases, by virtue of enhanced local targeting and reduced systemic side effects with the administration of minute drug dosages. Furthermore, with the high surface area and permeability of the lung, the 21st century has seen a paradigm shift to inhaled therapy for systemic use. But the pulmonary tract tends to be considered as very promising and attractive route for the administration of active substances intended to treat local pulmonary e.g., asthma, chronic obstructive pulmonary disease (COPD), microbial infections) as well as systemic diseases. (e.g., diabetes) Recent progress within biotechnology has generated a group of novel protein and peptide drugs to which administration to the respiratory tract, to obtain systemic delivery seems advantageous compared to e.g. parenteral or gastrointestinal administration (tablets, capsules etc.). The low metabolic activity in the lungs allows systemic delivery without liver passage Hence lung is an attractive environment for biomolecules, which are highly susceptible to enzymatic degradation in the gastrointestinal tract (ventricle and guts) as well as hepatic degradation (first pass metabolism).
Subject(s)
Child , Child, Preschool , Diabetic Ketoacidosis/therapy , Female , Fluid Therapy/methods , Humans , MaleABSTRACT
This report concerns an incident of multiple non-fatal poisonings due to datura, which was mixed in sweetmeat disguised as "prasad". The accused wished to kill his mother-in-law, but the "prasad" was consumed by many others also, who suffered from the manifestations of datura poisoning. However they responded well to routine treatment, and there were no fatalities.