Iatrogenic Isolated Ruptured Dorsalis Pedis Artery Pseudo Aneurysm : A Rare Case Report

A Dorsalis Pedis Artery (DPA) pseudo aneurysm is one of the most uncommon peripheral arterial aneurysms. These aneurysms can cause distal embolization and thrombosis, leading to limb loss. However, their rupture is unusual1. Any type of injury or perhaps an iatrogenic intervention can cause a pseudo localized swelling of the dorsalis pedis artery, which is a relatively unusual condition. Whenever it presents as a non-pulsatile soft tissue mass in the presence or absence of a specific predeceasing event, it can lead to a difficult diagnostic dilemma2. The rare instance of an iatrogenic pseudo aneurysm of the dorsalis pedis artery which mimicked cellulitis of the right foot is discussed in this case report. Coil embolization of the proximal artery, and the aneurysm was successfully done by the intervention radiologist. After the procedure, collateral circulation was maintained. No ischemic symptoms such as intermittent claudication or pain at rest were observed. This approach may be useful in treating similar cases

Comparison of pregnancy outcome between clomiphene citrate and sequential clomiphene citrate+human menopausal gonadotropin in intrauterine insemination

Background: Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples. This study compares the sequential clomiphene citrate (CC) treatment with CC and human menopausal gonadotropin (hMG) treatment in women undergoing IUI. Therefore, this study was designed to determine the effects of addition of gonadotropin (CC+hMG) would improve the pregnancy rate in women undergoing IUI. And also compare the sequential CC+hMG treatment with CC treatment in women undergoing IUI. Methods: A cross-sectional study design was conducted at D. Y. Patil Fertility Centre, D.Y Patil Hospital, Navi Mumbai from September 2018 to August 2019. Source populations were all patients who live in Mumbai, Maharashtra, India. A total of 67 patients were enrolled in this study. (It consisted of 67 sub fertile couples undergoing ovarian stimulation for IUI cycles). Results: There was no significant difference between the two studied groups regarding endometrial thickness (8.3±2.1 versus 9.7±2.8, respectively), number of mature follicles on the day of hCG injection (3.3±1.2 versus 3.5±1.1, respectively) and, but there was significant difference between the CC+hMG group and CC group regarding the total dose of gonadotropins used in ovulation induction (305±23.8 versus 655±192; total IU, respectively) p<0.05. Conclusions: Women undergoing IUI, ovarian stimulation CC combined with hMG, significantly improved the pregnancy and live birth rates as compared to that of CC group. In women undergoing ovarian stimulation and IUI, there are no significant differences in pregnancy and live birth rates among the various stimulation protocols.

Benzimidazole: A short review of their antimicrobial activities.

Benzimidazole is the heterocyclic compound formed from benzene and imidazole ring containing nitrogen, oxygen sulphor and its derivatives are of wide interest because of their diverse biological activity and clinical applications, they are remarkably effective compounds both with respect to their inhibitory activity and their favourable selectivity ratio. Reported nucleus is a constituent of vitamin-B12. Benzimidazoles are regarded as a promising class of bioactive heterocyclic compounds that exhibit a range of biological activities like anti-microbial, anti-viral, anti-diabetic, anti-cancer activity, numerous anti-oxidant, anti-parasitic, anti-helmintics, anti-proliferative, anti-HIV, anti-convulsant, anti-inflammatory, anti-hypertensive, anti-neoplastic, proton pump inhibitor and anti-trichinellosis. Benzimidazoles exhibit significant activity as potential antitumor agents, smooth muscle cell proliferation inhibitors, a treatment for intestinal cystitis, and in diverse area of chemistry. Some of the important benzimidazole derivatives have been reported as thyroid receptor agonist gonadotropin releasing hormone receptor antagonists, non-nucleoside HIV-1 reverse transcriptase inhibitors and interestingly alkynylbenzimidazoles as modulators of metabotropic glutamate receptors. The imidazole core is a common moiety in a large number of natural products and pharmacologically active compounds. The synthesis of novel benzimidazole derivatives remains a main focus of medicinal research. This comprehensive overview summarizes the chemistry of different derivative of substituted benzimidazole along with their anti-microbial activity containing anti-malarial anti-fungal, anti-bacterial, anti-viral activities.

Alterations in intestinal permeability and endotoxemia in severe acute pancreatitis.

Background: Intestinal permeability increases early in the course of acute pancreatitis and is associated with sepsis and organ failure. Aim: To evaluate the intestinal permeability (IP) and anti-endotoxin antibodies immunoglobulin G and A (AEA IgG and A) in severe acute pancreatitis (SAP) as compared to healthy controls and determine their significance in relation to various complications of SAP. Methods: IP was measured by urinary lactulose/mannitol (LM) excretion ratio and antiendotoxin antibodies by Endocab ELISA kit at days one and seven of admission (D1 and D7). Results: Thirty one patients of SAP [mean age (42.0±15.8) years, APACHE II scores (8.8±5.4) and CT severity index (6.4±2.0)] were included in this study. Infected pancreatic necrosis was detected in 13 (42%) patients of whom three died. Six died of persistent organ failure. Median values of LM ratio at D1 and D7 were similar to those in healthy controls. Patients experiencing complications [organ failure (4/9, 44%), infected pancreatic necrosis (5/10, 50%) and death (1/ 2, 50%)] manifested a substantial increase in their intestinal permeability at D7. Anti-endotoxin antibodies IgG were lower (p=0.003) in patients than the controls at admission. AEA IgG were lower (p=0.03) in non-survivors as compared to survivors at D7. Conclusion: Patients experiencing complications of severe acute pancreatitis showed an increase in intestinal permeability. Higher endotoxemia predicted poor outcome in severe acute pancreatitis.

Benzimidazole: A short review of their antimicrobial activities.

Benzimidazole is the heterocyclic compound formed from benzene and imidazole ring containing nitrogen, oxygen sulphor and its derivatives are of wide interest because of their diverse biological activity and clinical applications, they are remarkably effective compounds both with respect to their inhibitory activity and their favourable selectivity ratio. Reported nucleus is a constituent of vitamin-B12. Benzimidazoles are regarded as a promising class of bioactive heterocyclic compounds that exhibit a range of biological activities like anti-microbial, anti-viral, anti-diabetic, anti-cancer activity, numerous anti-oxidant, anti-parasitic, anti-helmintics, anti-proliferative, anti-HIV, anti-convulsant, anti-inflammatory, anti-hypertensive, anti-neoplastic, proton pump inhibitor and anti-trichinellosis. Benzimidazoles exhibit significant activity as potential antitumor agents, smooth muscle cell proliferation inhibitors, a treatment for intestinal cystitis, and in diverse area of chemistry. Some of the important benzimidazole derivatives have been reported as thyroid receptor agonist gonadotropin releasing hormone receptor antagonists, non-nucleoside HIV-1 reverse transcriptase inhibitors and interestingly alkynylbenzimidazoles as modulators of metabotropic glutamate receptors. The imidazole core is a common moiety in a large number of natural products and pharmacologically active compounds. The synthesis of novel benzimidazole derivatives remains a main focus of medicinal research. This comprehensive overview summarizes the chemistry of different derivative of substituted benzimidazole along with their anti-microbial activity containing anti-malarial anti-fungal, anti-bacterial, anti-viral activities.

Effect of antioxidant therapy on hospital stayand complications in patients with early acutepancreatitis: A randomised controlled trial.

Background: Oxidative stress (OS) in acute pancreatitis (AP) has been pathologically linked with the systemic inflammatory response and antioxidant supplementation may have a clinical benefit. Methods : In this prospective, randomised open label, controlled pilot study, patients admitted within 72 hours of onset of pain were randomised to receive either placebo (only standard medical treatment; SMT) or antioxidants (vitamin C 500 mg, N-acetyl cysteine 200 mg 8 hourly and antoxyl forte 1 capsule hourly with standard medical treatment; SMT+AO) daily, following informed consent. Patients with co-morbid illness and pregnancy were excluded. Primary efficacy measures were length of hospital stay and complications whilst secondary measures were biochemical markers of oxidative stress (thiobarbituric acid reactive substances [TBARS] and superoxide dismutase [SOD] and total antioxidant capacity [TAC] and vitamin C) at Days 1, 3 and 7. Results: Of 53 patients, 30 patients were randomised to SMT and 23 patients to SMT+AO. The mean duration of hospital stay in the SMT group (10.3±7 days) was more compared to SMT+AOT (7.2±5 days), but was not statistically significant (p=0.07), complications were similar in the 2 groups. At Day 7, OS was significantly lower in the SMT+AO group when compared with the SMT group (TBARS, p=0.05; SOD, p=0.03) with a significant increase in FRAP and vitamin C (p=0.01). Conclusions: Antioxidant supplementation may decrease the length of hospital stay and complication rate in patients with AP, but a larger clinical trial is needed to support this hypothesis. Further, it decreased the OS and improved the antioxidant status in patients with AP.

Presence of 25(OH) D deficiency in a rural North Indian village despite abundant sunshine.

BACKGROUND AND OBJECTIVE: Several studies have shown wide prevalence of vitamin D deficiency with serum 25(OH)D <49.9 nmol/L in urban Indians related to their poor sunshine exposure and skin pigmentation. However, there is limited information in rural Indians. We hypothesized presence of higher 25(OH)D in rural subjects as compared to urban because of farming related abundant sunshine exposure. DESIGN AND METHODS: We assessed serum 25(OH)D levels in residents of a North Indian village with 200 families, located 90 km East of Delhi during February (winter). Fifty seven subjects (32 males and 25 females) from 50 families consented for the study. RESULTS: The mean 25(OH)D values of all subjects in the rural area was 36.4 +/- 22.5 nmol/l/L. Males had significantly higher 25(OH)D values than females. When compared to urban subjects, the mean 25(OH)D value of rural males and females was six and three folds higher, respectively. However even with five hours of daily sunshine exposure only 31.5% had serum 25(OH)D levels > or = 50 nmol/L. CONCLUSIONS: Thus, with longer sunshine exposure subjects residing in rural area had better mean 25(OH)D values than that of urbans. However, 70% of them were still vitamin D deficient. These facts indicate the need for the countrywide vitamin D food fortification program irrespective of rural or urban setting.

Dietary survey and total dietary fiber intake in patients with irritable bowel syndrome attending a tertiary referral hospital.

BACKGROUND: Based on their chemical extraction, dietary fibers are classified into crude fibers and total dietary fibers (TDF). TDF gives the best estimate of fiber content in the diet. Whereas data on intake of crude fibers are available, there is a lack of data on intake of TDF in patients with irritable bowel syndrome (IBS). AIM: We assessed the TDF and its source in the diet of patients with IBS and healthy controls (HC). METHODS: Based on their predominant symptoms, 81 patients with IBS (according to Rome II criteria) were categorized into constipation-predominant (IBS-C, n=48), diarrhea-predominant (IBS-D, n=16) and mixed type (IBS-M, n=17). Information was collected on fiber supplementation and preference for high-fiber food. A pretested, open-ended, semi-quantitative food frequency questionnaire was used to collect dietary information on food groups and TDF. Age- and sex-matched healthy individuals (n=89) were recruited as HC. The mean (SD) age of patients and HC was 36.5 (11.4) years (59 men), and 36 (12) years (62 men), respectively. RESULTS: Thirty-nine patients (48%) were taking medicinal fiber supplements, of which 28 patients were taking supplements daily (2.10 [0.84] teaspoon full). The mean daily TDF intake was 51.7 (23.1) g vs. 52.3 (21.6) g for patients and HC, respectively (p=0.8). The intake of TDF was similar in patients having less (n=41) or more (n=40) preference for fiber-rich foods (55 [23] g vs. 47 [22] g, p=0.16). The daily mean cereal intake in patients was significantly lower than that in HC (322 g vs. 404 g, p=0.001). However, consumption of fruits (150 g vs. 80 g, p=0.001) and vegetables (348 g vs. 219 g, p=0.006) was higher in patients in comparison with HC. There was a positive correlation between TDF with cereals (p=0.001), pulses (p=0.001), vegetables and fruits (p=0.033) in patients with IBS but only with cereals (p=0.001) in HC. CONCLUSION: The intake of TDF in patients with IBS and HC is much higher than the dietary recommendation for healthy Indians. Patients with IBS consumed more fruits and vegetables rather than cereals as compared with HC.

Body mass index and per capita income influence duodenal ulcer healing and H. pylori eradication whilst dietary factors play no part.

BACKGROUND: The role of dietary and sociodemographic factors in the healing of duodenal ulcer following H. pylori eradication remains undefined. AIM: To assess the role of diet, sociodemography and body mass index in the healing of duodenal ulcer and eradication of H. pylori. METHODS: A cross-sectional study consisting of 67 consecutive duodenal ulcer patients was undertaken. Sociodemographic factors studied included age, sex, occupation, educational status, religion, type of family, number of family members, per capita income and residence (urban vs. rural). Personal habits studied included alcohol consumption and smoking. Regular dietary intake over a two-month period was assessed using the food frequency questionnaire. All patients had documented H. pylori infection at the time of inclusion and received standard triple eradication therapy. Follow-up endoscopy and testing for H. pylori were done 4 weeks after completion of eradication therapy. RESULTS: The mean age of the 67 patients (60 male, 7 female) was 39.9+/-13.6 years. Healing of duodenal ulcer was documented in 51 patients. H. pylori infection was successfully eradicated in 31 patients but not in the other 36. There was no difference between the groups (Group A1: H. pylori eradicated, Group B1: H. pylori not eradicated) with regard to dietary and socio-demographic variables, except for BMI, which was significantly higher in patients in whom H. pylori had been eradicated. Per capita income was significantly higher in Group A2 (healed duodenal ulcer) as compared to Group B2 (duodenal ulcer not healed) while there was no difference in dietary and socio-demographic variables in these two groups. CONCLUSION: We found that higher body mass index and higher per capita income were associated with successful H. pylori eradication and duodenal ulcer healing, respectively, and that diet had no role to play in either. Further epidemiological studies from different parts of India and studies that control for Helicobacter pylori are required to establish predictive factors.

Status of nutrition support services in selected hospitals in India.

Nutritional support of hospitalized patients is a neglected aspect of clinical management despite the fact that hospital malnutrition leads to increased morbidity and mortality. There is a paucity of data regarding the status of nutrition support services (NSS) from India; hence, the present study was conducted in 50 hospitals attached to medical colleges all over the country. A semi-structured, pre-tested questionnaire was utilized to collect data regarding the status of NSS in these hospitals. The results of the study revealed that only 64% of the hospitals had a dietetics department. About 18% did not have any dietician. The dietician-to-patient ratio was very low--0.28 dieticians available per 100 hospital indoor beds. The majority (82%) of the hospitals were providing hospital food to indoor patients. The average cost of 4 meals per day was Rs 22 per patient. It was seen that only 46% of the hospitals were not providing hospital-based special feeds to the patients. The findings of our study indicated that the NSS are inadequate even in tertiary care hospitals and there is a need to strengthen the services for the holistic management of patients.

Nutrition in the management of hepatic encephalopathy.

Nutritional factors play a major role both in the pathogenesis as well as management of hepatic encephalopathy (HE). Physicians treating patients with chronic liver disease often restrict the intake of dietary protein to prevent a rise in blood ammonia levels. The role of protein restriction in patients with chronic hepatic encephalopathy (CHE) has been questioned recently as the efficacy of protein withdrawal in patients with CHE has never been subjected to a controlled trial. Evidence suggests that protein intake plays only a limited role in precipitating encephalopathy. In fact, measures taken to suppress endogenous protein breakdown are more effective than dietary restrictions in reducing the load of amino acids on the decompensated liver. A protein intake of less than 40 g per day, as has been indicated, contributes to a negative nitrogen balance, which along with increased endogenous protein breakdown, worsens encephalopathy. A positive nitrogen balance may have positive effects on encephalopathy. Rather, depressed plasma branched-chain amino acid (BCAA) levels, implicated in the pathogenesis of HE, also supervene in cirrhosis only when malnutrition is present as well. Therefore, the emphasis in the nutritional management of patients with HE should not be on the reduction of protein intake. Instead, the goal should be to promote synthesis by making available ample amounts of amino acids, while instituting other measures to reverse the ongoing catabolism. Different protein sources have varying effects on HE and efforts should be made to identify the most tolerated protein source to prevent malnutrition and maintain these patients on a long-term basis.