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Bleeding haemorrhoids present commonly to surgical outpatient departments (OPDs) and sometimes in emergency. Most often conservative management suffices but infrequently the patients can land up in emergency operation theatre for uncontrolled bleeding. Some haematological disorders can also present with rectal bleeding and amongst them Chronic myeloid leukaemia (CML), a haematological malignancy, presenting as bleeding per rectum has been not been reported so far, though instances of CML with gingival bleed, epistaxis have been reported. CML per se is known to be asymptomatic (40% cases) and bleeding is rarely seen. Here we present an interesting case of an emergency hemorrhoidal bleed that was subsequently diagnosed as CML. The patient after failed conservative management for bleeding haemorrhoids was taken up for emergency haemorrhoidectomy and again a relook under general anaesthesia in the post-operative period as he continued to ooze. The total leucocyte counts which were initially high continued to rise further and the bone marrow examination was reported as chronic myeloproliferative neoplasm and the excised mass was consistent with haemorrhoids. Rectal bleeding associated with CML is so far unreported even though bleeding is seen due to platelet dysfunction from gums and nose in chronic phases of the disease. A high index of suspicion is needed particularly with deranged haematological parameters for considering a diagnosis of these rare presentations. and anaesthesia.
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Background: Traumatic avulsion injury poses severe risk as the overlying protective covering is lost and the raw tissue is exposed to the environment. Avulsion injuries involving the scalp are even more complicated to treat because of significant cosmetic concern involved. Aim of the study was to find a better solution than the existing method, we conducted a prospective study involving 13 patients with isolated traumatic scalp avulsion injury.Methods: This prospective study was conducted in Motilal Nehru Medical College and associated Swaroop Rani Nehru Hospital, Prayagraj, after taking written and informed consents from the patients, between June 2017 and June 2019.These were divided into two groups (A and B) based on whether the underlying periosteum was intact or not.Results: Patients with intact periosteum (Group A) underwent primary thin thickness skin grafting within a few hours of their admission while the other group (Group B) was treated with a traditional conservative approach. We compared the results of both the groups and found that Group A patients not only had satisfactory graft uptake (≥85 TBSA) but also had significant decreased risk of infection, lesser hospital stay, overall decreased healthcare cost, better cosmoses and early return to routine activity.Conclusions: For the surgeon, this single step procedure is safe and technically easy. Thus this approach was found to be superior than the current traditional approach.
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Background:Dementia is defined as acquired global impairment of higher cortical functions including memory, the capacity to solve problems of day to day living, the performance of learned perceptuo-motor skills, all aspects of language and communication and the control of emotional reaction, in the absence of clouding of consciousness. Methods: This study sample consisted of 95 demented patients seen at the Outpatient department of Nepal Medical College Teaching Hospital. Results:comparison between patients with Alzheimer’s and vascular dementia, these being the most frequent etiologies, a significant difference among the groups in relation to gender was detected, whereby the female gender predominated in Alzheimer Dementia, whereas males predominated in Vascular Dementia. Conclusion: clinicians need to be more vigilant to rule out depression, anxiety and dementia in geriatric patients. The increasing trend in the number of geriatric patients with neuropsychiatric disorders warrants a better healthcare and social support.
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Background: Treatment of femoral fractures in age group of 6 – 12 years is controversial. Operative treatment is becoming better accepted. Various modalities of fixation include plate osteosynthesis, External fixation; Antegrade locked nailing, and flexible intramedullary nailing. Methods: 60 children aged 6-12 years (Average age – 8.2 years) with 66 femoral diaphyseal fractures (61 closed and 05 open) in 60 patients were managed with closed Ender’s nailing. Pathological fractures due to unicameral bone cyst were evident in 5 patients. Femoral shaft fractures at the level proximal to distal three fifth with canal diameter of ≥ 6mm were included in the study. Out of 66 traumatic fractures 42 fractures had stable pattern and 19 had unstable fracture pattern. The results were evaluated clinically and radiologically. Results: All the 42 stable femoral fractures showed bridging callus in a mean time of 3.83 weeks (2.5 to 6.5 weeks). Full weight bearing was possible in a mean time of 4.19 weeks. Radiological union was seen in a mean time of 9.4 weeks. 34 fractures were evaluated by scanogram one year after injury and they revealed lengthening of 0.3cms. All the children returned to their previous level of activities. All the 19 unstable femoral fractures showed bridging callus in a mean time of 5.53 weeks (4 – 8 weeks). Full weight bearing was possible in a mean time of 6.21weeks. Radiological union was seen in a mean time of 12 weeks. 8 patients were readmitted for adjunctive procedures like nail impaction, traction and cast immobilization. 20% patients with unstable group had shortening of 1.3cms and 20% had external rotation of lower limb. Conclusions: Ender’s nailing is simple, cost-effective and minimally invasive procedure in 6-12 years of age. It offers stable fixation with rapid healing. There is prompt return of child to normal activity.
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Objective: To evaluate the diagnostic pharmacognostical characters of Costus speciosus (aerial parts) along with their physico-chemical parameters and fluorosence analysis.Method:microscopy, powder microscopy, leaf constant, fluorescence analysis and preliminary phytochemical investigation.Results:The findings of macroscopy revealed that leaves elliptic to oblong or oblong-lancoelate, The pharmacognostical characters were determined in terms of macroscopy, thick, spirally arranged, with stem clasping sheaths up to 4 cm, flowers large, white, cone-like terminal spikes, with bright red bracts. Transverse section of leaflet showed the presence of cuticularised epidermis with polygonal cells on adaxial surface and bluntly angled cells on abaxial surface of lamina, mesophyll cells differentiated in to single layered palisade cells on each surface and 2-3 layered spongy parenchyma, unicellular and uniseriate multicellular covering trichomes, paracytic stomata and vascular bundles surrounded by sclerenchymatous multicellular sheath. Preliminary phytochemical screening exhibited the presence of various phytochemical groups like alkaloids, glycosides, steroids, phenolic constituents. Further, the leaf constants, powder microscopy and fluorescence characteristics indicated outstanding results from this investigationConclusions:Various pharmacognostical and physico-chemical parameters have pivotal roles in identification, authentication and establishment of quality parameters of the species.
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Objective: Costus speciosus Koen. (Keu, Crape ginger), an ornamental plant, widely distributed in India is traditionally used as astringent, aphrodisiac, purgative, anthelmintic, depurative, febrifuge and expectorant. The plant is also used in rheumatism, dropsy, urinary diseases and jaundice. The purpose of this study is to evaluate the anti-arthritic activity of the methanolic extract of the aerial parts of Costus speciosus (CS) in experimental animal models. Materials and Methods: The powdered drug was subjected to successive solvent extraction, with solvents in increasing order of polarity to obtain the methanolic extract of the aerial parts of the plant. CS was evaluated for anti-arthritic action by Freund’s adjuvant induced arthritis test in adult Albino rats (150-200 gm). Rats were injected 0.1 ml of complete Freund’s adjuvant into the planter region of the left hind paw. Statistical analysis was performed using One way analysis of variance (ANOVA) followed by Bonferonni test. P<0.05 was considered statistically significant. Results: The methanolic extract of CS in doses of 400 and 800 mg/kg showed 75.50% and 68.33% protection against increase in paw edema, respectively. CS showed dose-dependent action in all the experimental models. Conclusion: The present study indicates that CS has significant anti-arthritic properties.
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Airway remodeling in asthma is recognized as irreversible structural change. However, several recent reports revealed that remodeling might be the process of repair from injury. Airway remodeling is increasingly recognised to be a serious consequence of chronic asthma.Stat3 and Cytokines play an integral role in the coordination and persistence of inflammation. However, exact role of Stat3 in airway inflammation is lacking. In the present study BALB/c mice were sensitized and challenged with OVA (OVA/OVA) after validation these mice models were further studied to check silencing effect of Stat3 .mRNA and ELISA studies revealed alteration in IL-4, IL-5, IL-13 and TGF-β in BALF and lung with blood eosinophilia also airway hyperresponsiveness in OVA/OVA mice. Airway hyperresponsiveness was studied by methacholine-induced specific airway resistance in a plethysmogrpah while eosinophils study was done using automatic blood analyser. Total and OVA-specific IgG and IgE antibodies depicted significant rise among mice sensitized and challenged with OVA. Studies pertaining to histology revealed fibrous tissue proliferation along with other inflammatory changes in airway structure among OVA/OVA mice and it are the characteristic of human model of asthma. Heightened expression of TGF-β and proliferation of fibrous tissue in lungs are directly related. On the contrary SAL/SAL mice revealed normal blood eosinophils. There was no change in IL-4, IL-5, IL-13 and TGF-β also OVA-specific IgG and IgE antibodies in SAL/SAL mice presented normal range. Our earlier studies showed downregulation of Stat3 gene in airway tissues is related with airway inflammation in a mouse model of asthma using this background we tried to study airway histology after silencing Stat3 gene in OVA/OVA mice interestingly our results showed that silencing Stat3 did not help in restoring airway histology in OVA/OVA mice in addition to this investigations pertaining to cytokines, immunoglobulins, blood eosinophils, sRAW and mRNA studies did not depicted any sign of restoration.
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The goal of delivery system is to get optimal therapeutic management. But, it still remains a challenge in the field of pharmaceuticals for delivery of ionic species and some non ionic. Several transdermal approaches have been used and recently there has been a great attention in using iontophoretic technique for the transdermal drug delivery of medications, both ionic and non ionic. This technique of facilitated movement of ions across a membrane under the influence of an externally applied electric potential difference is one of the most promising physical skin penetrations enhancing method. The payback of using iontophoretic technique includes improved systemic bioavailability ensuing from bypassing the first metabolism. Variables due to oral administration, such as pH, the presence of food or enzymes and transit times can all be eliminated. This article is an overview of the history of iontophoresis, mechanism, principles and factors influencing iontophoresis and its application for various dermatological conditions.