TREATMENT FOR A REFRACTORY CHRONIC TENDOACHILLES TENDINITIS WITH PLATELET-RICH PLASMA INJECTIONS: A CASE REPORT

To define the pain and functional improvement of the patient with chronic Achilles tendinitis treated with a single PRP (platelet-rich plasma) injection. Chronic Tendoachilles tendinitis is a severe cause for a decrease in physical activity and persistent pain. It arises secondary to an account of repetitive use or exaggerated overload. Platelet-rich plasma therapy is used to provide local regenerative healing of the tendon. This report describes a 50-year-old Active female who presented with continuous pain in bilateral Tendoachilles for Approximately 6 years duration. A single Platelet-rich plasma injection is given to the patient with chronic tendoachilles tendinitis to reduce pain and improve function and improved VAS (visual analogue score) score from 9 to 0 seen at 1-year follow-up. The patient has been pain-free for the past 2 years and is back to daily functional physical activity. A single injection of PRP in each tendoachilles distally has shown significant relief in pain and improvement in day-to-day physical activity and a rapid recovery from chronic TA tendinitis.

Amelioration of Acrylamide Induced Neurotoxicity in Wistar Rats

Present study was undertaken to study the neurotoxicity of oral acrylamide (ACR) and its amelioration using α-tocopherol, reduced glutathione (GSH) and hot aqueous extract (HAE) of Ocimum sanctum. Forty five male Wistar rats were divided into 12 groups. The study showed a significant reduction in the body weight of the rats fed with ACR in comparison to the other groups while body weight was restored in the rats fed with α-tocopherol and HAE. Neurotoxicity in rats fed with ACR was evident with the results of histopathology and oxidative stress (high MDA and decreased activities of GSH, SOD, GST and CAT in brain). Co-administration of α-tocopherol and HAE lowered these changes however, there was no marked improvement seen in neural damage but improvement was evident in behavioral as well as physiological changes at a marked point. Histopathology of brain in ACR alone fed group showed extensive neural degeneration and massive deposition of fibrin which was substantially decreased and ameliorated with the co-administration of α-tocopherol and HAE. These results support the oxidative stress results as well. Our results suggests that α-tocopherol and HAE can be useful for protecting brain tissue against ACR induced neurotoxicity through minimizing the free radical mediated oxidative stress

Comparison of metabolic effects of glimepride and sitagliptin with metformin in patients suffering from type 2 diabetes mellitus in a tertiary care hospital

Background: Diabetes mellitus (DM) is one of the major causes of mortality & morbidity, and patient’s with better control of glycaemic parameters have lesser chronic complications associated with it. Though monotherapy with metformin is first choice for T2DM but is effective in less than 50% of patient and they should be managed with two drug therapy. Both Glimepiride and Sitagliptin are effective with metformin but there has been no study done in this region hence, we planned to study comparison of effects of glimepiride and sitagliptin with metformin in patient of T2DM.Methods: This prospective, open-label, randomized study was done in all patient diagnosed with T2DM, not adequately managed by metformin alone. The patient was divided into two group G (Glimepiride with Metformin) and Group S (Sitagliptin with Metformin) and had a follow up at 3 and 6 months. The biochemical parameters were assessed at 12 weeks and 24 weeks.Results: The result of this study show that both glimepiride and sitagliptin with metformin significantly (p<0.05) lowered both the fasting blood sugar as well as postprandial blood glucose at 3 and 6 months. Glimepiride was more effective in lowering (p<0.05) the plasma glucose at 3 months but both the drugs had comparable result at 6 months. This study also showed that glycosylated haemoglobin was lowered in both groups at three and six months as compared to Day 0 (p<0.05), with glimepiride having better control of glycosylated haemoglobin at 3 months with both groups having comparable result at 6 months.Conclusions: To conclude, this study compared effects of sitagliptin and glimepiride on glycaemic parameters in patients of T2DM and found that both drugs had comparable results.

Cervical cancer: perception of peripheral health workers in Lucknow: a cross-sectional study

Background: Cervical cancer is one of the most prevalent cancers among Indian women. Cervical cancer incidence reduces dramatically when effective screening programs linked with access to treatment are in place and are readily accessible. Peripheral health workers (PHWs) being frontline workers have a major influence on raising awareness among community about acceptability of available screening programmes. This study was thus conducted to assess the awareness of PHWs regarding risk factors, signs and symptoms, early detection and prevention for cervical cancer.Methods: A questionnaire-based study was conducted among 450 PHWs (ASHAs and BHWs). Information was collected regarding their bio-social characteristics, awareness about female cancers, risk factors, signs/symptoms, early detection methods and services available for screening and prevention of cervical cancer.Results: Awareness of different aspects of cervical cancer was found to be very low. Only eight per cent of the PHWs had good awareness score. BHWs obtained statistically significant better mean scores as compared to ASHAs. Few (7.6%) PHWs had received training for any type of female cancers. Only 17 per cent of the PHWs were aware of HPV vaccine availability and only 29 per cent from them could name the vaccine.Conclusions: Majority of the PHWs had poor awareness about cervical cancer and available screening facility in our health system. They had almost no idea of availability of free HPV vaccination at the Sampoorna clinics. This low level of awareness calls for regular training of PHWs on cervical cancer which would ultimately trickle down to the community.

Study of Prevalence of Diabetic Peripheral Neuropathy in Newly Diagnosed Patients of Type 2 Diabetes Mellitus (T2DM) in a Tertiary Care Hospital

Background: The prevalence of type 2 diabetes mellitus(T2DM) is growing worldwide, and these patients may beasymptomatic and present with complications at the time ofdiagnosis. Diabetic neuropathy is the most commoncomplication affecting the patients who may present with distalpolyneuropathy at the time of diagnosis and also poorglycaemic control. The Diabetic peripheral polyneuropathyaffects approximately 1 in every 10 newly diagnosed patients,whereas two third of patients with diabetes mellitus haveclinical or subclinical neuropathy.Objective: This study is designed to find prevalence of diabeticperipheral neuropathy in Newly Diagnosed Patients of T2DM ina tertiary care hospital.Materials and Methods: This observational study was carriedout in patients diagnosed with T2DM as per ADA criteria. Athorough clinical examination; Nerve conduction velocitytesting; evaluation of plasma glucose and glycosylatedhemoglobin and assessment of neuropathy by using theDiabetic neuropathy index and diabetic neuropathy score wasperformed on all patients.Results: 18% of patients had signs of peripheral neuropathyas shown by NCV testing at the time of diagnosis. Thesepatients had elevated levels of glycosylated hemoglobin,fasting plasma glucose and 2-hour plasma glucose and lowerscores of DNI and DNS which were statistically significant. Themost common type of neuropathy seen in these patients wassensorimotor involvement with demyelinating type ofneuropathy with more involvement of lower limbs. The NCVstudies showed reduced distal latency and prolongedamplitude as well as conduction velocity in patients withdiabetic neuropathy.Conclusion: Our study showed that approximately 1 in 5newly diagnosed patients with type 2 diabetes mellitus are atrisk of developing diabetic peripheral neuropathy.

A Prospective Study to Analyse the Metabolic Effect of Metformin with Glimepiride on Type 2 Diabetic Patients of North India.

Background: Diabetes Mellitus is a leading disease of developing countries and its incidence is increasing day by day. Among Oral Hypoglycemic agents, Metformin is still the best treatment choice for type 2 diabetes mellitus. Metformin is associated with improvements in lipoprotein metabolism, including decreases in LDL-C, fasting and postprandial TGs, and free fatty acids. Methods: This prospective study was carried out on Type 2 Diabetic patients attending the Diabetic clinic at Teerthanker Mahaveer Medical College & Research Center, Moradabad. Only those patients were included who were not adequately controlled with a stable dose of metformin monotherapy. A total of 125 patients were enrolled in the study taking Glimepiride plus Metformin. The patients received therapy of metformin 500mg three times daily & glimepiride 5mg twice daily. Results: Out of the 125 patients enrolled in the study, only 82 patients completed the study. Out of 82 patients, 49 were males and 33 females. There was a significant reduction (p<0.05) of FPG as compared to baseline. The (PPBS) was reduced from 275.95 ±63.599 (mg/dl) to 167.04±27.084 (mg/dl) at 12 weeks and141.36±31.064(mg/dl) at 24 weeks (mg/dl). There was a significant reduction (p<0.05) of Hb1Ac, TC, TAG, LDL, VLDL, UA, SGOT as compared to baseline but no significant rise in HDL was seen as compared to baseline. Conclusion: Significant improvement in fasting blood sugar (FBS), Postprandial blood sugar (PPBS), Lipid profile and Glycosylated hemoglobin as compared to baseline.

Molecular Modeling and Docking Studies of Cold Active Lipase from Pseudomonas fluorescens.

Molecular Modeling is essential tool in the drug design process describes the generation, manipulation or representation of 3D structures of the molecules and associated physico-chemical properties while docking predicts the preferred orientation of one molecule to a second when bound to each other to form a stable complex. A cold active lipase producing potential psychrophilic bacteria (GN) was isolated and identified by 16S rRNA molecular studies as Pseudomonas vancouverensis. Lipase gene from closely related species P. fluorescens was investigated for their functional role and in silico characterization using molecular modeling and docking studies. A 3D structure of lipase gene was generated with SWISS-MODEL and Discovery Studio 3.0. The stereochemistry of the constructed model of cold active lipase was subjected to energy minimization and the stereo-chemical quality of the predicted structure was assessed. The superimposition of the template (PDBID: 2Z8X) with predicted structure showed that weighted root mean square deviation of Cα trace between the template and the final refined model was 0.2 Å with a significant Zscore of 8.2 and sequence identity was 80.5%. Three ligands P-Nitrophenol, Acetate ion and Diethyl phosphonate were taken for docking calculation with generated structure. They were interacting on the functional motifs of predicted model. It has been observed that Leu26, Tyr29, Asn31, Asp33, Pro315 and Thr316 residues were involved in hydrogen bonding interactions with selected ligands. So these interacted residues can be used as prominent active binding sites and which was common to the predicted active site. Based on above investigations it has been found that P. vancouverensis lipase protein can play a similar role in lipid metabolic process and triglyceride lipase functional activity as reported for P. fluorescens lipase protein.

Purification and characterization of Mn-peroxidase from Musa paradisiaca (banana) stem juice.

Mn-peroxidase (MnP), a biotechnologically important enzyme was purified for the first time from a plant source Musa paradisiaca (banana) stem, which is an agro-waste easily available after harvest of banana fruits. MnP was earlier purified only from the fungal sources. The enzyme was purified from stem juice by ultrafiltration and anion-exchange column chromatography on diethylamino ethylcellulose with 8-fold purification and purification yield of 65%. The enzyme gave a single protein band in SDS-PAGE corresponding to molecular mass 43 kDa. The Native-PAGE of the enzyme also gave a single protein band, confirming the purity of the enzyme. The UV/VIS spectrum of the purified enzyme differed from the other heme peroxidases, as the Soret band was shifted towards lower wavelength and the enzyme had an intense absorption band around 250 nm. The Km values using MnSO4 and H2O2 as the substrates of the purified enzyme were 21.0 and 9.5 μM, respectively. The calculated kcat value of the purified enzyme using Mn(II) as the substrate in 50 mM lactate buffer (pH 4.5) at 25°C was 6.7s-1, giving a kcat/Km value of 0.32 μM-1s-1. The kcat value for the MnP-catalyzed reaction was found to be dependent of the Mn(III) chelator molecules malonate, lactate and oxalate, indicating that the enzyme oxidized chelated Mn(II) to Mn(III). The pH and temperature optima of the enzyme were 4.5 and 25°C, respectively. The enzyme in combination with H2O2 liberated bromine and iodine in presence of KBr and KI respectively. All these enzymatic characteristics were similar to those of fungal MnP. The enzyme has the potential as a green brominating and iodinating agent in combination with KBr/KI and H2O2.

Phytochemical and Pharmacological Profile of Withania somnifera Dunal: A Review.

Withania somnifera (L) Dunal is a well known Indian medicinal plant widely used in the treatment of many clinical conditions in India. It is an important drug commonly known as Asgand which has been used either single or in combination with other drugs in Unani as well as Ayurvedic system of medicine for centuries. It has been described by Dioscorides (78 AD) in his book “Kitab-ul-Hashaish”. Asgand consists of the roots of Withania somnifera which has various therapeutic actions such as anti-inflammatory (Muhallil-e-Warm), sedative (Musakkin), alterative (Muaddil) and aphrodisiac (Muqawwi-e-Bah). Keeping in view the medicinal properties of Withania somnifera Dunal (Asgand), an attempt has been made in this review paper to explore various dimensions of the drug including phytochemical and pharmacological studies carried out on this drug.

Body composition & cardiovascular functions in healthy males acclimatized to desert & high altitude.

BACKGROUND & OBJECTIVES: Several physiological changes affecting physical fitness occur in humans whenever they are exposed to extremes of environments such as heat, cold and high altitude (HA). The present study was undertaken to evaluate effect of stay in desert and HA on physical fitness and body composition of physically active individuals. METHODS: Study was conducted on three groups of male soldiers (n=30 in each group) at different climatic conditions i.e., temperate (plains of north India), hot desert (Rajasthan), and HA (3600 m) in Western Himalayas. Subjects were acclimatized to hot and HA environments and had similar BMI (body mass index). Body fat, lean body mass, haemoglobin levels were determined along with, blood pressure and physical fitness index (PFI). RESULTS: The body fat of subjects at temperate, desert and HA was found to be 15.4, 12.8 and 16.9 per cent respectively. The resting heart rate and blood pressure were higher in altitude group in comparison to others. PFI score of volunteers at temperate, desert and HA were found to be 97.4 +/- 10.3, 92.4+/- 14.4 and 83.8 +/- 6.2 respectively. INTERPRETATION & CONCLUSION: A combination of different factors i.e., higher resting pulse rate, increased blood pressure and body fat may be responsible for lower PFI at HA. The observed differences in body fat content of different groups could be an adaptive feature to the environment.

Humoral response to rabies vaccines in pet dogs.

Humoral immune response was studied in dogs vaccinated with different tissue culture vaccines commonly used for immunization of dogs in India. The results revealed that after single dose of vaccination only 56% dogs developed protective titer (> or = 1:8). The response of the three vaccines used in the study was not similar, highlighting the need to maintain post marketing surveillance.

Outcome predictors for non-invasive positive pressure ventilation in acute respiratory failure.

BACKGROUND: Noninvasive positive pressure ventilation (NIPPV) has emerged as a significant advancement in the management of acute respiratory failure. OBJECTIVE: To identify factors, based on clinical and laboratory parameters, for predicting the outcome of NIPPV in patients with acute respiratory failure. MATERIALS AND METHODS: Fifty patients were included in the study. Inclusion criteria were RR>30 breaths/ min, PaO2<60mmHg, PaO2/FiO2<300, pCO2< or = 45mmHg and signs of increased work of breathing. Baseline clinical parameters and arterial blood gas (ABG) were recorded before initiating NIPPV. Clinical parameters including heart rate, respiratory rate, oxygen saturation and ABG was revaluated at 1, 4, 12, 24 hrs after initiation of NIPPV. Change in these parameters and need for intubation was evaluated. RESULTS: Of the 50 patients, 37 (74%) showed clinical and ABG improvement. Out of 13 (26%) patients who failed to respond, 7 (52%) needed endotracheal intubation within 1 hr. There was significant improvement in clinical and ABG parameters within 1st hr in success group and these parameters continues to improve even after 4 hrs of NIPPV treatment (p<0.05). Failure group had higher baseline heart rate than success group (p<0.05). CONCLUSION: Determination of baseline clinical factors such as heart rate and respiratory rate, available at the time of initiation and after a short period, can predict the likelihood of success or failure of NIPPV. As a result, delay in intubation can be avoided which itself is associated with significant mortality.

Percutaneous tracheostomy.

The purpose of this review is to discuss the various techniques of percutaneous tracheostomy and to assess their safety and efficacy profile, indications and contraindications, early and late complications. Literature was reviewed from Medline and MD Consult databases. Early techniques by Sheldon, toye and Schachner have been abandoned due to their high complication rates. Percutaneous dilational tracheostomy using the Ciaglia kit (Wiliam Cook Europe Bjaeverskov) and a Griggs kit (Portex PDT kit, POrtex, Hythe, Kent, UK) has been used most often. Griggs guide Wire Dilator Forceps kit (SIMS, Portex, Hythe, Kent, UK) is the next most common in use but its long-term studies are few. Fantoni (TLT set, Mallinckrodt Medical) and PercuTwist device (Riisch, Kernen, Germany) are two new techniques currently under study. Percutaneous dilational tracheostomy and conventional surgical tracheostomy are still competing methods to provide an airway for intensive care patient requiring assisted ventilation. Review of literature shows that percutaneous tracheostomy is safe, cost-effective and compares favourably with the open surgical tracheostomy. Many intensive care units now use the percutaneous tracheostomy as a procedure of choice. Percutaneous tracheostomy has a learning curve and requires appropriate case selection and meticulous attention to the technique by all those who want to use this method.

Role of cytokines in experimental and clinical uveitis.

Uveitis is a major cause of visual impairment. Experimental autoimmune uveitis mimics the clinical conditions of posterior uveitis in many ways. T-cells (particularly CD4+ helper-T-cells) have been shown to play an important role in pathogenesis of experimental and clinical uveitis. Based on the pattern of cytokine they secrete, CD4+ helper cells have been divided into Th1 and Th2 subsets. Various Th1 and Th2 cytokines appear to be involved in the pathogenesis and/or recovery from uveitis. This article discusses in detail the uveitopathogenic and therapeutic potential of Th1 and Th2 cytokines in experimental and clinical uveitis.

Detection of antibodies to Taenia solium in sera of patient with epilepsy using ELISA.

Enzyme linked immunosorbent assay (ELISA) was used for detection of antibodies to cysticerci of Taenia solium in patients suffering from suspected neurocysticercosis. Serum antibodies to cysticercosis were detected in 10.4% of the patients. Antibodies were absent in healthy controls. No cross-reactivity was observed in sera from patients with other parasitic diseases viz. toxoplasmosis, filariasis and kala-azar. However sera from patients with hydatid disease showed cross reactions in 20%. Age group distribution showed gradual non-significant increase in seropositivity rates with advancing age. No significant gender difference, was observed. Analysis of dietary habits of patients showed statistically significant difference in seropositivity rates in non-vegetarians (15.4%) as compared to vegetarians (6.9%) (P value < .001).

Experimental autoimmune uveitis as animal model for human posterior uveitis.

Uveitis is an intraocular inflammatory disease that mostly affects children and young adults. It is one of the major causes of blindness in young individuals in India and the world. It is responsible for about 10 per cent of total visual impairment. Unfortunately, etiological diagnosis is not evident in a majority of these patients. It is generally felt that autoimmune mechanism may be involved in so called 'idiopathic' cases which has led to search for the putative autoantigens in experimental animal models. It has been demonstrated that experimental autoimmune uveitis (EAU) can be elicited against several retinal proteins in rats, mice and sub-human primates. These include the S-antigen, a major protein on retinal photoreceptor cell, interphotoreceptor retinoid binding protein (IRBP) and several others. There are many similarities between clinical entities and the EAU, but the EAU differs from the clinical conditions in being self-limited, and requiring complete Freund's adjuvant for induction of the disease. The disease can be induced only in susceptible strains. Nevertheless, use of the EAU model has allowed for identification of disease causing epitopes of antigens and evaluation of disease modifying strategies which could be applied in clinical situations. There has been significant progress in this field, but still a lot more is required to be learnt to translate it into clinical practice.

C-reactive protein as an indicator of complications in bacterial meningitis.

OBJECTIVE: To determine the value of serum C-reactive protein (CRP) estimation in the follow-up of bacterial meningitis (BM). DESIGN: Longitudinal follow-up. SETTING: Urban hospital. METHODS: Sequential serum CRP estimation was done in 50 healthy children and in 100 children with BM. Serial serum CRP value was correlated with the clinical picture in BM. RESULTS: Serial serum CRP in 14 patients with complicated BM was significantly different than the 72 uncomplicated BM cases. CONCLUSIONS: Serial determination of serum CRP may be a cheap, simple and reliable prognostic indicator in BM.

Cellular immune response to retinal S-antigen & interphotoreceptor retinoid binding protein fragments in idiopathic human uveitis.

The role of retinal antigens in idiopathic human uveitis has been studied in 38 patients of uveitis, and 30 patients of systemic connective tissue disease (CTD) and 30 healthy volunteers. Lymphocyte proliferative responses were tested in vitro against native S-antigen, its uveitopathogenic peptides (peptide M, peptide G), yeast histone H3 peptide and uveitopathogenic fragment of interphotoreceptor retinoid binding protein (IRBP: R16) to establish their role in pathogenesis of human uveitis. Seven patients with uveitis, and none among CTD patients and healthy volunteers, responded (stimulation index > 3) to at least one retinal antigen used. One uveitis patient showed response to native S-antigen, peptide M and yeast histone H3. One responded to both S-antigen and peptide M and another responded to both peptide G and R16 peptide. Two responded to S-antigen only, one to peptide M and one to peptide G. In addition, one uveitis patient responded to yeast histone H3 only. These results suggest that retinal antigens may play a role in the etiopathogenesis of a subset of idiopathic human uveitis.