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Abstract Introduction Vitiligo is an acquired pigmentary disorder of unknown etiology, clinically characterized by whitish macules caused by selective loss of melanocytes. There are many melanocytes in the human cochlea. Recent studies have suggested a direct relation between cochlear dysfunction and decreased amounts of melanin. Objective To determine the effect of vitiligo on auditory function. Methods The present prospective, case control study was performed over a period of 1 year in patients between 15 and 40 years old with nonsegmental disease and the same number of controls. Pure tone audiometry (PTA) and Otoacoustic emission (OAE) were performed to analyze the correlation between vitiligo and auditory function. Results The mean pure tone audiometric threshold in the right ear at 0.5, 8 kHz, and in the left ear at the frequency of 8 kHz in the case group were significantly higher as compared with controls. The average band reproducibility (%) in the right and left ear of controls was significantly higher at the frequency of 4 kHz as compared with cases. It has been observed that signal to noise ratio was statistically higher at the frequency of 5kHz in the right ear and at 2, 3, and 5kHz in the left ear in controls as compared with cases. On the basis of disease type and duration of disease; mean pure tone audiometric threshold, average band reproducibility and signal to noise ratio, no significant effect was observed in the present study. Conclusion Vitiligo has an effect on cochlear function irrespective of the duration or distribution of the disease.
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Background:Amongst the many vector and water-borne diseases prevalent in tropics, dengue occupies a prominent place. Dengue epidemics are frequent and at times, during such epidemic, coinfections may occur causing diagnostic dilemmas.Case Report: A 36 years old lady, from a rural background, presented during the 2019 dengue epidemic with fever, vomiting, and non-colicky abdominal pain. The evaluation showed hepatosplenomegaly, leukocytosis, and thrombocytopenia. The investigations confirmed the diagnosis and she was treated conservatively as a case of dengue with warning signs. A longer than anticipated duration of fever and clinical deterioration prompted reassessment, which revealed the presence of an eschar over the right upper thigh. The Weil-Felix test using Proteus OX-K stain was positive at a titer of 1:320. Following treatment with oral doxycycline, she showed rapid defervescence and clinical improvement Conclusions:Coinfection with scrub typhus is rare with dengue. If left untreated, it adversely affects the outcome. The key to diagnosing such coinfections includes a high index of suspicion, repeated clinical examination, and the knowledge of local endemicity
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Hepatopulmonary syndrome (HPS) is one of the recognised complications of liver cirrhosis which warrants urgent liver transplantation. The symptoms usually improve post transplantation but might take 6-12 months to resolve completely. Severe hypoxemia post liver transplantation, especially when done for hepatopulmonary syndrome has been reported. iNO use for the same has been reported in literature with good response. However, it is practically very difficult to continue iNO in a stable child on a portable ventilator due to problems of scavenging.We report a case of 7-year-old girl who underwent orthotopic liver transplantation (OLT) for severe HPS. Post transplantation the patient had a stormy respiratory course and became severely hypoxemic. She was started on inhaled NO and showed a good response. However, the patient then became NO dependent and multiple attempts to wean iNO failed albeit minimal ventilatory requirements. Following IV L-Arginine infusion, iNO could be weaned within 6 hours without recurrence of hypoxemia. L-Arginine infusion should be considered as a treatment option when facing difficulties to wean iNO in an otherwise well responding patient.
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Background: The present study was conducted to evaluate peri- implantitis around dental implants. Methods: The present retrospective study was conducted on 60 patients of both genders with 90 dental implants. Pocket depth (PD) around the implant and around the teeth adjacent to the implant was calculated. Gingival recession (GR) was calculated. Clinical attachment loss (CAL) was calculated by adding GR and PD. Intraoral periapical radiographs (IOPAR) were taken to evaluate peri- implantitis. Results: Out of 60 patients, males were 35 and females were 25. In 35 males, 45 dental implant and in 25 females, 45 dental implants were present. The mean probing depth (PD) around implant was 4.26± 1.20 and adjacent teeth was 3.40± 1.32. The difference was significant (P- 0.01). Gingival recession (GR) around implants was 0.56± 0.98 and adjacent teeth was 0.86± 1.35 (P- 0.02). Clinical attachment loss (CAL) found to be 4.26± 1.32 around implant, 4.03± 1.32 around adjacent teeth. The difference was non- significant (P- 0.07). Conclusion: Periodontal diseases affect the outcome of dental implant treatment. Thus periodontal status should be healthy especially in the region adjacent to implant site.
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Background: The modern day oral oncotherapy is now concerned on the oral quality of life after treatment of the patient. There is need to evaluate final outcome following the different combination of treatment modalities available to make better therapeutic treatment decisions. Oral health-related quality of life (QHRQOL) and their nutritional status is gaining importance as a valuable outcome measure in oral cancer area and compare with the other control group. The aim of the study was to examine the nutritional status among the oral cancer patients and compare the QHRQoL of two groups (i.e., oral cancer group and control group) in Varanasi district.Methods: The prospective study was conducted from January 2018 to August 2018. 124 oral cancer patients and 124 control people from the Varanasi district participated in this study. Nutritional status of oral cancer treated patients was assessed. QHRQoL of the oral cancer patients were compared with the control group.Results: Among the 124 oral cancer patient, 67.74% were malnourished or at risk of malnutrition. Patients had worse QHRQoL among oral cancer group. There were highly statistically significant differences found in the oral health impact profile and oral impacts on daily performances on comparing the oral cancer patients with the control group.Conclusions: This study indicated that oral cancer patients with malnutrition or risk of malnutrition have significantly worse OHRQoL than with the control population group.
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Introduction: Smoking is an independent risk factor forischemic heart disease and acute myocardial infarction.Smoking raise both heart rate and blood pressure, thusincreasing myocardial oxygen demand, moreover it alsodecreases the dimension of coronary vessel and coronaryblood flow. Inferior wall Myocardial Infarction is consequenceof disease in usually Right coronary artery, whereas anteriorwall Myocardial Infarction is usually disease in left coronaryartery. The aim of the study is to evaluate whether smokinginfluence the incidence of inferior wall MI (Right coronaryartery). Study objective was to find out whether there was anassociation between smoking and inferior wall MyocardialInfarction and an early association of atherosclerosis andischemic heart disease with smoking.Material and methods: 126 patients of ST ElevationMyocardial Infarction admitted from the outdoor patientdepartment/ emergency department/ Cardiology OPD inMMIMSR, Mullana, Ambala, considered for study. Thosewho are willing to participate and fulfilling the inclusion andexclusion criteria.Result: In our study there was a high proportion of smokerin patient with inferior wall MI than other location of MI.Smokers were prone to get myocardial infarction at a youngerage as compared to others. Mortality was higher in anteriorwall MI as compared to Inferior wall MI. Anterior wall MIpresented with more complications i.e. cardiogenic shock andarrhythmias.Conclusion: Smoking enhance the risk of inferior wall MImore than other MI. Smoking thus appear to adversely affectthe Right coronary artery to greater extent than left coronaryarterial circulation by mechanism yet to be explored. Smokingleads to ischemic heart disease at early age.
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Background: Hypertension is an commonly encountered disease which adversely affect all aspects of quality of life (QoL). The existing studies are confounded by the presence of multiple comorbidities and inclusion of elderly, which by themselves impairs the QoL. There is thus a need to study the impact of hypertension on QoL, in isolation.Method: This is a single center, prospective, intention to treat, observation study. The aim of the study is to evaluate the change in the QoL over six months, in newly diagnosed asymptomatic patients of hypertension. The tools used to assess the QoL included World Health Organisation’s Quality of Life Questionnaire (WHOQOL- BREF) and Short Form-36 (SF-36).Result: A total of 232 patients (172 males and 60 females) were enrolled in the study. The mean age was 44.66 years. A total of 102 patients (43.97%) had stage-1 and 130 patients (56.03%) had stage-2 hypertension. The female gender is associated with a higher likelihood of presentation with stage-2 hypertension. The male cohort had a better baseline QoL. The desired blood pressures was achieved in 40.52%. With therapy, the QoL improved significantly; sub-hoc analysis showed, the improvement was higher in males and those with stage-1 hypertension. There is an inverse relationship between the QoL and requirement for higher number of antihypertensive mediations.Conclusions: In patients with asymptomatic primary hypertension, treatment improves all aspects of QoL. The factors adversely affecting the QoL include female gender, higher stage of hypertension, poor blood pressure control and requirement of higher numbers of antihypertensive medicine.
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Introduction: Pharmacology quiz participants undergo training by their teachers on pharmacology which is much more rigorousthen routine pharmacology teaching program. Effect of this training for pharmacology quiz on the performance of students inthe 2nd year MBBS exams, i.e., terminal, preliminary, and university exam has not been evaluated.Methodology: Study was a retrospective analysis of scores of three exams (1st term, 2nd term, and prelim) conducted in2nd-year MBBS student in the department of pharmacology of four batches. Participators were students who had given theirnames for participation in the quiz and had undergone pre-quiz training and selected candidates were among the participatorswho got selected to take part in the final quiz. Participators were trained for the quiz. Rest of the students were considered asnonparticipators. Equal number of topper nonparticipators was chosen based on number of selected students. Marks betweenthe groups were compared with paired and unpaired t-test, Mann–Whitney U-test, and Wilcoxon Signed-rank test. P < 0.05was considered statistically significant.Results: Out of a total of 728 students, 147 were participators, 131 participated but not selected, and 16 got selected, 581 werenonparticipators, 16 toppers were selected. The theory, practical and combined marks of participators and selected students werehigher than nonparticipators and not selected students, respectively. Practical and combine marks of topper nonparticipatorswere higher than the selected students at baseline, but in 3rd term the difference was not significant (P > 0.05).Conclusion: Quiz-based teaching in pharmacology enhances performance in pharmacology
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This study was conducted to estimate the depression label; due to edentulism and measure the treatment outcome. Methods: A questionnaire were distributed to 96 edentulous participants undergoing routine prosthetic care in Department of Dentistry, Heritage Institute of Medical Sciences Varanasi and Various private clinics in Varanasi district. Results: Among Ninety six people who completed the questionnaire, 56 stated that they had experienced difficulties in accepting the loss of their teeth. In comparison with people who had no difficulties in accepting the situation, these people were feel less confident about themselves, more likely to feel inhibited in carrying out everyday activities. Conclusion: The label of depression of majority of participants were minimal only few participants showed marked or severe depression.
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Background: Despite interventions, the prevalence of protein energy wasting in patients on dialysis continues to be unacceptably high. The objective of the study is to evaluate the efficacy of exogenous proteolytic enzyme Aminace 70000 (Hemoglobin Tyrosine Unit), as an adjuvant to dietary protein in improving the nutritional status.Methods: This is a retrospective, real world, single centre, observational study, aimed at assessing the changes in key nutritional indices, over 6 months in patients with chronic kidney disease (CKD) initiated on continuous ambulatory peritoneal dialysis (CAPD). The intervention included addition of egg protein and use of an exogenous proteolytic enzyme. Three cohorts were identified. Cohort 1, had access to a nephrologist and CAPD counsellor; Cohort 2, in addition had access to a dietician who emphasized the need for increase in dietary protein in form of 4-6 eggs a day; and cohort 3, were in addition given an exogenous proteolytic enzyme with the major protein meal.Results: The absolute fall in serum albumin at 6 months for the cohort 1, 2 and 3 is 0.48, 0.29 and 0.09 gm/dl respectively. Not only was the fall in serum albumin significantly less with the use of exogenous proteolytic enzyme, a higher proportion of patients were able to maintain or improve their serum albumin. The fall in midarm circumference was maximum in cohort 1 (2.08 cm) and least in cohort 3 (0.45 cm). This positive trend however, did not achieve statistical significance.Conclusions: Use of exogenous proteolytic enzyme, when combined with egg protein, improves key nutritional indices in patients of CKD on CAPD.
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Background & objectives: Curcuma oil (C. oil) isolated from turmeric (Curcuma longa L.) has been shown to have neuro-protective, anti-cancer, antioxidant and anti-hyperlipidaemic effects in experimental animal models. However, its effect in insulin resistant animals remains unclear. The present study was carried out to investigate the disease modifying potential and underlying mechanisms of the C. oil in animal models of diet induced insulin resistance and associated thrombotic complications. Methods: Male Golden Syrian hamsters on high fructose diet (HFr) for 12 wk were treated orally with vehicle, fenofibrate (30 mg/kg) or C. oil (300 mg/kg) in the last four weeks. Wistar rats fed HFr for 12 wk were treated orally with C. oil (300 mg/kg) in the last two weeks. To examine the protective effect of C. oil, blood glucose, serum insulin, platelet aggregation, thrombosis and inflammatory markers were assessed in these animals. Results: Animals fed with HFr diet for 12 wk demonstrated hyperlipidaemia, hyperglycaemia, hyperinsulinaemia, alteration in insulin sensitivity indices, increased lipid peroxidation, inflammation, endothelial dysfunction, platelet free radical generation, tyrosine phosphorylation, aggregation, adhesion and intravascular thrombosis. Curcuma oil treatment for the last four weeks in hamsters ameliorated HFr-induced hyperlipidaemia, hyperglycaemia, insulin resistance, oxidative stress, inflammation, endothelial dysfunction, platelet activation, and thrombosis. In HFr fed hamsters, the effect of C. oil at 300 mg/kg was comparable with the standard drug fenofibrate. Curcuma oil treatment in the last two weeks in rats ameliorated HFr-induced hyperglycaemia and hyperinsulinaemia by modulating hepatic expression of sterol regulatory element binding protein 1c (SREBP-1c), peroxisome proliferator-activated receptor-gamma co-activator 1 (PGC-1)α and PGC-1β genes known to be involved in lipid and glucose metabolism. Interpretation & conclusions: High fructose feeding to rats and hamsters led to the development of insulin resistance, hyperglycaemia, endothelial dysfunction and oxidative stress. C. oil prevented development of thrombotic complications associated with insulin resistance perhaps by modulating genes involved in lipid and glucose metabolism. Further studies are required to confirm these findings.
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Background: The management of ventricular electrical storm can prove to be a challenge for the clinician given its complexity and life threatening consequences. Case characteristics: 8-year-old boy with repeated life-threatening polymorphic ventricular tachycardia following aortic valve replacement surgery. Intervention: Defibrillated 45 times in addition to multiple antiarrhythmic drugs. Outcome: Conversion to stable sinus rhythm with normal neurological outcome. Message: Electric storm can be controlled by combination of multiple intravenous antiarrhythmic drugs.
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Transport of the drug through skin is best route of drug delivery because of the skin is largest organ human organ with total weight 3 kg and a surface of 1.5 -2.0 m2. Drug carries used in transdermal drug delivery such as liposomes, noisomes, or microemulsions has problem that they remains mostly confined to the skin surface and therefore do not transport drugs efficiently through the skin. By using the concept of rational membrane design we have recently devised special composite bodies, so-called Transfersomes. Transfersomes penetrate through the pores of stratum corneum which are smaller than its size and get into the underlying viable skin in intact form. This is because of its deformable nature. The system can be characterized by in vitro for vesicle shape and size, entrapment efficiency, degree of deformability, number of vesicles per cubic mm. They can act as a carrier for low as well as high molecular weight drugs e.g. analgesic, anesthetic, corticosteroids, sex hormone, anticancer, insulin, gap junction protein, and albumin.
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Transdermal drug delivery system was first introduced more than 30 years ago. The technology generated tremendous excitement and interest amongst major pharmaceutical companies in the 1980s and 90s. By the mid to late 1990s, the trend of transdermal drug delivery system merged into larger organizations. Ethosomes are the ethanolic phospholipid vesicles which are used mainly for transdermal delivery of drugs. Ethosomes have higher penetration rate through the skin as compared to liposomes hence these can be used widely in place of liposomes. Ethosomes have become an area of research interest, because of its enhanced skin permeation, improved drug delivery, increased drug entrapment efficiency etc. The purpose of writing this review on ethosomes drug delivery was to compile the focus on the various aspects of ethosomes including their mechanism of penetration, preparation, advantages, composition, characterization, application and marketed product of ethosomes. Characterizations of ethosomes include Particle size, Zeta potential, Differential Scanning Calorimertry, Entrapment efficiency, Surface tension activity measurement, Vesicle stability and Penetration Studies etc.
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The advantage of administering a single dose of a drug that is released over an extended period of time instead of numerous doses is now a day’s area of interest for formulation scientists in Pharmaceutical industry. There are several advantages of sustained release drug delivery over conventional dosage forms like improved patient compliance due to less frequent drug administration, maximum utilization of the drug, increased safety margin of potent drug, reduction of fluctuation in steady-state drug levels, reduction in healthcare costs through improved therapy and shorter treatment period. Wide varieties of polymers like Hydroxy Propyl Methyl Cellulose (HPMC), Carboxy Methyl Cellulose (CMC), Ethyl Cellulose (EC), Cellulose Acetate Phthalate, HPMC K100M, Xanthan gum, Carrageenan gum, Karaya gum, HPMC K15, Carbopol 971P and Carbopol 974P etc. are available for retarding the release rate of drugs hence sustains the action of drugs. This review article describes the basic information regarding sustained-release formulation, its advantages, disadvantages, selection of drug for sustain release, mechanism of release, different types, and factor involved in oral sustained-release dosage form design.
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Context: Reports of successful use of vasopressin in various shock states and cardiac arrest has lead to the emergence of vasopressin therapy as a potentially major advancement in the management of critically ill children. Objective: To provide an overview of physiology of vasopressin, rationale of its use and dose schedule in different disease states with special focus on recent advances in the therapeutic applications of vasopressin. Data Source: MEDLINE search (1966-September 2011) using terms “vasopressin”, “terlipressin”, “arginine-vasopressin”, “shock”, “septic shock”, “vasodilatory shock”, “cardiac arrest”, and “resuscitation” for reports on vasopressin/terlipressin use in children and manual review of article bibliographies. Search was restricted to human studies. Randomized controlled trials, cohort studies, evaluation studies, case series, and case reports on vasopressin/terlipressin use in children (preterm neonates to 21 years of age) were included. Outcome measures were analysed using following clinical questions: indication, dose and duration of vasopressin/terlipressin use, main effects especially on systemic blood pressure, catecholamine requirement, urine output, serum lactate, adverse effects, and mortality. Results: 51 reports on vasopressin (30 reports) and terlipressin (21 reports) use in pediatric population were identified. A total of 602 patients received vasopressin/terlipressin as vasopressors in various catecholamine-resistant states (septic - 176, post-cardiotomy - 136, other vasodilatory/mixed shock - 199, and cardiac arrest - 101). Commonly reported responses include rapid improvement in systemic blood pressure, decline in concurrent catecholamine requirement, and increase in urine output; despite these effects, the mortality rates remained high. Conclusion: In view of the limited clinical experience, and paucity of randomized controlled trials evaluating these drugs in pediatric population, currently no definitive recommendations on vasopressin/terlipressin use can be laid down. Nevertheless, available clinical data supports the use of vasopressin in critically ill children as a rescue therapy in refractory shock and cardiac arrest.