AGAR / CHITOSAN BLENDS FOR THE PREPARATION OF NOVEL HYDROGELS FOR PH SENSING, UREA ADSORPTION AND DYE ADSORPTION

Hydrogel posses a degree of flexibility very similar to natural tissues, due to their significant water content. Thus they find potential biomedical applications owing to their excellent bio-compatibility, bio degradability and non toxicity. The main highlight of the work is that it is taking naturally occurring polymers such as agar and Chitosan for the synthesis of hydrogel. Different compositions of Chitosan/Agar hydrogels were formulated and optimised with respect to pH sensing, Urea absorption and dye adsorption. Chitosan/Agar hydrogels are found to be suitable and a potential candidate for several agricultural and bio medical applications

Percutaneous Cd Fixation Of Spine In Spinal Fractures/ Instability By Free Hand Technique

Introduction: Lumbar spondylolisthesis is frequently found in adults as a result of spondylolysis or facet degeneration. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column and causes mechanical back pain and compression of neural structures. The initial treatment in most symptomatic patients with lumbar spondylolisthesis is nonoperative supportive care, which consists of a combination of pain medications, bracing, and physical therapy. Surgical intervention is indicated if the symptoms are disabling and they interfere with work despite supportive care, if there is progression of the slippage degree (SD) on serial radiologic examinations, or if there are overt neurological deficits 1,2. Pedicle screw placement is the most popular method in lumbar spinal instrumentation for achieving successful fusion. Recently, to reduce surgical damage to the normal muscular structures during pedicle screw placement, C-arm-guided percutaneous pedicle screw fixation (PPSF) was introduced, and it has become increasingly popular in spinal surgery. Percutaneous transpedicular fixation systems have become more widely used in recent years mainly for the treatment of dorsal, dorsolumbar, and lumbar instability. Aim & Objectives: The present study is aimed at evaluating the functional outcome with percutaneous pedicle screw fixation for spinal fractures& spinal instabilities by free hand technique in patients without neurological deficits. Materials & Methods: The present dissertation is a study of 25 consecutive cases of spinal fractures and spondylolisthesis who attended the orthopaedic emergency or outpatient department of Andhra medical college, Visakhapatnam from 2017 to 2019. All the cases were examined clinically fallowed by radiographic confirmation. Results: In total 25 patients spinal fractures 16 and instability 9, whose mean preoperative ODI scores is 81.04% and the mean postoperative score is 22.6 %. The total postoperative moderate disability patients are15 and minimal disability patients are 10. “PERCUTANEOUS CD FIXATION OF SPINE IN SPINAL FRACTURES/INSTABILITY BY FREEConclusion: HAND TECHNIQUE” is one of the better methods and is suggested for grade 1 & grade 2 spondylolisthesis and spinal fractures, also by which can reduce the morbidity and improve the function.

Cancer care continuum at a tertiary care centre in India during the Covid-19 pandemic and nationwide lockdown: Healthcare delivery through telemedicine

BACKGROUND The Covid-19 pandemic and subsequent lockdown in India caused disruptions in cancer treatment due to the restriction on movement of patients. We aimed to maintain continuity in cancer treatment during the lockdown through teleconsultations. We tried to reach out to our patients using telephonic consultations by establishing a Teleconsult Centre facility run by a team of doctors and patient navigators. METHODS We telephonically contacted all patients who had outpatient appointments from 23 March to 30 April 2020 at our centre through the Teleconsult Centre to understand their current circumstances, feasibility of follow-up, local resources and offered best possible alternatives to continue cancer treatment, if required. RESULTS Of the 2686 patients scheduled for follow-up during this period, we could contact 1783 patients in 9 working days. Through teleconsultations, we could defer follow-ups of 1034 patients (57.99%, 95% confidence interval [CI] 55.6%–60.3%), thus reducing the need for patients to travel to the hospital. Change in systemic therapy was made in 75 patients (4.2%, 95% CI 3.3%–5.2%) as per the requirements and available resources. Symptoms suggestive of disease progression were picked up in 12 patients (0.67%, 95% CI 0.35%–1.17%), who were advised to meet local physicians. CONCLUSION Our study suggests that the majority of patients on follow-up can be managed with teleconsultation in times of crisis. Teleconsultation has the potential of being one of the standard methods of patient follow-up even during periods of normalcy.

Biomechanical Comparison of Fixed- versus Variable-Angle Locking Screws for Distal Humerus Comminuted Fractures

BACKGROUND: To compare the stability of fixed- versus variable-angle locking constructs for the comminuted distal humerus fracture (AO/OTA 13-A3). METHODS: Eight pairs of complete humeri harvested from eight fresh frozen cadavers were used for the study. We fixed the intact humeri using 2.7-mm/3.5-mm locking VA-LCP stainless steel distal humerus posterolateral (nine-hole) and medial (seven-hole) plates. An oscillating saw was used to cut a 1-cm gap above the olecranon fossa. The specimens were loaded in axial mode with the rate of 1 mm per 10 seconds to failure, and stress-strain curves were compared in each pair. The mode of failure was recorded as well as the load needed for 2- and 4-mm displacement at the lateral end of the gap. RESULTS: The stiffness of the constructs, based on the slope of the stress-strain curve, did not show any difference between the fixed- versus variable-angle constructs. Likewise, there was no difference between the force needed for 2- or 4-mm displacement at the lateral gap between the fixed- and variable-angle constructs. The mode of failure was bending of both plates in all specimens and screw pull-out in four specimen pairs in addition to the plate bending. CONCLUSIONS: Our results did not show any difference in the biomechanical stability of the fixed- versus variable-angle constructs. There was not any screw breakage or failure of the plate-screw interface.

Effect of Cigarette Smoking on Male Fertility : A Prospective Hospital Based Study

Background: World Health Organization (WHO) has reported that smoking is very much prevalent among 30% of all 15 years and older men. Approximately 46% of smokers (men) belong to reproductive age (20∼39 years of age). A survey from 187 countries reported that the prevalence of smoking in male smokers was decreased from 41.2% in 1980 to 31.1% in 2012. Though, the number of everyday smokers increased from 721 million in 1980 to 967 million in 2012. Methods: Eighty male cases were included in this study. Out of eighty male cases 51 had low sperm count & 29 cases were normal. The study was conducted in Department of General Medicine, Kanachur Institute of Medical Sciences, Natekal Results: In the present study, low sperm count was occurred in 36.3% and normal sperm count was occurred in 63.7% cases. Conclusion: The results of the present study showed that smoking has severe effects on male fertility. It decreased the sperm motility and sperm count and causes a further decline with continuation of smoking for more than five years.

A Prospective Study on Incidence of Septicaemia in patients in IPD of Medicine Department

Background: Bloodstream infections are important causes of mortality and morbidity. Rapid empiric antibiotic therapy is often needed. Knowledge of epidemiological data of common pathogens and their antibiotic sensitivity pattern is needed for rapid therapy. Methods: This study was done to analyze the common causes of septicaemia and their antibiotic sensitivity pattern from the Department of General Medicine, Kanachur Institute of Medical Sciences, Natekal, Mangaluru. Isolates were identified using bacteriological and biochemical methods and antibiotic sensitivity was done using the Kirby-Bauer disc diffusion method. Results: This study showed that of the 75 patients examined 22 had septicaemia. 31-45 years age group patients constituted the greatest percentage of infected subjects (n=28) followed by patients aged between 46-60 years (n=17). Gram-positive bacteria were encountered more often than gram negative bacteria. Among the gram-positive bacteria, majority isolated were S. epidermiidis; followed by S. aureus. Conclusion: Majority of the organism isolated were from Gram positive category, in which S. epidermiidis was the most isolated.

Comparison between early and delayed facial nerve decompression in traumatic facial nerve paralysis - A retrospective study

ABSTRACT Purpose To study the intraoperative findings in case of early and delayed decompression of facial nerve paralysis and compare their results. Methods Retrospective data analysis of 23 cases of longitudinal temporal bone fracture with House-Brackmann grade V and VI facial nerve paralysis. All cases were thoroughly evaluated and underwent facial nerve decompression through the transmastoid approach. All cases were under regular follow-up till the date of manuscript submission. Results Clinical improvement of the facial nerve function was observed for early vs. delayed facial nerve decompression. In the early decompression group, facial nerve function improved to grade II in eight cases (80%) and grade III in two cases (20%), whereas in the delayed decompression group it improved to grade II in one case (7.70%), grade III in four cases (30.76%), grade IV in seven cases (53.84%), and grade V in one case (7.70%). Conclusions Early decompression of facial nerve provides better results than delayed decompression because it enables early expansion of the nerve.

Surgical Site Infections in a Rural Hospital: A Prospective Study.

Background: Surgical site infection (SSI) is one of the common causes of hospital-acquired infections, leading to high morbidity and mortality. SSIs contribute mainly about the increased health care costs in terms of prolonged hospital stay and lost work days. The infections are different in different areas and largely neglected in our area. It is very important to document and notify the incidence of SSI, which will help in proper categorization and surveillance of the patients, helps to identify the type of patients susceptible for wound infections. Aims and Objectives: To estimate the incidence, study bacteriology, and the factors associated with the occurrence of SSI in the study setting. Materials and Methods: The present prospective study was conducted in the surgical wards of MNR Medical College and Hospital, Sangareddy, Medak District, Telangana, India. Clinico-bacteriological follow-up of 100 post-operative cases to the development of SSI, as per the Center for Disease Prevention and Control criteria (1991). Incidence was expressed as the infection rate per 100 operations. Bacteriology was documented by sending pus for analysis. Association was tested by applying the Student’s t-test and the Chi-square test of significance. P < 0.05 was considered as significant. Results: The SSI rate was estimated to be 8% for clean, 58.3% for clean-contaminated, 85% for contaminated operations, and 66.6% for dirty cases. 38.46% of the isolates were Escherichia coli. Conclusion: The study emphasizes the need for the evidence-based infection control and to identify the patients susceptible for wound infection which helps in reducing the hospital stay and reduces hospital cost.

Development of a curcumin bioadhesive monolithic tablet for treatment of vaginal candidiasis

The present investigation was designed to formulate a natural tablet for the treatment of vaginal candidiasis in order to eliminate side effects that are caused by existing antifungal drugs. Curcumin has promising antifungal activity in comparison with the existing azole antifungal drugs. Bioadhesive curcumin vaginal tablets were prepared by direct compression with different ratios of biadhesive polymers like xanthan gum, guar gum and HPMC. Curcumin tablets were characterized by studies of friability, hardness, hydration, DSC, mucoadhesion, in vitro release and antifungal activity. DSC and FT-IR data indicate there was no interaction between the drug and the excipients and also polymer concentration has some effects on melting point of curcumin. Formulation F3 showed the best results in terms of swelling and mucoadhesion together with prolonged drug release. The antifungal activity of the Curcumin tablet has demonstrated a significant effect against Candida albicans. Hence, the study indicates the possible and effective use of curcumin bioadhesive monolithic vaginal tablet for vaginal candidiasis as a promising natural antifungal treatment

Development of pH sensitive nanoparticles for intestinal drug delivery using chemically modified guar gum co-polymer

The aim of the research work was to chemically modify guar gum[GG] as a pH sensitive co-polymer and formulating intestinal targeting ESO nanoparticles [NPs] using the synthesized co-polymer. Poly acrylamide-grafted-guar gum [PAAm-g-GG] co-polymer was synthesized by free radical polymerization. Chemical modification of PAAm-g-GG by alkaline hydrolysis results in formation of a pH-sensitive co-polymer. The effect of GG and acryl amide [AAm] on grafting was studied. Esomeprazole magnesium [ESO] loaded pH sensitive NPs were prepared by nano-emulsification polymer crosslinking method and characterized. Sixteen formulations were prepared and the concentration of process variables was varied to obtain nanoparticles of 200-600nm. The NPs were found to be homogenous in size distribution. The encapsulation efficiency and drug loading ranged from 33.2% to 50.1% and 12.2% to 17.2% respectively. Particle size, encapsulation efficiency and drug loading increased along with co-polymer concentration. In-vitro release studies at pH 1.2 for 2 h, followed by pH 6.8 showed that environment pH significantly affected the drug release. SEM has shown that NPs are spherical with smooth surface. The pH sensitive PAAm-g-GGNPs resisted the initial release of the drug from the drug loaded NPs in acidic pH and delayed the release process to a longer period in alkaline environment

Epidemiological study of cardiovascular risk factors among public transport drivers in rural area of Chittoor district of Andhra Pradesh.

Background: Non communicable diseases (NCDs) are considered as one of the major health and development challenges of the 21st century, recent studies had demonstrated that transport drivers are at greater risk of developing cardiovascular diseases due to an incorrect diet, sedentary behavior, unhealthy lifestyles and obesity. The objective of the study was the study was conducted with the aim of assessing some cardiovascular risk factors and its relation to sociodemographic variables. Methods: Cross sectional study was carried out from Jan 2013 to June 2013 with transport drivers of APSRTC of Venkatagiri Kota. Data was collected regarding socio-demographic profile, diabetes, use of medication, tobacco and alcohol consumption, work schedules and perceived occupational problems and their blood pressure and anthropometry were also measured & analyzed using SPSS software. Results: 204 transport drivers were studied. Out of95 tobacco consumers 68 were smokers and 27 were tobacco chewers and 110 subjects were alcohol consumers. Perceived reasons for smoking were it suppresses cold (27.94%) and enables to concentrate on work (20.58%). Perceived reasons for alcohol consumption were peer pressure (17.2%) and it suppresses cold (20%). Among 204 subjects 36.2% were pre-obese and 34.8% were obese with 23.05% of pre-hypertensive and 14.21% hypertensive. Duration of alcohol intake and tobacco use, BMI, WHR & WC were significantly associated with hypertension. Conclusions: There is a high prevalence of risk factors of cardiovascular disease with various perceived reasons and they were statistically significantly associated with hypertension.

Benign on cytology, malignant on histopathology: Coexistence of Hashimoto’s thyroiditis with Papillary carcinoma of thyroid.

Papillary thyroid carcinoma (PTC) and Hashimoto’s thyroiditis (HT) are common diseases in clinical practice. Hashimoto’s thyroiditis is the most common autoimmune thyroid disease and the most common cause of hypothyroidism. It is characterized by diffuse lymphocyte infiltration, fibrosis, and parenchymal atrophy. Papillary thyroid carcinoma is the most common malignant neoplasm of the thyroid. There is a high prevalence of association between HT and PTC FNAB is useful for diagnosing PTC in patients with HT associated thyroid lesions. The presence of HT in patients with PTC was associated with disease presentation at an earlier stage, less aggressive clinical course and better outcome. Here we have presented a case of hashimoto's thyroiditis with papillary thyroid carcinoma in a 37 years old female who came with complaints of swelling in front of neck. Cytology and radiology showed features of HT but, on histopathology it was diagnosed as HT with PTC.

Lactating adenoma of the breast: A case report.

Lactating adenomas are rare benign tumors of breast, frequently associated with pregnency and lactation. They are common in the third trimester of pregnancy during second and third decade. They present similarly as other benign lesions of breast and differentiation from them preoperatively is difficult both clinically and radiologically. it is characterised by typical changes of secretory epithelium leading to formation of a well-diffrentiated benign tumor. Cytology and histopathology remains the definitive tests for confirming the diagnosis. Surgery is the treatment of choice. They tend to regress spontaneously and prognosis is generally good. Here we have presennted such a rare case of lactating adenoma arising from 28 years old lactating women.

Utility of adenosine deaminase (ADA), PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease.

Background & objectives: Pleural effusion is a common occurrence in patients with late-stage chronic kidney disease (CKD). In developing countries, many effusions remain undiagnosed after pleural fluid analysis (PFA) and patients are empirically treated with antitubercular therapy. The aim of this study was to evaluate the role of adenosine deaminase (ADA), nucleic acid amplification tests (NAAT) and medical thoracoscopy in distinguishing tubercular and non-tubercular aetiologies in exudative pleural effusions complicating CKD. Methods: Consecutive stage 4 and 5 CKD patients with pleural effusions underwent PFA including ADA and PCR [65 kDa gene; multiplex (IS6110, protein antigen b, MPB64)]. Patients with exudative pleural effusion undiagnosed after PFA underwent medical thoracoscopy. Results: All 107 patients underwent thoracocentesis with 45 and 62 patients diagnosed as transudative and exudative pleural effusions, respectively. Twenty six of the 62 patients underwent medical thoracoscopy. Tuberculous pleurisy was diagnosed in six while uraemic pleuritis was diagnosed in 20 subjects. The sensitivity and specificity of pleural fluid ADA, 65 kDa gene PCR, and multiplex PCR were 66.7 and 90 per cent, 100 and 50 per cent, and 100 and 100 per cent, respectively. Thoracoscopy was associated with five complications in three patients. Interpretation & conclusions: Uraemia remains the most common cause of pleural effusion in CKD even in high TB prevalence country. Multiplex PCR and thoracoscopy are useful investigations in the diagnostic work-up of pleural effusions complicating CKD while the sensitivity and/or specificity of ADA and 65 kDa gene PCR is poor.

Incidentally detected carcinoma in situ in a fibroadenoma of breast in a postmenopausal woman: A case report.

Fibroadenomas are the most common benign tumor of the breast. it can occur in women of any age but the peak incidence seen in young adolescent women during the second and third decades of life, Fibroadenoma is a biphasic tumor, composed of an epithelial and a stromal component. Even though they are solitary lesions, multiple fibroadenomas can also occur especially in the older age group. Breast fibroadenomas seemed to display a wide spectrum of proliferative and non-proliferative histologic changes. Of all these changes, carcinoma arising from fibroadenoma is a rare occurrence. Here, we have presented such a rare case of carcinoma in situ arising from the long standing multiple fibroadenoma in a postmenopausal women. Clinical and radiological features are not helpful in identifying carcinoma arising from fibroadenoma. Histopathological examination of the excised specimen should be done for the confirmation of the diagnosis.

Malignant gastrointestinal stromal tumors (GISTs) of the duodenum – A rare occurrence: Case report.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Most of the cases are located in the stomach followed by the small intestine. They arise from the interstitial cells of cajal, which are located in the wall of the intestine. Malignant GISTs are rare type of tumors in GIT. Small intestine GIST is more likely to be malignant compared to stomach. Here we reported such a rare case of malignant GIST in a 54 years old female patient who came to the hospital with complaints of pain and mass in abdomen. Ultrasound revealed a mass originating from the duodenum. Provisional clinical diagnosis of duodenal carcinoma was considered preoperatively. Patient underwent complete surgical excision of the tumor. Histopathological examination confirmed the diagnosis of malignant GIST. As the recurrence rate for malignant GIST is high, patient was kept on follow up.

Adenosquamous carcinoma of stomach: A rare entity – Case report.

Primary gastric adenosquamous carcinomas are rare and constitute less than 0.5% of all gastric malignancies. They are common in males and seen in sixth decade of life. These tumors are composed of both adenocarcinoma and squamous cell carcinoma in varied proportions. Here we have presented such a rare case in a 47 years old male patient who presented with complaints of abdominal pain and bleeding. Routine investigations were normal except for mild anemia. Upper gastrointestinal endoscopy revealed ulcerartive lesion in the pyloric antrum. Histopathological examination confirmed the diagnosis of adenosquamous carcinoma. They are aggressive tumors and have worse prognosis compared to adenocarcinomas hence, follow up is necessary.

A rare case of paediatric trichotillomania complicating into Rapunzel syndrome: a case report

Background: Trichotillomania is a psychological condition that involves strong urge to pull one’s hair. Trichophagia is disorder of eating of hair. Bezoar is collection of undigested material such as hair, drugs and plastic or combinations. Rapunzel syndrome is a rare type of trichobezoar, which has mass of hair lodged in stomach extending up to ileum. In majority, diagnosis is made very late, at a stage where surgery is the only option. Case description: A 9 year old girl was brought with complaints of loss of hair on scalp since 8 months, decreased appetite, and constipation, weight loss since 5 months and vomiting since 2 weeks. Patient had paediatric consultations without much benefit; patient was referred to dermatologist and paediatric surgeon. Ultrasound showed mass in abdomen. Patient was operated to find a mass extending from stomach to terminal ileum. Patient was referred to a Psychiatrist and diagnosis of Trichotillomania was made. Discussion: Trichobezoar is common in young females, often with an underlying psychiatric disorder, they present late due to the low index of suspicion. As this condition is a rarity in paediatric age group and very little progress to Rapunzel syndrome, this paper discusses about the systemic team management of the above individual. Conclusion: High index of suspicion is needed to diagnose this condition in paediatric age group.

Productivity Enhancement of Kharif Rice Through Introduction of Pre Kharif Crops in Rice Based Cropping System.

A field experiment was conducted at Agricultural College Farm, Naira on sandy clay loam soil during pre kharif and kharif 2012-2013. The experiment was laid out in randomized block design, with four replications and seven cropping systems. Sunnhemp, greengram, blackgram, sesame, clusterbean and bhendi during pre kharif and rice during kharif were tried. Incorporation of different pre kharif crop residues significantly altered the growth and development of kharif rice. The results indicated that crop residue incorporation of sunnhemp recorded significantly higher growth parameters, yield attributes, yield (6501 kg ha-1) and nutrient uptake of kharif rice while lowest was recorded with that of fallow (4125 kg ha-1). Economics of rice was also observed with sunnhemp crop residue incorporation.

Evaluation of role of atorvastatin in cisplatin induced nephrotoxicity in wistar rats.

OBJECTIVES: This study was carried out to investigate the ameliorative effect of Atorvastatin on Cisplatin-induced Nephrotoxicity in Wistar rats. METHODS: Twenty Four (24) male rats were used for the experiment. Group I was administered per oral daily with Phosphate Buffered Saline (PBS) for 10 days. Group II was administered single intraperitoneal dose of Cisplatin 7.5mg kg-1 body weight on fifth day, Group III was administered daily per oral dose of Atorvastatin 3 mg kg- 1 body weight for 10 days and on fifth day single intraperitoneal dose of Cisplatin 7.5 mg kg-1 body weight. Group IV was administereddaily per oral dose of Atorvastatin 10 mg kg-1 body weight for 10 days and on fifth day a single intraperitoneal dose of Cisplatin 7.5 mg kg-1 body weight. After the last day of treatment animals were sacrificed and blood samples collected by cardiac puncture and used for analysis of serum creatinine, blood urea nitrogen and total protein. The antioxidant parameters of Catalase, GSH and TBARS were measured in kidneys. RESULTS: The result showed a significantly reduced serum concentration of creatinine, urea and total protein in groups treated with Cisplatin only when compared to PBS. CONCLUSION: It is concluded that the decrease in creatinine, blood urea and total protein were ameliorated by the administration of atorvastatin which may be due to its antioxidant properties.