Cardiorespiratory Adverse Events after First Vaccination in Preterm Neonates With Gestational Age ?30 Weeks

Objectives: To document the adverse cardiorespiratory events following first routine immunization in preterm neonates. Methods: We retrieved records of neonates with gestational age ?30 weeks, and included those who developed cardiorespiratory events after first vaccines before discharge. Our Unit’s protocol is to administer Bacillus Calmette-Guerin (BCG), hepatitis B vaccine to those discharged at <8 weeks postnatal age. Hexavalent, BCG, pneumococcal vaccine and rotavirus vaccines are given at 8 weeks of age, if hospital stay is predicted to be longer. Unit compliance to vaccination administration at appropriate ages were also measured. Results: Data of 161 neonates ?30 weeks (17.4% <27 week) who completed care in the unit was studied. Cardio-respiratory adverse events were reported in 21(13.7%). None of these required initiation of invasive ventilation. High flow nasal cannula therapy and caffeine restart were required for these events in 14 (9.3%) and 6 (3.9%) neonates, respectively. Lower gestational age, bronchopulmonary dysplasia and sepsis were significant risk factors on univariate analysis. On multivariate analysis, continued need for respiratory support at 4 weeks of age (P=aOR 14.5 (95% CI 5-59.1) was the only independent risk factor for post-vaccination cardiorespiratory adverse events. Of 38 who were not vaccinated at recommended ages by unit policy, 25 were missed opportunities, the rest were deemed unstable for vaccinations at that age by the clinical team. Conclusion: Adverse cardiorespiratory events were uncommon after first vaccinations in very preterm neonates. Administering vaccines in this group before discharge would allow monitoring for these events, especially for those who require long-term respiratory support.

Knowledge about COVID-19 Infection and Stress Levels among Ambulance Drivers during COVID-19 Pandemic — A Cross Sectional Study

Introduction : The medical personnel especially have to deal with both the Biological and Psychological consequences originating from the influence of virus. Emergency Care Units equipped with ambulance service always should be at the fore front to face all emerging untoward incidents. Ambulance Drivers often disregard their physical health and mental stress in order to fulfil the duties entrusted on them. Methodology : Cross-sectional questionnaire based on-line survey was conducted. Ambulance drivers were North and South India were taken as study subjects. Knowledge based questions and mental stress were assessed using Perceived Stress level Scale (PSS). The questionnaires were translated toTamil, Kannada, Telugu, Malayalam and Hindi languages. Chi-square test was done to find the association between variables. Results : Among the 101 respondents, 84.2% were having good knowledge about the pandemic. Statistically significant association between number of patients transported per day and the knowledge levels of Ambulance drivers was found (p =0.048)(Chi-square value=15.65). Drivers in Government sector were having more knowledge compared to private sector (p =0.038)(Chi square value=6.53). The perceived mental stress was found to increase with a greater number of patients being transported per day, which was statistically significant (p =0.001)(Chi-square value= 30.42). Conclusion : Knowledge regarding COVID-19 virus was adequate among the Ambulance Drivers. Knowledge was found to be more among drivers who work in Government medical establishments. Mental stress was more among drivers who transported more than 5 patients per day.

Impact of Early Pulmonary Rehabilitation in Postacute COVID Disease: A Single-Center Experience From India – A Quasi-Experimental Study

Background: It was observed that post?COVID patients reported persistent exertional dyspnea, cough, fatigue, or chest pain. About 10%–20% of patients may progress to pulmonary fibrosis. Pulmonary rehabilitation has been proven to be useful in improving effort tolerance and quality of life in chronic respiratory diseases. Objectives: The objective of this study was to assess the effectiveness of pulmonary rehabilitation in improving 6?min walk distance (6 MWD), peak flow, fatigue, anxiety, and depression in early postacute COVID disease. Materials and Methods: This quasi?experimental study was conducted during January 2021 to March 2021. The patients who recovered from COVID?19 and having persistent exertional dyspnea and fatigue after 3 weeks of recovery were included in the study. Baseline and postintervention assessment of 6 MWD, Visual Analog Scale for Fatigue (VAS?F), peak flow, and Hamilton rating scales (HAM) scales after 4 weeks were done. Compliance was ensured with weakly telemonitoring. Results: Significant improvement in peak flow, 6 MWD, Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and VAS-F (P < 0.01) after 4 weeks of pulmonary rehabilitation. Conclusion: Early pulmonary rehabilitation in post?COVID syndrome can contribute to statistically significant improvement in functional and psychological parameters as well as post-COVID fatigue.

Comparative study of reliability of inflammatory markers over 18-FDG−PET CT scan in monitoring skull base osteomyelitis / Estudo comparativo da confiabilidade entre marcadores inflamatórios e PET/TC com 18F-FDG no monitoramento da osteomielite da base do crânio

Abstract Introduction The end point of treatment in skull base osteomyelitis is a matter of debate. A treatment based on symptoms alone is fraught with recurrence. There is a need to restrict imaging though more informative. The inflammatory markers like C-reactive protein and erythrocyte sedimentation rate used commonly need a detailed evaluation to optimize its utility. Objectives To compare the diagnostic accuracy of inflammatory markers with a hybrid PET scan in monitoring skull base osteomyelitis. The secondary objective was to obtain a cut-off value of these markers to decide upon antibiotic termination. Methods A prospective cohort study was conducted in a tertiary care center with fifty-one patients with skull base osteomyelitis meeting eligibility criteria. Patients diagnosed with skull base osteomyelitis were serially monitored with weekly markers and PET scan after the initiation of treatment. A hybrid scan was taken at 6-8 weeks of treatment and repeated if required. The follow-up period varied from 6 weeks to 15 months. The outcome measures studied were the values of markers and the metabolic activity of PET scan when the patient became asymptomatic and when disease-free. Results C-reactive protein and erythrocyte sedimentation rate had a statistically significant correlation to disease activity in PET tomography scan as a prognostic marker. Both showed good clinical correlation. A cut off value of ≤ 3.6 mg/L for C-reactive protein and ≤ 35 mm/hour for erythrocyte sedimentation rate were taken as normalized values. Conclusion A consistent normalized value of C-reactive protein and erythrocyte sedimentation rate for 8-12 weeks in an asymptomatic patient may be an indicator of disease control, though not cure. So, relying solely on markers alone for antibiotic termination may cause relapse. It may be used cautiously in a peripheral setting without access to more specific hybrid scans. In a tertiary care, follow-up scans may be done based on the titres, thereby limiting the radiation exposure.

Resumo Introdução O endpoint do tratamento da osteomielite da base do crânio ainda é uma questão de debate. Um tratamento baseado apenas em sintomas é sujeito a altas taxas de recorrência. Por outro lado, embora sejam mais informativos, o uso dos exames de imagem tem sido cada vez mais restringido. Os marcadores inflamatórios como a proteína-C reativa e a velocidade de hemossedimentação, VHS, comumente usados, precisam de uma avaliação detalhada para aprimorar sua utilidade. Objetivos Comparar a acurácia diagnóstica de marcadores inflamatórios em relação à tomografia computadorizada por emissão de pósitrons, PET-TC, no monitoramento de osteomielite da base do crânio. O objetivo secundário foi obter um valor de corte desses marcadores para decidir sobre o momento da interrupção do antibiótico. Método Um estudo de coorte prospectivo foi conduzido em um centro de atendimento terciário com 51 pacientes com osteomielite da base do crânio que atendiam aos critérios de elegibilidade. Os pacientes com diagnóstico de osteomielite da base do crânio foram monitorados semanalmente por meio de exames seriados de marcadores e PET-CT após o início do tratamento. O exame de imagem foi feito em 6 a 8 semanas de tratamento e repetido se necessário. O período de acompanhamento variou de 6 semanas a 15 meses. As medidas de desfecho estudadas foram os valores dos marcadores inflamatórios e a atividade metabólica obtida por PET-CT quando o paciente se tornou assintomático e quando estava livre da doença. Resultados Proteína-C reativa e VHS apresentaram uma correlação estatisticamente significante com a atividade da doença ao PET-TC como marcadores prognósticos. Ambos mostraram boa correlação clínica. Um valor de corte de ≤ 3,6 mg/L para proteína-C reativa e ≤ 35 mm/hora para VHS foi considerado como normalizado. Conclusão Um valor normalizado consistente de proteína-C reativa e VHS por 8 a 12 semanas em um paciente assintomático pode ser um indicador de doença controlada, embora não de cura. Portanto, o uso apenas nesses marcadores para a interrupção do antibiótico pode ser causa de recidiva. Eles devem ser usados com cautela quando não há acesso a exames mais específicos. Em centros de atendimento terciários, o seguimento com exames de imagem pode ser feito com base nos títulos desses marcadores inflamatórios, o que limita a exposição dos pacientes à radiação.

Physico Chemical Analysis of the Formulation Kanakabindhvarishtam

Kanakabindhvarishtam is a formulation included in Arishta kalpana. It is mentioned by Acharya Charaka in the context of Kushta chikitsa. The formulation is having Khadira (Acacia Catechu) as Kashaya Dravya (decoction) and Triphala (Amalaki, Vibeetaki, Hareetaki), Trikadu (Maricham, Sundi, Pippali), Vidanga, Mustha, Indrayava, Guduchi, Haridra, Daruharidra and Vasa Moola as Prakshepa Dravyas. Even though Guda and honey were not mentioned in the yoga, they were added in order to facilitate the fermentation process. Dhataki flowers which are commonly used to accelerate the fermentation process were not added in the preparation. The whole process were carried out in two stages- initial stage include the preparation of Kanakabindhvarishta according to the reference by Charaka Acharya, and in the 2nd stage Physico chemical analysis of the yoga were carried out. The Physico chemical parameters include pH value (5.28), total solid content (2.03%), specific gravity (1.0105), reducing sugar (2.8129%), total sugar (6.43%) and alcoholic content (8%). 35lt of Arishta was prepared by fermentation process. The Sandhana patra (fermentation vessel) in which the Arishta was prepared were kept for a period of 45 days and all the Arishta siddha lakshanas were obtained as per the reference

Biosorption of Zinc using Bacillus subtilis (MTCC 2423)

Heavy metals such as zinc in untreated industrial effluents cause diseases and disorders in living organisms. They cannot be degraded like organic contaminants and hence have to be removed. Though physical and chemical methods are available for their removal, most of them are not economical and eco-friendly. Hence, a suitable technique is necessary to minimize the deleterious effects of dispersion of heavy metals in ecosystems. Though zinc serves as a micronutrient, it becomes toxic in higher concentrations. Bacteria can be used in the removal of zinc and the process is economical and ecofriendly. Hence, in the present study, we tested zinc removal efficiency of Bacillus subtilis (MTCC 2423) for various concentrations viz. 100, 200, 300, 400 and 500 ppm of zinc in nutrient broth for a period of 10 days. Samples were tested for the zinc level every two days in each concentration and the maximum removal was noticed after six days of treatment. With the increase in zinc concentration, both biomass and zinc removal efficiency showed an increase. Autoclaved cells showed maximum zinc removal when compared with other cell types. Among the other heavy metals tested, iron enhanced the biomass of B. subtilis during zinc treatment and the results are discussed.

Dosage form Development of Nagabala- Arjunadi Yoga and Chromatographic Analysis Using HPTLC

Nagabala -Arjunadi Yoga, is the combination of Nagabala and Arjuna Churna mentioned in Chakradatta, Hridroga Chikitsa, is prepared by giving Bhavana of Rasonadi Kwatha. Hridroga (cardiovascular disorders) are the most common health concern of the present era. It is the leading cause of death worldwide. Ancient Samhitas contain many formulations in the context of Hridroga, whose applicability is unexplored. Churna and Kwatha are the main dosage forms used in clinical practice. But compared to Churna and Kwatha, tablets are more patient compatible in terms of palatability and possess increased shelf life. Hence, Nagabala-Arjunadi Yoga, a tablet dosage form is developed using Nagabala- Arjuna Churna and Rasonadi Kwatha. No scientific evaluation data for this drug is available to date. The present study was done to evaluate the pharmacognostical and pharmaceutical profile of Nagabala-Arjunadi Yoga. The microscopic examination of the Nagabala- Arjunadi Yoga showed the presence of rosette crystals, rhomboidal crystals, simple fibres, oil globules and stones cells. The physicochemical analysis showed that pH value, hardness, loss on drying, ash value, water extractive value and methanol extractive value was 5.8, 3.5kg/cm2, 7.949%, 3.03%, 17.43%, 16.14% respectively. The HPTLC densitograms at UV 254 nm and UV 366nm using Toluene and Ethyl acetate in the ratio 9:1 showed maximum peak height in 3rd peak corresponding to the Rf value 0.18 and 0.17 respectively. The finding observed in the present study can be used as reference for future quality control.

Does perceived social support, psychological problems, and fatigue impact quality of life of geriatric patients with cancer?

Background: Health-related comorbidities often increase due to cancer among the ageing population. However, the domains of psychological functioning of geriatric patients remain undetected especially in the Indian scenario. This study aimed to evaluate psychological problems, perceived social support, fatigue, and quality of life among geriatric patients with cancer. Methods: A cross sectional study was conducted in a tertiary cancer center. Geriatric patients with cancer (n = 130) having solid malignancies categorized as older patients (>65 years) and younger geriatric patients (60–65 years) were included in the study. Depression, anxiety, perceived social support, fatigue, and quality of life was assessed using the Geriatric Depression Screening Scale, Geriatric Anxiety Scale, Multidimensional Scale of Perceived Social Support, Symbolic Assessment of Fatigue Extent, and the Old People Quality of life Scale, respectively. Descriptive and inferential statistics such as cross tab analysis, correlation and regression analysis. Results: A majority of patients 80 (61.5%) had low perceived social support, moderate-severe depression 61 (47.7%) and mild-moderate anxiety 55 (43.1%). Half of the patients were found to have poor quality of life. Further, psychological problems were higher among older geriatric patients (p = 0.000). Very few patients had a higher impact of fatigue on their daily functioning 17 (13.3%). There was a positive correlation between perceived social support, depression, anxiety, extent of fatigue, and quality of life (r = 0.256, P = 0.003). Conclusion: Psychological problems are higher among older geriatric patients with cancer undergoing treatment. Clinical implications could aim at regular screening to identify specific psychological issues and provide appropriate interventions. Future research warrants the efficacy of such therapeutic interventions for better quality of life outcomes

Impact of Covid-19 pandemic on upper gastrointestinal cancer services: Experience from an oncosurgical unit

BACKGROUND The Covid-19 pandemic continues to affect the delivery of cancer care across the world. We evaluated the impact of the pandemic on the delivery of cancer care, to patients diagnosed with upper gastrointestinal (UGI) tract malignancies, during the first 4 months of the pandemic in India. METHODS We retrospectively analysed a database of patients with UGI malignancies discussed in the Multidisciplinary Tumour Board (MDTB) between 24 March and 24 July 2020. The results in the study group were compared to that of a similar group of patients from the corresponding period in 2019. RESULTS A total of 117 and 61 patients were discussed in the MDTB in 2019 and 2020, respectively, thereby showing a 48% reduction in the number of new cases seen in 2020. The reduction in the number of new cases was huge for oesophageal cancer (53–13; 75.5% reduction), compared to gastric cancer (53–43; 18.9%). The proportion of patients with metastatic disease at presentation was significantly higher in 2020, compared to 2019 (39.3% v. 23.1%; p=0.023). In 8 (13.1%) patients, the pre-existing treatment protocol had to be modified to suit the prevailing pandemic situation. Two patients with gastric cancer acquired asymptomatic Covid-19 infection during the treatment, which delayed the delivery of further therapy. Oncosurgeries were less in 2020 compared to 2019 (25 v. 63). The rate of 30-day major postoperative complications in 2020 was comparable with that in 2019 (12% v. 6.3%; p=0.4). CONCLUSIONS The number of new patients with UGI cancer, seeking elective cancer care and the number of oncosurgical procedures reduced during the Covid-19 pandemic. Continuous delivery of UGI cancer services was ensured during the pandemic through clinical prioritization, the adaptation of specific care pathways and selective modification of protocols, to suit the prevailing local conditions.

Postoperative outcomes in patients undergoing elective general surgery after recovery from Covid-19 at a tertiary care centre: A one-year case series

BACKGROUND Planned elective surgery had to be postponed for a large number of patients who tested positive for Covid-19 in the preoperative period. We aimed to assess the postoperative outcomes of patients who were operated on for elective indications, following recovery from Covid-19 infection. METHODS We did a retrospective study of patients who underwent elective general surgery between 1 April 2020 and 31 March 2021, following recovery from Covid-19. The 30-day postoperative morbidity and mortality were analysed. The data relevant for the study were retrieved from the hospital’s electronic medical records. RESULTS Of the 109 patients included, 54.1% were women and the median (range) age was 49 (16–76) years; 53.2% of operations were performed for benign indications and the rest were for malignancies. Eighty-five (78%) patients underwent surgery following recovery from an asymptomatic Covid-19 infection and 23 (21.1%) patients following recovery from mild Covid-19 infection; 73.3% of the operations were performed following a planned delay of 2– 5 weeks from the diagnosis of Covid-19. The 30-day major postoperative morbidity (Clavien–Dindo grade ?3) was 6.4%, the postoperative pulmonary morbidity was 0.9%, and there was no 30-day mortality. CONCLUSIONS Elective general surgical procedures can be done safely in patients who have recovered from asymptomatic and mild Covid-19 infection, following a minimum wait period of 2 weeks.

Kytococcus schroeteri: An Emerging Pathogen on the Horizon

Kytococcus has long been considered to be a skin commensal or environmental contaminant. However, it has emerged as an aetiological agent of prosthetic valve infective endocarditis, pneumonia, bacteremia, osteoarticular, and implant/device infections, especially in patients with immunocompromised conditions, such as haematological malignancies, febrile neutropaenia and in patients on immunosuppressant therapy. We report a case of prosthetic valve endocarditis associated with Kytococcus schroeteri in a patient with rheumatic heart disease and mitral valve replacement. Special efforts to reach correct identification have to be made as Kytococcusis, commonly resistant to penicillins and oxacillins; and often needs prolonged treatment with glycopeptides containing combination antimicrobial therapy.

Assessment of Disease Activity in Rheumatoid Arthritis: A Comparative Study of Clinical and Laboratory Evaluation with Musculoskeletal Ultrasonography Assessment

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease and musculoskeletal ultrasonography (USG) is gaining popularity for assessing the disease activity bed side, objectively and cost effectively. There is paucity of such studies from India which establish the correlation between RA disease activity and musculoskeletal USG. Objective: The objective of this study was to compare the disease activity scores in RA patients, assessed by ‘clinical and laboratory evaluation’ with ‘musculoskeletal ultrasound scoring of the affected joints. Methodology: It was a cross sectional study conducted from December 2015to May 2017. We enrolled the diagnosed patients of RA, having at least one USG assessable joint with definite clinical synovitis. Disease activity was assessed by swollen joint count, tender joint count, Clinical Disease Activity Index (CDAI), Disease Activity Score (DAS) 28 ESR and DAS 28 CRP. Musculoskeletal USG was performed by experienced radiologist. Grayscale scores (GSUS) and Power Doppler scores (PDUS) were calculated in 22 joints as per SONAR criteria and each joint was examined as per standardized score. Results: Our study showed that DAS 28 CRP, DAS 28 ESR, CDAI, tender joint count and swollen joints count had positive correlation (p<0.001) with various musculoskeletal USG scores, whereas ESR and CRP failed to show any significant correlation. Conclusion: GSUS-PDUS can be used for diagnosing joint space narrowing, joint effusion, and synovial thickening. PD may become a cost-effective alternative to gadolinium enhanced MRI. Strong correlation exists between USG and physical examination of joint swelling as well as disease activity scores in RA patients.

Barreiras à atividade física percebidas entre adultos da Malásia durante a pandemia de COVID-19: um estudo transversal / Perceived barriers to physical activity among Malaysian adults during COVID-19 pandemic: a cross-sectional study

INTRODUÇÃO: A pandemia COVID-19 trouxe um impacto relativamente significativo no mundo. A Malásia implementou uma estratégia de isolamento social em todo o país para nivelar a curva da epidemia. À medida que os limites ao movimento e à interação social entraram em vigor, mais indivíduos parecem menos ativos fisicamente. OBJETIVO: determinar as barreiras percebidas para a atividade física entre jovens adultos da Malásia durante a pandemia de COVID-19. MÉTODOS E MATERIAIS: Total de 217 participantes incluídos na faixa etária de 18 a 40 anos participaram voluntariamente deste estudo. Os participantes foram excluídos se não fossem malaios e apresentassem quaisquer problemas psicológicos e deficiência física que impedissem a atividade física. O questionário Barrier to Being Active (BBAQ) foi distribuído por várias plataformas de mídia social de janeiro de 2021 a maio de 2021. Os dados categóricos foram apresentados usando frequência simples e absoluta na distribuição de perfis sociodemográficos e respostas do BBAQ. Qui-quadrado de Pearson com nível de confiança de 95%, p <0,05 foi utilizado como nível de significância para analisar a associação entre gênero e barreiras. RESULTADOS: A barreira relatada pelos participantes foi "falta de força de vontade" 136 (62,7%), seguida de "falta de energia" 117 (53,9%), "falta de recursos" 113 (52,1%), "falta de tempo", 109 (50,2%), "influência social" 100 (46,1%), "falta de habilidade" 48 (22,1%) e "medo de se machucar" 40 (18,4%). Não houve relação significativa entre gênero e barreira à atividade física entre jovens adultos da Malásia. CONCLUSÃO: A "falta de energia", "falta de força de vontade" e "falta de recursos" foram as barreiras mais percebidas para a atividade física entre jovens adultos da Malásia durante o confinamento por causa da COVID-19. Não houve associação significativa entre as barreiras de atividade física e o gênero.

INTRODUCTION: The COVID-19 pandemic has had a relatively significant impact on the world. Malaysia implemented a countrywide social isolation strategy to flatten the epidemic curve. As limits on movement and social interaction have come into force, more individuals appear less physically active. OBJECTIVE: To determine the perceived barriers to physical activity among Malaysian young adults during the COVID-19 Pandemic. METHODS AND MATERIALS: A total of 217 participants included with age group from 18-40 years old voluntarily participated in this study. Participants were excluded if they were non-Malaysian and had any psychological problems and physical impairment that hindered physical activity. The barrier to Being Active quiz (BBAQ) questionnaire was circulated through various social media platforms from January 2021 to May 2021. Categorical data were presented using simple and absolute frequency on the distribution of sociodemographic profiles and BBAQ responses. Pearson Chi-square with 95% confidence level, p<0.05, was used as the significant level to analyze the association between gender and barriers. RESULTS: The barrier reported by the participants was "lack of willpower" 136 (62.7%), followed by "lack of energy" 117(53.9%), "lack of resource" 113(52.1%), "Lack of time," 109(50.2%), "social influence" 100(46.1%), "lack of skill" 48(22.1%) and "fear of injury" 40(18.4%). There was no significant relationship between gender and Barrier to Physical Activity among Malaysian young adults. CONCLUSION: The "lack of energy," "lack of willpower," and "lack of resource" were the most perceived barriers to physical activity among Malaysian young adults during COVID-19 lockdown, and there was no significant association between physical activity barriers and gender.

Assessment of awareness of common rheumatological diseases amongst final year medical undergraduate students: single centre questionnaire-based survey

Background: Assessment of awareness of common rheumatological diseases amongst final year medical undergraduate students – single centre questionnaire-based survey.Methods: A cross-sectional survey of final year students was conducted during a national undergraduate medical summit. Participants were asked to fill out a 10-question survey (online link/in print). Results were summarized using descriptive statistics.Results: A total 162 medical students completed the survey. Only 18 of 162 respondents were able to score more than 50% in all domains with only one respondent getting all the questions correct. Partial awareness about the major rheumatological diseases in adults was seen with 122 (75%), 110 (68%) and 105 (65%) students having more than 50% correct in the domains of lupus, psoriasis and rheumatoid respectively without scoring completely. By contrast even general awareness of pediatric rheumatology was low with only 34 respondents (21%) having more 50% score in this domain.Conclusions: These findings are consistent with the general consensus amongst rheumatologists that medical students are inadequately exposed to rheumatological disorders and evolving treatments. Awareness of paediatric rheumatology is the lowest and needs urgent addressing.

Rhinosporidiosis – A Clinical Survey

Background: Rhinosporidiosis is a chronic inflammatory granulomatous disease caused by the organism Rhinosporidiumseeberi. This causal organism was once believed to be a sporozoan, but is now considered to be a fungus. The disease ispresent all over the world except in Australia. However, it is endemic only in India and Sri Lanka; more than 95% of reportedcases are from these two countries. The most common site of manifestation of rhinosporidiosis in man is the nose accountingfor about 70% of cases. Surgical excision remains the mainstay of treatment today even though dapsone and ketoconazolehave been tried to some extent in preventing recurrence after surgery.Aim of the Study: The aim of the study was to study the prevalence, distribution, clinical behavior, results of various forms oftreatment and to provide a baseline clinical data and to supplement information for ongoing studies in the field of rhinosporidiosis.Materials and Methods: A total of 20 patients diagnosed as rhinosporidiosis, who attended the ENT Outpatient Department ofMedical College Hospital, Calicut, during the period from December 1998 to November 1999. Detailed history was recorded andpatients were subjected to thorough otolaryngological examination. Special attention was given to the site of lesions and type ofattachment. Details were also collected with particular reference to bathing habits, occupation, contact with animals, and occurrenceof similar illness in the family or in the neighborhood. Investigations included regular blood and urine and blood grouping. All thepatients underwent surgical excision of the lesions. The diagnosis was confirmed by histopathological examination of specimenobtained postoperatively. 100 mg of dapsone was administered daily (50 mg daily in children), 6 days a week, for a period of 6 months.All patients were reviewed for follow-up at the end of 1 month, 2, 4, and 6 and 9 months and on completion of a year after surgery.Observations and Results: In this study, the average age of patients suffering from rhinosporidiosis was 30.6 ± 2.80 years and theage varied between 8 and 52 years. The sex incidence was as follows: Males 17 (85%), females 3 (15%). Male predominance wasseen in this series and the male to female ratio was 5.66:1. Most of the subjects suffering from rhinosporidiosis were manual laborers7 (35%) out of 20, of which 2 (10%) were agricultural workers. The other major group was students accounting for 5 (25%) out of20 cases. The external appearance of the nose was normal in all patients. Partial nasal obstruction was seen in 13 cases (65%),on the left six, on the right five, and bilateral two cases. The total obstruction was seen in 5 cases (25%) – left two, right two, andbilateral one. Both nasal cavities were patent in only two cases. The vestibule showed the presence of mass in four cases (20%).Conclusions: Rhinosporidiosis is not an uncommon disease encountered in day-to-day ENT practice. The occurrence of thedisease does not bear any relation to the occupation of the patient. The maximum incidence of rhinosporidiosis is seen inthe age group of 21–30 years and males predominate. Rhinosporidiosis is more common in the rural population. There is asignificant association between dip baths in ponds and the occurrence of disease.

The study of correlation between vitamin D and tuberculosis in newly detected tuberculosis - pulmonary and extra pulmonary patients attending to K R hospital, Mysuru, Karnataka, India

Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which has posed a constant challenge to mankind in its treatment due to increasing resistance and longer duration of treatment. The newer approach is to look towards strengthening host immune system along with suppressing the organism. Aim of the study was to assess the existence of Vitamin D deficiency in TB patients and aid in the strategies and development of newer improvised approaches in the treatment of TB. Objectives of the study was to estimate vitamin D levels in Tuberculosis (pulmonary and extrapulmonary) patients, assess Correlation between vitamin D and pulmonary tuberculosis and to assess correlation between Vitamin D and extrapulmonary Tuberculosis.Methods: This is a descriptive cross-sectional study. The study consisted of 80 tuberculosis patients both extrapulmonary and pulmonary. Blood samples was analysed for Vitamin D levels and results were compared with age and sex matched controls. Results was analysed using SPSS software.Results: The cases included patient in the age group of 18-60 year with the mean age being 42.34�.65 year. Of the 80 tuberculosis patients 42 were diagnosed with pulmonary tuberculosis and 38 constituted extrapulmonary tuberculosis. The mean Vitamin D in cases was 24.82�.33 and controls was 34.41�19. Among the cases 25 (31.3%) subjects had Vitamin D levels <20 pg/ml and none of the controls had levels <20 pg/ml. The mean Vitamin D level in pulmonary Tb patients was found to be 24.29�.86 pg/ml and Extra-pulmonary Tb was 25.40�.96 pg/ml. The unpaired t-test was statistically significant with p value of 0.005.Conclusions: This study has emphasized on the presence of nutritional deficiency in TB patients and necessity to correct them to achieve a better cure rate.

Quality by design (Qbd) approach to develop stability indicating HPLC method for estimation of rutin in chitosan-sodium alginate nanoparticles

Rutin is a flavonoid glycoside, mainly consists of phenolic compounds, responsible for many biological activities. The objective of the present study was to develop and validate a precise, simple, robust, rapid and reliable reverse phase high -performance liquid chromatography (RP-HPLC) technique by using Qbd approach for evaluating the rutin in nanoparticles. Central composite design (CCD) was employed for optimizing the experimental conditions of RP-HPLC method. Buffer pH, methanol content in the mobile phase composition, flow rate, and wavelength were selected as independent variables whereas retention time, peak area, and asymmetry factor was selected as dependent variables. The retention time, peak area and asymmetric factor of rutin by using optimized independent variables were found to be 3.75 min, 1014.79 mV, and 1.26 respectively. The limit of detection and limit of quantitation values were found to be 0.005 µg/mL and 0.15 µg/mL respectively. For confirming linearity, accuracy, precision, and robustness, the optimized assay condition was validated as per ICH guidelines. The proposed method, which was optimized by QbD approach was found to be a suitable method for analyzing the rutin in chitosan-sodium alginate nanoparticles.

Effects of Exogenous N-Acyl-Homoserine Lactones on Biofilm Formation and Motility in Acinetobacter nosocomialis

One of the major factors contributing to drug resistance in Acinetobacter nosocomialis infections is biofilm development, which is facilitate by quorum-sensing (QS) systems. Quorum sensing by the LuxI and LuxR homologues, AnoI and AnoR, in A. nosocomialis plays a role in biofilm formation and motility of this pathogenic bacterium. The aim of this study was to evaluate the effects of exogenous N-acyl-homoserine lactones (AHLs) on the regulation of biofilm and motility of A. nosocomialis and anoI-deletion mutant. We found that anoR mRNA expression levels in the anoI-deletion mutant were increased in the presence of different types of AHLs compared with that in the absence of exogenous AHL. Among AHLs, C12-HSL appeared to exert the greatest stimulatory effect on biofilm formation and motility. Notably, the anoI-deletion mutant also exhibited significant decreases in expression of the biofilm- and motility-related genes, csuC, csuD and pilT, decreases that were attenuated by addition of exogenous AHLs. Combining the AHL C12-HSL with C6-HSL or C10-HSL exerted synergistic effects that restored the motility phenotype in the anoI-deletion mutant. Taken together, our data demonstrate that C12-HSL may act as an important signaling molecule in A. nosocomialis through regulation of biofilm formation and cell motility, potentially providing a new target for the control of A. nosocomialis infections.

Ayurvedic Management Of Plaque Psoriasis- A Case Study

Psoriasis is a chronic, multisystem inflammatory disease with predominantly skin and joint involvement. In Ayurveda all skin diseases are described under the umbrella of Kushtha. Ayurvedic system of medicine is giving good results in management of Psoriasis. Repeated Samshodhana (purificatory therapies) along with Samshamana (palliative therapies) is the main line of treatment if skin diseases in Ayurveda. Three assessments were taken before and after treatment on scoring of Dermatology Life Quality Index (DLQI), Psoriasis Disability Index (PDI) and PASI score. Score of the patient was 63.3% before treatment and 13.3% after treatment and 3.3% after follow up on Dermatology Life Quality Index (DLQI), 44.4% before treatment and 15.5% after treatment and 5.3% after follow up on Psoriasis Disability Index (PDI) and 24.5% before treatment, 5.1% after treatment and 1.2% after follow up in PASI (Psoriasis Area and Severity Index). This case study wants to substantiate the effectiveness of Ayurvedic treatment in the management of Plaque psoriasis.