Robotic percutaneous coronary intervention (R-PCI): Time to focus on the pros and cons

Aim: To assess the safety, efficiency, and device compatibility of the Second Generation Robotic System. Methods: Data on Robot-Assisted PCI (RePCI) is frequently insufficient in India. Many articles were published in national, non-indexed journals that are not available online and are difficult to obtain. Recognizing these constraints, the current review is intended to compile the available data on this important new innovation technique. This review could encourage future research and serve as a valuable source of information. Results/Conclusion: In terms of procedure efficiency, operator radiation reduction, and safety, the recent implementation and development of second-generation robotic systems have had a significant impact on interventional cardiology. This technology will play a significant role in the future of interventional cardiology as advancements eliminate the need for manual assistance, improve devices compatibility, and expand the use of robotics for telestenting procedures. A larger study demonstrating the safety and feasibility of tele-stenting over greater geographic distances, as well as addressing fundamental technical difficulties, would be required before attempting RePCI

DETECTION OF METALLO-BETA-LACTAMASE PRODUCING PSEUDOMONAS AND ACINETOBACTER SPECIES FROM DIFFERENT CLINICAL SPECIMENS IN A TERTIARY CARE HOSPITAL AT PUDUCHERRY.

Introduction Pseudomonas and Acinetobacter species are frequently isolated non-fermenting gram negative bacteria in a variety of hospital acquired infections. Metallo-beta-lactamases have become a serious threat in treating infections because of their multiple drug resistance including carbapenems. To determine Objectives the prevalence of MBL production among Pseudomonas and Acinetobacter species and to evaluate the different phenotypic MBL detection methods. A total of 104 isolates of carbapenem resistant Pseudomonas (78) and Materials and methods Acinetobacter (26) from different clinical specimens were tested for MBL production by Modi?ed Hodge Test, Combined Disk Test and Double Disk Synergy Test. Antibiotic susceptibility was performed by Kirby- Bauer Disk Diffusion method. Results Pseudomonas aeruginosa (11.29%) Acinetobacterbaumanii (11.53%) were the predominant MBL producers. MBL production was detected 61.53%, 84.61% and 38.46 % by DDST( Doule disc synergy test), CDT (Combined disc test), and MHT (Modi?ed Hodge test) respectively. Colistin and Polymyxin B are the only option available for treating such infections. MBL Conclusion production among Pseudomonas and Acinetobacter species are increasing due to the continuous use of carbapenems and selective antibiotic pressure. Strict antibiotic policy and infection control practices help prevent the further spread.

Metabolites in Conocarpus erectus leaves attenuate α-amylase activity by modulating amino acid residues of α-amylase: an in vitro and docking study / Los metabolitos en las hojas de Conocarpus erectus atenúan la actividad de la α-amilasa al modular los residuos de aminoácidos de la α-amilasa: un estudio in vitro y de acoplamiento

The antioxidant activity and the inhibitory potential of α-amylase of lyophilized hydroethanolic extracts of Conocarpus erectus leaves obtained by ultrasonication were determined. The most potent extract was subjected to ultra-high performance liquid chromatography system equipped with mass spectrometer for metabolite identification. The identified metabolites were docked in α-glucosidase to assess their binding mode. The results revealed that 60% ethanolic extract exhibited highest ferric reducing antioxidant power (4.08 ± 0.187 mg TE/g DE) and α-amylase inhibition (IC50 58.20 ± 1.25 µg/mL. The metabolites like ellagic acid, 3-O-methyl ellagic acid, ferujol, 5, 2 ́-dihydroxy-6,7,8-trimethyl flavone and kaempferol glucoside were identified in the extract and subjected to molecular docking studies regarding α-amylase inhibition. The comparison of binding affinities revealed 3-O-methyl ellagic acid as most effective inhibitor of α-amylase with binding energy of -14.5911 kcal/mol comparable to that of acarbose (-15.7815 kcal/mol). The secondary metabolites identified in the study may be extended further for functional food development with antidiabetic properties.

Se determinó la actividad antioxidante y el potencial inhibidor de la α-amilasa de extractos hidroetanólicos liofilizados de hojas de Conocarpus erectus obtenidos por ultrasónicación. El extracto más potente se sometió a un sistema de cromatografía líquida de ultra alto rendimiento equipado con un espectrómetro de masas para la identificación de metabolitos. Los metabolitos identificados se acoplaron en α-glucosidasa para evaluar su modo de unión. Los resultados revelaron que el extracto etanólico al 60% exhibió el mayor poder antioxidante reductor férrico (4.08 ± 0.187 mg TE/g DE) e inhibición de la α-amilasa (IC50 58.20 ± 1.25 µg/mL. Los metabolitos como el ácido elágico, 3-O-metil elágico ácido, ferujol, 5, 2 ́-dihidroxi-6,7,8-trimetil flavona y kaempferol glucósido se identificaron en el extracto y se sometieron a estudios de acoplamiento molecular con respecto a la inhibición de la α-amilasa. La comparación de las afinidades de unión reveló 3-O-metil El ácido elágico como inhibidor más eficaz de la α-amilasa con una energía de unión de -14,5911 kcal/mol comparable a la de la acarbosa (-15,7815 kcal/mol). Los metabolitos secundarios identificados en el estudio pueden ampliarse aún más para el desarrollo funcional de alimentos con propiedades antidiabéticas.

A glued technique of external dacryocystorhinostomy

Purpose: Fibrin glue was used for anastomosis of lacrimal sac and nasal mucosal flaps and was compared with the conventional suture technique in external dacryocystorhinostomy. Methods: A prospective interventional randomized control study in which 50 consecutive patients of primary acquired nasolacrimal duct obstruction (PANDO) were equally allocated into two groups. The case group underwent glued technique of external dacryocystorhinostomy (Ext DCR) in which fibrin glue was used for the apposition of the anterior lacrimal sac and nasal mucosal flaps. In the control group, conventional technique of Ext DCR was used to suture the flaps. Functional success was assessed by improvement in epiphora and fluorescein dye disappearance test (FDDT), whereas anatomical success was assessed by lacrimal irrigation and endoscopic view of the osteotomy site. Results: The anatomical success in both the groups was 92%, whereas the functional success was 92% in the case group and 88% in the control group. The difference in the success rates between the two groups was statistically non?significant. Conclusion: Glued technique of Ext DCR is a simple and easy alternative to suturing of the flaps. Though the final outcome was comparable in both the groups, glue can be especially useful in uncooperative cases, in cases of excessive bleeding, or in situations where the flaps are very thin or have become friable

The need for communication between clinicians and pathologists in the context of oral and maxillofacial diseases

Abstract Good communication between clinicians and pathologists is a vital element in the diagnostic process, and poor communication can adversely affect patient care. There is a lack of research about communication in diagnostic oral and maxillofacial pathology. This narrative review explores different aspects of the quality of communication between clinicians and oral pathologists, with a focus on the diagnosis of oral and maxillofacial diseases. An electronic search was carried out in MEDLINE through the PubMed, Scopus, and Embase databases up to April 2021. No studies reporting communication, its adequacy or the required skills between clinicians and pathologists in oral diagnosis were found. According to studies published in medicine, strategies for improving communication skills include clinician-pathologist collaboration; a well-formatted, clear and thorough report; training in communication skills; and patient-centered care. Further studies evaluating the current practices and quality in oral and maxillofacial pathology are required to identify barriers and encourage optimal communication to facilitate diagnosis, as well as patient safety.

In vitro cytotoxicity assay of Fucoidan extracted from Turbinaria conoides against cancer cell lines MCF7, A549, and normal cell line L929

Abstract The main aim of the study is to quantify the cytotoxic property of the Fucoidan extracted from the Turbinaria conoides using the MTT assay with the standard fucose. Fucoidan was extracted using the soaked water method and it was determined using the HPLC procedure the obtained Test sample Fucoidan extracted from the Turbinaria conoides and standard fucose was subjected to the cytotoxicity assay against the MCF7 Human breast cancer cell line, A549 lung cancer cell line, and L929 normal mouse fibroblast cell line. From the results it was found that the Test sample showed good IC50 value for MCF7 cell line then A549 with an increasing concentration 24 hours incubation at 37°C The IC50 for MCF7 was 115.21 µg/ml and A549 396.46µg/ml and the Fucoidan extract was checked for its cytotoxicity against the normal mouse fibroblast cell line L929, Fucoidan was found non-lethal to the L929 mouse fibroblast normal cell line. Standard fucose also gave a significant result towards MCF7 and against the L929. This indicates that the Fucoidan extracted from Tubinaria conoides shows better anticancer potential in it. Hence its application can be further extended in the pharmacological fields.

In vitro pharmacological attributes and metabolite's fingerprinting of Conocarpus lancifolius / Atributos farmacológicos in vitro y huellas dactilares de metabolitos de Conocarpus lancifolius

Search for safe antioxidants and novel nutraceuticals urged to evaluate the antioxidant, anti-acetylcholine esterase and anti-lipoxygenase activity of various leaf extracts of Conocarpus lancifolius. Extraction was optimized from freeze dried plant extracts quenched with liquid nitrogen using water, ethanol, methanol, hexane, ethyl acetate and chloroform. Maximum extract yield, total phenolic contents and total flavonoid contents were obtained in case of ethanolic extraction. The highest 2,2-diphenyl-1-picrylhydrazylradical scavenging in terms of IC50 value of 55.26 µg/mL was observed for ethanolic leaf extract. The acetylcholine esterase and lipoxygenase inhibitory activities (IC50) were also observed for ethanolic extract. These findings for ethanolic extract were statistically significant when compared with other extracts (ρ<0.05). The haemolytic % values indicated that all extracts were associated with very low or negligible toxicity. The epicatechin, isorhamnetin, rutin, scopoleptin, skimmianine, quercetin-3-O-α-rhamnoside, quercetin-3-O-ß-glucoside, cornoside, creatinine, choline, pyruvic acid, α-hydroxybutyric acid, phyllanthin and hypophyllanthin were identified as major functional metabolites in ethanolic leaf extract of C. lancifoliusby 1H-NMR. The identified metabolites were probably responsible for the pharmacological properties of C.lancifolius. The findings may be utilized as pharmacological leads for drug development and food fortification.

Se insta a la búsqueda de antioxidantes seguros y nuevos nutracéuticos para evaluar la actividad antioxidante, anti-acetilcolina esterasa y anti-lipoxigenasa de varios extractos de hojas de Conocarpus lancifolius. La extracción se optimizó a partir de extractos de plantas liofilizados enfriados con nitrógeno líquido usando agua, etanol, metanol, hexano, acetato de etilo y cloroformo. En el caso de extracción etanólica se obtuvo el rendimiento máximo de extracto, el contenido de fenoles totales y el contenido de flavonoides totales. La mayor eliminación de radicales 2,2-difenil-1-picrilhidrazilo en términos de valor de CI50 de 55,26 µg/mL se observó para el extracto de hoja etanólico. También se observaron las actividades inhibidoras de la acetilcolina esterasa y lipoxigenasa (CI50) para el extracto etanólico. Estos hallazgos para el extracto etanólico fueron estadísticamente significativos en comparación con otros extractos (ρ<0.05). Los valores del % hemolítico indicaron que todos los extractos estaban asociados con una toxicidad muy baja o insignificante. Se identificaron la epicatequina, isorhamnetina, rutina, escopoleptina, skimmianina, quercetina-3-O-α-ramnosido, quercetina-3-O-ß-glucósido, cornosido, creatinina, colina, ácido pirúvico, ácido α-hidroxibutírico, filantrina e hipofillantina. como metabolitos funcionales principales en el extracto etanólico de hojas de C. lancifoliuspor 1H-NMR. Los metabolitos identificados probablemente fueron responsables de las propiedades farmacológicas de C. lancifolius. Los hallazgos pueden utilizarse como pistas farmacológicas para el desarrollo de fármacos y la fortificación de alimentos.

Effect of the Psychophysical Approach in Slipping Incident Among Workers at The Commercial Kitchen Activity

@#Introduction: The occurrence of slips can be disruptive in workers’ life, causing various types of injuries. Working with prolonged standing and walking postures in a commercial kitchen contributes to worker fatigue. A psychophysical approach can be used in identifying the extent to which workers’ fatigue contributes to the occurrence of slipping. Method: Electromyography (EMG) was used to record and analyze the data of three values of muscle activity obtained from the study. Twelve participants aged 23 to 60 years old with a Body Mass Index (BMI) mean of 27.82 ± 4.01 kg/m2. The participants were selected based on the experience of at least three years and above in commercial kitchen activity. The testing procedures were explained in detail upon agreement. They had to walk with four different types of walking speeds with water and oil as the contaminants on the floors. Results: The slip occurred high frequency for obese participants compared to overweight participants when increasing their speeds of walking on oily floor surfaces. Female participants experience slips more than male participants. The muscle Soleus and Tibialis frequently produce higher muscle activity during slip occurrence compared to muscle Peroneus. Conclusion: The results of the study show that the psychophysical approach is significant in the occurrence of slipping during work activities in commercial kitchens when the muscle of Soleus and Tibialis produces higher muscle activity during slip occurrence. There was no significant factor of age during the slip occurrence.

Ankle Angle Contribute to Slip During Commercial Kitchen Activity

@#Introduction: Working in a Commercial kitchen environment poses a potential hazard for a slip accident. Prolonged standing working posture reflects human balance issues. Therefore, this study investigated the ankle angle during Commercial kitchen activity to justify the potential of slip during the activity and correlate between the walking step and slip incident. Method: Vicon motion capture was used to record movements and Vicon Nexus software was used to analyze data. Six male and six female healthy adults with a minimum of three years of Commercial kitchen activity experience participated in this study. Participants have to walk at four different speeds and carry the load at the upper limb and flooring with water and oil as a contaminant. Results: The slip occurred frequently on the oily surfaces compared to water surfaces especially among overweight and obese participants. Ankle angle during slip occurrence was from 97.2 ± 6.7° for male participants and 112.5 ± 12.7° for female participants. Conclusion: The results presented that overweight and obese participants' significant slip occurred when walking on oily surfaces. There was no correlation between carrying load and Body Mass Index (BMI). The walking speed also significant with slip occurrence.

Propofol and Ketamine in Electroconvulsive Therapy Anesthesia: A Randomised Controlled Study

Introduction: Currently, the effects of combined anesthesia(propofol and ketamine) for patients with depressive disorderwho have undergone electroconvulsive therapy (ECT) areunclear. Study aimed to evaluate the effect of ketamine,propofol, and ketofol on hemodynamic profile, duration ofseizure activity, and recovery times in patients undergoingECT.Material and methods: Sixty patients who were scheduledfor ECT treatment were enrolled. The study population wasrandomly assigned to receive one of three anesthetic agents:ketamine, propofol, or ketofol. The required total dose of thethree agents was recorded. Mean arterial pressure (MAP),heart rate (HR), and oxygen saturation values were recordedat baseline, at induction, and at 1, 3, 5, and 10 min after theend of seizure.Results: We found that both ketamine and ketofol have anincreased mean seizure duration compared to propofol, ketofolhad more favorable hemodynamic effects than ketamine andpropofol, and ketamine was found to have longer recoverytimes compared to both propofol and ketofol.Conclusion: We found that both ketamine and ketofol have anincreased mean seizure duration compared to propofol.

Feasibility of minimally invasive management in patients with forgotten double J stent: a single centre experience

Background: aim of the study was to present the experience in managing forgotten/encrusted Double J (DJ) ureteral stents and to review the literature on the subject.Methods: Author retrospectively studied patients presenting to the Outpatient Department from January 2016 to January 2019 with forgotten DJ stent(s) (six or more than six months after the insertion). Data was collected for age, gender, indication for DJ stenting, clinical features at presentation, radiological imaging and surgical procedure performed to extract the DJ stents. The post-operative stay, complications of the procedures and morbidity was also studied.Results: During the study period, a total 32 patients reported to the department with history of forgotten DJ stents. Most common age group involved was 41-60 years. Most common presenting symptoms were lower urinary tract symptoms (LUTS) or dysuria.  Duration of stent in-situ ranged from 6 month to 15 years. Most common sites of encrustations along the forgotten DJ stent were ureter and kidney followed by urinary blabber. Fluoroscopic guided DJ stent removal was done in 8 patients. A combination of Cystolithotripsy, URSL and PCNL was needed to clear the stone and extract the DJ stent in remaining patients.Conclusions: Forgotten/encrusted DJ stent may lead to complications ranging from urinary tract infections to loss of renal function. They can be safely and successfully removed, and the renal function can be preserved. Endo-urological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

A Comparative Study of the Efficacy of Epidural 025% Bupivacaine Versus 025% Ropivacaine For Post Operative Pain Relief in Lower Abdominal Surgeries

Aim: To compare epidural 0.25% bupivacaine with 0.25% ropivacaine for post operative pain relief in cases of abdominal surgeries. Methods: 60 patients belonging to ASA physical status I & II of both sexes (each group 30 patients n=30) were randomly selected for the study. The sensory and motor block, analgesia, hemodynamic status, complications and need for rescue analgesia were compared in both the groups. Group B patients received 0.25% Bupivacaine as continuous epidural. Group R patients received 0.25% Ropivacaine as continuous epidural. Results: The sensory block was almost similar in both groups. No significant association is observed between the ASA class, age and sex of the groups (P>0.05). The difference in mean VAS between Bupivacaine and Ropivacaine was found to be statistically significant at 24 hours (P<0.05). Motor block was significantly more (17%) in group B than group R (3%) (P< 0.05). Haemodynamic changes did not differ in patients of either group (P >0.05). The rescue analgesia requirement were minimal in group R compared to group B. Complications were less in group R. Conclusion: Our study compared clinical efficacy of 0.25% Ropivacaine and 0.25%Bupivacaine in respect to analgesia, motor blockade, hemodynamic stability, requirement of rescue analgesia and complications. Sensory block and hemodynamic stability was comparable in the two groups. Ropivacaine group had significantly less motor block than Bupivacaine group.

Is 075% Ropivacaine More Efficient than 05% Bupivacaine for Prolonged Sensory Blockade in Epidural Anaesthesia for Orthopaedic Hip Surgeries?

The efficiency of 0.75% Ropivacaine as a single shot epidural anaesthetic in comparison to 0.5% Bupivacaine is less studied. Our study focuses on comparing the efficiency of sensory block between 0.75% ropivacaine and 0.5% bupivacaine for epidural anaesthesia. Methods: The study was done with 0.75% Ropivacaine and 0.5% Bupivacaine in epidural anaesthesia in orthopedic hip surgeries given as a single shot technique for which 60 patients of ASA I/II each were chosen and 15ml of the drug was given. Onset of the sensory sensations at T12 and regression at the same level were measured with the aid of response to pin prick and thus duration of epidural anaesthesia was calculated individually in group B and group R respectively. Results: Onset of sensory block was faster in group R than in group B and regression was slower in group R than in group B. Conclusion: It can be concluded that duration of epidural anaesthesia was prolonged and longer with 0.75% Ropivacaine than 0.5% Bupivacaine.

A comparative study to ascertain the efficacy of intravenous dexmedetomidine versus intravenous tramadol to prevent post-operative shivering after laparoscopic surgery

Background: Shivering is commonly encountered both after regional and general anaesthesia (GA) with a little higher incidence in patients receiving GA. The aim of study was to compare the effectiveness of dexmedetomidine and tramadol in decreasing postoperative shivering in patients undergoing laparoscopic surgery.Methods: Total 120 patients were included in this study. In order to get a 5% level of significance and 80% power number of patients required in each group was 40, with a total of 120 patients. Randomization of groups was done based on closed envelope method. Patients were allocated into three groups group I, II and III of 40 patients each. Patients in group I and group II were administered 0.75 μg/kg of dexmedetomidine and 1.5 mg /kg of tramadol in 100 ml NS respectively half a before extubation, while patients in group III did not receive any pharmacological intervention.Results: All three groups were comparable regarding distribution of age, gender, ASA grade and temperature at beginning and end of surgery and were non-significant.Conclusions: Dexmedetomidine seems to possess anti-shivering properties and was found to reduce the occurrence of shivering in patients undergoing general anaesthesia with minimal side effects although its anti-shivering effect was not superior to tramadol.

Efficacy of Intrathecal Fentanyl and Butorphanol for Lower Limb Orthopedic Surgery: A Randomized Comparative Study

Intrathecal opioids when added to local anaesthetics decrease their dosage and provide haemodynamic stability. Subarachnoid block is a common anesthesia procedure for lower abdominal or lower limb surgeries including perineal surgeries. Objectives: To assess the efficacy of anesthesia and analgesia between intrathecal fentanyl and butorphanol with bupivacaine heavy 0.5% for lower limb orthopaedic surgery. Methods: About 120 patients, aged 18-75 years, belonging to American society of anesthesiologists (ASA) physical status 1 or 2 and scheduled for elective, lower limb orthopedic surgeries was randomized into two groups. Group A received 2.5ml of 0.5% hyperbaric bupivacaine with 0.5ml (25μg fentanyl) a total volume of 3ml intrathecally. The Butorphanol was diluted using distilled sterile water to obtain 25μg in 0.5ml. This was then added to 2.5ml of 0.5% hyperbaric bupivacaine to make a total volume of 3ml which was given to group B. Results: The times required for onset of sensory and motor blockade were comparable among the two groups. Significantly slower block regression to S2 level was observed in the group receiving intrathecal butorphanol as compared to intrathecal fentanyl (P<.001). A higher number of patients in group A requested for rescue analgesia during the postoperative period than in group B (11 versus 3; P=0.0326). The average times to first request for rescue analgesia were 254.47±9.31 minutes and 291±8.45 minutes in group A and B, respectively (P<0.001). Conclusion: Both 25μg fentanyl and 25μg butorphanol given intrathecally along with 12.5 mg of hyperbaric bupivacaine provide effective anesthesia for lower limb surgeries. Intrathecal bupivacaine-butorphanol mixture provides longer duration of sensory blockade and superior analgesia than intrathecal fentanyl-bupivacaine mixture.

A comparative study of low doses of intrathecal ketamine and midazolam with bupivacaine for postoperative analgesia in infraumbilical surgeries

Background: Infra-umbilical surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, spinal block is still a first choice, because of its rapid onset, high quality of blockade, lack of catheter related infection, less failure rate and also cost effective but the duration of block and postoperative analgesia is limited. The purpose of study was to compare the efficacy of adding ketamine to 0.5% hyperbaric bupivacaine with midazolam to 0.5% hyperbaric bupivacaine in elective infraumbilical procedures.Methods: A randomized, single blinded, clinical study. 60 subjects were enrolled from the patients presenting for elective infraumbilical surgeries after following the inclusion and exclusion criteria laid down for the study. Sixty ASA Grade I and II patients undergoing infra umbilical surgeries were randomly divided into one of the two equal groups (n=30).Results: Total 60 patients were included in this study. The mean time to achieve T10 sensory level and modified bromage scale III was prolonged in group M (4.33±1.09, 6.66±1.26 min) as compared to group K (3.3±0.7, 4.96±1.21 min) which was statistically significant (P value <0.05).Conclusions: The present study concludes that addition of intrathecal midazolam to hyperbaric bupivacaine provide very good and prolonged post-operative analgesia without significant intra-operative and post-operative side effects compared to intrathecal ketamine.

Estimation of Hb, MCV, MCH variations in different types of febrile seizures

Introduction: Febrile seizures are seizures that occur between the age of 6 and 60 months with a temperature of 38°C (100.4°F) or higher, that are not the result of central nervous system infection or any metabolic imbalance, and that occur in the absence of a history of prior afebrile seizures. Aim of the study: To Estimate the HB, MCV, MCH variations in different types of Febrile Seizures. Materials and methods: This case-control study was conducted at the Department of Pediatrics, Tirunelveli Medical College Hospital, Tirunelveli, from 2017-2018.All cases of febrile seizures which include both simple febrile and complex febrile seizures between the age group of 6 and 60 months. The control group includes the children in the same age group with fever but without seizures Results: Among 75 children presenting with febrile seizures, 52 children were presenting with simple febrile seizures (69.3%) and 23 children were presenting with complex febrile seizures. Average mean Hb level in those children presenting with febrile seizures was 10.37 gm. Average mean Hb level in children those who do not have febrile seizures was 11.48 gm. The p-value between the mean Hb level of 2 groups was less than 0.001 which is statistically significant. In children with febrile seizures, the mean MCV was 70.83. In children, those who do not have febrile seizures the mean MCV was 77.89 which was higher than those of children having febrile seizures. The difference between the two groups was statically significant. Average mean of MCH in children with febrile seizures (23.69) was lower than the children those who are presenting without febrile seizures (27.58). Thus the p-value was less than 0.001 which was statistically significant. Conclusion: The hemoglobin levels were significantly lower in the case group compared to the control group. The present study concluded anemia as a risk factor for febrile seizures and emphasizes the importance of prevention and timely intervention and management of Iron deficiency anemia in children to decrease mortality and morbidity associated with febrile seizures.

Comparative study of serum ferritin level in simple and complex febrile seizures in Government Tirunelveli Medical College

Background: Febrile seizures are one of the common reasons for emergency room visits in pediatric population affecting up to one in twenty children in various parts of the world. Though febrile seizures are commonly benign it is a source of major family distress and anxiety. Aim of the study: To compare serum ferritin level in simple and complex febrile seizures among children. Materials and methods: This case-control study was conducted at the Department of Pediatrics, Tirunelveli Medical College Hospital, Tirunelveli, from 2017-2018. All cases of febrile seizures which include both simple febrile and complex febrile seizures between the age group of 6 and 60 months were studied. Serum ferritin was estimated by the Ferritin-Turbilatex, by LAB KIT, CHEMEX, S.A. semi auto analyzer. Results: The mean average serum ferritin level in simple febrile seizures was 22.76. The mean average serum ferritin level in complex febrile seizures was 24.72. Hence, it was statistically significant that low serum ferritin is present in those with simple febrile seizures. Conclusion: Iron deficiency anemia was more frequent among children with febrile seizures than those with febrile illness alone. The result suggests that Iron deficiency anemia may be a risk factor for febrile seizures. Thus screening for IDA should be considered in children with febrile seizures. Fever can worsen the negative effect of iron deficiency anemia on the brain and a seizure can occur as a consequence. This suggests that iron-deficient children are more prone to febrile seizures.

Statins everyday versus alternate days: Is there a difference in myalgia rates?

Objective Statins are widely used drugs, known to cause myalgia, leading to high discontinuation rates. The objective of our study was to determine the frequency of myalgia in patients on everyday-dose (EDD) regimen with those on alternate-day dose (ADD) regimen. Methods This cross sectional study was conducted in a tertiary care hospital of Pakistan. A sample size of 400 patients between the age of 40–70 years, taking simvastatin 40 mg for at least 6 months or more were selected. Patients with prior musculoskeletal or neuromuscular complains, and family history of muscular disorders were excluded. Subjects were evaluated for myalgia via a self-administered questionnaire, and those complaining of myalgia were then evaluated for serum vitamin D levels. Data was analyzed through SPSS 16.0 and compared using chi square test. Results The overall prevalence of myalgia was 7% (28/400). Frequency of myalgia in patients taking simvastatin everyday (n = 20, 10%) was significantly higher compared to those taking it every alternate day (n = 8, 4%) (p = 0.02). There was no significant difference between the time of onset, nature, severity, type, or location of myalgia between the 2 groups. The most common cited triggering factor for pain was physical exercise. Of the patients experiencing myalgia, 13 (6.5%) from the EDD group and 6 (3%) from the ADD group had low levels of vitamin D. Conclusions ADD regime was better tolerated by the patients than EDD regime. Alternate day therapy, with or without vitamin D supplementation, may be used by the physicians for troublesome muscular complains.

Efficacy of serum blood urea nitrogen, creatinine and electrolytes in the diagnosis and mortality risk assessment of patients with acute coronary syndrome

Background Although blood urea nitrogen (BUN), creatinine (Cr) and electrolytes are not the mainstay of diagnosis in acute coronary syndrome (ACS) patients but they may have a role in providing a more detailed view of the complications and mortality rates. The aim of this study was to determine the efficacy of these parameters in the diagnosis and mortality risk-assessment of patients with ACS. Methodology A total of 200 patients with ACS were recruited in this prospective study. The relationship of serum BUN, Cr and electrolytes with cardiac enzymes, Global Registry of Acute Coronary Events (GRACE) and mortality was assessed during a 6-months follow-up. Statistical test like multivariate linear regression and binary logistic regression analysis were applied. Results On multivariate linear regression analysis, serum potassium (K) (Unstandardized Coefficient B = −3.77; p = 0.04) showed significant negative association with Creatine Kinease and serum BUN (Unstandardized Coefficient B = 0.52; p = 0.001) showed significant positive association with Troponin I. The patients with GRACE > 105 had significantly higher levels of serum BUN and Cr. Receiver operating characteristic curves showed that area under curve (AUC) of BUN (0.7) was higher than AUC of Cr (0.5). Multiple adjusted model showed that patients with BUN > 32.5 mg/dl were almost 20 times more likely to be associated with mortality as compared to reference group. Conclusion In addition to cardiac enzymes, K along with BUN and Cr may serve as important aid in diagnosis of ACS. BUN and Cr may also serve as important tools in mortality-risk assessment of ACS patients.