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Background: Diabetic ketoacidosis (DKA) is an acute life threatening and a medical emergency that accounts for the majority of diabetes related mortality and morbidity in the pediatric age group who are suffering from type 1 Diabetes Mellitus (DM). Objective of this study was to compare the clinical outcome in a patient with DKA who are been treated with Milwaukee regimen (24hours) and 48 hours regimen.Methods: A retrospective study was conducted in PICU of tertiary care hospital in Chitradurga, Karnataka. Data was collected from 2015 to May 2018. Diagnosis of DKA was made by plasma glucose level higher than 200mg/dl, venous blood PH of <7.3 and /or bicarbonate <15 mmol/L, presence of ketonuria. Among 56 cases, 36 cases were treated with 48 hours regimen and 20 cases were treated with Milwaukee regimen and results were compared.Results: The median age of presentation was 7.52 years (Range: 2-14 years) with female: male ratio of 1:1.3. Newly diagnosed type 1 DM cases constituted 80.7%. The most common presenting complaints were hurried breathing and altered sensorium. The average length of stay in the ICU was 3.5 days for 48 hours regimen and 4.5 days for Milwaukee regimen. The mortality rate was 10.71 % (6 cases), among which 15% (3 cases) were patients treated with Milwaukee and 8.3% (3 cases) were patients treated with 48 hours regimen. Cerebral edema was found to be the commonest cause of fatality.Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.
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Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis remains a major cause of morbidity and mortality worldwide. Important biomarkers that can be used as prognostic markers in sepsis are C Reactive Protein (CRP) and serum Albumin levels. CRP levels markedly elevate in response to infection whereas albumin levels decrease in response to acute phase infection. We want to ascertain the value of CRP/albumin ratio as an independent predictor of 28-day mortality in sepsis patients.Methods: A prospective study was conducted including 150 patients satisfying the criteria for sepsis according to SOFA score of more than 2. Initial CRP/Albumin ratio was assessed to determine its significance in assessing the 28-day mortality, primary end point of our study. Secondary end points assessed were length of ICU stay, need for inotropic support, need for ventilator support and renal replacement therapy.Results: In the analysis of CRP/Albumin ratio as a predictor of 28-day mortality, patients were followed up from day of admission till 28 days to assess primary outcome. Among study subjects survivors were 92 in whom mean CRP/ALB ratio was 0.1197 and non survivors were 58 patients with mean CRP/ALB ratio was 0.0426. p-value <0.001, there was statistically significant difference found between survivor and Non-Survivor with respect to CRP/Albumin ratio. In assessing secondary outcome statistically significant association was found for need for ventilator and inotropic support, whereas it was insignificant in assessing need for dialysis and length of ICU stay.Conclusions: CRP/albumin ratio, which indicates the extent of residual inflammation, could be used as a prognostic marker in predicting mortality in patients with sepsis and septic shock.
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Background: Retinopathy of prematurity (ROP) is a disease process mostly reported in preterm neonates with a wide spectrum, ranging from mild, transient changes in the retina with regression to severe progressive vasoproliferation, scarring, detachment of retina and blindness. India shares 20% of the world childhood blindness. Besides congenital cataract, congenital glaucoma and ocular injuries, ROP is emerging as one of the important causes of childhood blindness in India.Methods: A cross sectional study was undertaken among all neonates born between 28-34 weeks of gestation admitted in NICU, who are under oxygen, screened for ROP. Babies with ocular disorder which interfere with fundus examination, babies who did not complete follow up till complete vascularisation of retina and babies with congenital retinal abnormalities were excluded from the study.Results: About 13.3% of male children and 18.0% of the female children had retinopathy of prematurity. Among the infants born before 30 weeks, 46.7% had retinopathy of prematurity. In the children with gestational age between 30- 32 weeks, 15.4%, 8.5% in the 32-35 weeks and none among those born between more than 35 weeks. About 27.9% of the newborns with birth weight of less than 1.5kgs and 5.8% of those who had birth weight of 1.5-2.5kgs had retinopathy of prematurity.Conclusions: This study had shown a significant association of retinopathy of prematurity with the low gestational age, birth weight and oxygen therapy. Reducing subsequent post-natal risk factors depends on optimal perinatal and postnatal care, as well as adhering to strict ROP screening guidelines. Recognizing and treating ROP in a timely fashion is critical for achieving the best visual outcome.
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Background: Metabolic syndrome is the cluster of diseases which arises due to excess of plasma glucose, cholesterol, fatty acids, blood pressure and obesity. The role of lipids in the development of MetS had been extensively studied. Though some non-lipid factors like hsCRP, uric acid and TSH level also remain elevated in the serum of the MetS patients, the role of these non-lipid risk factors remain incompletely understood. The objective of this study was to investigate which of these factors better predicts Mets, in order to help prevention and early detection of MetS and its associated type 2 diabetes mellitus and cardiovascular diseases. Aim and objectives was to study the significance of serum highly sensitive C-reactive protein (hs-CRP), serum uric acid (SUA) and thyroid stimulating hormone (TSH) levels in metabolic syndrome.Methods: A total of four hundred and fifty subjects (211 men and 239 women) aged ≥35 years attending the hospital were divided into three groups based on the components level of MetS as control (CS), normal (MS) and severe (SMS) MetS groups. Their fasting blood sample were taken and analyzed for the serum hs-CRP, uric acid and TSH levels. The result showed that the mean hs-CRP and uric acid levels were significantly higher in Metabolic Syndrome group (MS) and in Severe Metabolic Syndrome group (SMS) when compared to control group. But the mean TSH levels were more in MS group and in SMS group than the control which was statistically not significant. The analysis of relative significance of these risk factors showed that serum hs-CRP level had a positive linear correlation with the severity of MetS whereas, the TSH level was significantly high only in SMS and the uric acid level was not correlated with the MetS.Results: Our study revealed that type II (absence of sutural bones) was commoner than type I (presence of type I) asterion. The asterion was 4.82±0.58 cm from tip of the mastoid process on the right side and 4.70±0.70 cm on the left. It was greater in males than in females, p value being statistically significant (P = 0.00 and P = 0.02 for right and left sides respectively). The distance of asterion from supramastoid crest was 4.22±0.73 cm on the right and 4.23±0.58 cm on the left. The distance in males was more than in females. The P value 0.00 was statistically significant on the right side. Regarding the position of the asterion in relation to transverse sinus, it was on the transverse sinus in 62% cases, below it in 32% and above in 6%.Conclusions: In the present study, there was higher mean serum hs-CRP level in patients with metabolic syndrome which showed a linear increase with increasing number of components of the metabolic syndrome. Though available literature indicated that hyperuricemia adult subjects tend to develop MetS more frequently our findings showed this increase was not dependent on the severity of MetS. Also, significantly high TSH levels were found only in severe MetS suggest that as per this study the serum hs-CRP values may be consider as the diagnostic criteria for metabolic syndrome and helps to improve future prediction of development of type 2 DM and cardiovascular diseases.
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Background: Dengue is a systemic viral infection transmitted by mosquitoes such as Aedes aegypti or Aedes albopictus. Dengue Fever (DF) is characterized by fever, headache, muscle or joint pain, and rash. The spectrum of dengue virus infection spreads from an undifferentiated fever and dengue fever (DF) to dengue haemorrhagic fever (DHF) with shock. Factors responsible for bleeding manifestations in dengue are vasculopathy, thrombocytopenia, coagulopathy, and disseminated intravascular coagulation (DIC). Coagulopathy results in derangement of activated partial thromboplastin time (APTT) which is an indicator of impending bleeding risk.Methods: A prospective study was conducted from June to December in 2017 in R L Jalappa Hospital. Patients aged above 18 years with febrile thrombocytopenia who are positive for dengue virus serology (NS1Ag and/ or IgM) were included in the study. Serial daily monitoring of platelet count and analysis of APTT levels were done. APTT was considered abnormal if it was more than 33.8s. Patients were followed up for evidence of leaking and bleeding manifestations.Results: Out of 170 patients 28.1% patients had bleeding manifestations. Bleeding signs were seen on clinical examination in 52.37% of patients. capillary leak was found in the form of Pleural effusion in 35.3%, Ascites in 41.2% and Periorbital edema in 31.2% of patients. Elevated APTT levels were seen in 110(64.7%) patients. Among patients with abnormal APTT platelet transfusion was done in 78.9% of patients, and among those with normal APTT levels platelet transfusion was done in 21.1% of patients.Conclusions: Our study showed significant correlation between bleeding manifestations and prolonged APTT levels as well as thrombocytopenia with abnormal APTT levels. Study concluded that 21.1% of platelet transfusions could have been prevented considering prolonged APTT as a predictor of bleeding manifestation, thus saving the resources and reactions due to platelet concentrate transfusion.
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A series of novel (3,5-dichloro-4-((5-aryl-1,3,4-thiadiazol-2-yl)methoxy)phenyl) aryl methanones (10a-f), were synthesized by condensing 2-chloromethyl-5-aryl-1,3,4-thiadiazole (9a-c) with aryl(3,5-dichloro-4-hydroxyphenyl) methanones (4a-b) using TBAB and K2CO3. The chemical structure of the newly synthesised compounds was characterized by analytical and spectral (IR, 1H NMR, and LC-MS) methods. The title compounds were screened for qualitative (zone of inhibition) and quantitative antimicrobial activity (MIC) by agar well and microbroth dilution technique, respectively. Among the synthesized compounds in the series, the compound 10f was found to exhibit significant antibacterial activity at lower concentration, against Gram positive bacteria such as Bacillus subtilis, Staphylococcus aureus, Staphylococcus epidermidis, and Bacillus cereus and Gram negative bacteria such as E.coli, Pseudomonas aeruginosa, Salmonella typhi, and Klebsiella pneumoniae. The rest of the analogues in the series displayed moderate antimicrobial activity when compared to the standard positive controls gentamicin and nystatin.
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Diltiazem hydrochloride has poor oral bioavailability, easily undergo first passage effect in the liver. Hence, an attempt was made to prepare and evaluate mucoadhesive buccal films containing diltiazem hydrochloride by employing HPMC, eudragit, ethyl cellulose alone and in combination with PVP. The I.R and DSC studies showed that there was no interaction between drug and the utilized polymer. The prepared mucoadhesive buccal films showed uniform thickness, weight, folding endurance, surface pH, drug content and swelling index. The drug content of all the formulation was found to be uniform. In vitro drug release studies indicated that the films prepared with HPMC (3%) and ethyl cellulose (4%) has shown fast and slow release respectively. The formulations incorporated with SLS and sodium glycocholate indicated significant drug release from F11 and F15. Later the in-situ diffusion studies using goat cheek pouch showed faster drug release from film with 1% (SLS). About 93.04% and 91.83% of drug release profile were observed during in situ diffusion studies at the end of 9hrs and 18 hrs respectively. The formulated films were stable during stability studies at 45ºC and 75%RH with respect to drug content.
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A simple, selective, accurate reverse phase-high Performance Liquid Chromatographic (RP-HPLC) method was developed and validated for the analysis of Sildenafil Citrate in pharmaceutical formulations. Chromatographic separation achieved isocratically on a C18 column [Use Inertsil C18, 5m , 150 mm x 4.6 mm] utilizing a mobile phase of acetonitrile/phosphate buffer (70:30, v/v, pH 7.0) at a flow rate of 0.8 ml/m with UV detection at 228 nm. The retention time was 4.087. The method is accurate (99.15-101.85%), precise (intraday variation 0.13-1.56% and inter-day variation 0.30-1.60%) and linear within range 0.1- 30μg/ml (R2=0.999) concentration and was successfully used in monitoring left over drug. The detection limit of sildenafil citrate at a signal-to-noise ratio of 3 was 1.70ng/ml in formulations while quantification limit in drug was 5.40 ng/ml. The proposed method is applicable to stability studies and routine analysis of sildenafil citrate in pharmaceutical formulations.
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Non Hodgkin's Lymphomas of the sinonasal tract are uncommon neoplasms that can be morphologically difficult to distinguish from destructive non-neoplastic process or other malignant neoplasm in this site. Non-Hodgkin's Lymphomas of the sinonasal tract are heterogeneous diseases that can be clinically aggressive. Immunophenotypic pattern of Non-Hodgkin's Lymphomas shows marked variations. We are reporting a case of B-Cell type of Non-Hodgkin's Lymphoma of the nasal cavity and paranasal sinus with complete clinicopathological and immunohistochemical study as it is rare in Indian literature and review of the literature is done.