alien in the heart

We report a case of a 38-year-old-man who presented with altered mental status. The patient was diagnosed with infective endocarditis [IE] originating from the GORE HELEX septal occluder device, which was placed 15 months earlier for symptomatic atrial septal defect. Brain imaging revealed shower emboli phenomena from the known IE. The patient developed hydrocephalus for which external ventriculostomy was performed. Improved neurological status warranted open heart surgery. The patient was later confirmed to be an intravenous drugs abuser, prejudicing IE. This case highlights the importance of meticulously monitoring patients with suspected high-risk behavior with an implanted intracardiac prosthetic device

rare cause of recurrent aortic dissection

We report the case of a 19-year-old man with a history of Loeys-Dietz syndrome [LDS], which was diagnosed when he had a Stanford type A aortic dissection. He also had multiple aneurysms including ones in the innominate, right common carotid, and right internal mammary arteries. He had had multiple procedures including Bentall's procedure, repeat sternotomy with complete arch and valve replacement, and coil embolization of internal mammary artery aneurysm in the past. His LDS was characterized by gene mutation for transforming growth factor-beta receptor 1. He presented to our facility with sudden onset of back pain, radiating to the right shoulder and chest. He was diagnosed with Stanford type B aortic dissection and underwent thoracic aorta endovascular repair for his aortic dissection. This case represents the broad spectrum of pathology associated with LDS where even with regular surveillance and aggressive medical management the patient developed Stanford B aortic dissection

Large saphenous venous graft aneurysm with right atrial fistulous communication: case report and review of literature

We report a case of a 56-year-old Caucasian man who presented with acute onset of substernal chest pain at rest with electrocardiogram showing diffuse ST segment depression. He had coronary artery bypass graft surgery 16 years ago with a left internal mammary artery graft to the left anterior descending artery and saphenous vein grafts to the right coronary artery [RCA] and left circumflex artery. He underwent coronary angiography, which showed two large aneurysms in the saphenous venous graft [SVG] to the RCA and a venous leak from the aneurysm. The venous leak was later confirmed with computer tomographic scan to be a fistulous communication between the SVG and the right atrium. We discuss in detail about the treatment options of SVG aneurysm

Epidemiology of malaria in amritsar district of India

Malaria is today one of the major causes of human suffering, both in terms of increasing morbidity/mortality and stunting intellectual/ economic growth. In a developing country like India, it has devastating socioeconomic consequences. The present study was therefore carried out to study the epidemiology of malaria in Amritsar district. Diagnosed cases of Malaria reported from 1[st] January to 31[st] December 2009 in the erstwhile District of Amritsar were collected from the District Epidemiologist of Amritsar and Taran Taaran and studied. A total of 314 patients were studied. Data was assessed, systematically compiled and statistically analyzed. Most [84%] of the malaria patients in our study were less than 45 years of age. Male patients [57%] outnumbered females [43%]. The majority of patients with malaria [98%] were from rural areas and 68.5% of the studied patients belonged to upper lower socioeconomical class according to Kuppuswamy socioeconomic status scale. The majority [83%] of patients took treatment from Registered Medical Practitioners/quacks. Out of the total patients, only 14% used mosquito nets, 13% used repellents, and 7% had wire gauze doors in their homes. The people living in rural areas were found to be more vulnerable to malaria. The disease was found to be more prevalent among the lower socio economic strata and young population leading to considerable adverse effect on health and economy. Our study aims to stress the estimation of the true burden of malaria.

Feasibility of Neurovascular Antropylorus Perineal Transposition With Pudendal Nerve Anastomosis Following Anorectal Excision: A Cadaveric Study for Neoanal Reconstruction

PURPOSE: Perineal transposition of the antropyloric valve following an anorectal excision as a substitute for a permanent colostomy has recently been reported in humans. However, the problem of neural control still remains in these patients. Our aim herein was to study the anatomical feasibility of an anastomosis between the pudendal nerve branches (inferior rectal nerve) innervating the external anal sphincter and the anterior vagal branches of the perineally-transposed antropyloric segment in cadavers. METHODS: The antropyloric segment, along with its carefully dissected branch of the anterior vagus, was mobilized based on the left gastroepiploic pedicle in six fresh human cadavers. The antropyloric valve was then transposed in the perineum after the pudendal nerve branches had been dissected out, and an approximation of these two nerves was performed to ascertain the technical feasibility of their neural anastomosis. RESULTS: The anterior vagus innervating the antropylorus could be harvested in all cadavers below the hepatic division of the main vagus trunk. The inferior rectal nerve or its branches were found consistently around the 3 or the 9 o'clock position in the ischioanal fossa. An anatomical tension-free approximation of the anterior vagus branch (of the transposed antropyloric segment) to the inferior rectal nerve in the perineum was feasible in all the cadavers studied. CONCLUSION: An inferior rectal nerve anastomosis with the anterior vagal branch of the perineally-transposed antropyloric segment can be achieved anatomically. This preliminary step can be the basis for future animal studies and subsequent clinical application of the procedure for possible neural control of the transposed antropyloric segment in the perineum.

Physiological and Functional Evaluation of the Transposed Human Pylorus as a Distal Sphincter

BACKGROUND/AIMS: Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position. METHODS: Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position. RESULTS: The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position. CONCLUSIONS: The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity.

Investigation of swelling behavior and mechanical properties of a ph-sensitive superporous hydrogel composite

The objective of the present study is to develop and investigate the swelling behavior of pH-sensitive Superporous Hydrogel [SPH] and SPH composite [SPHC]. A novel superporous hydrogel containing poly [methacrylic acid-co-acrylamide] was synthesized from methacrylic acid and acrylamide through the aqueous solution polymerization, using N,N-methylenebisacrylamide as a crosslinker and ammonium persulfate as an initiator. SPHCs were made in the same way, except for the using of Ac-Di-Sol as a stabilizer. The synthesized SPH and SPHC were characterized by Fourier-transform infrared spectroscopy, swelling kinetics, porosity, mechanical properties and scanning electron microscopy. The swelling of SPH and SPHC was sensitive towards the pH, ionic strength, and temperature stimuli. The study of the surface morphology of SPH using scanning electron microscopy showed a highly porous structure. SPH polymers showed higher swelling ratio but less mechanical stability compared to SPHC polymers, which showed lower swelling ratio but a higher mechanical stability. With a change in pH from acidic to basic, a considerable increase in swelling was observed. Since the prepared SPH and SPHC swell only in the basic pH, it may be concluded that SPH and SPHC can be used as the pH-sensitive drug delivery system

Formulation and evaluation of olanzapine matrix pellets for controlled release

Olanzapine is an antipsychotic used in treatment of schizophrenia. This research was carried out to design oral controlled release matrix pellets of water insoluble drug Olanzapine [OZ], using blend of Sodium Alginate [SA] and Glyceryl Palmito-Stearate [GPS] as matrix polymers, micro crystalline cellulose [MCC] as spheronizer enhancer and Sodium Lauryl Sulphate [SLS] as pore forming agent. OZ formulations were developed by the pelletization technique by drug loaded pellets and characterized with regard to the drug content, size distribution, Scanning Electron Microscopy [SEM], Differential Scanning Calorimetry [DSC], Fourier Transform Infrared Spectroscopy [FTIR] and X-ray Diffraction study [XRD]. Stability studies were carried out on the optimized formulation for a period of 90 days at 40 +/- 2°C and 75 +/- 5% relative humidity. The drug content was in the range of 93.34-98.12%. The mean particle size of the drug loaded pellets was in the range 1024 to 1087 micro m. SEM photographs and calculated sphericity factor confirmed that the prepared formulations were spherical in nature. The compatibility between drug and polymers in the drug loaded pellets was confirmed by DSC and FTIR studies. Stability studies indicated that pellets are stable. XRD patterns revealed the crystalline nature of the pure OZ. Loose surface crystal study indicated that crystalline OZ is present in all formulations and more clear in formulation F5. Drug release was controlled for more than 24 hrs and mechanism of the drug release followed by Fickian diffusion. It may be concluded that F5 is an ideal formulation for once a day administration

prospective, randomized, controlled trial study of comparison of two techniques for laryngeal mask airway insertion

In this study we compared the use of an intravenous propofol/propofol auto-co-induction technique to propofol/midazolam for laryngeal mask insertion. We also studied the incidence of undesirable effects in relation to LMA insertion. In this prospective, randomized, controlled trial study, 60 adults belonging to ASA class 1 and 2 were randomly divided in three groups; Groupl- Saline-propofol; Group 2- Propofol-midazolam; Group 3-Propofol-propofol. The induction characteristics reviewing various parameters like the induction dose required, hemodynamic changes and the cost of induction were observed. Hemodynamic variables including heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], and mean arterial pressure [MAP] were recorded at 2, 4 and 6 minutes post induction. We noticed a decrease in HR, SBP, and DBP and MAP in all 3 groups which was not statistically significant. The total induction dose of propofol in Group 2 [106.3 +/- 21.26 mg] and Group 3 [136.50 +/- 20.29 mg] was significantly lower than Group 1 [1 59.75 +31 .39 mg] but not statistically different between group 2 and 3. The total cost of induction was significantly reduced in the midazolam co-induction group i.e. Group 2. The number of patients suffering from apnea differed significantly between 3 groups i.e. 12 patients in Group 1, 6 patients in Group 2 and 1 patient in Group 3. No significant difference was seen in 3 groups in incidence of hiccups, excitatory phenomenon or laryngospasm. Propofol co-induction [Group 2] and propofol auto co-induction is safe alternative to propofol induction and is more cost effective as they decrease the cost of induction. Midazolam co-induction is more economical than propofol auto co-induction

Evaluation of wound healing activity of polyherbal formulation

A herbal drug combination of Rubia cordifolia, Centella asiatica, Terminalia belerica, Plumbago zeylanica and Withania somnifera was evaluated for wound healing activity, on excision wound of albino rats. Wound healing activity of the plant was evaluated by formulating the drug in ointment dosage form and then compared with a marketed formulation [Soframycin cream] as reference drug. The parameters studied include the percentage closure of excision wound, period of epithelizalion and histopathology, The herbal drug combination has been observed to promote healing of wounds in animals. The results of study were validated statistically