New horizons in sickle cell crisis treatment

Even if life expectancy has increased, sickle cell disease (SCD) still presents difficulties, especially because of the painful episodes that occur frequently and without warning, known as Vaso-occlusive crises (VOCs). These crises are brought on by different cells adhering to one another and obstructing tiny blood veins, which can cause excruciating agony and eventually harm organs and tissues. While the majority of current treatments concentrate on symptom management and pain relief with the use of medications, hydration, and other general approaches, new discoveries about the fundamental mechanisms of VOCs provide intriguing new therapeutic options. With the goal of precisely addressing the pathways causing inflammation and cell adhesion, these cutting-edge treatments may lessen the frequency of VOCs and shield vital organs from harm. Though these treatments provide hope for improved SCD management, careful assessment and analysis of their efficacy and accessibility are necessary to guarantee their general benefit.

Functional limitation among older adults in a rural area in South Kerala and its associated factors

Background: A person is said to have a functional limitation when he/she does not have the physical or cognitive ability to independently perform the routine activities of daily living. If recognized at an early stage, these can often be improved greatly, helping them regain their functional abilities and independence. Objective: The objective of the study was to determine the prevalence of functional limitations among older adults in a rural area in south Kerala. Materials and Methods: The cross-sectional study was conducted among older adults residing in the field practice area of a rural health training center of a medical college in south Kerala for 3 months from October 2019 to December 2019. Data were collected by interview of the participants by the investigator. The modified Barthel Index for activities of daily living was used to determine the prevalence of functional limitations. Results: The overall prevalence of functional limitations among older adults in a rural area in south Kerala was 35.9%. The most common functional limitation experienced by the participants was difficulty in climbing stairs. Functional limitation was found to be significantly associated with the age, socioeconomic status, and type of family of the participants. Conclusion: There is an urgent need to focus on the functional limitation among older adults, especially among the oldest old and those in lower socioeconomic status with emphasis on the need to strengthen the health‑care facilities for them, with respect to early identification and management of their functional limitations.

To Study Efficacy Of Comprehensive Diabetes Care (cdc) Management Program In Type Ii Diabetic Obese Patients: An Observational Study

Context: Diabetes mellitus (DM) contributes to a major chunk of morbidity, mortality, and healthcare cost on a global level. The prevalence of DM is rising alarmingly, worldwide and India. Comprehensive Diabetes Care (CDC) is a combination of Panchakarma and diet management. Aims: This study was conducted to evaluate the effect of CDC on Glycosylated hemoglobin (HbA1c), body mass index (BMI), body weight, abdominal girth and dependency on conventional therapy in DM Patients. Setting and Design: This observational study was conducted in July 2017, wherein the data of obese Type II DM patients (HbA1c >6.5%) who attended out-patient departments (OPDs) at Madhavbaug clinics in Maharashtra, India were identified. Materials and Methods: Data of patients who were administered CDC (60-75 minutes) with minimum 6 sittings over 90 days (± 15 days) were considered. Variables were compared between day 1 and day 90 of CDC. Results: Out of 27 patients, 22 were included for analysis, out of which 10 were males while 12 females. CDC showed significant improvement in HbA1c 1.1% (from 8.80 ± 0.93 to 6.98 ± 1.73; p<0.001), BMI by 2.66 (from 33.79 ± 3.80 to 31.13 ± 3.91, p< 0.001), weight by 6.56 kg (from 83.67 ± 11.28 to 77.11 ± 12.27, p<0.001). Abdominal girth (from 104.34 ± 9.74 to 96.97 ± 11.93; p<0.001), also showed significant reduction. Dependency on concomitant medicines was reduced, with the number of patients on no concomitant medicines increasing from 27% to 41%. Conclusion: Comprehensive Diabetes Care Management Program found to be efficacious; by reducing HbA1c, as well as reducing dependency on allopathic medications.

Prosthetic rehabilitation of a partially edentulous patient with maxillary acquired defect by a two-piece hollow bulb obturator [using a dentogenic concept]

Patients may face functional, aesthetic, and social distress because of the palatal defects. Prosthetic rehabilitation of maxillectomy or developmental defect can be challenging for prosthodontists. Prognosis of the prosthetic appliances can be affected not only by patients' own ability to adapt to the prosthesis but also by the factors like the remaining teeth, bony structure, and existing mucosa. Maxillary defects are usually developed by surgical intercession of the benign or malignant conditions and trauma cases. Speech, mastication and aesthetics can be hampered by any extent of palatal defect. During obturation of palatal/maxillectomy defects, the primary intent of the prosthodontist should be the shutting of the maxillectomy defect and parting of the oral cavity from the sinonasal openings by use of different bulb designs. In the present case, dentogenic concept has been applied while fabricating the two-piece hollow bulb obturator for restoration of the defect. Well known fact about the gravitational force is that it acts on maxillary obturator and reduces its retentive qualities, this can be counteracted to some extent by making the obturator hollow. Dentogenic concept is the skill, training, and procedure of generating the chimera of natural teeth in artificial teeth during prosthodontic restorations

Un caso de nódulos cutáneos múltiples: linfoma cutáneo de células T / A case of multiple skin nodules: cutaneous T-cell lymphoma

La micosis fungoide es la variante más común de linfoma cutáneo de células T y se caracteriza por un curso asintomático con evolución posterior de placas y tumores. A medida que la enfermedad progresa se observa mayor compromiso cutáneo y diseminación a ganglios linfáticos, bazo, pulmones e hígado...

Atrial Fibrillation, Neurocognitive Decline and Gene Expression After Cardiopulmonary Bypass

ABSTRACT OBJECTIVE: Atrial fibrillation and neurocognitive decline are common complications after cardiopulmonary bypass. By utilizing genomic microarrays we investigate whether gene expression is associated with postoperative atrial fibrillation and neurocognitive decline. METHODS: Twenty one cardiac surgery patients were prospectively matched and underwent neurocognitive assessments pre-operatively and four days postoperatively. The whole blood collected in the pre-cardiopulmonary bypass, 6 hours after-cardiopulmonary bypass, and on the 4th postoperative day was hybridized to Affymetrix Gene Chip U133 Plus 2.0 Microarrays. Gene expression in patients who developed postoperative atrial fibrillation and neurocognitive decline (n=6; POAF+NCD) was compared with gene expression in patients with postoperative atrial fibrillation and normal cognitive function (n=5; POAF+NORM) and patients with sinus rhythm and normal cognitive function (n=10; SR+NORM). Regulated genes were identified using JMP Genomics 4.0 with a false discovery rate of 0.05 and fold change of >1.5 or <-1.5. RESULTS: Eleven patients developed postoperative atrial fibrillation. Six of these also developed neurocognitive decline. Of the 12 patients with sinus rhythm, only 2 developed neurocognitive decline. POAF+NCD patients had unique regulation of 17 named genes preoperatively, 60 named genes six hours after cardiopulmonary bypass, and 34 named genes four days postoperatively (P<0.05) compared with normal patients. Pathway analysis demonstrated that these genes are involved in cell death, inflammation, cardiac remodeling and nervous system function. CONCLUSION: Patients who developed postoperative atrial fibrillation and neurocognitive decline after cardiopulmonary bypass may have differential genomic responses compared to normal patients and patients with only postoperative atrial fibrillation, suggesting common pathophysiology for these conditions. Further exploration of these genes may provide insight into the etiology and improvements of these morbid outcomes.

Development and Validation of UV Spectrophotometric Area Under Curve (AUC) method for estimation of Pyrantel Pamoate in Bulk and Tablet Dosage Form.

The aim of present work was to develop an accurate, precise, reproducible and economical UV spectrophotometric method for estimation of Pyrantel Pamoate. This method was based on Area Under Curve (AUC) of UV spectrum between 231 to 241 nm and validated as per ICH guideline Q2 (R1). The method is linear in the range of 1.5-3.5 μg/ml. The value of correlation coefficient is 0.999. Values of % relative standard deviation (%RSD) for the intra-day and inter-day precision indicated that method is precise. Results of the recovery studies (99.94 %) showed accuracy of the method. LOD and LOQ were calculated as 0.017μg/ml and 0.0541μg/ml respectively. The developed method can be used for routine estimation of Pyrantel Pamoate in bulk and tablet dosage forms.

Physiological taste threshold in type 1 diabetes mellitus.

The sense of taste is one of the important oral chemical senses that play a critical role in human life. The taste threshold increases by number of factors such as age, local and systemic disease like diabetes, consumption of alcohol, smoking. The aim of the present study was to assess the relationship between taste threshold in type 1 diabetics and non diabetics for four basic taste modalities (i.e. sweet, salt, sour and bitter). We studied 70 cases of type 1 diabetic and 70 non diabetics. The taste threshold was evaluated using 7 different serially half diluted concentrations of glucose (2.00 M–0.031 M), Nacl (1.00 M– 0.0156 M), citric acid (0.05 M– 0.0007 M) and quinine sulphate (0.001 M–0.000015 M). A significant increase in taste threshold for sweet (P<0.0001), salt, sour and bitter (P<0.001) in type 1 diabetic was observed. We concluded that taste sensation was reduced in type 1 diabetics.

Deep Brain Stimulation: Technology at the Cutting Edge

Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy.

Deep Brain Stimulation: Technology at the Cutting Edge

Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy.

Evaluation of new gastro-intestinal prokinetic (ENGIP-II) study.

Non-ulcer dyspepsia is a common clinical disorder characterised by reduced gastric motility. Safety concerns have restricted use of currently available prokinetic drugs. Itopride is a new safer prokinetic drug with dopamine D2 antagonism and acetylcholinesterase inhibitory actions. The ENGIP-II study was conducted to investigate the efficacy, and safety of itopride in patients of non-ulcer dyspepsia. There were significant reductions in upper abdominal pain, heartburn frequency, gastro-oesophageal regurgitation, nausea, bloating, early satiety after meals at day 3 only; whereas significant improvements were noted in belching, anorexia at day 6 and in vomiting at day 9. Thus, ENGIP-II study shows that itopride was well tolerated patients and appears to be the drug of choice in patients with non-ulcer dyspepsia.

Evaluation of new gastro-intestinal prokinetic (ENGIP-I) study.

The ENGIP-I study was conducted to investigate the efficacy, and safety of itopride in patients of gastro-oesophageal reflux disease. There were significant reductions in heartburn frequency, heartburn severity, gastro-oesophageal regurgitation frequency at day 3 only. ENGIP-I study concluded that itopride was well tolerated by patients and appears to be the drug of choice in patients with gastro-oesophageal reflux disease.