A Critical Review on Dooshivishari Agada: A Herbo Mineral Formulation

Dooshivisha (cumulative toxicity) is a type of Kritrima visha (artificial poison). It is a transformed state of other types of poison if not eliminated, get collected in small doses leads to this type of poisoning. It is a unique concept of Ayurveda and is the cause of the majority of the health issues in the present era. Acharyas have said different treatment principles for the management of Dooshivisha (cumulative toxicity). Dooshivishari agada is the formulation of choice for its treatment, which is a herbo-mineral formulation comprised of twelve ingredients that are taken in equal amounts for the preparation. Many Acharyas such as Sushruta, Vagbhata, and Bhavaprakasha have explained it in their classical texts. Along with Dooshivisha (cumulative toxicity), it can also be used in its complications, and also for the treatment of all types of poisoning and other associated signs and symptoms.

Prevalence of pulmonary tuberculosis in patients with diabetes mellitus and lower respiratory tract infection

Background: Pulmonary Tuberculosis (PTB) still remains a global public health problem. Diabetes Mellitus (DM), is a metabolic disorder characterized by hyperglycaemia. Diabetes along with poor glycaemic control leads to an immune compromised state. As prevalence of both TB and DM is increasing in India, this association of PTB and DM may prove a threat to TB control program. Aims and objectives of the study was to detect prevalence of pulmonary tuberculosis in patients with DM and Lower Respiratory Tract Infection (LRTI).Methods: Sputum specimen from consecutive 250 known diabetic adult patients with type 2 diabetes and clinical evidence of LRTI were processed for microscopy, solid culture and Xpert MTB/RIF assay. Clinical findings, duration of DM, regularity of treatment and recent fasting blood glucose level were noted.Results: TB was detected in 31(12.8%) patients. Microscopy, culture and Xpert assay were positive in 14(5.6%), 29(11.6%) and 24(9.5%) cases respectively. Culture detected seven cases more than Xpert assay. Two additional cases were detected by Xpert assay than culture. Rifampicin resistance was detected in seven (29.17%) cases by Xpert assay. TB detection rate was higher in patients with more than two weeks of cough (14.38%), history of tuberculosis (15.9%), hyperglycemia (13.9%) and significantly higher in those with irregular anti-diabetic treatment (35.7%).Conclusions: Irregular anti-diabetic treatment, hyperglycaemia and history of tuberculosis were strongly associated with pulmonary TB. Xpert assay should be used as the initial diagnostic test for detection of tuberculosis as well as rifampicin resistance in diabetic patients by TB control programme.

Triaging patients with upper gastrointestinal bleeding: the utility of Glasgow-Blatchford score

Background: Glasgow-Blatchford bleeding score (GBS), was developed to predict the need for hospital-based intervention (transfusion, endoscopic therapy or surgery) or death following upper gastrointestinal bleeding. Study evaluated the Glasgow Blatchford score’s (GBS) ability to identify high risk patients who needed blood transfusion in patients with UGI haemorrhage.Methods: A total of 270 cases admitted with upper gastrointestinal bleeding in the Medical ICU/Wards of MKCG Medical College were put on Blatchford scoring system and classified as those requiring (high risk = GBS >1) and not requiring blood transfusion (low risk) based on the score assigned on admission and a correlation between initial scoring and requirement of blood transfusion was done.Results: Units of blood transfusion required, the GBS and duration of hospital stay were significantly lower among the low risk group, all with p value <0.001. No blood transfusion was required in patients with GBS <3. There was significant correlation between GB score and requirement of blood transfusion (p <0.001) and duration of hospital stay (p <0.001). GBS had 100% sensitivity, negative predictive value and positive likelihood ratio, when a cut off of > 16 was used in predicting mortality.Conclusions: Patients presenting with Upper GI bleeding can be triaged in casualty with Glasgow Blatchford scoring. Patients with a low score of less than or equal to 3 can be safely discharged and reviewed on follow up thereby reducing admission, allowing more efficient use of hospital resources.

Correlation of sociodemographic factors and intestinal parasites in pregnant women

Background: Pregnant women often experience more severe intestinal parasitic infections than their non-pregnant counterparts. Intestinal parasitic infections also disturb pregnancy at the maternal and fetal level. Objective of the study was to find out the prevalence of intestinal parasites in pregnant women and its relationship with various socio-demographic factors.Methods: A single stool specimen was collected. A saline and iodine mount was examined microscopically to demonstrate the intestinal parasites. Formol ether Concentration technique was performed to increase the yield of the eggs and larvae. Modified acid-fast staining was done for opportunistic parasitic infections.Results: In this study 300 pregnant women were screened for presence of intestinal parasites. The prevalence of intestinal parasites was 42.67%. Women who practiced hand washing regularly and had knowledge about parasites had lesser infection. The dietary practice of taking green leafy vegetables had protective effect during pregnancy. The prevalence of intestinal parasites was almost same in both rural and urban women. Higher prevalence of intestinal parasites was found in lower socioeconomic class. Women who used river as source of water supply had slightly more prevalence than those who used municipal water. The prevalence of hookworm infection was more in women who never wore sandals.Conclusions: The high prevalence of intestinal parasites in the pregnant women indicates faecal pollution of soil and domestic water supply.  Education and awareness regarding intestinal parasites need to be done during their routine antenatal visits. Emphasis should be made on consistent hand washing, consumption of washed leafy vegetables and use of footwear. Deworming of pregnant women should be considered in the national guidelines.

Study of resistance pattern of isolated micro-organisms towards commonly used anti-microbial agents in medical intensive care unit of a tertiary care teaching hospital

Background: The objective of the study was to find out different types of biological samples from admitted patients tested for culture and sensitivity (C&S), prevalence of different types of organisms isolated from those samples, and to analyze the resistance pattern of those isolated organisms against commonly used or tested anti-microbial agents (AMAs).Methods: Following institutional ethics committee approval and written informed consent, adult patients of both genders, receiving AMAs were enrolled from June 2014 to July 2015 and followed up daily till they were in medical intensive care unit (MICU). Demographic data, diagnosis, culture-sensitivity (antibiogram) and other investigation reports and treatment details were recorded. Descriptive statistical analysis of collected data was done.Results: Of the 514 samples (from 600 patients enrolled) sent for C&S testing, 143 were reported as sterile while from the rest 371 samples, 504 organisms were isolated; commonly isolated organisms were Pseudomonas aeruginosa (30%), Acinetobacter baumannii (23%), Klebsiella pneumoniae (16%), Providencia sp. (7.1%), Escherichia coli (5.7%), and Enterobacter sp. (4.2%). Samples were sent in 63% of enrolled patients, the commonest being broncho-alveolar lavage (48% of total). Microbial resistance was high for cephalosporins (ceftriaxone, cefepime, ceftazidime), carbapenems (meropenem, imipenem), penicillins (piperacillin), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin, netilmicin, amikacin) and cotrimoxazole. Most organisms were sensitive to colistin (100%), polymyxin B (92%) and tigecycline (69%).Conclusions: The information regarding commonly isolated organisms and their resistant pattern would aid in rational selection of AMAs and thus the present study is useful to clinicians managing MICU and the hospital infection committee to plan future policies regarding AMA use in MICU.

Effect of different methods of pasteurization on bactericidal action of human milk: A prospective observational study

Background & objectives: Pasteurization involves not only inactivation of pathogens, but also loss of immunological functions and bactericidal action of human milk. Hence, this study was aimed to explore the stability of such bactericidal action after subjecting human milk samples to thermal pasteurization under different condition of time and temperature. Methods: In this observational study 48 human milk samples were analyzed over a period of three months. The effect of holder and flash methods of pasteurization on bactericidal action against Escherichia coli was evaluated compared to the control sample before and after 72 h of storage at ?18癈. Results: Both holder and flash methods of pasteurization showed significant reduction in the E. coli growth to 46.4 and 25.5 per cent, respectively, after 24 h of incubation (P <0.001). The bactericidal activity was significantly more in samples subjected to holder method compared to flash method before and after 72 h of storage (46.41�.38 vs. 25.50�.74, P <0.001 and 42.27�.38 vs. 18.33�.55, P <0.001). Interpretation & conclusions: Our results showed that the bactericidal activity of human milk was better preserved by the holder method of pasteurization. Further well-powered and well-designed randomized trials are needed to confirm the findings.

Microalbuminuria among obese and non-obese individuals: a case control study

Background: Microalbuminuria among obesity cases reflects specific glomerular damage or is the marker of generalized endothelial cell dysfunction is still debatable. Thus, this study aimed to assess the presence of microalbuminuria among obese persons and non-obese individuals, who were euglycemic and normotensive.Methods: A case control study was conducted among patients attending outpatient department of general medicine in Govt Thiruvarur Medical College, Thiruvarur, for their illnesses from June 2017 to December 2017. A total of hundred participants with fifty obese cases and fifty non obese controls were included in this study. Detailed history and examination were done by the principal investigator and the same was documented in a proforma. Data entry was done using Microsoft excel and the statistical analysis includes odds ratio were calculated using Statistical Package for Social Sciences (SPSS) software version 17.Results: Among the study participants, 32% and 4% had microalbuminuria in obese and non-obese group, respectively. Also, obese participants were 11.29 times at higher chances of having microalbuminuria when compared to the non-obese patients with significant p value (p=0.002).Conclusions: Microalbuminuria can be used to predict the risk of complications in obese subjects in order to bring down the overall morbidity and mortality related to renal function.

Clinical and hematological profile of pancytopenia in a tertiary care hospital of Southern Odisha, India

Background: Pancytopenia (anemia, thrombocytopenia and leukopenia) is a common haematological condition with various etiologies like ineffective haematopoiesis, bone marrow suppression, bone marrow infiltration and peripheral destruction of blood cells. The present study was done to see the clinical features and etiologies of pancytopenia in this geographical region.Methods: About 150 patients above 15 years of age after fulfilling the inclusion criteria were included in the study. They were evaluated with appropriate laboratory tests including bone marrow study, if indicated to find out the underlying etiology.Results: Common symptoms were generalized weakness (93.3%), fever (75.3%) and dyspnoea (54%). Common physical findings were pallor (100%), lymphadenopathy (43.6%) and hepatosplenomegaly (32%). Most common causes were aplastic anemia (28%), megaloblastic anemia (20%) followed by infections like malaria (13.3%), dengue (5.3%) and sepsis (1.3%). Bone marrow was hypocellular in 50 patients (41.7%), hypercellular in 45 patients (37.5%) and normocellular in 25 patients (20.8%).Conclusions: There are some reversible causes of pancytopenia like megaloblastic anemia, malaria, dengue and sepsis. Conditions like disseminated TB, collagen vascular diseases also can be treated with specific treatment if diagnosed early to avoid further complications.

Improved case detection using Xpert Mycobacterium tuberculosis/rifampicin assay in skeletal tuberculosis

Background: In India, musculoskeletal tuberculosis (TB) accounts for 10%�% of extrapulmonary TB. Data on drug-resistant skeletal TB are lacking. At present, the diagnosis is based mainly on radiological techniques. Laboratory confirmation of skeletal TB is delayed as 6�weeks are required for culture results. Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay is a fully automated test which simultaneously detects MTB and RIF resistance within 3 h. Hence, this study was done to compare the yield of case detection using Xpert assay in comparison with culture in specimens received from clinically suspected skeletal TB cases. Methods: Retrospective analysis of microscopy, culture and Xpert assay results was carried out on specimens received in laboratory from skeletal TB cases from January 2016 to December 2017. Results: Of the 201 patients analysed, majority of the specimens were obtained from the spine (55.72%). MTB was detected in 48.68% of tissue and 24% of pus specimens. Xpert assay was detected MTB in 67 (33.33%) specimens of which 53 (47.32%) were from the spine. Culture was detected MTB in 66 (32.83%) specimens. Xpert assay was detected two specimens more than culture. One specimen was positive by only culture. RIF-resistant MTB was detected in 10 (14.92%) specimens by Xpert assay. Conclusion: The spine is the most common site involved. Tissue specimen is better for early diagnosis. High RIF resistance in skeletal TB is an alarming situation. Ability of Xpert MTB/RIF assay for rapid and simultaneous detection of MTB and RIF resistance in comparison with culture makes it a useful diagnostic tool in skeletal TB.

Fluoresceirv diacetate vital staining for detecting viability of acid-fast bacilli in patients on antituberculosis treatment

Objective: To determine the performance of PDA vital staining method in detecting viability of acid fast bacilli in comparison with culture and also its correlation with conventional drug susceptibility testing results for isoniazid and rifampicin. Design: The study was conducted from Jan 2014 to June 2015. Sputum samples of patients taking either Cat I or Cat II anti-TB treatment were tested by Ziehl Neelsen and PDA staining, culture and susceptibility to rifampicin and isoniazid at the end of intensive phase

Results: Of the 100 ZN positive specimens, 74 were PDA positive of which 70 were reported positive by both the readers. All specimens having higher grades [2+ and 3+] by ZN were positive by PDA staining. 87.88% of 1+ and 45% of scanty smears were positive by PDA staining. MTB was isolated in 75 specimens of which 72 were positive by PDA. Two culture negative specimens were PDA positive. PDA staining had sensitivity and specificity of 96% and 92% respectively. 70.66% of the total culture isolates were MDRTB strains. 2.66% strains demonstrated monoresistance to each of INH and rifampicin

Conclusion: PDA microscopy can be used as a simple and rapid TB treatment monitoring tool in resource limited settings to identify those patients requiring immediate culture and DST test

Dental fluorosis: A histological study using Light and Confocal microscopy.

Aims: To observe and characterize the histological features of fluorosed teeth under light and confocal microscope (CFM). Materials and Methods: A total of 25 fluorosed teeth and 5 normal teeth were collected from dentists across Dindigul, a known endemic area of fluorosis in South India. Ground sections of respective teeth were observed under light microscope and the sections were subsequently stained with acridine orange and studied under CFM. Results: Histological changes were observed in the ground sections of fluorosed teeth as compared with the normal teeth. Depending on the degree of fluorosis, the affected teeth showed various features of hypomineralization in enamel and dentin. Conclusions: Fluoride interacts with both mineral phases and organic macromolecules by strong ionic and hydrogen bonds resulting in incomplete crystal growth at prism peripheries. This presents as hypomineralization of enamel and dentin.

True hermaphrodite with teratoma.

A 32 years old healthy male, married for 6 years presented with infertility. Clinical examination revealed normal external genitalia with underdeveloped empty scrotum. Radiological investigations reported bilateral intra abdominal testis with left testis showing features of teratoma. Intra- operative findings showed bilateral intra abdominal testis along with uterus and fallopian tube and left testis with features of teratoma. Histopathology confirmed the presence of uterus, cervix, right adnexa with atropic testis with tube, seminal vesical, epididymis, and left adnexa ovotestis withmature teratoma, tube and epididymis. Cytogenetics reported 46, XY karyotype. This case is rare presentation of combination of male phenotype true hermaphrodite with presence of teratoma.

Dengue fever: atypical manifestation.

Dengue fever is affecting millions of population globally. For the past one decade, we have seen several outbreaks and even causing significant mortality of affected population. We witnessed numerous pattern and multisystem presentation of dengue in this period. The CNS manifestation like encephalitis, polyneuropathy (GB like syndrome) and paresthesias were uncommonly reported priorly. Pancreatitis, polyserositis, carditis of varying severity and hepatic failure are the, some of atypical manifestations observed in recent out breaks. So dengue illness can presents with multi system involvement and can account to significant mortality. Here an attempt was done to present varying, uncommon and atypical manifestation of dengue illness.

The Prevention of Parent-to-child Transmission Programme: Is it fair to women.

In February 2014, the Government of India launched a multi-antiretroviral drug regimen to treat infected women and infants in efforts to reduce parent-to-child transmission (PTCT) of the human immunodeficiency virus (HIV). The announcement has been long awaited because the multidrug regimen can reduce the risk of transmission during childbirth from 30% – 35% to less than 2% with replacement feeding.

Estimates of Variability, Heritability and Genetic Advance in Certain Inbreeds of Maize (Zea mays, L.).

Genetic variability, heritability (broad sense) and genetic advance were studied in 39 inbreeds of maize. The data were recorded on twelve quantitative traits viz., days to 50% silking, days to 50% tasseling, plant height (cm), ear height (cm), ear length (cm), ear diameter (cm), ear weight without husk (g). ear weight with husk (g), number of kernel rows per ear, number of kernels pr row, 100-seed weight and grain yield per palnt (g). Significant differences among the genotypes were observed for all the characters under study. The phenotypic coefficient of variation (PCV) and genotypic coefficient of variation (GCV) were highest for characters namely, ear weight without husk, ear weight with husk, number of kernels per row, 100 grain weight and grain yield per plant suggesting that these characters are under the influence of genetic control. High values of heritability coupled with high genetic advance as per cent of mean was noticed for traits viz., grain yield per plant, ear height, plant height, number of kernels per row, number of kernel rows per ear, ear length, 100 grain weight, ear weight with husk and without husk indicating their effectiveness in selection.

Free radical scavenging activity and reducing power of Gnidia glauca (Fresen.) Gilg.

The present study describes the free radical scavenging activity and reducing power of methanolic leaf extract of Gnidia glauca (Fresen.) Gilg.using ABTS [2, 2' azinobis-(3-ethylbenzothiazoline-6-sulfonic acid)], FRAP (Ferric reducing antioxidant power) and nitric oxide scavenging assays. Total antioxidants were determined by phosphomolybdenum method. The results have indicated that the total phenolic content of the extract was 203.3 GAE/g and showed significant antioxidant activity with an IC50 value of 16.3μg/mL in ABTS and 360.8μg/mL in nitric oxide scavenging assays respectively. A FRAP value of 993.7 μm TE/mg of leaf extract was recorded at 30 minutes. The total antioxidant activity was 142.5 mg AAE/g of extract. The results strongly establish the significant antioxidant property of G. glauca owing to its high phenolic content.

Anesthetic management of a child with corrected transposition of great vessels undergoing non-cardiac surgery

We describe the successful anesthetic management of a 14-year-old child, a corrected case of transposition of great vessels in childhood and presently with residual atrial septal defect, peripheral cyanosis, and neurological deficit of lower limb presented for tendoachillis lengthening

Development and validation of RP-HPLC method for the estimation of omeprazole in bulk and capsule dosage forms.

A method for the determination of omeprazole in bulk and capsule dosage form by reverse phase high performance liquid chromatography has been developed. This is a simple, rapid, precise and an accurate method. The method was developed on a Novapak C18, (250 x 4.6 mm, 5μ) column using phosphate buffer (pH 7.4) and acetonitrile in the ratio of 60:40, v/v as a mobile phase which was pumped at a flow rate of 1.0 ml/min and detection was done at 302 nm. The retention time of the drug was found to be 7.71 min. The method was validated for accuracy, precision, linearity, specificity, robustness. The linearity was observed in the range of 20-60 ppm. The results of recovery studies indicated that the method was accurate. Hence the developed method was found to be suitable for the estimation of omeprazole in bulk and capsule dosage forms.

Acute Pancreatitis in Pregnancy.

Acute pancreatitis is a rare event in pregnancy, which can have a high maternal mortality and fetal loss. Gallstone disease is thought to be responsible for about 70% of these cases. We report a case of a 28-year-old woman, who presented with severe pain confined to the upper abdomen, which was radiating to the back. Investigation undertaken led to the diagnoses of acute pancreatitis.