A fatal case of primary melioidotic prostatic abscess: the peril of poor drug compliance

@#Primary prostatic melioidosis is a rare presentation of melioidosis even in melioidosis endemic areas. We report a case of a 58-year-old man with underlying diabetes mellitus who presented with a 5-day history of high-grade fever associated with lower urinary tract symptoms. Suprapubic tenderness and tender prostatomegaly were noted on examination. An abdominal computed tomography (CT) scan confirmed the presence of a prostatic abscess. Both blood and prostatic pus cultures grew Burkholderia pseudomallei. He was initially started on intravenous ceftazidime, followed by an escalation to intravenous meropenem. He was discharged home with oral amoxicillin-clavulanate and doxycycline after completing 12 days of meropenem. Unfortunately, his compliance to oral antibiotic therapy was poor, and he succumbed to the disease.

Non operative treatment of chronic ankle sprain: a study conducted in teaching general hospital, Telangana, India.

Background: Chronic ankle sprain due to “sprained ankle syndrome” may be particularly troublesome. Some causes of chronic ankle instability may be symptomatic insufficiency of pathologic laxity, arthro-kinematic changes, degenerative changes, decrease of proprioception and inadequate neuromuscular control. This study was conducted to review our experience with footwear correction of chronic ankle sprains of grade 2 and 3. Methods: Ankles of 280 patients, who had chronic ankle sprains grade 2, grade 3 were considered in this study, to assess results of non-operate treatment. Diagnosis was made with history of pain, swelling on walking, clinical findings of swelling, tenderness on antero-lateral aspect of lateral malleolus. All patients were given 3 days of anti-inflammatories, analgesics and footwear modifications. Later patients were advised exercise program. Results: Out of 280 patients, who were regularly followed, 92% people had relief, 3.4% of patients continued footwear as they had associated symptoms, 3.9% of patient continued to have pain maybe obscure or not following doctor orders. Conclusion: The study concludes that lateral elevated foot wear made of micro cellular rubber of 0.75 cm is the choice of treatment for grade 2 and 3 ankle sprains. This foot wear helps in biomechanical correction from varus and also decreases symptoms and signs. Cosmetically acceptable.

Quantitative determination of Cimetidine in both bulk and formulations using neutralization titrations.

Cimetidine is the selective H2 receptor antagonist and inhibits the secretion of hydrochloric acid in the stomach. In the present study, simple titrimetric method was developed. Respective quantities of Cimetidine were taken in aqueous methanol and acetic acid titrated against 0.1N hydrochloric acid and 0.1N perchloric acid using methyl orange and crystal violet as indicators for neutralization and non-aqueous titrations. All the titrations are carried out by running simultaneous blank determinations. The final titer values are subtracted from blank to get actual amount of acid consumed was determined. These methods were found to be sensitive and inexpensive, do not require any sample processing steps and can be utilized for estimation of cimetidine in bulk and formulations.

Development of validated liquid chromatographic method for estimation of levocetirizine from pharmaceutical dosage forms.

A simple and rapid high-performance liquid chromatographic (HPLC) method for the determination levocetirizine has been developed. The chromatographic system consisted of a Water 2695 binary gradient pump, Water 2487 dual wavelength absorbance detector, and Empower 2 software. Separation was achieved on the XTerra symmetry C18 column at room temperature. The sample was introduced through an injector valve with a 20 μL sample loop. The results obtained showed a good agreement with the declared content. Recovery values of levocetirizine in tablets were from 99.57-100.48 %. The proposed method is rapid, accurate and selective; it may be used for the quantitative analysis of levocetirizine from raw materials, in bulk drugs and other dosage formulations.

Hepatoprotective activity of six polyherbal formulations in paracetamol induced liver toxicity in mice.

Background & objective: Polyherbal formulations available with a wide range of indications like protective to liver, appetite and growth promoters, gastrointestinal and hepatic regulator, as treatment for hepatic dysfunction, for hepatic regeneration as well as liver stimulant and tonic. Despite the widespread use, there is a lack of scientifi c evidence on their effi cacy and safety. This study was undertaken to evaluate the hepatoprotective activity of six commercially available formulations, namely Liv 52, Livergen, Livokin, Octogen, Stimuliv and Tefroliv in acute liver toxicity in mice model induced by paracetamol (PCM). Methods: Swiss albino mice of either sex were used, divided in 28 groups with six in each group. The dose of the polyherbal formulations was calculated from human dose (20 ml/day) using a standard conversion table. They were given as pretreatment (2.60 ml/kg/day) for 7 days by oral route twice a day prior to PCM administration. Hepatotoxicity was induced by administering a single oral dose of PCM (500 mg/kg bw) on day 8. The study parameters were conducted on day 9. The biochemical parameters included liver enzyme levels alanine tranaminases (ALT), aspartate transaminases (AST) and alkaline phosphatase (ALP). The pharmacological and pathological parameters were phenobarbitone sleeping time and macroscopic and microscopic changes of liver tissues respectively. Results: PCM toxicity signifi cantly increased ALT, AST and ALP (321.00 ± 87.93, 273.17 ± 45.68, 257.50 ± 17.64 IU/l vs normal control, 33.33 ± 0.61, 89.33 ± 9.50, 152.17 ± 11.40 IU/l respectively, P<0.05), prolonged phenobarbitone induced sleeping time (from 277.50 ± 8.04 min to 335.83 ± 7.00 min, P<0.05). When PCM higher dose (1g/kg p.o. single dose) was used, the liver tissue, in macroscopic appearance, showed extensive necrosis associated with haemorrhages. Low dose (500 mg/kg p.o. single dose) showed punctate haemorrhagic necrosis of liver tissue. In the microscopic studies, PCM induced toxicity showed haemorrhages, fatty changes and necrosis. The pretreatment in low doses (2.6 ml/kg/day) with liquid formulations of Liv 52 and Livergen reversed the PCM induced liver toxicity. At higher doses (5.2 ml/ kg/day), all the six herbal formulations conclusively showed marked benefi cial effects in the studied pharmacological, biochemical and histological parameters. Interpretation & conclusion: The present fi ndings demonstrated the effi cacy of polyherbal liquid formulations at two dose levels in PCM induced hepatotoxicity in mice. However, it suggests that a dose adjustment may be necessary to optimize the effects in clinical settings.

A comparative study of platelets behaviour in controls and acute myocardial infarction patients.

Acute myocardial infarction is one of the leading vascular diseases. Platelet-endothelium plays a crucial role in its etiopathogenesis. The present study was undertaken to compare the platelet aggregability in controls and acute myocardial infarction patients along with its effect on the peripheral platelet count. The work was conducted in five patients from ICCU and 5 controls between the age group of 40-60 years by using Chronolog Dual Channel Aggrometer with ADP and epinephrine as agonists. The platelets were counted by hemocytometry. The results were statistically analysed by Student's 't' test which was found to be significant. There was increase in the aggregation index in patients compared to controls. It was also observed that the degree of increase was more with ADP than epinephrine. Relatively, there was tendency of low platelet count. The increase in the aggregation index can be attributed to the hyperreactiveness of the platelets to ADP than epinephrine. The relative thrombocytopenia can be accounted to the sequestration of platelets in the coronary microvasculature. In conclusion, balance between EDRF and EDCF determines the platelet activation.

Hypopituitarism following snake bite.

A patient who developed hypopituitarism after viperine envenomation is described. Thrombosis as a part of disseminated intravascular coagulation may have been the cause. Hypopituitarism should be suspected in such cases especially when there is associated acute renal failure.

Histological and functional correlation of thyroid carcinoma by immunohistochemistry.

40 cases of thyroid carcinoma comprising of 22 follicular, 11 papillary, 4 medullary, 2 anaplastic and 1 medullary carcinoma with focal areas of papillary differentiation were selected for this immunohistochemical study for the presence of thyroglobulin, calcitonin and somatostatin. As per the functional classification recommended by Otto L Jungberg, 22 cases were well differentiated, 13 were of intermediate differentiation with 3 poorly differentiated cases. 2 cases of anaplastic carcinoma were negative for all the 3 markers. Correlation between functional classification and histological pattern show 77% of the well differentiated type to be of follicular pattern with the rest consisting of papillary carcinoma. In the intermediate type 38.4% were follicular carcinoma, 15.3% medullary carcinoma and the rest, papillary carcinoma. Poorly differentiated type consisted of 2 medullary carcinomas. Contrary to previous reports, functional differentiation did not always correlate with histological pattern.

Toxic effects of garlic extract and garlic oil in rats.

Significant rise in urea and D-aspartate aminotransferase and inhibition of alkaline phosphatase in serum were observed in rats fed garlic extract (2 ml/100 g body wt, intragastrically) for 10 days. The liver showed histological changes. Garlic oil feeding (10 mg/100 g body wt, intragastrically) after 24 hr fasting was found lethal. The cause of death appears to be acute pulmonary oedema. On histological examination, all the organs of the dead rats revealed severe congestion. However, similar feeding of garlic oil was well tolerated by rats in the fed state. Also, 24 hr fasted rats could tolerate this dose of garlic oil, provided they were previously adapted to garlic oil feeding.