Sputum positivity status for acid fast bacilli in patient attending a designated microscopy centre of a tertiary care hospital, Lucknow

Background: Tuberculosis is a contagious bacterial disease that is considered to be one of the deadliest diseases worldwide. It affects lungs and causes pulmonary TB. Today in India, every minute 3 to 4 people die of TB, more than 1000 die every day and more than 5 lakhs die every year. Demonstration of AFB in smear has a great important in control of TB, as smear positivity directly correlates with infectivity. Methods: It was a cross-sectional study. It lasted over a period of 6 months (January to June). Samples were collected from patients attending TB and Chest OPD of IIMS&R Hospital and sent for AFB examination by Ziehl-Neelsen (ZN) microscopy at microbiology lab. Patients with symptom of cough lasting for more than 2 weeks were included. Results: Out of 718 patient’s samples, 128 were smear positive by ZN staining method. Out of which 81 (63.28%) were males and 47 (36.72%) were females. According to age distribution 35 (27.35%) were <30 years of age, 68 (53.12%) were in between 30 and 60 while 25 (19.53%) were >60 years of age. 105 (82.03%) positive patients were found to be from rural area and remaining 23 (17.9%) patients belong to urban area. 29 patients were found to have a past history of TB of 1 year. Out of 128 positive patients none were smokers. 25 (19.53%) were tobacco chewers. 11 (8.56%) were contact with a case of TB. Conclusions: Demonstration of AFB in smear has a great important in control of TB, as smear positivity directly correlates with infectivity. Z-N staining method is the most commonly used worldwide.

Exploring the impact of early-term labor induction on cesarean section risk in gestational diabetes mellitus: insights from a tertiary care hospital study in Pakistan

Background: Gestational diabetes mellitus (GDM) is the most common endocrine disorder in pregnancy. It is associated with significant perinatal morbidity and mortality, therefore, an early-term delivery by routine induction of labor is proposed by some societies, to prevent/reduce these complications. Methods: This cross-sectional study was conducted between 1st January 2019 and 30th June 2020 at Aga Khan University Hospital, Pakistan to compare the pregnancy outcomes of patients with GDM when induced at 37, 38, and 39 weeks in comparison to women with GDM managed expectantly. The study included all women with singleton pregnancy and vertex presentation. Women induced after 41 weeks, previous cesarean delivery, placenta previa, major fetal anomalies, chronic maternal medical conditions that necessitate delivery, and those women presenting with spontaneous onset of labor were excluded. Data was analyzed in SPSS v.19. Results: A total of 293 women were included. The mean age of women was 27 years, and the mean BMI was 27.8 kg/m2. We found that women who were induced at earlier gestational weeks were managed with a combination of diet and pharmacological therapy in comparison to those induced at later gestational weeks and achieved glycemic control with diet and lifestyle modifications only. Around 77% of women required pharmacological therapy. The mode of delivery was not significantly different for women induced at different gestational weeks after 37 completed weeks. For neonatal outcomes, the birth weight was significantly greater for women induced at later gestational weeks. Conclusions: In women with gestational diabetes induced after 37 weeks at various gestational weeks, the mode of delivery is not significantly different.

An incidental colonoscopy: finding Trichuris trichiura: a case report and review of literature

Trichuris trichiura commonly referred to as whipworm, has a world-wide distribution, particularly countries with warm, humid climates. This parasite is reported from nearly one quarter of the world population, especially from less developed countries. Poor hygiene conditions are associated with trichuris transmission, usually this infection remains asymptomatic in human but heavy infection can lead to chronic bloody diarrhoea associated with complications like rectal prolapsed, appendicitis, proctitis. Very few cases of extensive trichuriasis have been reported world-wide. Usually, diagnosis is confirmed by detection of eggs in stool sample. This case report deals with a patient of trichuriasis, who was diagnosed by detection of the parasite on colonoscopy. Thus, colonoscopy might be a useful diagnostic tool, especially in symptomatic patients who are infected by only few male worms with no eggs in the stool. Hence cannot be diagnosed by conventional methods.

Synthesis and evaluation of 2-phenylamino-1,4-naphthoquinones derivatives as potential hypoglycaemic agents

Abstract Due to the severe side effects revealed by most of the currently used antidiabetic medicines, search for finding new and safe drugs to manage diabetes is continued. Naphthoquinones possessing strong antioxidant properties have been employed as candidates for diabetes therapy. Present study is aimed at finding the antioxidant and hypoglycaemic potential of some novel derivatives of 2-phenylamino-1,4-naphthoquinones (PAN) including chloro, nitro, methyl and bromo (5a-d) derivatives synthesized by single pot experiment. Product crystals were purified by TLC and characterized by FT-IR. The antioxidant potential of the compounds was assayed through DPPH radical scavenging and reducing power activities noted as UV-vis. absorbance. The DPPH assay has showed the powerful antioxidant activity of nitro and bromo derivatives, while the nitro derivative showed the significant reduction potential towards FRAP assay. Hypoglycaemic potential of the compounds was studied in rat animal model. All synthesized compounds revealed better hypoglycaemic activity; however, the chloro-derivative exhibited the more potent hypoglycaemic activity showing about 43% reduction in the mean blood glucose levels of the treated animals. As the bioreduction of naphthoquinones may be influenced by changing its redox properties, it has been noticed that the e-donating resonance effect (+R) of chloro group has shown the significant effects on biological activity through stabalization of its imine form which limits the potential of generation of free radicals during bioreduction of quinones and thus has been proposed as the reason of its hypoglycaemic activity. Future studies employing the properties of e-donating groups of PAN may optimize the drug-receptor interaction for better drug designing and drug development strategies against diabetes and also for the clinical trials.

Resumo Em razão dos graves efeitos colaterais causados pela maioria dos medicamentos antidiabéticos atualmente utilizados, continua a busca por novos medicamentos seguros para o controle do diabetes. As naftoquinonas, que possuem fortes propriedades antioxidantes, têm sido empregadas como candidatas à terapia do diabetes. O presente estudo visa encontrar o potencial antioxidante e hipoglicemiante de alguns novos derivados de 2-fenilamino-1,4-naftoquinonas (PAN), incluindo derivados de cloro, nitro, metil e bromo (5a-d) sintetizados por experimento em pote único. Os cristais do produto foram purificados por TLC e caracterizados por FT-IR. O potencial antioxidante dos compostos foi testado por meio de atividades de sequestro de radicais DPPH e redução de energia observada como absorção no UV-vis. O ensaio DPPH mostrou a poderosa atividade antioxidante dos derivados nitro e bromo, enquanto o derivado nitro mostrou o potencial de redução significativo para o ensaio FRAP. O potencial hipoglicêmico dos compostos foi estudado em modelo animal de rato. Todos os compostos sintetizados revelaram melhor atividade hipoglicemiante; no entanto, o derivado cloro apresentou atividade hipoglicêmica mais potente, com redução de 43% nos níveis médios de glicose no sangue dos animais tratados. Como a biorredução de naftoquinonas pode ser influenciada pela alteração de suas propriedades redox, notou-se que o efeito da doação eletrônica por ressonância (+R) do grupo cloro tem sido significativo na atividade biológica por meio da estabilização de sua forma imina, que limita o potencial de geração de radicais livres durante a biorredução de quinonas, e, portanto, tem sido proposto como a razão de sua atividade hipoglicemiante. Estudos futuros empregando as propriedades de grupos de doação eletrônica de PAN podem otimizar a interação droga-receptor para melhor planejamento de medicamentos e estratégias de desenvolvimento de medicamentos contra o diabetes e também para os ensaios clínicos.

Synthesis and evaluation of 2-phenylamino-1, 4-naphthoquinones derivatives as potential hypoglycaemic agents / Síntese e avaliação de derivados de 2-fenilamino-1, 4-naftoquinonas como potenciais agentes hipoglicemiantes

Due to the severe side effects revealed by most of the currently used antidiabetic medicines, search for finding new and safe drugs to manage diabetes is continued. Naphthoquinones possessing strong antioxidant properties have been employed as candidates for diabetes therapy. Present study is aimed at finding the antioxidant and hypoglycaemic potential of some novel derivatives of 2-phenylamino-1,4-naphthoquinones (PAN) including chloro, nitro, methyl and bromo (5a-d) derivatives synthesized by single pot experiment. Product crystals were purified by TLC and characterized by FT-IR. The antioxidant potential of the compounds was assayed through DPPH radical scavenging and reducing power activities noted as UV-vis. absorbance. The DPPH assay has showed the powerful antioxidant activity of nitro and bromo derivatives, while the nitro derivative showed the significant reduction potential towards FRAP assay. Hypoglycaemic potential of the compounds was studied in rat animal model. All synthesized compounds revealed better hypoglycaemic activity; however, the chloro-derivative exhibited the more potent hypoglycaemic activity showing about 43% reduction in the mean blood glucose levels of the treated animals. As the bioreduction of naphthoquinones may be influenced by changing its redox properties, it has been noticed that the e-donating resonance effect (+R) of 'chloro' group has shown the significant effects on biological activity through stabalization of its imine form which limits the potential of generation of free radicals during bioreduction of quinones and thus has been proposed as the reason of its hypoglycaemic activity. Future studies employing the properties of e-donating groups of PAN may optimize the drug-receptor interaction for better drug designing and drug development strategies against diabetes and also for the clinical trials.

Em razão dos graves efeitos colaterais causados pela maioria dos medicamentos antidiabéticos atualmente utilizados, continua a busca por novos medicamentos seguros para o controle do diabetes. As naftoquinonas, que possuem fortes propriedades antioxidantes, têm sido empregadas como candidatas à terapia do diabetes. O presente estudo visa encontrar o potencial antioxidante e hipoglicemiante de alguns novos derivados de 2-fenilamino-1,4-naftoquinonas (PAN), incluindo derivados de cloro, nitro, metil e bromo (5a-d) sintetizados por experimento em pote único. Os cristais do produto foram purificados por TLC e caracterizados por FT-IR. O potencial antioxidante dos compostos foi testado por meio de atividades de sequestro de radicais DPPH e redução de energia observada como absorção no UV-vis. O ensaio DPPH mostrou a poderosa atividade antioxidante dos derivados nitro e bromo, enquanto o derivado nitro mostrou o potencial de redução significativo para o ensaio FRAP. O potencial hipoglicêmico dos compostos foi estudado em modelo animal de rato. Todos os compostos sintetizados revelaram melhor atividade hipoglicemiante; no entanto, o derivado cloro apresentou atividade hipoglicêmica mais potente, com redução de 43% nos níveis médios de glicose no sangue dos animais tratados. Como a biorredução de naftoquinonas pode ser influenciada pela alteração de suas propriedades redox, notou-se que o efeito da doação eletrônica por ressonância (+R) do grupo "cloro" tem sido significativo na atividade biológica por meio da estabilização de sua forma imina, que limita o potencial de geração de radicais livres durante a biorredução de quinonas, e, portanto, tem sido proposto como a razão de sua atividade hipoglicemiante. Estudos futuros empregando as propriedades de grupos de doação eletrônica de PAN podem otimizar a interação droga-receptor para melhor planejamento de medicamentos e estratégias de desenvolvimento de medicamentos contra o diabetes e também para os ensaios clínicos.

Factors associated with vulnerability of patients to medical errors

Background: Patient safety has been an important concern among quality conscious health-care providers. Patients undergoing hospitalization are vulnerable to harms from various errors during patient care process. The vulnerability may differ from patient to patient depending on certain patient-specific factors. Objective: The objective of the study is to examine the association of certain patient-specific factors with occurrence of medical errors. Materials and Methods: The study used a case–control study design under which patients who faced one or more medical error were taken as cases and those who did not faced any medical errors used as controls. The data constitute of 109 cases and 236 controls over the period of the past 1 year. Five different patient’s factors; age, gender, literacy, income, and language inability were analyzed for their association with the occurrence of medical error. The Statistical Package for the Social Sciences version 16 was used to calculate odds ratio (OR) with confidence interval (C.I.) of 95% and P = 0.05. Results: It was found that old age patients, illiterate patients, and patients with language inability had a significant higher odd of suffering a medical error. The OR of old age patient is 1.22–1.83 (95% C.I., P = 0.001) in comparison to patients who are <60 years. The OR of illiterate patient is 1.75–3.12 (95% C.I., P < 0.001) in comparison to those who are not illiterate and the OR of patients with language problem is 2.32–8.83 (95% C.I., P < 0.001) in comparison with patients with no language problem. The OR of economically backward and gender (male and female) patients was not found to be significant. Conclusion: The study concludes that illiteracy, old age, and language problem when present in patient increase their vulnerability to suffer a medical error.

Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy undergoing modified radical mastectomy

Hypertrophic obstructive cardiomyopathy [HOCM] is a rare genetic disorder characterized by left ventricular outflow tract [LVOT] obstruction. Clinical presentation ranges from absence of symptoms to sudden death. Our 60 year old patient scheduled for left modified radical mastectomy had HOCM since seventeen years with severe LVOT obstruction and mitral regurgitation. An implantable cardioverter defibrillator [ICD] and permanent pacemaker [PPM] was inserted 15 months earlier for ventricular tachycardia. Anesthetic management of these patients presents considerable challenges and requires maintenance of desired hemodynamic parameters and management of specific complications. Factors like tachycardia, hypovolemia, vasodilation and increased cardiac contractility leads to exacerbation of the obstruction. In our patient there was the additional consideration of the ICD which required to be turned off during surgery with full provision for external defibrillation. We managed to successfully maintain the desired hemodynamics throughout the surgery and the patient was discharged home on the seventh postoperative day