Bilateral orbital cellulitis in an infant: An unusual case

Bilateral orbital cellulitis is an uncommon presentation in infants, and its association with rhinosinusitis has been scantily reported in the literature. An infant underwent bilateral uncinectomy and right ethmoidal decompression for bilateral orbital cellulitis with right ethmoidal sinusitis, after a period of non-recovery with conservative treatment. Mixed infection with Escherichia coli and methicillin-sensitive Staphylococcus aureus was observed. The right eyelid swelling began to resolve; however, the left lower eyelid showed an increase in the fluctuant swelling. Transconjunctival incision and drainage of pus was done in the left eye subsequently. The patient showed marked clinical recovery and is doing well. A multidisciplinary management approach can avert potentially life-threatening sequelae of this condition.

Parathyroid Adenoma In A Young Female Presenting With Craniofacial Brown Tumor And Acute Pancreatitis – A Case Report

Solitary Parathyroid adenomas have a diverse clinical presentation. They may be asymptomatic or may sometimes lead to extensive bony resorption and replacement of bone by fibrous tissue, also known as a brown tumor. Brown tumor is a relatively rare presentation of primary hyperparathyroidism and is even rarer in a younger age group. Here, we report the case of a 20-year-old female presenting with craniofacial brown tumor and during the course of hospital stay; she also developed an attack of acute pancreatitis due to hyperparathyroidism. This case report emphasizes the importance of a complete investigative work up in patients presenting with maxillofacial bony lesions for early diagnosis and planning of definitive management.

A Comperative Study Between Tympanoplasty With Cortical Mastoidectomy Versus Tympanoplasty In The Management Of Mucosal Variety Of Chronic Otitis Media

Introduction:Chronic suppurative otitis media (COM), mucosal variety is defined as a chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges or otorrhoea through a tympanic perforation. Aims:To find out the incidence of chronic otitis media with respect to age and sex in the study population and to compare the graft up-take rate, the graft failure rate, the rate of residual perforation and the degree of hearing improvement between the two modalities of treatment of type 1 tympanoplasty with cortical mastoidectomy and type 1 tympanoplasty aloone. Methods:The 80 patients were randomly divided into two equal groups with 40 patients undergoing type 1 tympanoplasty with cortical mastoidectomy (group A) and 40 patients undergoing type 1 tympanoplasty (Group B). Post operatively all the patients were followed up for a total of 6 months with weakly intervals on 1st month; bi weekly on 2nd month; monthly on 3rd and 6th month. Post operatively all the study patients were assessed for the status of the graft; mobility, rejection or residual perforation of the graft and the hearing improvement.ConclusionIn successful graft take up, results of hearing improvement is better in Tympanoplasty with cortical mastoidectomy than with Tympanoplasty alone. Possibility of finding mastoid antral pathology is more in patients having Chronic otitis media (mucosal) with sub total perforation as observed in this study

Scrub typhus: a hospital-based study in the northern districts of West Bengal, India

Background: Scrub typhus caused by Orientia tsutsugamushi, is a mite-borne zoonotic acute febrile illness. Geographically, it is confined to the Asia-Pacific region and important re-emerging infection in India. Clinical diagnosis of scrub typhus from other acute febrile illness is very difficult due to nonspecific symptoms and the relative absence of eschar in the Indian population. Case fatality rate varies from 30-70% depending on the clinical suspicion, delay in diagnosis and treatment. Antibody-based serological tests are the mainstay of diagnosis. IgM enzyme-linked immunosorbent assay (ELISA) against O. tsutsugamushi is helpful for the diagnosis of scrub typhus within the first week of illness.Methods: The aim of the study was to determine the prevalence of the disease in Northern districts of West Bengal, India using IgM ELISA.Results: Out of 577 serum samples tested 10.05% were positive for IgM antibodies. Majority of cases were below 40 years of age with higher prevalence in female patients. The disease showed a seasonal trend with a peak during the monsoon and later months. The case fatality rate among ELISA positive cases was 32.76%.Conclusions: Significant seropositivity against scrub typhus among cases of acute febrile illness with relatively higher mortality indicates that scrub typhus should be included in the differential diagnosis and confirmed by IgM ELISA.

14-3-3 proteins mediate the localization of Centrin2 to centrosome

14-3-3e and 14-3-3c localize to the centrosome and regulate centrosome duplication, by inhibiting cdc25C function. As14-3-3c and 14-3-3e form a complex with centrosomal proteins, we asked if this ability was required to regulate centrosomeduplication. The results in this report demonstrate that 14-3-3e and 14-3-3c form a complex with Centrin2 and that thebinding site is located in the N-terminal EF hand in Centrin2, EF1. A Centrin2 mutant that does not form a complex with14-3-3 proteins displays a punctate cytoplasmic localization and does not localize to the centrosome. These results suggestthat in addition to negatively regulating centrosome duplication as previously reported, 14-3-3 proteins might also berequired for centriole biogenesis by regulating the localization of Centrin2 at the centrosome.

Evaluation of Thyroid Dysfunction in Patients of Chronic Kidney Diseases

Chronic Kidney failures are progressive diseases and are divided into stages 1 to 5 based on the severity. Glomerular filtration rate (GFR) falls as the severity of kidney failure increases. Hypothyroidism was found to be present along with chronic renal failure and a presence of Low T3 was associated with increased chance of mortality due to cardiovascular complications. Significant association was known to exist in between thyroid dysfunction and chronic kidney disease progression. Aims & objectives: To study the pattern of thyroid dysfunction in chronic kidney disease population (who are not dialyses dependent) admitted at a tertiary care hospital of Tripura & to evaluate the correlation existing in between severity of kidney failure and thyroid dysfunction. Methods: 260 chronic kidney disease patients were included in the study. Diagnosis of chronic kidney failure was performed as per criteria laid down by Kidney Disease Outcome Quality Initiative. Blood was drawn for estimation of serum creatinine, GFR and thyroid profile. Data collected were analysed statistically and P≤0.05 was considered statistically significant. The statistical software namely SPSS 15.0 were used for statistical data analysis. Results: Among 260 individuals 138 were male and 122 female with age ranging from 20 to 82 years with mean age of 60.08±11.35 years. Calculation of GFR showed a mean GFR of 35.37±26.20 & mean serum creatinine level of 2.74±1.61mg/dl. Of the 260 patients, 68(26.1%), 74(28.5%), 74(28.5%), 31(11.9%) & 13(5%) patients belonged to CKD Stages 5,4,3,2 & 1 respectively. Low T3 is the most common thyroid dysfunction & the earliest abnormality noticed in CKD patients. The prevalence of low T3 syndrome in this study was 41.5 %( n=108). Increasing trend for Low T3 prevalence with increasing severity of CKD was noticed in this study and was statistically significant(P<O.001). The prevalence seen for LowT3 was CKD1-7.7%; CKD2-16.1%; CKD3-29.7%; CKD4-50% & CKD5- 63.2%. Statistically significant correlation was also seen with increasing prevalence of hypothyroidism & fall in GFR as the severity of kidney dysfunction increased (P<0.001). Conclusion: The present study was done to study the correlation of thyroid dysfunctions and chronic kidney diseases. It was observed that hypothyroidism both subclinical and overt exist with CKD and the most early and common dysfunction was lowT3 syndrome. The prevalence of thyroid dysfunction increase significantly as kidney failure progress .Low T3 is associated with increased chance of mortality due to cardiovascular complications and serves as a prognostic indicator in CKD individuals.

Protective effects of melatonin in endosulfan induced immunomodulation and their association with oxidative stress markers in rats

Endosulfan toxicity affects the nervous system as well as immunological functions. It also causes oxidative stress and subsequent mitochondrial dysfunction. In the present study, we tried to evaluate the protective effects of melatonin on endosulfan (END) induced immunological and biochemical changes in rats. Wistar rats (200-250 g, n=8/group) were immunized with fresh SRBC (0.5×109 cells/kg) and were exposed to END (4-16 mg/kg, orally), simultaneously exposed animals were treated with vehicle or melatonin (10 and 50 mg/kg) for 14 days. On day 15, their blood and spleen was collected for immunological assays and oxidative stress markers. Endosulfan (8 and 16 mg/kg) significantly suppressed (i) anti-SRBC antibody titer; (ii) footpad thickness; (iii) spleen PFC counts; and (iv) Th1 (IFN-γ) & Th2 (IL-4) and significantly increases serum TNF-α level as compared to controls (P <0.05 in all parameters). Endosulfan induced immunological changes were found associated with changes in oxidative stress markers as evidenced by the results of this study. Endosulfan, while significantly decreased GSH, SOD and CAT activity (P <0.05), it increased serum TBARS activities (P <0.001). These endosulfan induced changes in immunological and biochemical parameters were found significantly reversed by the treatment with melatonin (10 and 50 mg/kg) in a dose dependent manner by differential degrees. Results of the present immunological and biochemical data suggest the protective role of melatonin in endosulfan induced immunomodulation which is associated with oxidant/antioxidant imbalance.

Cellular and molecular mechanisms of action of polyherbal preparation UNIM-352 in experimental models of bronchial asthma.

Bronchial asthma is a chronic inflammatory disorder of the airways and pharmacotherapy is dependent on anti-inflammatory and bronchodilator agents. However, adverse effects of these agents on chronic administration and sometimes non-responsiveness to these drugs have prompted the search for viable alternatives from medicinal plant sources. UNIM-352 is a polyherbal preparation traditionally used in the Unani system of Indian medicine for the treatment of bronchial asthma. The present study defines the possible cellular and molecular mechanisms of action of UNIM-352 in experimental models of bronchial asthma and validates the observed therapeutically beneficial effects. Wistar rats were immunized and challenged with ovalbumin, and blood and bronchoalveolar lavage (BAL) fluid were assayed for cytological and biochemical markers. UNIM-352 (200 and 400 mg/kg) markedly reduced the eosinophil and neutrophil counts in both blood and BAL compared to control. The polyherbal agent also attenuated the levels of TNF-α, IL-4, GM-CSF and NF-κB whereas histone deacetylase (HDAC) levels were elevated, in both blood and BAL fluid. All effects of UNIM-352 were comparable with the standard drug, prednisolone. The results demonstrated possible cellular and molecular mechanisms of UNIM-352 and thus explain its beneficial effects in bronchial asthma.

Unilateral lung hypoplasia: A rare cause of unilateral opaque hemithorax in chest X-ray in a young boy.

Congenital abnormalities of lung are very rare entity, and very often under or misdiagnosed by physicians. The present case, a 12-year boy, who was initially diagnosed as unilateral massive pleural effusion with collapse of lung, and after thorough investigation, including CT scan of thorax, fiber-optic bronchoscopy, and echocardiography, a final diagnosis of unilateral lung hypoplasia was made. So if a teenager present with a unilateral opaque hemithorax in chest X-ray, this entity may be a differential diagnosis.

Role of therapeutic thoracentesis in tuberculous pleural effusion

Prevalence of tuberculous pleural effusion is very high in the Asian subcontinent but very few studies have come up from this part of the world about the course of recovery of pulmonary functions after institution of anti-tubercular therapy [ATT] and thoracentesis. To study initial lung function impairment, changes over time after institution of ATT and thoracentesis and residual abnormalities left at the end of six months of treatment. Randomized open level interventional study over two years in 52 patients at a tertiary level teaching hospital. The study population was divided into two equal groups, A [therapeutic thoracentesis] and B [diagnostic thoracentesis]. Spirometry, chest radiograph and ultrasonography of thorax were done initially and at each follow-up visit up to six months. Statistical analysis was done [P value < 0.05 considered significant]. Both groups were comparable initially. After six months none in group A and five patients in group B had minimal pleural effusion. During follow up, mean percentage predicted of FEV1 and FVC increased more in A than in B and the differences were statistically significant [P < 0.05]. Pleural thickening, initially absent in both groups, was found to be more in B as compared to A at subsequent follow-up visits and this was statistically significant [P < 0.05]. Thoracentesis should be considered in addition to anti-TB treatment, especially in large effusions, in order to relieve dyspnea, avoid possibility of residual pleural thickening and risk of developing restrictive functional impairment

Hydatid cyst of liver: A case with an unusual clinical presentation.

Hydatid cyst caused by the parasite Echinococcus most commonly involve liver and usually presented with right hypochondrial pain which may be associated with jaundice, urticarial skin rashes, pruritus etc., We report here a case of 32 years old young lady who clinically presented with acute exacerbation of bronchial asthma of recent onset. Her chest x-ray was unremarkable except slightly pushed up diaphragm on right side. Ultrasonography of abdomen revealed a cyst in the right lobe of liver, suggestive of hydatid cyst. Following confirmation of diagnosis by computed tomography (CT)-guided Fine Needle Aspiration Cytology (FNAC) surgical resection of the cystic lesion was done. On subsequent follow up for one year she was found to be cured of bronchial asthma. This case of hepatic hydatid cyst is reported here for its unique clinical presentation exclusively with bronchial asthma which completely subsided with resection of the cyst.

Free medical care and consumer protection.

This paper will examine the question of whether patients, who receive free medical care, whether from private charitable or governmental hospitals, can claim rights as ‘consumers’ under the Consumer Protection Act, 1986. The issue will be discussed from a constitutional perspective as well as that of the law of torts

A rare case of concurrent multiple primary lung cancer of different histological types.

Occurrence of concurrent multiple primary malignancies with different histopathological presentations of the same organ at the same time is often not diagnosed and rarely reported in the literature. We present a case of multiple primary lung cancers with hepatic metastasis where the patient had a moderately differentiated adenocarcinoma of the right lower lobe and a moderately differentiated squamous cell carcinoma of the right upper lobe.

Effects of diesel exhaust, heavy metals and pesticides on various organ systems: Possible mechanisms and strategies for prevention and treatment.

Environmental pollutants have a significant impact on the ecosystem and disrupt balance between environment, human and non-human components that result in deleterious effects to all forms of life. Identifying environmental factors for potential imbalance are extremely crucial for devising strategies for combating such toxic dysregulation. Automobile exhaust (in air), heavy metals (in food and water) and pesticides (in air, food, soil and water) are the most common environmental pollutants and their short and long term exposures can cause hazardous effects in humans leading to systemic disorders involving lungs, kidney and immune systems. Mechanisms involved in genesis of such toxic effects have revealed complex, interactive pathways. Strategies for the protection of homeostasis and health, viz., general preventive measures, nutritional supplements and herbal agents have been described, to counter these pollutants induced damaging effects on various body systems.

Evaluation of physicochemical properties and in-vitro release profile of glipizide-matrix patch

OBJECTIVES: The aim of the present investigation was to form matrix patches with ethyl cellulose (EC) as the base polymer, polyvinyl pyrrolidone (PVP) as the copolymer, plasticizer with dibutyl phthalate (DBP) or acetyl tributyl citrate (ATBC) and the drug glipizide (gz) by the solvent casting method. Physicochemical properties of the patches and in vitro drug release were determined in a modified Keshary-chien diffusion cell to optimize the patch formulations with the help of experimental data and figures for further studies. TECHNIQUES: EC and PVP of different proportions with different weight percentages of either DBP or ATBC and a fixed amount of glipizide were taken for matrix patch formations. The dried patches were used for measuring their drug contents as well as their thicknesses, tensile strengths, moisture contents and water absorption amounts in percentage. In vitro release amounts at different intervals were measured by UV-spectrophotometer. RESULTS: Drug contents varied from 96 - 99 percent. Thickness and tensile strength varied due to weight variation of the ingredients in the matrix patches. Moisture content and water absorption in wt percent were greater for the patches containing higher amount of PVP due to its hydrophilic nature. Variations in drug release were observed among various formulations. It was found that all of the releases followed diffusion controlled zero order kinetics. Two DBP patches yielded better and more adequate release. CONCLUSIONS: The two formulations with DBP were the preferred choice for making matrix patches for further studies.

O objetivo da presente pesquisa foi formar matrizes para bandagens de liberação transdérmica com etilcelulose (EC) como polímero base, polivinilpirrolidona (PVP), como copolímero, plastificante com ftalato de dibutila (DBP) ou citrato de tributilacetila (ATBC) e o fármaco glipizida (gz) pelo método de evaporação do solvente (moldagem com solvente). As propriedades físico-químicas das bandagens e a liberação do fármaco in vitro na célula de difusão de Keshary-chien modificada foram determinadas para aperfeiçoar as formulações das bandagens com o auxílio de dados experimentais e figuras para estudos posteriores. EC e PVP em diferentes proporções com porcentagens diferentes de massa tanto de DBP quanto de ATBC e quantidade fixa de glipizida foram utilizadas como matrizes para a formação de bandagens de liberação transdérmica. As bandagens secas foram empregadas para medir seus conteúdos em fármaco e, também, a sua espessura, resistência à tensão, conteúdos de umidade e porcentagem de absorção de água. As quantidades liberadas in vitro em diferentes intervalos de tempo foram medidas por espectrofotômetro de UV. Os conteúdos de fármaco variaram de 96 a 99 por cento. A espessura e a resistência à ruptura variaram devido à variação de massa dos componentes da matriz das bandagens. O conteúdo de umidade e a água absorvida, em porcentagem de massa, foram maiores para as bandagens que continham grandes quantidades de PVP devido à sua natureza hidrofílica. As variações na liberação de fármaco foram observadas entre as várias formulações. Todas as liberações seguiram a cinética de difusão controlada de ordem zero. Duas bandagens DBP resultaram em melhor e mais adequada liberação. As duas formulações com DBP foram escolhidas para a preparação de matriz de bandagens para estudos posteriores.

Assessment of protective role of polyherbal preparation, Livina, against anti-tubercular drug induced liver dysfunction.

The present study evaluated the possible protective role of Livina (a polyherbal preparation) against anti-tubercular therapy (ATT)-induced liver dysfunction in patients of pulmonary tuberculosis. Patients were given intensive phase treatment with 4-drugs (rifampicin, INH, pyrazinamide and ethambutol) used for anti-tubercular therapy for 2 months, followed by a 4-month continuous phase treatment with 2 drugs (rifampicin and INH) under clinical advice and supervision. Both qualitative and quantitative measures of liver function were assessed, at different time intervals, before and after ATT. Analysis of data showed that the incidence of qualitative manifestations of liver dysfunction were greater in the placebo treated group as compared to the test drug group. None of the patients of either group showed clinical jaundice. Most signific changes ant were observed in the SGOT and SGPT levels in the placebo group, wherein the levels of both enzymes were higher at 4 and 8 weeks post–ATT, as compared to the respective baseline (0 week) values. When Livina (2 capsules twice daily) was given with ATT drugs, incidence of qualitative manifestation of liver dysfunction was insignificant and SGOT and SGPT levels were also significantly lower than the placebo+ATT drugs treated group. These results indicate that the test drug (Livina) was efficacious, against ATT-induced hepatic dysfunction in patients of pulmonary tuberculosis.

Plasma cell granuloma of lung.

A 10 years old girl presented with fever, cough, haemoptysis, dyspnoea on exertion of two months duration. Chest skiagram and CT-scan of thorax revealed well defined mass lesion of varying density occupying right upper and middle lobes with areas of calcification. On thoracotomy, a huge mass in the right upper lobe was resected and hispathological examination proved it to be a case of plasma cell granuloma.

Involvement of nitric oxide (NO) in the regulation of stress susceptibility and adaptation in rats.

The present study evaluated the regulatory role of nitric oxide (NO) in stress susceptibility and adaptation in rats. Acute restraint stress (RS x1) reduced the number of entries and time spent in the open arms in the elevated plus maze (EPM) test and raised plasma corticosterone levels. RS (x1)-induced neurobehavioral suppression and raised corticosterone levels were attenuated by pretreatment with the NO precursor, L-arginine (500 and 1000 mg/kg)and unaffected or further aggravated by NO synthase inhibitor, L-NAME or 7-nitroindazole (10 and 50 mg/kg). Biochemical assay of plasma and brain homogenates showed that these RS - induced behavioral and neuroendocrinal changes were associated with lowered levels of plasma and brain total nitrates/nitrites (NOx). L-Arginine attenuated the RS-induced suppression of NOx levels in plasma and brain, whereas, the NO synthase inhibitors tended to produce reverse effects. In the experiments involving repeated stress i.e. RS (x5), exposure resulted in attenuation/reversal of (a) neurobehavioral suppression in the EPM test and (b) lowered brain NOx, that was seen after RS (x1). The RS (x5)-induced changes in EPM parameters and brain Nox were further potentiated after L-arginine pretreatment, whereas, the NO synthase inhibitors were less effective. Rats were screened as high and low emotional in the open-field test, and high emotional rats showed greater(a) behavioral suppression in the EPM, (b) corticosterone responses (c) brain NOx suppression, and (d) cold-restraint stress (CRS) induced gastric mucosal lesions as compared to their low emotional counterparts. L-Arginine pretreatment was more effective in modulating the above RS induced stress responses/markers in the high emotional group of rats. Our data suggest that NO plays a differential role during exposure to acute and repeated stress situations, and that the relationship between stress and emotionality status may be under the regulatory influence of NO.

Role of free radicals in stress-induced neurobehavioural changes in rats.

Effect of restraint stress (RS) and its modulation by antioxidants were evaluated on elevated plus maze (EPM) and open field (OF) tests in rats. Restraint stress (RS for 1 hr) reduced the number of open arm entries, as also the time spent on open arms indicating enhanced anxiogenic response in the EPM test as compared to normal non RS group of rats. Pretreatment with ascorbic acid (100 and 200 mg/kg) and alpha-tocopherol (30 and 60 mg/kg) attenuated these RS-induced effects. In the OF test, RS-reduced (a) ambulations; and (b) rearings, whereas an increase was seen in (a) latency of entry and (b) number of fecal boluses. The RS-induced changes in OF parameters were reversed after pretreatment with the antioxidants, (ascorbic acid and alpha tocopherol). Biochemical data showed that RS enhanced MDA levels in both serum and brain, and these were attenuated after pretreatment with the antioxidants. The pharmacological and biochemical results indicate that free radicals might be involved in such stress-induced neurobehavioural effects.

Pharmacological studies on mechanisms of aminophylline-induced seizures in rats.

In the present study, the possible role of free radicals in aminophylline-induced seizures was evaluated in albino rats. Aminophylline (theophylline in ethylene diamine; 50 - 300 mg/kg) induced convulsions in rats in a dose-dependent manner, and both incidence of seizure and mortality were maximum at 300 mg/kg. Conventional anti-epileptics, diphenylhydantoin and dizocilpine, as well as adenosine agonists were ineffective in antagonizing these seizures. On the other hand, phosphodiesterase inhibitors, pentoxyphylline and rolipram, showed insignificant seizurogenic effects. Pretreatment with antioxidants (ascorbic acid, alpha-tocopherol, and melatonin) showed differential attenuating effects on aminophylline seizures and lethality. Further, prior administration of 1-buthionine sulfoxamine (BSO, glutathione depletor) and triethyltetramine (TETA, superoxide dismutase inhibitor), precipitated seizures and enhanced lethality in response to subthreshold doses of aminophylline. The present results suggested of the possible involvement of oxidative stress during aminophylline-induced seizures.