Anomalous right coronary artery from distal left circumflex coronary artery:a rare case report

Coronary artery anomalies (CAAs) being a group of congenital disorders, present with highly variable manifestations andhave diverse pathophysiological manifestations. In middle aged to elderly patients, a coronary anomaly is often an incidental finding.We presenteda case of 65-year-old female with history of diabetes for past 9 years who presented to our emergency department with history of exertional chest pain for past 4 weeks. Anomalous origin of right coronary artery (RCA) from distal left circumflex artery (LCX) was observed on coronary angiography. Patient was managed with optimised medical therapy (OMT).

Is the use of high-intensity atorvastatin associated with memory impairment?

High-intensity statins are the cornerstone of medical management in Acute Coronary Syndromes (ACS). However, their effect on neurocognition are less clear. In this prospective observational study, we gave guideline-directed high-intensity atorvastatin 40 mg to middle-aged statin-naïve ACS patients. Memory assessments were performed before and 6 months after statin therapy using 2 validated scales-the PostGraduate Institute Memory Scale (PGI-MS), and the Logical Memory Passage Test (LMPT). There was no significant difference in the mean PGI-MS test scores (baseline 75.4 ± 7.9, 6months 76.5 ± 8.2;p ¼ 0.26) or the overall composite scores (baseline 32.02 ± 3.2, 6months 32.8 ± 3.1; p ¼ 0.20), after 6 months of statin use. There was a small improvement in immediate recall (baseline score 8.5 ± 2.5, 6 months 9.04 ± 1.8; p ¼ 0.05), and delayed recall (baseline 6.1 ± 2.6, 6 months 6.9 ± 1.9, p ¼ 0.002). High-intensity atorvastatin use did not affect memory at 6 months among statin-naïve middle-aged patients with ACS.

Target-based anticancer indole derivatives and insight into structure‒activity relationship: A mechanistic review update (2018-2021)

Cancer, which is the uncontrolled growth of cells, is the second leading cause of death after heart disease. Targeting drugs, especially to specific genes and proteins involved in growth and survival of cancer cells, is the prime need of research world-wide. Indole moiety, which is a combination of aromatic-heterocyclic compounds, is a constructive scaffold for the development of novel leads. Owing to its bioavailability, high unique chemical properties and significant pharmacological behaviours, indole is considered as the most inquisitive scaffold for anticancer drug research. This is illustrated by the fact that the U.S. Food and Drug Administration (FDA) has recently approved several indole-based anticancer agents such as panobinostat, alectinib, sunitinib, osimertinib, anlotinib and nintedanib for clinical use. Furthermore, hundreds of studies on the synthesis and activity of the indole ring have been published in the last three years. Taking into account the facts stated above, we have presented the most recent advances in medicinal chemistry of indole derivatives, encompassing hot articles published between 2018 and 2021 in anticancer drug research. The recent advances made towards the synthesis of promising indole-based anticancer compounds that may act via various targets such as topoisomerase, tubulin, apoptosis, aromatase, kinases, etc., have been discussed. This review also summarizes some of the recent efficient green chemical synthesis for indole rings using various catalysts for the period during 2018-2021. The review also covers the synthesis, structure‒activity relationship, and mechanism by which these leads have demonstrated improved and promising anticancer activity. Indole molecules under clinical and preclinical stages are classified into groups based on their cancer targets and presented in tabular form, along with their mechanism of action. The goal of this review article is to point the way for medicinal chemists to design and develop effective indole-based anticancer agents.

Effects of antenatal corticosteroids administration on fetoplacental circulation in preterm pregnancies with intrauterine growth restriction and its correlation with perinatal outcome

Background: Antenatal corticosteroid administration in preterm pregnancies is recommended to promote fetal lung maturation. Studies have reported temporary reduction in fetal heart rate, breathing and movements following maternal corticosteroid administration. Authors studied effect of maternal corticosteroid administration on fetoplacental circulation in preterm pregnancies with IUGR and its correlation with perinatal outcome.Methods: Observational study included 77 preterm singleton pregnant women with IUGR. Color doppler day 0 (before betamethasone) of umbilical artery of 77 cases done. All received two doses of 12 mg of betamethasone intramuscularly 24 hours apart. Umbilical artery doppler on day 2 (24 to 48 hours of 1st dose of betamethasone) and day 4 (72 to 96 hours of 1st dose of betamethasone) done. Pulsatility index (PI) of umbilical artery on doppler and Neonatal details of all women noted.Results: On day 2 doppler, 56 (73%) women (Group A) showed decrease in umbilical artery PI while 21 (27%) women (Group B) did not show decrease in umbilical artery PI. Mean umbilical artery PI of 77 cases on day 0 and day 2 were 1.73±0.73 and 1.54±0.76 respectively (p<0.001). Mean Umbilical artery PI values of undelivered 60 cases on day 0, day 2 and day 4 were 1.55±0.61, 1.33±0.55 and 1.47±0.63 respectively (p<0.001). Group B neonates had poorer Apgar scores, higher neonatal complication, longer hospital stay, lesser umbilical pH at birth and higher perinatal mortality rate than Group A neonates.Conclusions: Significant reduction in mean umbilical artery PI observed on day 2 following betamethasone administration (p<0.001), which was maintained till 4th day after 1st dose of betamethasone (p<0.05). Women who showed improvement in umbilical artery pulsatility index following betamethasone administration had a better perinatal outcome as compared to women who did not.

Emerging Threat of Salmonella typhimurium in Extraintestinal Infections: Cases from a Tertiary Care Hospital in North India

Purpose:Infections due to invasive non-typhoid salmonella can be dangerous and fatal. The mode of infection and the severity varies from the typhoidal fevers. It is important to find the association between clinical features and the infecting serovar to understand the pathophysiology and course of treatment Methods:In the present study, extra-intestinal specimens (blood, cerebrospinal fluid and pus) from three patients suffering from septicaemia, meningitis and osteomyelitis were received. Micro-biological and biochemical test for species identification and antibiotic susceptibility was done as per standard protocol.Further, PCR based amplification and sequencing of a portion of the flagellin gene (FliC) was done to confirm the serovar.Results: Salmonellaentericawas identified from all the threeby microbiological and biochemical examination.The sequence of the Flic gene confirmed the serovar to be S.typhimurium. All the patients were treated successfully for the infectionby appropriate antibiotic therapy. Conclusion:The study highlights that serovarTyphimurium is common in invasive non-typhoidal salmonellosis and its pathophysiology and virulence factors expression should be understood in various organ types for better treatment options and outcomes

Murraya koenigii Derived Phytochemicals against Dysentery

Phytochemicals are any of various biologically active compounds found in plants. These are produced by plants and have biological activity. It has been reported that Murraya koenigii leaf extract is traditionally used to cure dysentery. Dysentery is an intestinal inflammation, primarily of the colon. It can lead to mild or severe stomach cramps and severe diarrhoea with mucus or blood in the faeces. It is the infection in the intestinal tract. One enzyme, which is involved in its biochemical pathway, is known as alcohol dehydrogenase (which have pdb id.1Y9A). The molecular docking was studied by biovia discovery studio. In which the interaction is done between the phytochemical of the plant with the enzyme. The stability of the interaction was evaluated based on –CDocker energy and –CDocker interaction energy.

Evaluation of memory in persons with mesial temporal lobe sclerosis: A combined fMRI and VBM study

Persons with drug refractory TLE have the option of being managed by surgery. They may develop memoryimpairment with specific etiology of mesial temporal sclerosis and anterior temporal lobe resection (ATLR).The study evaluated the semantic verbal memory outcomes in pre- and post-surgery temporal lobe epilepsy(TLE) patients using functional MRI and voxel morphometric methods. Twenty consecutive persons withdrug-resistant epilepsy (DRE) and 20 healthy controls were recruited after obtaining the institute ethicsapproval. The fMRI scans were performed on a 1.5 T MR Scanner using standardized semantic verbal memorytasks using a native Hindi paradigm, before and after an anterior temporal lobectomy (in cases). A task-basedfunctional connectivity (FC) was estimated using a conn toolbox. Data analysis was carried out using thestatistical parametric imaging (SPM12) and CAT12 toolbox. Post-surgery TLE group showed increased robustFC in the right middle and posterior temporal regions as compared to pre-surgery session. A significantreduction in grey matter volume was observed in the left temporal lobe post-operatively as compared to presurgery and healthy control groups. In the post-surgery TLE group, neuropsychological scores were reduced inspecific PGI domains such as visuospatial, working memory, and executive functioning. Our results may helpin understanding of memory reorganization in TLE post-operatively.

Evaluation of Vitamin D Status in Children with Nephrotic Syndrome in Remission in a Tertiary Care Hospital of North India

Childhood nephrotic syndrome (NS) is characterized by massive proteinuria, hypoalbuminemia, hyperlipidemiaassociated with peripheral edema. Children with NS lose 25-OH vitamin D binding protein in urine, and canhave low blood levels of this metabolite. The present hospital-based study was carried out on a total of 50children with nephrotic syndrome who are in remission, in the age group of 1-15 years of either gender,attending to our pediatric nephrology clinic. 46% had clear deficiency of vitamin D, while insufficiency waspresent in 28% and normal levels in only 26% of patients. There was significant difference (p<0.05) in 25-OHvitamin D levels between frequent relapsers (FR) as compared to infrequent relapsers (IR) and first episode ofnephrotic syndrome. Hypocalcemia was present in 86% of patients, hypophosphatemia in 10% of patients,hyperphosphatemia in 50% and raised alkaline phosphatase in 36% of patients. Strong positive correlation isobserved between serum calcium and vitamin D levels (r=0.720; p<0.001) and moderate negative correlationbetween phosphorous and vitamin D levels (r= -0.577; p<0.001, but insignificant relation between vitamin Dand alkaline phosphate levels (r= -0.248; p<0.082). It is concluded that vitamin D deficiency is commonamong children with nephrotic syndrome even after remission of proteinuria. There exists a strong positivecorrelation between serum calcium and vitamin D levels.

Spot protein/creatinine ratio as a marker for fetomaternal outcome in hypertensive disorder of pregnancy

Background: Gestational hypertension is defined as systolic BP level of > 140 mmHg or a diastolic BP of > 90 mmHg that occur after 20 weeks of gestation. Pre-eclampsia is the hypertensive disorder of pregnancy, associated with adverse fetomaternal complications. It is assosciated with proteinuria. 24 hours urine collection is cumbersome, time consuming and potentially misleading if collected inaccurately. The spot P/C ratio has been considered equivalent to 24-hour urinary protein for predicting proteinuria. Aim of study was to compare spot P/C ratio to 24 hours urinary protein in patients of pre-eclampsia and to determine the fetomaternal outcome in the patients admitted in Dayanand Medical College and Hospital, Ludhiana.Methods: A prospective simple random study. It included 100 hypertensive pregnant women being evaluated for pre-elampsia, regardless of the alerting signs or symptoms. The main measures were the urinalysis of patients which included urinary spot P/C and 24 hours urinary protein excretion and the fetomaternal outcome in these patients. The data was statistically analyzed.Results: A good positive correlation existed between the P/C ratio and 24 hours protein excretion, with a correlation coefficient (r) of 0.912. The sensitivity and specificity of 24 hours urinary protein versus spot P/C ratio ranged between 86.29%-99.51% and 8.35%-99.95% respectively. The positive and negative likelihood ratio of 24 hours urinary protein versus spot P/C ratio was 48 (ranged between 6.89-334) and 0.04 (ranged between 0.01-0.16) respectively. The positive and negative predictive value of 24 hours urinary protein versus spot P/C ratio was 97.96% and 96.08% respectively. Our data showed that urine spot P/C ratio above 3.9/mg strongly predicts significant proteinuria of more than 4 gram/day.Conclusions: Spot urinary P/C ratio with suspected preeclampsia can be used as a rapid alternative test to 24 hours urinary protein.

Evaluation of renal function in subclinical and overt hypothyroidism

Background: Thyroid hormones can cause significant changes in renal function such as decrease in sodium re-absorption in the proximal tubules, impairment in the concentrating and diluting capacities of the distal tubules, a decrease in the urinary urate excretion and a decrease in the renal blood flow and glomerular filtration rate (GFR). This study was therefore planned to analyse the changes in biochemical markers of renal function in patients with subclinical and overt hypothyroidism and to correlate these values with the thyroid profile of the patients with an aim to determine whether thyroid dysfunction has deleterious effects on renal function.Methods: Study was conducted on 200 patients, in the age group of 20-70 years, in the Department of Medicine, in collaboration with Department of Biochemistry, GMC Jammu over a period of 6 months. After centrifugation, the serum was divided into 2 aliquots: one for renal function tests and the other for thyroid function tests.Results: Age wise, mean was found to be 33.2±9.3 years for euthyroid group and 42.8±8.7 years for hypothyroid group. Patients with both subclinical hypothyroidism and overt hypothyroidism showed statistically significant rise in TSH levels as compared to controls.Conclusions: It was seen that primary hypothyroidism is associated with a reversible elevation of serum creatinine in adults as well as children. It is believed that renal impairment with hypothyroidism is due to reduced cardiac output and increased systemic and renal vasoconstriction leading to reduced renal blood and plasma flow and decreased GFR.

Correlation between Peripheral Blood Thrombocytopenia and Bone Marrow Findings – A Study of 100 Cases

Thrombocytopenia (platelet count less than 150,000/µl) is commonly encountered in routine hematological investigations. Here we present a study done to understand the prevalence of various conditions leading to thrombocytopenia, referred for bone marrow examination. It is a retrospective study done on 100 cases of thrombocytopenia referred for bone marrow examination in a tertiary care hospital from January 2016 to October 2016. The commonest cause of thrombocytopenia for which bone marrow was sought came out to be megaloblastic anemia followed by acute leukemia and aplastic anemia. Aim: Calculate the prevalence of various conditions causing thrombocytopenia, in cases referred for bone marrow examination, and Understand the various megakaryocytic alterations in hematological disorders presenting with thrombocytopenia due to different mechanisms. Methods: A retrospective study was done on 100 patients of thrombocytopenia referred for bone-marrow aspiration in a tertiary care hospital catering to both rural and urban population from January 2016 to October 2016. All cases of thrombocytopenia (platelet count less than 1,50,000/µl) diagnosed on hematology analyzer and later confirmed by peripheral blood film examination, referred for bone marrow examination for various reasons were included in this study. Stained bone-marrow aspirate smears were examined. Records regarding the clinical indication for the procedure, peripheral blood smear reports, blood counts and significant findings on bone-marrow aspiration smears were retrieved. The role of bone-marrow aspiration in the diagnosis of hematological and non- hematological disorders was reviewed in the study. Results: The commonest cause of thrombocytopenia for which bone marrow examination was sought was megaloblastic anemia(76%), followed by acute leukemia(7%), aplastic anemia(5%), myelodysplastic syndrome (4%) which was followed by ITP(3%), and one case each of gelatinous marrow transformation, malaria and NHL spillover. Conclusion: Further studies on the evaluation of megakaryocytic alteration and their contribution to thrombocytopenia can provide growing knowledge to the pathogenesis of numerous hematopoietic disorders that may identify broader clinical applications of the newer strategies to regulate platelet count and functioning.

Influence of the timing of administration of crystalloid on maternal hypotension during low dose spinal anesthesia for elective cesarean delivery: Preload versus coload

Background: Spinal induced maternal hypotension is a common problem during cesarean delivery. Timing of infusion of crystalloid may be important because of its short stay in intravascular space. Aim: This study was conducted to compare effectiveness of preloading and co-loading with crystalloid in prevention of spinal anesthesia induced maternal hypotension during caesarean section. Material and Methods: In total 62 parturients were randomized to two groups. Preload group (Group P) received 15 ml/kg of Ringer Lactate solution over 20 min before giving low dose (2 ml, 0.5% hyperbaric Bupivacaine) spinal anesthesia and coload group (Group C) were given same volume of Ringer Lactate solution as fast as possible after CSF tapping and Bupivacaine injected. Non-invasive BP measurements were recorded. The incidence of hypotension and dose of inj. Mephentermine were checked. Blood pressure, heart rate, nausea and neonatal outcome were assessed. Results: The incidence of hypotension, blood pressure drop and dose of Mephentermine was lower in the coload group compared to the preload group (significant p<0.05). The incidence of nausea was also lower in the coload group. No significant differences in neonatal outcome. Arpit Singhal, Ashima Gupta, S.P. Chittora. Influence of the timing of administration of crystalloid on maternal hypotension during low dose spinal anesthesia for elective cesarean delivery: Preload versus coload. IAIM, 2019; 6(5): 16-21. Page 17 Conclusion: In case of using crystalloids (ringer lactate) for cesarean delivery, coload is more effective than preload for the prevention of maternal hypotension after spinal anesthesia for caesarean delivery.

Comparative Study of Bone Marrow Aspiration and Bone Marrow Trephine Biopsy in Haematological and Non-Haematological Disorders

Background: This study was conducted in the Department of Pathology, GMC Patiala on 100 patients over period of three years with the objective to study the comparison of the bone marrow aspiration and bone marrow trephine biopsy in haematological and non-haematological disorders in elderly age patients.(Age >50years). Methods: 100 cases with different hematological and non-hematological problems were taken up for the present study with age >50 years. Salah”s bone marrow aspiration needle and Jamshidi’s bone marrow biopsy needle were used to collect the samples. For staining Leishmann’s and H&E stains were used. Results: Majority of the cases were in the age of 50-60. Majority of haematological disorders comprised of anaemia (62%), leukemia(17.7%), multiple myeloma (7.5%), primary myelofibrosis(2.5%), myeloproliferative disorders(2.5%), hypocellular marrow (2.5%), increased eoisinophils and precurcors(1.2%), NHL (1.2%) lymphocytosis(1.2%) and plasmacytosis (1.2%). Both of the 2 cases of non-haematological disorders were of metastatic carcinomatous deposists. Conclusion: The bone marrow aspiration and trephine biopsy were comparative in most of the haematological disorders except in primary and secondary myelofibrosis where biopsy provided clue to the diagnosis. Non-haematological disorders showed the same findings.

Current Status of Stem Cell Treatment for Type I Diabetes Mellitus

BACKGROUND: Diabetes mellitus is a major health concern in current scenario which has been found to affect people of almost all ages. The disease has huge impact on global health; therefore, alternate methods apart from insulin injection are being explored to cure diabetes. Therefore, this review mainly focuses on the current status and therapeutic potential of stem cells mainly mesenchymal stem cells (MSCs) for Type 1 diabetes mellitus in preclinical animal models as well as humans. METHODS: Current treatment for Type 1 diabetes mellitus mainly includes use of insulin which has its own limitations and also the underlying mechanism of diseases is still not explored. Therefore, alternate methods to cure diabetes are being explored. Stem cells are being investigated as an alternative therapy for treatment of various diseases including diabetes. Few preclinical studies have also been conducted using undifferentiated MSCs as well as in vitro MSCs differentiated into β islet cells. RESULTS: These stem cell transplant studies have highlighted the benefits of MSCs, which have shown promising results. Few human trials using stem cells have also affirmed the potential of these cells in alleviating the symptoms. CONCLUSION: Stem cell transplantation may prove to be a safe and effective treatment for patients with Type 1 diabetes mellitus.

A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study

ABSTRACT BACKGROUND: The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD) patients. DESIGN AND SETTING: Prospective study in tertiary-level care center. METHODS: Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS: The patients' average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94%) and hypoalbuminemia (72%) were common. Diabetes mellitus (68%), hypertension (34%) and coronary artery disease (18%) were major comorbidities. Forty-five patients (90%) had been on hemodialysis for six months to three years. The patients' pre-dialysis mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P < 0.01). The increase in mean FEV1/FVC, from 97.8 ± 20.8% to 99.3 ± 20.1% of predicted, was not significant (P > 0.05). The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05). The mean peak expiratory flow was below normal (43.8 ± 30.7%) and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05). Males and females showed similar directions of change after hemodialysis. CONCLUSIONS: Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.

Direct detection of rpoB and katG gene mutations of Mycobacterium tuberculosis in clinical samples

Objectives To study the rpoB and katG gene mutation rate and its markers. Methods Cross-sectional study methods were used to study Tuberculosis. A total of 45 sputum samples were collected from Annapurna Neurological Institute and Allied sciences. Then, acid fast bacilli staining were performed. Positive and negative samples were carried for conventional polymerase chain reaction identification and electrophoresis. Results Out of 45 samples, 3 were acid fast bacilli positive and the rest were negative. Male participants were more as compare to female participants and the mutation in rpoB and katG gene was found similar i.e. 6.66% among the total samples. Conclusions We can conclude that genetic mutation in Mycobacterium tuberculosis can be identified directly from the clinical samples. However, we have carried this study in less sample size and to validate research on large number of sample is recommended.

High Origin of Radial Artery- A Cadaveric Case Report.

Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding.

Validation of ICMR index for identification of dental fluorosis in epidemiological studies.

Background & objectives: The Indian Council of Medical Research (ICMR) formulated a Task Force on dental fluorosis and recommended the subgroup to develop a simplified index for identification and grading of dental fluorosis to be used by the health workers. This study was conducted to pre-test the ‘ICMR Index for Dental Fluorosis’ in the field to check its reliability and reproducibility. Methods: A total of 600 photographs were taken, 150 in each grade of fluorosis by screening 14-17 yr school children from eight schools of Hisar (Haryana) and South west Delhi. Eighty photographs were finalized (20 in each grade) before calibration to be used for training of field workers. Calibration exercise was conducted involving the five member survey team on 100 diagnosed cases of dental fluorosis. The members again screened 74 children with dental fluorosis in the field to categorize in to different grades of fluorosis for assessment of inter-examiner reliability. Results: The ICMR criteria showed more difference in agreement in very mild and mild categories during calibration. The inter-examiner reliability (κ) ranged from 0.59-1. The criteria was further modified and inter- examiner reliability (κ) found to be 0.83-0.98 which was almost perfect agreement. Interpretation & conclusions: The tool developed by the ICMR to assess dental fluorosis can be used in a field set up by non-dental personnel reliably with high degree of reproducibility.