Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States

Background/Aims@#Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. @*Methods@#We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. @*Results@#From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. @*Conclusions@#Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

Incidence of vitreous loss and visual outcome following cataract surgery by surgeons with various levels of experience at a tertiary eye care center in North India

Purpose: To determine the incidence of vitreous loss and visual outcome after a vitreous loss during cataract surgery performed by surgeons with various levels of experience in adults >40 years of age at a tertiary eye care center in North India. Methods: The study was conducted at a tertiary eye care center in North India. This was an observational, retrospective, cross-sectional study of patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. All adult cataract cases who were operated on from August 1, 2011 to July 31, 2014 and who experienced vitreous loss during their surgery were included in the study. The visual outcomes of these patients who experienced vitreous loss during cataract surgery in uncomplicated cataract and were managed using standard automated vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, small-incision, and phacoemulsification) as well as at different levels of skill of the operative surgeon (consultant, short term fellow, and long-term fellow). Details of the postoperative period and best-corrected visual acuity (BCVA) were collected from patient records by the principal investigator on day 1, 1 week, 4 weeks, 6 weeks, and 3 months post cataract surgery. Results: Vitreous loss occurred in 374 out of 18,430 patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. The overall incidence of vitreous loss in our study was found to be 2.03% with consultants having a rate of 1.66%, short-term fellows at 5.19%, and long-term fellows at 2.02%. Two hundred eighty-eight patients of the 374 cases followed up for 3 months at the hospital and 75.69% of these patients had a final visual acuity of ?6/18. Conclusion: In an institute with a structured training program for residents/trainees, the vitreous loss rate is low during cataract surgery. Early intervention and proper management with the standard microsurgical technique by experienced hands can improve the final visual outcome in eyes with vitreous loss. Cystoid macular edema and corneal edema were the most common causes of poor postoperative vision

Clinico-microbiological Profile of Urinary Tract Infection with Special Reference to Uropathogenic E coli : Antibiotic susceptibility Pattern, Phylogenetic Background and Virulent Factor Distribution from West Bengal, India

Background and Objectives : Routine surveillance and monitoring studies pose a constant need to update clinicians on prevalent pathogens and rational and empirical treatment in Urinary Tract Infection (UTI). Escherichia coli (E coli) is the most commonly isolated uropathogen globally. Extended-Spectrum ?-Lactamase (ESBL) production and ?-Lactamase Inhibitor Resistance (BLIR) among these pathogens together with their uro-virulence determinants further complicate treatment approaches. This study investigated the clinico-microbiological pattern of UTI and determined the antibiotic sensitivity pattern, the phylogenetic background, and virulence determinants of E coli, the most commonly isolated uropathogen. Methods : Uropathogens isolated by urine culture from community and hospitalized patients were biochemically speciated. Antibiotic susceptibility was tested by Kirby-bauer disk diffusion method. Phylogenetic background and virulence determinants of E coli isolates were identified by PCR. SPSS 16.0 was used for statistical interpretation. Results : 45% of the urine samples showed growth positivity. 44% amongst them were E coli. All isolates were multidrug-resistant. 50% and 40% were ESBL producers and BLIR respectively. Former showed highest resistance to quinolone, fluoroquinolones, cotrimoxazole, and latter were resistant against all drugs tested except nitrofurantoin. Significant correlation existed between the ?-lactams, quinolone, fluoroquinolones, cotrimoxazole (p<0.05) resistance pattern. BLIR and ESBL E coli recorded highest prevalence of pathogenic phylogroup B2 and D respectively. Varied prevalence of fimbrial (fimH, papC, papEF, papG, GII) and toxin genes (iroN, hlyA, cnfI, i ucD, cdtBU) in ESBL, BLIR and non-ESBL isolates were observed. Their distribution was statistically significant (p=0.05). Interpretation and Conclusions : Nitrofurantoin is the drug of choice in empirical treatment of uncomplicated UTI. Aggressive and consistent investigation and health education are highly recommended for effective clinical management in UTI.

STUDY OF PATIENTS WITH ATRIAL FIBRILLATION IN VIEW OF ETIOLOGICAL EVALUATION AND CLINICAL PROFILE.

Background : Atrial fibrillation(AF) is the most common sustained arrhythmia encountered inclinical practice,accounting 1/3 of hospital-admissions for arrhythmia and rate of admissions for AFhas risen recently.The principle significance of AF both to patient and healthcare system is fivefoldincreased risk of embolic stroke.Methodology: Electrocardiogram confirmed 100 adult(≥18 years) patients of AF were included inthis study and evaluated clinically.Results: Incidence of AF in India is significantly high in younger age group and in Female(58%) ascompared to Western countries,where AF is more common in old age and in Male(42%).Mostcommon cause of AF is Rheumatic heart disease as compared to Western countries,where IHD is thecommonest cause.The average age of patient having RHD developing AF,in India,is 15-20 yearsearlier than patients from Western countries.Most common complication of AF is Congestive cardiacfailure. Most serious complication of AF is Cardio-embolic stroke.Increase in size of Left Atrium inAF is associated with increased risk of Cardio-embolic stroke.Conclusion: Trials have shown reduction in risk,if patients are adequately anticoagulated.so earlyevaluation and prophylactic treatment can reduce mortality and morbidity in patients of AF.

A nationwide analysis on the influence of obesity in inflammatory bowel disease hospitalizations

Background/Aims@#Proinflammatory cytokines released from adipocytes can influence the development, progression, and treatment of inflammatory bowel disease (IBD), and may be associated with worse clinical outcomes. @*Methods@#For 2016–2018, we analyzed data from the Nationwide Inpatient Sample to identify adult (≥18 years) hospitalizations with a primary discharge diagnosis of IBD. The study sample was divided based on the presence or absence of obesity. The primary outcomes included inpatient mortality, while the secondary outcomes consisted of system-based complications and disease implications on the United States healthcare system. @*Results@#We identified 282,005 hospitalizations of IBD from 2016 to 2018. Of these hospitalizations, 26,465 (9.4%) had a secondary diagnosis of obesity while 255,540 (90.6%) served as controls. IBD hospitalizations with obesity had a higher mean age (47.9 years vs. 45.2 years, P<0.001), middle age (range, 40–65 years) predominance (37.7% vs. 28.9%, P<0.001), female predominance (64.1% vs. 52.5%, P<0.001) and higher proportion of patients with comorbidities compared to the non-obese cohort. White predominance was observed in both subgroups. No difference in the odds of inpatient mortality was noted between the 2 subgroups; however, IBD hospitalizations with obesity had higher mean total hospital charge ($50,126 vs. $45,001, P<0.001), longer length of stay (5.5 days vs. 4.9 days, P<0.001) and higher proportion of complications compared to the non-obese cohort. @*Conclusions@#Obese IBD hospitalizations had higher length of stay, total hospital charge, and complications compared to the non-obese cohort.

Radiation Proctitis and Management Strategies

Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation against rapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of the pathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most common being radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based on the onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severity and complication rates. The treatment options available for RP are limited, with most of the data on treatment available from case reports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. We have primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, and prognosis of RP.

Robust home brew fragment sizing assay for detection of MET exon 14 skipping mutation in non–small cell lung cancer patients in resource constrained community hospitals

Background@#A mutation/deletion involving donor or acceptor sites for exon 14 results in splicing out of exon 14 of the mesenchymal epithelial transition (MET) gene and is known as “MET exon 14 skipping” (ΔMET14). The two recent approvals with substantial objective responses and improved progression-free survival to MET inhibitors namely capmatinib and tepotinib necessitate the identification of this alteration upfront. We herein describe our experience of ΔMET14 detection by an mRNA-based assay using polymerase chain reaction followed by fragment sizing. @*Methods@#This is a home brew assay which was developed with the concept that the transcripts from true ΔMET14 will be shorter by ~140 bases than their wild type counterparts. The cases which were called MET exon 14 skipping positive on next-generation sequencing (NGS) were subjected to this assay, along with 13 healthy controls in order to establish the validity for true negatives. @*Results@#Thirteen cases of ΔMET14 mutation were detected on NGS using RNA-based sequencing. Considering NGS as a gold standard, the sizing assay using both gel and capillary electrophoresis that showed 100% specificity for both with concordance rates of 84.6% and 88.2% with NGS, respectively, were obtained. @*Conclusions@#Owing to the cost-effective nature and easy to use procedures, this assay will prove beneficial for small- and medium-sized laboratories where skilled technical personnel and NGS platforms are unavailable.

Robust home brew fragment sizing assay for detection of MET exon 14 skipping mutation in non–small cell lung cancer patients in resource constrained community hospitals

Background@#A mutation/deletion involving donor or acceptor sites for exon 14 results in splicing out of exon 14 of the mesenchymal epithelial transition (MET) gene and is known as “MET exon 14 skipping” (ΔMET14). The two recent approvals with substantial objective responses and improved progression-free survival to MET inhibitors namely capmatinib and tepotinib necessitate the identification of this alteration upfront. We herein describe our experience of ΔMET14 detection by an mRNA-based assay using polymerase chain reaction followed by fragment sizing. @*Methods@#This is a home brew assay which was developed with the concept that the transcripts from true ΔMET14 will be shorter by ~140 bases than their wild type counterparts. The cases which were called MET exon 14 skipping positive on next-generation sequencing (NGS) were subjected to this assay, along with 13 healthy controls in order to establish the validity for true negatives. @*Results@#Thirteen cases of ΔMET14 mutation were detected on NGS using RNA-based sequencing. Considering NGS as a gold standard, the sizing assay using both gel and capillary electrophoresis that showed 100% specificity for both with concordance rates of 84.6% and 88.2% with NGS, respectively, were obtained. @*Conclusions@#Owing to the cost-effective nature and easy to use procedures, this assay will prove beneficial for small- and medium-sized laboratories where skilled technical personnel and NGS platforms are unavailable.

Physiotherapy Approach towards a Typical Case of Injection Induced Radial Nerve Palsy Presenting as Wrist Drop.

Wrist drop occurs as a consequence of radial nerve palsy. From the estimates, it is found that each person receives at least two injections annually in the developing countries, and 50 percent of these injections are not considered safe.(1) Unfortunately, trauma to peripheral nerves isn't unusual in our country. Though reliable statistics are not available at the national level, the incidence of injury to peripheral nerves, especially to radial nerve, is on the rise, largely due to increased road traffic accidents and increased violence in our society as a whole.(1) Radial Nerve damage occurring as a consequence of intramuscular injection application is comparatively less common than sciatic nerve injury.(2) When therapeutic and prophylactic agents are applied in the form of intramuscular injections into buttock and arm, occasionally damage to the peripheral nerves can occur. Those whose radial nerve function has been compromised would not be able to actively extend extensor muscles of the wrist and digits since the radial nerve innervates them. As a result, the hand hangs flaccidly in a flexed position when the patient attempts to move the arm to a horizontal position. Patients may also experience paraesthesia, hypoesthesia, numbness and other sensory disturbances. Simple, pain-free sensory deficits may be functionally less significant because they involve the anatomical snuffbox and the radial dorsum of the hand. Injury to radial nerve results in motor function impairment leading to weakness during extension of the forearm, wrist, and fingers. However, wrist extension may be relatively spared because common radial nerve innervates the extensor carpi radialis longus muscle proximal to its division.(3)The inability of a person to extend his wrist and/or fingers due to the above mentioned causes is called "wrist drop" or "finger drop."(4) The other causes of wrist drop include stab wound injury to shoulder area where the terminal branch of posterior cord of brachial plexus is given off as radial nerve and any agent causing persistent injury to nerve. Interventions for wrist drop include splinting, electrical stimulation, exercises for hand and fingers, surgery, and drug therapy. The present case is diagnosed with Wrist Drop caused due to the injection induced injury to the radial nerve of left side. Needle length recommendation is very important before inducing the injection in male and female.(4)In the developing countries, common diseases are treated with the application of injections. When therapeutic and prophylactic agents are applied in the form of intramuscular injections into buttock and arm, occasionally damage to the peripheral nerves can occur. There are various reasons for the injury to the peripheral nerves. In case of wrist drop, reasons for the injury to the radial nerve may be gun-shot injury, humeral shaft fracture, misplaced injection and compression or ischemia

Morphology of the Esophageal Hiatus: Is It Different in 3 Types of Hiatus Hernias?

Background/Aims@#The esophageal hiatus is formed by the right crus of the diaphragm in the majority of subjects. Contraction of the hiatus exerts a sphincter-like action on the lower esophageal sphincter (LES). The aim is to study the hiatal anatomy (using CT scan imaging) and function (using high-resolution manometry [HRM]), and esophageal motor function in patients with sliding and paraesophageal hiatal hernia. @*Methods@#We assessed normal subjects (n = 20), patients with sliding type 1 hernia (n = 18), paraesophageal type 2 hernia (n = 19), and mixed type 3 hernia (n = 19). Hernia diagnosis was confirmed on the upper gastrointestinal series. The hiatal morphology was constructed from the CT scan images. The LES pressure and relaxation, percent peristalsis, bolus pressure, and hiatal squeeze pressure were assessed by HRM. @*Results@#The CT images revealed that the esophageal hiatus is formed by the right crus of the diaphragm in all normal subjects and 86% of hernia patients. The hiatus is elliptical in shape with a surface area of 1037 mm2 in normal subjects. The hiatal dimensions were larger in patients compared to normal subjects. The HRM revealed impaired LES relaxation and higher bolus pressure in patients with paraesophageal compared to the sliding hernia. The hiatal pinch on HRM was recognized in significantly higher number of patients with sliding as compared to paraesophageal hernia. @*Conclusions@#Using a novel approach, we provide details of the esophageal hiatus in patients with various kinds of hiatal hernia. Impaired LES relaxation in paraesophageal hernia may play a role in its pathophysiology and genesis of symptoms.

An assessment of factors responsible for diarrhoea deaths of under five children in rural and urban settings of India

Background: Very little scientifically based information is available on cause-specific mortality rates of diarrhoea among all regions and populations wherein an inequitable proportion exits in low-income households, which have fewer resources and less knowledge to manage burden than high-income households. The strategic purpose of the study is to identify gaps in care seeking in order to make changes in approach to address these gaps either directly by working with the community and by doing area specific advocacy to improve service delivery through government channels.Methods: The study was conducted in nine locations (6 rural and 3 urban) of India. The ethical and confidentiality parameters of conducting verbal autopsies were followed and random sampling methodology was adapted.Results: Respondents of our study attributed 22% deaths to diarrhoea. From the study, it is revealed that children who passed stool for 5 or more number of times in a day are more likely to die 1.5 times than the children who passed stool for 3 times a day. Children having diarrhoea for 5 days or more than 5 days are more likely to die 1.6 times in comparison to the children who have had diarrhoea for 3 days. Approximately seven of the ten children died within five days of treatment.Conclusions: Information on diarrheal diseases, its determinants in India and preventive and control strategies in light of recent developments need to be reviewed for better planning and organization of health services within the community.

Association of increased oxidative burden and excessive fluoride exposure in obese children

Background: The modern scientific evidence representing that obesity associated with fluoride exposure may be a risk of reduced health quality in paediatric population. Obesity is an independent risk factor for cardiovascular diseases and markedly elevated risk of morbidity and mortality. Presence of higher levels of fluoride in drinking water (>1.5ppm) may be serious problems in health of the obese children. In the state of Rajasthan, almost all districts have high fluoride (up to 18.0 ppm) in their drinking / ground water sources. An estimated 66.6 million people (17 states in India) including 6 million less than 14 years children are at risk Aim: The aim of the present study was to evaluate the effect of fluoride in obese child of high endemic fluoride areas. Method: In the present study, we selected 54 obese children from the selected area of Jaipur- India, twenty seven children (n=27) from high fluoride (F > 2.5ppm) region and twenty seven (n=27) obese children (disease control) from, where fluoride content was normal (F< 1.5ppm) in their source of drinking water. Moreover, age matched healthy controls were selected from the Jaipur district where fluoride content in water was less than 1.5 ppm. After clinical examination, lipid profiles, oxidative stress parameters namely, lipid peroxide level (LPO), superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and reduced glutathione content. Results: The concentration of fluoride in serum was significantly correlates with their water concentration. Increased LPO levels and reduced antioxidant status in obese and fluoride exposed obese. Moreover, obese and fluoride exposed obese were more comparable. Conclusion: On the basis of the results it may conclude that fluoride enhances the severity of disease and fluoride promotes oxidative stress in obese paediatric population. However, further in depth of studies is required for the understanding of pathophysiology of child obesity those residing in endemic area of fluoride.

Spinal anesthesia in laparoscopy for infertility

Background: Spinal anesthesia in laparoscopy for infertility is coming up as a safe and effective alternative to general anesthesia with endotracheal intubation. This retrospective study was undertaken to evaluate the efficacy of spinal anesthesia in laparoscopy for infertility.Methods: In this retrospective observational study, a total of 100 patients had laparoscopic procedure done during the period January 2017 to December 2017 and were included in the study. Laparoscopic surgeries were performed under general anesthesia.Results: In our study of 60 patients, 30 (50%) patients underwent diagnostic laparoscopy and 30 (50%) patients underwent operative laparoscopy. Additional analgesia was required in 20 (33.33%) of patients. These patients either had longer operative time for more lengthy procedures or were more anxious. 55 (91.66%) patients were discharged from the hospital in less than 12 hours, 1 (1.66%) patient was discharged within 24 hours while 4 (6.66%) patients were discharged after 24 hours in whom lengthy procedures were performed. Post spinal headache was seen in 22 (36.33%) patients, nausea and vomiting in 20 (33.33%) patients, hypotension in 18 (30%) patients. Conversion to general anesthesia was needed in 3 (5%) patients due to longer operative time.Conclusions: Spinal anesthesia in laparoscopy for infertility is a safe and effective alternative to general anesthesia with endotracheal intubation.

ADMINISTRATION OF H2 BLOCKERS IN NSAID INDUCED GASTROPATHY IN RATS: effect on histopathological changes in gastric, hepatic and renal tissues

ABSTRACT Background Nonsteroidal anti-inflammatory drugs induces gastric mucosal lesions because of its acidic properties. Ranitidine, an H2 receptor antagonist, has proved beneficial in patients with gastric ulcers. Objective The present study was performed to assess the effect of administering ranitidine in Nonsteroidal anti-inflammatory drugs (diclofenac, nimesulide) induced gastropathy, and their effect on the histopathology of stomach, kidney and liver. Methods Diclofenac, nimesulide, and ranitidine were administered in doses of 2, 4, and 6 mg/kg, p.o. once daily for 14 days, and their effect on gastric volume, acidity, mean ulcer number, and gastric pH. In addition, histopathological examination was also performed on sections of stomach, kidney and liver. Results Following the administration of diclofenac or nimesulide, all the gastric parameters were significantly altered as well as the histopathology of stomach, liver and kidney. In the control group, the renal sections showed normal glomeruli with no thickening of glomerular basement membrane, while in diclofenac alone, nimesulide alone, and ranitidine with nimesulide groups, the thickening of glomerular basement membrane was observed. These alterations were observed to be reversed in the ranitidine with diclofenac group. In the sections from the liver, the control group showed anastomosing plates and cords of cuboidal hepatocytes with round well stained nuclei and abundant cytoplasm. In the ranitidine with diclofenac, and ranitidine with nimesulide groups, mild dilatation of sinusoids is seen coupled with prominence of central vein. In the diclofenac alone and nimesulide alone groups, the proximal and distal convoluted tubules show mild focal tubular necrosis. In the gastric sections, the control group showed several folds forming villi, and the epithelial lining surface of the mucosa. In the ranitidine with diclofenac, and ranitidine with nimesulide groups, the duodenum showed scattered inflammatory cells composed predominantly of lymphocytes. In diclofenac alone and nimesulide alone group, the sections from the gastric areas showed partial necrosis and mild chronic inflammation respectively. Conclusion The study, therefore, has provided therapeutic rationale towards simultaneous administration of H2 receptor blocker ranitidine with diclofenac to be more beneficial as compared to ranitidine with nimesulide, to minimise the gastric intolerance of diclofenac in long term treatment of inflammatory conditions.

RESUMO Contexto Anti-inflamatórios não esteroidais induzem lesões da mucosa gástrica devido às suas propriedades ácidas. Ranitidina, um antagonista dos receptores H2, revelou-se benéfico em pacientes com úlceras gástricas. Objetivo - O presente estudo foi realizado para avaliar o efeito da administração de ranitidina em gastropatia induzida por anti-inflamatórios não esteroidais (diclofenaco, nimesulida) e seu efeito sobre a histopatologia do estômago, dos rins e fígado. Métodos Diclofenaco, nimesulida e ranitidina foram administradas em doses de 2, 4 e 6 mg/kg, p.o. uma vez diariamente por 14 dias e seu efeito sobre o volume gástrico, acidez, significam o número de úlcera e o pH gástrico. Além disso, o exame histopatológico também foi realizado em seções do estômago, dos rins e fígado. Resultados Após a administração de diclofenaco ou nimesulida, todos os parâmetros gástricos foram significativamente alterados assim como a histopatologia do estômago, fígado e rim. No grupo controle, as seções renais mostraram glomérulos normais sem espessamento da membrana basal glomerular, enquanto em diclofenaco isolado, nimesulida isolado e grupos com ranitidina e nimesulida, foi observado espessamento da membrana basal glomerular. Estas alterações observou-se serem revertidas no grupo ranitidina com diclofenaco. As seções do fígado, o grupo controle mostrou placas e cordões de hepatócitos cuboidais anastomosados com núcleos bem demarcados e citoplasma abundante. Nos grupos ranitidina com diclofenaco e ranitidina com nimesulida, leve dilatação dos sinusoides é vista acoplados com proeminência de veia central. Nos grupos diclofenaco e nimesulida sozinhos, túbulos proximais e distais contorcidos mostram necrose tubular focal leve. Nas secções gástricas, o grupo controle mostrou várias dobras formando vilosidades e a superfície do revestimento epitelial da mucosa. Nos grupos ranitidina com diclofenaco e ranitidina com nimesulida, o duodeno mostrou dispersas células inflamatórias predominantemente compostas por linfócitos. Nos grupos diclofenaco e nimesulida sozinhos, as secções de áreas gástricas mostraram necrose parcial e inflamação crônica moderada respectivamente. Conclusão - O estudo, portanto, forneceu o fundamento terapêutico para administração simultânea de bloqueador de receptor H2 (ranitidina) com diclofenaco, sendo mais benéfica em comparação com ranitidina com nimesulida para minimizar a intolerância gástrica de diclofenaco no tratamento a longo prazo de condições inflamatórias.

Perfurador baseado em transposição de retalho estenocelidomastoide para defeitos da região posterior do pescoço: uma nova alternativa / Perforator based sternocleidomastoid transposition flap for nape of neck defect: a novel option

Retalhos do músculo esternocleidomastoideo têm sido descritos na literatura para reconstrução dos defeitos da cavidade oral e tratamento da síndrome de Frey. Apesar de largamente estudado, esses retalhos não são utilizados com frequência para reconstruções na região de cabeça e pescoço devido limitações como tamanho reduzido, camadas inseguras, contorno da deformidade no pescoço e questões de segurança oncológica. Relata-se uso de perfurador baseado em transposição de retalho para defeito na região da posterior do pescoço, seguido por excisão de sarcoma de partes moles. Trata-se de alternativa válida para procedimentos de reconstrução como retalhos regionais de pedículo ou transferência de tecido livre em um grupo apropriado de pacientes.

Sternocleidomastoid musculocutaneous flaps have been described in the literature for reconstruction of oral cavity defects and treatment of Frey's syndrome. Although widely studied, it is not used routinely in head and neck reconstruction due to limitations like small size, unreliable skin paddle, contour deformity in the neck and the question of oncologic safety. We report use of perforator based musculocutaneous transposition flap for defect over nape of the neck, followed by excision of a soft tissue sarcoma. This constitutes a valid alternative to other reconstructive procedures like pedicled regional flaps or free tissue transfer in a suitable group of patients.

A study of clinico-demographic profile and ventilatory pulmonary function tests in type 2 diabetes mellitus.

Background: Type 2 Diabetes Mellitus (DM) is a non-communicable disease. DM produces damage in small blood vessels characterized by morphologic and biochemical alterations of the capillary basal lamina. These abnormalities have been observed in several organs including the lung. As the prevalence of diabetes is rapidly increasing, it would be important to study pulmonary functions in this sub group. Methods: The present observational study carried out at medicine department. It includes previously diagnosed type 2 DM patients between 31 to 50 years of age, non-smoker, non-pregnant with no major respiratory illness. Ventilatory Pulmonary Function Test (VPFT) which includes FVC, FEV1 and FEV1% were studied in all selected participants. VPFT categorized as per American Thoracic Society (ATS). All collected data analysed using Microsoft Excel 2010. Results: The total of 55 previously diagnosed Type 2 DM cases was recruited. 26 (47.2 %) & 29 (52.7 %) were male & female respectively. 21 (38.2 %) has duration of DM more than 5. 11 (20 %) & 5 (9 %) had neuropathy and retinopathy respectively. 29 (52.7 %) had abnormal pulmonary function test. The Mean FVC (84.11 ± 14.94), Mean FEV1 (84 ± 13.72) & Mean FEV1% was (100.05 ± 7.32) among the study participants. 29 (100.0 %) were restrictive type of abnormality. Conclusion: The reduced lung function is likely being a complication of diabetes mellitus. Lung functions needs to be checked periodically.

Spasmolytic effect of traditional herbal formulation on guinea pig ileum.

Background: The herbal formulation consisting of Andrographis paniculata Nees., Cassia fistula L., Foeniculum vulgare Mill. and Cuminum cyminum L. is widely used by the local traditional practitioners in rural Northern Karnataka for spasmodic abdominal pain. Objective: The present study was undertaken to evaluate safety and spasmolytic effect of poly‑herbal formulation. Materials and Methods: Acute toxicity studies were carried out in Swiss mice, as per the Organization for Economic Co‑operation and Development (OECD) guidelines. The spasmolytic activity of the formulation was studied in isolated guinea pig ileum model using histamine and acetylcholine as agonists. The data were analyzed by one‑way ANOVA, followed by Dunnetts post‑hoc test and P ≤ 0.05 was considered as significant. Results: The formulation did not show any adverse toxic effects and found to be safe. It also showed significant (P < 0.05) relaxation in different agonist like histamine and acetylcholine‑induced contractions in guinea pig ileum. Conclusions: Antispasmodic activity of the herbal formulation can be attributed to its atropine‑like activity. The present findings, therefore, support its utility in spasmodic abdominal pain.

Enhanced Chrysene Degradation by a Mixed culture Biorem-CGBD using Response Surface Design.

Degradation of chrysene, a four ringed highly carcinogenic polycyclic aromatic hydrocarbon (PAH) has been demonstrated by bacterial mixed culture Biorem-CGBD comprising Achromobacter xylosoxidans, Pseudomonas sp. and Sphingomonas sp., isolated from crude oil polluted saline sites at Bhavnagar coast, Gujarat, India. A full factorial Central Composite Design (CCD) using Response Surface Methodology (RSM) was applied to construct response surfaces, predicting 41.93% of maximum chrysene degradation with an experimental validation of 66.45% chrysene degradation on 15th day, using a combination of 0.175, 0.175 and 0.385 mL of OD600=1 inoculum of A. xylosoxidans, Pseudomonas sp. and Sphingomonas sp., respectively and a regression coefficient (R2) of 0.9485 indicating reproducibility of the experiment. It was observed that chrysene degradation can be successfully enhanced using RSM, making mixed culture Biorem-CGBD a potential bioremediation target for PAH contaminated saline sites.

Male Genitourinary Tumors : 14 Years Experience in Garhwal Region of India.

Genitourinary tumors may show varied clinical presentation and frequency in different regions of the world. The present study was therefore conducted to analyze the frequency, clinical presentation and the histopathological types of the various male genitourinary tumors diagnosed over a period of 14 years in a major teaching institute of north Himalayan region of India. Material and Methods: Retrospective study was undertaken in the Pathology department of the Institute which included all the cases of male genitourinary tumors which were diagnosed on histopathology from the time period between 1 Jan 1997 till 31st Dec. 2010. Results: The study showed that prostate was the most common site for male genitourinary tumors with prostatic adenocarcinoma as the most common histopathological type of tumor. Testicular Non- Hodgkin’s lymphoma constituted about 8% of total tumors in testes which mostly presented in elderly age group. Renal cell carcinoma (66.2%) was the most common tumor in kidney with much lower frequency of Wilm’s tumor (16.9%). Occasional rare tumors such as hemangioma of urinary bladder and schwannoma of penis were also seen over 14 years. Conclusion: The study concludes clinically patients were associated with more severe symptoms as they presented late to the hospital from the remote areas of this Himalayan region leading to late detection of tumors. Prostatic adenocarcinoma was the most common tumor while renal cell carcinoma was most common tumor in kidney. The present study provides valuable information to clinicians and pathologists regarding frequency, clinical presentation and histopathological types of male genitourinary tumors in this region which can be further used to formulate strategies for better management of these tumors.

Activity of Plumbago zeylanica Linn. root and Holoptelea integrifolia Roxb. bark pastes in acute and chronic paw infl ammation in Wistar rats.

Background: The pastes prepared from roots of Plumbago zeylanica Linn. and barks of Holoptelea integrifolia Roxb. are widely used by traditional healers for the treatment of arthritis in rural northern Karnataka. Objective: The present study was undertaken to scientifi cally evaluate the safety and effi cacy of traditionally used formulations in experimental animals. Materials and Methods: The study, approved by IAEC was carried out in male Wistar rats and dermal toxicity in rabbits. Carrageenan model was used to assess effect on acute infl ammation. Paw volume were measured at 1, 2, 4, and 6th hour postchallenge. Chronic infl ammation was developed by using Complete Freund’s Adjuvant (CFA). Paw volume, ankle joint circumference, and body weight were assessed on 1st, 4th, 8th, 14th, 17th, and 21st day. Paste was applied once every day to the infl amed area of the paw of respective groups of animals, continuously for 14 days. Statistics: The data were analyzed by one way analysis of variance followed by Dunnett’s post hoc test. P ≤ 0.05 was considered as signifi cant. Results: The formulations did not show any dermal toxicity and found to be safe. Both the pastes signifi cantly (P < 0.05) suppressed, carrageenan-induced paw edema at 6th hour and Holoptelea integrifolia appears to be more effective than Plumbago zeylanica. Signifi cant reduction was observed in paw volume, ankle joint circumference and animal body weight gained. Conclusions: The tested formulations (P. zeylanica root and H. integrifolia bark pastes) showed signifi cant antiinfl ammatory activity. The present fi ndings therefore support its utility in arthritic pain, infl ammation and the claim of traditional practitioners.