Pharmaceutico-Analytical Study of Vishatinduka Taila

Vishatinduka Tailam is mentioned in context of Vataroga nidhanalakshana chikitshaadhyana of Basavarajiyam text for the treatment of Sarvangasandhiasthigatavata, Amlavata, Sula, Anulomanavayu, Sthambha, Dhanurvata, Kaphajavikaras, severe painful condition of the body, etc., It is prepared with ingredients like Vishatinduka, Jambira, Aranala, Tilataila and Erandataila. It is an attempt made to validate the pharmaceutical and analytical parameters of Vishatinduka taila. Three batches of Vishatindukataila were prepared. Pharmaceutical study of batches and its standardization was done. It took five days for preparation of each batch due to presence of Aranala. Intermittent cooling was done. At the end of Taila preparation, mustard brown coloured oil was obtained and strong odour present. All Sneha siddhi lakhanas were observed and the loss was approximately 10% in all the three batches of Taila. To establish standards of Vishatinduka Taila, physicochemical and chromatographical methods were performed. The results found are acid value 12.344mg/KOH/g, peroxide value 5Meq/kg, Density 0.932g/cm3, Specific gravity 0.932, pH 4.5+/_0.3, Loss on drying 0%, Refractive index 73.5+/_0.2% brix, saponification value 112.22mg KOH/1g and Total fatty matter 95.4%. Physicochemical test was done in first and second month also results obtained. In HPTLC evaluation variable number of spots are visualized. It showed the presence of four phytoconstituents.

Predictors Associated with In-hospital Mortality among COVID-19 Patients during the Second Wave in a Tertiary Care Hospital, Gujarat, India: A Retrospective Observational Study

Background: Fatalities due to coronavirus disease 2019 (COVID-19) have already crossed to more than 5 million globally so far. Hence, it is crucial for us to identify the risk factors associated with hospital deaths starting from first contact which can help to give timely treatment to the targeted population. Objectives: This retrospective cohort study was conducted to identify various factors related to in-hospital mortality related to COVID-19 in our region. Materials and methods: The present study was a single-center, retrospective cohort study of 675 adult patients, admitted with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between 1st April and 25th May 2021 in our tertiary care hospital. Baseline demographic profile, comorbidities, clinical characteristics, and investigatory findings were analyzed for increased odds of mortality. Results: A total of 181 (26.8%) patients died and 494 (73.2%) survived. There were 65.4% of males and no difference was found between genders in terms of mortality. Comorbidities associated with in-hospital death in our cohort were age group ?50 years (p<0.001), diabetes (p<0.0007), and renal injury (p<0.0001). More than half of the patients died during the first week of admission. Breathlessness (83%) was the most common symptom in non-survivors. Neutrophil-to-lymphocyte ratio (NLR), S. creatinine, D-dimer, ferritin, and C-reactive protein (CRP) were increased significantly among the patients who died. Multivariate logistic regression revealed age ?50 years [adjusted odds ratio (AOR) 2.30, 95% confidence interval (CI) 1.45–3.64] and oxygen (O2) saturation <94% at the time of admission (AOR 2.62, 95% CI 1.75–3.93) were associated with mortality. Conclusion: Overall in-hospital mortality was 26.8%. Higher age and low O2 saturation were the major risk factors associated with in-hospital mortality.

Prevalence and correlates of Depression, Anxiety and Stress among Nursing Students

Background: Nursing students experience significant amount of depression, anxiety and stress throughout their undergraduate education and there is limited evidence regarding magnitude of depression, anxiety and stress among them in India. Aims & Objectives: To assess the prevalence of depression, anxiety and stress and associated factors among nursing students. Materials & Methods: A web based cross sectional study was conducted among 214 nursing students of B.Sc. Nursing College, Dibrugarh in May 2021 using Google form containing structured questionnaire and DASS21 by convenience sampling. Logistic regression analysis was carried out to assess determinants of depression, anxiety and stress. Results: The prevalence of Depression, anxiety and stress was 55.1%, 63.1% and 29.9% respectively. On multiple regression analysis, mother’s occupation of the students was found to be significant predictor for depression and anxiety, getting less vacation was found to be significant predictor for depression and stress, satisfaction with nursing profession as a significant predictor for depression and caste as a significant predictor for stress. Conclusion: A high prevalence of Depression, anxiety and stress was found among nursing students.

Miscellaneous newly recognized types of CNS tumors in the WHO CNS5 classification (other than gliomas, glioneuronal and embryonal tumors)

In this review, we describe salient features of a few of the newer entities recognized in the fifth edition of World Health Organization (WHO) classification of central nervous system (CNS) tumors. While most of these have been offshoots of the deoxyribonucleic acid (DNA) methylation profiling of CNS tumors with distinct profiling such as desmoplastic myxoid tumor (DMT) of the pineal region, SMARCB1-mutant, these also demonstrate subtle, distinct morphological features, which should be carefully searched for to diagnose them.

Impact of Training on Awareness of COVID-19 among The Health Care Workers in A Tertiary Care Hospital of Dehradun

Background: Novel Corona virus infection (Covid-19) was declared global pandemic by WHO infecting more than 118,000 cases in 114 countries and the number of deaths counting to 4291. WHO recommends the only strategy to limit the spread of Corona virus is only by prevention itself. Aim and Objective: To assess the awareness among Health Care Workers on covid19 infection. To compare the level of knowledge among the study participants and to assess the impact of training about the knowledge on covid-19 control. Material and methods: The study was conducted by the Research team of Community Medicine Department, SGRRIM&HS, Dehradun between 1st October to 31st December 2020. Self-administered, pre-tested questionnaire was used to assess the knowledge and awareness among health care workers. Data collected and analysed using SPSS software for different parameters. Result: A total of 421 health care workers participated in the present study. Majority of the study participants were female with 346 (82.2%) while 75 (17.8%) of them were male. Independent t-test was used to compare pre and post-test values with Socio-demographic profile, designation, and work place of the respondents. Conclusion: Improvement in the knowledge and awareness among health care workers was observed post training.

An open randomized cross over study to compare the clinical effectiveness and safety of economical generic with branded generic telmisartan in essential hypertension

Background: Hypertension is a chronic disease and is a major risk factor for chronic heart disease, stroke, coronary heart disease, and its complications include heart failure, peripheral vascular disease, renal impairment, retinal hemorrhage, and visual impairment. Antihypertensive drugs are important to avoid such complications but compliance of patient is needed which may depend on the cost of therapy. Aim and Objective: This study aimed to assess the efficacy and safety of a branded generic with an economical generic. Materials and Methods: Out of 110 patients, 105 patients (53 patients in group A and 52 patients in group B) completed the study with follow-up over a period of 6 months. Group A patients received generic Telmisartan 40 mg in the beginning (0th day) which was continued for 12 weeks, cross-over was done with branded generic Telmisartan (Telma 40) which was given for further 3 months. Group B patients received the branded generic followed by generic Telmisartan in that sequence for 3 months each. Blood pressure (BP) was recorded at the baseline visit and at the end of 4, 8, 12, 16, 20, and 24 weeks. The adverse events were assessed throughout the study period. Results: Intra-group comparison show significant reduction in systolic (SBP) and diastolic BP (DBP) in each groups (P < 0.001) but when we compare the reduction of SBP and DBP in between the two groups the difference was not significant. Common adverse events were headache, dizziness, light-headedness, and vertigo. Conclusion: There was a huge difference between the prices of branded generic and unbranded generic. This study showed that both branded generic and unbranded generic are comparable in terms of efficacy, safety except the cost of therapy. Thus substitution of a Pharmacological generic (unbranded generic) drug could save lot of expenses.

Glandular-type inverted papilloma of urinary bladder – Report of a unique case with immunohistochemistry

Inverted papilloma of urothelium is a rare benign tumour accounting for 1–2% of all the urothelial lesions. Morphologically, these are of two main subtypes – trabecular and glandular, of which the former subtype is most frequently encountered compared to the latter. The glandular subtype closely mimics cystitis glandularis and urothelial carcinoma with inverted growth pattern. We discuss a case of a 27-year-old male presenting with hematuria. On cystoscopy, he was found to have a bladder mass which was diagnosed as glandular-type of inverted papilloma on histopathology. The image illustrates the histopathology for easy identification and early diagnosis of this rare entity.

Studies On Bioavailability Enhancement Of Curcumin

Objective: The objective of the present work was to improve aqueous solubility and in vivo bioavailability of curcumin and structural analogues of curcumin such as potassium, calcium, magnesium salts and nitro derivative. Methods: Structural analogues of curcumin were prepared by reaction of curcumin with potassium chloride, magnesium chloride hexahydrate and calcium chloride dihydrate in a suitable solvent. The nitro derivative synthesized by treating curcumin with sulphuric acid and nitric acid. The prepared analogues were evaluated for melting behavior, solubility, UV spectrophotometry, partition coefficient, moisture content, cellular uptake, FTIR analysis, antimicrobial activity and in vivo bioavailability in the rat. Results: Chemical modification of curcumin increased the saturation solubility to 11.6, 16.5, 21.5, 28.0 µg/ml in calcium salt, magnesium salt, potassium salt and nitro derivative respectively, against 8.6 µg/ml of curcumin. The analogues were chemically stable as curcumin analyzed by FTIR spectrophotometry. Increased cellular uptake, as well as enhanced antimicrobial activity, was demonstrated by modified curcumin analogues. Moreover, significant improvement in plasma levels was estimated with nitro derivative. Conclusion: The present work recommends that nitration of curcumin improves aqueous solubility which may improve absorption and in vivo bioavailability.

A report of orbital metastasis from a urinary bladder adenocarcinoma

A 60-year-old man presented with sudden-onset proptosis of the left eye and intermittent diplopia of 2 months duration. Ophthalmic examination revealed bilateral eyelid retraction, left eye proptosis and a firm, non-tender mass (2 cm × 1.5 cm) in left supero-medial orbit with restricted extraocular movements. Contrast-enhanced computed tomography showed a well-defined, enhancing antero-medial orbital mass which was removed via anterior orbitotomy approach. The histopathology/immunohistochemistry showed adenocarcinoma; metastasis of urothelial origin. The oncology consultation and metastatic workup revealed a urinary bladder carcinoma with distant metastasis. Our patient expired within 6 months of diagnosis. The ophthalmic symptoms due to orbital metastasis may be the first presentation of some cancer patients.

A rare case of hypereosinophilic syndrome presenting with unilateral proptosis and torticollis

Hypereosinophilic syndrome (HES) is a spectrum of myeloproliferative disorder, which is characterized by persistent and marked blood eosinophilia and damage to multiple organs due to eosinophilic infiltration. Idiopathic HES is identified after ruling out all other causes of eosinophilia. Poor prognosis is usually associated with cardiac involvement and malignant transformation of blood cells. We report a rare case of HES in an 8-year-old boy who presented with unilateral proptosis and torticollis. The patient responded well to corticosteroid therapy with reduction of proptosis and torticollis and normalization of serum eosinophil count.

Clinical profile of childhood blindness and inappropriate enrolment of children in schools for visually impaired in Uttar Pradesh, India

Purpose: To assess major causes of severe visual impairment (SVI)/blindness (BL) in children studying in schools for the blind in western Uttar Pradesh, India and the extent of inappropriate enrolment of children in blind schools. Methods: Students of five schools for the blind were examined in a tertiary care eye hospital. The anatomical sites and etiology for SVI/BL were recorded using the World Health Organization/Prevention of Blindness standard reporting form. Categorical variable were summarized using frequencies and percentages. Results: A total of 93 students were examined. Male/Female ratio was 3.4:1. The most common anatomical sites of SVI/BL were the whole globe (40.3%) and the cornea (26.4%). Postnatal or childhood causes were noted in 13.8% cases. Forty-one (56.9%) students had hereditary diseases which was most likely caused by chromosomal abnormalities. Three students were having an associated disability, one was deaf and mute, one was physically handicapped, and one was intellectually challenged. Fifty-four (58%) children were blind and 21 (22.6%) children had no visual impairment but were studying in schools for the blind. Conclusion: Schools for the blind should be screened routinely to reduce the incidence of misdiagnosed visual impairment. This will prevent inappropriate enrolment and will definitely help in reducing the social and economic burden of society and of the schools of blind too.

Live encysted Thelazia callipaeda presenting as a lump adjacent to the right lacrimal sac in a 42-year-old female: A rare case report

Thelazia callipaeda or the oriental eye worm infects a wide variety of hosts including dogs, cats, foxes, rabbits, and humans through the Drosophila flies. We report here a case of a 42-year-old female who presented with pain, redness, and cystic swelling in the right lacrimal sac area for 8 months. Ocular examination was within normal limits. Excision biopsy of the cyst revealed a live worm. In humans, the worm is usually found in the conjunctival sac, lacrimal canaliculi, or the lacrimal sac leading to a disease which can be subclinical or symptomatic. Thus, we report a rare presentation of thelaziasis, that is, periocular involvement. This case presentation is first of its kind in the Indian literature.

Community outreach: An indicator for assessment of prevalence of amblyopia

Purpose: To study the prevalence, determine the magnitude, and cause of amblyopia among the children aged 6 months to 16 years in Kamrup district, Assam, India. Methods: Among a total of 39,651 children between 6 months and 16 years of age, door-to-door screening was conducted by trained workers. For children above 5 years of age who failed to read the 6/9 line, camps were conducted in the nearby schools. Children below 5 years of age were directly referred to the tertiary eye care institute. After visual acuity assessment at the institute, cycloplegic refraction and complete ophthalmic examination were done to rule out other causes of diminution of vision. Axial length measurement and corneal topography were performed in children with high refractive errors. Results: Of the total 39,651 children screened, 469 were diagnosed to have amblyopia at the camp and 223 were diagnosed at the institute. The prevalence of amblyopia was 1.75%. Amblyopia was more common among the males (52.50%) as compared to females. Maximum number of patients were found in the age group of 11–16 (63.58%). Refractive amblyopia was found to be the most common cause of amblyopia (45.29%). In children below 5 years, deprivation amblyopia and strabismic amblyopia were more common. Conclusion: Awareness of amblyopia among the parents is essential for early detection and treatment of the disease, which will, in turn, reduce the burden of childhood visual impairment.

Oral manifestations associated with neutrophil deficiencyand neutrophil disorders: A review

The immune system evolved to protect multicellular organisms from pathogens. It defends the body against invaders, and generates an enormous variety of cells and molecules capable of specifically recognizing and eliminating foreign invaders, all of which act together in a dynamic network. Neutrophils have been referred to as a first line of defense, meaning that they are first defensive cells to be recruited to a site of inflammation; however the resident leukocytes are cells which normally exist at the sites of inflammation. Neutrophils exhibit their antibacterial action with the help of granules or by virtue of its ability to reduce dioxygen to hydrogen peroxide. The primary mission of neutrophils is to find bacteria and neutralize them by phagocytosis.

Does a correlation exist between nasal airway volume and craniofacial morphology: A cone beam computed tomography study.

Aim: To find the correlation between nasal airway volume and the craniofacial morphology using cone beam computed tomography (CBCT). Materials and Methods: This study consisted of preorthodontic anonymized CBCT scans of 34 healthy adults in the age span of 18–28 years. The volume was calculated using Dolphin 3DR software 11.5 version using semiautomatic segmentation method to calculate nasal volume after determining the nasal airway boundary. The subjects were grouped according to sagittal skeletal relation, craniofacial width, facial index, and facial form. Results: There was statistically significant correlation between nasal volume and craniofacial width (P = 0.009). Conclusion: Nasal volume was correlated only with width of the face and not with width/length ratio of face that could have affected the nasal volume.

A rare case of solitary hydatid cyst of kidney with renal pelvis involvement

Hydatid involvement of the kidney accounts for only 2–4% of all cases of hydatid disease it is very rare and again primary involvement of the kidney without involvement of liver parenchyma or lung parenchyma that makes it extremely rare. The purpose of this article is to review the imaging features of hydatid disease of the kidney and thus show the role of radiography, excretory urography, sonography, CT, and MRI in the diagnosis of Hydatidosis. Hydatiduria accompanies only 10 to 20 % of all cases of renal Hydatidosis and usually microscopic ,here we are reporting a 65 years old female with abdominal lump in right hypochondriac region with pain on USG finding suggestive of hydatid cyst of liver with indentation and possible involving right kidney but MDCT suggest it is a primary right renal hydatid large exophytic cyst having multiple daughter cysts involving upper pole of kidney with breech in the cortex and it extends to involve right renal pelvis which indenting to inferior surface of liver

A rare case of agenesis of dorsal pancreas

Dorsal pancreatic agenesis is an extremely rare congenital entity. Very few cases have been published in the literature about this congenital anomaly. Agenesis of the dorsal pancreas is associated with various anomalies, such as polysplenia syndrome, wandering spleen, interruption of the inferior vena cava, hemiazygos and azygos continuation, symmetrical liver, anomalous hepatic fissure or lobe, leftsided inferior vena cava, median gall bladder, inverted gallbladder and stomach, and intestinal malrotation. We have reported here an asymptomatic 31 year old male with incidental findings of hypoplasia of pancreatic body and absence of pancreatic tail on contrast enhanced abdominal computed tomography (CT) and similar findings were seen on Magnetic resonance imaging (MRI). Further Magnetic resonance cholangiopancreatography (MRCP) was done on which hypoplastic proximal MPD at body of pancreas with complete absent of MPD at tail region noted. The final diagnosis was dorsal pancreatic agenesis.