Carotid Intimal Medial Thickness (CIMT) in Patients of Chronic Kidney Disease (CKD) and its Association with CKD Staging

Introduction: Association between Chronic kidney disease(CKD) and increased risk of cardiovascular disease (CVD)is well established. Relationships of carotid intima-mediathickness (CIMT) as a measure of subclinical atherosclerosisin CKD patients is a matter of debate. Current research aimedto study the role of CIMT in CKD patients and its associationwith the CKD staging.Material and Methods: Hundred CKD patients werestudied and compared with 50 subjects without CKD in theDepartment of Medicine, G.R. Medical College & J.A. Groupof Hospitals, Gwalior (M.P.) India. GFR was determined byMDRD (Modification of diet in renal study) equation. Studypopulations were subjected for high resolution B - modeCarotid ultrasonography.Results: In case group, majority were males (68%) havingage between 30-60 years (62%). Majority had stage V CKD(67%), 21% had stage III and 14% had stage IV CKD.Majority of the cases had CIMT between 0.9-1.0 mm (42%)followed by 0.7-0.8 mm (17%) as compared to 0.5-0.6 mm(42%) in control. Mean CIMT was significantly higher incases (0.87±0.24) as compared to control (0.61±0.34) group(p<0.001). No significant difference in mean CIMT was foundbetween different stages of CKD (p=0.649).Conclusion: CKD patients have significantly more carotidarterial wall thickness in comparison to age matched controls.The CIMT does not differ in different stages of CKD.

Computerized tomography based evaluation of level I and II axillary lymph nodes by high conventional tangential fields in carcinoma breast

Background: Axillary radiation and surgery have provided equivalent local control in early breast cancer patients. It is believed that tangential field (TF) radiation that was used to treat the breast coincidently delivered radiation treatment to the lower axilla and eradicated the disease. In the era of CT-based three dimensional- (3D) radiotherapy planning, however concerns have been raised about the adequacy of coverage of the axillary levels in the tangential fields. In this study, author evaluated the coverage of the axillary nodal levels I and II using high conventional tangential fields in patients with or without axillary dissection.Methods: A prospective study was conducted which included 18 cases for a period of one year, radiation therapy was planned to the chest wall or whole breast by using the high conventional tangential field using 2D radiation portals. Central lung distance (CLD) and the distance of superior border was measured form the head of the humerus and were recorded. CECT chest was done in the same position alike during conventional simulation. All the images were shifted to the treatment planning system. The Contouring of Axillary lymph nodes level I and II was done on Oncentra contouring software.Results: The coverage of the axillary nodes was not related to central lung distance (CLD). However, some with CLD of 1cm had more coverage of the level I nodes than with CLD of 2 cm and the maximum CLD in the field was 2.5 cm. Of the 18 patients in the study, 13 patients had <2 cm distance from the humeral head and all the axillary level II LN covered in the field. Whereas 5 patients having distance >2 cm did not have adequate coverage of level II axillary LN’s.Conclusions: The distance of the cranial border of the tangent portal from the head of the humerus shows a relationship with coverage of level II nodes cranially. As the distance decreases the coverage of level II nodes cranially keeps increasing. In majority of the patients a distance of 2 cm or less than 2 cm ensured good coverage of level II nodes cranially. Similarly, no correlation was found between volumetric coverage of the axillary nodes with central lung distance.

Effect of Lifestyle based Edu Vaccine in Indian community: Study Outcomes of National Program for Prevention and Eradication of Heart Attack (NPPEHA)

Objective: The present study was designed to evaluate the impact of Education (Edu) vaccine in National Program forPrevention and Eradication of Heart Attack (NPPEHA).Methods: This pretest–posttest designed study was held in the SAAOL Heart Center in different cities (Delhi,Kolkata, Bangalore, and Mumbai) of India from Nov 2016 to Dec 2017. Total 6,225 community people were enrolled.An educational counseling intervention (Edu vaccine) comprising: knowledge of heart, heart disease awareness,risk factor awareness, preventive measure awareness and diagnostic, and regular medical checkups were given tocommunity people with expert doctors through face-to-face interactions and video counseling. The effect of lifestylebased counseling was assessed through pre- and post-designed Edu vaccine questionnaire.Results: The results of this study showed a significant improvement in knowledge of heart (79.6%), heart diseaseawareness (87.8%), risk factor awareness (74.9%), preventive measure awareness (89.8%), diagnostic, and regularmedical checkups (84.7%), respectively.Conclusion: The results of this study showed a significant improvement in knowledge of heart (79.6%), heart diseaseawareness (87.8%), risk factor awareness (74.9%), preventive measure awareness (89.8%), diagnostic, and regularmedical checkups (84.7%), respectively. The first phase study of NPPEHA results conclude that lifestyle-based Eduvaccine is effective, and this tool is very easy to follow and heart attack prevention methods. The next phase ofNPPEHA program is ongoing and results are awaited.

Cervical Infantile Fibrosarcoma: a rare cause of paediatric parapharyngeal neck mass

Soft tissue tumors are not uncommon in childhood and comprise entities that range from common to very rare malignancies. Infantile fibrosarcoma (IFS) is a rare pediatric malignancy mainly seen in the first two years of life. The data about the incidence of infantile fibrosarcoma occurring in the neck in the Indian subcontinent is scarce. To the best of our knowledge, only one case of infant cervical IFS has been reported previously in the Indian subcontinent. We present another case of an eight-year-old male patient with a rapidly growing mass on the left side of the neck. He was successfully treated with a combined modality of surgery and chemotherapy with a good outcome. Among the soft tissue tumors of childhood, IFS is a rare entity. It has a good prognosis and lesser chance of distant metastasis as compared to adult fibrosarcoma. Though surgical excision is the mainstay of treatment, chemotherapy also has a significant role in the treatment of primary tumor and metastasis. We discuss the stated case to bring to the notice this uncommon cause, which can be considered as a differential diagnosis of upper cervical swellings. A better understanding of this entity would help in early diagnosis and aggressive treatment, reducing the overall morbidity and mortality.

Concurrent chemoradiation in head and neck cancers with weekly cisplatin: analysing toxicities

Background: Head and neck cancers constitute 6% of cancers worldwide. The management requires a multidisciplinary approach. Concomitant chemoradiotherapy with cisplatin is the standard approach for locally advanced head and neck cancers. The most commonly used regime uses three weekly cisplatin which is more toxic. Low-dose once-a-week cisplatin is substituted because of perceived lower toxicity and convenience.  Methods: Squamous cell carcinoma of stage III, IVA and IVB of oropharynx, hypopharynx and larynx were studied for one year. 82 patients were studied. Total dose of radiation was 66Gy/33#/6 ½ weeks from Monday to Friday with inj. Cisplatin 40mg/m2 i.v. infusion weekly.Results: 88% of patients were able to complete five or more weekly chemotherapy cycles with cumulative dose of 200mg/m2. Grade 2 and 3 acute toxicities were seen in weekly cisplatin arm but were conservatively managed.Conclusions: Weekly cisplatin can be used with concurrent radiotherapy as the acute toxicities are manageable and is well tolerated.

Development And Validation Of Hplc Method For Simultaneous Estimation Of Sertaconazole Nitrate And Zinc Pyrithione In Combined Dosage Form

Drugs like Sertraconazole nitrate and Zinc Pyrithion were analyzed by manymethods individually viz HPLC (High performance liquid chromatography) etc but there is nosingle method reported for the simultaneous determination of Sertraconazole nitrate and ZincPyrithion in combination. Although Sertraconazole nitrate is official in British Pharmacopoeiabut Zinc Pyrithion is not official in any Pharmacopoeia. Hence a proper research work is wellaimed to develop and validate a new analytical method for simultaneous estimation ofSertraconazole nitrate and zinc Pyrithion in Pharmaceutical Dosage form.

Prospective Study Of 200 Cases Of Staghorn Calculus- A Single Centre Experience.

Background: Staghorn stones are large branching stones that fill the renal pelvis and renal calyces and they can be complete or partial depending on the occupancy of the collecting system. . PCNL is a demanding procedure mainly for staghorn stones and may require multilple percutaneous tracts or multilple sessions of PCNL for complete clearance of stones. Hence ; we planned the present study to analyse patients undergoing PCNL for staghorn calculi. Material and Methods: In present study 200 patients underwent PCNL for the treatment of staghorn kidney stones. After exclusion criteria patients were selected and underwent standard PCNL. Preoperative , Intraoperative and Postoperative data was collected. Results: Out of 200 patients 95 (47.5%) were males and 105 (52.5%) patients were females. 120 patients (60%) were diagnosed with partial staghorn calculi whereas 80(40%) patients were diagnosed as complete staghorn Calculi. 37.5% patients were rendered stone free through single access port whereas 62.5% required multiple access port for PCNL in which 57.5% needed 2 access ports, 3% needed 3 access ports and only 2% needed 4 access ports for PCNL. 24 (12%) patients required 2nd stage procedure for residual stones and 1 (0.5%) patient become stone free after 3rd stage PCNL. Bleeding requiring blood transfusion was the most common complication in 21% patients. Whereas fever, hemothorax, hydrothorax, paralytic ileus were encountered in 12%,0.5%,0.5% and 4% patients respectively. Conclusion: For staghorn calculus PCNLis safe and effective procedure with acceptable morbidity and without mortality. Now PCNLhas almost replaced the open surgeries like pyelolithotomy , nephrolithotomy . with experience staghorn calculus can now be managed by minimum invasive technique like PCNL with no scar , no risk of incisional hernia , lesser hospital stay and minimum morbidity compared to open procedures

Prospective Study of 500 Cases of TURP

Introduction: Clinical benign prostatic hyperplasia (BPH)is one of the most common cause of lower urinary tractsymptoms in ageing men. Gold standard for BPH now days,is transurethral resection of the prostate (TURP). Hence; thepresent study was planned to prospectively analyse 500 TURPcases.Material and methods: 500 patients who underwent TURPafter failed medical therapy for BPH or with absoluteindication for TURP were anlayzed. All patients underwentultrasonography for post void residual urine and prostatesize, Serum PSA, DRE and uroflowmetry. Urine routineand culture along with renal function test was done in allpatients. Urodynamic study was done in patients suspectedfor neurogenic bladder. Data in relation to intraoperativeparameters and postoperative follow-up were analysed.Results: In the present study, data of a total of 500 patientswas analysed. Fever, haematuria and clot retention was foundto be present in 20, 25 and 18 patients respectively. Deathoccurred in 1 patient due to cardiac complication. Bloodtransfusion was required in 50 patients. Stricture and bladderneck contracture was seen in 16 and 9 patients respectively asa manifestation of late complication. Incontinence was foundto be present in 1 patients.Conclusion: TURP is one of the best minimally invasivetreatment for BPH. Along with being cost-effective, it isalso associated with significantly shorter hospital stay andminimum morbidity

Four percent formalin application for the management of radiation proctitis in carcinoma cervix patients: An effective, safe, and economical practice

Context: Radiotherapy is a very effective treatment modality for pelvic malignancies such as carcinoma of the cervix. However, it is quite common for chronic radiation proctitis (CRP) to manifest after radical radiotherapy. CRP is a source of significant morbidity, and there is a lack of effective treatment modalities. There also exists a general lack of guidelines on management of CRP. Aims: To assess the benefit from 4% formalin application for the treatment of Grade >2 CRP among patients previously treated with radical radiotherapy for cervical carcinoma. Settings and Design: This retrospective descriptive study involved 29 eligible patients who were treated from November 2010 - November 2015 for CRP with 4% formalin application. Materials and Methods: Of the 1864 patients of carcinoma cervix treated during the said patients, 29 patients fulfilled the eligibility criteria. Eligible patients were invited telephonically for follow-up and were assessed for response and complications of the procedure. Results: The treatment of hemorrhagic radiation proctitis with local formalin instillation is effective, well tolerated and safe procedure. The procedure is inexpensive, technically simple and can be done on an outpatient basis. 62% patients had complete freedom from rectal bleed, while 34.5% patients had partial benefit. Only one patient required diversion colostomy for persistent bleeding.

Isolated Sigmoid Colon Injury Following Blunt Trauma Abdomen - An Unusual Occurrence.

Colon injury is far more common in penetrating injury than blunt trauma. Blunt trauma to the abdomen is more likely to damage solid organs such as the liver, spleen, pancreas and kidneys. Colon injury in blunt trauma is severe and is associated with other organ injuries, making its diagnosis difficult. However, isolated sigmoid colon injury in blunt trauma is rare. We report a case of 42 year old male who presented to us with blunt trauma to abdomen following a fall on iron Jaal (Grid) with slipping of one lower limb between two iron bars. The patient presented 4 days after injury with tenderness and guarding all over abdomen. X-ray abdomen was normal, ultrasonogram of abdomen showed presence of free fluid. Patient was operated on clinical basis. A single perforation of size 2 cm×1 cm was present in proximal sigmoid colon and there was no other injury. The perforated colon loop was mobilized and brought to anterior abdominal wall as colostomy. Isolated sigmoid colon injury is rare presentation. Initial radiologic investigations and clinical presentation may be misleading.

Study Of Carotid Intima Media Thickness In Patients Of Chronic Kidney Disease.

Background: Patients with Chronic Kidney Disease (CKD) are at high risk for developing cardiovascular disease (CVD). Carotid intima media thickness (CIMT) has been found to correlate with coronary artery atherosclerosis. Methodology: This was a prospective study of carotid intima media thickness in patients of CKD, done in the Department of Medicine, G.R. Medical College & J.A. Group of Hospitals, Gwalior (M.P.), India. A total of 70 patients of CKD and 35 age and sex matched controls were enrolled. Bilateral assessment of intima media thickness was done in common carotid artery and higher value of CIMT of any one carotid artery was recorded. Results: Out of total 70 patients of CKD, 42 were males. Clinical findings in CKD patients were anemia (92.5%), edema (71.4%), decreased urine output (41.42%), obesity (12.5%). Proteinuria (>300mg/24 hrs) was seen in 91.4% patients. CIMT in CKD patients was between 0.9-1.0mm whereas in controls was between 0.5-0.6mm. 62.5% of total patients (CIMT 0.91±0.24 to 1.15±0.24) were having mean BP between 90 to 130 mmHg, 12.7% of total patients (CIMT 1.00±0.26) were having mean BP>130 mmHg. CKD patients with dyslipidemia were having mean CIMT 1.08±0.19 in comparison to controls with dyslipidemia having mean CIMT 0.67±0.22. Conclusion: CIMT was increased in CKD patients with increased age, progression of stage of CKD and proteinuria. Mean CIMT was increased in all stages of CKD and there was no significant difference in CIMT in different stages of CKD. Patients having high mean blood pressure was having higher mean CIMT in comparison to patients having lower mean blood pressure, patient with dyslipidemia had high mean CIMT as compared to mean CIMT of controls having dyslipidemia.

Biodegradable microparticulate drug delivery system of diltiazem HCl

The efficacy of a drug in a specific application requires the maintenance of appropriate drug blood level concentration during a prolonged period of time. Controlled release delivery is available for many routes of administration and offers many advantages (as microparticles and nanoparticles) over immediate release delivery. These advantages include reduced dosing frequency, better therapeutic control, fewer side effects, and, consequently, these dosage forms are well accepted by patients. Advances in polymer material science, particle engineering design, manufacture, and nanotechnology have led the way to the introduction of several marketed controlled release products and several more are in pre-clinical and clinical development. The objective of this work is to prepare and evaluate diltiazem HCl loaded albumin microparticles using a factorial design. Albumin (natural polymer) microparticles were prepared by emulsion heat-stabilization method. Selected formulations were characterized for their entrapment efficiency, particle size, surface morphology, and release behavior. Analysis of variance for entrapment efficiency indicates that entrapment efficiency is best fitted to a response surface linear model. Surface morphology was studied by scanning electron microscopy. Scanning electron microscopy of the microparticles revealed a spherical, nonporous and uniform appearance, with a smooth surface. The geometric mean diameter of the microparticles was found to be 2-9 µm, which more than 75% were below 3.5 µm and drug incorporation efficiency of 59.74 to 72.48% (w/w). In vitro release profile for formulations containing diltiazem HCl loaded BSA microparticles with heat stabilization technique shows slow controlled the release of the drug up to 24 hours. The release pattern was biphasic, characterized by an initial burst effect followed by a slow release. All selected microparticles exhibited a prolonged release for almost 24 hours. On comparing regression-coefficient (r²) values for Hixson Crowel, Higuchi and Peppas kinetic models, different batches of microparticles showed Fickian, non-Fickian, and diffusion kinetics. The release mechanism was regulated by D:P ratio. From the statistical analysis it was observed that as the drug:polymer (D:P) ratio increased, there was a significant increase in the encapsulation efficiency. Based on the particle size, entrapment efficiency and physical appearance, DTM-3 formulations were selected for in vivo release study and stability study. The in vivo result of drug loaded microparticles showed preferential drug targeting to liver followed by lungs, kidneys and spleen. Stability studies showed that maximum drug content and closest in vitro release to initial data were found in the formulation stored at 4 ºC. In present study, diltiazem HCl loaded BSA microparticles were prepared and targeted to various organs to satisfactory level and were found to be stable at 4 ºC.

A eficácia terapêutica de um fármaco depende da manutenção de seu nível plasmático adequado em determinado intervalo de tempo. Nesse sentido, a liberação modificada de fármacos está disponível em muitas vias de administração e oferece muitas vantagens (como micropartículas e nanopartículas) quando comparada às formulações de liberação imediata. Essas vantagens incluem reduzida frequência da dosagem, melhor controle terapêutico e menos efeitos colaterais. Assim sendo, esses produtos apresentam maior aceitação pelos pacientes. Os avanços na ciência dos materiais, na engenharia das partículas, em manufatura e em nanotecnologia permitiram a introdução no mercado de vários produtos de liberação modificada e vários outros se encontram em desenvolvimento pré-clínico e clínico. O objetivo do presente trabalho foi preparar e avaliar o fármaco cloridrato de diltiazem associado a micropartículas de albumina utilizando planejamento fatorial. As micropartículas de albumina, um polímero natural, foram preparadas por método de emulsão empregando estabilização por calor. As formulações selecionadas foram caracterizadas no que se refere à sua eficiência de encapsulamento, tamanho médio de partículas, morfologia de superfície e perfil de liberação do fármaco. A análise de variância relativa à eficiência de encapsulamento indicou superfície de resposta linear. Com referência à morfologia superficial, essa foi avaliada empregando microscopia eletrônica de varredura. Essa análise revelou micropartículas esféricas, não porosas e de aparência uniforme, com superfície lisa. O diâmetro médio das micropartículas foi entre 2 e 9 µm, sendo que mais de 75% das micropartículas se apresentaram abaixo de 3,5 µm. Além disso, a eficiência de encapsulamento foi entre 59,74 e 72,48%. Quanto ao ensaio para avaliação do perfil de liberação in vitro do fármaco associado às micropartículas, as formulações apresentaram liberação lenta até 24 horas. O comportamento foi caracterizado por liberação inicial (efeito burst) seguida por liberação lenta. Todas as fórmulas selecionadas apresentaram liberação prolongada por aproximadamente 24 horas. Na comparação entre os valores de coeficientes de regressão (R²), os modelos propostos por Hixson Crowel, Higuchi e Peppas, para diferentes formulações de micropartículas, demonstraram cinética de liberação de acordo com modelo Fickiano e não-Fickiano. O mecanismo de liberação do fármaco foi regulado pela razão entre o fármaco e o polímero. A análise estatística revelou significativo aumento da eficiência de encapsulamento quando essa razão aumentou. As avaliações relativas à análise dimensional das micropartículas, à eficiência de encapsulamento do fármaco e à morfologia permitiram a seleção da formulação DTM-3 para os ensaios de liberação in vivo e para o estudo da estabilidade. O ensaio de liberação in vivo do fármaco associado às micropartículas demonstrou sítio-alvo preferencial no fígado, seguido pelos pulmões rins e baço. No presente estudo, as micropartículas de albumina contendo cloridrato de diltiazem foram adequadamente preparadas e orientadas satisfatoriamente para vários órgãos. Além disso, a formulação selecionada apresentou estabilidade físico-química a 4 ºC.

Effect of yoga on pulmonary function tests of hypothyroid patients.

Aim of this study was to see any effect on respiratory functions in hypothyroid patients after pranayama (yoga). The subjects for the study were 20 hypothyroid females, 39.70±8.27 years of mean age referred from medicine department of UCMS & G.T.B. Hospital. Spiro metric recordings were taken with hypair (version-1.28). Baseline (first) recordings were taken when patient came for the first time. Patients came to yoga lab in physiology department for 21 days continuously where they were trained by the yoga instructors and then told to do pranayama at home and called at regular intervals after 7 days to see the compliance. The breathing exercises were done for 45 minutes everyday. After 6 months of pranayama second recording was taken and compared with the baseline. There were significant improvement in forced expiratory volume in first second (FEV1), Maximum voluntary ventilation (MVV) and Inspiratory Capacity(IC). Thus Pranayama and meditation has beneficial effect on pulmonary functions of hypothyroid patients along with conventional treatment.