Metronidazole: A culprit to balance and speech

In a country like India, oral metronidazole is the commonly prescribed drug of choice for entities such as amebiasis and visceral abscesses. Oral such cases, it is usually well tolerated and safe but can cause serious neurological adverse events. Peripheral neuropathy commonly encounters in practice but central nervous system toxicity is also well documented as it crosses the blood–brain barrier easily. Neurological toxicity of metronidazole may be due to prolonged administration, high doses, or high cumulative doses. Magnetic resonance imaging (MRI) of brain is the modality of choice to evaluate brain involvement. In the brain, the splenium of the corpus callosum, dentate nucleus of the cerebellum, and posterior pons involvement are commonly seen and diagnostic. Here, we have an interesting case report of a patient who was on oral metronidazole treatment for his large liver abscess, presenting with a complaint of neurological symptoms of unsteady gait, vertigo, dysdiadochokinesia, and difficulty in speech. Moreover, thus suspected as metronidazole drug toxicity and further investigated for the same, and MRI typically shows cerebellar and posterior corpus callosal involvement

Kasurdi Health and Demographic Surveillance System: A Profile and Way Forward

Kasurdi Health and Demographic Surveillance System (Kasurdi HDSS) was established at Rural Health Training Center Kasurdi on February 16, 2018. Kasurdi HDSS has been established to increase the research potential of medical colleges and develop real?time data for research purposes to study the changes in population demography, health, and health?care utilization. Kasurdi HDSS currently follows 2755 individuals living in 549 households. The system collects the data from the population through annual rounds conducted by postgraduate residents of the department of community medicine. The data are collected in the digital format with the help of android-based tablets. HDSS has collected demographic data, reproductive data, data on diseases such as tuberculosis and noncommunicable diseases, and socioeconomic data. The HDSS is in the process to upgrade its data management system to a more integrated platform, coordinated and guided by national/international standards, and data sharing policy.

Relation between non-alcoholic fatty liver disease and ischemic heart disease studied at rural tertiary care centre in Uttar Pradesh, India

Background: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States and other industrialized countries, many study has identified NAFLD as a risk factor not only for premature coronary artery disease and cardiovascular events, but also for early subclinical abnormalities in myocardial structure and function. Aim of this study was to the presence of NAFLD in patients with Ischemic Heart Disease (IHD) and Relation of NAFLD with other risk factors of IHD.Methods: The study group consisted of 150 patients that comply with inclusion criteria and selected of 100 consecutive patients who underwent coronary angiographies. Coronary artery disease was defined as a stenosis at least 50% in at least one major coronary artery. Fatty liver was diagnosed by abdominal ultrasonography (4 stages: Grades 0, 1, 2 and 3). Statistical evaluations were performed using T test, Chi- square test.Results: The present study was done in 100 patients of coronary artery disease divided into two groups i.e. Non NAFLD group n= 62 (62%) and NAFLD group n= 38 (38%). The present study shows that the prevalence of NAFLD was highest (86.8%) in more than 40 years of age group. The present study shows that the prevalence of NAFLD was more in males (84.2%) as compare to females (15.8%). The present study also shows significantly high incidence of metabolic syndrome in patients with NAFLD (23.7%) as compared to Non-NAFLD (3.2%) patients with Coronary Artery (CAD).Conclusions: The presence of fatty liver and its severity should be carefully considered as independent risk factors for IHD. The study results suggest the synergistic effect in between fatty liver and deranged lipid profile for developing IHD. Abdominal ultrasonography may provide valuable information about IHD risk assessment.

An experimental study to evaluate the role of aspirin and metformin in prevention of depression in rats

Background: Depression was seen to be associated with an increased level of inflammatory biomarkers along with the disturbance in the monoamine neurotransmitter system. Current therapies are mostly focussed on the neurotransmitters imbalance but due to increasing cases of treatment failure there is a need to shift our treatment focus to other potential therapies. This study aimed to evaluate the preventive role of aspirin and metformin in stress induced model of depression in wistar rats.Methods: Fifty four wistar rats were randomly divided into nine groups as normal control, experimental control, aspirin (30 mg/kg, 60 mg/kg), metformin (50 mg/kg, 100 mg/kg), two combination groups and imipramine (15 mg/kg). Depression model was created by the induction of chronic unpredictable mild stress (CUMS) for consecutive 28 days. Behavioural assessment was done by evaluating immobility time in forced swim test (FST) and sucrose preference ratio (SPR) in sucrose preference test. The data were analysed by analysis of variance (ANOVA) test using SPSS software. P<0.05 was considered to be statistically significant.Results: The CUMS led to an increase in immobility time and decrease in SPR. Aspirin and Metformin alone and their combinations showed statistically significant response in preventing the immobility time to increase (p<0.001) and SPR to decrease (p<0.001). However the response of Aspirin was comparable with Imipramine but the response of Metformin was not as significant as of Imipramine (p>0.05).Conclusions: Aspirin and metformin might have a potential role in the prevention of depression.

Review of Paediatric Typhoid Perforation Cases Managed at a Tertiary Care Centre

Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing a case of Paediatric gastrointestinal perforation to Typhoid would be of help in reaching a proper diagnosis to guide appropriate management.Aims and Objectives: To review all cases of Typhoid perforation for their clinical, pathologic and intra-operative findings.Materials and Methods: A retrospective study was conducted on all cases of typhoid perforation (gastrointestinal perforation with positive Widal test) operated at a tertiary care centre from September 2015 to September 2018. Data regarding their clinical findings, investigation results, intraoperative findings, nature of thesurgical intervention, postoperative results and histopathological findings were collected from their records and analysed.Results: A total of 13 patients were operated during this period with positive Widal’s test at presentation. 6/13 had single ileal perforation; two patients had multiple ileal perforations; perforation at atypical sites were found in four patients (one each at gastric, duodenal, caecal and rectal); one patient presented with Meckel’s band obstruction with multiple ulcers –this patient was sick and died despite a diverting ileostomy in the postoperative period. While 8/13 patients had primary closure of the perforation site, diversion through ileostomy was performed in five patients. All patients did well in the post-operative period except one patient of multiple ulcers and obstructing Meckel’s band who died in the post-operative period. Conclusion: On encountering a gastrointestinal perforation, no definite symptomatology or its pattern, no clinical examination findings, no intraoperative characteristics of the perforation and no biopsy can definitively point towards Typhoid as the cause. Therefore, we still have to depend on serological tests in correlation with clinical features to reach a conclusive diagnosis. Cultures and PCR, although sensitive are either time-taking or expensive to guide management. Typhoid perforation can have vivid and atypical presentation depending on the number and site of perforation

Drug resistance profile among multi-drug resistant tuberculosis patients at diagnosis and correlation with history of anti-tubercular treatment in a tertiary care center

Background: Drug Resistant Tuberculosis (DR-TB) is a major threat to the realization of the goal of a TB free world in the near future. It is important to study the reasons for the increasing number of such cases so that effective action can be taken to control this growing epidemic.Methods: Sputum from 36 patients diagnosed with acquired pulmonary Multidrug Resistant Tuberculosis (MDR-TB) were subjected to first- and second-line Drug Sensitivity Testing (DST) after liquid culture in mycobacterium growth Indicator Tube (MGIT). Primary MDR-TB cases were excluded. The relation of the drug sensitivity profile with the history of prior treatment taken was statistically analysed.Results: Majority of the patients had received appropriate treatment, and most had adhered to prescribed treatment. Among the 36 patients, 24(66.7%) were found to be Pre-Extensively Drug Resistant (Pre-XDR-TB) and 4(11.1%) were extensively drug resistant XDR-TB cases. Inappropriate prescription of fluoroquinolone (FQ) was found to be most common. Prior intake of any drug was not found to significantly affect subsequent resistance to that drug.Conclusions: Fluoroquinolone resistance is quite common in patients with DR-TB (66.7%). This study did not find the prior use of FQ or any other drug to significantly affect subsequent resistance to the drug. Primary drug resistance is thus a major concern. 11.1% patients were found to be XDR-TB cases. Hence DST for first- and second-line drugs should be done at the time of diagnosis to avoid failure of treatment with a predesigned regimen.

Assessment Of Plantar Fasciitis Among Adults Having Higher Body Mass Index And Glucose Intolerance In A Medical Institute Of Raipur

Introduction: Plantar fasciitis (PF) is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin on the calcaneus. PF is reported to be the most common cause of inferior heel pain in diabetic and non diabetic patient population. Calcaneal spurs (CS) have commonly been implicated as a risk factor for PF. To this purpose we have evaluated the frequency of Calcaneal spur (CS) in obese patients with Type-2 diabetes. Method: Study was designed as a cross sectional Analytical study . Male and female study subjects who were Obese (BMI ≥30 kg/m2), Having Diagnosed type 2 diabetes & above the age of 18 years, with a history of plantar heel tenderness and/or pain were included in the study Information was analysed by using the Microsoft Excel and SPSS . Chi square test was used for analysis. Results:Atotal of 65 obese diabetic patients were included into the study. The mean age of the patients was 54±5.8 years. There were 25 males and 40 females. The median duration of diabetes was 4.2 years (1-10 years). The mean HbA1c was 8.4±0.9. 78% were having plantar fasciitis. Conclusion: Poor diabetes control Peripheral Neuropathy seems to be the main reasons Existence seems to be in a relationship with diabetic complications; therefore, obese diabetic patients may be more prone to these complications. Therefore, weight reduction should be encouraged in these patients

A cross sectional study for Screening of the risk factors of Diabetes among rural population

Background: The rise in diabetes mellitus (DM) has made it a major public health problem & a disaster of major proportion of Populations in India . This scenario becomes worse in rural setup where limited heath care facilities are available. So, to detect risk of diabetes the determinants of type-2 DM in people who are ≥45 years of age a study was done by selective screening methodology in rural area of Arang Block of Raipur district Methods: A cross-sectional population-based study was conducted in Arang block of Raipur District during 22nd April to 30th May 2019 among those who are at risk of developing DM, as per the WHO guidelines on Laboratory Diagnosis and monitoring of Diabetes Mellitus . Blood glucose estimation was done using a blood glucose meter. Personal Interview, Anthropometric measurements & Clinical Examination was done and a Pre-designed Questionnaire form was filled from every study subject. Analyzed on SPSS. Results: 8.4 % of the persons above the age of 45 years were diabetic. Study also revealed the proportion of people diagnosed with DM increases with increasing age groups. The difference between the post meal blood glucose level among the diabetics and nondiabetics was statistically significant. The proportion of diabetics was more among those who had family history of diabetes , BMI more than 25 and those with sedentary lifestyle. Conclusions: Implementation of preventive measures to reduce the burden of diabetes is needed. Identification of the various factors adversely related to glucose intolerance will help in evolving preventive strategies.

Cost comparison of antihypertensive drugs available in India with Drugs Prices Control Order price list

Background: DPCO (Drugs Prices Control Order) price list is issued by NPPA (National Pharmaceutical Pricing Authority) each year to guide the pharmaceuticals companies for controlling the prices in India. Some drugs cost more than the DPCO list. As antihypertensive drugs are taken lifelong once diagnosis is made, price variation and costing above prescribed price cause a huge economic burden on such patients. This study was undertaken to know the number of antihypertensive drugs brands with price above the recommended DPCO price list 2017.Methods: Authors have collected the data from website medguideindia.com, CIMS (current index of medical specialties), Drug Today, and compared the listed antihypertensive drugs of various available brands in India with DPCO price list 2017. Data was entered in Microsoft excel 2010. Percentage of selling price above the DPCO price list was calculated for each drug.Results: The data of 30 formulations of 16 antihypertensive drugs was analysed. The total number of available brands of all formulations was 1365 out of which only 831 (60.88%) brands were found to have price <DPCO recommended list. 534 (39.12%) brands had price more than the recommended limit. The minimum violation of price limit was found in case of metoprolol 25mg (6.66%) and maximum price violation was observed with spironolactone 25mg and sodium nitroprusside inj 10mg/ml.Conclusions: Reassessment and monitoring for implementation of DPCO price list should be done as still large number of brands are not following the regulations and are violating the limit set by NPPA/DPCO.

Conservative Management of a Traumatic Tracheal Tear: A Case Report

We describe here a case of traumatic anterior tracheal walltear managed conservatively with a successful outcome.Conservative treatment has a high likelihood of success inpatients who meet strict selection criteria and are closelymonitored in ICUs or elsewhere. This case highlights the roleof conservative management in treating such crucial cases inthe presence of limited resources, especially in a governmentset up in India.

Immunosuppressant effect of Boswellia serrata extract on CFA induced arthritis in rats

Background: Rheumatoid arthritis (RA) is an immune-mediated arthropathy, so for the treatment disease modifying antirheumatoid drugs are required. In this study we are evaluating the immunomodulatory property of Boswellia serrata extract (BSE) as an alternative medicine.Methods: Complete Freund’s adjuvant (CFA), 0.1ml was injected intradermally in the footpad of left hind paw in 36 Wistar rats to induce RA. Animals were divided into 6 groups. BSE in the doses of 45mg/kg, 90mg/kg and 180mg/kg was administered and cyclophosphamide as standard drug. Various parameters as body weight, paw thickness, ankle diameter, paw volume, arthritis index, TNF- ? and histopathological changes were analyzed.Results: Marked reduction in paw thickness, ankle diameter, paw volume, arthritis index and an improved body weight was found in high dose BSE (180mg/kg) group but the effect was lesser than standard drug Cyclophosphamide.Conclusions: BSE has significant potential as an alternative medicine for treatment of autoimmune diseases like rheumatoid arthritis.

Evaluation of Correlation of Dental Fluorosis and Cognitive Status.

Background: Fluoride in groundwater is more common in crystalline igneous rocks and alkaline soils located in semiarid climate, which exist in the northwestern parts of the Jharkhand state in the district of Garhwa and Palamu. The present study was undertaken to evaluate the intelligent quotient among children affected with and without dental fluorosis visiting dental college in the Garhwa district. Methods: The present prospective study comprised of 30 subjects selected randomly in the age group of 6-12 years visiting Vananchal dental college & hospital, Garhwa. The study compared IQ levels of children of study and control groups by means of Seguin Form Board Test. Data so obtained was statistically analyzed using Student ‘t’ test with p value <0.05 as significant value. Results: Regarding drinking water source, 45% was drinking groundwater among study group. Mean scores for average timing category was found to be significantly higher (P<0.05) among children with dental fluorosis (29±2.87) than among children without dental fluorosis (27±3.02). Conclusion: The present study concludes that children with dental fluorosis have low Intelligence Quotient (IQ) than children without dental fluorosis. About half of the patients suffering from dental fluorosis were dependent on groundwater for drinking purposes. Fluoride water level of villages located in these regions should be selected in priority for application of defluoridation measures.

The extent of price variation amongst branded antihypertensive drugs and its association with number of pharmaceutical companies.

Background: The study was performed to analyze the extent of price variation amongst branded antihypertensive drugs in India and the relation of this price variation to number of pharmaceutical companies manufacturing/marketing these drugs. Methods: Price of different brands of antihypertensive drugs was collected from authentic sources. The data were segregated and the percentage price variation was calculated applying suitable statistical tools. Results: A total of 116 formulations from different companies representing 38 antihypertensive drugs were analyzed. Maximum price variation (3233.33%) was seen with 10 mg dose of propranolol. In general the price variations are proportionally correlated to the number of pharmaceutical companies. Conclusions: Price variation of great extent was found among many formulations. Physicians should be aware of these variations for choosing the appropriate brand for rational therapeutics. This will reduce the burden on patients and family.

Restriction on animal experimentation for medical education and research: pros and cons.

Recently, a lot have been written and discussed about animal experiments and ethics. Still there is too much confusion among academicians and researchers about the future of use of animals in biomedical research and up to what extent their use in laboratory, research institutions, and medical colleges. This article highlighted and discussed about various aspects of this burning issue along with several pros and cons.

Functional genomics of tomato: Opportunities and challenges in post-genome NGS era.

The Tomato Genome Sequencing Project represented a landmark venture in the history of sequencing projects where both Sanger’s and next-generation sequencing (NGS) technologies were employed, and a highly accurate and one of the best assembled plant genomes along with a draft of the wild relative, Solanum pimpinellifolium, were released in 2012. However, the functional potential of the major portion of this newly generated resource is still undefined. The very first challenge before scientists working on tomato functional biology is to exploit this high-quality reference sequence for tapping of the wealth of genetic variants for improving agronomic traits in cultivated tomatoes. The sequence data generated recently by 150 Tomato Genome Consortium would further uncover the natural alleles present in different tomato genotypes. Therefore, we found it relevant to have a fresh outlook on tomato functional genomics in the context of application of NGS technologies in its post-genome sequencing phase. Herein, we provide an overview how NGS technologies vis-à-vis available reference sequence have assisted each other for their mutual improvement and how their combined use could further facilitate the development of other ‘omics’ tools, required to propel the Solanaceae research. Additionally, we highlight the challenges associated with the application of these cutting-edge technologies.

Comparative evaluation of itopride and domperidone in gastroesophageal reflux disease.

Background: Gastroesophageal reflux disease (GERD) presents in various ways in terms of symptoms and severity. This study was conducted to assess the severity of GERD patients and to evaluate the effect of itopride and domperidone on symptoms and severity of GERD. Methods: A single-blind study was carried out in 70 patients. Group A (n=35) patients were kept on itopride therapy, 50 mg thrice a day before meal. Group B (n=35) patients were kept on domperidone therapy, 10 mg thrice a day before meal. Patients of both groups were given rabeprazole, 20 mg once a day for hyperacidity. Patients served their own control. Each patient was followed-up at 2 weeks interval up to 8 weeks. Results: The most common symptom was heartburn, present in 95.71% patients. Regurgitation was the next most common symptom (65.71%). The most common lesion seen endoscopically (according to Savary Miller classification) was grade I (38.57%). In 24.29% patient, only symptoms of GERD were present without any endoscopically visible mucosal injury. At the end of 2, 4, 6, and 8 weeks, relief of symptoms was more with a combination of itopride and rabeprazole in comparison to the combination of domperidane and rabeprazole, but the difference was statistically insignificant. Healing rate at the end of 4th and 8th week was slight better with a combination of itopride and rabeprazole, but the difference again was statistically insignificant. Conclusion: Combination of itopride and rabeprazole showed insignificantly better results, both symptomatically and endoscopically in comparison to the combination of domperidone and rabeprazole.

Reliability of digital panoramic radiographs in detecting calcified carotid artery atheromatous plaques: A clinical study.

Objectives: The objective of this study was to determine whether digital panoramic radiography is a reliable method to detect calcified carotid artery atheromatous plaques (CCAAP) as compared with ultrasonography. Study Design: Digital panoramic radiographs were obtained from 50 patients who also underwent carotid ultrasound examination. The images were interpreted by trained maxillofacial radiologist for the presence or absence of calcified atheromatous plaques. The extent of carotid calcification on carotid ultrasonography was determined by a trained Sonologist, which was considered as the gold standard assessment. Results: Digital panoramic radiographs had a sensitivity of 76% and specificity of 98.66% in determining CCAAP. There was a high level of agreement between diagnoses, with a kappa value of 0.8. Conclusion: To conclude, digital panoramic radiographs had good sensitivity and high specificity in detecting CCAAP. If properly trained, dentists can detect such plaques and can refer patients to physician for timely medical treatment.

Lack of research aptitude in medical education.

Students are attracted towards the medical profession to become a doctor and not to be a researcher. According to a recent study there are about 1,00,000 undergraduate medical students in India at a given point of time, out of them only 0.9% of the students have shown research aptitude. During their training period of graduation in medical sciences, they are so much burdened with the work load of exams, practicals, ward duties and tutorials. In such an over burdened situation very few of them can think about research. A study had shown that training in research methodology received early in medical school helps students to develop a positive attitude towards research. So changes in the undergraduate and postgraduate curriculum are required to promote research among medical students.

Use of extraoral periapical radiography in Indian population: Technique and case reports.

Performing intraoral radiography in certain patients is difficult as these patients are unable to tolerate intraoral film placement. To assist such patients a new technique has been innovated using extraoral film placement. Use of this technique has been documented in Caucasian and Taiwanese populations. In this paper we report use of this technique for Indian population. We have done about 40 cases using this technique and have found the average angulation for maxillary (-25+/-5 degrees) and mandibular (-15+/-5 degrees) teeth for Indian population. We recommend use of this technique in the personal dental clinics where panoramic radiographic machines are not readily available. Here we report the technique and cases where diagnostic imaging was performed in patients using the extraoral periapical technique.

Non- Surgical Endodontic Management of The Combined Endo- Perio Lesion: Report of Three Case.

Endodontic–periodontal lesions offer a constant challenge to the clinician for diagnosis, treatment and prognosis of the teeth that are of great concern. Treatment and prognosis of endodontic–periodontal diseases vary depending on the cause and the correct diagnosis of each specific condition. This article presents successful healing of combined endo-perio lesions after non-surgical endodontic management with long term follow up.