Design, synthesis, in silico studies, and antidiabetic activity of several sulfanilamide incorporated 2,3-disubstitut-ed thiazolidin-4-ones

A panel of 2,3-disubstituted thiazolidin-4-ones 4a-n was synthesised from Schiff bases 3a-n derived from sulfanilamide, by reaction with thioglycolic acid. The compounds were characterised by means of IR, NMR, and Mass spectral data. Compounds 4a-n were screened for DPPH scavenging assay and compounds 4e, 4h, 4i, and 4n exhibited moderate activity. Compounds 4e, 4h, and 4i were tested at 200 mg/kg and 4e at 50 mg/kg b.w. orally for antidiabetic activity in fructose induced diabetic rats. They exhibited significant antidiabetic activity compared to the control group. Pioglitazone was used as a standard drug. The tested compounds exhibited better and ignificant serum cholesterol lowering activity when compared with the control and standard groups. They also reduced the triglyceride level after the 21st day; however, it was insignificant when compared to the control group. Compound 4n displayed the highest binding energy when docked with PPAR-γ followed by compounds 4e, 4h, and 4i when compared to pioglitazone. The physicochemical, drug likeness and ADME properties of the title compounds were found to be satisfactory.

Se sintetizó un panel de tiazolidinas-4-onas 2,3-disustituidas 4a-n a partir de las bases de Schiff 3a-n derivadas de la sulfanilamida por reacción con ácido tioglicólico. Los compuestos se caracterizaron por IR, RMN y datos espectrales de masa. Los compuestos 4a-n se analizaron para DPPH y los compuestos 4e, 4h, 4i y 4n mostraron una actividad moderada. Los compuestos 4e, 4h y 4i se probaron a 200 mg/kg y 4e a 50 mg/kg b.w. oralmente para la actividad antidiabética en ratas diabéticas, inducida por fructosa. Los compuestos mostraron una actividad antidiabética muy significativa en comparación con el grupo control. La pioglitazona se utilizó como fármaco estándar. Los compuestos ensayados mostraron una mejor y significativa actividad reductora del colesterol sérico en comparación con los grupos control y estándar. Estos compuestos también redujeron el nivel de triglicéridos después del 21° día, aunque fue insignificante en comparación con el grupo control. El compuesto 4n mostró la mayor afinidad de unión cuando se acopló a PPAR-γ, seguido de 4e, 4h y 4i en comparación con la pioglitazona. Las propiedades fisicoquímicas, la similitud con el fármaco y las propiedades ADME de los compuestos fueron satisfactorias, lo que los convierte en útiles agentes antidiabéticos.

Um painel de 2,3-disubstituído thiazolidina-4-ones 4a-n foram sintetizados a partir de bases Schiff 3a-n derivado da sulfanilamida por reacção com ácido tioglicólico. Os compostos eram caracterizado por IR, NMR e dados espectrais de massa. Os compostos 4a-n foram rastreados para O ensaio DPPH de limpeza radical e os compostos 4e, 4h, 4i e 4n exibiram actividade moderada. Os compostos 4e, 4h e 4i foram testados a 200 mg/kg e 4e a 50 mg/kg de peso corporal por via oral para antidiabéticos. actividade em ratos diabéticos induzidos por frutose. Exibiram uma actividade antidiabética altamente significativa actividade em comparação com o controlo. A pioglitazona foi utilizada como droga padrão. Os compostos testados exibiu uma melhor e significativa actividade de redução do colesterol sérico quando comparado comde triglicéridos após o 21° dia; no entanto, foi insignificante quando comparado com o controlo. O composto 4n mostrou a maior afinidade de ligação quando acoplado com PPAR-γ seguido de 4e, 4h, 4i quando comparado com pioglitazona. O propriedades físico-químicas, de semelhança com drogas e ADME dos compostos do título de propriedade também foram encontrados paraser satisfatórios, tornando-os agentes antidiabéticos úteis.

Outcome of superior manual small-incision cataract surgery in pediatric age group - A five year retrospective study at a tertiary eye hospital in Karnataka

Purpose: To analyze intraoperative difficulties and visual and surgical outcomes following pediatric cataract surgery. Methods: This five?year retrospective study (2014�19) included 138 eyes (85 children) with cataract aged between 12 months and 18 years (either sex). All children had undergone best?corrected visual acuity (BCVA), anterior and posterior segment evaluation, intraocular lens (IOL) power calculation, superior manual?small?incision cataract surgery (MSICS) with or without posterior capsulotomy/anterior vitrectomy and IOL implantation under general or local anesthesia, visual rehabilitation, and had been followed up for a minimum period of 12 months. Results: The mean age was 111.27 � 4.84 months. Preoperative BCVA distance: 113 (81.88%)eyes had BCVA < 6/60; near BCVA: 114 (82.6%) eyes had ?N36. At last postoperative follow?up (mean: 20.98 � 13.08 months): distant BCVA? ?6/60 had been recorded in 120 (86.96%) eyes; near BCVA? >N36 in 123 (89.13%) eyes. Improvement in BCVA was statistically significant. Intraoperative scleral tunnel difficulties were seen in three eyes (thin flap in two, and buttonhole in one eye); in the majority of the eyes 113 (81.88%), IOL was placed in the bag. Twenty eyes had early postoperative inflammation. At last follow?up: posterior capsular opacity was recorded in six eyes, IOL decenteration in two eyes, secondary glaucoma in six eyes, and severe amblyopia in 36 (26.09%) eyes. The mean myopic shift was ? 1.11 � 0.89 D and was statistically significant. Conclusion: Superior MSICS as a treatment for pediatric cataract has minimal intraoperative complications and satisfactory visual and surgical outcomes.

Presence and development of strabismus in children with telecanthus, epicanthus and hypertelorism

Purpose: To study the presence and development of strabismus in children with telecanthus, epicanthus, and hypertelorism. Methods: This is a prospective, longitudinal, and observational study. Sixty children aged between 6 months and 18 years with telecanthus, epicanthus, and hypertelorism in isolation or in combination were recruited. A detailed analysis of the history, determination of best corrected visual acuity, complete evaluation of strabismus, and ocular examination were carried out. The presence of telecanthus, epicanthus, and hypertelorism and associated strabismus, if any, was noted. All children were followed up for a minimum and maximum period of 12 and 18 months, respectively, to analyze the strabismus (previously present) and for detection of strabismus in those who did not have. The data were analyzed descriptively with mean and standard deviation. Chi square test and Fishers exact test were used to analyze the data between the groups. A P value less than 0.05 was considered to be statistically significant. Results: Telecanthus was the most common lid feature (55%). At baseline, ten (16.66%) children had strabismus (six: esotropia; four: exotropia). Two (3.33%) children underwent surgery. One child developed exotropia at the third follow?up (18 months). At the end of the study, 11 (18.33%) children had strabismus. No significant association was seen between lid characteristics and the type of strabismus. Conclusion: Children with telecanthus, epicanthus, and hypertelorism in isolation or in combination may or may not have associated strabismus. These features can pose difficulty in strabismus diagnosis, which mandates a careful examination, especially in younger age groups and small?angle strabismus. On the other hand, children without strabismus need longer follow?up to detect the development of strabismus and to initiate further management at the earliest.

Incidência de doença inflamatória intestinal: estudo retrospectivo de um único centro / Incidence of inflammatory bowel disease: a single centre retrospective study

ABSTRACT Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder affecting the gastrointestinal tract. The etiology of this alarming condition is multifactorial. A Recently increasing trend in IBD is noted in our country. Objective: The present study was designed with the main objective to assess the incidence and to identify the associated risk factors including demographic, geographical areas, and dietary patterns of IBD population of Northern of Karnataka viz. Hubli-Dharwad city. Methods: A retrospective investigation was conducted on a cohort of 226 patients with a working diagnosis of IBD and those who were admitted between 2015 to 2019 the department of gastroenterology, SDMCMS&H. The diagnosis of IBD was made based on clinical, radiological, endoscopic, and histopathologic findings. The patients were categorized into IBD and those who have symptoms suggestive of IBD but did not fit into the diagnostic criteria into, non-IBD groups. The data about of on demography, diet patterns, and laboratory parameters were recorded. Results: Among 226 patients enrolled in this study 2015-2019, IBD was confirmed in 54 Ulcerative colitis - 44 (19.46%), Crohn's disease - 10 (4.42%) patients with varying distribution of disease among different age groups and both genders, Ulcerative colitis (UC) [M: F: 28 (63.6%): 16 (36.4%)] and Crohn's disease (CD) [M: F: 07 (70.0%):03 (30.0%)]. Dietary pattern and other habitats had no significant contribution to illness and its symptoms. Urban (U) and Rural (R) divide was UC [U: R: 32 (72.7%): 12 (27.3%)], CD [U:R:07(70.0%):03(30.0%)] maintained. Conclusion Incidence of IBD was high with UC as compared to CD. The incidence of IBD among patients presenting with symptoms suggestive of IBD is 19.46% with UC being major as compared to CD (4.42%). Male predominant patterns of IBD incidences were noted. Year by year increasing trend in disease burden was observed. The Dietary pattern has no direct correlation with IBD disease prevalence and incidences.

Resumo Contexto: A Doença inflamatória intestinal (DII) é uma doença inflamatória crônica que afeta o trato gastrointestinal. A etiologia desta condição alarmante é multifatorial. Uma tendência recentemente crescente na DII é notada em nosso país. Objetivo: O presente estudo foi desenhado com o objetivo principal de avaliar a incidência e identificar os fatores de risco associados, incluindo demográficos, áreas geográficas e padrões alimentares da população com DII do Norte de Karnataka viz. Cidade de Hubli-Dharwad. Metodos: Uma investigação retrospectiva foi realizada em uma coorte de 226 pacientes com diagnóstico de DII e que foram admitidos entre 2015 e 2019 no departamento de gastroenterologia, SDMCMS&H. O diagnóstico de DII foi feito com base em achados clínicos, radiológicos, endoscópicos e histopatológicos. Os pacientes foram categorizados em DII e aqueles que apresentam sintomas sugestivos de DII, mas não se enquadraram nos critérios diagnósticos em grupos sem DII. Os dados sobre a demografia, padrões de dieta e parâmetros laboratoriais foram registrados. Resultados: Entre os 226 pacientes inscritos neste estudo entre 2015-2019, DII foi confirmada em 54 [RCUI - 44 (19,46%), DC - 10 (4,42%)] com distribuição variada da doença entre diferentes faixas etárias e ambos os sexos, colite ulcerativa (RCUI) [M: F: 28 (63,6%):16 (36,4%)] e doença de Crohn (DC) [M: F: 07 (70,0%): 03 (30,0%)]. O padrão alimentar e outros hábitos não tiveram contribuição significativa para a doença e seus sintomas. Urbanos (U) e rurais (R) dividiram-se em RCUI [U: R: 32 (72,7%):12 (27,3%)], DC [07 (70,0%): 03 (30,0%)]. Conclusão A incidência de DII foi elevada para RCUI em relação a DC. A incidência de DII entre os pacientes com sintomas sugestivos de DIB é de 19,46% com a RCUI sendo maior em relação a DC (4,42%). Foram observados padrões predominantes masculinos de incidência de DII. Ano a ano foi observada tendência crescente de carga da doença. O padrão dietético não tem correlação direta com a prevalência e incidências da DII.

Analysis of postoperative visual and surgical outcome following surgery for absorbed cataract in pediatric age group and the intraoperative difficulties

Purpose: To analyze the postoperative visual and surgical outcomes following surgery for pediatric?absorbed cataracts and intraoperative difficulties. Methods: This prospective longitudinal study included 43 eyes (30 children) with absorbed cataracts aged between 6 months and 18 years (either sex). All children underwent best?corrected visual acuity (BCVA), anterior and posterior segment evaluation, rubella titer estimation, intraocular lens (IOL) power calculation, superior small incision cataract surgery with or without posterior capsulotomy/anterior vitrectomy/IOL implantation under general anesthesia, visual rehabilitation, and were followed up for 1 year. Results: The mean age was 7.89 ± 4.84 years. Preoperative BCVA distance: 39 eyes had either perception of light (PL) or counting finger close to face (CFCF); near BCVA: all eyes had either PL or N36. Postoperative (12 months) distant BCVA: a majority of the eyes (27) had 6/60–1/60, 11 eyes had 6/18–6/36; near: N18 in 19 eyes, N6 in 7 eyes. Anterior continuous curvilinear capsulorrhexis (ACCC) was possible in eight eyes. Cortical aspiration was difficult in 16 eyes (peripheral calcified ring). A majority (32 eyes) underwent in the sulcus implantation (in?the?bag: eight eyes); two eyes: no IOL, one eye: secondary IOL. Eleven eyes had early postoperative inflammation. At 12 months, one eye underwent membranectomy for visual axis opacification and 38 eyes had well?centered IOLs. Conclusion: Surgery in absorbed cataracts is challenging because of the anatomic disorganization of the absorbed lens. By adopting appropriate surgical methods and good visual rehabilitation, one can achieve satisfactory surgical and visual outcomes, highlighting the need for surgical intervention

A RARE CAUSE OF LOWER LIMB PAIN - INTRAMEDULLARY DERMOID - A CASE REPORT

Dermoid cyst is a benign tumor. It accounts for only 1-2% of intra spinal tumors. -It is most common in children less than 10yrs of age accounting for 10-17%. -Only 1% of dermoid cyst occurs intramedullary. The usual sites are lumbosacral spine(60%), thoracic spine(10%), and cervical spine(10%). -The common presentation is with pain in lower limbs, back pain, balance problems, numbness and weakness, seizures, headaches. Here we are presenting 4 year male child.

Comparative evaluation of change in root canal shape and area in primary molars using ProTaper and K3 rotary systems In vitro study

Background: Rotary instrument techniques have shown evidence of simultaneously enlarging the root canal and maintaining the canal anatomy. Protocols for the use of rotary systems in primary molars are not well established. Aims: The aim of the study was to evaluate and compare root canal shape and area after ProTaper and K3 rotary instrumentation in primary molars. Settings and Design: Coronal access cavities with straight-line access into the root canals were prepared on primary mandibular molar teeth, extracted for therapeutic reasons. The teeth were aligned in a prefabricated template in individual self-cure acrylic blocks such that their respective positions could be reproduced later. Subject and Methods: Forty-two primary mandibular molar teeth selected were equally divided into three groups: instruments with stainless-steel (SS) hand K-files, ProTaper, and K3 Endo rotary system. Precomputed tomography (CT) slices were taken at predetermined levels (coronal, middle, and apical third) followed by instrumentation of canals using selected files and post-CT scan. Statistical Analysis Used: Data obtained were evaluated using independent t-test with a 0.05 level of significance and ANOVA. Results: SS hand K-files and rotary ProTaper and K3 Endo of 0.04 taper produced a predominantly round shape at coronal, middle, and apical levels. ProTaper system caused the greatest increase in round-shaped canals and canal area followed by K3 Endo of 0.04 taper. Conclusions: Shaping abilities of both manual and rotary instrumentation systems in primary molars were similar, whereas for enlarging and maintaining anatomy, rotary systems (ProTaper and K3) were better.

Synthesis, antibacterial, and antioxidant studies of 7-amino-3-(4-fluorobenzoyl)indolizine-1-carboxylate derivatives

In the present work, the quaternary salts of 4-aminopyridine, i.e., 4-amino-1-[2-(4-bromophenyl)-2-oxoethyl]pyridin-1-iumbromides were obtained by stirring 4-aminopyridine with phenacyl bromides in acetone at room temperature separately.These quaternary salts of 4-aminopyridine were treated with acetylenes (electron deficient), in the presence of anhydrouspossium carbonate in N,N-dimethylformamide solvent to get indolizine derivatives. The structures of newly synthesisedcompounds have been confirmed by spectroscopic techniques, such as liquid chromatography mass spectrometry,1H-NMR, and elemental analysis. Synthesized all compounds were screened for antibacterial and antioxidant activity.The compounds 2e, 2g, and 2j shows inhibition zone against bacteria and compounds 2a and 2f moderately active againstbacteria. All compounds 2a to 2j show 1,1-diphenyl-2-picrylhydrazide radical free radical scavenging activity, NitricOxide free radical scavenging activity, Reducing power scavenging activity, and Lipid peroxidation inhibition activity.

Clinical Features and Risk Factors Associated With 30-Day Mortality in Patients With Pneumonia Caused by Hypervirulent Klebsiella pneumoniae (hvKP)

Background@#Reports on metastatic or invasive infections by hypervirulent Klebsiella pneumoniae (hvKP) have increased recently. However, the effects of its virulence on clinical course and outcomes in pneumonia patients have rarely been addressed. We assessed and compared the clinical features of hvKp and classic K. pneumoniae (cKP) strains isolated from patients with pneumonia caused by K. pneumoniae. We also investigated the effects of virulence factors and the K. pneumoniae capsular serotypes K1 and K2 on mortality. @*Methods@#In this retrospective study, we enrolled 91 patients diagnosed as having pneumonia caused by K. pneumoniae and obtained their demographic and clinical data from medical records. We evaluated genes for K1 and K2, antimicrobial susceptibility, and the virulence genes rmpA, iutA, entB, ybtS, kfu, mrkD, and allS. Strains that possessed rmpA and iutA were defined as hvKP (N=39), while the remaining were classified as cKP (N=52).Odds ratio (OR) for the risk factors associated with 30-day mortality was calculated using the binary logistic regression model. @*Results@#The 30-day mortality in all patients was 23.1%; it was 17.9% (7/39) in the hvKP group and 26.9% (14/52) in the cKP group (P = 0.315). Bacteremia (OR = 38.1; 95% confidence interval [CI], 2.5–570.2), altered mental status (OR = 8.8; 95% CI, 1.7–45.0), and respiratory rate > 30 breaths/min (OR = 4.8; 95% CI, 1.2–20.0) were independent risk factors for 30-day mortality in all patients. @*Conclusions@#Our results suggest that hypervirulence determinants do not have a significant effect on 30-day mortality in patients with pneumonia caused by K. pneumoniae.

Prevalence and factors associated with effective helmet use among motorcyclists in Mysuru City of Southern India

BACKGROUND@#Helmet use reduces the risk and severity of head injury and death due to road traffic crash among motorcyclists. The protective efficacy of different types of helmets varies. Wearing firmly fastened full-face helmet termed as effective helmet use provides greatest protection. This study estimates the prevalence and factors associated with effective helmet use among motorcyclists in Mysuru, a tier II city in Southern India.@*METHODS@#Cross-sectional road side observational study of 3499 motorcyclists (2134 motorcycle riders and 1365 pillion riders) at four traffic intersections was done followed by interview of random sample of 129 of the above riders. Effective helmet use proportion and effective helmet use per 100 person-minute of observation was calculated. Multivariate logistic regression analysis was done to identify factors associated with effective helmet use.@*RESULTS@#Prevalence of effective helmet use was 28 per 100 riders and 19.5 per 100 person-minute of observation in traffic intersections. Prevalence rates of effective helmet use was higher among riders (34.5% vs pillion riders 18.1%), female riders (51.3% vs male riders 26.8%), and male pillion riders (30.5% vs female pillion riders 13.7%). Riders commuting for work and school and those ever stopped by the police in the past 3 months had significantly higher odds of effective helmet use.@*CONCLUSION@#Despite helmet use being compulsory by law for motorcyclists, the effective helmet use was low in Mysore. Strict enforcement and frequent checks by the police are necessary to increase the effective helmet use.

A clinical, radiological and etiological study of neonatal pneumonia

Background: Pneumonia contributes to between 7, 50,000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year worldwide1. It is estimated that 3.9 million of the 10.8 million deaths in children annually worldwide occur in the first 28 days of life.2 Neonatal pneumonia can be preventable if it is diagnosed as early as possible. Early recognition and prompt management are essential for the better outcome.Aim and objective: To determine bacterial etiology of neonatal pneumonia and to study the risk factors associated with neonatal pneumonia.Methods: A prospective, descriptive study was conducted for the duration of one year from July 2014 to June 2015 in Pragna children's Hospital, a tertiary care centre, Hyderabad, Telangana, India. A total of 100 neonates were admitted in Pragna children's Hospital with the signs and symptoms of neonatal pneumonia. A detailed history was taken including age, obstetric history of the mother, detailed birth history including resuscitation details and gestational age assessment were evaluated.Results: Out of 100 cases, 39(39%) neonates were preterm babies and 61(61%) were term. Also found history of Prolonged Rupture of Membrane (PROM) in 22% cases, maternal fever in 18%, home deliveries in 14% and foul smelling liquor in 18%. Out of 100 cases, 51 (51%) cases had positive finding in Chest X-Ray for neonatal pneumonia and 57(57%) had pneumonia with septicemia. Out of 100 cases, 9% of cases are positive for Coagulase negative staphylococcus (CONS), 5% for Klebsiella pneumonia, 2% for Pseudomonas aeroginosa and the remaining 84% of the cases had no growth for any organism.Conclusions: Major predisposing factors included PROM, foul smelling liquor, maternal fever, and home deliveries. CONS was the commonest organism isolated in blood culture.

A clinical study of respiratory distress in neonates

Background: Respiratory distress is a medical emergency responsible for most of the admissions in NICUs during neonatal period. It is a major contributor to neonatal morbidity and mortality and results from a variety of respiratory and non-respiratory etiology. It occurs in 0.96 to 12% of live births and responsible for about 20% of neonatal mortality. Aim of study to find out the proportion of patients with different etiology of respiratory distress in neonates.Methods: The present study is a prospective, descriptive study which was carried out at neonatal units attached to SMS Medical College, Jaipur. All the neonates with respiratory distress admitted in NICU admitted from April 2012 to March 2013were selected for the present study. Detailed history including antenatal history, natal history, postnatal history with thorough clinical examinations and investigations done in each case and were recorded in the performa.Results: A total of 500 neonates were admitted and among them 375 were inborn (delivered in our hospitals) and 125 out-born (referred to our hospitals from outside). In inborn group hyaline membrane disease (HMD) was the most common cause (32%) of respiratory distress and in out-born congenital pneumonia/septicaemia (34.4%). There was male preponderance in both inborn and out-born groups with male: female ratio 1.45:1 and 1.6:1 respectively.Conclusions: Majority of cases in both inborn and out-born groups were preterm (56.8% and 54.4% respectively) which emphasises the need for care of mother during antenatal period for prevention of premature delivery.

High grade renal trauma due to blunt injury in children: do all require intervention? / Trauma renal de alto grau devido a lesão contusa em crianças: será que todas necessitam intervenção?

ABSTRACT Introduction: The aim of this study was to analyze the presentation and management of major grade renal trauma in children. Method: A retrospective study was performed including data collected from the patients who were admitted in Pediatric surgery with major grade renal injury (grade 3 and more) from January 2015 to August 2018. Demography, clinical parameters, management, duration of hospital stay and final outcome were noted. Results: Out of 13 children (9 males and 4 females), with age range 2-12 years (mean of 8 years), reported self-fall was the commonest mode of injury followed by road traffic accident. The majority (10/13, 75%) had a right renal injury. Eight children had a grade IV injury, one had a grade V injury, and four children had grade III injury. Duration of hospital stay varied from 3 to 28 (mean of 11.7) days. Three children required blood transfusion. One child required image guided aspiration twice and two required pigtail insertion for perinephric collection. All the 13 children improved without readmission or need for any other surgical intervention. Conclusion: Children with major grade renal trauma due to blunt injury can be successfully managed without surgical intervention and minimal intervention may only be needed in select situations.

RESUMO Introdução: O objetivo deste estudo foi analisar a apresentação e tratamento de grande trauma renal em crianças. Método: Foi realizado um estudo retrospectivo incluindo dados coletados dos pacientes que foram internados na cirurgia pediátrica com lesão renal de grau importante (grau 3 ou mais) de janeiro de 2015 a agosto de 2018. Coletamos dados a respeito de demografia, parâmetros clínicos, manejo, tempo de internação e resultado final. Resultados: Das 13 crianças (9 homens e 4 mulheres) com faixa etária de 2-12 anos (média de 8 anos), a queda auto-relatada foi o modo de lesão mais comum seguido de acidente de trânsito. A maioria (10/13, 75%) apresentou lesão renal direita. Oito crianças tiveram uma lesão grau IV, uma apresentou uma lesão grau V e quatro crianças apresentaram lesão grau III. A duração da internação hospitalar variou de 3 a 28 (média de 11,7) dias. Três crianças necessitaram de transfusão de sangue. Uma criança necessitou de aspiração guiada por imagem duas vezes e duas inserções de dreno pigtail exigidas para coleções perinefréticas. Todas as 13 crianças melhoraram sem re-internação ou necessidade de qualquer outra intervenção cirúrgica. Conclusão: Crianças com trauma renal de alto grau devido a lesão contusa podem ser manejadas com sucesso sem intervenção cirúrgica, e intervenção mínima pode ser necessária apenas em situações selecionadas.

Clinical and immunological responses of zidovudine lamivudine-nevirapine versus tenofovir lamivudine-efavirenz antiretroviral treatment among HIV-1 infected adults: Gandhi Hospital, Telangana, India

Background: HAART (Highly active antiretroviral therapy) is the cornerstone of management of patients with HIV infection. Antiretroviral therapy was started in the year 1986 with the first drug Zidovudine (ZDV). Later on, other antiretroviral drugs (NRTIs, NNRTIs and Pls) were introduced. Dual and mono therapies were used initially but the problem of resistance emerged. Currently, 3 or more ARV drugs are recommended globally for the treatment of people with HIV infection.Methods: A cross-sectional descriptive study conducted at a tertiary care Hospital over 200 patients, two commonly used medications are ZLN (Zidovudine+Lamivudine+Nevirapine) and TLE (Tenofovir+Lamivudine+Efavirenz ). The factors considered to affect the clinical and immunologic outcomes in both groups were assessed using baseline CD4 count, WHO clinical staging, presence of chronic diarrhea, anemia, and baseline weight, occurrence of TB, and switching of ART regimen.Results: A total of 200 patients were included in the study. ART documents of 100 patients are on Zidovudine+Lamivudine+Nevirapine) and 100 patients are on TLE (Tenofovir+Lamivudine+Efavirenz) regimen. Out of 200 patients, 97 were males and 103 were females. Maximum number of subjects were in the age of 15-45 years (82.5%) followed by 45 and above (17.5%). Mean age was 34.5±2.5 (years) with range 15 to 65 years. The baseline CD4 count of the patients, 94 were <350 and 6 were ≥350 on ZLN, in case of TLE 82 were <350 and 18 were ≥350. CD4 count after 6 months in 200 patients as follows, 60 were <350 and 40 were ≥350 in case of TLE 53 were <350 and 47 were ≥350.Conclusions: This research finding concluded that there is no critical difference between the two medications in regards to serious adverse events but did find that TDF is superior to AZT in terms of immunologic response and adherence and more frequent emergence of resistance.

Thrombotic Thrombocytopenic Purpura In A Patient With Snake Bite

Snakebite envenomation is a common scenario in southern India. Among the various causes of acquired thrombotic thrombocytopenic purpura (TTP), snake bite envenomation is very rarely reported. We present a rare case of a 51-year-old man with TTP following snakebite envenomation. He developed features of TTP including impaired neurological state, renal dysfunction, low platelets, fever, microangiopathic hemolytic anemia on day 5 following snakebite. He received 7 cycles of plasma exchange and showed remarkable improvement. We are presenting this case to create awareness regarding TTP following snakebite as it has a very significant implication on treatment and mortality.

A Comparative Study Of Topical Betaxalol And Timolol For Their Efficacy And Side Effects

Purpose:Primary open angle glaucoma (POAG) is one such field in Ophthalmology where ophthalmologists have failed to stop blindness due to it. All the available treatment modalities are directed towards the reduction of intra-ocular pressure (IOP) but without interfering the basic aetiopathogenesis. In this study we propose to study efficacy, potency and adverse effects of topical Timolol and Betaxalol in primary open angle glaucoma. Methodology:A com-parative study of topical Betaxalol 0.5% and Timolol 0.5% in the management of POAG was conducted at Tertiary care hospital. Fifty patients of newly diagnosed POAG of different age, sex, religion from both urban and rural popu-lation attending eye OPD were included in this study.25 patients were treated with topical Timolol maleate 0.5% ophthalmic solution BD and 25 patients were treated with topical 0.5% Betaxalol hydrochloride phthalmic solution BD. At 20 weeks follow up IOP levels n both the groups measured by applanation tonometer were compare to each other. Results:In this study a total of 50 patients with POAG were studied. 25 patients were treated with Timolol maleate 0.5% ophthalmic solution and 25 patients were treated with 0.5% Betaxalol hydrochloride ophthalmic solu-tion. Out of 50 patients, 29 (58%) were male and 21(42%) were female patients. POAG was most common in the age group of 51-60 years with average age 51.50 (S.D. 9.8) years. Average age in males was 54.50 years, while in female it was 49.31 years. Conclusion: both Timolol and Betaxalol are effective in decreasing IOP in POAG patients. The mag-nitude of Timolol in decreasing IOP is more as compared to Betaxalol. The selective beta 1 adrenergic inhibition of Betaxalol provides an added benefit for those patients in whom beta 2 blockade could be harmful.

Solitary fibrous tumour of the kidney: A case report

A solitary fibrous tumour (SFT) is an unusual spindle cell neoplasm that usually occurs in the pleura but has recently been described in diverse extrapleural sites. Urogenital localisation is rare, and to our knowledge, only 82 cases of SFT of the kidney have been described. Although SFT of the kidney is extremely rare, this tumour must be included in the differential diagnosis, whenever a renal tumour consisting of mesenchymal elements is encountered. We report a case of a large SFT of the left kidney which was clinically and radiologically thought to be a renal cell carcinoma, and a final diagnosis was made after immunohistochemical study.

Management of dental erosion induced by gastro-esophageal reflux disorder with direct composite veneering aided by a flexible splint matrix

Dental erosion is frequently overlooked in clinical practice. The management of erosion-induced damage to the dentition is often delayed, such that extensive occlusal rehabilitation is required. These cases can be diagnosed by a careful clinical examination and a thorough review of the patient's medical history and/or lifestyle habits. This case report presents the diagnosis, categorization, and management of a case of gastro-esophageal reflux disease-induced palatal erosion of the maxillary teeth. The early management of such cases is of utmost importance to delay or prevent the progression of damage both to the dentition and to occlusal stability. Non-invasive adhesively bonded restorations aid in achieving this goal.