A Pilot Study to Evaluate the Effects of Cerebroprotein Hydrolysate on Neurological Outcomes and Hospital Stay in Patients Admitted for Ischemic and Hemorrhagic Stroke

Introduction: Neurological stroke is the most common cause of disability and leaves nearly 65% of survivors with sensory, motor and coordinative disabilities. At present, there are no therapies to prevent long-term neurological deficits after stroke. Many neuroprotective drugs are being tested with the aim to ensure these effects. Preclinical studies have shown a modulatory effect of cerebroprotein hydrolysate on synaptic remodeling and facilitated synaptic transmission. Material and methods: This was a hospital-based, open-label pilot study conducted in a tertiary care hospital of North India. All patients admitted with a diagnosis of stroke both ischemic and hemorrhagic, were included in the study. Patients were randomized into two groups. The test group was given cerebroprotein hydrolysate, along with standard treatment for stroke, whereas the other group was kept on standard treatment for stroke as per the latest guidelines, without cerebroprotein. Results: A total of 50 patients of stroke, admitted in a tertiary care center were included in the study. The mean age of the patients was 65.7 ± 11.86 years. Twenty-six (52%) were males and 24 (48%) were females. Out of the total 50 patients, 23 (46%) had ischemic stroke and 27 (54%) had hemorrhagic stroke. Twenty (40%) had diabetes, 37 (74%) had hypertension, 8 (16%) were known cases of coronary artery disease, 28 (56%) had dyslipidemia, 22 (44%) were smokers, 7 (14%) had a history of ethanol consumption and 13 (26%) were obese. Mean Barthel score at admission was 21.2 ± 11.3 and mean Rankin score at admission was 3.6 ± 1.37. Mean Barthel score at end of treatment was 53.9 ± 28.72 and mean Rankin score at end of treatment was 2.6 ± 1.65. The mean duration of admission was 6.8 ± 3.57 days. Conclusion: The current study highlights the role of cerebroprotein hydrolysate in improving the neurological scores and reducing hospital stay among patients hospitalized with stroke.

A Pilot Study to Evaluate the Effects of Cerebroprotein Hydrolysate on Neurological Outcomes and Hospital Stay in Patients Admitted for Ischemic and Hemorrhagic Stroke

Introduction: Neurological stroke is the most common cause of disability and leaves nearly 65% of survivors with sensory, motor and coordinative disabilities. At present, there are no therapies to prevent long-term neurological deficits after stroke. Many neuroprotective drugs are being tested with the aim to ensure these effects. Preclinical studies have shown a modulatory effect of cerebroprotein hydrolysate on synaptic remodeling and facilitated synaptic transmission. Material and methods: This was a hospital-based, open-label pilot study conducted in a tertiary care hospital of North India. All patients admitted with a diagnosis of stroke both ischemic and hemorrhagic, were included in the study. Patients were randomized into two groups. The test group was given cerebroprotein hydrolysate, along with standard treatment for stroke, whereas the other group was kept on standard treatment for stroke as per the latest guidelines, without cerebroprotein. Results: A total of 50 patients of stroke, admitted in a tertiary care center were included in the study. The mean age of the patients was 65.7 ± 11.86 years. Twenty-six (52%) were males and 24 (48%) were females. Out of the total 50 patients, 23 (46%) had ischemic stroke and 27 (54%) had hemorrhagic stroke. Twenty (40%) had diabetes, 37 (74%) had hypertension, 8 (16%) were known cases of coronary artery disease, 28 (56%) had dyslipidemia, 22 (44%) were smokers, 7 (14%) had a history of ethanol consumption and 13 (26%) were obese. Mean Barthel score at admission was 21.2 ± 11.3 and mean Rankin score at admission was 3.6 ± 1.37. Mean Barthel score at end of treatment was 53.9 ± 28.72 and mean Rankin score at end of treatment was 2.6 ± 1.65. The mean duration of admission was 6.8 ± 3.57 days. Conclusion: The current study highlights the role of cerebroprotein hydrolysate in improving the neurological scores and reducing hospital stay among patients hospitalized with stroke.

Why the "sugars" in traditional Unani formulations are a pivotal component: A viewpoint perspective / 中西医结合学报

Traditional medicine systems around the globe, like Unani, Ayurveda and traditional Chinese medicine, include a number of sugar-based formulations, which contain a large amount of saccharide-containing sweetener, such as honey, sucrose or jaggery. With pervasive lifestyle disorders throughout the world, there have been discussions to consider alternative sweetening agents. Here, from the perspective of Unani medicine, we discuss how the saccharide-based sweeteners may be an essential component of these traditional preparations, like electuaries, which may be deprived of their bioactivities without these saccharides. With contemporary researches, it is known that apart from their own therapeutic effects, saccharides also form deep eutectic solvents which help in enhancing the bioactivity of other ingredients present in crude drugs. In addition, they provide energy for fermentation which is essential for biotransformation of compounds. Interestingly, the sugars also increase the shelf-life of these compound drugs and act as natural preservatives. On the basis of this review, we strongly believe that saccharide-based sweeteners are an essential component of traditional medicines and not merely an excipient.

A Rare Case of Acrodermatitis Enteropathica in a One Year Old Child.

Acrodermatitis enteropathica (AE) is a rare autosomal recessive disorder caused by zinc deficiency.[1] It can be classified as primary zinc deficiency, genetically based zinc deficiency (classical, AE, acquired zinc deficiency of lactogenic origin), and acquired secondary zinc deficiency.[2] Genetic zinc deficiency is associated with the defects in two zinc transporters, of which one is involved in intestinal zinc uptake ZRT- and IRT-like Protein-4 (ZIP), causing classical and AE. The other is responsible for zinc secretion in breast milk zinc transporter-2 (ZnT) resulting in zinc deficiency of lactogenic origin.[3] Here, we have discussed and reviewed the clinical aspects and probable role of zinc transporters in the manifestation of AE.Acrodermatitis enteropathica (AE), manifests as acral and periorificial dermatitis, alopecia, intractable diarrhoea, and failure to thrive. It is classified as primary zinc deficiency, genetically based deficiency, and acquired secondary deficiency. We hereby report a case of genetically based AE in a one year old child. After reviewing the literature, we have also emphasized the possible role of genetics in the manifestation of AE

A Rare Case of 10-Year-Old Glomus Tumour with Excellent Response to Surgical Excision

Glomus body is an arteriovenous anastomosis located mostly in the finger nailbed and has a role in thermoregulation. Glomus tumour is a rare benign hamartoma, comprising of vascular spaces (the Sucquet-Hoyer canal) internally lined by endothelium and externally surrounded by glomus cells, arising from the glomus body at arterial end. 1,2 Wood first reported it in 1812.1 Most of the glomus tumours are small, benign neoplasia located in the dermis and subcutaneous tissue of the extremities.3 They can vary in number from being solitary most often or multiple in few cases. They can develop in any part of the body. They account for 1-5% of all hand tumours. They are most commonly seen in middle age women. One such rare case of glomus tumour of 10 years duration is reported here.

A Rare Case of Herpes Zoster Ophthalmicus Secondary to Methotrexate Induced Immunosuppression.

Herpes zoster ophthalmicus (HZO) is defined as herpes zoster (HZ) due to involvement of the ophthalmic division of the fifth cranial nerve.1 It is the second most common type of herpes zoster, after thoracic zoster. Herpes zoster affects about 20% of the world's population at least once in their lifetime, with nearly 20% of these showing an ophthalmic involvement.2 It is estimated that 1 million adults in the USA are afflicted with herpes zoster every year. The risk of developing herpes zoster increases considerably with age, reaching 50% in those aged 85 or older. Advanced age and dysfunctional cell-mediated immune responses are two well-established risk factors for varicella zoster virus reactivation. Other risk factors, such as female gender, Caucasian ethnicity, diabetes mellitus, psychological stress, mechanical trauma, heavy metal exposure, as well as family history, have also been postulated. It causes debilitating pain, neuropathy and inflammatory complications.3

Study of Clinical and Laboratory Profile of Fever with Thrombocytopenia in Tertiary Hospital

Introduction: Fever is the most challenging problem in thefield of medicine, consists of occult manifestation of commondiseases rather than the actual diseases. An A.M temperatureof >37.2°C (98.9°F) or a P.M temperature of > 37.7°C (99.9°F)will be considered as fever. Thrombocytopenia is defined asplatelet count <150,000/µl. This is due to decreased productionof platelets, increased destruction and increased sequestrationin the spleen. Study aimed to evaluate clinical and laboratoryprofile in patients having fever with thrombocytopenia.Material and methods: A series of 100 patients admittedin SMBT Medical College and Hospital with fever andthrombocytopenia were evaluated. During the hospital stay,all the patients were subjected repeat CBC once in 2 days.Follow up of all patients regarding treatment and outcomeswere done during the hospital stay.Results: Out of 100 cases of fever with thrombocytopenia,62 were males and 38 were females. The most common causewas malaria in 38% of cases followed by dengue in 30% ofcases and septicemia in 17% of cases. Based on severity mild,moderate and severe thrombocytopenia observed in 47%, 35%and 18% respectively. Bleeding manifestations were seen in36 patients. 94 patients recovered and 6 expired.Conclusion: Fever with thrombocytopenia is one of thechallenging problems in the field of medicine. Bleedingmanifestations associated with thrombocytopenia were seenamong dengue cases. Platelet transfusions should be carriedout as per WHO guidelines. Thus a well organized systemicapproach needs to be carried out with an awareness ofdifferent causes of fever with thrombocytopenia which canhelp to diagnose and manage the case early

Etiology of Pancytopenia and its Bone Marrow Picture

Introduction: Pancytopenia is an important clinicalhematological entity encountered in our day-to-day clinicalpractice. Pancytopenia may be a presentation of a widevariety of disorders, which primarily or secondarily affect thebone marrow. Study aimed to identify the etiology and bonemarrow morphology of pancytopenia patients.Material and methods: Total 30 non-malignant patientswho had pancytopenia were included in the study. Based onclinical findings bone marrow aspiration and trephine biopsywere carried out. All the bone marrow aspirate smears werestained with May-Grunwald Giemsa and trephine biopsieswere stained with and hematoxylin and eosin.Results: The majority of patients were from age group 29-38years (9 cases). Male to female ratio was 1.5:1. Commonestcomplaint presented was weakness in 28 cases followed byfever in 21 cases. Other presenting complaints were fatigue,breathlessness, icterus. Severe acute malnutrition was presentin 6 patients followed by malaria and dengue (5 cases each),Enteric fever in 2 patients. The most common cause ofPancytopenia was megaloblastic anaemia and was seen in 13cases. Bone marrow was hypercellular in all cases.Conclusion: Detailed physical examination; hematologicalinvestigations along with bone marrow aspiration andbone marrow biopsy wherever necessary in Pancytopenicpatients are helpful to diagnose or to rule out the causes ofPancytopenia.

Association Of Typhoid Fever With Hepatitis A And Hepatitis E Viral Infections: A South Indian Perspective

Introduction: Endemic, enteric infectious agents continue to wreak havoc on the health of communities in our country. The present study was undertaken with the aim of elucidating the association of typhoid fever with Hepatitis A(HAV) and Hepatitis E (HEV) viral infections as there is a paucity of data regarding the prevalence of concurrent infections with these pathogens from our region. Materials and Methods: Of the serum specimens received during February – March 2018, 100 samples were routinely tested by Widal tube agglutination method. The same specimens were analysed for the presence of HAVand HEV IgM antibodies by ELISA. Results: The prevalence of typhoid, HAV and HEV in the study population was 3 %, 1% and 3% respectively while co-infection with typhoid and HEVwas found in 1% of cases. Conclusions: There is a need to conduct similar studies but on a larger scale to correctly estimate the burden of co-infections with common enteric pathogens.

Sequential use of clomiphene citrate and human menopausal gonadotropin in anovulatory infertility

Background: Infertility is a complex disorder with significant medical, psychosocial and economic aspects. Infertility causes great distress to many couples, causing increased numbers of them to seek specialist fertility care. Objectives: To measure the success rate of combined clomiphene citrate and gonadotropin therapy in anovulatory infertile patients overcoming the drawbacks of clomiphene alone treatment. Materials and methods: In this observational analytical study, total of 100 anovulatory infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotropin (CC – hMG) regime and maximum of three treatment cycle were given. Results: Out of 100 patients in present study, 46 patients became pregnant. Primary infertility was seen in 81 patients (81%) and secondary infertility in remaining 19(19%) of patients. Polycystic ovary disease (PCOD) was the commonest cause of anovulation seen in 62% of patients. Miscarriage was seen in 3 patients (3%). Multiple pregnancies were observed in 8 patients (8%). Number of patients conceived after 1 cycle was 12 (26%), 2 nd cycle was 20 (43.47%), 3 rd cycle was 14 (30.43%). Conclusions: Present study shows the success rate of 46% with CC-HMG combined regimen. Sequential clomiphene/ HMG regimen appears to be an effective protocol for controlled ovarian stimulation in infertile women who are resistant to clomiphene alone which has drawback of poor endometrial quality. It is easy to administer, requires less intense monitoring, fewer medications, and Ashwini Devarashetty, Humera Sultana, G. Nikhat Parveen, Yasmin Iqbal. Sequential use of clomiphene citrate and human menopausal gonadotropin in anovulatory infertility. IAIM, 2017; 4(10): 236-249. Page 237 is cheaper without sacrificing efficacy, in other words it’s a cost effective technique in the management of infertile patients.

An Observational Study for Evaluation of Supreme LMA in Paediatric Patients.

Background: The need of securing the airway quickly in an easier and safer way, especially in paediatric patients still remains a major concern. Newer and safer alternates to endotracheal intubations are being introduced. LMA supreme is one of such advancement in the field of paediatric anaesthesiology. Easy and quick insertion without any introducer, gastric access and high seal pressure are few advantages claimed by LMA Supreme. Apart from a few studies; the safety and efficacy of its paediatric version is yet to be established in Indian paediatric population. Thus, we have conducted an observational study for evaluation of Supreme LMA in paediatric patients. Observational clinical study. Methods: After obtaining approval from institutional ethical committee and consent from patient’s attendants, 50 patients of ASA grade I and II, weighing 10-20 kg of either sex undergoing general anaesthesia were included. After induction of anaesthesia and muscle relaxation, the LMA Supreme size 2 was inserted. Number of insertion attempts, ease of insertion, time taken for insertion, hemodynamic responses, ease of NGT insertion and incidence of airway trauma were recorded. Results: In 90% of patients, LMA Supreme was inserted in first attempt. In 94% of cases, insertion was easy. Average time required to insert LMA Supreme was 11.66 ± 0.81 seconds. There were no significant hemodynamic changes noted. In 2 % of cases, airway trauma was observed. Conclusion: LMA supreme emerged as a good alternate airway device. It is quick and easy to insert with fast learning curve with least alteration of hemodynamic status in paediatric population.

Study of Somato Sensory Evoked Potentials in Braille Reading Congenitally Blind Individuals.

Cortical pathways for perception of sensory input are believed to be modulated by signals from other modalities. It is responsible for the fine tuning of the ability to perceive in the absence of a particular sense. In blind individuals associative visual areas of occipital cortex are polymodal in nature involved in processing of somatosensory and auditory signals in the absence of visual stimuli. Objectives – To study and compare the somatosensory evoked individuals in congenitally blind individuals. Materials & Methods – Ten Visually challenged females in the age group of 18-30 yrs were included in the study along with ten age & sex matched individuals. Somatosensory evoked potentials were recorded on Nicolet Viking select neurodiagnostic system version 10.0 using 3-channel with normal averaging technique. Conclusions – In congenitally blind individuals, the latency of N20 and P25 are shortened indicating faster conduction along the involved neural tracts & amplitude of N20 & P25 are increased which indicates greater somatosensory cortical activity.

Effect of Different Sugar Free Flavoured Chewing Gums on Salivary pH- a Double Blinded, Parallel Arm Randomized Clinical Trial.

Aim: To evaluate and compare the effect of four different sugar free chewing-gums on salivary pH at 0, 10, 20, 30 minutes. Study Design: Double blinded, parallel arm Randomized Clinical Trial. Place and Duration of the Study: Department of Public Health Dentistry, College Of Dental Sciences, Davangere, India. Jan-Feb 2015. Methodology: Forty healthy dental students, aged 21 -25 years, mean age- 20.3 years were randomly allocated into 4 different study groups: Licorice group, Ginger group, Cinnamon group, and Xylitol group. Unstimulated saliva was collected from the participants at baseline, following which the participants were given respective gums to chew and the subsequent salivary samples were collected at intervals of 10, 20 & 30 minutes and pH was analyzed using pH meter. Statistical analysis was done using repeated measures ANOVA and One way ANOVA followed by Tukey’s post-hoc test. Results: Intergroup comparison showed, statistically significant difference between the groups at ten minutes (P=0.025), twenty minutes (P=0.004) and thirty minutes (P=0.001). At the end of thirty minutes, Ginger group showed maximum increase in salivary pH followed by Xylitol. When intragroup analysis was done, there was statistically significant difference in Licorice (P=0.033), Cinnamon (P=0.034) and Xylitol group (P=0.041) at different time intervals. Conclusion: The above results showed that, Ginger flavoured gum followed by Xylitol gum significantly increases salivary pH, as a means of caries prevention; it can be a good way to promote dental health. Hence, it can be suggested that the ginger flavoured gums can be advised in the subjects who are more susceptible to salivary pH fall and dental caries.

Perception and Attitude towards Wearing White Coats in Public Places among Dental Undergraduates and Postgraduates of Davangere City, India.

Introduction: Wearing a white coat is an accepted part of medical and dental practice. The actual use of white coats and how often they are changed varies greatly among individuals and their specialties. There has always been some concern that white coats may actually play a part in transmitting pathogenic bacteria. Objectives: To assess the perception and attitudes of dental undergraduates and postgraduates towards wearing white coats in public. Methods: 1146 structured, closed ended questionnaires were distributed to all undergraduates and postgraduates of two colleges in Davangere. Chi-square test was used to test associations between the responses among the genders and the responses within the educational levels of the participants. Binary logistic regression models were fitted to the data to calculate odds ratios (OR) for the responses among the genders. Results: A response rate of 88.74% was obtained, 93.5% of subjects had seen doctors wearing white coats in public, 24% of participants agreed that the lack of provision for storage of aprons could be the possible reason for wearing white coats outside the clinical setting. 52.5% of students believed that white coats are potential source for spreading infection. Conclusion: The present study highlights the fact that white coats are potential source of cross infection. Strict audit process and protocols should be set in workplace for preventing cross‑contamination from the white coats.

Photodynamic Therapy-A Review

Photodynamic therapy (PDT) is a simple, minimally invasive treatment modality. It is also known as photoradiation therapy/phototherapy. Photodynamic therapy became more popular when international photodynamic association was formed by Thomas Dougherty in the year 1986. For the first time, it was used in dermatology in the year 1992, later in oncology (1995), microbiology since the year 1996 and itis also been used in dentistry. Three components namely light source, photosensitising agent and oxygen are utilised, which individually are harmless by itself, but when combined with oxygen they produce cytotoxic agents that have the ability to inactivate the tumour cells. This enables the selectivity of the diseased tissue. Main advantages of PDT are as follows: it is cost-effective, can be performed on out-patient basis and tissue heals by little or no scarring. PDT can be used in the treatment of actinic keratosis, Bowen's disease, superficial squamous cell carcinoma, and so on. Uses of PDT are increasing day by day and even nowadays research is going on to make use of nanoparticles in PDT to make it a more promising treatment approach.

Oral Squamous Cell Carcinoma in Background of Oral Submucous Fibrosis: A Case Report.

Oral submucous fibrosis (OSMF) is a well-recognized, potentially malignant disorder of the oral cavity that can affect any part of the oral mucosa, characterized by mucosal rigidity of varying intensity caused by fibro elastic transformation of the juxta epithelial layer of connective tissue. OSMF occurs in Indians and other population of the Indian subcontinent with certain oral habits. Betel quid chewing is a popular oral habit with potential links to the occurrence of oral cancer. In patients with submucous fibrosis, the oral epithelium becomes atrophic and thereby becomes more vulnerable to carcinogens. Since the ingredients of betel quid, tobacco are crucial for tumor initiation, promotion and progression, exposure to these toxicants simultaneously has been shown to markedly potentiate the oral cancer incidence in OSMF patients. The rate of malignant transformation of OSMF has been estimated to be 2-10%. Most cases with malignant transformation in OSMF have occurred gradually over a long period of time. This paper presents a case of oral submucous fibrosis turning into malignancy in a 34-year-old male patient.

Behavioral risks factors associated with spread of dengue infections: a community based study

Objective: To determine the behavioral risks factors associated with spread of dengue infections in a rural community of Gulshan-e-Iqbal town, Karachi, Pakistan

Methods: A questionnaire based cross sectional survey was conducted during September 2013- February 2014 in union councils of Gulshan-e-Iqbal town, Karachi. The sample size was 350. Systematic random sampling was used for selecting the study subject, from each household taken as one unit. Sample was taken from a total of 3225 houses to achieve total sample of 350 households. All the data was entered and analysed by using SPSS software version 15. Means with standard deviation for numerical variables and proportions for categorical variables are presented. Chi square test was performed to find the association of behavioral risks factors with spread of dengue infections in a rural community of Karachi, Pakistan

Results: Dengue infection was clinically diagnosed in 203 [58%] patients and were hospitalized during August 2012 to February 2013. Among all patients, higher frequency was found in the middle age group 37 to 54 years i.e. 44% [n=154].The behaviors of self-mosquito bite protection [p<0.01], selfprevention in breading mosquitoes [p<0.01], density of vegetation [p<0.01], behaviors regarding lack of self-efficacy in controlling vector [p<0.01] and lack of preventive measure in community [p<0.01] were significantly associated with transmission of dengue infections

Conclusion: The behavioral risks factors associated with spread of dengue infections in a rural community included lack of preventive measure in community, lack of comprehension of Health belief models, lack of knowledge,lack of self- prevention in breading mosquitoes, high density of vegetation and lack of self-efficacy in controlling vector

Pre menstrual syndrome in undergraduate medical students: hostellers versus dayscholars

Objective: to find out frequency of pre menstrual syndrome [PMS] and its impact on undergraduate medical students living in hostels in comparison with day-scholars

Study design: cross sectional study

Place and Duration of Study: baqai Medical University Karachi, from October 2014 to December 2014

Methodology: a group of 100 were selected for the study. Stratified random sampling technique was used to gather meaningful information from the students. Quantitative design was used to acquire date. Chi square and Fisher Exact tests were used for analysis

Results: the mean age of the selected females was 21.48 + 1.761 year. Among a large array of variables, 24 were found significant in the study. This included dysmenorreha, muscle pain, bloated sensation, breast swelling and joint pain

Conclusion: the hostellers were more likely to develop PMS related symptoms in comparison with dayscholars

Epidemiological surveillance of dengue infections: a community based study in rural, Karachi (2010 - 2012)

Objective: To determine the incidence cases and their demographic, clinical and haematological risk factors of dengue infections in a low resource rural community during outbreaks of 2010-2012 in Gadap town Karachi, Pakistan. Methods: An active surveillance data collection on epidemiological and clinical observations on patients with Dengue infections in a low resource community during 2010 - 2012 was done. The surveillance reports were collected from union councils of Gadap Town, Karachi. The diagnosis of Dengue fever, Dengue haemorrhagic fever and Dengue shock syndrome was confirmed by IgM and IgG anti bodies detection using Enzyme-linked immunosorbent assays [ELISAs] technique based on World Health Organization [WHO] criteria. The sampling technique was cluster random sampling from the union councils of Gadap Town, Karachi and sample size calculated was 350. Data was collected on a performa after informed consent of patients. Data analysis was done on SPSS version 16. Frequency was reported for categorical variables and chi-square test performed for statistical significance to determine associated risk factors among positive cases of dengue infections. Results: Out of 350, 105 [30%] cases had dengue infections in rural area of Gadap town Karachi. About 58 [16.6%] had dengue fever, 30 [8.6%] dengue haemorrhagic fever and 17 [4.9%] had dengue shock syndrome. Twelve patients died during treatment. Presence of fever and cutaneous manifestation were observed in all cases. The significant associated risk factors were found in female, unmarried having 5 years education and severe pain at p<0.001. Conclusion: In endemic areas during dengue surveillance dengue infections were found in 30% cases. The significant associated risk factors were female, unmarried, with 5 years education and severe pain. Febrile illness represented patients with typical clinical features and haematological findings suggestive of dengue fever