SYNTHESIS AND COMPARATIVE STUDY OF CURCUMINOID ANALOGUES BY CONVENTIONAL AND NON-CONVENTIONAL METHODS

Conventionally, Starting as an vanillin condensed with acetyl acetone by using tributyl borate, boric anhydride and butyl amine then reaction mixture was allowed to stand for overnight at room temperature, after workup it convert yellowish product. Similarly, Non-conventionally, Acetyl acetone, boric acid, anhydrous Sodium sulfate mixed in toluene then substituted aromatic aldehydes added with n-BuNH2, formed mixture irradiated to MWI, after workup, final compound was collected. Second method is environmentally benign gives good yields of curcumin analogues under microwave condition. The reaction performed in less time of reaction, cleaner, no side product, good to excellent yield of product.

A study of postnatal foot length to determine gestational maturity in neonates

Background: Gestational age is a major determinant of newborn prognosis. Early identification of gestational age is a major priority to reduce global mortality from preterm birth. Therefore this study was conducted with an aim to find out an alternate simple, low cost and reliable method to identify accurate gestational ages.Methods: The cross sectional study was carried out at Rukmani Chainani Maternity and Neonatal Unit, SSGH and Medical College, Baroda from December 2019 to May 2020. Total 500 live newborns of different gestational ages within 72 hrs of birth which were appropriate for gestational age were enrolled in this study. Foot length, head circumference, crown heel length and weight were measured. Gestational age was estimated by antenatal USG, Ballard scoring and LMP. Correlation of foot length to gestational age and other anthropometric variables was done.Results: There was statistically significant positive correlation found between foot length and gestational age (correlation coefficient of 0.944 and p value of <0.0001). There was also positive correlation found between foot length and weight, head circumference and length with correlation coefficient of 0.942, 0.888 and 0.906, respectively. Using ROC curve, foot length cut-off value of 7.2 cm can be used for identifying preterm babies with sensitivity of 94.4% and specificity of 95.6%. Regression equation for gestational age calculation was GA=6.669+4.0601[FL].Conclusions: This study had demonstrated that Foot length is a simple and reliable anthropometric measurement to assess gestational age and to screen prematurity.

Comparative Study of Bacteriological Profile of Cellulitis in Diabetic versus Non-Diabetic Patient

Introduction: Comparative study of bacteriological profile of cellulitis - in diabetic versus non diabetic patient.Materials and Methods: During a period of June 2018–May 2019 in Sanjay Gandhi Memorial Hospital surgical wards,approximately 100 cases including both diabetic and non-diabetic getting admitted through surgery out patient department,casualty, or transferred from other departments diagnosed as cellulitis based on clinical suspicion. Samples were collectedfrom the deeper portion of the ulcers, among these samples, one swab was used for Gram staining and the other was usedfor culture. A direct Gram stained smear of the specimen was examined. The organisms were identified on the basis of theirGram staining properties, their biochemical reactions, and the culture identified.Results: According to pus culture sensitivity is was found that among Gram-negative isolates, Pseudomonas aeruginosa(25.19% in D and 28.06 in ND) is most common in both diabetic and non-diabetic followed by Escherichia coli (16.12% in Dand 17.39% in ND) and Klebsiella pneumoniae (12.9% in D and 8.6% in ND). Among Gram-positive isolates, Staphylococcusaureus is most commonly isolated followed by Enterococcus in diabetics, as in non-diabetics, S. aureus (32. 25% in D and30.43% in ND) is most commonly isolated followed by Enterococcus (9.6% in D and 4.3% in ND) and methicillin-sensitive S.aureus (1.6% in D and 2.17% in ND) (D – diabetics and ND – non-diabetics).Conclusion: Microbiological evaluation of the ulcers revealed that the prevalence of Gram-negative organisms 47 (57.75%)was found to be more than Gram-positive organisms 14 (17.5%), Candida albicans 3 (3.75%), and polymicrobial species17 (21.25%). Among Gram-negative isolates, P. aeruginosa is most common in both diabetic and non-diabetic followed by E.coli and K. pneumoniae. Among Gram-positive isolates, S. aureus is most commonly isolated followed by Enterococcus indiabetics, as in non-diabetics, S. aureus is most commonly isolated followed by Enterococcus and methicillin-sensitive S. aureus.

A Randomized Controlled Trial to Compare the Efficacy, Safety and Tolerability of Asenapine versus Olanzapine in Management of Schizophrenia

Objective@#Schizophrenia is a serious disease characterized by impairment in the perception or expression of reality, leading to occupational and social dysfunction. The use of antipsychotic medication is now universal in the first-line treatment of schizophrenia. This study was undertaken to compare the efficacy of asenapine with a standard atypical antipsychotic, olanzapine in treating this disease. @*Methods@#It was designed as a single blind, randomized, controlled, parallel group, single centre Phase IV trial of a newer atypical antipsychotic, asenapine versus existing standard atypical antipsychotic, olanzapine. Total 80 subjects were enrolled as per eligibility criteria.Each recruited subject received daily treatment with the trial medication (Olanzapine 10 mg or Asenapine 10 mg daily) for duration of 12 weeks. BPRS, CGI-S, CGI-I, Laboratory parameters and compliance was assessed and analyzed. Continuous variables were compared by t test and non-parametric data was analyzed by Mann−Whitney U test and Wilcoxon signed rank test. Likely categorical variables were analyzed by chi-square test or Fisher’s exact test, as appropriate. @*Results@#The duration of schizophrenia at presentation was comparable in both the treatment groups. There was significant reduction of BPRS score between any two visits of each treatment groups. The decline in CGI-S and CGI-I scores was statistically significant (p ＜ 0.001) when compared between visits of any of the both treatment arms.Adherence to treatment was excellent for all patients. @*Conclusion@#Newer atypical antipsychotic asenapine is more effective than standard olanzapine in reducing the symptoms of schizophrenia in this study and further larger studies are to be done.

Successful Transcatheter PDA Device Closure in an Adult with Retrograde Wiring and Antegrade Snaring Approach

Patent ductus arteriosus accounts for 5 – 10% of all congenital heart disease in children. Currently, transcatheter closure is standard of care. Device closure in PDA is usually done by an antegrade technique where PDA is crossed from the PA side. In some patients, this universal procedure may not be successful due to anatomical differences. In such patients, the retrograde technique with retrograde wiring and antegrade snaring approach followed by PDA device closure may be used successfully to close PDA. We report such a case of difficult PDA device closure where the antegrade technique was not successful and PDA device closure was completed by retrograde approach.

Successful Percutaneous Device Closure of Ventricular Septal Rupture in a Patient with Acute Anterior Wall Myocardial Infarction and Cardiogenic Shock

Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of acute myocardial infarction. The incidence of VSR has decreased from 1-3% following ST-segment elevation myocardial infarction in the pre-reperfusion era to 0.17-0.31% following primary percutaneous coronary intervention. Survival to 1 month without intervention is 6%. We report a case of a 60-year-old male, admitted in a peripheral hospital with acute anterior wall myocardial Infarction. He was thrombolized with streptokinase. He developed breathlessness at rest and shifted to our hospital for further management. On evaluation in intensive care unit found to have VSR. The patient was in cardiogenic shock. The ventricular septal rupture was successfully closed with a septal occluder device. After which the patient stabilized hemodynamically and was discharged after 8 days.

Successful Percutaneous Retrieval of Embolised Septal Occluder Device and Device Closure of Atrial Septal Defect in Combined Procedure

Transcatheter device closure is the treatment of choice in patients with secundum atrial septal defects with adequate rims. It is technically safe, feasible and has the obvious advantage of being a nonsurgical technique. Patient is free from the scar especially young, unmarried females. It is not free of complications. Device embolization and arrhythmias are the major complications. Embolised device can cause hemodynamic compromise by obstructing the blood flow if it gets embolised in pulmonary artery. We report a case of 24 year old female, taken for device closure of atrial septal defect. Device gets embolised in pulmonary artery causing hemodynamic compromise by causing obstruction to blood flow. This embolised device was successfully retrieved percutaneously. The atrial septal defect was closed with one size larger device, in the same sitting. Patient is asymptomatic and is free from any scar.

Percutaneous Balloon Mitral Valvotomy and Percutaneous Coronary Intervention of Left Anterior Descending Artery in Combined Procedure

In countries like India rheumatic heart disease (RHD) is still a common problem, and with improvements in diagnosis and treatment, the lifespan of these patients is increased. With increase in the lifespan, these patients may develop coronary artery disease (CAD) and present as acute coronary syndrome (ACS). In some cases especially RHD with severe mitral stenosis (MS), thrombus that develop in left atrium may embolize in one of the coronary arteries, leading to acute coronary syndrome. We report a case of 51 year old female who was a known case of rheumatic heart disease and now presented with acute coronary syndrome. Patient was hemodynamically unstable and underwent percutaneous balloon mitral valvotomy (PBMV) and percutaneous coronary intervention (PCI) simultaneously. We here discuss the possible complications that need to be addressed in such scenario and how can we approach such cases. This is first of such intervention at our institute and also there are very few such records available online. Patient tolerated the procedure well with significant clinical improvement.

Ruptured Sinus of Valsalva Aneurysm Presenting as Complete Heart Block - A Rare Presentation

The dissection of the sinus of Valsalva aneurysm into the interventricular septum leading to complete heart block is a rare complication with only few cases reported in the literature. We report a case of young farm laborer, who presented with multiple episodes of syncope. Upon clinical evaluation, we found third-degree atrioventricular block due the rupture of right sinus of Valsalva into the interventricular septum.

Serial Electrocardiographic Changes in a Young Female with Acute Myocarditis

Electrocardiographic changes in myocarditis mimic a wide range of ECG diagnoses ranging from ST-elevation myocardial infarction to complete heart block. We report a case of acute myocarditis in a young female with a wide range of ECG changes that mimic ST-elevation myocardial infarction and atrioventricular block.

Successful Primary PCI in a Patient with Acute Myocardial Infarction and Cardiogenic Shock with Super-dominant Right Coronary Artery and Absent Left Circumflex Artery

Super-dominant right coronary artery and the absent left circumflex artery is a rare congenital coronary anomaly, with only a few cases reported in the literature. Left anterior descending artery arises directly from the left anterior coronary cusp. Rare coronary anomalies are sometimes encountered during primary percutaneous interventions, which may lead to changes in the course of action. We report a case of a 38-year-old patient admitted with acute anterior wall myocardial infarction and cardiogenic shock. Coronary angiography revealed super-dominant right coronary artery and absent left circumflex artery. There was thrombotic occlusion of the proximal left anterior descending artery. The patient underwent successful primary percutaneous intervention of the left anterior descending artery with a good result, was discharged after 5 days. Our case also shows the importance of taking coronary angiogram of the contralateral artery first, before taking the shoot of the infarct-related artery.

Successful Percutaneous Balloon Dilatation of Membranous Sub-aortic Stenosis in a 22 Year Old Pregnant Patient

Congenital obstruction of the left ventricular outflow tract comprises a heterogeneous group of disorders, with obstruction potentially occurring below, above, or at the level of the aortic valve. Subvalvular stenosis is the second most common type of left ventricular outflow tract obstruction, of which discrete membranous type is the most common. Although surgical resection of the subaortic membrane is the treatment of choice in discrete membranous subaortic stenosis, in selected patients with isolated membranous subaortic stenosis, without significant aortic insufficiency, percutaneous balloon tearing of the membrane results in reduction in the degree of left ventricular outflow tract obstruction and symptomatic relief. We report a case of 22 year old pregnant patient admitted with NYHA class III breathlessness, found to have discrete membranous subaortic stenosis. Balloon aortic valvuloplasty was performed in the patient with good result. Patient underwent normal vaginal delivery at 38 weeks. Both mother and newborn were asymptomatic. Patient is asymptomatic on subsequent follow-ups.

Study of respiratory complications and outcome in meconium stained deliveries

Background: To study the development of respiratory complications in the form of meconium aspiration syndrome (MAS), persistent pulmonary hypertension of newborn (PPHN), pulmonary hemorrhage and pneumothorax in neonates born through meconium stained liquor.Methods: It was a prospective study conducted during the period of February to October 2018. All live babies associated with meconium stained liquor were included.Results: Total 606 neonates with meconium stained amniotic fluid (MSAF) were enrolled. Chance of meconium passage was more after 37wk of gestation, in birth weight >2.5 kg and in AGA babies. The rate of LSCS was higher in MSAF group. MAS developed in 28% cases, out of which 42.9% expired. PPHN developed in 6.9% cases, out of which 80% expired. 100% mortality was there in babies with pulmonary hemorrhage. Apgar scores <7 is significantly associated with the development of respiratory complications. 22.8% of vigorous babies and all non-vigorous babies developed respiratory complications showing statistical significance with P-value of <0.00001. Mortality in MSAF was 12%. All babies who expired had severe meconium aspiration syndrome. 83.9% of the patients stayed for <7 days in the hospital. All of the expiry except one occurred within 7 days of life due to development of respiratory complications.Conclusions: MSAF is associated with the development of respiratory complications and mortality in neonates. Non-vigorous babies and the babies with Apgar scores <7 at birth are more prone to developing respiratory complications. Most of the MSAF babies were discharged and mortality was more in patients with respiratory complications.

Mobitz Type 1 Second‐degree Atrioventricular Block in Anterior Wall Myocardial Infarction and Its Reversal with Successful PCI of Left Anterior Descending Artery – An Extremely Rare Association

Arrhythmias can complicate the course of patients with ST-elevation myocardial infarction. These arrhythmias can include both tachyarrhythmias and bradyarrhythmias. Tachyarrhythmias range from Ventricular premature complexes to life-threatening ventricular tachycardia/ fibrillation. Bradyarrhythmias range from sinus bradycardia to complete heart block. These arrhythmias have the ability to provoke hemodynamic consequences and increase mortality. Tachyarrhythmias are more common with Anterior wall myocardial infarction and bradyarrhythmias are more common with Inferior wall myocardial infarction. We report a case of Mobitz Type 1 (Wenkebach) second-degree atrioventricular block in a patient with Anterior wall myocardial infarction. Angiography showed a significant lesion in Left anterior descending artery, after the first septal and diagonal branch. After the successful percutaneous coronary intervention, this second degree AV block reverted to first degree AV block. To the best of our knowledge, there is no case report describing this association separately.

Successful PCI of Anomalous Left Circumflex Coronary Artery Arising from Right Coronary Sinus – A Case Report

Coronary artery anomalies occur in 1.3-5.6% of patients undergoing coronary arteriography. An anomalous origin of LCX from right coronary sinus is the most common congenital variant. It is usually considered “benign” since it is not known to predispose individuals to sudden cardiac death. Such vessels are particularly predisposed to atherosclerotic disease in their proximal portion, due to the acute angulation of its origin from the aorta and its posterior retro aortic course. We present a case of 55 years old female admitted with acute coronary syndrome. Coronary angiogram showed the anomalous origin of the left circumflex artery from right coronary sinus. This artery had a significant lesion which was successfully stented with a drug-eluting stent.

Isotretinoin and dermatosurgical procedures

Several early reports suggested that performance of dermatosurgical procedures in patients on oral isotretinoin is associated with abnormal skin healing, keloid or hypertrophic scar formation. However, this association has been recently questioned in some studies. This review examines this issue, analyzes the studies published and concludes that the recommendation made earlier about the need to avoid dermatosurgical procedures in patients on isotretinoin is based on inadequate and insufficient evidence and hence needs revision. The review also suggests that recent studies on the subject establish that performing such procedures is safe.

Wandering Spleen Presenting As Gastric Mass: A Rare Case

Wandering or ectopic spleen is a rare condition in which spleen is located outside its normal location. Wandering spleen is an incidental finding with a reported incidence of <0.2%, fewer than 500 cases reported worldwide in literature. It presents as a diagnostic challenge as it can easily mimic a neoplastic mass, an abscess, or an organized hematoma. Ultrasonography and contrast tomography are useful radiological methods in the diagnosis of wandering spleen. We report here autopsy case of a 51-year-old male with wandering spleen in gastric wall diagnosed on histopathology but presented as gastric mass mimicking malignancy. This case highlights the importance of radiology and histopathology in the diagnosis of an ectopic spleen. In the absence of spleen on radiology at a normal site and with a presence of intra-abdominal mass, the clinician should keep in mind ectopic spleen as a differential diagnosis

Perceptions of first year dental students on case based learning in Physiology

Background: Application of basic science knowledge to clinical practice is the aim of first year undergraduate dental curriculum. To bring in application of basic science theory to the clinical dental application, a case based learning (CBL) approach has been tried among first year dental students. Materials and methods: Randomized control trial was conducted by grouping first year undergraduate dental students (N= 73) into traditional group (N=35) and CBL group (N=38). Conventional lecture was given to traditional group and case based lecture and small group discussion for CBL group facilitated by faculty. Pre and post tests were administered for both the groups. Perceptions on CBL approach were collected using a questionnaire. Results were analyzed using paired and unpaired ‘t’ test. Results: Test scores were expressed in mean ± SD. deviation. Post-tests scores of traditional - (7.5 ±1.6) and CBL (7.7±1.9) groups were significantly higher than pretest scores of traditional - (5.7 ± 1.4) and CBL (4.9 ± 1.7) groups. Attitude score showed positive perceptions for most of the parameters. Conclusion: The first time CBL approach for Physiology concept provoked interest among dental students. Participants felt the method involved them in active learning and they recommended this approach to other sessions as well. Recall of factual knowledge did not improve significantly over traditional method, but was equally effective.

Double blind randomized control trial to evaluate the efficacy of ketoprofen patch to attenuate pain during venous cannulation

BACKGROUND: Venipuncture pain is an uncomfortable suffering to the patient. It creates anxiety, fear and dissatisfaction. The ketoprofen transdermal patch is a proven treatment for musculoskeletal and arthritic pain. We planned this study to evaluate the efficacy of the ketoprofen patch to reduce venipuncture pain. METHODS: Two hundred adult patients, aged 18–60 years, of either sex, ASA grade I or II, were enrolled. Presuming that therapy would decrease venipuncture pain by 30%, a power calculation with α = 0.05 and β = 0.80 required enrollment of at least 24 patients into each group. However, 100 patients in each group were recruited. Group I (Control) received a placebo patch; Group II (Ketoprofen) received a 20 mg ketoprofen patch. A selected vein on the dorsum of the patient's non-dominant hand was cannulated with 18 g intravenous cannula 1 h after the application of the respective patch. Assessment of pain was done by a 10 cm visual analogue scale (VAS) of 0–10, where 0 depicts “no pain” and 10 is “the worst imaginable pain”. The venipuncture site was assessed for the presence of skin erythema, swelling and rashes at 12 h, 24 h and at the time of decannulation. RESULTS: Incidence of pain was 100% (94/94) in the control group as compared to 93% (85/91) in the ketoprofen group. The severity of the venipuncture pain was 6 (2) and 2 (2) for control and ketoprofen groups respectively (P < 0.05). CONCLUSIONS: Application of a ketoprofen patch at the proposed site of venipuncture one hour before the attempt is effective and safe for attenuating venipuncture pain.