Formulation And Evaluation Of Garlic Powder Loaded Floating Matrix Tablet

Objective: The objective of the present work was to formulate and evaluate a stable, odour free garlic powder loaded floating matrix tablet for the treatment of peptic ulcers. Methods: A gastro-retentive floating matrix tablet (FMT) formulation of garlic powder (GP) was prepared using various concentrations of hydroxypropyl methylcellulose K4M (HPMC K4 M) and effervescent system (sodium bicarbonate and citric acid in 1:1 % w/w) to achieve desirable floating time (FT), floating lag time (FLT) and drug release. Wet granulation method was selected using ethanol as a binder for preparation of tablet. 32 full factorial designs were used for selection of suitable polymer concentration and effervescent system. Nonenteric film coating was applied to mask GP odour. Results: It was observed that FMT with optimum quantities of HPMC K4M and the effervescent system showed 97 % of drug release in 12 h with FT up to 10 h and minimum FLT of 3 min. There was no significant change in FLT, FT and drug content during the stability study of FMT. Conclusion: A stable, sustained release FMT of GP tablets using HPMC K4M and an effervescent system was successfully prepared. This formulation can overcome problems of taste and odour masking, gastric irritation, and loss of active constituents present in garlic.

Osteosarcoma of the Skull: An Unusual Presentation in the Left Parietal-Occipital Region

Osteosarcoma (OS) is an uncommon primary malignant brain tumor. The incidence of osteosarcoma of the skull is low with an estimated 3.4 cases per million reported per year. We report a case of OS of the skull in an 18-year-old female patient. She had complained of swelling on the left side of the head accompanied with frequent headache and diminished vision in the left eye. An PET-CT of the skull revealed a large 93x90 mm lesion in the left parietal-occipital region. Osteoblastic osteogenic sarcoma of the skull was confirmed histopathologically. The patient received six cycles of Adriamycin and cisplatin; is under close observation and currently doing well. It is empirical to report case reports, specifically unusual cases like OS of the skull. Case reports not only help disseminate knowledge but also help streamline diagnostic and treatment approaches for unusual cases.

Efficacy and tolerability of fixed dose combination of silymarin, alpha lipoic acid, N-acetyl cysteine and selenium in the management of some liver disorders

Globally liver disorders are major cause of illness death and death. Oxidative stress plays a critical role in the progression of alcoholic and nonalcoholic related diseases. The aim of the present study was to evaluate the efficacy and tolerability of fixed dose combination (FDC) of silymarin, alpha lipoic acid, N-acetyl cysteine and selenium in the management of liver disorders. This was an observational, non-randomized, open label, non-comparative, multi-centric post-marketing surveillance study. The above mentioned FDC was administered to 15 patients diagnosed with alcoholic or viral hepatitis for three months. Evaluation of liver function tests (LFT) were carried out at baseline and at the end of 3rd month of the treatment. Significant changes were observed in the LFT parameters at the end of three months of this study. aspartate aminotransferase (AST): (Mean ± SEM) 369.9 ± 128.0 to 97.00 ± 34.27 U/L, (p < 0.0001); alanine aminotransferase (ALT): 652.93 ± 214.57 to 194.40 ± 82.51 U/L, (p < 0.03); Alkaline phosphatase: 197.47 ± 25.57 to 151.60 ± 17.92 U/L, (p < 0.0059); Gamma glutamyl transferase: 156.67 ± 49.80 to 87.33 ± 22.94 U/L, (p < 0.0490); Total bilirubin: 3.44 ± 0.76 to 1.66 ± 0.57 mg/dL, (p < 0.0192) and bilirubin direct: 2.13 ± 0.58 to 1.00 ± 0.50 mg/dL, (p < 0.0273). Two patients reported mild gastrointestinal adverse events (nausea, bloating). This FDC was therapeutically effective under the circumstances of elevated oxidative stress and produces significant reduction in LFT parameters in alcoholic and viral hepatitis patients.

Anomalous branching pattern of the axillary artery.

In routine dissection of upper extremity, in a 70yrs old male cadaver, we found the abnormal branching pattern of the third part of axillary artery on the right side. The third part of axillary artery divided into medial and lateral trunks. The medial trunk is referred to as deep brachial artery and lateral trunk is referred to as superficial brachial artery. The superficial brachial artery continues as brachial artery in arm and finally in cubital fossa divides into radial and ulnar arteries. The deep brachial artery at its origin was trapped by two roots of median nerve and later divided in to Subscapular artery, Anterior circumflex humeral artery, Posterior circumflex humeral artery and profunda brachii artery. The branching pattern of the axillary artery was normal on left side. This variation is important for surgeons for lymphectomies, to anesthesiologist and orthopedic surgeons considering the frequency of procedures done in this region.

Transfersomes: a surrogated carrier for transdermal drug delivery system.

The transdermal route of drug delivery has gained great interest of pharmaceutical research, as it circumvents number of problems associated with oral route of drug administration. The major barrier in transdermal delivery of drug is the skin intrinsic barrier, the stratum corneum, the outermost envelop of the skin that offers the principal hurdle for diffusion of hydrophilic ionizable bioactives. Recently, various strategies have been used to augment the transdermal delivery of bioactives. Mainly, they include iontophoresis, electrophoresis, sonophoresis, chemical permeation enhancers, microneedles, and vesicular system (liposomes, niosomes, elastic liposomes such as ethosomes and transfersomes). Among these strategies transferosomes appear promising.Transfersomes possess an infrastructure consisting of hydrophobic and hydrophilic moieties together and as a result can accommodate drug molecules with wide range of solubility. Transfersomes can deform and pass through narrow constriction (from 5 to 10 times less than their own diameter) without measurable loss. This high deformability gives better penetration of intact vesicles. They can act as a carrier for low as well as high molecular weight drugs e.g. analgesic, anesthetic, corticosteroids, sex hormone, anticancer, insulin, gap junction protein, and albumin.

Profile of management of animal bite cases among rural population in district Pune, Maharashtra.

The study was carried out in three randomly selected Primary Health Centres (PHCs) of district Pune. During three months of study period all the patients with animal bite attending PHCs were enrolled for the study. All the animal bite cases (451) were due to dog bite and 61.4% were reported to be bitten by pet dogs. In spite of having the knowledge about seriousness of illness, immediate care like washing of wound with soap and water was practiced by only 23.5%. Majority of them did not report immediately to PHC for treatment after dog bite.

Adult type anomalous left coronary artery from pulmonary artery.

Anomalous origin of Left Coronary Artery from Pulmonary Artery (ALCAPA) is a rare congenital anomaly. Its survival into adulthood is further rare. Clinical manifestations result from evolving morphological - functional alterations in pulmonary circulation that occur after the birth. We report a case of 43 year old adult patient with effort angina and without any ECG or Echo abnormalities. On coronary angiography, typical anatomy of ALCAPA was revealed.

Propagation of Chandipura virus in chick embryos.

Stocks of three Indian Chandipura virus (CHPV) isolates; one isolate from an adult febrile case in 1965 from Chandipura town, Maharashtra, and two isolates from two pediatric encephalitis cases from Andhra Pradesh, 2003 were inoculated in 10-day-old chick embryos by allantoic route. All three virus isolates replicated in chick embryos showing titre of log 10(12) to log 10(13) EID50. The results demonstrated that chick embryos are susceptible to CHPV and virus grows to high titres in this system. Therefore chick embryos can be used as an alternative host system for cultivation and isolation of CHPV as they are less expensive than laboratory animals and have several other advantages over cell cultures. Also this system can be used for the development of vaccine and diagnostic reagents.

Choroid plexus papilloma of the posterior third ventricle during infancy & childhood: report of two cases with management morbidities.

We report two cases of posterior third ventricular choroid plexus papilloma, one in an 8-month-old infant and another in a two-year-old child. These cases presented with features of obstructive hydrocephalus. Both these patients underwent a ventriculo-peritoneal (VP) shunt surgery prior to the tumor excision. Following the VP shunt surgery both patients developed ascitis requiring exteriorization of the abdominal end of the shunt. There was a clear proof of CSF overproduction: 1400-1500 ml/day in the eight-month-old infant and 900-1200 ml/day in the two-year-old child. In the former it was transient and could be treated with revision of the VP shunt whereas in the second case a ventriculo-arterial shunt had to be done. In the second case a staged reduction cranioplasty was also performed for an enormously enlarged head (head circumference--74 cm). Interesting clinical and radiological findings and useful management strategies are described.

Sudden bilateral foot drop: an unusual presentation of lumbar disc prolapse.

Bilateral acute foot drop is reported in a 30-year-old healthy male. He presented with a 7-day history of sudden severe backache, radiating to both the lower limbs and 1-day history of sudden bilateral ankle weakness that progressed to bilateral foot drop within 6 hours. He also developed retention of urine. Investigations revealed a large central disc prolapse at L3-4 with significant canal stenosis at that level. Following surgery the patient had progressive improvement.

Long term outcome in patients with severe head injury and bilateral fixed dilated pupils.

Patients with severe head injury with bilateral dilated unreactive pupils are considered to have a grave prognosis. Hence proper planning and aggressive management becomes mandatory for achieving good results. We present the outcome of consecutive 166 patients with severe head injury, admitted between January 1996 and December 2000 and analysed retrospectively. All the patients had an initial GCS of 8 or less and post resuscitation bilateral dilated unreactive pupils. Our aim was to analyze the long term outcome in these patients and identify the other significant prognostic factors. Of the 166 patients, 42 (25.30%) had a functional outcome (good recovery in 10.24%, moderate disability in 15.06%), and 124 (74.69%) had a poor outcome (death in 58.43% and severe disability in 16.26% of cases). There were 45 patients with polytrauma and 24 of these patients (53.33%) succumbed to the injuries. Obliteration of the basal cisterns and contusion were the common CT scan findings. Factors adversely affecting the survival included age of the patient, polytrauma with shock, initial GCS of 3 or 4, and compression of the basal cisterns on the initial CT scans. At follow up, most of the patients with a functional outcome showed a significant improvement in their motor function but continued to have neuro-behavioral and cognitive deficits.

Antimicrobial activity of extracts of Terminalia catappa root.

The effect against bacteria of petroleum ether (60-80 degrees C), chloroform and methanolic extract of dried root of Terminalia catappa Linn. (combrataceae) was employed by cup plate agar diffusion method. The chloroform extract showed prominent antimicrobial activity against S. aureus and E. coli as compared to other tested microorganisms, while petroleum ether extract was devoid of antimicrobial activity. The methanolic: extract exhibited MIC of 0.065 mg/ml against E. coli. and chloroform extract exhibited MIC of 0.4 mg/ml against S. aureus The chloroform has well as methanolic extracts showed good antimicrobial activity against Gram positive and Gram negative microorganisms.

An unusual presentation of an intra-parenchymatous frontal yolk sac tumour : case report.

Yolk sac tumours are rare conditions among the germ cell tumours. Intracerebral germ cell tumours are exceedingly rare. A 15 year old girl presenting with a one week history of raised intracranial pressure is described. She had bilateral papilloedema and a right 6th nerve palsy. CT scan showed an intra-parenchymatous right frontal ring enhancing lesion of 2 cms diameter. The patient underwent microsurgical total excision of the tumour, followed by chemotherapy. She was asymptomatic at three years following surgery.

Hypersensitivity to glucocorticoids in patients with raised ICP : report of two cases.

Corticosteroids are widely used in patients with raised intracranial pressure associated with cerebral neoplasms, cerebral vascular malformations, cerebral ischaemia and benign intracranial hypertension. In general clinical practice, anti-allergic, anti-inflammatory and immuno-suppressive properties of corticosteroids are commonly utilised in the management of allergic and immunological diseases. However in exceptionally rare circumstances, steroids may be the cause of hypersensitive reactions. Authors report two patients with raised intracranial pressure who developed steroid hypersensitivity. A review of the relevant literature is discussed.

Sciatica due to malignant nerve sheath tumour of sciatic nerve in the thigh.

Malignant peripheral nerve sheath tumour (MPNST) is a rare malignant neoplasm arising from the supportive non-neural component of the peripheral nerves. An unusual case of pain and weakness of the foot and calf muscles due to a giant MPNST of the sciatic nerve in the posterior compartment of the thigh is presented. The patient was already investigated as a case of sciatica due to a lumbar disc disease with a negative magnetic resonance imaging and then unsuccessfully operated elsewhere twice, with a misdiagnosis of tarsal tunnel syndrome. Neurosurgical referral prompted a diagnostic magnetic resonance study of the thigh, revealing the lesion, which was completely excised microsurgically with total relief in the pain and partial improvement in the weakness and sensations in the sole of the foot.

Spinal cord and cauda equina compression in 'DISH'.

Diffuse idiopathic skeletal hyperostosis (DISH) has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Precise information is lacking in the world literature. Authors report the results of a retrospective analysis of 74 cases of DISH. Eleven patients presented with progressive spinal cord or cauda equina compression. In nine cases ossified posterior longitudinal ligament (OPLL) and in two cases ossified ligamentum flavum (OLF) were primarily responsible. Surgically treated patients (eight) had far better outcome as compared to the patients managed conservatively, as they had refused surgery. 'DISH' is neither a benign condition, nor it always runs a innocuous clinical course. In fact, in about 15% of the cases, serious neurological manifestations occur, which may require a major neurosurgical intervention.

Solitary skull metastasis from mucoepidermoid mimicking a parotid tumour.

Metastatic parotid tumours in the skull are very rare. An interesting case of a mucoepidermoid parotid tumour metastasizing to the skull vault is described in a patient who had previously been operated for a pituitary adenoma 20 years back with no post operative radiotherapy; however, she required hormonal supplementation therapy. She underwent an operation for a parotid tumour 7 years ago and received postoperative radiotherapy for the parotid tumour away from the site of the skull metastases. No local recurrence of the parotid tumour was noted. The initial diagnosis was that of a solitary intradiploic meningioma. Interesting clinico-radiological findings are presented.

Colonization of pregnant women and their newborn infants with group-B streptococci.

As group B streptococci (GBS) prevalence varies from place to place and this organism is responsible for serious infections in newborns such as septicaemia and meningitis, the present study was carried out to find the prevalence of GBS in pregnant women and their neonates. From June 1998 to April 1999 a total of 317 pregnant women and their neonates were examined for GBS. GBS colonization rate was 2.52% and 1.26% in pregnant women and their neonates respectively. Four sites - viz. throat, external ears, external nares and stump of umbilicus from neonates were found to be equally colonized by GBS immediately after birth and at the time of discharge from hospital, except the umbilicus which was not swabbed at the time of discharge. None of the neonates developed GBS related sepsis. Selective broth medium (SBM) was found to be a superior transport method over Stuart transport medium and filter paper method. All the isolates were sensitive to Ampicillin, Erythromycin, Penicillin followed by Chloramphenicol 66.6% (12/18). All the strains were resistant to Gentamicin, followed by Tetracycline 94.4% (17/18) and Kanamycin 88.8% (16/18).

Gluteal neuralgia - unusual presentation in an adult with intrasacral meningocele: a case report and review of literature.

A nineteen year old man with intrasacral meningocele is reported, who presented with long standing episodic gluteal pain and progressive muscle wasting. Magnetic resonance imaging established the diagnosis. Surgical excision relieved the pain but muscle wasting persisted. Pertinent literature is reviewed.