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

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

Cost comparison of commonly used antidepressant drugs with drug price control order in India

Background: Price of a drug is an important factor for compliance to the treatment. So, to overcome the high prices of drugs, National Pharmaceutical Pricing Authority (NPPA) under government of India has issued Drug Price Control Order (DPCO) list containing commonly used drugs. Pharmaceutical companies can be punished if they keep their prices higher than the ceiling price mentioned in the DPCO. To find out the price variations of commonly used antidepressant drugs included in DPCO list of 29th April 2019.Methods: A list of all oral antidepressant drugs included in DPCO of 29th April 2019 and available in Indian market was procured from medguide India. Analysis of number of total brands following as well as not following DPCO ceiling price was done.Results: Author found 17 formulations of four antidepressant drugs included in DPCO. Total 556 brands found out of which 84.6% were following the DPCO and 15.4% of brands prices were higher than the ceiling price of DPCO.Conclusions: Though large number of companies are following the DPCO but still strict regulation is needed to further increase the compliance of guidelines.

Comparative Evaluation of Conventional Approach Versus Paraglossal Approach for Routine Anesthesia

Background: Paraglossal technique was described as early as 1930 but is seldom taught now or practiced. AIM: To evaluate the effectiveness of paraglossal technique over conventional approach and to evaluate the ease of insertion and glottic view obtained. Methods: This Randomized Controlled Trial, was done after taking informed consent 140 patients scheduled for elective surgery under general anesthesia were enrolled for the study. They were randomly divided into Group P: Intubation was performed using paraglossal approach with Miller blade and Group C: Intubation was done using conventional larynogoscopy technique with Mcintosh blade. Comparisons were made in improvement in Cormack Lehane grade, intubation difficulty score, time taken for intubation and complications if any. Results: Cormack Lehane Grade I was obtained in 97.1% subjects in paraglossal group as compared to 67.1% in group C (p=0.02). Time taken for intubation was significantly more in group C (p=0.014). The ease of intubation on Likert scale was graded as 1 (1-2) and 1 (1-1) for Group P and C respectively. Conclusion: Paraglossal approach improves the glottic visualization and also leads to successful intubation. We recommend that paraglossal approach be taught to anesthesia residents as an alternative technique so that it can be used with confidence if conventional laryngoscopy fails.

Evaluation of the Role of Pre-Operative Ketamine Gargle to Control URTI in Patients with Endotracheal Intubation

Background: Postoperative sore throat is a common and disturbing complication after endotracheal intubation, leading to patient discomfort and dissatisfaction. Objective: To find out the efficacy of ketamine gargles in reducing the incidence and severity of postoperative sore throat after endotracheal intubation. Methods: We studied the role of preoperative ketamine gargles for reducing postoperative sore throat. Patients undergoing elective abdominal and pelvic surgery under general anaesthesia with endotracheal tube were included in the study. They were randomly allocated in two groups, each group comprising of 30 patients. Group 1 received preservative free ketamine 50mg in 29 ml distilled water. Group 2 gargled with 30 ml distilled water. Patients were asked to gargle for 30 seconds, 5minutes before induction of anaesthesia. Postoperatively sore throat was assessed at 0, 4, 8 and 24 hours after extubation. The severity of sore throat was assessed from mild to severe. Results: Immediately after extubation, 90% patients in group 2 had sore throat compared to 66.7% in group 1. 24 hours after extubation, the incidence decreased to 50% in group 2 and 13.3% in group 1. Similar decrease incidence was noted at 4 and 8 hours post extubation in group 1. No patient in group 1 complained of change in voice or hoarseness of voice. Conclusion: We found that preoperative gargling with ketamine is a simple and cost effective way to reduce the incidence and severity of postoperative sore throat.

The use of cyclooxygenase-2 inhibitors in depression: a narrative review of the state of evidence

Multiple lines of evidence suggest that inflammation contribute to the pathophysiology of depression. Various studies have found that patients with major depression have higher levels of pro-inflammatory cytokines like interleukin-1, interleukin-6, tumor necrosis factor-alpha and C-reactive protein. As a consequence of above findings this narrative literature review was done to look for the role of cyclooxygenase (COX)-2 inhibitors in the patients of depression. A web based search was done using the keywords like antidepressants, anti-inflammatory treatment, celecoxib, depression, neuro inflammation in well recognized databases like PubMed, Google scholar from the year 2006 to 2019 to come out with data that matches our inclusion criteria that have been pooled and critically analyzed. Although the exact mechanism remains to become elucidated the results suggest that COX-2 have beneficial role in treatment of depression and it may be used as an adjunct to the anti-depressant treatment as it may hasten the response to current treatment without any serious side effects.

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

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

Comparative Diagnostic Role of Computed Tomography Angiography (CTA) and Noncontrast Magnetic Resonance Angiography (NC-MRA) in Evaluation of Cerebrovascular Accidents

Background: Cerebrovascular accidents (CVA) are a major cause of mortality and morbidity in middle and elderly age-groups. It can be ischemic or hemorrhagic and thrombotic or embolic. Digital subtraction angiography (DSA) is a gold standard investigation for evaluating patients with CVA. Due to invasive nature of DSA, computed tomography angiography (CTA) has long been used as a primary noninvasive imaging tool to evaluated patients with CVA. Angiography can also be performed with magnetic resonance imaging, both with & without contrast.Introduction: CTA serves as a primary noninvasive imaging tool in evaluation of patients with CVA as nearly half of these patients do not have treatable underlying cause. Due to increasing awareness regarding the radiation exposure, contrast-induced nephrotoxicity and iodine-sensitivity, magnetic resonance angiography (MRA) is gaining more and more attention. Noncontrast MRA (NC-MRA) can be performed utilizing 3D-time of flight sequence which provides results comparable to that of CTA. Hence, we performed a study to evaluate comparable role of NC-MRA and CTA. Methods: Fifty patients with cerebrovascular accidents wereevaluated with CTA & NC-MRA in tandem on the same day. The results obtained were statistically evaluated and conclusions were drawn. Results & Conclusions: Detection of aneurysm in intracranial and stenoses in intracranial as well as extracranial vessels can be detected with good accuracy by NC-MRA. The results of NC-MRA was comparable to that obtained by CTA except in very small aneurysm (<3mm) and early stenosis (20-30%) which rarely affect immediate patient management. Hence, NC-MRA can be a good substitute to CTA especially in patients where iodinated contrast is relatively or absolutely contraindicated and in combination with routine protocol for stroke imaging.

Surgical Outcome in IDEM Tumors in Short Term Follow Up

Background: To review the clinical and histological aspect of IDEM tumors with functional outcome after surgery of all radiologically diagnosed cases of IDEM. Methods: 12 cases of IDEM tumors, which had been surgically treated and studied in terms of clinical features as pain by VAS, functional score by Nuricks grading, in preoperative and postoperative period. The correlation of histopathology and tumor size in terms of clinical features and outcome was done. Results: Most common diagnosis was schwannoma (83.3%) and rest 2 patients were meningiomas(16.7%), distribution - 3(25%) dorsal, 5(41.6%) lumbar, 2(16.6%) cervical, 1(8%) cervico-dorsal and 1(8%) dorso-lumbar and average percentage of the intradural space occupied by tumor was 77.02%. Average age was 40 years. Meningioma was common in 55 to 60 yr age all female; schwannoma the mean age was 37 year. The most common symptoms were local pain, tingling and numbness, motor weakness which were observed in all the cases. All patients improved postoperatively. VAS score and Nurick grade inproved in all. Conclusion: Most common pathology was schwannoma then meningioma. All the tumors excised through the posterior approach. The postoperative recovery was good in all the cases regardless of any condition. Therefore, aggressive surgical excision is recommended even for cases with a long duration of symptoms or a severe neurologic deficit.

Evaluation Of The Changes In The Soft And Hard Tissue Profile After Anterior Segmental Osteotomy Of Maxilla And Mandible

Aim of this study is to evaluate the changes in the soft and hard tissue profile after Anterior Segmental Osteotomy of Maxilla and Mandible in Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Vijayawada. Subjects include 10 men and women who were diagnosed as bialveolar protrusion and underwent maxillary and mandibular anterior segmental osteotomy. Statistical analysis showed changes in both soft and hard tissues parameters. A reduction of the labial prominence with increase nasolabial angle was noted subsequent to anterior segmental osteotomies. Long term, prospective, methodology sound clinical trials with larger samples are required to provide sufficient information for predicting the soft and hard tissues changes response to anterior segmental osteotomies.

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

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

Lack of research aptitude in medical education.

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

Accumulation of metals in selected macrophytes grown in mixture of drain water and tannery effluent and their phytoremediation potential.

Phytoremediation is an emerging, ecofriendly and economically feasible technique for the restoration of heavy metals contaminated environment. In the present investigation, five native macrophytes growing naturally in a drain receiving tannery effluent viz Bacopa monnieri, Eichhornia crassipes, Hydrilla verticillata, Ipomoea aquatica and Marsilea minuta were evaluated for their heavy metal (Cr, Cu, Ni and Pb) accumulation potential in field conditions at Unnao, U.P., India. The results showed that metal accumulation by these macrophytes differed among species and tissue parts. The concentration of Cr, Cu, Ni and Pb in the root tissues were estimated in the range 3.38 -45.59, 1.01 -16.85, 1.81-4.43 and 1.02 -4.24 µg g-1 d.wt., whereas the corresponding shoot values were 8.79 -48.81, 1.01-8.67, 0.84 -2.89 and 1.02 -2.84 for Cr, Cu, Ni and Pb respectively. Among the studied plants the translocation factor (TF) ranged between 1.07-2.60, 0.75-3.83, 1.44-2.57 and 0.49-3.76 for Cr, Cu, Ni and Pb, respectively. The highest metal TF was found in M. minuta (2.60, 3.83 and 2.57) for Cr, Cu and Ni respectively, whereas Pb was best translocated (3.76) by B. monnieri. Roots and shoots of the studied macrophytes showed a value of greater than 1 for metal enrichment coefficient. Findings suggest that E. crassipes can be used for phytoremediation of Cu and Ni whereas M. minuta and H. verticillata can be applied for the removal of Cr and Pb respectively from the contaminated water bodies.

How do health care providers deal with kala-azar in the Indian subcontinent.

Background & objectives: Three countries, Bangladesh, India and Nepal, set out to eliminate kala-azar by 2015. This study was aimed to document the knowledge and practices in kala-azar case management of public and private health providers in these three countries. Methods: A health care provider survey was conducted in 2007 at 4 study sites, viz., Muzaffarpur and Vaishali districts in India, Mahottari district in Nepal, and Rajshahi district in Bangladesh. Interviews were conducted with formal and informal health care providers at their home or practice. Results: About half of the providers in India and Nepal knew the rapid diagnostic test rK39 recommended by the elimination initiative, but this was not in Bangladesh. Knowledge of the recommended first-line drug, miltefosine, was good in India and Nepal but less so in Bangladesh. Interpretation & conclusions: Innovative tools for VL care have not yet been fully taken up by private for profit care providers in the three countries that launched a VL elimination initiative. The elimination initiative needs to address these gaps in private providers’ knowledge, given their substantial share in the care of VL patients.

Accumulation and translocation of heavy metals in soil and plants from fly ash contaminated area.

The present investigation deals with the accumulation of heavy metals in fields contaminated with fly ash from a thermal power plant and subsequent uptake in different parts of naturally grown plants. Results revealed that in the contaminated site, the mean level of all the metals (Cd, Zn, Cr, Pb, Cu, Ni, Mn and Fe) in soil and different parts (root and shoots) of plant species were found to be significantly (p<0.01) higher than the uncontaminated site. The enrichment factor (EF) of these metals in contaminated soil was found to be in the sequence of Cd (2.33) > Fe (1.88) > Ni (1.58) > Pb (1.42) > Zn (1.31) > Mn (1.27) > Cr (1.11) > Cu (1.10). Whereas, enrichment factor of metals in root and shoot parts, were found to be in the order of Cd (7.56) > Fe (4.75) > Zn (2.79) > Ni (2.22) > Cu (1.69) > Mn (1.53) > Pb (1.31) > Cr (1.02) and Cd (6.06) ~ Fe (6.06) > Zn (2.65) > Ni (2.57) > Mn (2.19) > Cu (1.58) > Pb (1.37) > Cr (1.01) respectively. In contaminated site, translocation factor (TF) of metals from root to shoot was found to be in the order of Mn (1.38) > Fe (1.27) > Pb (1.03) > Ni (0.94) > Zn (0.85) > Cd (0.82) > Cr (0.73) and that of the metals Cd with Cr, Cu, Mn, Fe; Cr with Pb, Mn, Fe and Pb with Fe were found to be significantly correlated. The present findings provide us a clue for the selection of plant species, which show natural resistance against toxic metals and are efficient metal accumulators.

Knowledge About Sandflies in Relation to Public and Domestic Control Activities of Kala-azar in Rural Endemic Areas of Bihar.

Visceral Leishmaniasis (VL) control is a global cause of concern. To identify the gaps in People's knowledge/ awareness about sand flies and control activities of kala-azar in rural endemic areas of Bihar, this study consisting of 450 respondents with 288 male and 162 female was carried out. The result showed that 95% respondents had heard about the disease up to some extent, but majority respondents were neither aware about the vector of kala-azar, nor they had any idea about transmission of the disease. About 61% had wrong impression that mosquitoes were causing kala-azar. Regarding knowledge about breeding and resting sites of vectors, 20% reported cattle shed, 16% crevices in the household followed by 15% damp dark places. The attitude of respondents towards vector control programme was poor, as 99% lost faith in the DDT spraying because of ineffectiveness, like no reduction in mosquito nuisance. Bed net was considered the best protection method against sand fly or mosquito nuisance but the cost was considered the major constraint in its use. Proper health education programme in Simple and local language along with visual demonstration should be promoted to enhance the awareness and co-operation at community level.

Nutrient dynamics and decomposition rates during composting of sulphitation pressmud by different methods.

Decomposition rates and nutrient contents of sulphitation pressmud (SPM), either alone or by mixing with cow dung and rice straw, under the aerobic (heap and NADEP), anaerobic (pit) and vermicomposting methods were compared. Loss in Organic C and C/N ratios of the decomposing materials indicated the heap and NADEP methods faster for the composting of SPM alone and SPM + cow dung and vermicomposting method for SPM + rice straw registering significant reductions in Organic C ranging from 45.0 to 61.0% from the respective decomposing materials at termination time (119 days). The heap and NADEP methods recorded C/N ratio of SPM alone as low as 11 and 12 and SPM + cow dung as 12.0 and 13.9 at termination stage. Vermicomposting method brought the C/N ratio of SPM + rice straw to 16.4 as compared to 18.6 to 29.8 with the other methods. Irrespective of the composting methods, CO2 evolution from the decomposing materials was higher in early period (up to 28 days). Among methods, NADEP and heap methods recorded more CO2 evolution in early period while vermicomposting method showed more CO2 evolution at the later intervals in comparison to the other methods. Nutrient content in the decomposing materials at different intervals depended on their initial contents. Total N in the composts were statistically comparable, however, the composts of SPM alone recorded relatively more N than SPM + cow dung and SPM + rice-straw prepared by the respective methods. Total P and K contents of the composts increased with time irrespective of the composting methods. Composts of SPM alone recorded significantly more total P than SPM + cow dung and SPM + rice straw at 62, 91 and 119 days while SPM + rice straw recorded more total K than the composts of other materials. Total P in the composts did not differ with the composting methods, but total K in composts of SPM alone was relatively more with heap and NADEP methods, in SPM + cow dung with pit method and in SPM + rice straw by vermicomposting method. Total S in the composts decreased with time and both the aerobic methods showed more reductions than pit and vermicomposting methods.

Bone metastasis from ovarian cancer.

We report a case of epithelial ovarian cancer, which presented with lumbar vertebral metastasis soon after treatment, as a part of distant spread. This patient was then treated by palliative radiotherapy and put on second line chemotherapy i.e, Topotecan. She responded to treatment well.

Utilization of composted sugar industry waste (pressmud) to improve properties of sodic soil for rice cultivation.

Sulphitation pressmud (SPM) and its composts were prepared by heap, pit, NADEP and vermicomposting methods and their effects were compared with soil properties and growth, yield and nutrient uptake by rice in a sodic soil under pot conditions. Application of 15 t ha(-1) SPM and its different composts significantly increased the plant height and dry matter accumulation at different intervals, grain and straw yields and N, P and K uptake by the crop over the control. NADEP compost of SPM alone recorded the maximum and significant plant height by 8.5 to 19.3% and plant dry matter by 14.6 to 32.8% over the raw SPM at different intervals. NADEP composts of SPM alone and SPM + rice straw were also found to be superior than raw SPM by recording 34.8 and 27.8% more grain yield respectively. The SPM composts prepared by NADEP and SPM by vermicomposting methods significantly accumulated higher N and K in rice grains and straw, while NADEP compost of SPM and SPM + rice straw recorded more P in grains and straw than raw SPM. Application of SPM and its composts reduced the pH, EC and bulk density of the soil after rice harvesting, though the reductions were not significant in comparison to the control. However, these treatments increased the soil organic C by 33.33 to 69.0%, available N by 41.4 to 74.8%, available P by 47.1 to 97.8%, available K by 11.8 to 59.2% and available S by 10.3 to 90.7% over the control. NADEP composts, in general, were found to be superior than the raw SPM and other composts in residual soil nutrient content after rice crop.

Validation of coupled bioassay for inhibin by pituitary cell culture assay.

Studies on the characterization of inhibin and inhibin-like factors have depended for the most part on the classical in vitro pituitary cell culture assay. A major drawback with this assay is the turn-around time which is in the order of two weeks and consequently slows down purification efforts. The 24 h bioassay for inhibin has been found to be sufficiently sensitive and also statistically valid. Unfortunately, based as it is on a secondary response, ambiguities arise in interpreting the results. By including a parallel assay in which the mice are primed with human menopausal gonadotropin rather than human chorionic gonadotropin, it was possible to device the coupled bioassay. This enables distinguishing inhibin-like factors acting to suppress pituitary follicle stimulating hormone output from those acting at the level of gonads. In this study the coupled assay for inhibin has been compared with the classical pituitary cell culture assay in order to assess its biological and statistical validity. The data validates the bioassay on both the above counts and when considered in conjunction with the short turn-around time suggests that this assay can be highly useful in studies on isolation of inhibin from various. sources.