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Aim: To address the existing gaps in knowledge about long-acting nitroglycerine (LA-NTG) and provide recommendations to address these issues. Methodology: Approved LA-NTG questionnaire that included 17 questions related to the role of LA-NTG in the management of angina and chronic coronary syndrome (CCS) was shared with 150 expert cardiologists from different regions from India. Results of these survey questionnaires were further discussed in 12 regional level meetings. The opinions and suggestions from all the meetings were compiled and analyzed. Further, recommendations were made with the help of attending national cardiology experts and a consensus statement was derived. Results: This is the first consensus on LA-NTG, summarizing the clinical evidence from India and suggesting recommendations based on these data. The experts recommended early use of LA-NTG as a first-line antianginal therapy in combination with beta-blocker since it improves exercise tolerance in patients with CCS. A strong consensus was observed for using LA-NTG in patients with co-morbid hypertension, diabetes, chronic kidney disease and post-percutaneous coronary intervention angina. As a part of cardiac rehabilitation, LA-NTG allows patients with angina to exercise to a greater functional capacity. Conclusions: A national consensus was observed for several aspects of LA-NTG in the management of angina and CCS. The clinical experience of the experts confirmed an extremely satisfied patient perception about the efficacy of LA-NTG.
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Background & objectives: Thyrotoxic periodic paralysis (TPP) is an endocrine emergency presenting with acute-onset flaccid paralysis in a patient having thyrotoxicosis accompanied by hypokalaemia. This study was conducted to evaluate the clinical profile of patients with TPP presenting to three centres in India. Methods: This retrospective, observational study was conducted at three tertiary care Armed Forces medical centres, located at Lucknow, Kolkata and Delhi. The history, clinical features, treatment details and outcomes were evaluated. Results: Of the 244 patients with thyrotoxicosis, 15 were diagnosed with TPP and included in the study. These 15 patients (14 male and 1 female) had 32 episodes of TPP which were analyzed. The mean age was 30.2�2 yr (range: 21-39), and overt thyrotoxicosis was seen in all patients except one who had subclinical hyperthyroidism. Graves' disease was the most common cause of thyrotoxicosis (13/15) and the remaining two patients had subacute thyroiditis and gestational thyrotoxicosis. Hypokalaemia (serum potassium <3.5 mmol/l) was seen in 12 patients, and the mean serum potassium was 3.2�9 mmol/l (range: 2.1-4.9). All patients had flaccid weakness, predominantly involving the lower limb with no bulbar, respiratory or cranial nerve involvement. The average duration of paralysis was 10.6�7 h (range: 3-28 h). Interpretation & conclusions: Our study demonstrated an early age of presentation and presence of clinical and biochemical thyrotoxicosis in majority of patients with TPP. Hypokalaemia may not always be evident in patients with TPP.
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Background & objectives: Salmonellosis due to the consumption of contaminated poultry products is a well-known public health concern, and assessing the distribution of Salmonella serovars among poultry becomes important for better prevention and control. The objective of the present study was to assess the distribution of Salmonella serovars among poultry. Methods: The isolates received at National Salmonella and Escherichia Centre during 2011-2016 were subjected to biochemical identification, followed by serological characterization to identify the Salmonella serovars, and the data were presented to exhibit the distribution of Salmonella serovars among poultry. Results: Salmonella was found to be present in poultry in all the regions included in the study. Salmonella Typhimurium, S. Gallinarum and S. Enteritidis were the most prevalent serovars accounting for 96.2 per cent of isolates. Salmonella was identified in poultry from all major egg-producing and egg-consuming States. Other serovars which were scantly identified included S. Infantis (2.7%), S. Montevideo (0.64%), S. Newport (0.26%) and S. Pullorum (0.13%). Interpretation & conclusions: Diverse distribution of Salmonella serovars in poultry in India, with known potential to infect human population and/or other poultry flocks, requires urgent nationwide stringent control measures.
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Objective: To develop and validate a sensitive liquid chromatography-electrospray ionization-tandem mass spectrometric (LC-ESI-MS/MS) technique for the quantification of dapagliflozin and saxagliptin in plasma by linagliptin as internal standard. Methods: Chromatography was achieved on hypersil C18 (50 mmx4 mm) 5 µ analytical column with 0.1% formic acid and acetonitrile (25:75 V/V) as mobile phase at 0.7 ml/min flow rate. Dapagliflozin, saxagliptin, and linagliptin were detected at m/z 409.14/135.0, m/z 316.2/180.13 and m/z 472.54/456.21 respectively. Drugs and internal standard were extracted by LLE (liquid-liquid extraction). Results: Developed technique was validated over 0.5-1500.0 ng/ml linear concentration range for dapagliflozin and 2.00-2000.0 ng/ml for saxagliptin. This method established with intra-batch and inter-batch precision within 2.44-8.12% and 1.25-7.14 % for dapagliflozin and 1.84-7.5 % and 1.02–6.00 % for saxagliptin. This method established with intra-batch and inter-batch accuracy for dapagliflozin within 98.86-103% and 96.98-102 % respectively and for saxagliptin within 98.05-109.06 % and 97.00-104.00 % respectively. Conclusion: Both dapagliflozin and saxagliptin were stable during three freeze-thaw cycles, long term and bench-top stability studies. The developed method was useful for the routine analysis of dapagliflozin and saxagliptin simultaneously in plasma samples.
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Background: To study the effects of early enteral feeding in postoperative patients who have undergone elective abdominal surgeries by both open and laparoscopic method. Methods: Nasogastric tube was removed after patients recovered from anesthesia. Patients were started on a clear fluid diet, 30ml/hour at 24thhour, then 60ml/hour in the next 12 hours and full fluid diet within 48 hours, then semi-solid diet over next 24 hours. Patient who don’t tolerate oral diet, nasogastric tube was reinserted and managed with nil by mouth till the ileus was resolved. Patients were discharged only after they tolerated solid diet for at least 24 hours in intestinal groups and 12 hours in non-intestinal groups. Length of hospitalization or hospital stay was measured in terms of post-operative stay. Results: A total of 100 patients were selected for the study. Under both open (n=56) and laparoscopic surgery group (n=44), patients were categorized into those who underwent intestinal surgeries and those who underwent non-intestinal surgeries. Among open intestinal surgery group, total number of patients were (n=27) and among open non-intestinal surgery group, total number of patients were (n=29). Similarly, among laparoscopic intestinal surgery group, total number of patients were (n=10) and non-intestinal group, total number of patients were (n=34). The most common complication among all the groups was vomiting, 23% in open surgery group and 20% in laparoscopic surgery group. The incidence of nasogastric tube reinsertion among open surgery group was more (29%), among laparoscopic group was 25%. Among open surgery group, 71% patients who had complications, passed first stools within 5 days after operation whereas among laparoscopic surgery group, 73% patients with complications passed first stools within 3 days after surgery, signifying reduced duration of postoperative ileus with early oral feeding. 62% and 66% patients tolerated early oral feeding among open surgery group and laparoscopic surgery group respectively. The rate of early discharges were 77% for open intestinal surgery group patients and 83% for open non-intestinal surgery group patients. Similarly, the rate of early discharges were 80% among laparoscopic intestinal surgery group patients and 85% for laparoscopic non-intestinal surgery group patients. Conclusion: The result of this study suggests that early oral feeding is well tolerated and there is no merit in continuing to keep patients nil by mouth until bowel function is resumed. This study also shows that early oral feeding reduces the length of hospitalization. Significant percentage of patients in both groups had early resolution of bowel function and time to discharge was early. Furthermore, the duration of postoperative ileus was reduced in patients of both groups which led to early discharge. Thus in patients undergoing elective abdominal surgeries, both open and laparoscopic method, early postoperative feeding is well tolerated and reduces the length of hospitalization.
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Background: Immunization is an important among activity in the Public Health Services. The vaccines are highly temperature sensitive and vaccine potency once lost cannot be restored. A well-managed cold chain will increase the efficiency of immunization and reduce vaccine wastage. An assessment of cold chain system for vaccine storage was done in the all PHCs of the study area. Aims & Objectives: To evaluate the cold chain practices, with particular reference to assessing the availability of cold chain equipment, vaccine storage practices, monitoring of cold chain in primary health centres (PHCs) of Bhojpur district. Material & Methods: A cross-sectional study was conducted at all the cold chain points of 14 PHCs of Bhojpur district during January to May 2015. A predesigned, pretested checklist was used by the trained investigators during their visits. The information was evaluated on the basis of important components related to the cold chain points. Results: All the PHCs had a dedicated cold chain room with sufficient number of cold chain equipment. Consolidated effective vaccine management score for cold chain points of 8 (57.1%) PHCs were average (60-79%). None of the PHCs have satisfactory score (≥ 80%). Vaccine storage practice and availability of complete RI micro-plan were found satisfactory at 12 (85.7%) PHCs. Maintenance of cold chain equipment were satisfactory at 10 (71%) PHCs. But, temperature monitoring. (5) (35.7%) and waste disposal related to routine immunization 3 (21.4%) PHCs were disappointing. Conclusion: The primary health centres had average performance related to the cold chain system, which is a matter of concern warranting for the cold chain monitoring. We recommend supportive supervision as the key measures in improvement of cold chain system.
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Background: The presbycusis patients (usually beyond 50 years) come to us with much loss of hearing sensitivity. The deafness unperceived starts much earlier before their perception. Objectives: To identify the severity of the subtle deafness in the cosmopolitan, small town and rural areas. Materials and methods: We had selected the people with absolutely normal hearing (claimed by the subjects) between 21-50 years. They were confident of their hearing status, even on deep probing. We divided the people into three categories like cosmopolitan, small town and rural. We had selected the people of Mumbai under the cosmopolitan category. The audiological evaluation was carried out in sound treated room meeting the ANSI Standards of permissible ambient noise levels in sound treated room.Manual Pure Tone Audiometer in a two room set up that confirm to ANSI S-3.6-1996 standard was used. The instrument used for this study was calibrated ALPS AD 2100 audiometer with TDH 49 ear phones. Results: The cosmopolitan population were affected most. Later small town people and lastly rural area people were affected. In cosmopolitan population the 4 kHz was mostly affected, suggesting the significant impact of noise on their hearing. In town population also the 4 kHz is affected, but not to the extent of cosmopolitan people. The cosmopolitan people were affected worst among the three categories. And interestingly the small town population and rural population have almost the same hearing thresholds. Y. Kishore Kumar, Jaya Sahu, Ajay Basod, Nityam Sagar Patel. The Comparative Study of Subtle Deafness in Cosmopolitan, Town and Rural Population. IAIM, 2017; 4(1): 72-77. Page 73 Conclusion: The severity of subtle deafness is most in cosmopolitan, lesser in small town and least in rural population. The pure tone audiometry should be done in cosmopolitan people in early twenties, in small town people in early thirties and in rural population in early forties.
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Background & objectives: Salmonellosis is a major public health concern worldwide. Besides typhoidal salmonellae, infections due to non-typhoidal serovars of Salmonella are also associated with high morbidity and mortality leading to huge economic losses. Among non-typhoidal serovars, Salmonella Newport has been reported as a major cause of foodborne infections resulting in outbreaks due to consumption of contaminated food items. Little data related to this serovar are available from India leading to the scarcity of information on the distribution trends of this important serovar in the country. Therefore, an effort was made in the present study to generate data on distribution trends and antibiogram of S. Newport in the country. Methods: S. Newport isolates received at the National Salmonella and Escherichia Centre at Kasauli, India, during January 2010 to December 2013 were analysed for their distribution trends and antibiogram data were also generated using standard methods. Results: In the present study, S. Newport isolates were received from eight States and one union territory of the country and highest proportion of S. Newport isolates were found to be from humans (53.61%) followed by animals (27.84%) and food (18.56%). S. Newport isolates exhibited resistance to all drugs used in the present study except chloramphenicol, ciprofloxacin and cefuroxime. Interpretation & conclusions: Considering distribution of this important serovar of Salmonalla and its wide range of reservoirs, steps towards formulation and execution of efficient surveillance programmes should be taken.
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Background: Tai Chi Chuan (meaning Supreme Ultimate Force), popularly known as Tai Chi is an internal Chinese martial art practised for both defence and health purposes. Materials and methods: We selected 4 male persons of age group between 65 and 72 years with presbystasis. All of them had been treated with medication and good rest for a period of more than 6 months without much relief. We planned to evaluate the efficiency of Tai Chi through comparison of functional test of balance (Romberg test) and the perception of balance and falls by using Dizziness Handicap Inventory (DHI) questionnaire obtained prior and following the Tai Chi course. Results: All the patients observed not only significant improvement in the balance, they also got more confidence in walking, running, bending and from the fear of falling. They were re-examined after one month (total 12 weeks of exercises) with Romberg test (to rule out bias by the patients) and DHI questionnaire. There was a significant improvement in the Romberg test and there was significant decrease in the DHI score from average 63.5 (severe dizziness) to 43.5 (moderate dizziness) Conclusion: The findings of the Tai Chi in the rehabilitation of balance problem in the elderly persons found to be very effective. Tai Chi is easy to carry out and very comfortable for the older people. They can practice the exercises at home, at outdoor without much effort and difficulty
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A 50 year female presented with dysphagia for 2 months and she denied pain during swallowing, retrosternal pain, drooling of saliva, nasal regurgitation, cough, breathlessness, hoarseness of voice abdominal pain, vomiting, loss of weight or loss of appetite. Upper gastrointestinal (UGI) endoscopy revealed a web at 17 cm from incisors. Post endoscopy patient developed pain over the upper abdomen which worsened during swallowing and breathing. Because of rapid development of these symptoms we suspected esophageal perforation/dissection. Complete blood picture suggestive of neutrophilic leukocytosis and other parameters were normal. Thin barium study showed pseudo lumen in esophagus and confirmed the diagnosis of esophageal web with esophageal dissection. Patient was treated conservatively with nil per oral and parenteral fluids and antibiotics. Web was dilated after 2 weeks with Salivary-Gilliard dilators and procedure was uneventful and oral feeding was initiated.
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Aims: Patients with severe sepsis and septic shock often exhibit significant cardiovascular dysfunction. We designed the study with an aim to determine the severity of cardiac dysfunction in the different group of sepsis patients. Study Design: Single-center, cross-sectional study Place and Duration of Study: The study was carried out at Department of Cardiology, Kasturba Medical College and Hospital, Manipal from June 2011 to December 2012. Methodology: A total of 74 patients who were diagnosed with sepsis were enrolled in the study. All patients were subjected to routine analysis, laboratory test and echocardiogrphic assessment. Results: The patients were divided into 3 groups: sepsis group (n = 11), severe sepsis group (n =37) and septic shock group (n = 26). The mitral E/A value is significantly higher in patients with septic shock than that of the patients with sepsis (P = 0.04). The indices of right ventricular dysfunction did not show any significant difference in the patients with septic shock and that of sepsis. Conclusion: Left ventricular dysfunction may be considered prevalent in sepsis as per the significant E/A values. However, the other echocardiographic parameter should also be considered. This may even infer that cardiac dysfunction may not correlate with the severity of sepsis.
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Objective: Nevirapine (NVP) is a non nucleoside reverse transcriptase inhibitor widely used in combination with other antiretroviral agents for the treatment of human immunodeficiency virus disease. The present study was aimed to develop generic formulation of extended release (ER) tablets of Nevirapine anhydrous (NVP) using hydrophilic polymer. Method: Nevirapine NVP(ER) tablets were prepared by different manufacturing technology i.e. direct compression, roller compaction, and wet granulation method by employing hydrophilic polymer (HPMC K15M).The matrix granules were prepared by mixing drug along with polymer and diluents in different polymer ratio from wet granulation technology used water as a granulating fluid. Results: The prepared granules were evaluated for various physicochemical parameters by official procedure and compressed in tablets. The In-vitro release profile of various batches was prepared by different technologies and has been compared with the innovator product. In-vitro release profiles of NVP from ER tablets were determined using USP apparatus type II (Paddle), 50 rpm and bath temperature 37ºC. Dissolution of tablets was carried out in 900 ml of media (phosphate buffer pH 6.8). Samples were withdrawn at predetermined time intervals up to 24 hrs and analyzed using UV detector at a wavelength of 247 nm. Conclusion: Stress stability studies indicated that the formulation is stable and In-vitro release profile study showed that formulation using wet granulation technology.
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Aim: In the present study, Sumatriptan succinate was formulated as oral elementary osmotic pump with a zero-order drug release profile. Methodology: The effect of different formulation variables i.e. different types of osmogens, concentrations of osmogen and concentration of coating solution were studied. The in vitro evaluation was carried out in different release media. Result: Highest percentage of drug release was observed at high concentration of mannitol i.e., 1:3 (drug: mannitol). Osmogen with low osmotic pressure (38 atm) showed 71.01% zero-order drug release for 12 hours when compared to that of the osmogen with high osmotic pressure (356 atm) which showed 67.38% of release by zero order. Conclusion: Elementary osmotic pump tablets of Sumatriptan succinate were able to deliver zero-order release up to 12 hours independent of pH of dissolution media and have overcome the problem of chronotherapeutic effect.
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Introduction: Intestinal parasites continue to be a significant health problem in renal transplantation patients. Strongyloides infection is unique that it excretes larvae and can continue life cycle by auto infective cycle also. Presentation of the case: We present a 26 years old man presented with acute cellular rejection after three months of kidney transplantation. Before transplantation stool of both recipient and donor was negative for parasites. He received three doses of intravenous methylprednisolone. After one month he presented with severe epigastric pain and vomiting. On examination he was malnourished, dehydrated and lost two kilograms of weight over one month. His serum albumin was 2.9 mg/dL. Pain did not subside with proton pump inhibitors. Stool examination was negative for parasites. As index of suspicion for parasites was high, upper GI endoscopy was done; it showed multiple ulcers in duodenum. Biopsy of the ulcer showed strongyloides infection He was treated with ivermectin. Abdomen Pain was subsided soon. He gained weight of 1.5 kilograms over next month. Conclusion: When transplant patients from developing country with recent increase of immunosupression presents with severe abdomen pain, the intestinal parasitic infection should be entertained. If stool examination is negative and serology is unavailable, early evaluation by endoscopic biopsy is helpful to diagnose strongyloides. Prolonged treatment with ivermectin and follow-up stool examinations are important for complete cure of strongyloides infection.
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Two simple, accurate, rapid and sensitive Methods (A and B) have been developed for the estimation of Alosetron in its pharmaceutical dosage form. The Method A is based on the formation yellow colored chromogen, due to reaction of Alosetron Hydrochloride with Metanil yellow dye, formation of ion association complexes of the drug with dyes in phosphate buffer of pH 3.6 followed by their extraction in chloroform which exhibits λmax at 410 nm. The Method B is based on the formation of light yellow colored chromogen due to reaction of Alosetron Hydrochloride with Methyl Orange dye, formation of ion association complexes of the drug with dyes in phosphate buffer of pH 3.6 followed by their extraction in chloroform, which exhibits λ max at 422 nm. The absorbance-concentration plot is linear over the range of 5-60 mcg/mL for Method A and 50-120 mcg/mL for Method B. Results of analysis for all the methods were validated statistically and by recovery studies. The proposed methods are precise, accurate, economical and sensitive for the estimation of Alosetron in bulk drug and in its Tablet dosage form.
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Background and Objectives: Recent amendments in syllabus from 2012 batch for learning physiotherapy ethics for 4 years & passing internal assessment in final year has prompted to undertake innovation with e module as against traditional lecture method which is currently in practice. e- Learning is teaching using electronic media which developed rapidly and power point presentations are being extensively used and hence pilot tested on 2012 final year exam appearing physiotherapy students although traditional lecture method continued for first and second year students. Aim of the study: To study the response of final B.P.Th. students on e module of ethics. Materials & Methods: Needs assessment on innovation was done. This was followed by e-module preparation. Module prepared according to syllabus in power point format. Module incorporated expert opinion from physiotherapy & M.E.T. faculty before final module was prepared which took one month and included one assignment. Module was posted on emails of all 25 final year students. 3 months time was given before evaluation by feedback forms, assignment completion & internal assessment scores. Results: All 25 students completed assignment & scored marks between 50-76% in internals. Students found that Module was easy to learn & follow, created self learning and could be read according to their convenience. Conclusions: it was possible to implement e modular pattern of learning although developing the e module required time and effort. e module enhanced self directed learning and can be implemented for all batches.
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Adiantum capillus-veneris L., Pteridaceae, is a fern reputed to have numerous applications in traditional medicine in the treatment of leprosy, animal bites, thyroid dysfunction and musculoskeletal disorder.The proposed study was aimed to investigate the potency of the fern Adiantum capillus-veneris on the thyroid dysfunction - hypothyroidism in terms of determining thyroid gland weight, thyroid peroxidase activity, estimation of iodine in urine, concentrations of total thyroxine (T4), triiodothyronine (T3) and thyroid stimulating hormone (TSH) in serum. The weight of thyroid gland was decreased, while thyroid peroxidase activity, serum T4 (p < 0.01) and serum T3 levels (p < 0.01) were increased in animals treated with the ethanol plant extract (500 mg/kg); but serum TSH level decreased significantly (p < 0.01) when compared with hypothyroid control animals. The SOD, Catalase and glutathione antioxidant enzyme levels and lipid peroxidation were measured.The results of lipid peroxidation and antioxidant enzyme assay indicated that the level of malondialdehyde was significantly lowered and the levels of antioxidant enzymes were significantly increased when treated with ethanol extract of Adiantum capillus (500 mg/kg). Polyphenolic compounds viz., quercetin and gallic acid were determined by HPTLC analysis. With the outlined results, Adiantum capillus could be used for the regulation of hypothyroidism.
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The aim of the present study was to design and evaluate the suppositories of aceclofenac a non-steroidal anti inflammatory drug (NSAID). Aceclofenac, rectal suppositories were developed by employing various hydrophilic and hydrophobic polymeric bases like gelatin, PEG-400 and hydrogenated vegetable oil using propylene glycol as plasticizer and beeswax as hardening agent. The in-vitro release rate data was evaluated statistically and was found that from all the formulations the drug release is by diffusion mechanism (r = 0.9547 to 0.9967) according to Higuchi’s equation. All the prepared formulations have shown zero-order release kinetics except those prepared by utilizing 15% and 20 % of PEG-400. The formulation prepared using 7.5% beeswax in hydrogenated vegetable oil has dis-played zero-order drug release (r = 0.9927) and has released 99.18% of the aceclofenac within 4h, hence, this formulation is considered as a promising formulation. The stability study on the promising formulation was con-ducted over a period of 6 months and found that there are no significant changes in the drug content and in-vitro drug release rate (p<0.05). The result suggests that the suppositories can be prepared by employing hydrophilic and hydrophobic polymers.
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The aim of the present study was to design and evaluate the suppositories of aceclofenac a non-steroidal anti inflammatory drug (NSAID). Aceclofenac, rectal suppositories were developed by employing various hydrophilic and hydrophobic polymeric bases like gelatin, PEG-400 and hydrogenated vegetable oil using propylene glycol as plasticizer and beeswax as hardening agent. The in-vitro release rate data was evaluated statistically and was found that from all the formulations the drug release is by diffusion mechanism (r = 0.9547 to 0.9967) according to Higuchi’s equation. All the prepared formulations have shown zero-order release kinetics except those prepared by utilizing 15% and 20 % of PEG-400. The formulation prepared using 7.5% beeswax in hydrogenated vegetable oil has dis-played zero-order drug release (r = 0.9927) and has released 99.18% of the aceclofenac within 4h, hence, this formulation is considered as a promising formulation. The stability study on the promising formulation was con-ducted over a period of 6 months and found that there are no significant changes in the drug content and in-vitro drug release rate (p<0.05). The result suggests that the suppositories can be prepared by employing hydrophilic and hydrophobic polymers.