Hypoglycemic activity of Syzygium cumini (L.) Skeels seed extracts: an approach to in vitro, in vivo, and in silico studies.

This research is carried out to explore the hypoglycemic activity of Syzygium cumini seed extracts by in vitro, in vivo, and in silico methods. For in vitro studies the α-amylase and α-glucosidase enzyme inhibition assays were employed. For in vivo studies 30 alloxan induced Wistar rats were used. They were orally administered with glibenclamide and low/high dose of the extracts and were monitored regularly for the change in blood glucose levels for about 28 days. The in silico molecular docking was conducted to evaluate the binding interaction of 1,2,3-Benzenetriol with human pancreatic α-amylase and α-glucosidase. It was found that all the extracts were able to inhibit the α-amylase and α-glucosidase enzymes. Among which the acetone extract showed greater inhibition with 72.52 ± 0.51% and 63.02 ± 0.73% for both the enzymes, respectively. There was significant (p < 0.05) reduction in blood glucose levels in the rats administered with glibenclamide and extracts. In silico docking results revealed that the compound 1,2,3-Benzenetriol exhibited the highest binding affinity for human pancreatic α-amylase with binding energy -7.7 kcal/mol. Thus suggesting the utilization of S. cumini seeds in the management of diabetes mellitus.Communicated by Ramaswamy H. Sarma.

Challenges of diabetes in elderly TB patients.

Diabetes mellitus (DM) and tuberculosis (TB) are worldwide health burdens post-COVID-19. TB is the second-leading cause of death by a single infectious microbe. There is much evidence around the world about the responsibility of TB-DM co-morbidity. Both TB and DM prevalence is high in low- and middle-income countries. Especially the elderly with diabetes are more prone to TB infection due to compromised immune systems. Diabetic patients are three times as likely to develop tuberculosis as non-diabetic patients. DM interferes with the status of TB and leads to undesirable outcomes in the treatment of TB. This may later lead to the development of multidrug-resistant tuberculosis (MDR-TB). The coexistence of TB and DM leads to a high mortality rate and therefore becomes an enormous challenge for the medical field. This viewpoint includes the most current information about TB and DM, disease complications, treatment strategies, challenges to be faced in disease management and the importance of TB-DM bidirectional screening in older adults, which helps in early detection and better treatment programme.

Priapism - A Rare Presentation in Chronic Myeloid Leukemia: Case Report.

Priapism is a complication rarely seen in leukemia. We report a 19-year-old man presented with persistent painful erection of penis for over 24 hours at home. The patient had underwent immediate irrigation and decompression of priapism by urologist at emergency services of the hospital. This approach resulted in a flaccid penis later. During hospitalization, peripheral blood smear and bone marrow aspiration confirmed the diagnosis of chronic myeloid leukemia.

Incidence of prostate cancer at a single tertiary care center in North Karnataka.

CONTEXT: Prostate cancer (PC) remains one of the most common cancers affecting men today. Thus, understanding the prevalence, disease characteristics, and changing demographics of Indian PC patients has emerged as an important aspect of study. AIMS: We aimed to present the case series of PC patients from single tertiary care center in North Karnataka. SETTINGS AND DESIGN: The study designed over a period of 8 years from 2007 to 2015 was conducted in the Department of Urology, KLES Dr. Prabhakar Kore Hospital, Belagavi, Karnataka. MATERIALS AND METHODS: A total of 471 newly diagnosed patients with PC from 2007 to 2015 were included in the study. Sociodemographic, clinical characteristics, radiological and histopathological findings of all patients were collected and analyzed for the risk of PC. STATISTICAL ANALYSIS USED: The statistical analysis used in this study was IBM SPSS Statistics software Inc., version 20.0. RESULTS: A total of 471 patients were diagnosed with PC, the mean age at presentation was 70 years, and mean prostate-specific antigen (PSA) level was 37.71 ng/mL. Digital rectal examination (DRE) was abnormal in 87.5% of 471 cases. Significant correlation was observed between PSA level and DRE (P = 0.0005), correlation of PSA and Gleason's score was P = 0.0006, and histopathological results showed high risk in patients (P = 0.0001). CONCLUSIONS: This is the first hospital-based study of PC incidence with clinical and histopathological features. PC remains an important public health problem with increasing incidence and significant burden on health-care resources in India.

Fibrocalculous pancreatic diabetes in adult.

Fibrocalculous pancreatic diabetes has distinctive features like younger age at onset, presence of large intraductal calculi, aggressive course of the disease, and proneness for pancreatic cancer. Pancreatic calculi are the hallmark for the diagnosis. We report a 32-year-old male patient, a known case of diabetes since 2 years, presented with recurrent pain abdomen, malabsorption, and neuropathic symptoms. The diagnosis was established on the basis of clinical examination, biochemical and radiological investigations. He was prescribed two doses of premix insulin and pancreatic enzyme supplements for relief of abdominal pain and steatorrhea.

Pheochromocytoma of the Urinary Bladder - A Case Report of an Unusual Presentation.

Urinary bladder pheochromocytoma is rare. We report a case of bladder pheochromocytoma presenting with practically no obvious clinical symptoms in an adolescent who had undergone repair of mitral valve disease.

Hepatoprotective activity of the neem-based constituent azadirachtin-A in carbon tetrachloride intoxicated Wistar rats.

The aim of this study was to investigate the hepatoprotective role of azadirachtin-A in carbon tetrachloride (CCl4) induced hepatotoxicity in rats. The group allotment for the animals used in the hepatoprotective study included a vehicle treatment group, CCl4 (1 mL · (kg body mass)(-1)) treatment group, silymarin (100 µg · (kg body mass)(-1) · day(-1)) + CCl4 treatment group, and groups treated with different doses of azadirachtin-A (100 or 200 µg · (kg body mass)(-1) · day(-1)) + CCl4. On the 9th day, blood was obtained for measuring the biochemical parameters, and liver tissue was obtained for pathological examination. The acute toxicity test with azadirachtin-A (500, 1000, or 2000 µg · (kg body mass)(-1)) indicated no mortality after 14 days of treatment; further, there was no change in behavior, food consumption, or organ mass. However with the higher dose, some hematological parameters showed changes. Hepatoprotective studies revealed that the CCl4 treatment group exhibited a decrease in total protein and albumin levels, whereas a significant increase in BUN, AST, ALT, and ALP levels were noticed compared with the vehicle-treated control, indicating that there was liver damage caused by CCl4. Histology and ultrastructure study confirmed that pretreatment with azadirachtin-A dose-dependently reduced hepatocellular necrosis and, therefore, protected the liver against toxicity caused by CCl4. The results from this study indicate that pretreatment with azadirachtin-A at the higher dose levels, moderately restores the rat liver to normal. This study confirms that azadirachtin-A possesses greater hepatoprotective action; however, the effective concentration needs to be determined.

Nephron sparing surgery for unilateral non-syndromic wilms tumor.

The initial therapy for most children with Wilms tumor is radical nephrectomy. Several centers, have explored the role of Nephron-sparing procedures in children with unilateral non-syndromic Wilms tumors. The primary motivation for this approach is concern about late occurrence of renal dysfunction after unilateral nephrectomy. We report our experience with NSS for unilateral non-syndromic Wilms tumor. We reviewed the records of nine children who underwent nephron sparing surgery for unilateral, nonsyndromic Wilms tumors at our Hospital between Jan 2000 through Jan 2012. All patients received preoperative chemotherapy with two drugs (vincristine, and dactinomycin) following which patients underwent tumor resection. Subsequent renal function was assessed by estimating the glomerular filtration rate using creatinine clearance and other measures of long-term renal function assessment included blood pressure evaluation and the need for antihypertensive medications. During the study period nine children with a mean age 19.66 ± 14.37 months at diagnosis and presenting with unilateral non-syndromic Wilms tumor underwent nephron sparing surgery. In all the nine children, the renal plane of resection showed a tumor-free margin. Post-operative serum creatinine repeated at the end of 3 months revealed maintenance of good renal function in all children. Nephron sparing surgery is a safe and effective option in the management of early stage unilateral non-syndromic Wilms tumor. It is oncologically safe and does not lead to decreased local tumor control. The function of the kidney remnant remains rather well.

Diabetes mellitus and smoking among tuberculosis patients in a tertiary care centre in Karnataka, India.

Diabetes mellitus (DM) and smoking are risk factors for adverse outcomes in the treatment of tuberculosis (TB). In a tertiary care hospital at Belgaum in the South Indian State of Karnataka, all TB patients aged ≥18 years consecutively diagnosed from February to September 2012 were evaluated for DM and smoking. Of 307 TB patients, 35.5% were found to have DM, 9.8% were current smokers, and 3.6% had DM and were also smokers. Measures to assess and address both these factors need to be taken into account during TB treatment.

Le diabète sucré (DM) et le tabagisme sont des facteurs de risque de mauvais résultats dans le traitement de la tuberculose (TB). Dans un hôpital de soins tertiaires à Belgaum dans l'Etat de Karnataka en Inde du Sud, tous les patients TB âgés de ≥18 ans et diagnostiqués consécutivement entre février et septembre 2012 ont été évalués en matière de DM et de tabagisme. Sur 307 patients TB, on a trouvé un DM chez 35,5%, un tabagisme actuel chez 9,8% et chez 3,6%, à la fois un DM et un tabagisme actuel. Il est indispensable d'incorporer des mesures d'évaluation et de réaction à ces deux facteurs au cours du traitement de la TB.

La diabetes sacarina (DM) y el tabaquismo representan factores de riesgo de alcanzar desenlaces terapéuticos desfavorables en el tratamiento de la tuberculosis (TB). En un hospital de atención terciaria de Belgaum, en el estado de Karnataka del sur de la India, se investigaron el tabaquismo y la DM en todos los pacientes consecutivos de ≥18 años de edad, en quienes se estableció el diagnóstico de TB entre febrero y septiembre del 2012. De los 307 pacientes TB, se diagnosticó DM en el 35,5%, el 9,8% eran fumadores actuales y el 3,6% eran diabéticos y fumadores actuales. Es necesario incorporar medidas de evaluación y de respuesta a estos dos factores durante el tratamiento de la TB.

Percutaneous nephrolithotomy in patients on chronic anticoagulant/antiplatelet therapy.

Percutaneous nephrolithotomy (PCNL) is an integral component in the management of large volume renal stone disease either as monotherapy or in combination with shock wave lithotripsy. Stone disease in patients on chronic anticoagulation/antiplatelet therapy, however, poses a difficult scenario. Bleeding is a major concern for any patient undergoing PCNL. We retrospectively analyzed our series of patients with renal calculi who were on chronic anticoagulant therapy and who underwent PCNL. We reviewed the case records of patients undergoing PCNL during the period from January 2005 to December 2011. We analyzed the changes in preoperative and postoperative hemoglobin, serum creatinine, and clotting parameters, as well as intraoperative and postoperative bleeding and thromboembolic complications. During the 5-year study period, a total of 36 patients (30 males and 6 females) with a mean age of 46.33±9.96 years (range, 29-61 years) who were on chronic anticoagulant/antiplatelet therapy underwent PCNL for urolithiasis. The mean size of the stone was 6.40±1.98 cm(2) (range, 2.8-9 cm(2)). The mean operating time was 62.08±10.10 min. The bleeding was successfully managed in all patients and the anticoagulant/antiplatelet agents were restarted after an appropriate duration. The mean rise in serum creatinine at discharge was 0.05±0.03 mg/dl and the mean fall in serum hemoglobin was 1.63±0.77 g/dl. At 3 months after surgery, the stone-free rate was 100%. With careful preoperative care and regulation of anticoagulation/antiplatelet therapy and appropriate intraoperative management, PCNL can be performed safely and successfully in properly selected patients with renal calculi who are on chronic anticoagulant/antiplatelet therapy.

Surgical outcomes of laparoscopic dismembered pyeloplasty in children with giant hydronephrosis secondary to ureteropelvic junction obstruction.

OBJECTIVE: Studies of surgical outcomes after reconstructive surgery for giant hydronephrosis (GH) secondary to ureteropelvic junction (UPJ) obstruction are limited. Over the past two decades, laparoscopic pyeloplasty has gradually replaced open repair in children in several centres. The objective of this study was to assess surgical outcomes of laparoscopic pyeloplasty in children with GH. MATERIALS AND METHODS: Children with unilateral primary UPJ obstruction and GH were prospectively included and underwent laparoscopic pyeloplasty. Postoperative ultrasonography was repeated at 3 and 12 months to assess renal parenchymal thickness, and similarly a renogram was repeated to assess improvement in differential renal function. RESULTS: During the study period 2005-2009, 53 children underwent laparoscopic dismembered pyeloplasty for UPJ obstruction. Of these, 8 children had GH caused by UPJ obstruction. The postoperative differential renal function improved in all of them. The postoperative improvement in renal parenchymal thickness at the end of 12 months was comparable to that of the non-GH group. CONCLUSIONS: At 12 months, surgical outcomes after laparoscopic pyeloplasty for GH were satisfactory. Relief of obstruction allows adequate and comparable nephron sparing.

Solitary urethrocutaneous fistula managed by the PATIO repair.

OBJECTIVE: A novel technique has been described for repairing penile urethrocutaneous fistula: the PATIO ('preserve the tract and turn it inside out') repair. We report our experience with this technique in managing solitary urethrocutaneous fistula following primary hypospadias repair. METHODS: Children with fistulae underwent the PATIO technique of repair. The inclusion criterion was solitary fistula of <4mm widest diameter. RESULTS: Ten children underwent the procedure. The mean operating time was 22 min. In four of these children a healthy vascularized tunica vaginalis flap was interposed between the urethra and skin. No recurrence of fistula was noted. CONCLUSION: The PATIO repair is simple and easy to perform, with low morbidity, and is reliable in treating solitary urethrocutaneous fistula <4mm in size.

Vascularized tunica vaginalis interposition flap for the treatment of recto-urethral fistulas.

Introduction : Recto-urethral fistula is a rare complication of pelvic surgery, trauma, or inflammation. The many techniques for repairing these fistulas vary in their success rates. We describe the use of vascularised tunica vaginalis flap interposition in the repair of a recto-urethral fistula. Materials and Methods : Three children who had developed rectourethral fistula following surgery for anorectal anomaly/Hirschsprungs disease underwent repair through the perineal approach and interposition of vascularised tunica vaginalis flap in between the rectum and the urethra. Results : Three patients, all males aged 6 to 14 years old, presented with passage of urine per rectum following surgery. Following repair of the recto-urethral fistula, there was no recurrence of fistula in the follow-up period ranging from 1 to 6 years. Conclusions : Vascularised tunica vaginalis flap interposition is a straight-forward technique that can result in successful fistula repair.

Effect of endosulfan on ovarian compensatory hypertrophy in hemicastrated albino mice.

Endosulfan, a chlorinated cyclodiene insecticide, was administered orally at 1.5, 3, 6, and 9 mg/kg per day to normal hemicastrated virgin mice for 15 consecutive days to examine the effect on ovarian function. Sham-operated and hemicastrated control mice were administered a similar volume of olive oil. The vaginal smear and body weight of the mice were recorded daily and mice were sacrificed on day 16. The remaining left ovary, uterus, kidney, adrenal, liver, thymus, and thyroid were removed and weighed. The left ovary from each animal was serially sectioned and stained for histologic studies. The hemicastrated control mice had a 40.5% increase in weight of the remaining left ovary and a significant increase in healthy and atretic follicles when compared with sham-operated controls. The remaining left ovaries of mice treated with 1.5mg endosulfan had a 37.2% increase in weight with no significant difference in ovarian weight and or in the healthy and atretic follicles when compared with hemicastrated olive oil-treated controls. However, treatment with 3, 6, and 9 mg endosulfan resulted in weight increases in the remaining left ovary of only 14.9, 7.4, and 0.8% and a significant decrease in healthy follicles with a concomitant increase in the number of atretic follicles compared to the olive oil-treated controls. There was no significant change in the number of estrous cycles or the duration of each phase of the estrous cycle with 1.5 and 3mg/kg per day endosulfan. However, there was a significant decrease in the number of estrous cycles, and the duration of estrus and metestrus with a concomitant significant increase in the duration of the diestrus phase with 6 and 9 mg/kg per day endosulfan treatment when compared with hemicastrated olive oil-treated controls. There were no significant change in body weight or the weights of the uterus, kidney, adrenal, liver, thymus, or thyroid after endosulfan treatment. These observations show that endosulfan treatment caused a significant decrease in compensatory ovarian hypertrophy. An increase in the number of atretic follicles and disruption of the estrous cycle may have been due to a direct effect on the ovary or to effects on the hypothalamo-hypophysial-ovarian axis.

The anti-implantation action of endosulfan in albino mice: possible mechanisms.

Endosulfan, a chlorinated pesticide, was administered orally for 7 consecutive days to a group of virgin pregnant albino mice at doses of 1 to 4 mg/kg/d to examine its effect on implantation. For comparison, a second group of animals received 5 microg/kg/d estradiol-17beta, a third group received similar quantities of olive oil. Autopsy on day 8 revealed that the olive oil-treated mice were pregnant with a normal number of implantations and a normal duration of diestrus. Treatment with estradiol-17beta completely inhibited implantation and significantly decreased the duration of diestrus with a concomitant increase in estrus. Treatment with 1, 2, or 3 mg/kg/d endosulfan neither inhibited implantation nor significantly changed diestrus, whereas 4 mg/kg/d endosulfan completely inhibited implantation, with the uterus showing no signs of implantation. This group exhibited a significant decrease in diestrus with a concomitant increase in estrus. In endosulfan-treated mice, no significant changes occurred in body and organ weight, except for a significant increase in uterine weight in groups treated with 4 mg/kg/d endosulfan or estradiol-17beta. Because endosulfan is neither tubal locking nor causes expulsion of the blastocyst from the uterus like estradiol-17beta, the pesticide might inhibit implantation by altering the estrogen-progesterone ratio essential for implantation.

Effect of mancozeb on ovarian compensatory hypertrophy and biochemical constituents in hemicastrated albino rat.

Mancozeb a carbamate fungicide was administered orally at doses of 500, 600, 700, and 800 mg/kg/day to normal hemicastrated virgin rats for 15 consecutive days to examine the effect on ovarian hypertrophy. Sham-operated and hemicastrated control rats were administered a similar quantity of olive oil. The vaginal smear and body weight of the rats were recorded daily and rats were sacrificed on the Day 16. The ovary, uterus, kidney, adrenal, spleen, liver, lungs, heart, thymus, and thyroid were removed and weighed. The left ovary from each animal was serially sectioned and stained for histologic studies. The hemicastrated control rats revealed a significant increase in relative ovarian weight with 66.3% hypertrophy. Treatment with 700 and 800 mg/kg/day mancozeb revealed a decrease in ovarian hypertrophy with 28.2 and 22.8% hypertrophy, respectively. There was no significant change in the number of estrous cycles and duration of each phase of the estrous cycle with 500 mg/kg/day mancozeb. However, there was a decrease in the number of estrous cycles, duration of proestrus, estrus, and metestrus with concomitant significant increase in the duration of the diestrus phase with 600, 700, and 800 mg/kg/day mancozeb treatment. There was a significant decrease in the number of healthy follicles with concomitant increase in the number of atretic follicles at higher doses of mancozeb. There were no significant changes in the body and organ weight with 500, 600, 700, and 800 mg/kg/day of mancozeb. The levels of protein, glycogen, total lipid, phospholipid, and neutral lipid were elevated in the liver, uterus, and ovary after hemicastration. Protein, glycogen, total lipid, phospholipid, and neutral lipid were not significantly changed in the liver, uterus, and ovary after 500 mg/kg/day mancozeb. However, treatment with 600, 700, and 800 mg/kg/day mancozeb showed a significant decrease in the levels of protein, glycogen, total lipid, phospholipid, and neutral lipid in the liver, uterus, and ovary, with the exception of liver total lipid and uterine glycogen. In addition to the decrease in the compensatory ovarian hypertrophy, mancozeb treatment reduced the number of healthy follicles with a concomitant increase in the number of atretic follicles. This finding plus disruption of the estrous cycle may be due to a direct effect on the ovary or the hypothalamo-hypophysial-ovarian axis.