Epidermoid Cyst of the Cerebellopontine Angle Presenting with Contralateral Trigeminal Neuralgia: Extremely Rare Case and Review of Literature.

BACKGROUND: An epidermoid cyst is a rare tumor of the cerebellopontine angle region. It usually presents with ipsilateral compressive symptoms. The contralateral trigeminal neuralgia is an unusual presentation in such cases. We did not find such case reports in the literature. CASE DESCRIPTION: Here, we report a case of a 62-year-old female with a right cerebellopontine angle epidermoid cyst presenting with right hearing impairment and the contralateral trigeminal neuralgia. CONCLUSION: The possible mechanism leading to the contralateral trigeminal neuralgia is discussed here along with the diagnosis and management of the case.

Prospective study to evaluate the clinical outcome of intralesional interferon-α2b in the management of Peyronie's disease.

CONTEXT: Interferon (IFN)-α2b in Peyronie's disease (PD). AIMS: This study aims to evaluate clinical efficacy of the IFN-α2b in both subjective and objective manner for the treatment of PD and compared with previously used intralesional verapamil in terms of cost-benefit analysis. SETTINGS AND DESIGN: Prospective study. MATERIALS AND METHODS: A prospective study conducted from January 2013 to July 2016 in the Department of Urology, Government Medical College, Kota, Rajasthan, India. We included patients with identifiable Peyronie's plaque with or without pain, curvature ranging between 30 and 90 degrees. We excluded patients with a calcified plaque and the ventral location of the plaque, any infective foci over the penis, erectile dysfunction due to other etiologies and patients who had received previous intralesional therapy. Patients were evaluated by clinical history, physical examination including plaque location, size, consistency, and penile curvature. Patients received intralesional IFN-α2b in a dose of 3 × 106 IU. Patients completed the visual analogue pain (VAS) score for pain, and International Index of Erectile Function-5 (IIEF-5) questionnaire at first visit as well as at follow-up of 1 month and 3 months. STATISTICAL ANALYSIS USED: Comparisons were performed using the paired Student's t-test and Chi-square tests as appropriate. Patient's objective and subjective clinical characteristics were described as a means (standard deviation). RESULTS: We included 86 patients in this study. Patients had a mean age of 48.6 years, mean plaque volume 256 mm3, and disease duration of 15.2 years. After 1 month of treatment, there was a significant change in plaque volume 256-60.8 mm3; P < 0.01) and penile curvature 34.8-24.6°; P < 0.01). The patients reported significant improvement in pain score VAS and IIEF-5. CONCLUSIONS: IFN-α2b, as minimal invasive (intralesional) options for the treatment of PD, demonstrated significant improvement in plaque volume, penile curvature with minimal complications. Patients subjectively reported significant improvement in pain on erection and sexual activities. IFN-α2b and verapamil had an almost similar clinical outcome, but verapamil at much lower cost.

Vertebral Hemangioma an Extremely Rare Cause of Spinal Cord Compression in Children: A Case Report.

Symptomatic benign vascular tumors of the bone are rare. Vertebral hemangiomas are rare detectable spinal tumors. Those presenting with neurological deficits are extremely rare. Early diagnosis and complete excision of the lesion with decompression of the cord is the definitive management in such cases. Delay in treatment may cause irreversible damage to the cord and may leave patient with lifelong neurological deficit. Here, we report a similar case of a thoracic vertebral hemangioma causing spinal cord compression in a child.

Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure.

BACKGROUND: Patients undergoing coronary artery bypass graft (CABG) procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT) has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observational study, evaluated the accuracy of the TMHT in predicting difficult laryngoscopy. METHODOLOGY: A total of 345 patients undergoing CABG of either sex, in the age group of 35-80 years, American Society of Anesthesiologists 111, undergoing CABG, were studied. Airway assessment was performed with modified Mallampati test with the addition of thyromental distance, sternomental distance, and TMHT. Intraoperatively, direct laryngoscopy was done in accordance with Cormack and Lehane grade of laryngoscopy. The preoperative data and laryngoscopic findings were used together to evaluate the accuracy of TMHT. The sensitivity, specificity, positive and negative predictive values of other three tests were calculated according to standard formula. RESULTS: A total of 345 patients were in the group with mean age of study population at 56.7 (standard deviation 9.1) years (35-80 years). This study showed that almost all tests had good specificity, but sensitivity was poor. However, sensitivity of TMHT was 75% with accuracy of 95%. Receiver operating characteristic curve analysis of TMHT-derived cutoff was 52.17 which increased sensitivity to 81.25% and specificity to 92.3%. CONCLUSION: TMHT had a higher sensitivity compared to other tests along with good positive and negative predictive value and a very high specificity.

Early Cranioplasty in Patients With Posttraumatic Decompressive Craniectomy and Its Correlation with Changes in Cerebral Perfusion Parameters and Neurocognitive Outcome.

BACKGROUND: Decompressive craniectomy is a life-saving procedure in many patients after traumatic brain injury. Delayed recovery in such patients can be attributed to various causes. Cranioplasty (CP) helps in early improvement of neurocognitive function along with better brain protection and cosmesis. The mechanism responsible for this functional improvement and the ideal time to perform cranial reconstruction is less understood. METHODS: We studied 16 patients who underwent CP after decompressive craniectomy (DC) for traumatic brain injury. These patients were divided in 2 groups, early and late CP, depending on the interval between DC and CP. Three months was the cutoff time for early CP. Neurocognitive status was assessed by Glasgow Coma Scale, Glasgow Outcome Scale, and Mini-Mental State Examination scores prior to and after CP. Computed tomography (CT) perfusion was done to correlate the improvement in neurologic status and CT perfusion parameters. RESULTS: We observed that there was a positive influence of CP on neurologic and psychologic function in all of the patients. The neurocognitive improvement after CP was more remarkable in the early CP group. More complications were noted in patients in the late CP group. Brain perfusion after CP showed improvement in all parameters in both of the groups, both on the operated and contralateral side. CONCLUSIONS: Neurocognitive improvement is noted after CP in all of the patients. CP should be offered once the brain edema subsides, at the earliest. Improved cerebral perfusion may be the key factor for the improved functional outcome.

Surgical management of pygopagus conjoined twins with spinal bifida.

PURPOSE: Conjoined twins are a rare complication of 9 monozygotic twins and are associated with high perinatal mortality. Pygopagus are one of the rare types of conjoined twins with only a handful of cases reported in the literature. We present the case of one-and-half month-old male pygopagus conjoined twins, who were joined together dorsally in lower lumbar and sacral region and had spina bifida and shared a single thecal sac with combined weight of 6.14 kg. Spinal cord was separated at the level of the conus followed by duraplasty. They had uneventful recovery with normal 15 months follow-up. CONCLUSION: Separation of conjoined twins is recommended in where this is feasible with the anticipated survival of both or one infant.

A Novel Approach using Hydrotropic Solubalization Technique for Quantitative Estimation of Entacapone in Bulk Drug and Dosage Form.

PURPOSE: Analysis of drug utilized the organic solvent which are costlier, toxic and causing environment pollution. Hydrotropic solution may be a proper choice to preclude the use of organic solvents so that a simple, accurate, novel, safe and precise method has been developed for estimation of poorly water soluble drug Entacapone (Water Solubility-7.97e-(02) g/l). METHODS: Solubility of entacapone is increased by using 8M Urea as hydrotropic agent. There was more than 67 fold solubility enhanced in hydrotropic solution as compare with distilled water. The entacapone (ENT) shows the maximum absorbance at 378 nm. At this wavelength hydrotropic agent and other tablet excipients do not shows any significant interference in the spectrophotometric assay. RESULTS: The developed method was found to be linear in the range of 4-20 µg/ml with correlation coefficient (r(2)) of 0.9998. The mean percent label claims of tablets of ENT in tablet dosage form estimated by the proposed method were found to be 99.17±0.63. The developed methods were validated according to ICH guidelines and values of accuracy, precision and other statistical analysis were found to be in good accordance with the prescribed values. CONCLUSION: As hydrotropic agent used in the proposed method so this method is Ecofriendly and it can be used in routine quantitative analysis of drug in bulk drug and dosage form in industries.

Novel UV-spectrophotometric method for quantitative estimation of furazolidone using mixed hydrotropic agent.

A novel, eco friendly, accurate, sensitive, economic and safe spectrophotometric method was developed by application of mixed hydrotropy using 2 M sodium acetate, 8 M urea, 2 M niacinamide and 2 M sodium benzoate solution (25:25:25:25% V/V) as hydrotropic agent, for the solubalizing of poorly water-soluble Furazolidone (FZ) (solubility:- 3.64e-01 mg/mL in water). There were more than 32 times enhancements in the solubility of FZ were found in mixed hydrotropic solution as compared to solubilities in distilled water. FZ shows maximum absorbance at 360 nm where sodium acetate, urea, niacinamide, sodium benzoate and other tablets excipients did not show any absorbance above 300 nm, and thus no interference in the estimation was seen. FZ was obeyed Beers law in the concentration range of 10 to 50 µg/ml (r(2)=0.9992) in mixed hydrotropic solvent with mean recovery ranging from 97.32% to 98.9%. Proposed method is new, simple, economic, safe, rapid, accurate and reproducible and was validated according to ICH guidelines and values of accuracy, precision and other statistical analysis were found to be in good accordance with the prescribed values.

Protective role of Beta vulgaris L. leaves extract and fractions on ethanol-mediated hepatic toxicity.

The present study was undertaken to investigate the hepatoprotective action of Beta vulgaris Linn. (BV, Chenopodiaceae) leaves against ethanol-mediated hepatotoxicity. Rat hepatocyte culture and rats were used as in vitro and in vivo screening models, respectively. In the in vitro studies, different extracts (i.e., petroleum ether, ethanol and aqueous) and fractions derived from ethanol extract (i.e., chloroform, ethyl acetate and n-butanol) of BV leaves were screened. In vivo hepatoprotective activity was assessed in rats intoxicated with ethanol. Levels of serum markers enzymes together with antioxidants were measured to evaluate the extent of hepatic protection. Silymarin was taken as reference drug. In the in vitro studies, n-butanol fraction of BV leaves (BVBF) was found to be more potent than others. Moreover, in the in vivo evaluation, BVBF at doses of 50, 100 and 200 mg/kg showed marked protective action against ethanol-induced hepatic toxicity as evident by restoration of biochemical changes caused by ethanol. The present study concluded that BVBF possess potent hepatoprotective effect against ethanol-induced hepatic toxicity and it may have a great potential role in the management of alcoholic liver disease.

Yoga cAMP in ayurvedgrams of chhattisgarh.

The clinical and empirical health benefits of yoga and pranayam have been reiterated through research. Yoga is being adopted as a system to alleviate the burden of noncommunicable diseases (NCDs) across the globe. The Directorate of AYUSH, Government of Chhattisgarh (DoA, GoCG) conducts annual 5-day-yoga camp across 146 Ayurvedgrams in the State. The present article brings out the AYUSH initiatives the State is taking toward active ageing. A total of 71,096 people participated in the 5-day-yoga camp across the State. A mean participation of 5079 people over 5 days was reported across districts. Such statewide practices need to be promoted and appraised.

Protective effects of Phyllanthus acidus (L.) Skeels leaf extracts on acetaminophen and thioacetamide induced hepatic injuries in Wistar rats.

OBJECTIVE: To investigate and compare the hepatoprotective effects of crude ethanolic and aqueous extracts of Phyllanthus acidus (L.) Skeels (P. acidus) leaves on acetaminophen (APAP) and thioacetamide (TAA) induced liver toxicity in wistar rats. Silymarin was the reference hepatoprotective agent. METHODS: In two different sets of experiments, the P. acidus extracts (200 and 400 mg/kg, body weight) and silymarin (100 mg/kg, body weight) were given orally for 7 days and a single dose of APAP (2 g/kg, per oral) or TAA (100 mg/kg, subcutaneous) were given to rats. The level of serum aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), total bilirubin and total protein were monitored to assess hepatotoxicity and hepatoprotection. RESULTS: APAP or TAA administration caused severe hepatic damage in rats as evident from significant rise in serum AST, ALT, ALP, total bilirubin and concurrent depletion in total serum protein. The P. acidus extracts and silymarin prevented the toxic effects of APAP or TAA on the above serum parameters indicating the hepatoprotective action. The aqueous extract was found to be more potent than the corresponding ethanolic extract against both toxicants. The phenolic and flavonoid content (175.02±4.35 and 74.68±1.28, respectively) and 2,2-diphenyl-1-picrylhydrazil (DPPH) [IC(50) = (33.2±0.31)µg/mL] scavenging potential was found maximum with aqueous extract as compared to ethanolic extract. CONCLUSIONS: The results of present study suggests that the aqueous extract of P. acidus leaves has significant hepatoprotective activity on APAP and TAA induced hepatotoxicity, which might be associate with its high phenolic and flavonoid content and antioxidant properties.

Effects of Phyllanthus acidus (L.) Skeels fruit on carbon tetrachloride-induced acute oxidative damage in livers of rats and mice.

OBJECTIVE: The present study was undertaken with a view to validate the traditional use of Phyllanthus acidus (L.) Skeels fruit as a hepatoprotective agent. METHODS: The 70% ethanolic extract of P. acidus fruit (100, 200 and 400 mg/kg, p.o.), and reference drug silymarin (100 mg/kg, p.o.) were given to rats of different groups respectively once a day for 5 d and the carbon tetrachloride (CCl4) (2 mL/kg, subcutaneously) was given on days 2 and 3. Serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), total bilirubin (TB) and total protein (TP) were assessed along with liver histopathological examination. The effects on oxidative stress markers such as lipid peroxidation (LPO), reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were also assessed in liver tissue homogenate to evaluate in vivo antioxidant activity. In addition, the effects on hexobarbitone-induced sleeping time were observed and the free radical-scavenging potential was determined by using 2, 2-diphenyl-1-picrylhydrazil (DPPH) in mice. RESULTS: P. acidus extracts and silymarin exhibited a significant hepatoprotective effect as evident from the decreases of serum AST, ALT and ALP levels and LPO and increases in the levels of TP, GSH, SOD, CAT, and GPx compared with control group (P<0.01 or P<0.05). The biochemical results were supplemented with results of histopathological sections of the liver tissues. P. acidus extracts considerably shortened the duration of hexobarbitone-induced sleeping time in mice compared with control group (P<0.01) and showed remarkable DPPH-scavenging activity. CONCLUSION: The present findings suggest that the hepatoprotective effect of P. acidus against CCl4-induced oxidative damage may be related to its antioxidant and free radical-scavenging potentials.

Development and validation of reversed phase-high-performance liquid chromatography method for determination of paracetamol and lornoxicam in tablet dosage form.

A simple, precise, reliable, rapid and reproducible reversed phase-high-performance liquid chromatography method was developed and validated for the simultaneous estimation of Paracetamol (PCM) and Lornoxicam (LOX) present in tablet dosage forms. Chromatographic separation achieved isocratically on Luna C18 column (5 µm, 150 × 4.60 mm) and methanol/phosphate buffer (60:40, v/v, pH 7.0) as mobile phase, at a flow rate of 1 ml/min. Detection was carried out at 260 nm. Parameters such as linearity, precision, accuracy, recovery, specificity and ruggedness are studied as reported in the ICH guidelines. The retention times for PCM and LOX was found to be 2.06±0.013and 4.38±0.07 min, respectively. Linearity for PCM and LOX was in the range of 10-50 mg/ml and 8-40 mg/ml, respectively. The mean recoveries obtained for LOX and PCM were 100± 0.16 and 99.50± 0.43%, respectively, and relative standard deviation (RSD) was less than 2. The correlation coefficients for all components are close to 1. The RSDs for three replicate measurements in three concentrations of samples in tablets are always less than 2%. Developed method was found to be accurate, precise, selective and rapid for simultaneous estimation of PCM and LOX in tablets.

The RP-HPLC method for simultaneous estimation of esomeprazole and naproxen in binary combination.

OBJECTIVE: A simple, precise, reliable, rapid, sensitive and validated RP-HPLC method has been developed to determine esomeprazole magnesium trihydrate (ESO) and naproxen (NAP) in synthetic mixture form. MATERIALS AND METHODS: Chromatographic separation achieved isocratically on Phenomenex, Luna C18 column (5 µm, 150mm × 4.60mm) and acetonitrile: phosphate buffer (pH 7.0) in the ratio of 50:50 (v/v) as the mobile phase, at a flow rate of 0.5 ml/min. Detection was carried out at 300 nm. The retention times for NAP and ESO was found to be 2.67 ±0.014 and 5.65 ±0.09 min respectively. Parameters such as linearity, precision, accuracy, recovery, specificity and ruggedness are studied as reported in the ICH guidelines. RESULTS: The method was linear in the concentration range of 50-250 µg/ml for NAP and 2-10 µg/ml for ESO with correlation coefficient of 0.999 and 0.998 respectively. The mean recoveries obtained for NAP and ESO were 100.01% and 97.76 % respectively and RSD was less than 2. The correlation coefficients for all components are close to 1. CONCLUSIONS: Developed method was found to be accurate, precise, selective and rapid for simultaneous estimation of NAP and ESO.

Modified technique of percutaneous cystolithotripsy using a new instrument--combined single-step trocar-dilator with self-retaining adjustable access sheath.

OBJECTIVES: To evaluate a new instrument and technique for access that overcomes the difficulties with percutaneous cystolithotripsy (PCCL). PCCL is a safe and established minimally invasive surgical option for large vesical calculi. It is commonly performed using a guidewire, serial dilation, and an Amplatz sheath. However, this technique has its shortcomings, including lengthy dilation, the cost of the disposable instruments (eg, guidewire, Amplatz), fluoroscopic/cystoscopic guidance, and the need for a surgical assistant. METHODS: The present prospective study was performed during a 6-year period. A total of 140 patients with a vesical calculus underwent PCCL. The modified technique using the new instrument was used for access, followed by primary closure of the stab wound. The operative time, length of hospitalization, complications, need for accessories, surgical assistant use, cosmesis, and cost were evaluated. RESULTS: Of the 140 patients, 100 were adults and 40 were children. The mean stone size was 4.15 cm. The modified PCCL technique using the newly designed combined single-step safety trocar-dilator with self-retaining adjustable access sheath resulted in a shorter operative time (mean 29.4 minutes), lower analgesic requirements, shorter hospitalization (2.28 days), lower cost, fewer complications, and better cosmesis. CONCLUSIONS: Our results have shown that this PCCL technique using the new trocar access system followed by primary wound closure is safe, technically easy, and cost-effective. It overcomes the shortcomings of the currently practiced methods, including lengthy dilation, cost of disposable instruments, the need for fluoroscopy/endoscopy, and the need for a surgical assistant. It also resulted in a decreased hospital stay and better cosmesis.

Evaluation of wound-healing activity of Acorus calamus Linn.

The aim of the present study was to assess the wound-healing activity of ethanolic extracts of Acorus calamus leaves. A wound was induced by an excision- and incision-based wound model in rats of either sex. The mature green leaves of A. calamus were collected and authenticated. Extractions of dried leaves were carried out with 80% ethanol in a soxhlet apparatus. For wound-healing activity, the extracts were applied topically once daily in conc. of 40% w/w and 20% w/w in the form of ointment and compared with a standard drug (povidion-iodine). The healing of the wound was assessed by the rate of wound closure, period of epithelialisation, tensile strength and weight of the granulation tissue, hydroxyproline content and histopathology of the granulation tissue. The ethanolic extract of A. calamus promoted wound-healing activity significantly in both the wound models studied. The histological study of the granulation tissue with 20% A. calamus extract ointment-treated animals showed a larger number of inflammatory cells and lesser collagen when compared with the 40% A. calamus extract ointment-treated animals. However, this was better than the control group of animals. Enhanced wound contraction, decreased epithelialisation time, increased hydroxyproline content and histological characteristics suggest that A. calamus extract may have therapeutic benefits in wound healing.