Unique case of midbrain tuberculoma presenting as isolated inferior rectus palsy with nystagmus.

Isolated brain stem tuberculoma constitutes about 5% of all intracranial tuberculomas. A case of isolated inferior rectus palsy with downbeat nystagmus due to presumed midbrain tuberculoma in an immunocompetent patient is described here. This report documents a rare entity of a combination of partial third nerve palsy with pupil involvement along with downbeat nystagmus.

Radial left ventricular dyssynchrony by speckle tracking in apical versus non apical right ventricular pacing- evidence of dyssynchrony on medium term follow up.

INTRODUCTION: To study effects of various sites of right ventricular pacing lead implantation on left ventricular function by 2-dimensional (2D) speckle tracking for radial strain and LV dyssynchrony. METHODS: This was retrospective prospective study. Fifteen patients each with right ventricular (RV) apical (RV apex and apical septum) and non-apical (mid septal and low right ventricular outflow tract [RVOT]) were programmed to obtain 100% ventricular pacing for evaluation by echo. Location and orientation of lead tip was noted and archived by fluoroscopy. Electrocardiography (ECG) was archived and 2D echo radial dyssynchrony was calculated. RESULTS: The baseline data was similar between two groups. Intraventricular dyssynchrony was significantly more in apical location as compared to non-apical location (radial dyssynchrony: 108.2 ± 50.2 vs. 50.5 ± 24, P < 0.001; septal to posterior wall delay [SLWD] 63.5 ± 27.5 vs. 34 ± 10.7, P < 0.001, SPWD 112.5 ± 58.1 vs. 62.7 ± 12.1, P = 0.003). The left ventricular ejection fraction was decreased more in apical location than non apical location. Interventricular dyssynchrony was more in apical group but was not statistically significant. The QRS duration, QTc and lead thresholds were higher in apical group but not statistically significant. CONCLUSION: Pacing in non apical location (RV mid septum or low RVOT) is associated with less dyssynchrony by specific measures like 2D radial strain and correlates with better ventricular function in long term.

A study on impact of clinical pharmacist interventions on medication adherence and quality of life in rural hypertensive patients.

Hypertension is the very common chronic disease in rural, urban and semi-urban areas of today's world, which needs continuous monitoring and treatment through out the life. Lack of education, lifestyle modification, and low level of understanding on disease management in rural people will influence directly on their quality of life (QOL). The objective of this study was to know the impact of clinical pharmacist interventions on medication adherence and QOL. It was a prospective, randomized and interventional study. Fifty-six patients were enrolled; only 52 patients completed the study. Interventional group patients received patient counselling, patient information leaflets (PILS), and frequent telephonic reminding. In the baseline, first and second follow-ups, medication adherence and QOL were assessed by using Morisky Medication Adherence Scale (MMAS) and Medication Adherence Report Scale (MARS) Questionnaires and SF-12v2 Quality of life Questionnaire in both the groups. The results showed that systolic blood pressure P value in the second follow-up was 0.086+ when compared to baseline follow-up P value 0.094. The diastolic blood pressure reading of the intervention group at the second follow-up was 77.73 ± 3.63 in mmHg when compared to the baseline, i.e. 86.62 ± 11.35 in mmHg. The MMAS and MARS scores P values were 0.007(**), 1.000, <0.001(**); 0.007, 0.014 and 0.000 at the baseline, first and second follow-ups, respectively. The QOL score P values of physical component scale and mental component scale showed highly significant. This study concluded/showed that the impact of clinical pharmacist provided patient counselling had a positive impact on medication adherence and QOL.

Isolation and evaluation of a polysaccharide from Prunus amygdalus as a carrier for transbuccosal delivery of Losartan potassium.

An oral buccoadhesive drug delivery system for Losartan potassium using a hydrophilic polysaccharide, isolated from Prunus amygdalaus (Badam gum), was developed and evaluated for its potential to overcome the drawbacks associated with the conventional drug therapy. The results of the study indicate that the isolated polysaccharide has good physicochemical and morphological characteristics and is suitable for use as a mucoadhesive sustain release polymer in pharmaceutical dosage forms, to alleviate the drawbacks of the conventional drug therapy of Losartan potassium.

Reduced frequency of known mutations in a cohort of LHON patients from India.

BACKGROUND: Three mitochondrial mutations account for 95% of Leber's hereditary optic neuropathy (LHON) in the European population: G3640A, G11778A and T14484C. The purpose of the study was to investigate the frequency of these mitochondrial DNA mutations in LHON patients from a South Indian population. METHODS: LHON was diagnosed by inheritance pattern, ophthalmologic examination, and by exclusion of non-LHON forms of optic neuropathy. Ninety unrelated LHON patients and 20 at-risk family members (5 with LHON and 15 without LHON) underwent molecular screening for the mitochondrial DNA mutations G3640A, G11778A and T14484C by amplification refractory mutation system (ARMS) polymerase chain reaction (PCR). Positive results were confirmed with bi-directional sequencing. RESULTS: The G11778A mutation was detected in 8 of 90 (8.9%) LHON families. The T14484 mutation was detected in 3 of 90 (3.3%) LHON families. No instances of the G3460A mutation were detected. Other variants were incidentally detected by the DNA sequencing assay. CONCLUSIONS: Three mitochondrial mutations (G3640A, G11778A and T14484C) account for the vast majority of LHON cases in Europe. However, these mutations were detected in only 11 (12%) of 90 LHON families from Southern India in our study. These results suggest that a different set of LHON-causing mutations is present in the South Indian population than in the European population. Further study of subjects with LHON from India may lead to the discovery of novel disease-causing mutations and/or genes.

In vitro and in vivo studies on HPMC-K-100 M matrices containing naproxen sodium.

Controlled release (CR) matrix tablets of naproxen sodium were prepared by wet granulation using hydroxypropyl methyl cellulose (HPMC-K-100 CR) as the hydrophilic rate controlling polymer. The effect of the concentration of the polymer and different fillers on the in vitro drug release rate was studied. The studies indicated that the drug release can be modulated by varying the concentration of the polymer and the fillers. An optimized formulation subjected to accelerated stability studies for 3 months revealed that the developed CR tablets are stable. A complete cross-over bioavailability study of the optimized formulation of the developed CR tablets and marketed immediate release tablets was performed in 6 healthy male volunteers. The extent of absorption of drug from the CR tablets was significantly higher than that for the marketed naproxen sodium tablet due to lower elimination rate and longer half-life.