The impact of time at home on potential yield of home-based TB contact investigation.

BACKGROUND: The yield of TB contact tracing is often limited by challenges in reaching individuals during the screening process. We investigated the times at which index patients and household contacts were typically at home and the potential effects of expanding the timing of home-based contact investigation.METHODS: Index patients and household contacts in Kampala, Uganda, were asked about their likely availability at different day/time combinations. We calculated the "participant identification gap" (defined as the proportion of participants who reported being home <50% of the time) during business hours only. We then estimated the incremental reduction in the participant identification gap if hours were expanded to include weekday evenings, Saturdays, and Sundays. Statistical significance was assessed using McNemar´s tests.RESULTS: Nearly half of eligible individuals (42% of index patients and 52% of contacts) were not likely to be home during contact investigation conducted only during business hours. Expanding to weekday evenings, Saturdays, and Sundays would reduce this participant identification gap to 15% among index patients and 18% among contacts - while also reducing differences by sex and employment.CONCLUSIONS: Expanding hours for conducting contact investigation or other home-based health interventions could substantially reduce the number of individuals missed and address disparities in access to care.

Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization.

Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe lifethreatening hemoptysis, particularly when other treatment options are unavailable or ineffective.

Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.

BACKGROUND: Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal. METHODS: We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months. RESULTS: 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001). CONCLUSIONS: Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal. TRIAL REGISTRATION: ClinicalTrial.gov: NCT02981251.

Prevalence, associated factors, awareness, treatment, and control of hypertension: Findings from a cross sectional study conducted as a part of a community based intervention trial in Surkhet, Mid-western region of Nepal.

BACKGROUND: Hypertension is one of the leading public health problems globally. About half of the deaths from cardiovascular diseases were attributed to hypertension in 2008. Reduction of blood pressure to normal range is one of the major challenges in preventing complications and future burden of cardiovascular diseases. Therefore, this study aims to determine prevalence, awareness, treatment and control of hypertension and its associated factors in Nepal. METHODS: This was a community based cross-sectional study conducted as a part of a community based intervention trial in Birendranagar Municipality of Surkhet district located at the Mid-western region of Nepal. We enrolled 1159 subjects aged 30 years and above. Out of 12 wards (administrative unit), four wards were selected randomly. Three hundred participants were recruited from each selected ward. Trained enumerator collected socio-demographic, anthropometric, and clinical data using standard STEPS questionnaires. RESULTS: Out of all participants, women were 71% and mean age was 47±12.6 years. The overall prevalence of hypertension was 38.9% (95% CI: 36-41.7) while age and sex adjusted prevalence was 40.6%. The hypertension was present in 48.1% (95% CI: 45.2-50.9) of men and 35.2% (95% CI: 32.4-37.9)] of women. Male gender (OR = 1.49), older age (OR = 1.04 per year), Dalit caste (OR = 1.71), past history of cigarettes smoking (OR = 2.78), current alcohol consumption (OR = 1.75), and raised body mass index (OR = 1.17 per unit) were identified as significant factors associated with hypertension. Of total hypertensive respondents, 53.4% (95% CI: 48.7-58) were aware, 29% (95% CI: 24.8-33.1) were receiving treatment for high blood pressure, and 8.2% (95% CI: 5.6-10.7) had controlled blood pressure. The awareness, treatment, and control status were worse in younger participants. CONCLUSIONS: The study revealed high prevalence with low awareness, treatment, and control of hypertension in Nepal. Gender, age, ethnicity, smoking, drinking alcohol, and body mass index were associated with hypertension. Immediate public health and individual measures are warranted to reduce future burden of cardiovascular diseases. TRIAL REGISTRATION: ClinicalTrial.gov (NCT02981251).

Factors Determining Availability, Utilization and Retention of Child Health Card in Western Nepal.

BACKGROUND: The immunization card is revised with addition of general information about child health and is later called as child health card. This card is a tool used by Health Management Information System in Nepal. It is important for tracking the records of immunization. Aim is to identify the factors determining the availability, utilization and retention of the child health card in Western Nepal. METHODS: A cross sectional study was conducted among mothers having children < 24 months old from Gorkha (Western Hill) and Nawalparasi (Western Terai) districts. The sample size for the study was 600 and systematic random sampling was used to select the mothers having less than 24 months old children. Data entry and analysis was done by using SPSS. Qualitative data was analyzed by making matrix. RESULTS: The average age of respondents was 24 years. The majority of respondents have gained higher level education. Retention of the card was found to be 82.2%. 90.3% retention was seen among 0-12 months children age group whereas it was 74 % among12 to 24 months age group. The reasons for less retention were torn by the child/played by child (54.6%) followed by lack of proper place,unaware about importance and poor quality of card.The new child health cards were insufficient, compelling use of both new and old cards which created problem in consistency. Regarding utilization of child health card, it was found to be used for birth registration and for further studies in abroad. CONCLUSIONS: The areas of utilization of child health card should be broadened so that the retention of card can be increased. The main reasons for less retention of the card are torn by children and lack of the proper place.

Magnesium sulphate in management of severe pre-eclampsia and eclampsia.

BACKGROUND: Pre-eclampsia and eclampsia (PE/E) are the second leading cause of maternal mortality in Nepal accounting for 21% of all maternal deaths and 30% of all facility based maternal deaths. For treatment of severe pre-eclampsia and eclampsia (SPE/E), WHO has identified magnesium sulphate (MgSO4) as the most effective and low cost medication. The objective of the study was to explore current situation of SPE/E management using MgSO4 in 10 health facilities of Mid Western Development Region. METHODS: Descriptive and single group pre-test, post test study design was used for the study. Data were collected by reviewing records, taking interviews and through observation. Knowledge and skills of service provider was assessed and scored (0-100%) before and after the educational intervention. RESULTS: One year records indicate that 0.5% SPE/E cases were found in Dang Sub Regional Hospital and Pyuthan District Hospital; 0.4% in Bheri Zonal Hospital; 0.9% in Mehelkuna PHCC and 0.5% in Rajapur PHCC. In most of the hospitals, these cases were managed with MgSO4. During pre-testing none of the health facility was able to get standard score (80%) but in post test, 50% health facilities were able to get 80% or higher score. CONCLUSIONS: Establishing national standard and providing one-time training is not sufficient, it requires refresher onsite training for propermanagement of SPE/E on time to improve maternal and neonatal health.

Different pharmacological solutions in intracanal irrigation.

Irrigation of root canals during endodontic therapy is an important step. Sodium hypochlorite (NaOCl), hydrogen peroxide (H2O2), chlorhexidine (CHX) and normal saline are commonly used intracanal irrigants to disinfect and clean the root canals. This prospective study was set to observe the efficacy of normal saline (0.9% NaCl) irrigation with sequential irrigation of 3% H2O2, 5.2% NaOCl and 0.9% NaCl. A total number of 228 dental patients were screened and 104 patients fulfilling the inclusion criteria were enrolled for the endodontic therapy of mature permanent teeth for the period of one year. Two treatment groups were constituted in which patients were randomly allocated equally in each treatment group. Post-obturation pain, swelling, analgesic use and eight weeks post-obturation radiological evaluation of the patients were carried out as the measurement of clinical and radiological success of the endodontic treatment. No statistically significant differences were observed in the measured treatment outcomes between two groups. However, studies involving larger sample size and longer post-obturation follow up are recommended for the further either confirmation or rejection of present findings.

Tuning intermolecular interactions in dioctyl-substituted polyfluorene via hydrostatic pressure.

Polyfluorenes (PFs) represent a unique class of poly-para-phenylene-based blue-emitting polymers with intriguing structure-property relationships. Slight variations in the choice of functionalizing side chains result in dramatic differences in the inter- and intrachain structures in PFs. Dioctyl-substituted PF (PF8) is characterized by different backbone conformations that depend upon the torsion angle between the monomers. We present photoluminescence (PL) and Raman scattering studies of bulk samples and thin films of dioctyl-substituted PF (PF8) under hydrostatic pressure. The bulk sample was further thermally annealed and studied as a function of pressure. The PL energies of the as-is and thermally annealed samples both red shift but at very different rates, and the difference between their pressure coefficients elucidates the role of the backbone torsional angle. This is further corroborated by density functional theoretical calculations of a fluorene oligomer, where the energy gap is calculated as a function of both the torsion angle as well as compression. The Raman peaks harden with increasing pressures; the intraring C-C stretch frequency at 1600 cm(-1) has a pressure coefficient of 7.2 cm(-1)/GPa and exhibits asymmetric line shapes at higher pressures, characteristic of a strong electron-phonon interaction.

Prevalence of pharmacotherapy in the department of paediatric dentistry.

BACKGROUND: Pharmacotherapy plays important role in the management of paediatric dental patients in the department of paediatric dentistry. Many children at their early age suffer from different kinds of dental conditions such as acute and chronic irreversible pulpitis, acute and chronic alveolar abscesses, dentoalveolar and vestibular abscesses, etc along with physiological tooth movement that requires professional help for dental treatment. Treatment of such conditions most frequently requires pharmacotherapy as an either adjunct to dental therapeutic procedure or as a monotherapy. OBJECTIVE: To assess the prescribing patterns vis-a-vis generic or trade name, generic class, dosage form, route, frequency, duration, number of drugs per patient, cost and indication of drug therapy, patterns of dental treatment and Frankl's behavioral rating. MATERIALS AND METHODS: Prescriptions of 200 paediatric dental patients undergoing dental treatment in the department of paediatric dentistry were analyzed prospectively for a period of six months in a dental teaching hospital. RESULTS: 133 (56.5%) patients were males and 87 (43.5%) females and age group 6-10 years was the most frequent group (70%, P = 0.0000000) and all the patients received pharmacotherapy. Total numbers of 357 drugs were prescribed. Out of them, 212 (59.4%, P = 0.0000008) were analgesic agents, 133 (37.3%) antimicrobial agents (AMAs) and 12 (3.3%) other drugs. Extended spectrum Penicillins were the most commonly prescribed (90.2%) AMA followed by Metronidazole (9.8%). 247 drugs (69.2%, P = 0.0000000) were prescribed by trade names. 60% (P = 0.0000002) drugs were prescribed in the form of tablet or capsule followed by syrup 37% and administered entirely through oral route. Percentage of patients receiving three drugs, two drugs and one drug was 13.5%, 56.5% (P = 0.0000000) and 30% respectively and one patient received on average 1.78 medicines. 133 patients (56.5%, P = 0.0000000) received both AMA and analgesic agent. Minimum to maximum number of days for pharmacotherapy were 2 to 15 and highest frequency was up to four times a day. Cost of medicines was in the range of 10-150 Nepalese Rupees. Chronic irreversible pulpitis was the commonest diagnosis (28%) and extraction (92.5%) was the commonest dental procedure. Frankl's behaviour rating showed that 78.5% (P = 0.0000000) patients had positive attitude towards the dental procedures. CONCLUSION: Findings of the study suggest that pharmacotherapy is the mainstay in therapy to treat the paediatric dental patients along with dental procedures either to control the dental pain or odontogenic infection. Age group 6-10 years, chronic irreversible pulpitis and dental extraction are the commonest age group, diagnosis and dental procedure respectively in the department of paediatric dentistry. Analgesic (non-steroidal anti-inflammatory drugs- Nimesulide, Ibuprofen and Paracetamol) and Amoxicillin are the most frequently prescribed drugs mostly in the solid dosage forms in trade names via oral route. Duration of pharmacotherapy ranges from 2 to 15 days with highest frequency being up to 4 times a day. Majority of the patients are manageable without any behavioural modification technique- physical or pharmacological.

An ultrasonographic evaluation of solitary muscular and soft tissue cysticercosis.

BACKGROUND: Cysticercosis in humans is infection with the larval form (cysticercus cellulosae) of the pork tapeworm T. solium. Encystment of larvae can occur in almost any tissue. The location of cysts in order of frequency is the central nervous system, subcutaneous tissue and striated muscle, vitreous humour of the eye and, rarely, other tissues. High resolution ultrasound can be used in the diagnosis of muscular and soft tissue cysticercosis. OBJECTIVE: The aim of this study is to evaluate the ultrasonographic findings in cases of muscular and soft tissue cysticercosis. MATERIALS AND METHODS: It was a retrospective review of the cases of muscular and soft tissue cysticercosis which were diagnosed by ultrasound during June 2007 to May 2009 in the department of Radiology and Imaging, Nepalgunj Medical College Teaching Hospital. A total of six patients were evaluated. RESULT: There were four males and two females. Age of the patient ranged from 18 to 50 years. All of the patients presented with a swelling with pain in fi ve of them. There was a wide variation in the location of the cysts. In all cases ultrasound revealed a cystic lesion with an echogenic eccentric pedunculated nodule attached to the wall. The mean diameter of the cyst was 6mm. Smooth wall was present in fi ve cases whereas one of the cysts revealed irregular wall. Pericystic inflammatory changes were seen in the adjacent muscles. CONCLUSION: Ultrasound is a safe and non-invasive method that can be used in the diagnosis of muscular and soft tissue cysticercosis.

Ascorbic acid, catalase and chlorpromazine reduce cryopreservation-induced damages to crossbred bull spermatozoa.

The present study evaluated the effectiveness of ascorbic acid, catalase, chlorpromazine and their combinations in reducing the cryodamages to crossbred bull (Bos taurus x Bos indicus) spermatozoa. A total of 32 ejaculates (eight each from four bulls) were diluted in Tris-citric acid-fructose-egg yolk-glycerol extender. Each ejaculate was split into six parts (five treatment and one control). Treatment groups included 10 mm ascorbic acid, 0.1 mm chlorpromazine, 200 IU/ml catalase, 10 mm ascorbic acid + 0.1 mm chlorpromazine or 200 IU/ml catalase + 0.1 mm chlorpromazine in the extender. Fluorescent probes (Fluorescein isothiocyanate--Pisum sativum agglutinin + Propidium iodide) were used for the assessment of spermatozoa viability and acrosomal status. The proportion of acrosome intact live (AIL), acrosome intact dead, acrosome reacted live and acrosome reacted dead sperm was assessed in fresh, equilibrated and frozen-thawed semen. The functional status of the sperm was assessed using hypo-osmotic sperm swelling test (HOSST). Activities of acrosin and hyaluronidase enzyme were also determined. Lipid peroxidation level was assayed based on the melonaldehyde (MDA) production. In cryopreserved semen, the values of AIL spermatozoa, HOSST response, hyaluronidase and acrosin activity were reduced by 53%, 47%, 34% and 54%, respectively from their initial values in fresh semen. However, MDA level was threefold higher in the frozen-thawed sperm compared with fresh sperm. Significant (p < 0.05) improvement in motility, viability, HOSST response, retention of hyaluonidase and acrosin and reduction in MDA was recorded in ascorbic acid, catalase, ascorbic acid + chlorpromazine and catalase + chlorpromazine incorporated groups. The percentage of AIL sperm was significantly (p < 0.05) higher in ascorbic acid, catalase and ascorbic acid + chlorpromazine incorporated groups compared with the control. Chlorpromazine alone did not improve the post-thaw semen quality but when combined with either ascorbic acid or catalase, improvement in semen quality was noticed. It was inferred that incorporation of ascorbic acid, catalase and ascorbic acid + chlorpromazine in semen extender improved the post-thaw semen quality in crossbred bulls.

A study of wasp bites in a tertiary hospital of western Nepal.

Hymenopterid stings and subsequent allergic reactions including fatal anaphylaxis are common indications for emergency department visits worldwide. Besides that, sting can cause death as a result of multi-system involvement ranging from intravascular hemolysis, rhabdomyolysis, acute renal failure, hepatic dysfunction and occasionally thrombocytopenia and coagulopathy. Eleven cases (all male, age 35.5 +/- 15.2 years) of wasp bites admitted in the Manipal Teaching Hospital (MTH), Pokhara during 01st February, 2006 to 30th October, 2007 were enrolled in this study. Mean wasp bites number was 48.7 +/- 7.1 (11-100) and mean time to reach the hospital from the bite time was 69.1 +/- 149.7 hours (1.5 h-12 days). Nine patients developed acute renal failure (ARF) and secondary hypertension. Eight patients underwent hemodialysis. Two patients stuck by more than 75 stings developed refractory pulmonary edema and died in the course of treatment. Victims with lesser numbers of wasp envenomation, who received quick initiation of alkaline diuresis and intensive dialytic support had shorter hospital stay and less severe complications.

Unusually large prostatic utricle cyst.

Prostatic utricle cyst is one of the uncommon conditions and only a few cases have been reported. We present a case of unusually large prostatic utricle cyst in a 13- year- old male. He presented with burning urination and post-void dribbling of urine. A cystic mass was felt on digital per rectal examination. Ultrasound pelvis revealed a well-defined midline cystic mass posterior to the urinary bladder. Subsequent magnetic resonance imaging (MRI) of the pelvis demonstrated fluid containing cystic lesion communicating with posterior urethra. Surgical resection of the cyst was performed through the posterior sagittal approach. Follow up of the patient after three months of operation, there was complete resolution of the symptoms.

Effect of Ocimum sanctum, ascorbic acid, and verapamil on macrophage function and oxidative stress in mice exposed to cocaine.

OBJECTIVE: To investigate the effect of Ocimum sanctum, ascorbic acid, and verapamil on macrophage function and oxidative stress in experimental animals exposed to cocaine. MATERIALS AND METHODS: Mice were used in this study and were divided randomly into different groups of six animals each. They were either treated with intraperitoneal injection of saline or cocaine hydrochloride or an oral feeding of oil of Ocimum sanctum, ascorbic acid or verapamil, or both (ascorbic acid and verapamil), and were evaluated for a respiratory burst of macrophages, superoxide and nitric oxide (NO) production, estimation of TNF-alpha in the serum and supernatant of cultured macrophages, estimation of lipid peroxidation (malondialdehyde- MDA) in the serum, and superoxide dismutase activity in the erythrocytes. RESULTS: Unstimulated respiratory burst as well as superoxide production was enhanced on treatment with cocaine and all the three drugs were found to attenuate this enhancement. The bactericidal capacity of macrophages decreased significantly on chronic cocaine exposure, as it was associated with decreased respiratory burst and superoxide production. There was a significant decrease in NO production by macrophages on chronic cocaine exposure and all the test drugs were found to restore nitrite formation to a normal level. There was an increase in the malonylodialdehyde (MDA) level and decrease in the superoxide dismutase level on chronic cocaine exposure, and all the three drugs effectively decreased the MDA level and increased superoxide dismutase level. There was an increase in serum TNF-alpha on chronic cocaine exposure, which was decreased significantly by ascorbic acid and verapamil. CONCLUSION: O. sanctum, ascorbic acid, and verapamil were equally effective in improving the macrophage function and reducing oxidative stress. These findings suggested that O. sanctum, ascorbic acid, and verapamil attenuated acute and chronic cocaine-mediated effects.

Metformin and troglitazone in the treatment of female infertility associated with polycystic ovarian syndrome.

Polycystic ovarian syndrome is the most common cause of anovulatory infertility and causes menstrual disruption in 5-10% females, and is characterized by insulin resistance, hyperinsulinemia, hyperandrogenism and anovulation. Such factors are responsible for the increased miscarriage and infertility in women with PCOS. Administration of various insulin sensitizing drugs, such as metformin and troglitazone have been shown to decrease serum androgen concentrations and to increase ovulation rates, increase conception and decrease miscarriage in affected women.

Relationship between plasma leptin and plasma insulin levels in type-2 diabetic patients before and after treatment with glibenclamide and glimepiride.

Type 2 diabetes affects 100 million people throughout the world. Among the various factors implicated in the causation of this disease, the role of leptin, an obesity gene product, is increasingly being investigated. This especially assumes importance in the light of knowledge that obesity confers a minimum of 3-10 fold higher risk of diabetes. This study was planned to investigate the relationship between leptin and insulin levels in type 2 diabetic patients before and after treatment with glibenclamide or glimepiride. 60 type 2 diabetic patients were recruited for the study and were divided into 2 groups-one receiving glimepiride and the other group receiving glibenclamide for duration of 10 weeks. This study demonstrated a highly positive correlation of plasma leptin levels with BMI, plasma insulin and insulin resistance. No gender specific differences were observed in leptin concentrations. The study, however, failed to demonstrate any possible relationship between glycemic control as assessed by blood sugars/ glycosylated hemoglobin (HbAlc) and plasma leptin. The administration of glibenclamide or glimepiride significantly lowered blood glucose levels coupled with a decrease in (HbAlc). Both the drugs increased insulin concentrations. Glibenclamide increased leptin levels but they remained unaltered with glimepiride. Glibenclamide and glimepiride were found to be equally effective in their glucose lowering action. However, the patients receiving glibenclamide experienced higher episode of hypoglycaemic spells than those receiving glimepiride.

Prevalence of antimicrobial chemotherapy in hospitalized patients in the department of internal medicine in a tertiary care center.

Use of antimicrobial agents (AMAs) is associated with significant reduction in morbidity and mortality. However, indiscriminate and injudicious use of AMAs leads to the ineffective treatment, increased adverse effects, exacerbation or prolongation of illness, emergence of bacterial resistance and an additional burden of an expensive medical cost to the patients. So controlled use of AMAs at right dose, right interval and right duration is of utmost importance. In this retrospective study, prevalence and prescription patterns, and cost of the prescribed AMAs in the hospitalized patients in the department of internal medicine in a tertiary care center were analyzed. A total of 428 hospitalized patients were included in the study. Out of 428 patients, 274 (64.0%, P < 0.01) patients received AMAs for therapeutic (66.4%) and prophylactic (24.1%) purposes. In 9.5% patients AMA prescription was inappropriate. Use of intravenous route was significantly higher (55.48, P < 0.01) than the oral route. COPD with acute exacerbation was most frequent condition for AMA prescription. Majority (90.42%) of AMA prescriptions were based on empirical basis. Mean number of AMA per patient was 2.12 (minimum 1 and maximum 8). Most frequently prescribed AMA was Ceftriaxone (30.2%) from cephalosporin group (33.9%, P < 0.05). Patients received AMAs for the duration of 1-31 days and total cost of single AMA dosage regimen was as high as $ 482.3. As most of the hospitalized patients were prescribed AMA empirically, strategic AMA prescription guidelines and AMA prescription monitoring systems are extremely necessary in the hospitals to prevent emergence of microbial resistance and to expedite the cost effectiveness of medical treatment.

Recent advancement in drug delivery system.

Ease of drug administration, safety, affordability and efficacy are the major concerns in pharmacotherapy leading to exploration of better drug delivery systems. Liposomes are lyotropic liquid crystals composed mainly of amphiphilic bilayers and these are more frequently used as drug carriers. Liposomes help reduce the toxicity and deliver the drug to the target tissue. So far, liposomes have been the most intensively studied lipid-based delivery system. In liposomes, a hydrophilic drug can be trapped in aqueous interior or channels between successive phospholipids bilayers whereas a hydrophobic drug can reside with the bilayer itself. The non-toxic and nonimmunogenic bilayers dissipate allowing the diffusion of the drug into the tissues. Attachment of polyethyl glycol to the surface of liposome (known as stealth liposome) aids in the better targeting of the drug to the tissues. Pegylated proteins and polymers of lactic and glycolic acids have been well studied as drug carriers and found to be resistant to phagocytosis and complement activation. Newer DNA based strategies including DNA vaccination and antisense oligonucleotides and immunomodulation show good results for new therapeutic systems. Though the DNA based therapeutic systems have high selectivity and specificity with few adverse effects, these systems are so far restricted to animal models and clinical trials.

Parkisonism with Shy-Drager syndrome--a case report.

A previously healthy 60 years old female patient presented with bradykinesia, postural instability and increased rigidity of both upper and lower limbs for 2 years and was diagnosed as Parkinsonism for last years. Later on she developed features of autonomic dysfunction including postural hypotension, hyperhydrosis and urinary incontinence so was diagnosed as Shy-Drager Syndrome. She was treated with fludrocortisone and nefidipine for the management of postural hypotension. Patient developed aspiration pneumonia during oral feeding, despite of ICU management for the same cause patient died of respiratory arrest.

When left ventricular failure complicates chronic obstructive pulmonary disease: hypoxia plays the major role.

INTRODUCTION: As the chronic obstructive pulmonary disease (COPD) progress, is usually accompanied by involvement of the both left ventricle (LV) and right ventricle (RV), and their systolic and diastolic function. Signs and symptoms of LV failure can be difficult to distinguish from those of COPD. OBJECTIVE: The study was carried out to determine the prevalence of LV systolic dysfunction in the COPD patients and to assess the possible risk factor behind such development. MATERIAL AND METHODS: It is a prospective study of 60 cases of COPD patients with or without cor-pulmonale attending Manipal Teaching Hospital. RESULTS: The prevalence of LV systolic dysfunction was found to be 26.7%, and the findings directly correlate with the severity of COPD i.e., the more the severity of the lung disease more the probability for the incidence of LV systolic dysfunction. These data are in support of the hypothesis that hypoxia and the excess accumulation of toxic metabolic products like lactic acid, significant right-to-left shunting through the bronchial circulation explains the diminished LV ejection fraction in severe COPD patients. CONCLUSION: Routine echocardiography investigation of the severe COPD patients is required for assessing the status of LV function and to rule out the possible association of LV systolic dysfunction.