A clinical study of bilateral non-obstructive acute pyelonephritis with acute kidney injury in patients of type 2 diabetes mellitus.

The aim of our study was to study the clinical profile of type 2 diabetes mellitus patients admitted with the diagnosis of acute kidney injury (AKI) due to bilateral acute non-obstructive pyelonephritis. The bilateral involvement was identified on various imaging modalities (ultrasound, computed tomography, nuclear scintigrapy). All the patients had AKI. Those with severe AKI underwent hemodialysis. The factors associated with the severity of illness were identified. Twenty-five patients of type 2 diabetes mellitus admitted with the diagnosis of AKI due to bilateral acute non-obstructive pyelonephritis were identified. On ultrasound, bilateral involvement was found in 12 patients and in 17 patients on computed tomography and eight patients on nuclear scintigraphy. Fourteen of them needed dialysis support. Bilateral acute pyelonephritis needs to be considered while evaluating the AKI in type 2 diabetes mellitus patients.

Large orbital hemangioma: managed with systemic propranolol.

Most infantile hemangiomas resolve spontaneously without any need for therapy. However some hemangiomas require treatment to preserve function (vision, feeding and breathing) or to treat complications like ulceration, bleeding and scarring. The authors present a 5-mo-old infant with large orbital hemangioma on left side completely obscuring palpebral fissure, successfully managed with oral propranolol.

Attenuation of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation with Pre Induction IV Fentanyl Versus Combination of IV Fentanyl and Sub Lingual Nitroglycerin Spray.

INTRODUCTION: Endotracheal intubation is one of the most invasive stimuli in anesthesia and it's often accompanied by a hemodynamic pressor response. The purpose of this study was to investigate the efficacy of a single pre-induction 2 µg/kg bolus injection of fentanyl followed by two puffs of nitroglycerin sub lingual spray (400 µg /spray) with a thiopentone/suxamethonium sequence in the attenuation of the hemodynamic response to endotracheal intubation in normotensive patients. MATERIAL AND METHODS: The study consisted of 80 randomly selected ASA physical status I/II male/female adults who were aged between 18 through 60 years and scheduled for elective surgery. Group I received a single 2 µg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy followed by two puffs of nitroglycerin sub lingual spray (400 µg/spray) 2 minutes prior to intubation (n=40). Group II received a single 2 µg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy (n=40). Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product were compared to basal values at pre-induction, induction, intubation and post-intubation as well as at time increments of 1, 3, 5, 7 and 10 min. RESULTS: Fentanyl combined with nitroglycerin did not attenuate hemodynamic pressor responses more than fentanyl alone. Increases of HR (7.9%), DBP (4.0%), MAP (3.6%) and RPP (6.0%) along with attenuation of SBP (2.7%) were observed in the fentanyl-nitroglycerin group as compared to the equivalent control measured values. CONCLUSIONS: A single pre-induction bolus injection of fentanyl followed by two puffs of nitroglycerin sub lingual spray in a thiopentone/suxamethonium anesthetic sequence neither successfully attenuates nor successfully suppresses the hemodynamic pressor response more effectively than fentanyl alone in normotensive patients resulting from endotracheal intubation.

Sternal tuberculosis in a patient with chronic kidney disease.

Sternum is generally regarded as resistant to infections and thus is an infrequent site of osteomyelitis. Involvement of sternum by Mycobacterium tuberculosis is rare. Sternal tuberculosis in chronic kidney disease (CKD) was not reported till date. We report a 40-year-old patient with stage IV CKD, who presented with sternal and cervical lymphnodal tuberculosis.

Epitrochlear mass in a patient on maintenance hemodialysis--Kimura disease.

Kimura disease is a rare benign inflammatory disorder presenting as subcutaneous masses or lymphnodal mass in the cervical region. Kimura disease is reported sparsely in patients on maintenance hemodialysis. We report an unusual location of Kimura disease in a patient on maintenance hemodialysis, who had a prolonged, persistent asymptomatic eosinophilia.

Swyer syndrome: a case report with literature review.

Gonadoblastomas are known to develop in dysgenetic gonads, especially so, if Y chromosome material is present. A 20-years-old girl who noticed breast development since the age of 12 years presented with primary amenorhoea, distension of lower abdomen and intermittent pain for two months. She had breakthrough bleeding with six months of estrogen replacement. Tanner breast stage was five and pubic hair stage was also five. Examination revealed a mass in the lower abdomen extending into hypogastrium, umbilical and lumbar regions. Her gonadotropin levels were grossly elevated. Karyotyping showed 46XY. CT scan of abdomen showed a 17X11 cm mass in the pelvis without visible gonads. Surgical excision of the mass along with bilateral salpingophorectomy was performed. Histopathology revealed the mass to be a dysgerminoma, while the right gonad lodged gonadoblastoma. She was diagnosed as a rare case of Swyer syndrome.

Malposition of hemodialysis catheter in left superior intercostal vein.

Malposition of hemodialysis catheter needs to be identified promptly. Straight descent of left side internal jugular catheter mandates a thorough evaluation than unnecessary apprehensions. We report an unusual case of straight descent of hemodialysis catheter into superior intercostal vein.

Malposition of hemodialysis catheter in left superior intercostal vein.

Malposition of hemodialysis catheter needs to be identified promptly. Straight descent of left side internal jugular catheter mandates a thorough evaluation than unnecessary apprehensions. We report an unusual case of straight descent of hemodialysis catheter into superior intercostal vein.

Detection of lip, alveolar ridge and hard palate abnormalities using two-dimensional ultrasound enhanced with the three-dimensional reverse-face view.

OBJECTIVE: The aim of this study was to assess conventional two-dimensional (2D) ultrasound enhanced with a three-dimensional (3D) ultrasound technique, the 'reverse-face' view (3D-RF) in prenatal evaluation of the involvement of the lips, alveolar ridge and secondary palate in suspected isolated orofacial clefting. METHODS: One hundred and twenty-four cases of suspected orofacial clefting diagnosed by a routine 2D ultrasound scan were referred for specialist ultrasound at 20-34 weeks' gestation for a detailed assessment of the lips and palate using both 2D and 3D ultrasound. For the 3D examination the lips and alveolar ridges were examined both in profile and in the frontal plane. The palate was then assessed in the reverse coronal view by rotating the face through 180° on the vertical axis to produce the 3D-RF view. Antenatal diagnoses were compared with postnatal findings. Left and right lip and alveolar ridge defects were counted separately according to the Kernohan 'striped Y' classification. RESULTS: Of 124 patients, 110 had isolated facial clefts and were available for follow-up; in 10, 3D-RF views were not successfully obtained, leaving 100 cases for assessment. The sensitivity of the 2D enhanced with 3D-RF technique for the diagnosis of cleft of the lip was 116/122 (95%), false-positive rate (FPR) 7.7%; for alveolar ridge was 87/103 (84.5%), FPR 7.2%; and for hard palate was 61/68 (89.7%), FPR 15.6%. CONCLUSION: The data reported represent the largest series of orofacial abnormalities diagnosed by 2D ultrasound and enhanced with 3D imaging to refine the detection of clefts of the hard palate. The technique is feasible in 90% of patients in whom almost 90% have a correct classification of clefts of the lip, alveolar ridge and palate.

Effect of bitter gourd and spent turmeric on glycoconjugate metabolism in streptozotocin-induced diabetic rats.

AIM: Changes in glycoconjugate metabolism during the development of diabetic complications and their modulation by feeding bitter gourd and spent turmeric as fiber-rich source. METHOD: This was studied by measuring the contents of total sugar, uronic acid, amino sugar, and sulfate in the streptozotocin-induced diabetic rats. RESULTS: Total sugar content decreased in liver, spleen, and brain, while an increase was observed in heart and lungs. Uronic acid content in liver, spleen, and brain decreased, and marginal increase was observed in testis. Amino sugar content decreased in liver, spleen, lungs and heart during diabetes, and augmentation was observed to different extents. Decrease in sulfation of glycoconjugates was observed in liver, spleen, lungs and heart during diabetes and was significantly ameliorated by bitter gourd and spent turmeric, except brain. Protein content decreased in liver, while an increase was observed in brain. The studies clearly showed alteration in glycoconjugate metabolism during diabetes and amelioration to different extents by feeding bitter gourd and spent turmeric. CONCLUSION: Improvement is due to slow release of glucose by fiber in the gastrointestinal track and short-chain fatty acid production from fiber by colon microbes.

Effect of bitter gourd and spent turmeric on constituents of glycosaminoglycans in different tissues in streptozotocin induced diabetic rats.

Diet is now one of the well established means in the management of diabetes. Bitter gourd and spent turmeric at 10% level were tested for their efficacy on glycosaminoglycan metabolism in various tissues viz., liver, spleen, lungs, heart and testis in control, diabetic and treated rats. The glycosaminoglycans (GAGs) were isolated from defatted and dried tissues. The contents of sulfated GAGs decreased in all the tissues and the decrease was more prominent in heart and testis. In the isolated GAGs, contents of total sugar, amino sugar, uronic acid and sulfate were studied. Decrease in total sugar content was maximum in testis. Amino sugar content decreased considerably in testis (38%) and lungs (15%). The content of uronic acid also decreased in testis (33%) besides heart (29%) and liver (25%). Sulfate groups in GAGs perform pivotal functions in many biological events and decrease in sulfate content was significant in heart (40%), testis (37%) and liver (37%). GAGs profile on the cellulose acetate electrophoresis revealed that heparan sulfate (HS), hyaluronic acid (HA) and chondroitin sulfate/dermatan sulfate (CS/DS) were present in liver, spleen and lungs. HS, CS were present in heart, DS/CS was observed in testis. The observed beneficial effects in GAGs metabolism during diabetes may be due to the presence of high amounts of dietary fibres present in bitter gourd and spent turmeric, besides, possible presence of bioactive compounds in one or both of them.

Pharmacognostical stucies on the seeds of mulam citrullus lanatus (thunb.) mats & nakai (cucurbitacae).

In the Siddha system of Medicine cotyledons of the seeds of C. Lanatus are known as Mulam/Pullum/Pitcha (Tamil) and used as Pulukolli (Vermifuge), Karpa moolikai (General tonic) and as Aanmeiperukki (Aphrodisiac). In the Ayurvedic system of Medicine seeds are said to have properties like Sheeta (cooling), Mootrala (Diuretic) and Vrshya (Aphrodisiac). The present paper deals with macro and microscopical studies, maceration, histochemical tests, solubility, physical contents, extractive values, tests for inorganic and organic constituents, U.V. and thin layer chromatographic studies.

Pharmacognostical studies on orilaitamarai -hybanthus enneaspermus (L) f. Muell-(violaceae).

The paper deals with the detailed pharmacognosy of the whole plant of Orilaitamarai (Hybanthus enneasperms) sold in the local market under the name Purusharatna, Ratanpursuha. The studies include macro, microscopical, histochemical and diagnostic characters of the root, stem and leaf. The physical constants, fluorescence characteristics and chromatographic studies of the whole plant are also presented.

Ayurvedic rationale of the southern Indian vegetable soup saaru or rasam.

Spices are historically known contributions to the world. The credit for identifying the spices with medicinal and culinary values goes to Ayurveda. Saaru or Rasam is a very popular soup used all over southern India. In this paper an attempt has been made to present the ayurvedic rationale behind formulating the receipt of saaru or rasam.

Macro and microscopical studies on vanaharidra curcuma aromatica salisb.

The drug Vanaharidra is used in various kinds of diseases like Kusta, Kasa, etc., Pharmacognosy of the root and rhizome of Vanaharidra is presented in this paper.