Rare case of coexisting hepatic, splenic, and vertebral hemangiomas - A case report.

Synchronous existence of hepatic, splenic, and skeletal hemangiomas has not been reported previously in the English literature to our knowledge. In this case report, we present a case of coexistence of hepatic, splenic, and skeletal hemangiomas in a 30-year-old woman with on and off bilateral lumbar region pain and no significant past medical history. Radiological investigations, including ultrasound and computed tomography and magnetic resonance imaging helped identify the synchronous existence of hepatic, splenic, and skeletal hemangiomas. The patient improved with conservative management and was kept on follow-ups. Although there have been reports of coexistence of splenic and hepatic hemangiomas in the literature, to our knowledge, this is the first report of synchronous existence of hepatic, splenic, and skeletal hemangiomas.

Green Spectrophotometric Determination of Organophosphate in Selected Fruits and Vegetables.

A simple, sensitive, precise, and environmentally safe spectrophotometry method was developed and validated for the determination of organophosphate in various fruits and vegetables using a UV-Visible spectrophotometer using a magnesia mixture. The volume of reagent used for analysis and the stability of the color complex were also optimized. The drug showed a stable white color complex at 420 nm. The greenness of the methods was estimated using an ecoscale (84), the Green Analytical Procedure Index, and AGREE (0.89), which were found to be excellent green method based on spectrophotometric determination. The method was validated using ICH guidelines and has acceptable values for linearity (0.5-2.5 mg/ml), accuracy (98.5-102.5%), precision, robustness, limit of detection (0.16 mg), and limit of quantification (0.486 mg). The concentration of the organophosphate in the analyzed sample was in the range of 0.003 to 2.45 mg. Altogether, the proposed green analytical method was found to be a simple, selective, sensitive, accurate, and ecofriendly method for the analysis of organophosphate in various fruits and vegetables.

Kikuchi-Fujimoto disease in a 20-year-old female: a case report.

Kikuchi disease is an uncommon, self-limited disease that mimics malignant lymphoma in presentation but with an excellent prognosis. The study highlights the importance of diagnosis of Kikuchi disease and modalities to reach it. Case presentation: The authors present a case of a 20-year-old Asian female who had complaints of swelling at the angle of the mandible along with fever. There was bilateral cervical lymphadenopathy. Ultrasonography of the neck showed features of tubercular lymphadenitis whereas cell and tissue study revealed the diagnosis of Kikuchi disease. She was managed conservatively and her lesions subsided. Discussion: Kikuchi disease is a rare but self-limiting disease characterized by lymphadenopathy. It has similarities with other etiologies especially malignancy and tubercular lymphadenitis which leads to misdiagnosis. Hence, knowledge about incidence, and clinicopathological features helps to reach proper diagnosis prompting effective management. Conclusion: Kikuchi disease, being a benign disease needs to be kept in mind to avoid overtreatment in the line of malignancy or tubercular lymphadenitis.

A Brief Review of Analytical Methods for the Estimation of Allopurinol in Pharmaceutical Formulation and Biological Matrices.

This review article represents the collection and discussion of various analytical methods available in the literature for the determination of allopurinol (ALLP) in pharmaceutical and biological samples consisting of HPLC, UV-visible method, near-IR spectroscopy, spectrofluorometry, capillary electrophoresis, polarography, voltammetry, and hyphenated techniques such as LC-MS, LC-MS/MS, UPLC-MS/MS, and GC-MS. The anticipated review provides details about the comparative utilization of various analytical techniques for the determination of ALLP. The present review article can be effectively explored to conduct future analytical investigation for the estimation of ALLP.

Attitudes of ambulatory care older Nepalese patients towards deprescribing and predictors of their willingness to deprescribe.

INTRODUCTION: Older adults continue to receive potentially inappropriate medications necessitating the need for medication optimization, by deprescribing. To ensure a holistic approach to deprescribing, it is essential to understand the perception of older adults towards deprescribing. This study aimed to assess the attitude of older ambulatory patients towards deprescribing and to identify factors predicting their willingness to deprescribe. METHODS: A cross-sectional survey was conducted in central Nepal between March and September 2019 among 385 older ambulatory care patients (aged ⩾65 years) who were taking at least one regular medicine. The perception of patients towards deprescribing was assessed using the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire via a face-to-face interview method. Descriptive statistics were performed to describe patients' characteristics and their attitudes towards deprescribing. A multivariate logistic regression analysis was used to determine predictors of the willingness of older ambulatory patients towards deprescribing. RESULTS: The median [interquartile range (IQR)] age of patients was 72 (8) years. Nearly three in five patients (64.9%) had hypertension, with 11.2% having polypharmacy. More than half of the patients (57.4%) would be willing to stop one or more of their regular medicines if their doctor said it was possible to do so. Regression analysis showed that age [odds ratio (OR) 0.946; 95% CI 0.913, 0.981; p = 0.003] and concerns about stopping medicine score (OR 0.541; 95% CI 0.334, 0.876; p = 0.013) were predictors of the willingness of the older patients towards deprescribing. CONCLUSION: One in two older ambulatory care patients in Nepal would be willing to have one or more of their medicines deprescribed. The factors predicting their willingness to deprescribe are their age and concerns about stopping medicines. Clinicians should consider discussing the possibility of deprescribing with older patients for the prevention of potential medication-related harms. PLAIN LANGUAGE SUMMARY: What do older Nepalese patients think about withdrawal or dose reduction of an inappropriate medication?Introduction: Research suggests that older adults (aged ⩾65 years) continue to receive medications that have the potential for harm rather than a benefit. This necessitates the need for withdrawal or dose reduction of such inappropriate medications, the process known as deprescribing. Understanding what older patients think about this process could be a stepping-stone to the general approach for its implementation. Data on deprescribing is lacking from Nepal. Therefore, we designed a survey to explore the attitude of older patients towards deprescribing and factors that could predict their willingness to deprescribe.Methods: This study was conducted between March to September 2019 among 385 older patients who were taking at least one regular medicine and were visiting selected hospitals of Nepal for outpatient services. We performed a face-to-face interview to assess the attitude of patients towards deprescribing using a validated tool called revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire that quantified the response through scoring. The data were subjected to statistical analysis to determine the attitudes of Nepalese older patients towards deprescribing and to develop a model to predict their willingness to deprescribe.Results: The average age of the participant was 72 years with 65% having hypertension and 11% using more than five medications. Our data suggested that one in two older Nepalese patients would be willing to stop one or more of their regular medications if their doctors said it was possible to do so. Their willingness to deprescribe could be predicted from their age and concerns about stopping medications.Conclusion: Clinicians should consider discussing the possibility of deprescribing with older patients for the prevention of potential medication-related harms.

Isolation and Characterization of Klebsiella Phages for Phage Therapy.

Introduction: Klebsiella is a clinically important pathogen causing a variety of antimicrobial resistant infections in both community and nosocomial settings, particularly pneumonia, urinary tract infection, and sepsis. Bacteriophage (phage) therapy is being considered a primary option for the treatment of drug-resistant infections of these types. Methods: We report the successful isolation and characterization of 30 novel, genetically diverse Klebsiella phages. Results: The isolated phages span six different phage families and nine genera, representing both lysogenic and lytic lifestyles. Individual Klebsiella phage isolates infected up to 11 of the 18 Klebsiella capsule types tested, and all 18 capsule-types were infected by at least one of the phages. Conclusions: Of the Klebsiella-infecting phages presented in this study, the lytic phages are most suitable for phage therapy, based on their broad host range, high virulence, short lysis period and given that they encode no known toxin or antimicrobial resistance genes. Phage isolates belonging to the Sugarlandvirus and Slopekvirus genera were deemed most suitable for phage therapy based on our characterization. Importantly, when applied alone, none of the characterized phages were able to suppress the growth of Klebsiella for more than 12 h, likely due to the inherent ease of Klebsiella to generate spontaneous phage-resistant mutants. This indicates that for successful phage therapy, a cocktail of multiple phages would be necessary to treat Klebsiella infections.

Early Versus Late Removal of Internally Fixated Kirschner's Wires for Displaced Lateral Condyle Fracture of Humerus in Children.

INTRODUCTION: Lateral condyle fracture of the distal humerus is the second most common paediatric elbow fracture. Unstable, rotated and displaced (>2 mm) fractures are managed with open reduction and internal fixation with Kirschner's wires or screws. Debate persists as for how long the Kirschner's wires should be placed in situ after internal fixation. We aimed to compare the functional and radiological outcome after early versus late removal of internally fixated Kirschner's wires for displaced lateral condyle fracture of distal humerus. METHODS: Children that underwent early (3-4 weeks) or late (5-7 weeks) removal of Kirschner's wire after open reduction and internal fixation for displaced lateral condyle fracture of humerus were observed for a period of minimum 6 months. Time to radiological union, carrying angle, range of motion was assessed and compared between early and late group. Functional outcome was compared using the Dhillon scoring system. RESULTS: We report the outcome of 40 cases (20 cases in each early and late group). Radiological union was achieved in all the cases of both group at 12 weeks follow up. The mean loss of carrying angle was statistically insignificant (p = 0.394) between the early and late group. There was no significant difference between the early and late group in relation to arc of motion at 12 weeks (p=0.724) and 6 months (p=0.638) follow up. Using the Dhillon scoring system, there was 100% excellent Dhillon score in early group, 80% excellent and 20% good Dhillon score in late group. Functional outcome was statistically insignificant between the two groups (p = 0.106). CONCLUSION: Early removal of internally fixated K-wires for displaced lateral condyle fracture of humerus in children showed similar radiological and functional results to late removal.

Evaluation of Antinociceptive and Anti-inflammatory Activity of Phytosterol Present in Chloroform Extract of Phyllanthus Maderaspatensis.

Inflammation and pain is a common cause of medical consultation which generally occurs when a tissue is injured. In recent scenario, attention has been paid for screening new drugs with analgesic activity from plant sources, to reduce or treat pain with less adverse effects than allopathic drugs. The objectives of this research work was to evaluate the antinociceptive and anti-inflammatory activity of phytosterol present in chloroform extract of Phyllanthus maderaspatensis (CEPM) through carrageenan-induced hind paw oedema and hot plate method in male wistar rats. The test groups received CEPM (suspended in 1% caboxymethylcellulose, CMC) at doses 400 mg/kg, p.o.; the reference group received indomethacin (10 mg/ kg, in 1% CMC, p.o.) as positive control and the negative control animals received the vehicle only (1% CMC, 10 mL/kg, p.o.). Oral administration of CEPM or indomethacin showed significant (P<0.001) effect in the reduction of the paw oedema induced by 0.1 mL of 1% carrageenan (in 1% CMC) solution into the subplantar region. CEPM showed the highest inhibition 71.42% at 3rd hr. CEPM extract and pentazocin significantly (P<0.001) increases the basal reaction time when compare to control group. The present study demonstrates the potential anti-inflammatory and analgesic effect of the CEPM which supports the claims by the traditional medicine practitioners.