Study of Nitrosative Stress in 'Pregnancy Induced Hypertension'.

INTRODUCTION: Hypertension is the most common medical problem encountered during pregnancy. Pregnancy Induced Hypertension (PIH) is also called a disease of maternal endothelium. Nitric-oxide being a potent vasodilator released by endothelial cells, its role has been implicated in PIH. AIM: To study the role of reactive nitrogen species in PIH. MATERIALS AND METHODS: One hundred and twenty samples were selected for the study. Of these, 60 patients had PIH (case) and the rest without PIH (control). Estimation of serum nitric- oxide, serum nitrothiol, serum total thiol was done. RESULTS: The study showed decreased NOx (Mono nitrogen oxide No and No2) levels in PIH as compared to control (p< 0.001). PIH patients had significantly higher levels of S-nitrothiols than control (p<0.01). Thiol levels were decreased in PIH as compared to control (p<0.001). CONCLUSION: Thus, it is concluded from this study that nitrosative stress represents a point of convergence for several contributing factors potentially leading to the clinical manifestations of pregnancy induced hypertension. The antioxidants are used up while scavenging the free radicals.

Citric acid treatment of chronic nonhealing ulcerated tophaceous gout with bursitis.

The ulceration associated with gout tophi is very difficult to treat because of impaired and halted local inflammatory response resulting from the gout treatment regimen. We report chronic nonhealing tophaceous gout with bursitis in an 80-year-old male, not responding to conventional treatment modality for months together. This nonhealing ulcer was treated successfully with local application of 3% citric acid ointment for 22 days.

Effect of core stabilization exercises versus conventional exercises on pain and functional status in patients with non-specific low back pain: a randomized clinical trial.

BACKGROUND AND OBJECTIVES: Low Back Pain (LBP) results in significant level of disability, producing significant restriction on usual activity such as an inability to work. Nearly two third of the adults are affected by non-specific low back pain at some point in their lives. The purpose of the study was to determine the effect of core stabilization exercises in comparison with conventional exercises on pain, functional status in patients with non-specific LBP. MATERIAL AND METHODS: Thirty patients diagnosed with non-specific LBP participated with age group between 20-50 years and divided in to 2 groups, one with core stabilization exercises and other conventional exercises, 15 subjects each. Three months study, pre and post treatment outcome measures used were VAS for pain intensity and Modified Oswestry Low Back Pain Disability Index for functional status (disability). RESULTS: Data were analyzed using student 't' test (paired and unpaired). Whereas both groups improved significantly from the initiation of treatment, a between-group comparison revealed significantly greater (p<0.001) improvements regarding pain and functional status for experimental group compared to control group. CONCLUSION: Core stabilization exercises were found to be more effective in reducing pain and improving functional status by decreasing disability of patients with non-specific low back pain in comparison with conventional exercises.

Treatment of lepromatous ulcers using citric acid as a sole antimicrobial agent.

A prospective study was carried out to assess the role of citric acid as a sole antimicrobial agent in the management of lepromatous ulcers. Thirty-four known cases of lepromatous ulcers not responding to conventional antibiotic therapies for long duration were investigated for culture and susceptibility studies. Staphylococcus aureus (25·00%) and Klebsiella spp. (23·43%) were found to be the most common isolates. Amikacin (68·75%) and ciprofloxacin (67·18%) were found to be the most effective antimicrobial agents. Topical application of citric acid ointment resulted in complete healing in 25 (73·52%) cases. In eight cases (26·48%), there was elimination of infective agent from ulcer site and formation of healthy granulation, but no complete healing of ulcer was seen. Results indicate that citric acid is the best alternative for the effective management of lepromatous ulcers when other therapies are exhausted.

Citric acid treatment of necrotizing fasciitis: a report of two cases.

Necrotizing fasciitis is a destructive invasive infection of skin, subcutaneous tissue and deep fascia, with relative sparing of muscle. It is a life-threatening condition. Here we report two cases of necrotizing fasciitis, which were not responding to conventional antibiotic therapy and local wound care after aggressive debridement. These two cases were treated simply by local application of 3% citric acid. Thus, citric acid was used to compliment wound management following surgical treatment with antibiotics.

Simple, effective and affordable approach for the treatment of burns infections.

OBJECTIVE: The aim of the present study was to develop a simple and effective treatment modality using citric acid as a sole antimicrobial agent to control infections in burns patients not responding to conventional treatment. METHODS: Forty-six cases with 5-60% superficial to deep burns in a study group and 20 cases with 10-70% superficial to deep burns in a control group were investigated for culture and susceptibility. The isolates in study group were further tested for susceptibility to citric acid. Three percent citric acid gel was applied to burns wounds in study group; however, the control group received conventional antibiotic therapy and local wound care. RESULTS: In the control group, Pseudomonas aeruginosa (44.44%) and Staphylococcus aureus (33.33%) were found to be the commonest bacterial isolates and, amikacin and ciprofloxacin (40.74%) were found to be most effective antibacterial agents. In study group, P. aeruginosa (30.48%) and S. aureus (23.17%) were found to be the commonest bacterial isolates. Ceftazidime (52.43%), ciprofloxacin (47.56%) and amikacin (46.34%) were found to be most effective antibacterial agents. Application of citric acid to burn wounds resulted in complete healing in 40 (86.95%) cases in 7-25 applications (P value 0.145); however, in a control group conventional antibiotic therapy and local wound care resulted in complete healing in nine (45%) patients only. CONCLUSIONS: Citric acid treatment was found effective in the control of burns infections as compared to conventional therapy. Complete healing in 86.95% cases as compared to 45% in a control group indicates that citric acid is nontoxic, economical and quite effective in the management of burns infections.

A simple and effective approach for the treatment of diabetic foot ulcers with different Wagner grades.

Diabetic foot infections are the major cause of morbidity. Infection is the common sequel of diabetic foot ulceration that leads to delayed wound healing. These infections are difficult to control. If not addressed well in time, they may lead to amputation of foot. An attempt has been made to develop simple and effective treatment modality by using citric acid as a sole antimicrobial agent to control diabetic foot infections not responding to conventional treatment. Hundred and fifteen cases of diabetic foot ulcers of different Wagner grades infected with a variety of bacteria were investigated for culture and susceptibility, and susceptibility to citric acid. Citric acid gel was applied to ulcer to determine its efficacy in the management of diabetic foot ulcers with different Wagner grades. Citric acid gel was found effective in the control of foot infections; especially in Wagner grades I and II, the success rate was found to be more than 94%. In Wagner grade III also, it was found effective in complete healing of ulcers without deep osteomyelitis. Citric acid treatment is effective in the control of diabetic foot infections and in successful management of diabetic foot ulcers with Wagner grades I and II, and even with Wagner grade III, without deep osteomyelitis.