Typhoid intestinal perforation: 24 perforations in one patient.

Intestine perforation is one of the most dreaded and common complication of typhoid fever remarkably so in developing world; it usually leads to diffuse peritonitis, requiring early surgical intervention. Despite various measures such as safe drinking water supply and safe disposal of waste, intestinal perforation from salmonellosis remains the most common emergency surgery performed. The incidence continues to rise, so also the mortality, despite new antibiotics and improvement in surgical technique. More disturbing is that we now see increasing number of ileal perforations and colonic involvement. We hereby present a case report of 35-year-old male with multiple (24) intestinal perforation in the Ileum and Cecum.

Formulation and in vitro characterization of cefpodoxime proxetil gastroretentive microballoons.

BACKGROUND AND THE PURPOSE OF THE STUDY: The objective of the present work was to improve bioavailability of cepodoxime proxetil through gastroretentive microballoon formulation. METHODS: Microballoons of cefpodoxime proxetil were formulated by solvent evaporation and diffusion method employing hydroxypropylmethyl cellulose (HPMC) and ethyl cellulose (EC) polymers and characterized for particle size, surface morphology, incorporation efficiency, floating behavior, in vitro drug release study and differential scanning calorimetry (DSC). RESULTS: The average particle size of formulated microballoons was in the range of 54.23±2.78-95.66±2.19µm. Incorporation efficiencies of over 83.77±0.85% were achieved for the optimized formulations. Most of formulations remained buoyant (having buoyancy percentage maximum of 81.36±1.96%) for more than 12 hrs indicating good floating behavior of microballoons. Higher values of correlation coefficients were obtained with Higuchi's square root of time kinetic treatment heralding diffusion as predominant mechanism of drug release. CONCLUSION: Inferences drawn from in vitro studies suggest that microballoons may be potential delivery system for cefpodoxime proxetil with improvement in bioavailability in comparison to conventional dosage forms.

Domestic violence against women and their mental health status in a colony in delhi.

BACKGROUND: Violence against women is a major public health and human rights issue in the world today. This study was conducted to assess the consequences of domestic violence on the mental health of women of reproductive age group. MATERIALS AND METHODS: A community-based, cross-sectional study was conducted in Raj Nagar- I, urban locality in west Delhi near Palam. 350 women of 15-49 years age group residing in the community were selected by stratified random sampling. These women were administered an interview schedule adapted from WHO multi-country study on women's health and domestic violence. They were assessed for the presence of domestic violence. Mental health status of these women was estimated by using self-reporting questionnaire 20. Data were analyzed using SPSS 12 software. The test applied was chi square test for proportion and binary logistic regression. RESULTS: 42.8% of the women reported one or the other types of violence. 34.9% of the women reported either physical or sexual violence ever in life. 29.1% of the women reported either physical or sexual violence in past 1 year (current violence). 12% of the women reported mental ill health. Women who had experienced domestic violence were more likely to report mental ill health status and suicidal tendencies as compared to women who had not experienced violence. CONCLUSIONS: Domestic violence is associated with mental ill health.

Color doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome.

OBJECTIVE: The aim of our study was to evaluate the usefulness of the pulsatility index (PI) of the umbilical artery (UA) and that of the fetal middle cerebral artery (MCA), as well as the ratio of the MCA PI to the UA PI (C/U ratio), in the diagnosis of small-for-gestational-age (SGA) fetuses and in the prediction of adverse perinatal outcome. MATERIALS AND METHODS: The study population comprised 90 pregnancies of 30-41 weeks gestation that had been diagnosed clinically as intrauterine growth retardation (IUGR) over a period of 1 year. The UA PI and the MCA PI as well as the C/U ratio were calculated. RESULTS: Of the 90 pregnancies in the study, 24 showed abnormal UA PI. Among these, 21 (87.5%) were SGA and 19 (79.2%) had adverse perinatal outcome. Of the four of the 90 pregnancies that showed abnormal MCA PI, all were SGA and had adverse perinatal outcome. Similarly, of the 20 out of 90 pregnancies that showed abnormal C/U ratio (<1.08), all 20 (100%) were SGA and had adverse perinatal outcome. The results were correlated with parameters of fetal outcome. CONCLUSION: INFERENCES DRAWN FROM THE STUDY WERE: (1) The C/U ratio is a better predictor of SGA fetuses and adverse perinatal outcome than the MCA PI or the UA PI used alone, (2) The UA PI can be used to identify IUGR per se and (3) The MCA PI alone is not a reliable indicator for predicting fetal distress.

A Cross-sectional Study of QOL of Diabetic Patients at Tertiary Care Hospitals in Delhi.

BACKGROUND: According to WHO estimates India will be the global capital of diabetes by 2025, accounting for 57.2 million diabetics. Worsening the situation is the fact that diabetes affects the economically productive age-group (45-65 years) in developing countries. OBJECTIVE: To measure quality of life (QOL) and study the clinical profiles and associated sociodemographic factors affecting diabetic patients aged 20 years and above. MATERIALS AND METHODS: We conducted a hospital-based cross-sectional study using a generic instrument, Short-Form 36 (SF-36 of the Medical Outcome Study Group) to measure QOL of diabetic subjects aged >/=20 years. Two hundred and sixty diabetics, including 91 males and 169 females, were selected from the clinics of SSK Hospital and Dr RML Hospital of New Delhi. Data was analysed using SPSS for Windows, version 12. RESULTS: The mean age of the respondents was 49.7 years, with 80% of respondents being in the age-group of 40-69 years. The majority (52.1%) of female respondents were illiterate and 91.1% were economically dependent. Of the male respondents, 65.9% were skilled workers. Substance abuse was present among 41.8% male subjects. Type 2 diabetes was the commonest, with 94.6% of the subjects having this form. The mean duration of diabetes was 6.96 +/- 6.08 years. Oral hypoglycemic agents were being taken by 70.77% of the respondents. Among the diabetics the most common comorbidity was hypertension (30.8%) and the commonest complication was neuropathy (26.2%). We calculated the body mass index (BMI) of all subjects and found that, 46.2% of the male and 59.8% of the female respondents were either overweight or obese. As predicted by the waist/hip ratio (WHR), 53.8% of the male and 66.9% of the female respondents had high risk for CHD. Regular physical activity was undertaken by less than half of the subjects (46.5%). Out of eight domains of QOL in the SF-36, the two most affected were 'General Health' and 'Vitality.' Overall, males had higher QOL scores; this was found to be statistically significant (P = 0.0001). SF-36 and its eight domain scores had significant association with socioeconomic status, education, and habitual physical activity. CONCLUSION: Diabetes had an adverse effect on the QOL of these study subjects. Females had a significantly poorer QOL than males. The domains most affected were 'General Health' and 'Vitality.' Poor scores in the QOL domains were significantly associated with lower socioeconomic status, lesser education, and lesser habitual physical activity.

Camphor-based alpha-bromo ketones for the asymmetric darzens reaction

(1R)-2-endo-Bromoacetyl-1,7,7-trimethylbicyclo[2.2.1]heptan-2-ol (endo-2-bromoacetylisoborneol) 4 and its trimethylsilyl ether 3 are presented as efficient reagents for the asymmetric Darzens reaction. From the alpha,beta-epoxy ketone adducts the chiral inductor camphor is removed, by treatment with ceric(IV) ammonium nitrate, to yield the corresponding epoxy acids which are isolated as their dicyclohexylammonium salts.

Transport Properties of Aqueous Glycerol and Aqueous Mannitol through the Zirconium Oxide Membrane

The transport properties of aqueous glycerol and aqueous mannitol across a zirconium oxide membrane are, investigated from the point of view of irreversible thermodynamics. The data on hydrodynamic permeability are analyzed in terms of frictional coefficients and entropy of activation. The phenomenological coefficient characterizing the electroosmotic flow and the membrane characteristics are also estimated for the various solutions with the object of determining the efficiencies of electrokinetic energy conversion and zeta potential. Copyright 1997Academic Press

Lymphoproliferation and in vitro antibody synthesis in leprosy patients

An in vitro system to assess B-cell function in leprosy patients is described. In vitro lymphoproliferation and antibody synthesis by peripheral blood mononuclear cells (PBMC) in response to pokeweed mitogen (PWM) and Formalin-treated Staphylococcus aureus Cowan I (FSA) from 31 leprosy patients and 13 healthy controls were studied. DNA synthesis was induced by both PWM and FSA in PBMC from all of the leprosy patients and control subjects. Lepromatous leprosy (LL) patients' cells showed higher responses to both PWM and FSA. However, these increases were not statistically significant. The levels of secreted IgM, IgG, or IgA were examined in the 7-day culture supernatants of PBMC cultured with or without PWM or FSA using an enzyme-linked immunosorbent assay. Wide individual variations were observed in in vitro antibody synthesis. IgM secretion in PBMC from normal subjects and various groups of leprosy patients in response to PWM and FSA was comparable. In vitro IgG secretion in response to PWM was the highest in cells from LL patients; it was significantly decreased in cells from tuberculoid leprosy (TT) patients (p less than 0.01). The levels in cells from borderline leprosy (BB) patients were intermediate in response to the same mitogen. Cells from leprosy patients as a group showed a higher spontaneous secretion of IgA in comparison with cells from normal subjects. Overall, the in vitro Ig secretion by PBMC in different patient groups appears to reproduce the spectrum of antibody levels observed in patients in vivo. Thus, the present in vitro culture system may help to delineate the mechanisms of B-cell dysregulation in leprosy