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   2014| July-December  | Volume 5 | Issue 2  
    Online since July 1, 2014

 
 
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ORIGINAL ARTICLES
Seroprevalence of Transfusion Transmissible Infections (TTIs) among blood donors in a tertiary care hospital, central India: A prospective study
Alok Kumar, Shatish M Sharma, Narayan S Ingole, Nitin Gangane
July-December 2014, 5(2):113-116
DOI:10.4103/0975-9727.135737  
Background: Blood transfusion having some risks of transfusion transmissible infections (TTIs) in the recipients especially when blood is collected during window period. In Africa, about 10-15% of human immunodeficiency virus (HIV) transmission had been related to blood transfusions. Aims: The aim of this study is to present the prevalence of TTIs among the apparently healthy donors, both voluntary as well as replacement donors. Settings and Design: This was a prospective study, carried out in a blood bank attached to a tertiary care hospital, Central India. Materials and Methods: All blood bags collected from these blood donors during the study period were screened for TTIs like hepatitis B surface antigen (HBsAg; Hepalisa, J. Mitra), anti-HIV antibodies (HIV Ab; HIV 3rd generation kit for detection of antibodies to HIV1 and HIV2, J. Mitra), anti-hepatitis C virus antibodies (HCV Ab; MicroELISA 3rd generation, J. Mitra), and Venereal Diseases Research Laboratory (VDRL) reactivity (Carbogen kit, Tulip Diagnostics). Serum were separated from all blood bags and serological test was performed according to the instructions provided by the manufacturers of respective kit. All seroreactive blood bags were considered as positive for TTIs and the blood bags were discarded. Statistical Analysis: A total of 10,582 blood donors were selected for blood donation after clinical history and brief medical examination by medical officer. Blood bags collected from them were screened for TTIs. Among the total blood bags screened, 273 (2.57%) were found positive for transfusion transmissible infectious diseases. Results: Among TTIs, the most common infection was hepatitis B followed by HIV infection in our study. Prevalence of coinfection in our study was very low (0.01%). Voluntary donations have low seroreactivity (2.40%) for TTIs as compared to replacement donations (3.20%). Conclusions: Multiple infections have a very small but definite risk to the recipients, recieving blood and blood products. Hepatitis B was the most common infection in our study. The incidence of coinfection was very low in our study. Prevalence of TTIs was more among replacement donors as compared to the voluntary donors. So, it is possible to improve the safety of blood and blood product by the promotion of voluntary donation, selection of low-risk donors, and use of highly sensitive laboratory screening test.
  4 3,859 984
Detection of Rotavirus and Adenovirus diarrhea in children below five years, in Dakshina Kannada District, a coastal region of Karnataka State, India
Anup Kumar Shetty, Faizan Mohammad Kalekhan, Sibin Jose Muthiravalapil, Rekha Boloor, Beena Antony
July-December 2014, 5(2):143-148
DOI:10.4103/0975-9727.135749  
Context: Diarrheal disease is the second largest cause of death of children under 5 years. Viral diarrhea is most common which is usually caused by Rotavirus followed by enteric Adenovirus. Rotaviruses are responsible for approximately 527,000 deaths mainly in low-income countries of Africa and Asia. There is limited number of studies done on viral diarrhea in this coastal belt. Aim: To determine the prevalence of Rotavirus and Adenovirus diarrhea among children below 5 years of age and its epidemiological importance in this coastal region of Karnataka State, India. The impact of factors like socio-economic status, drinking water, and Rotavirus immunization status that can contribute to the disease were also evaluated and recommendations are formulated for disease prevention. Materials and Methods: Children below 5 years of age with history of diarrhea, vomiting and fever of less than 3 days were included in this study. The sample size was 35. General physical examination, clinical findings and other details like socio-economic status, personal hygiene, growth milestones and family income were also recorded. A commercial Rotavirus and Adenovirus antigen detection kit was used to detect the presence of Rotavirus and Adenovirus antigen from the stool sample. Results: Out of 35 patients screened, 25 (71.43%) patients were negative for both Adenovirus and Rotavirus, 10 children (28.57%) were positive for Rotavirus and no patients were positive for Adenovirus. Severe dehydration, fever, loose stools and vomiting were the commonest symptoms seen in Rotavirus positive children. The highest incidence of infection with Rotavirus was seen among 7-12 months age group. Children whose stool was positive for Rotavirus used public water supply. Conclusions: Rotavirus is an important cause of diarrhea in children below 5 years in this coastal region. A simple, rapid immunochromatography test is useful and economical tool to simultaneously detect and screen Adenovirus and Rotavirus. Low socioeconomic state and unsafe water supply contributes to diarrheal disease.
  3 5,563 562
CASE REPORTS
Warthin tumor with extensive squamous and mucinous metaplasia: Pathologist's dilemma
JB Leena, Reshma G Kini, Sumanth Devaraju, Subhan R Ali
July-December 2014, 5(2):179-181
DOI:10.4103/0975-9727.135768  
Secondary changes in Warthin tumor (WT) are not uncommon. Diagnostic error in Fine Needle Aspiration (FNA) is caused by a lack of typical features and the presence of individual atypical squamous cells in a necrotic background, mimicking carcinoma. Mucoepidermoid carcinoma, squamous cell carcinoma, and oncocytoma are the commonest tumors diagnosed in place of WT, the source of error being the presence of squamous metaplasia in the former two and the absence of the lymphoid cells in the latter. We report a case of WT with extensive squamous and mucinous metaplasia with desmoplasia and a certain degree of atypia which was diagnosed on FNA as Low Grade Mucoepidermoid Carcinoma (LGMEC). Prior FNA of the lesion may be the reason for the extensive metaplasia, desmoplasia, as well as atypia in our case. An extensive histopathological examination of the superficial parotidectomy specimen helped us arrive at the correct diagnosis.
  2 4,808 438
MEDICAL HISTORY PAGE
Discovery of artemisinin: The Chinese wonder drug
Padmaja Udaykumar
July-December 2014, 5(2):191-192
DOI:10.4103/0975-9727.135780  
Artemisinin, a great boon to the patients of multidrug-resistant malaria, has an equally amazing history. Although used by the Chinese herbal healers centuries ago, its introduction to the modern system of medicine was preceded by extensive research. The success of 'project 523' is further evidence to the medical fraternity that collaborative research can yield rich dividends. Although many claim credit, Dr. Youyou Tu was awarded the Lasker prize for the feat.
  2 3,440 367
ORIGINAL ARTICLES
Impact of adiposity markers on Peak expiratory flow rate in young adult South Indian females
Jnaneshwara Panduranga Shenoy, J Shivakumar, B Kalpana, Shankar K Bhat
July-December 2014, 5(2):121-124
DOI:10.4103/0975-9727.135739  
Background: Even though several factors like respiratory muscle strength, lung compliance, resistance to airflow, and elastic recoil of lungs determine lung functions, physical factors such as height, weight and central pattern of fat distribution also affect the pulmonary functions. Objective: The present study was done to assess the impact of both general as well as central adiposity markers on PEFR in young adult females. Materials and Methods: The study was conducted on 186 healthy young female medical students in the age group of 18-22 years. The study group was divided into three groups based on BMI (as per WHO Asian guidelines). Those with BMI between 18.5 to 22.9 kg/m 2 were considered as normal weight individuals, those having a BMI of 23-24.9 kg/m 2 were taken as overweight individuals and those with a BMI more than 25 were considered as obese. Waist circumference (WC), Waist to hip ratio (WHR) and waist to height ratio were also calculated; these serve as measures for central pattern of fat distribution. PEFR was recorded with Wright's peak flow meter and the best of three readings was considered. The data obtained was statistically analyzed using one way ANOVA and Pearson's correlation tests. A P-value less than 0.05 was considered as significant. Results: Mean value of PEFR did not show significant differences when compared between three groups. On correlation a negative association of various adiposity markers with PEFR was observed and was more related with central adiposity markers than BMI. Conclusion: Our findings suggest that obesity itself and especially the pattern of body fat distribution have independent effects on PEFR in young adult females. Abdominal adiposity may influence pulmonary functions by restricting the descent of the diaphragm and limiting lung expansion as compared to overall adiposity which may compress the chest wall.
  2 3,755 409
Study of cognitive functions in breast cancer patients: A case control study
Anupama Zeena Sequeira, K Krishnamurthy
July-December 2014, 5(2):129-133
DOI:10.4103/0975-9727.135745  
Context: One-third of breast cancer survivors report difficulties with concentration, multi-tasking, and memory. Cognitive dysfunction can have an impact on quality of life by affecting activities of daily living, treatment compliance, interpersonal relationships, work/profession, and future. Aims: The objective of this study was to evaluate the cognitive functions in breast cancer patients. Settings and Design: This study was conducted in the outpatient department of Oncology from where the cases were recruited. The controls were patients attending other departments and not suffering from cancer. Materials and Methods: A total of 60 patients, 30 breast cancer patients and 30 non-cancer individuals patients matched for age, education were evaluated. Tools used were SMMSE, TMT-B, and DSST for evaluation of cognitive functions. Statistical Analysis: The various findings were analyzed using Chi-square test, Mann-Whitney Test, T test and ANOVA. Results: Breast cancer patients had highly statistically significant cognitive deficits in language and recall domains and significant deficit on orientation domain of SMMSE. They performed poorly in TMT-B, taking more time to complete the test which was statistically highly significant. No significant deficits were noted on the DSST test. Conclusion: Breast cancer patients show statistically significant cognitive deficits as compared to non cancer individuals.
  2 2,925 304
Immunobullous disorders: Clinical histopathological and immunofluorescence study of thirty-six cases
Srinath M Kambil, P Madavamurthy
July-December 2014, 5(2):134-138
DOI:10.4103/0975-9727.135747  
Background: Immunobullous disorders are characterized by antibody-mediated bullous lesions affecting the skin and mucosa. Accurate diagnosis of these disorders requires clinicopathological correlation along with immunofluorescence study. Aims and Objectives: To study the clinical, histopathological, and immunopathological features of immunobullous disorders and to analyse the utility of immunofluorescence in the diagnosis of these disorders. Materials and Methods: A total of 36 cases of immunobullous disorders observed over a span of 2 years in our institution were studied. Detailed clinical examination, histopathological examination and immunofluorescence study were done in all cases. Results: Out of 36 cases studied, 18 cases (50%) belonged to pemphigus group, 10 cases (27.78%) were bullous pemphigoid (BP), 5 cases (13.89%) were linear IgA disease (LAD), 2 cases (5.56%) were cicatricial pemphigoid (CP) and 1 case (2.77%) was lichen planus pemphigoides (LPP). Twenty-one patients (58.33%) were in the age group of 21-60 years, 9 patients (25%) were above 60 years and 6 patients (16.67%) were below 20 years. Histopathology of all cases of pemphigus vulgaris (PV) showed suprabasal bulla with acantholytic cells. Pemphigus foliaceus (PF) showed subcorneal bulla in all three cases. Immunofluorescence in all 15 cases of PV showed IgG deposition in intercellular substance (ICS) and C3 deposition in ICS in six cases. PF showed IgG deposition in ICS in all three cases. BP and CP showed deposition of IgG and C3 in a linear band at basement membrane zone (BMZ) in all cases. All cases of LAD showed linear IgA band at BMZ. Conclusion: In three cases (two cases of BP and 1 LAD), immunofluorescence was absolutely essential to come to a final diagnosis, while in two cases of CP immunofluorescence helped in confirming the clinical diagnosis as histopathological finding was nonspecific. In the remaining cases it helped in confirming the diagnosis suggested by clinical examination and light microscopy.
  2 6,236 478
REVIEW ARTICLES
SGLT2 inhibitors for treatment of Type 2 diabetes mellitus: Focus on Canagliflozin
Santosh Kumar Singh, AK Gupta
July-December 2014, 5(2):166-173
DOI:10.4103/0975-9727.135761  
The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide. The existing therapeutic classes of antidiabetic drugs are not adequately effective in maintaining long-term glycemic control in most patients, even when used in combination. Many marketed compounds do not address relevant aspects of the disease. In addition, side effects for established therapies such as hypoglycemia and weight gain have to be controlled. One emerging novel therapeutic class of antidiabetic drugs is sodium glucose co-transporter 2 (SGLT2) inhibitors. SGLT2 accounts for 90% of the glucose reabsorption in the kidney. The SGLT2 inhibitors increase urinary excretion of glucose and lower plasma glucose levels in an insulin-independent manner. This article discusses the role of novel SGLT2 inhibitor canagliflozin in the treatment of T2DM.
  2 5,294 504
CASE REPORTS
Nitrobenzene poisoning presenting as Methemoglobinemia
Amit A Bharadiya, Akshay N Lakhotia, Aparna Patange, Jyotsna B Jaju, Kushal Choraria
July-December 2014, 5(2):185-187
DOI:10.4103/0975-9727.135774  
Consumption of toxic compounds in an attempt to commit suicide is very common. Organophosphorus compounds are the most commonly consumed and fatal poisons. Nitrobenzene consumption for suicidal purposes is very rare. We would like to report a case of acute poisoning with nitrobenzene leading to methemoglobinemia, an unusual presentation.
  1 4,021 275
LETTERS TO EDITOR
Osteochondroma of zygomatic bone and its excision through intraoral approach: A rare case report
Jagannath B Kamath, Ankush Bansal, Thangam Verghese Joshua, M Gururaj
July-December 2014, 5(2):200-200
DOI:10.4103/0975-9727.135809  
  1 2,919 269
Toxic epidermal necrolysis secondary to timolol, ketorolac, and moxifloxacin eyedrops
Sandhya George, K Devi, N Asokan, Beena Narayanan
July-December 2014, 5(2):200-201
DOI:10.4103/0975-9727.135813  
  1 2,886 238
ORIGINAL ARTICLES
Fears of school-age children and parental perceptions of nursing support during hospitalization in a selected pediatric hospital, Mangalore
Helma Maria Monteiro, Asha P Shetty, Praveen V Bagali
July-December 2014, 5(2):139-142
DOI:10.4103/0975-9727.135748  
Background: A child's hospitalization is usually an unpleasant and difficult experience, both for the child and parents. Unfamiliarity of the environment, uncertainty regarding outcomes, and painful procedures are just a few stressors during hospitalization that can create overwhelming anxiety for children and their parents. Objectives: The objectives of the study were to assess the fears of school-age children during their hospitalization, assess parental perceptions of nursing support during their child's hospitalization, and to find association between children's fear and selected variables. Materials and Methods: To accomplish the objectives of the problem under study, nonexperimental typical descriptive design was adopted. The study was conducted in Regional Advanced Pediatric Care Center, Mangalore with the sample size of 60 hospitalized school-age children and their parents. Non-probability purposive sampling technique was used to select the sample. The researcher used background proforma for children and parents, Modified Child Medical Fear Scale and Modified Nurse Parent Support Tool to collect data from hospitalized school-age children and their parents, respectively. The tools were assessed for their reliability with the similar sample and found reliable. Informed consent was obtained from the study subjects. Results: Majority of the school-age children (91.67%) had moderate fear and 8.33% had high fear of hospitalization. Majority (70%) of parents have perceived fully satisfactory nursing support and 30% were satisfied with nursing support provided during their child's hospitalization. There was no significant association between the fears and selected demographic variables such as age of the child, gender, number of days of hospitalization, and previous experience of hospitalization. There was no significant difference between the fears in different age-groups of hospitalized school-age children to the different areas of fear in the hospital, i.e., environmental, procedural, interpersonal, and intrapersonal fears. Conclusion: Nurses should encourage children to express their fears and discuss their coping strategies. Nurses can promote the quality of family-centered care and should be aware of the importance of the several types of nursing support in meeting the requests of parents.
  1 3,619 363
Autoantibody profile in a cohort of South Indian children with Kawasaki disease
Suchetha Rao, Chaitanya Verma, Rathika Shenoy, Nutan Kamath
July-December 2014, 5(2):125-128
DOI:10.4103/0975-9727.135742  
Objective: There is no clear data on autoantibody levels in Kawasaki Disease (KD) especially from the Indian Subcontinent. Aim: To look for the presence of organ nonspecific and organ specific antibodies to strengthen the search for an autoimmune cause of KD. We tested the presence of antinuclear antibody (ANA) and antithyroid microsomal antibody (TMA) in children with KD, 6 months after the acute phase. Anti Neutrophil Cytoplasmic Antibody (pANCA, cANCA), Anti Endothelial Cytoplasm Antibody (AECA) and Anti Smooth Muscle Antibody (SMA) was additionally tested in those with elevated titers of ANA and/or TMA. Materials and Methods: Prospective case-control study of 24 children with KD on follow up and an equal number of age and sex matched controls. Historical data about acute phase of illness was obtained from the medical records. After obtaining institutional ethics committee clearance and informed consent from the parents, blood was tested for ANA and TMA by the indirect immunofluorescence method (IIF), using a kit developed by Euroimmun. Positive samples were additionally tested for pANCA, cANCA, AECA and SMA. Relationship of autoantibody elevation and clinical course in the cases was determined. Results: The age of the study group was 4 ΁ 3.2 years. Incomplete KD was seen in 12.5% of the cases. Five cases (21%) had cardiac involvement. All but one with mitral and tricuspid regurgitation resolved after the acute phase of the disease. Only her ANA was elevated. Two children (8%) positive for TMA did not show any cardiac abnormalities. Further antibody testing was negative. All three children with elevated autoantibodies were females. (P value = 0.02: statistically significant). Conclusion: Elevated autoantibodies in three (12.5%) children after the acute phase may suggest the role of autoimmunity in the etiopathogenesis of KD, even though our observations were not statistically significant.
  1 3,417 302
REVIEW ARTICLES
Steroid pulse therapies in dermatology
Gaurang Gupta, Ambuj Jain, Naveen Kikkeri Narayanasetty
July-December 2014, 5(2):155-158
DOI:10.4103/0975-9727.135756  
Steroids pulse therapies are used in inflammatory and autoimmune conditions as they are cumulatively less toxic. Pulse therapy is the administration of supra therapeutic administration of steroids in intermittent manner. This form of therapy has given excellent treatment response with very few side-effects. Various modifications of steroid pulse therapies have been tried in pemphigus, alopecia, vitiligo etc., successfully.
  1 41,058 2,441
CASE REPORTS
Acquired Horner's syndrome in an infant: A case report
Sumana J Kamath, Madhurima A Nayak, Flora D Lobo
July-December 2014, 5(2):174-176
DOI:10.4103/0975-9727.135765  
Horner's syndrome has varied etiology. We report a case of acquired Horner's syndrome in an infant. A 3-month-old female child was referred for drooping of right eye upper lid on the second postoperative day following neck surgery. On examination, she had mild ptosis of right eye; with enophthalmos and miosis. A clinical diagnosis of Horner's syndrome was made. One percent phenylephrine test was done which dilated right pupil, suggestive of a postganglionic lesion. The sample was biopsied and revealed an infected lymphatic cyst. Horner's syndrome is a collection of signs due to interruption of sympathetic innervation to eye and face, characterized by miosis, mild ptosis, enophthalmos, and anhydrosis. The sympathetic pathway is a three neuron pathway. The present lesion is in the third order fibers which form plexus around the internal carotid artery. Dissection along the carotid can be an important cause for interruption of the sympathetic pathway.
  - 3,570 208
Jejunal diverticulitis: An unusual cause of left lower quadrant abdominal pain in a young female
Chandrashekhar A Sohoni
July-December 2014, 5(2):177-178
DOI:10.4103/0975-9727.135766  
Acquired small bowel diverticulitis is an uncommon condition, predominantly affecting elderly population. It is exceedingly rare in young adults. Such a rare case of jejunal diverticulitis in a young female is presented here. Due to the nonspecific clinical presentation, accurate clinical diagnosis of this condition is difficult. Computed tomography (CT) scan provides early and specific diagnosis, thus facilitating successful nonsurgical treatment.
  - 2,883 223
Primary Sjogren's Syndrome presenting with Interstitial lung disease and Myositis
Kumkum Sarkar, Soumendra Nath Haldar, Shyamasish Das, Debananda Gonjhu, Netai Pramanik
July-December 2014, 5(2):182-184
DOI:10.4103/0975-9727.135771  
Sjogren's syndrome (SS) is an autoimmune disease, is the most common autoimmune disease following rheumatoid arthritis but remains undiagnosed in more than half. The hallmark histopathological features of SS are periepithelial lymphocytic infiltration of the affected organs. Antibodies to SSA (Ro) and SSB (La) are characteristically associated with SS. The reported frequency of pulmonary involvement in primary SS varies widely, ranging from 9% to 75% and consists of various forms of small airway diseases and interstitial lung diseases (ILD). We are reporting a case of primary SS presenting with ILD and myositis.
  - 2,946 225
Filariasis in body fluids: Report of three cases
K Jayaprakash Shetty, HL Kishan Prasad, Harish S Permi, Meera Jayakumar, HS Kiran, Netra Sajjan
July-December 2014, 5(2):188-190
DOI:10.4103/0975-9727.135778  
Filariasis is disabling parasitic disease which is prevalent worldwide and caused by various species of filarial organism. Wuchereria bancrofti (W. Bancrofti) is responsible for 90% of cases of filariasis and is found throughout the tropics and in some sub-tropical areas. Cytology has an important role in the diagnosis of subclinical filariasis. Microfilaria is frequently detected in association with neoplasm, although the role in tumorogenesis is controversial. The early detection of the disease could thus mean the difference between a productive healthy life and a lifetime of chronic disability. The identification of microfilaria in body fluids is a rare scenario. We are presenting here with three cases of microfilaria, which was detected in the pleural fluid, bronchoalveolar lavage, pericardial fluid, and in semen with different clinical scenarios. The purpose of this paper was to illustrate these examples and to review the appropriate literature in order to make physicians aware of this uncommon entity.
  - 4,799 305
EDITORIAL
Onychomycosis: Insights in disease development
P Chaitra, Nanda Kishore Bala
July-December 2014, 5(2):101-105
DOI:10.4103/0975-9727.135735  
  - 3,551 4,077
LETTERS TO EDITOR
Incidence of cervical spine injury in maxillofacial trauma
Mohammad Akheel, Suryapratap Singh Tomar
July-December 2014, 5(2):201-202
DOI:10.4103/0975-9727.135814  
  - 1,854 187
Axillary hematoma in an 18-month-old Nigerian boy with post-measles thrombocytopenia
Ibrahim Aliyu
July-December 2014, 5(2):202-203
DOI:10.4103/0975-9727.135815  
  - 2,062 189
ORIGINAL ARTICLES
Perceived behavior and practices of adolescents on sexual and reproductive health and associated factors in Kathmandu, Nepal
Dillee Prasad Paudel, Laxmi Paudel
July-December 2014, 5(2):106-112
DOI:10.4103/0975-9727.135736  
Background: Adolescence is a period of both opportunities and threats. It is an episode of exploring new options and ideas as opportunity. It is also a phase in life marked by vulnerability to risky sexual behavior and underprivileged reproductive health outcomes. Due to the deficiency of courtesy and proper guidance, millions of adolescents are facing the problems of teenage pregnancy, unsafe-abortion, psycho-social abomination, sexually transmitted diseases (STDs) and HIV/AIDS. The aim of the study was to explore the sexual and reproductive health (SRH) practices, perceived behavior, and associated factors among the adolescents. Materials and Methods: An institutional based cross-sectional study was conducted from January to May 2007 in different educational institutions of Kathmandu. Information was collected from 417 adolescents using pretested and self-administered questionnaire with their informed consent. Analysis was done using computer database SPSS-12.5 version applying appropriate statistical rules. Results were presented in tabular, graphical, and narrative forms. Results: The mean age of respondents was 17.7 ΁ 0.86 years and 57.9% of them were in grade XII. About 70.9% had good practice on Sexual and reproductive health (SRH). Most of them (83.9%) were informed on SRH via radio, TV or the internet (98.63%) and through books and newspapers (94.52%). About (22.9%) were involved in premarital sex in which 75.0% of them used condom. About 44.2% discussed on the SRH issues with family members. Gender, family income, family types, and knowledge of SRH were found significant (P < 0.05) factors affecting SRH practice. Conclusion: Nearly one quarter of the adolescents under the study had been involved in premarital sexual contact. Half of them were found to discuss on SRH with their family members. Awareness and curriculum based teaching-learning activities will support to reduce the consequences of premarital sexual contact and teenage pregnancy.
  - 6,298 2,244
Effects of esmolol on hemodynamic responses to laryngoscopy and tracheal intubation in diabetic and non-diabetic patients
Shaik Gulam Osmani, Shaila S Kamath
July-December 2014, 5(2):117-120
DOI:10.4103/0975-9727.135738  
Background: The hemodynamic response to laryngoscopy and endotracheal intubation is of concern in diabetic patients. They usually have underlying coronary and cerebrovascular disease which may lead to catastrophes during anesthesia. Materials and Methods: Seventy controlled diabetic and 70 non-diabetic patients were allocated in to four groups. Esmolol 1 mg/kg to study groups and normal saline to control groups was infused slowly over 1 min. Later all patients induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg. SBP, DBP, HR, and SpO 2 recorded every minute after intubation for 10 min. Results: In non-diabetic esmolol (NDE) and diabetic esmolol (DE) group we observed increase in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP), more in DE group compared to NDE group, but was non-significant (P > 0.05). In group non-diabetic control (NDC) and diabetic control (DC) there was significant increase (P = < 0.05) in HR, SBP, DBP for first 2 mins of intubation when compared with base line values. Rise is more marked in DC group than NDC group. Blood glucose measured after 10 mins of intubation shows no significant difference among both groups. Conclusion: Esmolol with low dose fentanyl is a near ideal drug for attenuating pressor response to laryngoscopy and intubation in controlled diabetics.
  - 3,444 363
Role of palmaris longus as a contributing factor in Carpal Tunnel Syndrome-Ultrasonographic evaluation of Median Nerve and Carpal canal diameter
Jagannath B Kamath, Babul Reddy, Nikil Jayasheelan, Amarnath D Savur
July-December 2014, 5(2):149-151
DOI:10.4103/0975-9727.135750  
Purpose: To assess the diameter of Carpal tunnel (CT) and the Median Nerve (MN) in individuals with unilateral absence of Palmaris longus (PL) and compare it with the side with presence of Palmaris longus. Materials and Methods: Volunteers (students in the age group of 18-20 years) from a medical college were enrolled over a 2-month period, October to November 2007. Twenty-five subjects with unilateral absence of PL were selected for the study. We used the wrists with PL agenesis as cases and the contra lateral side with PL as controls. Anteroposterior (AP) and transverse diameters of carpal canal and MN were measured at both proximal (pisiform) level and distal (hook of the hamate) level with wrist in neutral position. Results: Significant differences were noted in the dimensions of Carpal canal and MN on the sides with PL as compared to the sides with PL agenesis. The difference in the CT AP diameter was very highly significant at proximal and distal level (P < 0.01) whereas the transverse diameter was significantly different at both the levels. The difference in MN AP diameter was highly significant at distal level. The MN transverse diameter was significantly different at both the levels. Conclusion: In our study we found that the PL tendon is independently associated with decreased CT and MN dimensions (AP > transverse). This study supports the previously done studies on the association between the Carpal Tunnel Syndrome (CTS) and presence of PL tendon.
  - 2,927 241
REVIEW ARTICLES
Fidaxomicin: A new fight against clostridium difficile-associated diarrhea
Dick B. S. Brashier, Amol Khanapure, AK Sharma
July-December 2014, 5(2):152-154
DOI:10.4103/0975-9727.135753  
Clostridium difficile-associated diarrhea (CDAD) occurs commonly as a side effect of broad-spectrum antibiotics. Drugs approved for CDAD are only two of them, metronidazole and vancomycin. Most promising drug for treatment of CDAD is vancomycin, but due to emergence of hypervirulent strains, outcomes have become poor. Fidaxomicin has being approved lately for treatment of CDAD, which has shown good results as compared to vancomycin. Fidaxomicin inhibits protein synthesis by inhibiting transcription carried out by sigma subunit of RNA polymerase. Fidaxomicin has been seen to be a well tolerated, with minimal adverse effects. Clinical trials has showed that fidaxomicin has similar results to vancomycin in showing clinical response, whereas it was superior to vancomycin in having sustained clinical effect, in CDAD.
  - 2,673 273
Preclinical pharmacological profile of Eberconazole: A review and update
Latha Subramanya Moodahadu, Ashis Patnaik, Vakati Venkat Arvind, Ranjit Madhukar Bhide, Kavitha Katta, Binny Krishnankutty, Shantala Bellary
July-December 2014, 5(2):159-165
DOI:10.4103/0975-9727.135757  
Eberconazole is a broad-spectrum imidazole antifungal agent used as a topical preparation in the management of cutaneous mycoses. In vitro studies have shown that eberconazole is effective against dermatophytes, candidiasis, yeasts (including those which are triazole resistant) and Pityriasis versicolor. It inhibits fungal lanosterol 14α-demethylase, thereby inhibiting ergosterol synthesis leading to inhibition of fungal growth. In addition to its antifungal activity, it is also effective against Gram-positive bacteria, a property that is useful clinically. It also possesses anti-inflammatory property thus making it a suitable agent in the clinical management of inflamed cutaneous mycoses. Topical application of eberconazole was well tolerated in preclinical studies without any report of delayed hypersensitivity or photosensitivity reactions. There were no phototoxic effects. There was no significant systemic absorption. Animal toxicity studies have shown that it is safe, and the No Observed Effect Level was 2 ml/kg body weight in tested animals. It was not mutagenic and shared similar cytotoxicity profile with other imidazole antifungal products studied. Penetration studies using synthetic membranes revealed that eberconazole intrasets showed less variation as compared to clotrimazole and terbinafine intrasets. Overall amount of eberconazole released was more compared to comparators. In vitro and preclinical studies have demonstrated better therapeutic efficacy with eberconazole than clotrimazole and ketoconazole.
  - 6,810 479
SHORT COMMUNICATIONS
Utility of pre-treatment evaluation in Initiation of multi-drug resistant tuberculosis treatment
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
July-December 2014, 5(2):193-194
DOI:10.4103/0975-9727.135788  
The emergence of resistance to the first line anti-tuberculosis) drugs has posed a significant threat to the global mission of reducing the magnitude of TB. Considering the life threatening nature of the multi-drug resistant TB (MDR-TB), in addition to the poor cure rate or success rate, high default rate or incidence of complications and the potential risk of transmission of the disease to a susceptible contact, early diagnosis and initiation of the patient on second-line anti-TB drugs is of prime public health importance. The first step in ensuring a good outcome is to initiate the MDR-TB treatment regimen based on the pre-treatment evaluation (PTE) done at the drug resistant TB (DR-TB) center by an expert committee. To conclude, PTE is the crucial foundation in ensuring a favorable outcome to the treatment of DR-TB as a good PTE can detect and avert the possible drug induced adverse effects at the earliest.
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WHAT IS NEW?
Perampanel: New drug for treatment of refractory partial onset seizures
Santosh Kumar Singh, Dick B. S. Brashier
July-December 2014, 5(2):195-199
DOI:10.4103/0975-9727.135796  
Perampanel (2-[2-oxo-1-phenyl-5-pyridin-2-yl-1,2-dihydropyridin-3-yl] benzonitrile hydrate) is the latest antiepileptic drugs for treatment of refractory partial onset seizures. Perampanel inhibits α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-induced increase in intracellular Ca 2+ and selectively blocks AMPA receptor-mediated synaptic trans­mission, thus reducing neuronal excitation. Three Phase III multicenter, randomized, double-blind, placebo-controlled trials demonstrated the efficacy and good tolerability of perampanel as adjunctive treatment in patients with refractory partial-onset seizures. The drug is approved for use in the European Union and United States. The pharmacology of perampanel offers potential as more than just another new antiepileptic drug. This first-in-class drug will provide another option for practitioners of rational polytherapy.
  - 8,442 858
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