Use of the temporal extension of the buccal fat pad for closure of oro-antral communications.

Oro-antral communications/fistulae (OAC/OAF) can cause significant patient morbidity, with treatment for defects greater than 5mm in size requiring surgical reconstruction. This technical note evaluates the effectiveness, and proposes the use of, the temporal extension of the buccal fat pad (TEBFP) for the closure of large OAC. The TEBFP can be an effective means of large OAC closure due to its ease of harvesting, with minimal damage to surrounding structures or aesthetic changes. The use of the TEBFP provides stability, versatility, and tension-free closure, with minimal postoperative complications.

Efficacy and safety of a single-tablet regimen containing tenofovir disoproxil fumarate 300 mg, lamivudine 300 mg and efavirenz 400 mg as a switch strategy in virologically suppressed HIV-1-infected subjects on nonnucleoside reverse transcriptase inhibitor-containing first-line antiretroviral therapy in Pune, India.

OBJECTIVES: As per National AIDS Control Organization (NACO) estimates, there are 2.1 million people living with HIV (PWH) in India, of whom 1.2 million are on first-line antiretroviral therapy (ART). This study explored the use of a single-tablet regimen containing tenofovir disoproxil fumarate 300 mg + lamivudine 300 mg + efavirenz 400 mg (TLE400 STR) as a first-line switch strategy in PWH in Pune, India. METHODS: This retrospective cohort study was conducted in private sector ART clinics in three tertiary-level hospitals in Pune, India. PWH > 12 years of age (n = 502) who initiated first-line ART (predominantly TLE600 STR), completed ≥ 6 months of follow-up and achieved virological suppression [plasma viral load (VL) < 1000 HIV-1 RNA copies/mL] were identified and switched to TLE400 STR. The virological and immunological efficacy of TLE400 STR at 6 and 12 months of follow-up were noted. Grade 3/4 adverse events (especially efavirenz-related neuropsychiatric adverse events) leading to regimen discontinuation were also noted. RESULTS: Of 502 PWH who switched to TLE400 STR, complete virological suppression (VL < 20 copies/mL) was maintained in more than 97% of patients at follow-up. TLE400 STR was successful in maintaining CD4 counts within the range observed at the start of the regimen. Grade 3/4 adverse events leading to TLE400 STR discontinuation were seen in 11 (2.2%) patients. Virological failure (VL > 1000 copies/mL) and treatment regimen failure were seen in six (1.2%) and 49 (9.8%) subjects, respectively. CONCLUSIONS: TLE400 STR exhibits excellent efficacy and safety as a switch strategy and should be introduced in the Indian National ART Program, especially for PWH who are virologically suppressed on TLE600 STR.

Effect of chilled storage on quality characteristics of battered and breaded snack product from large sized Catla (Catla catla).

This study was performed to determine quality changes of battered and breaded pre-fried snack product developed from large sized (5.5-10.5 kg) Catla (Catla catla) fish stored at chilled temperature (- 2 to - 4 °C). Quality changes were assessed based on biochemical, microbiological and sensory quality evaluation at 2 days interval for a period of 18 days. Results of biochemical analysis showed increase in total volatile base-nitrogen (TVB-N) values from initial value of 4.15-13.74 mg/100 g, free fatty acid (FFA) increased from 0.95 to 2.98% in terms of oleic acid, peroxide value (PV) increased from 2.6 to 3.9 meq of O2/kg of fat and pH increased from 6.5 to 6.79 during 18 days chilled storage. Linearity (r2) of TVB-N, FFA, PV and pH values during storage were found to be 0.98, 0.99, 0.97 and 0.99 respectively. In microbiological quality evaluation total plate count (Log. Values) increased from 2.17 to 4.65, while Escherichia coli, Staphylococcus aureus, Salmonella and spore count were not detected during storage period. Results of sensory analysis reported a negative correlation with storage period concluding the shelf life of battered and breaded fish cutlet from Catla fish to be 12 days at chilled storage conditions.

Anti-urolithiatic effects of Punica granatum in male rats.

ETHNOPHARMACOLOGICAL RELEVANCE: The traditional use of Punica granatum has been reported to regulate urine discharge and controls the burning sensation of urine. MATERIALS AND METHODS: Animals model of calcium oxalate urolithiasis was developed in male rats by adding ethylene glycol 0.75% in drinking water. The Punica granatum chloroform extract (PGCE) and Punica grantum methanol extract (PGME) orally at 100, 200 and 400mg/kg, respectively, were administered along with ethylene glycol for 28 days. On 28 day, 24h urine was collected from individual rats and used for estimation of urine calcium, phosphate and oxalate. The serum creatinine, urea and uric acid levels were estimated in each animal. The kidney homogenate was used for the estimation of renal oxalate contents. The paraffin kidney sections were prepared to observe the CaOx deposits. RESULTS: The ethylene glycol control (Gr.-II) had significant (P<0.001 vs. normal) increase in levels of urine oxalate, calcium and phosphate, serum creatinine, urea and uric acid and renal tissues oxalates, as compared to normal (Gr.-I). The paraffin kidney sections show significant histopathological changes. The treatment of PGCE and PGME at 100, 200 and 400mg/kg doses, significantly (P<0.001 vs. control) decreased the urine oxalate, calcium and phosphate, renal tissue oxalates and serum creatinine, urea and uric acid, in EG induced urolithiasis after 28 days. CONCLUSIONS: The PGCE and PGME at the doses of 400mg/kg, found to be more effective in decreasing the urolithiasis and regeneration of renal tissues in male rats.

Extra-oesophageal presentation of gastro-oesophageal reflux disease.

Gastro-oesophageal reflux disease has now been definitely associated with pulmonary symptoms and diseases, such as asthma, cough, chronic bronchitis, pneumonia, and pulmonary fibrosis; otolaryngologic symptoms and findings include hoarseness, pharyngitis, cough, laryngitis, subglottic stenosis, globus, and laryngeal cancer. Gastro-oesophageal reflux disease is also associated with noncardiac chest pain, dental erosion, sinusitis and sleep apnoea. This discussion focuses on some of these extra-oesophageal presentations of gastro-oesophageal reflux disease and the general management of these individuals.

Isoniazid toxicity presenting as status epilepticus and severe metabolic acidosis.

Isoniazid (INH) is an integral component of treatment of tuberculosis. An acute overdose is potentially fatal and is characterized by the clinical triad of repetitive seizures unresponsive to the usual anticonvulsants, metabolic acidosis with a high anion gap and coma. The diagnosis of INH overdose should be considered in any patient who presents to emergency medical services (EMS) with the triad. We report a patient presenting with multiple generalised tonic clonic (GTC) convulsions with severe metabolic acidosis as a manifestation of INH toxicity.

Free Radical Scavenging Activity of Calotropis gigantea on Streptozotocin-Induced Diabetic Rats.

Swarnabhasma, an Ayurvedic preparation containing Calotropis gigantea R. Br. (Asclepiadaceae) is extensively used by Ayurvedic physicians for treatment of diabetes mellitus, bronchial asthma, rheumatoid arthritis and nervous disorders. In the present study, we report the effect of chloroform extracts of Calotropis gigantea leaf and flower on free radical scavenging activity, and lipid profile in streptozotozin-induced diabetic rats. The lipid peroxidation, superoxide dismutase, and catalase were measured in liver homogenate and serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, lipid profile were measured in blood serum. Administration of single dose of streptozotozin (55 mg/kg, i.p.) caused significant increases in lipid peroxidation, serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, cholesterol and triglyceride levels, while superoxide dismutase and catalase levels were significantly decreased. Further, administration of chloroform extracts of Calotropis gigantea leaf and flower to streptozotocin-induced diabetes rats at a dose of 10, 20 and 50 mg/kg orally for 27 d lead to a significant decrease in lipid peroxidation, serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, cholesterol and triglyceride levels. Consequently, superoxide dismutase and catalase levels were significantly increased. Glibenclamide was used as a positive control (10 mg/kg). It was observed that the effect of chloroform extracts of Calotropis gigantea on alkaline phosphatase, cholesterol, superoxide dismutase, serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, levels are comparable to that of those produced by the positive control.

Depression--an adverse event with nifedipine.

Two cases are reported in which depression was associated with the use of calcium channel blocker, nifedipine. In one instance, a patient became unresponsive to treatment with nortriptyline when nifedipine was introduced. In both cases, the depression resolved following discontinuation of nifedipine.

Alprozolam poisoning.

We report a rare case of Alprazolam poisoning presented with coma and respiratory depression in a young girl with positive family history of suicidal attempts by her father, mother and sister. The Alprazolam was available in large amount in form of "Physicians Samples" as her elder sister was a medical representative. The patient was successfully managed.

Relationship between waiting time and retention in treatment amongst substance abusers.

The assumption that immediate response to substance abusers' pleas for help increases the likelihood of retention in treatment is tested in a substance abuse facility in the Home Counties which offers a range of treatment options excluding prescription of narcotics substitutes. It has shorter waiting times between referral and first appointments and higher rates of initial attendance than the local general psychiatric clinics. Patients seen within 7 days continue to attend for no longer than those who have to wait longer. Those who continue longer are more likely to be referred by their G.P., are more likely to have alcohol or alcohol and other drug related problems and are less likely to seek or need immediate inpatient admission.

Sporadic Ehlers-Danlos syndrome with neurologic, cardiac and dental involvement.

A sporadic case of Ehlers-Danlos syndrome associated with atlantoaxial dislocation, mitral valve prolapse and dental abnormalities is presented. This case could not be assigned to any of the nine defined types of the syndrome.

Heroin misuse and delinquency in a new town.

The subjects of this study were eighty misusers of heroin who lived in the New Town of Crawley, West Sussex. The relationship between their criminal histories and their histories of drug misuse were examined. It was found that more of the heroin misusers than would be expected had been convicted of criminal offenses before they began to misuse drugs, while the reduction or cessation of heroin use during a four-year follow-up period was accompanied by a reduction in convictions. Some social characteristics of the male heroin misusers were compared with those of two other Crawley groups--a group of juvenile offenders who did not misuse heroin and their control group of non-delinquents. Characteristics commonly associated with maladjustment did not distinguish the heroin misusers from the juvenile offenders, nor were they found to be associated with the continued use of heroin. Analysis of the data in epidemiological terms suggested that among the necessary conditions for an outbreak of drug misuse in a particular community the availability of drugs together with socializing drug users were more important than the presence of predisposed individuals.

Case-note abstraction: a methodological substudy as cautionary tale.

A sample of 42 case notes of alcoholic patients were abstracted for 17 items by three different raters. Interrater agreement was generally rather low. Research based on case-note abstraction which does not report on abstraction reliabilities must therefore be viewed with some suspicion. It would be helpful if clinical material could more often be collected in a standardized manner.