Clinico-Epidemiological Profile and Predictors of Poor Outcome Among Children During a Diphtheria Outbreak in Haryana

Objective: To study the clinico-epidemiological profile and predictors of poor outcome in an outbreak of diphtheria. Methods: Records of 390 children admitted with the diagnosis of clinical diphtheria in a tertiary care teaching hospital in Nuh, Haryana, from January, 2018 to December, 2020 were analysed with respect to demographic details, immunization status, clinical features, complications and mortality. Patients were divided into survivors and nonsurvivors, and various variables were compared between the two groups to identify the factors associated with poor outcome. Results: Out of 390 cases, data of 318 (81.5%) was included. Young children (median age 5 year) were predominantly affected, and only 8 (2.5%) children were fully immunized. Pseudomembrane was present in 245 (77%) cases. Albert staining and culture were positive in 84.6% (269) and 12.9% (41) cases, respectively. Complications developed in 48.4% (n=154) cases and included: airway compromise 22.6% (n=72), diphtheritic cardiomyopathy 12.9% (n=41), acute kidney injury 3.7% (n=12), thrombocytopenia 8.5% (n=27) and hepatitis 0.6% (n=2) cases. Anti-diphtheritic serum (ADS) was administered to all admitted patients. Tracheostomy was done in (n=57) (17.9%) children. Case fatality rate was 17.9%. Conclusion: Diphtheria mostly affected young unvaccinated or partially vaccinated children. Mortality was high in unimmunized or partially immunized young children and those with bull neck, pseudomembrane, delayed (?5 days) administration of ADS, acute kidney injury, thrombocytopenia and leukocytosis. Myocarditis was strongly associated with high mortality.

Isolation of dihydrobenzofuran derivatives from ethnomedicinal species Polygonum barbatum as anticancer compounds

BACKGROUND: Ethnomedicinally, the family Polygonaceae is famous for the management of cancer. Various species of this family have been reported with anticancer potentials. This study was designed to isolate anticancer compounds from ethnomedicinally important species Polygonum barbatum. METHODS: The column chromatography was used for the isolation of compounds from the solvent fraction of P. barbatum. The characterization of isolated compounds was performed by various spectroscopic techniques like UV, IR, mass spectrometry and 1D-2D NMR spectroscopy. Keeping in view the ethnomedicinal importance of the family, genus and species of P barbatum, the isolated compounds (1-3) were screened for anticancer potentials against oral cancer (CAL-27) and lungs cancer (NCI H460) cell lines using MTT assay. Active compound was further investigated for apoptosis by using morphological changes and flow cytometry analysis. In vivo anti-angiogenic study of the isolated compounds was also carried using chorioallantoic membrane assay. Docking studies were carried out to explore the mechanism of anticancer activity. RESULTS: Three dihydrobenzofuran derivatives (1-3) have been isolated from the ethyl acetate fraction of P. barbatum. The structures of isolated compounds were elucidated as methyl (2S,3S)-2-(3,4-dimethoxyphenyl)-4-((E)-3-ethoxy-3-oxoprop-1-en-1-yl)-7-methoxy-2,3-dihydrobenzo-furan-3-carboxylate (1), (E)-3-((2S,3S)-2-(3,4-dimethoxyphenyl)-7-methoxy-3-(methoxy carbonyl)-2,3-dihydrobenzofuran-4-yl)acrylic acid (2) and (2S,3 S)-4-((E)-2-carboxyvinyl)-2-(3,4-dimethoxyphenyl)-7-hydroxy-2,3-dihydrobenzofuran-3-carboxylic acid (3). The compound 1 was found to be more potent with IC50 of 48.52 ± 0.95 and 53.24 ± 1.49 against oral cancer cells as compared to standard drug (IC50 = 97.76 ± 3.44 µM). Both compound also inhibited lung cancer cells but at higher concentrations. Morphological and flow cytometry analysis further confirms that compound 1 induces apoptosis after 24 to 48 h treatment. In antiangiogenesis assay, compounds 1, 2 and 3 exhibited IC50 values of 8.2 ± 1.1,13.4 ± 1.1 and 57.7 ± 0.3 µM respectively. The docking studies revealed that the compounds under study have the potential to target the DNA and thymidylate synthase (TS). CONCLUSION: Based on its overwhelming potency against the tested cell lines and in angiogenesis assay, compound 1 can be further evaluated mechanistically and can be developed as anticancer drug candidate.

Frequency of hepatocellular carcinoma in cirrhotic patients with hepatitis-C virus positive patients in Karachi-Pakistan.

Background: Hepatocellular Carcinoma is the 5th most common neoplasm in the world and 4th most common cancer death. Most patients with HCC have an underlying chronic liver disease (often cirrhosis), resulting mainly from chronic infection by Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), excessive alcohol consumption, and often an association of these causes. HCC has recently gained more interest due to its increasing incidence in industrialized countries. Objective: To determine the frequency of hepatocellular carcinoma in hepatitis C reactive cirrhotic patients. Methods: Place and duration of study: Department of medicine, civil hospital Karachi. Duration: Six months from 16-12-2012 to 15-6-2013. Subjects and methods: Patients admitted in medical wards of civil hospital Karachi with liver cirrhosis due to hepatitis C virus were included in the study. Investigation relevant to hepatocellular carcinoma like alpha fetoprotein and ultrasound was performed. If the Alpha fetoprotein is greater, then 200 ng/ml in the setting of a mass in a cirrhotic liver the likelihood of hepatocellular carcinoma is greater then 90% and biopsy is not required. Results: Overall mean age was 41.1 ± 7.1 years with Male:Female = 4.2:1. Out of 141 cases; hepatocellular carcinoma was diagnosed in 8 (5.7%) of patients with HCV related cirrhosis with mean age 48.6 ± 6.4 years. Proportion of hepatocellular carcinoma was high 7 (6.1%) in male. 7 (6.4%) cases had child pugh-C, 1 (5%) case had child pugh-B and while no HCC was seen in child pugh-A. Conclusion: In this study hepatocellular carcinoma was 5.7% in cases with hepatitis-C induced cirrhosis. Older age (>54 years), male sex and child pugh-C were predominant factors leading to hepatocellular carcinoma.

UPLC method development and validation for cefditoren pivoxil in active pharmaceutical ingredient.

The objective of the study was to develop UPLC method for the determination of purity of Cefditoren Pivoxil in API and its validation. UPLC is a better technique than HPLC in terms of performance and speed, so it was selected. The method was developed using Acetonitrile and Ammonium Acetate buffer (pH 6.7) and Kromacil column C18 (50×2.1mm, 3.5μ) as a stationary phase at a flow rate of 0.25ml/min. Validation was done by linearity, precision, and robustness studies. The precision was found to be within the limits. The linearity studies indicated the drug obeys Beer’s law and revealed the specified range of linearity for drug was between 80μg/ml and 120μg/ml. The robustness was observed from the insignificant variation in the analysis by changes in flow rate, mobile phase ratio, wavelength, column oven temperature and pH. Forced Degradation study revealed the drug degraded initially by the influence of acid, alkali, and peroxide. Solution stability study showed the drug was not stable for more than 2 h at 25˚C but stable at 5˚C. It can be concluded that the proposed method was simple, precise, and robust and can be useful for determination of purity of Cefditoren Pivoxil in API by using UPLC.