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Rheumatoid arthritis (RA) is a chronic, symmetrical, inflammatory autoimmune disease that affects small joints. RA has a population prevalence of 0.5% to 1% in the U.S. The annual cost of care for chronic treatment of RA in the United States is estimated at $12,509. Pharmaceutical companies have developed drugs to treat RA using Janus kinase (JAK) inhibitors. These drugs can have potential adverse effects. Forecasting a better output to JAK inhibitors (JAKI’s). Therapy duration of JAKI’s and Problems regarding to strategies of dose reduction or if the discontinuation of therapy takes place in case of low disease activity. The accurate pharmacological profile and interactions of other drugs with JAKI’s have to establish. Proper safety, efficacy profile of JAKI’s and when administered in combination with DMARD’s. The safety, efficacy data of JAKI’s when compared to non-anti-TNF biologics. Obtaining of experience on JAKI’s that were already existed in the market and further experimental findings on newer compounds and which may clarify many of the aspects which are to be solved in nearer future as these JAKI will have greater application in treatment of RA. Regardless of significant developments in latest years in the pharmacotherapy of RA in the use of JAK inhibitors, yet the adverse effects of JAK inhibitors are unanswered. Therefore, one of the main concerns associated with JAK inhibitor is the potential adverse effects. The challenges can be addressed by clinical pharmacist mediated interventions related to dosing of JAK inhibitors and proper management of adverse drug reactions (ADRs).
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Background: Medicine is a challenging study and is known for its demanding nature. This also results in increased stress levels among students. Understanding factors that influence stress and quality of life from medical students in different regions is important for the development of effective interventions and support systems. Methods: A meticulous quantitative method approach has been utilized. This research is done via data fetched through a questionnaire. Statistical analyses are comprised of t-tests and correlation tests to employ a dissection of quantitative data while the data is subjected to analysis to uncover the underlying patterns and nuances. These results showcase crucial disparities in the stress levels between medical students in Southern Asia and the South Caucasus while imparting light on factors impacting the quality of life experienced by students in both regions. Results: The implications of this study hold primary significance for sharing information with targeted interventions with an aim at bolstering the mental health and academic performance of medical students in both the areas of Southern Asia and the South Caucasus. Conclusions: The major objective of this study is to hold comparisons of stress levels and quality aspects of life in Southern Asia and South Caucasus, with the identification of the multifaceted factors that contribute to the stress levels among students in both regions, understanding the various challenges and sharing a glimpse of actionable implications for interventions which are aimed at bolstering students’ well-being.
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Non-steroidal anti-inflammatory drugs (NSAIDS) are used in a wide range but may cause harm to the gastrointestinal mucosa, which leads to various complications. This study shows the impact of long term NSAID use on small and large intestine and presents 2 cases of patients with NSAID induced perforations. The first case involves a 62-year-old male patient with RA on long term Ibuprofen use, presented with abdominal pain, vomiting, and lower limbs pain. Laparotomy revealed a 5 mm perforation in the proximal jejunum. The second case, a male patient of 65 years of age using diclofenac without a prescription, which lead to a 4×4 cm sigmoid colon perforation. The comparison of both the cases presents a difference in examination and laboratory findings. Long-term NSAID use has been associated with various GI complications, including perforations. The case presents the importance of considering NSAID related complications, mainly in older patients and the persons with ulcers. Combining NSAIDS with other drugs, like misoprostol may minimize the risk of the GI complications. NSAIDs are also linked with cardiovascular events, and heart related issues. This study shows the need of careful NSAID prescription, with their association with preventable adverse effects. 30% of hospitalizations for adverse drug reactions are only by the NSAIDs. PPIs and H2 receptor antagonist are commonly used to protect the gastrointestinal mucosa which minimizes the occurrence of ulcers. Healthcare professionals should be careful particularly in case of high risk patients to minimize the NSAID related complications.
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Present research work was carried out at the research farm of Department of Genetics and Plant Breeding, Rama University, Kanpur to investigate the pattern of genetic variability and heritability in the elite genotypes of wheat germplasm. In current study 27 wheat genotypes including checks entries viz., HD 2967 AND PBW 152 have been evaluated in randomized block design in 3 replication and the observations have been recorded on the eleven metric traits viz., Days to 50% flowering, Days to maturity, Flag leaf area (cm2), Tillers per plant, plant height (cm), spike length (cm), Spikelet per spike, Grain yield per plant (g), Biological yield per plant (g), Test weight (g) and Harvest index (%). The analysis of variance showed significant mean sum of squares due to all traits under study. High estimates of heritability were observed for all of the traits viz., grain yield per plant (98.90%) followed by test weight (95.53%) and harvest index (94.88 %), whereas, high estimates of genetic advance (>20%) in per cent over mean was recorded for the traits grain yield per plant (44.26%) followed by spike length (36.12%) and Test weight (28.51%), High heritability accompanied with high genetic advance for the traits showed additive gene action and the selection for such traits would be rewarding.
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The current study, which was conducted at the Agricultural Research Farm of Rama University in Mandhana, Kanpur, India, was titled Effect of varying amounts of Nitrogen (N), Phosphorus (P2O5), and Potassium (K2O) on growth and development of Sweet Orange (Citrus sinesis Osbeck) plants. In terms of maximum plant height (83.57 cm), maximum number of leaves (421.04), maximum number of branches (26.36), maximum stem diameter (3.04 cm), maximum spread of canopy (42.36 cm), maximum length of inter-nodes (9.68 cm), and maximum chlorophyll content (4.58 mg/g), the results showed that treatment T2 (850 g / plant Nitrogen, 600 g / plant Phosphorus, and 850 g / plant Potash) achieved the best results followed by treatment T9 (800 g / plant Nitrogen, 400 g / plant Phosphorus and500 g / plant Potash) and the minimum was recorded in T4(700g / plant Nitrogen, 400g / plant Phosphorus and 400g / plant Potash).
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Myoid hamartomas of breast are extremely rare lesions with poorly defined pathogenesis. They are composed of differentiated mammary glandular and stromal structures with areas of smooth muscle differentiation. They are postulated to arise from walls of the blood vessels and/or muscularis mammillae of the areolae. They usual present as a well demarcated lump and it is difficult to diagnose them on clinical and radiological basis. Diagnosis requires demonstration of smooth muscle phenotype using immunohistochemistry by smooth muscle actin and desmin. Surgical resection is the curative treatment. We reported a case of myoid hamartoma in a 50-year-old postmenopausal lady with its clinical, radiological and histopathological discussion. The lesion presented as a painless lump and was initially reported as BIRADS 4a on mammography. Apart from the stroma showing spindle cell component with smooth muscle differentiation, the histopathology also showed epithelial changes including epithelial hyperplasia and columnar cell change.
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Aim: Arrowroot (Maranta arundinacea L) is an underutilized tuber crop belonging to the family marantaceae. This study mainly aims to evaluate different arrowroot accessions for quality starch and best yield.Study of Design: The field experiment was conducted in randomized block design with total ten accessions and three replications.Place and Duration of Research: The present investigation was undertaken at the College Orchard, Department of Vegetable Science, Horticultural College & Research Institute, TNAU, Coimbatore during the year 2022-2023.Methodology: In this study, ten arrowroot accessions viz.,TAr18-01, TAr18-02,TAr18-04,TAr18-05,TAr18-10, TAr18-11, TAr18-12, TAr18-13, TAr18-14 and Local were evaluated for their growth, yield and quality parameters.Results: The statistical results revealed that all the accessions significantly differ from each other. Results obtained as maximum height in the accession TAr18-14(132.01cm), maximum number of leaves in TAr18-10 (109.33), number of tillers in TAr18-14 (8.45) and biggest rhizome weight in TAr18-14(198.81g) respectively. The yield traits like rhizome length (25.49 cm), diameter (9.46cm) and number of rhizome per plant (30.00), rhizome yield per plant (1.49kg) were maximum in TAr18-10. The quality parameters viz., dry matter (%) was highest for TAr18-10(56.76%),TSS in TAr18-12 (27.83%), ash contents in TAr18-10 (3.88%). These parameters mainly decide the quality and nutritive value of Arrowroot. There is a significant variation in the quality parameters like starch, TSS, dry matter, protein, crude fiber. Among various accessions TAr18-04 recorded the highest starch (54.62%) and TAr18-14recorded highest protein content (6.194%). Amylose content (21.88%) was maximum in TAr18-01.Conclusion: It can be concluded from the following study that TAr18-10 recorded highest rhizome yield, dry matter content with quality starch and can be selected for further evaluation and exploitation in industrial applications.
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Background: The pandemic of COVID-19 infection has almost paralyzed the world since the first infection was reported in December 2019. We have seen 3 waves of infection in the country, out of which the second wave caused by the delta variant was the most severe. Along with the preventive measures of masking, maintaining social distance, and handwashing, the vaccines seemed to be the most logical next step. Many vaccines received emergency use approvals with hardly any efficacy and adverse effects data available with the process inducing a significant amount of anxiety among the public. This survey was aimed at understanding the attitude and perception of our hospital employees towards COVID-19 vaccination. Methods: This is a cross-sectional study conducted among health care workers (HCW) at CMC, Vellore between March 2021 to July 2021. The HCWs who are willing to participate in this study were recruited and collected the quantitative data on their attitude and perception towards COVID vaccine. In-depth interviews were conducted among those who did not take vaccine to understand the reasons for not taking vaccine. The data were analyzed using statistical package for the social sciences (SPSS). Results: The survey results were analyzed on 435 HCWs. 58.4 percent of the HCWs trust the institutional protocols as the trusted source of information about vaccine. Most of the HCWs agreed that vaccines are the only protective way, and they are safe and effective. Conclusions: Sensitization and awareness programs with transparency of vaccine development processes, safety and efficacy will help remove barriers.
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Rice is the staple food to half of world’s population providing more than one fifth of the calories consumed worldwide. Cereal grains are rich sources of phenolic compounds present in cell walls that help in combating many life style diseases occurring due to oxidative stress. Rice has been domesticated more than 10000 years ago but even today the farmers prefer selling freshly harvested paddy at a lower price. Few entrepreneurial farmers have come up with the idea of primary processing the paddy as semi polished and brown rice that can fetch them more profits along with providing health benefits. Each Kg of paddy, white, semi polished and brown rice cost Rs. 17 – 18.50, 46 – 48, 58 – 60 and 65 respectively. Similarly, one Kg of brokens get Rs. 15, bran Rs. 12 during season and Rs. 20 during off season. The rice without any processing fetched the farmer profit of about Rs. 24400 to 36000 on an average per acre. But if the farmer subjected the rice to primary processing and sold as white, semi polished or brown rice, the profits generated per acre were Rs. 57156 – 66480 Rs. Rs. 82996 – 102400and Rs. 105910 – 120400 can be generated. As can be seen the decrease in processing produced lower quantity of brokens and bran and income from them was comparatively lower than on processed rice indicating that there can be rise in income with minimal processing with added health benefits. There can an increase in profits by 4 to 5 times due to primary processing benefiting the paddy growers. The white, semi polished and brown rice can increase the income of farmer by 76.92, 127.79 and 161.58% per one bag of paddy weighing 75 Kg. There was a significant decrease in brokens and bran produced in semi polished and brown rice that actually fetch less prize than the actual produce. The growing awareness of consumers towards health foods, improved eating habits and health consciousness is expanding brown rice market at higher compounded annual growth rate (CAGR) compared to overall rice market.
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Here we report a 25 years old male patient came to our emergency department with chief complaints of headache from 3 months, blurring of vision 7 days, abdominal pain 7 days, and vomiting from 2 days. Young male, with no known comorbidities, presented to our casualty with headache since, 3 months, episodic in nature, increased over the last 1 week, holocranial, gradually progressive in severity. last recorded Blood pressure outside was 220/120 mmHg and papilledema were noted on fundoscopy. USG abdomen and pelvis, CECT abdomen done and diagnosed to have bilateral adrenal pheochromocytoma. Patient underwent bilateral adrenalectomy was performed with good intra op BP control. Right adrenals were enlarged and shows multiple nodular lesions, left adrenal noted shows nodular lesions. Surgery remains the first line of management in malignant pheochromocytoma. Norepinephrine, epinephrine, and dopamine all act on their target receptors, which causes a physiological change in the body. Increase in catecholamines cause severe hypertension and multiple systemic complications like (cardiovascular, cerebrovascular events) and can lead to death if untreated.
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Objective: The objective of this study was to evaluate the uptake and specificity of [11C]MPC-6827, a MT targeted PET ligand in prostate, glioblastoma and breast cancer cells. Methods: [11C]MPC-6827 was synthesized by reacting corresponding desmethyl precursors with [11C]CH3I in a GE-FX2MeI/FX2M radiochemistry module. In vitro binding of [11C]MPC-6827 was performed in breast cancer MDA-MB-231, glioblastoma (GBM) patient-derived tumor (GBM-PDX), GBM U251 and prostate cancer 3 (PC3) cell lines at 37 °C in quadruplicate at 5, 15, 30, 60, and 90 minute incubation time. The nonspecific bindings were determined by incubation with unlabeled microtubule targeting agents MPC-6827, HD-800, colchicine, paclitaxel and docetaxel (5.0 mM). Results: [11C]MPC-6827 provided the highest binding in the breast cancer cell, MDA-MB-231, among all the cells studied, with 90% specific binding. [11C]MPC-6827 binds to glioblastoma PDX and U251 cells with ~50% and 40% specific binding, whereas, prostate cancer cell line, PC3 cells showed 40% specific binding. [11C]MPC-6827 also exhibits binding to the taxane and colchicine binding sites of MTs, in MDA-MB-231 cells. Conclusion: These data indicate that [11C]MPC-6827 can be a promising PET radiotracer for preclinical imaging of the brain and peripheral cancers.
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Glycyrrhiza glabra, commonly known as licorice, has traditionally been used in various medicinal preparations as expectorant, antimicrobial, antiviral, anticancer, anti allergic agent. It has also prominent role in skin whitening and has anti-inflammatory and esterogenic properties. This study aims to the characterization of the bioactive constituent glabridin in plant extract of Glycyrrhiza glabra in ethanol, methanol and ethyl acetate using UV-VIS and FTIR and HPLC. A wavelength scan (200-600 nm) by UV-Vis spectrophotometer was performed and the characteristic peaks were recorded. The scan confirmed presence of glabridin with λmax at 281 nm with a small number of additional phytochemicals indicated by the extra peaks. FTIR spectrum of 62% pure glabridin was compared to the spectra shown by the three extracts. Presence of glabridin in all the three extracts was corroborated by HPLC analysis with the retention time of 4.05 minute. Glabridin was also evaluated for its antibacterial activity against Propionibacterium acne, causative agent of Acne vulgaris and found to have the detrimental effect at concentration 500, 1000 and 1500 ppm.
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Induction of posterior vitreous detachment (PVD) is one of the most critical steps for the success of retinal detachment (RD) surgery. Failure to completely remove the vitreous can result in re-detachments. We describe a novel technique to induce PVD. After core vitrectomy, perfluorocarbon liquid (PFCL) is injected. The vitreous on the posterior pole is gently stroked, with a diamond-dusted membrane scraper, to create a defect in it. This defect is gradually enlarged to create a ring of rolled out vitreous. The entire vitreous is removed in form of a sheet by lifting the edges of the ring using an internal limiting membrane peeling forceps. PFCL naturally slides into the potential space, gradually extending the vitreous detachment peripherally. With this technique, the vitreous sheet in case of RD can easily, effectively and safely be removed with this technique.
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Objective: The objective of the work was to validate the structural binding affinity of Squalene with the envelope protein of Dengue virus by means of molecular simulations. Methods: Three-dimensional (3D) structure of dengue 2 virus envelope protein was retrieved from Protein Data Bank PDB and Squalene compound from the ZINC database. Molecular docking between the E protein and Squalene were carried out by means of Auto Dock 4.2. Results: Based on the study, it was observed that the binding/docking energy for the complex structure was calculated to be-5.55 kcal/mol. Critical residues to interact with E protein were scrutinized by analyzing the interface of the complex within 4 Å proximity. Residues such as Thr 48, Glu49, Ala 50, Val 130, Leu 135, Ser 186, Pro 187, Thr 189, Gly 190, Leu 191, Phe 193, Leu 198, Leu 207, Thr 268, Phe 279, Thr 280, Gly 281, His 282 and Leu 283 were found to be non-covalently located around the squalene. Conclusion: Scopes to design de novo anti-viral compounds to the dengue viruses by using squalene as a new class of template structure have also been concisely brought into fore.
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Purpose: Data from developing countries about incidence, prognosis and healthcare cost of cytomegalovirus (CMV) reactivation amongst patients with allogeneic hematopoietic stem cell transplantation (AHSCT) remain scarce. The purpose of the study was to describe the epidemiology, outcome and cost implications of CMV reactivation and CMV disease amongst patients with AHSCT in cancer hospital in Eastern India. Materials and Methods: The study design was a retrospective audit of clinical records. Results: Ninety-nine per cent of patients and 94% of the donors were found to be CMV seropositive. CMV reactivation rate was 43.8% amongst patients with AHSCT (n = 130 patients). CMV reactivation occurred 118 days after AHSCT (median; range: 28–943 days). Patients with any grade of graft-versus-host disease (GVHD) had higher CMV reactivation rate than patients without GVHD. Patients with CMV reactivation had more frequent GVHD than patients without CMV reactivation. Use of steroids was associated with CMV reactivation. We found no differences in overall survival of patients with or without CMV reactivation. The cost of in-house CMV-polymerase chain reaction at our centre was USD $57 (Rs. 3650), cost for intravenous ganciclovir was USD $26 (Rs. 1665) per infusion and oral valganciclovir USD $8 (Rs. 512)/900 mg tablet. The median duration of anti-CMV therapy was 14 days (interquartile range: 14–28 days) and the average cost per patient per month directed towards CMV management ranged between USD $800 and USD $1,300 (Rs. 51,238–Rs. 83,264). Three patients (2.3%) in this series had CMV disease, all of whom died. Conclusion: In an increasingly globalised world, where medical tourism is common, data from developing countries regarding cost and outcome of CMV infections in AHSCT patients are of relevance.
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Background: In few studies, Dexmedetomidine was used an adjuvant to local anesthetics in peripheral nerve blocks Aim: This study was aimed to examine the effect of adding Dexmedetomidine to Bupivacaine 05% during the femoral sciatic nerve blocks and to evaluate its effect in prolonging post-operative analgesia Materials and methods: This was a prospective, double blinded, randomized study which consisted of 80 patients, Patients were randomly allocated into two groups (40patients each): In group BD, (Bupivacaine-Dexmedetomidine hydrochloride), one mL, containing 100 μg, was added to 39 mL of Bupivacaine 05% In group B; 1 mL of normal saline was added to the same volume of Bupivacaine 05% Results: There were no statistically differences between the two groups in demographic data and surgical characteristics The onset time of sensory block, motor block and surgical anesthesia time were significantly shorter in group BD when compared to group B The durations of sensory block, motor block and analgesia were longer in BD group when compared to group B Systolic arterial pressure (SAP) and heart rate were significantly lower in group BD when compared to group B from 10 to 90minutes after initiation of block (P<005), diastolic arterial pressure was similarly lower in group BD at 45, 60, and 90 minutes following initiation of block Conclusion: This study showed that a prolonged duration of analgesia was associated with addition of Dexmedetomidine 100μg to bupivacaine 05% during US-guided combined femoral and sciatic block for below knee surgery and is also associated with significant bradycardia requiring treatment
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Permanent tracheostomy following total laryngectomy is a common practice. Distal migration of fractured tracheostomy tube in such patient is a rare complication. We report this rare occurrence in which flexible bronchoscopy guided retrieval of migrated tracheostomy tube was failed. We applied an innovative approach to safely remove the migrated fractured metallic tracheostomy tube.
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Background: Alpha-2 agonists are added to local anesthetic agents to extend the duration of peripheral nerve blocks. Objective: We evaluated the effect of combining dexmedetomidine with levobupivacine with respect to duration of motor and sensory block and duration of analgesia. Material and Methods: Sixty patients of ASA grade I or II aged between 18-60 years, posted for elective upper limb surgeries were enrolled for a prospective, randomized, double-blind study. Patients were divided into two groups, the control group B and the study group BD. In group B (n = 30), 30 ml of 0.325% levobupivacaine + normal saline; and in group BD (n = 30), 30 ml of 0.325%levobupivacaine + 1μg/kg dexmedetomidine were given for ultrasound guided supraclavicular brachial plexus block. Duration of motor and sensory block and time to first rescue analgesia were recorded. Results: Demographic profile and surgical characteristics were similar in both groups. The onset times for sensory and motor blocks were significantly shorter in BD group (p < 0.05), while the duration of sensory and motor blocks and duration of analgesia (DOA) was significantly longer in BD group. Heart rate level and SBP and DBP levels in group BD were significantly lower 15-20 min after block (p< 0.05). Bradycardia was observed in two patients in the group BD. No other adverse effects were observed in either of the groups. Conclusion: Dexmedetomidine added as an adjuvant to levobupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia.
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A simple, highly sensitive stability indicating reverse phase high-performance liquid chromatographic (RP-HPLC) method was developed and validated for the determination of sumatriptan succinate in bulk and tablet dosage form. The analysis was performed on reverse phase C18 ODS Inertsil (250×4.6mm, 5μm) column, with a mobile phase containing buffer: aetonitrile: methanol (80:10:10 v/v/v), pH was adjusted to 2.5 with orthophosphoric acid (OPA) at 221nm, by an isocratic elution mode with 1ml/min flow rate using photo diode array (PDA) detector at ambient temperature. The injection volume and retention time was found 20 μl and 4.4 minutes respectively. The method produced linear responses in the concentration range of 5-150 μg/ml, with a correlation coefficient of 0.999. The limit of detection (LOD) and limit of quantification (LOQ) values for HPLC method were found to be 1.967 and 5.961 μg/ml respectively. The recovery of the method was 98% of the labelled value. This method was validated for accuracy, precision, linearity and robustness. Sumatriptan subjected to different ICH prescribed stress conditions of acid, alkali, peroxide, reduction, thermal, photolytic and humidity degradation. This method can easily and conveniently take up for routine quantitative analysis of sumatriptan in bulk and pharmaceutical dosage form by easily available materials with low cost.