Use of CDR-sob and ADAS-cog score to check protective role of Non-steroidal AntiInflammatory Drugs in Alzheimer Disease: A Systematic Review and Meta-Analysis

Background Alzheimer’s disease is the major neurodegenerative disease, affecting more than two third cases of dementia in the world. NSAIDs are widely used anti-inflammatory analgesic agents representing 7.7% of worldwide prescription of which 90% are in patients over 65 year old. Based on mixed findings by different RCTs, a systematic review and meta-analysis on CDR-sob and ADAS-cog score was conducted to develop the better understanding on the protective role of Non-steroidal anti inflammatory drugs (NSAIDs) in AD. Methods Data base search was Pubmed, WebScience and Embase. RCTs investigating the effect of NSAIDs on AD or test scores assessing cognitive function in people without AD at baseline were included. Two indicators ADAS-cog score, and CDR-sob are used. Total 09 studies are included in the present Metaanalysis. Results For ADAS-score pooled the pooled summary effect size was calculated using random effect model was -0.03 with 95% C.I -0.13 to 0.07, which was statistically insignificant (p-value =0.44). For CDRsob score difference, the pooled the pooled summary effect size was calculated using random effect model was -0.09 with 95% C.I -0.29 to 0.11 which was statistically insignificant (p=0.3812).For CDR-sob score, the pooled summary effect size was calculated using random effect model was 0.21 with 95% C.I -0.09 to 0.51, which was statistically insignificant (p-value = 0.1741). Conclusion Present Meta analysis shows that NSAIDs in general are not effective in treatment of AD. They also have no protective effect against development of AD on their sustained use.

The Study of Correlation Between Bronchiectasis Severity Index and FACED Score for Assessment of Severity of Bronchiectasis

Introduction: Two different validated scores are currently used to assess the severity of bronchiectasis: the FACED score and the Bronchiectasis Severity Index (BSI). The study was conducted to evaluate clini-cal etiology in bronchiectasis patients. And to compare the results of the assessment of bronchiectasis severity obtained via FACED and BSI scores. Methods: The study was conducted at a tertiary care hospital in the outpatients of the department of respiratory medicine. Detailed clinical history and necessary investigations were done. BSI and the FACED score were calculated. Statistical analysis was performed using the SPSS package. Results: According to the FACED score, we found 28 patients with mild bronchiectasis, 17 with moder-ate, and 5 with severe bronchiectasis. The frequency of patients with low, intermediate, and high BSI was 24, 21, and 5, respectively. Moreover, we observed a weak but statistically significant association of 43% agreement between FACED and BSI scores: Fisher’s exact test(p=0.399), tau-b de Kendall (-0.123; p = 0.337) and kappa test (0.032; p = 0.878). Conclusions: There is a small but significant correlation between the two scales (BSI and FACED). a ten-dency is observed for patients to be classified with a higher BSI compared to the FACED score.

Epidermal growth factor receptor mutations in adenocarcinoma lung: Comparison of techniques for mutation detection

Background: Targeted therapy using tyrosine kinase inhibitors in cases of non-small-cell lung carcinoma (NSCLC) that harbor epidermal growth factor receptor (EGFR) mutations has drastically improved the overall survival rate. The current study estimated the frequency of EGFR mutations in the Indian population by analyzing the diagnostic parameters of various techniques available for the detection of these mutations. Materials and Methods: A case series of 100 histologically diagnosed and immunohistochemically confirmed NSCLC with the adenocarcinoma phenotype comprises the study sample. EGFR mutations were detected using clone-specific immunohistochemistry (IHC), real-time polymerase chain reaction (PCR), and Sanger sequencing. Results: EGFR mutations were identified in 48% cases with 72.78% mutations involving exon 19. Clone-specific IHC had a low sensitivity of 46.43%, and the specificity was 79.17%. Sanger sequencing yielded interpretable results in 16% cases only, which were in concordance with the results of real-time PCR. Conclusion: EGFR mutations are increasingly being explored for targeted therapy and personalized medicine. Real-time PCR was found to be the best and the most accurate method for the detection of somatic EGFR mutations in adenocarcinoma primarily in the lungs.

Correlation Of Spirometry And Six Minute Walk Test (6MWT) In Patients Of Stable COPD

Background: Spirometryis the GOLD standard for the diagnosis of COPD. This test also grades the severity of the disease which helps in the management of patients.Many times Spirometry is not available in remote areas. In these situations 6MWT can be done. 6 minute walk test (6MWT) is a simple test to assess patient’s functional capacity (ability for day to day activities).Material And Methods:A prospective study was conducted in the department of Respiratory Medicine, AMC MET MEDICAL COLLEGE, L.G. HOSPITAL, AHMEDABAD for 6 months from date of Confirmation of IRB.The patient who was a confirmed and stable case of COPD and who gave consent was taken for the study.Conclusion:The 6MWT plays a major role in measuring the functional status and disease tolerance of COPD patients.Also, it is observed that as severity of FEV1 increses 6MWD decreses.This suggests that in the absence of spirometry 6MWT is a reasonable tool for the assessment of disease severity and functional status in COPD Patients.

An open randomized cross over study to compare the clinical effectiveness and safety of economical generic with branded generic telmisartan in essential hypertension

Background: Hypertension is a chronic disease and is a major risk factor for chronic heart disease, stroke, coronary heart disease, and its complications include heart failure, peripheral vascular disease, renal impairment, retinal hemorrhage, and visual impairment. Antihypertensive drugs are important to avoid such complications but compliance of patient is needed which may depend on the cost of therapy. Aim and Objective: This study aimed to assess the efficacy and safety of a branded generic with an economical generic. Materials and Methods: Out of 110 patients, 105 patients (53 patients in group A and 52 patients in group B) completed the study with follow-up over a period of 6 months. Group A patients received generic Telmisartan 40 mg in the beginning (0th day) which was continued for 12 weeks, cross-over was done with branded generic Telmisartan (Telma 40) which was given for further 3 months. Group B patients received the branded generic followed by generic Telmisartan in that sequence for 3 months each. Blood pressure (BP) was recorded at the baseline visit and at the end of 4, 8, 12, 16, 20, and 24 weeks. The adverse events were assessed throughout the study period. Results: Intra-group comparison show significant reduction in systolic (SBP) and diastolic BP (DBP) in each groups (P < 0.001) but when we compare the reduction of SBP and DBP in between the two groups the difference was not significant. Common adverse events were headache, dizziness, light-headedness, and vertigo. Conclusion: There was a huge difference between the prices of branded generic and unbranded generic. This study showed that both branded generic and unbranded generic are comparable in terms of efficacy, safety except the cost of therapy. Thus substitution of a Pharmacological generic (unbranded generic) drug could save lot of expenses.

Study Of 215 Patients Who Required High Flow Nasal Cannula During Corona Virus Epidemic

Background:High flow nasal cannula is a newer modality of treatment for hypoxemic respiratory failure. Present study is conducted to evaluate demographic characteristics, co-morbidities and outcome parameters of patients on High flow nasal cannula. Material And Methods:In retrospective observational study all patients on High flow nasal canula with covid-19 were evaluated for demographic characteristics and outcome with comorbidities during study period.Result:Maximum number of patients belongs to age group 51-60 years. Highest mortality was in the age group of 61-70 years.Conclusion:The High flow nasal cannula therapy may provide important newer modality and helpful in patients with respiratory failure.

Development of non-stress baseline of crop water stress index for wheat in humid sub-tropical climate in India

Aim: A study was conducted to develop a new approach of non-stress baseline and evaluate different approach of determining non stress baseline for Crop Water Stress Index (CWSI).Methodology: To observe maximum and minimum canopy temperature, two plots with three replications were maintained at fully stress (no irrigation) and no stress (fully irrigated) conditions, respectively. Portable weather station with data logger was installed at the middle of field to record continuous data at half an hour interval. Gypsum block soil moisture sensor were buried at 20 cm interval up to 100 cm and connected with data logger. Infrared radiometer was used to measure canopy temperature. Results: The evaluation was based on five statistical indicators; correlation coefficient (R2), root mean square error (RMSE), mean absolute error (MAE), mean bias error (MBE) and Wilmot index of agreement (d). It was found that new regression base line performed better than other existing approaches. The calculated value of RMSE, MAE, MBE, d and R2 were 0.65, 0.51, 0.02, 0.79 and 0.83, respectively, for new baseline approach. Interpretation: The newly developed multiple regression equation (incorporating three weather parameters (Rn, VPD and u) and two crop growth parameters (h and CC)) helped to reduce error in the calculation of non-stress baseline for wheat crop in humid subtropical climate

Pars-plana vitrectomy with phacofragmentation for hyperdense cataracts in eyes with severe microcornea and chorio-retinal coloboma: A novel approach

Purpose: To report the outcomes of pars-plana approach for the management of brunescent cataract in eyes with severe microcornea and associated chorio-retinal coloboma. Methods: This was a retrospective, single center, interventional case series performed in a tertiary eyecare center in central Medical records of consecutive cases of microcornea with coloboma who underwent pars-plana vitrectomy with phacofragmentation (PF) between January 2015 and December 2017 were reviewed. Results: The study group comprised of 30 eyes of 30 patients, of which 18 (60%) were males and 12 (40%) were females. The mean age of the patients was 41.9 years (range of 17� years). The mean corneal diameter was 6.7 mm with a range of 4�mm and all the eyes had dense cataract with nuclear sclerosis of grade 4 or more. The mean preoperative visual acuity was 1.97 (+/-0.067) Log MAR and the mean postoperative vision at 1 month was 1.6 (+/-0.39) Log MAR. Postoperatively, 21 patients (70%) gained ambulatory vision. The visual gain in all the patients was maintained over a mean follow-up period of 15.5 months. Conclusion: Pars-plana vitrectomy with PF can be considered in eyes with severe microcornea and brunescent cataracts, where cataract surgery through the limbal (anterior) approach is not only difficult but at times impossible due to anatomical restraints.

Prescription audit to evaluate the pattern and errors in a tertiary care hospital

Background: Medication errors are widespread public health issue. Prescription errors commonly results in medication error. Prescription error can be largely avoidable this study was performed with aim to point out the common mistake in the prescription which may endanger patients.Methods: Our study was cross-sectional and observational, performed in Index Medical College. 320 prescriptions were reviewed. Analysis was done for presence or absence of essential components of prescription like prescriber information’s, patients information’s, details of drug like its dosage form, strength, frequency, total duration of treatment, warnings or instruction for use. The observed data was expressed in number and percentage.Results: Patient information was complete 315 (98.44%) in prescriptions. Prescriber’s information were present in 284 (88.75%). Legibility was seen in 240 (75%). Use of generic drug, capital letters for drug name, warning are seen in 9 (2.81%), 39 (12.19%), 3 (0.94%) respectively. Completeness in terms of the name of drug, dose, strength, route, frequency, duration and dosage forms of prescribed drugs was seen in 252 (78.75%) prescriptions.Conclusions: Properly framed and written prescription can largely prevent medication error. Regular prescription audit must be carried out so that common mistake can be identified and corrective measure with the help of training session, workshop can be taken.

A cluster of central retinal artery occlusions following cataract surgery

Purpose: To report a series of central retinal artery occlusions (CRAO) following cataract surgery complicated by posterior capsular rupture (PCR). Methods: Data from 14 patients with acute CRAO following cataract surgery was collected for this study including subject demographics, initial and final best-corrected visual acuity, systemic investigations, optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) findings. Results: Mean subject age was 59.9 ± 12.1 years. Male: Female ratio was 1:1. All patients were operated between October and November 2015 and presented with acute vision loss 1 to 4 days after surgery. All the patients underwent cataract surgery under peribulbar anesthesia and had PCR for which anterior vitrectomy (AV) was done. In all the cases Ethylene oxide (ETO) sterilized vitrectomy probe was used for AV. Clinical picture of CRAO was noted in all the cases during the immediate postoperative period. OCT showed inner retinal layer hyperreflectivity while FFA was normal in all the cases. The final visual acuity was poor in all the eyes. This paper discusses the possible mechanisms of CRAO in these cases. Conclusion: CRAO is a potential complication of peribulbar anesthesia for intraocular surgery in patients with vascular risk factors and hence any substance that can aggravate the vasospasm in such patients should be used cautiously. Vasospasm could be caused by ETO as residual ETO could be present in the vitrectomy machine tubing causing toxicity. It is recommended to be cautious while using ETO sterilized instruments for cataract surgery.

Fine root growth and soil nutrient dynamics during shifting cultivation in tropical semi-evergreen forests of northeast India

Aim: The present study aimed to understand the periodical changes in fine root biomass, production, turnover and carbon and nitrogen return in forest fallows following shifting agriculture in Mizoram, Northeast India. Methodology: Root biomass was determined using sequential coring method in different fallow lands (FL-3, FL-5 and FL-10) following shifting agriculture. Annual fine root production was calculated as the sum of differences between annual maximum and minimum root biomass of different diameter classes. Concentrations of carbon and nitrogen in soil and roots were determined using CHN auto-analyzer, and their accumulations and returns were computed as the product of mass and element concentrations. Results: Total root biomass was maximum (561 g m-2) at FL-10, which decreased to 141 g m-2 at FL-3 with greater accumulation of fine roots in upper soil layer (0-10 cm) and coarse roots in lower depths. Root biomass was maximum (1499 g m-2) at the time of slashing which decreased to about one fourth just after burning. The amount of organic matter, carbon and nitrogen return to soil through fine root death was significantly regulated by soil moisture, microbial biomass carbon and total nitrogen in different fallow lands. Interpretation: Addition of organic matter, carbon and nitrogen to soil through death and decomposition of fine roots is an important mechanism responsible for sustaining soil fertility and crop productivity in different fallow lands. The output of the study has implications for the management of fallow lands following shifting cultivation and modeling global cycles of carbon and nitrogen.

Role of Quality Management in Multispecialty Hospitals: A case on Fire Mishaps in Eastern Zone of India

For a long time, healthcare service providers have depended principally on human resources playing out their role accurately to shield patients from unintended negative effects. Many years of research, has demonstrated that most mishaps are brought about by able yet questionable individuals working in useless frameworks. Healthcare associations are presently obtaining systems from different enterprises and utilizing frameworks in order to deal with and enhance the efficiency of the health care services. India to a large extent has been able to incorporate Quality Management tools in its Healthcare sector. This has helped India to attain competitive advantage over other Nations by providing Quality Services at an affordable price with continuous improvement of their Service quality.

Evidence of Late Palaeocene-Early Eocene equatorial rain forest refugia in southern Western Ghats, India.

Equatorial rain forests that maintain a balance between speciation and extinction are hot-spots for studies of biodiversity. Western Ghats in southern India have gained attention due to high tropical biodiversity and endemism in their southern most area. We attempted to track the affi nities of the pollen fl ora of the endemic plants of Western Ghat area within the fossil palynofl ora of late Palaeocene-early Eocene (~55–50 Ma) sedimentary deposits of western and northeastern Indian region. The study shows striking similarity of extant pollen with twenty eight most common fossil pollen taxa of the early Palaeogene. Widespread occurrences of coal and lignite deposits during early Palaeogene provide evidence of existence of well diversifi ed rain forest community and swampy vegetation in the coastal low lying areas all along the western and northeastern margins of the Indian subcontinent. Prevalence of excessive humid climate during this period has been seen as a result of equatorial positioning of Indian subcontinent, superimposed by a long term global warming phase (PETM and EECO) during the early Palaeogene. The study presents clear evidence that highly diversifi ed equatorial rain forest vegetation once widespread in the Indian subcontinent during early Palaeogene times, are now restricted in a small area as a refugia in the southernmost part of the Western Ghat area. High precipitation and shorter periods of dry months seem to have provided suitable environment to sustain lineages of ancient tropical vegetation in this area of Western Ghats in spite of dramatic climatic changes subsequent to the post India-Asia collision and during the Quaternary and Recent times.

A study of bone marrow failure syndrome in children.

Background: Bone marrow failure syndrome (BMFS), or aplastic anemia, includes peripheral blood single cytopenias, as well as pancytopenia due to inability of the marrow to effectively produce blood cells. Aim: To study the clinico-hematological profile and etiological factors of bone marrow failure syndrome in children. Setting and Design: This prospective study was carried out in the Department of Pediatrics of a university teaching hospital over 36 months. Materials and Methods: Children with pancytopenia (Hb 9 /L, platelet count < 100 x 10 9 /L) and bone marrow cellularity < 25% were included in the study. History of exposure to drugs, socioeconomic status, ethnicity and occupation of father were noted. Bone marrow aspiration; trephine biopsy; Ham test; viral studies for hepatitis A, B and C; and cytogenetic investigations were carried out. Statistical Analysis: Relative risk was estimated by odds ratio (OR) with 95% confidence interval (CI) in matched cases and controls. Results: Of the 53 children studied, 6 (11.3%) were diagnosed as Fanconi anemia. Two cases had features of myelodysplastic syndrome. Forty-five children were labeled as acquired aplastic anemia, of whom one had evidence of hepatitis B infection and two patients (5.8%) had paroxysmal nocturnal hemoglobinuria. Aplastic anemia was more common in children from family with lower socioeconomic status; in Muslims; and where the father's occupation was weaving, dyeing and painting. However, the number was small to make statistically significant conclusions. No correlation could be established with exposure to drugs. Conclusion: Fanconi anemia was responsible for approximately one-tenth of the cases of bone marrow failure syndrome. Majority of the patients had acquired aplastic anemia. Hepatitis B infection was an uncommon cause of acquired aplastic anemia.

Abnormal anther development and high sporopollenin synthesis in benzotriazole treated male sterile Helianthus annuus L.

Foliar application of 1.5% benzotriazole induced 100% pollen sterility in H. annuus. Pollen abortion in treated plants was mainly associated with abnormal behaviour of tapetum. A limited number of anther locule showed early degeneration of tapetum followed by disintegration of sporogenous tissues. On the other hand, some locules showed normal development of tapetum at initial stages. However, this tapetum exhibited degenerated and non-functional cell organelles. In both these situations tapetum failed to provide proper nourishment to developing microspores. The ultrastructure of both tapetum and microspores is different from that of control material with irregularities of exine deposition, endopolyploidy of tapetal nuclei and an alteration of organelle composition being correlated with sterility. Pollen grains thus developed were devoid of nucleus and cell organelles and were complete sterile.

Inflammatory markers in meconium induced lung injury in neonates and effect of steroids on their levels: a randomized controlled trial.

PURPOSE: To determine the levels of TNFa and IL-1beta in tracheal aspirates of neonates with meconium aspiration syndrome (MAS) and to ascertain whether the use of steroids by systemic or nebulized routes suppresses the levels of these inflammatory markers. METHODS: This was a double blind, randomized, controlled, prospective, interventional study done over one year period in the neonatal unit of the Lady Hardinge Medical College. Fifty-one babies of MAS which were randomly distributed into three groups; control, systemic and nebulized steroids; were included in the study. Methyl prednisolone was given intravenously in the dosage of 0.5 mg/kg/day in two divided doses while nebulized budecort was given in a dosage of 50 mcg/dose twice daily. Tracheal aspirates were taken on day 1, 3 and 4 and were analyzed for TNFa and IL-1b by ELISA technique. RESULTS: TNFa in tracheal aspirates showed an increasing trend in babies of MAS in first four days, thereby signifying an inflammatory process underlying the condition. The levels of TNFa were suppressed by use of steroids. Higher levels of TNFa were associated with longer stay in hospital. IL-1b did not show any significant correlation. CONCLUSIONS: TNFa is associated with meconium-associated inflammation. Its level is suppressed with the use of steroids and can also be used to assess prognosis of neonates with MAS.

A study on drug use in a district hospital of West Bengal.

A cross-sectional study at Howrah General Hospital, West Bengal for prescription analysis and assessment of drug dispensing in 341 patients revealed that the average number of drugs prescribed per encounter was 2.98 +/- 1.69, 38.2% drugs were in generic name and majority were from essential drugs list. 18.6% and 5.2% encounters used antibiotics and injections respectively. Average consultation and dispensing time were short. Majority of drugs were dispensed but unlabeled. 46.8% patients knew correct dosage of drugs. Only 4.7% patients were treated without drugs. Average drug cost per encounter was Rs. 31.32+30.89 where antibiotics and injections shared 36.5% and 4.6% respectively.

Immunotoxicity induced by subacute acephate exposure in white leghorn cockerels.

Acephate (Ace) is an organophosphate foliar spray insecticide of moderate persistence with residual systemic activity of about 10–15 days. This study was designed to evaluate the immunotoxic effect of oral subacute acephate exposure in 125-day old WLH Cockerel chicks for 28 days. The experimental birds were randomly divided into five groups (C1, C2, T1, T2 and T3), each comprising 25 birds. The birds of group C1 were given no treatment and served as control. Group C2 was administered groundnut oil (1ml/kg) and served as control (vehicle). Group T1 was given ALD50/40 (21.3 mg/kg), and Group T2 was put on ALD50/30 (28.4 mg/kg), while group T3 received ALD50/20 (42.6 mg/kg) of acephate suspended in groundnut oil. Experimental birds of all groups were vaccinated with New Castle disease vaccine at day 7. Blood was collected at two-week intervals for evaluation of humoral immune response. Parameters such as TLC, TP, antibody titre against ND vaccine, DNCB dye test, and histopathology of immune organs were studied to evaluate immunotoxicity. The results were statistically compared (p<0.05) with the control. Acephate produced decreased humoral immune response in terms of New Castle disease vaccine antibody titre, total protein, serum globulin, and serum albumin. Cell mediated immune response was checked with 1-chloro 2, 4 dinitrobenzene dye dermal sensitization test, and it did not reveal any significant differences. Lymphoid organs such as thymus, spleen, bursa, and liver were weighed during necropsy for calculation of organ weight: body weight ratio. After 28 days of acephate exposure, organ:body weight ratios of immune organs were significantly reduced except liver:body weight ratio on 14 days of exposure, which was increased in all treatment groups as compared to control groups. Histopathologically, bursa and spleen showed mild depletion of lymphocytes. To further identify the specific type of cell death as apoptotic or necrotic, DNA ladder assay was performed. DNA fragmentation assay detected ladder pattern (180bp) in DNA from hepatocytes and splenocytes of acephate-treated birds. It is concluded that acephate is immunotoxic, and exerts its immunotoxicity through induction of apoptosis and alteration of immunological parameters.

Poor knowledge about osteoporosis in learned Indian women.

OBJECTIVES: The present study was done to assess knowledge about osteoporosis in learned Indian women, identify their source of knowledge and to study the correlation of level of knowledge with other variables. METHODS: A total of 73 female staff members (average age 44.7 years) of a teaching institute completed the Osteoporosis Questionnaire (OPQ). The mean +/- SD of total score for the sample was 4.1 +/- 4.1 (range -8 to 15; maximum possible score 20). RESULTS: The correct definition of osteoporosis was given by 74%, but there was general lack of awareness in all the areas assessed. There was statistically significant difference in the total score depending on the faculty of education, with staff members from the science faculty having the maximum mean score (p < 0.05). We found no influence of age, menopausal status, previous history of fracture and family history of osteoporosis on the level of knowledge. Media (74%) was the commonest source of knowledge followed by friends (49%) and doctors (25%). CONCLUSIONS: This study highlights the general lack of knowledge about osteoporosis in learned Indian women and also the need for increased involvement of medical professionals in patient education.