RESUMO
Background: The potential involvement of Notch signaling pathway in cell fate decision, tumor heterogeneity and angiogenesis in solid tumors can be explored in colorectal cancer (CRC). This might further help to improve outcomes in CRC. Here, the promoter methylation of Notch receptor gene (Notch2 and Notch3) and their co-expression with its downstream transcription factor Hes1 has been analyzed. Methods: Seventy-two CRC patients were enrolled to study the role of Notch2, Notch3 and Hes1 genes in colorectal cancer. Promoter methylation and mRNA expression in tumor and adjoining normal tissue were assessed by Methylation Specific PCR and quantitative Real time PCR respectively. Statistical correlation was done by using SPSS. Results: We found that Notch2 and Notch3 were hypomethylated in 52/72 (72.22%) and 54/72 (75%) cases respectively. Hypomethylation of Notch 2 and Notch 3 showed significant association with advanced stage (p=0.001) and (p=0.003) and nodal metastasis (p=0.036) and (p=0.012) respectively. Both Notch 2 and Notch 3 showed increased mRNA expression in 49 (68.05%) and 51(70.84%) patients with a fold change of 3.37 and 5.43 respectively. Positive correlation between hypomethylation and expression was observed for both genes. High expression of Hes1 was found in 53(73.61%) of cases which was highly relatable with over expression of notch receptor genes. Upregulation of Notch 2, Notch 3 and Hes1 showed significant association with high grade tumors, advance stage and presence of LN metastasis, additionally Notch 3 and Hes1 showed significant association with distant metastasis. Conclusion: Hypomethylation of Notch 2 and 3 receptors is playing crucial role in regulating the expression of these genes in CRC. Overexpression of Notch 2, Notch 3 and Hes1 are associated with disease progression in CRC.
RESUMO
Introduction : The Coronavirus disease 2019 (COVID-19) primarily involves respiratory system but may also affect the Cardiovascular System leading to abnormal ECGs. Its early recognition is crucial as it may be associated with increased mortality. Hence we aimed to find out various Electrocardiographic (ECG) manifestations of COVID19 patients admitted in a Tertiary Care Hospital and its relation to disease severity. Methods : We performed a hospital-based retrospective observational study between April, 2021 to November 2021 and analyzed the ECG changes at admission by three Cardiologists according to standard definitions and diagnostic criteria. Results : Out of 579 patients, ECG of 473 was available for analysis. ECG was normal in 227 (48%) and abnormal in 246 (52%) patients. Most common abnormal ECG finding in COVID19 patients was Sinus Tachycardia(19.5%) and less common findings were Sinus Bradycardia (5.3%), Incomplete Right Bundle Branch Block (RBBB) (3.2%), atrial fibrillation (2.5%), complete RBBB (2.3%), atrial premature complexes (2.3%), S1Q1T3 pattern (2.1%), first degree AV block (1.5%), ST-T wave changes (1.3%), Atrial flutter (1.1%). In mechanically ventilated patients, incidence of acute Right Ventricular Pressure Overload (RVPO) related ECG findings were more frequent. Conclusion : There is a wide spectrum of ECG manifestations in COVID-19 patients which varies depending upon the severity of COVID as well as prior Cardiovascular status, associated comorbidities and need for ventilatory support. Knowledge of ECG changes might help in risk stratification and triaging of COVID-19 patients.
RESUMO
Background: In complex pelvic fracture urethral distraction defects (PFUDD), early management prevents incidence of devastating complications such as urinary incontinence, restenosis and urethra cutaneous fistula. The aim of the present study was to study the outcome of patients with PFUDD undergoing early alignment (either by rail roading or endoscopic) compared with initial suprapubic urinary diversion with delayed urethroplasty.Methods: This was a prospective randomized study done at KGMU, Lucknow; having PFUDD during the period from June 2014 to July 2017. Patients with PFUDD were randomized in to two groups. Group A included 22 patients and managed by supra pubic cystostomy followed by delayed urethroplasty. Group B included 23 patients and managed by primary alignment by rail-roading and early endoscopic alignment. Patients were followed up after 6 weeks, 3 months and 6 months for measuring the primary and secondary outcomes during follow up.Results: The most common age group that sustained pelvic fracture urethral distraction defects injury are male of 21-40 years. In group A, stricture was present in all patients at 6 weeks post-surgery. Open urethroplasty was done at 3 months in 60% and 10% patients at 6 months. In group B, stricture was present in 80% at 6 weeks, 40% at 3 months and 10% at 6 months. The incidence of ED in group A at 6 weeks, 3 months, was 25% patient which reduced to 20% at 6 months. In group B, ED was present in 30% patients 6 weeks, 3 months and which reduced to 25% at 6 months. No incontinence was observed in both groups.Conclusions: Primary realignment has significant benefits compared to SPC as realignment approach is associated with a 50%-55% decrease in stricture formation.
RESUMO
Background: Osteoporosis and Coronary artery disease are known to share common risk factors, like inflammation, but a direct relationship between the two has not been established. Some of the previous studies showed low BMD (osteoporosis and/orosteopenia) as an independent predictive factor for coronary artery disease in ambulatory patients. However, some reports have failed to demonstrate a direct relationship between low bone mineral density (BMD) and CAD or cardiovascular risk factors. This study was carried out to estimate bone mineral density (BMD) in patients with coronary artery disease (CAD) and also to evaluate the association between bone mineral density and coronary artery disease.Methods: Hospital based prospective observational study, involving 96 consecutive patients who were referred for coronary angiography for the evaluation of established or suspected CAD and also patients who had acute coronary syndrome (ACS) are enrolled in this study. BMD was determined for the lumbar spine (L2-L4) and femoral neck using DXA scan.Results: The total number of subjects was 96. Out of 96, 24 (25%) patients were females and remaining 72 (75%) were males. Coronary angiography was carried out in all patients. 42 patients from the total had coronary angiography proven single vessel disease (SVD), 33 patients had double vessel disease (DVD) and 21 patients had triple vessel disease (TVD). DXA scan was carried out in all patients. T- score of neck of femur region and lumbar spine was calculated. Neither the presence of significant coronary stenoses ≥50% in two or more coronary vessels nor the prevalence of severe coronary stenoses ≥70% differed significantly between patients with normal bone density, osteopenia, or osteoporosis (p<0.05, respectively).Conclusions: The result of this study suggests that in patients undergoing coronary angiography for the evaluation of CAD, the prevalence of low BMD is high; however, there is no statistically significant relationship between osteoporosis, osteopenia and coronary artery disease state.
RESUMO
Background: Population explosion is a major issue especially in our country with the second largest population in world next only to china starting the use of contraception in postpartum period is an effective method of increasing the gap between two pregnancies and hence reducing the family size. Objective was to study the efficacy of DMPA injection in postpartum period for contraception.Methods: The study was a prospective study conducted on 100 patients during June 2018 to May 2019 in the department of obstetrics and gynaecology, S. P. Medical College Associate A. G. H., Bikaner, Rajasthan, India.Results: In present study mild irregular bleeding was present in 21, 35 and 38 cases at initial visit, at 3 months and at 6 months follow up respectively. Moderate irregular bleeding was present in 8 cases at initial visit, 27 cases at 3 months and 18 cases at 6 months follow up while 37 and 43 cases had severe irregular bleeding at 3 and 6 months follow up respectively. At baseline, 89 and 10 and 1 cases had their blood sugar <100, 100-120 and >120 respectively, at 3 months follow-up, 94, 6 and 0 cases had their blood sugar level <100, 100-120 and >120 respectively while at 6 months follow-up 97, 3 and 1 cases had their blood sugar level <100, 100-200 and >200 respectively.Conclusions: Injection DMPA use in postpartum period is safe, effective and reversible method with no deleterious metabolic effects and do not need special training to administer to it, so it is a good option of contraception for women who are lactating.
RESUMO
Background: Human milk bank plays an essential role by providing human milk to infants who would otherwise not be able to receive human milk. The aims and Objectives is to study the morbidity and mortality outcome' profile of babies fed with PDHM (pasteurized donor human milk) comparing data between Pre Human Milk Breast bank (2015) and Post Human Milk Breast bank (2016, 2017 and 2018).Methods: Milk bank collect, screen, store, process, and distribute human milk. Retrospective observational study was done in Department of Neonatology, Institute of Obstetrics and Gynaecology and Women and Children Hospital, Chennai. Data obtained retrospectively comparing data Pre HMB (2015) and Post HMB (2016, 2017 and 2018).Results: In this study authors collected the data comparing Pre human milk bank (Pre HMB) and Post human milk bank (Post HMB).' After starting human milk bank, around 1799 babies were benefitted and 14.45 lakh ml milk was collected from 16000 donor mothers in last 3 years. Bacterial contamination rate of PDHM has reduced to 4.39% (2018) compared to 7.73% (2016) with P Value 0.0042 (statistically significant). CONS and Staphylococcus aureus were the most common Organisms isolated. There was reduction in morbidity profile like sepsis rate, NEC/ Feed intolerance and ROP profile. Mortality profile also reduced to (7.73-9.31%). Duration of hospital and Duration to attain full feeds were improved all GA group babies.Conclusions: In this study, after starting human milk bank there was reduction in mortality, morbidity outcome, sepsis. Duration to attain full feeds' and duration of hospital stay reduced. We concluded that establishment of breast milk bank will be more useful and beneficial for all GA group babies for better outcome.
RESUMO
Background: Quality of life (QoL) is a standard indicating a person抯 life in better condition as compared to a diseased person or patient. Diabetes itself is not a dangerous disease if managed properly, but it becomes life-threatening after a certain time period because of the patient抯 poor interest in disease management and treatment adherence. Diabetes mellitus is an endocrine system disorder that invokes lack of insulin secretion in the bloodstream. The study was conducted to assess the QoL of type-2 diabetes mellitus patients with QoL instrument.Methods: Questionnaire based cross-sectional, prospective study was conducted at Teerthanker Mahaveer Hospital, Moradabad, for a duration of 6 months from January - June 2019, on 196 patients of type-2 diabetes mellitus.Results: On an average 56.5% people have accepted that due to the diabetic condition their working proficiency is decreased. 80.3% of patients have accepted that they were facing problems due to diabetic symptoms. Similarly, 84% of patients have accepted that the ongoing treatment was quite expensive than their expectations. Finally, the last section of the patient抯 emotional/mental satisfaction showed that 49.7% of patients were very satisfied with their family support while 13.7% of patients were not satisfied.Conclusions: QOL instrument for Indian diabetes patient抯 instrument helped to evaluate the patient抯 physical strength, psychological strength of the patient during disease condition, the response provided from the family members and relatives, the economical status of the patient and its effects on their living.
RESUMO
Background: Total thyroidectomy (TT) is a commonly performed procedure for various thyroid disorders, with parathyroid insufficiency manifesting as hypocalcaemia being a well-known complication. Albeit, vitamin D is well implicated in calcium homeostasis, the association between hypovitaminosis D and postoperative hypocalcaemia is yet to be concluded. The aim of our study is to evaluate the correlation of preoperative serum vitamin D3 levels with occurrence of post-operative hypocalcemia in patients undergoing TT.Methods: A prospective study was conducted on 50 patients undergoing TT for benign thyroid diseases from November 2016 to May 2018. Pre-operative vitamin D3 levels were estimated. Serum calcium levels was measured pre‑ and post‑operatively at 24hours, 1st week and 4th week. Serum calcium level ≤8.5 mg/dl was considered as biochemical hypocalcemia. A data of demographic, clinical, biochemical and intraoperative findings were documented and analysed.Results: Statically 14 (28%) patients developed symptomatic hypocalcemia. Out of these, 11 (78.5%) patients had preoperative vitamin D levels of <30 ng/dl (p=0.034). 24 hours postoperative serum calcium level was significantly lesser in patients with lower preoperative vitamin D levels (p=0.015), suggesting that postoperative hypocalcemia (24 hr) is statistically related to pre-operative vitamin D3 levels.Conclusions: It could be concluded from our study that preoperative serum vitamin D3 levels can predict post-operative occurrence of symptomatic and/or biochemical hypocalcemia. Thus, it could be hypothesized that supplementing vitamin D preoperatively could curb the incidence of hypocalcaemia following TT. However, further relevant trials are needed to attest to this.
Assuntos
Humanos , Masculino , Adulto , Derrame Pleural/etiologia , Teníase/complicações , Ascaridíase , Albendazol , EosinofiliaRESUMO
Thermal injury to the upper respiratory tract caused by aspiration of hot liquids resulting in laryngeal edema and subsequent obstruction of the airway is commonly not seen in the pediatric population. Unlike adults, children are more prone for subglottic injury, swelling and resulting obstruction of the airway due to the smaller size of the trachea and relatively large epiglottis. Examination of the airway with laryngoscopy hence should be recommended in all patients with inhalational and aspiration burn injury as it will help in guiding airway management and preventing development of complications. Authors report a case of a 3-year-old male child with accidental ingestion of just made hot tea. Upon presentation there was severe stridor and signs of respiratory distress requiring emergency intubation. Direct laryngoscopy revealed glottic edema and ulcer. Upper GI endoscopy showed erythematous arytenoids, esophagus and stomach showing few erythematous flat lesions. Chest radiographic examination showed bilateral para cardiac and perihilar inhomogeneous opacities suggestive of aspiration pneumonitis. The child was gradually weaned and extubated on day three of admission. Ingestion of hot liquids can cause airway and esophageal thermal burns. Rapid diagnosis and treatment are essential in management of inhalational and aspiration burn injury to reduce the morbidity, mortality and long-term sequelae in these patients. Children are more prone for burn accidents due to their curious and exploratory behavior and their inability to perceive the hazards. Since most of the pediatric burn accidents happen at home, parents should be offered education about prevention of burn and advised on how to manage and treat minor burn injuries and to watch for any warning signs in which case to rush to the nearest hospital.
RESUMO
Type II diabetes mellitus (T2DM) is closely associated with Obstructive sleep apnea (OSA) and obesity. Type 2 diabetes and OSA may be pathophysiologically independent conditions although the joint association with obesity or visceral adiposity. There is a consistent relationship between obesity and OSA, which has been reported in 60-90% of OSA patients. The prevalence of obesity increases with a parallel increase in the prevalence of OSA. Continuous positive airway pressure (CPAP) therapy is an effective choice of treatment for OSA, an overnight test, or titration some patients may reduce apnea events by minimizes airway collapse by CPAP. Several studies showed that the effect of drug treatment with 3 months of C-PAP in patients with type 2 diabetes. In the present study, we include 300 patients in different groups, out of the 100 patients undergoing treatment of CPAP therapy minimum for three months. Blood sugar, HbA1c, and lipid profile were measured and an overnight sleep study was done. The obtained data shows the significant effect of therapy on physiological and biochemical parameters. AHI and BMI were highly significant in group II and Group III when compared to group I. FBS, HbA1C, and Lipid profile parameters also gave significance results (p-value <0.001) in group II and group III when compared with healthy subjects (group I).
RESUMO
Post-operative sorethroat (POST) is a well-recognized complication in patients with endotracheal intubation for general anaesthesia. Many pharmacological measures for attenuating POST are being used during anaesthesia. In our study we compared the effectiveness of ketamine and benzydamine hydrochloride versus a placebo as preoperative gargle in decresing the incidence and severity of POST in patients undergoing endotracheal intubation for general anaesthesia. Methods: A total of 90 patients aged between 18-60 years of ASA I-II of either sex were randomly assigned into three groups of 30 patients each . Group 1(C) received distilled water,group2(BH) received 15 ml of benzydamine hcl(0.15%) and group 3(K) received preservative free ketamine 40 mg as preoperative gargle 10 min before induction. The incid- ence of POST was recorded at 2,4 and 24 hr post operatively. Results: The three groups were comparable in term of demographic characteristics. The incidence and severity of POST is much more in group 1(C) i.e control group (30%) after 24 hr compared to group 2 (BH) 0% and group 3(K)3.5%. There was no significant difference of POST in group 2(BH) and group 3(K). Conclusion: From our study it can be concluded that both benzydamine and ketamine gargle significantly reduces the incidence and severity of POST compared to ditilled water gargle up to 24 hr in the patients undergoing general anaesthesia with endotracheal intubation. Both the Benzydamine and ketamine gargles are safe, simple and equally effective in reducing POST.
RESUMO
Background: Individuals with type 2 diabetes display features of low-grade inflammation. Mediators of inflammation such as IL-6 have been proposed to be involved in the events causing as well as progression of diabetes. Diabetic nephropathy is one of the commonest causes of chronic kidney failure throughout the world. Although diabetic nephropathy is traditionally considered a non-immune disease, accumulating evidence now indicates that immunologic and inflammatory mechanisms play a significant role in its development and progression.Methods: This cross sectional study was conducted in the department of medicine, UPUMS, Saifai. The study was conducted from June 2018 to February 2019. A total of 80 type 2 diabetes patients were included in the study. After informed consent, patients were recruited. FBS, PPBS, HbA1C, 24 Hrs Urinary protein and interleukin-6 levels were measured. The data was analysed using SPSS 23. Pearson co relation co efficient was determined between IL -6, HbA1c and Urinary protein.Result: A total of 80 type 2 diabetes patients were studied. The study subjects were divided into 3 groups based on the urinary protein level into normo-albuminuria, Micro- albuminuria and macro- albuminuria. FBS, PPBS, HBA1c, 24 Hrs Urinary protein and Interleukin – 6 were significantly associated with proteinuria (p<0.001). Urinary protein was positively correlated with IL-6 (R2=0.57, p<0.01). The blood glucose was positively correlated with IL-6 (R2=0.413, p-0.01).Conclusion: Raised IL-6 levels in diabetics revealed the presence of inflammation. Our study showed positive correlation between IL-6, HBA1c and Urinary protein.
RESUMO
Background: Diabetes Mellitus comprises a group of metabolic disorder leading to hyperglycaemia. Vitamin D deficiency plays a role in Type 2 Diabetes Mellitus pathogenesis. Vitamin D appears to affect several metabolisms that have been associated with coronary artery disease. Vitamin D level has been recently considered as an adjustable risk factor of cardiovascular diseases, in individuals with type 2 Diabetes.Methods: This case control study was conducted in the Department of Medicine, UPUMS. 100 diabetic individuals with low Vitamin D level were taken as cases and 100 diabetic individuals with normal vitamin D level as control. History and examination with necessary investigations were done. Patients with positive history were subjected to investigations to diagnose CAD.Results: The proportion of case and controls had no significant difference in age distribution. The risk of coronary artery disease was 2.76 times higher among diabetes mellitus patients with vitamin D deficiency (1.36-5.59). The risk of CAD was adjusted for various risk factors (age, sex, hypertension, smoking, physical activity, and lipid profile) Odds ratio was found to be 2.8 (95% CI-1.19-6.94, p-0.018).Conclusions: Vitamin D deficiency among diabetes patients was found to be an independent risk factor for CAD after adjusting other risk factors emphasizing that vitamin D can be a potential risk factor for development of coronary artery disease.
RESUMO
Background: Abnormal uterine bleeding affects 50% women of perimenopausal age group. The use of ormeloxifene (SERMS) in management of AUB is well known. The objective of the present study was aimed to see the effects of ormeloxifene on different types of endometrium.in the medical management of Abnormal Uterine Bleeding (AUB).Methods: It was Prospective, interventional study. A total of 90 women who attended Outpatient Gynaecology Department, Guwahati with complain of AUB in perimenopausal age group (37-48) were prescribed 60mg ormeloxifene twice weekly for 3 months followed by once weekly for next 3 months after preliminary D and C.Results: Ormeloxifene was found to be more effective in reducing PBAC score and ET in patients with proliferative and secretory endometrium The reduction in mean PBAC score with ormeloxifene (175.3 to 20.93)(p value 0.0001) and ET (9.6 to 2.9 mm) (p value 0.0001) in proliferative endometrium, (179.2 to 14.8 (p value 0.0001) ) and ET 11.1 to 1.9 mm (p value 0.0003)in secretory endometrium was observed after 6 months. However, it was found not to be effective in reducing PBAC score and ET in patients with atrophic endometrium. Change in PBAC SCORE from 176.4 to 150.8 (p value 0.08) and in ET from 2.8 to 2.1mm( p value 0.3) was observed. No major side effects were reported.Conclusions: Ormeloxifene is effective in AUB with proliferative and secretory endometrium.
RESUMO
Nonalcoholic fatty liver disease (NAFLD) is characterized by the accumulation of fat in the liver without any history of chronic alcohol consumption. It encompasses a wide spectrum of diseases that range from simple steatosis to nonalcoholicsteatohepatitis. NAFLD is strongly associated with obesity, insulin resistance / type-2 diabetes mellitus and the metabolic syndrome. NAFLD is a complex disorder; environmental and genetic factors interact with NAFLD manifestation and determine its progression. In this review, an attempt was made to provide current information on the genetic variants of NAFLD in Asian populations. Literature search was performed by using PubMed, Medline and Google Scholar database. Candidate gene, validation and genomewide association studies (GWASs) were included in this review. A total of 41 studies fulfilled inclusion criteria of which 12 candidate gene studies exclusively focussed on the PNPLA3 gene and 17 other studies on other important candidate genes such as NCANCILP2, PPARG,AGTR1, FABP1, APOC3 etc. reported significant association with NAFLD. Eight validation studies identified associations of variants on PNPLA3, LYPLAL1, TM6SF2, ADIPOR2, STAT3, GCKR, SAMM50 etc. with NAFLD. Thus, so far, four GWASs have been conducted in Asian population that reported PNPLA3, SAMM50, PARVB and GATAD2A genes which were significantly associated with NAFLD. Findings indicate that PNPLA3, APOC3, PPARG, NCAN and GCKR genes emerge out to be the important biological markers associated with NAFLD.
RESUMO
Background: Diarrhoea is described as three or more loose orwatery stools a day. Infection commonly causes acuteDiarrhoea. Noninfectious etiologies are more common as theduration of Diarrhoea becomes chronic. Hence; under the lightof above mentioned data, we planned the present study assessand compare the efficacy of various treatment modalities in theTreating diarrhoea patients.Materials & Methods: A total of 160 patients with diarrhoeawere included in the present study. All the patients werebroadly divided into four study groups with 40 patients in eachgroup: group 1- patients who were given Nitazoxanide therapywhile group 2- included patients who were given metronidazoletherapy, group 3- patients who were given cefixime therapy,and group 4 – patients who were given norfloxacin therapy.Stool samples were obtained from patients of both the studygroups for assessing the effectiveness of treatment therapy.Both clinical and microbiological success was recorded. All theresults were recorded and analysed by SPSS software.Results: Clinical success was recorded in 95 percent of thepatients of group 1 and it was recorded in 97.5 percent ofthe patients of group 2. Microbiological and clinical successamong subjects of group 3 was 90 percent and 92.5 percentrespectively. Microbiological and clinical success amongsubjects of group 4 was 92.5 percent and 92.5 percentrespectively. Non-significant results were obtained whilecomparing the efficacy of both the antibiotics in treatingdiarrhoea patients.Conclusion: All the antibiotics can be used with equal efficacyin treating diarrhoea patients.
RESUMO
Objective: To explore the effect of hydroalcoholic extract of Cynodon dactylon on the whole body radiation-induced oxidative status of the cerebellum and cognitive impairments in mice. Methods: Swiss albino mice were randomly divided into the control group, radiation control group, low dose and high dose Cynodon dactylon extract treated groups and pre-treated with Cynodon dactylon extract before irradiation. Cynodon dactylon extract was administered for 7 d daily in low dose (0.25 g/kg) and high dose (1 g/kg). On day 7, mice were irradiated with a sublethal dose of 5 Gy gamma rays. Motor coordination was assessed by elevated rotarod test and spatial memory was studied by water maze test. Subsequently, biochemical markers (glutathione, lipid peroxidation and nitric oxide levels) in the cerebellum were evaluated. Results: The gamma irradiated group showed significant impairment in motor coordination and spatial memory compared to normal mice. Mice treated by Cynodon dactylon extract prior to gamma radiation showed good improvement in both paradigms compared to the radiation control group. Moreover, glutathione level was increased, while lipid peroxidation and nitric oxide levels were significantly reduced in mice receiving low dose and high dose of Cynodon dactylon extract compared to the radiation control group. Conclusions: The present study suggests the neuroprotective role of Cynodon dactylon against radiation-induced cognitive impairment and oxidative stress on the cerebellum of mice.
RESUMO
Pantoprazole sodium, a substituted benzimidazole derivative, is an irreversible proton pump inhibitor which is primarily used for the treatment of duodenal ulcers, gastric ulcers, and gastroesophageal reflux disease (GERD). The monographs of European Pharmacopoeia (Ph. Eur.) and United States Pharmaco-poeia (USP) specify six impurities, viz.; impurities A, B, C, D, E and F, respectively for its active phar-maceutical ingredient (API). The identification and synthesis of all impurities except impurity E are well described in the literature; however, there is no report related to impurity E. The prospects to the for-mation and controlling of impurity E up to ≤0.03% in the synthesis of pantoprazole sodium sesquihydrate (PAN) were discussed in detail for the first time. The present work described the journey towards the successful development of an optimal preparation procedure of dimer impurity E. The most plausible mechanism involved in the formation of impurity E has been proposed.
RESUMO
Introduction: In laparoscopic cholecystectomy gall bladder perforation and spillage are the common complications encountered during dissection and removal of gall bladder. Gall bladder removal can be completed simply and safely when a retrieval bag is used. This trial was undertaken to compare the retrieval of gall bladder with endobag versus without endobag. A sterile latex glove was used as an endobag which is an easily available and a cheaper alternative with similar effectiveness. Aim: To compare the benefits and complications of extraction of gallbladder in an endobag v/s direct extraction through 10 mm port in laparoscopic cholecystectomy in terms of operative time, port site infection, port site pain and duration of hospital stay. Materials and Methods: This study was carried out in Department of Surgery SN Medical College Agra to compare benefits and complications of extraction of gallbladder in an Endobag versus direct extraction. A total of 100 patients with symptomatic cholelithiasis were included in the study after surgical assessment and confirming diagnosis. They were divided into two groups of 50 each by randomization. Results: In this study of 100 patients 92% were females and 8% were males. With the use of an endobag, mean operative time taken was 1 hour as compared to 1.3 hours taken in procedure without using an endobag. Mean hospital stay was of 3.45 days and only 2% patients had port site infection in cases with endobag as compared to 3.6 days and 10% patients had port site infection in cases without endobag. There was no spillage of stones and bile with the usage of endobag. Conclusion:An endobag for retrieval of gall bladder during laparoscopic cholecystectomy was found better than the direct extraction of the gall bladder. A sterile latex glove made endobag is a simple, safe and cost–effective method and can be used instead of endobag