Antimicrobial Effect of Non-Thermal Atmospheric Plasma on Streptococcus Mutans -The Key Cariogenic Microorganism in Plaque Biofilm

Background: To evaluate the antimicrobial effect of non-thermal atmospheric plasma on mutans biofilms. Materials: A 100 µl culture of Streptococcus mutans poured into two 120 well flat base microtiter plates, allowed to adhere and incubated overnight using brain heart infusion (BHI). These 120 wells were grouped into four groups, group A-helium treated, group B-plasma treated, group C- chlorohexidine treated and group D-control group (untreated group) with a group size of 30 wells per group. Triphenyl tetrazolium chloride (TTC) essay & Colony Forming Units (CFU) counting was done to check the viability & survival of streptococcus mutans biofilms. Results: The results showed that there was a significant difference in the mean optical density (OD) among the four groups (p<0.001). Post-hoc analysis revealed that untreated samples and Helium had significantly higher mean OD than plasma and chlorhexidine groups. A similar result was also seen using the survival essay by CFU counting. Conclusion: Plasma utilizes the air from the atmosphere, thus rendering plasma a better reach in the oral cavity. This property of plasma can be efficiently used to neutralize Streptococcus mutans biofilms in the oral cavity.

Comparative evaluation of amisulpride and escitalopram on Hamilton anxiety rating scale among depression patients in a tertiary care teaching hospital in Nepal.

Background: Depression is an important global public health problem and is a major cause of disability and premature death. The present study was conducted to compare effi cacy and safety of amisulpride and escitalopram on Hamilton anxiety rating scale (HAM-A) among depression patients in a tertiary care teaching hospital in Nepal. Methods: The study was conducted in patients for 1-year in the Department of Neuropsychiatry, Nepalgunj Medical College and Teaching Hospital. A total of 117 depression patients were divided into two groups. Group I (58 patients) received amisulpride tablet at a dose of 50 mg/day and Group II (59 patients) were given escitalopram at a dose of 10 mg/day. The patients were required to follow-up at 4, 8 and 15 weeks. The effi cacy of the drugs was calculated by HAM-A. Adverse drug reactions (ADRs) were monitored at every follow-up. Appropriate statistical tools using Graphpad instat 3.0 were used for analysis p<0.05 was considered signifi cant. Results: HAM-A score in group receiving amisulpride at 0 and 15 weeks was 19.83±0.33 and 8.17±0.32 (p<0.0001). HAM-A score in group receiving escitalopram at 0 and 15 weeks was 20.76±0.28 and 8.98±0.24 (p<0.0001). Gastrointestinal disturbances, sexual disturbances, amenorrhea, lactation, agitation, and insomnia were the commonly encountered ADRs. Conclusion: Both amisulpride and escitalopram were highly effective in the treatment of anxiety in depression patients during the study period. Further, more clinical studies with longer follow-up duration are needed to substantiate the therapeutic effects of amisulpride.

Comparative evaluation of effi cacy and safety of carboxymethylcellulose either alone or in combination with non-steroidal anti-infl ammatory drug in the treatment of dry eye in a tertiary care teaching hospital.

Background: Dry eye produces discomfort and reduced vision. The treatment of dry eyes has traditionally involved hydrating and lubricating artifi cial tears. The newer medications include non-steroidal anti-infl ammatory drugs (NSAIDs) for the treatment of dry eye disorders. This study was designed to compare the effect of topical carboxymethylcellulose (CMC) alone or in combination with topical NSAID for the treatment of dry eye in a tertiary care teaching hospital. Methods: A total of 60 patients diagnosed with dry eye were enrolled for a study period of 1 year. Patient of either sex (male/female), age between 18 and 70 years, and all diagnosed cases of dry eye in ophthalmology outpatient department were selected. Patients (n=60) were stabilized on CMC for 2 weeks and thereafter divided into two groups. Group I (n=30) received only topical CMC; Group II (n=30) received CMC+NSAID. The patients were followed up to 12 weeks. Diagnostic tests included Schirmer’s test and tear break up time (TBUT). Ocular Surface Disease Index (OSDI) was used for assessing the Quality of Life. Analysis was done using GraphPad InStat software. p<0.05 was considered signifi cant. Results: This was an open-label study revealing a mean age of 46.0±1.79 years. Females (56.67%) showed a signifi cantly higher prevalence of dry eye symptoms compared to males (43.33%). The mean duration of illness was 1.95±0.16 years. Schirmer’s test, TBUT test values and OSDI score in Group I and Group II at 0 and 12 weeks revealed signifi cant intragroup difference (p<0.0001). At 12 weeks intergroup comparison in Schirmer’s test value (p>0.05) and TBUT test value (p>0.05) showed no signifi cant difference while OSDI score revealed signifi cant difference (p<0.05). Burning, stinging, blurring of vision, photophobia, and hyperemia were among the common adverse effects seen. Conclusion: Both groups showed signifi cant improvement in Schirmer’s test and TBUT test value and OSDI score at the end of the study. Intergroup comparison showed a signifi cant difference with reference to OSDI score. Patients receiving NSAID reported more adverse effects.

Drug utilization study in genitourinary infections used as a teaching tool for rational therapy for MBBS students in a Medical College at Dehradun, Uttarakhand.

Background: There is a need to introduce clinical pharmacology at the undergraduate level in order to improve rational prescribing of medicines. The present study was undertaken to analyze drug utilization pattern of genitourinary infections to teach certain basic skills to MBBS students which will form an integral component of practicing rational therapeutics. Methods: The retrospective study was conducted by Pharmacology Department in Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS). A total of 92 prescriptions were collected by second professional MBBS students and randomly evaluated for prescribing pattern using WHO drug indicators. Results: A total of 92 prescriptions were analyzed. Male:female ratio was 1.96:1. Age wise distribution was done: 0-15 years were 14 (15.21%), 16-30 years were 26 (28.26%), 31-45 years were 24 (26.08%), 46-60 years were 19 (20.65%), and >60 years were 9 (9.78%). A total of 260 drugs were prescribed. 116 (44.61%) antimicrobials, 70 (26.92%) antacids and antiemetics, 40 (15.38%) analgesics, 11 (4.23%) urinary alkalizers, 9 (3.23%) antifibrinolytics, and 14 (5.38%) miscellaneous drugs were prescribed. 144 (55.38%) injectable and 116 (44.61%) oral drugs were prescribed. Numbers of fi xed-dose combinations were 32 (34.78%). 2.82 drugs per prescription were prescribed. 171 (65.76%) drugs were prescribed from National List of Essential Medicines 2013 (NLEM 2013). Majority of drugs were prescribed by brand names. Conclusion: Majority of drugs were prescribed from NLEM 2013. The main purpose of undergraduate medical curriculum is to develop the requisite diagnostic and therapeutic skills of a basic doctor. It is only by drug utilization studies that burden of diseases and corresponding utilization of drugs can be measured.

Management of infected abdominal aortic aneurysm associated with vertebral destruction due to chronic leak

We report a case of a patient with an infected abdominal aortic aneurysm due to Staphylococcus versus Brucellar spine infection complicated by aortic aneurysm with chronic contained leak. A 75-year-old patient who had a history of Brucellosis 4 years ago presented one year later with 4.5 cm infra renal abdominal aortic aneurysm [AAA]. He presented with aggravated acute abdominal pain radiating to the back and right hip, loss of weight, anorexia, and malaise. The CT-scan showed an AAA of size 6.5 cm involving infra-renal abdominal aorta with erosion of the body of lumbar vertebrae L3 and L4, and stretching of psoas muscle by a chronic contained posterior leak. Investigations showed erythrocyte sedimentation rate of 30, C-reactive proteins of 89, and the Brucella titer was negative. The diagnosis was infected aneurysm and the patient underwent axillo bifemoral bypass and ligation of aorta below the renal arteries. Tissue culture postoperatively showed coagulase negative Staphylococcus

Bilateral fibular hemimelia with recto-vestibular fistula associated with amniotic bands.

Fibular Hemimelia is a rare congenital disorder of deficiency to complete absence of fibula. It has been associated with post axial skeletal anomalies like shortening of femur, absence of lateral rays of foot and syndactyle, polydactyle etc. We report this case because of associated amniotic constriction bands over both the forearm, suggesting amniotic bands may be one of the causal factors of Fibular Hemimelia due to insult to the growing limb bud.

Pulmonary tuberculosis presenting as atypical pneumonia syndrome

A case of dessimanted pulmonary tuberculosis in a 30 year old Somali male who presented with fever, cough, weight loss over a period of one month, is reported because of its unusual presentation. On examination the patient looked ill, dyspnoeic, pale and on auscultation of the chest there were late inspiratory crackles. Repeated sputum samples were negative for acid-fast bacilli. Chest x-ray showed bilateral micronodular infiltration. All other investigations were negative apart from Legionella titre. Initially he was treated as a case of atypical pneumonia with erythromycin but did not show improvement. Lung biopsy was carried out for diagnostic reasons and this confirmed the presence of pulmonary tuberculosis. Clinical and radiological improvement started after instituting anti-tuberculosis treatment

Complicaciones diabéticas: progresos en el desarrollo del tratamiento / Diabetic complications: progress in the development of treatment

A pesar de los avances en el tratamiento de la diabetes, las complicaciones de la enfermedad a largo plazo, tales como la retinopatía, la nefropatía y la neuropatía, siguen siendo la mayor causa de morbilidad y mortalidad en los pacientes diabéticos. Los estudios clínicos prospectivos con insulinoterapia intensificada han establecido una clara correlación entre la hiperglucemiay el desarrollo de las complicaciones diabéticas estudios en animales han demostrado el vínculo entre el incremento del metabolismo de la glucosa inducido por la hiperglucemia diabética a través de la vía del sorbitol y el desarrollo de lascomplicaciones. Por otra parte, una mejor comprensión de los mecanismos patogénicos de la neuropatía diabética ha promovido la utilización de las mediciones electrofisiológicas como medio confiable de cuantificar la progresión de la neuropatía diabética y también ha redefinido metas realistas de tratamiento para las complicaciones diabéticas, como la detención o atenuación de los procesos de la enfermedad en vez de su reversión. Estudios clínicos recientes con insulinoterapiaintensificada e inhibidores de aldosareductasa, apoyan claramente estos nuevos objetivos de tratamiento. En estudios a largo plazo de 5 a 8 años, la insulinoterapia intensificada no revirtió los signos clínicos y los síntomas de la neuropatía diabética, pero si evitó su aparición en pacientes sin evidencia de neuropatía al comienzo del estudio.La insulinoterapia intensificada tampoco restauró la pérdida preexistente de la función,pero redujo la pérdida acelerada de esa función,característica de la neuropatía diabética

Tobacco smoking and its impact on the micro-environment

Statistical data have been presented to show that cultivation and manufacture of tobacco has, as an economic activity of the country, recorded a 20% reduction in the production of cigarettes and also in its imports. The 70.000 tens of tobacco grown in Pakistan provides six to seven billion lethal doses to its sixty million smokers. The intoxication symptoms enjoyed by smokers have been discussed. It has been suggested that they are psychological as well as result of interaction of the dry distillation products of tobacco with the respiratory system in the micro-environment. These products include carbon monoxide, hydrocyanic acid, nitrogen oxide, ammonia, pyridine and tar besides nicotine. The stresses created in the micro-environment surface up in the form of circulatory and intestinal disturbances. Nicotine interacts in the micro-environment [1] with the ganglia cells of the autonomous nervous system and creates a stimulating effect followed by depression [2] with the gastro-intestinal canal to create sympatheticotropic effects resulting in intestinal movements ad [3] with the sympathetic nervous system to effect gastric secretion. The other products of decomposition also react with the circulatory system to decrease the oxygen carrying capacity of blood through the interaction of [i] carbon monoxide to form carboxyhaemoglobin, and [ii] of nitrogen oxides, hydrogen cyanides, and other decomposition products to form methaemoglobin and [iii] the inhibition of carbonic anhydrase activity to create an acid-base imbalance in the circulatory system. Hot fumes containing ammonia, methanol and organic acids inhaled during smoking create irritation in the micro-environment and a burning sensation in the mucosa of mouth and throat. Chronic irritation can create a permanently damaged site in the respiratory tract. Lung cancer by smoking has been suggested to be due to tar depositing at the sites in the micro-environment which have been dehydrated by the hot vapours. The increase in cancer cases can be attributed to changes in lifestyle and smoking is one such change. Strong social pressure may reverse the degradation process and perhaps this is one of the reasons for the decrease in the production of tobacco manufactures in the country

concept of temperament and aging

The Greco-Arab system of medicine has been examined with reference to the concept of temperament and compatibility and the elements aire, water, earth and fire which have the properties of being cold, wet, dry and hot have been interpreted as endothermic, hydration, dehydration and exothermic reactions. Compatibility of a substance with a living body has been suggested to be dependent on its being hydrogen bondable. Temperament of the living body is suggested to be its ability to maintain an optimum hydration level, a positive mass and energy balance as well as the elemental [chemical] and substrate balance and to reactivate the deactivated enzymes. In case of any imbalances, the life processes would be disturbed and the most favoured reactions that would predominate over others would comprise oxidative dehydration reactions which would give rise to a cold and dry temperament that would characterize aging

Changes in the micro-environment and aging

The dehydration Theory of Aging has been further elaborated by citing reactions between proteins such as those of bacterial cell walls, algae and collagen and toxins such as dyes and metals, formaldehyde quinone and the tannins. It has been argued that the reactions are initiated by disturbance in the micro-environment followed by fixation to the protein and finally introduction of cross-links accompanied by dehydration

Stresses in the micro-environment and aging

Changes introduced in the micro-environment as a result of stresses are suggested to lead to accelerated aging in material as well as living systems. Both have a designed capacity to undergo stresses. For a machine it is possible to estimate the capacity or safety from the ratio of damaging stress to working stress but in the absence of such data on living organisms, a guideline can be obtained from the analysis of biological fluids and metabolites present therein, for food or other material input, to retard aging. Interactions and reactions of living organisms are governed by Le Chatelier's principle just as much as in material system. It has been shown that stresses are a part of the reaction equilibria on which living systems operate. A rat race, that is on to attain better quality of life, is putting considerable stress on the individuals concerned. They have to fit into a fast moving society or else they would be counted out. Stresses such as these demand extra work from mind as well as body. The resultant strain then appears in the form muscular or mental fatigues delirium, nervous tension, blood pressure or heart ailment. Living system, the paper observes, has to adjust to environmental constraints according to the said principle to respond to stresses and for conservation as well as maintenance of metabolites observed among plants, animals and mankind, wears out the strained parts of the body and are responsible for aging. Human system has been suggested to have the ability to absorb and transmit environmental stresses, through its superior central nervous system into the endocrine glands. The adjustment process demands considerable amount of extra energy for operation of the psyche and the high demand on the system leads to accelerated aging

Stresses in the micro-environment of the respiratory systems and initiation of aging

Hydration of carbon dioxide and dehydration of carbonic acid constitute the equilibria occurring in the respiratory system. They have been examined in the light of the Dehydration Theory of Aging. It has been argued that water, carbon dioxide and oxyhaemoglobin formed as the products of respiratory reactions combine to form the bicarbonate ion and release haemoglobin along with molecular oxygen. This reaction provides the main driving force for the respiratory system and if reversed constitutes the oxidative dehydration process which is the mechanism that governs the aging process. The reversal. However, takes place only partially to the extent of 0.15% since the ratio of concentration of bicarbonate ion to dissolved carbon dioxide is 20 to 1. The aging process is accordingly very slow. The demand of oxygen as a result of body activity is suggested to be governed by Le Chatelier's principle. The thickening of alveolar and capillary interface as well as attenuation of surface area for diffusion take place by the oxidative dehydration through formation of cross links due to pressure required for the transfer of gases to meet the demaned. The formation of cross links is, however, retarded by antioxidants such as ascorbic acid and as such the process of aging is not rapid. Stress created by smoking of tobacco on the respiratory system has been taken as an example to elucidate the effects of oxidative dehydration in the mirco-environment

Circulation system in life processes and aging

The Dehydration Theory of Aging has been extended to the circulation system which has to transport as mush fluid daily as two to three times the weight of the body. The fluid quality and volume has to be precisely controlled. The system is put to tremendous strain in order to overcome the resistance from arterioles and micro-capillaries in the body which carry the fluids and from the glomeruli of the kidney. The latter provide a mechanism for ultrafiltration as well as reabsorption of 99% of the glomerular fluid to pass as urine. The resistance in transportation has been suggested to be due to cross-links formed between hydrophobic materials such as cholesterol and the muscle fibres, an example being the age pigment lipofuscin. Such cross-links introduced by small but significant quantities of aldehydes among collagen of blood vessels are suggested to be responsible for the rigidity of old blood vessels for the 60% reduction in the blood flow in the kidneys and for the reduction in flow in the peripheral vascular system during the aging process. The oxidative dehydration process of aging strike a balance in the circulation system just as much as in the respiratory system. This balance does not allow the accumulation of hydrogen ions which otherwise could give rise to acidosis, and this condition does not allow cross-link formation as is observed in the case of tanning the hide or dyeing the leathers. Excretion of surplus water, non-metabolized solutes in the diet and nitrogenous end products is a function of the kidney. It thus controls the osmolality of solutes and the hydration and dehydration processes. The carbonic anhydrase enzyme which plays a major role in catalyzing the absorption of carbon dioxide to form carbonic acid and its conversion to bicarbonate would lose its activity in the event of reduction of hydration level. This is suggested to be the major reason for the 60% reduction of kidney function during aging. Imbalance in the citrate and calcium ion transportation makes the cells more alkaline and favours calcium deposition. The crystalloids of calcium, magnesium, phosphate, oxalate and urates are present in the urine in supersaturated state. The presence of sequestering agents inhibits the growth and deposition of the crystalloids but their inhibitory effect is reduced in the acidic environment of the kidney or in stress situations and causes the deposition of renal calculi. The acidification of urine has also been considered in terms of the hydration and dehydration process and the circulation system in life processes has been suggested to support the hypothesis

Specificity and relative efficacy of different assay methods for thiamine hydrochloride in vitamin B-complex syrups

Vitamin B-complex syrups were prepared using locally manufactured sucrose and liquid glucose vehicles, and stored at room temperature, 37°C and 45°C, for 6-12 months to evaluate the stability of thiamine hydrochloride. The stability testing of the syrups has been designed to determine quantitatively and qualitatively the changes which they undergo during storage. The chemical stability has been studied using four different assay methods. The specificity and relative efficiency of the methods have been compared and the U.S.P. fluorimetric method has been found to be the most accurate and specific for the assay of the vitamin