An Unusual Case of Pancytopenia: The Lessons Learnt.

Pancytopenia is a common hematological abnormality encountered in clinical practice. We here report a 36-year-old male who presented to emergency department with complaints of weakness of bilateral lower limbs, burning sensation in all four limbs with history of loose stools, and vomiting 5 days back. The complete blood count of patient showed pancytopenia with no circulating atypical cells. Bone marrow examination performed showed nonspecific but characteristic findings. After excluding the possibility of infective etiology, a possibility of heavy metal toxicity was suspected in multidisciplinary meeting. The urine and blood levels of arsenic done came out very high, and a diagnosis of arsenic poisoning was made. Patient had multisystemic involvement with features characteristic of arsenic poisoning. The present case was a diagnostic challenge in face of nonforthcoming history. This case beautifully highlighted the importance of multidepartmental approach in such cases to arrive at unerring diagnosis and the unique bone marrow findings, although nonspecific were sufficient enough to indicate the possibility of acute insult to the hematopoiesis. How to cite this article: Nair RR, Singh PK, Sharma J, Gambhir I, Khanna S, Jain AK, et al. An Unusual Case of Pancytopenia: The Lessons Learnt. Indian J Crit Care Med 2022;26(1):141-144.

A synergistic approach of adapalene-loaded nanostructured lipid carriers, and vitamin C co-administration for treating acne.

The present study documents the fabrication and characterization of a topically applicable gel loaded with nanostructured lipid carriers (NLCs) of adapalene (ADA) and vitamin C (ascorbyl-6-palmitate [AP]). The NLCs were prepared by high pressure homogenization (HPH) method followed by incorporation into AP loaded gel. The fabricated system was characterized for size, poly dispersity index, entrapment efficiency (EE) and in vitro drug release properties, and was further investigated for skin compliance, skin transport characteristics (skin permeation and bio-distribution), rheological behavior, texture profile analysis and anti-acne therapeutic potential against testosterone-induced acne in male Wistar rats. The NLC-based formulation improved targeting of the skin epidermal layer and reducing systemic penetration. The co-administration of vitamin C led to an adjunct effect in acne therapy in physiological conditions. In brief, the present results suggest the potential of NLCs as a novel carrier for the dermal delivery of ADA and also the synergistic effect of vitamin C in topical therapeutics.

Locally Advanced Breast Cancer: Response Evaluation to Neoadjuvant Chemotherapy by Clinico-Histopathological Parameters and Molecular Imaging.

In India, breast cancer (BC) is not only the commonest cancer but also the commonest cause of cancer mortality among females. Advanced BC constitutes >70% of BC cases at initial presentation in India, among which locally advanced breast cancer (LABC) requires a multi-disciplinary approach with a combination of systemic and locoregional therapies. This descriptive hospital-based study was conducted over 1½ years after seeking approval from the institutional ethics committee. Fifty-five patients satisfying all the criteria of the study were enrolled. The data, thus, collected was pooled into Excel spreadsheet and analyzed using appropriate statistical tools. Most of the patients were postmenopausal, multiparous with breast lump being the commonest symptom. Mean baseline characteristics were age - 48 years, SUV max - 9.2, and Ki-67 - 17.8%. cT4 and cN2 were the commonest pre-NACT tumor and lymph node stage. Invasive ductal carcinoma was the commonest tumor type with the most common tumor grade being grade 3. Hormone receptor positivity and HER2 overexpression were seen in 33 and 17 patients respectively. Post-NACT 32 patients underwent breast-conserving surgery. Pathological complete response (pCR), i.e., ypT0N0, was seen in 13 patients (23.6%). There was slight alteration in hormone receptor status, HER2 expression and Ki-67 in the post-NACT resected tumor. pCR, which is a surrogate marker for improved clinical outcome (DFS and OS) in LABC patients, occurred more commonly in patients with pre-NACT grade 3 tumors, high Ki-67, hormone receptor-negative, and HER2 overexpressing BC (overall, in triple negative BC) but was statistically significant only with Ki-67. Post-NACT, SUV max with a cut off ≤1.5, and ΔSUV max of >80% correlated closely with pCR.

An experience with Goel-Harms C1-C2 fixation for type II odontoid fractures.

Objective: Type II odontoid fractures need surgical stabilization for disabling neck pain and instability. Anterior odontoid screw fixation is a well-known technique. However, certain patients require posterior fixation. We present our surgical results and experiences with nine cases managed by the Goel-Harms technique. Materials and Methods: This is a retrospective review of nine patients operated on between January 2019 and December 2021 for Type II odontoid fractures with posterior fixation technique. Their clinical profile was collected from case files. The radiological data were retrieved from radiology archives. The indications for surgery were instability and refractory neck pain. The surgical decision for posterior fixation was guided by fracture morphology. Results: The mean age of presentation was 37.22 ± 9.85 years. Seven patients had Type II, and two had Type IIa odontoid fracture. All patients presented with unbearable neck pain. One patient had a quadriparesis. The fracture line was anterior-inferior sloping in six, posterior-inferior sloping in two, and transverse in one case. The anterior-posterior displacement of fracture ranged from 0 to 7 mm (mean 2.44 ± 2.18 mm). Partial transverse ligament tear without the Atlanto Axial Dislocation was present in three patients. The C1-C2 joint distraction was required in five cases. C1-C2 joint spacer was required in two cases. Following surgery, neck pain was relieved in all cases. Complete fracture alignment was achieved in eight patients. There were no postoperative complications. At the mean follow-up of 16.22 ± 9.61 months, there was no implant failure. Conclusions: Posterior C1-C2 fixation by the Goel-Harms technique is an excellent alternative to anterior fixation in selected cases.

A Prospective Comparative Evaluation of Surgery and Conservative Treatment for Compound Depressed Skull Fractures.

OBJECTIVE: The Brain Trauma Foundation issued level III evidence guidelines for surgical management of compound depressed fractures. However, some patients undergo successful conservative treatment. This study compares these 2 treatment modalities. METHODS: This prospective study included 67 patients with compound depressed skull fractures with surgical indications and a minimum follow-up of 6 months. Depressed fractures in front of the hairline (operated on for cosmetic reasons) and associated with significant intracranial injuries were excluded. Those who gave consent for surgery were included in the surgical group, and those who denied were included in the conservative group. RESULTS: The surgical group had 38 patients and the conservative group had 29. Both groups were comparable in mean age, gender, Glasgow Coma Scale score, head injury severity, depth of fractures, and follow-up duration. Focal neurologic deficits were observed in 19 patients at presentation and were higher in the surgical group. Mean hospital stay was significantly shorter in the conservative group. Mean Glasgow Outcome Scale score at follow-up was statistically similar in both groups (P = 0.13). Focal neurologic deficits improved equally in both groups (P = 0.67). The severity of traumatic brain injury (P = 0.004) and the presence of focal neurologic deficits (P < 0.001) affected the neurologic outcomes. The age, gender, mode of treatment (surgery vs. conservative), surgical site infections, and seizures did not affect neurologic outcomes. The overall complication rates were similar among groups (P = 0.50). New-onset focal neurologic deficits, seizures, and infection rates were not significantly different among the groups (P = 0.98, P = 0.72, P = 0.69). CONCLUSIONS: Conservative management has equivalent neurologic outcomes and complications compared with surgical management.

Multivariate and Online Prediction of Closing Price Using Kernel Adaptive Filtering.

This paper proposes a multivariate and online prediction of stock prices via the paradigm of kernel adaptive filtering (KAF). The prediction of stock prices in traditional classification and regression problems needs independent and batch-oriented nature of training. In this article, we challenge this existing notion of the literature and propose an online kernel adaptive filtering-based approach to predict stock prices. We experiment with ten different KAF algorithms to analyze stocks' performance and show the efficacy of the work presented here. In addition to this, and in contrast to the current literature, we look at granular level data. The experiments are performed with quotes gathered at the window of one minute, five minutes, ten minutes, fifteen minutes, twenty minutes, thirty minutes, one hour, and one day. These time windows represent some of the common windows frequently used by traders. The proposed framework is tested on 50 different stocks making up the Indian stock index: Nifty-50. The experimental results show that online learning and KAF is not only a good option, but practically speaking, they can be deployed in high-frequency trading as well.

Evaluation of change in pterygium induced keratometric astigmatism in patients following pterygium excision with autologous graft surgery.

Pterygium is a common surface disorder of the eye that may cause change in visual acuity of patients by inducing astigmatic refractive error. Surgical excision with grafting is considered the most effective recommended treatment for pterygium. The objective of this study was to evaluate the outcomes of pterygium excision with autologous graft surgery on keratometric astigmatism and visual acuity. MATERIALS AND METHODS: In this study total 64 eyes of 64 patients were enrolled having the diagnosis of pterygium. Prior to the pterygium excision surgery all the enrolled patients were studied for grading of pterygium, clinical symptoms, keratometric values and best corrected visual acuity (BCVA). Postoperatively, BCVA and keratometric readings were recorded at one week, one month, two months and four months intervals. RESULTS: Mean age of study participants was 34.16 ± 8.24 years in the age group of 18-60 years. 42 (65.62%) eyes had grade II pterygium, while 16 (25.0 %) and 6 (9.38%) eyes were having grade III and grade IV pterygium, respectively. Preoperative median and quartiles (25% -75%) horizontal and vertical keratometric values were 43.00 (42.50-44.00) D and 44.25 (43.75-44.50) D, respectively and both reduced significantly to 42.50 (42.50-42.94) D and 42.50 (42.50- 43.00) D, respectively after four months postoperatively. Median keratometric astigmatism before surgery was 1.37 (1.25-1.93) D which reduced significantly to 0.50 (0.32-0.75) D after four months of pterygium excision. Similarly, BCVA improved significantly [0.20(0.16-0.25) vs 0.53 (0.50-0.80)] when assessed postoperatively after four months. CONCLUSION: Excision of pterygium with autologous graft reduced pterygium-induced keratometric astigmatism and improved BCVA significantly.

Challenges in the use of carbon nanotubes for biomedical applications.

Carbon nanotubes (CNTs) are considered for use in numerous technological applications, including as biocompatible modules for the delivery of bioactives. However, there are unique properties of CNTs that limit their use as vehicles for various purposes. This review highlights the various challenges to a pharmaceutical scientist while exploring CNTs as bioactive delivery vehicles. The lack of solubility, nonbiodegradability, circulation half-life of 3-3.5 hours, biocompatibility, and immunogenicity limitations of CNTs are discussed in this review. These limitations indicate the need for modifications in order to explore the feasibility of CNTs as delivery vehicles.

Assessment of Antimicrobial Prescribing Pattern in the Outpatient Department of Ophthalmology in a Tertiary Care Hospital of Western Uttar Pradesh, India.

INTRODUCTION: Assessment of prescribing pattern at regular interval is essential to avoid inappropriate use of drugs, especially of antimicrobial drugs. OBJECTIVES: The present study was performed to evaluate the prescribing pattern of antimicrobial drugs in the Ophthalmology Out-Patient Department (OPD) of Santosh Medical College and Hospital, Ghaziabad, India. MATERIAL AND METHOD: The present study included a total 600 prescriptions of patients attending OPD. A structured proforma was used to record all necessary information of each patient including demographic profi le of patient, diagnosis, total number of drugs and antimicrobials prescribed, group of antimicrobial prescribed, the percentage of antimicrobials prescribed by generic name etc. Results: Total 600 prescriptions were evaluated. Mean age of the study subjects was 28.4 ± 15.05 years. Total 720 antimicrobials were prescribed and the average number of antimicrobial drugs per prescription was 1.2. Fluoroquinolones were most commonly prescribed antimicrobial drugs followed by aminoglycosides and macrolides. 85% of drugs were prescribed in the form of eye drops while 15% were in the form of an ointment. 1.2% of antimicrobial drugs were prescribed by generic names. Out of total antimicrobials drugs, 420 drugs were in the form of fi xed dose combination. Only 1.6% of drugs were prescribed from National Essential Medicines List (NEML) 2015, India. CONCLUSION: Most of the antimicrobials were prescribed by brand names which require important consideration to promote rational use of antimicrobial drugs. In addition, the number of drugs prescribed from NEML was very less, indicating the need of sensitization among prescribers for the promotion of rational use of drugs.

Fatty acid vesicles acting as expanding horizon for transdermal delivery.

The body is protected against the external environment by the skin due to its physical barrier nature. Stratum corneum composed of corneocytes surrounded by lipid region performs a major barrier function as it lies in the uppermost area of skin. Alteration in barrier function, increase in permeability, and disorganization of stratum corneum represent diseased skin. Drugs applied to the diseased skin should induce a local effect at the site of application or area close to it along with cutaneous absorption rather than percutaneous absorption. Conventional formulations like ointments, gels, and creams suffer from the drawback of limited local activity. For the enhancement of drug penetration and localization of the drug at the site of action approaches explored are liposomes, niosomes, ethosomes microparticles, and solid lipid nanoparticles. Vesicles composed of fatty acids like oleic acid and linoleic acid represent the new approach used for transdermal penetration and localization. In this review article, our major aim was to explore the applications of fatty acid vesicles for transdermal delivery of various bioactives.

Assessment of metabolic syndrome in HIV-infected individuals.

BACKGROUND: Metabolic syndrome (MS) is a cluster of risk factors for cardiovascular disease and Type 2 diabetes mellitus. OBJECTIVES: The aim is to assess the prevalence of MS in HIV patients receiving highly active antiretroviral therapy (HAART) and to compare it with treatment naïve HIV patients. METHODS: Cross-sectional study carried out in a teaching hospital in North India. A total of 116 HIV positive patients who were on HAART and those who were treatment naïve were included in the study. Adult Treatment Panel III (ATP III) and International Diabetes Foundation (IDF) definitions were used to define MS. Clinical and laboratory investigations were performed as per requirement and then analyzed using SPSS software. RESULTS: A high prevalence of MS was observed in HIV positive patients (ATP III - 19.8% and IDF - 25.9%). The prevalence of MS was higher in the anti-retroviral therapy (ART) group (ATP III - 33.3% and IDF - 36.4%) than ART-naïve group (ATP III - 2% and IDF - 12%). CONCLUSIONS: A sincere effort should always be made to detect MS in patients on HAART, especially in Indian subcontinent where there is a genetic predisposition to cardiovascular risk.

Comparison of Surti goat milk with cow and buffalo milk for physicochemical characteristics, selected processing-related parameters and activity of selected enzymes.

AIM: The study was undertaken to find out the physicochemical characteristics, selected processing-related parameters and activity of selected enzymes in Surti goat milk. MATERIALS AND METHODS: Milk samples from Surti goats and buffalo milk samples were collected during the period from July 2013 to January 2014 at Reproductive Biology Research Unit, Anand Agricultural University (AAU), Anand. Milk samples from Kankrej cows were collected from Livestock Research Station, AAU, Anand. Samples were analyzed for physicochemical characteristics such as acidity, viscosity, surface tension, specific gravity, refractive index, freezing point, and electrical conductivity. Samples were also analyzed for selected processing-related parameters such as heat coagulation time (HCT), rennet coagulation time (RCT), rate of acid production by starter culture, alcohol stability, and activity of selected enzymes such as alkaline phosphatase activity, catalase activity, proteolytic activity, and lipase activity. RESULTS: Goat milk had the highest acidity, viscosity and surface tension, followed by cow milk and buffalo milk. However, the differences in acidity, specific gravity, surface tension, refractive index, electrical conductivity, HCT and lipase activity of three types of milk studied, viz., goat, cow, and buffalo milk were found statistically non-significant (p<0.05). The buffalo milk had the highest specific gravity, followed by those found in cow and goat milk. The viscosity, freezing point and RCT of goat milk was significantly lower (p>0.05) than that of the buffalo milk. However, the difference in viscosity, freezing point and RCT of goat milk and that of the cow milk was statistically non-significant. The cow milk had the highest refractive index, followed by goat and buffalo milk. The cow milk had the highest proteolytic activity and heat coagulation time (HCT), followed by those found in buffalo and goat milk. The goat milk had the lowest freezing point, lipase activity, and RCT, followed by those found in cow and buffalo milk. The goat milk had the highest electrical conductivity, followed by those found in buffalo and cow milk. The collected goat, cow and buffalo milk samples showed negative stability at 68% (v/v) alcohol concentration. Goat milk showed positive alcohol test at 75% (v/v) alcohol concentration. Acidity was found to increase proportionally with time. After 14 h, it was found that goat milk became thicker, but the curd had a very low consistency. Cow milk had the highest alkaline phosphatase activity and catalase activity followed by those found in goat milk and lowest alkaline phosphatase activity and catalase activity was found in buffalo milk. The alkaline phosphatase activity and proteolytic activity of goat milk was significantly lower (p>0.05) than that of the cow milk. However, the difference in alkaline phosphatase activity and proteolytic activity of goat milk and that of the buffalo milk was statistically non-significant. Alkaline phosphatase activity of buffalo milk was significantly lower (p>0.05) than that of the alkaline phosphatase activity in cow milk. CONCLUSION: It can be concluded from the study that the goat milk has highest acidity, viscosity, electrical conductivity, and surface tension compared to that of cow and buffalo milk. The goat milk has lowest specific gravity, freezing point, proteolytic activity, lipase activity, RCT and HCT compared to cow and buffalo milk. Goat milk had highest refractive index compared to buffalo milk, whereas lowest refractive index compared to cow milk. Goat milk showed positive alcohol test at 75% (v/v) alcohol concentration. The curd formed from goat milk after 14 h was having very weak consistency. The goat milk has higher alkaline phosphatase activity, catalase activity compared to buffalo milk while it has lower alkaline phosphatase activity, catalase activity compared to cow milk.

Pulmonary Delivery of Anti-Tubercular Drugs Using Ligand Anchored pH Sensitive Liposomes for the Treatment of Pulmonary Tuberculosis.

BACKGROUND: Mycobacterium tuberculosis (M. TB) remains the prime cause of bacterial mortality and morbidity world-wide. Therefore, effective delivery and targeting of drug to the cellular tropics is essentially required to generate significant results for tuberculosis treatment. The aim of the present study was to develop and characterize ligand anchored pH sensitive liposomes (TPSL) as dry powder inhaler for the targeted delivery of drugs in the target site i.e. lungs. METHOD: Ligand anchored PSL (TPSL) was prepared by thin film hydration for the combined delivery of Isoniazid (INH) and Ciprofloxacin HCl (CIP HCl) using 4-aminophenyl-α-D mannopyranoside (Man) as surface functionalized ligand and characterized using different parameters. RESULTS: It was observed that size of the ligand anchored liposomes (TPSL) was slightly more than the non-ligand anchored liposomes (PSL). Drug release was studied at different pH for 24 hrs and it was observed that liposomes exhibited slow release at alkaline pH (58-64%) as compared to macrophage pH (81-87%) where it increased dramatically due to the destabilization of pH sensitive liposome (PSL). In vitro cellular uptake study showed that much higher concentration was achieved in the alveolar macrophage using ligand anchored liposomes as compared to its counterpart. In vivo study showed that maximum drug accumulation was achieved in the lung by delivering drug using ligand anchored PSL as compared to conventional PSL. CONCLUSION: It was concluded that ligand anchored pH sensitive liposome is one of the promising systems for the targeted drug therapy in pulmonary tuberculosis.

Comparison of Surti goat milk with cow and buffalo milk for gross composition, nitrogen distribution, and selected minerals content.

AIM: The study was undertaken to find out the gross composition, nitrogen distribution, and selected mineral content in Surti goat milk, and its comparison was made between cow and buffalo milk. MATERIALS AND METHODS: Goat milk samples of Surti breed and buffalo milk samples were collected during the period from July to January 2014 at Reproductive Biology Research Unit, Anand Agricultural University (AAU), Anand. Cow milk samples of Kankrej breed were collected from Livestock Research Station, AAU, Anand. Samples were analyzed for gross composition such as total solids (TS), fat, solid not fat (SNF), protein, lactose, and ash. Samples were also analyzed for nitrogen distribution such as total nitrogen (TN), non-casein nitrogen (NCN), non-protein nitrogen (NPN), and selected minerals content such as calcium, magnesium, phosphorous, and chloride. Total five replications were carried out. RESULTS: Goat milk had the lowest TS, fat, protein, and lactose content among all three types of milk studied in the present investigation. On the other hand, the highest TS, fat, protein, and lactose content were found in buffalo milk. Buffalo milk had the highest SNF, calcium, magnesium, and phosphorous content, which was followed by goat milk and lowest in cow milk. The SNF, protein, TN, and calcium content of goat milk were statistically non-significant (p<0.05) with cow milk. The lactose content of goat milk was significantly lower (p>0.05) than that of the cow milk as well as buffalo milk. The goat milk had the highest ash and NCN content, which were followed by buffalo milk and lowest in cow milk. However, the differences in ash, NPN, and phosphorous content of three types of milk studied, viz., goat milk, cow milk, and buffalo milk were found statistically non-significant (p<0.05). The NCN content of buffalo milk was statistically non-significant (p<0.05) with cow milk as well as goat milk. The NCN and magnesium content of goat milk were significantly higher (p>0.05) than that of the cow milk. The magnesium content of goat milk was statistically non-significant (p<0.05) with buffalo milk. The chloride content of goat milk was significantly higher (p>0.05) than that of the buffalo milk as well as cow milk. CONCLUSION: It can be concluded from the study that the goat milk has lower TS, fat, lactose, protein content, TN as well as NPN but higher ash and NCN content compared to cow milk and buffalo milk. The goat milk has lower calcium, phosphorous compared to buffalo milk while it has higher calcium, phosphorous compared to cow milk, and it has higher magnesium, chloride content compared to cow milk and buffalo milk.

Moyamoya Disease Associated with Recurrent Right Thalamic Haemorrhage and Hydrocephalus: A Case Report.

Moyamoya disease, a rare chronic, progressive cerebrovascular disease leads to occlusion of intracranial internal carotid arteries and its proximal branches. We report a case of a 51-year-old female who presented with recurrent thalamic bleed and intraventricular haemorrhage nine years apart in the same territory. The first bleed was managed conservatively and second bleed led to development of hydrocephalus. The acute phase of the hydrocephalus was managed by external ventricular drainage and the final CSF diversion was managed by ventriculoperitoneal shunt. The definitive treatment could not be done to denial of consent from the patient. We present the case to highlight the role CSF diversion as a means of palliative treatment for the Moyamoya disease.

Nanotechnology: a magic bullet for HIV AIDS treatment.

Human immunodeficiency virus (HIV) infection has become devastating in last a few years. Nearly 7400 new infection cases are coming every day. Highly active antiretroviral therapy (HAART), which involves combination of at least three antiretroviral (ARV) drugs, has been used to extend the life span of the HIV-infected patients. HAART has played an important role to reduce mortality rate in the developed countries but in the developing countries condition is still worst with millions of people being infected by this disease. For the improvement of the situation, nanotechnology-based drug system has been explored for the HIV therapeutics. Nanosystems used for HIV therapeutics offer some unique advantage like enhancement of bioavailability, water solubility, stability, and targeting ability of ARV drugs. Main nanotechnology-based systems explored for HIV therapeutics are liposomes, nanoparticles, niosomes, polymeric micelles, and dendrimers. Present manuscript reviews conventional method of HIV therapeutics and recent advances in the field of nanotechnology-based systems for treatment of HIV-AIDS.

Galactose engineered solid lipid nanoparticles for targeted delivery of doxorubicin.

The present investigation reports the preparation, optimization, and characterization of surface engineered solid lipid nanoparticles (SLNs) encapsulated with doxorubicin (DOX). Salient features such as biocompatibility, controlled release, target competency, potential of penetration, improved physical stability, low cost and ease of scaling-up make SLNs viable alternative to liposomes for effective drug delivery. Galactosylation of SLNs instructs some gratifying characteristic, which leads to the evolution of promising delivery vehicles. The impendence of lectin receptors on different cell surfaces makes the galactosylated carriers admirable for targeted delivery of drugs to ameliorate their therapeutic index. Active participation of some lectin receptors in immune responses to antigen overlaid the application of galactosylated carriers in delivery of antigen and immunotherapy for treatment of maladies like cancer. These advantages revealed the promising potential of galactosylated carriers in each perspective of drug delivery. The developed DOX loaded galactosylated SLNs formulation was found to have particle size 239 ± 2.40 nm, PDI 0.307 ± 0.004, entrapment efficiency 72.3 ± 0.9%. Higher cellular uptake, cytotoxicity, and nuclear localization of galactosylated SLNs against A549 cells revealed higher efficiency of the formulation. In a nutshell, the galactosylation strategy with SLNs could be a promising approach in improving the delivery of DOX for cancer therapy.

Transdermal drug delivery of imipramine hydrochloride. I. Effect of terpenes.

The objective of this investigation was to study the effect of different terpenes on IMH permeation in EtOH:W (2:1) system. Permeation studies of IMH were carried out with unjacketed Franz diffusion cells through rat skin. The flux of IMH with terpenes was found to be significantly higher than that in control (EtOH:W, 2:1) (P<0.05). Amongst all studied terpenes, menthol, terpineol, cineole and menthone were found to be effective permeation enhancers for IMH. It was found that the contribution of diffusivity in enhanced permeation of IMH was much higher in comparison to partitioning of IMH in skin with terpene treatment. Results of this study were explained with the help of H-bond breaking potential and self-association of terpenes. In order to elucidate the effect of terpenes on stratum corneum barrier FT-IR was used.

Effect of temperature on imipramine hydrochloride permeation: role of lipid bilayer arrangement and chemical composition of rat skin.

The aim of this investigation was to study the effect of temperature on the permeation of imipramine hydrochloride (IMH) across rat skin from two different vehicles. Differential scanning calorimetry (DSC) was used to characterize the phase transitions of rat epidermis and extracted rat SC lipids, and the transition temperatures were correlated with the permeability of IMH at different temperatures. Permeability of IMH from ethanol and propylene glycol (PG) was determined at five different temperatures and observed that a significant increase in IMH permeability occurred 45 degrees C from both the vehicles. Further, high energies of activation for rat skin permeation suggested that IMH diffuses across intercellular lipid matrix and therefore any change in the packing of SC lipids will have an effect on IMH permeation. Three endotherms T(1), T(2) and T(3) of rat epidermis were observed in DSC thermograms at 44, 53 and 64 degrees C and were assigned as transitions corresponding to orthorhombic to hexagonal, hexagonal to more disordered phase and melting of lipids with high cholesterol content, respectively. The high permeability values of IMH above 45 degrees C were therefore reasoned to be because of orthorhombic to hexagonal phase transition in rat skin from close to that temperature.

Acute necrotising pancreatitis associated with leptospirosis-a case report.

Acute Necrotizing Pancreatitis is a rare complication of leptospirosis and this association carries a high mortality rate. Only few cases have been reported in literature. We hereby report one such case we encountered.