Assessment of RV Function in Patients of (COPD).

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) has considerable effects on cardiac functions primarily affecting the pulmonary vasculature and then right ventricle along with left ventricle. One of the important causes of increased morbidity and mortality associated with COPD is cor pulmonale. Echocardiography provides a rapid, non-invasive method to evaluate cardiac changes. Our aim was to evaluate RVfunction in COPD as per guidelines of American Society of Echocardiography with an aim to find a simpler way of predicting cardiac morbidity. MATERIALS AND METHODS: A cross sectional observational study was conducted on 17 COPD patients attending Respiratory Medicine outdoor of R. G. KAR Medical College, Kolkata, India, through history taking, clinical examination, PFT (PFT) and Echocardiography. Statistical analysis was done by using Statistical Package for the Social Sciences (SPSS) version-17. RESULTS: Fractional area change of RV (FAC-%) was positively correlated with Forced Expiratory Volume in One Second (FEV1) (r = 0.4879), FEV1/ Forced Vital Capacity (FVC) ratio (r = 0.5048) and Peak Expiratory Flow Rate (PEFR) (r = 0.5361). There was strong negative correlation of Systolic Pulmonary Artery Pressure (SPAP) with FEV1/FVC ratio (r = -0.5553) and PEFR (r = - 0.4604). Right Index of Myocardial Performance (RIMP) of right ventricle was negatively correlated with FEV1/FVC ratio (r = - 0.598), PEFR (r = - 0.619), Forced Expiratory Flow (FEF) 25-75 (r = -0.515). Tricuspid annular plane systolic excursion (TAPSE) did not show any association with PFT parameters though it showed strong positive correlation with RV wall thickness. CONCLUSION: This study substantiates that FAC% and RIMP can be vital prognostic factors for RV function apart from SPAP, TAPSE to define RV dysfunction and predict morbidity in COPD.

Optimization of process parameters for gelatin extraction from the skin of Blackspotted croaker using response surface methodology.

Utilization of waste from fish processing industry for production of value added products has attracted substantial attention. Blackspotted croaker (Protonibea diacanthus) is a marine fish having the potential of abundant supply of raw skins for production of gelatin. This study was aimed to optimize the extraction conditions for gelatin production from skin of Blackspotted croaker. Response surface methodology (RSM) was adopted by following central composite design to determine the optimal conditions of four independent variables namely concentration of NaOH (X1), soaking time (X2), extraction temperature (X3) and extraction time (X4) for three response variables namely yield, gel strength and melting point. The models obtained by RSM produced a satisfactory fit to the data with respect to gelatin extraction (for gelatin yield, R (2) = 0.867, P = 0.0003; for gel strength, R (2) = 0.837, P = 0.007; for melting point, R (2) = 0.765, P = 0.01). Based on these models, the optimum conditions to achieve the predicted maximum values were: yield of 17.21 % at X1 = 0.23 %, X2 = 46.19 min, X3 = 55.29 °C and X4 = 17.29 h; gel strength of 422.69 g at X1 = 0.22 %, X2 = 44.56 min, X3 = 59.02 °C and X4 = 15.35 h and melting point of 23.48 °C at X1 = 0.20 %, X2 = 46.68 min, X3 = 56.23 °C and X4 = 15.21 h. It can be concluded from the present study that Blackspotted croaker skin is a prospective source to produce gelatin in good yield with desirable quality attributes comparable to commercially available mammalian gelatins.

Comparative evaluation of efficacy and safety of artesunate-lumefantrine vs. artemether-lumefantrine fixed-dose combination in the treatment of uncomplicated Plasmodium falciparum malaria.

OBJECTIVE: To establish efficacy and safety of artesunate/lumefantrine fixed-dose combination (FDC) in comparison with artemether/lumefantrine FDC in treatment of uncomplicated Plasmodium falciparum malaria. METHODS: Confirmed cases of uncomplicated P. falciparum malaria were randomly assigned to receive artesunate (100 mg)/lumefantrine (480 mg) (ASLF FDC) or artemether (80 mg)/lumefantrine (480 mg) (AMLF FDC) tablets for 3 days. Patients were followed up on Day 7, 14, 21 and 28. RESULTS: Of the 158 enrolled patients, 144 completed the study. Seventy-three patients (94.8%) from the ASLF group and 71 patients (94.7%) from the AMLF group showed parasite clearance within 48 h. The mean parasite clearance time was 25.40 ± 14.82 h in the ASLF group and 24 ± 13.32 h in the AMLF group (P = 0.542). All patients showed gametocyte clearance by Day 7 and remained gametocyte free till Day 28. Sixty-five patients (84.4%) from the ASLF group and 56 patients (74.7%) from the AMLF group were afebrile within 24 h. The mean fever clearance time was 17.38 ± 12.33 h in the ASLF group and 17.2 ± 12.01 h in the AMLF group (P = 0.929). There was one early treatment failure in the AMLF group as per WHO criteria. Improvement in haemoglobin and haematocrit was comparable in both the treatment groups. In the ASLF group, of the 25 (32.47%) patients anaemic at baseline, only seven (9.09%) reported anaemia on Day 28, while in the AMLF group, of the 14 (18.67%) patients anaemic at baseline, only four (5.33%) reported anaemia on Day 28. Both study medications were well tolerated. CONCLUSION: Artesunate (100 mg)/lumefantrine (480 mg) fixed-dose combination could add one more option to currently available artemisinin combinations in treatment of uncomplicated P. falciparum malaria.

Sudden onset quadriparesis after minor injury to neck in a male with OS odontoideum.

Os odontoideum is a rare anomaly of the second cervical vertebra. Here, a young male patient with quadriparesis secondary to myelopathy associated with os odontoideum is reported. The patient was totally asymptomatic prior to this episode which was precipitated by trivial neck injury. He started recovering with conservative measures and was referred to our neurosurgery department for further evaluation and definitive surgical intervention as there is always a chance of recurrence of symptoms in these patients. There is a role for conservative treatment of an asymptomatic incidentally found, radiologically stable, and noncompressive os odontoideum, however surgery has a definite role in symptomatic cases.

A sound sleep.

Benzodiazepine is a commonly encountered agent of poisoning, which is readily diagnosed by a pertinent history of drug ingestion and the clinical scenario. In the absence of a proper drug history, the diagnosis becomes challenging. Proper clinical assessment, urine assays and imaging play a very important role in reaching the diagnosis. We present a case of acute benzodiazepine poisoning without a history of drug intake. The key pointers toward diagnosis were an unarousable state with obstructive apnea. Magnetic resonance imaging (MRI) of the brain revealed peculiar symmetrical isolated globus pallidus T2 hyperintensity. We believe this to be the first report of isolated bilateral basal ganglia T2-weighted hyperintensity in MRI in the setting of acute benzodiazepine poisoning from India.

Improvement of gel strength and melting point of fish gelatin by addition of coenhancers using response surface methodology.

UNLABELLED: Fish gelatin is a potential alternative to mammalian gelatin. However, poor gel strength and low melting point limit its applications. The study was aimed at improving these properties by adding coenhancers in the range obtained from response surface methodology (RSM) by using Box-Behnken design. Three different coenhancers, MgSO4, sucrose, and transglutaminase were used as the independent variables for improving the gel strength and melting point of gelatin extracted from Tiger-toothed croaker (Otolithes ruber). Addition of coenhancers at different combinations resulted gel strength and melting point in the range of 150.5 to 240.5 g and 19.5 to 22.5 °C, respectively. The optimal concentrations of coenhancers for predicted maximum gel strength (242.8 g) obtained by RSM were 0.23 M MgSO4, 12.60% sucrose (w/v), and 5.92 mg/g transglutaminase and for predicted maximum melting point (22.57 °C), the values were 0.24 M MgSO4, 10.44% sucrose (w/v), and 5.72 mg/g transglutaminase. By addition of coenhancers at these optimal concentrations in verification experiments, the gel strength and melting point were improved from 170 to 240.89 g and 20.3 to 22.7 °C, respectively. These experimental values agreed well with the predicted values demonstrating the fitness of the models. Results from the present study clearly revealed that the addition of coenhancers at a particular combination can improve the gel strength and melting point of fish gelatin to enhance its range of applications. PRACTICAL APPLICATION: There is a growing interest in the use of fish gelatin as an alternative to mammalian gelatin. However, poor gel strength and low melting point of fish gelatin have limited its commercial applications. The gel strength and melting point of fish gelatin can be increased by incorporation of coenhancers such as magnesium sulphate, sucrose, and transglutaminase. Results of this work help to produce the fish gelatin suitable for wide range of applications in the food industry.

Is there enough information about foot care among patients with diabetes?

The United Kingdom has a diabetic population of approximately 1.2 million. It is estimated that approximately 15% of all patients with diabetes will develop a foot ulcer in their lifetime. Twenty-five percent of all patients with foot ulcers will have a major amputation. There have been several publications demonstrating a reduction in foot ulcer and amputation rate through a range of active educational programs and ways of improving patient awareness of the problem. The authors' study attempted to establish the amount of information patients with diabetes have about care of their feet. Of 110 patients recruited, 37 (33%) claimed they had never received any information about foot care. Of those who had received advice, approximately half had received information or had access to information over the previous 10 years. In the majority of cases, information had been given once only. In conclusion, 33% of patients with diabetes did not recall receiving any information about foot care.