Lumbar artery pseudoaneurysm: a rare case of delayed onset incomplete cauda equina syndrome following transforaminal lumbar interbody fusion.

BACKGROUND: Cauda equina syndrome following transforaminal lumbar interbody fusion (TLIF) is very rare, and the causes implicated include inadequate decompression, retained disc fragments, epidural haematoma, gel foams, fat pad grafts, retained sponges, intradural masses and ischaemia of conus. This is a rare case report of pseudoaneurysm of dorsal branch of lumbar artery presenting with delayed onset incomplete cauda equina syndrome following TLIF. OBJECTIVE: To describe the very rare case of lumbar artery pseudoaneurysm causing delayed onset incomplete cauda equina syndrome following TLIF and its management with endovascular embolisation. METHOD: An 80-year-old female presented with incomplete cauda equina syndrome on 14th post-operative day following TLIF. On evaluation, computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed haematoma with heterogeneous signal intensity, which was pulsatile in ultrasonogram. Doppler and contrast-enhanced CT revealed pseudoaneurysm from posterior branch of left lumbar L4 artery, which was managed with endovascular embolisation. RESULT: After endovascular embolisation, the patient had immediate relief from radiating pain in left lower limb and regained full motor power and perianal sensation at the end of 3 weeks. Post-procedure ultrasonography done on the tenth day revealed complete resolution of the pseudoaneurysm. CONCLUSION: This case presentation shows the necessity of diagnosing epidural haematomas due to vascular aneurysm in patients with post-operative radiculopathy and neurodeficit and the effectiveness of endovascular embolisation in treating such a threatening condition.

An in vitro comparative study to evaluate the retention of different attachment systems used in implant-retained overdentures.

AIM: The aim of this in vitro study was to compare the change in the retentive force and removal torque of three attachment systems during simulation of insertion-removal cycles. METHODOLOGY: Edentulous mandibular models were made with heat-cured polymethyl methacrylate resin. Two implant replicas (CMI), of 3.75 mm diameter and 10 mm length, were placed in the intraforaminal region. Acrylic resin mandibular overdentures were fabricated and provision was made to receive three different overdenture attachment systems, prefabricated ball/o-ring attachment (Lifecare Biosystems, Thane, India), Hader bar and clip attachment (Sterngold, Attleboro, MA), and Locator(®) implant overdenture attachment stud type (Zest Anchors LLC, USA). Using a universal testing machine, each of the models were subjected to 100 pulls each to dislodge the overdenture from the acrylic model, and the force values as indicated on the digital indicator were tabulated both before and after thermocycling (AT). STATISTICAL ANALYSIS USED: Statistical analysis comprised Kolmogorov-Smirnov test, Friedman test, and Wilcoxon signed ranks test. RESULTS: The statistical model revealed a significantly different behavior of the attachment systems both before and AT. The ball/o-ring and bar attachments developed higher retentive force as compared to the locator attachment. The bar and clip attachment exhibited the highest peak as well as the highest mean retention force at the end of the study. The Locator(®) attachment showed a decrease in retentive potential after an early peak. CONCLUSIONS AND CLINICAL IMPLICATIONS: The ball/o-ring and bar and clip attachments exhibit higher retentive capacities than the Locator(®) attachment over time.

Effect of Soil Temperature on Canine Soil-Transmitted Nematodes in Kandy District with the First Record of Hookworm, Ancylostoma tubaeforme from Sri Lanka.

PURPOSE: Soil-transmitted nematodes (STNs) are widespread in tropical and subtropical regions, particularly where the communities are socio-economically challenged. We investigated the effect of soil temperature on the prevalence and intensity of STN infection in free-roaming dogs. METHODS: Fresh faecal samples collected from free-roaming dogs in Digana and Pussellawa town areas in the Kandy District, Sri Lanka, were microscopically analysed for canine STNs. Soil temperature was measured at each sampling site. Highly prevalent canine hookworm Ancylostoma, was further studied using PCR and sequencing, followed by phylogenetic analysis. RESULTS: The soil temperature ranged between 28 and 31 °C (mean = 29.79 °C) and 18-21 °C (mean = 19.52 °C) in Digana and Pussellawa, respectively, showing a significant difference in the two sites (Students t-test t = 1.68, p < 0.0001). Of the total 44 dogs sampled, 41 (93.2%) were positive for STNs. During microscopic analysis, five nematodes: Ancylostoma spp., Capillaria sp., Strongyloides sp., Toxocara canis, and Trichuris sp., were identified. Ancylostoma species (93.2%) were the most prevalent, followed by Strongyloides sp. (22.7%) and Toxocara canis (15.9%). Infection prevalence of Strongyloides sp. was higher in Digana (40.9%) compared to that in Pussellawa (4.5%; Chi-square test, χ2 = 8.28, p = 0.004) and also the infection intensity from Digana (EPG = 8.02 ± 20.2) compared to that from Pussellawa (0.45 ± 2.1; Mann Whitney U test, p = 0.006). Amplicons (ITS1-5.8S-ITS2) of the expected size for A. caninum, and A. tubaeforme were produced. An A. caninum sequence reported here (OQ101719) illustrated the highest similarity of 99.2% to one of the local sequences (MZ707153) upon pairwise comparison. CONCLUSION: Digana, with a higher soil temperature than Pussellawa, had a significantly higher prevalence and infection intensity, particularly Strongyloides sp. This study also signifies the first molecular identification of hookworm species A. tubaeforme in Sri Lanka.

Sealing Ability Comparison of Three Different Obturating Systems to Intraradicular Dentin-An In Vitro Stereomicroscopic Study.

Background: Different obturation techniques are being used to improve canal sealing, thereby minimizing marginal leakage. Aims and Objectives: To evaluate the marginal leakage of three different obturating materials and techniques using stereomicroscope. Materials and Methods: Thirty freshly extracted maxillary anterior teeth were collected and were divided into three groups of 10 each for which the biomechanical preparation was done. The teeth were divided into three experimental groups according to the obturation material and technique used, Group I: gutta-percha with AH Plus root canal sealer (lateral condensation): Group II: thermoplasticized gutta-percha technique-non-carrier-based (calamus) with AH Plus sealer (backfill): Group III: C point (self-sealing root canal obturating system) with bioceramic sealer (single cone). Each specimen was subjected for testing apical sealing ability. The values of microleakage associated with different root canal sealers were evaluated using a stereomicroscope. Results: There was no statistically significant difference in the mean scores of apical dye penetration/leakage among all the three groups (P = 0.091), whereas Group I showed a higher degree of apical leakage than the other techniques tested. Conclusion: None of the tested filling materials provided a gap-free or void-free root canal filling; however, thermoplasticized gutta-percha is used with AH Plus sealer exhibited less voids and gaps when compared to other tested materials.

Complete Genome Sequence and Probiotic Characterization of Lactobacillus delbrueckii subsp. Indicus DC-3 Isolated from Traditional Indigenous Fermented Milk.

In this study, Lactobacillus delbrueckii subsp. indicus DC-3 was isolated from Indian traditional indigenous fermented milk Dahi and identified using whole genome sequencing. The safety of the strain was evaluated using genetic and phenotypic analyses, such as the presence of virulence factors, mobile and insertion elements, plasmids, antibiotic resistance, etc. Besides this, the strain was comprehensively investigated for in vitro probiotic traits, biofilm formation, antibacterials, and exopolysaccharide (EPS) production. In results, the strain showed a single circular chromosome (3,145,837 bp) with a GC content of 56.73%, a higher number of accessory and unique genes, an open pan-genome, and the absence of mobile and insertion elements, plasmids, virulence, and transmissible antibiotic resistance genes. The strain was capable of surviving in gastric juice (83% viability at 3 h) and intestinal juice (71% viability at 6 h) and showed 42.5% autoaggregation, adhesion to mucin, 8.7% adhesion to xylene, and 8.3% adhesion to Caco-2 cells. The γ-hemolytic nature, usual antibiotic susceptibility profile, and negative results for mucin and gelatin degradation ensure the safety of the strain. The strain produced 10.5 g/L of D-lactic acid and hydrogen peroxide, capable of inhibiting and co-aggregating Escherichia coli MTCC 1687, Proteus mirabilis MTCC 425, and Candida albicans ATCC 14,053. In addition, the strain showed 90 mg/L EPS (48 h) and biofilm formation. In conclusion, this study demonstrates that L. delbrueckii subsp. indicus DC-3 is unique and different than previously reported L. delbrueckii subsp. indicus strains and is a safe potential probiotic candidate.

Challenges in diagnosis and treatment of tuberculosis in elderly.

Tuberculosis (TB) is a major infectious disease worldwide. Early diagnosis and prompt treatment reduces the transmission, morbidity and mortality in tuberculosis. Elderly (age >65 years) have many risk factors to develop tuberculosis. Recent survey in India showed incidence of TB higher in elderly. They may not have classical symptoms, clinical and radiological signs of TB which can lead to delayed diagnosis or misdiagnosis. In addition, elderly have many comorbid and coexisting diseases which make diagnosis and treatment of TB challenging. Comorbidities, poor general health status and other medications may lead to increased drug adverse reactions and poor adherence to treatment in elderly. Hence special emphasis should be given to elderly for early diagnosis and treatment. Elderly with multiple comorbidities require individualized approach for better outcome.

Role of chest radiography in the diagnosis of pulmonary tuberculosis during nCovid19 pandemic.

Pulmonary tuberculosis and nCovid 19 share many common risk factors. nCovid19 may increase the risk to develop pulmonary tuberculosis. Pulmonary tuberculosis may precede, co-exist or follow nCovid19. Careful evaluation of chest radiography is useful to differentiate tuberculosis from nCovid19 bronchopneumonia. Symptoms of tuberculosis may be mistaken for long covid. A normal chest x ray in the absence of sputum production may help to rule out tuberculosis in such cases. All patients with nCovid19 bronchopneumonia should undergo a careful chest x ray evaluation for any lesions suggestive of tuberculosis. All patients with chest radiological abnormality should undergo sputum examination to rule tuberculosis as atypical radiological manifestations may be more common in patients with nCovid19. Symptoms, signs, clinical features and chest radiographic features of Pulmonary tuberculosis and nCovid19 bronchopneumonia may overlap in some cases. Correlation of chest radiographic findings with epidemiologic history, clinical presentation, and RT-PCR test results or in later stages antibody titres will help in confirming or excluding the diagnosis in suspected cases of nCovid19. In pulmonary tuberculosis definitive diagnosis should be established by bacteriological confirmation. Molecular diagnostic tools should be used to confirm or exclude tuberculosis in suspect cases as the results are rapid, accurate and reliable.

Study on Anatomical Variations in Fissures of Lung by CT Scan.

Introduction Refinements in the modern computed tomography (CT) imaging techniques have led to anatomical variations in the fissures of lung being diagnosed more frequently. So far, majority of the studies conducted are cadaveric. There is paucity of studies in this aspect based on chest CT images. Hence, we undertook this study to find the anatomical variations in the fissures. Prior detection of anatomical abnormalities is important to reduce postoperative complications in lung resection surgeries. Materials and Methods This was a cross-sectional study conducted over a period of 2 years. Data were collected from the patients who underwent CT scan thorax. Patients in whom normal anatomy of lung was distorted and cases where both lungs were not visualized completely were excluded from the study. All the CT images were reviewed by a single radiologist. The presence or absence of the normal and accessory pulmonary fissures, as well as the continuity of each fissure, was recorded by the radiologist. Data were compiled and analyzed. Results The study population consisted of 394 (70.4%) males and 166 (29.6%) females, totaling 560 cases. Fissural variations were detected in 22.9% ( n = 128). Also, 17.5% ( n = 98) fissural variations were seen in males and 5.4% ( n = 30) fissural variations were seen in females. Further, 54.7% ( n = 70) of variations were detected in the right lung and 45.3% ( n = 58) in the left lung. The most common fissural variation noted was right incomplete oblique fissure with a frequency of 8.4% cases ( n = 47). The most common accessory fissure detected was inferior accessory fissure. Total 22 cases were detected in both the lungs, 17 cases in male and 5 in female. Conclusion Anatomical variations in fissures were found to be more in the right lung than the left lung. Accessory fissures were detected in higher incidence on the right side.

Recent Insights Into Processing Approaches and Potential Health Benefits of Goat Milk and Its Products: A Review.

Goat milk is considered to be a potential source of various macro- and micro-nutrients. It contains a good proportion of protein, fat, carbohydrates, and other nutritional components which help in promoting nutritional and desirable health benefits. Goat milk is considered to be superior in terms of numerous health benefits, and lower risk of allergy, when compared to the milk of other species. Several processing techniques such as pasteurization, ultrafiltration, microfiltration, and ultrasound have been employed to enhance the quality and shelf life of goat milk and its products. The diverse range of goat milk-based products such as yogurt, cheese, fermented milk, goat milk powder, and others are available in the market and are prepared by the intervention of advanced processing technologies. Goats raised in pasture-based feeding systems are shown to have a better milk nutritional composition than its counterpart. Goat milk contains potential bioactive components, which aids in the maintenance of the proper metabolism and functioning of the human body. This review gives insight into the key nutritional ingredients and bioactive constituents present in goat milk and their potential role in the development of various functional foods using different processing technologies. Goat milk could be considered as a significant option for milk consumption in infants, as compared to other milk available.

The effects of local anesthetic concentration and dose on continuous infraclavicular nerve blocks: a multicenter, randomized, observer-masked, controlled study.

BACKGROUND: It remains unclear whether local anesthetic concentration or total drug dose is the primary determinant of continuous peripheral nerve block effects. The only previous investigation, involving continuous popliteal-sciatic nerve blocks, specifically addressing this issue reported that insensate limbs were far more common with higher volumes of relatively dilute ropivacaine compared with lower volumes of relatively concentrated ropivacaine. However, it remains unknown if this relationship is specific to the sciatic nerve in the popliteal fossa or whether it varies depending on anatomic location. We therefore tested the null hypothesis that providing ropivacaine at different concentrations and rates, but at an equal total basal dose, produces comparable effects when used in a continuous infraclavicular brachial plexus block. METHODS: Preoperatively, an infraclavicular catheter was inserted using the coracoid approach in patients undergoing moderately painful orthopedic surgery distal to the elbow. Patients were randomly assigned to receive a postoperative perineural ropivacaine infusion of either 0.2% (basal 8 mL/h, bolus 4 mL) or 0.4% (basal 4 mL/h, bolus 2 mL) through the second postoperative day. Both groups, therefore, received 16 mg of ropivacaine each hour with a possible addition of 8 mg every 30 min via a patient-controlled bolus dose. Our primary end point was the incidence of an insensate limb during the 24-h period beginning the morning after surgery. Secondary end points included analgesia and patient satisfaction. RESULTS: Patients given 0.4% ropivacaine (n = 27) experienced an insensate limb, a mean (sd) of 1.8 (1.6) times, compared with 0.6 (0.9) times for subjects receiving 0.2% ropivacaine (n = 23; estimated difference = 1.2 episodes, 95% confidence interval, 0.5-1.9 episodes; P = 0.001). Satisfaction with postoperative analgesia (scale 0-10, 10 = highest) was scored a median (25th-75th percentiles) of 10.0 (8.0-10.0) in Group 0.2% and 7.0 (5.3-8.9) in Group 0.4% (P = 0.018). Analgesia was similar in each group. CONCLUSIONS: For continuous infraclavicular nerve blocks, local anesthetic concentration and volume influence perineural infusion effects in addition to the total mass of local anesthetic administered. Insensate limbs were far more common with smaller volumes of relatively concentrated ropivacaine. This is the opposite of the relationship previously reported for continuous popliteal-sciatic nerve blocks. The interaction between local anesthetic concentration and volume is thus complex and varies among catheter locations.

The effects of varying local anesthetic concentration and volume on continuous popliteal sciatic nerve blocks: a dual-center, randomized, controlled study.

BACKGROUND: It remains unknown whether local anesthetic concentration, or simply total drug dose, is the primary determinant of continuous peripheral nerve block effects. We therefore tested the null hypothesis that providing different concentrations and rates of ropivacaine, but at equal total doses, produces comparable effects when used in a continuous sciatic nerve block in the popliteal fossa. METHODS: Preoperatively, a perineural catheter was inserted adjacent to the sciatic nerve using a posterior popliteal approach in patients undergoing moderately painful orthopedic surgery at or distal to the ankle. Postoperatively, patients were randomly assigned to receive a perineural ropivacaine infusion of either 0.2% (basal 8 mL/h, bolus 4 mL) or 0.4% (basal 4 mL/h, bolus 2 mL) through the second postoperative day. Therefore, both groups received 16 mg of ropivacaine each hour with a possible addition of 8 mg every 30 min via a patient-controlled bolus dose. The primary end point was the incidence of an insensate limb, considered undesirable, during the 24-h period beginning the morning after surgery. Secondary end points included analgesia and patient satisfaction. RESULTS: Patients given 0.2% ropivacaine (n = 25) experienced an insensate limb with a mean (sd) of 1.8 (1.8) times, compared with 0.6 (1.1) times for subjects receiving 0.4% ropivacaine (n = 25; estimated difference = 1.2 episodes, 95% confidence interval, 0.3-2.0 episodes; P = 0.009). In contrast, analgesia and satisfaction were similar in each group. CONCLUSIONS: For continuous popliteal-sciatic nerve blocks, local anesthetic concentration and volume influence block characteristics. Insensate limbs were far more common with larger volumes of relatively dilute ropivacaine. During continuous sciatic nerve block in the popliteal fossa, a relatively concentrated solution in smaller volume thus appears preferable.

Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology.

The Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology developed this evidence-based practice guideline for management of chronic constipation. A modified Delphi process was used to develop this consensus containing 29 statements, which were generated by electronic voting iteration as well as face to face meeting and review of the supporting literature primarily from India. These statements include 9 on epidemiology, clinical presentation, and diagnostic criteria; 8 on pathophysiology; and the remaining 12 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The members of the consensus team believe that this would be useful for teaching, clinical practice, and research on chronic constipation in India and in other countries with similar spectrum of the disorders.

Relative Efficacy of Quercetin Compared with Benzydamine Hydrochloride in Minor Aphthae: A Prospective, Parallel, Double Blind, Active Control, Preliminary Study.

BACKGROUND AND OBJECTIVES: Recurrent aphthous stomatitis is an inflammatory condition present since ancient era wherein numerous treatment modalities have been tried. But complete eradication of the disease has not been possible and hence newer agents are being introduced. One such agent is a flavonoid named quercetin with proven antioxidant, anti-inflammatory, and ulcer healing properties. METHODS: 40 patients with minor aphthous ulcers were divided equally into two groups: A and B. Group A patients were advised to apply quercetin gel and Group B patients were advised to take benzydamine hydrochloride mouth wash. Clinical evaluation including assessment of ulcer size and pain score and questionnaire about the acceptability of both the drugs in terms of taste and ease of application was carried out. Each criterion was compared and statistically analyzed. RESULTS: There was statistically significant reduction in the mean score of pain sensation and ulcer area in both the groups. Quercetin showed statistically highly significant ulcer size reduction as compared to benzydamine hydrochloride. CONCLUSION: From the present study, it is evident that quercetin is safe, well tolerated, and effective therapy which promotes complete ulcer healing in a short duration of time.

Litigations in Obstetric and Gynecological Practice: Can it be prevented? A Probability to Possibility.

BACKGROUND: Litigation in medical practice is becoming a global problem. So it is necessary to know what constitutes negligence and what is required to prove it and how far it is preventable. OBJECTIVES: To analyze the prevalence and reasons for litigations in Obstetrics and Gynaecology for medical negligence and deficiency in service. To analyze on what grounds negligence was proved and to know whether it was preventable. MATERIALS AND METHODS: It is a retrospective analysis of the judgments obtained from all the District Consumer Courts of South India and was specifically analyzed for reasons in filing the case, nature of settlement, and factors considered in deciding negligence especially in the field of obstetrics and gynecology. RESULTS: Totally 1317 cases were found on medical negligence and deficiency in service, with 347 (26.34 %) cases on Obstetrics and Gynecology (OBG) topping the list. Out of 347 cases on OBG 312 (89.91 %) cases were settled in the Courts. Negligence was proved in 98 (31.41 %) cases and 214 (68.59 %) cases were dismissed without compensation. 77 (24.68 %) cases on gynecology were filed with common reasons for litigation being Post-op complications, intraop complications (11.68 %), extension of surgery beyond consent (2.6 %) and out of 235 (75.32 %) cases on Obstetrics, tubectomy failure (23.82 %), birth asphyxia (10.21 %), traumatic injury to new born (5.96 %) were the common reasons for litigations. Inadequate documentation and improper consent were the main factors considered in deciding negligence on part of the doctors. CONCLUSION: With reasonable skill and care in diagnosis and treatment, proper documentation and legally valid consent it is not probable but possible to prevent litigations.

Autophagy: A boon or bane in oral cancer.

Autophagy is a catabolic process involving cellular recycling and is believed to play a distinct role in cell survival especially when exposed to stressors, rendering it comparable to the elixir sustaining life. It plays a significant role in various conditions like cancers, neuropathies, heart diseases, auto-immune diseases, etc. Its role in tumorigenesis and cancer therapeutics is worth exploring. Autophagy is believed to help in survival and longevity of cancer cells by buffering metabolic stress. Inhibition of autophagy in an environment of nutrient deprivation leads to cell death. Autophagy is also seen to facilitate metastasizing tumor cells in surviving the conditions of metabolic deprivation and in recovery when conditions turn favorable. Many current cancer therapies tend to inflict metabolic stress, thus autophagy inhibitors may be useful in cancer treatment. As per the adage, "excess of anything is bad", the autophagy promoters can also be exploited as beneficial tools in the fight against cancer. Another method for tumor-cell elimination can be by inducing autophagic cell death through over-stimulation. Oral cancers are becoming a leading cause of deaths worldwide. Much remains to be explored about the role autophagy plays in progression of head and neck cancers, so as to harness it in the therapeutics of these cancers. Research on autophagy is still in its infancy. There are knowledge gaps in understanding this complex process. But there is no doubt that understanding exact mechanism behind autophagy will open up new avenues in cancer therapeutics and even prevention.

Verrucous carcinoma-an enigma: Case report and review.

Verrucous hyperplasia, verrucous keratosis, and VC may not be distinguished clinically or may coexist. Though it appears remarkably harmless, the histopathological diagnosis of VC should be accompanied with careful identification of tumors with a greater chance to become frank cancers. Here, we report two cases of OVC, referring all the diagnostic intricacy occurring in the clinicopathological examination along with a review of the scientific literature.

Relative efficacy of pimecrolimus cream and triamcinolone acetonide paste in the treatment of symptomatic oral lichen planus.

BACKGROUND AND OBJECTIVES: Oral lichen planus (OLP) is a relatively common, chronic inflammatory condition that frequently presents with symptoms of pain and burning sensation. It is generally a very unrelenting disorder despite several kinds of treatment. Only symptomatic OLP requires treatment, and it remains a challenging predicament. Efforts are made in a sustained manner for searching for novel therapies for symptomatic OLP. Therefore, this study was aimed to compare the efficacy of treatment with topical pimecrolimus cream 1% with that of triamcinolone acetonide oral paste 0.1% in subjects with symptomatic OLP. MATERIALS AND METHODS: A prospective, parallel-group, randomized, active control clinical study was conducted among 30 symptomatic OLP subjects (20 females and 10 males, with 15 patients in each treatment group) treated with topical pimecrolimus 1% cream and triamcinolone acetonide 0.1% oral paste four times daily for two consecutive months and treatment-free follow-up was performed for 2 months. Pain or burning sensation, mean clinical score and presence of erythematous areas were assessed. The data obtained were statistically analyzed using Wilcoxon's Rank test and the Mann Whitney test. RESULTS: Subjects in both the groups showed significant improvement in symptom scores; however, the overall treatment response was higher in the pimecrolimus group compared with the triamcinolone acetonide group. On intergroup comparison, there was no statistically significant difference between the groups in the reduction in burning sensation (P = 0.18) and erythematous area (P = 0.07), but there was a statistically highly significant improvement in reduction of clinical scoring (P < 0.01%). Following the termination of the treatment, sustained remission of symptoms and long-lasting therapeutic effects was detected in 93.3% of the patients treated with pimecrolimus. INTERPRETATION AND CONCLUSION: Topical pimecrolimus 1% cream showed better therapeutic response compared with triamcinolone acetonide 0.1% oral paste in subjects with symptomatic OLP.

Role of dried fruits of Carissa carandas as anti-inflammatory agents and the analysis of phytochemical constituents by GC-MS.

Inflammation plays an important role in various diseases with high prevalence within populations such as rheumatoid arthritis, ulcer, atherosclerosis, and asthma. Many drugs are available in the market for inflammatory diseases. They exhibit several unwanted side effects to humans. Therefore, alternative treatments with safer compounds are needed. Carissa carandas plant is used in traditional medicinal system for its various diseases curing property. In the present study, we examined the anti-inflammatory effects of dried fruit methanol extract on carrageenan-induced hind paw edema in rats. C. carandas was defatted with petroleum ether, followed by methanol extraction. The methanol extracts of the dried fruits of Carissa carandas were given orally to the experimental rats caused significant activity (P ≤ 0.05) when compared with the control group. The maximum inhibition of paw edema was found to be in Group V, that is, 76.12% with inhibition of paw volume in a dose-dependent manner. The anti-inflammatory activity of the methanol extract of the dried fruits shows that the presence of potential constituents present in this extract may provide assistance in the drug discovery process. The phytochemical compounds of the extract were screened by GC-MS analysis and it was found that 11 compounds are present in methanol extract of dried fruits of Carissa carandas.

Olmesartan-related sprue-like enteropathy.

Chronic diarrhea is a common clinical problem in gastroenterology practice and often difficult to diagnose the cause. Presence of villous atrophy in these subjects is not specific as differential diagnosis can be broad. Drug-induced diarrhea is often overlooked during the evaluation. We report a short series of such challenging small bowel diarrhea secondary to olmesartan-related sprue-like enteropathy.