Treatment Till Research Articles

Diagnosis and Management of CMV Endotheliitis

The purpose of this review is to elucidate the recent developments in the diagnostic armamentarium and the treatment strategy of CMV endotheliitis. CMV endotheliitis is now increasingly recognized entity especially in the Asian population. The exact pathogenesis is still unknown but many risk factors have been identified. A strong suspicion based on clinical features with the use of modern diagnostic tools like PCR and high resolution imaging modalities can lead to early confirmation of the disease. Early diagnosis and appropriate treatment at the initial stage are crucial to avoid the sequelae. Apart from the typical clinical features, any patient presenting with KPs, raised IOP with mild AC reaction especially following corneal transplant, diagnosis of CMV endotheliitis should be considered. CMV endotheliitis can mimic graft rejection. PCR can help confirm but clinical acumen still remains the mainstay tool for diagnosis. Oral valganciclovir is the definitive treatment till date but recurrences are common. Future studies to find the appropriate dosage, duration, and the route of ganciclovir administration for prophylaxis are needed.

The Expressions of Dickkopf-Related Protein 1 and Frizzled-Related Protein Are Negatively Correlated to Local Inflammation and Osteoarthritis Severity.

To investigate the presence of WNT antagonists Dickkopf-related protein 1 (DKK1), Frizzled-related protein (FRZB) and BMP antagonist Gremlin 1 (GREM1) in synovial fluid (SF) and serum, respectively, from end-stage knee osteoarthritis (OA) patients, and correlate their expression with other markers of OA. In a cross-sectional study, SF and serum were collected from OA patients (n = 132). The concentrations of DKK1, FRZB and GREM1 in SF and serum were determined using immunoassays. Correlation measurements were performed between groups and previously assessed disease markers, such as synovium nitric oxide (NO), inerleukin-1β (IL1β), tumor necrosis factor-α (TNFα), and prostaglandin E2 (PGE2). The OA patients with the celecoxib treatment till surgery have higher median SF FRZB values compared with the control (no treatment); the celecoxib 3-days before surgery stopped treatment group has higher median serum FRZB values than the control and the naproxen treatment group. The combinational analysis of SF DKK1 and SF FRZB negatively correlated with macroscopic cartilage scores and histological synovium scores in OA patients. The expression of DKK1 and FRZB in SF showed the same expression trend as their expression in serum. Furthermore, the SF concentration of DKK1 was positively correlated with FRZB in both SF and serum. In contrast, it was negatively correlated with synovium NO and IL1β. SF FRZB was negatively correlated with synovium NO, IL1β, cartilage PGE2, and age. Our findings suggest DKK1 and FRZB were negatively correlated with OA severity and multiple pro-inflammatory cytokines. Our data indicate that DKK1 and FRZB can be joint disease-specific biomarkers.

Comparison of Caralluma tuberculata with Metformin for Anti-Diabetic Activity: An Animal Study

Background: Caralluma tuberculata, is a wild herb, which grows in the hills of Balochistan and has been known to have medicinal and nutritional properties since antiquity. This experimental research was designed to study the hypoglycemic properties of Caralluma tuberculata and to compare them with Metformin.Material and Methods: This was a laboratory-based animal experimental study. It was conducted in the Pharmacology laboratory of Khyber Medical University, Peshawar from February 2016 to August 2016. Two types of extracts of Caralluma tuberculata [crude extract and carbon tetrachloride (CCl4) extract] were prepared and administered to normal and alloxan treated diabetic rabbits. To study anti-diabetic activity, eighty-four rabbits were divided into two main groups. Group I (Normal/Non-Diabetic Rabbits; n= 21) and Group II (Diabetic/Alloxanized Rabbits; n=63). Each group was further divided into sub-groups (7 rabbits in each). Effect of Caralluma tuberculata, Metformin and 2% gum tragacanth on blood glucose levels were checked at 0, 2, 4, 6, 8, 12 and 24 hours of drug administration. The extracts were given in capsule form and in cooking oil. Data analysis was done using SPSS version 16. For calculation and comparison of the hypoglycemic effects at various doses and different time intervals, analysis of variance (ANOVA) and Tukey’s post hoc test were applied.Results: The crude extract, 200mg/kg body weight of Caralluma tuberculata showed significant decrease (p<0.001) in mean blood glucose levels from 2-hour till12 hours. Whereas, highly significant reduction of blood glucose was seen from 2 hours after treatment till 24 hours, when carbon tetrachloride (CCl4) fraction of Caralluma (100mg/kg body weight) in capsule form was administered. Metformin 500mg/kg body weight was given to compare its effects with plant crude extract and it was found that metformin appeared to be less effective in comparison with Caralluma tuberculata.Conclusion: Caralluma tuberculata lowered the blood glucose level and turned out to be more significant in developing hypoglycemia when taken with cooking oil. More work is essential to provide stronger evidence for the use of this natural agent in the management of Diabetes Mellites.

Amyotrophic Lateral Sclerosis: The Most Common And Lethal Form Of Motor Neuron Disease-a Case Report From Middle East

A neurodegenerative disorder which is fatal, rapidly progressive and has no effective treatment till date is amyotrophic lateral sclerosis. Almost 90% of all cases occur in the sporadic form, with the rest occurring in the familial form. It is a devastating disease leading to death within 3-5 years in most cases. The diagnosis of AML is difficult to made in spite of acknowledgment for 140 years. It is diagnosed by clinical presentation which is a combination of upper and lower motor neuron signs and electro diagnostic studies which gives information about diffuse motor axonal injury. This neurodegenerative disorder results in degeneration of corticospinal tracts and anterior horn cells and involving motor neurons of the cerebral cortex, brainstem, and spinal cord. There are a variable signs and symptoms of this disease, so the diagnosis is very important for the management and better outcome of the patients. Cause of death in these patients is usually respiratory failure

Effect of Spirulina platensis on Immunity in Cadmium Treated Chickens

One hundred chickens of one day age were divided randomly into five groups of 20 birds each. After two weeks of adaptation period, group I was kept as control, group II was fed with 0.2% Spirulina platensis powder till 90th day post treatment (DPT). Group III was administered 1.6 ppm cadmium as cadmium chloride monohydrate (CdCl2.H2O) in triple glass distilled water. Groups IV and V were administered 1.61 ppm cadmium in triple glass distilled water along with Spirulina platensis powder orally in standard recommended feed at the rate of 0.2% concentration. However, in Group V Spirulina platensis powder was given after 60th day post treatment (DPT) till 90th day post treatment (DPT). Humoral immune response was assessed by hemagglutination and hemagglutination inhibition assays from the serum separated from 5 chickens from each group at 0, 30th, 60th and 90th DPT and cell mediated immune response was assessed using lymphocyte stimulation test from 5 chickens from each group at 0, 30th, 60th and 90th DPT using heparinised peripheral blood. There was a significant decrease in humoral immune response in cadmium treated group III, as compared to group I control. In groups IV and V, Spirulina platensis showed significant increase in humoral immune response in chickens which were also treated with cadmium. There was no significant change in cell mediated immune response in any group throughout the period of experiment. Present study showed the immunotoxic property of cadmium in chickens even at NOAEL dose and also Spirulina platensis has shown immunopotentiating effects in birds even in which the immunity was down regulated due to cadmium.

Video-assisted anal fistula treatment in the management of fistula-in-ano: A 3-year experience

Background: Fistula-in-ano and especially the high and complicated type is still one of the difficult surgical problems to solve. The new promising technique, video-assisted anal fistula treatment (VAAFT) was done first by Professor P. Meinero in 2006. Objective: The objective of the study was to describe the technique and the encouraging result of VAAFT. Materials and Methods: Using Karl Storz Company fistuloscope, 200 patients with anal fistulas were treated in Babylon Private Hospital in Al Hilla (Center of Babylon Governorate). This was done in two phases: diagnostic phase including visualization of fistula tract and identification of internal opening, followed by the operative phase by cauterization, curettage of the tract, irrigation using 1% mannitol solution, and closure of the internal opening using no. 1 Vicryl (polyglactin). Results: From the 200 patients with anal fistulas, 40 patients (20%) had undergone classical fistula surgery. No major complications were recorded. Early and late postoperative pain and discomfort were mild. The cases followed up at 6 weeks and 3 months postoperatively. Primary healing rate was 70% at 12 weeks and 74% at 3-month follow-up. The overall healing rate percent after 1 year was 80%. Conclusion: VAAFT is a safe, sphincter-saving, painless procedure and can be done as a day case with promising preliminary results, and we can repeat the treatment till cure is achieved.

Therapeutic and prophylactic role of cognitive enhancers in electroconvulsive therapy-induced cognitive deficits.

Objectives:The objective is to evaluate the pattern of cognitive deficits after electroconvulsive therapy (ECT); to ascertain the role of various psychosocial, illness and treatment-related parameters on cognitive functions after ECT; and to evaluate the effect of donepezil on various cognitive deficits.Materials and Methods:A triple-blind randomized controlled trial was undertaken. Ninety patients undergoing ECT were included into study after due consent and institutional ethical approval. They were randomized into two groups: one using donepezil with ECT and the other using placebo with ECT. Various cognitive parameters were studied before ECT, after a course of ECT and after 4 weeks of last ECT. Findings were assessed in the light of available socialdemographic and clinical parameters and existing literature.Results:ECT was found to be an effective therapeutic modality. Immediate memory worsened over the course of ECT till after 4 weeks of ECT. Augmentation of donepezil was found useful. It sped up the improvement of general memory and working memory during ECT.Conclusion:Donepezil has therapeutic and prophylactic benefit on cognition of patients undergoing ECT over the course of treatment till 4 weeks after the ECT.

Adjunctive Effect of Doxycycline with Conventional Periodontal Therapy on Glycemic Level for Chronic Periodontitis with Type 2 Diabetes Mellitus Subjects

This study aimed to assess the use of doxycycline in adjunct to periodontal therapy on the glycemic levels for chronic periodontitis patients with type 2 diabetes mellitus (DM). Fifty-one diabetic subjects with chronic periodontitis were selected and randomly assigned into 3 groups with 17 subjects each. Scaling and root planing (SRP) was done in group I, SRP and doxycycline was given in group II, and group III did not receive any periodontal treatment till 3 months. Probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and metabolic parameters were evaluated at baseline (day 0) and after 3 months (day 90). The statistical analysis was carried out using SPSS 17.0 software with significance fixed at 95% CI (p < 0.05). The mean difference between baseline and day 90 for all periodontal parameters was significantly higher (p < 0.01) in group I and group II compared to control (group III). The metabolic parameters such as fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (PPG), and glycated hemoglobin (HbA1c%) level were reduced in groups I and II compared to group III; however, only HbA1c% values were found significantly reduced (p < 0.01) at day 90. Group II showed significantly better metabolic parameters than group I at day 90. The adjunct of doxycycline to conventional periodontal therapy provides additional benefit in reducing glycemic level and improves periodontal health. The prevalence of diabetes as well as periodontitis is increasing nowadays in the world. With treatment of periodontitis, it is found that there is reduction of glycemic level in diabetes. So it is an alert to health professionals about the relation of diabetes and periodontitis and so that they conduct a multidisciplinary treatment.

PENERAPAN METHODOLOGY SIX SIGMA UNTUK MENGURANGI PEMBOROSAN BIAYA OPERASIONAL WASTE WATER TREATMENT DI PT CLARIANT INDONESIA (STUDI KASUS DI PERUSAHAAN KIMIA)

One of the method used to improve of process to give the solution to increase process standart in internal manufacturing purpose to minimize defect or non conforming and reduce waste so the trend of failure product reduced in period is six sigma method. Through of application cycles of DMAIC (Define, Measure, Analyze, Improve and Control) in six sigm, so one of problem can to clear define the root causes and can to improve with structural. This riset in PT Clariant Indonesia Tangerang Site, in Waste Water Treatment analysis costing needed to operasional water treatment in one year. Where there are several cost aloction not yet effective and efficient so occur waste of operational costing Waste Water Treatment in 2015. Result of the riset is success to defined several root causes and defined several solution to tackle problem waste of cost operational in Waste Water Treatment. In the end of riset success to reduce operational cost Waste Water Treatment till 360 mio IDR in 6 months Control phase. Keyword : Quality Control, Six Sigma, DMAIC, Waste Water Treatment, Continuous Improvement.

Postoperative Pain and Recurrence after Mesh Fixation with Absorbable versus Non-Absorbable Tacks in Patients undergoing Laparoscopic Transabdominal Inguinal Hernia Repair: A Comparative Study

Introduction: Inguinal hernia is a common disease. Many researches were done to evaluate the different methods of treatment yet there is no ideal method for treatment till now. Since the use of laparoscopy in hernia repair evolved, it is probably becoming the treatment of choice for hernia. Objectives: This is a prospective randomized trial that aimed at comparing the outcome of using absorbable versus non-absorbable tacks as mesh fixation devices in patients undergoing laparoscopic transabdominal inguinal hernia repair (TAPP) regarding postoperative groin pain and early recurrence. Patients and Methods: Thirty patients were enrolled in this study. The patients were divided into two groups: Group A included 15 patients who underwent TAPP with mesh fixation by non absorbable tack (NAT) and group B included 15 patients who underwent TAPP with mesh fixation by absorbable tack (AT). Follow up was done at the first day, second week, sixth month and one year postoperatively. Results: The 2 groups had similar features regarding demographics, operation time, postoperative hospital stay and morbidity. The 2 fixation methods were found similar for postoperative pain and recurrence with no significant difference. Disclosure: This article is not sponsored by any company, so the authors have no competing interests as defined by Nature Publishing Group, or other interests that might be perceived to influence the results and/or discussion reported in this article.

Tumores de Células Germinativas Testiculares: Casuística do Hospital CUF Infante Santo

INTRODUÇÃO: Os tumores de células germinativas são tumores raros, constituindo 1% a 2% do total das neoplasias malignas e cerca de 5% do total dos tumores malignos urológicos. Originam-se no testículo em mais de 90% dos casos.MÉTODOS: Os autores reveem os casos de tumores de células germinativas, incluindo o diagnóstico, tratamento e follow-up, ocorridos no Hospital CUF Infante Santo num período de mais de 15 anos, compreendido entre agosto de 1999 e novembro de 2014.RESULTADOS: A série compreende 33 doentes, todos submetidos inicialmente a orquidectomia radical, diagnóstica e terapêutica, estando o maior número de doentes, 21 (63,6%) em estádio I. Destes, 14 (66% dos estádios I), vieram a fazer tratamento pós-orquidectomia. Todos os doentes em estádios mais avançados efetuaram tratamento pós-cirúrgico. Verificaram-se apenas quatro recidivas (12,1%), ocorridas em mediana 20 meses pós-diagnóstico e todas salvas por posterior tratamento.CONCLUSÃO: A toxicidade parece-nos aceitável, não tendo ocorrido nenhuma morte relacionada com qualquer modalidade de tratamento. Com uma mediana de follow-up de 59 meses à data da conclusão da revisão, a sobrevivência livre de doença foi de 100%.

Association between duration of intravenous antibiotic administration and early-life microbiota development in late-preterm infants

Antibiotic treatment is common practice in the neonatal ward for the prevention and treatment of sepsis, which is one of the leading causes of mortality and morbidity in preterm infants. Although the effect of antibiotic treatment on microbiota development is well recognised, little attention has been paid to treatment duration. We studied the effect of short and long intravenous antibiotic administration on intestinal microbiota development in preterm infants. Faecal samples from 15 preterm infants (35 ± 1 weeks gestation and 2871 ± 260 g birth weight) exposed to no, short (≤ 3 days) or long (≥ 5 days) treatment with amoxicillin/ceftazidime were collected during the first six postnatal weeks. Microbiota composition was determined through 16S rRNA gene sequencing and by quantitative polymerase chain reaction (qPCR). Short and long antibiotic treat ment significantly lowered the abundance of Bifidobacterium right after treatment (p = 0.027) till postnatal week three (p = 0.028). Long treatment caused Bifidobacterium abundance to remain decreased till postnatal week six (p = 0.009). Antibiotic treatment was effective against members of the Enterobacteriaceae family, but allowed Enterococcus to thrive and remain dominant for up to two weeks after antibiotic treatment discontinuation. Community richness and diversity were not affected by antibiotic treatment, but were positively associated with postnatal age (p < 0.023) and with abundance of Bifidobacterium (p = 0.003). Intravenous antibiotic administration during the first postnatal week greatly affects the infant’s gastrointestinal microbiota. However, quick antibiotic treatment cessation allows for its recovery. Disturbances in microbiota development caused by short and, more extensively, by long antibiotic treatment could affect healthy development of the infant via interference with maturation of the immune system and gastrointestinal tract.

Natural Products as Anticancerous Therapeutic Molecules with Special Reference to Enzymatic Targets Topoisomerase, COX, LOX and Aromatase.

Cancer, characterized by uncontrolled growth and proliferation of cells, is affecting millions of people every year and estimated as the second leading cause of death. Its successful treatment yet remains a challenge due to the lack of selectivity, toxicity and the development of multidrug resistant cells to the currently available drugs. Plant derived natural products hold great promise for discovery and development of new pharmaceuticals against cancer as evident by the fact that out of 121 drugs prescribed for cancer treatment till date, 90 are derived from plant sources. Furthermore, the plant derived therapeutic molecules are also considered as safer substitutes to those of synthetic ones. In this review, the therapeutic potentials of plant derived natural products belonging to secondary metabolites, namely alkaloids, flavonoids and terpenoids as anticancer molecules, involving various strategies of treatment, have been discussed with special reference to topoisomerases (Topo), cyclooxygenases (COX), lipoxygenase (LOX) and aromatase as enzymatic targets for various types of cancers. Furthermore, in view of the recent advances made in the field of computer aided drug design, the present review also discusses the use of computational approaches such as ADMET, molecular docking, molecular dynamics simulation and QSAR to assess and predict the safety, efficacy, potency and identification of such potent anticancerous therapeutic molecules.

Iron Deficiency Anemia with Menorrhagia: Ferric Carboxymaltose a Safer Alternative to Blood Transfusion.

Background:Menstrual disorder accounts for 5%–10% of the women presenting with iron deficiency anemia (IDA) in the perimenopausal age group. Heavy menstrual bleeding in this age group leads to severe anemia and frequently requires blood transfusion which has its own adverse effects. We today have ferric carboxymaltose (FCM) as a safer alternative to blood transfusion.Objective:The objective of the study is to evaluate the safety and efficacy of FCM in treating anemia in patients of menorrhagia. Thus avoiding blood transfusion.Materials and Methods:It was an open, single arm observational study including 90 women of age more than 30 years with definitive diagnosis of menorrhagia with IDA and hemoglobin (Hb) levels between 4 gm% and 11 gm%. Intravenous FCM (500–1500 mg) was administered, and the improvement in blood indices was assessed after 3 weeks of total dose infusion. Menorrhagia was controlled by medical treatment till Hb improvement was achieved and definitive surgical intervention was done.Result:Most of the women were in the age group of 40–50 years. Blood indices measured pre-FCM and 3 weeks post-FCM showed a mean increase in Hb from 8.33 ± 1.10 to 10.89 ± 1.02 with a statistically significant P < 0.01. There was a statistically significant rise of packed cell volume, serum ferritin, and serum iron in the post-FCM blood levels after 3 weeks. No serious life-threatening adverse events were observed after FCM administration.Conclusion:Intravenous FCM is an effective and a safe treatment option for IDA with a single administration of high dose without serious adverse effects obviating the need for blood transfusion before surgery.

Patients with MDR-TB on domiciliary care in programmatic settings in Myanmar: Effect of a support package on preventing early deaths.

BackgroundThe community-based MDR-TB care (CBMDR-TBC) project was implemented in 2015 by The Union in collaboration with national TB programme (NTP) in 33 townships of upper Myanmar to improve treatment outcomes among patients with MDR-TB registered under NTP. They received community-based support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each project township had a project nurse exclusively for MDR-TB and a community volunteer who provided evening directly observed therapy (in addition to morning directly observed therapy by NTP).ObjectivesTo determine the effect of CBMDR-TBC project on death and unfavourable outcomes during the intensive phase of MDR-TB treatment.MethodsIn this cohort study involving record review, all patients diagnosed with MDR-TB between January 2015 and June 2016 in project townships and initiated on treatment till 31 Dec 2016 were included. CBMDR-TBC status was categorized as “receiving support” if project initiation in patient’s township was before treatment initiation, “receiving partial support” if project initiation was after treatment initiation, and “not receiving support” if project initiation was after intensive phase treatment outcome declaration. Time to event analysis (censored on 10 April 2017) and cox regression was done.ResultsOf 261 patients initiated on treatment, death and unfavourable outcomes were accounted for 13% and 21% among “receiving support (n = 163)”, 3% and 24% among “receiving partial support (n = 75)” and 13% and 26% among “not receiving support (n = 23)” respectively. After adjusting for other potential confounders, the association between CBMDR-TBC and unfavourable outcomes was not statistically significant. However, when compared to “not receiving support”, those “receiving support” and “receiving partial support” had 20% [aHR (0.95 CI: 0.8 (0.2–3.1)] and 90% lower hazard [aHR (0.95 CI: 0.1 (0.02–0.9)] of death, respectively. This was intriguing. Implementation of CBMDR-TBC coincided with implementation of decentralized MDR-TB centers at district level. Hence, patients that would have generally not accessed MDR-TB treatment before decentralization also started receiving treatment and were also included under CBMDR-TBC “received support” group. These patients could possibly be expected to sicker at treatment initiation than patients in other CBMDR-TBC groups. This could be the possible reason for nullifying the effect of CBMDR-TBC in “receiving support” group and therefore similar survival was found when compared to “not receiving support”.ConclusionCBMDR-TBC may prevent early deaths and has a scope for expansion to other townships of Myanmar and implications for NTPs globally. However, future studies should consider including data on extent of sickness at treatment initiation and patient level support received under CBMDR-TBC.

Therapeutic potential of gambogic acid, a caged xanthone, to target cancer

Natural compounds have enormous biological and clinical activity against dreadful diseases such as cancer, as well as cardiovascular and neurodegenerative disorders. In spite of the widespread research carried out in the field of cancer therapeutics, cancer is one of the most prevalent diseases with no perfect treatment till date. Adverse side effects and the development of chemoresistance are the imperative limiting factors associated with conventional chemotherapeutics. For this reason, there is an urgent need to find compounds that are highly safe and efficacious for the prevention and treatment of cancer. Gambogic acid (GA) is a xanthone structure extracted from the dry, brownish gamboge resin secreted from the Garcinia hanburyi tree in Southeast Asia and has inherent anti-cancer properties. In this review, the molecular mechanisms underlying the targets of GA that are liable for its effective anti-cancer activity are discussed that reveal the potential of GA as a pertinent candidate that can be appropriately developed and designed into a capable anti-cancer drug.

Effect of early use of different doses of enteral nutrition on prognosis of patients with acute respiratory failure

To observe the impact of initial low-dose (trophic type) enteral nutrition (EN) support on mechanical ventilation (MV) time, the incidence of complications and survival rate in patients with acute respiratory failure (ARF). A prospective study was conducted. Forty-four patients with ARF undergoing MV admitted to Department of Critical Care Medicine of Hangzhou Traditional Chinese Medical Hospital from September 2015 to February 2017 were enrolled, and they were divided into a trophic feeding group (n = 23, study group) and a standard-dose feeding group (n = 21, control group). In the two groups, the EN support feeding was given to the patients through a nasogastric tube within 24-hour MV for consecutive 7 days, the protein supply to each one of all of them was 1.2-1.6 g×kg-1×d-1. The study group received EN according to non-protein calories of 41.84-83.68 kJ×kg-1×d-1 to calculate, while the control group accepted EN according to non-protein calories of 104.60-125.50 kJ×kg-1×d-1 to calculate. The serum albumin (Alb) and fasting blood glucose (FBG) levels were measured in two groups 1 day before EN treatment and at 1, 2, 3, 7 days of treatment, and the energy levels in initial 3 days and 7 days of MV and the 24-hour urine creatinine (UCr) level on the 7th day after treatment were recorded. The creatinine-height index (CHI, CHI = actual UCr/standard UCr) was calculated. The incidence of intestinal intolerance (vomiting, gastric retention, diarrhea, gastrointestinal bleeding, etc.) in 7 days of treatment, MV time, the length of stay in ICU, the total length of stay in the hospital and the 28-day incidence of new infections (pulmonary, hematogenous, urinary, abdominal, and other infections) and 60-day survival rate were observed between the two groups. The EN supplies within 3 days and 7 days in the study group were significantly lower than those in the control group [within 3 days (kJ/d): 1 710.58±703.96 vs. 4 152.79±1 334.65, 7 days (kJ/d): 2 471.28±815.50 vs. 5 058.08±875.25, both P < 0.05]; there were no statistically significant differences in CHI after EN therapy for 7 days and serum Alb levels before and after EN between the two groups. FBG level of the study group was significantly lower than that of the control group since the 2nd day of treatment (mmol/L: 8.58±2.37 vs. 10.93±3.75), and continued to the 7th day (mmol/L: 8.96±1.76 vs. 10.97±4.11, both P < 0.05), the incidence of elevated blood glucose was also significantly lower than that of the control group [26.1% (6/23) vs. 66.7% (14/21), P < 0.05]. The incidence of feeding intolerance in the study group was significantly lower than that in the control group from 2 days of treatment till 7 days (26.1% vs. 47.6%, P < 0.05). There were no statistically significant differences in MV time (days: 15.04±6.75 vs. 16.14±8.51), the length of stay in ICU (days: 16.52±6.89 vs. 17.24±7.67), total length of stay in hospital (days: 26.35±9.69 vs. 25.33±7.73), 28-day new infection rate [26.1% (6/23) vs. 42.9% (9/21)] and 60-day survival rate [65.2% (15/23) vs. 66.7% (14/21)] between the study and control groups (all P > 0.05). Initial trophic EN feeding results in clinical outcomes similar to those of early standard-dose EN feeding in MV patients with ARF, but the former one has less incidence of high blood sugar and more satisfactory gastrointestinal tolerance situation.

Acaricidal potency of polyherbal spray against Rhipicephalus microplus and Hyalomma anatolicum infestation in cattle.

Acaricidal potential of polyherbal spray (Andropogon citrates, Cymbopogon citratus, Ocimum sanctum, Pinus longifoia, Calotropis procera, Datura stramonium, Aegle marmelos, Ricinus communis, Azadirachta indica, Allium sativum, Carica papaya, Annona squamosa and Pongamia glabra) was assessed against tick infestation in cattle on the basis of measurement of tick count, complete blood count and plasma glucose, total protein, albumin and globulin before treatment and 21days after treatment. Single application of polyherbal spray over body of 20 randomly selected tick infested cattle revealed significant reduction in mean tick count starting from 3days post treatment till 21days post treatment. Highly significant (P<0.01) increase in total erythrocyte count and packed cell volume was observed in treated cows 21days after application of spray compared to pre-treatment values indicating the reduction in blood loss due to heavy tick infestation before treatment. Plasma biochemical parameters revealed no significant changes in pre-treatment and post treatment values. The results of present study imply the clinical and haematological improvement in tick infested cattle treated with polyherbal spray and it could be potential product for use in livestock as acaricide.

Evaluation of Topicure® Plus spray on sheep infested with Myiasis

The present study was designed to evaluate the therapeutic efficacy of polyherbal aerosol spray - Topicure® Plus against maggot infested wounds in sheep. Two sheep presented at Vellore Veterinary Dispensary with a history of maggot infested wound were selected. Based on the severity of wound, antibiotics (Ampicillin - 10 mg/kg body weight) and NSAIDs (Meloxicam - 0.5 mg/kg body weight on 1st day) were administered. The site of wound was clipped off the hair and cleaned with sterile saline solution and wiped with dry sterile cotton on first day of the treatment. Then Topicure® Plus was sprayed in sufficient quantities to cover the entire wound twice daily till complete healing of wound occurs. When Topicure® Plus spray was administered concurrent local treatment with other fly repellents/maggoticidal agents was not followed. Wound was observed for the changes in swelling, discharge, granulation tissue and wound healing process following the treatment till complete recovery. Similarly, fly repellent activity and duration, maggot repellent property, activity level and product satisfaction score were also recorded. The results indicate that Topicure® Plus had ensured faster wound healing (within 8 days) which is evident through reduction in pain, swelling, discharge and granulation tissue score along with superior fly repellent activity and duration, maggot repellent property. Therefore, it appears from the present study that treatment of myiasis wound with Topicure® Plus spray along with antibiotic regime was the most effective in field conditions as it avoids the day to day manual removal of maggots and induces the faster wound healing.Asian J. Med. Biol. Res. June 2017, 3(2): 216-220

A model to estimate survival in ambulatory patients with hepatocellular carcinoma: Can it predict the natural course of hepatocellular carcinoma?

BackgroundSeveral hepatocellular carcinoma (HCC) staging systems are available including the newly developed staging system, the Model to Estimate Survival in Ambulatory HCC patients (MESIAH); however, whether these staging systems could predict the natural course of HCC is largely unknown. Methods1013 patients with history of HCC treatment and 111 patients without any history of treatment till death or last follow-up at a single tertiary hospital were included. ResultsThe MESIAH score showed a better discrimination ability, with a C-statistic of 0.835 [95% confidence interval (CI), 0.810–0.861] in the group of treated patients compared to the Barcelona Clinic Liver Cancer (BCLC) staging system [0.739 (95% CI, 0.709–0.769)] before propensity score matching. However, the MESIAH score failed to stratify patients according to their risk of death in the group of untreated patients unlike the BCLC staging system. Propensity score matching analysis confirmed that the MESIAH score was most strongly influenced by whether treatment was given or not. ConclusionsAlthough the MESIAH score provided better prognostic stratification than other staging systems in treated HCC patients, it was not helpful in predicting the natural course of HCC. Since the treatment affects patient outcome and prognosis, it is necessary to develop a new staging system that can also reflect the natural course of HCC.