Pharmacokinetics of thrice-weekly rifampicin, isoniazid and pyrazinamide in adult tuberculosis patients in India

OBJECTIVE

To study the pharmacokinetics of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA) in adult tuberculosis (TB) patients and examine factors that influence drug pharmacokinetics.

METHODS

Adult TB patients (n = 101) receiving thrice-weekly anti-tuberculosis treatment in the Revised National TB Control Programme (RNTCP) were studied. The study was conducted at steady state after directly observed drug administration. RMP, INH and PZA concentrations were estimated using high-performance liquid chromatography and NAT2 genotyping by real-time polymerase chain reaction.

RESULTS

RMP peak concentration (Cmax) was sub-therapeutic (<8 μg/ml) in 88% of the patients. The Cmax of RMP, INH and PZA at 2 h was observed in respectively 83.2%, 97.0% and 92.1% of the patients. The Cmax and area under the curve from 0 to 8 h (AUC0-8) of PZA was lower in TB patients with diabetes mellitus than in non-diabetics. Significant associations were observed between the Cmax and the AUC0-8 of RMP, INH and PZA with drug doses; RMP with category of treatment; INH with smoking, body mass index and N-acetyl transferase 2 genotype; and PZA with sex and smoking.

CONCLUSIONS

Several risk factors for drug concentration variations were identified. Two-hour post-dosing drug concentrations mimicked Cmax. A high proportion of TB patients had RMP Cmax below the expected range, which is a matter of concern.

Outcomes of Ulnar Shortening for Ulnar Impaction Syndrome Using the 2.7 mm AO Ulna Shortening Osteotomy System

Background: Ulnar shortening osteotomy is a well-established treatment for ulnar impaction syndrome. Controversy remains regarding the most effective system to achieve efficient bony union, whilst minimising incidence of complications, particularly hardware irritation. We present outcomes at 2 years using the recently released low profile AO osteotomy system.

Methods: 32 consecutive patients with significant pain from ulnar impaction syndrome (idiopathic or post-traumatic), without degenerative changes of the distal radio-ulnar joint, were included. Time to union, range of motion, grip strength, pain and complications were recorded.

Results: Median time to union was 10.14 weeks (9.27–11.01, 95%CI), with one nonunion. Visual Analogue Pain score, grip strength and range of motion improved significantly. No patient experienced hardware irritation. No plate required removal. Positive ulnar variance was reduced by 3.8 mm (mean).

Conclusions: The low profile AO system appears effective in achieving bony union whilst minimising incidence of hardware irritation, at a follow up of 2 years

Rayleigh lidar observation of tropical mesospheric inversion layer: a comparison between dynamics and chemistry

The Rayleigh lidar at National Atmospheric Research Laboratory, Gadanki (13.5°N, 79.2°E), India operates at 532 nm green laser with ~600 mJ/pulse since 2007. The vertical temperature profiles are derived above ~30 km by assuming the atmosphere is in hydrostatic equilibrium and obeys ideal gas law. A large mesospheric inversion layer (MIL) is observed at ~77.4-84.6 km on the night of 22 March 2007 over Gadanki. Although dynamics and chemistry play vital role, both the mechanisms are compared for the occurrence of the MIL in the present study.

Comparative Evaluation of Dental and Skeletal Fluorosis in an Endemic Fluorosed District, Salem, Tamil Nadu

Background:

High levels of fluoride in the drinking water, especially ground water, results in skeletal fluorosis which involves the bone and major joints. This study was conducted to assess the prevalence of skeletal fluorosis to compare with dental fluorosis in an endemically fluorosed population in the District of Salem, Tamil Nadu.

Materials and Methods:

Institutional ethical clearance was obtained. A total of 206 patients who reported to the Department of Hematology for blood investigations were the participants in this study. Age, sex, place, weight, height, dental fluorosis, and skeletal complaints were noted down. Body mass index was calculated, and statistical analysis was performed.

Results:

Dental fluorosis was present in 63.1% and absent in 36.9% of the samples reported. Skeletal fluorosis was present in 24.8% and was absent in 75.2%. A large number of the patients had knee pain and difficulty in bending. Chi-square test was used for statistical analysis. Skeletal fluorosis and age were compared and P value was 0.00 and was significant. Dental fluorosis and skeletal fluorosis were compared and P value was found to be 0.000 and significant.

Discussion and Conclusion:

There is a need to take measures to prevent dental and skeletal fluorosis among the residents of Salem district. Calcium balance should be maintained, and fluoride intake should be minimized to reduce the symptoms. The government should provide water with low fluoride level for drinking and cooking. Once the symptoms develop, treatment largely remains symptomatic, using analgesics and physiotherapy.

Association between QTd, Tp-e/QT Ratio and In-hospital Prognosis in Thrombolysed Acute ST-elevation Myocardial Elevation (STEMI) Patients

BACKGROUND

Both QTd and Tp-e/QT ratio have been linked to increased risk for arrhythmia and mortality. But Significance of QTd in STEMI Patients is not documented in all studies and Tp-e/QT ratio is a novel index which is understudied in these patients. Therefore, the present study is aimed to determine the short term, in-hospital prognostic value of QTd and Tp-e/QT ratio in thrombolysed STEMI patients.

METHODS

This is a prospective, observational study that includes 321 patients. Relevant clinical data is collected. QTd and Tp-e/QT ratio (tangent method) is calculated from "at admission ECG" just before thrombolysis. Multivariate logistic regression analysis was done to determine the predictors of in-hospital outcomes. A p-value of >0.05 is considered statistically significant.

RESULTS

The mean age of study population was 56.72 ± 11.36 with males:females ratio of 2.73:1. Mean value of QTd and Tp-e/QT ratio were 80.29 ±10.2 ms and 0.28 ± 0.05 respectively. The QTd and Tp-e/QT ratio are found to be independent predictors of in MACE, in addition to absence of beta-blocker therapy at admission, AWMI. Tp-e/QT ratio is independent predictor of in-hospital mortality in addition to reduced LVEF and AWMI. Analysis of the ROC curve demonstrated that the optimal cut-off value for in-hospital outcomes was a Tp-e/QT ratio of ≥0.30.

CONCLUSION

Both QTd and Tp-e/QT ratio may serve as a prognostic predictors of in hospital MACE independently but only Tp-e/QT ratio predicts patients with in-hospital all cause mortality in thrombolysed STEMI patients.

pH responsive N-succinyl chitosan/Poly (acrylamide-co-acrylic acid) hydrogels and in vitro release of 5-fluorouracil

There has been significant progress in the last few decades in addressing the biomedical applications of polymer hydrogels. Particularly, stimuli responsive hydrogels have been inspected as elegant drug delivery systems capable to deliver at the appropriate site of action within the specific time. The present work describes the synthesis of pH responsive semi-interpenetrating network (semi-IPN) hydrogels of N-succinyl-chitosan (NSC) via Schiff base mechanism using glutaraldehyde as a crosslinking agent and Poly (acrylamide-co-acrylic acid)(Poly (AAm-co-AA)) was embedded within the N-succinyl chitosan network. The physico-chemical interactions were characterized by Fourier transform infrared (FTIR), X-ray diffraction (XRD), thermogravimetric analysis (TGA), and field emission scanning electron microscope (FESEM). The synthesized hydrogels constitute porous structure. The swelling ability was analyzed in physiological mediums of pH 7.4 and pH 1.2 at 37°C. Swelling properties of formulations with various amounts of NSC/ Poly (AAm-co-AA) and crosslinking agent at pH 7.4 and pH 1.2 were investigated. Hydrogels showed higher swelling ratios at pH 7.4 while lower at pH 1.2. Swelling kinetics and diffusion parameters were also determined. Drug loading, encapsulation efficiency, and in vitro release of 5-fluorouracil (5-FU) from the synthesized hydrogels were observed. In vitro release profile revealed the significant influence of pH, amount of NSC, Poly (AAm-co-AA), and crosslinking agent on the release of 5-FU. Accordingly, rapid and large release of drug was observed at pH 7.4 than at pH 1.2. The maximum encapsulation efficiency and release of 5-FU from SP2 were found to be 72.45% and 85.99%, respectively. Kinetics of drug release suggested controlled release mechanism of 5-FU is according to trend of non-Fickian. From the above results, it can be concluded that the synthesized hydrogels have capability to adapt their potential exploitation as targeted oral drug delivery carriers.

Degradation of ultra-high molecular weight poly(methyl methacrylate-co-butyl acrylate-co-acrylic acid) under ultra violet irradiation

A new acrylic terpolymer, poly(methyl methacrylate-co-butyl acrylate-co-acrylic acid) [P(MMA-co-BA-co-AA)] of ultra-high molecular weight (UHMW) was synthesizedviaseeded emulsion polymerization.

Effects of slip and convective conditions on the peristaltic flow of couple stress fluid in an asymmetric channel through porous medium

BACKGROUND

Assessment of the fluid flow pattern in a non-pregnant uterus is important for understanding embryo transport in the uterus. Fertilization occurs in the fallopian tube and the embryo enters the uterine cavity within three days of ovulation. In the uterus, the embryo is conveyed by the uterine fluid for another three to four days to a successful implantation site at the upper part of the uterus. The movements of fluid within the uterus may be induced by several mechanisms, but they seem to be dominated by myometrial contractions. The intrauterine fluid flow due to these myometrial contractions is peristaltic type motion in nature and the myometrial contractions may occur in both symmetric and asymmetric directions.

OBJECTIVE

The aim of the present article is to investigate the peristaltic transport of couple stress fluid in an asymmetric channel. The channel asymmetry is produced by choosing the peristaltic wave train on the walls to have different wave amplitudes and phase differences. The fluid is filled with a homogeneous porous medium. The effects of slip and convective boundary conditions are also taken into consideration.

METHOD

The flow is investigated in the wave frame of reference moving with constant velocity with the wave. Long wavelength and low Reynolds number approximations are utilized in problem formulation. Exact solutions are presented for the stream function, pressure gradient and temperature.

RESULTS

The graphical analysis is carried out to examine the effects of sundry parameters on flow quantities of interest. Comparative study is also made for couple stress fluid with Newtonian fluid.

CONCLUSIONS

The results revealed that the trapping fluid can be increased and the central line axial velocity can be raised to a considerable extent by increasing Darcy number. Increasing of slip parameter increases the velocity near the boundary of the walls and Brinkman number increases the temperature of the fluid.

The potential of incorporation of binary salts and ionic liquid in P(VP-co-VAc) gel polymer electrolyte in electrochemical and photovoltaic performances

In this study, dye-sensitized solar cells (DSSCs) has been assembled with poly(1-vinylpyrrolidone-co-vinyl acetate) (P(VP-co-VAc)) gel polymer electrolytes (GPEs) which have been incorporated with binary salt and an ionic liquid. The potential of this combination was studied and reported. The binary salt system GPEs was having ionic conductivity and power conversion efficiency (PCE) that could reach up to 1.90 × 10⁻³ S cm⁻¹ and 5.53%, respectively. Interestingly, upon the addition of the ionic liquid, MPII into the binary salt system the ionic conductivity and PCE had risen steadily up to 4.09 × 10⁻³ S cm⁻¹ and 5.94%, respectively. In order to know more about this phenomenon, the electrochemical impedance studies (EIS) of the GPE samples have been done and reported. Fourier transform infrared studies (FTIR) and thermogravimetric analysis (TGA) have also been studied to understand more on the structural and thermal properties of the GPEs. The Nyquist plot and Bodes plot studies have been done in order to understand the electrochemical properties of the GPE based DSSCs and Tafel polarization studies were done to determine the electrocatalytic activity of the GPE samples.

An Approach to Solid-State Electrical Double Layer Capacitors Fabricated with Graphene Oxide-Doped, Ionic Liquid-Based Solid Copolymer Electrolytes

Solid polymer electrolyte (SPE) composed of semi-crystalline poly (vinylidene fluoride-hexafluoropropylene) [P(VdF-HFP)] copolymer, 1-ethyl-3-methylimidazolium bis (trifluoromethyl sulphonyl) imide [EMI-BTI] and graphene oxide (GO) was prepared and its performance evaluated. The effects of GO nano-filler were investigated in terms of enhancement in ionic conductivity along with the electrochemical properties of its electrical double layer capacitors (EDLC). The GO-doped SPE shows improvement in ionic conductivity compared to the P(VdF-HFP)-[EMI-BTI] SPE system due to the existence of the abundant oxygen-containing functional group in GO that assists in the improvement of the ion mobility in the polymer matrix. The complexation of the materials in the SPE is confirmed in X-ray diffraction (XRD) and thermogravimetric analysis (TGA) studies. The electrochemical performance of EDLC fabricated with GO-doped SPE is examined using cyclic voltammetry and charge–discharge techniques. The maximum specific capacitance obtained is 29.6 F∙g⁻¹, which is observed at a scan rate of 3 mV/s in 6 wt % GO-doped, SPE-based EDLC. It also has excellent cyclic retention as it is able keep the performance of the EDLC at 94% even after 3000 cycles. These results suggest GO doped SPE plays a significant role in energy storage application.

Facile sonochemical synthesis of nanostructured NiO with different particle sizes and its electrochemical properties for supercapacitor application

In this work, we demonstrate the influence of nickel oxides with divergent particle sizes as the working electrodes for supercapacitor application. The nanostructured nickel oxide (NiO) is synthesized via facile sonochemical method, followed by calcination process. The crystallinity and surface purity of prepared samples are clearly examined by X-ray diffraction and Raman analysis. NiO crystallinity is significantly increased with increasing calcination temperatures. The surface analysis confirmed that the calcination at 250°C exhibited nanoclutser like NiO with average particle size of ∼6nm. While increasing the calcination temperature beyond 250°C, hexagonal shaped NiO is observed with enhanced particle sizes. The electrochemical performance confirmed the good redox behavior of NiO electrodes. Moreover, NiO with average particle size of ∼6nm exhibited high specific capacitance of 449F/g at a scan rate of 5mV/s compared to other samples with particle sizes of ∼21nm (323F/g) and ∼41nm (63F/g). This is due to the good ion transfer mechanism and effective electrochemical utilization of the working electrode.

Delirium in critically ill patients in a tertiary care centre in western region of Nepal

BACKGROUND

Delirium affects a significant proportion of critically ill patients admitted in hospital. It is associated with various adverse outcomes. Despite its enormous prognostic significance it tends to be underdiagnosed. There is a dearth of studies on risk factors of delirium in our setting.

OBJECTIVES

The main objectives of this study was to find out the prevalence, rate of non recognition and risk factors associated with delirium in hospitalized critically ill patients.

METHODS

A hospital based cross-sectional study was carried out. Data was collected using a predesigned semi-structured proforma and Intensive care delirium screening checklist was used to screen for delirium in patients admitted in various wards of Manipal teaching hospital, Pokhara, Nepal.

RESULTS

Ninety five cases were included in the analysis. The mean age of study group was 58.9 ± 19.1 years. Delirium was present in 15/95 cases and it was not recognized by treating physician in about one third of cases. Odds ratio (OR) was statistically significantly increased in patients with history of stroke (OR=4.484 95% CI=1.0896;18.459), alcohol use (OR=10.792 95% CI=2.906;40.072), smoking (OR= 4.836 95% CI= 1.411;16.576), use of restraint (OR=17.143 95% CI=4.401;66.766), nasogastric tube placement (OR= 7.731 95% CI=2.348;25.452) and use of Foley's catheter (OR=12.000 95% CI= 3.072;46.877).

CONCLUSION

About 16% of critically ill patients were found to be delirious. In about one third of the cases delirium was not recognized. Both patient related and iatrogenic factors may increase the risk of delirium in hospitalized critically ill patients.

Enhanced electrochemical performance of cobalt oxide nanocube intercalated reduced graphene oxide for supercapacitor application

We investigated different molar concentrations of cobalt precursor intercalated reduced graphene oxide (rGO) as possible electrode materials for supercapacitors.

Ultrahigh capacitance of amorphous nickel phosphate for asymmetric supercapacitor applications

This article presents the effect of different calcination temperatures on the structural, morphological and capacitance of nickel phosphate (Ni₃(PO₄)₂) as an electrode material for supercapacitor applications.

Self-assembly, doxorubicin-loading and antibacterial activity of well-defined ABA-type amphiphilic poly(N-vinylpyrrolidone)-b-poly(d,l-lactide)-b-poly(N-vinyl pyrrolidone) triblock copolymers

Synthesis, self-assembly, DOX-loading and antibacterial activity of well-defined ABA-type amphiphilic poly(N-vinylpyrrolidone)-b-poly(d,l-lactide)-b-poly(N-vinylpyrrolidone) triblock copolymers.

Dendrimer like star polymer based on β-cyclodextrin with ABC type miktoarms

The present article reports the synthesis and self aggregation study of a novel dendrimer like star polymer based on β-cyclodextrin (β-CD), in which the primary alcoholic arms of β-CD have been linked to ABC type miktoarm star polymers.

Dental rehabilitation of a child with early childhood caries using Groper's appliance

The mainstay of pediatric dental practice is the successful esthetic rehabilitation of a preschooler with advanced carious lesions. Loss of masticatory efficiency, compromised esthesis, mispronunciation of labiodentals sounds, and development of abnormal oral habits are compromises arising due to the loss of primary anterior teeth at an early age either due to trauma or due to caries. Parental desire is the most decisive factor for the placement of an anterior esthetic appliance. This unique case report highlights the fabrication of simple, Groper's appliance in a 5-year-old child with early childhood caries.

Evaluation of Health on the Net seal label and DISCERN as content quality indicators for patients seeking information about thumb sucking habit

Aims:

The aim of this study was to evaluate the reliability of websites on the thumb sucking habit using DISCERN instrument and Health on the Net (HON) seal code at a single moment in time.

Subjects and Methods:

An Internet search engine (www.google.com) was used to identify websites comprising information on “thumb sucking habit.” Of over 204,000 links for thumb sucking habit, the first 100 were analyzed in detail. After excluding discussion groups, news and video feeds, and removing carbon copy sites, only 36 relevant websites remained, which were then assessed using the DISCERN instrument and HON seal code. Using the 16 questions of DISCERN for assessing the reliability and quality of the consumer information which were scored from 1 to 5, an appropriate index of the quality of the information was generated. All the assessed websites were also checked for presence or absence of HON seal code.

Results:

The maximum score attainable for an outstanding website is 80. Of the 36 websites that were scored the highest score obtained by one of the websites according to the DISCERN tool was 55 of 80, and the lowest score achieved was 16 of 80. The websites achieving the maximum and minimum score were children.webmd.com and thebehaviorsolution.com, respectively. The HON seal was displayed only in three websites, which were medicinenet.com, righthealth.com, and children.webmd.com.

Conclusions:

By directing patients to validated websites on the thumb sucking habit, clinicians can ensure patients find appropriate information.

Accumulation of silver by Fucus spp. (Phaeophyceae) and its toxicity to Fucus ceranoides under different salinity regimes

Metals constitute an important group of abiotic stressors that elicit stress responses in marine algae that include the production of reactive oxygen species (ROS). Silver (Ag) is a highly toxic metal to organisms but despite this there are relatively few studies on how it affects marine macroalgae (seaweeds). In a landmark study published in 1977 the first information was provided on the accumulation of Ag in Fucus spp. (Phaeophyceae) from the Looe estuary, located in south-west England, an area with a long history of mining activity. In the present study, the estuary has been re-visited and the patterns of Ag accumulation in two Fucus spp. and sediment re-examined after 35 years. We conclude that Ag concentrations in sediment and macroalgae from specific sites within the catchment remain high, but more generally sediment concentrations have declined by approximately 65 % and the dissolved, bioavailable fraction by 24 % over this period. In addition, from laboratory studies we provide data on the speciation and toxic effects of Ag under different salinity regimes in the euryhaline brown seaweed, Fucus ceranoides. From these exposure experiments, it was found that with increasing Ag concentrations growth was inhibited and lipid peroxidation associated with ROS production increased. The magnitude of the toxic effects was greater at a salinity of 10 than 28 psu which reflects the greater bioavailability of the toxic species of Ag (Ag(+) and AgCl(0)) at reduced salinities. These findings emphasise the importance of investigating the effects of metal pollution in conjunction with other, natural, environmental stressors such as salinity.

Clinical profile of human immunodeficiency virus patients with opportunistic infections: A descriptive case series study

BACKGROUND

Human immunodeficiency virus (HIV) virus, causative agent in acquired immunodeficiency syndrome, is fast becoming a major threat in the Indian subcontinent, with an estimated 3.7 million persons being infected with HIV. HIV infection is complicated by various opportunistic infections (OIs) such as tuberculosis (TB), candidiasis, herpes zoster, Pneumocystis jirvoceii, cytomegalovirus (CMV) etc., This study carried out to know the clinical profile of HIV patients with OIs.

METHODS

A case series study was carried out at a tertiary care hospital in Bellary, Karnataka, India. A hospital based case series study was conducted among 164 HIV patients with OIs admitted to various wards as well as attending outpatient department at Vijayanagara Institute of Medical Sciences Hospital, Bellary during Jan 2013 to Nov 2013. Both primary and secondary data was collected to gather information on clinical profile. The statistical tests used were descriptive statistics and independent t test.

RESULTS

Among 164 patients, 29.3% were females and 68.3% males. High proportions of patients were observed in 28-37 years of age group and heterosexual route was the most common mode of transmission. TB (50%) is the most frequent OI followed by candidiasis (49%), pneumocystis (16%) and others. The mean CD4 cell count in TB was 237.02/mL and in candidiasis 189.07/mL. Low values were observed in promyelocytic leukemia (18.10/mL), CMV (18.5/mL) and in toxoplasmosis (73.1/mL).

CONCLUSIONS

Respiratory system was the most common system involved by OIs and most of patients with OIs had CD4 T cell count below 200/mL, whereas there were no patients in the study with counts above 500/mL.

Effect of organic farming practices on soil and performance of soybean (Glycine max) under semi-arid tropical conditions in Central India

A field experiment was conducted to evaluate the influence of organic farming practices on soil health and crop performance of Soybean (Glycine max).The crop cultivar JS-335 of soybean was grown with 30:26.2:16.6 kg ha-1 (NPK) recommended dose of fertilizers under three management practices viz., organic, chemical and integrated (50:50) in randomized block design, replicated three times. Soil organic carbon, available N, P and K, microbial enzymatic activities, total biomass, seed yield and harvest index (HI) were analysed during the study. It was observed that soil organic carbon (11.3 g kg-1), available N (125 mg kg-1), P (49.7 mg kg-1) and soil enzyme activities viz., dehydrogenase (DHA) (98.20 µ grams TPF/g soil/24 h) and alkaline phosphatase (178.2 µ grams p-nitro phenol/g soil/h) were found significantly higher in the plot managed organically while available K (320.1 mg kg-1) was not significant with respect to chemical and integrated practices. The total biomass (1927 kg ha-1) and seed yield (601 kg ha-1) of soybean was found highest in organic farming practices followed by integrated and chemical practices. Very poor microbial activities were observed in chemically managed plots. Thus, the study demonstrated that the organic farming practice improved soil health and performance of soybean crop.

Proliferating Cell Nuclear Antigen in Premalignancy and Oral Squamous Cell Carcinoma

INTRODUCTION

Cancer has multifactorial aetiology and is a multistep process involving initiation, promotion and tumour progression. Cellular proliferation is one of the important indicators for the biologic aggressiveness of a malignant lesion. The dysregulated proliferation may be a significant change to determine the potential prognosis of various malignant tumours.

AIM

The aim of this study was to evaluate the expression of proliferating cell nuclear antigen (PCNA) as an indicator for clinical aggressiveness in oral premalignancy and squamous cell carcinoma.

MATERIALS AND METHODS

A total of 50 blocks were taken from the Department of Oral Pathology which was diagnosed previously histopathologically. It comprised of normal oral mucosa (10), dysplasia (10) and grades of oral squamous cell carcinoma (30) of patients between the age group of 40-60 years. From each block, sections of 4 micro metre thicknesses were prepared and placed on poly- L lysine coated slides. These sections were immunohistochemically stained with monoclonal proliferating cell antibody (PC10). The stained slides were evaluated by a single examiner for cell count.

RESULTS

A comparison between study groups and controls showed a probability value (p-value) < 0.05. Significant increase in the proliferative index from the normal to oral squamous cell carcinoma was noticed. Poorly differentiated squamous cell carcinoma showed maximum proliferative index followed by moderately differentiated, well differentiated squamous cell carcinoma, dysplasia and normal mucosa.

CONCLUSION

Present study concluded that PCNA index can be used to assess the proliferation and aggressiveness in dysplasia and different grades oral squamous cell carcinoma.