Suicide note on the palm: three case reports and discussion of medico-legal aspects

Suicide notes are usually written by the victim on paper or readily accessible things such as notebooks, walls or mirrors. Though writing may be found on the body of the deceased, suicide notes in a structured manner written on the palm have not been reported in forensic literature. In all the three cases presented here, we found a handwritten note on the palm of the deceased at the time of autopsy. The victims had written a brief note in their own handwriting, citing the reasons for ending their lives. The suicide note in one case also mentioned details regarding the custody of the victim's children to be given to her mother. Since we have not found similar cases in the literature, we present and discuss our three cases herein.

Design, development, and acceleration trials of radio-frequency quadrupole

A deuteron radio frequency quadrupole (RFQ) accelerator has been designed, fabricated, and tested at BARC, which will be used for neutron generation. The RFQ operates at a frequency of 350 MHz and needs an inter-vane voltage of 44 kV to accelerate the deuteron beam to 400 keV within a length of 1.03 m. The error analysis shows that the offset of two opposite vanes in the same direction by 100 μm leads to a change in resonant frequency by 1.3 MHz and a significant change of fields in the quadrants (∼±40% with respect to average field). From the 3D analysis, we have observed that the unwanted dipole mode frequencies are very near to the quadrupole mode frequency which will make structure sensitive to the perturbations. In order to move the dipole modes away from the quadrupole modes, we have used the dipole stabilizer rods. The 5 wire transmission line theory was used to study the perturbative analysis of the RFQ and based on this a computer program has been written to tune the cavity to get required field distribution. Based on these studies, a 1.03 m long RFQ made of OFE copper has been fabricated and tested. Even though the RFQ was designed for deuteron (D(+)) beam, we tested it by accelerating both the proton (H(+)) and D(+) beams. The RFQ was operated in pulsed mode and accelerated both H(+) and D(+) beams to designed values of 200 and 400 keV, respectively. The measured parameters are in good agreement with the designed values validating our simulations and fabrication processes. In this paper, simulations, RF measurements, and beam commissioning results are presented.

Crystallographic site swapping of La3+ ion in BaA'LaTeO6 (A' = Na, K, Rb) double perovskite type compounds: diffraction and photoluminescence evidence for the site swapping

Double perovskite type compounds of the formula BaA'LaTeO6 (A' = Na, K, Rb) were synthesized by solid state route and their crystal structures were determined by Rietveld analysis using powder X-ray diffraction and neutron diffraction data. Na compound crystallizes in the monoclinic system with P2₁/n space group whereas, K and Rb compounds crystallize in Fm3m space group. All the three compounds show rock salt type ordering at B site. Crystal structure analysis shows that La ion occupies A site in Na compound whereas, it occupies B site in K and Rb compounds according to the general formula of AA'BB'O6 for a double perovskite type compound. Effect of this crystallographic site swapping of the La ion was also observed in the photoluminescence study by doping Eu(3+) in La(3+) site. The large decrease in the intensity of the electric dipole ((5)D0-(7)F2) transition in the Rb compound compared to the Na compound indicates that Eu(3+) ion resides in the centrosymmetric octahedral environment in the Rb compound.

Comparative toxicity of carbaryl, carbofuran, cypermethrin and fenvalerate in Metaphire posthuma and Eisenia fetida -a possible mechanism

To establish the use of Metaphire posthuma as a sensitive test model for ecotoxicological studies, acute toxicity testing of carbaryl, carbofuran, cypermethrin and fenvalerate on Eisenia fetida and Metaphire posthuma were carried out. Two different types of bioassays, contact filter paper toxicity and soil toxicity bioassays were used to determine LC50 values for these insecticides. Among the tested chemicals, carbofuran was the most toxic to both the earthworm species. In paper contact method, 72 h-LC50 values of carbofuran in M. posthuma and E. fetida were found to be 0.08 μg/cm(2) and 1.55 μg/cm(2) respectively while in soil test, 14-d LC50 values were 0.49 mg/kg and 21.15 mg/kg respectively. On comparing the toxicity data of these chemicals for both the earthworm species, M. posthuma was found to be more sensitive than E. fetida. Based on the acute toxicity data, the order of toxicity of insecticides in both the test procedures was carbofuran>cypermethrin>carbaryl>fenvalerate for M. posthuma whereas for E. fetida it was carbofuran>carbaryl>fenvalerate>cypermethrin. Morphological changes also appeared in the organisms exposed to these chemicals which were more pronounced in M. posthuma at lower concentrations than E. fetida in both the test procedures. The results of the present study advocates the use of M. posthuma for ecotoxicity studies, being a more sensitive and reliable model than E. fetida. Based on the data on partial atomic charges, structural features and spectroscopic studies on carbaryl and carbofuran, a possible mechanism of toxicity of carbamate insecticides in earthworm was proposed.

A micron resolution optical scanner for characterization of silicon detectors

The emergence of high position resolution (∼10 μm) silicon detectors in recent times have highlighted the urgent need for the development of new automated optical scanners of micron level resolution suited for characterizing microscopic features of these detectors. More specifically, for the newly developed silicon photo-multipliers (SiPM) that are compact, possessing excellent photon detection efficiency with gain comparable to photo-multiplier tube. In a short time, since their invention the SiPMs are already being widely used in several high-energy physics and astrophysics experiments as the photon readout element. The SiPM is a high quantum efficiency, multi-pixel photon counting detector with fast timing and high gain. The presence of a wide variety of photo sensitive silicon detectors with high spatial resolution requires their performance evaluation to be carried out by photon beams of very compact spot size. We have designed a high resolution optical scanner that provides a monochromatic focused beam on a target plane. The transverse size of the beam was measured by the knife-edge method to be 1.7 μm at 1 - σ level. Since the beam size was an order of magnitude smaller than the typical feature size of silicon detectors, this optical scanner can be used for selective excitation of these detectors. The design and operational details of the optical scanner, high precision programmed movement of target plane (0.1 μm) integrated with general purpose data acquisition system developed for recording static and transient response photo sensitive silicon detector are reported in this paper. Entire functionality of scanner is validated by using it for selective excitation of individual pixels in a SiPM and identifying response of active and dead regions within SiPM. Results from these studies are presented in this paper.

Classical Supravalvar Aortic Stenosis and Peripheral Pulmonary Stenosis

Supravalvar aortic stenosis as well as peripheral pulmonary stenosis are rare forms of congenital heart disease, which occur, however, relatively frequently in association. Here we report and discuss the classical findings of SVAS and PPS upon clinical examination and imaging in a six-year-old girl that presented with repeated respiratory tract infections and failure to thrive.

Supplementation of microbial levan in the diet of Cyprinus carpio fry (Linnaeus, 1758) exposed to sublethal toxicity of fipronil: effect on growth and metabolic responses

A 60-day feeding trial was conducted to study the effect of dietary microbial levan on growth performance and metabolic responses of Cyprinus carpio fry exposed to sublethal dose (1/10th LC₅₀) of fipronil [(±)-5-amino-1-(2,6-dichloro-α,α,α-trifluoro-p-tolyl)-4-trifluoromethylsulfinylpyrazole-3-carbonitrile]. Two hundred and twenty five fry were randomly distributed in five treatments in triplicates. Four purified diets were prepared with graded levels of microbial levan. Five different treatment groups were levan control L₀P₀ (basal feed + 0 % levan without exposure to pesticide); pesticide control L₀P₁ (basal feed + 0 % levan with exposure to pesticide); L₀.₂₅P₁ (basal feed + 0.25 % levan with exposure to pesticide); L₀.₅₀P₁ (basal feed + 0.50 % levan with exposure to pesticide); and L₀.₇₅P₁ (basal feed + 0.75 % levan with exposure to pesticide). Weight gain% and specific growth rate were significantly higher (p < 0.05) in levan fed groups compared to their non-levan fed counterpart. Highest (p < 0.05) content of ascorbic acid in muscle, liver and brain tissues was observed with higher level of dietary levan. Glucose-6-phosphate dehydrogenase activity decreased with the increasing level of dietary levan in the liver and muscle. Aspartate aminotransferase activity exhibited a second order polynomial relationship with the dietary levan, both in liver (Y = -1.001x² + 5.366x + 5.812, r² = 0.887) and muscle (Y = -0.566x² + 2.833x + 6.506, r² = 0.858) while alanine aminotransferase activity showed third order polynomial relationship both in liver (Y = 1.195x³ - 12.30x² + 35.23x + 9.874, r² = 0.879) and muscle (Y = 0.527x³ - 8.429x² + 31.80x + 8.718, r² = 0.990). Highest (p < 0.05) superoxide dismutase activity in gill was observed in the group fed with 0.75 % levan supplemented diet. Overall results indicated that dietary microbial levan at 0.75 % in C. carpio fry ameliorated the negative effects of fipronil and augmented the growth.

Comparison between limbal (von Noorden) and para limbal (Santiago) conjunctival incisions for adjustable recessions of horizontal recti

INTRODUCTION

Both limbal and para limbal conjunctival incisions are routinely used in strabismus surgery with comparable results however their outcome has not been compared while using adjustable sutures.

OBJECTIVE

To compare limbal (von Noorden) and para limbal (Santiago) conjunctival incisions for adjustable recessions of horizontal recti.

SUBJECTS AND METHODS

Uniocular adjustable recessions (with conventional non adjustable resection) in 24 appropriate patients were performed according to standard slip knot technique. The patients were assigned to the two groups after obtaining an informed consent using systematmic randomization. Twelve patients in first group received the von Noorden incision with bare sclera closure and 12 in the second group received the Santiago's modification of Swan incision with deferred closure. The surgeries were performed by a single surgeon and the adjustments performed after 24 hours. The incisions were studied on the established subjective (pain) and objective (hyperaemia, chemosis, discharge and gap in incision) variables at follow ups of 1st day post adjustment, 2 weeks and 12 weeks.

STATISTICS

'Repeated Measures Anova' test was used for statistical analysis. A p value Less than 0.05 was considered statistically significant.

RESULTS

The limbal incision was superior to the paralimbal incision on both objective and subjective criteria by 'Repeated Measures Anova' test.

CONCLUSION

We recommend using limbal incision and avoiding para limbal incisions while performing adjustable recessions.

Topically applied standardized aqueous extract of Curcuma longa Linn. suppresses endotoxin-induced uveal inflammation in rats

Aqueous extract of C. longa when administered 4 h after induction of E. coli lipopolysaccharide-induced uveitis in rats showed significantly suppressed inflammation with a significantly lower mean clinical grade, histopathological grade and aqueous humor (AH) protein level compared to vehicle treated group. Although, prednisolone group showed significantly lower clinical grade, histopathological grades and AH protein levels compared to C. longa group, TNF-alpha levels did not differ significantly. Moreover, when the aqueous extract was administered starting from 3 days before induction of uveitis, the mean clinical and histopathological grade as well as AH protein and TNF-alpha levels were comparable to C. longa group when treatment was administered 4 h after induction of uveitis. It is concluded that topically applied standardized aqueous extract of C. longa suppresses endotoxin-induced uveitis in rats by reducing TNF-alpha activity.

Treatment of ruptured saccular aneurysms of the fenestrated vertebrobasilar junction with balloon remodeling technique. A short case series and review of the literature

Fenestration of the intracranial arteries is a relatively common occurrence. This anatomic variation may predispose to aneurysm formation at certain sites. Treatment of such aneurysms is difficult as it may occlude one of the limbs of fenestration with resultant deficit. Thus, preservation of both the limbs with adequate exclusion of the aneurysm from the circulation should be the aim of any treatment. We describe a series of four cases of ruptured aneurysms arising from a fenestrated vertebrobasilar junction treated with endovascular balloon remodeling technique.

Cut wrists, electrocution and subsequent drowning in a water drum: an unusual combination of methods in complex suicide

A 25-year-old male was found dead in a water drum inside the bathroom of his house one morning. Autopsy revealed a fatal right wrist cut, superficial cuts on middle phalanx of left index finger and features of ante mortem drowning. Investigation revealed the victim was an alcoholic and was depressed due to financial problems. On the previous night, under the influence of alcohol, he first tried to commit suicide by cutting wrist with razor blades, but death was not immediate. He then attempted electrocuting himself by touching a live wire, inside the bathroom, which failed and finally he drowned in a water drum. The victim had left a message, written with his blood on the floor of the room, reflecting his suicidal intentions. In complex suicide, many bizarre methods are used, but this combination of methods is unusual and not found in available forensic literature.

Efficacy of sutureless and glue free limbal conjunctival autograft for primary pterygium surgery

INTRODUCTION

There are numerous adjunctive measures described to reduce the recurrence rates after pterygium excision.

OBJECTIVE

To study the efficacy and complications of sutureless and glue free limbal conjunctival autograft for the management of primary pterygium over a period of one year.

MATERIALS AND METHODS

A prospective interventional case series was carried out in 40 consecutive eyes with primary nasal pterygium requiring surgical excision. Pterygium excision with limbal conjunctival autografting without using glue or sutures was performed in all the patients followed by bandaging for 48 hours. The patients were followed up post operatively on 2nd day, 1 week, 6 weeks, 6 months and 12 months. They were examined for haemorrhage, wound gape, graft shrinkage, chemosis, graft dehiscence, recurrence or any other complication.

RESULTS

The mean age of the patients was 42.8 years (range 23-61), 75% of which were males. Total graft dehiscence occurred in 2 eyes (5%), graft retraction in 3 eyes (7.5%) and recurrence was seen in 1 eye (2.5%). At 6 weeks postoperatively, the gain in uncorrected visual acuity ranged from 0.18 to 0.5 log MAR in 7 eyes. No other complication was noted.

CONCLUSIONS

Sutureless and glue free limbal conjunctival autografting following pterygium excision is a safe, effective and economical option for the management of primary pterygium.

Risk Factors for Acute Respiratory Infections in Hospitalized Under Five Children in Central Nepal

Introduction: Acute respiratory infection is a leading cause of morbidity and mortality in under 5 children in developing countries. There are various modifiable risk factors associated with Acute Respiratory Tract Infection (ARI). Hence, identification of associated risk factors for ARI may be helpful to reduce the burden of disease. The aims of this study were to study the risk factors for ARI in under five hospitalized children and to correlate risk factors with ARI related morbidity. It was a hospital- based prospective study. Materials and Methods: Children of less than 5 years admitted in ward with diagnosis of ARI were enrolled in the study as cases. Control included children under 5 years of age attending to Well Baby Clinic, Immunization Clinic and siblings or relatives under 5 years who came with patients in the Paediatric outpatient department of the same institution during the same period. Various risk factors, demographic and clinical data of each child were recorded in a pre-designed proforma of both groups. Results: A total of 200 cases and 200 controls were enrolled. The various risk factors associated with ARI on stepwise logistic regression were male gender, rural residency, overcrowding, history of ARI in any family member within two weeks and undernutrition. The statistically insignificant risk factors were infancy, economic status, illiterate parents, cooking fuel other than LPG, low birth weight, prematurity, lack of exclusive breast feeding, vitamin A deficiency and incomplete immunization. Conclusion: The various risk factors for ARI identified in this study were male gender, rural residency, overcrowding, history of ARI in any family member within two weeks and undernutrition. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7358 J Nepal Paediatr Soc. 2013;33(1):39-44

Predictors of weight loss during conformal radiotherapy for head and neck cancers - how important are planning target volumes?

AIMS

Nutritional compromise is common during high dose radiotherapy (RT) or chemoradiotherapy (CRT) for head and neck cancers. We aimed to identify the factors that determine nutritional outcome for head and neck cancer patients during radiotherapy.

METHODS

Data from 103 patients with head and neck cancer treated with highly conformal radiotherapy to doses of 60 Gy or more in 30-33 fractions in the adjuvant or definitive setting was analyzed. All patients received complex 3D conformal radiotherapy (3DCRT) or intensity modulated radiotherapy (IMRT). Patients received regular nutritional counseling and need-based interventions. Their weight was recorded at the beginning and end of radiotherapy. Using univariate and multivariate models we tested possible predictors of weight loss of >5% and NG tube requirement.

RESULTS

The mean weight loss was 3.8%. The incidence of weight loss >5% was 37.9% and NG tube placement was 24.3%. The factors significantly associated with >5% weight loss in the univariate analysis were tumor site (oro-hypopharyngeal vs. others), definitive vs. adjuvant RT; prescription dose of >60 Gy vs. 60 Gy; CRT vs. RT alone; prescription dose planning target volume (PTV) volume >235 cc and total PTV volume >615 cc. Age, sex, T stage, N stage and modality (3DCRT/IMRT) were not significant. In multivariate analysis, the total PTV volume, prescription dose PTV volume and use of chemotherapy were significant after controlling for other factors. Patients could be risk stratified based on the use of CRT and large PTV volumes. Patients with none, one or both factors had a likelihood of >5% weight loss of 0%, 30.3%, and 56.9% (p < 0.001) and likelihood of NG tube placement of 5.3%, 15.2% and 37.3% (p = 0.007).

CONCLUSIONS

It is possible to predict weight loss and NG tube requirements from disease and treatment related factors. PTV volumes are important predictors of nutritional compromise. Risk stratification may enable more focused counseling and identification of patients who require preventive interventions.

A multicentre, multinational, randomized, placebo-controlled, double-blind, phase 3 trial to evaluate the efficacy and safety of gemigliptin (LC15-0444) in patients with type 2 diabetes

AIM

This study was designed to assess the efficacy and safety of the dipeptidyl peptidase IV inhibitor gemigliptin (LC15-0444) 50 mg versus placebo in patients with type 2 diabetes.

METHODS

We conducted a 24-week, randomized, double-blind, placebo-controlled phase III trial in 182 patients (74 from Korea and 108 from India) with type 2 diabetes. After an initial 2 weeks of a diet and exercise programme followed by 2 weeks of a single-blind placebo run-in period, eligible patients were randomized to gemigliptin 50 mg or placebo, receiving the assigned treatment for 24 weeks. HbA1c and fasting plasma glucose (FPG) were measured periodically, and oral glucose tolerance test was performed at baseline and weeks 12 and 24.

RESULTS

At week 24, gemigliptin treatment led to significant reductions in HbA1c measurements compared to placebo (adjust mean after subtracting the placebo effect size: -0.71%, 95% confidence interval: -1.04 to -0.37%). A significantly greater proportion of patients achieved an HbA1c <7% with gemigliptin than with placebo. The placebo-subtracted FPG change from baseline at week 24 was -19.80 mg/dl. The overall incidence rates for adverse events were similar in the gemigliptin and placebo groups.

CONCLUSIONS

This study showed the efficacy and safety of gemigliptin 50 mg administered once daily as a monotherapy for type 2 diabetes patients.

Comparative cardioprotective effects and mechanisms of vitamin E and lisinopril against ischemic reperfusion induced cardiac toxicity

The present study was undertaken to scientifically evaluate, validate and compare the cardioprotective effects of lisinopril (Lsp), an angiotensin converting enzyme (ACE) inhibitor and vitamin E (Vit E), an antioxidant in the setting of ischemia and reperfusion (I-R) injury. An open chest left anterior descending coronary artery occlusion and reperfusion induced myocardial injury cardiotoxicity model was used in the present study. Hemodynamic, biochemical and histopathological assessment of myocardial injury was undertaken. Pre-treatment (1 month) with Lsp (50 mg/kg) and Vit E (100 mg/kg) to healthy experimental controls did not adversely affect the histopathological architecture of the myocardium as well as the baseline antioxidant parameters. Subsequent to I-R injury, Lsp demonstrated modest antioxidant effects, superior recovery in left ventricular function as compared to the control IR group. Histopathological and biochemical assessment of injury confirmed the myocardial salvaging effect of this intervention. The cardioprotection afforded by Lsp was found to be superior as compared to Vit E treatment.

Pathogenic Variation in the Pearl Millet Blast Pathogen Magnaporthe grisea and Identification of Resistance to Diverse Pathotypes

Blast, also known as leaf spot, caused by Pyricularia grisea (teleomorph: Magnaporthe grisea), has emerged as a serious disease affecting both forage and grain production in pearl millet in India. Pathogenic variation was studied in a greenhouse using 25 M. grisea isolates collected from four major pearl-millet-growing states in India (Rajasthan, Haryana, Maharashtra, and Uttar Pradesh) on 10 pearl millet genotypes (ICMB 02444, ICMB 02777, ICMB 06444, ICMB 93333, ICMB 96666, ICMB 97222, ICMB 99444, 863B, ICMR 06222, and ICMB 95444). Differential reactions to the test isolates were recorded on ICMB 02444, ICMB 93333, ICMB 97222, 863B, and ICMR 06222. The 25 isolates were grouped into five different pathotypes based on their reaction types (virulent = score ≥ 4 and avirulent = score ≤ 3 on a 1-to-9 scale). For the identification of resistance sources, a pearl millet mini-core comprising 238 accessions was evaluated under greenhouse conditions against five M. grisea isolates (Pg118, Pg119, Pg56, Pg53, and Pg45) representing the five pathotypes. Of 238 accessions, 32 were found to be resistant to at least one pathotype. Resistance to multiple pathotypes (two or more) was recorded in several accessions, while three accessions (IP 7846, IP 11036, and IP 21187) exhibited resistance to four of the five pathotypes. Four early-flowering (≤50 days) blast-resistant mini-core accessions (IP 7846, IP 4291, IP 15256, and IP 22449) and four accessions (IP 5964, IP 11010, IP 13636, and IP 20577) having high scores (≥7) for grain and green fodder yield potential and overall plant aspect were found to be promising for utilization in pearl millet improvement programs. Identification of five pathotypes of M. grisea and sources of resistance to these pathotypes will provide a foundation for breeding for blast resistance in pearl millet in India.

Vajikarana: Treatment of sexual dysfunctions based on Indian concepts

Vajikarana or Vrishya chikitsa is a one of eight major specialty of the Ashtanga Ayurveda. This subject is concerned with aphrodisiacs, virility and improving health of progeny. As per Charak Samhita, by proper use of these formulations, one becomes endowed with good physique, potency, strength, and complexion and sexually exhilarated and sexually potent. This in turn is helpful in many common sexual dysfunctions, including Infertility, Premature Ejaculation and Erectile dysfunction. The therapy is preceded by living in strict compliance with the directions mentioned in Ayurvedic classics, various methods of body cleansing and other non-medicinal strategies like sexual health promoting conduct, behavior and diet. Certain individualized herbal and herbo-mineral combinations are administered as per the nature of a person according to the Ayurveda. Many limitations need to be considered before considering the use of theses therapy like lack of scientific studies, possibilities of adulteration in the herbal and herbo-mineral combinations available in market and possibilities of unexpected side-effects etc., The article calls upon initiating research in this area so that claims of ancient Ayurvedic texts could be substantiated and vajikaran therapy may be utilized by modern medicine.

Association of vitamin D levels, lipid profile and intima media thickness in HIV positive patients

BACKGROUND

People with HIV are living decades longer than before due to combination ART; however, complications including CVD< osteoporosis and non AIDS defining malignancies are higher than in the general population. Many of the emerging complications related to chronic HIV infection represent disease processes where vitamin D is known to play an important role.

OBJECTIVES

A single point cross sectional case control study was conducted in a tertiary care hospital to determine the prevalence of vitamin D deficiency and its association with carotid intima media thickness (CIMT) in HIV patients and to study the association of lipid profile with HIV infection. Out of the 45 HIV positive cases, vitamin D deficiency was found in 42 cases (93.33%) whereas only 33 out of 45 (73.33%) healthy controls. Fifty one point eleven percent of cases had dyslipidemia compared to 15.55% of controls. A positive association was seen between CD4 levels and 25 hydroxy vitamin D. An inverse co-relation between CD4 count and triglycerides and VLDL levels while a positive co-relation with total cholesterol, LDL cholesterol and HDL cholesterol levels was seen. No significant difference was seen in CIMT in cases and controls.

Atypical features of a midline pre-pontine epidermoid cyst

Intracranial epidermoid cysts are uncommon lesions with typical radiological and operative findings. We report a midline cystic lesion in the pre-pontine cistern, with radiological features of an epidermoid, but intra-operatively yielding a thin-walled cyst with fluid contents. The cyst wall showed stratified squamous epithelium on histopathology.

Spontaneous expulsion of an interesting long standing metallic foreign body (iron nail) from left main bronchus

Worldwide experiences of spontaneous expulsion of foreign body bronchus ranges between 2-4%. We are reporting here an unusual and interesting case of a long standing irregular metallic large foreign body in left main bronchus, which was lying there for more than one month duration and suddenly while preparing the patient for endoscopic removal, it was expelled out spontaneously. These types of incidences make us wiser to keep the rare and remote possibility in mind, especially when there is a remote but dangerous possibility of subglottic lodgement of foreign body with spontaneous expulsion.

Formulation and evaluation of rifampicin sustained release tablets using juice of Citrus limetta as bio-retardant

The advantages of biopolymers over synthetic polymers are low cost, natural origin, free from side effects, biocompatible, bio-acceptable, environmental friendly processing, local availability, better patient tolerance as well as public acceptance. Sustained release tablets containing rifampicin was prepared by adding 100 mg polymer and 50 mg Drug and Granules. Same procedure was followed with 3% and 5% of polymer for preparation of sustained release tablets. Additional Tablets of 100 mg, 200 mg and 400 mg were prepared using 5% of the polymer. The results indicated that the selected biopolymer had a good release retardant property thus it can be concluded that the selected biopolymer can be utilized as low cost natural biocompatible and biodegradable agent.

A comparative clinical study of Snuhi Ksheera Sutra, Tilanala Kshara Sutra and Apamarga Kshara Sutra in Bhagandara (Fistula in Ano)

Bhagandara (Fistula in Ano) at modern parlance is a common anorectal condition prevalent in the populations worldwide and its prevalence is second highest after Arsha (hemorrhoids). Kshara Sutra (K.S.) is one of the chief modality in the treatment of Bhagandara in Ayurvedic science. Exploration of the new plants for the preparation of Kshara as a better substitute to Apamarga Kshara is the need of the hour. To find out an effective alternative to Apamarga K.S. in view of easy processing, a Snuhi Ksheera Sutra without any Kshara and the Tilanala K.S. were opted for their clinical evaluation. Total 33 cases of Bhagandara were divided randomly into 3 groups, having 11 patients in each group. In Group A, Snuhi Ksheera Sutra; in Group B, Tilanala K.S. and in Group C, Apamarga K.S. were used. Assessment was done on objective (Unit Cutting Time - UCT) and subjective parameters. Statistically insignificant difference was observed in the efficacy of treatment by subjective parameters like pain, discharge, etc. between the three groups. It was found that Tilanala K.S. showed higher UCT (9.76 days) while lower in Snuhi Ksheera Sutra (7.42 days) as compared to Apamarga K.S. (8.82 days). Thus Tilanala K.S. can be used as a substitute for Apamarga K.S. and Snuhi Ksheera Sutra can be employed in the recurrent fibrosed cases of Bhagandara.