Effectiveness of Tolperisone Hydrochloride with Aceclofenac as Combined Therapy in Acute Low Back Pain

Objective

An open label, non-randomised, prospective study was conducted to evaluate the effectiveness of tolperisone hydrochloride 150mg thrice daily with aceclofenac 100mg twice daily compared to aceclofenac 100mg twice daily alone for the treatment of acute low back pain (LBP) for 14 days. total (n=242) patients recruited for the study were divided into two treatment groups. One of the group (n=124) received oral tolperisone plus aceclofenac and the other (n=118) Aceclofenac alone. The pain intensity was assessed by visual analogue scale. Patients were informed to report any adverse effect encountered during the study period. The overall effect of the drug (global assessment of the study medication) on pain and adverse effects were assessed by the patients at the end of the trial on a categorical scale. There was significant reduction in pain score in the tolperisone group than aceclofenac group with insignificant adverse effects which didn't require discontinuation of the study. Tolperisone when added with aceclofenac can be more effective than aceclofenac alone for relief of acute LBP with minimum adverse effects.

Silver nanotoxicity using a light-emitting biosensor Pseudomonas putida isolated from a wastewater treatment plant

The effect of silver ions, nano- and micro-particles on a luminescent biosensor bacterium Pseudomonas putida originally isolated from activated sludge was assessed. The bacterium carrying a stable chromosomal copy of the lux operon (luxCDABE) was able to detect toxicity of ionic and particulate silver over short term incubations ranging from 30 to 240 min. The IC(50) values obtained at different time intervals showed that highest toxicity (lowest IC(50)) was obtained after 90 min incubation for all toxicants and this is considered the optimum incubation for testing. The data show that ionic silver is the most toxic followed by nanosilver particles with microsilver particles being least toxic. Release of nanomaterials is likely to have an effect on the activated sludge process as indicated by the study using a common sludge bacterium involved in biodegradation of organic wastes.

Burn injury in Bangladesh: electrical injury a major contributor

Electrical injury is a major cause of burn injury and significant cause of mortality, morbidity and disability. To explore the proportional incidence of thermal and electrical burn injuries in Bangladesh, a population-based cross sectional survey was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429.The study was designed to describe the proportional incidence of thermal, electrical and chemical cause of burn in Bangladesh. Electrical injury constituted about one third of the total burn injuries. Among the total 1,999 injuries about 31% were due to electrical injuries, about 26% were due to flame, about 25% were due to hot liquid, over 16% by hot object, about 2% by chemical and less than 1% were due to explosives. The incidence of death rate was 3.97 per 100,000 populations per year. Thermal burn was found as the major cause of death due to burn injures and constituted 58% of the total deaths due to burn. Electrical injuries caused 42% of the deaths. It was estimated that more than 5,600 people die due to burn and electrical injuries every year in Bangladesh considering the incidence rate of 3.97 per 100,000 populations per year in the 150 million population. Electrical injury including lightning constitute about one third of the burn related mortality, morbidity and disabilities. Rural people and children are the more vulnerable group. Electrical injury needs to be included as a special component in a burn prevention strategy, particularly in rural Bangladesh.

Disseminated cutaneous Mycobacterium chelonae infection in an immunocompetent host

Mycobacterium chelonae is a rare, rapidly growing, atypical acid-fast bacillus. Disseminated cutaneous infection has been reported in immunocompromised patients. We report an immunocompetent 86-year-old white woman, who presented with an 8-month history of extensive ulcerated abscess-like nodules. Mycobacterial culture confirmed M. chelonae infection and the patient was treated with a combination of clarithromycin and tobramycin. To our knowledge, this is the first reported case of spontaneous, disseminated cutaneous disease occurring in an immunocompetent patient.

Metabolic and body composition changes after six months of highly active antiretroviral therapy in northern Indian patients

This study was carried out to evaluate the metabolic and body composition changes among northern Indian patients receiving combination antiretroviral therapy (cART). We prospectively studied 68 adult patients at the All India Institute of Medical Sciences hospital, New Delhi. The CD4 count, blood pressure, anthropometry, metabolic and bioelectrical impedance data were collected prior to initiation of cART and six months later. The participants had a mean age of 35.9 years and 57 (84%) were male. Hypertension developed in 10.3%. The body mass index, waist circumference, total body fat and lean body mass increased significantly. The total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol, triglyceride and non-HDL-c increased significantly (P < 0.0001). Diabetes mellitus developed in 2.1%; metabolic syndrome in 19.1% (according to International Diabetes Federation criteria) and 25% (National Cholesterol Education Program--Adult Treatment Panel III criteria). Prolonged survival in the cART era may thus predispose these patients to adverse cardiovascular consequences. To the best of our knowledge, this is the first study of metabolic abnormalities in northern Indian HIV/AIDS patients receiving cART. Larger studies across India with long-term follow-up periods are required to confirm these preliminary findings. We also recommend that frequent biochemical monitoring should be performed in such patients.

Takotsubo cardiomyopathy: an uncommon cause of reversible heart failure

Takotsubo cardiomyopathy is increasingly being diagnosed as a cause of acute coronary syndrome in postmenopausal women. It may also present as reversible acute left heart failure with an excellent prognosis for recovery. Although rare, it may be an underdiagnosed condition in the medical intensive care units among patients admitted with non-cardiac acute conditions. Therefore, intensivists must be aware of the possibility of this condition; this can help to avoid unnecessary costly investigations and provide an early, definite prognosis.

Hypertension in diabetes: optimal pharmacotherapy

Hypertension is commonly associated with diabetes mellitus. The combination of hypertension with obesity and diabetes is a well recognized entity known as the metabolic syndrome, which shares a common pathophysiology of insulin resistance. The individual components of this syndrome act synergistically to substantially increase the risk of renal disease, stroke, coronary artery disease, and death. Hypertension increases both macrovascular and microvascular complications of diabetes such as neuropathy, nephropathy, coronary artery disease, stroke, and retinopathy. Hence there is a pressing need to achieve good control of hypertension to reduce such complications. Studies have been conducted to define target blood pressure in order to minimize such complications and also to decide on the type of drugs most likely to reduce complications/adverse events among diabetics. Along with the trusted and proven therapies to control blood pressure in diabetes, efforts should also be underway to define the hitherto unknown factors contributing to this problem and the ways to control them. There is also a need to prevent the development of diabetes among those predisposed to it and a defined approach needs to be established.

A randomised controlled trial of low-dose misoprostol and dinoprostone vaginal pessaries for cervical priming

OBJECTIVE

We studied the efficacy of 25-microg misoprostol pessaries as either single or double dose compared with a 3-mg dinoprostone pessary for cervical priming.

DESIGN AND SETTING

A randomised controlled trial in Singapore.

POPULATION

One hundred and seventy-one women with term pregnancies and modified Bishop scores (mBS) < or =6 from 2003 to 2004.

METHOD

Patients were randomised to single misoprostol dose, double misoprostol dose or the current dinoprostone regimen.

MAIN OUTCOME MEASURES

Primary outcome was number of women who achieved favourable mBS >6 or active labour by day 2. Secondary outcomes were time interval from insertion to delivery, cardiotocographic abnormalities, delivery and neonatal outcome.

RESULTS

More women in the misoprostol double-dose group (96.6%) and dinoprostone group (93%) achieved the primary outcome compared with the single-dose group (77.8%) (P = 0.003 and P = 0.03, respectively). There was no difference in secondary outcomes. More multiparous women achieve primary outcome compared with nulliparous women (odds ratio 0.21, 95% confidence interval 0.06-0.77).

CONCLUSION

Double-dose misoprostol 25 microg is as effective as dinoprostone 3 mg inserts for cervical priming; both are more efficacious than a single-dose misoprostol pessary. Parity prognosticates the success of induction.

An uncommon presentation of a cardiac pseudoaneurysm

Cardiac pseudoaneurysms are more likely than true aneurysms to rupture causing sudden death. Although pseudoaneurysms are typically managed surgically, medical management is reasonable in certain scenarios. We present the case of a sixty-four-year-old gentleman with an unusual initial presentation of left ventricular free wall rupture, which was treated medically. We stress the usefulness of two-dimensional echocardiography over ventriculography in diagnosing such lesions.

Effect of soybean meal substitution by different concentrations of sunflower meal on egg quality traits of white and coloured dwarf dam lines

1. The effect of soybean meal substitution by different concentrations of sunflower meal on egg quality traits of white and coloured dwarf dam lines was investigated. 2. A total of 144 dwarf hens (38 weeks of age) from the same hatch were randomly divided into 12 groups of 12 birds (4 dietary treatments x 3 replicates). 3. A 2 x 4 factorial design was used to study the effect of 2 lines (Factor A) and substitution of soybean meal (SBM) with 4 concentrations (0, 10, 15 and 20%) of sunflower meal (SFM) [Factor B] on egg quality traits of dwarf dam line hens. 4. All the diets were designed to be isocaloric (113 MJ ME/kg) and isonitrogenous (180 g/kg crude protein) The duration of the experiment was 12 weeks. 5. Analysis of variance indicated a highly significant line effect. There were non-significant effects of substitution of soybean meal with different concentrations of sunflower meal on egg quality traits except for Haugh unit. 6. White plumaged dwarf broiler breeder dam line produced significantly fewer, but larger, eggs than coloured dwarf dam line hens.