Effect of a novel succinamic acid derivative as potential anti-diabetic agent in experimental diabetic rats

4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid which is a succinamic acid derivative has been synthesized in 3 step reaction with malic acid. Its structure confirmation was done by various techniques like 1H NMR, 13C NMR, & HRMS and is recently proposed as an insulinotropic agent for the treatment of non-insulin dependent diabetes mellitus. In the present study, the effect of 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid on plasma glucose, serum insulin, serum lipid profile and lipid peroxidation in streptozotocin–nicotinamide induced type 2 diabetic model was investigated.  4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid was administered orally (20 mg/kg b.w.) to streptozotocin + nicotinamide (STZ + NAD) induced diabetic rats for 28 days. A significant increase in fasting blood glucose levels, HbA1c levels, Serum lipid profile (TG & TC) and in  the levels of Malonaldialdehyde (MDA, end product of lipid peroxidation) was observed in STZ +NAD diabetic rats whereas the levels of high density lipoprotein-cholesterol (HDL-C) and serum insulin levels were significantly decreased  in STZ + NAD induced diabetic rats The effect of 4-((benzyloxy)amino)-2-hydroxy-4-oxobutanoic acid was compared with glibenclamide, a reference drug. Treatment with 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid and glibenclamide resulted in a significant reduction of fasting blood glucose levels with increase in plasma insulin levels in diabetic treated rats. 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid also resulted in a significant improvement in serum lipids and lipid peroxidation products. Our results suggest the potential role of 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid in the management of type-2 diabetes mellitus experimental rats. Keywords: 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid, dyslipidemia, streptozotocin induced diabetes, lipid peroxidatio

Total Hip Arthroplasty (THA) versus Bipolar Hemi-arthroplasty (BHA) for displaced fracture neck of femur in elderly patients- A prospective study

Background Femoral neck fracture is the most common injury in elderly population. Prevention of complications by early surgery and mobilization in these patients is of prime importance. Bipolar hemi-arthroplasty (BHA) and Total Hip Arthroplasty (THA) are the treatment options available for elderly patients with displaced femoral neck fractures. In our study, we analysed the outcomes following Bipolar Hemi-arthroplasty (BHA) in comparison to Total Hip Arthroplasty (THA)

Tubercular sinus over manubrium sterni: a rare presentation

Isolated sternal involvement in tuberculosis is rare. Very few case reports are available in literature even from the countries where tuberculosis is endemic. We are reporting a case of 32-year-old female who presented to us with a pus discharging sinus over manubrium sterni with no other systemic features of tuberculosis. Sinus tract was excised and biopsy confirmed tuberculosis. Patient received antitubercular therapy for 9 months

Hyperhomocysteinemia presenting as Wallenberg syndrome: A report of two cases and review of literature

Wallenberg syndrome or lateral medullary syndrome occurs due to infarction of the lateral medulla usually supplied by the posterior inferior cerebellar artery (PICA). It most commonly results from occlusion of the vertebral artery followed by the PICA. The clinical manifestations result from impaired functioning of vestibular nuclei, inferior cerebellar peduncle, central tegmental tract, descending sympathetic fibers, nucleus ambiguus, spinothalamic tracts and spinal trigeminal nucleus. The clinical manifestations include dysphagia, nausea, vomiting, ataxia, Horner′s syndrome, ipsilateral loss of pain and temperature over the face and contralateral loss over the trunk and body etc. Manifestations depend on the site of lesion. The most common etiology of Wallenberg syndrome being atherosclerotic occlusion of the arteries followed by secondary thrombosis. However, prothrombotic states rarely present as lateral medullary syndrome. Therefore, we report two cases of Wallenberg syndrome where patients were found to have hyperhomocysteinemia as a risk factor for the prothrombotic state

Bridging Immune Realms: A Striking Case Report on Autoimmune Thyroiditis Co-existing with Immune Thrombocytopenic Purpura

Immune Thrombocytopenic Purpura (ITP), an autoimmune disease, is characterised by isolated thrombocytopenia, with or without bleeding. Thyroid autoimmune illness can coexist with ITP. The specific clinical characteristics are still unknown. The length of ITP or the patients’ response to treatment is not related to their thyroid condition. In patients with ITP, thyroid impairment is more common. In the present case report, a 60-year-old female patient, a known case of asthma, presented to the hospital with complaints of swelling in the neck along with transient episodes of breathlessness for 3-4 years. On local examination, a butterfly-shaped mass was seen in the neck, which moved upwards on deglutination but did not move on protrusion of the tongue. Pemberton’s sign was also positive. On palpation, the thyroid measured around 8×6 cm in size, thyroid lobes were bosselated, consistency was firm, and no bruit was heard on auscultation. Based on routine laboratory findings, she was found to have refractory thrombocytopenia with a normal thyroid profile. Further investigations revealed that the patient had positive antithyroid stimulating hormone antibodies, and Fine Needle Aspiration Cytology (FNAC) showed colloid nodular goitre with haemorrhagic cystic changes. A bone marrow biopsy was performed in view of refractory thrombocytopenia, which was suggestive of ITP. The patient was advised to take tablet eltrombopag, after which the platelet counts improved drastically. Subsequently, the patient was advised to undergo thyroidectomy, but this could not be done due to haemodynamic instability

Varied manifestations of tuberous sclerosis

Tuberous sclerosis complex (TSC) is a rare autosomal dominant disease. The prevalence of TSC is estimated to be 1 in 95,136 in general population and in those <6 years of age, it is 1 in 14,608. It is an autosomal dominant neurocutaenous disease and in about 80% of cases it is caused by a de novo mutation. The relationship between cardiac rhabdomyomas and TSC is well established. The cardiac rhabdomyomas may arise anywhere in the myocardium but are more commonly seen in the left ventricle. However, in our case an interventricular septal rhabdomyoma was seen. Angiomyolipomas (AMLs) occur in up to 80% of patients with TSC. Bilateral renal AMLs were seen in our case. There was evidence of systemic involvement in form of lymphangiomyomatosis and subependymal hamartomas

A rare case of underlying pulmonary sequestration in a patient with recently diagnosed medium and large vessel vasculitis

Vasculitis of medium- and large-sized arteries is an inflammatory and stenotic disease characterized by a strong predilection for the aortic arch and its branches. It presents with symptoms and signs as per the vessels and organs involved. Pulmonary sequestration is a rare abnormality characterized by a mass of nonfunctioning lung tissue that receives its vascular supply from a systemic artery and is separated from the normal tracheobronchial tree. The following is a rare case report showing the presence of pulmonary sequestration in a patient with recently diagnosed hypertension and intestinal angina due to medium and large vessel vasculitis

Complete Heart Block Secondary to Section Concomitant Use of Metoprolol and Fluoxetine in a Case of Chronic Depression and Systemic Hypertension: A Case Report

Bradyarrhythmia can be brought on by intrinsic or extrinsic causes that disrupt the cardiac conduction system, with iatrogenic drug usage being the most common extrinsic cause. Atrioventricular (AV) block is frequently brought on by beta-blockers, calcium channel blockers, anti-arrhythmics, and digoxin. The first course of treatment for heart block involves stopping the problematic medications. Psychotropic medications have the potential to cause cardiotoxic adverse effects that affect the heart. In a patient with a pre-existing cardiac disorder, psychotropic drugs can manifest with dangerous arrhythmias. It is yet unknown what intricate processes cause these effects. A variety of arrhythmias may be brought on by or made worse by many commonly used drugs. Hereby, the authors present a case report of 56-year-old hypertensive male, a known case of chronic depression with chest heaviness. The Electrocardiogram (ECG) revealed Complete Heart Block (CHB) with Right Bundle Branch Block (RBBB). The patient was on fluoxetine and beta-blockers for his mental illness and hypertension. Three days after withholding the drugs, the CHB resolved, and his baseline ECG remained as RBBB. The present case highlights the interaction of drugs leading to CHB in present patient. Therefore, the importance of a detailed drug history in such cases becomes imperative