THERAPEUTIC ADVANCEMENTS IN MANAGEMENT OF IRON OVERLOAD–A REVIEW

Removal of excess of free iron, produced under certain physiological conditions in human body, has always been of great concern for therapists worldwide. A number of naturally occurring and synthetic ligands are being explored for maximal iron decorporation, enhanced patient compliance and minimal side effects. Siderophores are the most important class of currently used chelators and few of them are approved for treating iron overload. This review focuses on the developments taking place in the field of iron overload treatment to find the most novel, efficient and safest iron decorporating agent. The importance of many natural and synthetic iron scavengers, having potential for clinical application in the treatment of iron overload and their associated side effects, are discussed along with the currently followed methods. Special emphasis is given to review the status of new ligands, combination therapy and methodologies adopted for overcoming limitations of existing therapeutic agents for treatment of different iron overload disorders.Â

Os níveis plasmáticos, farmacocinética e regime de dosagem de gatifloxacina administrado por via intravenosa em bezerros búfalos (Bubalus bubalis) na administração concomitante com meloxicam

The pharmacokinetics of intravenously administered gatifloxacin, upon concomitant administration with meloxicam was investigated in buffalo calves. Meloxicam was administered subcutaneously (0.5 mg.kg-1) immediately followed by intravenous administration of Gatifloxacin (4 mg.kg-1). The concentration of gatifloxacin was estimated in plasma by microbiological assay. Pharmacokinetic parameters were calculated and appropriate dosage schedule was computed. The therapeutic plasma drug concentration was maintained up to 12 h. Gatifloxacin was rapidly distributed from blood to tissue compartment, which was evident from the high values of distribution rate constant, α1 (11.9 ± 0.52 h-1) and the ratio of rate constant of transfer of drug from central to peripheral compartments and vice versa, K12/K21 (3.05 ± 0.36) and K13/K31 (2.04 ± 0.12). The area under the plasma drug concentration-time curve and apparent volume of distribution were 12.0 ± 0.68 µg.ml-1.h and 2.69 ± 0.14 L.kg-1, respectively. The elimination half-life (t1/2β), total body clearance (ClB) and the ratio of drug present in peripheral to central compartment (P/C) were 5.59 ± 0.40 h, 337.6 ± 19.9 ml.kg-1.h-1 and 8.04 ± 0.50, respectively. The present study revealed that the most suitable dosage regimen of gatifloxacin when concomitantly administered with meloxicam in buffalo calves would be 2.5 mg.kg-1 followed by 2.0 mg.kg-1 at 12 h intervals.Investigou-se a farmacocinética da gatifloxacina, administrada por via intravenosa, concomitante à aplicação de meloxicam em bezerros búfalos. O meloxicam foi administrado por via subcutânea (0,5 mg.kg-1), imediatamente seguido pela administração intravenosa de gatifloxacina (4 mg.kg-1). A concentração plasmática de gatifloxacina foi estimada por ensaio microbiológico. Os parâmetros farmacocinéticos foram calculados e a posologia adequada foi computada. A concentração plasmática do fármaco-terapêutico foi mantida por 12 h. A gatifloxacina foi rapidamente distribuída a partir de sangue para o compartimento de tecido, o que ficou evidente a partir dos valores elevados da taxa constante de distribuição, α1 (11.9 ± 0.52 h-1) e a proporção de velocidade constante de transferência de droga a partir de centrais para os compartimentos periféricos e vice-versa, K12/K21 (3.05 ± 0.36) e K13/K31 (2.04 ± 0.12). A área sob a curva plasmática de concentração-tempo da droga e o volume aparente de distribuição foi de 12.0 ± 0.68 µg.ml-1.h e 2.69 ± 0.14 L.kg-1, respectivamente. A meia-vida (t1/2β), a depuração corporal total (ClB) e relação da droga presente no sangue periférico para o compartimento central (P/C) foram 5.59 ± 0.40 h, 337.6 ± 19.9 ml.kg-1.h-1 e 8.04 ± 0.50, respectivamente. O presente estudo revelou que o regime de dosagem mais adequado de gatifloxacina quando administrada concomitantemente com meloxicam em bezerros búfalos seria 2,5 mg.kg-1 seguida de 2,0 mg.kg-1 em intervalos de 12 h

Dynamic hip screw versus proximal femoral nail in the treatment of intertrochanteric fracture of femur

Background: As the elderly population grows, the number of hip fractures continues to increase. This study aims to compare the clinical outcomes of dyanamic hip screw and proximal femoral nail in the fixation of intertrochanteric fracture of femur. Methods: After obtaining approval of the ethics committee, a prospective study was conducted in the department of orthopedics, SKR Hospital, Pathankot from January 2021 till December 2022. Informed consent was taken from patients who fulfilled the inclusion/exclusion criteria and relevant clinical information was collected, including intra and post-operative details. Results: During the study period, 65 patients with intertrochanteric fracture were included in the study, of which 33 were treated with PFN and 32 with DHS. It was observed that 91% of the patients who underwent PFN had blood loss less than 100 ml, while 72% of the patients who had DHS had blood loss between 100-300 ml. Mobilization started on the first postoperative day in 67% of PFN patients while as compared to 13% of DHS patients (p value <0.01). Among late complications, there was one case of implant failure among PFN cases, while there were two cases of non-union, two cases of implant failure and one case of late infection among DHS group of patients. It was observed that 91% of PFN group patients had excellent outcomes, while outcome was excellent in 66% of DHS group patients. Conclusions: Our study showed that PFN is a superior method of osteosynthesis as compared to DHS in the treatment of intertrochanteric fractures

Farmakokinetika gatifloksacina u bivolje teladi nakon jednokratne intramuskularne primjene

The pharmacokinetics and in vivo plasma protein binding of gatifloxacin after a single intramuscular injection of 4 mg/kg were studied in buffalo calves. The minimum therapeutic concentration of drug was maintained in plasma from 1 min to 12 h. Gatifloxacin was rapidly absorbed from the extravascular site of injection, as evident from the high value of absorption rate constant (4.91 ± 0.22 /h) and attained a Cmax of 2.98 ± 0.08 μg/mL at 1h. The area under the plasma concentration-time curve and apparent volume of distribution were 10.8 ± 0.64 μg/mL/h and 3.2 ± 0.08 L/kg, respectively. Elimination half-life and total body clearance were 7.45 ± 0.55 h and 301.5 ± 34.4 mL/kg/h, respectively. Cmax/MIC ratio was 14.9 ± 0.3 and systemic bioavailability was 79.7 ± 3.35 per cent. Gatifloxacin was bound to plasma proteins of buffalo calves to the extent of 25.0 ± 1.05 per cent. A suitable intramuscular dosage regimen of gatifloxacin in buffalo calves would be 6.0 mg/kg followed by 5.3 mg/kg at 24 h intervals.Farmakokinetika i in vivo vezanje gatifloksacina na proteine plazme istraživani su u bivolje teladi nakon jednokratne intramuskularne primjene u dozi od 4 mg/kg. Minimalna terapijska koncentracija lijeka održavana je u plazmi u tijeku od 1 minute do 12 sati. Gatifloksacin se brzo resorbirao s mjesta ubrizgavanja što je vidljivo po visokoj vrijednosti konstante brzine apsorpcije (4,91 ± 0,22 sati) i postignute Cmax 2,98 ± 0,08 μg/mL/sat. Površina ispod koncentracijske krivulje u plazmi iznosila je 10,8 ± 0,64 μg/mL/sat, a prividni volumen raspodjele 3,2 ± 0,08 L/kg. Poluvrijeme izlučivanja iznosilo je 7,45 ± 0,55 sati, a ukupni tjelesni klirens 301,5 ± 34,4 mL/kg/sat. Omjer Cmax/MIC bio je 14,9 ± 0,3, a sustavna bioraspoloživost iznosila je 79,7 ± 3,35%. Gatifloksacin je bio vezan na bjelančevine plazme do 25,0 ± 1,05%. Prikladno intramuskularno doziranje u bivolje teladi bilo bi 6,0 mg/kg, a u sljedećim dozama treba davati 5,3 mg/kg u razmacima od 24 sata

Functional outcome of patients with lumbar intervertebral disc herniation treated by minimally invasive microdiscectomy

Background: The disorder lumbosacral radiculopathy affects the function of one or more lumbosacral nerve roots. The aim of this research is to understand the clinical and epidemiological features of patients diagnosed with disc herniation and treated at our facility using minimally invasive microdisectomy. Methods: From August 2021 to August 2022, we conducted a prospective research in the Department of Orthopedics at a tertiary care hospital in Pathankot. During the study period, all patients over the age of 18 who presented with complaints of leg or back pain, or other neurological symptoms supported by Magnetic Resonance Imaging (MRI) suggestive of disc herniation, were included. All patients were operated using a minimally invasive micro lumbar discectomy method. Results: The majority of patients had less than 100 mL of blood loss (75%) and 72% underwent surgery in less than an hour. Only one patient had an intraoperative cerebrospinal fluid leak and no patient had post-operative infection. It was observed that 81% were admitted for 5 to 8 days. Immediately post-operatively, we observed that 50% had good outcome on MacNab score and 9% had excellent functional outcome. At the final outcome at 6 months, 44% had good functional outcome and 47% had an excellent functional outcome. At the final outcome at 6 months, 44% had good and 50% had excellent functional outcomes. Conclusions: The findings of our study can aid us in budgeting and infrastructure planning for disc herniation patients. Long-term clinical outcomes in these individuals should be the focus of future study

Effect of iodine impregnated plastic adhesive drapes in preventing surgical site infection post spine surgeries

Background: Surgical Site Infection (SSI) complicates roughly 1-3% of orthopaedic surgeries. This study aimed to assess the effect of iodine impregnated plastic adhesive drapes (PAD) in preventing surgical site infection post spine surgeries. Methods: This non-randomized experimental study was conducted in the Department of Orthopedics, of a tertiary care hospital in Pathankot, Punjab, from January 1, 2022 till July 31, 2022, in which adult patients who underwent elective spine surgeries involving cervical, thoracic and lumbar spine and requiring post-operative care of at least 3 days were included. Every alternate patient received iodine impregnated surgical incise plastic adhesive drape (3M ioban 2) for draping before the skin incision. The patients were followed up on for six months after surgery. Results: It was observed a significantly higher duration of surgery in the PAD group, as compared to those without PAD (140.4±45.6 vs 112.5±36.7 mins, p value <0.05). Furthermore, length of incision was not significantly different between the two patient groups (15.4±6.6 vs 17.3±8.5 cm, p value = 0.71). It was observed that overall infection rate in our study population was 3.85% (n=3). It was found to be 3% in the patients with iodine impregnated PAD and 5% in patients without iodine impregnated PAD, with no significant difference between them (p value = 0.88). Conclusions: We found no data supporting or denying the use of iodine impregnated PAD for lowering the incidence of SSI in patients having elective spine surgery cases

Interlocking nailing for treating comminuted fractures of the shaft of femur

Background: The fracture of the femoral shaft is one of the most frequent fractures seen in orthopaedic practise. The purpose of this study was to evaluate the operative procedure for managing communited fractures of the femoral shaft using interlocking fixation. Methods: This prospective study was conducted in Pathankot, Punjab, with patients who presented to our emergency department as participants. We included all patients over the age of 18 who presented to our emergency department with a comminuted femoral shaft fracture. All patients underwent interlocking nailing. Results: During the study period, 62 patients fulfilled our inclusion and exclusion criteria, 79% of which were males. In the present study, 50% of the patients demonstrated clinical union of the fracture in 12 to 14 weeks, 24% had clinical union in 10 to 12 weeks, while 26% had clinical union in 14 to 16 weeks. Similarly, majority of the patients showed radiological union of the fracture in 16 to 18 weeks (48%). Radiological union occurred in 23% in 14 to 16 weeks and in 29% in 18 to 20 weeks. Majority (77%) of the patients stayed in hospital for 10 to 14 days and the functional outcome as measured by Klemm and Borner criteria was excellent in 63% patients. Infection (5%) and limb length discrepancy less than 5 mm (3%) were the only complications observed in our patient population. Conclusions: Our results show that Interlocking nailing results in good functional outcome with minimal complications

EOSINOPHILIC GASTRITIS- A RARE CAUSE OF GASTRIC WALL THICKNESS: A RARE CASE REPORT

Idiopathic eosinophilic gastroenteritis is a rare inflammatory disease of unknown origin, characterized by diffuse eosinophilic infiltration of the gastrointestinal tract, accompanied by varying abdominal symptoms related to the location, severity and depth of invasion. A 63-year old male was admitted to our hospital with complaints of abdominal pain and constipation. Physical examination revealed a distended abdomen with diffuse tenderness. Ultrasound showed free fluid in peritoneal cavity. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. Pylorus of stomach showed thickening of wall. A Gastric perforation with indurated and rolled margins was identified, gastrojejunostomy was performed and provisional diagnosis of malignant growth with complication of perforation was made but histologically, thickened wall of the stomach revealed dense infiltration of eosinophils and eosiniphilic gastroenteritis was diagnosed. KEYWORDS: Eosinophils, Gastroenteritis; Eosinophilic gastroenteritis; Coticosteroid

EOSINOPHILIC GASTRITIS- A RARE CAUSE OF GASTRIC WALL THICKNESS: A RARE CASE REPORT

Idiopathic eosinophilic gastroenteritis is a rare inflammatory disease of unknown origin, characterized by diffuse eosinophilic infiltration of the gastrointestinal tract, accompanied by varying abdominal symptoms related to the location, severity and depth of invasion. A 63-year old male was admitted to our hospital with complaints of abdominal pain and constipation. Physical examination revealed a distended abdomen with diffuse tenderness. Ultrasound showed free fluid in peritoneal cavity. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. Pylorus of stomach showed thickening of wall. A Gastric perforation with indurated and rolled margins was identified, gastrojejunostomy was performed and provisional diagnosis of malignant growth with complication of perforation was made but histologically, thickened wall of the stomach revealed dense infiltration of eosinophils and eosiniphilic gastroenteritis was diagnosed. KEYWORDS: Eosinophils, Gastroenteritis; Eosinophilic gastroenteritis; Coticosteroid