The utility of serial serum cholinesterase as a prognostic marker in organophosphorus compound poisoning

Background: Acute organophosphorus (OP) poisoning is one of the most common poisonings in India contributing to significant morbidity and mortality. Irreversible inhibition of cholinesterase enzymes is attributed to the serious clinical outcomes in these patients, which is assessed by the estimation of serum cholinesterase (SChE) levels. The present study was undertaken to evaluate the utility of serial estimation of SChE levels in patients of OP poisoning in predicting the clinical outcome.Methods: Medical records of 31 patients from January 2013 to December 2013 admitted in our institute with acute OP poisoning were analyzed for SChE at admission, 48 hrs, 72 hrs and 120 hrs after admission. Data regarding clinical findings at admission and outcomes were recorded.Results: Monocrotophos (55%) was the most commonly used OP compound. Mean serial SChE levels (in KU/L) at admission, 48, 72, and 120 hrs in patients who survived are 0.18±0.10, 0.28±0.14, 0.41±0.21, 0.46±0.16 and in patients who expired are 0.02±0.01, 0.05±0.02, 0.03±0.02, 0.03±0.02, respectively. SChE levels at admission in survived group, compared to those in expired group were statistically significant (p<0.001). About 92% patients in moderate to severe grade of poisoning (SChE levels <0.2 KU/L) were mechanically ventilated. The relationship between serial SChE levels in survival group and was found to be statistically significant (p<0.01).Conclusion: In the present study, significant increase in serial SChE levels were correlating with better clinical outcome as evidenced by an improvement with mechanical ventilation and survival rates in acute OP poisoning

Approximate Solutions To Constrained Risk-Sensitive Markov Decision Processes

This paper considers the problem of finding near-optimal Markovian randomized (MR) policies for finite-state-action, infinite-horizon, constrained risk-sensitive Markov decision processes (CRSMDPs). Constraints are in the form of standard expected discounted cost functions as well as expected risk-sensitive discounted cost functions over finite and infinite horizons. The main contribution is to show that the problem possesses a solution if it is feasible, and to provide two methods for finding an approximate solution in the form of an ultimately stationary (US) MR policy. The latter is achieved through two approximating finite-horizon CRSMDPs which are constructed from the original CRSMDP by time-truncating the original objective and constraint cost functions, and suitably perturbing the constraint upper bounds. The first approximation gives a US policy which is $\epsilon$-optimal and feasible for the original problem, while the second approximation gives a near-optimal US policy whose violation of the original constraints is bounded above by a specified $\epsilon$. A key step in the proofs is an appropriate choice of a metric that makes the set of infinite-horizon MR policies and the feasible regions of the three CRSMDPs compact, and the objective and constraint functions continuous. A linear-programming-based formulation for solving the approximating finite-horizon CRSMDPs is also given.Comment: 38 page

A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PARALLEL GROUP CLINICAL STUDY TO EVALUATE THE ANALGESIC EFFECT OF AQUEOUS EXTRACT OF TERMINALIA CHEBULA, A PROPRIETARY CHROMIUM COMPLEX, AND THEIR COMBINATION IN SUBJECTS WITH JOINT DISCOMFORT

Objective: To evaluate the analgesic effect of an aqueous extract of Terminalia chebula (TCE), a proprietary chromium complex (PCC), and theircombination in subjects with joint discomfort.Methods: A total of 100 patients with knee joint discomfort were randomized into five treatment groups - TCE 500 mg BID, TCE 500 mg BID+PCC400 µg OD, PCC 400 µg OD alone, placebo, and TCE 250 mg BID, for 12 weeks in a double-blinded manner. Assessment of symptoms of knee joint painand discomfort was done by modified Western Ontario and McMaster Universities Arthritis Index (mWOMAC) and knee swelling index (KSI); visualanalog scale (VAS) was used for subjective assessment of pain, stiffness, and disability. Statistical analysis was done with GraphPad Prism 6.Results: Absolute reduction in mWOMAC score in TCE 500 mg (19.82±8.35), TCE 500 mg+PCC 400 µg (13.10±5.69), PCC 400 µg (8.30±3.81), placebo(2.45±3.07), and TCE 250 mg (10.47±4.43), respectively, at the end of 12 weeks as compared to the baseline values. Absolute reduction in KSI inTCE 500 mg (28.95±16.82), TCE 500 mg+PCC 400 µg (19.14±9.50), PCC 400 µg (12.7±4.86), placebo (10.03±3.8), and TCE 250 mg (18.24±6.86),respectively, at the end of 12 weeks as compared to the baseline values (p&lt;0.001). Similar results were seen with VAS assessments for pain, stiffness,and disability. All the treatments were well tolerated.Conclusion: TCE and PCC reduce joint discomfort.Keywords: Terminalia chebula extract, Proprietary chromium complex, Western Ontario and McMaster Universities Arthritis Index

Correlation between endothelial dysfunction, inflammatory status, oxidative stress and total (nitrite/ nitrate) in subjects with diabetes mellitus type 2

Background: Diabetes Mellitus is a systemic metabolic disorder associated with Endothelial dysfunction and increased systemic inflammatory state with oxidative stress leading to increased Cardiovascular risk. This study planned to correlate the level of Endothelial dysfunction with oxidative stress and inflammatory status.Methods: Study was conducted in 60 Diabetes Mellitus subjects of both genders with duration of more than two years. Endothelial dysfunction assessed as Augmentation Pressure and Augmentation Index generated from Radial artery waveforms by tonometer using Spygmocor PWA system. Plasma Total Nitrite/ Nitrate, High sensitive C - Reactive Protein, Malondialdehyde and Glutathione were measured.Results: Out of total 60 Diabetes Mellitus subjects 16 subjects were with Coronary Artery Disease. There was no significant difference in High sensitive C - Reactive Protein, Glutathione, Malondialdehyde and Total Nitrite/ Nitrate between Diabetes Mellitus with Coronary Artery Disease and without Coronary Artery Disease, however significant difference (p=0.02) was observed Augmentation Pressure between Diabetic alone (12.8±5.19 mm of Mercury) and diabetics with Coronary Artery Disease (16.13±33.47 mm of Mercury) and Augmentation Index (p=0.04) between Diabetic alone (29.8±5.68 mm of Mercury) and diabetics with Coronary Artery Disease (40.01±5.74). As endothelial function is age dependent the subjects were divided into three age groups (20-40 years, 40-60 years and more than 60 years). High sensitive C - Reactive Protein, Glutathione, Malondialdehyde, Total Nitrite/ Nitrate and Augmentation Index did not differ in the three age groups while Augmentation Pressure (p=0.0096) showed significant difference between age group 20-40 years (10.59±3.24) and age group more than 60 years (15.83±3.92).Conclusions: There is significant endothelial dysfunction observed in Diabetes Mellitus subjects and Diabetes Mellitus with coronary artery disease showed greater endothelial dyfunction. Thereby concluding that Diabetes Mellitus subjects were at higher risk for development of coronary artery disease and as endothelial dysfunction is an early event, it may have some prognostic value

Thioridazine: a potential adjuvant in pharmacotherapy of drug resistant tuberculosis Ki

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Despite advances in control strategies, inadequate treatment and failure to comply with drug regimens have resulted in TB to emerge as one of the most common and deadly infectious diseases worldwide. The emergence of drug-resistant TBhas evolved as a formidable obstacle for comprehensive TB control. Drug-resistant TB can be classified as multi-drug-resistant TB, extensively drug-resistant TB and totally drug resistant TB (TDR-TB). There is a paucity in the development of new drugs against drug-resistant mycobacteria. The focus has shifted to the exploration of anti-mycobacterial properties of drugs approved for other indications. Thioridazine, a drug approved for use in schizophrenia is one such potential agent, which has shown anti-mycobacterial activity. There is evidence of anti-mycobacterial action of Thioridazine in in-vitro and mouse models. There is a compelling need for new anti-mycobacterial drugs that are more effective and have less toxicity. Further clinical trials are advocated favoring the use of thioridazine as an adjuvant in the treatment of TB, especially TDR-TB

Comparison of remineralizing effect of organic and inorganic fluoride by evaluation of microhardness and quantitative analysis of calcium and phosphorus ratio on enamel surface: an in-vitro study

Background Enamel is a highly mineralized tissue of the body which is composed of 96% inorganic salts and 4% organic matter. Enamel is permeable to water and ions, particularly cations and low molecular weight substances. The enamel continues to mature even after eruption with mineral replacing protein. Recently, the interest on the development of calcium phosphate-based remineralization technology has been increased that led to the development of various remineralizing agents like Fluoride, CPP-ACP (Tooth Mouse plus), Bioglass (Novamin), Ozone, Xylitol, Sensistat etc. Aim Aim of the present in vitro study was to evaluate and compare the remineralizing effect of Organic fluoride (AmF) and inorganic fluoride (NaF) by evaluating Vickers microhardness and quantitative analysis of Calcium and Phosphorus ratio on enamel surface using Scanning Electron Microscope-Energy Dispersive X-ray analysis. Materials and methods Sixteen maxillary central incisors were decoronated at the cementoenamel junction and mounted in cylindrical moulds filled with self-cure acrylic resin. Artificial demineralized lesions were created on the enamel surface by suspending them in 0.1 M Citric acid buffer at pH of 3.2 for 72 hrs. The samples were then randomly divided into two groups and labelled, Group A – remineralized with NaF for 3 minutes twice daily for one week and Group B - remineralized with AmF for 3 minutes twice daily for one week. Microhardness and SEM-EDX analysis were done before demineralization, after demineralization and after remineralization. Results Data were analyzed by comparing the mean values between the groups using independent sample t-test. The intra-group analysis was done using repeated-measures ANOVA with posthoc Bonferroni test, and a p-value of &lt;0.05 was considered statistically significant. Conclusion OrganicFluoride resulted in better remineralization than inorganic Fluoride. After remineralization for one week, enamel samples treated with AmF demonstrated a statistically significant increase in mean microhardness and Ca:P ratio when compared to enamel samples treated with NaF

Electronic Structure of Ordered Double Perovskite Ba2CoWO6

Ba2CoWO6 (BCoW) has been synthesized in polycrystalline form by solid state reaction at 1200C. Structural characterization of the compound was done through X-ray diffraction (XRD) followed by Rietveld analysis of the XRD pattern. The crystal structure is cubic, space group Fm-3m (No 225) with the lattice parameter, a=8.210A. Optical band-gap of the present system has been calculated using the UV-Vis Spectroscopy and Kubelka-Munk function, its value being 2.45 eV. A detailed study of the electronic properties has also been carried out using the density functional theory (DFT) techniques implemented on WIEN2k. Importance of electron-electron interaction between the Co ions leading to half-metallic behavior, crystal and exchange splitting together with the hybridization between O and Co, W has been investigated using the total and partial density of states.Comment: 3 pages, 3 figures, submitted to 58th DAE-SSPS 201

First donor-acceptor interaction promoted gelation of organic fluids

Bile acid derivatives functionalized at the 3-position with an aromatic group formed gels in organic solvents in the presence of trinitrofluorenone