Sturge Weber Syndrome: An Unusual Case with Multisystem Manifestations

Background: Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder. It is characterized by the presence of facial port wine stains, neurological abnormalities like seizures and mental retardation, ocular disorders, oral involvement and leptomeningeal angiomas.Case Report: A 13-year-old boy presented with the chief complaint of swollen, bleeding gums and deposits on the teeth. Detailed medical and dental history, clinical examination and investigations confirmed the diagnosis of Sturge-Weber syndrome. The treatment comprised of a thorough plaque control regimen to reduce the gingival enlargement, and it included oral hygiene instructions, thorough scaling, root planing at regular intervals and plaque index scoring which motivated the patient at each visit.Conclusion: This case illustrates that early intervention in a patient with Sturge-Weber syndrome is quintessential because of its associated gingival vascular features and their complicating manifestations. Furthermore, the need for periodic oral examinations and maintenance of good oral hygiene to prevent any complications from the oral vascular lesions has been highlighted.Keywords: Gingival overgrowth, Hemangioma, Plaque control regimen, Port wine stains, Sturge–Weber syndrom

Processing and Application of Aluminium Foams

Foam is defined as a uniform dispersion of a gaseous phase in a liquid, seperated by a thin film of liquid making a cell or pore. This morphology when preserved in solid state is known as solid foam or cellular solid. When we talk about metal foam, it is understood to have uniformly distributed gas pores in solid metal with volume fraction in the range of 40-98%

Comparative efficacy and safety of DPP-4 inhibitors and α-glucosidase inhibitors as add on therapy in type 2 diabetes

Background: Diabetes mellitus (DM) is a spectrum of metabolic disorders as a consequence of different pathogenic mechanisms resulting in hyperglycemia. A genetic predisposition to develop β-cell dysfunction synergizes with insulin resistance to lead to type 2 DM. Adequate management of type 2 DM requires institution of non pharmacological treatment followed by pharmacological treatment. Monotherapy is started initially followed by combination therapy (dual/triple). Sitagliptin, a DPP-4 inhibitor and voglibose, an α-glucosidase inhibitor has been implicated as an add on therapy to metformin and glimepiride. So, we aimed to assess the efficacy and safety of the sitagliptin and voglibose as add on therapy to metformin and glimepitide in type 2 DM.Methods: This open label randomized control trial was conducted in the department of Pharmacology among patients attending medicine OPD of a tertiary care hospital. 80 patients were randomly divided into two groups of 40 patients each. group A:sitagliptin + metformin + glimepiride and group B:voglibose + metformin + glimepiride. Patients were followed every week for a period of 12 weeks. Data was analysed using paired t test, unpaired t test and chi square test.Results: There was a significant decrease in HbA1c, FPG and PPG in both the groups. Intergroup comparison at 4, 8 and 12 weeks showed a better improvement in glycemic control in group A as compared to group B.Conclusions: Sitagliptin showed a better glycemic control than that with voglibose in patients with uncontrolled type 2 DM on metformin and glimepiride

Potential drug-drug interactions among elderly in-patients with cardiac illness at a tertiary care centre

Background: Drug interactions are major cause of concern in hospitalized patients with cardiac illness especially in elderly population. Therefore, the study was conducted to determine the prevalence and pattern of potential drug-drug interactions (pDDI) and risk factors, if any.Methods: It was a prospective observational study involving 75 elderly in-patients with cardiac diseases. IHEC approval was taken before commencement of study and written informed consent was taken from all the study participants. Data was collected using structured data collection tool. pDDI were analyzed using MEDSCAPE databse. Data was analyzed using SPSS 20.0 in terms of descriptive statistics. Pearson correlation coefficient was used to find the association between the risk factors and potential DDIs. P value of ≤0.05 was considered statistically significant.Results: The prevalence of pDDI was found to be 100%. Total 593 pDDI and 33 interacting drug pairs were observed in the study. The common drug interacting pairs were aspirin and furosemide 140 (23.61%), followed by aspirin+ enalapril 98 (16.53%) and heparin and clopidogrel 56 (9.44%). Majority of pDDI 480 (81%) were found to be of moderate severity. A significant association was documented between length of hospital stay (p=0.041) and occurrence of pDDI. A statistically significant correlation (r =0.621; p<0.01) was noted between number of drugs prescribed and total number of pDDIs.Conclusions: A high prevalence of pDDI was observed. The prevalence rate is directly related to number of drugs prescribed and length of hospital stay. Therefore, close monitoring of hospitalized patients is recommended

Prescribing pattern of oral anti-diabetic agents in type 2 diabetes mellitus patients in a tertiary care hospital

Background: Prescription pattern studies are a tool for assessing the prescribing, dispensing and distribution of medicines. The main aim of assessing prescribing pattern is to facilitate rational use of medicines. So the main aim of the study was to assess the prescribing pattern of oral anti-diabetic agents in type 2 diabetes mellitus, to assess the rationality of the prescribed drugs and also to assess the pattern of co-morbid conditions associated with type 2 diabetes mellitus in a tertiary care hospital.Methods: This cross sectional study was conducted in the Department of Pharmacology in collaboration with Department of General Medicine. Study was conducted from 1st June 2016 to 31st Aug 2016 (3 months). A total of 100 patients were enrolled after taking written informed consent. A structured case recording form was used to record demographic details and prescription details. The rationality of prescriptions was assessed using American Diabetes Association guidelines 2015.Results: Majority of the patients were prescribed combination therapy (54%) followed by monotherapy (46%). Oral anti-diabetic agents used as monotherapy other than metformin were inappropriate. Among the patients receiving combination therapy majority were receiving a fixed dose combination which were inappropriate.Conclusions: Majority of the patients were receiving fixed dose combinations without justifiable pharmacokinetic/pharmacodynamic benefits. Such kinds of studies are required to improve rationality of prescription of drugs, decreasing morbidity and mortality of patients and decreasing the cost of treatment

What is the role of a specialist regional mesothelioma multidisciplinary team meeting?:A service evaluation of one tertiary referral centre in the UK

BACKGROUND: Multidisciplinary team meetings are standard care for cancer in the UK and Europe. Professional bodies recommend that mesothelioma cases should be discussed at specialist multidisciplinary team meetings. However, no evidence exists exploring the role of the specialist mesothelioma multidisciplinary team meeting. OBJECTIVES: To evaluate the clinical activity of 1 specialist mesothelioma multidisciplinary team meeting and to determine how often a definitive diagnosis was made, whether the core requirements of the meeting were met and whether there was any associated benefit or detriment. DESIGN AND SETTING: A service evaluation using routinely collected data from 1 specialist mesothelioma multidisciplinary team meeting in a tertiary referral hospital in the South-West of England. PARTICIPANTS: All cases discussed between 1/1/2014 and 31/12/2015. OUTCOME MEASURES: The primary outcome measure was whether a definitive diagnosis was made. Secondary outcomes included whether treatment advice was offered, information on clinical trials provided or further investigations suggested. Additional benefits of the multidisciplinary team meeting and time taken from referral to outcome were also collected. RESULTS: A definitive diagnosis was reached in 171 of 210 cases discussed (81%). Mesothelioma was diagnosed in 153/210 (73%). Treatment advice was provided for 127 of 171 diagnostic cases (74%) and further investigations suggested for all 35 non-diagnostic cases. 86/210 cases (41%) were invited to participate in a trial, of whom 43/86 (50%) subsequently enrolled. Additional benefits included the avoidance of postmortem examination if the coroner was satisfied with the multidisciplinary team decision. The overall process from referral to outcome dispatch was <2 weeks in 75% of cases. CONCLUSIONS: This specialist mesothelioma multidisciplinary team meeting was effective at making diagnoses and providing recommendations for further investigations or treatment. The core requirements of a specialist mesothelioma multidisciplinary team meeting were met. The process was timely, with most outcomes returned within 2 weeks of referral

Morbidly adherent placenta: management is real challenge

Background: The objective of the present study was to describe management of morbidly adherent placenta with placenta previa and feto-maternal outcome.Methods: All antenatal USG diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non-separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay was recorded.Results: From January 2010 to October 2018, 22 cases of morbidly adherent placenta were diagnosed on gray scale and color Doppler during antenatal ultrasound scan. Scheduled caesarean hysterectomy without attempting placental removal was done. Subtotal hysterectomy was performed in 17(77.2%) cases and total hysterectomy in remaining 5(22.8%) cases. All the patients required blood transfusion.  Seven (31.8%) patients had urinary bladder injury. One case developed DIC and One needed ventilatory support. No patient died in this series.Conclusions: Antenatal diagnosed cases of morbidly adherent placenta, avoidance of placental separation and caesarean hysterectomy results in better maternal outcome