Comparative study between levobupivacaine with clonidine and levobupivacaine with fentanyl in epidural labour analgesia in rural set up

Background: Neuraxial techniques are the gold standard for intrapartum labour analgesia. Neuraxial labour analgesia using new local anaesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Multiple randomized controlled trials comparing epidural analgesia with systemic opioids, nitrous oxide or both have demonstrated lower internal pain scores and higher maternal satisfaction with neuraxial analgesia. The purpose of this study is to compare fentanyl and clonidine combination with levobupivacaine in terms of effect of epidural labour analgesia on fetal outcome and incidence of instrumental or caesarean delivery and duration of second stage of labour.Methods: A total of 50 primiparous with singleton pregnancy and vertex presentation and cervical dilatation of 3-5 cm were enrolled for the study in our hospital in department of obstetrics and gynecology. They were divided into group 1 and group 2 (25 patients in each group). Group 1 received 10 ml. of 0.125% isobaric levobupivacaine with 25µg fentanyl and group 2 received 10 ml of 0.125% isobaric levobupivacaine with 60 µg clonidine. Parturients were given epidural analgesia on numerical rating scale (NRS) Score >3. Breakthrough pain supplemented with 3-5 ml of 0.125% levobupivacaine. Data collected were demographic profile of the patients, analgesic qualities, 1st and 2nd stage labour duration, side effects and feto-maternal outcome.Results: Post treatment mean NRS were almost similar between two groups at all periods except at 15 minutes when it was significantly lower for group 2 (2.64±0.49). Onset of analgesia was earlier in group 2 (13.68±0.94) in comparison to group 1 (15.36±1.18) and was statistically significant.Conclusions: In conclusion Group 2 (levobupivacaine with clonidine) showed significant difference in early onset of analgesia but did not show any significant difference in duration of labour, maternal and fetal outcome and mode of delivery

Prediction of morbidity and mortality in middle and old aged surgical patients-comparison of standard scoring system and addition of echocardiography with hemodynamic indices

Background: A prospective study was carried out in our hospital to predict morbidity and mortality in middle and old aged surgical patients by adding echocardiography to standard scoring system with hemodynamic studies.Methods: A total of 50 patients of either sex ranging from 40-70 years of ASA grade 1 & 2 scheduled for various types of noncardiac surgeries were enrolled for the study in our hospital. Patients were divided in two groups according to echocardiographic examinations. The patients with normal echocardiographic values were kept in control group and the patients with abnormal values were kept under study group. The patients in study group were further divided in three groups according to LVEF. Group1-LEVF≥60%, Group2-LVEF≥50-59%, Gr3≥40-49% Tab lorazepam was given to all the patients’ orally prior night of surgery. All the patients were induced with same type inducing agents according to body weight. All the patients were maintained on IPPV by anaesthesia machine with supplemental fentanyl, N2O, O2 and muscle relaxant. SPO2, electrocardiograph (ECG), Non-invasive/invasive blood pressure (BP), Spirometry, Capnography and temperature were monitored. At the end of the research project data’s were compiled systematically and were subjected to statistical analysis using odd’s ratio(OR),95% confidence interval (CI), z value and p value, two statistical software programme were used.Results: Significant difference in the results seen between the three study groups (Gr1, Gr2, Gr3) for perioperative ischemic changes, CHF and arrhythmias.Conclusions: In conclusion preoperative TTE before non-cardiac surgery can predict the risk of perioperative cardiac complications in known or suspected cases of cardiac disease patients.

Epidural ropivacaine combined with fentanyl or in combination with clonidine in infraumblical surgeries: a comparative study

Background: The addition of an adjuvant, like clonidine and fentanyl, in epidural blockade has enhanced the effectiveness of local anaesthetics as they not only help in intensifying and prolonging the blockade effect but also help in the reduction of the dose of local anaesthetics.Methods: Our study had 45 patients, all patients belonged to ASA grade-I or II, between 20 and 55 years of age requiring neuraxial blockade for lower abdominal surgeries. All the patients were randomly allocated into two groups. Group-I: Epidural ropivacaine 0.75% (14.5ml) + Fentanyl 50 µgm (1 ml) + 0.5 ml distilled water. Group-II: Epidural ropivacaine 0.75% (14.5ml) + Fentanyl 50 µgm (1 ml) + clonidine 50 µgm. Patients were monitored for sensory and motor blockade, hemodynamic parameters, rescue analgesia and adverse effects in perioperative period.Results: Highest level of sensory and motor blockade was found to be insignificant (p>0.05) in both the groups. Mean time for regression of sensory blockade to T10 was significantly longer (p<0.05) in group II as compared to group I. The duration of motor blockade was significantly (p<0.001) higher in patients of Group-II as compared to Group-I. The addition of clonidine to epidural Ropivacaine and fentanyl (Group-II) produces longer duration of analgesia as compared to Group-I. Haemodynamically the patients in both the groups behaved similarly. The patients, in whom epidural fentanyl was used, had slightly higher incidence of nausea, vomiting, dry mouth and pruritus.Conclusions: So this study re-established the fact, that the fentanyl and clonidine when added as adjuvant to epidural ropivacaine, significantly prolongs the analgesic duration without causing significant hemodynamic and respiratory changes.

Genetic diversity and recombination within populations of Fusarium pseudograminearum from western Canada

Genetic diversity within populations of Fusarium pseudograminearum isolated from wheat grains from the Canadian provinces of Alberta and Saskatchewan was investigated. Three restriction enzymes (EcoRI, HaeIII, and PstI) were used to carry out restriction analysis of the nuclear ribosomal DNA (nrDNA) intergenic spacer region (IGS region) and eight primers were used to generate inter-simple sequence-repeat (ISSR) molecular markers. Our study indicated substantially high genetic diversity within these two populations, but low genetic differentiation and frequent gene flow among populations. The IGS data showed no genetic distinction between the two Alberta populations and only minor genetic differentiation between the Saskatchewan and Alberta populations. Analysis of molecular variance indicated that most genetic variability resulted from differences among isolates within populations. Multilocus linkage disequilibrium analysis suggested a panmictic population genetic structure and the occurrence of significant recombination in F. pseudograminearum. Regular gene flow and random mating between isolates from different populations could result in novel genotypes with both improved pathological and biological traits. [Int Microbiol 2006; 9(1):65-68

Orbital Myiasis: Due to Invasion of Larvae of Flesh Fly (Wohlfahrtia magnifica) in a Child; Rare Presentation

Wohlfahrtia magnifica larvae cause myiasis in mammals, mainly in sheep and rarely in human. In human it may infest the ear, eye, mouth or nose, damaging living tissues. We report a case of ocular myiasis in 1.5 years old child belonging to urban slum after history of minor injury on left upper lid due to fall from bed. The purpose of reporting this case is to highlight the ocular association of W. magnifica

An Emerging Trend in Tablet Technology:- Floating Tablets of Ranitidine HCl

The rationale of this research was to prepare a gastroretentive drug delivery system of Ranitidine HCL. Floating Drug delivery system used to target drug release in the stomach or to the upper part of the intestine. The oral delivery of Ranitidine is tested by preparing a non-disintegrating floating dosage form, which increase its absorption in the stomach by increasing the drug’s gastric residence time. The polymer PVC and Sodium bicarbonate was used as the gas–generating agents. Sodium bicarbonate causes the tablets to floats for more then 24hr. The prepared tablets were evaluated on their physicochemical properties and drug release characters. In-vitro release studies indicate that the Ranitidine release form the floating dosage form was uniform followed zero order release. A combination of sodium bicarbonate (70mg) and citric acid (15mg) was found to achieve Optimum in vitro buoyancy. The tablets with methocel K100 were found to float for longer duration of time as compared to formulations containing methocel K15M. The drug release from the tablets was sufficiently sustained.Keywords: Ranitidine; Floating tablets; Methoce

Innovation of System Biological Approach in Computational Drug Discovery

Computational methods like classification and network-based algorithms can be used to understand the mode of action and the efficacy of a given compound and to help elucidating the patho-physiology of a disease. In the pharmacological industry there has already been a shift from symptomatic oriented drugs that can relieve the symptoms but not the cause of the disease to pathology-based drugs whose targets are the genes and proteins involved in the etiology of the disease. Drugs targeting the affected pathway have thus the potential to become therapeutic. A network approach to drug design would examine the effect of drugs in the context of a network of relevant protein regulatory metabolic interactions resulting in the development of a drug that would hit multiple targets selected in such a way as to decrease network integrity and so completely disrupt the functioning of the network. The screening of a compound to quickly identify the proteins it interacts with gives us all the necessary tools to identify and repair the deregulated biological pathway causing the disease

Polymorphisms of TNF-enhancer and gene for FcγRIIa correlate with the severity of falciparum malaria in the ethnically diverse Indian population

<p>Abstract</p> <p>Background</p> <p>Susceptibility/resistance to <it>Plasmodium falciparum </it>malaria has been correlated with polymorphisms in more than 30 human genes with most association analyses having been carried out on patients from Africa and south-east Asia. The aim of this study was to examine the possible contribution of genetic variants in the <it>TNF </it>and <it>FCGR2A </it>genes in determining severity/resistance to <it>P. falciparum </it>malaria in Indian subjects.</p> <p>Methods</p> <p>Allelic frequency distribution in populations across India was first determined by typing genetic variants of the <it>TNF </it>enhancer and the <it>FCGR2A </it>G/A SNP in 1871 individuals from 55 populations. Genotyping was carried out by DNA sequencing, single base extension (SNaPshot), and DNA mass array (Sequenom). Plasma TNF was determined by ELISA. Comparison of datasets was carried out by Kruskal-Wallis and Mann-Whitney tests. Haplotypes and LD plots were generated by PHASE and Haploview, respectively. Odds ratio (OR) for risk assessment was calculated using EpiInfo™ version 3.4.</p> <p>Results</p> <p>A novel single nucleotide polymorphism (SNP) at position -76 was identified in the <it>TNF </it>enhancer along with other reported variants. Five <it>TNF </it>enhancer SNPs and the <it>FCGR2A </it>R131H (G/A) SNP were analyzed for association with severity of <it>P. falciparum </it>malaria in a malaria-endemic and a non-endemic region of India in a case-control study with ethnically-matched controls enrolled from both regions. <it>TNF </it>-1031C and -863A alleles as well as homozygotes for the TNF enhancer haplotype CACGG (-1031T>C, -863C>A, -857C>T, -308G>A, -238G>A) correlated with enhanced plasma TNF levels in both patients and controls. Significantly higher TNF levels were observed in patients with severe malaria. Minor alleles of -1031 and -863 SNPs were associated with increased susceptibility to severe malaria. The high-affinity IgG2 binding FcγRIIa AA (131H) genotype was significantly associated with protection from disease manifestation, with stronger association observed in the malaria non-endemic region. These results represent the first genetic analysis of the two immune regulatory molecules in the context of <it>P. falciparum </it>severity/resistance in the Indian population.</p> <p>Conclusion</p> <p>Association of specific <it>TNF </it>and <it>FCGR2A </it>SNPs with cytokine levels and disease severity/resistance was indicated in patients from areas with differential disease endemicity. The data emphasizes the need for addressing the contribution of human genetic factors in malaria in the context of disease epidemiology and population genetic substructure within India.</p

Preparation and evaluation of mouth dissolving tablets of meloxicam

The aim of the present study was to develop evaluate mouth dissolving tablet of meloxicam. Drug delivery systems became sophisticated as pharmaceutical scientists acquire a better understanding of the physicochemical and biochemical parameters pertinent to their performance. Over the past three decades, mouth dissolving or orally disintegrating tablets have gained considerable attention as a preferred alternative to conventional tablets due to better patient compliance. The most preferrable route of drug administration (e.g. oral) is limited to drug candidate that show poor permeability across the gastric mucosa and those, which are sparingly soluble. A large majority of the new chemical entities and many new existing drug molecules are poorly soluble, thereby limiting their potential uses and increasing the difficulty of formulating bioavailable drug products,so lastlly the purpose of this study was to grow mouth dissolve tablets of Meloxicam. Meloxicam is a newer selective COX-1 inhibitor. These tablets were prepared by wet granulation procedure. The tablets were evaluated for % friability, wetting time and disintegration time. Sublimation of camphor from tablets resulted in better tablets as compared to the tablets prepared from granules that were exposing to vacuum. The systematic formulation approach helped in understanding the effect of formulation processing variables.Keywords: Mouth dissolving tablet; Maloxicam; Bioavailability; NSAI