A rare case of iii cranial nerve palsy - mucormycosis involving the right maxillary and ethmoidal sinus

IIIrd Cranial nerve palsy, known as oculomotor nerve palsy, may result from various causes, however, the etiology remains unknown in some instances. This case report aims to present the authors' experience with a case of IIIrd cranial nerve palsy, together with a review of the literature. Many etiologies have been associated with isolated oculomotor nerve palsies. We report the case of a patient who presented with right maxillary and ethmoidal sinusitis with IIIrd cranial nerve palsy associated with mucormycosis. Careful examinations to rule out other causes must be done and then treatment with antifungals should be considered after early diagnosis

Gene Therapy in Cardiac Arrhythmias

Gene therapy has progressed from a dream to a bedside reality in quite a few human diseases. From its first application in adenosine deaminase deficiency, through the years, its application has evolved to vascular angiogenesis and cardiac arrhythmias. Gene based biological pacemakers using viral vectors or mesenchymal cells tested in animal models hold much promise. Induction of pacemaker activity within the left bundle branch can provide stable heart rates. Genetic modification of the AV node mimicking beta blockade can be therapeutic in the management of atrial fibrillation. G protein overexpression to modify the AV node also is experimental. Modification and expression of potassium channel genes altering the delayed rectifier potassium currents may permit better management of congenital long QT syndromes. Arrhythmias in a failing heart are due to abnormal calcium cycling. Potential targets for genetic modulation include the sarcoplasmic reticulum calcium pump, calsequestrin and sodium calcium exchanger. Lastly the ethical concerns need to be addressed

A CONCEPTUAL APPRAISAL OF VIRECHANA KARMA

Panchakarma is getting global attention nowadays and Virechana is one among its procedures which is actively used by the Ayurvedic fraternity. Four different types of Virechana namely Anulomana, Sramsana, Bhedana and Rechana are mentioned in our classics but they are not apprised properly for their clinical utility. The Brihattrayis give ample illustrations of their use without highlighting the underlying rationale. Sarangdhara Samhita defines each of this therapeutics without indicating the disease conditions. This paper tries to understand the specific clinical utility of the four types of Rechana by tracing back their indications in scriptures. Anulomana is a mild form of Virechana where the Paka of Malas occur. Sramsana is a mild form of Virechana which does not cause Paka of Malas. Bhedana does not cause Paka of Malas but it is a strong type of Virechana. Rechana also does not cause Paka of mala but the strength of the procedure can be modulated by the use of different types of drugs. The selection of the type of Rechana depends on the pharmaco-therapeutic action necessary to harmonise the Dosa, Dhatu and Mala without causing any further complication or Upadrava

Predictors of angiographic restenosis in patients with coronary artery disease who have undergone percutaneous coronary intervention with drug eluting stents

Background: Percutaneous transluminal coronary angioplasty (PTCA) is now widely accepted as a nonsurgical revascularization procedure for selected patients with CAD. In-stent restenosis (ISR) is a frequent complication after PCI which limits its long-term efficacy. Identification of those clinical and angiographic characteristics that may predict the risk of restenosis is extremely important to eliminate restenosis. In this context we conducted this study to assess the profile of patients with drug eluting stents - ISR with an emphasis on demographic characteristics, risk factors, mode of presentation and coronary angiographic characterization.Methods: This study was a Case control study based on the catheterization registry of all patients who have undergone PCI with DES during the period from October 2012 to April 2015. All patients who have undergone PCI with DES and repeat coronary angiogram for evaluation of symptoms and detected to have ISR during same period were taken as case and age matched patients who had previously undergone PCI with DES and repeat coronary angiogram for evaluation of symptoms between 1/10/2012 to 30/4/2015 and detected to have fully patent stents were taken as control.Results: A total of 26 patients were detected to have ISR during the study period as per the study protocol with equal number of age matched controls. The most common presentation of ISR was as chronic stable angina (70%). Binary logistic regression analysis of 6 factors namely diabetes, hypertension, lesion type, stent diameter, stent length and stent overlap found significant in univariate analysis, showed only the lesion type to be statistically significant with p value of 0.023.Conclusions: Patients who have undergone PCI with DES particularly for complex lesions, diabetics with longer stents, lesser diameter stents and overlapping stents need to be meticulously followed up to rule out the possibility of restenosis, as in a small number of patients the presentation could be ACS with comparatively bad prognosis

d-β-Tocotrienol-mediated cell cycle arrest and apoptosis in human melanoma cells

Background: The rate-limiting enzyme of the mevalonate pathway, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, provides essential intermediates for the prenylation or dolichylation of growth-related proteins. d-δ-Tocotrienol, a post-transcriptional downregulator of HMG CoA reductase, suppresses the proliferation of murine B16 melanoma cells. Dietary d-δ- tocotrienol suppresses the growth of implanted B16 melanomas without toxicity to host mice. Materials and Methods: The proliferation of human A2058 and A375 melanoma cells following a 72 h incubation in 96-well plates was measured by CellTiter 96® Aqueous One Solution. Cell cycle distribution was determined by flow cytometry. Fluorescence microscopy following acridine orange and ethidium bromide dual staining and procaspase-3 cleavage were used to detect apoptosis. Western-blot was employed to measure protein expression. Results: d-δ-Tocotrienol induced dose-dependent suppression of cell proliferation with 50% inhibitory concentrations (IC50) of 37.5±1.4 (A2058) and 22.3±1.8 (A375) μmol/l, respectively (data are reported as mean±standard deviation). d-δ-Tocotrienol-mediated cell cycle arrest at the G1 phase was accompanied by reduced expression of cyclin-dependent kinase 4. Concomitantly, d- δ-tocotrienol induced caspase-3 activation and apoptosis. The impact of d-δ-tocotrienol on A2058 cell proliferation was potentiated by lovastatin (IC50=3.1±0.5 μmol/l), a competitive inhibitor of HMG CoA reductase. Conclusion: d-δ-Tocotrienol may have potential application in melanoma chemoprevention and/or therapy

Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery.

ObjectiveThis retrospective cohort study seeks to identify risk factors associated with complications following posterior cervical laminectomy and fusion (PCLF) surgery.MethodsAdults undergoing PCLF from 2012 through 2018 at a single center were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Multivariate logistic regression models identified independent predictors of complications following surgery.ResultsA total of 196 patients met the inclusion criteria and were included in the study. The medical, surgical, and overall complication rates were 10.2%, 23.0%, and 29.1% respectively. Risk factors associated with medical complications in multivariate analysis included impaired ambulation status (odds ratio [OR], 2.27; p=0.02) and estimated blood loss over 500 mL (OR, 3.67; p=0.02). Multivariate analysis revealed preoperative narcotic use (OR, 2.43; p=0.02) and operative time (OR, 1.005; p=0.03) as risk factors for surgical complication, whereas antidepressant use was a protective factor (OR, 0.21; p=0.01). Overall complication was associated with preoperative narcotic use (OR, 1.97; p=0.04) and higher intraoperative blood loss (OR, 1.0007; p=0.03).ConclusionPreoperative narcotic use and estimated blood loss predicted the incidence of complications following PCLF for CSM. Ambulation status was a significant predictor of the development of a medical complication specifically. These results may help surgeons in counseling patients who may be at increased risk of complication following surgery

A Study on Inventory Management in Manufacturing Industry with specific reference to Bangalore

The study evaluates inventory control aspects, including turnover, stock outs, carrying costs, and order fulfilment rates.Commendable aspects of industryof current practices include maintaining adequate stock levels and minimizing excess inventory. However, opportunities for improvement lie in enhancing demand forecasting accuracy and real-time stock monitoring. The study suggests integrating advanced technologies and data analytics to address these gaps. Using the secondary data of the balance sheet we have analysed the inventory turnover, growth of total inventory, current assets on raw materials. Also, we have analysed the ABC analysis of the materials. The result shows that the business has maintained a relatively high percentage of inventories on current assets, indicating its reliance on inventory as a key asset