Impact of oral palonosetron in improving quality of life as compared to other oral 5-HT3 antagonists in delayed chemotherapy induced nausea and vomiting in patients of head and neck cancer

Background: Chemotherapy induced nausea and vomiting (CINV) remains one of the most common and debilitating complications of highly emetogenic chemotherapy (HEC). This study was undertaken to evaluate palanosetron against other 5-HT3 receptor antagonists in preventing delayed CINV with the aim of achieving complete response (CR) and improving quality of life (QoL).Methods: This was a prospective, observational study conducted on 75 histopathologically proven patients of squamous cell carcinoma of Head and Neck (H&N), who came to the Department of Radiation Oncology, Gandhi Medical College and Hamidia Hospital, Bhopal from January to December 2015. Standard protocol based chemotherapy containing highly emetogenic cisplatin based chemotherapy was administered to all the patients. For prevention of delayed chemotherapy induced nausea and vomiting all patients were prescribed oral 5-HT3 antagonists. Oral Ondansetron 4mg TDS was given to cohort 1, oral Granisetron 1 mg BD to cohort2 and oral Palanosetron 0.5mg OD was given to cohort 3. They were graded as complete response when they did not have complains of nausea and vomiting.Results: In Ondansetron, Granisetron and in Palanosetron cohort 29%, 53% and 98% patients had complete response.Conclusions: Palanosetron appears superior. Our study was conducted on handfull of patients and compared palanosetron against only two 5-HT3 receptor antagonists, so a larger study is suggested to establish the efficacy and better response of palanosetron

Serial measurement of lipid profile and inflammatory markers in patients with acute myocardial infarction

Serum concentration of lipids and lipoproteins changes during the course of acute coronary syndrome as a consequence of the inflammatory response. The objective of this study was to evaluate the effect of acute myocardial infarction (AMI) on the levels of lipid profile and inflammatory markers. We investigated 400 patients with AMI who were admitted within 24 h of onset of symptoms. Serum levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) were determined by standard enzymatic methods along with high sensitive C-reactive protein (hs-CRP) (latex enhanced immunoturbidimetric assay) and cytokines, interleukin (IL)-6 and IL-10 (quantitative ‘‘sandwich’’ enzyme-linked immunosorbent assay). The results indicate a trend of reduced TC, LDL, and HDL, and elevated TG levels, along with pro- and anti-inflammatory markers (p < 0.001), between day 1 and the day 2 serum samples of AMI patients. However, corrections in the serum levels have been observed at day 7. Our results demonstrate significant variations in the mean lipid levels and inflammatory markers between days 1, 2 and 7 after AMI. Therefore, it is recommended that the serum lipids should be assessed within 24 hours after infarction. Early treatment of hyperlipidemia provides potential benefits. Exact knowledge regarding baseline serum lipids and lipoprotein levels as well as their varying characteristics can provide a rational basis for clinical decisions about lipid lowering therapy

ADVERSE DRUG REACTIONS ASSOCIATED WITH FIRST-LINE ANTI TUBERCULAR DRUGS IN A TERTIARY CARE HOSPITAL OF CENTRAL INDIA: A STUDY OF CLINICAL PRESENTATIONS, CAUSALITY, AND SEVERITY

  Objective: The objective was to study the adverse drug reactions (ADRs) associated with first-line anti-tubercular drugs for clinical presentations, causality, and severity.Methods: A retrospective study was undertaken in a 750 bedded tertiary care teaching hospital of central India for the duration of 1 year (May 2013‑May 2014). Patients diagnosed with tuberculosis and under treatment with the first-line anti-tubercular drugs were study subjects. Causality, preventability, and severity were analyzed and other parameters such as male to female ratio, most affected system, most common class of drug, and common types of ADRs, were studied.Results: Nearly 118 patients were started on anti-tubercular treatment of first-line drugs in the study duration. Out of these 45 patients suffered one or more ADRs with a total number of reported ADRs being 91. 57.77% were males. Maximum patients belonged to the age group of 31-40 years (26.66%). The most commonly involved system was hepatic and biliary system (53.33%) followed by gastrointestinal system (51.11%), the most common ADR observed was disturbed liver transaminases (33.33%) followed by nausea and vomiting (28.88%). Causality assessment by Naranjo's scale showed 58.2% ADRs scoring probable, 31.86% were of possible score, whereas 9.8% definite score category. Severity assessment shows 68.88% cases of mild grading, 31.11% of moderate and no case of severe grading was reported in the study duration.Conclusions: Vigilance regarding these ADRs occurrences can result in early diagnosis and thus, proper management can be instituted earliest. This will build confidence of patients and will decrease the dropouts which in turn can result in decrease chances of developing drug-resistant strains.Keywords: Adverse drug reactions, Multidrug resistant tuberculosis, Extensively drug-resistant tuberculosis, Causality, Naranjo's algorith

COMPARATIVE STUDY OF THE SHIVA GUGGULU AND SIMHANADA GUGGULU IN THE MANAGEMENT OF AMAVATA (RHEUMATOID ARTHRITIS)

Objective: Comparison of effectiveness of two drugs (Shiva Guggulu and Simhanada Guggulu in the same dose of both drug given separately in two different groupA and Group B) on patients of Amavata. Methods: Patients between 18-60 y of age with classical features of Amavata [9] from OPD and IPD of Government autonomous Ayurvedic College and Hospital were selected for the present work; irrespective of their sex, religion, education, etc. Detailed research Performa was prepared to incorporate all the signs and symptoms of the disease Amavata is the second most common joint disorders. Nowadays erroneous dietary habits, lifestyle and environment have led to various autoimmune disorders i.e. Amavisajanya Vikaara and Amavata is one among them. Rheumatoid arthritis can be correlated with Amavata in view of its clinical features. Many research studies have been done to solve this clinical enigma, but an effective, safe, less complicated treatment is still required for the management of Amavata. In the present study, 24 patients of Amavata were registered and randomly grouped into two. In group A, Shiva Guggulu 6 g/day in divided doses and in group B, Simhanada Guggulu 6 g/day in divided doses were given for 8 w. On analysis of the results, it was found that Simhanada Guggulu provided better results as compared to Shiva Guggulu in the management of Amavata. In group A, the mean score of grip strength was 1.14 before treatment, which was reduced to 0.57 after treatment, with 50% relief. It was statistically insignificant. The mean score of grip strength in group B was 2.4 before treatment, which was reduced to 1.5 after treatment, with 37.5% relief. It was statistically highly significant. Results: Before treatment the mean score of walking time in group A was 2, which was reduced to 1 after treatment, with 50% relief. It was statistically insignificant. The mean score of walking time in group B was 1.75 before treatment, which was reduced to 0.75 after treatment, with 45.71% relief. It was statistically significant. In group A, the mean score of foot pressure was 1 before treatment, which was decreased to 0.66 after treatment, with 33.33% relief. It was statistically insignificant. The mean score of foot pressure in group B was 2.3 before treatment, which was decreased to 1.4 after treatment with, 39.13% relief. It was statistically highly significant. In group A, the mean score of general functional capacity was 1.33 before treatment, which was reduced to 0.66 after treatment, with 50% relief. It was statistically highly significant. The mean score of general functional capacity in group B was 1.66 before treatment, which was reduced to 0.66 after treatment, with 60% relief and was statistically insignificant. In group A, the mean score of the degree of disease activity was 1.75 before treatment, which was reduced to 1 after treatment, with 42.85% relief. It was statistically highly significant. The mean score of the degree of disease activity in group B was 1.5 before treatment, which was reduced to 0.75 after treatment, with 50% relief. It was statistically significant. Regarding ESR value, the mean scores before treatment in A and B groups were 54.5 and 55.2, respectively, and they were reduced to 45.3 and 40.1, respectively, after treatment. Group A percentage relief was 16.88%, while in group B it was 27.35%. An apparent difference in improvement of all the cardinal symptoms was observed with the treatment. On comparing Group B proved to be better than Group A. Statistically highly significant difference was found in the improvement of Sandhigraha and statistically significant difference was found in the improvement of Sandhishoola and Sparshasahyata by Simhanada Guggulu than Shiva Guggulu, whereas insignificant difference was observed in the improvement of Sandhishotha. So, from the obtained data it may be inferred that group B is more effective than groupA. Conclusion: It was observed from the treatment that Simhanada Guggulu provided comparatively better relief in cardinal signs and symptoms of Amavata. Keywords: Agni, Ama, Amavata, Rheumatoid arthritis, Shiva Guggulu, Simhanada Guggul

C-reactive protein, inflammation and coronary heart disease

Inflammation is widely considered to be an important contributing factor of the pathophysiology of coronary heart disease (CHD), and the inflammatory cascade is particularly important in the atherosclerotic process. In consideration of the important role that inflammatory processes play in CHD, recent work has been focused on whether biomarkers of inflammation may help to improve risk stratification and identify patient groups who might benefit from particular treatment strategies. Of these biomarkers, C-reactive protein (CRP) has emerged as one of the most important novel inflammatory markers. CRP an acute phase protein is synthesized by hepatocytes in response to proinflammatory cytokines, in particular interleukin-6. Many large-scale prospective studies demonstrate that CRP strongly and independently predicts adverse cardiovascular events, including myocardial infarction, ischemic stroke, and sudden cardiac death in individuals both with and without overt CHD. CRP is believed to be both a marker and a mediator of atherosclerosis and CHD. CRP plays a pivotal role in many aspects of atherogenesis including, activation of complement pathway, lipids uptake by macrophage, release of proinflammatory cytokines, induces the expression of tissue factor in monocytes, promotes the endothelial dysfunction and inhibits nitric oxide production. The commercial availability of CRP high sensitive assays has made screening for this marker simple, reliable, and reproducible and can be used as a clinical guide to diagnosis, management, and prognosis of CHD

Dual-Sided Involvement of Energy Optimization and Strategic Bidding in Wind-PV System to Maximize Benefits for Customers and Power Providers

Global warming is causing industrial development to increase greenhouse gas emissions, impact power provider economies, and potentially pose a solution through renewable energy. In order to solve these issues, the research offers a dual strategic auction difficulty for renewable energy market clear prices (MCPs) to maximize supplier and buyer revenues while mitigating rival unpredictability and renewable vacillation power supply sources. The study uses scenario reduction techniques, including Beta and Weibull distribution of probability, forward-reduction technique, and underestimation and overestimation of the cost function to manage uncertainties in renewable energy. The Gravitation Search algorithm and a hybrid approach ordered weighted average distance (OWAD) combined, with Topsis operational gravitational search algorithm TOGSA (OWAD-TOGSA), are used to solve the multi-objective issue. The study evaluates the performance of IEEE standard 30-bus and 57-bus test systems and an Indian 75-bus operational system to solve a problem involving wind and sun energy in spite of its volatility. The proposed bidding approach is feasible and could increase revenue by nearly 10 &#x0025;, potentially improving efficiency for electric energy-producing utilities and consumers, and its findings will be beneficial for similar research using optimization techniques

Clinico-Epidemiological Profile of Extra-pulmonary Tuberculosis in Central India

Introduction: Tuberculosis (TB) remains a major global health issue. India being highest TB burden country needs concern. It was found that the percentage of patients with EPTB was more in tertiary care centres of India, ranging from 30% to 53%. The primary objective of this study was to describe the basic demographic, clinical characteristics and risk factors of Extrapulmonary Tuberculosis in patients, registered at DOTS centre of tertiary care teaching hospital. Materials and Methods: This is a retrospective, record-based study of patients of EPTB, at the LN Medical College and Hospital, Bhopal, from 1st January 2012 to 30th June 2014. Results: Among 491 cases registered for treatment of all forms of tuberculosis, 361(73.53%) had PTB and 130 (26.47%) had EPTB. The ratio of percentage EPTB: PTB is 1:3.6. Commonest type of EPTB was found in cases of lymph nodes and lymphatic (30.76%), followed by TB in pleural cavity (23.03%). Among different age groups studied, the age group of 20-39 years had the highest proportion of EPTB both in males and females which is the economically productive population of society. Conclusion: The frequency of EPTB in this study was higher (26.47%) with the highest proportion in lymph node (30.76%). The burden of EPTB is more among the productive age group, moreover, being male, young adults and having associated diabetes mellitus were significant risk factors for patient being EPTB positive

Evaluation of Antimicrobial Activity of 3-(4-1H-Indol-3-yl)-(2,3- dihydro-1H-benzo[b]diazepin-2-yl)-2H-chromen-2-one

Abstract-1,5-Benzodiazepines and its derivatives constitute an important class of heterocyclic compounds which possess wide range of therapeutic and pharmacological properties as anticonvulsant, analgesic, sedative, antidepressive, and hypnotic agents. In the last decade, the area of biological interest of 1,5-Benzodiazepines has been extended to several diseases such as cancer, viral infection and cardiovascular disorders. With this background, we had synthesized RVB-01 (3- Structure of this compound have been elucidated by using physical and extensive spectral data. The antimicrobial activity of RVB-01 against B subtilis , P aeruginosa, E coli, M luteus, S aureus was determined by agar diffusion method at 10, 50, 500 and 1000 mcg/ml using ciprofloxacin as a reference. MIC value of RVB-01 against B subtilis was determined by tube dilution method. RVB-01 showed remarkable activity against all microorganisms except E coli and having an MIC value of 250-300 mcg/ml against B subtilis. The results indicated that 2,3-Dihydro-1H-1,5-Benzodiazepines could be the potential candidate eliciting antibacterial activity, and further studies can be conducted using molecular modeling tools for designing 1,5-benzodiazepines having better activity