Single dose surfactant early rescue therapy in respiratory distress syndrome-experience and outcome at a tertiary care centre

Background: Neonatal respiratory distress syndrome (RDS) is a progressive respiratory failure that is caused primarily by a deficiency of pulmonary surfactants (PS). We undertook a prospective study to evaluate outcomes of neonatal respiratory distress syndrome (RDS) patients treated with early rescue pulmonary surfactant.Methods: This was a prospective cross sectional study conducted at level III NICU. A total of 47 eligible  patients out of 142 diagnosed RDS on chest x-ray or FiO2 ≥40 was needed to reach SpO2 between 85 and 93%  received early recue surfactant therapy (within 2hrs of life) and  maternal ,neonatal and clinical data was analysed using SPSS software.Results: In this study prevalence of RDS amongst neonates admitted in NICU was 16.4%, early rescue surfactant therapy could be given only to 47 cases. There was male predominance (2.62:1). Mean age of administration of surfactant was 1.30±0.8 hr and Antenatal steroid was given in only 21.3% of mothers. Fraction of inspired oxygen concentration (Fio2) requirement also significantly decreases before and after therapy (p value˂0.0001) at 6,12, and 24 hrs. PEEP also shows decreasing trend at 24 hrs (p value ˂0.05). Sepsis was the commonest complication leading to mortality.Conclusion: Implementation of early rescue administration of surfactant in infants at high risk for developing RDS in neonatal ICU is a safe and effective modality of respiratory support which decreases ventilatory requirements, improves respiratory status, and causes early extubation.

Falls from flat roofed house in and around the city of Rewa, Madhya Pradesh: a study from central India

Background: High falls from flat-roofed houses are a common cause of death and disability in this part of central India; the aim of this study was to describe the experience of such falls seen over a 2-year period.Methods: In this cross sectional study one hundred and twenty two patients (96 male and 26 female) who fell from flat roofed houses were entered and analysed.Results: The Prevalence of fall from flat roofed house was 60.3% (122/202). The mean age of the whole group of patients was 16 years (range 1-75 years); majority of cases were of 11-30year age group (54.1%). Males, adolescent and rural population showed a greater tendency to fall from height. The mean height of these accidental falls was 3.65±2:6 m. Head injury was the most common injury and most common cause of mortality and morbidity in these patients.Conclusions: Death due to fall from height is an unforeseen and unfortunate occurrence. Cranio-cerebral trauma is the most common injury in fatal falls from flat roofs. Parental control, guidance and construction of parapet on roof tops can reduce this economic burden and protect vulnerable groups of people of our country from this type of incidents

Giant Calcifying Aponeurotic Fibroma of Web Space: Case Report with Review of Literature

Calcifying aponeurotic fibromais an uncommon, benign fibroblastic tumor which has a preference for neighborhood invasion and a high relapse rate. Henceforth, precise preoperative analysis and complete extraction are imperative to counteract the recurrence of the tumor after careful surgical removal. We report a case of 75 year old man with left hand first web space calcified aponeurotic fibroma with distinct radiological and MRI features

Kimura's Disease: A Case Report and Review of Literature

Kimura's Disease (KD) is a benign chronic inflammatory disorder attributed to an immune mediated hypersensitivity. It typically manifests by painless subcutaneous nodules in head or neck region and often accompanied by regional lymphadenopathy, salivary gland involvement along with hyper eosinophilia and elevated serum IgE. Most cases have been described predominantly in Chinese and Japanese people. Kimura's disease has been confused with Angiolymphoid Hyperplasia with Eosinophilia (ALHE), from which it probably should be distinguished as a separate entity. The course is usually benign except for the potential cosmetic disfigurement. The diagnosis may be suggested by a fine needle aspirate, but is established by a biopsy. A case of Kimura's disease in a 42 year male with recurrent left submandibular swelling is presented together with a brief review of the literature

PREFORMULATION STUDIES OF DILTIAZEM HYDROCHLORIDE FROM TABLETED MICROSPHERES

Microspheres are solid, spherical particles of protein or polymer-based matrix which comprised of a fairly homogeneous mixture of polymer and active agents.It undergoes considerable presystemic metabolism (45-55%) which results in reduced bioavailability. Diltiazem hydrochloride was scanned in the Methanol, acid buffer, pH 1.2and phosphate buffer, pH 7.2. 10 mg of drug was dissolved in methanol in 100 ml in volumetric flask, and volume was made to 100 ml with same solvent. This stock solution was further diluted to get concentration of 10mcg/ml. This solution was scanned in UV-spectrophotometer and characteristic peak was observed at 239 nm for methanol,237 nm for acid buffer, pH 1.2 and phosphate buffer, pH 7.2. Standard curve of Diltiazem hydrochloride was plotted in Methanol, acid buffer (pH 1.2) and phosphate buffer (pH 7.2).  The critical values for regression coefficient in each plot was less than 0.001 (i.e., P < 0.001).  That indicates that there was high linear correlation between concentrations of drug with absorbance. Keywords: Diltiazem hydrochloride, regression coefficient, bioavailability, Microspheres

Formulation of Rapid Dissolving Films Containing Granisetron Hydrochloride and Ondansetron Hydrochloride

The oral mucosa is conveniently and easily accessible and therefore allows uncomplicated application of dosage forms. A rapid-dissolving drug delivery system, in most cases, is a tablet that dissolves or disintegrates in the oral cavity without the need for water or chewing. More recently, fast-dissolving films are gaining interest as an alternative to fast-dissolving tablets to definitely eliminate patients’ fear of chocking and overcome patent impediments. In the present study, calculations for amount of drugs were determined, Rapid dissolving films containing GSH were prepared using solvent casting method. An aqueous solution of polymer was prepared in distilled water. For preparing the solution, polymer was soaked in water for some time (wherever required). This was followed by addition of GSH in the aqueous solution of the polymer. Now, plasticizer (PEG 400 and/or Glycerol), sweetening agent (Aspartame and/or Sucralose), citric acid and flavor were also added to this solution. In-vitro disintegration time (DT) of the prepared rapid dissolving films was determined visually in a glass beaker containing 50ml water and swirling every 10 seconds. Average of 3 films was taken for this purpose. In-vivo DT of the prepared rapid dissolving film was determined by mouth in three human volunteers. Evaluation of taste was done by a taste panel with 2mg drug and subsequently one film held in the mouth for 10-15 seconds. For preparing rapid dissolving films, varying amount of Pullulan, METHO K3P, METHO E3P were taken. Solvent evaporation method was used for preparation of the film. Various polymers used in the study were: Pullulan, Metho K3P, Metho E3P, Metho E15P and Poly N10. PEG-400 and glycerol were used as plasticizer. Aspartame and sucralose were used as sweetening agent while citric acid was used as saliva stimulating agent Keywords: Rapid dissolving film, Ondansetron hydrochloride (OND), Granisetron Hydrochloride (GSH)

Preformulation Studies of Rapid Dissolving Films Containing Granisetron Hydrochloride

Rapid-dissolving solid drug dosage forms for application onto the oral cavity for the pediatric population seem to be very appropriate, especially in preterm and term infants. The delivery of drugs via the oral mucosa offers easy application, prevents drug degradation by gastrointestinal fluids, avoids first-pass metabolism and potentially improves bioavailability. Granisetron hydrochloride (GSH) drug is used as antiemetic agent. Proposed work comprise of preformulation studies of Granisetron hydrochloride. For that, physicochemical parameters were determined; like melting point of GSH was determined using melting point apparatus, Granisetron hydrochloride was scanned in the distilled water, Acid buffer, pH 1.2 and Phosphate buffer, pH 6.8. The IR spectrum of pure drug (GSH), Pullulan, METHO K3P, METHO E3P, METHO E15P and POLYOX WSR N10 were recorded in potassium bromide using Shimadzu FTIR – 8400S(CE). Solubility of Granisetron hydrochloride was determined using shake flask method. Standard Plot of Granisetron hydrochloride in distilled water, Acid buffer, pH 1.2 and Phosphate buffer, pH 6.8 were taken, all the parameter obtained were satisfactory, which will be used further for formulation of rapid dissolving film. Keywords: Rapid dissolving film, Granisetron hydrochloride (GSH), Preformulation

Heterotopic subserosal pancreatic tissue in jejunum

Heterotopic pancreas (HP) is typically an asymptomatic malformation that can present anywhere along the gastrointestinal tract. It is frequently detected incidentally on surgery for other diseases or autopsy. We encountered an incidentally detected subserosal nodule in proximal jejunum during exploratory laparotomy for other cause which was resected and on histopathology confirmed to be HP. Histologically, most of the tumors are located in the submucosa, rarely in the muscularis propria, and only seldom in the subserosal. This case is of great interest because of the subserosal location of the tumor

Kimura's disease

Kimura's disease (KD) is a benign chronic inflammatory disorder attributed to an immune-mediated hypersensitivity which often presents as a tumor-like swelling in the head and neck region with or without lymphadenopathy, associated with hypereosinophilia and elevated serum immunoglobulin E. Most cases have been described predominantly in Chinese and Japanese people. KD has been confused with angiolymphoid hyperplasia with eosinophilia, from which it probably should be distinguished as a separate entity. The course is usually benign except for the potential cosmetic disfigurement. The diagnosis may be suggested by a fine-needle aspirate but is established by a biopsy. A case of KD in a 42-year-old male with recurrent left submandibular swelling is presented together with a brief review of the literature

Web Space Lipoma Causing Separation of Toes - A Rare Case Report with Review of Literature

Lipomas are common and benign soft tissue neoplasms which are composed of fat cells. These tumours often develop where adipose tissue is present. Some lipomas are believed to develop after blunt trauma. Reports of a lipoma in the foot exist, but the occurrence of the tumour in web space is rare. Here we present case of a 65 year old female with lipoma at the third web space causing separation of toes