Therapeutic plasma exchange in neuro-immunological disorder

Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used to remove high molecular weight substances from the plasma. Examples of these substances include immune complexes, pathogenic autoantibodies, endotoxin, cryoglobulins and cholesterol-containing lipoproteins and myeloma light chains. Therapeutic Plasma exchange is a well-established therapeutic procedure most commonly used in many neuro-immunological disorders. The benefit of plasma exchange occurs by elimination of pathognomonic inflammatory mediators, including complement components, autoantibodies and cytokines. Various studied have demonstrated that TPE plays an important role in neuro-immunological disorder (eg. Guillain-Barré syndrome, myasthenia gravis and other forms of immune neuropathies).Methods: It is descriptive and prospective study on the effect of TPE in neuro-immunological disorders. TPE are studied prospectively for a period from September 2011 to August 2013. The amount of plasma to be exchanged during TPE was determined using the formula EPV = (0.065 x weight [kg]) x (1-hematocrit). TPE was performed using a Haemonetics MCS+ intermittent flow cell separator. An average of 1-1.5 plasma volume is removed on alternative days. Clinical outcome of TPE was assessed at the time of discharge.Results: A total of 138 Therapeutic plasma exchange procedure were performed on 30 patients. In which the improvement begins within days of commencing the treatments and progressed steadily so that 25 out of 30 patients who responded favourably to TPE with a manageable adverse reaction. And only 5 patients failed to respond this therapy. So the clinical outcome for therapeutic plasma exchange for Neuro-immunological cases were 83.3% and remaining 16.7% doesn’t show any improvement after five plasma exchanges.Conclusions: Therapeutic plasma exchange is a first line of management for most of the neuro-immunological disorder. In our study there was an improvement in motor performance after 3-5 plasma exchanges which are mainly due to removal of unbound antibodies from the plasma. Although the statistical power of our study was not sufficient to allow definitive conclusion, the result strongly suggest that 3-5 procedures on alternative days with 1-1.5 volume of plasma exchange gives a better result in patient with neuro-immunlogical diseases. The success of therapeutic plasma exchange also depends on composition of the replacement fluid. The risk and complication associated with procedure are also minimal and easily manageable

PHYTOCHEMICAL STUDIES AND GAS CHROMATOGRAPHY-MASS SPECTROMETRY ANALYSIS OF SARCOSTEMMA BREVISTIGMA, WIGHT & ARN.

ABSTRACTObjective: To explore the phytochemical constituents present in Sarcostemma brevistigma using gas chromatography-mass spectrometry (GC-MS).Methods: Preliminary phytochemical analysis of secondary metabolites was made by following standard procedures. GC-MS analysis of the plantextracts was performed by using GC-MS equipped with a DB-35MS capillary standard non-polar column and gas chromatograph interfaced to a MassSelective Detector (MS-DSQ-II) with Xcalibur software.Results: The qualitative phytochemical analysis of this species exhibited the presence of alkaloids, glycosides, flavonoids, phenols, steroids, aminoacids, tannins, terpenoids, quinones, and coumarin. The GC-MS analysis revealed the presence of 24 compounds in the ethanolic extract of aerial partof Sarcostemma brevistigma. The most prevailing compound was 14,17 bis(dimethylaminoamino)[3.3]paracyclophan-5,8-diacetonitrile (14.86%).Conclusion: The study concludes that the species Sarcostemma brevistigma is a potential source for bioactive compounds such as esters, alkanes,alcohols, alkenes, amide, amine, phenol, ketone, and so forth. This study justifies the traditional usage of this species.Keywords: Gas chromatography-mass spectrometry, Sarcostemma brevistigma, Phytochemical compounds, Medicinal plants

UV-VISIBLE SPECTROSCOPIC AND FTIR ANALYSIS OF SARCOSTEMMA BREVISTIGMA, WIGHT. AND ARN

Objective:  The present study was carried out to characterize the bioactive constituents present in aerial parts of ethanolic extract of Sarcostemma brevistigma using UV-VIS and FTIR.Methods:  FTIR spectroscopy is an established timeâ€saving method to characterize and identify functional groups.Results:  The UV-VIS profile showed different peaks ranging from 200â€1044 nm with different absorption respectively. UV-VIS profile showed the peaks at 254.00 and 680.00 nm for flavonoid. FTIR spectra showed the peak at 3418.85 cm-1 for N-H group. FTIR analysis and UV-VIS analysis showed the presence of flavonoids and a phenolic compound. The FTIR spectra had amply evidenced the occurrence of OH group together with the Terpenoids, and Phenol. The FT-IR spectrum showed the presence of an amine (N-H), alkyl (C-H), nitrile (C≡N), halo formyl (C=O), alkenyl (C=C), hydroxyl (O-H), haloalkane (C-F), nitrates and carbonate compounds.Conclusion:  The results confirm the fact that this plant posse's important bioactive constituent, so further scientific investigation is needed

A STUDY ON HYPERPHOSPHATEMIA AND EFFECT OF SEVELAMER ON CARDIAC ENZYME LEVELS IN CHRONIC KIDNEY DISEASE PATIENTS

Objective: Chronic Kidney Disease (CKD) is characterized by progressive loss of kidney function over a period of time. Sevelamer hydrochloride is a phosphate binding agent used to control serum phosphate levels in End Stage Renal Disease (ESRD) patients with hyperphosphatemia. Since hyperphosphatemia is associated with acute myocyte injury and elevation of cardiac biomarkers. ESRD patients treated with sevelamer hydrochloride display reduced cardiac biomarker levels due to a decrease in serum phosphate. Therefore, the study was designed to evaluate the effect of sevelamer hydrochloride on cardiac enzyme levels. Methods: This retrospective observational study was carried out in the nephrology department of a multispecialty hospital for a period of two months. Clinical and biochemistry reports of 30 ESRD patients were collected in designed case report forms. All statistical analysis was carried out using International Business Machines-Statistical Package for the Social Sciences, version 17 (IBM SPSS 17) Statistics package.Results: No significant difference in cardiac enzymes between sevelamer-treated and untreated groups was observed. Hence, further prospective studies on sevelamer hydrochloride are necessary to determine their activity in preventing hyperphosphatemia-induced acute myocyte injury.Conclusion: A direct correlation was observed between cardiac enzyme markers and phosphate levels. However, sevelamer at conventional doses was not found to be effective in reducing acute cardiomyocytes injury caused by hyperphosphatemia. Hence, higher doses sevelamer or other modalities achieving normal serum phosphorous levels are necessary for preventing cardiac damage due to hyperphosphatemia in ESRD patients.Keywords: ESRD, Hyperphosphatemia, Sevelamer, Cardiomyocytes injury

EFFECT OF ORAL AZITHROMYCIN AND METRONIDAZOLE AS AN ADJUNCT TO SCALING AND ROOT PLANING ON GLYCEMIC CONTROL IN TYPE II DIABETIC PATIENTS WITH CHRONIC PERIODONTITIS

ABSTRACTObjective: Periodontitis, a chronic inflammatory disease characterized by destruction of the periodontal ligament and alveolar bone is the sixthcomplication of diabetes mellitus. Periodontal treatment that reduces gingival inflammation aids in the control of hyperglycemia. Therefore, thepresent study was designed to determine the effect of treating chronic periodontitis with oral antibiotics azithromycin and metronidazole on the levelof serum glycated hemoglobin in type-II diabetic patients.Methods: This prospective observational study was carried out in the dental department of a tertiary care hospital for 9 months. Clinical andbiochemistry reports of 90 patients were collected in designed case report forms. All statistical analyses were performed using IBM Statistical Packagefor Social Sciences 17 and Graph Pad Prism 7.0.Results: Significant reduction in all the clinical and dental parameters was comparatively higher in patients who received azithromycin than inpatients who received metronidazole and scaling and root planning alone.Conclusion: Periodontal therapy with oral azithromycin can be employed as a supportive strategy for the management of diabetes mellitus.Henceforth, prevention and control of periodontal disease along with antibiotics must be considered an integral part of glycemic control. However,due to the lesser sample size in this study, further investigations are required to confirm the effect of periodontal therapy on systemic diseases.Keywords: Periodontitis, Azithromycin, Metronidazole, Glycemic control, Diabetes mellitus

Video Based Emotion Recognition Using CNN and BRNN

Video-based Emotion recognition is rather challenging than vision task. It needs to model spatial information of each image frame as well as the temporal contextual correlations among sequential frames. For this purpose, we propose hierarchical deep network architecture to extract high-level spatial temporal features. Two classic neural networks, Convolutional neural network (CNN) and Bi-directional recurrent neural network (BRNN) are employed to capture facial textural characteristics in spatial domain and dynamic emotion changes in temporal domain. We endeavor to coordinate the two networks by optimizing each of them to boost the performance of the emotion recognition as well as to achieve greater accuracy as compared with baselines

A Complete Design of Smart Wind Farm Enriched with Novel Anemometer

Renewable energy are endless and environment friendly sources of power production and also it is considered as the alternative of non- sustainable energy sources like coal, fossil fuels and nuclear power. Wind Energy is accounted as one of the fast depleting, pollution free energy source compared to hydro power and thermal power. Internet of Things (IoT), which is a wireless, self configuring network of sensors powered with communication facility promotes the facility of remote monitoring and control activities in smarter way without human intervention. Likewise machine learning is another technological giant offers accurate prediction over the voluminous data and imposes intelligence to the machines kept for operation. The primary objective is to develop an IoT based wind farm module that enables installed capacity identification, structural monitoring and scope for power generation in that locality

Study on outcome of N-acetylcysteine in rodenticide poisoning cases in a rural tertiary care teaching hospital

Background: Rodenticide is one of the pesticides and heterogeneous substances used to kill rats. Rodenticide poisoning is the major health problem in Asian countries, particularly mode of self-poisoning, prevalent in India. It causes hepatotoxicity and no antidote has been found. N-acetylcysteine (NAC) is a powerful antioxidant and used in the treatment of acetaminophen-induced hepatotoxicity.  The aim of the study is to find the outcome of use of NAC in rodenticide poisoning.  The main objectives of this study were to determine the role of NAC in liver impairment rodenticide poisoning patients.   Methods: A record based observational study was conducted for the period of 3 months from August 2019 to October 2019 at Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar, Tamil Nadu. Data were collected according to the proforma designed and results were analyzed using standard methods.Results: Out of 50 patients, 21 (42%) were males and 29 (58%) were females. Age group between 21-30 years contributes the highest 20 (40%). Majority of type of rodenticide compound consumed by patients were paste 29 (58%) and less than four hours 34 (68%) patients were admitted. Patients with abnormal liver functions were tested, serum glutamic oxaloacetic transaminase/ aspartate aminotransferase -12 patients, 7 treated with NAC. serum glutamic pyruvic transaminase/ alanine aminotransferase - 9 patients, 2 treated with NAC. 37 (74%) were recovered out of 50 (100%), among them 28 (56%) treated with NAC.Conclusions: In liver impairment rodenticide poisoning patients, early use of NAC shows a significant result and the rate of recovery is also high

ATTITUDE TOWARDS GENERIC FORMULATIONS USAGE: NARROWING THE GAP BETWEEN PHARMACIST AND PHYSICIANS

Objective: The thought of providing the best quality of medicines at cheaper costs made the governments to think of generic drug substitutions in order to minimize the economic burden. This study was designed to investigate the attitude of physicians and pharmacists towards generic medicines and thus to reduce the gap between them.Methods: This is a simple, prospective, cross-sectional, comparative study conducted for a period of 3 mo. 100 Subjects (50 pharmacists and 50 physicians) were included in this study. Subjects who ever graduated with the pharmacy degree and working as pharmacists, as well as clinical practitioners, were included in this study. Data collected using a validated questionnaire.Results: 60% of physicians and 80% of pharmacists were confident enough in dispensing generic products. 56% of physicians agree that pharmacists play a vital role in providing assistance on the use of generic medicines. 70% of physicians and 90% of pharmacists agreed that the generic medicines are of less expensive.Conclusion: Our Study concludes that pharmacist's shows a higher positive response towards the usage of generic products than physicians. Generic drugs typically cost 30% to 60% less than their brand products. In addition, patients taking generic drugs seem to be more willing to continue therapy