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Introduction: Overexpression of cyclooxygenase-2 (COX2) in urothelial carcinoma of bladder (UCB) had been studied in the past by different workers and the results were contradictory. The objective of the present study was to evaluate the prognostic implication of COX2 expression in primary urothelial carcinomas of the urinary bladder and its correlation with clinical parameters, tumor stage, grade, and recurrence. Materials and methods: A total of 68 cases who underwent surgery for urothelial carcinoma in our medical college from January 2013 to December 2015 were evaluated in our study. Hematoxylin and eosin-stained slides were examined by two faculties applying standard reporting protocol. Tumor staging and grading was performed as per the WHO guidelines. Immunohistochemistry for expression of COX2 was performed to study any correlation of tumor grade with COX2 expression. The distribution of COX2 positivity was studied in tumors stratified according to established bladder cancer prognostic factor, for example, tumor size, grade, invasion, and spread. Results: Out of 68 cases, 42 cases showed COX2 positivity (61%). In low-grade cases of bladder carcinoma, COX2 positivity was 16 out of 24 cases (60%), and in high-grade cases, COX2 positivity was 10 out of 18 cases (64.28%). Conclusion: In the present study, the association of COX2 overexpression with advanced tumor invasion and tumor grade has been substantiated. Hence, COX2 expression can be taken as a prognostic factor along with other usual prognostic factors in patients of UCB. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented based on the topic of diagnosis of sexually transmitted diseases syndrome-wise in a subdivision level hospital of rural West Bengal, India.

Aims: The aim of the present study is to substantiate and compare the quality and extent of nerve block by using intrathecal bupivacaine or extradural bupivacaine alone and in combined spinal-epidural (CSE) technique using smaller dose of intrathecal bupivacaine and extradural injection of a smaller dose of bupivacaine or normal saline. Setting and Design: A prospective study design was set up with 60 adult patients scheduled for vaginal and lower abdominal operation under CSE technique and single spinal or epidural technique. Materials and Methods: 60 patients undergoing infra-umbilical surgery were divided into three groups (Group). Group A1 (control) 10 patients received 3 ml of intrathecal heavy bupivacaine. A2-10 patients received 16 ml isobaric bupivacaine extradurally Group B (n = 20) patients received 2 ml intrathecal heavy bupivacaine and 10 ml normal saline extradurally. Group C patients (n = 20) received 2 ml heavy bupivacaine intrathecally and 10 ml isobaric bupivacaine extradurally. A total duration of this study was 18 months. Duration of motor block, sensory block, analgesia, onset of sensory block and cephaloid extent of sensory block and side-effects noted among patients. Visual analog scale in the post-operative period was recorded. Statistical Analysis: The results were analyzed statistically by applying analysis of variable, odds ratio and Chi-square test. Results: Patients were comparable regarding the onset time and height and duration of sensory block with a significant difference, though there was no difference in duration of motor block and analgesia. The side-effects in the control group are higher than the other two groups. Conclusion: Quality of nerve block in combined technique using bupivacaine both intrathecally and extradurally is better and associated with lower side-effect compared with intrathecal heavy bupivacaine or extradural isobaric bupivacaine alone. [ABSTRACT FROM AUTHOR]

Background: Humans are accidental hosts in the zoonotic disease Scrub typhus. The disease though widespread in our county, it remains grossly underdiagnosed because of its non-septic clinical manifestations and lack of access to specific laboratory facilities. Aims and Objectives: The objective of present study is to evaluate the clinical presentations of Scrub Typhus among the study group. Furthermore, to assess the various laboratory findings in Scrub Typhus cases among the study group is the other objective of this study. Materials and Methods: The present study is an Institution-based, observational, and cross-sectional study conducted for 18 months with the admitted patients having 14-70 years of age. Data collected regarding patients' demographic profile, symptoms, clinical findings, laboratory, and radiological findings. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Results: In our study, we found that most of the patients were 14-20 years old and female population was higher. It was found that 34.3% of patients had Eschar, 42.9% of patients had Rash, and 91.4% of patients had Pallor, 8.6% of patients had Ascites, 25.7% had Edema, 8.6% of patients had Jaundice, 11.4% had shock, and 57.1% had pneumonia/pneumonitis. The present study showed that 65.7% of patients had drug response (Doxycycline). Conclusion: Knowledge of geographical distribution, evidence of exposure to vector, clinical features such as fever, rash, eschar, headache, and myalgia along with high index of suspicion are crucial factors for early diagnosis and that helps in timely treatment of the cases. [ABSTRACT FROM AUTHOR]

Background: Subarachnoid anesthesia also known as spinal anesthesia is now considered to be a safe form of anesthesia for lower abdominal and lower limb surgeries. The height of sensory block achieved in spinal anesthesia after drug administration can be altered by changing the position of the patient, and this precisely is the advantage of using hyperbaric local anesthetic drug. Aims and Objectives: The aim of this study is to compare the effect of position - horizontal and Trendelenburg on the height of sensory block in spinal anesthesia. Materials and Methods: After obtaining the institutional ethical clearance, total 66 patients scheduled for lower abdominal surgery under spinal anesthesia were selected and divided into two groups - Group A patients were placed in Trendelenburg position with 20° head down for 40 s and then returned to horizontal position and Group B patients were placed in horizontal position after spinal anesthesia. The level of sensory block was compared among the two groups at different points of time up to 30 min of drug administration. Results: The patients who remained in Trendelenburg position for 40 s after spinal anesthesia achieved a higher level of sensory block earlier as compared to the horizontal group and the maximum block height was two spinal segments higher than that of the horizontal group. Conclusion: From our current study, we can conclude that Trendelenburg position can be used to achieve a higher level of sensory block as compared to horizontal position after successful neuraxial block. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the relative efficacy of prophylactic intravenous (IV) clonidine and tramadol for control of intraoperative shivering following spinal anesthesia. Materials and Methods: After institutional ethical clearance, 142 patients were chosen from either gender, aged 20-60 years, physical status American Society of Anesthesiology Class I and II scheduled for elective infraumbilical surgery under spinal anesthesia. Patients were randomized into two groups: Group C (n = 71) received injection clonidine 50 µg) IV in 100 ml normal saline (NS) over 10 min and Group T (n = 71) received injection tramadol 50 mg IV. In 100 ml NS over 10 min after spinal anesthesia. Results: Incidence of shivering was not significant when compared between the two groups (P > 0.05). The axillary temperatures fell significantly in Group C from the baseline and remained at a significantly lower level up to 60 min after rescue drug was administered in patients who shivered. There was a similar fall in axillary temperature in Group T in patients having shivering, but the difference was not significant. When compared between the two groups among patients who shivered, the difference in fall of temperature was not significant. Side effects such as hypotension, bradycardia, and sedation were significantly more common in clonidine group, whereas nausea was significantly more common patients of tramadol group. Conclusion: Prophylactic administration of both tramadol and clonidine is effective for controlling shivering under spinal anesthesia. However, tramadol is better because of higher response rate, less sedation, and lesser hemodynamic alterations. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is known to induce oxidative stress along with deranging various metabolisms; one of the late complications of diabetes mellitus is diabetic retinopathy, which is a leading cause of acquired blindness. Poor glycemic control and oxidative stress have been attributed to the development of complications like diabetic retinopathy. The aim of this study was to analyze and correlate oxidative stress marker, Malondialdehyde (MDA), and antioxidants (erythrocyte glutathione, vitamin C) along with glycosylated hemoglobin (HbA1c) and fasting blood sugar (FBS) in diabetic patients with and without retinopathy. Materials and Methods: The study population comprised of 50 type 2 diabetics with retinopathy as Group 1 (G1) and 50 type 2 diabetics without retinopathy as Group 2 (G2) in the age group 40-70 years as patients, and 50 ageand gender-matched healthy individuals as controls, Group 3 (G3). FBS, HbA1c MDA, glutathione in erythrocytes, and vitamin C were assayed. Results were analyzed using SPSS 11.0, Mann-Whitney U-test, and Pearson correlation coefficient. Results: Mean FBS (mg/dl) were 194.04 ± 48.52 (G1), 181.24 ± 50.05 (G2), and 92.20 ± 9.19 (G3) (P < 0.001). Mean values of MDA were 6.65 ± 0.30 (G1), 4.63 ± 0.56 (G2), and 3.90 ± 0.34 (G3) (P < 0.001). The mean reduced glutathione (GSH) levels were (mg/g of Hb) 6.10 ± 1.41 (G1), 6.44 ± 1.53 (G2), and 13.09 ± 2.49 (G3) (P < 0.001). The mean vitamin C levels (mg/dl) were 0.70 ± 0.24 (G1), 0.87 ± 0.29 (G2), and 1.25 ± 0.27 (G3) (P < 0.001). Conclusion: Estimation of HbA1c, MDA, GSH in erythrocytes, and vitamin C levels can contribute to determine the extent of oxidative stress in diabetes and help in effective control and prevention of the onset and progression of diabetic retinopathy [ABSTRACT FROM AUTHOR]

The article presents information on a study conducted to differentiate between oxidative stress caused by chemical and biological agents causing hepatitis. In the study, the control group consisted of 100 healthy individuals aged 20-75 years from Kolkata, India. The second group consists of 100 alcoholic hepatitis patients, aged between 20 and 75 years; and the third group consisted of 100 clinically proven cases of hepatitis B patients admitted in hospital. In the blood samples of the three groups, aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (ALP), and gamma glutamyl transferase (GGT) were measured. Pearson correlation was used to compare the oxidative stress parameters with liver enzymes.