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Recent evidence suggests Trendelenburg positioning can produce a significant rise in intra-ocular pressure. Peri-operative vision loss in patients undergoing laparoscopic colorectal surgery has been reported with the rise in intra-ocular pressure suggested as a possible factor. Acetazolamide decreases intra-ocular pressure by reducing the formation of aqueous humour, so we aimed to investigate if it could attenuate the intra-ocular pressure rise that can occur in the Trendelenburg position. Nine healthy volunteers were recruited and randomly assigned to a double-blind crossover comparison of placebo or acetazolamide with a minimal 4 days' washout period before the second study day. One and a half hours after taking the medication, volunteers lay head-down at 17° for 4 h. Intraocular pressure measurements were repeated in both eyes every 30 min over a 4-h period. There were two males and seven female volunteers, with a mean (SD) age of 54.3 (18.5) years. The mean (SD) increase in intra-ocular pressure following 4 h in the Trendelenburg position was 3.17 (4.63) mmHg after the placebo, and 0.02 (4.01) mmHg (p = 0.02) after acetazolamide. We have shown than acetazolamide can attenuate the rise that occurs in intra-ocular pressure when in the Trendelenburg position. [ABSTRACT FROM AUTHOR]

High-risk human papillomavirus (hr-HPV) infection is causal for almost all cervical malignancy (both squamous and adenocarcinoma), 90% of anal neoplasia, 70% of penile tumors, and 25% of head and neck cancers. The shared immunogenetics of cervical and esophageal malignancy suggests that HPV infection could well be a common denominator in the etiology of both cancers. In this regard, we have demonstrated that transcriptionally active hr-HPV (genotypes 16 and 18) is strongly associated with Barrett's dysplasia and esophageal adenocarcinoma. Increasing hr-HPV viral load and integration status has been linked with greater disease severity along the Barrett metaplasia–dysplasia–adenocarcinoma sequence as has been demonstrated in cervical intraepithelial neoplasia and cancer. HPV infections in both the cervix and esophagus are both focal, i.e. present in greater quantities at the squamocolumnar junction (SCJ). HPV affinity is to junctional tissue, as basal cells are particularly accessible at the squamocolumnar transformation zone and especially susceptible to this viral infection. We have postulated that progressive acid damage to the esophagus increases the likelihood of mucosal breaks enabling the virus to enter the basal layer of the transformation zone. The SCJ is the transformation zone of the esophagus and is strikingly similar to the transition zone (ectoendocervical SCJ) of the uterine cervix where almost all high-grade cervical lesions and cancers arise including 80% of adenocarcinomas. These transition zone cells exhibit features of squamous epithelium as well as glandular cells, which have been described in both Barrett's esophagus and cervical mucosa. Barrett's esophagus (BE) is derived from a discrete population of embryonic cells residing at the SCJ. There is loss of SCJ immune-phenotype following excision without regeneration at other junctional sites. Prevention of cervical cancer in up to 80–95% of patients with screen-detected CIN is dependent on the excision/ablation of the entire transformation zone. The persistence of hr-HPV 16/18 following eradication of CIN is a significant risk factor for recurrence. Similarly, we have demonstrated that persistent hr-HPV infection 16/18 and p53 overexpression are associated with treatment failure after endoscopic ablation of BD/EAC. Thus, we believe that excision/ablation of the SCJ in patients with BD/intramucosal EAC should be performed to reduce the potential malignant risk. We propose to test this hypothesis by a multicenter randomized controlled trial whereby patients (both HPV positive and those which are virus negative) will be allocated into two arms: complete excision of the SCJ via endoscopic mucosal resection (EMR) in addition to radiofrequency ablation (RFA) ± EMR of BD/intramucosal EAC (experimental arm) versus current standard of care (RFA ± EMR) of said lesions. Treatment efficacy in both groups will be evaluated by comparing disease elimination, regression/progression, and recurrence (if any). All patients would be entered into an intensive endoscopic surveillance protocol (biannually) for at least 2 years with lesional/neosquamous biopsies to compare the recurrence rate of both dysplasia/neoplasia in both arms. Viral (HPV DNA/p16INK4A/E6/E7 mRNA) and host biomarkers (e.g. p53) will be analyzed both at baseline and posttreatment intervals. A positive study would initiate development of tools best suited for SCJ destruction. [ABSTRACT FROM AUTHOR]

Objectives: Levosimendan is a calcium sensitizer drug which has been used in cardiac surgery for the prevention of postoperative low cardiac output syndrome (LCOS) and in difficult weaning from cardiopulmonary bypass (CPB). This study aims to evaluate perioperative hemodynamic effects of levosimendan pretreatment in patients for offpump coronary artery bypass graft (OPCABG) surgery with low left ventricular ejection fractions (LVEF < 30%). Materials and Methods: Fifty patients undergoing OPCABG surgery with low LVEF (<30%) were enrolled in the study. Patients were randomly divided in two groups: Levosimendan pretreatment (Group L) and placebo pretreatment (Group C) of 25 each. Group L, patients received levosimendan infusion 200 mg/kg over 24 h and in Group C Patients received placebo. The clinical parameters measured before and after the drug administration up to 48 h were heart rate (HR; for the hour after drug infusion), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP). The requirement of inotropes, intraaortic balloon pump (IABP), CPB, intensive care unit (ICU) stay, and hospital stay were also measured. Results: The patients in group L exhibited higher CI and PCWP during operative in early postoperative period as compared to control group C. Group L also had a less requirement for inotropes, CPB support and IABP with shorter ICU stay as well as hospital stay. Conclusion: Levosimendan pretreatment (24 h infusion) in patient for OPCABG with poor LVEF shows better outcomes and hemodynamics in terms of inotropes, CPB and IABP requirements. It also reduces ICU stay. [ABSTRACT FROM AUTHOR]

There is rising interest of herbal drugs in the health and their benefits. The beneficial reason is that they might offer a natural safeguard against the development of certain conditions and be a reputed treatment for some diseases or ailments. One such area may be the lowering of the blood pressure in elevated (hypertension) patient. One major class of clinical medicines that are used to lower the blood pressure are known as diuretics and they work by increasing the volume of urinary excretion as well as the amount of sodium in urine from our body. There are a large number of studies which supports the diuretic effects of traditional herbal medicines. This article reviews the various herbal drugs used traditionally as diuretics and identify which chemical constituent of the plant promotes diuresis. We review many species and genuses which show diuretic activity. [ABSTRACT FROM AUTHOR]

Background Dexlansoprazole MR employs a dual delayed-release delivery system that extends drug exposure and prolongs pH control compared with lansoprazole. Aim To assess the efficacy and safety of dexlansoprazole MR in healing erosive oesophagitis (EO). Methods Patients in two identical double-blind, randomized controlled trials ( n = 4092) received dexlansoprazole MR 60 or 90 mg or lansoprazole 30 mg once daily. Week 8 healing was assessed using a closed testing procedure – first for non-inferiority, then superiority, vs. lansoprazole. Secondary endpoints included week 4 healing and week 8 healing in patients with moderate-to-severe disease (Los Angeles Classification grades C and D). Life-table and crude rate analyses were performed. Symptoms and tolerability were assessed. Results Dexlansoprazole MR achieved non-inferiority to lansoprazole, allowing testing for superiority. Using life-table analysis, dexlansoprazole MR healed 92–95% of patients in individual studies vs. 86–92% for lansoprazole; the differences were not statistically significant ( P > 0.025). Using crude rate analysis, dexlansoprazole MR 90 mg was superior to lansoprazole in both studies and 60 mg was superior in one study. Week 4 healing was >64% with all treatments in both studies. In an integrated analysis of 8-week healing in patients with moderate-to-severe EO, dexlansoprazole MR 90 mg was superior to lansoprazole. All treatments effectively relieved symptoms and were well tolerated. Conclusion Dexlansoprazole MR is highly effective in healing EO and offers benefits over lansoprazole, particularly in moderate-to-severe disease. [ABSTRACT FROM AUTHOR]

Aqueous extract of leaves of neem (Azadirachta indica Juss.), provided control of leaf stripe pathogen (Drechslera graminea) on barley that was as effective as the fungicide bavistin (carbendazim). The treated leaves exhibited significantly high activity of enzymes phenylalanine ammonia lyase (PAL) and tyrosine ammonia lyase (TAL) alongwith rapid and distinct accumulation of fungitoxic phenolic compounds. The population of most phylloplane mycoflora species remained unaltered except for a few species which were inhibited by the leaf extract. Germination of spores of D. graminea was not significantly inhibited by neem extract. The results support the hypothesis that neem extract may act indirectly by inducing plant defence reactions and it may be useful in integrated management of leaf stripe disease of barley. [Copyright &y& Elsevier]

A 6-year study on the treatment of typhoid fever in children from India - Are we running out of options? So, to know the actual practices of antibiotics in the treatment of typhoid fever we designed the current study in a tertiary care hospital. In the hospitalized patients the antibiotics given were measured as days of therapy per 1000 patient days and in OPD as per the antibiotic were prescribed. [Extracted from the article]

Background: Antibiotic resistance in enteric fever continues to pose major therapeutic challenge with increase in ciprofloxacin resistance. Azithromycin has been used to treat enteric fever as an alternate treatment option without any guidelines for laboratory interpretation. In 2015 issue CLSI has added breakpoints for testing azithromycin susceptibility in typhoidal Salmonellae. We aimed to assess the prevalence of resistance to azithromycin in S. Typhi and S. Paratyphi A in a collection of strains to characterize the mechanisms underlying resistance. Methods & Materials: A total number of 224 S. Typhi and S. Paratyphi A isolates were available in the cryopreservated stock which were isolated from the patients presented with enteric fever during 1990 to 2015. Antimicrobial susceptibility testing was done by disk diffusion method as per CLSI 2015 and MICs were determined by E test method as per manufacturer's guidelines (AB Biodisk, Sweden). For molecular chaeacterization of azithromycin resistance, PCR detection was done to screen for the presence of genes responsible for azithromycin resistance i.e, ereA, ereB, ermB, mefA, mphA, mphB and mphD from plasmid and genomic DNA. Sequence analysis was done to detect mutations in acrR, rlpD and rlpV from genomic DNA. Results: It was observed that 96.11% of the isolates were susceptible to azithromycin using disk diffusion method. There was a linear trend observed with time in azithromycin susceptibility (X² = 5.240, P value <0.02). The MIC 50 and MIC 90 values were 6 and 12μg/ml respectively while the resistance breakpoint is ≥16μg/ml. There was no acquired gene for macrolide resistance in plasmid or genomic DNA of any isolate and DNA sequences of acrR, rlpD and rlpV genes did not show any mutations. Total use of azithromycin in pediatric population was only 13,125 mg given to 16 patients in 2014-15. Conclusion: Azithromycin is a good promising agent against typhoid fever on the basis of MIC distribution in India at present. More studies are required to study the use of azithromycin in complicated infections as at present it is being used only for uncomplicated cases. [ABSTRACT FROM AUTHOR]

Femoral shaft fractures are common in children and are increasingly being treated with elastic intramedullary nail. We outline an instrument we have used successfully to make an entry point for placement of elastic nail. [ABSTRACT FROM AUTHOR]

Background: Salmonella enterica ser. Typhi is the causative agent of the clinical condition called typhoid fever that results after an incubation period of 10 to 15 days following infection. The main line of treatment of typhoid fever includes antibiotics such as fluoroquinolones and aminoglycosides; however, several studies have reported decreased susceptibilities of fluoroquinolones among Salmonella spp isolated from human infections. Thus, this necessitates the studies to explore alternative or adjunct therapeutic agents. Methods & Materials: In this study we isolated and screened the antimicrobial potential of 92 vaginal lactic acid bacteria from healthy women against S. enterica ser. Typhi MTCC 733 by using agar gel diffusion assay. Further, the susceptibility of S. enterica to various antibiotics and the synergistic activity of the culture supernatant (CS) of the isolate 12a along with antibiotics was determined by using Kirby Bauer disk diffusion and chequerboard titration methods, respectively. Results: The isolate no. 12a, identified as Enterococcus spp. by using physico-chemical characterisation showed broad spectrum antimicrobial activity against many Gram-negative pathogens including S. enterica MTCC733. The antimicrobial activity of the CS of 12a was proteinaceous in nature and lost its activity on treatment with pepsin, proteinase K and papain. The minimum inhibitory concentration of the CS was 2133 AU/ml and was stable over a wide pH range of 3-11. Further, the antimicrobial activity of the CS was lost at 100°C; 1 hr treatment. The susceptibility of S. enterica to various antibiotics was determined and it showed reduced susceptibilities to many fluoroquinolones and aminoglycosides. Chequerboard titration assay showed that CS of 12a synergised antimicrobial activities of the antibiotics belonging to the classes fluoroquinolones, aminoglycosides and β-lactam against S. enterica. Conclusion: In conclusion, the study indicates the potential of the probiotic strains of enterococci as adjunct therapeutic agent against resistant forms of S. enterica. [ABSTRACT FROM AUTHOR]

Losing a much-awaited pregnancy and an unborn child, time and again is known to be a painful experience in recurrent miscarriage or pregnancy loss (RPL). Literature on psychological consequences of RPL is abundant. Nonetheless, application of psychological intervention in RPL remains to be an overlooked area. Using a repeated measures design and standardized psychological measures, this case study assessed the outcomes of mindfulness-based therapy administered with routine fertility treatment in a couple with the history of recurrent miscarriages and secondary infertility. Data analysis was done using clinically significant change and analysis of graphic trends. Psychotherapy helped the couple initiate a meaningful discourse with the stress following miscarriage, uncertainty of pregnancy, and fertility-related emotional struggles by mindfully transforming stressors into less painful experiences. Control studies on applications of such therapies are needed to provide definitive answers to "what works, for whom, when, and how," with distressed patients experiencing RPL. [ABSTRACT FROM AUTHOR]

Aim Polyphosphate kinase 1 ( PPK1) plays an important role in virulence, antibiotic resistance and survival under stress conditions and, therefore, is an attractive therapeutic target to control infections caused by multiple drug resistant Pseudomonas aeruginosa. This study explores the PPK1 inhibiting activity of ellagic acid derivatives ( EADs) from Terminalia chebula Retz. that could increase the susceptibility of Ps. aeruginosa to in vitro stress conditions. Methods and Results EADs reduced ppk1 gene expression by 93% ( P < 0·05) and completely inhibited its activity ( P < 0·01) at 0·5 mg ml−1. EADs-treated Ps. aeruginosa showed marked reduction in polyphosphate granules in cytosol. Expression of rpoS, the downstream master stress response regulator, was reduced by 94% ( P < 0·05) and the sensitivity of Ps. aeruginosa increased many fold to desiccation, oxidative (H2O2) and antibiotic (piperacillin) stresses. PPK-regulated swimming, swarming and twitching motilities and biofilm formation were also reduced significantly ( P ≤ 0·05) in MPAO1 and the clinical strains of Ps. aeruginosa. Conclusion EADs from T. chebula inhibited PPK1 expression and its activity and increased the sensitivity of Ps. aeruginosa to desiccation and oxidative stress while reducing tolerance to piperacillin. Significance and Impact of the Study The study underlines the potential of EADs as therapeutic agent against Ps. aeruginosa. [ABSTRACT FROM AUTHOR]

Roots of Veerataru-Dichrostachys cinerea Linn. are reported to have medicinal value in Ayurveda specially used in disurea, renal troubles, rheumatism and urinary calculi. The pharmacognostic study including morphology and microscopy of root and its powder were carried out. [ABSTRACT FROM AUTHOR]

The chemopreventive response was evaluated of non-steroidal anti-inflammatory drug, Diclofenac, a preferential cyclooxygenase-2 (COX-2) inhibitor in 1,2-dimethyhydrazine (DMH)-induced colon cancer in rat model. The signs of neoplasm were evident in the animals receiving 30 mg of DMH per kg body weight in a weekly s.c injection for six weeks. The putative biomarker of carcinogenesis was visible in the form of multiple plaque lesions in DMH treatment and then regression seen in those animals which also received an oral dose of Diclofenac, 8 mg/kg body weight whereas no such macroscopic neoplastic lesions were seen in the animals receiving Diclofenac only or the control animals receiving the vehicle of the drug. Histopathological results showed the presence of early aberrant changes in the form of severe dysplasia and also numerous crypt fissions in the apical surface of the colonic mucosa. A very high expression of COX-2 was seen in the colonic epithelium of DMH-treated rats, as analyzed by immunohistochemistry. Also, the apoptotic events were assessed by terminal deoxynucleotidyl dUTP nick end labeling (TUNEL) assay, where the DMH group shows few number of TUNEL positive cells which dramatically increased in the Diclofenac treatment. The results suggest that Diclofenac could be an effective chemopreventive agent in colon cancer, where perhaps apoptosis plays a very dominant end effect in cancer cell killings. [ABSTRACT FROM AUTHOR]

Background: The vasoconstrictor terlipressin is used for type 1 hepatorenal syndrome (HRS-1) in many parts of the world and is part of the clinical practice guidelines in Europe.Methods: We conducted a phase 3 trial to confirm the efficacy and safety of terlipressin plus albumin in adults with HRS-1. The patients were randomly assigned in a 2:1 ratio to receive terlipressin or placebo for up to 14 days; in both groups, concomitant use of albumin was strongly recommended. The primary end point was verified reversal of HRS, defined as two consecutive serum creatinine measurements of 1.5 mg per deciliter or less at least 2 hours apart and survival without renal-replacement therapy for at least 10 days after the completion of treatment. Four prespecified secondary end points were analyzed with the Hochberg procedure to account for multiple comparisons.Results: A total of 300 patients underwent randomization - 199 were assigned to the terlipressin group and 101 to the placebo group. Verified reversal of HRS was reported in 63 patients (32%) in the terlipressin group and 17 patients (17%) in the placebo group (P = 0.006). With respect to the prespecified secondary end points, HRS reversal, defined as any serum creatinine level of 1.5 mg per deciliter or less during the first 14 days, was reported in 78 patients (39%) in the terlipressin group and 18 (18%) in the placebo group (P<0.001); HRS reversal without renal-replacement therapy by day 30, in 68 (34%) and 17 (17%), respectively (P = 0.001); HRS reversal among patients with systemic inflammatory response syndrome (84 patients in the terlipressin group and 48 patients in the placebo group), in 31 (37%) and 3 (6%), respectively (P<0.001); and verified reversal of HRS without recurrence by day 30, in 52 (26%) and 17 (17%), respectively (P = 0.08). At day 90, liver transplantations had been performed in 46 patients (23%) in the terlipressin group and 29 patients (29%) in the placebo group, and death occurred in 101 (51%) and 45 (45%), respectively. More adverse events, including abdominal pain, nausea, diarrhea, and respiratory failure, occurred with terlipressin than with placebo. Death within 90 days due to respiratory disorders occurred in 22 patients (11%) in the terlipressin group and 2 patients (2%) in the placebo group.Conclusions: In this trial involving adults with cirrhosis and HRS-1, terlipressin was more effective than placebo in improving renal function but was associated with serious adverse events, including respiratory failure. (Funded by Mallinckrodt Pharmaceuticals; CONFIRM ClinicalTrials.gov number, NCT02770716.). [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitors (ICIs) are being increasingly utilised in the front-line (1L) setting of metastatic clear-cell renal cell carcinoma (mccRCC). Limited data exist on responses and survival on second-line (2L) vascular endothelial growth factor–receptor tyrosine kinase inhibitor (VEGFR-TKI) therapy after 1L ICI therapy. This is a retrospective study of mccRCC patients treated with 2L VEGFR-TKI after progressive disease (PD) with 1L ICI. Patients were treated at MD Anderson Cancer Center or Memorial Sloan Kettering Cancer Center between December 2015 and February 2018. Objective response was assessed by blinded radiologists' review using Response Evaluation Criteria in Solid Tumours v1.1. Descriptive statistics and Kaplan–Meier method were used. Seventy patients were included in the analysis. Median age at mccRCC diagnosis was 59 years; 8 patients (11%) had international metastatic database consortium favourable-risk disease, 48 (69%) had intermediate-risk disease and 14 (20%) had poor-risk disease. As 1L therapy, 12 patients (17%) received anti–programmed death ligand-1 (PD-(L)1) monotherapy with nivolumab or atezolizumab, 33 (47%) received nivolumab plus ipilimumab and 25 (36%) received combination anti–PD-(L)1 plus bevacizumab. 2L TKI therapies included pazopanib, sunitinib, axitinib and cabozantinib. On 2L TKI therapy, one patient (1.5%) achieved a complete response, 27 patients (39.7%) a partial response and 36 patients (52.9%) stable disease. Median progression-free survival (mPFS) was 13.2 months (95% confidence interval: 10.1, NA). Forty-five percent of subjects required a dose reduction, and twenty-seven percent of patients discontinued treatment because of toxicity. In this retrospective study of patients with mccRCC receiving 2L TKI monotherapy after 1L ICI, we observed 2L antitumour activity and tolerance comparable to historical data for 1L TKI. • Immunotherapy (ICI) is moving to front-line treatment in metastatic RCC for intermediate- and poor-risk patients. • Little data exists on responses to second-line (2L) TKI after front-line (1L) ICI. • Our data showed that 2L VEGFR-TKI have ORR 41% and DCR 94% after 1L ICI–containing regimen. • Median PFS on 2L VEGFR-TKI after 1L ICI in metastatic clear-cell RCC was 13.2 mo. • Safety and tolerability of 2L VEGFR-TKI after 1L ICI is typical of class effects. [ABSTRACT FROM AUTHOR]

SUMMARY: Barrett's esophagus progresses to esophageal adenocarcinoma in a stepwise histological fashion of no dysplasia, low grade dysplasia, high grade dysplasia and cancer. Hence the progression to cancer from various histological stages is different. Progression to cancer from low grade dysplasia is highly variable in the literature due to high inter-observer variability between pathologists in diagnosing it. Studies have shown the utility of having confirmation of low grade dysplasia by expert pathologists or documenting its persistence on two subsequent endoscopies in order to unify the diagnosis. The treatment of low grade dysplasia is variable. In this article we summarize the diagnosis, evaluation and management of low grade dysplasia in Barrett's Esophagus [ABSTRACT FROM AUTHOR]

Abstract: The incidence of non dermatophytic mould (NDM) onychomycosis (OM) has been steadily increasing Fusarium spp is the most common cause of NDM OM in most geographical locations. Fusarium spp and other NDMs are largely resistant to commonly used anti‐fungals. The successful use of laser and light based devices has been demonstrated in dermatophytic OM, but there is no previous report of their successful use in any NDM OM. We describe a patient with OM caused by Fusarium solani spp, who was clinically (with a normal appearing nail) and mycologically (with negative microscopy and culture on repeated samples) cured of her infection following treatment with 2 sessions of Qs NdYAG (532nm and 1064nm) given 1 month apart. [ABSTRACT FROM AUTHOR]

Targeting a T-cell inhibitory checkpoint with the anti-CTLA-4 monoclonal antibody, ipilimumab, represents a scientific breakthrough in immunotherapy for the treatment of cancer. However, ipilimumab therapy is also associated with unique side effects, known as immune-related adverse events (irAEs), which need to be recognized and managed with immunosuppressive agents. To date, the majority of our knowledge regarding ipilimumab-associated side effects is based upon clinical studies in melanoma. Here we provide a review of ipilimumab-induced irAEs and our experience in a cohort of 44 patients with prostate cancer who were treated at the MD Anderson Cancer Center on two different clinical trial protocols. [ABSTRACT FROM AUTHOR]

The present investigation was carried out at local veterinary hospitals and LRS, Rathi of College of Veterinary and Animal Science, Bikaner where milk samples of 48 quarters from 12 apparently healthy Rathi cows were subjected to various tests viz. modified California mastitis test (MCMT), total somatic cell count (TSCC), pH, electrical conductivity (EC) and cultural examination for the diagnosis of sub-clinical mastitis. The aim of present investigation was to evaluate the therapeutic potential of Ocimum sanctum (Tulsi). The 12 Rathi cows were divided into two groups with 6 animals in each group viz. Group I powdered O. sanctum @ 600 mg/kg b.wt., Group II aqueous extract of O. sanctum @ 150 mg/kg b.wt. On 8th day post-treatment, there was nonsignificant decrease (p>0.05) in electrical conductivity (EC) in both the groups. There was significant change (p>0.05) in pH in Group I and Group II post-treatment. Similarly, there were significant changes (p<0.05) recorded in Group I and Group II in TSCC values post-treatment. Thus, the results indicated that the aqueous extract of O. sanctum have shown therapeutic potential in treating subclinical mastitis in cattle. [ABSTRACT FROM AUTHOR]

Background: There are very few studies from India which have evaluated the prescription pattern for antidepressants by psychiatrists for treatment of depression. Aim: To study the psychotropic prescription patterns of patients with first episode depression from diverse settings including teaching institutions in public and private sectors and even privately run psychiatric clinics. Materials and Methods: Prescription data of 706 patients with first episode depression, who participated in the IPS multicentric study, were evaluated. Results: Escitalopram was the most commonly prescribed antidepressant, comprising 40% of the total prescriptions. This was followed by sertraline (17.6%) and fluoxetine (16.3%). In total, selective serotonin reuptake inhibitors (SSRIs) formed 79.2% of all the prescriptions. Tricyclic antidepressants formed a small part (15.15%) of total prescriptions, with imipramine being the most commonly used tricyclic antidepressant. Serotonin-norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine and duloxetine) were prescribed to 11.3% of patients with equal share of venlafaxine and duloxetine. About one-sixth (N=104; 14.7%) of the patients were prescribed more than one antidepressant. Nearly three-fourth of the patients (N=523; 74.1%) were prescribed a benzodiazepine, with clonazepam being the most preferred agent, prescribed to nearly half of the participants (49%) and formed nearly two-third of the total benzodiazepine prescriptions (346 out of 523). Conclusion: Escitalopram is the most commonly prescribed antidepressant and SSRIs are the most commonly prescribed class of antidepressants. Poly pharmacy in the form of concomitant use of two antidepressants is practiced infrequently. However, benzodiazepines are used quite frequently as the co-prescription. [ABSTRACT FROM AUTHOR]

What is known and Objective: Intravenous immunoglobulin (IVIg) is a commonly used therapy for autoimmune disease, but may cause chronic hypertension and thrombosis. We determined whether: (i) IVIg systematically affects blood pressure in the short term; (ii) acute changes in plasma viscosity because of IVIg correlate with blood pressure effects; (iii) effects of IVIg on acute blood pressure are related to baseline blood pressure or hypertension status and (iv) IVIg influences plasma markers of inflammation, anticardiolipin antibodies and homocysteine as additional putative prothrombotic risk factors. Methods: Twenty adults with autoimmune neurological disease who received a course of IVIg were evaluated immediately before and after each infusion, on every day of the course. Blood pressure, pulse and the following haematological parameters were determined: plasma viscosity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), haematocrit, fibrinogen, interleukin-6 (IL-6), homocysteine and anticardiolipin positivity. Results: Intravenous immunoglobulin caused both acute and cumulative rises in plasma viscosity across a treatment course, but no concordant changes in blood pressure. There was also no correlation between individual blood pressure changes and viscosity, baseline blood pressure or hypertension status. Levels of IL-6 rose across the course of therapy, but the acute-phase reactants CRP and fibrinogen did not. One patient developed anticardiolipin antibodies during therapy. What is new and Conclusion: Individual courses of IVIg do not systematically raise blood pressure. Where IVIg is found to cause hypertension, this does not appear to be due to a direct effect of IVIg on plasma viscosity. [ABSTRACT FROM AUTHOR]

Long term D-penicillamine therapy, especially when used to treat Wilson's disease has been shown to cause elastosis perforans serpiginosa, pseudoxanthoma elasticum perforans and other degenerative dermatoses. We report a 23-year-old male patient who presented with multiple firm papules, nodules over the neck, axillae, front of elbows for five years. He was a known case of Wilson's disease on long-term treatment with penicillamine for the past 12 years. The papulonodular lesions were non-tender and some were discrete while others were arranged in a circinate pattern. There was central scarring of the skin within the circinate lesions. In addition, there were several small yellowish papules on both sides of the neck which eventually became confluent to form plaques. Histopathology confirmed the diagnosis of elastosis perforans serpiginosa and pseudoxanthoma elasticum. He was treated with cryotherapy (using liquid nitrogen through cryojet) for former lesions. The lesions showed remarkable improvement after five sittings. Now the patient is under trientine hydrochloride (750 mg twice daily) for Wilson's disease. [ABSTRACT FROM AUTHOR]

The Revised National Tuberculosis Control Programme (RNTCP), which incorporated the WHO DOTS strategy was introduced in India in the mid-1990s. An operational research project was conducted between 1996 and 1998 to assess the needs and perspectives of patients and providers in two chest clinics in Delhi, Moti Nagar and Nehru Nagar, during the introduction of the new strategy. This paper reports on the findings of the project, concentrating on information collected from 40 in-depth interviews with patient defaulters and from non-participant observations in clinics and directly observed treatment centres. In Moti Nagar chest clinic, 117 of 1786 (6.5%) patients and 195 of 1890 (10%) patients in Nehru Nagar left care before their treatment was complete. It was argued that the reasons for default stem from a poor correlation between patient and programme needs and priorities, and from particular characteristics of the disease and its treatment. Patient needs that were not met by the health system included convenient clinic timings, arrangements for the provision for treatment in the event of a family emergency and provision for complicated cases like alcoholics. The problems facing the provider were poor interpersonal communication with the health staff, lack of attention and support at the clinic, difficulty for patients to re-enter the system if they missed treatment and, in certain areas, long distances to the clinic. Problems related to diseases were inability of the staff to deal with drug side-effects, and patients' conception of equating well-being with cure. Simple, practical measures could improve the provision of tuberculosis (TB) treatment: more flexible hours, allowances for poor patients to reach the clinics and training health care staff for respectful communication and monitoring drug side-effects. The findings indicate a need to rethink the label of 'defaulter' often given to the patients. The important areas for future operational research is also highlighted. [ABSTRACT FROM AUTHOR]