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Background/Aim: Pharmacovigilance in oncology is imperative as antineoplastic drugs are two-edged swords whose irrational use can pose a major health problem and a needless financial burden on the patient. The aim of this study was to study the comprehensive safety profile of anti-neoplastic drugs used for treating oral cancers. Methods: This hospital-based prospective observational study was conducted at two premiers (a government and a private) tertiary care centres in North-Western India among newly diagnosed cases of oral cancers of both sexes between the ages of 20-70 years and requiring chemotherapy treatment. The prescribing pattern of chemotherapy drugs, associated adverse effects and potential risk factors for the development of adverse effects was studied. An adverse drug reaction (ADR) causality was assessed by the WHO-UMC algorithm and preventability by Schumock and Thornton's criteria. Univariate and multivariate logistic regression analyses were used to identify the predictors related to chemotherapy-induced adverse effects. Results: The data concerned 188 patients, of which 64.3 % developed chemotherapy-related adverse effects. Among the prescribed anti-neoplastic drugs, a combination of 5-Fluorouracil, Cisplatin and Paclitaxel regimen was associated with the majority (91.42 %) of the adverse effects. Alopecia was the most common adverse effect noted in 26.44 % of patients, followed by nausea and anaemia in 15.7 % and 9.9 % of patients, respectively. Independent predictors of chemotherapy-related adverse effects were site (Adjusted odds ratio [AOR] = 1.95; 95 % CI 1.04 - 3.62, p = 0.03), chemotherapy and radiotherapy treatment (AOR = 5.00; 95 % CI 2.62 - 9.53, p < 0.001), combination regimen of 5-Fluorouracil, Cisplatin and Paclitaxel (AOR = 8.68; 95 % CI 2.55 - 29.48, p = 0.001), associated comorbidities (AOR = 16.68; 95 % CI 2.45 - 28.34, p < 0.001). Causality assessment revealed most adverse effects (82.64 %) to be possible. Conclusion: The adverse effect varies with the type of regimen which is prescribed for the patient. Site of cancer, concomitant radiotherapy treatment and associated comorbidities were the identifiable risk factors for developing adverse effects. Onco-pharmacovigilance studies in the future will help to provide tailored treatment to patients and improve their quality of life.

Objective: Evaluation of Antimicrobial and Antifungal potential of Phytoconstituents present in leaf extracts of Bergenia ligulata (wall.) plant. Methods: The antimicrobial effects of leaves of Bergenia ligulata (wall.) were evaluated using both ethanol and aqueous extracts against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, and Penicillium spp. Agar well diffusion method was employed in determining the antimicrobial activity and the broth dilution method for determining the Minimum Inhibitory Concentration. All the isolates examined were susceptible to both the ethanol, aqueous, and the combined aqueous and ethanol extracts (synergetic effect) of the Bergenia ligulata leaves. Results: The zone of inhibition ranged from 6.93±0.02b mm to 12.81±0.03a mm, with Escherichia coli being the most susceptible at 12.81±0.03a mm to the ethanol and 11.53±0.02a mm to the aqueous extracts at 250 mg/ml concentration while P. aeruginosa and Penicillin spp. were the slightest susceptible at 10.88±0.02a mm to the ethanol and 09.76±0.02a mm to the aqueous extract at 250 mg/ml concentration. The control/standard antimicrobial agent (Gentamicin and Metronidazole) exhibited higher inhibitory activity than the plant extracts. The least inhibitory value of 6.25 mg/ml was produced against P. aeruginosa by the ethanolic extract and against C. albicans by the combined (aqueous and ethanol) extracts of the plant. The qualitative and quantitative phytochemical screening of the leaves of Bergenia ligulata reveals the presence of flavonoids, tannins, saponins, alkaloids, and steroids. The most abundant percentage composition observed was flavonoids (7.72%), while tannins had the least component (4.29%). Conclusion: The findings from this study show that the leaves extracts hold considerable antimicrobial activity against commonly encountered microorganisms in the environment. This, therefore, implies that it can be used as a chemotherapeutic agent which will contribute to the development of antibiotic drugs against the test organisms.

Cigarette smoke (CS) induced emphysema and chronic pulmonary inflammation are major comorbidities of chronic obstructive pulmonary disease (COPD), a major cause of morbidity and mortality worldwide. CS exposure exacerbates pulmonary inflammation and compromises immunity to various infections. Aurintricarboxylic acid (ATA) is a polyanionic aromatic compound especially recognized for its anti-inflammatory, nucleic acid, and protein interaction inhibition properties. The study was designed to investigate the anti-inflammatory role of ATA against cigarette smoke extract (CSE) induced pulmonary inflammation. Nicotine concentration was quantified in CSE by UPLC/MS technique. In vitro, fluorescence microscopy, and flow cytometry was performed in CSE stimulated alveolar epithelial cells to determine the effect of ATA on oxidative stress-mediated cellular apoptosis. In vivo, pulmonary inflammation was induced in male Wistar rats via a modified non-invasive intratracheal instillation of cigarette smoke extract (100 µl/animal) twice a week for 8 weeks and post-treated with ATA (10 mg/kg) intraperitoneally for 15 days. Lung homogenates were assessed for MDA and GSH. Lung tissues were subjected to western blotting and histopathological analysis. As result, ATA reduced CSE-induced chromatin condensation, fragmentation, cellular apoptosis in alveolar epithelial cells, and apoptotic biomarkers expression including BAX and Caspase-3 in the lungs. ATA reduced inflammation by normalizing redox balance reflected by MDA/GSH levels. ATA obviated airspace enlargement, fiber deposition, and immune cell infiltration. Reduced inflammation was accompanied by inhibition of inflammatory biomarkers TNF-α, TNFR1, TWEAK, and NF-ҡB/p65 activation and nuclear translocation. ATA efficaciously diminished the oxidative stress and pulmonary inflammation associated with lung pathogenesis through TNF-α/TNFR1/NF-ҡB/p65 signaling pathway. HIGHLIGHTSATA treatment attenuates CSE-stimulated chromatin condensation, fragmentation, and cellular apoptosis in alveolar epithelial cells.ATA treatment inhibits CSE stimulated activation and nuclear translocation of NF-ҡB/p65.ATA treatment diminishes CSE-induced oxidant injury, apoptosis, and emphysema-like phenotypic changes in the lungs.ATA inhibits lung inflammation via suppression of the NF-ҡB/p65 signaling pathway. ATA treatment attenuates CSE-stimulated chromatin condensation, fragmentation, and cellular apoptosis in alveolar epithelial cells. ATA treatment inhibits CSE stimulated activation and nuclear translocation of NF-ҡB/p65. ATA treatment diminishes CSE-induced oxidant injury, apoptosis, and emphysema-like phenotypic changes in the lungs. ATA inhibits lung inflammation via suppression of the NF-ҡB/p65 signaling pathway.

Nerium oleander is an eminent source of structurally diverse cardiac glycosides (CGs), plays a prominent role in the treatment of heart failure, and inhibits the proliferation of cancer cell lines. CGs exert their cardiotonic action by binding to the extracellularly exposed recognition sites on NaWe aimed to quantitatively determine CGs and their seasonal variation in leaf and stem samples of N. oleander utilizing UHPLC-ESI-MS/MS techniques.The UHPLC-ESI-MS/MS analytical method was developed utilizing multiple reaction monitoring (MRM) mode. The Waters BEH C18 (150 mm × 2.1 mm, 1.7 μm) column was used with a 22-min linear gradient consisting of acetonitrile and 5 mM ammonium acetate buffer.In total 21 CGs were quantitatively determined in the seasonal leaf and stem samples of N. oleander along with the absolute quantitation of the three chemical markers odoroside H (244.8 μg/g), odoroside A (231.4 μg/g), and oleandrin (703.9 μg/g). The season-specific accumulation of chemical markers was observed in the order of predominance odoroside A (summer season, stem), odoroside H (winter season, stem), and oleandrin (rainy season, leaf). Besides this, the remaining 18 CGs were relatively quantified in the same samples.The developed method is simple and reliable and can be used for the identification and quantification of multiple CGs in N. oleander.

The primary result of our experiment revealed that the germination percentage of N. oleander mature seeds is only 30%. From this observation, the concept of protocol standardization for zygotic embryo culture of this plant was originated. Zygotic embryo culture was proved an efficient in vitro multiplication system of N. oleander. The maximum germination percentage (96%) of zygotic embryos was observed on ¼ MS medium with 15 gm/L sucrose, whereas the best growth medium was optimized as ½ B5 with same sucrose concentration. The second part of this study was aimed to find out the cardiac glycoside accumulation pattern in both in vitro and acclimatized plants. For this purpose, one-month-old in vitro plantlets and acclimatized plants were subjected to LC-MS analysis and 09 cardiac glycosides were detected and quantified in both the systems. Most of the cardiac glycosides including odoroside A (32.71 mg/gm DW), odoroside H (4.69 mg/gm DW) and oleandrin (0.52 mg/gm DW) were found to be accumulated at maximum level within in vitro plantlets. CG 840b (1.89 mg/gm DW) is the only cardiac glycoside, which was maximally accumulated in acclimatized plants. From this study, it can be concluded that, zygotic embryo culture is a better choice for in vitro multiplication of N. oleander when compared to matured seeds and in vitro grown plantlets of this species favor cardiac glycosides biosynthesis in comparison to acclimatized plants. Therefore, all future research on the enrichment of cardiac glycosides from this plant may be conducted on zygotic embryos derived in vitro grown plantlets or cultures.

Cajanus scarabaeoides, belonging to the Fabaceae family, is an underutilized herb and traditionally used to treat several ailments. However, it is not well explored phytochemically. Therefore, mass spectrometry (MS)-based phytochemical analysis was carried out to investigate the bioactive ingredients of the herb.A ultra-performance liquid chromatography (UPLC) coupled to photodiode array detection (PDA) and electrospray ionization (ESI) tandem mass spectrometry (UPLC-PDA-ESI-MS/MS) system was used for the qualitative and quantitative analysis of phytochemicals. The chromatographic separation was achieved on the Acquity BEH C18 column (150 × 2.1 mm, 1.7 μm) using a gradient system consisting of three solvents, acetonitrile, methanol, and 0.1% formic acid, used at a flow rate of 0.300 ml/min.Sixteen bioactive ingredients (gallic acid, gallocatechin, epigallocatechin, catechin, procyanidin dimer, epicatechin, procyanidin trimer, isoorientin, orientin, vitexin, isovitexin, quercetin-mono-O-glycoside, isoquercitrin, luteolin-7-O-glucoside, quercetin, and luteolin) were identified and structurally characterized. Consequently, 12 compounds were reported for the first time from C. scarabaeoides, and 13 were quantitatively determined in different seasons. Isoorientin (10.2-7.1% w/w) and orientin (5.78-5.17% w/w) were the most abundant constituents in the dry weight of plant material, followed by vitexin and isovitexin in the rainy season.The phytochemical investigation has revealed that C. scarabaeoides could be a potential alternate source of bioactive ingredients, namely, isoorientin, orientin, vitexin, and isovitexin, contributing to further exploration of its biological activity. In addition, analytical methods can be used for the rapid identification and quantification of bioactive ingredients in C. scarabaeoides.

Cinchona which belongs to family Rubiaceae, got its importance from the centuries because of its anti- malarial activity. Alkaloids present in this herb, Quinine, Chichonine, Quinidine and Cinchonidine are the main, but percentage may vary in species to species. Since the early 17th century, these alkaloid are frequently used in Indian ayurvedic, sidha and traditional folk medicine to treating fever and Still now in modern medicine cinchona alkaloids are used for the treatment of malaria as well as for other diseases and became the well-known drug after the treatment of malaria caused by Plasmodium Sp. Literature study revealed that along with the antimalarial activity the cinchona alkaloids has other potentiality like anti-obesity, anti-cancer, anti-oxidant, anti-inflammatory, anti-microbial activity. These article reviews the biological activities of cinchona alkaloids along with its toxic effect.

Ultraperformance liquid chromatography coupled with electrospray ionization tandem mass spectrometry (UPLC-ESI-MS/MS) is an economical and indispensable tool in natural product research to investigate novel metabolites, biomarker discovery, chemical diversity exploration, and structure elucidation. In this study, the structural analysis of 38 naturally occurring cardiac glycosides (CGs) in various tissues of Nerium oleander was achieved by the extensive use of mass spectrometry. The chemical diversity of CGs was described on the basis of characteristic MS/MS fragmentation patterns, accurate mass measurement, and published scientific information on CGs from Nerium oleander. It was observed that only six genins, viz., Δ16anhydrogitoxigenin, Δ16adynerigenin, gitoxigenin, oleandrigenin, digitoxigenin, and adynerigenine, produce 38 diverse chemical structures of CGs. Among them, 20 were identified as diastereomers having a difference in a sugar (l-oleandrose, β-d-diginose, and β-d-sarmentose) unit. However, the differentiation of diastereomeric CGs was not possible by only MS/MS fragments. Thus, the diastereomer's chromatographic elution order was assigned on the basis of the relative retention time (RRt) of two reference standards (odoroside A and oleandrin) among their diastereomers. Besides this, the in-source fragmentation of CGs and the MS/MS of m/z 325 and 323 disaccharide daughter ions also exposed the intrinsic structure information on the sugar units. The daughter ions m/z 162, 145, 113, 95, and 85 in MS/MS spectra indicated the abundance of l-oleandrose, β-d-diginose, and β-d-sarmentose sugars. At the same time, m/z 161, 143, 129, and 87 product ions confirmed the presence of a β-d-digitalose unit. As a result, the UPLC-ESI/TQD system was successfully utilized for the structure characterization of CGs in Nerium oleander tissues.

The present study was aimed to investigate the effect of different media, plant growth regulators, carbon sources, sucrose concentrations and pH of the medium for indole alkaloids (IAs) accumulation in the callus culture of Alstonia scholaris. The optimized conditions for the accumulation of IAs like echitamine, acetylechitamine, tubotaiwine and picrinine were found to be the MS medium supplemented with 0.3 mg/L of 2,4-D, 0.5 mg/L of FAP and 3% (w/v) sucrose with medium pH 5.8. Efforts were also made to standardize the enrichment protocols of these IAs by modulating concentration and incubation period of various elicitors and precursors. The quantitative analysis of IAs in callus samples was performed by using ultra high-performance liquid chromatography-mass spectrometry. Substantial enrichments of acetylechitamine (6.3780 mg/g DW i.e. ~ 15-fold) and echitamine (1.6513 mg/g DW i.e. ~ 12-fold) were found with 4.5 g/L KCl in 10 days incubation period, followed by tubotaiwine (0.0952 mg/g DW i.e. ~ 4-folds) with 3.0 g/L KCl in 10 days and picrinine (0.3784 mg/g DW i.e. ~ 4-fold) with 4.5 g/L KCl in 2 days.

β - escin is a mixture of triterpene saponins and other components including alpha aescin, progestoescigenin, barringtogenol, cryptoescin and benzyopyrones.Βaescin or β-escin isolated from the horse chestnut seeds (Aesculus hippocastanum L.) β-escin has been traditionally used to treat conditons such as chronic venous insufficiency, inflammation, hemorrhoids, edema, elevated glucose, obesity, and cerebral ischemic damage. The drug shows its property in clinical trail’s patient with HIV-1 used as a traditional medicines.

Pathophysiological changes secondary to cirrhosis predispose patients of chronic liver disease to develop various electrolyte disturbances which have a significant impact on morbidity, mortality, and prognosis of these patients. This study aims to estimate the level of electrolyte disturbance and its association with the severity, complication, and outcome in chronic liver disease patients attending a hospital in the Kumaon region of Uttarakhand.Our study was a hospital-based cross-sectional study conducted on 100 chronic liver disease patients at the OPD/IPD Department of Medicine, Dr. Sushila Tiwari Hospital, Haldwani, Uttarakhand, from January 2020 to September 2021.Hyponatremia was observed in 49% of the patients, hypokalemia in 30%, and hypocalcemia in 16% of the patients. The electrolyte levels were similar irrespective of the disease severity and presence of complications. The sodium and potassium levels had a significant association with the outcomes.Hyponatremia was the commonest electrolyte disturbance seen in the study patients. No significant association was observed between the electrolyte and severity of the disease and complications.

Geopolymer concrete, because of its less embodied energy as compared to conventional cement concrete, has paved the way for achieving sustainable development goals. In this study, an effort was made to optimize its quality characteristics or responses, namely, workability, and the compressive and flexural strengths of Ground Granulated Blast-furnace Slag (GGBS)-based geopolymer concrete incorporated with polypropylene (PP) fibers by Taguchi’s method. A three-factor and three-level design of experiments was adopted with the three factors and their corresponding levels as alkali ratio (NaOH:Na2SiO3) (1:1.5 (8 M NaOH); 1:2 (10 M NaOH); 1:2.5 (12 M NaOH)), percentage of GGBS (80%, 90%, and 100%) and PP fibers (1.5%, 2%, and 2.5%). M25 was taken as the control mix for gauging and comparing the results. Nine mixes were obtained using an L9 orthogonal array, and an analysis was performed. The analysis revealed the optimum levels as 1:2 (10 molar) alkali ratio, 80% GGBS, and 2% PP fibers for workability; 1:2 (10 molar) alkali ratio, 80% GGBS, and 2.5% PP fibers for compressive strength; and 1:2 (10 molar) alkali ratio, 80% GGBS, and 1.5% PP fibers for flexural strength. The percentage of GGBS was found to be the most effective parameter for all three responses. The analysis also revealed the ranks of all the factors in terms of significance in determining the three responses. ANOVA conducted on the results validated the reliability of the results obtained by Taguchi’s method. The optimized results were further verified by confirmation tests. The confirmation tests revealed the compressive and flexural strengths to be quite close to the strengths of the control mix. Thus, optimum mixes with comparable strengths were successfully achieved by replacing cement with GGBS and thereby providing a better path for sustainable development.

T-complex protein-1 (TCP1) is a chaperonin protein known to fold various proteins like actin and tubulin. In Leishmania donovani only one subunit of TCP1 that is gamma subunit (LdTCP1γ) has been functionally characterized. It not only performs ATP dependent protein folding but is also essential for survival and virulence. The present work demonstrates that LdTCP1γ also has a role in miltefosine resistance. Overexpression of LdTCP1γ in L. donovani promastigotes results in decreased sensitivity of parasites towards miltefosine, while single-allele replacement mutants exhibited increased sensitivity as compared to wild-type promastigotes. This response was specific to miltefosine with no cross-resistance to other drugs. The LdTCP1γ-mediated drug resistance was directly related to miltefosine-induced apoptotic death of the parasite, as was evidenced by 2 to 3-fold decrease in cell death parameters in overexpressing cells and >2-fold increase in single-allele replacement mutants. Further, deciphering the mechanism revealed that resistance of overexpressing cells was associated with efficient ROS neutralization due to increased levels of thiols and upregulation of cytosolic tryparedoxin peroxidase (cTxnPx). Further, modulation of LdTCP1γ expression in parasite also modulates the levels of proinflammatory cytokine (TNF-α) and anti-inflammatory cytokine (IL-10) of the host macrophages. The study provides evidence for the involvement of a chaperonin protein LdTCP1γ in the protection against miltefosine induced oxidative damage and reveals the fundamental role of LdTCP1γ in parasite biology.

Emerging observations suggest that ribosomal proteins (RPs) play important extra-ribosomal roles in maintenance of cellular homeostasis. However, the mechanistic insights into these processes have not been extensively explored, especially in pathogenic bacteria. Here, we present our findings on potential extra-ribosomal functions of Mycobacterium tuberculosis (Mtb) RPs. We observed that Mtb RpsB and RpsQ are differentially localized to cell wall fraction in M. tuberculosis (H37Rv), while their M. smegmatis (Msm) homologs are primarily cytosolic. Cellular fractionation of ectopically expressed Mtb RPs in surrogate host (M. smegmatis) also shows their association with cell membrane/cell wall without any gross changes in cell morphology. M. smegmatis expressing Mtb RpsB exhibited altered redox homeostasis, decreased drug-induced ROS, reduced cell wall permeability and increased tolerance to various proteotoxic stress (oxidative stress, SDS and starvation). Mtb RpsB expression was also associated with increased resistance specifically towards Isoniazid, Ethionamide and Streptomycin. The enhanced drug tolerance was specific to Mtb RpsB and not observed upon ectopic expression of M. smegmatis homolog (Msm RpsB). Interestingly, C-terminus deletion in Mtb RpsB affected its localization and reversed the stress-resilient phenotypes. We also observed that M. tuberculosis (H37Rv) with upregulated RpsB levels had higher intracellular survival in macrophage. All these observations hint towards existence of moonlighting roles of Mtb RpsB in imparting stress resilience to mycobacteria. This work open avenues for further exploration of alternative pathways associated with fitness and drug tolerance in mycobacteria.

Background: Scarring due to acne is a frequently encountered problem in dermatological outpatient department. Microneedling has been a well-accepted modality for the treatment of atrophic acne scars. Platelet-rich plasma (PRP) is a newer option to investigate. Aims: The aims of this study were (1) to compare the efficacy of combined dermaroller and PRP therapy with dermaroller alone in facial acne scars and (2) to assess the psychosocial impact due to acne scars and its treatment. Methods: A total of 55 patients were included in the study and randomly divided into two groups, Group A: 28 and Group B: 27. Proper counseling was done, and detailed clinical findings were recorded. Patients in Group A were treated with dermaroller alone while Group B patients underwent treatment with a combination of dermaroller and intradermal PRP injections. A total of three sitting were done at monthly interval. Final response was assessed at 1 month after the last sitting. Criteria of evaluation included Goodman and Baron's quantitative scale, visual analog score, and dermatology life quality index scores. Side effects were noted. Results were analyzed using Chi-square test and t-test. Results: Significant percentage improvement was noted in both the groups. However, Group B treated with both modalities had better results when compared with that in the Group A. Conclusion: A combination approach using dermaroller and PRP was a safe and better option than using dermaroller alone in atrophic acne scars for clinical improvement as well as for improvement in dermatology life quality index score.

Background Osteoporosis is an asymptomatic bone disorder leading to altered bone microarchitecture, mineralization and strength. Musa paradisiaca has been reported to have antioxidant and anti-inflammatory effects in various diseases. Its impact on postmenopausal osteoporosis has not been investigated yet. Purpose The intention of the current study was to evaluate the bone regeneration and osteoprotective potential of extract and fraction of M. paradisiaca flower in ovariectomized (Ovx) Sprague Dawley (SD) rats, a model of post-menopausal bone loss. The study also aims to identify osteogenic compounds from active fraction. Methods Ethanolic extract (MFE) and butanolic fraction (MFE-Bu) from flower of M. paradisiaca were prepared and their efficacy was tested in rat femur osteotomy model at different doses. Effective dose from both extract (250 mg/kg) and fraction (50 mg/kg) were taken for study in osteopenic bone loss model. PTH was taken as reference standard (20 µg/kg/twice a week). Bones were harvested at autopsy for dynamic and static histomorphometry. Serum was collected for ELISA. Pure compounds were isolated from butanolic fraction (MFE-Bu), and were assessed for their osteogenic effect. Results MFE and MFE-Bu were observed for their potential in bone healing and prevention of bone loss. Both MFE and MFE-Bu promoted new bone regeneration at injury site as assessed by microCT and calcein dye labeling studies. These also led to restoration of bone microarchitecture deteriorated as a result of osteopenia and improved bone biomechanical properties. Extract as well as the fraction exhibited dual bone anabolic and anti-resorptive properties where they elevated serum procollagen type I N-terminal propeptide (P1NP), a bone formation marker and suppressed serum C-telopeptide of type I collagen (CTX-1), a bone resorption marker. As many as four osteogenic compounds were isolated from MFE-Bu. Oleracein-E was found to be the most potent osteogenic agent based on osteoblast differentiation, mineralization assays, qPCR and protein expression studies. Conclusion Our studies demonstrates that ethanolic extract from the flower of M. paradisiaca and its butanolic fraction exhibit dual osteogenic and anti-resorptive potential, and have an advantage over PTH which though promotes bone formation but is also bone catabolic in nature.

Up regulated genes during serum replenishment (Of the 32 up regulated genes 16 were uncharacterized). (DOCX 15 kb)

List of genes belonging to very high class. (DOCX 21 kb)

Primer List. (DOCX 16 kb)

List of genes belonging to very low class. (DOCX 23 kb)

Heterogeneous Networks are bunch of homogeneous networks base stations grouped together. The term introduced in this research paper Time Efficiency (Te) gives out the information on the heterogeneous networks where most of the data flows in and out. In this paper, a model for evaluating Time Efficiency in heterogeneous network is developed. The common goals of different base stations in a heterogeneous network are towards coverage of area and capability improvement. Base stations in a homogeneous network differs in transmitted power, achievable rate of data, area covered, density of a base station, energy efficiency and time efficiency. To find out the area of most data flow in certain period, Time efficiency can be used as a major factor.

Cirrhosis of the liver commonly leads to a state of chronic hypervolemic hyponatremia. Profound exacerbation of the hyponatremic state may occur in patients with decompensated cirrhosis in conjunction with acute stressors such as infection. Hyponatremia in cirrhosis is associated with increased morbidity and mortality. we report a case of52 year old man with a history of alcoholic cirrhosis presented to the hospital with symptomatic profound hyponatremia (serum sodium concentration of 102 meq/L). The patient was treated with antibiotics, diuretics and hypertonic saline and was placed on a fluid restricted diet. The serum sodium level corrected slowly over four days with symptomatic improvement occurring after five days. In patients with cirrhosis, it is important to recognize the symptoms of hyponatremia, identify and treat any exacerbating conditions early in their course, and correct the serum sodium concentration slowly with frequent monitoring. Key words: hyponatremia, cirrhosis, liver

Nitrobenzene, a pale yellow oily liquid with an odor of bitter almonds, is used in the synthesis of Aniline dyes, flavoring agent, and also in rubber industry. Recently it is also used as a plant growth nutrient. It causes methemoglobinemia with symptoms including headache, nausea, dizziness, fatigue, shortness of breath, cyanosis, and convulsions. Severe acute exposure to nitrobenzene can cause jaundice, renal failure, and coma, and it may be fatal. We report a case of Plant growth nutrient (nitrobenzene) poisoning with multiple complications like hemolytic anemia, renal failure, seizures, and pneumonia. Patient was managed with intravenous methylene blue along with other supportive therapy and survived. So, early aggressive management and a watch on complications might be helpful in saving patient's life from this poisoning.

Leishmaniasis is a major public health problem in various part of world; it has also emerged in new geographic areas and host populations. Visceral infection can remain subclinical or become symptomatic, with an acute, subacute or chronic course. Kala-azar, or visceral leishmaniasis (VL), presents as fever, pancytopenia and hypergammaglobulinaemia. The presence of splenomegaly is characteristic of VL. It may be absent in immunocompromised patients, who may present atypically. Absence of splenomegaly is rare in immunocompetent patients, though it may occur in the early stages. Atypical presentations can be challenging to the clinician. This paper presents an atypical presentation of kala-azar, with multi-organ failure in the absence of splenomegaly or fever.

Aluminium phosphide (AlP) is a cheap solid fumigant and a highly toxic pesticide that is commonly used for grain preservation. AlP has currently generated interest with increasing number of cases in the past four decades because of its increased use for agricultural and nonagricultural purposes, and also its easy availability in the markets has led to its increased misuse to commit suicide. Ingestion is usually suicidal in intent, uncommonly accidental and rarely homicidal. The poison affects all systems, shock, cardiac arrhythmias with varied ECG changes and gastrointestinal features being the most prominent. Diagnosis is made on the basis of clinical suspicion, a positive silver nitrate paper test to phosphine, and gastric aspirate and viscera biochemistry. Treatment includes early gastric lavage with potassium permanganate or a combination of coconut oil and sodium bicarbonate, administration of charcoal and palliative care. Specific therapy includes intravenous magnesium sulphate and oral coconut oil. Unfortunately, the lack of a specific antidote Results in very high mortality and the key to treatment lies in rapid decontamination and institution of resuscitative measures. This article aims to identify the salient features and mechanism of AlP poisoning along with its management strategies and prognostic variables.

Context: Vitiligo is a psychosocial problem which significantly affects quality of life in Indian scenario. Aims: The purpose of this study was to compare the changes in quality of life in patients of vitiligo before and after treatment with narrowband ultraviolet B (NBUVB) phototherapy. Subjects and Methods: A total of 54 patients had completed the study. The age ranged between 16 and 70 years with a mean age of 26.77±14.2 years. The initial dose of NBUVB was 300 mJ/cm2 in adults and 150 mJ/cm2 in children twice weekly with 20% dose increment on subsequent visits. It was given for a maximum period of 6 months and was followed up for another 6 months to determine stability of repigmentation. Results: The average number of exposure given to the patients was 45.63±12.74 while the mean irradiation cumulative dose was 39.8 J/cm2. Mean Dermatology Life Quality Index (DLQI) of the vitiligo patients was 8.64±4.32 while those patients with acrofacial vitiligo had a mean DLQI of 11.78±5.61. After treatment with NBUVB, mean DLQI of all vitiligo patients was significantly reduced to 5.86±2.15 (P

Image Enhancement is one of the first steps in Image processing. In this technique, the original image is processed so that the resultant image is more suitable than the original for specific applications. Preprocessing an image include removal of noise, edge or boundary enhancement, automatic edge detection, automatic contrast adjustment and segmentation. Image enhancement is a purely subjective processing technique. An image enhancement technique used to process images might be excellent for a person but the same result might not be good enough for another. Image enhancement is a cosmetic procedure i.e. it does not add any extra information to the original image. It merely improves the subjective quality of the images by working with the existing data. This Research paper focuses on Contrast Stretching and Image Sharpening techniques. In this paper, an approach that simultaneously adjusts contrast and enhances boundaries is presented. Histogram has been plotted to verify the result of various cases arising due to implementation of contrast stretching on image sharpening. The edges of the objects in the image are also enhanced by this methodology. Various other edge enhancement techniques are also available like Contrast Stretching on Adaptive Thresholding for enhancing edges of MRI knee images. The proposed methodology shows much better result than the one said above.

Bardet–Biedl syndrome (BBS) is a rare, genetically heterogeneous, autosomal recessive inherited disorder with wide variability in expression. The accepted major criteria for diagnosis include retinal dystrophy, obesity, polydactyly, male hypogonadism, mental retardation, and renal dysfunction. We are presenting a 20-year-old male patient exhibiting characteristic features of BBS in association with nonalcoholic steatohepatitis, hypertension, and hypothyroidism, which is uncommon. Literature is also reviewed in brief.

Background: Heart disease in pregnancy is a potentially serious medical complication in pregnancy. Limited studies have been conducted in India to assess heart disease in pregnancy. Objective: To determine the type of cardiac lesions and to assess the maternal and fetal outcomes in patients with heart disease in pregnancy. Materials and Methods: In this retrospective study, 42 pregnant women with known or newly diagnosed heart disease were followed from January 2012 to December 2013. The data analysis was done using statistical software Systat 12. Results: Out of total 42 subjects selected for the study, maximum 13 (30.9%) were in the age group of 26-30 years. Majority of the women 30 (71.4%) were primigravida. Mostly 26 (61.9%) patients belonged to New York Heart Association (NYHA) class I andII. In total, 30 (71.4%) women presented with rheumatic heart disease and 6 (14.3%), with congenital heart disease. Majority 22 (52.4%) had spontaneous vaginal deliveryand only 8 (19.0%) required induction of labor. Most common maternal complication was heart failure (16.7%) and maternal deaths were 4.8%. The live birth was recorded in 38 cases (90.5%) of them 16 (42.1%) were preterm babies. Intrauterine death occurred in four cases while five babies died in neonatal period. Conclusion: The study results conclude that the rheumatic heart disease is still a predominant lesion and heart disease in pregnancy is associated with increased maternal and fetal risk.