Left Main Myocardial Infarction in a Healthy Young Male—A Case Report

Acute left main coronary artery occlusion is a catastrophic and mostly fatal event. Patients may present with sudden death or cardiogenic shock. Intra-aortic balloon pump support and emergency revascularization is indicated to preserve the left ventricular function. We describe a case of left main thrombus in a health 24-year-old young male with no risk factors for coronary atherosclerosis.     

Taking Up Subfascial Endoscopic Perforator Surgery for Patients of Lower Limb Varicose Veins with Below Knee Perforators,in A Government Medical College–A Review of Eleven Cases

Varicose veins are the most common manifestation of chronic venous insufficiency (CVI) worldwide. They interfere with the patients’ daily activities and hamper their professional endeavors, and therefore need to be addressed at the earliest with the best tools. Eleven patients of varicose veins of the lower limb with below knee perforators underwent subfascial endoscopic perforator surgery (SEPS) from October 2010 to December 2011 in our institute. The procedure was successfully completed in all 11 patients. The mean operating time was 78 min (60–96 min). The results showed a favorable outcome for the patients in terms of faster recovery and less morbidity.     

Detection of hepatocellular carcinoma capsule by contrast-enhanced ultrasound using Levovist: correlations with pathological findings

Purpose To determine the most appropriate therapy for each hepatocellular carcinoma (HCC) nodule, it is important to ascertain whether the tumor has a capsule. The aim of this study was to investigate the diagnostic potential of contrast-enhanced ultrasound (CEUS) in HCC capsule detection by comparing ultrasound findings with histological results from operative specimens. Methods Thirty-six HCC nodules (all smaller than 5 cm) from 36 patients who had undergone hepatectomy were examined by CEUS using Levovist with agent detection imaging. The vascular phase images and time course changes of HCC were observed after a bolus injection of Levovist. We classified the appearance of the tumor artery, tumor enhancement, and washout into several patterns. We grouped HCCs into encapsulated or nonencapsulated on the basis of the histology of the operative specimens, taking into account the effectiveness of transcatheter arterial chemoembolization. Ultrasound and pathological findings were compared to assess the ability of CEUS to detect HCC capsules. Results During the arterial phase, 12 (80.0%) encapsulated and 3 (14.3%) nonencapsulated HCC nodules showed a surrounding artery with branches pattern (P < 0.0001). The sensitivity, specificity, and accuracy of this pattern for HCC capsule detection were 80%, 86%, and 83%, respectively. A branching artery was found in 15 (71.4%) nonencapsulated but in only 3 (20.0%) encapsulated HCC nodules (P < 0.01). The sensitivity, specificity, and accuracy of this branching artery pattern for confirming the absence of a capsule in HCC nodules were 71%, 80%, and 75%, respectively. Almost all HCC nodules showed strong–moderate or weak enhancement and strong–moderate or mild washout. Neither enhancement nor washout pattern correlated with the presence of a capsule. Conclusion The arterial phase of CEUS is very useful for detection of HCC capsules and therefore facilitates selection of the most appropriate treatment method for HCC.     

Involvement of both intrinsic and extrinsic pathways in hepatoprotection of arjunolic acid against cadmium induced acute damage in vitro

Cadmium (Cd) is one of the ubiquitous environmental pollutants and is responsible for various organ pathophysiology including hepatic disorders. It is extremely toxic even in low concentrations and bioaccumulate in organisms. The present study has been carried out to investigate the cytoprotective role of arjunolic acid (AA), a tri terpenoid saponin, against Cd induced oxidative impairment and cell death in murine hepatocytes. Administration of cadmium (30 μM), in the form of chloride (CdCl(2)) for 2h, significantly enhanced the ALT, ALP and LDH leakage, increased reactive oxygen species (ROS) production, reduced hepatocytes viability and altered the antioxidant status of hepatocytes by reducing intracellular GSH level, anti-oxidant enzymes activity and increasing intracellular GSSG and lipid peroxidation. Evidence for Cd-induced nature of cell death was sought by flow cytometric analysis. Signal transduction studies revealed that Cd markedly increased the levels of caspase-9, -8, -3, Fas and Bid, decreased mitochondrial membrane potential, enhanced cytochrome c release in the cytosol, disturbed the Bcl-2 family protein balance, cleaved PARP protein and ultimately led to apoptotic cell death. Results showed that Cd could trigger both intrinsic and extrinsic apoptotic pathways. In addition, Cd markedly increased NF-κB nuclear translocation in association with IKKα/β phosphorylation and IκBα degradation. Simultaneous treatment with AA (200 μM), however, reduced Cd-induced oxidative stress, attenuated the nuclear translocation of NF-κB and protects the hepatocytes from Cd-induced apoptotic death. Combining, data suggest that Cd-induced hepatic dysfunction and apoptosis might be supported by the ROS formation and mediated via the activation of NF-κB. AA treatment, on the other hand, reduced Cd-induced oxidative stress, attenuated the activation of NF-κB and mitochondrion-dependent and independent apoptotic signaling pathways.     

Persistence of Napropamide in/on Tea under North-East Indian Climatic Condition

Napropamide is an amide group of herbicide, used as pre-emergence herbicide controlling in broad leaved weeds of tea, ground nut, citrus, etc. Napropamide 45 SC (Devrinol) was applied on tea bushes twice @ 1.125 and 2.250 g a.i./ha along with untreated control. After following the standard extraction process, the residue of napropamide in made tea and soil cropped with tea was analyzed by HPLC. Napropamide was rapidly dissipated in soil following the first-order kinetics with half-lives in the range of 12.54–27.87 days. The residue in made tea found to be below detectable limit on 7th day samples.     

Supracondylar femoral extension osteotomy and patellar tendon advancement in the management of persistent crouch gait in cerebral palsy

Background:

Severe crouch gait in adolescent cerebral palsy is a difficult problem to manage. The patients develop loading of patellofemoral joint, leading to pain, gait deviation, excessive energy expenditure and progressive loss of function. Patella alta and avulsion of patella are the other complications. Different treatment options have been described in the literature to deal with this difficult problem. We evaluated outcome of supracondylar femoral extension osteotomy (SCFEO) and patellar tendon advancement (PTA) in the treatment of crouch gait in patients with cerebral palsy.

Materials and Methods:

Fourteen adolescents with crouch gait were operated by SCFEO and PTA. All subjects were evaluated pre and postoperatively. Clinical, radiographic, observational gait analysis and functional measures were included to assess the changes in knee function.

Results:

Cases were followed up to 3 years. The patients walked with increased knee extension and improvement in quadriceps muscle strength. Knee pain was decreased and improvements in functional mobility and radiologic improvement were found.

Conclusion:

SCFEO and PTA for adolescent crouch gait is effective in improving knee extensor strength, reducing knee pain and improving function.     

In Vivo Therapeutic Efficacy of Chloroquine Alone or in Combination with Primaquine against Vivax Malaria in Kolkata,West Bengal,India, and Polymorphism in pvmdr1 and pvcrt-o Genes

Plasmodium vivax malaria, though benign, has now become a matter of concern due to recent reports of life-threatening severity and development of parasite resistance to different antimalarial drugs. The magnitude of the problem is still undetermined. The present study was undertaken to determine the in vivo efficacy of chloroquine (CQ) and chloroquine plus primaquine in P. vivax malaria in Kolkata and polymorphisms in the pvmdr1 and pvcrt-o genes. A total of 250 patients with P. vivax monoinfection were recruited and randomized into two groups, A and B; treated with chloroquine and chloroquine plus primaquine, respectively; and followed up for 42 days according to the WHO protocol of 2009. Data were analyzed using per-protocol analyses. We assessed polymorphisms of the pvmdr1 and pvcrt-o genes by a DNA-sequencing method. Out of the 250 patients recruited, 204 completed a 42-day follow-up period, 101 in group A and 103 in group B. In group A, the non-PCR-corrected efficacy of CQ was 99% (95% confidence interval [CI], 0.944 to 1.00), and in group B, all cases were classified as adequate clinical and parasitological response (ACPR). Day 3 positivity was observed in 11 (5.3%) cases. No specific mutation pattern was recorded in the pvcrt-o gene. Eight nonsynonymous mutations were found in the pvmdr1 gene, three of which were new. The Y976F mutation was not detected in any isolate. Chloroquine, either alone or in combination with primaquine, is still effective against P. vivax malaria in the study area. (The study protocol was registered in CTRI [Clinical Trial Registry-India] of the Indian council of Medical Research under registration no. CTRI/2011/09/002031.)     

Traditional extract of Pithecellobium dulce fruits protects mice against CCl(4) induced renal oxidative impairments and necrotic cell death

The present study has been carried out to investigate the role of the aqueous extract of the fruits of Pithecellobium dulce (AEPD) against carbon tetrachloride (CCl(4)) induced renal oxidative injury in mice. HPLC analysis shows that AEPD contains phenolics, flavonoids and saponins as the major active components. Creatinine and blood urea nitrogen (BUN) levels were assayed to determine renal protective action of AEPD in CCl(4)-induced renal pathophysiology. Its antioxidant activity was determined by measuring radical scavenging activity, antioxidant enzymes activities, GSH content, protein carbonylation and lipid peroxidation. In addition, FACS analysis, DNA fragmentation and histological studies were carried out to determine its effect in CCl(4) induced renal oxidative injury and cell death. CCl(4) exposure increased the intracellular reactive oxygen species production, decreased intracellular antioxidant defence, reduced mitochondrial membrane potential, attenuated the intracellular ATP content and caused renal cell death mainly via the necrotic pathway as revealed by DNA fragmentation analysis. Treatment with AEPD both prior and post to the toxin exposure protected the organ from CCl(4) induced oxidative insult. Histological studies also support our results. Combining, results suggest that the protective role of AEPD against CCl(4) induced renal oxidative impairments is probably due to the antioxidative properties present in its active constituents.     

Efficacy of oral miltefosine in visceral leishmaniasis in rural West Bengal, India

Context:

Visceral leishmaniasis (VL), also known as Kala-azar (KA) is a public health problem of tropical and subtropical countries, which infects about 12 million people annually, out of which about 1.5 million are new cases. India contributes a major share of the global burden of VL. For many years leishmaniasis has been treated with pentavalent antimonials. Antimony resistance is a problem in India and in other different geographic areas of the world. Amphotericin B deoxycholate and pentamidine isethionate are effective by parenteral administration and associated with toxicities. The quest for an effective, orally administered, non-toxic and less expensive alternative resulted in the identification of miltefosine (hexadecylphosphocholine). In India, therapeutic efficacy of miltefosine in VL was assessed by many groups of scientists, mainly from Bihar and Uttar Pradesh. No such data is available from West Bengal.

Aims:

The present study was designed to observe the efficacy of miltefosine in VL in rural West Bengal.

Materials and Methods:

A total of 71 parasitologically proven VL patients participated in the study who received miltefosine in accordance with the National Vector Born Disease Control Programme (NVBDCP) of India and were followed up for the following one year.

Results:

The overall efficacy of the drug was 93% and no significant adverse side effects were observed during the study period.

Conclusions:

The study concludes that miltefosine is effective, well tolerated, and easily administrable drug in the treatment of visceral leishmaniasis at the field levels.KEY WORDS: India, visceral leishmaniasis, miltefosine