The impact of creatinine clearance on the outcome of diabetic foot ulcers in north Indian tertiary care hospital

AimWound healing has been reported to be poor in diabetic patients with impaired kidney functions that usually accompanies retinopathy and neuropathy. The insensitive foot is vulnerable to repeated trauma and development of ulcer precedes 70–80% of non-traumatic lower extremity amputation. The present study was aimed to study the impact of creatinine clearance (CCre) on the outcome of diabetic foot ulcers (DFU).Materials and methodsData from 162 DFU patients admitted to Rajiv Gandhi Centre for Diabetes and Endocrinology of J.N. Medical College, Aligarh Muslim University, Aligarh, India, between December 2009 and March 2011 were analyzed. Detailed history and patient's profile, grade of DFU, co-morbidities and complications, laboratory data, microbiological profile and final outcome were collected. CCre was calculated according to MDRD formula.ResultsThe study revealed that, DFU healing was worst in patients with decreased CCre than in those who had normal CCre. Other factors associated with poor outcome were, higher grade of ulcer, infection type (subcutaneous and osteomyelitis) and biofilm infection. Amputation rates were also found to be higher in those with poor renal functions.ConclusionsThe results suggest that CCre is an important factor affecting wound healing in patients with DFUs. The automatic reporting of eGFR each time a serum creatinine concentration is requested will increase the awareness of significant kidney dysfunction in clinical practice especially in DFU patients and appropriate measures will improve the outcome.     

Aspergilloma in preexisting cavity – serial chest roentgenograms can help in diagnosis

A 24-year-old male presented with hemoptysis, off and on, which was gradually increasing. The patient had four chest roentgenograms, which depicts various stages of aspergilloma formation in preexisting cavity. The diagnosis of aspergilloma was made and patient underwent lobectomy.     

Evaluation of [3H]LY341495 for labeling group II metabotropic glutamate receptors in vivo

New glutamatergic drugs are being developed as potential therapies for neurodegenerative disorders, anxiety disorders, and psychoses. The development of effective mGluR radiotracers would provide essential tools with which to probe these sites in living humans, providing critical information about certain disease processes involving the glutamaterigic system and its regulation in humans. As a first step towards this goal, the tritiated form of the high affinity group II metabotropic glutamate receptor (mGluR) antagonist LY341495 [K(D) (mGluR(2)) = 1.67 +/- 0.20 nM, K(D) (mGluR(3)) = 0.75 +/- 0.43 nM] was evaluated to determine its potential to label mGluRs in vivo. Dissection analysis of the regional brain distribution over time of [(3)H]LY341495 in male rats revealed low brain uptake and no significant demonstrable saturable binding of this tracer. A group II mGluR tracer possessing higher affinity than [(3)H]LY341495 and an absence of carboxylic acid groups is likely required for in vivo PET imaging purposes.     

Triple-component nanocomposite films prepared using a casting method: Its potential in drug delivery

The purpose of this study was to fabricate a triple-component nanocomposite system consisting of chitosan, polyethylene glycol (PEG), and drug for assessing the application of chitosan–PEG nanocomposites in drug delivery and also to assess the effect of different molecular weights of PEG on nanocomposite characteristics. The casting/solvent evaporation method was used to prepare chitosan–PEG nanocomposite films incorporating piroxicam-β-cyclodextrin. In order to characterize the morphology and structure of nanocomposites, X-ray diffraction technique, scanning electron microscopy, thermogravimetric analysis, and Fourier transmission infrared spectroscopy were used. Drug content uniformity test, swelling studies, water content, erosion studies, dissolution studies, and anti-inflammatory activity were also performed. The permeation studies across rat skin were also performed on nanocomposite films using Franz diffusion cell. The release behavior of films was found to be sensitive to pH and ionic strength of release medium. The maximum swelling ratio and water content was found in HCl buffer pH 1.2 as compared to acetate buffer of pH 4.5 and phosphate buffer pH 7.4. The release rate constants obtained from kinetic modeling and flux values of ex vivo permeation studies showed that release of piroxicam-β-cyclodextrin increased with an increase in concentration of PEG. The formulation F10 containing 75% concentration of PEG showed the highest swelling ratio (3.42 ± 0.02) in HCl buffer pH 1.2, water content (47.89 ± 1.53%) in HCl buffer pH 1.2, maximum cumulative drug permeation through rat skin (2405.15 ± 10.97 μg/cm²) in phosphate buffer pH 7.4, and in vitro drug release (35.51 ± 0.26%) in sequential pH change mediums, and showed a significantly (p < 0.0001) higher anti-inflammatory effect (0.4 cm). It can be concluded from the results that film composition had a particular impact on drug release properties. The different molecular weights of PEG have a strong influence on swelling, drug release, and permeation rate. The developed films can act as successful drug delivery approach for localized drug delivery through the skin.     

Ethnomedicinal knowledge of the most commonly used plants from Deosai Plateau,Western Himalayas,Gilgit Baltistan,Pakistan

Ethnopharmacological relevance

The current survey was aimed to identify the prime important medicinal plants in terms of medicines and further pharmacological screening of such plants. As far as, we know, no reported data from Deosai Plateau have been published and this is the first documented information of the study area.

Material and methods

Ethnomedicinal information of plants was collected through semi-structured interviews through a participatory rural appraisal (PRA) method.

Results and discussion

This study provided information of 50 medicinal plant species used to treat 29 different ailments. A total of 42 species (84%) were herbs while shrubs and subshrubs were represented by 8 species (16%). Leaves (37%) were the predominant plant parts followed by, roots (27%), aerial parts (13%), flowers (12%), fruit (7%), seeds (3%), and tuber (1%). Method of preparation fall into five categories including infusion (31%), paste (23%), decoction (20%), powder (18%), and juice (8%).

Conclusion

The study area is rich in medicinal plant diversity growing in wild. Our efforts in this regard are only a little contribution to the ethnobotanical study of this area focusing on medicinal plants while more clinical studies are required in future to prove such claims of local inhabitants.     

Efficacy and Safety of <Emphasis Type="Italic">Saccharomyces boulardii</Emphasis> in Acute Childhood Diarrhea: A Double Blind Randomised Controlled Trial

Objective  

To see the efficacy and safety of 250 mg of Saccharomyces boulardii twice daily for 5 d in acute childhood diarrhea.     

Radiation-Induced Malignant Gliomas: Is There a Role for Reirradiation?

PURPOSE: To review the literature regarding the role of radiotherapy (RT) in the treatment of patients with radiation-induced malignant gliomas (RIMGs). METHODS AND MATERIALS: A PubMed search of English-language articles dealing with RIMG was performed, yielding 52 articles with 92 patients available for review. RESULTS: Initial tumor types treated with RT included brain tumor in 37 patients (40%), acute lymphoblastic leukemia in 33 (36%), benign disease in 11 (12%), and other in 11 (12%). Median time from RT to development of an RIMG was 8.75 years (range, 2.5-61 years). The RIMG occurred within 10 years after RT in 81% of patients with acute lymphoblastic leukemia/lymphoma, 59% of patients with brain/other, and 18% of patients with benign conditions (p = 0.002). Type of RIMG was glioblastoma in 69 (75%) and anaplastic astrocytoma in 23 (25%). One-, 2-, and 5-year overall survival rates were 29.3%, 7.3%, and 0% for patients with glioblastoma and 59.7%, 30.3%, and 20.2% for patients with anaplastic astrocytoma. For the 85 patients with data regarding treatment for RIMG, 35 underwent reirradiation to a median dose of 50 Gy (range, 30-76 Gy). For patients undergoing reirradiation, 1-, 2- and 5-year overall survival rates were 58.9%, 20.5%, and 6.8%. For those not undergoing reirradiation, they were 15.1%, 3%, and 0% (p = 0.0009). CONCLUSIONS: The RIMG appeared earlier in patients treated for leukemia and lymphoma and latest for those treated for a benign condition. Patients who underwent reirradiation for RIMG have longer survival times compared with those not receiving RT.