Interaction between enrofloxacin and monensin in broiler chickens

Enrofloxacin, a fluoroquinolone, and its interaction with monensin, an ionophore drug, was studied to explore the influence of enrofloxacin on drug metabolizing enzymes that can lead to physiological and toxicological consequences upon coadministration with monensin in broiler chickens. Group I, treated with 100 mg monesin/kg feed from 1 d old to 41st d of age, did not show any influence on aniline hydroxylase and cytochrome b5 levels. Group II, treated with 10 mg enrofloxacin/kg body weight per os for three consecutive days on 33rd, 34th, 35th d of age, had a highly significant decrease in aniline hydroxylase on 38th d (ie on 3rd d post-treatment with enrofloxacin); a reversal effect was noticed on the 41st day (ie on 6th d post-treatment with enrofloxacin). There was no alteration in cytochrome b5 level. Group III with monensin and enrofloxacin coadministration 100 mg monensin/kg feed from 1 d old to the 41st day + 10 mg enrofloxacin/kg body weight, per os for 3 consecutive days on the 33rd, 34th, 35th d of age) had a significant decrease in aniline hydroxylase level on the 3rd d post-treatment with enrofloxacin, but an elevation tending to reach normal on the 6th d post-treatment with enrofloxacin. Monensin + enrofloxacin coadministration did not produce any alteration in cytochrome b5 level. Creatine kinase (CK) and alanine amino transferase (ALT) levels significantly increased on the 3rd d post-treatment with enrofloxacin, but on the 6th d post-treatment with enrofloxacin the increase declined. Aspartate amino transferase (AST) significantly increased on the 6th d post enrofloxacin treatment. This study demonstrated the reversible competitive type of inhibition of enrofloxacin on CYP450 enzymes, and with coadministration with monensin produced increased CK, AST and ALT serum enzymes suggesting heart and liver injury. Simultaneous administration of enrofloxacin and monensin even at recommended levels could result in adverse interactions.     

Palliative care in Kerala, India: a model for resource-poor settings

BACKGROUND: The need for palliative care is increasing throughout the world. Developing countries are progressively faced with an ageing population, whose changing health needs require urgent action. Insufficient access to care for both cancer and AIDS patients make palliative care the only humane and feasible response in many contexts. MATERIAL AND METHODS: In order to describe the need for palliative care in Kerala and the development of the new palliative care policy, we have collected and reviewed information from government officials, health professionals involved in cancer care, patients and their families, sponsors, and members of palliative care teams across Kerala. We also collected data on the functioning of the newly established palliative care clinics. RESULTS: The Pain and Palliative Care Society developed in a few years a network of 33 palliative care clinics across Kerala, providing care free of charge to patients in need. Outpatient treatment with a supportive home care service was adopted as the main mode of operation. Trained volunteers from the community assisted in providing care, and family members were empowered to the highest degree in order to ensure continuity of treatment. In 2002 the network of clinics saw about 6,000 new patients, about 25% of incident cancer cases. CONCLUSIONS: The synergistic effect of motivation and knowledge, coupled with the use of local resources, has made possible the development of a network of palliative care services, available for free to terminally ill patients. The challenge of adapting such a model to other developing countries is discussed.     

Matrix metalloproteinase inhibitors

Matrix metalloproteinases (MMPs) are a family of zincdependent proteinases that are associated with the tumorigenic process. MMPs degrade the extracellular matrix, promoting tumor invasion and metastasis. They also regulate host defense mechanisms and normal cell function; blocking all MMPs may not lead to a positive therapeutic outcome. Most clinical trials of MMP inhibitors (MMPIs) have yielded disappointing results, perhaps due to inappropriate study design or tumor staging, or to lack of selectivity. Positive results have been seen in gastric cancer with marimastat and in Kaposi’s sarcoma with metastat. This review summarizes the current status of MMPIs.     

Effect of Coccinia indica leaf extract on plasma antioxidants in streptozotocin- induced experimental diabetes in rats

The present study was carried out to investigate the antioxidant effect of an ethanolic extract of Coccinia indica leaves, an indigenous plant used in Ayurvedic Medicine in India, in Streptozotocin-diabetic rats. Oral administration of Coccinia indica leaf extract (CLEt) (200 mg/kg body weight) for 45 days resulted in a significant reduction in plasma thiobarbituric acid reactive substances, hydroperoxides, vitamin E and ceruloplasmin. The extract also caused a significant increase in plasma vitamin C and reduced glutathione, which clearly shows the antioxidant property of CLEt. The effect of CLEt at 200 mg/kg body weight was more effective than glibenclamide.     

Antihyperglycaemic effect of Diamed, a herbal formulation, in experimental diabetes in rats

Diamed is a herbal formulation composed of the aqueous extracts of three medicinal plants (Azardirachta indica, Cassia auriculata and Momordica charantia). We have investigated Diamed for its possible antihyperglycaemic action in rats with alloxan-induced experimental diabetes. Oral administration of Diamed (1.39 (0.25 g), 1.67 (0.30 g) or 1.94 (0.35 g) mL kg(-1)) for 30 days resulted in a significant reduction in blood glucose, glycosylated haemoglobin, and an increase in plasma insulin and total haemoglobin. The effect was highly significant after administration of the 1.94 mL (0.35 g) g(-1) body weight dose. Diamed also prevented a decrease in body weight. An oral glucose tolerance test was performed in experimental diabetic rats in which there was a significant improvement in glucose tolerance in the animals treated with Diamed. The effect was compared with 600 microg kg(-1) glibenclamide. The results showed that Diamed had antihyperglycaemic action in experimental diabetes in rats.     

A genome-wide association screen identifies regions on chromosomes 1q25 and 7p21 as risk loci for sporadic prostate cancer

We conducted a genome-wide association study of 3090 sporadic prostate cancer patients and controls using the Affymetrix 10 000 SNP GeneChip. Initial screening of 40 prostate cancer cases and 40 non-cancer controls revealed 237 SNPs to be associated with prostate cancer (P<0.05). Among these SNPs, 33 were selected for further association analysis of 2069 men who had undergone a cancer-screening prostate biopsy. Results identified five loci as being significantly associated with increased prostate cancer risk in this larger sample (rs 1930293, OR=1.7, P=0.03; rs 717809-2p12, OR=1.3, P=0.03; rs 494770-4q34, OR=1.3, P=0.01; rs 2348763-7p21, OR=1.5, P=0.01; rs 1552895-9p22, OR=1.5, P=0.002). To validate these association data, 61 additional HapMap tagSNPs spanning the latter five loci were genotyped in this subject cohort and an additional 1021 men (total subject number=3090). This analysis revealed tag SNP rs 4568789 (chromosome 1q25) and tag SNP rs 13225697 (chromosome 7p21) to be significantly associated with prostate cancer (P-values 0.009 and 0.008, respectively). Haplotype analysis revealed significant associations of prostate cancer with two allele risk haplotypes on both chromosome 1q25 (adjusted OR of 2.7 for prostate cancer, P=0.0003) and chromosome 7p21 (adjusted OR of 1.3, P=0.0004). As linkage data have identified a putative prostate cancer gene on chromosome 1q25 (HPC1), and microarray data have revealed the ETV1 oncogene to be overexpressed in prostate cancer tissue, it appears that chromosome 1q25 and 7p21 may be sites of gene variants conferring risk for sporadic and inherited forms of prostate cancer.     

Management of Laryngotracheal Trauma During the COVID 19 Pandemic: Our Experience

Objective To study the outcomes in terms of airway, voice and swallowing as well as the economic impact of the trauma on patients’ finances and the constrained health infrastructure due to the pandemic. Materials and methods Study design Retrospective study. Setting: Tertiary care teaching hospital. Subjects and methods: A retrospective study was done of the 19 subjects who sustained acute laryngotracheal trauma during the SARS CoV-2 pandemic and was managed at our institution from January 2020 to September 2021.Results Change in voice was the most common presenting symptom and thyroid cartilage fractures were the commonest cartilage injury noted. It was found that 93% (decannulated) of the patients had good functional outcome and 90% of them required financial support to meet the medical expenses.Conclusion During the COVID 19 pandemic, it was not only, early presentation, timely detection and intervention by the treating team, but also the multidisciplinary teamwork and the support system that facilitated the recuperation and restoration of these traumatized individuals back into society with good laryngeal function.     

Primary Ewing tumor of the vertebrae: clinical characteristics, prognostic factors, and outcome

BACKGROUND: Fewer than 10% of Ewing family of tumors (EFT) arise in the vertebrae. Little information is available regarding the clinical presentation and outcome of these tumors. PROCEDURE: We reviewed the clinical features, prognostic factors, and outcome of EFT of the spine identified at our institution between 1962 and 1999. RESULTS: Thirty-three (10%) of 344 patients with EFT had a primary vertebral tumor. There were 21 (64%) males. Median age at diagnosis was 13.3 years. Six patients had metastatic disease and 10 had tumors > or = 8 cm in diameter. Primary sites were sacral (13), thoracic (10), lumbar (8), and cervical (2) vertebrae. We found no association between the affected spinal region and outcome, although sacral tumors were associated with delayed diagnosis (4 vs. 2 months after onset of symptoms, P = 0.076). Pain (n = 32) and neurologic deficits (n = 31; 82% motor, 58% sensory, 42% bladder, 27% bowel) were the most common presenting features. All patients received combination chemotherapy and local radiotherapy. With a median follow up of 9.7 years, 5-year survival and event-free survival ( +/- SD) estimates were 48.1% (8.9%) and 35.6% (8.6%), respectively, comparable to those of other patients with EFT. Outcome was better for patients with tumor size < 8 cm (P = 0.008) or localized disease (P = 0.084). Treatment era and specific tumor site did not affect outcome. CONCLUSIONS: Outcomes are similar for primary EFT of the spine and primary EFT in other sites. Unlike others, we found that patients with sacral tumors did not fare worse than patients with tumors at other spinal sites.     

Effect of patent ductus arteriosus on the heart in preterm infants

There continues to be controversy on the long‐term effects of a patent ductus arteriosus (PDA) and its management. However, the hemodynamic effects of a large PDA in a preterm infant are well known. This article aims to provide insight into the adaptive changes and remodeling effects of a PDA on the myocardium in preterm infants.     

Inexpensive video-laryngoscopy guided intubation using a personal computer: initial experience of a novel technique

Video-laryngoscopy may provide an enhanced view of laryngeal structures compared to direct visualization. Commercial video-laryngoscopes are often expensive, limiting its adoption for routine use. We describe our initial experience using an inexpensive custom made device. Patients >15 years age, were randomly chosen, after informed consent, for video-laryngoscopy. A custom device easily assembled using an USB endoscopic camera, a conventional Macintosh laryngoscope blade size 3 or 4, and a personal computer was used. Patients with Mallampati class 1–3 were chosen. Video-laryngoscopy was recorded and reviewed. Twenty-four patients aged 16–68 years, of mean weight 58.46 ± 12.54 (40–86) kg were studied. The glottis could be visualized and intubation could be performed in all patients with 22/24 patients on first attempt. Mean duration of laryngoscopy was 22.17 ± 12.78 (7–59) s. Time taken for intubation, was mean of 28.58 ± 21.01 (9–89) s. Three patients with anticipated difficult airways could be intubated on the first attempt. Minor blood staining of the airway was seen in the video in two patients. Cormack–Lehane laryngoscopy grade visualized was 1 in 9/24, 2 in 15/24 patients. Percentage of glottic opening score was 62.29 ± 28.40 (20–100) %. Real-time video could be captured in all cases. The custom-made, inexpensive, video-laryngoscopy device is safe and reliable for clinical use. Real-time visualization and endotracheal intubation were successful in all patients, including those with anticipated difficult airway. Further, this device helps in archiving the video of intubation.