Choice of wound care in diabetic foot ulcer: A practical approach

Diabetic foot ulcers are the consequence of multiple factors including peripheral neuropathy,decreased blood supply,high plantar pressures,etc.,and pose a significant risk for morbidity,limb loss and mortality.The critical aspects of the wound healing mechanism and host physiological status in patients with diabetes necessitate the selection of an appropriate treatment strategy based on the complexity and type of wound.In addition to systemic antibiotics and surgical intervention,wound care is considered to be an important component of diabetic foot ulcer management.This article will focus on the use of different wound care materials in diabetic foot.From a clinical perspective,it is important to decide on the wound care material depending on the type and grade of the ulcer.This article will also provide clinicians with a simple approach to the choice of wound care materials in diabetic foot ulcer.     

Analysis of Indian cholesterol gallstones by particle-induced X-ray emission and thermogravimetry-derivative thermogravimetry

OBJECTIVES: It has been reported that the role of some minor elements plays a significant role in the formation of gallstones. The relationship between minor and trace element concentrations was established in the present investigation and the trace element profile of the current investigation was compared with the literature values of south Indian gallstone samples in order to determine their possible role in stone formation and growth. The rate of weight loss and classification of cholesterol type of gallstones were also investigated by thermal analysis. BASIC METHODS: The trace element profile of the cholesterol gallstones was determined by proton-induced X-ray emission spectroscopic technique and the thermal properties of the cholesterol stones were studied by thermogravimetry-derivative thermogravimetry analysis. RESULTS: It was observed that 14 minor/trace elements, namely S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Br and Pb, were present in the cholesterol stone samples. The average concentration of Fe in south Indian (Chennai region) gallstone samples (503.4 ppm) is about 2.5 times more than that of the east Indian gallstone samples (205.0 ppm), whereas the concentration of Fe is still higher in other parts of south India (848.2 ppm) as analysed by Ashok et al. CONCLUSIONS: The higher concentration of Cu (in some parts of south India except the Chennai region) and Fe in south Indian cholesterol stone samples may be due to the intake of tamarind (Garcinia camborginia) as their regular food. The thermogravimetry and derivative thermogravimetry curves provided information on the thermal decompositions of cholesterol stones.     

A multicentric study on epidemiology of chronic obstructive pulmonary disease and its relationship with tobacco smoking and environmental tobacco smoke exposure

INTRODUCTION: Population prevalence of chronic obstructive pulmonary disease (COPD) and its relationship with tobacco smoking, environmental tobacco smoke (ETS) exposure and other variables were studied in adult subjects of 35 years and above at four different centres in India. Question-items for the diagnosis of COPD were included in the questionnaire used for the field study on asthma epidemiology. METHODS: Field surveys were conducted in both the urban and the rural populations at Bangalore, Chandigarh, Delhi and Kanpur with the help of a structured and validated questionnaire for diagnosis of asthma and COPD. Separate sets of questions were used for the diagnoses of the two diseases. A two-stage stratified sample design was employed where a village or an urban locality formed the first stage unit and a household formed the second stage unit. A uniform methodology was used at all the four centres and the analyses were done at the central coordinating centre--Chandigarh. Chronic obstructive pulmonary disease, defined by chronic bronchitis (CB) criteria, was diagnosed from the presence of cough and expectoration on most of the days for at least three months in a year for two consecutive years or more. RESULTS: Chronic obstructive pulmonary disease was diagnosed in 4.1% of 35295 subjects, with a male to female ratio of 1.56:1 and a smoker to nonsmoker ratio of 2.65: 1. Prevalence among bidi and cigarette smokers was 8.2% and 5.9%, respectively. Odds ratio (OR) for COPD was higher for men, elderly individuals, lower socio-economic status and urban (or mixed) residence. Environmental tobacco smoke exposure among nonsmokers had an OR of 1.4(95% CI 1.21-1.61). Combined exposure to both ETS and solid fuel combustion had higher OR than for ETS exposure alone. CONCLUSIONS: Population prevalence of COPD is very high in India with some centre to centre differences. Smoking of both bidis and cigarettes, and ETS exposure among nonsmokers, were two important risk factors at all centres. It is important to employ uniform methodology for assessment of national burden and disease-surveillance programme.     

Mesenteric Vein Thrombosis Associated with Intravaginal Contraceptives: A Case Report and Review of the Literature

Mesenteric vein thrombosis (MVT) is a distinct clinical cause of intestinal ischemia representing 5-15% of all ischemic events. MVT has acute, subacute, and chronic presentations and an underlying cause can be found in nearly 75% of cases. Exogenous hormones are used worldwide by millions of women for contraception and postmenopausal replacement therapy. Current preparations include oral, transdermal, and intravaginal delivery systems. The risk of venous and arterial thrombosis with oral preparations is well established, however the risk with parenteral preparations has not been fully established. The mechanisms underlying these increased risks have not been fully elucidated.We report a case of mesenteric vein thrombosis associated with intravaginal hormonal contraception. A review of the current literature reveals no prior reports of this complication of intravaginal or transdermal hormonal therapy. When taking a medical history, it is imperative for physicians to be aware of all medications, including those not taken orally.     

Bioactivity guided isolation of mosquito larvicide from Piper longum

ObjectiveTo isolate the larvicidal component from the fruits of Piper longum (P. longum) against the filariasis vector, Culex quinquefasciatus (C. quinquefasciatus).MethodsPulverized fruits of P. longum were subjected to soxhlet extraction using series of organic solvents of increasing polarity. All the solvent extracts were verified for their larvicidal efficacy against 4th instar larvae of C. quinquefasciatus employing standard WHO procedure. Bioassay-guided fractionation through column chromatography lead to the isolation of a bioactive amide, pipyahyine from the petroleum ether extract.ResultsPetroleum ether extract was found to be the most active fraction among all the extracts tested with LC₅₀ and LC₉₀ being 1.03 and 2.04 ppm respectively. Whereas, pipyahyine, an isolated component of the same fraction was found to be even more effective than the parent extract in terms of LC₅₀ being 0.58 and 1.88 ppm respectively.ConclusionsFrom the results, it is evident that P. longum can be considered as a powerful arsenal for the control of mosquito population.     

Lack of association of common cystic fibrosis transmembrane conductance regulator gene mutations with primary sclerosing cholangitis

BACKGROUND: Primary sclerosing cholangitis (PSC) is a chronic progressive cholestatic liver disease of uncertain etiology. However, the histologic features of PSC liver disease can resemble those in cystic fibrosis (CF), an inherited disorder caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. We sought to determine if PSC patients have a higher frequency of common CF alleles than disease controls. METHODS: DNA was extracted from peripheral lymphocytes of patients with end-stage liver disease. Samples were obtained before liver transplantation from 59 PSC patients and from three groups of control patients (20 each with primary biliary cirrhosis, autoimmune hepatitis, or hepatitis C). DNA samples were genotyped for 32 common CF mutations, the intron 8 T tract variants, and the M470V variant. RESULTS: One of 59 PSC patients (1.7%) had the common CF mutation (DeltaF508) in one CFTR gene. Two controls (3.3%) carried a single CF mutation (DeltaF508 in one primary biliary cirrhosis patient; W1282X in one hepatitis C patient). These rates do not differ from expected in the general population. The frequency of CFTR variants (5T and M470V) was also similar between PSC patients and controls. CONCLUSIONS: Despite anatomical similarities between CF liver disease and PSC, we could not confirm that PSC patients carried common CF mutations or common CFTR variants in higher than expected frequencies. These data suggest that CFTR dysfunction does not influence the pathogenesis of PSC.     

Central and peripheral glucocorticoid receptors are involved in the plasma cortisol response to an acute stressor in rainbow trout

Cortisol, the primary circulating corticosteroid in teleosts, is elevated during stress following activation of the hypothalamus-pituitary-interrenal (HPI) axis. Cortisol exerts genomic effects on target tissues in part by activating glucocorticoid receptors (GR). Despite a well-established negative feedback loop involved in plasma cortisol regulation, the role of GR in the functioning of the HPI axis during stress in fish is still unclear. We used mifepristone (a GR antagonist) to suppress GR signaling in rainbow trout (Oncorhynchus mykiss) and assessed the resultant changes to HPI axis activity. We show for the first time that mifepristone caused a functional knockdown of GR by depleting protein expression 40-75%. The lower GR protein expression corresponded with a compensatory up-regulation of GR mRNA levels across tissues. Mifepristone treatment completely abolished the stressor-induced elevation in plasma cortisol and glucose levels seen in the control fish. A reduction in corticotropin-releasing factor (CRF) mRNA abundance in the hypothalamic preoptic area was also observed, suggesting that GR signaling is involved in maintaining basal CRF levels. We further characterized the effect of mifepristone treatment on the steroidogenic capacity of interrenal tissue in vitro. A marked reduction in cortisol production following adrenocorticotropic hormone stimulation of head kidney pieces was observed from mifepristone treated fish. This coincided with the suppression of steroidogenic acute regulatory protein, but not P450 side chain cleavage mRNA abundances. Overall, our results underscore a critical role for central and peripheral GR signaling in the regulation of plasma cortisol levels during stress in fish.