Introduction: Breastfeeding is a natural act and an unequalled way of providing ideal food for the healthy growth and development of infants, it is also an integral part of the reproductive process with important implications for the health of mother. Objectives: To assess the knowledge, attitude, practice of exclusive breastfeeding among the married women in Mangalore. Methodology: A cross sectional study was conducted in rural areas of Mangalore for a period of one week. In among 110 randomly selected married women to assess the Knowledge, Attitude and Practice towards breastfeeding. Results: In our study, 68 (61.8%) belongs to the age group of 20 to 40 years. Of the 110, 90% knew about the importance of colostrums but only 37.3% knew that it helps mothers to lose weight after pregnancy. Around 75.5% were aware that breast feeding can help preventing diseases affecting breast and only 47.3 % knew about its contraceptive advantage. Most of them, 60 (54.54%) women disagreed with the fact that formula-feeding is more convenient than breastfeeding, 45 (40.91%) were of opinion that formula-fed babies are more likely to gain weight more quickly and 40 (36.36%) felt formula feeding is better choice for working women. Among the study participants, only 50.9% of the participants initiated breast feeding within half an hour and only 20(22.47%) women who were home makers exclusively breastfed their babies. 44.5% and 34.5% supplemented newborn with formula to improve babies health and because breast milk was insufficient respectively and it was seen more (79.35%) among women who were literates. Conclusion: The study concludes that even though women have good knowledge and almost all have positive attitude towards exclusive breastfeeding, still not all of them are practicing exclusive breast feeding and many still supplement newborns with formula feeding even though not recommended

Cholesterol and triglyceride fats are transported as part of lipoprotein particles in the bloodstream. The various lipoprotein classes Low Density Lipoprotein (LDL) that carry most part of the blood cholesterol, Very Low Density Lipoprotein (VLDL), which carry most of the blood triglycerides, High Density Lipoprotein (HDL) and Chylomicrons. LDL also found as serum cholesterol plays a significant role in coronary heart diseases. The role of these lipoproteins is quite independent of other risk factors and is quite predictive that could be easily assessed. The present article is focused on the estimation of plasma lipoprotein (a) [Lp(a)] level in AMI patients along with their cardiac Troponin-I levels to study the correlation between the two and to look into the possibility of dual marker approach to deal with complications associated with acute myocardial infarction. Lp(a) is a major risk factor of several cardiovascular diseases, namely atherosclerotic vascular diseases, aortic calcification, and perhaps also venous thromboembolic diseases and hence could be a prominent therapeutic target for primary and secondary prevention. This calls for the development of a safe and effective means of lowering Lp(a) that will provide an opportunity to conduct intervention trials to further decipher its contribution in the etiology of CHD

Healthy and strong body function was essential in the job of prison management, and smoking had been proved to induce negative impacts. Based on the health belief model, the current research explored the association among health belief on smoke -cessation, self-efficacy on ceasing smoke, and possibility of ceasing smoke among the prison officials. Samples were 182 officials recruited by snowball sampling method, 72.53% were male. Test results indicated the barrier to ceasing smoke had a lowest average 2.95(±1.04), followed by benefit of ceasing smoke (3.49±0.54), perceived susceptibility (3.51±0.75), perceived severity (3.59± 0.78), self-efficacy (3.65±0.77), and possibility of ceasing smoke (3.67 ± 0.99). As to the variance analysis, history of smoking and residence were two major variables that made the constructs different, whereas age and marriage contributed the least. Noteworthy was that the education is the major contributor to the difference of smoke-ceasing possibility among respondents. Results from regression analyses indicated that perceived benefits (β=.52) and perceived barriers (β=.23) were the two major predictors of smoke-ceasing, and the other independent variables (IV) were not significant in this model (adj. R2=.279). The variance explained increased to 48.3% (adj. R2=.483) in the model with additional variable of self-efficacy. Perceived benefits and perceived barriers were replaced by the self-efficacy, and made all original IVs not significant. This indicated the mediating effects of self-efficacy between predictors and smoke-ceasing. The current research suggested the judicial correction institute shall logically staff required officials for the jobs of prison management, and recommend several smoke-ceasing measures.

Non traumatic liver rupture is an extremely rare condition; it most often complicates HELLP syndrome and rarely some liver diseases. We are reporting a case of 26-year-old man followed for behcet’s disease, presented to the emergency hemodynamically instable on a large hemoperitoneum due to a spontaneous liver rupture. We believe that intrahepatic hematoma was caused by a rupture of a segmental right liver artery aneurysm and then spontaneous rupture of the intrahepatic hematoma occurred leading to liver rupture. The surgical management consisted on perihepatic packing and two months later a medical management of sub infected liquefied residual liver hematoma

Brown tumors are benign osteolytic bone lesions, they are rare, caused by the disorder of the phosphocalcic metabolism that typically complicate primary hyperparathyroidism (PPHT) in 4.5% and secondary hyperparathyroidism (HPTS) in 1.5 to 1.7%. Brown tumors are located mainly in the ribs, the pelvis, femurs and mandibles. Spinal locations are very rare, they especially affect the thoracic region. Very few cases of cervical brown tumors have been reported in the literature. To date, there have been only 12 cases, the last in 2018 by M. Sánchez-Calderón et al. Reporting the case of a 65-year-old woman treated in our department for cervical C4-C5-C6 brown tumor responsible for spinal compression, revealing primary hyperparathyroidism. We note the interest of the suspicion of a brown tumor in front of any osteolytic vertebral lesion, especially in patients suffred from end stage renal disease, and hypercalcemia. Early diagnosis and setting up a multidisciplinary management prevent complications and functional aftereffect, despite the benign histological characterof her injuries.

Objective: To evaluate the characteristics of central corneal thickness (CCT) in glaucoma patients followed a military hospital in Rabat. Patients and methods: This is a retrospective study of glaucoma patients followed in the military hospital ophthalmology flap service between January and December 2018. All subjects underwent a complete ophthalmic examination that included measures of CCT with an ultrasonic pachymeter. Results: A total of 205 patients (123 men and 82 women) were included in this study corresponding to 410 eyes. The age of patients ranged between 19 and 79 years. The average central corneal thickness was 519.54 ± 27.52µm in the right eye and 520.71 ± 27.99 µm in the left eye. Comparing the CCT between men and women and between the right eye and the left eye the other hand finds no statistically significant difference. Thus, the average age of the patients was 50.74 ± 12.7 years, with a mean central corneal thickness of 520.12 ± 27.75 microns. Discussion and conclusion: Compared to the Caucasian patient, our glaucoma patients differ in the early glaucoma and the thinness of the cornea, and are close to black African patients. This may induce a potential error in the measurement of intraocular pressure in glaucoma patients where our interests of Forever correlate intraocular pressure with pachymetry.

Background: Fine-needle aspiration (FNAC) cytology is well established and widely used to evaluate palpable lesions and, with imaging studies as an adjunct, is equally applicable to deep-seated lesions. Although FNAC is considered quite a reliable procedure for diagnosing salivary gland lesions, one comes across frequent diagnostic challenges in diagnosing salivary gland lesion. Methods: 180 patients were enrolled in the study from January 2014 – august 2016 .Out of these 69 samples had histopathology samples. Special stains (PAS-D) and cell blocks were prepared wherever necessary. Results: Benign neoplastic lesions were (68.1%) found to be the most common with pleomorphic adenoma being predominant of all. Mucoepidermoid carcinoma was the most common malignant lesion followed by adenoid cystic carcinoma. Conclusion: Diagnostic dilemmas are commoner in certain lesions such as basaloid neoplasms, oncocyte lesions, mucus containing cysts and lesions with squamous cells or lymphocytes, spindle cells. These pitfalls can be reduced to minimum by adequate sampling by multiple passes from different areas along with thorough clinical and radiological examination.

A simple, rapid, precise, stability indicating, isocratic reverse phase-high performance liquid chromatography method has been developed and validated for the determination of Zonisamide in bulk and pharmaceutical dosage form. The Chromatographic Separation was achieved by using Enable ODS reverse phase (250 x 4.6 mm, 5 μm particle size) C18G column. Mobile phase consists of mixture of 0.1% (v/v) ortho phosphoric acid and Methanol in the ratio of 30:70 (v/v) and was delivered at a flow rate of 1 ml/min, while the detection was monitored at a wave length of 285 nm. The developed method showed excellent linear response (r2>0.9999) in the range of 10-70 μg/ml. The retention time for Zonisamide was found to be 3.5 mins. The proposed method was validated as per ICH guideline and can be applied for estimation of Zonisamide in pharmaceutical dosage forms in routine analysis.

The aim of the present study was to study the efficacy and safety of Nebivolol and Metoprolol in post-myocardial infarction patient and to compare the efficacy and safety of Nebivolol and Metoprolol in post-myocardial infarction patients. This randomized, open-label and comparative study was done in the Department of General Medicine, Kakatiya Medical College, and MGM Hospital Warangal. A total of n=110 patients were selected based on inclusion and exclusion criteria. Patients were randomized to two groups N-groups of n=55, M-group to receive once-daily Nebivolol 5 mg and Metoprolol 50mg twice-daily respectively for 2 months. Clinical laboratory parameters were measured at day (0), and at day 56. Results The standing baseline mean systolic blood pressure 166±9 mmHg was reduced to 139±10 mmHg after 2 months treatment with Nebivolol, whereas in case of Metoprolol standing baseline systolic blood pressure 161±11 mmHg reduced to 143±14 mmHg after 2 months treatment. In case of standing, baseline mean diastolic blood pressure 103±7 mm Hg reduced to 84±4 mmHg after 2 months of treatment with Nebivolol, whereas with Metoprolol standing baseline diastolic blood pressure 100±6 mmHg reduced to 87±7 mmHg after 2 months treatment. Heart rate in case of N-group baseline 87±9 beats/min reduced to 74±6 beats/min after 2 months treatment, whereas in M-group baseline heart rate 82±7 beats/min reduced to 76±5 beats/min after 2 months treatment. Conclusion: it can be concluded that Nebivolol is superior to Metoprolol in control of blood pressure in post-myocardial infarction patients with hypertension. The distinct advantages of Nebivolol include lower incidences of adverse effects and since the dose is single there is better compliance as compared to Metoprolol

Plants of the genus Ceiba (Bombacaceae) are widely implemented in folklore treatment of diabetes, bronchitis, chronic fever, diarrhea, dysentery, gastritis, peptic ulcers and parasitic infections in many countries. Over the years, at least eighty-three compounds have been isolated from different parts of plant species of Ceiba. These compounds belong to the plant steroids, triterpenes, sesquiterpenes, sesquiterpene lactones, coumarins, flavonoids, anthocyanins, oxidized naphthalenes, phenolic acids, alcohols, fatty acids and esters. Extracts and isolated compounds of Ceiba plants have been extensively examined for their possible analgesic, antipyretic, anti-inflammatory, anti-microbial, cytotoxicity, antitumor, antidiabetic, hypolipidemic, antioxidant, and hepatoprotective, activities. This review compiles the different isolated phytochemicals as well as the biological studies carried out on extracts and isolated compounds of the genus Ceiba plants. It will also provide important knowledge for the researchers in the field of natural therapeutics to explore further alternative medicine from Ceiba plants.

Introduction: Dysphagia is a common reason for gastroenterology consultation. Esophageal manometry is recommended for the exploration of dysphagia, when gastroscopy is normal and esophageal biopsies are negative. The advent of high-resolution manometry (HRM) has led to the development of a new classification of esophageal motor disorders. The goal of this study is to evaluate the frequency and identify the type of esophageal motor disorders in dysphagic patients with normal upper digestive endoscopy. Materials and Methods: 141 patients with dysphagia with normal upper gastrointestinal endoscopy, negative esophageal biopsies and HRM were included. Esophageal motor disorders have been identified according to the Chicago classification. Results: HRM was pathological in 87 cases (61.7%). It revealed achalasia in 74 patients (52.5%). It was a type I achalasia in 23 patients (16.3%), type II in 44 patients (31.2%) type III in 7 cases (5%). It showed motor disorders that could correspond to scleroderma in 6 patients (4.2%), obstruction of the oesogastric junction in 4 cases (2.8%), and a jackhammer oesophagus in 3 cases (2.1%). HRM was normal in 54 patients (38.3%). Conclusion: The HRM of the esophagus represents an undeniable progress in the exploration of the motor system of the esophagus, mainly dysphagia with normal endoscopy. Achalasia, which can now be classified into 3 types according to HRM results, remains the most frequently found primary motor disorder.

Introduction: Plummer-Vinson syndrome (PVS), also known as sideropenic dysphagia, is a very rare entity that combines a classic triad: iron deficiency anemia, dysphagia and upper esophageal diaphragm. Its association with celiac disease has been rarely reported. The goal of this work is to determine the clinical characteristics of patients with PVS, in celiac disease, thus the evolutionary profile. Materials and Methods: This is a descriptive retrospective study covering a period of 26 years, from January 1993 to January 2019, collecting all patients followed in the service of Medecine C at the University Hospital Ibn Sina of Rabat-Morocco for PVS who have systematically benefited from jealousy biopsies in search of celiac disease. Results: Out of a total of 149 patients followed in the PVS unit, the prevalence of celiac disease was 6.1% (10 cases). 8 cases diagnosed as part of the etiological assessment of PVS, the diagnosis of celiac disease was concomitant with PVS in 2 cases. These were 8 women and 2 men with a sex ratio of 0.25. The average age was 28 years [19- 56 years]. All patients had organic dysphagia, five cases (62.5%) had clinical anemic syndrome associated with malabsorption diarrhea. Upper GI fibroscopy showed a ring at the killian's mouth in all cases. After oesophageal dilation by candles of different diameters, fibroscopy showed a rarefaction of duodenal folds in 9 cases (90%) and a duodenum of normal appearance in one case (10%). The anatomopathological study of duodenal biopsies showed intraepithelial lymphocytosis (IEL) > 30% in all cases, moderate atrophy of the villus in 6 cases and severe atrophy in 4 patients. All our patients have received martial treatment in combination with a gluten-free diet (GFD). The progression was favourable in 8 patients after a single dilation session and a well-followed GFD; 2 patients with poor GFD compliance also had a recurrence of dysphagia. Conclusion: PVS on celiac disease remains rare, found only in 3.5% in our series; good compliance with the GFD has improved signs of malabsorption and the disappearance of dysphagia in 80%.

Aim: The present research work was planned to prepare pluronic f 127 (poloxamer 407) based hydrogel formulations of ketorolac and to evaluate the parameters like swelling behaviour, drug PH stability, invite and in vivo drug release and in vitro cytotoxic activity. Methodology: Two different strengths of ketorolac hydrogel formulations were prepared using pluronic f127 and were analysed by validated HPLC method for drug content, PH stability and in vivo drug release. Further invitro anticancer activity was evaluated using sulphorhodamine B (SRB) assay in SCC29 cell lines. Result: Both the formulations F1 and F2 showed better PH stability at PH 3.5, 5.5 and 6.8. In vitro and in vivo drug release pattern showed half life at 3 hours, AUC0−t 669 and 667ng h/ml, Cmax 884 and 872 ng/ml for F1 and F2 respectively. Conclusion: Hydrogel formulation F1 showed better percentage control growth when compared to F2 hydrogel formulation and ketorolac alone.

A major trend in ulcer management currently is the role of nitric oxide (NO) and its agonists such as L-Arginine in ameliorating gastric ulcers. The current study focuses on the possible effects of L-Arginine supplementation on indomethacin-induced gastric ulcerations in rats. Male Wistar albino rats weighing between 150-180g were used and divided thus: Group I (Control) – saline, 8ml/kg, Group II- L-Arginine 1g/kg B.W for 3 days, Group III- L-Arginine 1g/kg B.W for 7 days. The effect of L-arginine supplementation was on indomethacin-induced gastric ulcerations, ulcer dimensions and histological profile of the gastric mucosa was examined. The result showed that arginine supplementation possesses capabilities of reducing ulcer formation as evident by the lower ulcer scores of the supplemented groups when compared with the Control. The 3-day supplemented group had a significantly lower ulcer score (p<0.05). Ulcer area and width were significantly reduced in the 3-day supplemented group (p<0.05) while the ulcer depth was significantly reduced in both supplemented groups (p<0.01). Histological examination of the gastric tissues showed that the 3-day supplemented group had greater reduction in the level of gastric disturbance than both Control group and the 7-day supplemented group. We proposed that a rapid angiogenetic activity in response to arginine supplementation which then wanes over time may be responsible for this pattern. This study provides evidence that arginine supplementation is beneficial in reducing the risk of gastric ulcer induced by NSAIDS and this is possibly mediated by direct enhancement of angiogenetic activity around the disturbed gastrum.

Neuroendocrine tumors are rare and can affect many organs, including the gastrointestinal tract and bronchi. The involvement of the larynx is exceptional, although neuroendocrine tumors are the second histological type of laryngeal malignancy after squamous cell carcinoma. They constitute a group of heterogeneous tumors, 4 in number, among the neuroendocrine tumors of the larynx, the carcinoma tumor neuroendocrine poorly differentiated is the most common. The diagnosis is purely histological, and the treatment is surgical. The prognosis is relatively good