Diabetes is a metabolic disorder that has worldwide become a major health concern. Medications in current management of diabetes are efficient, although they are significantly associated with intense side effects. Nature has always been a primary source of safer medications historically. As synthetic procedures involves high amount of costs, in silico methods has become essential in drug development methods for screening large dataset of compounds against a target receptor with better rates of success. This study thus aims to explore novel compounds from Swertia chirata that can be effectively used in diabetes management through computational methods. The compounds of S. chirata were screened against human Maltase-glucoamylase (PDB ID: 2QMJ) using Maestro V10.1 of Schrodinger LLC by molecular docking method. In addition, pharmacokinetic and ADME/T properties were analyzed through Swiss ADME online server. Best docked poses were then visualized using Discovery Studio software. Molecular docking studies revealed that Sweroside had the best docking score (-6.039 kcal/mol) against 2QMJ and similar interactions with receptor’s amino acid residues as like the standard drug. Also ADME/T properties of this compound were within the accepted range. In this research, the molecular docking, binding mode and ADME/T characteristics confirm that phytochemicals from this plant especially Sweroside can be a potential lead molecule as anti-diabetic medication.

In the present study, α-amylase was produced from newly isolated Bacillus aerius GC6 [KJ775810] strain from mushroom compost. The produced 𝛼-amylase was purified through various chromatographic techniques. B. aerius GC6 α-amylase activity of crude enzyme was 844.97 IU and 462.55 IU after ammonium sulphate precipitation with 1.38 purification fold and recovery of 54.74 %. Enzyme showed an increased respective enzyme activity of 382.44 IU with a purification fold of 15.16 and 45.26% recovery during gel exclusion chromatography. Anion exchange chromatography was then carried out, yielding 225.78 IU of α-amylase for B. aerius GC6 with a final purification fold of 17.86 and 26.72% recovery. Purified α-amylase appeared as a 43 kDa monomeric enzyme, as estimated by SDS-PAGE and Sephadex G-75 gel filtration. The 𝛼-amylase had an optimal temperature and pH of 50 oC and 9.0, respectively. The 𝛼-amylase enzyme showed great stability against the solvents like ethanol and acetone i.e. 99.55 and 96.35% respectively. Values of Vmax and Km for the purified enzyme were found 4.40 mMol/min and 1404 μmol/ mg/min. The spectrum of amylase application has widened in various fields such as clinical, medical, analytical chemistries, textile, food, fuel as well as detergent industries.

This observational study was carried out in the department of Paediatric Medicine and NICU of Dhaka Shishu Hospital during the period of July’2015 to June’2017. The main objective of this study was to observe the Significance of ECG changes in different stages of birth asphyxia and its correlation with Cardiac Troponin-I. A total of 75 neonates diagnosed as perinatal asphyxia with different stages of Hypoxic Ischemic Encephalopathy. Among the total 75 cases, ECG changes were seen in 32(42.66%) patients, remaining 43 babies had no change in ECG. Maximum changes were noticed among the cases with HIE stage-III 21(28.00%), followed by HIE stage-II 10(13.33%) and Stage-I 1(1.33%). Most common type of ECG abnormality was Grade-II changes which was present in 16 patients. This was followed by Grade-III type of changes, found in 9 patients and Grade-I type seen in 7 patients. No significant difference was seen among the neonates with HIE Stage-I, HIE stage-II and HIE stage-III groups with respect to parameters like birth weight, sex, gestational age, crown heel length (CHL), occipital frontal circumference (OFC), maternal age, and antenatal complications. Measurement of serum cardiac troponin I and determination of Myocardial performance index (Tei index), both are effective in assessment of myocardial dysfunction in asphyxiated neonates with HIE. Pearson’s Correlation Coefficient (r) test was done to see whether the two methods correlate in diagnosing myocardial dysfunction. Thorough clinical examination done with special attention to heart rate, blood pressure, and capillary refill time at admission and followed up till discharge or death. Blood pressure (systolic) was measured by auscultatory or flush method and plotted on blood pressure chart, capillary refill time (CRT) assessed by giving pressure over the sternum.

Orbital emphysema is typically a benign condition that occurs following forceful injection of air into the orbital soft tissue spaces. The authors report a frequent case of post traumatic orbital emphysema, we insist on the clinical aspects, radiological and therapeutic, and on the complications of this benign pathology.

Retinal nerve fiber layer thickness (RNFLT) is affected in several ocular and systemic conditions, most commonly glaucoma and diabetic retinopathy. This cross sectional study was done to compare the RNFLT in 180 eyes of 90 patients. A total of 90 patients were assigned to 3 groups of 30 patients each of primary open angle glaucoma (POAG), type 2 diabetes mellitus (T2DM) and POAG with T2DM (POAG/T2DM). The RNFLT was measured with spectral-domain OCT. Readings from all the areas of retina were measured in both eyes. Presence of T2DM in patients of POAG significantly affected the RNFLT as compared to patients of POAG or T2DM individually. The RNFLT was negatively correlated with the duration of glaucoma, duration of diabetes and HBA1c levels. Hence, care should be taken in interpreting optical coherence tomography readings in patients of POAG/T2 DM. The changes in RNFLT can be used to monitor the progression of diseases affecting RNFLT and efficacy of treatment modalities.

Perinatal asphyxia leading to Hypoxic Ischemic Encephalopathy (HIE) is a major concern in newborn morbidity and mortality in India. In this study we have done transcranial USG and MRI brain of both term and preterm newborns to detect the HIE related changes in neonatal brain and also evaluated wheather MRI is better than USG in detecting the lesions.This cross sectional analytical study was conducted at Calcutta National Medical College and Hospital, Kolkata with 57 newborns (26 preterm,31 term) for a period of one year. Cranial USG was done on day 5 to day 7 of the baby and MRI brain of the same baby after 24 hrs of doing USG. We found that cerebral oedema, lesions of basal Ganglia, thalamus and parasagittal subcortical white matter injury were more common in term babies, whereas Germinal Matrix Haemorrage (GMH), IntraVentricular Haemorrage (IVH) and PeriVentricular Leucomalacia (PVL) were common in preterms.When we compared USG and MRI findings we found statistically significant difference in relation to detection of abnormal findings(49 by MRI,33 by USG},deep grey matter insult of basal ganglia, thalamus (22 by MRI, 8 by USG), parasagittal subcortical white matter injury (6 by MRI,0 by USG) with p value less than 0.05.Detection of GMH and IVH was 15 by MRI and 9 by USG. In conclusion, though USG is a less expensive initial screening tool in detecting HIE related lesions and it can detect IVH, GMH very effectively, but MRI brain should be the final investigation of choice to detect both central and peripheral cortical injuries in newborn with perinatal asphyxia.

This study was carried out in 388 premature babies for incidence of retinopathy of prematurity, foetal and maternal risk factors to design an effective screening program for ROP. Further, the efficacy of mode of treatment was evaluated. Preterm neonates with birth weight ≤ 1500 grams and/or gestation age ≤ 32 weeks; and selected patients with birth weight between 1500 to 2000 grams or gestational age > 32 weeks but ≤ 35 weeks with unstable clinical course were included in the study. The incidence of any stage of ROP in this study was 23.70%. Majority of patients (88.64%) developed mild forms of ROP (stage 1 and 2). On univariate analysis, the significant risk factors predisposing to ROP were low gestation age, low birth weight, respiratory distress, unmonitored oxygen supplementation, sepsis, blood transfusion, surfactant use and metabolic acidosis. Significant maternal risk factor was pregnancy-induced hypertension. On multivariate logistic regression, low gestational age, unmonitored oxygen supplementation, use of surfactant and pregnancy induced hypertension were found to be independent risk factors. The majority of cases (70.65%) of ROP of stage 1 and 2 without plus disease regressed without any treatment. Rest 29.35% cases needed treatment, and were treated with Diode laser photocoagulation to avascular retina. Regression occurred in all the cases.

Background: Facial appearance often plays a vital role in forming an impression of others, especially during the initial stages of acquaintance. The impression one gets of the other person during this initial encounter is often a long lasting one and could be either positive or negative at different times. Looks, however, play an important role during this first impression. Materials & Methods: The attractiveness of different smile variables on the perception of smile esthetics was evaluated. The study consisted of 3 groups of evaluators: General dentists (100), dental students (100) and patients (100). 4 pleasant smile pictures of young females were selected and modified with one esthetic parameter each of midline diastema, crown length, gingival display, and midline shift. Results: A small amount of space between the maxillary central incisors was not rated as unattractive by any group. The general dentists and dental students were more critical than patients when evaluating midline diastema discrepancy. The general dentists and dental students did not perceive a change in attractiveness until the midline shift was 3mm. While the patients did not perceive any change in attractiveness even at the maximum of 4mm shift. A reduction of maxillary lateral incisor by 1.5mm was rated unattractive by the general dentists and the dental students while patients perception for attractive smile changed when the crown length was reduced to 2mm. Conclusion: The type and degree of deviation from the norm and the opinion of the patient need to be taken into consideration. Among all the four esthetic parameters, midline diastema was more unattractive for all the groups. So, correction of this parameter by the dental professional is of paramount importance for a better esthetic result.

Sarcoidosis is a systemic granulomatous disease of unknown etiology and involves many organs. The liver is the third most commonly involved organ after the lymph nodes and the lungs, usually clinically silent. As in the other organs, liver sarcoidosis is characterized histopathologically by non-caseating granulomas. In rare instances (5% of cases), liver sarcoidosis is complicated by portal hypertension or chronic cholestasis. The aim of this study is to show that liver sarcoidosis can cause portal hypertension without progression to cirrhosis.

This is a prospective, unmasked and interventional study. The 207 premature babies were examined for incidence of retinopathy of prematurity (ROP), foetal and maternal risk factors to design an effective screening program for ROP. Further, the efficacy of the modes of treatment were evaluated. Preterm neonates with birth weight ≤ 1500 grams and/or gestation age ≤ 32 weeks; and selected patients with birth weight between 1500 to 2000 grams, or gestational age > 32 weeks but ≤ 35 weeks with unstable clinical course were included in the study. The incidence of any stage of ROP in this study was 21.26%. Majority of patients (84.1%) with ROP developed mild forms of ROP (stage 1 and 2) without plus disease and regressed spontaneous during observation. On univariate analysis, the significant risk factors predisposing to ROP were low gestation age, low birth weight, respiratory distress, unmonitored oxygen supplementation, sepsis, blood transfusion, surfactant use and metabolic acidosis. Maternal risk factor was pregnancy induced hypertension. On multivariate analysis, unmonitored oxygen exposure was the only independent risk factor for ROP. The 15.9% of ROP cases required treatment, and the majority were treated with Diode laser photocoagulation to avascular retina. Intravitreal Bevacizumab was used in 2 cases of AP-ROP in zone 1. Retinopathy in all the five patients regressed.

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.

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.

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.

A simple and precise reversed-phase high performance liquid chromatography (HPLC) assay for the determination of rifampicin (RIF) in human plasma was developed and validated. Using hydrochlorothiazide (HCT) as an internal standard, separation was achieved on Atlantis dC18 column with a mobile phase composed of 0.01 M monobasic sodium phosphate and acetonitrile (60:40, v:v) and delivered at a flow rate of 1 ml/minute. RIF and HCT were extracted from plasma using methyl tert-butyl ether and dichloromethane (70:30%, v:v) and monitored using photodiode array detector set at 337 nm. Relationship between RIF concentration and peak height ratio of RIF to HCT was linear over the range of 0.3-25 μg/ml. Coefficient of variation and bias were ≤9.7% and ≤6.0%, respectively. Mean extraction recovery of RIF and HCT was 95% and 90%, respectively. Stability of RIF in extracted (24 hours at room temperature or 48 hours at -20 °C) and unprocessed (24 hours at room temperature, 8 weeks at -20 °C, or 3 freeze-thaw cycles) samples was ≥91%.

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%.

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.

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.

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

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.

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.

Pituitary abscess is a rare, but potentially life-threatening condition unless promptly diagnosed and treated, and it accounts for less than 1% of all pituitary diseases, few cases have then been published in the literature, the majority of this cases are diagnosed either post mortem or post operatively. Pituitary abscesses may occur in a normal pituitary gland in 70% of cases (primary types), or secondary to a preexisting lesion. We report a successfully managed case of a 66-year-old woman. We discuss the pathogenicity, the morphologic and radiologic criteria suggestive of this unusual infection of pituitary region and also treatment options

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.