Objective:To investigate different presentations of tuberculosis in HIV positive patients and their treatment outcome with directly observed short course therapy (DOTS). Methods: All patients having tuberculosis-HIV (TB-HIV) co-infection were taken. Different manifestations of tuberculosis in HIV positive patients were analyzed. Outcome of the treatment was observed in 14 patients. The rest of the patients were either transferred to other districts or still continuing their DOTS therapy according to the revised national tuberculosis control programme (RNTCP). Results:A total of 901 patients were diagnosed as tuberculosis. Out of these, 227 had positive pulmonary tuberculosis smear, 212 had negative smear and 462 had extra pulmonary tuberculosis. A total of 65 patients suffered from TB-HIV co-infection (7%). Result showed that the incidence of TB-HIV coinfection was the highest in productive age group of 16-45 years old (75%). Treatment completion rate was only 57%and the rate was higher in extra pulmonary tuberculosis patients (83%). Out of 4 sputum positive cases, 3 were declared cured (75%). Conclusions:TB-HIV co-infection in wardha (Cental India) is around 7%. Pattern of tuberculosis in HIV positive patient is the same as in HIV negative patient. Pattern of extra-pulmonary tuberculosis in HIV positive patients is mainly in form of tubercular lymphadenitis and pleural effusion. DOTS is the best modality of treatment of tuberculosis.

Status epilepticus is a life threatening neurological emergency. In persons with status epilepticus, if administration of a benzodiazepine and at least one antiepileptic drug has failed then management protocols for refractory status epilepticus should be put into effect. The article summarises the causes, effects, pathophysiology and treatment protocols for refractory status epilepticus.The concept of super refractory status and newer etiologies and therapeutic options are also discussed.

Acute eididymo-orchitis is the most common cause of intrascrotal inflammation, and retrograde ascent of pathogens is the usual route of infection. Here we intend to present a case of young boy, not sexually active, suffering from acute epididymo-orchitis due to Pseudomonas aeruginosa presented with acute respiratory distress syndrome. Proper timely diagnosis of the primary cause and prompt treatment including support with non invasive ventilation lead to a favourable outcome in the same case.

Spontaneous or idiopathic splenic rupture is a rare cause of acute abdominal pain and hemoperitoneum and its incidence is 1% of all cases of splenic rupture. The etiology of spontaneous splenic rupture can be idiopathic or it may occur as a complication of an infectious, neoplastic or hematologic disease. Splenic rupture presents with pain in the left upper quadrant with shock and features of peritoneal irritation, like Kehr’s sign (left shoulder pain due to diaphragmatic irritation) and Balance sign (palpable tender mass in left upper abdomen). The diagnosis of spontaneous splenic rupture presents a diagnostic challenge due to the absence of a history of trauma. Focused Abdominal Sonography for Trauma FAST may be suggestive but due to its limitations, Computerized Tomography Scan CT scan of abdomen is the best imaging modality both for detection and grading of splenic injury. Management can be non-operative or surgical depending on grade and hemodynamic status of the patient. We report a rare case of spontaneous rupture of the spleen, which was idiopathic and fulfills the criteria of Orloff and Peskin, due to absence of any history of trauma, absence of perisplenic adhesions or scarring, and it without any evidence of disease affecting the spleen with macro and microscopically normal spleen. This case also adheres to fifth criteria described by Crate and Payne, as there was no immunological evidence suggestive of any viral infections affecting the spleen.

Gastroesophageal reflux disease (GERD) is a chronic, progressive, and costly medical condition affecting a substantial proportion of the world population, predominantly the Western population. The available treatment options for patients with refractory GERD symptoms are limited to either laparoscopic surgery with significant sequelae or potentially lifelong, high-dose proton pump inhibitor therapy. The restoration of the antireflux competence of the gastroesophageal junction at the anatomic and physiologic levels is critical for the effective long-term treatment of GERD. Transoral incisionless fundoplication (TIF) surgery is a safe, well-tolerated, and effective treatment that has yielded significant symptomatic improvement in patients with medically refractory GERD symptoms. In this review article, we have summarized case series and reports describing the role of TIF for patients with gastroesophageal reflux symptoms. The reported indications, techniques, complications, and success rates are also discussed.
Esophagogastric Junction ; Fundoplication* ; Gastroesophageal Reflux* ; Humans ; Laparoscopy ; Mental Competency ; Proton Pump Inhibitors ; Proton Pumps

Advances in diagnostic modalities and improvement in surveillance programs for Barrett esophagus has resulted in an increase in the incidence of superficial esophageal cancers (SECs). SEC, due to their limited metastatic potential, are amenable to non-invasive treatment modalities. Endoscopic ultrasound, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are some of the new modalities that gastroenterologists have used over the last decade to diagnose and treat SEC. However, esophageal stricture (ES) is a very common complication and a major cause of morbidity post-ESD. In the past few years, there has been a tremendous effort to reduce the incidence of ES among patients undergoing ESD. Steroids have shown the most consistent results over time with minimal complications although the preferred mode of delivery is debatable, with both systemic and local therapy having pros and cons for specific subgroups of patients. Newer modalities such as esophageal stents, autologous cell sheet transplantation, polyglycolic acid, and tranilast have shown promising results but the depth of experience with these methods is still limited. We have summarized case reports, prospective single center studies, and randomized controlled trials describing the various methods intended to reduce the incidence of ES after ESD. Indications, techniques, outcomes, limitations, and reported complications are discussed.
Barrett Esophagus ; Esophageal Neoplasms ; Esophageal Stenosis* ; Humans ; Incidence ; Polyglycolic Acid ; Prospective Studies ; Stents ; Steroids ; Ultrasonography

OBJECTIVETo evaluate the analgesic, anti-inflammatory and antipyretic activity of methanolic Tecomaria capensis (T. capensis) leaves extract using different models in rats.

METHODSMethanolic T. capensis leaves extract (100, 300, 1000 and 2000 mg/kg body weight) was given to rats orally to observe acute toxicity, and observed for 14 days. Analgesic activity was evaluated using tail immersion and formalin induced paw licking models in rats. Anti-inflammatory activity was evaluated using carrageenan induced paw edema model in rats. Antipyretic activity was evaluated using brewer's yeast induced pyrexia model in rats. Methanolic T. capensis leaves extract were given at dose of 100, 200 and 500 mg/kg p.o.

RESULTSResults demonstrated that the no mortality was reported even after 14 days. This indicated that the methanol extract was safe up to a single dose of 2 000 mg/kg body weight. Methanolic T. capensis leaves extract (100, 200 and 500 mg/kg p.o.) significantly increased the latency period in the tail immersion test, reduced the licking time in both the neurogenic and inflammatory phases in the formalin test. Methanolic T. capensis leaves extract (100, 200 and 500 mg/kg p.o.) significantly prevented increase in volume of paw edema. Methanolic T. capensis leaves extract at the doses of (100, 200 and 500 mg/kg p.o.) significantly decreased the rectal temperature of the rats.

CONCLUSIONSThis study exhibites that methanolic T. capensis leaves extract possesses analgesic, anti-inflammatory and antipyretic activity which may be mediated by the central and peripheral mechanisms.

Analgesics ; chemistry ; pharmacology ; therapeutic use ; toxicity ; Animals ; Anti-Inflammatory Agents ; chemistry ; pharmacology ; therapeutic use ; toxicity ; Antipyretics ; chemistry ; pharmacology ; therapeutic use ; toxicity ; Behavior, Animal ; drug effects ; Bignoniaceae ; chemistry ; Disease Models, Animal ; Edema ; Female ; Fever ; Male ; Pain Management ; methods ; Pain Measurement ; Plant Extracts ; chemistry ; pharmacology ; therapeutic use ; toxicity ; Plant Leaves ; chemistry ; Rats

A rapid and sensitive ultra performance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS) method is described for determination of letrozole in human plasma. Following solid phase ex-traction (SPE) of letrozole and letrozole-d4 on Orochem DVB-LP cartridges, chromatography was per-formed on Acquity UPLC BEH C18 (50 mm ? 2.1 mm, 1.7 mm) column using methanol-0.1%formic acid in water (85:15, v/v) as the mobile phase. Detection was carried out on a triple quadrupole mass spec-trometer with an electrospray source, operated under positive ionization mode. Quantitation of letrozole and letrozole-d4 was done using multiple reaction monitoring (MRM) following the transitions at m/z 286.2-217.0 and m/z 290.2-221.0, respectively. The calibration plots were linear through the con-centration range of 0.10–100 ng/mL (r2Z0.9990) using 100 mL human plasma. The extraction recovery of letrozole ranged from 94.3% to 96.2% and the intra-batch and inter-batch precision was r 5.2%. The method was successfully applied to a bioequivalence study of letrozole after oral administration of 2.5 mg tablet formulation to 16 healthy postmenopausal Indian women. The assay reproducibility was also established through incurred sample reanalysis (ISR) of 74 subject samples.

Objective: This study aimed to determine the prevalence of epilepsy in prisoners suffering from substance dependence and the relationship between onset of epilepsy and substance dependence in a prison population. Methods: The present cross-sectional study in a prison population was conducted in Central Jail (CJ), New Delhi, India over a period of 3 months. The convenience sample consisted of 900 subjects. The study group consisted of 450 prisoners taken from the deaddiction ward and the rest were placed in the control group. Physical examination and Mini Mental State Examination (MMSE) of subjects were done to make necessary exclusion. Assessment tools were applied in the order starting from MMSE, Basic Socio-demographic Performa, Present State Examination (PSE), and Addiction Severity Index (ASI). Results: The average ages of study and control subjects were 34.5 + 2.3 years (mean + standard deviation) and 35.6 + 3.6 years respectively. Prevalence of epilepsy among substance using prisoners was 1.4 times higher than in non-substance using prisoners. Alcohol, opioid, and cannabis, either alone or in various combinations, were the most commonly used substances. Subjects suffering from epilepsy were likely to have higher chances of consuming three or more substances than those without problem of epilepsy. Study subjects suffering from epilepsy compared with those without epilepsy performed worse in all parameters. This is indicative of higher severity of psychoactive substance dependence. Conclusion: Findings of high prevalence rate of epilepsy and co-morbid substance dependence highlight the need for better screening among epileptic subjects for substance abuse at entry into prison for effective treatment while in custody, and at follow-up on release. Specialist addiction services for prisoners have a considerable impact in a wellplanned intervention programme for prisoners with substance use and comorbid epilepsy. ASEAN Journal of Psychiatry, Vol. 15 (2): July – December 2014: 153-163.

Objectives: The aims of the study were to investigate whether Sudarshan Kriya (SK), a form of Yoga and related practices can lead to increased Global Assessment of Functioning (GAF) and increased feeling of wellness in patients with substance dependence. Method: This was a 3-month single blind parallel randomized controlled study with sample size of 111 patients which were allocated by simple randomization to two groups. Study subjects were involved in an intensive program of Sudarshan Kriya and practices (SK&P) which they practised daily for 6 weeks. The control subjects were instructed to sit in an armchair with their eyes closed and pay gentle attention to their breath. A period sample of three months consisting of all patients admitted in De-addiction (DAC) ward fulfilling study criteria was taken. Only male patients diagnosed to be suffering from Substance Dependence by ICD-10 (DCR) criteria, aged between 18-65 years were included in this study. The assessment tools were the Basic Socio-demographic Performa, Mini Mental State Examination (MMSE), Severity of Dependence Scale (SDS), Schedule for Clinical Assessment in Neuropsychiatry (SCAN) based clinical interview, Global Assessment of Functioning (GAF) and Psychological General Well Being (PGWB). These assessments were conducted before starting the intervention and six weeks thereafter. Results: In the final analysis, number of participants analyzed in the study group was 55 and in the control group was 56. Majority of subjects were unemployed, married individuals who did not have occupational skills of more than skilled labour level. After six weeks of SK&P, statistically significant improvement in study subject dimensional scores of GAF (48.43+/- 0.08 to 66.77+/-0.14), Anxiety (ANX) (9.64+/-0.52 to 15.66+/-0.38), Depressed Mood (DEP)(7.19+/-0.2 to 9.18+/-0.37), Positive Well Being (PWB)(10.28+/-0.61 to 12.92+/-0.73), General Health (GH)(7.74+/-0.18 to 9.75+/-0.22) and Total PGWB(41.46+/-0.35 to 59.28+/-0.63) were noticed. However, when compared with control subjects, improvement was statistically significant in the case of GAF (p=0.000158), Anxiety (ANX)(p=0.011), Positive Well Being (PWB)(p=0.02), General Health (GH)(p=0.02) and Total PGWB(p=0.05); but not in the case of Depressed Mood (DEP), Self Control (SC) and Vitality. Conclusion: Practicing SK&P helps in improving Global Assessment of Functioning, Psychological General Well Being, General Health (GH) and positive well being of an individual. SK&P also causes significant reduction in anxiety levels of an individual.