Diffuse idiopathic skeletal hyperostosis is a disease of old age, in which there is bony proliferation of spine in ventral and lateral aspects of vertebral body. A 80-years-old male presented to us with features of low back pain radiating along the right lower limb in the posterolateral aspect. After examination and investigations, he was found to have metabolic syndrome, degenerative lumbar disc disease, and his X-Ray and MRI showed diffuse thickening of lumbar vertebrae from L2-S1. This suggested that the patient had diffuse idiopathic skeletal hyperostosis with extraspinal manifestations which coexisted with lumbar degenerative disc disease. This case shows that both diffuse idiopathic skeletal hyperostosis and lumbar degenerative disc disease can coexist. Diffuse idiopathic skeletal hyperostosis should also be kept as a differential diagnosis in chronic low back pain in old age.

Young-onset dementia, defined as dementia occurring under the age of 65, is an increasingly recognized cause of morbidity and disability. There are few reports of the clinical profile of young-onset dementia from India. The objective of this study was to determine the clinical profile of patients attending a specialist cognitive disorders clinic in West Bengal, an eastern state of India. Almost one-fourth (94/379, 24.5%) of all the patients with dementia were of young onset. Women constituted about one-third of these cases. There was a gradual increase in the number of cases with rising age. The most common etiologies were Alzheimer disease (33%), frontotemporal dementia (27%), and vascular dementia (20%). In contrast to other published studies of young-onset dementia, frontotemporal dementia was commoner than vascular dementia. This could be due to referral bias. A positive family history was found in close to one-fifth of the patients. Close to 10% of the patients had reversible causes of dementia. Community based study is required to confirm the findings of this study.

Till today, there is no effective treatment protocol for the complete clearance of Wuchereria bancrofti (W.b) infection that causes secondary lymphoedema. In a double blind randomized control trial (RCT), 146 asymptomatic W. b infected individuals were randomly assigned to one of the four regimens for 12 days, DEC 300 mg + Doxycycline 100 mg coadministration or DEC 300 mg + Albendazole 400 mg co-administration or DEC 300 mg + Albendazole 400 mg sequential administration or control regimen DEC 300 mg and were followed up at 13, 26 and 52 weeks post-treatment for the clearance of infection. At intake, there was no significant variation in mf counts (F(3,137)=0.044; P=0.988) and antigen levels (F(3,137)=1.433; P=0.236) between the regimens. Primary outcome analysis showed that DEC + Albendazole sequential administration has an enhanced efficacy over DEC + Albendazole co-administration (80.6 Vs 64.7%), and this regimen is significantly different when compared to DEC + doxycycline co-administration and control (P<0.05), in clearing microfilaria in 13 weeks. Secondary outcome analysis showed that, all the trial regimens were comparable to control regimen in clearing antigen (F(3, 109)=0.405; P=0.750). Therefore, DEC + Albendazole sequential administration appears to be a better option for rapid clearance of W. b microfilariae in 13 weeks time. (Clinical trials.gov identifier – NCT02005653)

Unilateral adrenalectomy was performed in six black Bengal goat (Capra hircus)to study electrocardiograph in connection with mineral metabolism with special reference to sodium and potassium and some other factors of physiological importance. The parameters were studied at every 12 hrs interval upto 120 hrs and 24 hrs interval from 120 to 240 hrs.Physiological parameters, like body weight and rectal temperature, changed non-significantly (p<0.05)after adrenalectomy. Among minerals, plasma sodium (p<0.01)and plasma potassium (p<0.05) concentration were changed significantly between hours leaving impression in ECG as widening of QRS complex and peaked T wave with increased amplitude found after unilateral adrenalectomy. Heart rate also increased significantly (p<0.01)between hours.
*Adrenalectomy ; Animals ; Body Temperature ; Body Weight ; *Electrocardiography/adverse effects ; Female ; Goats ; Heart Rate ; Potassium/*metabolism ; Sodium/*metabolism

<p>OBJECTIVE3-Bromobenzanthrone (3-BBA), an anthraquinone intermediate dye, is extensively used in textile industry. Since, our prior studies have shown that 3-BBA caused significant depletion of ascorbic acid (AsA) levels, the effect of exogenous supplementation of AsA on the urinary elimination of 3-BBA metabolites was investigated.p><p>METHODGuinea pigs were treated with single oral dose of 3-BBA (50 mg/kg b. wt.) in groundnut oil while another group was treated with single oral dose of 3-BBA (50 mg/kg b. wt.) along with 3 day prior and post oral supplementation of AsA. Control groups were either treated with groundnut oil or AsA alone. Urine from individual animals was collected, extracted and analysed on HPTLC.p><p>RESULTSThe highest elimination of 3-BBA (75 microg) was found to be in 0-24 h urine fraction which decreased to 18 microg and 5 microg in the two subsequent 24 hourly fractions of urine. Exogenous supplementation of AsA increased the total urinary elimination of 3-BBA by almost 77%. A total of 10 fluorescent metabolites excluding the parent compound were eliminated in the urine of guinea pigs treated with 3-BBA. Densitometric scanning of chromatogram showed different peaks at Rf 0.18, 0.22, 0.27, 0.34, 0.40, 0.48, 0.56, 0.66, 0.72, 0.80, and 0.95 which were eliminated and marked as urinary metabolite 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11 respectively. AsA not only significantly enhanced the elimination of 3-BBA metabolites but also modified the pattern of metabolites drastically in 0-6 h, 6-24 h and 24-48 h urine fractions.p><p>CONCLUSIONThese results indicate that AsA may be useful in protecting the toxicity of 3-BBA by fascilitating the urinary metabolite(s) excretion of 3-BBA.p>
Administration, Oral ; Animals ; Antioxidants ; pharmacology ; Ascorbic Acid ; pharmacology ; urine ; Benz(a)Anthracenes ; analysis ; metabolism ; Chromatography, High Pressure Liquid ; Guinea Pigs ; Lipid Peroxidation ; drug effects ; Plant Oils ; metabolism ; Time Factors

Epilepsy is a major health problem in India, but community based incidence study is rare. This study was undertaken to determine the incidence rate in a rural community of the state of West Bengal, India. The study was done through house to house survey by a dedicated team of neurologists, who carried out the survey cum case detection over 5 years. A total of 38 cases were detected during the survey period in a population of 20,966. The age adjusted (to World Standard Population) average annual incidence rate was 42.08 per 100,000 persons per year (95% confidence interval, 29.75-57.86). This rate was higher than many developed countries, but lower than the developing countries. Cerebral infection was the most common putative factor observed. An increasing trend of incidence of epilepsy has been observed over the years during the period of the study.

OBJECTIVE: To evaluate the radiation dose for pregnant women and fetuses undergoing commonly used computed tomography of the pulmonary arteries (CTPA) scan protocols and subsequently evaluate the simulated effect of an optimized scan length. MATERIALS AND METHODS: A total of 120 CTPA datasets were acquired using four distinctive scan protocols, with 30 patients per protocol. These datasets were mapped to Cristy phantoms in order to simulate pregnancy and to assess the effect of an effective radiation dose (in mSv) in the first, second, or third trimester of pregnancy, including a simulation of fetal dose in second and third trimesters. The investigated scan protocols involved a 64-slice helical scan at 120 kVp, a high-pitch dual source acquisition at 100 kVp, a dual-energy acquisition at 80/140 kVp, and an automated-kV-selection, high pitch helical scan at a reference kV of 100 kVref. The effective dose for women and fetuses was simulated before and after scan length adaptation. The original images were interpreted before and after scan length adaptations to evaluate potentially missed diagnoses. RESULTS: Large inter-scanner and inter-protocol variations were found; application of the latest technology decreased the dose for non-pregnant women by 69% (7.0–2.2 mSv). Individual scan length optimization proved safe and effective, decreasing the fetal dose by 76–83%. Nineteen (16%) cases of pulmonary embolism were diagnosed and, after scan length optimization, none were missed. CONCLUSION: Careful CTPA scan protocol selection and additional optimization of scan length may result in significant radiation dose reduction for a pregnant patient and her fetus, whilst maintaining diagnostic confidence.
Angiography ; Dataset ; Diagnosis ; Female ; Fetus ; Humans ; Pregnancy Trimester, Third ; Pregnancy ; Pregnant Women ; Pulmonary Artery ; Pulmonary Embolism

OBJECTIVES: This study aims to determine the prevalence, and associated factors of undiagnosed hypertension [Systolic Diastolic Hypertension (SDH), Isolated Systolic Hypertension (ISH) and Isolated Diastolic Hypertension (IDH)] in the Nepalese adult population.METHODS: Nepal Demographic and Health Survey 2016 data from adults (≥ 18 years) was used in this study. The final weighted sample size was 13,393. Blood pressure (BP) was measured 3 times and the average of the second and third measurement was reported. SDH (systolic BP (SBP) ≥ 140 mmHg and diastolic BP (DBP) ≥ 90 mmHg), ISH (SBP ≥ 140 mmHg and DBP < 90 mmHg), and IDH (SBP < 140 mmHg and DBP ≥ 90 mmHg) were measured. Multilevel logistic regression analyses were conducted to find the association between the independent variables and the covariates.RESULTS: The prevalence of SDH, IDH and ISH were 8.1%, 7.5%, and 3.3% respectively. The odds of having SDH and ISH increased with old age. However, the odds of having IDH decreased with increasing age. Females has lower odds of having SDH and IDH compared with male participants. Individuals that had been married, resided in Province 4 (p < 0.05) or 5 (p < 0.01) were statistically significantly associated with having IDH. Being overweight or obese was statistically significantly associated with all 3 HTN subtypes (p < 0.001).CONCLUSION: The necessary steps should be taken so that public health promotion programs in Nepal may prevent and control undiagnosed hypertension.
Adult ; Blood Pressure ; Female ; Health Surveys ; Humans ; Hypertension ; Logistic Models ; Male ; Nepal ; Overweight ; Prevalence ; Public Health ; Sample Size

Purpose: Nodal downstaging after preoperative therapy for gastric cancer has been shown to impart excellent prognosis, but this has not been validated in a national cohort. The role of neoadjuvant chemoradiation (NACR) in nodal downstaging remains unclear when compared with that of neoadjuvant chemotherapy alone (NAC). Furthermore, it is unknown whether the prognostic implications of nodal downstaging differ by preoperative regimen. Materials and Methods: Using the National Cancer Database, overall survival (OS) duration was compared among natural N0 (cN0/ypN0), downstaged N0 (cN+/ypN0), and nodepositive (ypN+) gastric cancer patients treated with NACR or NAC. Factors associated with nodal downstaging were examined in a propensity score-matched cohort of cN+ patients, matched 1:1 by receipt of NACR or NAC. Results: Of 7,426 patients (natural N0 [n=1,858, 25.4%], downstaged N0 [n=1,813, 24.4%], node-positive [n=3,755, 50.4%]), 58.2% received NACR, and 41.9% received NAC. The median OS durations of downstaged N0 (5.1 years) and natural N0 (5.6 years) patients were similar to one another and longer than that of node-positive patients (2.1 years) (P<0.001). In the matched cohort of cN+ patients, more recent diagnosis (2010–2015 vs. 2004–2009) (odds ratio [OR], 2.57; P<0.001) and NACR (OR, 2.02; P<0.001) were independently associated with nodal downstaging. The 5-year OS rate of downstaged N0 patients was significantly lower after NACR (46.4%) than after NAC (57.7%) (P=0.003). Conclusions Downstaged N0 patients have the same prognosis as natural N0 patients.Nodal downstaging occurred more frequently after NACR; however, the survival benefit of nodal downstaging after NACR may be less than that when such is achieved by NAC.