We report a case of Mirizzi syndrome type II associated with biliary enteric fistula. It is important to identify this combination early, as it is associated with high morbidity. In our case, intraoperative findings were cholecystoduodenal fistula and communication of Hartmann’s pouch with common bile duct (CBD). A subtotal cholecystectomy with excision of cholecystoduodenal fistula was performed. A minimal surgical maneuver of Calot’s Triangle with repair of cholecystoduodenal fistula is required during the intraoperative period.
Intestinal Fistula ; Gallstones ; Mirizzi Syndrome

Introduction: Diagnosis of subungual glomus tumour is mostly based on detailed history and clinical examination. Recently, Magnetic Resonance Imaging (MRI) and Ultrasound have been proposed as the imaging modality to confirm the clinical diagnosis and in planning the surgical management of these tumours. However, these imaging modalities are not routinely available in rural setting and also are expensive. Due to these limitations, we set out to establish that diagnosis and management of these rare tumours can be based solely on a battery of clinical tests and history taking. Materials and Methods: Retrospectively, we reviewed nine cases of glomus tumour. A clinical evaluation proforma was developed on the basis of clinical history and specific clinical test for diagnosis of these tumours. All the cases were evaluated and treated surgically by a single surgeon with a specific technique. Post-operatively, diagnosis was confirmed by histopathological examination. Results: Females (77.78%) were predominantly affected in this series and the tumours commonly occurred in the right hand (66.66%). Spontaneous pain, cold sensitivity test and Love’s Pin test was positive in all cases (100%). Hildreth’s test was positive in 88.89%. In none of the cases the tumours recurred during minimum follow-up of one year. In all cases, histopathological examination confirmed the preoperative diagnosis of glomus tumours. Conclusion: Diagnosis of glomus tumours can be made clinically based on history taking and clinical examination. Magnetic Resonance Imaging and Ultrasound are not necessary for diagnosis and management of typical subungual tumours.

The interaction of baicalein with bovine serum albumin (BSA) was investigated with the help of spec-troscopic and molecular docking studies. The binding affinity of baicalein towards BSA was estimated to be in order of 105 M?1 from fluorescence quenching studies. NegativeΔH° (?5.6670.14 kJ/mol) and positive (ΔS°) ( t 79.96 7 0.65 J/mol K) indicate the presence of electrostatic interactions along with the hydrophobic forces that result in a positiveΔS°. The hydrophobic association of baicalein with BSA di-minishes in the presence of sodium dodecyl sulfate (SDS) due to probable hydrophobic association of baicalein with SDS, resulting in a negativeΔS° ( ? 40.65 7 0.87 J/mol K). Matrix-assisted laser desorption ionization/time of flight (MALDI–TOF) experiments indicate a 1:1 complexation between baicalein and BSA. The unfolding and refolding phenomena of BSA were investigated in the absence and presence of baicalein using steady-state and fluorescence lifetime measurements. It was observed that the presence of urea ruptured the non-covalent interaction between baicalein and BSA. The presence of metal ions (Ag t , Mg2 t , Ni2 t , Mn2 t , Co2 t and Zn2 t ) increased the binding affinity of ligand towards BSA. The changes in conformational aspects of BSA after ligand binding were also investigated using circular di-chroism (CD) and Fourier transform infrared (FT-IR) spectroscopic techniques. Site selectivity studies following molecular docking analyses indicated the binding of baicalein to site 1 (subdomain IIA) of BSA.&2016 Xi'an Jiaotong University. Production and hosting by Elsevier B.V. This is an open access article.

Objective: The present report embodies detailed diagnostic features of five important Red listed Swertia species for easy and authentic identification along with HPTLC fingerprinting using the c-glucoxanthone mangiferin as a biomarker. The key objectives of this study were to reduce indiscriminate harvesting of different Swertia species from its natural habitat and the development of a reliable kit based on HPTLC fingerprinting to reduce adulteration in commercial trade. Methods:Chromatography was performed on Silica gel 60 F254 TLC plates with ethyl acetate-glacial acetic acid-formic acid- water- 100:11.0:11.0:26 as mobile phase. Densitometric measurement was performed at λ=254 nm. The method was found to be simple, reliable, precise and convenient for routine analysis. Results: Although mangiferin was detected in substantial amount from all populations of Swertia chirata irrespective of their geographical locations and to a lesser degree in Swertia nervosa, the biomarker was totally absent in Swertia bimaculata, Swertia dilatata and Swertiapaniculata. Conclusions:Floral morphology can be effectively used for the construction of an easy identification tool that can be utilized at the field level to screen out Swertia chirata from other closely related species that flower at the same time along with Swertia chirata. High Performance TLC using mangiferin as a biomarker can be utilized for quality screening and checking adulteration among different species and populations of Swertia.

Objective: To develop agents that are specifically effective in controlling the key disturbance of visceral hyperalgesia besides abating of associated multiple symptoms, and evaluate comparative effectiveness for IBS symptom relief for standard regimen (antispasmodic and probiotic) and add-on amitriptyine or riluzole regimens following two weeks administration.Methods:groups were studied. First group received standard treatment (mebeverine 200 mg twice daily and probiotic 200 mg twice daily). Second group received add-on amitriptyline 25 mg before bedtime, while the third group got add-on riluzole 50 mg twice daily. Overall gastrointestinal symptom rating scale improving symptoms and hospital anxiety depression scale improving associated psychological morbidity were employed as measures at induction and at two-week follow-up period. Individual symptom scores were also examined to define the outcome profiles.Results:108 patients with visceral hypersensitivity accompanying IBS, divided into three rating scale score, not the other two regimens. Pain relief was seen with both riluzole and amitriptyline regimens significantly superior to standard treatment regimen, but riluzole effect appeared specific and independent anxiolytic effect. Amitriptyline caused relief in diarrhea and did not benefit in constipation point to non-specific remedial role in IBS. Riluzole regimen resulted in significant reduction of overall gastrointestinal symptom Conclusions: Riluzole specifically relieves visceral hypersensitivity and is proved to be superior to current treatments in IBS patients. It appears a lead remedy based on glutamate transporter mechanisms in visceral hypersensititvity.

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterised by various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal abnormalities and tendency to develop neoplasms. Only few cases of Non-Familial Spinal Neurofibromatosis-1 (Non-FSNF1) have been described in literature with tumors involving the spinal roots at every level being even rarer. We reported an interesting case of bilateral symmetrical cervical neurofibroma with multiple spinal neurofibromas appearing as mirror image on CT, associated with non familial NF-1 as a rare presentation in a 25-year-old adult male.

BACKGROUND: Evidence for superior outcome by adhering to therapy guidelines is imperative to their acceptance and adaptation for the optimal management of disease variants. OBJECTIVE: Comparative study of prospective outcomes in simultaneous consideration of independent variables in groups of 150 patients of plaque psoriasis either treated adhering to or in digression of standard guidelines. METHODS: The psoriasis area severity index (PASI) and the dermatology life quality index (DLQI), prior to and after three months of uninterrupted therapy were examined in treatment groups among 150 patients. Recovery rates of 75% or more in PASI were compared. Independent variables were also examined for their bearing on the outcome. RESULTS: The vast majority was early onset disease phenotype. All three treatment regimens when administered in adherence to the guidelines yielded significantly superior rates of defined recovery both in PASI and DLQI. Compromise of the therapeutic outcome appeared in high stress profiles, obesity, female sex and alcohol, tobacco or smoking habit. CONCLUSION: Conventional drug therapy of plaque psoriasis yields superior outcome by adhering to the consensus guidelines. Psychiatric address to stress must be integral and special considerations for phenotypic/syndromic variants is emphasized for effective therapy of psoriasis.
Consensus ; Dermatology ; Female ; Humans ; Obesity ; Phenotype ; Prospective Studies ; Psoriasis ; Quality of Life ; Smoke ; Smoking ; Tobacco ; Ursidae

N-Methylhydrasteine hydroxylactam and 1-methoxyberberine chloride, both alkaloids, extracted from Corydalis longipes have been assayed for their activities against two powdery mildews. The spore germination of Erysiphe cichoracearum on detached leaf of balsam(Impatiens balsaminia) following pre- and post-inoculation treatments by their mixture has shown high efficacy against the pathogen at 100, 200 and 300 microg/ml. The mixture was also effective at both pre- and post-inoculation treatments at 500, 1000, 1500 microg/ml doses against E. pisi causing pea powdery mildew in pea(Pisum sativum) under field conditions. The significant efficacy of the mixture of two compounds against spore germination on detached leaves of balsam and also under field conditions in pea warrants its inclusion in trials against some other diseases under field conditions.
Alkaloids* ; Corydalis* ; Germination ; Peas* ; Plants* ; Spores

BACKGROUND: Some reports have shown that co-inheritance of alpha-thalassemia and sickle cell disease improves hematological parameters and results in a relatively mild clinical picture for patients; however, the exact molecular basis and clinical significance of the interaction between alpha-thalassemia and sickle cell disease in India has not yet been described. There is little agreement on the clinical effects of alpha-thalassemia on the phenotype of sickle cell disease. METHODS: Complete blood count and red cell indices were measured by an automated cell analyzer. Quantitative assessment of hemoglobin variants HbF, HbA, HbA2, and HbS was performed by high performance liquid chromatography (HPLC). DNA extraction was performed using the phenol-chloroform method, and molecular study for common alpha-deletions was done by gap-PCR. RESULTS: Out of 60 sickle cell anemia patients, the alpha-thalassemia genotype was found in 18 patients. Three patients had the triplicated alpha-genotype (Anti alpha-3.7 kb), and the remaining patients did not have alpha-deletions. This study indicates that patients with co-existing alpha-thalassemia and sickle cell disease had a mild phenotype, significantly improved hematological parameters, and fewer blood transfusions than the patients with sickle cell anemia without co-existing alpha-deletions. CONCLUSION: Co-existence of alpha-thalassemia and sickle cell anemia has significant effects on the phenotype of Indian sickle cell patients.
alpha-Thalassemia ; Anemia, Sickle Cell ; Blood Cell Count ; Blood Transfusion ; Chromatography, Liquid ; DNA ; Erythrocyte Indices ; Genotype ; Hemoglobinopathies ; Hemoglobins ; Humans ; India ; Phenotype

Chaerophylline and berberine hydroxide, both being alkaloids, isolated from Corydalis chaerophylla and C. longipes respectively were assayed against spore germination of some fungi, e.g. Alternaria solani, A. brassicola, A. brassicicola, Helminthosporium penniseti, Helminthosporium sp., Heterosporium sp., Curvularia penniseti, C. maculens and C. palliscens. While chaerophylline inhibited spore germination of most of the fungi at 1000 ppm, being also effective at 50, 100, 200 and 500 ppm, berberine hydroxide was significantly effective at much lower concentration, i.e., 400 ppm against several fungi. This compound was also effective against some fungi at 50, 100, 150, 200 ppm. There was 100% inhibition of spore germination in several fungi at highest concentration of both the compounds. Some of the fungi showed similar results even at lower concentrations.
Alkaloids ; Alternaria ; Berberine* ; Corydalis* ; Fungi ; Germination ; Helminthosporium ; Spores