Predictors of mortality and nephrectomy in emphysematous pyelonephritis: a tertiary care centre study

INTRODUCTION

Emphysematous pyelonephritis (EPN) is a deadly disease due to its associated morbidity and mortality. Attempts have been made to identify predictors of severity, mortality and need for nephrectomy in EPN with little success.

METHODS

We conducted an ambispective study of EPN patients between March 2014 and September 2019. Retrospective data were collected which included age, sex, comorbidities, symptoms, signs, laboratory investigations including imaging, need for dialysis, management and any complications. All patients were then followed prospectively for renal dynamic scan, stone surgery or nephrectomy. Univariate analysis was performed to identify factors affecting mortality and need for elective nephrectomy.

RESULTS

In total, 112 patients were included. Mean patient age was 50.01 years, 55% were female and 5% had bilateral involvement. Fever and flank pain were the most common symptoms. Diabetes was seen in 75% of cases and 30% of cases required haemodialysis at initial presentation. About 60% of patients improved with pigtail drainage. Need for nephrectomy was greater in Huang-Tseng stage 3a (14.8%). Huang-Tseng stages 3b and 4 had higher mortality rates (25%) than the other stages (2.2%). Twelve of 99 patients had non functional kidney on follow-up and underwent elective nephrectomy. Low platelet counts, high body mass index, septic shock, dialysis and higher Huang-Tseng stage were found to be predictive of mortality and renal parenchymal thickness on computed tomography scan was predictive of follow-up nephrectomy.

CONCLUSIONS

Thrombocytopaenia, high body mass index, septic shock, haemodialysis and higher Huang-Tseng stage are predictors of mortality and renal parenchymal thickness <5mm is a predictor of poor salvage of affected kidney on follow-up.

High rising flames: a sign of complex extraperitoneal bladder rupture

Extraperitoneal bladder rupture is the most common type of bladder injury following pelvic trauma and is seen in 80-90% of cases. Generally, the contrast extravasation seen on computed tomography (CT) cystography is confined to the perivesical space, giving a characteristic flame-shaped appearance. Occasionally contrast extravasation can extend to the scrotum, thigh or anterior abdominal wall, depending on the extent of injury. Here we report an unusual CT cystogram finding of complex extraperitoneal bladder rupture with associated pelvic fracture urethral distraction defect, showing large-volume contrast extravasation extending beyond the perivesical space to the left perinephric region resembling high rising flames.

A huge ureteric stone in a functionally, metabolically and anatomically normal kidney: an alliance of rarity

Urinary stones are a common health problem, necessitating frequent outpatient visits and hospital admissions. Ureteric stones demand special attention, given their propensity for upstream hydroureteronephrosis and loss of renal function. They are usually predisposed by diverse anatomical, functional or metabolic abnormalities of the urinary tract and have an early symptomatic presentation. We report an exceptional clinical presentation of a huge ureteric stone yet functional renal moiety with no obvious anatomical or metabolic predilection for urolithiasis, and its minimally invasive management in a young woman. We emphasise that swift salvaging of the renal function is of utmost importance in these cases. Open exploration can be avoided in favour of laparoscopic ureterolithotomy with better cosmesis and early recovery.

Corrigendum to "P095 - Clinical outcomes of robot-assisted laparoscopic partial nephrectomy: Lessons learnt from 221 cases" [Eur Urol Suppl 2019;18(11);e3528]

[This corrects the article DOI: 10.1016/S1569-9056(19)34675-5.].

Synthesis and Anti-HIV Activity of Prodrugs of Azidothymidine

In order to enhance the therapeutic efficacy of azidothymidine (AZT) by improving its pharmacokinetic properties, three prodrugs of AZT were synthesized by esterifying the 5′-hydroxyl of AZT with three pharmacologically inactive steroidal 17β-carboxylic acids. Preliminary results of in vitro anti-HIV activity screening of the compounds show that all of these esters have anti-HIV activity comparable to that of AZT. This report discusses the synthesis and anti-HIV activity screening results of the prodrugs.

Population genetic structure of Indian shad, Tenualosa ilisha inferred from variation in mitochondrial DNA sequences

Indian shad, Tenualosa ilisha, is a commercially important anadromous fish representing major catch in Indo-pacific region. The present study evaluated partial Cytochrome b (Cyt b) gene sequence of mtDNA in T. ilisha for determining genetic variation from Bay of Bengal and Arabian Sea origins. The genomic DNA extracted from T. ilisha samples representing two distant rivers in the Indian subcontinent, the Bhagirathi (lower stretch of Ganges) and the Tapi was analyzed. Sequencing of 307 bp mtDNA Cytochrome b gene fragment revealed the presence of 5 haplotypes, with high haplotype diversity (Hd) of 0.9048 with variance 0.103 and low nucleotide diversity (π) of 0.14301. Three population specific haplotypes were observed in river Ganga and two haplotypes in river Tapi. Neighbour-joining tree based on Cytochrome b gene sequences of T. ilisha showed that population from Bay of Bengal and Arabian Sea origins belonged to two distinct clusters.

Probiotics in fish and shellfish culture: immunomodulatory and ecophysiological responses

Aquaculture is emerging as one of the most viable and promising enterprises for keeping pace with the surging need for animal protein, providing nutritional and food security to humans, particularly those residing in regions where livestock is relatively scarce. With every step toward intensification of aquaculture practices, there is an increase in the stress level in the animal as well as the environment. Hence, disease outbreak is being increasingly recognized as one of the most important constraints to aquaculture production in many countries, including India. Conventionally, the disease control in aquaculture has relied on the use of chemical compounds and antibiotics. The development of non-antibiotic and environmentally friendly agents is one of the key factors for health management in aquaculture. Consequently, with the emerging need for environmentally friendly aquaculture, the use of alternatives to antibiotic growth promoters in fish nutrition is now widely accepted. In recent years, probiotics have taken center stage and are being used as an unconventional approach that has numerous beneficial effects in fish and shellfish culture: improved activity of gastrointestinal microbiota and enhanced immune status, disease resistance, survival, feed utilization and growth performance. As natural products, probiotics have much potential to increase the efficiency and sustainability of aquaculture production. Therefore, comprehensive research to fully characterize the intestinal microbiota of prominent fish species, mechanisms of action of probiotics and their effects on the intestinal ecosystem, immunity, fish health and performance is reasonable. This review highlights the classifications and applications of probiotics in aquaculture. The review also summarizes the advancement and research highlights of the probiotic status and mode of action, which are of great significance from an ecofriendly, sustainable, intensive aquaculture point of view.

Parasagittal Ependymoma Mimicking Falcine Meningioma

Parasagittal Ependymoma Mimicking Falcine Meningioma

Langerhan's Cell Histiocystosis - a case report

Langerhan's Cell Histiocystosis - a case report Diagnostic challenge in a 21/2 years age girl: A cliniceo-radio-pathological correlation

Nature and Management of Penetrating Spinal Cord Missile Injuries at Shree Birendra Hospital, Chhauni from November 2001 to November 2004

Nature and Management of Penetrating Spinal Cord Missile Injuries at Shree Birendra Hospital, Chhauni from November 2001 to November 2004

Trauma Systems

Trauma systems

STUDY OF PHYSICAL COMPOSITION AND BACTERIOLOGICAL ANALYSIS OF SOLID WASTE OF KATHMANDU CITY

ABSTRACT

PREVALENCE OF GONOCOCCAL INFECTION AMONG THE PATIENTS VISITING AT DERMATOLOGY/VENEROLOGY AND GYNAECOLOGY DEPARTMENT OF TRIBHUVAN UNIVERSITY TEACHING HOSPITAL

A substantial proportion of women with gonococcal infection are asymptomatic butsymptomatic in male. Thus in developing countries, problem arises in active casedetection where laboratory facilities for testing are limited. During the study, thediagnostic validity of the hierarchial clinical algorithm as well as that of a non-hierarchial scoring system were assessed among 102 patient visiting at Dermatology/Venerology (DV) and Gynecology(Gynae) out patient department(OPD) of TribhuvanUniversity Teaching Hospital (TUTH), Kathmandu, Nepal. In the study period of 8months, May –December 1999, 9 (8.82%) were infected with N. gonorrhoea& 2(1.96%)with Gram Negative intracellular diplococci. Age group of 20-30 years were found tobe more infected followed by age groups 30-40 years & 40-50 years ( P< 0.10). Themale were found to be predominantly infected than female and married were foundto be more infected than unmarried. Among the infected people most of them hadsecondary level education and least of them had higher level education. Service holderswere found to be more infected than farmers, drivers & others. But male serviceholders & housewives were equally infected.Antimicrobial susceptibility of N. gonorrhoeashowed 100% susceptible to Ceftriaxone,followed by Ciprofloxacin (88.88%) whereas 22.22% resistant to Tetracycline, 55.55%to Cotrimoxazole and 55.55% to Penicillin. Among isolates, 33.33% were ß- lactamaseproducer. Co-micro organisms like Candida sppand Staphylococcus sppwere alsoobserved.Key Words: Gonococcal infection; Outpatient department, Antimicrobial susceptibility, Nepal.

SURVEILLANCE OF ANTI-TUBERCULAR DRUG RESISTANCE

Tuberculosis is the leading cause of death in Nepal. Failure in early detection anddrug resistance are two most important problems in treatment and cure of thetuberculosis. The objective of the study was to assess the drug resistance pattern inMycobacterium tuberculosis isolated in Tribhuvan University teaching Hospital. Morethan 85% of isolates were sensitive to all the four drugs and 5.5% of isolates weremultidrug resistant. The drug resistant isolates were obtained more frequently frompreviously treated patients. More extensive studies should be carried out by independentorganizations to collect more representative data on drug resistance tuberculosis.Key Words: Tuberculosis, drug resistance and surveillance.

Study on Air Bacterial Flora of Kathmandu Valley

Abstract

Nature and Management of Penetrating Craniocerebral Missile Injuries at Shree Birendra Hospital From November 2001 to November 2002

Nature and Management of Penetrating Craniocerebral Missile Injuries at Shree Birendra Hospital From November 2001 to November 2002

Prognostic factors for persistent distal renal tubular acidosis after surgery for posterior urethral valve

Risk factors, including age at presentation, age at surgery, time between presentation and surgery, urodynamic abnormalities, and vesicoureteric reflux, were prospectively studied for the development of distal renal tubular acidosis (DRTA) before surgery and persistent DRTA after surgery in 24 boys with posterior urethral valve (PUV) with normal serum creatinine levels. DRTA was persistent in 11 of 17 boys (65%) at the end of follow-up after intervention. For the development of DRTA before surgery, only a longer time between presentation and surgery (intervening period) turned out to be a significant risk factor on multivariate analysis (beta = -0.13; P = 0.04). Boys with persistent DRTA after surgery had older age at presentation (P = 0.03), older age at surgery (P = 0.001), a longer intervening period (P = 0.0007), and bilateral or severe unilateral reflux (P = 0.04) before surgery. On univariate logistic regression, age at surgery (beta = -0.07; P = 0.04) and intervening period (beta = -0.13; P = 0.02) were found to be significant risk factors for persistent DRTA, but on multivariate analysis, only intervening period was found to be significant (beta = -0.13; P = 0.02). A delay in intervention after noticing voiding symptoms can predict a high incidence of DRTA before intervention and persistent DRTA after surgery in boys with PUV.

Prognostic significance of distal renal tubular acidosis in posterior urethral valve

The prognostic significance of distal renal tubular acidosis (DRTA) in the development of overt nephropathy (ON) in children with posterior urethral valves (PUV) is not clear. This condition was studied prospectively in 22 children with posterior urethral valve (PUV), with normal renal function. Prior to surgery, the children with ON had a higher incidence of bilateral reflux (P=0.006), but the difference was not significant for age at surgery (P=0.31), duration of voiding symptoms prior to surgery (P=0.30), presence of DRTA (P=0.35) and bladder abnormalities (P=0.27), with none of these factors being significant on logistic regression analysis. At the end of the follow-up, after surgery, age at surgery (P < or = 0.0001), duration of voiding symptoms prior to surgery (P < or = 0.0003), persistent DRTA (P=0.0001) and persistent bladder dysfunction (P=0.02) after surgery were significantly higher in children with ON. On univariate logistic regression analysis, age at surgery (P=0.009), duration of voiding symptoms prior to surgery (P=0.01), persistent DRTA (P=0.002) and persistent bladder abnormalities (P=0.03) after surgery were significant for ON after surgery, but on stepwise multivariate logistic regression analysis only persistent DRTA (P=0.002) turned out to be significant. We conclude that persistent DRTA after surgery can predict overt nephropathy in children with PUV after surgery.

Cyclosporin A withdrawal in live related renal transplantation: long-term results

Cyclosporin A (CsA) withdrawal after 1 yr of stable graft function has been shown to be beneficial in cadaveric renal transplantation. This strategy could be even more suitable for 'immunologically advantaged' grafts as in live related renal transplantation. We report the long-term outcome of patients in a live related transplantation programme undergoing early (between 1989 and 1992) and late (1993 onwards) CsA withdrawal as compared with those on long-term low dose CsA (1993 onwards). Two-hundred and fifty-two patients were divided into three groups based on the following immunosuppressive protocol: group ECyW (n=99), early CsA withdrawal (9 months after transplantation); group LCyW (n=44), late CsA withdrawal (median 16 months, range 13--22 months after transplantation); and group LDCy (n=109), long-term low dose CsA. The median period of follow-up was 66 months after transplantation (range 43--84 months). There was no difference in the actuarial 6-yr patient or graft survival among the three groups. Acute rejection episodes were more frequent in ECyW (54.4%) than in LDCy (31.8%) and LCyW (23.8%) (p=0.001). The risk of developing late (> or =9 months) acute rejection was highest in ECyW 32/99 (32.3%) as compared with LCyW 8/44 (18.4%; p=0.08) and LDCy 8/109 (7.3%; p=0.0001). Of the 32 ECyW patients who developed acute rejection episodes after CsA withdrawal, 13 (40.6%) lost their grafts either due to uncontrolled acute rejection or to chronic rejection. Chronic rejection was higher in ECyW (24%) than in LCyW (11%; p=0.04) and LDCy (17%; p=0.17). Antihypertensive requirement was highest in patients maintained on low dose CsA. Graft function, as measured by serum creatinine levels, was significantly better in LCyW (1.24+/-0.4 mg%) as compared with ECyW (1.49+/-0.5 mg%) and LDCy (1.48+/-0.6 mg%). Early CsA withdrawal after live related renal transplantation is associated with a significant risk of acute rejection and subsequent chronic rejection. Slow withdrawal after 1 yr is safe and more economical than the long-term administration of low dose CsA.

Acute renal failure associated with liver disease in India: etiology and outcome

Acute renal failure (ARF) associated with liver disease is a commonly encountered clinical problem of varied etiology and high mortality. We have prospectively analyzed patients with liver disease and ARF to determine the etiology, clinical spectrum, prognosis and factors affecting the outcome. Other than hepatorenal syndrome patients, out of 221 cases, 66 developed ARF secondary to various liver disease like cirrhosis (n = 29, mortality 8, risk factors-older age p < 0.01, grade III/IV encephalopathy p < 0.05), fulminant hepatic failure (n = 25, mortality 15, risk factor-prolonged prothrombin time p < 0.01), and obstructive jaundice (n = 12, mortality 7, risk factor-sepsis p < 0.01). In these three groups the factors leading to ARF were volume depletion (24), gastrointestinal bleed (28), sepsis (34), drugs (27) [aminoglycosides (9) and NSAID (18)] along with hyperbilirubinemia. Various types of ARF with contemporaneous liver injury were malaria (n = 37, mortality 15, risk factors-higher bilirubin p < 0.001, higher creatinine p < 0.05, anuria p < 0.05 and dialysis dependency p < 0.05), sepsis (n = 36, mortality 22, risk factors-age p < 0.001, higher bilirubin p < 0.01, oliguria p < 0.05), hypovolemia with ischemic hepatic injury (n = 14, mortality 5, risk factors-higher creatinine p < 0.05 and SGPT p < 0.01), acute pancreatitis (n = 12, mortality 4, risk factors-higher bilirubin p < 0.001, higher SGPT p < 0.01, dialysis dependency p < 0.05), rifampicin toxicity (n = 10, no mortality), paroxysmal nocturnal hemoglobinuria (n = 3, no mortality), CuSO4 poisoning (n = 3 mortality 2), post abortal (n = 11, mortality 6, risk factors higher creatinine p < 0.05 and SGPT p < 0.01), ARF following delivery including HELLP syndrome (n = 12, mortality 4, risk factors-higher bilirubin p < 0.01 and SGPT p < 0.01), and of uncertain etiology (n= 14 mortality 4). 133 patients (60.2%), required hemodialysis hemodialfiltration or peritoneal dialysis. ARF associated with liver disease is having high mortality (42.5%). Avoidance of dehydration, hypotension, nephrotoxic drugs and sepsis, with promote dialytic support are necessary to reduce mortality and morbidity.

Does serum albumin at start of continuous ambulatory peritoneal dialysis (CAPD) or its drop during CAPD determine patient outcome?

The impact of serum albumin at start of continuous ambulatory peritoneal dialysis (SA1), serum albumin before death (SA2), and change in serum albumin during continuous ambulatory peritoneal dialysis (delta SA) were prospectively studied in 41 continuous ambulatory peritoneal dialysis (CAPD) patients with a follow-up of 19 +/- 11.6 months. For analysis, patients were divided into two groups at each measurement point: SA1 or SA2 > 3.0 g/dL or delta SA < 1.0 g/dL (group I), and SA1 or SA2 < 3.0 g/dL or delta SA > 1.0 g/dL (group II). On log rank test, the mortality rate was significantly higher in group II patients in relation to SA1 (p < or = 0.0001), SA2 (p = 0.0002), and delta SA (p = 0.001). On univariate Cox proportional hazard regression analysis, SA1 (p = 0.0001), SA2 (p = 0.0001), delta SA (p = 0.002), and episodes of peritonitis (p = 0.0001) were significant. On multivariate analysis, SA2 (p = 0.003) was significantly related to patient mortality. SA2 (r = 0.8; p = 0.0001), but not delta SA, was related to SA1. We conclude that SA2 is the best predictor of patient mortality on CAPD. SA2 is strongly related to SA1. Thus protein restriction in the pre-dialysis stage should be advised cautiously to avoid consequent hypoalbuminemia.

Peritoneal equilibration test in Indian patients on continuous ambulatory peritoneal dialysis: does it affect patient outcome?

The variations in peritoneal equilibration test (PET) characteristics in various ethnic groups have been reported. Data are scarce regarding the pattern of membrane characteristics in Indian patients. The factors affecting PET and the PET, in turn, affecting patient outcome are controversial issues. We prospectively analyzed 41 patients to evaluate: (1) the pattern of PET characteristics in Indian patients; (2) the factors affecting the PET; (3) the effect of membrane characteristics on patient outcome. The mean period of follow up was 17.1 +/- 9.3 months. The PET results revealed 21 high transporters (51%), 13 high-average transporters (32%), 6 low-average transporters (15%), and 1 low transporter (2%). The distribution of the various PET categories in patients below the age of 60 years and those 60 years or above was not significant (p = 0.70). The sex distribution (p = 0.94) and prevalence of diabetes (p = 0.62) were not significantly different in various PET categories. On regression analysis, PET values were not affected by the age of patients (beta = 0.80, p = 0.61). Patient survival among high and high-average transporters was significantly less compared with low and low-average transporters (p = 0.01). We conclude that Indian patients on continuous ambulatory peritoneal dialysis (CAPD) have a higher proportion of high and high-average transporters. The pattern of membrane kinetics cannot be explained by differences in patient characteristics and diabetic status. Patients with high PET values have poorer patient survival on CAPD.

Varicose Veins: A 2-year study in Military Hospital, Chhauni

Varicose Veins: A 2-year study in Military Hospital, Chhauni

Etiology, prognosis, and outcome of post-operative acute renal failure

A Multivariate analysis was done in all patients who developed post operative ARF, during the period 1990-1995 to determine the etiological spectrum and to identify various variables affecting the outcome. Of 140 patients (110 operated at SGPGI and 30 operated outside) 116 underwent elective surgery. The different types of surgery leading to ARF were urosurgery (3.5%), open heart surgery (32.9%), gastrosurgery (16.4%), pancreatic surgery (9.3%), obstetrical surgery (3.6%) and others (2.8%). The incidence of ARF in SGPGI patients was highest in pancreatic surgery group (8.2%) followed by open heart surgery (3%). The different etiological factors responsible for ARF were perioperative hypotension (67.1%), sepsis (63.6%) and exposure to nephrotoxic drugs (29.3%). Sixty-four patients (45.7%) required dialysis. The overall mortality was 45%. The mortality was highest in patients who underwent open heart surgery (89.1%) followed by pancreatic surgery (84.6%). The factors associated with high mortality, other than the type of surgery, were preoperative hypotension (p < 0.05), oliguria (p < 0.01), need for dialysis (p < 0.05) and multiorgan failure (p < 0.001). AM following emergency surgery had poor outcome, though not statistically significant. Perioperative sepsis (p < 0.05) and preoperative use of aminoglycoside (p < 0.05) were significantly higher in patients operated outside SGPGI. This was associated with higher incidence of ARF. Thus we conclude that presence of multiorgan failure, oligoanuria, preoperative hypotension and need far dialysis are poor prognostic markers in ARF following surgery.

Changing trends of histopathology in childhood nephrotic syndrome

This study was conducted to analyze the trend of histopathologic subtypes in idiopathic nephrotic syndrome (INS) in a homogenous racial group in India population. A prospective analysis of 400 consecutive children with INS was performed. Kidney biopsies were performed according to standard indications. Steroids were administered following the Arbeitsgeminschaft fur Padiatrische Nephrologie protocol. Cyclophosphamide was administered to children in the frequent-relapser, steroid-dependent, and steroid-nonresponder categories. Of the various histopathologic subtypes, focal segmental glomerulosclerosis (FSGS) was the most common (87 of 222 subtypes; 39.1%). Children who underwent biopsy between July 1992 and December 1996 (group B, n = 157) were compared with our initial published data of biopsies performed between January 1990 and June 1992 (group A, n = 65), with similar indications for biopsy in both groups. The incidence of FSGS was significantly greater in biopsies performed in the recent period (group B, 47% versus group A, 20%; P = 0.0002). The different clinical and biochemical parameters were also analyzed to differentiate FSGS from the other 2 subtypes. Hypertension (P = 0. 005), renal insufficiency at presentation (P = 0.001), and steroid resistance (P = 0.0006) were significantly greater in children with FSGS. On follow-up (mean, 5.4 years), children with FSGS were at a significantly greater risk for developing renal insufficiency (P = 0. 0001). We conclude there is a shift toward an increasing prevalence of FSGS over the years in the Indian population. This trend has immense therapeutic and prognostic significance.

A Case Report of Intradural Herniated Disc

A Case Report of Intradural Herniated Disc

A Prospective Study of Adult Inguinal Hernia Repairs Implementing a New Technique Over A 5-year Period

A Prospective Study of Adult Inguinal Hernia Repairs Implementing a New Technique Over A 5-year Period

Effect of vesical feedback on rate of urine formation demonstrated by infusing hypotonic and hypertonic saline into the urinary bladder of dogs

The present study was undertaken to investigate the effect of the presence of solutions of different osmolality (hypertonic 3%, 4% and 5% hypotonic 0.1%, 0.2% and 0.3% in the urinary bladder on renal urine formation. The study was conducted on 36 dogs of either sex. 100 ml normal saline was used for distending the bladder. Various hypertonic and hypotonic solutions were infused inside the bladder and rate of urine formation was recorded. Presence of hypertonic fluid increased the rate of urine formation and hypotonic fluid decreased it.

Structure-activity relationship of antiestrogens. Studies on 2,3-diaryl-1-benzopyrans

A series of 2,3-diaryl-1-benzopyran analogues substituted at position 4 of 2-phenyl with a hydroxy or pyrrolidinoethoxy residue were synthesized as models for (E)-triarylpropenones constrained in the s-trans conformation. The prototypes, belonging to five chemical series, were evaluated for their estrogen receptor affinity and for estrogen agonist-antagonist activities. The 4H-1-benzopyran-4-one, the 2,3-dihydro-4H-1-benzopyran-4-one, the 4H-1-benzopyran, and the 2,3-dihydro-1-benzopyran derivatives were found to be inactive or only marginally activate as receptor ligands or estrogen agonists-antagonists. In the 2H-1-benzopyran category the parent phenol was also inactive whereas the basic ethers 16 and 26 were modest receptor ligands while being quite active as antiestrogens. In a comparative study the benzopyran 16 was found to be more effective antiestrogen than tamoxifen while being as effective as LY-117018. The benzopyrans have thus emerged as a new class of potent antiestrogens.

Structure-activity relationship of antiestrogens. Effect of the side chain and its position on the activity of 2,3-diaryl-2H-1-benzopyrans

A series of 2,3-diaryl-2H-1-benzopyrans carrying a tertiary aminoethoxy chain at the ortho, meta, or para position of 2-phenyl or an alkyl at position 4 of the pyran ring were synthesized and evaluated for their affinity for estrogen receptor (ER) and for microsomal antiestrogen specific binding site and for their uterotrophic-antiuterotrophic activities in rodents. The analogues bearing the side chain at the para position of 2-phenyl were found to be active while those substituted at the meta and ortho positions were inactive as ER ligands as well as estrogen agonists-antagonists. Among para-substituted ethers, the 2-piperidinoethoxy analogue 5 was found to be a more effective antiestrogen than the corresponding pyrrolidino, dimethylamino, and related analogues. Incorporation of a methyl or an ethyl at C4 in the pyran nucleus was found to increase receptor affinity of the prototypes. The ethyl was also found to potentiate agonist activity of the prototype while abolishing its antagonist activity. The piperidino analogue 5 was found to be a better antiestrogen than tamoxifen as well as LY-117018 in rats as well as mice. The prototypes were also found to have high affinity for the microsomal antiestrogen specific binding sites. The benzopyrans have thus emerged as a new group of potent antiestrogens.

Structure-activity relationship of antiestrogens. Phenolic analogues of 2,3-diaryl-2H-1-benzopyrans

Phenolic analogues of 2-[4-(2-piperidinoethoxy)phenyl]-3-phenyl-2H-1-benzopyran (1), a novel antiestrogen, were synthesized and evaluated for their structure-activity relationship. Incorporation of OH at position 7 was found to improve receptor affinity of the benzopyran while having no effect on its action as an antagonist. Similar substitution of 2-phenyl as well potentiated receptor affinity as well as antagonist activity of the prototype. The monophenol 19 and the diphenol 25 were thus found to be good receptor ligands, devoid of estrogen agonist activity and associated with marked antiestrogenic activity of comparable order. Both caused nearly complete inhibition of the estradiol stimulated uterine growth in rats as well as mice and were thus found to be better antiestrogens than tamoxifen, trioxifen, and LY-117018. A binding-site model for estrogen receptor rationalizing the structure-activity relationship of benzopyrans in relation to that of the triarylethylene and the triarylpropenone antiestrogens has been discussed.

Serum magnesium levels in chronic renal failure. Clinical significance and correlation with sodium potassium and calcium

Fifty cases with chronic renal failure and 25 age and sex matched normal healthy controls were studied. The mean serum magnesium level was significantly higher (4.10 +/- 0.85 mg/dl) in the patients as compared to controls (2.40 +/- 0.14 mg/dl; p less than 0.001) and levels rose progressively with deterioration in renal function. Significantly higher serum magnesium levels were observed in patients of chronic renal failure with encephalopathy than in those without. Greater the impairment in level of consciousness, higher was the magnesium level. Improvement in neurological status correlated well with fall in serum magnesium level. The fall was significantly higher in patients on dialysis as compared to non-dialysed patients. Serum magnesium is a worthwhile tool in assessing duration of disease, morbidity and mortality in patients with chronic renal failure. Its estimation may help in evaluating conservative treatment and dialysis in chronic renal failure.

A simple most probable number method for the enumeration of sulphate-reducing bacteria in biocide containing waters

A simple most probable number (MPN) method has been developed for the enumeration of sulphate-reducing bacteria (SRB) in biocide-containing waters. The medium used is based on source water, it contains no toxic thioglycollate and is resistant to oxidation through mishandling. Reduction is by a suspension of Pseudomonas putida which acts as a powerful adsorbent of biguanide, phenolic, quaternary ammonium compound, glutaraldehyde and isothiazolone biocides. Good recoveries of SRB type strains were obtained using this method and were comparable to other published techniques. Recovery of SRB in mixed culture was comparable to that using a standard laboratory technique.

Keratitis due to Aspergillus flavus successfully treated with thiabendazole

A case of Aspergillus flavus keratitis treated successfully with 4% suspension of thiabendazole is reported. This seems to be the first case of successful treatment of keratomycosis with thiabendazole. All other reported cases treated with this drug either had their eyes removed or did not retain any useful vision. Its ability to penetrate ocular tissues, ability to remain in concentrations higher than the minimal inhibitory concentration of many fungi, and broad spectrum of activity make it a worthwhile drug for further investigation in keratomycosis.

Bacteriological Quality Of Groundwater in Urban Patan and Antibiotic Sensitivity Against Isolated Enteric Bacteria

Abstract