Clinical profile of febrile encephalopathy patients at a tertiary care hospital in India:A retrospective study

Objective:To investigate demography,etiology,and clinical profile and to analyze the outcomes of patients presenting with febrile encephalopathy at a tertiary care center in Eastern India.Methods:This retrospective,observational study included a total of 50 patients(>18 years)who presented with fever and encephalopathy.All patients underwent blood analysis;culture test for blood,urine,sputum,cerebrospinal fluid,and other body fluids;chest and abdominal ultrasonography;neuroimaging;polymerase chain reaction test,and other relevant tests as and when applicable.Results:The mean age of all enrolled patients was(58.0±16.0)years with male to female ratio of 1.27꞉1.Viral encephalitis was diagnosed in 16(32%)patients,sepsis-associated encephalitis in 14(28%),bacterial meningoencephalitis in 8(16%)and tuberculosis meningoencephalitis in 5(10%).The mean hospital stay was 10(4,17)days.At 6-month follow-up,10(20%)patients died,10(20%)patients recovered with sequelae(cognitive impairment,critical care neuropathy,etc.),and 30(60%)patients recovered without sequelae.A statistically significant association was noted between Glasgow Coma Scale(<8)and mortality rate(P=0.02).Conclusions:Primary central nervous system infection is the most frequent etiology of febrile encephalopathy and viral encephalitis is the most common etiological cause.Accurate,systematic,timely diagnosis and management are prime factors to reduce mortality and morbidity.

Sitagliptin,sitagliptin and metformin,or sitagliptin and amitriptyline attenuate streptozotocin-nicotinamide induced diabetic neuropathy in rats

Diabetic neuropathies are a family of nerve disorders caused by diabetes. Symptoms of the disease include nerve palsy, mononeuropathy, mononeuropathy multiplex, diabetic amyotrophy, painful polyneuropathy, autonomic neu- ropathy, and thoracoabdominal neuropathy. In this study, type 2 diabetes in rats was induced with nicotinamide- streptozotocin. Drug treatment was initiated on the d 15, with the combination regimen of metformin, pioglitazone and glimipiride or metformin and sitagliptin or sitagliptin, amitriptyline and sitagliptin and led to significantly im- proved glycemic control, increased grip strength and paw jumping response on d 21, 28 and 35 （P 〈 0.001）. Signif- icant increases in blood protein levels and decreases in urinary protein levels were observed in the animals treated with the different regimens on d 21, 28 and 35 （P 〈 0.001）. Combined treatment of streptozotocin and nicotinamide caused marked degeneration of nerve cells, while administration of metformin and sitagliptin showed tissue regen- eration and no body weight gain. In conclusion, treatment with sitagliptin and sitagliptin combined with metformin or amitriptyline results in no body weight gain, but causes an increase in grip strength and pain sensitivity, exhibits neural protection, and reverses the alteration of biochemical parameters in rats with streptozotocin-nicotinamide induced type 2 diabetes.

Cardioprotective activity of alcoholic extract of Tinospora cordifolia (Willd.) Miers in calcium chloride-induced cardiac arrhythmia in rats

The present study investigated the antiarrhythmic activity of alcoholic extract of Tinospora cordifolia （T. cordifolia） in CaCl2 induced arrhythmia. CaCl2 （25 mg/kg） was administered by intravenous infusion （iv） to produce arrhythmia in rats. The animals were then treated with T. cordifolia extract （150, 250, and 450 mg/kg） and verapamil （5 mg/kg,iv）. Lead II electrocardiogram was monitored. Plasma calcium, sodium and potassium levels were measured. In CaCl2 induced arrhythmia, heart rate was decreased by 41.10%, T. cordifolia at 150, 300, and 450 mg/kg decreased the heart rate by 26.30%, 29.16%, and 38.29%, respectively, and verapamil reduced the heart rate by 9.70% compared to the normal group. The PQRST waves were normalized and atrial and ventricular fibrillation was controlled in rats treated with verapamil and T. cordifolia. CaCl2 increased calcium and sodium levels and decreased potassium levels in blood. T. cordifolia dose-dependently decreased calcium and sodium levels and increased potassium levels. Hence, T. cordifolia can be used in antiarrhythmic clinical settings and beneficial in atrial and ventricular fibrillation and flutter and may be indicated in ventricular tachyarrhythmia.

Involvement of adenosine and standardization of aqueous extract of garlic(Allium sativum Linn.)on cardioprotective and cardiodepressant properties in ischemic preconditioning and myocardial ischemia-reperfusion induced cardiac injury

The present study investigated the effect of garlic （Allium sativum Linn.） aqueous extracts on ischemic pre- conditioning and ischemia-reperfusion induced cardiac injury, as well as adenosine involvement in ischemic pre- conditioning and garlic extract induced cardioprotection. A model of ischemia-reperfusion injury was established using Langendorff apparatus. Aqueous extract of garlic dose was standardized （0.5%, 0.4%, 0.3%, 0.2%, 0.1%, 0.07%, 0.05%, 0.03%, 0,01%）, and the 0.05% dose was found to be the most effective. Higher doses （more than 0.05%） were highly toxic, causing arrhythmia and cardiodepression, whereas the lower doses were ineffective. Garlic exaggerated the cardioprotective effect of ischemic preconditioning. The cardioprotective effect of ischemic preconditioning and garlic cardioprotection was significantly attenuated by theophylline （1,000 ~tmol/L） and 8-SPT （10 mg/kg, i.p.） and expressed by increased myocardial infarct size, increased LDH level, and reduced nitrite and adenosine levels. These findings suggest that adenosine is involved in the pharmacological and molecular mechanism of garlic induced cardioprotection and mediated by the modulation of nitric oxide.