New objective scoring system to clinically assess fecal incontinence

BACKGROUND Several scoring systems are used to assess fecal incontinence(FI),among which,the most commonly used are Wexner and Vaizey’s scoring systems.However,there are significant lacunae in these scoring systems,due to which they are neither accurate nor comprehensive.AIM To develop a new scoring system for FI that is accurate,comprehensive,and easy to use.METHODS A pro forma was made in which six types of FI were included:solid,liquid,flatus,mucous,stress,and urge.The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100(0-least,100-maximum disability).The disability was assessed on a modified EQ-5D+(EuroQol)description system,4D3L(4 dimensions and 3 levels)for each FI.The average score of each FI was calculated,divided by 10,and rounded off to determine the weight of each FI type.The scores for the three levels of frequency of each FI were assigned as never=0(No episode of FI ever),occasional=1(≤1 episode of FI/wk),and common=2(>1 episode of FI/wk),and was termed as frequency score.The score for each FI would be derived by multiplying the frequency score and the weight for that FI type.In the second phase of the study,a group of colorectal surgeons was asked to rank the six FI types in order of severity,and their ranking was compared with the patient and laypersons’rankings.RESULTS Fifty patients and 50 laypersons participated in the study.The weight was assigned to each FI(solid-8,liquid-8,urge-7,flatus-6,mucus-6,and stress-5),and an new scoring system was formulated.The maximum possible score was 80(total incontinence),and the least 0(no incontinence).The surgeons’ranking of FI severity did not correlate well with patients’and laypersons’rankings of FI,highlighting that surgeons and patients may perceive the severity of FI differently.CONCLUSION A new scoring system for FI was formulated,which was simple,logical,comprehensive,and easy to use,and eliminated previous shortcomings.Patients’and surgeons’perceptions of FI severity of FI did not correlate well.

Brazilin from Caesalpinia sappan heartwood and its pharmacological activities:A review

Caesalpinia sappan L.(CS) is a plant of Leguminosae family,commonly known as Brazil or Sappan wood.CS is distributed in Southeast Asia and its dried heartwood has been used as traditional ingredient of food or beverages and has a wide variety of medicinal properties.Higher extraction yield of CS wood was achieved with 95% ethanol for 2 h.Chemical constituent's investigation of sappan wood resulled in the isolation of various structural types of phenolic components including one xanihone,one coumarin,three chalcones,two flavones three homoisoflavonoids and brazilin.Brazilin[(6a S-cis)-7,11b-dihydrobcnz[b]indeno[1.2-d]pyran-3.6a.9.10(6H)- tetroll.a major and active compound found in CS heartwood.Most of the folkloric uses of brazilin were validated by the scientific studies such as antioxidant,antibacterial,anti-inflammatory,anti-photoaging.hypoglycemic,vasorelaxant,hepatoproteetive and anti-acne activity.CS heartwood extract is safe and did not produce any acute or subacute toxicity in both male and female rats.Brazilin is the safe natural compound having potential to develop as a medicinal compound with application in food,beverage,cosmetics and pharmaceutical industries to screen its clinical use in modern medicine.The information gained could provide the important and potential approach for pharmaceutical researcher to implicate the knowledge of brazilin in the formulation of new drug and to reveal therapeutic and gaps requiring future research opportunities.More studies are needed to evaluate the potential application of brazilin as preservative and coloring agent in food processing industries.

Coriander(Coriandrum sativum L.) essential oil: chemistry and biological activity

Coriandrum sativum L.(C. sativum) is one of the most useful essential oil bearing spices as well as medicinal plants, belonging to the family Umbelliferae/Apiaceae. The leaves and seeds of the plant are widely used in folk medicine in addition to its use as a seasoning in food preparation. The C. sativum essential oil and extracts possess promising antibacterial, antifungal and anti-oxidative activities as various chemical components in dif erent parts of the plant, which thus play a great role in maintaining the shelf-life of foods by preventing their spoilage. This edible plant is non-toxic to humans, and the C. sativum essential oil is thus used in dif erent ways, viz., in foods(like l avoring and preservatives) and in pharmaceutical products(therapeutic action) as well as in perfumes(fragancias and lotions). The current updates on the usefulness of the plant C. sativum are due to scientii c research published in dif erent web-based journals.

Sleep, circadian dysrhythmia, obesity and diabetes

Synchrony of biological processes with environmental cues developed over millennia to match growth, reproduction and senescence. This entails a complex interplay of genetic, metabolic, chemical, light, hormonal andhedonistic factors across life forms. Sleep is one of the most prominent rhythms where such a match is established. Over the past 100 years or so, it has been possible to disturb the synchrony between sleep-wake cycle and environmental cues. Development of electric lights, shift work and continual accessibility of the internet has disrupted this match. As a result, many noncommunicable diseases such as obesity, insulin resistance, type 2 diabetes, coronary artery disease and malignancies have been attributed in part to such disruption. In this presentation a review is made of the origin and evolution of sleep studies, the pathogenic mediators for such asynchrony, clinical evidence and relevance and suggested management options to deal with the disturbances.

Rare case report of Van Gogh syndrome in a patient with paranoid schizophrenia

Self-mutilation is often associated with psychiatric disorders.We describe here a 22-year-old male Indian with decreased sleep,aggressive behaviour,self-muttering,disorganised behaviour,frequent spitting,biting and selfmutilation;he bit off his right ring finger and left thumb(Van Gogh syndrome).Self-harm behaviour was frequently evidenced by family members resulting in various injuries.The patient was diagnosed with paranoid schizophrenia and was treated with anti-psychotics which resulted in a decrease in his behavioural disturbances along with treatment for his self-mutilation injuries.Here we discuss Van Gogh syndrome’s presentation of self-mutilation in paranoid schizophrenia and its implications.

The effectiveness of self instructional module on cardiac rehabilitation

Objective:Nurses play a strong role in helping patients reduce their risk for disease and make informed lifestyle changes.Reliability of the nurses is critical for them to serve as role models and educators.The aim of the present study was to improve nurse knowledge of post-myocardial infarction rehabilitation at selected hospitals in Indore through a newly designed self-instructional module.Methods:Sixty cardiac center staff nurses were administered a questionnaire,a pre-test on cardiac care and the self-instructional module.Five days after the nurses were administered the module,a post-test was given to assess the gain in knowledge on in postmyocardial infarction cardiac rehabilitation.Results:The mean pre-test score was 8.27±4.40 but increased to 23.18±3.69 in the posttest following administration of the self-instructional module.The change in score was statistically significant(P<0.0001)indicating that the self-instructional module was instrumental in increasing knowledge of post-myocardial infarction rehabilitation.Conclusions:The results of this study highlight the need for continuing education of nurses in cardiac rehabilitation.Self-instructional modules are a useful tool for furthering nurse education.

Acute oedema associated with risperidone use:a report

Risperidone acts by potent serotonergic,dopaminergic and alpha adrenergic receptor antagonism.The most common side effects reported are extrapyramidal symptoms,dizziness,sedation,insomnia,headache,anxiety,nausea,constipation and weight gain.Oedema associated with risperidone use is a rare side effect.Here we present a report on pedal oedema associated with use of oral risperidone 4 mg per day for acute-onset psychotic illness.Through this case report we want to make clinicians aware about this important side effect as it can affect patients*compliance and quality of life.

Central Nervous System Control of Glucose Homeostasis

Hypothalamus and brain stem play important roles in Glucose Homeostasis. There are two types of cells in the hypothalamus: Glucose excited (GE) and Glucose inhibited (GI). GE increases glucose concentration and GI decreases glucose concentration. They are located in ventromedial (VMH), arcuate, lateral, dorsomedial and paraventricular areas of hypothalamus. Nucleus of solitary tract, area postrema, dorsomedial nucleus of vagus and basolateral medulla are also related to glucose homeostasis. VMH contains sympathetic nucleus and upregulates plasma glucose and decreases hepatic glycogen, while lateral hypothalamus contains parasympathetic and down regulates plasma glucose. Through Glut-1, dependent transport glucose enters neurons and astrocytes. Glucose is metabolized and provides energy for GE and GI neurons. Their activity is guided by blood sugar level. Blood sugar level sends numerous signals through vagal pathway from periphery. Neuron astrocyte establishes via autonomic system connections with liver, pancreas, adrenal gland and maintains glucose homeostasis. Post prandial glucose levels are regulated by CNS.

Obesity Management-Bariatric Surgery vs Lifestyle Modification

Role of Bariatric surgery for obesity is briefly outlined. Selection criteria, contraindications, evaluations of patients before surgery, types of bariatric surgery with their merits and demerits are discussed. Results of lifestyle modifications is compared with that of bariatric surgery.

Biomarkers in acute brain trauma: A narrative review

Biomarkers have been used to diagnose, prognose, evaluate, and identify the severity and outcomes in traumatic brain injury (TBI) patients. This study explored if it is possible to predict the outcome of TBI patients by estimating the biomarkers in cerebrospinal fluid and serum. We searched data bases and literature about biomarkers, and found forty epidemiologic studies from 92 potentially relevant articles. However, limited data are available about postanoxic encephalopathy. It showed that presently, neurofilament, S100B, glial fibrillary acidic protein, and ubiquitin carboxyl terminal hydrolase-L1 seemed to have the best potential as diagnostic biomarkers for distinguishing focal and diffuse injury, whereas C-Tau, neuron-specific enolase, S100B, glial fibrillary acidic protein, and spectrin breakdown products appear to be candidates for reflective biomarkers of TBI. Point-of-care biomarkers are needed in TBI which is one of the most important additional risk factors in road traffic injuries. In a holistic approach, more researches about biomarkers of TBI are required. These biomarkers are very useful for treatment of patients with TBI.

A rare interesting case of seborrheic keratosis of pinna

Seborrheic keratosis is a benign tumour of external ear originating from proliferative epithelial cells. Its most common site ranges from the retroauricular region to the helical rim. Diagnosis is made on the basis of clinical & histopathological examination. Here, we discuss the clinical presentation, differential diagnosis, pathological diagnosis and management of such a case.

Spontaneous Retropharyngeal Haematoma in a One-Year-Old Child: A Case Report

Spontaneous retropharyngeal haematoma is an unusual condition and difficult to diagnosis early especially in infants. It has multiple aetiological factors and can present to a number of specialists including the otolaryngologist. We describe an unusual case of a spontaneous huge retropharyngeal haematoma in 1-year-old male child which demonstrates the dramatic presentation and emphasizes the need for immediate surgical approach.

Outcome of buttress plate-nail construct used for reconstruction of broken lateral wall in intertrochanteric fractures

Purpose:Intramedullary implants are well accepted fixation of all types of intertrochanteric(IT)frac-tures,both stable and unstable types.Intramedullary nails have an ability to effectively support the posteromedial part,but fail to buttress the broken lateral wall requiring lateral augmentation.The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures,which was fixed to the femur through hip screw and anti-rotation screw nail.Methods:Of 30 patients,20 had Jensen-Evan typeⅢand 10 had type V fractures.Patients with IT fracture of broken lateral wall and aged more than 18 years,in whom satisfactory reduction was achieved by closed methods,were included in the study.Patients with pathologic or open fractures,polytrauma,prior hip surgery,non-ambulatory prior to surgery,and those who refused to participate were excluded.The operative time,blood loss,radiation exposure,quality of reduction,functional outcome,and union time were evaluated.All data were coded and recorded in Microsoft Excel spread sheet program.SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.Results:The mean age of patients in the study was 60.3 years.The mean duration of surgery(min),mean intra-operative blood loss(mL)and mean number of exposures were 91.86±12.8(range 70-122),144.8±3.6(range 116-208),and 56.6(range 38-112),respectively.The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.Conclusion:Lateral trochanteric wall in IT fractures is significantly important,and needs to be recon-structed adequately.Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment,fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.

Indian olive, Elaeocarpus floribundus fruits in combating MRSA infection

Objective: To explore the antibacterial activity of Elaeocarpus floribundus fruits aqueous extracts against methicillin resistant Staphylococcus aureus (MRSA) clinical isolates. Methods: The fresh olive fruits were collected, dried and milled in order to prepare aqueous extracts of olive seed and olive mesocarp-epicarp. The extracts were tested against clinical isolates of MRSA by agar well diffusion method, and the diameter of inhibition zone was recorded, and antibacterial capacity of the extracts (AU/mL) was determined. Results: The MRSA isolates were sensitive to aqueous extract of olive mesocarp-epicarp with diameter of inhibition zone ranging from (11.670 ± 0.577) to (15.330 ± 0.577) mm;the olive aqueous seed extract had no anti-MRSA activity. The antibacterial capacity of the extracts against the tested MRSA isolates ranged from 733.33 to 800 AU/mL. Conclusions: The olive fruits can be used as a new source of plant based non-antibiotic biotherapeutic agents for the treatment of MRSA infection.