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Jaundice icterus [keywords]
- A review on phytochemical, pharmacological, and pharmacognostical profile of Wrightia tinctoria: Adulterant of kurchi. [REVIEW]
- Pharmacogn Rev 2014 1; 8(15):36-44.
Wrightia tinctoria R. Br. belongs to family Apocynaceae commonly called as Sweet Indrajao, Pala Indigo Plant, Dyer's Oleander. "Jaundice curative tree" in south India. Sweet Indrajao is a small, deciduous tree with a light gray, scaly smooth bark. Native to India and Burma, Wrightia is named after a Scottish physician and botanist William Wright (1740-1827). Sweet Indrajao is called dhudi (Hindi) because of its preservative nature. The juice of the tender leaves is used efficaciously in jaundice. Crushed fresh leaves when filled in the cavity of decayed tooth relieve toothache. In Siddha system of medicine, it is used for psoriasis and other skin diseases. Oil 777 prepared out of the fresh leaves of the plant has been assigned to analgesic, anti-inflammatory, and anti-pyretic activities and to be effective in the treatment of psoriasis. The plant is reported to contain presence of flavanoid, glycoflavones-iso-orientin, and phenolic acids. The various chemical constituents isolated from various parts of the plant are reported as 3,4-Seco-lup-20 (29)-en-3-oic acid, lupeol, stigmasterol and campetosterol, Indigotin, indirubin, tryptanthrin, isatin, anthranillate and rutin Triacontanol, Wrightial, cycloartenone, cycloeucalenol, β-amyrin, Alpha-Amyrin, and β-sitosterol, 14α-methylzymosterol. Four uncommon sterols, desmosterol, clerosterol, 24-methylene-25-methylcholesterol, and 24-dehydropollinastanol, were isolated and identified in addition to several more common phytosterols. The Triterpinoids components of the leaves and pods of Wrightia tinctoria also isolated. This article intends to provide an overview of the chemical constituents present in various parts of the plants and their pharmacological actions and pharmacognostical evaluation.
- Leptospirosis diagnosis: competancy of various laboratory tests. [Journal Article]
- J Clin Diagn Res 2014 Jan; 8(1):199-202.
Leptospira can be found in virtually all tropical and temperate areas of the world and is presumed to be the most wide spread zoonoses in the world.Humans contact leptospirosis through mucosal or percutaneous exposure to leptospires in environments contaminated by the urine of chronically infected animal sources. Despite being common, the diagnosis of leptospirosis is often not made unless a patient presents with textbook manifestations of the so called Weil's disease, such as fever plus jaundice, renal failure and pulmonary haemorrhage. Leptospiral infection often has minimal or no clinical manifestations; of the cases in which fever develops, as many as 90% are undifferentiated febrile illnesses. Because of the variety of clinical symptoms seen in the symptomatic cases, leptospirosis at its onset is often misdiagnosed as aseptic meningitis, influenza, hepatic disease or fever (pyrexia) of unknown origin. Moreover, clinicians may fail to recognize that transmission of leptospirosis can occur in the urban setting because it is incorrectly perceived to be a rural disease. Therefore, diagnosis is based on laboratory tests rather than on clinical symptoms alone. In developing countries, laboratory facilities may be inadequate for diagnosis despite a high prevalence of the disease. Of substantial clinical importance, the syndrome of leptospiral pulmonary haemorrhage has emerged in recent years, in diverse places around the world.
- Polymyxin B Protects Against Hepatic Ischemia/Reperfusion Injury in a Rat Model of Obstructive Jaundice. [JOURNAL ARTICLE]
- Inflammation 2014 Mar 5.
This study was conducted in order to investigate the effects of polymyxin B (PMB) against hepatic ischemia/reperfusion (I/R) injury in rats with obstructive jaundice. Thirty-six Wistar rats (eighteen each) with induced hepatic I/R injury by biliary tract ligation and recanalization were assigned to a control group (reperfused with normal saline) and a PMB group (reperfused with PMB). Indicators involving liver function, oxidation resistance, pro-inflammatory state, and anti-apoptosis effect were determined following the instructions. Compared with normal saline, PMB reperfusion resulted in a significant improvement of liver function (increase of glutathione and reduction of aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase), oxidation resistance (decreased malondialdehyde and myeloperoxidase activity), alleviation of pro-inflammatory state (less tumor necrosis factor (TNF)-α, interleukin-1 beta (IL-1β), nuclear factor kappa B (NF-κB) mRNA, and intercellular adhesion molecule (ICAM)-1), and anti-apoptosis effect (more Bcl-2 and less Bax). PMB protects the liver from I/R injury mainly through reducing cellular oncosis and apoptosis and regulating the expression of NF-κB, TNF-α, IL-1β, and ICAM-1.
- [Antenatal corticosteroid therapy and late preterm infant morbidity and mortality.] [JOURNAL ARTICLE]
- An Pediatr (Barc) 2014 Mar 1.
Late preterm infants (34-36weeks gestation) have a morbidity rate significantly higher than those born at term. However, few interventions have been undertaken to reduce this increased morbidity and mortality. Antenatal corticosteroid administration could be an effective preventive measure.The aim of this study was to describe the morbidity associated with late prematurity in our institution, and determine if there are differences between those who received antenatal corticosteroids.A prospective observational study was conducted on late preterm infants born in a tertiary hospital from October 2011 until September 2012. Two groups were formed according to whether or not they had received antenatal steroids. The rates of morbidity and mortality for each of the groups were analysed and compared.There was a total of 4127 live newborns during the study period, of whom 3795 were term and 332 were preterm (the overall prematurity rate was 8.04%). There were 247 late preterm deliveries, representing 6% of live born infants, and 74.4% of all premature infants. Of late preterm infants, 63.2% were admitted to the Neonatal Unit and 29.6% had received antenatal steroids. The incidence of admission to the Neonatal Unit and Neonatal Intensive Care, transient tachypnea, need for respiratory support in the form of continuous positive pressure airway and oxygen therapy, incidence of hypoglycemia, feeding difficulty, and jaundice requiring phototherapy were significantly higher (P<.05) in the late preterm group that did not receive antenatal steroids.Our finding suggests that the administration of antenatal corticosteroids to patients at risk of 34-36weeks delivery could significantly reduce the cost and acute morbidity associated with late preterm birth.
- Signet ring carcinoma of ampulla of vater. [Journal Article]
- Adv Biomed Res 2014.:30.
Signet ring carcinoma is a common type of adenocarcinoma of stomach but its occurrence in ampulla of Vater is extremely rare. There are only a few previous reported cases of signet ring carcinoma of ampulla of Vater. Here we reported a 61-year-old woman with obstructive jaundice. Ultrasonography and computed tomography (CT scan) examination showed intra- and extrahepatic bile duct dilatation. Endoscopic examination with biopsies revealed a small-size mass in ampulla of Vater with diagnosis of signet ring carcinoma. On consequent pancreatoduodenectomy the tumor was diagnosed as T2N0M0, stage IB. Because of the specific site of signet ring carcinoma of ampulla of Vater, the tumor seems to present itself at an early stage of disease. We review in the literature to suggest our idea.
- Primary neuroendocrine carcinoma of breast with liver and bone metastasis detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography. [Journal Article]
- Indian J Nucl Med 2014 Jan; 29(1):32-3.
Cases of primary neuroendocrine carcinoma (NEC) of the breast have been reported, though rare. We report the case of a 45-year-old woman presented with jaundice and evaluated to have liver metastasis from neuroendocrine origin. She underwent whole body positron emission tomography/computed tomography, which showed left breast lesion and bone metastasis. Fine-needle aspiration (FNA) of breast revealed a NEC. A diagnosis of a primary NEC of the breast was rendered with hepatic and bone metastasis. She was treated with peptide receptor radionuclide therapy and is on follow-up.
- Supporting breastfeeding to reduce newborn readmissions for hyperbilirubinemia. [Journal Article]
- Nurs Womens Health 2013 Dec; 17(6):498-507.
Lack of breastfeeding support can result in inadequate feedings at the breast, putting newborns at risk for hyperbilirubinemia, severe jaundice and possible hospital readmission. Nurses can help prevent readmissions for hyperbilirubinemia by becoming educated about the risk factors for hyperbilirubinemia and by implementing preventive measures through improved breastfeeding support.
- Pancreatic involvement in small cell lung cancer. [REVIEW]
- Radiol Oncol 2014 Mar; 48(1):11-19.
Few data are available concerning incidence, clinical picture, and prognosis for pancreatic metastases of small cell lung carcinoma. In this paper we review the related literature available in English language.Although pancreatic metastases are generally asymptomatic, they can rarely produce clinical symptoms or functional abnormalities. The widespread use of multi-detector computerised tomography (CT) in contemporary medical practice has led to an increased detection of pancreatic metastases in oncology patients. Tissue diagnosis is imperative because radiological techniques alone are incapable of differentiating them from primary pancreatic tumours. Pancreatic metastases occur in the relative end stage of small cell lung cancer. The main complications of these lesions, although rare, are acute pancreatitis and obstructive jaundice. Early chemotherapy can provide a survival benefit even in patients with mild acute pancreatitis or extrahepatic biliary obstruction.
- Frequency of Vital Signs Monitoring and its Association with Mortality among Adults with Severe Sepsis Admitted to a General Medical Ward in Uganda. [Journal Article]
- PLoS One 2014; 9(2):e89879.
Optimal vital signs monitoring of patients with severe sepsis in resource-limited settings may improve outcomes. The objective of this study was to determine the frequency of vital signs monitoring of patients with severe sepsis and its association with mortality in a regional referral hospital in Uganda.We reviewed medical records of patients admitted to Mbarara Regional Referral Hospital in Southwestern Uganda with severe sepsis defined by the presence of infection plus ≥2 of the systemic inflammatory response syndrome criteria, and ≥1 organ dysfunction (altered mental state, hypotension, jaundice, or thrombocytopenia). We recorded frequency of vital signs monitoring in addition to socio-demographic, clinical, and outcome data. We analyzed the data using logistic regression.We identified 202 patients with severe sepsis. The median age was 35 years (IQR, 25-47) and 98 (48%) were female. HIV infection and anemia was present in 115 (57%) and 83 (41%) patients respectively. There were 67 (33%) in-hospital deaths. The median monitoring frequency per day was 1.1 (IQR 0.9-1.5) for blood pressure, 1.0 (IQR, 0.8-1.3) for temperature and pulse, and 0.5 (IQR, 0.3-1.0) for respiratory rate. The frequency of vital signs monitoring decreased during the course of hospitalization. Patients who died had a higher frequency of vital signs monitoring (p<0.05). The admission respiratory rate was associated with both frequency of monitoring (coefficient of linear regression 0.6, 95% CI 0.5-0.8, p<0.001) and mortality (AOR 2.5, 95% CI 1.3-5.3, p = 0.01). Other predictors of mortality included severity of illness, HIV infection, and anemia (p<0.05).More research is needed to determine the optimal frequency of vital signs monitoring for severely septic patients in resource-limited settings such as Uganda.
- Safety and Efficacy of FOLFOX Followed by Cetuximab for Metastatic Colorectal Cancer With Severe Liver Dysfunction. [Journal Article]
- J Natl Compr Canc Netw 2014 Feb 1; 12(2):155-60.
Both 5-FU and oxaliplatin have been used as single agents in patients with colorectal cancer and severe liver dysfunction, but the combination of these drugs has not yet been investigated. A 67-year-old man diagnosed with colorectal cancer in 2008 presented in April 2011 to Appalachian Regional Healthcare Cancer Center with obstructive jaundice and weight loss. Imaging studies were compatible with a liver mass and dilatation of the intrahepatic bile ducts. A liver biopsy confirmed metastatic colorectal cancer. Because his total bilirubin level was 23.1 mg/dL, a percutaneous catheter was placed in May 2011. His total bilirubin level decreased to 5.9 mg/dL, but then increased to 9.4 mg/dL in June 2011. He was started on a FOLFOX regimen, with a 50% dose reduction of 5-FU bolus (200 mg/m(2)) and continuous infusion (1200 mg/m(2)) over 46 hours, and a 15% dose reduction of oxaliplatin (75 mg/m(2)) every 2 weeks. He tolerated this regimen very well, with normalization of his bilirubin level, a significant decrease in his tumor markers, and a partial response seen on PET/CT scan. His only significant toxicity was a grade 2 stomatitis. He received 21 cycles of FOLFOX, and was later switched to cetuximab treatment after disease progression. These findings suggest that FOLFOX might be effective in metastatic colon cancer with severe liver dysfunction, with minimal toxicity, and deserves further investigation.