Acute Kidney Injury (AKI) complicating snake envenomation may pass for a "neglected" health condition in regions or parts of the world where its incidence is not as common. Now -a -days snake bite is a quite common in rural areas of India. Hence snake bite is considered as a important health hazard. Snake bite may also cause the mortality and morbidities of a person. Snake bite may produce the toxic effects to the multiple organs and may produce the injury mainly to the kidneys. Mostly snake bite produce the acute kidney injury and also risk for the many complications to the multiple organ dysfunctions and if it was not treated well leads to the mortality. Here we report a case of a person with snake bite which induce the acute kidney injury i,e acute tubular necrosis. He was treated with appropriate therapy according to the symptoms and also treated with haemodialysis without development of adverse effects and with supportive therapy.

Achalasia cardia is a rare chronic neurodegenerative disorder of the oesophagus which causes progressive delay in contractility of lower oesophageal muscles during swallowing leading to regurgitation of food contents and fluids in advanced stages within the region of oesophagus. The underlying aetiology include autoimmune disorder, nervous degeneration due to loss of inhibitory ganglion in myenteric plexus of oesophagus, presence of inhibitory neurotransmitters such as nitric oxide and its receptors in lower oesophagus. Achalasia is characterised by oesophageal nonperistaltic contraction and incomplete relaxation of lower oesophageal sphincter. The common symptoms are dysphagia, regurgitation, and heartburn. Case report discussed below is of a 38 years old female patient presented with dysphagia for two years. The symptoms of which worsened for one month along with vomiting after consumption of food.

Addition of rituximab (375 mg/m2) to CHOP has been shown to improve survival in patients with DLBCL. However there is limited data on the pharmacokinetics (PK) and pharmacodynamics (PD) of this drug in this condition. We have evaluated the PK and PD of a biosimilar rituximab (Reditux®, Dr. Reddy’s Laboratories Ltd, Hyderabad, India) in 17 patients with newly diagnosed DLBCL treated at a single center with R-CHOP as part of a multi-center study undertaken to assess the safety and efficacy of this drug. R-CHOP (rituximab-375mg/m2; cyclophopsphamide-750mg/m2; adriamycin-50mg/m2; vincristine-1.4mg/m2 on day 1 and prednisolone-60mg/m2 on days 1 to 5) was given every 3 weeks for a total of 6 cycles. Blood samples for measurement of rituximab were collected just prior to start of infusion and 10min, 24, 72, 192 and 360 hours post-infusion for all patients during cycle 1 and in 6 patients during cycle 6 also. Additional samples were collected pre- and 10 minutes post-infusion after cycles 2, 3, 4, 5 and 6. Plasma rituximab levels were quantified using an immunoassay (sensitivity: 1ug/ml). B-lymphocyte counts were measured in peripheral blood samples taken from all patients at the beginning of each cycle. All patients were evaluated for clinical and radiological response after the 2nd, 4th and 6th cycles. Patients, mean age: 52 years (range:31–71) had disease in the following stages: stage II: 5, stage III: 7, stage IV: 5. Twelve out of 17 patients achieved complete remission while 5 had partial response (NCI criteria). At a mean follow-up of 5 months (range: 3–8), 3 patients had relapse of the disease. The arithmetic mean ±SD of PK parameters of Rituximab during cycle 1 were as follows: T½(hrs): 167±63; Cmax(ug/ml): 186±49; Cmin(ug/ml): 22.4±12.84; AUC0-∞ (ug.hrs/ml): 28162±11227) and Cl/F (ml/kg/hr): 23.8±10.8. These data are comparable with values previously reported for rituximab in other conditions. Though a 2–7 fold inter-individual variation was noted among these patients, there was no significant difference in these parameters between those in whom the disease relapsed as opposed to those who maintained remission. Among the 6 patients in whom data was available for the 1st and 6th cycles (table), there was significant reduction in Cl/F with associated increase in Cmax and AUC in the 6th cycle as compared to the 1st cycle. In 16 patients for whom the data was available, pre-treatment mean B lymphocyte count which was 121/ul (range:1.5–410.5) dropped to a mean of 9.9/ul (range:0.3–62.3) after the first cycle and remained in that range for the rest of treatment period. These data show that even with a 3-weekly regimen, therapeutic trough levels (25 μg/ml) of rituximab was observed across all cycles. In fact, the changing PK parameters of the drug with progressive cycles of R-CHOP suggest that fixed-dose regimens may not be the optimal way to administer this drug. Parameter Cycle1 (n=6) Cycle 6 (n=6) p value T ½ (hours) 200 386 0.0481 Cmax (μg/ml) 203 279 0.0556 Cmin (360Hr) 24.71 82.16 0.0028 AUC0- ∞ (μg.hrs/ml) 31167 92240 0.0049 Cl/F(ml/kg/hr) 20.5 7.6 0.0030

Cardiovascular diseases and Cerebro-vascular diseases account for majority of the burden of NCDs. Stroke is one the major component of these, posing public health challenges. 1 in 6 people suffer with stroke in their life time. The impact of stroke can be short or long term, depending on which part of the brain is affected and how quick it is treated. This hospital based case                       study was undertaken with aim to study the prescribing pattern and the functional outcomes in cerebral stroke. Study was carried out in the Santhiram Medical hospital, Nandyal, Andhra Pradesh, India. Methodology: Patients visiting the neurology clinic were asked to answer the questionnaire covering functional outcomes by using functional assesment scales to determine the clinical status of the patient; Most of the patient’s data were collected from case sheets. A total of 150 patients were included in the observational study. Data from case sheets were analysed to assess the prescribing pattern and the questionnaires like mRS, SSQOLS, MMSE scales were used to interview the stroke patients to assess the functional outcomes. Results: Our study presents that there is a minimal Modified Rankin Scale (MRS) score progress in patients. MRS, SSQOL, MMSE scales, which showed improvement in the quality of life and cognition in stroke patients after treatment. Conclusion: In conclusion, that significant functional gains in rehabilitation process of                         stroke can be attained by combination therapy, lifestyle changes, and better management of risk factors said to possess the major effect on recovery of stroke with improved quality of life and symptoms.