Background:Snake bite envenomation is a major public health concern in developing countries. Acute kidney injury (AKI) is as important cause of mortality in patients with vasculotoxic snake bite.Aims:This study was to evaluate the clinical profile of snake bite patients and to determine the predictors of developing AKI following snake bite.Materials and Methods:Two hundred and eighty-one patients with snake envenomation were included. Eighty-seven patients developed AKI (Group A) and 194 (Group B) did not. History, examination findings and investigations results were recorded and compared between the two groups.Results:In group A, 61 (70.11%) patients were male and in group B, 117 (60.30%) patients were male. Out of 281 patients, 232 had cellulitis, 113 had bleeding tendencies, 87 had oliguria, 76 had neuroparalysis, and 23 had hypotension at presentation. After multivariate analysis, bite to hospital time (P = 0.016), hypotension (P = 0.000), albuminuria (P = 0.000), bleeding time (P = 0.000), prothrombin time (P = 0.000), hemoglobin (P = 0.000) and total bilirubin (P = 0.010) were significant independent predictors of AKI.Conclusions:AKI developed in 30.96% of patients with snake bite, leading to mortality in 39.08% patients. Factors associated with AKI are bite to hospital time, hypotension, albuminuria, prolonged bleeding time, prolonged prothrombin time, low hemoglobin and a high total bilirubin.

Background and Aims:This study was undertaken, to assess the clinical parameters in patients of poisonous snakebite, complications which occurred in them, their outcome and to evaluate various clinical predictors of mortalityMaterials and Methods:Four hundred and thirty-two patients of snake bite were admitted, of which 172 did not show any signs of envenomation and excluded. Two hundred and sixty patients had signs of local or systemic envenomation and included. Complete clinical examination, blood counts, kidney function tests, serum electrolytes, coagulation profile was done in all patients. All received tetanus toxoid and anti-snake venom (ASV). Appropriate supportive treatment was given. Clinical and laboratory parameters were compared between patients who were discharged (Group A) and those who expired (Group B). All data analysis was performed by using stata software version 10 [StataCorp LP, Texas, USA] and SPSS version 11 [SPSS Inc, Chicago, USA].Results:Out of 260 patients, 58 died and 202 survived. Mean age was 34.97 ± 14.07 years. One hundred and eighty-six (71.5%) patients were from rural areas and 74 (28.5%) from urban. 63.4% of bites occurred during rainy season. One hundred and ninety-seven (75.8%) had bite on lower limb and 62 (23.8%) on upper limbs. All 260 patients (100%) had pain at site of bite, local swelling in 252 (96.9%) and blackening of skin, blebs in 18 (6.9%). Seventy-seven (29.6%) had bleeding tendencies. Ptosis was present in all the 65 patients with signs of neuroparalysis. Eighty (30.8%) patients had acute renal failure. The mean duration of stay in survivors was 7.50 + 4.13 days and in non-survivors it was 3.45 + 3.02 days. Out of 58 who died 18 (31%) patients, succumbed within 24 hrs. On multivariate analysis, significant predictors o mortality were bleeding tendency (P = 0.013), mean PTTK (sec) (P = 0.047), respiratory failure (P = 0.045), shock (P = 0.013), mean ASV dose (cc) (P < 0.001).Conclusions:Mortality in patients with snake bite can be predicted by simple variables like presence of bleeding tendencies, respiratory failure, and shock. These parameters can help the doctors at peripheral health centers to predict outcome, so that such high risk cases can be referred to higher centers for expertise management without wasting time.

Objectives: Patients with raised serum prostate-specific antigen and/or an abnormal-feeling prostate were subjected to transrectal ultrasound-guided prostatic biopsy to rule out any prostatic malignancy. There are many methods for pain relief and to treat discomfort during the procedure but we compared the efficacy of intravenous (IV) midazolam for pain control. Patients and Methods: This was a prospective study of 50 patients. All patients underwent a ten quadrant biopsy. The patients were divided into two groups: group 1 (study group) which included 25 patients who used 1 ml of IV midazolam and group 2 (control group) which included 25 patients who did not use IV midazolam. Results: In group 1, of 25 patients only 1 patient had mild pain (VAS 2) during and after the procedure. In group 2, of 25 patients, 15 patients had pain during the procedure. Conclusion: Midazolam is a benzodiazepine derivative with an anxiolytic, sedative, amnestic and hypnotic action. Our study shows that using midazolam is a very simple technique which gives excellent analgesia and no other analgesia was required. No monitoring was needed, there was a very low incidence of complications and it did not require any technical expertise.

Background:The altered expression of histone deacetylase family member 8 (HDAC8) has been found to be linked with various cancers, thereby making its selective inhibition a potential strategy in cancer therapy. Recently, plant secondary metabolites, particularly phenolic compounds, have been shown to possess HDAC inhibitory activity.Objective:In the present work, we have evaluated the potential of cinnamaldehyde (CAL), cinnamic acid (CA), and cinnamyl alcohol (CALC) (bioactives of Cinnamomum) as well as aqueous cinnamon extract (ACE), to inhibit HDAC8 activity in vitro and in silico.Materials and Methods:HDAC8 inhibitory activity of ACE and cinnamon bioactives was determined in vitro using HDAC8 inhibitor screening kit. Trichostatin A (TSA), a well-known anti-cancer agent and HDAC inhibitor, was used as a positive control. In silico studies included molecular descriptor Analysis molecular docking absorption, distribution, metabolism, excretion, and toxicity prediction, density function theory calculation and synthetic accessibility program.Results:Pharmacoinformatics studies implicated that ACE and its Bioactives (CAL, CA, and CALC) exhibited comparable activity with that of TSA. The highest occupied molecular orbitals and lowest unoccupied molecular orbitals along with binding energy of cinnamon bioactives were comparable with that of TSA. Molecular docking results suggested that all the ligands maintained two hydrogen bond interactions within the active site of HDAC8. Finally, the synthetic accessibility values showed that cinnamon bioactives were easy to synthesize compared to TSA.Conclusion:It was evident from both the experimental and computational data that cinnamon bioactives exhibited significant HDAC8 inhibitory activity, thereby suggesting their potential therapeutic implications against cancer.SUMMARY Pharmacoinformatics studies revealed that cinnamon bioactives bound to the active site of HDAC8 enzyme in a way similar to that of TSAThe molecular descriptors of cinnamon compounds successfully correlated with TSA values. The binding interactions and energies were also found to be close to TSASynthetic accessibility values showed that cinnamon bioactives were easy to synthesize compared to TSA. Abbreviations used: ACE: Aqueous Cinnamon Extract; DFT: Density Function Theory; CAL: Cinnamaldehyde; CA: Cinnamic Acid; CALC: Cinnamyl Alcohol; MW: Molecular Weight; ROTBs: Rotatable Bonds; ROF: Lipinski's Rule of Five; TSA: Trichostatin A; PDB: Protein Data Bank; RMSD: Root Mean Square Deviation; HBA: Hydrogen Bond Acceptor; HBD: Hydrogen Bond Donor; ADMET: Absorption, Distribution, Metabolism, Excretion and Toxicity; FO: Frontier Orbital; HOMOs: Highest Occupied Molecular Orbitals; LUMOs: Lowest Unoccupied Molecular Orbitals; BE: Binding Energy.

Purpose: Incorporating 18 F-fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG-PET/CT) for gross tumor volume (GTV) delineation is challenging due to varying tumor edge based on the set threshold of the standardized uptake value (SUV). This study aims to determine an optimal SUV threshold that correlates best with the pathological tumor size. Materials and Methods: From January 2013 to July 2014, 25 consecutive patients of operable nonsmall-cell lung cancer (NSCLC) who underwent staging 18 F-FDG-PET/CT before surgical resection were included in the test cohort and 12 patients in the validation cohort. GTVs were delineated on the staging PET/CT by automatic delineation using various percentage threshold of maximum SUV (SUVmax) and absolute SUV. The maximum pathological tumor diameter was then matched with the maximum auto-delineated tumor diameter with varying SUV thresholds. First-order linear regression and Bland–Altman plots were used to obtain an optimal SUV threshold for each patient. Three radiation oncologists with varying degrees of experiences also delineated GTVs with the visual aid of PET/CT to assess interobserver variation in delineation. Results: In the test set, the mean optimal percentage threshold for GTV was SUVmax of 35.6%±18.6% and absolute SUV of 4.35 ± 1.7. In the validation set, the mean optimal percentage threshold SUV and absolute SUV were 36.9 ± 16.9 and 4.1 ± 1.6, respectively. After a combined analysis of all 37 patients, the mean optimal threshold was 36% ± 17.9% and 4.27 ± 1.7, respectively. Using Bland–Altman plots, auto-contouring with 40% SUVmax and SUV 4 was in greater agreement with the pathological tumor diameter. Conclusion: Automatic GTV delineation on PETCT in NSCLC with percentage threshold SUV of 40% and absolute SUV of 4 correlated best with pathological tumor size. Auto-contouring using these thresholds will increase the precision of radiotherapy contouring of GTV and will save time.