Background:Hyponatremia is one of the most common electrolyte abnormalities encountered in clinical practice and has a significant impact on morbidity and mortality in hospitalized patients. The optimal management of hyponatremia is still evolving. Over the last decade, vaptans have been increasingly used in clinical practice with promising results.Materials and Methods:The study included eighty patients with symptomatic hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH) admitted and treated in Intensive Care Unit (ICU) with either conivaptan or hypertonic (3%) saline. They were compared for time taken to achieve normal serum sodium, length of ICU and hospital stay, and adverse effects.Results:The demographic data and serum sodium levels at admission were comparable between the two groups. After initiating correction, sodium levels at 6, 12, and 24 h were similar between the two groups. However, at 48 h, patients in the conivaptan group (Group C) had higher sodium levels (133.0 ± 3.8 mEq/L) as compared to hypertonic saline group (Group HS) (128.9 ± 2.6 mEq/L), which was statistically significant (P < 0.001). The length of ICU stay was less in the Group C (3.35 ± 0.89 days) when compared with the Group HS (4.61 ± 0.91 days) (P < 0.001). There was no significant difference in mortality between the two groups.Conclusion:In patients with symptomatic hyponatremia due to SIADH, conivaptan with its aquaresis property can achieve a significantly better sodium correction, resulting in reduced ICU and hospital stay with no significant adverse effects.

To determine the role of grated papaya fruit dressings in the management of diabetic foot ulcers. STUDY DESIGN: In our study, all the patients with diabetic foot ulcers (n=94) were included. The initial management was control of hyperglycemia, surgical debridement, antibiotics and then wound care with the help of grated papaya dressings. In this study, dressings were changed every 24 hours. The wound was considered healthy, when it was covered with healthy granulation tissue and had epithelial growth on wound edges. RESULTS: In this study, results reveal that majority (83.0%) of the patients were male. Among them, surgical debridement was done for sixty three patients (67.2%) and thirty one patients (33.8%) required amputation. After the initial surgical debridement papaya dressings were needed in about 89.0%. Six patients (7%) needed further surgical debridement and four (4.0%) required amputations. Duration of healing was 17 to 28 days. Mean healing period was 21.56 days. CONCLUSION: Topical grated papaya dressings provide good enzymatic wound debridement. It is cost effective, reduces the duration of healing time, number of surgical debridements required and reduces the incidence of amputation.

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Foreign bodies in the bladder and ensuing calculus formation around it is an unusual cause for intravesical stone formation. Iatrogenic cause due to intrauterine device (popular and safe method of contraception due to its high efficacy, low risk and low-cost) migration to adjacent organs is a rare one with only a few reports in the medical literature. Treatment of foreign bodies is determined by their size, location, shape, and mobility. In most cases, minimally invasive procedures such as endoscopic removal are recommended. We report a case of a 39 year old female who presented with chronic urinary symptoms USG, X-ray and CT scan showed the presence of IUCD with calculus. Cystoscopic examination confirmed the diagnosis and allowed removal of the intrauterine contraceptive device and calculus.

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