Trigeminal neuralgia: updated management

The so-called idiopathic trigeminal neuralgia is easily diagnosed by the clinical history of the patient and present a constant cause, a neurovascular conflict in the cerebellopontine angle in the majority of cases, which is clearly identified by MRI assessment. Knowing the cause, after a trial period with a medical treatment, a curative surgical solution can be now offered to the patient when the medications do not provide a pain-free result or when the patients wish a more definitive solution. Combining the use of both operating microscope and endoscope increases the efficiency of the neurovascular decompression and decreases drastically the potential morbidity of the surgical procedure. From 355 patients suffering of trigeminal neuralgia who underwent endoscope-assisted retrosigmoid approach, the authors present their experiences and results

FORMULATION DEVELOPMENT AND EVALUATION OF TEMOZOLOMIDE LOADED HYDROGENATED SOYA PHOSPHATIDYLCHOLINE LIPOSOMES FOR THE TREATMENT OF BRAIN CANCER

Objective: The objective of this study was to encapsulate temozolomide (TMZ) in the liposomal formulation for the treatment of glioblastoma. TMZis one of the most effective substances in vitro against cells derived from glioblastoma. However, it may not have a significant effect in vivo due topoor penetration in brain which may be attributed to the blood-brain-barrier. The main objective of this investigation is to develop a liposomal drugdelivery system which could improve the brain targeting, and solve the treatment-related problems.Methods: In this study, TMZ loaded liposomes were prepared by ethanol injection method. The characterization of formulated liposomes was carriedout by vesicle size, entrapment efficiency, surface morphology, and in vitro drug release study. The prepared liposomes were also evaluated for celluptake and cell cytotoxicity studies.Results: Particle size and entrapment efficiency were found to be 105.7±3.9 nm and 78.25±0.98%, respectively. 75% of the entrapped drug wasreleased in 24 hrs from the selected liposomal formulation. Cell uptake study reveals that hydrogenated soya phosphatidylcholine (HSPC) loaded TMZliposomes interact with the glioblastoma cells and kill the cancer cells effectively. Cytotoxicity assay confirms that drug loaded HSPC liposomes aremore efficient with respect to killing of glioblastoma cells as compared to plain drug.Conclusion: These results suggest that the TMZ loaded HSPC liposome may serve as a proficient targeted drug delivery system for the effectivemanagement of glioblastoma.Keywords: Temozolomide, Liposomes, Hydrogenated soya phosphatidylcholine, Cholesterol, Glioblastoma

A series of clinical cases highlighting cardiotoxicity induced by polymyxin B

Polymyxins, particularly polymyxin B, have resurfaced as critical agents against Multidrug-Resistant Organisms (MDROs) despite their historical withdrawal from clinical use due to significant nephrotoxicity and neurotoxicity. This resurgence is largely driven by the increasing prevalence of infections caused by Carbapenem-Resistant Enterobacterales (CRE) and Carbapenem-Resistant Acinetobacter Baumannii (CRAB). In this report, three clinical cases highlighting the association between polymyxin B administration and severe cardiac events, including ventricular tachycardia and cardiac arrest in patients with multiple co morbidities. The cardio toxic effects of polymyxins are attributed to their impact on cardiac myocyte ionic channels, particularly potassium channels, leading to arrhythmias and potential cardiovascular collapse. Given the rising use of polymyxins amidst escalating resistance patterns, it is imperative for clinicians to recognize and monitor for cardio toxicity, ensuring prompt intervention to mitigate risks associated with this potent antibiotic.

Modified intact canal wall mastoidectomy — long term results in hearing and healing

INTRODUCTION: The classic intact canal wall (ICW) mastoidectomy with tympanoplasty (combined approach tympanoplasty) [1, 2] has anatomic constraints for clearance of disease from the anterior attic and sinus tympani leading to high recidivism. Farrior [3, 4] described the modification of this technique and senior author (AM) has been using it with further modifications since 1973. MATERIALS AND METHODS: We report our long-term experience in hearing and healing in 126 cases with special reference to the age (pediatric versus adults), ossicle status (presence or absence of stapes suprastructure) and type of cholesteatoma (Attic versus posterior-superior versus secondary acquired cholesteatoma). RESULTS: All the patients had unsafe CSOM and underwent Modified ICW mastoidectomy with primary ossiculoplasty except five where the procedure was staged. CONCLUSION: Modified ICW technique is a one-stage procedure with the lowest recidivism rate when compared to various other ICW techniques. There is no significant difference in relation to age of the patient or type of cholesteatoma if the operative cases are selected judicially

Assessment Of Cardiovascular Disease Risk by Using Framingham Risk Equation Amongst the Residents of Ahmedabad City

Introduction: Coronary heart disease (CHD) risk estimation tools are a simple means of identifying those at high risk in a community and hence a potentially cost-effective strategy for CHD prevention in resource-poor countries. Aim: To estimate 10 years risk for hard CHD among the urban population by using Framingham Heart Study produced sex-specific coronary heart disease (CHD) prediction functions and to find out correlates of CHD risk in study population. Methodology: Present community based descriptive study was carried out in 1133 residents of south zone of Ahmedabad Municipal Corporation, Gujarat state (India), age 20 years or more without any previous history of CVD. Framingham Heart Study produced simple model with office based non laboratory predictors was used to assess for estimating 10 years risk of developing hard coronary heart disease . Results: The median 10-year probability of CHD was 2.9% (5.6% for men and 1.8% for women). One third (33.4%) population above 30 years had CVD risk 20% or more. Males had significantly higher CVD risk as compared to females (20% of males & 4.5% of female had high CVD risk). Cardiovascular disease risk was also person with inadequate sleep & in executives. Conclusion- Higher risk in males & unskilled worker was mainly due to tobacco addiction while in executives it was mainly due to diabetes & obesity