Pioglitazone is a thiazolidinedione that has significant extra-glycemic benefits most promising of which is its anti-atherogenicity. Pioglitazone may be cardioprotective interfering with atherosclerosis at various points such as atherogenesis, plaque inflammation, plaque rupture and hemostatic disturbances (i.e., thrombus/embolism formation), and microangiopathy. The far reaching effects of pioglitazone and its extra-glycemic benefits warrant a better place for it in the plethora of drugs that a diabetic is treated with. A review of literature is presented.

Renal cell carcinoma is the most lethal urologic malignancy. Up to 30% of patients with kidney cancer have metastatic disease and 30% of those treated for local or locally advanced disease progress to metastases. Radical nephrectomy is the standard treatment for the management of nondisseminated kidney cancer, but the role of cytoreductive nephrectomy in patients with metastatic disease is controversial.

Anesthesiologists and intensivists are encountering increasing number of diabetic patients in daily clinical practice. Majority of such patients may require insulin injections for control of hyperglycemia. Advancements in diabetes management have led to usage of newer insulin injections ranging from human insulin and insulin analogs to glucagon-like peptides-1 analogs. The adequacy of glycemic control and successful outcome with such therapeutic interventions depends upon the adoption of correct injection techniques and procedures. Peri-operative and critically ill diabetic patients are highly prone to develop acute complications of diabetes if appropriate therapeutic strategies are not formulated and implemented. As such, the in-depth knowledge and awareness about various injection technique guidelines is essential from the patient care and healthcare provider's perspective in the operative and critical care settings. This description is an abridged version of the Forum for Injection Techniques, India: The first Indian recommendations for best practice in insulin injection technique and their significance in peri-operative period and critically ill patients in intensive care units (ICU). These insulin injection techniques are based on evidence-based recommendations and are meant to improve the management of diabetes by the attending staff and physicians in operative and critical care arenas.

Introduction & Objective: The purpose of this study was to compare different parameters of mandible and to correlate them with age of fetus in lunar months. Thus we can arrive at the age of fetus with reasonable approximation. Materials and Methods: Study consists of fetal hemimandibles both right and left sides. Fetal age ranges from 4 ^th to 7 ^th lunar month. Sixty-four hemimandibles (32 mandibles) were collected from fetuses after their maceration. The measurements were performed Condyle-Coronoid (Co-Cp), Gonion-Coronoid (Go-Cp), Gonion-Gnathion (Go-Gn), Condyle-Gnathion (Co-Gn), Symphyseal height (SH), and Mandibular angle (MA) processes. Data was analyzed with SPSS software program and 't' test was performed. Statistically highly signifi cant positive correlation was found between CR length and Co-Cp, Go-Cp, Go-Gn, Co-Gn, and SH and a negative correlation was found between CR length and MA of both sides. Correlation coefficient of right and left hemimandibles were nearly equal. The regression equation for CR length was estimated by SPSS software program. Results and Conclusion: It is possible to arrive at the CR length of fetus with the help of regression equation. From CR length, we can easily predict the age using these hemimandibles.

Purpose: Pyrazolines and its derivatives are reported to possess a wide spectrum of biological activities. Many class of chemotherapeutic agents containing pyrazoline nucleus are in clinical use. The purpose of this present study was to examine whether the molecular modification might result in detection of new potent anti-tubercular agent. Materials and Methods: A series of 2-pyrazoline compounds (P13-P24) have synthesized by treating N-(substituted aryl)-acrylamide (C13-C24). The starting material was synthesized from substituted P-aminoacetophenone and substituted benzaldehyde. Their structure was confirmed by infrared and ¹ H NMR spectral data. The synthesized compounds were screened for anti-tubercular activity by Microplate Alamar Blue Assay method. Results: Compound P ₁₅ and P ₂₀ have shown excellent anti-tubercular activity; compound P ₁₆ and P ₂₂ have shown significant activity as compared with the standard and rest of them have shown moderate to low anti-tubercular activity. Conclusion: These compounds may result in the potent anti-tubercular entity with molecular modification and manipulations.

Aims and Objectives: To compare the frequency of complications of laparoscopic repair of incisional hernia using fixation of mesh with transabdominal sutures tacks. Materials and Methods: This study was conducted as part of an interventional multicenter trial at the Rehman Medical Institute, Peshawar, Peshawar Institute of Medical Sciences, and Pakistan Institute of Medical Science, Islamabad, from the 1 ^st of November 2008 till 31 ^st October 2011. The frequency of complications was calculated as the measure of comparing two methods of fixation in laparoscopic repair of incisional hernia using the IPOM technique. These patients were admitted via the outpatient department and their demographic data were collected on a pro forma basis. Forty-five patients were alternately placed in either group, and group I comprised patients with a ventral hernia that was fixed using spiral tacks whereas the other group was fixed with transabdominal sutures. A polytetraflouroethylene (Dual ^R ) mesh was applied in all cases. All data were collected onthe individual pro forma of each patient and was loaded on the SPSS ^R version 13.0. Results: The BMI in both groups was similar (P=0.94) The mean hospital stay was higher in the PTFE mesh group but the values were not significant (P=1.22).No perioperative death was observed in either group. One patient (2.2%) from group I was readmitted with varying complaints and was diagnosed as having subacute intestinal obstruction (P>0.05). A higher but insignificant recurrence rate was observed in the polyester group over a one-year period of follow-up. Three patients (6.6%) were diagnosed with recurrences in group I. Instead the PTFE group had a similar recurrence rate recurrence (P=1.00). Conclusion: The rate of recurrence in this study showed no significant difference by either mode of fixation. But statistically significant pain scores and increased operative time to fixation favors the use of tacks that limits to the few inner millimeters of the peritoneum.

Background: The designing of ocular dosage form off ers complicated issues. Numerous protective mechanisms are present in the eye to prevent the absorption of drug candidate from the corneal membrane. The poor bioavailability and therapeutic response exhibited by conventional ophthalmic solutions due to rapid precorneal elimination of the drug may be overcome by the use of in situ gel forming systems, which are instilled as drops into the eye and then undergo a sol-gel transition in the cul-de-sac. In situ forming polymeric formulations drug delivery systems is in sol form before administration in the body, but once administered, undergoes gelation in situ to form a gel. The formulation of gel depends upon factors like temperature modulation, pH changes, presence of ions, and ultraviolet irradiation, from which drug gets released in sustained and controlled manner. Objective: The present investigation deals with formulation and evaluation of Pluronic; based in situ gel of ofloxacin. Material and Method: Pluronic as gelling agent, HPMC as viscosity modifying agent was used. Ofloxacin was used as Active Pharmaceutical Ingredient. Results: In vitro drug release studies indicated that the formulated in situ gel retained the drug better than the conventional dosage forms. The formulations were therapeutically efficacious, sterile, stable, and provided controlled release of the drug over a period of time. Conclusion: The results demonstrate that the developed system is an alternative to conventional ophthalmic drops, patient compliance, industrially-oriented, and economical.

Objective: To compare the impact of polyglactin 910 (1-0) (Vicryl rapide) (VR) and Chromic Catgut (1-0) (CC) sutures on perineal pain in walking, sitting, and lying posture at 24 h, 48 h, and 6 weeks after episiotomy wound repair. Materials and Methods: Patients were divided randomly into two groups: VR group and CC group. Each group consisted of 50 patients. Severity of the pain was assessed by the visual analogue scale and by the requirement of analgesics. Ordinal data were analyzed by Mann-Whitney U-test. Categorical data were analyzed by Chi-square test. Results: Compared to CC, VR produced significantly less pain (P < 0.001) among patients following episiotomy wound repair in walking, sitting, and lying posture at 24 h, 48 h, and 6 weeks postpartum. Conclusion: Perineal repair with VR suture is associated with less pain perception compared to CC suture.

Fracture of the proximal humerus is a common and debilitating injury occurring mainly in elderly females and accounts for 4-5% of all adult fractures. Patients with displaced, unstable proximal humeral fractures may have improved outcomes if managed operatively. Objectives: To study the effect of using Joshi's external stabilizing system (JESS) for the management of fractures of proximal humerus in elderly. Materials and Methods: This prospective study was conducted in a tertiary care hospital in West Bengal on 28 subjects with proximal humerus fractures. As per Neer's classification, 3- and 4-part fractures were included and prepared for JESS fixation. The results of the treatment were evaluated as per Neer's criteria. Patients were followed up for 10 − 12 months. Results: Among 18 females and 10 males, 22 had 3-part fracture and 6 had 4-part fracture. Mean duration of JESS application was 10 weeks. Among patients with 3-part fractures 4 cases had excellent result, 12 had satisfactory result, 4 had unsatisfactory result and treatment failed in 2 cases. With 4-part fractures, 2 cases had unsatisfactory result and 4 cases were failures. Conclusion: JESS is an alternative option for the treatment of proximal humerus fractures, especially in elderly patients with osteoporosis, showing excellent to good results in cases of Neer's type 3-part fracture.

A 10-year-old girl presented with faucial diphtheria, 2 weeks following which she presented with acute flaccid paralysis (AFP). The case was notified to the district polio surveillance officer and was epidemiologically investigated. Outer ring immunization was done and her stool samples were negative for wild polio. The case was thus labelled nonpolio AFP postdiphtheria.

Polycystic kidney disease is a rare developmental anomaly inherited as autosomal dominant or autosomal recessive. It is characterized by cystic dilatation of the collecting ducts frequently associated with hepatic involvement and progression to renal failure. It is included in the differential diagnosis of cystic diseases of the kidney. We report a case of polycystic kidney disease, in 22 weeks fetus incidentally detected on routine antenatal ultrasonography and confirmed by fetal autopsy. This report elucidates the importance of early diagnosis and intervention in cystic kidney diseases.

A middle aged male patient came with multiple swellings over his body which were gradually increasing in number. He was asymptomatic for any other disease and was worried for cosmetic reasons. His examination was unremarkable except xanthelesma on all of his four eyelids and multiple swellings of varying size all over his body. His blood investigations including lipid profile, ECG and X-ray chest were normal. As this patient had xanthelesma it was presumed that the swellings on other parts of his body were a part of the same etiology namely xanthomas. However FNAC of the swellings surprisingly proved it to be lipoma. This case reports an uncommon distribution of lipomas all over the body in the presence of xanthelesma.

Compound fracture dislocations of proximal carpal bones are very rare. We report a 26-year-old male, Defense personnel by profession, who sustained a compound Gustilo Anderson type IIIA transstyloid, transscaphoid, perilunate dislocation. The patient underwent primary proximal row carpectomy and stabilization with uni-planar, uni-lateral external fixator, and K-Wires. On follow-up after a year, the patient had almost negligible range of motion around wrist without any significant discomfort.

Even though lipoma is the most common soft tissue tumor, pure lipoma primary to uterus is very rare. Most reported cases have been of mixed type, consisting of admixture with smooth muscle or fibrous tissue. Preoperative diagnosis is seldom made and usually comes to light only on pathological study. We report a case of a 60 year old woman presenting with lump in abdomen. CT scan report was suggestive of leiomyoma with fatty degeneration. Gross showed fatty tumor in the uterus and microscopy confirmed the diagnosis of pure lipoma of uterus.

Chronic venous leg ulcer represents a major issue for both patients and health-care provider being associated with impaired quality of life. We here report a case of non-healing venous ulcer over gaiter area of right leg. The ulcer presented with unique features of polymicrobial infection of multi-drug resistant species including, methicillin-resistant Staphylococcus aureus, metallo-β lactamase producing Acinetobacter baumanii and Acinetobacter lowffii.