Journal of Chemical Health Risks (Islamic Azad University, Iran)
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To Study Forced Degradation Behavior of Tivozanib Hcl Under Forced Degradation Conditions¬_- A Comprehensive Liquid Chromatography-Mass Spectroscopy and In-Silico Study
No full textIntroduction
Tivozanib hydrochloride (Tivozanib HCl) is a selective VEGF receptor tyrosine kinase inhibitor used in the management of renal cell carcinoma. Forced degradation studies are essential to understand its stability profile, identify degradation products, and ensure drug safety and regulatory compliance. Integration of analytical and in silico approaches provides additional insight into the biological relevance and toxicological risk of degradation products.
Objectives
The study aimed to investigate the forced degradation behavior of Tivozanib HCl, develop and validate a stability-indicating RP-HPLC method, identify degradation products using LC-MS, and evaluate their therapeutic and toxicological profiles through in silico tools.
Methodology
Tivozanib HCl was subjected to oxidative, thermal, photolytic, acidic, alkaline, and hydrolytic stress conditions. Chromatographic separation was achieved using an ODS C-18 column with Methanol:Water (75:25 % v/v) as the mobile phase. The RP-HPLC method was validated as per ICH Q2 (R1) guidelines. Degradation products formed under alkaline stress were characterized by LC-MS. Molecular docking studies were conducted using AutoDock with VEGF receptor tyrosine kinase (PDB ID: 3VHE). Toxicity and biological activity predictions were performed using Toxtree and PASS software.
Results
Significant degradation of Tivozanib HCl was observed only under alkaline conditions. The validated RP-HPLC method effectively separated the drug from its degradation products and showed linearity in the 80%–120% concentration range. Two previously unreported degradation products were identified by LC-MS. Docking studies indicated moderate VEGF inhibitory potential of these products, while toxicity predictions suggested possible safety concerns.
Conclusion
This study established a validated stability-indicating RP-HPLC method and revealed the alkaline sensitivity of Tivozanib HCl. The identification and in silico evaluation of novel degradation products provide valuable insights for drug development, quality control, and regulatory assessment
Implementation of Thermoregulation Bundle to Improve Admission Temperature in Preterm Infants: A Quality Improvement Study
No full textBackground: Admission hypothermia remains a frequent and preventable complication among preterm neonates and is independently associated with increased mortality and morbidity. Despite established recommendations for thermal care at birth, implementation gaps persist, particularly in routine clinical settings. Quality improvement (QI) approaches offer a pragmatic framework to translate evidence into sustained practice change. This study aimed to reduce the incidence of admission hypothermia in preterm neonates (≤36 weeks’ gestation) by at least 50% through implementation of a comprehensive thermoregulation bundle using Plan–Do–Study–Act (PDSA) methodology.
Methods: We conducted a prospective QI study over six months (April–September 2019) at a tertiary care teaching hospital. All inborn preterm neonates (24–36 weeks’ gestation) were included. Using the World Health Organization Point-of-Care QI model, a multidisciplinary team implemented a thermoregulation bundle comprising delivery room temperature standardization (25–26°C), pre-warmed towels during delayed cord clamping, polyethylene occlusive wraps, woolen caps, transport incubators, and structured staff education. The primary outcome was NICU admission temperature. Secondary outcomes included delivery room ambient temperature and infant temperature at the time of transport. Outcomes were assessed across pre-implementation, implementation, and post-implementation phases.
Results: Fifty-four preterm neonates were evaluated. Mean delivery room temperature increased from 19.00 ± 3.10°C to 24.00 ± 1.10°C (p < 0.001). Infant temperature at transport improved from 35.22 ± 0.50°C to 36.50 ± 0.10°C (p < 0.001). Mean NICU admission temperature increased from 35.65 ± 0.55°C to 36.87 ± 0.47°C (p = 0.002). The prevalence of admission hypothermia decreased from 88% at baseline to 15% post-implementation, representing an 83% relative reduction.
Conclusion: A bundled thermoregulation strategy implemented through PDSA-based quality improvement substantially improved thermal stability and reduced admission hypothermia among preterm neonates. These findings support routine adoption of structured thermoregulation bundles as a scalable, low-cost intervention in neonatal care settings
Clinicopathologic Case Series Of Thyroglossal Cyst In A Tertiary Care Center
No full textBackground:Thyroglossal duct cysts (TGDCs) are the most common congenital midline neck lesions resulting from persistent remnants of the thyroglossal duct. Although typically presenting in childhood, TGDCs may manifest at any age with varied clinical and radiological features, occasionally posing diagnostic challenges.
Aim:To analyze the clinicopathological characteristics, anatomical distribution, and radiological features of histopathologically confirmed TGDCs in a tertiary care center.
Materials and Methods:
A retrospective observational study was conducted in the Department of Pathology at Sri Ramachandra Medical College and Research Institute from January 2016 to September 2025. A total of 65 formalin-fixed paraffin-embedded tissue blocks of surgically resected TGDCs were reviewed. Clinical details, including age, sex, site, and radiological findings, were retrieved from the laboratory information system. Hematoxylin and eosin–stained sections were examined, and results were correlated with clinicopathological parameters.
Results:Among the 65 patients evaluated, males constituted the majority at 74%, while females accounted for 26%, reflecting a clear male predominance, with ages ranging from 2 to 50 years (mean: 17.3 years; median: 12.5 years). The infrahyoid region was the most common site (90.8%), followed by suprahyoid and intralingual locations (4.6% each). Classical clinical presentation of a midline neck swelling moving with deglutition and tongue protrusion occurred in 72.3% of patients. Ultrasonography was performed in 86.2% of cases and demonstrated typical anechoic cystic lesions, while CT and MRI were utilized in 18.5% of cases each, aiding in the identification of atypical features and tract delineation. In this study of 65 cases, respiratory epithelium alone was seen in 7.69%, squamous epithelium in 1.54%, and a combination of both in 10.77%. Inflammation was present in 18.46%, mucoserous glands in 3.08%, and hyoid bone involvement in 20.00%. Thyroid tissue was identified in 15.38% of specimens. Cyst wall alone was noted in 7.69%, with skeletal muscle or adipose tissue components each occurring in 1.54%. Skeletal muscle alone was found in 3.08%, adipose tissue alone in 1.54%, and no case showed a combination of both. Papillary thyroid carcinoma was detected in 7.69% of cases.
Conclusion:Thyroglossal duct cysts are predominantly benign congenital neck lesions that commonly present in the infrahyoid region during childhood and adolescence. Ultrasonography remains the primary diagnostic tool, with CT and MRI aiding in atypical cases. Histopathologic evaluation confirms their embryologic origin and low malignant potential. Accurate clinicopathological correlation ensures appropriate surgical management and minimizes recurrence. 
Assessment of Faunal Diversity in the College Campus of S. T. Hindu College, Nagercoil, Tamil Nadu, India
No full textIntroduction: Biodiversity assessment in semi-urban educational campuses is essential for understanding local ecological health, species richness, and the conservation value of managed green spaces.
Objectives: The present study aimed to document the faunal diversity of a College Campus in Tamil Nadu using the Visual Encounter Survey (VES) method from September 2024 to December 2024.
Results: A total of 62 species belonging to three phyla—Arthropoda, Mollusca, and Chordata—across six classes and multiple orders were recorded, with Arthropoda being the most dominant phylum (58 species). Insecta exhibited the highest species richness (54 species), followed by Arachnida (3 species), Gastropoda (1 species), Aves (2 species), and Reptilia (2 species). These findings underscore the ecological significance of semi-urban green spaces and highlight the need for conservation strategies such as habitat enrichment, pollution control, and biodiversity awareness initiatives.
Conclusion: The study provides baseline data that can support long-term ecological monitoring and conservation planning
Pharmacological Mechanisms of Sungkai Leaf Extract as an Immunostimulant in Enhancing the Body\u27s Defense System
No full textIntroduction: The increasing demand for natural immunostimulants has led to the exploration of plant-derived bioactive compounds with potential immunomodulatory effects. Peronema canescens Jack, commonly known as sungkai, has been traditionally used in various ethnopharmacological applications, including immune system enhancement. However, its pharmacological mechanisms as an immunostimulant remain inadequately explored.
Objective: This study aims to systematically analyze the pharmacological mechanisms of sungkai leaf extract in modulating the immune response, with a focus on its bioactive constituents, signaling pathways, and potential therapeutic applications.
Methods: A comprehensive literature review was conducted using data from indexed scientific databases, including Scopus, PubMed, and ScienceDirect. Studies related to the phytochemical composition, pharmacological activities, and molecular mechanisms of sungkai leaf extract in immune modulation were critically analyzed.
Results: Sungkai leaf extract contains a diverse range of bioactive compounds, including flavonoids, alkaloids, terpenoids, and polyphenols, which contribute to its immunostimulatory properties. These compounds have been reported to enhance macrophage activation, cytokine production (IL-2, IFN-γ), and lymphocyte proliferation through key signaling pathways, such as NF-κB, MAPK, and JAK-STAT. Furthermore, in vivo and in vitro studies suggest that sungkai leaf extract can stimulate humoral and cellular immune responses, promoting pathogen clearance and reducing susceptibility to infections.
Conclusion: The immunostimulant potential of sungkai leaf extract is attributed to its ability to modulate key immune pathways and enhance immune cell activation. Future research should focus on clinical validation, dosage optimization, and safety profiling to establish its therapeutic applications in immunomodulatory treatments
Comparative Study of Port-Site Pain After Gallbladder Extraction via Epigastric vs Umbilical Port
No full textBackground: Laparoscopic cholecystectomy (LC) is the gold-standard treatment for symptomatic gallstones[1]. However, port-site pain remains a common morbidity that can prolong recovery. Gallbladder specimens are usually removed through either the umbilical or epigastric (subxiphoid) trocar site, but evidence on which site causes less postoperative pain is mixed[4][5]. We conducted a comparative observational study to determine whether retrieval via the epigastric port results in less postoperative port-site pain than the umbilical port.
Materials and Methods: Eighty adult patients undergoing elective four-port LC were allocated to two groups (n=40 each) based on the port used for gallbladder extraction. Group U (umbilical port) and Group E (epigastric port) were comparable in demographics (mean age ~52.7±11.8 years, ~62% female) and comorbidities. All patients received standard perioperative care and postoperative analgesia (intravenous paracetamol). Pain at the extraction site was assessed by Visual Analog Scale (VAS, 0–10) immediately post-op and at 1, 6, 12, 24 hours, and on discharge. Operative variables (surgery duration, specimen retrieval time, need for port incision enlargement) and complications were recorded. Data were analyzed by t-tests and χ²; p<0.05 was considered significant.
Results: Baseline characteristics (age, gender, BMI, ASA, comorbidity profile) did not differ significantly between groups. The mean operative time was significantly longer in Group U (78.3±16.2 min) than Group E (66.6±16.7 min, p=0.011). Likewise, mean gallbladder retrieval time was longer via the umbilical port (19.8±6.9 sec) than via the epigastric port (14.9±1.7 sec, p<0.001). Enlarging the fascial incision was required more often for umbilical extraction (8 of 40 patients, 20%) than epigastric (1 of 40, 2.5%; p=0.001). Surgical site infection (SSI) rates were low and similar (umbilical 3/40 vs epigastric 1/40; p=0.18).
Port-site pain scores were markedly lower in the epigastric group after the immediate postoperative period. Figure 1 shows that both groups had very high pain immediately post-op (mean VAS≈9.5), but at 1 h and thereafter, Group E consistently reported lower VAS scores than Group U. At 1 h (7.05±0.41 vs 7.73±0.69), 6 h (5.96±0.61 vs 6.74±0.69), 12 h (7.05±0.41 vs 7.53±0.68), 24 h (6.05±0.64 vs 6.53±0.68), and on discharge (3.27±1.21 vs 4.35±1.21), the differences were highly significant (p<0.001 for each time point). The immediate postoperative VAS did not differ significantly (9.32 vs 9.50, p=0.19). In summary, epigastric retrieval was associated with significantly lower postoperative pain scores than umbilical retrieval at all measured intervals after the immediate post-op period. (Tables 1–3 summarize demographics, intraoperative details, and pain outcomes; Figures 2–3 illustrate retrieval/surgery times and complication rates.)
Conclusion: In this study, retrieving the gallbladder via the epigastric port significantly reduced port-site pain and shortened operative time compared to umbilical extraction. No difference was found in infection rates. These findings suggest the epigastric site may be preferable for specimen extraction to minimize pain. However, the literature is mixed: some studies and meta-analyses have found no difference or even favor umbilical retrieval for pain[4][5]. Further randomized trials are warranted
Association between Helicobacter Pylori Infection and Glycosylated Hemoglobin Levels in Dyspeptic Patients
No full textBackground: Helicobacter pylori (H. pylori) infects roughly half of the world’s population[3]. Concurrently, the global burden of type 2 diabetes mellitus (T2DM) is rising, with over 529 million adults affected in 2021. Some studies suggest a link between chronic H. pylori infection and impaired glycemic control[1], but findings are inconsistent. This study evaluated whether H. pylori infection is associated with elevated glycated hemoglobin (HbA1c) levels in dyspeptic patients.
Materials and Methods: We conducted a hospital-based cross-sectional study at A.J. Institute of Medical Sciences (Mangalore) from August 2022 to February 2024. Forty-six adult patients (age ≥18 years) with dyspeptic symptoms undergoing elective gastroscopy were enrolled. Patients previously treated for H. pylori, on recent antibiotics or proton-pump inhibitors, with active GI bleeding or malignancy, or unwilling to consent were excluded. During endoscopy, gastric biopsies were taken for a rapid urease test (RUT) to detect H. pylori. Glycemic status was assessed by measuring HbA1c in all subjects. Patient data (age, sex, BMI, endoscopic findings) were recorded. Descriptive statistics summarized the data (mean ± SD for continuous variables, proportions for categorical data). The association between H. pylori status and glycemic control (HbA1c <6.5% vs ≥6.5%) was tested by chi-square analysis. A two-sided p<0.05 was considered significant.
Results: Of 46 participants (mean age 58.7±16.5 years; 63.0% male), 21.7% had pangastritis, 26.1% fundal gastritis, and 52.2% antral gastritis on endoscopy. Mean body mass index (BMI) was 23.7±2.4 kg/m²; 73.9% had BMI in the normal range (18.5–25 kg/m²), 26.1% were overweight (>25 kg/m²). Mean HbA1c was 7.32±1.27%; notably, 76.1% of subjects had HbA1c ≥6.5%. Rapid urease testing was positive for H. pylori in 24/46 (52.2%) patients. Importantly, H. pylori infection was significantly more frequent in patients with HbA1c ≥6.5%: 23 of 35 (65.7%) high-HbA1c patients were H. pylori-positive, versus only 1 of 11 (9.1%) with HbA1c <6.5% (χ²=10.8, p=0.001). In other words, a high HbA1c level was associated with a higher prevalence of H. pylori infection in this cohort.
Conclusion: In this dyspeptic adult population, H. pylori infection was common and was strongly associated with poor glycemic control. Patients with elevated HbA1c (>6.5%) had a significantly higher rate of H. pylori positivity. These findings support a possible bidirectional relationship, as suggested by recent studies[1][2]. Clinicians should be aware that elevated HbA1c may predispose to H. pylori infection (and vice versa), highlighting the importance of screening for and eradicating H. pylori in patients with diabetes or prediabetes
“Impact of Maternal Food Safety and Hygiene Practices on Child Nutrition in Urban Slums of Sambalpur"
No full textBackground:- Food safety knowledge involves understanding and applying practices that prevent food borne illnesses, ensuring food remains safe for consumption. This includes proper handling, preparation, storage, and sanitation to avoid contamination by harmful pathogens, chemicals, and physical hazards.
Mother’s nutritional knowledge plays a crucial role in safeguarding children from factors that contribute to low weight-for-height z-score (WHZ), low weight-for-age z-score (WAZ) and low height-for-age z-score (HAZ). This study seeks to examine the relation between maternal food safety knowledge, practices and their influence on the nutritional status of children aged 6 months to 5 years.
Methods:- A descriptive cross-sectional study was conducted among 550 purposively selected mothers of children aged 6 months to 5 years in urban slums of Sambalpur. Data on cooking practices, nutrition knowledge, hygiene and sanitation were collected using structured tools, and children\u27s nutritional status was assessed through anthropometry. Statistical analysis was done using SPSS v23, applying descriptive statistics, Chi-square tests, Pearson correlation, and multinomial regression (p ≤ 0.05).
Results:- Although variations in mothers\u27 food safety knowledge were observed across different categories of children\u27s nutritional status (wasting, stunting, underweight, and CIAF), these differences were not statistically significant (p > 0.05). Most mothers, regardless of their child\u27s nutritional status, had poor to fair food safety knowledge. Correlation analysis showed a weak but significant positive relationship between mothers\u27 food safety knowledge and child wasting (r = .094, p = .028), while no significant correlation was found with stunting. Strong correlations were observed among child nutritional indicators, particularly between wasting and underweight (r = .571), and between stunting and CIAF (r = .690), all significant at p < .001. Multivariate analysis identified family structure and cooking practices as significant factors associated with stunting; children from nuclear families and those with better maternal cooking practices had lower odds of stunting. Other factors, including gender, family size, religion, caste, socioeconomic status, food safety knowledge, and hygiene conditions, showed no statistically significant associations.
Conclusion:- Mothers’ food safety knowledge varied across child nutritional categories but showed no significant association, except for a weak positive correlation with wasting. Stunting was significantly associated with family structure and cooking practices, whiles other demographic, socioeconomic, and hygiene factors showed no significant impact
Cut-Off Serology Anti-CMV Values for Acquired Cytomegalovirus Infection Detection in Children
No full textCases of Cytomegalovirus (CMV) infection among Indonesian children are increasing, with symptoms ranging from mild to severe. Diagnosis remains challenging since PCR, the gold standard, is costly and not regularly performed. Therefore, establishing an alternative serological test by determining the optimal cut-off value of IgM, IgG, or combined IgM-IgG is essential. This study aimed to determine the cut-off value of anti-CMV serology (IgM, IgG, or both) compared with RT-PCR of CMV DNA in patients suspected of CMV infection. A diagnostic test study was conducted on 63 children aged 3 months to 18 years who were suspected of having CMV infection based on anti-CMV serology results at Dr. Wahidin Sudirohusodo General Hospital, Makassar. Serological testing was performed using the Chemiluminescent Microparticle Immunoassay (CMIA) method and compared with RT-PCR of CMV DNA. Forty children (63.5%) were PCR-positive. The IgM cut-off of ≥ 1.105 index yielded 37.5% sensitivity and 95.65% specificity, while the IgG cut-off of ≥ 167.7 AU/ml produced 65% sensitivity and 69.57% specificity. Combined IgM–IgG results achieved 53.85% sensitivity and 93.75% specificity, all significantly correlated with PCR (p<0.05) but with weak diagnostic strength. The results suggest that IgM or IgG serology can be used as a confirmatory test in facilities lacking PCR capability; However, PCR remains the gold standard diagnostic metho
Digital Impressions in Prosthodontics: Contemporary Concepts, Technologies, and Clinical Methodologies: A Narrative Review
No full textDigital impression technology has revolutionized prosthodontic practice by providing a reliable and efficient alternative to conventional impression techniques. Through accurate three-dimensional recording of intraoral structures, digital impressions have facilitated seamless integration with computer-aided design and computer-aided manufacturing (CAD/CAM) systems, thereby enhancing diagnostic accuracy, treatment planning, and prosthesis fabrication. This narrative review explores the fundamental concepts, technological principles, clinical workflows, scanner systems, accuracy, advantages, limitations, and future prospects of digital impression techniques in prosthodontics, with an emphasis on their expanding clinical relevance