Ajai Kumar Singh

Primary spinal epidural lymphomas

An epidural location for lymphoma is observed in 0.1–6.5% of all the lymphomas. Primary spinal epidural lymphoma (PSEL) is a subset of lymphomas, where there are no other recognizable sites of lymphomas at the time of diagnosis. The incidence of this subset of lymphomas is much less. It, however, is increasingly diagnosed, due to the increased use of more sensitive imaging modalities. For the electronic search, Pubmed was used to identify journals that enlisted and enumerated PSEL from 1961 to January 2011. The following combination of terms: “primary,” “spinal,” “epidural,” and “lymphoma” were used. The most significant articles and their bibliographies were analyzed by the authors. The symptoms, pathogenesis, diagnostic workup, histopathology, treatment, and outcome have been analyzed in a systematic manner

Hyperprolactinemia: An often missed cause of male infertility.

1. Tu HY, Zini A. Finasteride-induced secondary infertility associated with sperm DNA damage. Fertil Steril 2011;95:2125.e13-4. 2. Liu KE, Binsaleh S, Lo KC, Jarvi K. Propecia-induced spermatogenic failure: A report of two cases. Fertil Steril 2008;90:849.e17-9. 3. Chiba K, Yamaguchi K, Li F, Ando M, Fujisawa M. Finasteride-associated male infertility. Fertil Steril 2011;95:1786.e9-11. 4. Amory JK, Wang C, Swerdloff RS, Anawalt BD, Matsumoto AM, Bremner WJ, et al. The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men. J Clin Endocrinol Metab 2007;92: 1659-65. 5. Parivar K, Yaghmaei P, Sekhavati S. The role and effect of finasteride on the spermatogenesis, prostate gland and epididym of mature NMRI mouse in in vivo and in vitro conditions. Med Sci J Islam Azad Univ 2008;179:2333-8. 6. Laborde E, Brannigan RE. Effect of 1-mg dose of finasteride on spermatogenesis and pregnancy. J Androl 2010;31: e1-2. 7. Overstreet JW, Fuh VL, Gould J, Howards SS, Lieber MM, Hellstrom W, et al. Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. J Urol 1999;162:1295-300.

Association of psychiatric co-morbidity and efficacy of treatment in chronic daily headache in Indian population

Objective: To study the prevalence of psychiatric co-morbidity in patients of chronic daily headache (CDH) and compare the efficacy of treatment between various type of headache associated with psychiatric co-morbidity. Materials and Methods: Prospective case control cohort study, 92 consecutive patients of CDH meeting eligibility criteria. The diagnosis of various subtypes of CDH was made according to the IHS criteria. Age, sex, educational, marital and socioeconomic status, matched controls were also selected. Patients were evaluated with the Mini International Neuropsychiatric Interview (MINI) scale at the time of enrolment and at 3 months. Results: CDH accounted for 28% of all headache patients. The mean age of presentation was 30.2 ± 10.3 years, male: Female ratio of 28:64 and mean duration of 4.56 ± 0.56 years. Chronic migraine (CM) accounted for 59 patients, chronic tension type headache (CTTH) 22 patients, new daily persistent headache (NDPH) 3 patients and miscellaneous 8 patients. Psychiatric co-morbidity was present in 53.3% patients with CDH, and was more common in CM (62.7%) as compared to CTTH (36.4%). Single psychiatric co-morbidity was seen in 26 patients, while 23 patients had multiple co-morbidity. Major depressive episode, anxiety disorder, agoraphobia and dysthymia were significant psychiatric co-morbidities. Patients with CM were treated with topiramate or divalproex sodium ER and CTTH were treated with amitriptyline. 55 patients came for follow up at 3 months, improvement in headache was seen in 29 patients. Conclusion: Psychiatric co-morbidity was present in more than 50% patients with CDH and its presence along with a duration of ≥2 years was associated with a poor response to treatment.

Fingolimod: The first oral drug approved by food and drug administration; A breakthrough in treatment of multiple sclerosis

Sir, In continuation of our effort to deeply understand the reactions of triazinone, we carried out the optimization of sodium acetate, which is utilized as a catalyst in the reaction mechanism.[1] We carry forward the synthesis of triazinone, which begins with 4-(4-bromobenzylidene)-2-phenyloxazol-5(4H)-one and acid hydrazide. During reaction monitoring, a light spot started appearing on the thin layer chromatography (TLC) after 4 h of the commencement of the reaction, which eventually deepened after 12 h. On cooling, this reaction mixture produced white colored crystals, which were earlier presumed to be triazinone. The fourier transform infrared (FT-IR) spectrum reflected the presence of two sharp stretchings above 3,000 cm-1, but it was expected to be only one. The two sharp stretchings were observed at 3456.39 and 3231.78, which signifies the presence of two acidic protons, i.e., -NH or -OH, while in 1HNMR spectrum, a singlet was expected for –CONH at 11-12 ppm, which was absent in our spectra. Instead, a singlet appeared at 9.6 ppm; apart from this, the presumed number of protons was 18, which was found to be only 12. Also, the total number of singlets were expected to be 2 (-CH, -NH), which were found to be 3, of which 2 were displaceable. This suggested the presence of two acidic protons in the synthesized compound. Further, the mass spectra showed a peak at 368, which was expected to be at 475. On further investigation of 1HNMR and mass fragmentation pattern, it was found that the synthesized compound was not triazinone; rather, it was a hydrolyzed product of 4-(4-bromobenzylidene)-2-phenyloxazol-5(4H)-one, i.e., acrylic acid derivative, having molecular weight 345, which appeared at 368 (with the peak of Na+) in our spectrum. This was further assured by separately carrying out the hydrolysis of 4-(4-bromobenzylidene)-2-phenyloxazol-5(4H)-one in glacial acetic acid [Scheme 1] and comparing its TLC and spectral data with our synthesized compound. This acrylic acid derivative is not yet reported. Kapish Madaan, Tarawanti Verma, Darpan Kaushik, Nancy, Nanjan Mahadevan Department of Pharmaceutical Chemistry, Rajendra Institute of Technology and Sciences, 4th Mile Stone, Hisar Road, Sirsa-125 055, India E-mail: darpkaush@yahoomail.com

Bromocriptine or cabergoline induced pituitary apoplexy: Rare but life-threatening catastrophe

Sir, Prolactin secreting pituitary tumor is one of the common causes of infertility in males and females.[1] Prolactin level is also high in non-prolactin secreting pituitary adenoma (e.g., growth hormone secreting) due to stalk effect.[2] Most of the prolactinomas can be managed medically with bromocriptine or cabergoline which are largely used as primary treatment for prolactinomas, as they help to normalize serum prolactin levels and induce reduction in the tumor size, promoting restoration of gonadal function, cessation of galactorrhea and improvement in visual defects in the majority of patients.[1,2] Bromocriptine or cabergoline induced pituitary apoplexy is a life-threatening complication which is rare but well known.[2-5] This condition is characterized by sudden onset of headache, visual loss or deterioration, meningismus, altered mental status, and rarely, even death.[1,2] This pathology is caused by hemorrhagic necrosis of tumor or pituitary gland infarction, in which pituitary function is compromised, necessitating rapid administration of corticosteroids and endocrine evaluation.[1] Rapid surgical decompression is required if there is sudden constriction of visual fields, and/ or rapid deterioration of acuity, or neurological deterioration due to hydrocephalus.[1,2] These reports point toward the possibility of bromocriptine or cabergoline induced pituitary apoplexy, which should be kept in mind when a patient is neurologically deteriorating after starting these drugs. Careful follow-up is required when treatment with bromocriptine or cabergoline is attempted for prolactinoma in reproductive medicine clinic for infertility management in male and female patients.

Art of publication and selection of journal

Publication is both an art and a science. For the beginner, not knowing the intricacies of publication, choice of subject and the appropriate journal to get their work published are major obstacles. In this article, the authors share their experience on how to go about getting an article published and selecting the most suitable journal for publication. They hope this article stimulates medical writing.

Effect of epilepsy on female fertility and reproductive abnormalities.

Journal of Human Reproductive Sciences / Volume 4 / Issue 2 / May Aug 2011 endocrinal disturbances.[2] They may interfere with the hypothalamic pituitary axis and produce amenorrhea, oligomenorrhea, and prolonged and irregular cycles. [2] Higher incidence of PCOD is also reported in women taking valproate sodium, and a retrospective series reported PCOD in 43% of women taking valproate for epilepsy.[2,6] A recent study done in India, concluded that infertility was least common (7.1%) in those epileptic women who were not on antiepileptic drug (AED) exposure compared to those who were with AED exposure (31.8% with one AED exposure, 40.7% with two AED exposures, and 60.3% with three or more AED exposures).[1] Epileptic women who were taking phenobarbital had a significantly higher risk of infertility, but no such trend was observed with other AED drugs.[1] Infertility was also common in epileptic women who were older in age, with lower education.[1]

Free full text articles: where to search for them?

References form the backbone of any medical literature. Presently, because of high inflation, it is very difficult for any library/organization/college to purchase all journals. The condition is even worse for an individual person, such as private practitioners. The solution lies in the free availability of full-text articles. Here, the authors share their experiences about the accessibility of free full-text articles.

HIV: Pre-exposure Prophylaxis

Results of one study (iPrEx study) showed that a once‑daily pill containing tenofovir plus emtricitabine was safe and provided an average of 44% additional protection against HIV infection to men and transgender women who have sex with men, who were also provided with a comprehensive package of prevention services.