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Background : Gallstone ileus is an uncommon complication of gall stones associated with potentially serious morbidity and mortality. Case Report: We reported a 60-year-old male case who presented with renal failure and pain in right hypochondriac region. He also had a history of brain infarcts along with diabetes which is an additional factor for mortality. On Computed Tomography of the abdomen, he was diagnosed to have cholecystocholedochal fistula including air in the gall bladder and obstruction in the distal part of the ileum. Computed tomography plays an important role to make the proper diagnosis and in treatment. Conclusion s: As in our case, diagnosis was challengeable because of renal failure,diabetes, septicaemia and intestinal obstruction (peritonitis). We did surgery on the basis of peritonitis which remains the only choice in such cases. . In follow- up of 1 month patient was doing well and asymptomatic.

Context: Virtual screening techniques or computational methods are used for the drug discovery and development. Objective: In search for the safer and effective anticonvulsant agents, docking study on pyridazinone derivatives was performed to potentiate GABA mediated chlorine channel opening. Methods: A total of eighteen compounds were screened for their anticonvulsant activity using molecular docking inside the ligand binding domain of PDB ID 2Q1Q using Molegro Virtual docker. QikProp 3.4 & molinspiration software were also used to evaluate drug likeliness and to perform comparative bioactivity analysis for all the pyridazinone derivatives. Results: Out of eighteen compounds, (I) showed highest Mol dock score and (XVIII) formed maximum number of hydrogen bond interactions. Oxygen atom of the Nitro group on the biphenyl ring of compound (XV) formed a strong hydrogen bond with Thr199 with a distance 2.33?. Mol dock score of diazepam (standard drug) was -101.5306. Conclusions: Based on the results of mol dock score and number of hydrogen bond interactions, compounds (XVIII) and (XIII) observed to be the most potent compounds.

A fixed-ratio combination of the basal insulin analogue insulin degludec and the glucagon-like peptide-1 (GLP-1) analogue liraglutide has been developed as a once-daily injection for the treatment of type 2 diabetes. We aimed to compare combined insulin degludec-liraglutide (IDegLira) with its components given alone in insulin-naive patients.In this phase 3, 26-week, open-label, randomised trial, adults with type 2 diabetes, HbA1c of 7-10% (inclusive), a BMI of 40 kg/m(2) or less, and treated with metformin with or without pioglitazone were randomly assigned (2:1:1) to daily injections of IDegLira, insulin degludec, or liraglutide (1·8 mg per day). IDegLira and insulin degludec were titrated to achieve a self-measured prebreakfast plasma glucose concentration of 4-5 mmol/L. The primary endpoint was change in HbA1c after 26 weeks of treatment, and the main objective was to assess the non-inferiority of IDegLira to insulin degludec (with an upper 95% CI margin of 0·3%), and the superiority of IDegLira to liraglutide (with a lower 95% CI margin of 0%). This study is registered with ClinicalTrials.gov, number NCT01336023.1663 adults (mean age 55 years [SD 10], HbA1c 8·3% [0·9], and BMI 31·2 kg/m(2) [4·8]) were randomly assigned, 834 to IDegLira, 414 to insulin degludec, and 415 to liraglutide. After 26 weeks, mean HbA1c had decreased by 1·9% (SD 1·1) to 6·4% (1·0) with IDegLira, by 1·4% (1·0) to 6·9% (1·1) with insulin degludec, and by 1·3% (1·1) to 7·0% (1·2) with liraglutide. IDegLira was non-inferior to insulin degludec (estimated treatment difference -0·47%, 95% CI -0·58 to -0·36, p0·0001) and superior to liraglutide (-0·64%, -0·75 to -0·53, p0·0001). IDegLira was generally well tolerated; fewer participants in the IDegLira group than in the liraglutide group reported gastrointestinal adverse events (nausea 8·8 vs 19·7%), although the insulin degludec group had the fewest participants with gastrointestinal adverse events (nausea 3·6%). We noted no clinically relevant differences between treatments with respect to standard safety assessments, and the safety profile of IDegLira reflected those of its component parts. The number of confirmed hypoglycaemic events per patient year was 1·8 for IDegLira, 0·2 for liraglutide, and 2·6 for insulin degludec. Serious adverse events occurred in 19 (2%) of 825 patients in the IDegLira group, eight (2%) of 412 in the insulin degludec group, and 14 (3%) of 412 in the liraglutide group.IDegLira combines the clinical advantages of basal insulin and GLP-1 receptor agonist treatment, resulting in improved glycaemic control compared with its components given alone.Novo Nordisk.

Hintergrund: Optimierung der Therapieabläufe einer Verbrennungsintensivstation auf Basis der, auf der DAV 2013 vorgestellten, wissenschaftlichen Erkenntnisse Methoden: Ab Februar 2013 Anpassung und Entwicklung von Therapievorgaben in Richtung Aufnahmemanagement, Volumentherapie, Analgosedierung,[for full text, please go to the a.m. URL], 32. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2014)

A 19-year-old female patient sustained a closed spiral midshaft femoral fracture and subsequently underwent femoral intramedullary nail insertion. At followup she complained of difficulty in walking and was found to have a unilateral in-toeing gait. CT imaging revealed 30 degrees of internal rotation at the fracture site, which had healed. A circumferential osteotomy was performed distal to the united fracture site using a Gigli saw with the intramedullary femoral nail in situ. The static distal interlocking screws were removed and the malrotation was corrected. Two further static distal interlocking screws were inserted to secure the intramedullary nail in position. The osteotomy went on to union and her symptoms of pain, walking difficulty, and in-toeing resolved. Our paper is the first to describe a technique for derotation osteotomy following intramedullary malreduction that leaves the intramedullary nail in situ.

Hintergrund: Die postoperative Rezidivbildung nach Pterygiumexzision stellt nach wie vor ein Problem dar. Bis zu 39% der Pterygien rezidivieren selbst nach Verwendung freier autologer Bindehauttransplantate (BH-TX). Diese hier vorgestellte Studie vergleicht die Rezidivraten nach Pterygiumexzision[for full text, please go to the a.m. URL], 173. Versammlung des Vereins Rheinisch-Westfälischer Augenärzte