A study of effectiveness and safety of topical combination therapy for acne vulgaris patients in dermatology department of a tertiary care teaching hospital

Background: Acne vulgaris is a dermatological disorder characterised by formation of comedones and inflammatory lesions. Acne is one of the most common reason for visiting a dermatologist in early adulthood. The current line of management for mild to moderate acne is topical medications with antimicrobials and retinoids. The present study assessed the effectiveness and safety of topical combination therapy for mild to moderate acne vulgaris.Methods: An observational, prospective and comparative study conducted on newly diagnosed acne vulgaris patients who were treated with topical combination therapy. Changes in the total, inflammatory and non-inflammatory lesion counts, investigator global assessment (IGA) and dermatology life quality index (DLQI) scales were recorded to check effectiveness. Treatment emergent adverse events were recorded in suspected ADR reporting form for safety assessment.Results: Participants (n=97) were treated with three topical combination treatments either clindamycin-benzoyl peroxide (group-A), clindamycin-adapalene (group-B) or benzoyl peroxide-adapalene (group C). Majority of participants (42.3%) were treated with clindamycin-benzoyl peroxide group. Reduction from baseline of total, inflammatory and non-inflammatory lesion counts were highly significant within group comparison (p<0.001), but between group differences were not significant. Significant improvement in DLQI and IGA scores were noted in all three groups, but between group comparison showed no significant differences. All three groups were safe and well tolerated and equally improve participant’s quality of life.Conclusions: all three topical combination drugs for mild acne vulgaris had similar effectiveness in terms of reduction in acne lesions with similar safety profile.

Histological evaluation of placenta in hypertensive pregnancies

Background: Maternal and fetal status are reflected in placenta. Toxemia of pregnancy exerts great impact on placenta and thereby fetal and maternal outcomes. Placenta reflects changes of toxemia and these changes are seen morphology as well as histology. Hence study of placenta gives information on the in-utero fetal condition.Methods: A total of 1000 placenta, 500 each from hypertensive and normotensive groups were included in this study conducted in Anatomy Department of SBKS Medical College and Research Centre, Vadodara. Histological evaluation of the samples taken was done under microscope.Results: Microscopic examination of the placenta revealed the presence of calcification, infarction, fibrinoid necrosis, villous hyalinization, syncytial knots and cytotrophoblastic cellular proliferation in both control and hypertension groups. In the present study, calcification was seen in 35.8% in the control group, while the same was seen in 53.8% patients in test group. Fibrinoid necrosis was seen in 48.8% patients in control group as against 69% patients in test group. Villous Hyalinization was seen in 7.40% and 21.4% patients in control and test groups respectively. On the other hand, syncytial knots were seen in 38% and 69% patients in control and test groups respectively. In test group, cytotrophoblastic cellular proliferation was seen in 69% patients while in control group, it was seen in 33.2% patients. Infarction was also seen in test (42.4%) and control (12.6%) groups.Conclusions: Hypertensive disorders of pregnancy have significant effect on the histology of placenta and also influences the fetal outcomes.

Ertugliflozin: a novel anti-diabetic drug

Diabetes Mellitus is a disorder of global proportion. Despite various treatment modalities presently being available, yet the desired glycaemic control and patient outcomes have not been achieved completely. Sodium glucose co-transporter type 2 inhibitors (SGLT2 inhibitors) are one such promising group of emerging drugs in diabetes treatment. Ertugliflozin prevents the reabsorption of glucose by inhibiting sodium-glucose cotransporter-2 (SGLT2) at proximal convoluted tubules. Ertugliflozin is available as 5mg and 15mg tablets. Ertugliflozin has been related to genital mycotic infections and urinary tract infections. Benefits of Ertugliflozin include better control on blood glucose, body weight and blood pressure.

Netarsudil: a novel intra-ocular pressure lowering agent

Optic disc health is an important indicator of visual functions. The first line of management to prevent/halt the damage to optic disc is to control responsible pathological condition, if identified. In absence of identifiable cause, the most validated approach is lowering of intra-ocular pressure (IOP). Individually, as well as combinations of currently available drugs are not fully effective in all patients of glaucoma in achieving desired IOP control. Hence, there is a need of newer alternatives which address this unmet need. Recently, a newer IOP lowering agent with a novel mechanism of action, netarsudil, has been approved by United States Food and Drug Administration (US-FDA) in December 2017. Netarsudil acts by inhibiting Rho-associated protein kinase resulting in lowering of overall tone of the contractible cells in trabecular meshwork thereby improving drainage of aqueous humor outflow and lowering of IOP. Though in its early days, this drug gives an armamentarium to ophthalmologists and physicians to control IOP in patients of open-angle glaucoma and ocular hypertension.

Evaluation of Periodontal Status among Premenopausal and Postmenopausal Women- A Comparative Study.

Background: The aim of the study was to compare the periodontal status among pre menopausal and post menopausal women. Methods: A total population of 100 women of age group 45-55 years visiting the Department of Periodontology,VMSDC, Salem, were taken and divided into two groups-pre and postmenopausal. All patients were evaluated for plaque index (PI), gingival index (GI), probing depth (PD),and clinical attachment loss(CAL). Results: The prevalence of periodontitis was significantly greater among postmenopausal women than among premenopausal women. Statistical analysis of data were carried out using mean ± standard deviation (SD), p – value, t – test between two groups; premenopausal and postmenopausal. For PI, GI, PPD and CAL, we found a highly significant difference p< 0.001 between two groups. Conclusion: Postmenopausal women had a greater chance of having periodontitis than premenopausal women.

Wilckodontics- A Magical Wand for Rapid Success-A Review.

The orthodontic treatment is, perhaps, in terms of duration, the longest-performed dental procedure. In this fast-paced world any treatment that would consume 1 – 2 years is unwelcome. It is universally accepted that if the duration of the orthodontic treatment is reduced, there will be an increased favorable attitude towards the orthodontic therapy. To accelerate the tooth movement the orthodontists and the periodontists together have worked out a success formula which is termed Periodontally Accelerated Osteogenic Orthodontics (PAOO) or wilckodontics. Theoretically this procedure is based on the healing property of bone known as (RAP) regional acceleratory phenomenon. This procedure involves the surgical demineralization of the cortical bone (corticotomy) thereby decreasing the resistance offered by the cortical bone of the teeth to the orthodontic force applied and use of particulate bone grafting. This method not only enhances the width of the alveolar bone but also decreases the duration of the treatment and chances of apical root resoption. It also increases the stability of the treatment by reducing the chances of relapse. A proper case selection, careful surgical procedure and accurate orthodontic movements are important for the success of wilckodontics. This review article includes history, biomechanics, indication, contraindication, case selection, treatment planning, surgical techniques and its modifications.

Biologics and biosimilars: role in modern pharmacotherapy and importance of pharmacovigilance.

Biologics are highly sensitive large molecules with complex structure, difficult to characterize and reproduce, derived from living cells; used for treatment, diagnosis or prevention of disease. Examples are therapeutic hormones, vaccines, monoclonal antibodies etc. Biologicals are beneficial in the management of several health conditions which were once upon a time difficult to manage like cancer, multiple sclerosis, Alzheimer’s disease, rheumatoid arthritis, diabetes etc. Biosimilars are proteins that are similar to innovator biologics but not the same as they differ slightly in structure however with no clinically significant difference. Biosimilars are not the exact replicas of originator biologic and are therefore not generics. Biosimilars for their approval are not required to undergo intense clinical trials as innovator biologic but are required to produce data that demonstrates its similarity to an original biologic in terms of clinical efficacy and safety. However, manufactures of both the biologics and biosimilars are required to submit pharmacovigilance and risk management plans as part of their application. Marketing authorization for biosimilars was for the first time framed by EMA along with the guidelines for developing them. As biologics and biosimilars are derived proteins they have immunogenic potential and risk of adverse events which cautions their use. Pharmacovigilance is needed to ensure that adverse events are quickly detected, reported and attributed to the correct product and manufacturer. Regulations are implemented to improve identification and traceability of biologics. Automatic substitution should not be permitted for biologicals.

Leptin in non PCOS and PCOS women: a comparative study.

Background: Leptin, a hormone secreted by adipose tissues, controls body weight through regulation of appetite and thermogenesis. The present study was aimed to observe role of leptin in healthy and polycystic ovary syndrome (PCOS) women. Methods: Correlation between serum leptin and anthropometric, endocrine and metabolic profile was studied in 30 apparently healthy women (control group) and 38 PCOS women (PCOS group). Each group was stratified based on body mass Index (BMI), as normal weight (BMI<23) and overweight/obese (BMI>23). Results Leptin level was high in 30% control group and in 65.79% PCOS group. Mean leptin (ng/ml) in PCOS group was higher compared to control group (18±1.9 v/s 12±1.7, p<0.05). Mean leptin levels were higher in overweight/obese subgroup as compared to normal weight subgroup in both Control (p<0.05) and PCOS groups (p=<0.05). In control group, leptin showed positive correlation with waist circumference (WC) (r=-0.49, p<0.01) and negative correlation with Cholesterol: HDL ratio (p<0.05). In PCOS group, leptin showed positive correlation with BMI (r=0.377,p<0.05) and Triglyceride (r=0.34,<0.05) and negative correlation with Fasting Blood Glucose( FBG)(r=-0.33,p<0.05). In normal weight subgroup among control group (n=25), leptin showed positive correlation with LDL (r=0.49, p<0.05). In control overweight/obese subgroup (n=5), leptin showed positive correlation with Follicle Stimulating Hormone (FSH) (r=+1.0, p<0.05) and inverse correlation with testosterone(r=-1.0,p<0.05). In normal weight subgroup among PCOS group, leptin had a positive correlation with LDL: HDL ratio (r=0.488, p<0.05). Conclusions: Hyperleptinemia is common in obesity. Leptin controls glycemic status in patients with IR. Correlation of leptin with FSH and testosterone is influenced by obesity and PCOS. Leptin regulation of lipid homeostasis is influenced by obesity or PCOS.

Pre-operative ondansetron vs. metoclopramide for prevention of post-operative nausea and vomiting in elective lower-segment caesarean section under spinal anaesthesia.

Background: The problem of nausea and vomiting is a very old but a less thought of problem. Nausea and vomiting are the most common distressing symptom in the postoperative period. Antiemetic drugs play an important role in therapy of post-operative nausea and vomiting (PONV). Though many drugs have been tried as prophylaxis and treatment of PONV, no drug has been proved significantly effective and hence, the present study was undertaken to compare the efficacy and safety of IV metoclopramide and IV Ondansetron as prophylaxis for postoperative nausea and vomiting in lower-segment caesarean section (LSCS) under spinal anaesthesia. Methods: After institutional approval and informed consent 100 ASA I & II patients undergoing non emergent LSCS taken for study. The patients were divided randomly into 2 groups of 50 each. Group I received IV metoclopramide 10mg and Group II received IV. Ondansetron 4mg. Anaesthetic management was standardized. The incidence of vomiting and retching as number of episodes was studied. Nausea was graded depending on the severity and data derived. Results: The mean age, weight and duration of surgery was not significantly different when compared group-1 parturiants with group-2. The mean episodes of emesis, nausea and retching at different postoperative duration were significantly decreased (p<0.05) in Ondansetron group when compared to metoclopramide group as postoperative time progresses. Conclusions: Injection ondansetron 4mg provided decrease in the incidence of PONV than metoclopramide as the side effects with these drugs were minimal.

Efficacy of ondansetron as antiemetic agent in preventing the incidence of PONV in LSCS under subarachnoid block.

Background: Nausea and vomiting are the most common distressing symptom in the postoperative period. Antiemetic drugs play an important role in therapy of PONV. Though many drugs have been tried as prophylaxis and treatment of PONV, no drug has been proved significantly effective and hence, the present study was undertaken to evaluate the efficacy of prophylactic ondansetron in LSCS patients given spinal anaesthesia. Methods: After institutional approval and informed consent 100 ASA I & II patients undergoing non emergent LSCS taken for study. The patients were received ondansetron 4mg i.v. 3-5min before surgery. Episodes and severity of nausea, vomiting and retching were noted at the end of 1st, 2nd, 6th and 24th hr. Results: The mean age, weight and duration of surgery was not significantly different when compared group-A parturiants with group-B. The mean episodes of emesis, nausea and retching at different postoperative duration were significantly decreasing as postoperative time progresses. Conclusion: The present study suggests that prophylactic ondansetron 4mg is more efficacious in preventing post operative nausea and vomiting in LSCS under spinal anaesthesia.

A case of Kartagener’s syndrome: Importance of early diagnosis and treatment.

Kartagener’s syndrome is a very rare congenital malformation comprising of a classic triad of sinusitis, situs inversus and bronchiectasis. Primary ciliary dyskinesia is a genetic disorder with manifestations present from early life and this distinguishes it from acquired mucociliary disorders. Approximately one half of patients with primary ciliary dyskinesia have situs inversus and, thus are having Kartagener syndrome. We present a case of 12 year old boy with sinusitis, situs inversus and bronchiectasis. The correct diagnosis of this rare congenital autosomal recessive disorder in early life is important in the overall prognosis of the syndrome, as many of the complications can be prevented if timely management is instituted, as was done in this in this case.

Present and Future Climate Change in Indian Cardamom Hills: Implications for Cardamom Production and Sustainability.

Aims: This paper examines the interactions between climate parameters and cardamom capsule yield and its sustainability in Indian Cardamom Hills. Methodology: Temporal trends were evaluated at annual, seasonal and monthly time scale using Mann-Kendall method. Significant trends were identified at annual, seasonal and monthly scale using two tailed Z-Test. The temporal trends were evaluated using the non-parametric Mann-Kendall test. To quantify the slope we used Sen’s non-parametric estimator of slope. The significance of the test was evaluated using two tailed Z-Test. A p value of <0.05 was used to indicate statistical significance, using two tailed Z test. Results: Climate warming was significant in the recent decades in the Indian Cardamom Hills, which is recognized as one of the ecologically sensitive and biologically diverse areas. Considerable and significant spatial and temporal variations have occurred in the main climatic elements like air temperature, rainfall and relative humidity in the hill region. Significant positive trend in day-night time temperature has been observed and the trend differed from one station to another. Significant increasing trend was also observed for minimum temperature than maximum temperature and this had caused decline in diurnal temperature. Both winter and summer monsoon rainfall as well as high relative humidity had a positive influence on the yield of cardamom. However, the variability in these two types of rainfall was high for the entire region and the trend is negative. The variability of monthly mean precipitation is high for May, December and January under AR4 climate scenario. Conclusion: The sustainable yield of cardamom may be possible only when the winter and summer rainfall variabilities were minimal. Increasing trend of soil temperature from 0-10 cm depth was recorded, which was significant at 5 cm depth and can cause considerable negative implications for sustainable cardamom production both in terms of reduced soil moisture availability and altered pest population dynamics.

A case of Kartagener's syndrome: Importance of early diagnosis and treatment.

Kartagener's syndrome is a very rare congenital malformation comprising of a classic triad of sinusitis, situs inversus and bronchiectasis. Primary ciliary dyskinesia is a genetic disorder with manifestations present from early life and this distinguishes it from acquired mucociliary disorders. Approximately one half of patients with primary ciliary dyskinesia have situs inversus and, thus are having Kartagener syndrome. We present a case of 12 year old boy with sinusitis, situs inversus and bronchiectasis. The correct diagnosis of this rare congenital autosomal recessive disorder in early life is important in the overall prognosis of the syndrome, as many of the complications can be prevented if timely management is instituted, as was done in this in this case.

Association of carotid intima-media thickness with left main coronary artery disease.

BACKGROUND: Previous studies have shown that carotid intima-media thickness correlates well with the presence and extent of coronary artery disease. This study was conducted to determine whether it could reliably predict the presence of left main coronary artery disease. METHODS: Common carotid intima-media thickness was measured in 50 patients with angiographically proven significant (> or =50%stenosis) left main coronary artery disease and in another 50 age- and sex-matched patients with coronary artery disease without the involvement of the left main coronary artery. Measurements of the carotid intima-media thickness were made on the far wall 1 cm from the distal end of the common carotid artery bilaterally, and the average and the greater of the two values thus obtained for each patient were used for analysis. Plaques were not included in the measurement of carotid intima-media thickness. RESULTS: The average and greater of the two values were significantly higher in patients with left main coronary artery disease as compared to those without it (average intima-media thickness: 0.926 +/- 0.12 vs. 0.78 9 +/- 0.16 mm; p< 0.001; greater intima-media thickness: 0.994 +/- 0.13 vs. 0.844 +/- 0.20 mm; p< 0.001). The cut-off values of 0.81 mm for the average carotid intima-media thickness and 0.87 mm for the greater carotid intima-media thickness were found to have optimum sensitivity (92% and 90%, respectively) and specificity (60% and 64%, respectively) for the detection of left main coronary artery disease. A higher cut-off value of 1.0 mm increased specificity to 92% and 84%, respectively, for the average and greater thicknesses, but sensitivity decreased markedly. CONCLUSIONS: There is a significant association between increased carotid intima-media thickness and the presence of left main coronary artery disease. The measurement of carotid intima-media thickness can be used with reasonably good sensitivity and specificity for the detection of left main coronary artery disease in patients who are undergoing evaluation for suspectedcoronary artery disease.

Low-dose dobutamine echocardiography predicts recovery of left ventricular systolic function following revascularization even in presence of low contractile reserve.

BACKGROUND: Coronary revascularization is known to improve left ventricular ejection function (LVEF) in patients with severe left ventricular systolic dysfunction if there is myocardial viability and contractile reserve is >40% as determined by low-dose dobutamine echocardiography (LDDE). We tried to assess effect of coronary revascularization on left ventricular systolic function in patients with low contractile reserve (40%). METHODS AND RESULTS: In a retrospective analysis we studied 114 consecutive patients with left ventricular systolic dysfunction (LVEF <40%) with low contractile reserve (<40%) as detected by LDDE (16-segment model). Contractile reserve was defined as number of dysfunctional segments that improved on LDDE divided by total number of left ventricular segments studied. Dysfunctional segments at baseline that improved on low-dose dobutamine were considered viable. On the basis of presence or absence of viability and treatment modality, patients were grouped as: revascularization with viability-group A; revascularization without viability-group B; medical therapy with viability-group C, and; medical therapy without viability-group D. At subsequent follow-up (3 months, 1 year and 2 years) left ventricular systolic function was assessed by LVEF and wall motion score index (WMSI). Improvement in left ventricular systolic function was considered to have occurred only if both LVEF and WMSI showed statistically significant ( p<0.05) improvement from baseline. The mean LVEF in viable and non-viable groups were 33.3 -/+ 6.8% and 30.3 -/+ 7.1%, respectively. In patients with viability, the mean number of dysfunctional segments that improved at LDDE was 3.4 -/+ 1.7 and mean contractile reserve was 21.1 -/+ 17.8%. At LDDE, significant improvement in LVEF was seen in all four groups; however, significant improvement in WMSI was seen only in those with viability. At subsequent follow-up (3 months, 1 year and 2 years), significant improvement in LVEF and WMSI as compared to baseline was evident in group A alone. At two years, although the improvement in WMSI was of borderline significance (p = 0.05), the improvement in LVEF was significant ( p < 0.05). No significant improvement was seen in LVEF and/or WMSI in groups B, C and D. CONCLUSION: Presence of myocardial viability on LDDE predicts recovery of left ventricular systolic function even in patients with low contractile reserve which is maintained at long-term follow-up, following revascularization.

Quadricuspid aortic valve with severe aortic regurgitation.

Quadricuspid aortic valve is a rare congenital anomaly that usually presents with aortic regurgitation. Its importance, however, lies in its association with coronary abnormalities, which may lead to surgical catastrophe, if not diagnosed pre-operatively. This report describes a case of quadricuspid aortic valve detected incidentally during routine pre-operative transesophageal echocardiography.

Carotid Intima-Media Thickness and Brachial Artery Flow-Mediated Dilatation in Patients with and without Metabolic Syndrome.

BACKGROUND, Metabolic syndrome has recently emerged as a marker of future cardiovascular risk. However its incremental value for this purpose, over conventional cardiovascular risk factors and diabetes mellitus in particular, is debated. The present study was conducted to determine the extent of subclinical atherosclerosis in patients with metabolic syndrome, and compare it with the same in individuals with cardiovascular risk factors not having metabolic syndrome. METHODS, A total of 156 individuals seeking outpatient cardiac consultation for various indications were included in the study and were divided into four groups - group 1: cardiovascular risk factors present but not metabolic syndrome (n = 60) : group 2 : metabolic syndrome without diabetes mellitus or coronary artery disease (n = 21) ;group 3: metabolic syndrome with diabetes mellitus without coronary artery disease ( n = 27) ;and group 4:patients with documented coronary artery disease (n = 48). Metabolic syndrome was diagnosed on the basis of Adult Treatment Panel III (ATPIII) criteria. All patients underwent assessment of carotid intima-media thickness and brachial artery flow-mediated vasodilatation. RESULTS, Both carotid intima-media thickness and brachial artery flow-mediated vasodilatation were similar in groups 1 and 2 (carotid intima-media thickness: 0.687 -/+ 0.13mm and 0.706 -/+0.23mm, p = 0.963; brachial artery flow-mediated vasodilatation: 11.80 -/+ 5.16% and 12.87 -/+ 7.04%, respectively, p =0.883) , but group 3 patients had significantly higher carotid intima-media thickness (0.774 +/- 0.15mm, p = 0.047) and significantly lower brachial artery flow-mediated vasodilatation (7.37 -/+ 6.12%, p -/+ 0.007) as compared to group 1 patients. There was no significant difference in the two parameters between groups 3 and 4 (carotid intima-media thickness in group 4:0.789 -/+ 0.16mm,p = 0.976 and brachial artery flow-mediated vasodilatation:5.86 -/+ 3.85%, p -/+ 0.709). CONCLUSIONS, In absence of diabetes mellitus, metabolic syndrome was not associated with greater extent of subclinical atherosclerosis compared to individual cardiovascular risk factors. Presence of diabetes mellitus, however, resulted in significant endothelial dysfunction and evidence of subclinical atherosclerosis, similar to that seen in patients with already established coronary artery disease.