No obvious symptoms in acute (eltroxin) thyroxine poisoning in euthyroid – A case report

Levothyroxine (T4) (Eltroxin) poisoning is a rare clinical entity which is usually asymptomatic. It can occur accidently, mostly in children, and can happen intentionally in adults with suicidal intention especially psychiatric patients. Thyrotoxicosis from an overdose of medicinal thyroid hormone is a condition that may be associated with a significant delay in onset of toxicity. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In this case report, we present a patient who ingested high doses of levothyroxine i.e., 90 tab. of Eltroxin 100 mcg, for suicidal intension and admitted to intensive care unit. She is an euthyroid person but took these tablets, which her mother was taking Eltroxin tablets for hypothyroidism. Gastric lavage was done with activated charcoal, Inj. Hydrocortisone, Tab Propranolol and Tab Neomercazole administered. Despite ingestion of high dose of levothyroxine, thyrotoxicosis symptoms like palpitations resolved with appropriate treatment and the patient was discharged after complete recovery.

HIV epidemic in Mizoram, India: A rapid review to inform future responses

Background & objectives: Mizoram, a northeastern State of India bordering Myanmar, is home to several tribal clans under the ethnic group Mizo: Renthelei, Ralte, Paite, Lai, Hmar, Lusei, Mara, Thado and Kuki. Mizos also reside in the neighbouring northeastern States of Tripura, Assam, Manipur and Nagaland. The majority of Mizo people outside India live across the border in the neighbouring Chin State and Sagaing Region of Myanmar. Over the last decade, Mizoram witnessed a concerning level of rise in HIV prevalence among the general population. The present rapid review was conducted to identify various interventions that could help curb this rising trend. Methods: An electronic search strategy with broad domains of ‘HIV/AIDS’, ‘key population’, ‘community engagement’ and ‘interventions in Mizoram’ using PubMed, Embase and Cochrane was adopted; grey literature were also accessed. Evidence, thus gleaned, were synthesized. Results: Twenty eight resource materials comprising articles, reports and dissertations contributed to the current review. Changing tribal social support structure, early initiation of drugs, sexual debut at an early age and drug–sex interface were identified as factors associated with the progression of HIV epidemic in the State. Issues pertaining to the migration of people across the borders and easy access to drugs continue to be of concern. Churches and youth leaders have a strong influence on the society, at times even constraining access of key population groups to HIV prevention and care services. Tackling stigma and discrimination, ensuring uninterrupted HIV services and creation of an enabling environment in this context seems urgently needed. Incarcerated people in the State have been found with a high level of HIV infection and their linkages with prevention and care services need strengthening. Interpretation & conclusions: This review underscores the importance of drawing upon successful intervention examples from the past such as ‘Friends on Friday’ and Red Ribbon Clubs. Active engagement of community-based organizations in programme planning, implementation and monitoring is essential. Establishment of harm reduction interventions for general and key populations paired with strategic communication appear to be the need of the hour.

Challenges faced by ethics committee members in India during COVID-19 pandemic: A mixed-methods exploration

Background & objectives: The COVID-19 pandemic had a distinct impact on scientific research and Ethics Committees (ECs). We conducted a mixed-methods investigation to understand the issues faced and solutions identified by ECs during this pandemic in India. Methods: A quantitative online survey form (30 members) and qualitative in-depth interviews (10 members) from various ECs were conducted. Thematic content analysis for qualitative and proportion analysis for quantitative data was carried out. Results: During the online survey, an average difficulty score, which was measured using the Visual Analogue Scale, was 5.3 (SD 2.1). Pressure for expedited approvals was felt by EC members with a drastic increase in the number of submission of research projects. The scarcity of information on investigational products (IPs) and requisite consent process posed major hurdles. Ongoing non-COVID studies and post-graduate dissertations were badly hit due to the shift in attention towards COVID-related research. Non-familiarity with virtual technology and lack of face-to-face interactions were highlighted as demerits. However, a few of the EC members welcomed newer methods, being time-saving, convenient and reducing travel hassles. Site monitoring and severe adverse event-related analyses were also negatively impacted upon. Solutions included the alternate methods of consenting (virtual, abbreviated), a detailed explanation of the protocol and IPs and benefits versus risk assessment. Interpretation & conclusions: Despite various challenges posed by the COVID-19 pandemic, the ECs in India steered well through the hurdles. Moreover, adapting a hybrid mode, technical training and updating guidelines were perceived as urgent by EC members

Epidemiological Profile of Oral Cancer Patients Attending Katihar Medical College, Katihar (Bihar)

Background: India has very high incidence of oral cancer. The purpose of this prospective study was to analyze the epidemiology of oral cancer patients in katihar medical college. Methods: Prospective study was performed in 100 patients of diagnosed oral cancer from October 2016 to August 2018. Results: The largest number of cases in this study was distributed in age group of 56 yr – 70 yrs of age (46%). The lowest number of case distribution were noted in 25-35yrs (4%). Tabacco chewing in the form of paan ,khaini , gutka , was habit of 48% where as smoking in the form of bidi cigarrets was in 27% of patients . 13 % of patients were both of tabacco chewing and smoking habits. Conclusion: Smokeless tobacco specially in our country in the form of paan khaini , gutka are heavily consumed specially in younger age of society which has to stop at any cost to decrease the incidence of oral cancer.

Pharmacokinetic evaluation, molecular docking and in vitro biological evaluation of 1, 3, 4-oxadiazole derivatives as potent antioxidants and STAT3 inhibitors / 药物分析学报

1, 3, 4-Oxadiazole derivatives (4a–5f) were previously synthesized to investigate their anticancer properties. However, studies relating to their antioxidant potential and signal transducer and activator of transcription (STAT) inhibition have not been performed. We investigated previously synthesized 1, 3, 4-oxadiazole de-rivatives (4a–5f) for various radical scavenging properties using several in vitro antioxidant assays and also for direct inhibition of STAT3 through molecular docking. The data obtained from various antioxidant assays such as 2, 2,-diphenyl-1-picrylhydrazyl radical (DPPH), nitric oxide, hydrogen peroxide, and superoxide anion radical revealed that among al the derivatives, compound 5e displayed high antioxidant activities than the standard antioxidant L-ascorbic acid. Additionally, the total reduction assay and antioxidant capacity assay further confirmed the antioxidant potential of compound 5e. Furthermore, the molecular docking studies performed for all derivatives along with the standard inhibitor STX-0119 showed that binding energy re-leased in direct binding with the SH2 domain of STAT3 was the highest for compound 5e (-9.91kcal/mol). Through virtual screening, compound 5e was found to exhibit optimum competency in inhibiting STAT3 activity. Compound 5e decreased the activation of STAT3 as observed with Western blot. In brief, compound 5e was identified as a potent antioxidant agent and STAT3 inhibitor and effective agent for cancer treatment.

Complexation of ibuprofen with water soluble p-sulfonatocalix [4]arene: a potential candidate for drug delivery application

Complexation of ibuprofen with water soluble p-sulfonatocalix[4]arene [3] was evaluated. Both molecules exhibit a host and guest type complexation. pH, complex stoichiometry and binding constant were determined by UV-Vis and FT-IR spectroscopy. The maximum complexation of 3 with ibuprofen occurs at pH 2. Stability constant values [9.897] show that there is favorable complex formed due to vital role of p-sulfonatocalix[4]arene, while the thermodynamic parameters, i.e. [Delta]G, [Delta]H and [Delta]S have been found as -24.09 KJ/mol, 0.012 KJ/mol and 0.12 KJ/mol. K, respectively. The results show that 3 has efficiency to carry the drug at particular conditions and can be used for drug delivery as a carrier

Phenolic compounds and antioxidant activity of Calligonum polygonoides stem and buds

In the present study we demonstrate the identification of phenolic compounds and the phenolic contents of the methanol extracts from stem and buds of Calligonum polygonoides with antioxidant activity. Eleven and nine phenolic compounds were identified and quantified from stem and buds, respectively by high-performance liquid chromatography [HPLC]. p-Coumaric acid was predominant in stem and gallic acid in buds. In general, the samples with the highest phenolic contents had the highest antioxidant activities. Stem and buds sparked attention due to their high phenolic contents and antioxidant activities. The Results from present study reveal that the C. polygonoides could be considered as a promising source of antioxidant phytochemicals

Urgent aortic valve replacement in severe aortic stenosis with severe left ventricular dysfunction and severe pulmonary hypertension: a perioperative multidisciplinary management approach

Severe aortic stenosis [AS] with reduced left ventricular systolic function and pulmonary artery hypertension [PH] is associated with poor outcome if remained untreated We report a case report of a 62 years old male patient weighing 69 kg had progressive dyspnea for 5 years and was diagnosed cardiac patient, and was scheduled for an urgent aortic valve replacement. He had severely reduced left ventricular [LV] function and severe pulmonary hypertension. The patient was put on bypass with special emphasis on myocardial protection. Tissue valve was placed and patient was successfully put off cardiopulmonary bypass on high inotrope score, which was tapered after some time. The patient was shifted to CICU after chest closure and was extubated on fast track mode. The patient was followed up for three months showing improvement in symptoms and LV function The objective of reporting the case is to highlight the role of multidisciplinary integrated approach in the perioperative period for best patient outcome

Maternal and child health services in the context of the ebola virus disease: health care workers' knowledge, attitudes and practices in rural Guinea

The objective of this study was to document maternal and child health care workers' knowledge, attitudes and practices on service delivery before, during and after the 2014 EVD outbreak in rural Guinea. We conducted a descriptive cross-sectional study in ten health districts between October and December 2015, using a standardized self-administered questionnaire. Overall 299 CHWs (94% response rate) participated in the study, including nurses/health technicians (49%), midwives (23%), managers (16%) and physicians (12%). Prior to the EVD outbreak, 87% of CHWs directly engaged in managing febrile cases within the facility, while the majority (89% and 63%) referred such cases to another facility and/or EVD treatment centre during and after the EVD outbreak, respectively. Compared to the period before the EVD outbreak when approximately half of CHWs (49%) reported systematically measuring body temperature prior to providing any care to patients, most CHWs reported doing so during (98%) and after the EVD outbreak (88%). The main challenges encountered were the lack of capacity to screen for EVD cases within the facility (39%) and the lack of relevant equipment (10%). The majority (91%) of HCWs reported a decrease in the use of services during the EVD outbreak while an increase was reported by 72% of respondents in the period following the EVD outbreak. Infection prevention and control measures established during the EVD outbreak have substantially improved self-reported provider practices for maternal and child health services in rural Guinea. However, more efforts are needed to maintain and sustain the gain achieved

Immunopotentiality of Ayurvedic polyherbal formulations “Saribadi” and “Anantamul Salsa” with augmentation of IgM production and lymphocytes proliferation: A preliminary study

Objective To assess the immunopotentiality of Ayurvedic polyherbal preparations, “Saribadi” and “Anantamul Salsa”. Methods Freshly prepared BALB/c mice splenocytes were cultured with “Saribadi” or “Anantamul Salsa” treatment [doses of 0.25%, 0.50%, 0.75%, 1.00%, 1.50%, 2.00%, 3.00% and 4.00% (v/v)] at 37 °C for 5 days. The immunoglobulin M (IgM) production and lymphocytes proliferation were determined by ELISA and MTT methods, respectively. Endotoxin contamination was assessed by treating the preparations with polymyxin B. Results The doses of “Saribadi” [0.25%, 0.50%, 0.75% and 1.00% (v/v)] significantly increased IgM productions (0.966, 0.728, 0.695 and 0.615 μg/mL vs. control 0.265 μg/mL) and lymphocytes proliferation [absorbance 0.311, 0.394, 0.372 and 0.334 optical density (OD) vs. control 0.162 OD]. Similarly, the doses of “Anantamul Salsa” [0.50%, 0.75%, 1.00% and 1.50% (v/v)] promoted IgM productions (0.933, 0.919, 0.917 and 0.892 μg/mL vs. control 0.502 μg/mL) and the doses of “Anantamul Salsa” [0.50%, 0.75%, 1.00%, 1.50%, 2.00%, and 3.00% (v/v)] stimulated lymphocytes proliferation (absorbance 0.395, 0.326, 0.440, 0.398, 0.452 and 0.355 OD vs. control 0.199 OD). The activity of “Saribadi” and “Anantamul Salsa” was not retarded by the treatment of preparations with polymyxin B. Conclusions Immunomodulatory activity of “Saribadi” and “Anantamul Salsa” was unveiled for the first time. “Saribadi” and “Anantamul Salsa” possess immunostimulating potential acting through the induction of lymphocyte proliferation and IgM production. These preparations may be useful in strengthening immune responses. However, further cellular and in vivo studies are required.

Cardiac surgery benchmarking: a quality improvement initiative

Background: Benchmarking programs help in reviewing and validating clinical practice and improves quality of care

Methodology: Fifteen accredited hospitals participated in International cardiac surgery benchmarking [ICSB] project from eight different countries including ours, Aga Khan University Hospital, a "clinical data coordinator" was trained to facilitate data collection, verification and eventual submission. The data was collected prospectively for preoperative characteristics, intraoperative variables and postoperative outcomes. Onsite data validation was also performed by a JCI representative for the accuracy of data. Data analyzed and reported on six quarters starting from October, 2009 to March, 2011

Results: A total of 4761 isolated CABG including 474 from our hospital entered into ICSB. The postoperative complication rate for ICSB and our hospital were calculated showing a higher rate of reopening [2.5 vs. 1.7%], higher postop renal dysfunction [5% vs. 1%] and a higher RBC transfusion [61 vs. 36%] but the incidence of stroke, myocardial infarction and deep sternal wound infection were low at our hospital. Risk factors that predict surgical death for CABG in this model are very similar to those used in New York state hospitals. The overall risk adjusted 30-day mortality was 3.4% at our hospital compared to 1.9% for ICSB

Conclusion: By benchmarking program our practice and data collection methodology has been reviewed and validated. Feedback will serve as regulatory function leading towards self-assessments to improve quality of care

Intraperitoneal Drainage Under Local Anaesthesia In Patients Of Perforation Peritonitis Before Definitive Management: Is It Justified?

Introduction: Perforation peritonitis is one of the most frequently encounter surgical emergency around the world. In spite of advances in diagnosis, antimicrobial therapy, surgery, it remains a fatal affliction with high mortality rate. This high mortality rate makes way for innovation in techniques in addition to the persisting knowledge for a better outcome. Aims: A pilot study was conducted, to evaluate the efficacy of intraperitoneal drainage in patients of perforation peritonitis during the resuscitation period before definitive surgical treatment. Methods: This was a prospective control study, conducted on the patients of perforation peritonitis with gastro-intestinal perforation for a period of 2 years w.e.f. January, 2011 to November 2012. 100 patients were included in this study and were divided into two groups (50 each). Group I- patient with preoperative intraperitoneal drainage under local anaesthesia, group II- patient without preoperative intraperitoneal drainage, before definitive surgery. Results: The overall morbidity and mortality of the patients in group-I were comparable with those in group-II Conclusion: Intraperitoneal drainage under local anaesthesia, in patients of gastrointestinal perforation peritonitis seems to be effective in decreasing morbidity and mortality.

Surviving shot through the heart: management in two cases

Penetrating cardiac injuries after gunshot are usually fatal and are very challenging to manage for surgeons even in fully-equipped centres. Such injuries can cause ventricular septal defect [VSD] or cardiac tamponade depending upon the distance, direction and velocity of the bullet. Stable patients can be subjected to investigations like computed tomography [CT] to avoid unnecessary intervention, but unstable patients should be rushed to the operating room. We discuss management in two cases of traversing bullet injury to the heart. In the first case, traumatic VSD was significant, requiring closure on cardiopulmonary bypass [CPB] along with repair of right and left ventricular injury. In the second case, only the repair of right and left ventricles was performed without CPB. They both had traversing bullet injury through the heart

Clinical evaluation of unani ear drops herbotic for earache

An ear infection [acute otitis media] is most often a bacterial or viral infection that affects the middle ear. Children as compared to adults are more are prone to infections. A study has been conducted on 200 patients with herbal medicine Herbotic and allopathic drug Ofloxacin for the treatment of otitis media. The efficacy of test and control drug was monitored before and after treatment and diagnosed on clinical history, clinical presentation and pathological investigation. This study was a case control, multicenter, prospective randomized authentic allopathic controlled, two arm parallel group clinical trial The data on clinical proforma was gathered between April 2014-March 2015 and subjected to statistical analysis. From the statistical results it was concluded that Herbotic and Ofloxacin are equally effective for the treatment of earache, effect being confirmed by physicians and patients alike

Stabilization of open femoral fractures with the sign intramedullary nail: treatment protocol and early clinical results

Objective: to evaluate the effectiveness of SIGN-Nail [Surgical Implant Generation Network[registered sign]] for the treatment of open femoral fractures

Study design: case-Series

Place and Duration of study: department of Orthopaedics and Traumatology, Lady Reading Hospital Peshawar, from September 2010 to June 2012

Methodology: patients with open fractures of femur were included in the study. Femoral IM nailing was done using SIGN [Surgical Implant Generation Network[registered sign]] nail with standard SIGN-technique with hand reaming without using bone-grafting or image intensifier. Patients were evaluated for infection, radiographic parameters, range of movements, time to weight bearing [partial and complete] and complications or revision surgery, if needed

Results: there were a total of twenty-two [21 male and 1 female] patients in this series. The mechanism of injury was gunshot in 12, bomb blast in 4 and road traffic accident in 6 cases. Seventeen [77%] patients had Gustilo Type IIIa fracture, 3 [14%] patients had Type IIIb fracture and two [9%] patients had Type II fracture. The average time from injury to surgery was 13.8 days [range 2 to 35 days]. Two patients developed surgical site infection. The frequency of infection in Type IIIa fractures was 5.8% [1/17] and in Type IIIb fractures 33% [1/3]. In follow up all patients had greater than 90 degrees flexion at the knee joint. Twenty patients [91%] were full weight bearing at 4 months. Two revision surgeries were done. Bone grafting plus exchange nailing was done in both the patients to achieve union

Conclusion: use of SIGN-nail is an effective treatment modality in treating open fractures of femur with excellent fracture healing

A study on the use of abbreviations among doctors and nurses in the medical department of a tertiary hospital in Malaysia

Introduction: Misinterpretation of abbreviations by healthcare professionals has been reported to compromise patient safety. This study was done to determine the prevalence of abbreviations usage among medical doctors and nurses and their ability to interpret commonly used abbreviations in medical practice. Methods: Seventy-seven medical doctors and eighty nurses answered a self-administered questionnaire designed to capture demographic data and information regarding abbreviation use in medical practice. Comparisons were made between doctors and nurses with regards to frequency and reasons for using abbreviations; from where abbreviations were learned; frequency of encountering abbreviations in medical practice; prevalence of medical errors due to misinterpretation of abbreviations; and their ability to correctly interpret commonly used abbreviations. Results: The use of abbreviations was highly prevalent among doctors and nurses. Time saving, avoidance of writing sentences in full and convenience, were the main reasons for using abbreviations. Doctors learned abbreviations from fellow doctors while nurses learned from fellow nurses and doctors. More doctors than nurses reported encountering abbreviations. Both groups reported no difficulties in interpreting abbreviations although nurses reported often resorting to guesswork. Both groups felt abbreviations were necessary and an acceptable part of work. Doctors outperformed nurses in correctly interpreting commonly used standard and non-standard abbreviations. Conclusion: The use of standard and non-standard abbreviation in clinical practice by doctors and nurses was highly prevalent. Significant variability in interpretation of abbreviations exists between doctors and nurses.

A comparative study on how medical students learn about the use of abbreviations in medical practice

Background: Misinterpretation of abbreviations by healthcare workers has been reported to compromise patient safety. Medical students are future doctors. We explored how early medical students acquired the practice of using abbreviations, and their ability to interpret commonly used abbreviations in medical practice. Method: Eighty junior and 74 senior medical students were surveyed using a self-administered questionnaire designed to capture demographic data; frequency and reasons for using abbreviations; from where abbreviations were learned; frequency of encountering abbreviations in medical practice; prevalence of mishaps due to misinterpretation; and the ability of students to correctly interpret commonly used abbreviations. Comparisons were made between senior and junior medical students. Results: Abbreviation use was highly prevalent among junior and senior medical students. They acquired the habit mainly from the clinical notes of doctors in the hospital. They used abbreviations mainly to save time, space and avoid writing in full sentences. The students experienced difficulties, frustrations and often resorted to guesswork when interpreting abbreviations; with junior students experiencing these more than senior students. The latter were better at interpreting standard and nonstandard abbreviations. Nevertheless, the students felt the use of abbreviations was necessary and acceptable. Only a few students reported encountering mishaps in patient management as a result of misinterpretation of abbreviations. Conclusion: Medical students acquired the habit of using abbreviations early in their training. Senior students knew more and correctly interpreted more standard and non-standard abbreviations compared to junior students. Medical students should be taught to use standard abbreviations only.

Acute Postpartum Pulmonary Edema in a 32-Year-Old Woman Five Days after Cesarean Delivery.

Acute dyspnea after pregnancy is a rare presentation, and a number of important conditions may accompany it. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary edema are some of the potential causes that must be considered. The percentage of pregnancies that are complicated by acute pulmonary edema has been estimated 0.08%. The most common contributing factors include the administration of tocolytic agents, underlying cardiac disease, iatrogenic fluid overload and preeclampsia. Here we report a case of 32- year-old woman of 5th postpartum day following lower uterine cesarean section with acute dyspnea from her first pregnancy who was admitted in coronary care unit with history of one episode of raised blood pressure 160/90 mm Hg and cough on 1st postoperative day. Clinical examination and relevant investigations explored that it was a case of bilateral pulmonary edema. Patient was kept in ventilator and was treated with nitroglycerine (GTN), frusemide and ACE inhibitor. After diuresis, considerable improvement was observed in her respiratory status. From the 4th day, the patient became hemodynamically stable and was weaned off the ventilator. After five days, all the biochemical parameters became normal and she had no dyspnea.

efficacy of stress inoculation training upon the happiness rate and life's quality of old persons

Introduction: The old age is one of the inevitable period of each person's life that correct cognition and reaction toward it can improve [alter] the life's quality. The good life's quality is related to happiness and stress decreasing therefore, the aim of the present study was the determining of the efficacy of stress inoculation training upon the happiness rate and life's quality of old [aged] persons of Mazandaran

Materials and Methods: method research Quasi-experimental and design of pre-test - post-test control group was. the statistical universe of the present study was consist of the all old persons of Mazandaran [223 persons] that lived at boarding - house institutions. after executing the happiness and life's quality questionnaires, 40 person's having the least happiness rate and life's quality, were selected randomly, put into two groups [experimental and control]. In order to gather the data, oxford happiness questionnaire and life quality questionnaire of worldly hygiene foundation were used the instruction program of stress inoculation was done in experiment group at 8 sessions every session, including 60 minutes for two month and After completion of training, two months later both groups [experimental and control] happiness and quality of life questionnaires in the same situation and the same were completed and evaluated

Resulting: The results gained from the study using covariance analysis revealed that the stress inoculation training was meaningful [significant] upon happiness and life's quality for experimental group

Conclusion: therefore, according to the results, the stress inoculation is effective upon the increasing of happiness and life's quality of old [aged] persons

Comparison of the impact of powerpoint and chalkboard in undergraduate medical teaching: an evidence based study

To compare the impact of the PowerPoint multimedia presentation and chalkboard in teaching by assessing the knowledge based on the marks obtained. Cross-sectional study. Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, from December 2007 - June 2009. Three-hundred male medical students were divided into three groups and a selected content-based lecture in physiology was delivered. For one group lecture was delivered using PowerPoint presentation, for second group using chalkboard and for third group the lecture was delivered by using both PowerPoint as well as chalkboard. Single-best Multiple Choice Questions [MCQs] paper was used for assessing the knowledge gained. The same exercise was repeated in another medical science school for the confirmation of validity and reliability of the results. Students who attended the class on both PowerPoint and chalkboard obtained significantly higher score in single best MCQ examination compared to those students who attended the same content based lecture on the PowerPoint or chalkboard alone [p = 0.05]. The integrated [PowerPoint and chalkboard] method of teaching was found more suitable tool of teaching and learning than PowerPoint or chalkboard alone