Comparison of serum calcium, serum magnesium, serum sodium and serum potassium in patients of preeclampsia and normal pregnant women-a cross-sectional study

Background: Preeclampsia is a clinical condition in which the patient is suffering from hypertension and proteinuria, which may be associated with pathological edema. There are multiple systems involved in pre-eclampsia which is the main culprit to complicate the pregnancy. In developing nations, approximately 4–18% of pregnancies are complicated by preeclampsia which is a major cause of morbidity and mortality globally. It does not affect pregnant females only, but may be life-threatening for growing fetuses too. If we consider the mortality in all pregnant females, about 10–15% of maternal deaths are due to pre-eclampsia. Aims and Objectives: The main objective of this study is to compare the serum calcium, magnesium, sodium and potassium level in preeclampsia patients and normal pregnant women. Materials and Methods: After taking written consent from the patients, randomly 50 pregnant females diagnosed by a gynecologist as suffering from preeclampsia were selected and for the control group 50 pregnant females who came for routine checkups were selected. 5 ml of blood was collected in the clot activator tube. The samples were analyzed for serum calcium, magnesium, sodium, and potassium on a fully automated biochemistry analyzer ”Erba XL 640” in HiTech, clinical biochemistry laboratory, B.J medical college, Ahmedabad. Results: The result showed a decreased level of serum calcium, magnesium, sodium, and potassium in the study group compared to the control group. The S. calcium level was (7.624 ± 0.84) and (8.52 ± 0.80) mg/dl in the study and control groups respectively. The S. magnesium level in the study and control were (1.47 ± 0.25) and (1.79 ± 0.18) mg/dl, respectively. S. sodium levels were (131.46 ± 6.96) and (139.92±7.86) mEq/L in the study and control groups, respectively. And the level of S. potassium in the study and control groups was (3.39 ± 0.52) and (3.67 ± 0.38) mEq/L, respectively. All the parameter values are significantly lower in a study group in comparison to control group patients (P < 0.001). Conclusion: From our study, we have concluded that the serum level of some parameters such as calcium, magnesium, sodium, and potassium was significantly decreased in patients suffering from preeclampsia. We can also conclude that these parameters can be used as a biomarker for the diagnosis of preeclampsia.

Study of success rate of vaginal birth after cesarean section in relation to FLAMM score

Background: Globally, there is an increased trend of cesarean section (CS). Repeat CS is associated with various complications. Successful vaginal birth after caesarean section (VBAC) helps to decrease CS rate and its associated morbidities. Practice of protocol of applying FLAMM score and monitoring by partogram reduces the rate of cesarean section in the previous one lower segment cesarean section patient. Aims and Objectives: The present study is conducted to evaluate the impact of FLAMM scoring for vaginal birth after CS on obstetrics and perinatal outcome in case of the previous one lower segment CS delivery. Materials and Methods: The prospective and observational study was conducted in Obstetrics and Gynaecology department of one of the teaching institutes of Ahmedabad over a period of 1 year. Total 100 pregnant women from labour room with history of the previous one CS, who gave consent for trial of labor after the previous cesarean (TOLAC) were selected and FLAMM score applied on them. Study participants were divided in two groups according to outcome. Group A: Successful TOLAC and Group B: Failed TOLAC. Maternal and neonatal outcome was measured in both groups. Results: Out of 98 patients <40 years, 74.48% had VBAC and 25% had failed TOLAC and two patients were >40 years of age had VBAC. Out of 94 patients with favorable FLAMM’s score, 79% (n = 75) had VBAC and 100% (n = 6) with unfavorable FLAMM had CS. Conclusion: Careful patient selection for TOLAC is of utmost priority to increase success rate and decrease complications. FLAMM scoring system is a very efficient guiding tool for this. By applying FLAMM score, we increase success rate of TOLAC and thereby decrease CS rate in case of previous CS.

Practice of handling livestock and its determinant among livestock handlers of Banaskantha district of Gujarat – A cross-sectional study

Background: As per Livestock Census 2019, Banaskantha district shares 9.4% of livestock of Gujarat. About 80–83% of farmers practicing dairy farming in Banaskantha district have low to medium level of knowledge about zoonotic diseases. The practice of handling livestock and its determinants among different populations of Banaskantha district is yet to be studied. Aim and Objectives: The aim of the study was to assess level of awareness and hygienic practice of handling livestock and its determinants among the livestock handlers of Banaskantha district. Materials and Methods: This cross-sectional study was conducted among 172 livestock handlers of nine villages of Banaskantha district. The questionnaire included demographics, knowledge about zoonotic diseases, and practices for handling livestock. One score was given for correct knowledge and practice and “zero” score was given for incorrect knowledge and practice. There were maximum 20 scores for knowledge and practice each. Results: Livestock handlers were well aware of rabies but knowledge of other zoonotic disease was very less. Average knowledge and practice score was 12.76 and 12.39 out of 20, respectively. About 1/3rd of livestock handlers (33.1%) were following hygienic practice very well. Practice score was higher in male livestock handlers and those who received training and livestock handlers with more number of animals. Conclusion: Practice of use of gloves, not using milk during treatment of cattle, testing of animal before purchase, and safe disposal of infected material were very less prevalent. Training should be focused on conveying the importance of correct practicing especially to female livestock handlers with few numbers of animals.

Comparison of efficacy of two topical drug therapy of acne vulgaris – 1% clindamycin versus 5% dapsone: A split face comparative study

Background: Acne vulgaris is common skin problem for adolescents and young adults. Topical clindamycin is an established treatment modality effective in mild-to-moderate acne. Dapsone has been used orally for the treatment of acne but used less due to its systemic side effects. Topical dapsone may offer new treatment option for acne vulgaris due to its dual anti-inflammatory and anti-microbial effect. Aim and Objective: The aim of the study was to compare the efficacy of 1% clindamycin gel with 5% dapsone gel in the patient of Grade II acne vulgaris. Materials and Methods: It was a prospective interventional study with split face comparative study design. Each patient was received a pair of labeled tubes of medication – Right (Rt) side containing clindamycin 1% and left (Lt) side containing dapsone gel 5%. The assessment was done by calculating the change from baseline, after 4, 8, and 12 weeks of the total lesion count and both inflammatory and non-inflammatory lesions using repeated measures analysis of variance. Results: A total of 40 patients were included in the study. Both inflammatory and non-inflammatory lesion count reduce significantly at the end of 4, 8, and 12 weeks on both side (P < 0.05). Mean reduction in total count of lesions after 12 weeks of therapy by dapsone 5% was 5.4 ± 5.05 (50.0%), while by clindamycin 1% gel was 5.0 ± 2.76 (50.5%). Conclusion: Dapsone 5% gel monotherapy and clindamycin 1% gel monotherapy have almost equal efficacy when compared after 12 weeks of therapy, but dapsone 5% gel therapy is slightly better effect on inflammatory lesions than clindamycin 1% gel.

Treatment Of Bilateral Gingival Recession Using Coronally Advanced Flap And Amniotic Membrane On One Side And Coronally Advanced Flap And PRF Membrane On Other Side: A Case Report

Gingival Recession is a common, complex, and unpleasant clinical condition. It is more commonly associated with root hypersensitivity, impaired esthetics and root caries. Successful treatment outcome becomes challenging in such cases. Coronally advanced flap for rootcoverage is most commonly used technique. Combination of biological membranes derived from human body itself along with coronally advanced flap yields better results. This case report describe s a case of bilateral Class I gingival recession treated with amniotic membrane on one sideand PRF membrane along with Coronally advanced flap on other side.

Development Of Water Transplant Based Single Core Osmotic Pump For Fluvoxamine Maleate Employing Quality By Design Principles

The present study draw a bead on preparing single core osmotic pump with improved water transplant by employing Quality by Design (QbD) principles to achieve zero order drug release for prolonged period of time. QbD principles were employed in preparing single core osmotic pump by deriving quality target product profile (QTPP), critical quality attributes (CQA) followed by risk assessment using ishikawa diagram and risk estimation matrix. Box-Behnken Design was employed to study the effect of various independent parameters like concentration of Natrosol 250 HX (X1) and concentration of Xylitab (X2) no. of orifice (X3), on various dependent parameters like lag time (Y1) and time required for release 25%, 50%, 75% and 100% drug (Y2, Y3, Y4 and Y5). A controlled space was designed where each criteria or CQA was satisfied. Optimized formulation was further characterized for its efficiency. The results of design suggest the suitability of design for optimization of single core osmotic pump. In the initial period, drug release was driven by no. of orifice which on later stage depends on concentration of swellable polymer and concentration of osmogen. Optimized design was validated by preparing check point batch having less than 5% predicted error. Model fitting with drug release kinetics showed that optimized single core osmotic pump released drug in zero order. Stability data suggested that prepared formulation was stable for 3 month period without significant changes in the CQA. Single core osmotic pump using water transplant was successfully developed for a poorly soluble drug using QbD principles.

Conservation of Indigenous Cattle Breed

India, one of the twelve mega biodiversity countries in the world, is home to large diversified cattle genetic resources, having 190.9 M cattle and so far 43 registered native cattle breeds. These cattle breeds are specially adapted to different agro-climatic conditions of India and their genetic diversity is due to the process of domestication over the centuries. There is decrease of 4.10% in cattle population and 3.14% in cattle genetic resources of India as compared to the quinquennial livestock census. The exotic / crossbred population has been increased by 20.18% during the period of last census while population of indigenous cattle has been decreased by 8.94% during the same duration. The reasons for depletion of native breeds includes crossbreeding with exotic breeds, economically less viable, loosing utility, reduction in herd size and the large scale mechanization of agricultural operation. The native breeds need to be conserved for genetic insurance in future, scientific study, as a part of our ecosystem, cultural and ethical requirements and for energy sources in future. The indigenous breeds of cattle posses various unique characteristics such as the presence of unique genetic variation in HSP70 gene family, carry a ‘thermometer gene’ and presence of A2 allelic variant in cow milk, which makes them well adapted to the tropical climate. The conservation includes the preservation along with up-gradation (improvement) of the genetic potential and management of a breed for use in future. The effective management of indigenous cattle resources includes identification, characterization, evaluation, documentation and conservation. The future strategy should be to combine genetic improvement and conservation. Establishment of regional gene banks and people’s participation by involving breeders, communities, gaushalas, NGOs and other relevant stakeholders in conservation programs. For more effective conservation measures, proper coordination and integration among various agencies (ICAR, SAHD, SAUs, SVUs and Research Institutes) is highly needed. “National Consortium of Partners’ comprising different stakeholders should be formulated for conservation of indigenous breed resources with a holistic approach.

An observational study to compare the effect of pregabalin with pregabalin and dexamethasone for post operative analgesia in orthopedic surgeries under spinal anesthesia.

Background: Post-operative pain is a troublesome problem after orthopedic surgeries. Pregabalin acts as a synthetic analog of the neurotransmitter gamma-aminobutyric acid (GABA) with analgesic, anticonvulsant, and anxiolytic effects. Pregabalin is effective in controlling postoperative pain and in decreasing analgesic consumption. Glucocorticoids have strong anti-inflammatory effects and exhibit antiemetic and analgesic efficacy. Dexamethasone increases the efficacy of analgesia when given alone or in combination with other drugs. Material and methods: The aim was to determine the efficiency of pregabalin alone and the combination with dexamethasone to the orthopedic operations regarding postoperative pain control and analgesic consumption. It was an observational study in which participants were allocated in two groups of 30 each. In group P – Tab Pregabalin: 300 mg and in group D –Tab Pregabalin: 300 mg + Inj. Dexamethasone: 16 mg IV was given. Pain was assessed by Visual analogue scale at 0, 2, 4, 6, 12, 24 hours post-operatively. Any patient with the visual analogue scale more than 3 were given Inj. diclofenac 1.5 mg/kg IM. Time since spinal anesthesia to the first dose of analgesic and total dose of analgesic in first 24 hours was recorded. P<0.05 was considered statistically significant. Agrawal R, Mehta M, Patel J. An observational study to compare the effect of pregabalin with pregabalin and dexamethasone for post operative analgesia in orthopedic surgeries under spinal anesthesia. IAIM, 2016; 3(4): 146-155. Page 147 Results: Rescue analgesia was not required only in 1 (3.3%) case in Group D. Those who required analgesia, maximum proportion of patients required two doses in Group P (n=17, 56.6 %) while in Group D the max proportion of patients required one dose (n=15; 50.0%). Statistically, the number of patients requiring more number of rescue analgesia was significantly higher in Group P as compared to Group D (p<0.001). Conclusion: Combined administration of pregabalin and dexamethasone conferred analgesic benefits superior to those of pregabalin alone, by reducing the requirement of rescue analgesia and side effects.

Infantile Cardiac Rhabdomyoma–Pearls Inside the Heart.

Cardiac rhabdomyoma is the most common primary pediatric tumor of the heart. We report a 1- month old male infant who presented to our institute for routine cardiac evaluation since he was diagnosed to have a cardiac mass in the right ventricle (RV) in utero. After he was born, an echocardiogram showed two large cardiac masses occupying entire RV cavity and origin of right ventricular outflow tract (RVOT). Although our patient was asymptomatic, surgical removal of these two masses was done due to its proximity to RVOT and also because it was almost obliterating the entire RV cavity.

Emerging antimicrobial resistance pattern of Helicobacter pylori in central Gujarat.

Background: Antimicrobial resistance is a growing problem in H. pylori treatment. The study was intended to evaluate the prevalence of resistance amongst 80 H.pylori isolates cultured from biopsy taken during routine endoscopies in 2008-2011. Materials and Methods: 855 gastro duodenal biopsies were collected and cultured on H.pylori selective medium (containing Brucella agar and Columbia agar (Hi media), with Skirrow’s supplement (antibiotic supplement) and 7% human blood cells). H.pylori was isolated from 80 specimens. The antimicrobial susceptibility of H.pylori isolates was carried out by the Kirby Bauer technique against metronidazole (5 μg), clarithromycin (15 μg), ciprofloxacin (5 μg), amoxicillin (10 μg), tetracycline (30 μg), erythromycin (15 μg), levofloxacin (5 μg), and furazolidone (50 μg) (Sigma- Aldrich, MO). Results: 83.8% isolates were resistant to metronidazole, 58.8% were resistant to Clarithromycin 72.5% were resistant to Amoxicillin, 50% to Ciprofloxacin and 53.8% to tetracycline. furazolidone, erythromycin and Levofloxacin showed only 13.8% resistance to H.pylori. Multi drug resistance with metronidazole+ clarithromycin+ tetracycline was 85%. For all the drugs Antimicrobial resistance rate was found higher in males compare to females. Metronidazole and amoxicillin resistance was found noteworthy in patients with duodenal ulcer (p = 0.018), gastritis (P = 0.00), and in reflux esophagitis (P = 0.00). clarithromycin and tetracycline resistance was suggestively linked with duodenitis (P = 0.018), while furazolidone, erythromycin and levofloxacin showed excellent sensitivity in patients with duodenitis (P value- 0.018), gastritis (P= 0.00) and reflux esophagitis (P = 0.00). Resistance with metronidazole (P = 0.481), clarithromycin (P= 0.261), amoxicillin (P = 0.276), tetracycline (P = 0.356), ciprofloxacin (P = 0.164) was not correlated well with Age-group and Gender of the patients. Conclusion: A very high percentage of patients were infected with metronidazole and clarithromycin resistant strains. The use of antibiotics for other indications seems to be the major risk factor for the development of primary resistance. High incidence should alarm the gastroenterologist while prescribing the eradication regimen.

A study of venous drainage of thyroid gland in 50 cadavers.

Introduction: The thyroid gland is drain by mainly three vein, superior thyroid vein, middle thyroid vein, inferior thyroid vein. Some time fourth thyroid vein of kocher is also present. Material and Methods: Anatomy of venous drainage of thyroid gland was studied in 50 formalin embalmed cadaver, aged between 60 to 80 years. Dissection method was use for this study. Result and Observation: Middle thyroid vein found to be absent in 12 cases. No abnormality found in superior thyroid vein and inferior thyroid vein. Termination of all veins was traced. Thyroid vein of kocher was not found in any cases. Conclusion: A better understanding of the anatomic variability in superior thyroid vein, middle thyroid vein and inferior thyroid vein may be useful not only to minimize the risk of bleeding, but it also can help to perform a more accurate dissection with the goal of preserving the laryngeal nerves and parathyroid glands, especially because of its location and relationships with other adjacent structures.

A Study of Metabolic Syndrome and its Components in Type 2 Diabetes Mellitus Subjects and their Asymptomatic First-degree Relatives.

Objectives: To study clinical profile of metabolic syndrome and its individual components in type 2 diabetes mellitus subjects and their asymptomatic first-degree relatives. To identify risk factors of glucose intolerance. Material and methods: Randomly selected type 2 diabetes mellitus (T2DM) subjects age >40 years (n = 20, 10 males, 10 females) and their asymptomatic first-degree relatives age >30 years (excluding pregnant women) (n = 80; 46 males; 34 females) subjected to regression analysis with reference to components of metabolic syndrome (waist circumference, serum triglyceride, serum high-density lipoprotein (HDL), fasting plasma glucose, hypertension) and other variables. Student t-test was used for comparison of results. Results: Among T2DM subjects: Ninety percent were hypertensive, 85% had low HDL, 30% males and 80% females had central obesity, 85% had metabolic syndrome. Among asymptomatic first-degree relatives of T2DM subjects: 48.7% had metabolic syndrome; hypertension, low HDL, central obesity, impaired glucose tolerance, T2DM were present in 52.5%, 68.7%, 48.7%, 26.2%, 35%, respectively. In subjects with abnormal glucose level (n = 49) 59.18% subjects and in subjects with normal glucose level (n = 31) 32.25% met the criteria for metabolic syndrome (p = 0.023). Impaired fasting glucose, increased hip circumference and low HDL independently determined two hours glycemia value in OGTT. (R2 = 0.7; p = 0.001). Conclusion: In T2DM and their asymptomatic first-degree relatives, hypertension and low HDL were commonest components of metabolic syndrome, females were more obese. Glucose intolerance was significantly associated with other components of metabolic syndrome. Impaired fasting glucose, increased hip circumference and low HDL levels were risk factors for glucose intolerance.

Follicular Ameloblastoma with emphasis on correlation between pathological findings and clinical behaviour.

Ameloblastoma constitutes a homogenous group of neoplasm with mandible as a common site of occurrence in head and neck region. Histologically it appears in different patterns with follicular and plexiform as common one. We hereby report a case of 47 year old male with emphasis on correlation between histological findings and clinical behaviour of lesion. Regular follow up of patients should be carried out to predict the behaviour of this tumour and to ascertain histopathologic correlation to biological behaviour of the tumour.

Forensic odontology in the era of computer and technology.

We are living in the era of science and technology and it have infused with many aspects of our everyday life. With the advent of newer technologies the criminals have made full use of it which sometimes facade a challenging task to investigators such as forensic experts to catch the crime. This paper will discuss the need for computer forensics and application of technologies to be practiced in an effective and legal way, formalize basic technical issues, and point to references for further reading. It promotes the idea that the proficient practice of computer forensics and awareness of applicable laws is essential for today’s networked organizations.

A study of inter-pedicular distances of the lumbar vertebrae measured in dried vertebrae in Gujarat.

The reduced inter-pedicular distance is one of the common causes of primary narrowing of the spinal canal. Stenosis of the spinal canal due to decreased inter-pedicular distance is to the best of our knowledge, virtually unexplored so we under took this study of inter-pedicular distance. Eisestein S measured inter-pedicular distance in Caucasoid, Zulu Negroid and Sotho Negroid population which is compared with data of present study. Methods: All measurements were made by using Electronic Digital Vernier Calipers. Transverse diameter of the lumbar spinal canal was measured as the minimum distance between the medial surfaces of the pedicles of a given vertebra (Inter-pedicular distance. Results & Observation: Inter-pedicular distances of lumbar vertebral canal at levels L1 to L5 was measured in dry vertebrae of 63 subjects (32 male, 31 female) from Gujarat of age group 35 to 80 yrs. Mean transverse diameter (Inter-pedicular distance) is minimum at L1 (22.6 mm in male and 21.3 mm in female) and maximum at L5 (27.0 mm in male and 26.4 mm in female) showing a gradual increase from level L1 to L5. The inter-pedicular distance increased steadily from L1 to L5 in all populations in both sexes. The Gujarati population has greater IPDs at all level from L1 to L5 than that of Zulu Negroid and Sotho Negroid. But IPDs in Gujaratis are lower at L1, & L2 in male and L1, L2 & L3 in female and greater at L3, L4 & L5 in male and L4 & L5 in female than that of Caucasoid. Conclusions: A comparison between the present data and the data published data on inter-pedicular distance at lumbar levels of other populations also shows that there are marked differences between the mean values reported for the population of different geographic areas. The present study confirms that there is ethnic as well as racial variation in the size of the lumbar vertebral canal, thus, emphasizing the need to have normal values and ranges for the transverse diameter of the canal for different populations.

New Spectrophotometric Methods for Simultaneous Determination of Amlodipine besylate and Lisinopril in Tablet Dosage Forms.

Two simple, accurate, precise, reproducible, requiring no prior separation and economical procedures for simultaneous estimation of Amlodipine besylate (AML) and Lisinopril (LIS) in tablet dosage form have been developed. First method is simultaneous equation method; in this method 360.0 nm and 248.0 nm were selected to measure the absorbance of drugs at both wavelengths. The second method is Q-value analysis based on measurement of absorptivity at 300.0 nm (as an iso-absorptive point) and 360.0 nm. AMD and LIS at maximum wavelength of AML, 360.0 nm and at isoabsorptive point 300.0 nm shows linearity in a concentration range of 5- 40 μg/mL. Recovery studies range from >99.82% for AMD and >98.09% for LIS in case of simultaneous equation method and >100% for AMD and >98.45% for LIS in case of Q-analysis method confirming the accuracy of the proposed method. The proposed methods are recommended for routine analysis since it is rapid, simple, accurate and also sensitive and specific (no heating and no organic solvent extraction is required).

Mechanism of vasorelaxant activity of a fraction of root extract of Sesamum indicum Linn.

The petroleum ether soluble fraction (SIPE) of the root extract of S. indicum was evaluated for the vasorelaxant activity using isolated rat aorta. SIPE up to 180 microg/ml concentration significantly inhibited phenylephrine- and KCl-induced contraction to the extent of 98.13 +/- 6.37 and 70.19 +/- 3.43% respectively in isolated rat aorta in a concentration dependent manner. The vasorelaxant activity was not blocked by propranolol (10 microM), atropine (1 microM) indomethacin (10 microM) and glibenclamide (10 microM). Influence of SIPE on phenylephrine-induced contractions in aortic preparations in absence of functional endothelium and on pre-incubating the tissue with L-NAME (300 microM) or methylene blue (10 microM) was also studied. SIPE at 180 microg/ml concentration could elicit partial relaxation in presence of L-NAME or methylene blue to the extent of 34.26 +/- 6.13 and 25.66 +/- 10.95% respectively. However, in absence of functional endothelium, SIPE exhibited little relaxation to the extent of 6.70 +/- 4.87%. These studies revealed that the vasorelaxant activity of SIPE was chiefly mediated through endothelium-dependent pathway.

Nevirapine versus efavirenz based antiretroviral treatment in naive Indian patients: comparison of effectiveness in clinical cohort.

OBJECTIVE: Our objective was to compare immunologic effectiveness of nevirapine and efavirenz based antiretroviral therapy in antiretroviral naïve HIV-1 infected Indian patients. DESIGN AND METHODS: Study was an observational, non-randomized, longitudinal cohort. Antiretroviral naive HIV-1 infected patients receiving efavirenz + 2NRTI (n=254) and nevirapine + 2 NRTI (n=857) from April 2000 were followed up at two tertiary care HIV clinics at Ahmedabad and Pune. Patients were followed up clinically monthly and CD4 was carried out every 3 monthly. All patients were examined for various side effects as well as development of various OIs. Data were analyzed using standard statistical methods. RESULTS: Baseline characteristics for both the groups (NVP and EFV) were comparable. In the random effects model, there was an increase of 40.97 (p < 0.05) units of CD4 cell counts with an unit increase in time in the NVP arm as against a 44.75 (p < 0.05) units of increase in CD4 cell counts in the EFV group with a unit increase in time, which is significant for both groups. However, at any given point of time there was no difference in the rate of increase of CD4 count between the two treatment arms (p = 0.58). Hypersensitivity reaction (6.6% in NVP vs. 2.32% in EFV, p = 0.0146) and hepatitis (3.2% in NVP vs. 0% in EFV, p = 0.0085) were more common with nevirapine, while neurologic disturbances (0.93% in NVP vs. 20.15% in EFV, p = 0.0001) were more common with efavirenz. Incidence of distal sensory neuropathy and lipid abnormalities was similar in both the groups. CONCLUSION: Use of NVP and EFV based HAART in antiretroviral naive Indian patients led to significant and durable rise in CD4 cell count. Although observational and non-randomized, our study showed equivalent immunological response amongst NVP and EFV based HAART which is in line with the results of the 2NN study.

Dietary intake of choline and plasma choline concentrations in pregnant women in Jamaica / La ingestión de colina en la dieta y las concentraciones de colina en plasma en las mujeres embarazadas en Jamaica

Choline is an essential nutrient for humans and its availability during pregnancy is important for optimal fetal development. The Food and Nutrition Board of the Institute of Medicine in the United States of America has set the adequate choline intake during pregnancy at 450 mg/day. There is limited data available on normal plasma choline concentrations in pregnancy. Moreover, there are neither documented studies of choline intake among pregnant women in the Jamaican population nor of free plasma choline concentrations during pregnancy. Sixteen women presenting to the antenatal clinic of the University Hospital of the West Indies (UHWI) at 10-15 weeks of gestation were selected for this pilot study. A food frequency questionnaire was administered to estimate frequency of consumption of foods rich in choline. Fasting blood samples were collected by venepuncture and plasma assayed for choline using liquid chromatography electrospray ionization isotopic dilution mass spectrometry. Most of the women reported consumption of diets that delivered less than the recommended choline intake (mean +/- SEM, 278.5 +/- 28.9 mg). Mean plasma choline concentration was 8.4 +/- 0.4 micromol/L. This falls below the normal concentration (10 micromol/L) reported for individuals that are not pregnant and pregnant (14.5 micromol/L). The results of this study may be an indication that the choline included in the diet of pregnant women in Jamaica may not be adequate to meet both the needs of the mother and fetus and that further studies are warranted to determine clinical implications.

La colina es un nutriente esencial para los seres humanos y su disponibilidad durante el embarazo es importante para el óptimo desarrollo del feto. La Junta de Alimentos y Nutrición (Food and Nutrition Board) del Instituto de Medicina de los Estados Unidos ha establecido que la ingestión de colina durante el embarazo debe ser 450 mg/día. Los datos disponibles sobre concentraciones de colina en plasma durante el embarazo son limitados. Por otro lado, no existen estudios documentados sobre la ingestión de colina entre las mujeres embarazadas en la población de Jamaica, ni sobre las concentraciones libres de colina en plasma durante el embarazo. Dieciséis mujeres que se presentaron a la clínica de atención prenatal del Hospital Universitario de West Indies entre las 10–15 semanas de gestación, fueron seleccionadas para este estudio piloto. Se aplicó un cuestionario de frecuencia alimentaria a fin de estimar la frecuencia de consumo de alimentos ricos en colina. Se recogieron muestras de sangre en ayunas mediante venopuntura, y se sometió el plasma a análisis en busca de colina, usando la espectrometría de masa de dilución isotópica, ionización por electrospray y cromatografía líquida. La mayoría de las mujeres reportaron consumo de dietas que suministrabanmenos de los niveles de ingestion de colina recomendados (media ± SEM, 278.5 ± 28.9 mg). La concentracion media de colina en plasma fue 8.4 ± 0.4 mmoles/L. Esto se halla por debajo de la concentracion normal (10 mmoles/L) reportado tanto para no embrazadas como para embarazadas (14.5 mmoles/L). Concluimos que los resultados de este estudio pueden ser una indicacion de que los niveles de colina incluidos en la dieta de las mujeres en estado de gestacion en Jamaica no son adecuados para satisfacer las necesidades ni de la madre ni del feto, y que vale la pena la realizacion de estudios ulteriores al objeto de determinar las implicaciones clinicas.

Lactic acidosis in HIV-I infected patients receiving antiretroviral therapy.

Highly active antiretroviral therapy (HAART) has resulted in dramatic declines in morbidity and mortality in HIV-I infected patients in the developed world. However, with the availability of generic antiretroviral treatments (ART) in India, a large number of patients now receive ART. Increase in experience with ART has led to the detection of drug-related toxicities. We report herein potentially fatal side effects associated with the use of nucleoside analogues in HIV treatment--hyperlactatemia and lactic acidosis/hepatic steatosis.