A cross-sectional study to assess hypothyroid status of pregnant women at 12–16 weeks of gestation

Background: Physiological changes occur during pregnancy. These changes include metabolic, hematologic, cardiovascular, renal, and respiratory changes. In some cases, these changes may alter and lead to complications which result in adverse pregnancy outcomes. In India, hypothyroidism in pregnancy has a prevalence of 4.8–11%. Aims and Objectives: The aim of this study was to estimate the prevalence of hypothyroidism in pregnant women at 12–16 weeks of gestation. Materials and Methods: A cross-sectional study was planned on pregnant women attending the ANC clinic of Outpatient Department of Obstetrics and Gynecology at K.L. E’S Dr Prabhakar Kore Hospital and Medical Research Center Belagavi. Serum thyroid stimulating hormone (TSH) was estimated in the study participants. Serum TSH levels >4.5 ?IU/ml were labeled as hypothyroid pregnant women. Results: In our study, the prevalence of hypothyroidism was observed to be 8.68%. Conclusion: Hence, we conclude that all pregnant women should be screened for hypothyroidism at earlier weeks of gestation.

A cross-sectional study of influence of cerebral dominance on cardiovascular responses to autonomic stressor tests in adolescents

Background: Hand preference is perhaps the most obvious behavioral asymmetry observed in humans and is related to cerebral dominance. Animal and human studies have shown that cerebral cortex has a definite role in regulation of cardiovascular autonomic activity. Each hemisphere exhibits differential control over dynamics of heart especially the sympathetic activity is controlled by right hemisphere insula in particular. Hence, the present study was conducted to evaluate influence of cerebral dominance (handedness) on cardiovascular responses such as heart rate (HR) and blood pressure (BP) indices to autonomic stressor tests in the left and right hander adolescents. Aims and Objectives: The aim of the study was to evaluate the differences in cardiovascular responses in the left and right handers to autonomic stressor tests. Materials and Methods: The present cross-sectional study was conducted in 35 right and 35 left hander students of age group 16–20 years. Autonomic stressor tests used in the study were handgrip dynamometry and cold pressor test (CPT). Results: The right and left handers had similar baseline values of BP and HR. All the subjects responded to Autonomic function tests by increased BP and HR from baseline. The absolute BP values and change in BP from baseline were significantly higher in the left than right handers both during and after the tests. HR values showed significant differences in peak values during both the tests. Visual analog score was similar during CPT in both groups. Conclusion: The HR and BP responses to autonomic stressor tests are higher in the left handers than right handers supports the fact that the right hemisphere has more influence on sympathetic activity of heart.

Langerhans Cell Histiocytosis in an Adult Female with Multisystem Involvement

Langerhans cell histiocytosis (LCH) also known as histiocytosis X, is a rare systemic disorder arising from the clonal proliferation of myeloid dendritic cells (histiocytes) with a tendency to involve single or multiple organ systems with variable clinical course and prognosis. Clinical presentation usually depends on the site of involvement. The organs commonly affected in adults by order of decreasing frequency include lungs, bone, skin, pituitary glands, lymph nodes, and the liver. Vulval and perianal involvement is extremely rare in adults. We describe the case of a 31-year-old non-smoker adult female with multisystemic LCH involving the vulva, perianal region, and lung. Probable involvement of other sites with LCH included mandibular bone, pituitary gland, skin, lymph nodes, liver, thyroid, and colon. She is undergoing systemic chemotherapy and has completed two cycles of cytarabine and steroids without any complications. Treatment is not standardized due to the very less incidence of the disease and inadequate knowledge regarding its pathophysiology. Langerhans cell histiocytosis remains a major concern for treating physicians because of its rarity with many faces and requires careful consideration for management.

A comparative study of PSI and Curb-65 scoring systems in predicting ICU admissions and mortality in cases of community-acquired pneumonia

Background:Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Despite advanced diagnostic modalities and treatment options, CAP is the fourth leading cause of death in developing countries.Several severity scores have been proposed to guide initial decision making on hospitalization and to predict the outcome. Pneumonia Severity Index (PSI) and CURB 65 are the two most widely used scoring systems to prognosticate pneumonia. Aim: To compare the efficacy of PSI and CURB 65 scoring systems inprognosticating the ICU admission and outcome in cases of CAP. Methodology: This wasan observational study conducted at a tertiary care hospital in westernMaharashtra.A hundred patients of CAP fulfilling the inclusion criteria were enrolled in the study, classified as per CURB 65 and PSI system and their outcome compared. Result: The study subjects comprised of 100 patients (64 men and 36 women) of CAP. Twenty-four patients needed ICU admission.In both PSI and CURB-65 risk scoring systems, the need for intensive care unit (ICU) admission and mortality rates increased progressively with increasing scores.PSI class ≥IV and CURB 65 ≥III had 77.52% and 40.24% sensitivity and 88.46% and 69.48% specificity respectively in predicting ICU admissions. The PSI class ≥IV had more sensitivity and specificity in predicting ICU admission than CURB-65.CURB 65 class III and IV had sensitivity86.59% and 89.64% and specificity 89.64% and 97.54% respectivelyin predicting mortality, while PSI class IV and Vhadsensitivity68.92% and 72.58% and specificity 24.74% and 54.86% respectively. CURB 65 had more sensitivity and specificity than PSI in predicting mortality. Conclusion: The PSI is better in predicting the need for ICU admission and CURB 65 is a better predictor of mortality in cases of community-acquired pneumonia.

Protective Effect Of Diosgenin On Streptozotocin Induced Diabetic Nephropathy In Experimental Rats

Diabetes mellitus is a multifactorial metabolic disorder associated with the diabetes related vascular diseases. Oxidative stress along with inflammation is the Key factor leading to diabetic complications. Present study was designed to investigate the protective role of diosgenin, a steroidal saponin, in diabetes induced early kidney injury and oxidative stress markers and histopathological changes in kidney of diabetic rats, induced by single intra-peritoneal injection of streptozotocin (55 mg/kg weight (b.w.). After 72 hrs, experimental rats received diosgenin at different doses (10, 20 and 40 mg/kg b.w.) once daily for four weeks. At the end of the experiment, diabetic rats showed a significant increase in the levels of plasma glucose, glycosylated hemoglobin with a significant decrease in insulin and total hemoglobin. The activities of antioxidant enzymes such as superoxide dismutase, catalase, reduced glutathione, and the levels of reduced glutathione were decreased while increases in the levels of lipid peroxidation markers were observed in kidney tissues of diabetic rats. Oral administration of diosgenin to diabetic rats considerably shrivelled the plasma glucose and exaggerated the endocrine level supported a dose dependent manner. Diosgenin at a dose of 40 mg/kg b.w. was more pronounced effect than the other two doses and used for further studies. All the manifestations observed in diabetic rats were significantly reversed to near normal at a dose of 40 mg/kg b.w. of diosgenin. These findings recommend that diosgenin may have a helpful role against excretory organ harm evoked by aerobic stress within the diabetic state.

Eat Fast, Die Young: The Pattern of Fast Food Consumption amongst International Medical Students

Objective:To investigate the factors influencing fast-food consumption amongst the International Medical Students of USM-KLE.Hypothesis:Fast food consumption is deleterious to the overall health of a person, and thus we expect low fast food consumption amongstmedical students of USM-KLE. Nevertheless, due to the lack of awareness and poor understanding of the ill effects of fast food consumption, the pattern of fast food consumption is increasing among the medical students of USM-KLE. Materials andMethods:A cross-sectional survey-based study was conducted in the month of June 2018 by distributing questionnaires to 326 Malaysian students –from year 1 to year 5 –who are studying in Belgaum, India. The questions touched on the aspects of their profile, driving factors offast food consumption, routine exercise pattern, and their knowledge on the deleterious effects of fast food on their health. Data wascollected for their experiencebothin Malaysia & India, & these werethen analysed using SPSS 16.0 software.Results:In this study, theresults werecoded & translated according to each question. It is observed that there isahigh prevalence of fast food consumption amongst the students; 97% of the students consume fast food. Conclusion:The results of this study showed thatdespite their knowledge on the poor health effects of these foods.the students prefer to consume fast food mostly on the basis of their hectic schedule, the restaurants’ close distance, the good taste of the meals, as well as their fast availability

Non surgical management of unilateral lacrimal gland swelling in a paediatric patient of Rosai-Dorfman disease: A case report

A 10-year-old girl presented to us with inferonasally displaced, non-axial proptosis of oculus dexter (OD), with ipsilateral, painless massive cervical lymphadenopathy of ten weeks duration. After a detailed hematological work-up and imaging, the histological evidence obtained on cervical lymph node biopsy established the diagnosis of Rosai-Dorfman disease. Although, Rosai-Dorfman disease of unilateral lacrimal gland is extremely infrequent, a high degree of suspicion is warranted in a case of young patient presenting with unilateral isolated lacrimal gland swelling and associated lymphadenopathy, wherein no other cause is found. Treatment protocol should be individualized as per the extent of systemic involvement and functional disability.

A study on clinical correlation of EEG in neonates with perinatal asphyxia

Background: Perinatal asphyxia is the most common and important cause of preventable cerebral injury occurring in the neonatal period. The WHO has estimated that 4 million babies die during the neonatal period every year. According to WHO, perinatal asphyxia is defined as the failure to initiate and sustain breathing at birth. The objective is to study the electroencephalographic changes and correlation between severity of Perinatal asphyxia with EEG changes.Methods: It is prospective observational study, which includes 40 term neonates admitted in NICU with perinatal asphyxia in GMCH Aurangabad. EEG analysis focused on background activity and classified into four categories.Results: The EEG was normal in 45%, mild abnormal in 25%, intermediate in 15%, and severely abnormal in 15%.' Outcome at discharge was normal in 19(47.5%) and abnormal in 21(52.5%) including 1 death. Abnormal outcome was seen in 27% of newborns with normal EEG and 72% of abnormal EEG.Conclusions: Severity of perinatal asphyxia correlated well with abnormality of EEG. EEG changes and severity showed good correlation with immediate outcome of newborn in terms of duration of hospitalization and normal neurological examination.

Stability analysis and quantitative evaluation of metronidazole suspension.

Suspension is a heterogeneous mixture including solid particles that are satisfactorily bulky for sedimentation. Generally they must be larger than one micrometer. It is when particles are left floating around freely in a solvent. The inner phase (solid) is discrete all through the external phase (fluid) during mechanical stir, with utilizing of certain excipients or suspending agents. Metronidazole or 2-(2 methyl-5 nitro-1 H –imidazol-1 yl) ethanol belongs to the nitro imidazole group of antibiotics whose antimicrobial property through derive from the formation of toxic free radicals by intracellular reduction. The objective of present study was to prepare suspension of Metronidazole by using different suspending agents and stability testing was to provide evidence on how the quality of suspensions varies with the time under of influence of environmental factors such as temperature, light, oxygen, moisture, other ingredient or excipients in the dosage form, particle size of drug, microbial contamination etc. and to establish a recommended storage condition. The FTIR and DSC techniques are use for characterization of active ingredient MBZ. This suspension was evaluated for appearance, pH, sedimentation volume and dissolution study for in vitro drug release. Result of evaluation indicates 1% w/v xanthan gum give optimal characteristic suspension. Suspension containing 1% w/v was exposed for the stability studies as per ICH guidelines. The suspensions were evaluated for their physicochemical parameter, particle size, drug release, drug content and microbiological assessment. The suspension shows good stability at 25ºC ± 2 ºC /60%± 5% RH, 30 ºC ± 2 ºC /65%± 5% RH and good quantitative analysis result throughout the period of study. Suspension stored at 40 ºC ± 2 ºC /75%± 5% RH shows noncompliance with the analysis parameter after 4 week of storage. This indicate high temperature storage was shows degradation of the suspension which results in crystal growth in formulation and affect the physicochemical parameter as Appearance, pH, viscosity, specific gravity, drug dissolution profile and drug content.

Place of birth and risk of gallbladder cancer in India.

CONTEXT: Within India, the incidence of gallbladder cancer (GBC) is characterized by marked geographical variation; however, the reasons for these differences are unclear. AIMS: To evaluate the role of place of birth, length of residence, and effect of migration from high‑ to low‑risk region on GBC development. SETTINGS AND DESIGN: Population‑based cancer registries (PBCRs); case–control study. SUBJECTS AND METHODS: Data of PBCRs were used to demonstrate geographical variation in GBC incidence rates. A case–control study data examined the role of birth place, residence length, and effect of migration in etiology of GBC. STATISTICAL ANALYSIS: Rate ratios for different PBCRs were estimated using Chennai Cancer Registry as the reference population. Odds ratios (ORs) for developing GBC in a high‑risk region compared to a low‑risk region and associated 95% confidence interval (CI) were estimated through unconditional logistic regression models using case–control study. RESULTS: GBC shows marked variation in incidence with risk highest in Northeast regions and lowest in South India. OR of 4.82 (95% CI: 3.87–5.99) was observed for developing GBC for individuals born in a high‑risk region compared to those born in a low‑risk region after adjusting for confounders. A dose–response relationship with increased risk with increased length of residence in a high‑risk region was observed (OR lifetime 5.58 [95% CI: 4.42–7.05]; Ptrend ≤ 0.001). The risk persisted even if study participant migrated from high‑ to low‑risk region (OR = 1.36; 95% CI: 1.02–1.82). CONCLUSIONS: The present study signifies the importance of place of birth, length of stay, and effect of migration from high‑ to low‑risk region in the development of GBC. The data indicate role of environmental and genetic factors in etiology of disease.

Comparative study of neonatal outcome between first and second twin babies delivered by vaginal route.

Introduction: The incidence of twinning has been increasing due to availability and increased use of ovulation inducing drugs and assisted reproductive technology. Despite substantial concerns over the well-being of the second twin with regard to intra partum events, outcome studies on this issue are conflicting. Some have reported no increase in perinatal complications, while others showed significant associations between labor and delivery of the second twin and increased perinatal morbidity and mortality. Material and methods: 106 cases of twin pregnancy fulfilling of age 18 - 35 years, at more than 32 weeks gestation, first twin with cephalic presentation and selected for vaginal delivery were included in the study. Intrauterine death of either one of the twins before the onset of labour, pregnancies complicated or fetal malformations and those with contraindication to vaginal birth were excluded. After thorough screening of included cases delivery was performed according to fixed protocol. After delivery, mode of delivery, cry, APGAR score, birth weight, complications, birth injury, time interval between deliveries, NICU admission and condition on discharge of each baby was noted. Results: 106 twins were included as delivered vaginally, including 3 patients who were delivered by vaginal delivery for 1st twin followed by caesarean delivery for 2nd twin. Stillbirth and early neonatal deaths resulted in 24 deaths. There is no significant difference between mortality of 1st and 2nd born twins. The neonatal mortality was equal in first and second twin. Neonatal morbidity was more in 2nd twin than 1st twin (27.65% v/s 15.95%). There were 41 NICU admissions (19.34%), out of those 36.6% were for first twin (n=15) and 63.4% for second twin (n=26), (p value 0.056). Incidence of RDS, invasive ventilator support, NICU Stay >7 days is significantly higher in second twin as compared to first twin. Breech presentations were associated with 10% neonatal mortality for second twin compared to none for first twin. Most common group for neonatal mortality and morbidity was birth weight 1000-1499 gm. Neonatal morbidity was 100% for discordancy 30 to 40% group while 85.71% for discordancy 20 to 30% group. These results are significant when compared for heavier twin v/s lighter twin (p value 0.001).Neonatal mortality and morbidity between first and second twin is statistically significant when compared according to Apgar score (p value 0.037). Incidences of stillbirth + early neonatal death for 2nd twin less in early preterm group but increased in in late preterm group. Neonatal outcome of 2nd twin was better in dichorionic pregnancies 11% v/s 16.67% in monochorionic pregnancies (p>0.05). Conclusion: Twin vaginal delivery is safe in first cephalic presentation in twin pregnancy. Caution should taken while delivering babies < 1500 gm, birth discordancy > 20% , gestational age < 34 weeks, as vaginal delivery in these conditions is associated with increased early neonatal morbidity and neonatal mortality.

Spasmolytic effect of traditional herbal formulation on guinea pig ileum.

Background: The herbal formulation consisting of Andrographis paniculata Nees., Cassia fistula L., Foeniculum vulgare Mill. and Cuminum cyminum L. is widely used by the local traditional practitioners in rural Northern Karnataka for spasmodic abdominal pain. Objective: The present study was undertaken to evaluate safety and spasmolytic effect of poly‑herbal formulation. Materials and Methods: Acute toxicity studies were carried out in Swiss mice, as per the Organization for Economic Co‑operation and Development (OECD) guidelines. The spasmolytic activity of the formulation was studied in isolated guinea pig ileum model using histamine and acetylcholine as agonists. The data were analyzed by one‑way ANOVA, followed by Dunnetts post‑hoc test and P ≤ 0.05 was considered as significant. Results: The formulation did not show any adverse toxic effects and found to be safe. It also showed significant (P < 0.05) relaxation in different agonist like histamine and acetylcholine‑induced contractions in guinea pig ileum. Conclusions: Antispasmodic activity of the herbal formulation can be attributed to its atropine‑like activity. The present findings, therefore, support its utility in spasmodic abdominal pain.

Effect of rifampicin, isoniazid on acute and subacute inflammation in male Wistar rats: an experimental study.

Background: Tuberculosis (TB) is characterized by significant inflammation leading to complications like pulmonary fibrosis, constrictive pericarditis, etc. Drugs possessing anti-inflammatory activity can reduce the complications of infections occurring due to inflammation and fibrosis. To study the effect of rifampicin, isoniazid on acute and subacute models of inflammation in male Wistar rats. Methods: The in vivo anti-inflammatory activity of rifampicin, isoniazid was studied using acute (carrageenan paw edema) and sub-acute (cotton pellet granuloma and histopathologic examination of grass pith) models of inflammation. Results: Rifampicin and isoniazid used in the present study showed significant antiinflammatory activity in acute as well as subacute models of inflammation. Conclusion: Rifampicin and isoniazid when administered to treat TB can reduce complications of TB by virtue of its anti-inflammatory activity.

Learning Styles Preferences of First Year Medical Students Of J N Medical College Belgaum: A Single Institute Experience In Karnataka, India.

Abstracts: Background: Researchers agree that in addition to cognitive factor, non-cognitive factors like learning style are predictors of performance. Students use different sensory modalities for assembling knowledge and information. This study was aim to recognize preferred learning styles of first year medical students at KLE university’s J N Medical college Belgaum India. Methodology: A cross sectional study was conducted on 150 consented students .The students were subjected to VARK learning style questionnaire to identify their learning styles preferences. The questionnaires which identify four learning style preferences/modes as visual (v), auditory (A), read and write(R) and kinaesthetic (K). Descriptive statistics was used to identify the learning styles of the students. Results: Hundred present students preferred multimodal style of learning, while 92%preferred quadrimodal, 7% trimodal , 1% bimodal. Among the four learning style preferences it was found that 99% of them preferred kinaesthetic, followed by, auditory, read/ write and visual modality. Conclusion: This study gives insight that no single teaching –learning strategy can work for effective teaching learning in medical students. Faculty teaching first year medical students has to adopt multi modal teaching-learning strategies to create effective teaching and learning environment.

Mapping of biophysical constraints of soils in semi-arid northern transition zone of India by GIS techniques.

The present study was untaken in order to identify and map soil biophysical constraints by GIS techniques in Singhanhalli-Bogur microwatershed in northern transition zone of Karnataka. Ten biophysical soil parameter including depth, coarse fragment/stoniness, texture, structure, tillage pan, rooting condition, surface crust, organic matter, biological activity and sodicity were assessed and interpreted for soil health. The depth of the soils varied from shallow to deep and structure varied from weak to strong with some mapping units showing slightly developed tillage pans. The texture of soils varied from sandy loam to sandy clay, sandy clay loam and clay while the content of coarse fragments ranged from common to many and abundant. Soils having sandy loam texture showed high content of coarse fragments. No signs of unrestricted root developments were observed as the rooting condition was good. The organic matter content of soils ranged from low to high with presence of few to many termite holes indicating biological activity. Physical soil crusts ranging from slight to severe were observed in some mapping units. The soils were free of high sodium concentrations and hence, classified as non-sodic soils. Overall, soil health status varied from poor to medium with the level of constraints ranging from moderate to severe. Soils with severe constraints showed poor health status while soils with moderate constraints showed medium health status.

Tailgut cyst: An uncommonly diagnosed common entity - A case report and review of literature.

Tailgut cysts (TGC) though relatively common are rarely diagnosed and documented. Most of the times, they are misdiagnosed and mismanaged. When malignancy develops in TGC it is rarely attributed to it as it is undiagnosed earlier and later on there may not be any evidence left behind. We report one such case which was diagnosed though not preoperatively. Review of literature reveals only few such cases after the initial description by Hjermstad and Helwig in 1988. Surprisingly most of the reports especially the larger case series are by radiologists. Surgeons and pathologists have contributed very few cases. This case report is aimed at increasing the awareness about this entity so that it will be suspected, investigated properly and treated before development of complications like recurrent fistulae, ischioanal abscesses which increase the morbidity and life threatening complications like malignant change.

Activity of Plumbago zeylanica Linn. root and Holoptelea integrifolia Roxb. bark pastes in acute and chronic paw infl ammation in Wistar rats.

Background: The pastes prepared from roots of Plumbago zeylanica Linn. and barks of Holoptelea integrifolia Roxb. are widely used by traditional healers for the treatment of arthritis in rural northern Karnataka. Objective: The present study was undertaken to scientifi cally evaluate the safety and effi cacy of traditionally used formulations in experimental animals. Materials and Methods: The study, approved by IAEC was carried out in male Wistar rats and dermal toxicity in rabbits. Carrageenan model was used to assess effect on acute infl ammation. Paw volume were measured at 1, 2, 4, and 6th hour postchallenge. Chronic infl ammation was developed by using Complete Freund’s Adjuvant (CFA). Paw volume, ankle joint circumference, and body weight were assessed on 1st, 4th, 8th, 14th, 17th, and 21st day. Paste was applied once every day to the infl amed area of the paw of respective groups of animals, continuously for 14 days. Statistics: The data were analyzed by one way analysis of variance followed by Dunnett’s post hoc test. P ≤ 0.05 was considered as signifi cant. Results: The formulations did not show any dermal toxicity and found to be safe. Both the pastes signifi cantly (P < 0.05) suppressed, carrageenan-induced paw edema at 6th hour and Holoptelea integrifolia appears to be more effective than Plumbago zeylanica. Signifi cant reduction was observed in paw volume, ankle joint circumference and animal body weight gained. Conclusions: The tested formulations (P. zeylanica root and H. integrifolia bark pastes) showed signifi cant antiinfl ammatory activity. The present fi ndings therefore support its utility in arthritic pain, infl ammation and the claim of traditional practitioners.

Antiulcer activity of water soaked Glycine max L. grains in aspirin induced model of gastric ulcer in Wistar rats.

Introduction: Glycine max L. with Drakshasava, widely used by traditional healers as a formulation for the treatment of peptic ulcer in rural northern Karnataka in India, appears to be effective as assessed by patients and in our previously published research work of traditionally used formulation. Aim: The present study was undertaken to evaluate the safety and effi cacy of the overnight water soaked G. max grains. This is one of the components of traditional formulation. The study, approved by Institutional Animal Ethics Committee was carried out in male Wistar rats after assessing its toxicity in mice. Materials and Methods: Four groups of rats (n = 6 in each group) were treated with aspirin 200 mg/kg oral. In addition to aspirin control group received normal saline, standard group received 20 mg/kg omeprazole and 3rd and 4th group received G. max 250 and 500 mg/kg, respectively. All treatments were administered orally every 24 h for 7 days. After 24 hours fasting, on the 8th day stomach contents were aspirated under anesthesia to estimate free and total acidity. Stomachs were opened along the greater curvature to calculate ulcer index and subjected to histopathology studies. Statistics: The results were analyzed by one-way analysis of variance followed-by Dunnett’s post hoc test. P ≤0.05 was considered as signifi cant. Results: The severity of aspirin induced ulceration was found signifi cantly (P < 0.05) decreased in test groups compared with the control group. Free and total acidity was signifi cantly reduced in 500 mg/kg treated group, compared with the control group and was inferior to omeprazole treated group. Conclusion: The grain of G. max was found to be effective against aspirin induced ulcers.