Evaluation of endometrial thickness with transvaginal ultrasonography in perimenopausal women presenting with abnormal uterine bleeding and correlation with its histopathological findings

Background: Abnormal uterine bleeding is the most common presenting menstrual complaint in women of perimenopausal age group. Most frequently used diagnostics tests to investigate the causes of abnormal bleeding are Transvaginal ultrasonography (TVS) and endometrial biopsy. Uterine curettage is an invasive procedure and is performed with anaesthesia. TVS is a non-invasive method that has been used to evaluate the endometrium and uterine cavity. The objectives of this study were to measure and evaluate the role and accuracy of endometrial thickness by transvaginal ultrasonography study to detect endometrial pathology in perimenopausal women presenting with Abnormal Uterine Bleeding. To correlate the transvaginal sonographic results with the Histopathological findings to discriminate normal from pathological endometrium.Methods: Prospective study including 150 perimenopausal women with abnormal uterine bleeding. Endometrial thickness was measured by TVS and then D and C was performed for all the patients.Results: Out of 150 women, 128 (85.3%) had normal and 22 (15%) had an abnormal endometrium. 43.3% were of 41-45 years and 65.3% patients presented with complaint of heavy menstrual bleeding. Majority of the patients in the study group were para 2 or more. Fibroid uterus (24%) was the commonest uterine pathology detected on TVS. 53.3% of patients had endometrial thickness in the range 10-14.9 mm. Most common finding on HPE was secretory endometrium (44.6%). Endometrial carcinoma was found in 3%. Endometrial thickness <14mm was associated with least abnormal endometrial pathology.Conclusions: Endometrial thickness of less than 14 mm need not be indicated for D and C in perimenopausal abnormal uterine bleeding. In perimenopausal women with AUB, TVS should be the investigation of choice due to its convenience, accuracy and non- invasiveness.

Profile of dog bite cases reporting to ARV OPD of a tertiary care hospital

Background: Animal bites pose a major public health problem in children and adults worldwide. Rabies is a viral zoonosis caused by bite of a rabid dog that occurs in >100 countries and territories. India accounts for 60% of all the world burden of rabies related deaths. The objective of the present study is to analyse the profile of dog bite victims reporting to ARV OPD of a tertiary care hospital.Methods: This was a cross-sectional study conducted in the ARV OPD of a tertiary care hospital. A total of 228 victims of dog bite were interviewed. They were selected using systematic random sampling technique. Analysis of data obtained was done using SPSS.Results: Majority of the participants belonged to the age group 20-30 years. The proportion of male was higher than female. Most of the victims had suffered category II type of dog bite (66.2%). A statistically significant association was seen between age group and nature of dog bite, sex of victim and type of dog, type of dog and category of dog bite and the category of bite and history of dog biting other individuals.Conclusions: The burden of dog bite seems to be borne by the economically productive age group. All individuals need to be educated on how to behave around animals so that they can avoid animal bite.

Prescribing pattern of anticancer drugs in the medical oncology department of a tertiary care teaching hospital

Background: To study drug utilization of anticancer drugs in the oncology inpatient department (IPD) of Kamineni Hospitals, L.B. Nagar, Hyderabad, India.Methods: One hundred prescription records were screened and analysed as per the study parameters from the oncology IPD of Kamineni Hospitals, Hyderabad. Commonly used anticancer drugs were recorded; furthermore, different types of carcinomas were noted.Results: Age group of patients was in between 04 and 80 years, 62 were females and 38 were male patients. The most common type of carcinoma was carcinoma of the breast (28%). Cisplatin was the most commonly used anticancer drug (29%). Adjuvant drugs were used in 98% of the patients.Conclusions: Incidence of cancer is more in females than males. Adjuvant and cytoprotective drugs used may have had a bearing on the relatively lower incidence of adverse effects.

Time series analysis of dengue cases reporting to a tertiary care hospital

Background: Dengue fever is a major public health problem, the concern is high as the disease is closely related to climate change. Methods: This was a retrospective study, conducted for 1 year in a tertiary care hospital in the city of Mumbai. Data of Dengue cases and climate for the city of Mumbai between 2011 and 2015 were obtained. Data was analysed using SPSS- time series analysis and forecasting model. Results: 33% cases belonged to the 21-30 years, proportion of men affected were more than women. A seasonal distribution of cases was observed. A strong correlation was noted between the total number of cases reported and (a) mean monthly rainfall and (b) number of days of rainfall. ARIMA model was used for forecasting. Conclusions: The trend analysis along with forecasting model helps in being prepared for the year ahead.

An evaluation of knowledge, attitude and practice of pharmacovigilance among medical students and doctors at a tertiary care hospital

Background: Drugs are one of the most commonly used interventions in medical therapeutics. Spontaneous reporting of adverse drug reactions (ADRs) is the backbone of pharmacovigilance (PV) program. Under-reporting of ADRs by prescribers was possibly due to lack of knowledge, attitude and practices regarding PV. This study was done to assess the knowledge, attitude, and practice (KAP) of medical students (grouped to sixth and eighth semester) and medical doctors about PV in a tertiary care hospital.Methods: It was a questionnaire based cross-sectional study administered to 246 medical students and doctors. Study tool was a validated questionnaire containing 15 questions to evaluate KAP of PV among medical students and doctors. A descriptive analysis of data was done where necessary, statistical significance for associations between the group and their responses to questionnaire was provided using Pearson Chi square test and Fisher exact test.Results: Sixty-eight percent of the participants (90% doctors; 76% eighth-semester and 46% sixth-semester medical students) know the correct definition of PV. Sixty-one percent of the participants (67% sixth-semester, 61% doctors and 53% eighth-semester) think that reporting is a professional obligation for them. Only 15% of the participants have ever been taught or trained on how to report an ADR.Conclusions: Medical doctors and students lack adequate knowledge and practice of reporting ADRs, but they seem to have a positive attitude towards the PV program. Our study findings strongly suggest that there is a great need to create awareness amongst them to promote reporting of ADRs.

A Study of Factors Associated with Low Birth Weight in a Tertiary Care Centre in Rural South India

Low birth weight (LBW) is a significant indicator of child survival and future morbidity in any community all over the world. It has reduced considerably in developing countries due to improved living conditions and better care of women and adolescent girls. However, in developing countries, it is still an important cause of child mortality and morbidity. LBW is typically multifactorial at different levels such as maternal, fetal, and environmental factors. Objectives: The objectives are as follows: (1) To assess the prevalence of LBW in a tertiary care setting in a rural area and (2) to determine various sociodemographic factors associated with LBW and degree of association of each. Materials and Methods: A record based study was conducted at Adichunchanagiri Hospital and Research Centre, wherein all singleton live births data for 1 year (January 1, 2016–December 31, 2016) were accessed from the MRD section of AH and RC. All available data were analyzed using percentages, odds ratio, and Multivariate analysis. Results: Overall, the prevalence of LBW was 15.89% (194 LBW out of 1221 live births). Female babies (17.12%), Teenage mothers (19.37%), Rural residence (15.94%), Maternal Hypertension (21%), and Shorter spacing between pregnancies (17.47%), and Preterm (62%) were some associated factors with LBW. Of all the above risk factors, teenage mothers, spacing, and gestational age were found to be statistically significantly associated with LBW. Conclusions: Although declining in most communities, LBW still remains unacceptably high in many undeveloped regions. It requires a multi-pronged approach by a team of dedicated professionals to reduce this problem afflicting mankind.

Red Blood Cell Count: Brief History and New Method.

Introduction: Red blood cells (RBCs) were observed under microscope by Jan Swammerdam in 1658. The RBC count was done in 1852 by Professor Karl Vierordt from Germany for the first time almost after 192 years. After this, the other scientists have also done RBC count with different methods. Hayem used a new diluting fluid (Hayem‖s diluting fluid) for RBC count which is used even today. The present methods have many errors mainly due to sampling, diluting, and pipetting. Materials and methods: In this study, the modified method of RBC counting has been shown. The RBC counting was done using hemoglobinometer pipette and modified diluting fluid - Hayem‖s fluid mixed with Leishman‖s stain (HFLS) RBC diluting fluid - in the ratio of 97.5 mL of Hayem‖s RBC diluting fluid and 2.5 mL of Leishman‖s stain to make 100 mL. Amber colored glass bottle top dispenser was used to dispense 2 and 4 mL of diluting fluid into the glass test tubes .With aseptic precautions, 10 and 20 μL of blood samples were collected by using the hemoglobinometer pipette (marked with black marker pen to get accurate measurement for 10 μL) from finger prick with sterile needle. The blood samples were added to the glass test tubes containing HFLS RBC diluting fluid and mixing was done with a glass stirrer. With the help of glass capillary tube, Neubauer chambers were charged and observed under microscope. Results: Red blood cells were seen better. The RBCs retained their shape and size even after 96 hours when the blood samples mixed with HFLS RBC diluting fluid were kept at room temperature. Conclusion: Red blood cells were seen better with this method and diluting and charging errors were minimized.

Better Visualization of Red Blood Cells by Adding Leishman’s Stain to Hayem’s Fluid.

The visualization of red blood cells (RBCs) was compared by the modified method and the conventional method. The RBCs were seen better with the modified method.

A novel rapid - acting oral inhalation human insulin for diabetes mellitus: Afrezza.

Afrezza is rapid-acting oral inhalation insulin that is administered at the beginning of each meal. The U.S Food and Drug Administration has approved Afrezza (insulin human) inhalation powder, a rapid-acting inhaled insulin to improve glycemic control in adults ≥18 years of age with Type 1 or Type 2 diabetes mellitus (T1DM or T2DM). Afrezza must be used in combination with long-acting insulin in patients with T1DM. Afrezza may be used with either oral anti-diabetic drugs or basal insulin in patients with T2DM. Afrezza should be administered via oral inhalation using Afrezza inhaler. Dosage adjustment is needed when switching from injection insulin to oral inhalation Afrezza. It is contraindicated in individuals with chronic lung disease and smokers because of the risk of the acute bronchospasm. Before initiating, Afrezza, a complete medical history, physical examination and spirometry (forced expiratory volume 1 sec) results is required in all individuals to identify the potential lung disease. Common adverse reactions in individuals treated with Afrezza include hypoglycemia, cough, throat pain or irritation, headache, and diarrhea.

Psychosomatic Disorders Pertaining To Dental Practice

Psychosomatic symptoms are by definition clinical symptoms with no underlying organic pathology. Psychosomatic disorders represent impaired adaptation or deficiencies that limit the capacity to adapt successfully to the demands of everyday life. The symptoms are thought to be a response to stress. Appropriate health consultation should be considered for further evaluation and treatment.

Biophysics and Surface Chemistry in Physiology.

Even though the physiology deals with the study of normal functions of the body the various physiological processes can be explained better with the help of underlying physical and chemical changes. The scientific progresses and advances in the subjects like physics, chemistry and biology gave us opportunity to apply principles of these sciences to understand the working of living organisms better. The underlying physical properties of lipids, water and their surface interaction led to the discovery of cell membrane. The use of vegetable oil to calm the sea waves was known to mankind since 4000 BC since the time from Akkadian ruler Hammurabi, but the more scientific experiments in this area were done by Benjamin Franklin, Lord Rayleigh, Agnes Pockels and Irving Langmuir. In this review we trace back the history of surface chemistry of lipids on water surface and their application in physiology.

Green tea- A Healthy sip.

After water, tea is the most consumed popular drink in the world. Green tea which is a leading beverage in the Far East for thousands of years is regarded as a health product. It is nothing but a non-fermented tea which contains more catechins, than black tea or oolong tea. Catechins are strong antioxidants with its additional content of certain minerals and vitamins increasing its antioxidant potential. High-molecular-weight polyphenols isolated from green tea which includesepigallocatechin 3 gallate (EGCG) constitute the most interesting components in green tea leaves. Th e aqueous extract or the major polyphenols of green tea possess cariostatic, antimutagenic, antidiabetic, antioxidant, antibacterial, anti infl ammatory, antitumor, hypocholesterolemic, as well as cancer-preventive activities in a variety of experimental animal models system and have been demonstrated in various studies.

Liposarcoma: A Rare Case Report with Review of Literature.

Liposarcoma is one of the most common malignant mesenchymal neoplasms, comprising approximately 15% of all soft-tissue sarcomas. First described by “Virchow” in 1857, it has been extensively reported in the literature, although its incidence remains exceedingly rare in the head and neck region with an annual incidence estimated to be 2.5/1 million inhabitants in population-based studies. It is one of the most common malignant mesenchymal neoplasms, comprising approximately 15% of all soft-tissue sarcomas. It is a heterogeneous disease with distinct sub-entities presenting with differential clinical behavior. The purpose of this article is to report an additional case of liposarcoma of the buccal vestibule and to review the literature.

Skin Carvings: Predictive Diagnosis in Modern Era.

The science and art of markings of the skin especially hands and feet’s is known as dermatoglyphics, where derma means skin and glyph mean carving. For centuries, the features of the hands have fascinated scholars, sages, theologians, doctors, and layman alike. In 1926 Cummins introduced the term “dermatoglyphics.” “Samudra Shastra” was known as ridge pattern study in ancient India. The epidermal ridge patterns were classified into “Chakra, Shankya, and Padma” which corresponds with the whorl, loop, and arch system of modern classification. All individuals have unique fingerprints which remain unchanged over the lifetime. Multiple genes determine fingerprint configurations and the study of fingerprints reveal vital genetic and medical information about an individual. Dermatoglyphics is considered as the window of congenital abnormalities and is a sensitive indicator of intrauterine anomalies. For preliminary investigations in conditions with a suspected genetic basis dermatoglyphic analysis is now beginning to prove itself as an extremely useful tool. In dentistry, various studies have been published on the dermatoglyphics. Here in this present review, the dermatoglyphic patterns of the palms and soles, the methods to record the palm and sole prints and various studies conducted among the dental disorders has been highlighted.

Hepatoprotective activity of Eclipta alba against carbon tetrachlorideinduced hepatotoxicity in albino rats.

Background: Despite the tremendous scientific advancement in the field of gastroenterology over the recent years, there is not even a single effective allopathic medication available for the treatment of liver disorders. Hence, the study was conducted to elucidate the hepatoprotective activity of aqueous extract of traditional medicinal plant Eclipta alba against carbon tetrachloride (CCl4) induced toxicity in male albino rats. Methods: The hepatoprotective effect of the aqueous extracts of E. alba was evaluated by biochemical parameters such as serum alanine transferases (ALT), serum aspartate transferases (AST), alkaline phosphatase (ALP), total serum bilirubin, and serum protein, and confirmed by histopathology of liver. The hepatotoxic agent CCl4 was used to induce liver toxicity and silymarin was used as a control drug. The aqueous extracts of E. alba were administered at the doses of 250 mg/kg/day and 500 mg/kg/day orally for 4 days. One-way Analysis of Variance was used for the statistical analysis of data. A probability value of p<0.05 was considered as significant. Results: E. alba administration at doses 250 mg/kg and 500 mg/kg orally demonstrated significant hepatoprotective activity by preventing the increase of ALT, AST, ALP, and serum bilirubin and also confirmed by histopathology of the liver. The results were comparable to that of silymarin. Conclusion: The results of the study confirmed the hepatoprotective activity of aqueous extracts of E. alba at doses of 250 mg/kg and 500 mg/kg against CCl4 induced hepatotoxicity in rats. However, the dose adjustments may be necessary to optimize the similar hepatoprotective efficacy in clinical settings.

Couvelaire uterus – A case report.

“Couvelaire uterus” or “Utero-placental apoplexy” is a rare complication of severe forms of placental abruption. It occurs when vascular damage within the placenta causes hemorrhage that progresses to and infiltrates the wall of the uterus. We presented here rare case of 23 years old female with Couvelaire uterus.

Evaluation of hepatoprotective activity of Boerhaavia diffusa against carbon tetrachloride induced liver toxicity in albino rats.

Background: Modern allopathic medicine has very little to offer for the treatment of liver disorders in spite of consistent effort for new drug discovery. Hence, this study was conducted to elucidate the hepatoprotective activity of aqueous extract of traditional medicinal plant Boerhaavia diffusa against carbon tetrachloride (CCl4) induced toxicity in male albino rats. Methods: The hepatoprotective effect of the aqueous extracts of B. diffusa was evaluated by biochemical parameters such as serum alanine transferases (ALT), serum asparate transferases (AST), alkaline phosphatase (ALP), total serum bilirubin, and serum protein, and confirmed by histopathology of liver. The toxicant CCl4 was used to induce hepatotoxicity and silymarin were used as control drug. The aqueous extracts of B. diffusa were administered at the doses of 250 mg/kg/day and 500 mg/kg/day orally for 4 days. One-way analysis of variance was used for the statistical analysis of data. A probability value of p<0.05 was considered as significant. Results: Administration of B. diffusa at doses 250 and 500 mg/kg orally demonstrated hepatoprotective activity by preventing the increase of ALT, AST, ALP, and serum bilirubin and also confirmed by histopathology of the liver. The results were comparable to that of silymarin®. Conclusion: The results of this study confirmed the hepatoprotective activity of aqueous extracts of B. diffusa at doses of 250 mg/kg/and 500 mg/kg/against CCl4 induced hepatotoxicity in rats. However, the dose adjustments may be necessary to optimize the similar hepatoprotective efficacy in clinical settings.

National list of essential medicines of India, National Essential List of Medicine 2011 – does it have any merit.

Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. The WHO Model List is a guide for the development of national and institutional essential medicine lists. The WHO Model List is updated and revised every 2 years by the WHO Expert Committee on selection and use of medicines. The 19th WHO Expert Committee on Selection and Use met in April 2013 to produce the following lists: 18th WHO Model List of Essential Medicines (2013) and 4th WHO Model List of Medicines for Children (2013). The concept of essential medicines is present in more than 150 countries which have their national list based on WHO Model List.

Evaluation of novel methods of assessments in pharmacology to develop new attitudes and skills in Caribbean Medical School.

Background: Assessment is said to drive student learning and define the curriculum. The problem-solving type of multiple choice questions (MCQs), which can be used to probe and assess medical students in pharmacology should have a clinical vignette containing presenting complaints, abstract history, physical examination and laboratory data, followed by a single or series of questions based on it. National Board of Medical Examination (NBME), USA has an extensive bank of problem-solving MCQs, and these questions are often regarded as similar in format and focus to MCQs of United States Medical Licensing Examination (USMLE). The objective assessment of teaching and curriculum in this study is done by comparison of students’ performance in pharmacology comprehensive exam of NBME, USA before and after curriculum changes. This study was designed to obtain an objective assessment of teaching and curriculum by comparison of students’ performance in terms of student mean grades, percentage of students passed, percentage of students failed, percentage of students with honors, and individual highest scores of five semesters before and five semesters after curriculum changes in pharmacology comprehensive exam of NBME, USA among the 5th semester students of American University of the Caribbean, School of Medicine, St. Maarten. Methods: We have compared the students’ performance of pharmacology comprehensive exam of NBME using five parameters like student mean grades, percentage of students passed, percentage of students failed, percentage of students with honor, and individual highest score of five semesters May 2009, September 2009, January 2010, May 2010 and September 2010 semester batches before the introduction of curriculum changes with subsequent semesters January 2011, May 2011, September 2011, January 2012 and May 2012 semesters after the introduction of curriculum changes. Results: The pre-curriculum student performances were compared with post-curriculum changes using the Student’s t-test. The students mean scores improved significantly from 50.76 before curriculum changes to 56.54, students passed (%) increased from 94.57% before curriculum changes to 96.93% after curriculum changes and students with honors (%) increased significantly from 64.72% before curriculum change to 75.51% after curriculum changes and also seem to have remained consistently better. The students failed (%) decreased dramatically from 5.43% to 3.07% after curriculum changes. The highest individual mean score also improved significantly from 72.4 to 80.8 after curriculum changes and have remained consistent in the following semesters. Conclusions: There seems to be obvious improvements in student performance as reflected by a significant increase in mean scores, students pass (%), and students with honors (%) probably due to inclusion of problem-solving MCQs in formative and summative assessments in new curriculum compared with declarative MCQs in old curriculum. The student failed (%) decreased dramatically, which could be attributed to the changes in teaching content and format brought by curriculum changes in pharmacology. The teaching of pharmacology principles as pathophysiology of drug therapy also seemed to have prepared students better for NBME comprehensive exam and also USMLE Step 1. The clinical pharmacology exercises in small groups as role playing sessions seem to have really improved students’ comprehension and retention of the basic sciences knowledge for clinical application based on students’ feedback.

Canagliflozin: a novel ‘glucuretic’ approach for the treatment of type 2 diabetes mellitus.

Canagliflozin is the first in a new class of glucose-lowering drugs, an oral inhibitor of sodium glucose cotransporter 2 (SGLT2). SGLT2, the transporter is responsible for reabsorbing the majority of glucose filtered by the kidney. SGLT2 inhibitors are a new class of oral drugs indicated only for the treatment of type 2 diabetes mellitus in conjunction with exercise and a healthy diet. They inhibit glucose re-absorption in the proximal renal tubules providing an insulin independent mechanism to lower blood glucose. Their use in clinical studies is associated with improved glycemic control, weight loss, and a low risk of hypoglycemia. They have been studied alone and with other medications including sulfonylureas, sitagliptin, and insulin.