Study the role of hepcidin in diagnosis of iron deficiency anemia in young females of northern India

Background: Iron deficiency is one of the most common nutritional disorder. Maintenance of body iron status is an integral part of healthcare in young female of reproductive age group. Thereby early detection could lead to early intervention and reduce its comorbidity.  Indeed, an ideal screening test should be capable of identifying iron deficiency long before developing anemia. Henceforth, the present study was aimed to determine utility of serum hepcidin in iron deficiency and to access the baseline value of hepcidin in young female.Methods: This sectional study was conducted in the Department of biochemistry SGT Medical College Hospital and Research Institute, Budhera, Gurugram. It included non-pregnant female students of age 18-25 years with normal RBC indices and hemoglobin >12 gm%. Estimation of serum hepcidin-25 was by ELISA.Results: The reference range of hepcidin established in this study was 12.14-139.89 ng/ml for females with the mean being 42.4±29.13 ng/ml. It showed higher discriminating power in evaluating iron status in young healthy women (AUC 0.984) with best combination of diagnostic sensitivity (95.7%) and specificity (93.2%) at a cut off of >15.7 ng/ml. Serum hepcidin identified 17% of young healthy females with normal hemoglobin to have functional or storage iron deficiency.Conclusions: The prevention of iron deficiency anemia remains insufficient worldwide especially among underprivileged women and children Therefore, estimation of serum hepcidin may be considered as a valuable tool in assessing iron status in young healthy female population who are the prime target group for iron supplements to reduce comorbidity associated with iron deficiency and anemia.

Fabrication of potential gastroretentive microspheres of itraconazole for stomach-specific delivery: Statistical optimization and in vitro evaluation

The premise of the study was to develop and optimize multiple unit gastroretentive microspheres of itraconazoleto prolong its localization in the stomach and analyzed using response surface methodology. The emulsion solventdiffusion evaporation method was used to prepare hollow microsphere of ethyl cellulose and Eudragit RS100 as lowdensity shell-forming polymers. The experimental design matrix was prepared using a central composite design tostudy the effect of various process parameters over response variables. The optimized microspheres showed a particlesize of 285.1µm, drug entrapment efficiency of 86.8%, buoyancy of 51.1%, and cumulative drug release of 77.80%.The experimental responses were in good harmony with the predicted values. The compatibility between drug andexcipients was determined by Fourier-transform infrared and differential scanning calorimetry analysis. The resultssignify that gastroretentive hollow microspheres are a promising vehicle to extend the retention time of itraconazolein the upper GI tract, and it can be floated in an acidic medium for a prolonged period.

Caesarean scar pregnancy: a case report with review of management options

Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology.

A study of preinduction transvaginal ultrasonographic cervical length and its comparison with bishop score in predicting successful labour

Background: Significant number of induced pregnancies land in caesarean delivery. Cervical assessment is integral to successful outcome of induction of labour. Objective of this study was to study preinduction transvaginal ultrasonographic cervical length and to compare it with Bishop Score in predicting successful labour.Methods: This prospective study was conducted at the department of obstetrics and gynaecology, MMIMSR, Mullana, Ambala on 150 patients. A total of 150 women were studied from January 2015 to June 2016 after taking an informed consent. The sociodemographic particulars were recorded, detailed history was taken and examination performed. Transvaginal ultrasound was done to assess cervical length after evacuation of bladder. Bishop score was then determined by separate observer. The occurrence of vaginal delivery was considered as primary outcome. All statistics collected were entered in statistical software SPSS-15. ROC curves were constructed for both Bishop Score and TVS.Results: The mean gestational age was 38 week 6 days, majority 134 (89.3%) being less than 40 weeks of gestation. The ROC curve for Bishop Score demonstrated better predictability compared to cervical length by TVS. Optimized cut off for Bishop score in addition to TVS was determined by ROC curve to predict successful vaginal delivery, it was ≥ 6 for Bishop score (sensitivity 90.7%, specificity 68.6%, positive predictive value 91.5% and negative predictive value 66.7%) and ≤ 3.0 cm for cervical length on TVS (sensitivity 74.6%, specificity 51.6%, positive predictive value 74.5% and negative predictive value 51.6%). The relation of both cervical length and Bishop score with successful vaginal delivery was found to be statistically significant with p value of 0.0001.Conclusions: The present study indicates that Bishop Score is a better predictor for successful vaginal delivery as compared to cervical length by transvaginal ultrasonography.

Provisioning of dental health in public hospitals: A case study of District Jalandhar, Punjab.

Background: The Government of India is increasingly emphasizing the provisioning of dental services in public hospitals, but the rural and deprived sections are struggling to get basic dental procedures done in public hospitals. Aim: To study variations within and across public hospitals for provisioning of dental health settings in Jalandhar district of Punjab. Settings and Design: The study area consisted of four Community Health Centers (CHCs) and District Hospital situated in Jalandhar, Punjab, India. Materials and Methods: The dental infrastructure and dental procedures performed in the public hospital were checked with the help of a checklist as listed in the Indian Public Health Standards 2012 for CHCs and district hospital, and then, the variations within and across these public hospitals were compared. Statistical Analysis: Percentages were used to make comparisons within and across the public health institutions. Results and Conclusions: The results showed that out of total outpatient department (OPD) of the public hospitals, dental OPD formed 5%–10% in public hospitals and extraction was the most frequently performed procedure. There is no availability of prosthodontic and orthodontic procedures in the public hospitals. There were no dental auxiliaries in the CHCs, and there was lack of proper dental materials needed in the dental clinics.

Evaluation of dentine hypersensitivity in adult population with chronic periodontitis visiting dental hospital in Chandigarh.

Background: Periodontal attachment loss could be an earlier indicator or a possible risk factor of dentine hypersensitivity (DH). Thus, there is a need for diagnosing this condition both by questionnaire and by clinical examination before rendering both home care and in‑office treatment modalities. Aims: To investigate the relationship between various demographic factors and DH and to detect the percentage of patients using desensitizing agents. Materials and Methods: In this cross‑sectional study, 2051 patients were evaluated till the required sample size of 1000 patients was achieved who were evaluated both by questionnaire and clinical test. Association between DH clinical attachment level and apparent recession was established. Results: This study found that the prevalence of dentine hypersensitivity in chronic periodontitis patients was 37.2% according to questionnaire and 47.8% according to the results of clinical test. Various demographic factors were found to affect dentine hypersensitivity such as age, gender, education, diet, and locality. Conclusion: The prevalence of dentine hypersensitivity in chronic periodontitis patients was 37.2% according to questionnaire and 47.8% according to the results of clinical test. Periodontal attachment loss could be an earlier indicator or a possible risk factor of DH. Only 14.36% of the patients with sensitive teeth used desensitizing paste. This could be due to the fact that either the patients did not consider the condition bad enough to warrant treatment or it was not being diagnosed.

A case report on severe hypothyroidism associated with complete bilateral ptosis: A rare presentation / Journal of the ASEAN Federation of Endocrine Societies

@#Thyroid hormones exert a major control over many vital functions of the human body and thus have an important role in maintaining homeostasis. Therefore, the hypothyroid state is associated with a wide spectrum of symptoms affecting almost all bodily functions. Among the major organs affected, nervous system and body metabolism are severely affected. Facial appearance, including ocular changes, is a characteristic of the hypothyroid state. The most prominent ocular features of hypothyroidism include loss of eyelashes and eyebrows, especially on the temporal side, puffiness of the eyelids, ocular irritation and ocular protrusion. Mild drooping of the eyelids is also seen in some patients due to loss of sympathetic tone; however the occurrence of complete bilateral ptosis is rare in the setting of hypothyroidism. Our patient, who presented with sudden onset bilateral ptosis, had no manifestations of diseases involving the ocular structure, cranial nerves or central nervous system primarily; the cause may be attributed to severe hypothyroidism considering the dramatic response to thyroxine replacement therapy.

Squamous Cell Carcinoma Arising In A Mature Cystic Teratoma, An Unusual Presentation As Pain Abdomen.

Germ cell tumors constitute approximately 20%- 30% of all ovarian tumors.Mature cystic teratomas account for 95% of germ cell tumors. Malignant transformation in a mature cystic teratoma of the ovary is a rare event, developing in 1 to 2 % of cases with squamous cell carcinoma being the most common malignant transformation(75%). We report a case of malignant transformation in mature cystic teratoma of the ovary in a 45 year old multiparous woman who had presented with pain abdomen for last two months. Pain was not releaved by symptomatic measures and therefore investigations were carried out, Radiological investigations revealed bilateral ovarian teratoma. During laprotomy a large cystic mass was seen arising from the left ovary that was adherant to the large gut. Right ovary was also found to be enlarged. Final histological diagnosis of bilateral cystic teratoma of ovaries with malignant squamous cell carcinoma arising in left ovarian teratoma was made.

Anesthetic management of a case of suicidal cut throat injury

Traumatic airway injuries may be rare, but these can be difficult to manage as there is a chance of aspiration of blood and risk of hypoxia as happened in our case. We present a case of suicidal cut throat injury in a 16 year old male. Tracheal intubation was initially done directly through the tracheal cut; and tracheostomy with repair of wound followed later on. The patient was electively ventilated for 12 hours post operatively and recovered completely. Mortality and late complications in these patients are high and may be related to delay in definitive treatment

Direct Observation and Focused Feedback for Clinical Skills Training.

Direct observation of the medical trainee by an expert assessor and providing authentic feedback is considered an important tool for development of clinical and procedural skills. Mini-clinical evaluation exercise and Direct Observation of Procedural Skills are two important tools to observe the trainee during a clinical encounter or during a procedure, make an expert standardized (though subjective) observation, and use it to provide developmental feedback. Both can be easily integrated into routine work of clinical departments, and both provide a reliable assessment if 6-8 such encounters are used.

Feasibility and Acceptability of Direct Observation of Procedural Skills to Improve Procedural Skills.

Procedural skill learning is usually unobserved during post graduate training. This study is an attempt to evaluate feasibility and acceptability of direct observation of procedural skills in a medical school in Northern India for postgraduates in Pediatrics. Eighty procedures performed by 15 trainees were observed by 9 faculty members. Seven of nine assessors considered direct observation to be feasible and non-intrusive in their routine clinical and teaching schedule while 5 out of 9 felt that it was time consuming. All fifteen trainees felt that direct observation enhanced their procedural skills and wished it to be extended to all procedures.

Periodontal-Restorative Interactions: A Review.

The interrelationship of restorative dentistry and periodontics is a dynamic one. We have reviewed the various guidelines for performing periodontally compatible restorative dentistry. Using these basic guidelines, restorative care can be used to directly aid periodontal treatment by restoring an esthetically pleasing, comfortable and stable dentition. This article addresses the interactions between periodontal tissues and restorative procedures.

In vitro propagation and mass scale multiplication of a critically endangered epiphytic orchid, Gastrochilus calceolaris (Buch.-Ham ex J.E.Sm.) D.Don.

In vitro asymbiotic seed germination potential of its immature seeds (36 weeks after pollination) of G. calceolaris was successfully tested on three different agar gelled nutrient media i.e. Murashige and Skoog (MS), Mitra et al. (M) and potato dextrose agar (PDA). Seeds germinated within 15.75±0.75 to 35.75±0.75 days in the three different media. The protocorms developed therefrom subsequently differentiated into first leaf and root primordia, and complete seedlings were obtained within 111.25±1.25 to 141.25±1.25 days on MS and M media. The protocorms, though failed to differentiate further on basal PDA medium, despite repeated subculturings, incorporation of peptone (P; 1gl-1), yeast extract (YE; 2 gl-1) and coconut water (CW; 20%) in the medium proved beneficial in inducing differentiation, in these germinating entities. Additional use of growth additives (P/YE/CW), in general, favoured better germination, protocorm formation and seedling development. The optimal nutritional combination during seed germination, protocorm growth and multiplication and seedling development was found to be CW (10%) enriched MS medium.

Detrimental effect of expression of Bt endotoxin Cry1Ac on in vitro regeneration, in vivo growth and development of tobacco and cotton transgenics.

High levels of expression of the cry1Ac gene from Bacillus thuringiensis cannot be routinely achieved in transgenic plants despite modifications made in the gene to improve its expression. This has been attributed to the instability of the transcript in a few reports. In the present study, based on the genetic transformation of cotton and tobacco, we show that the expression of the Cry1Ac endotoxin has detrimental effects on both the in vitro and in vivo growth and development of transgenic plants. A number of experiments on developing transgenics in cotton with different versions of cry1Ac gene showed that the majority of the plants did not express any Cry1Ac protein. Based on Southern blot analysis, it was also observed that a substantial number of lines did not contain the cry1Ac gene cassette although they contained the marker gene nptII. More significantly, all the lines that showed appreciable levels of expression were found to be phenotypically abnormal. Experiments on transformation of tobacco with different constructs expressing the cry1Ac gene showed that in vitro regeneration was inhibited by the encoded protein. Further, out of a total of 145 independent events generated with the different cry1Ac gene constructs in tobacco, only 21 showed expression of the Cry1Ac protein, confirming observations made in cotton that regenerants that express high levels of the Cry1Ac protein are selected against during regeneration of transformed events. This problem was circumvented by targeting the Cry1Ac protein to the chloroplast, which also significantly improved the expression of the protein.

Utility of Indian adaptation of Integrated Management of Childhood Illness (IMCI) algorithm.

OBJECTIVE: To evaluate the utility of Indian adaptation of IMCI algorithm. METHODS: Children presenting to outpatient department (n=169) or casualty (n=140) among 309 cases were assessed and classified as per IMCI algorithm, the final diagnosis made after detailed evaluation and relevant investigations, served as the gold standard. The diagnostic and therapeutic agreements between the gold standard, IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed. RESULTS: Coexistence of illness was observed in 75% of children as per IMCI algorithm. The mean (SD) number of morbidities as per the Gold standard and IMCI were 1.75 +/- 0.75 and 2.19 +/- 0.96 respectively. The referral criteria proved useful in predicting hospitalisation with high sensitivity and specificity (99.3% & 97.3%). IMCI algorithm covered majority of recorded illnesses. A total agreement with IMCI was found in 88.4% cases, while total disagreement was seen in 34.5% cases. Corresponding figures for vertical program were 88% and 18.6%. The difference was primarily due to underdiagnosis. The diagnostic discordance of IMCI and gold standard was evident for the cough category due to underdiagnosis of bronchial asthma and bronchiolitis and an overdiagnosis of pneumonia. The IMCI algorithm had a provision for preventive services of immunization (24.5% possibility of availing missed opportunity) and feeding advice. CONCLUSIONS: There is a sound scientific basis for adopting the IMCI approach since: (1) Co-existence of morbidities is a rule rather than exception for sick under-five children. (2) The algorithm provides good sensitivity and specificity for assessing severe illness and (3) IMCI algorithm is superior to vertical disease specific programs. It is, however, important to carefully adapt the generic IMCI algorithm to reflect the local morbidity profile.