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India is a heliophobic country; despite ample sunshine, almost 490 million people are vitamin D deficient in the country. Additionally, the Indian diet has not been successful in providing the daily need for vitamin D, leading to a vitamin D deficiency. The need to fortifying food with vitamin D has been raised several times. Besides, there have been discussions about whether vitamin D is a hormone or a vitamin? In this review, the authors have reviewed vitamin D deficiency and its status in India, assessment and screening, the role of vitamin D in various disease conditions, dosage recommendation and regimen.
ABSTRACT
India is a heliophobic country; despite ample sunshine, almost 490 million people are vitamin D deficient in the country. Additionally, the Indian diet has not been successful in providing the daily need for vitamin D, leading to a vitamin D deficiency. The need to fortifying food with vitamin D has been raised several times. Besides, there have been discussions about whether vitamin D is a hormone or a vitamin? In this review, the authors have reviewed vitamin D deficiency and its status in India, assessment and screening, the role of vitamin D in various disease conditions, dosage recommendation and regimen.
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The prevalence of prediabetes, a forerunner of diabetes is very high, and its conversion to diabetes is also more rapid among Asian Indians. Prediabetes also predisposes to the development of macrovascular and to a lesser extent of microvascular complications of diabetes. In a large community-based epidemiological study, the Indian Council of Medical Research–India Diabetes (ICMR–INDIAB), data reported an overall prevalence of prediabetes of 10.3%, derived from 15 Indian states. This shows that the diabetes epidemic is far from over as many of them may soon convert to diabetes. Prediabetes, however, should not be considered a path to diabetes rather it should be a window of opportunity for the prevention of diabetes. This early screening, detection, and treatment of prediabetes should be made a national priority. Several countries have introduced lifestyle programs to prevent diabetes and, when indicated, pharmacological intervention with metformin as well. This consensus statement outlines the approaches to screening and lifestyle and pharmacological management of prediabetes in Asian Indians.
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Objectives: This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Methods: Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). Results: The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31–50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin–angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Conclusion: Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.
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Objective: This study aims to compare the effect of metformin monotherapy with the combination therapy of metformin and apple cider vinegar on the parameters of Body Mass Index and glycemic control of recently diagnosed type 2 diabetes mellitus patients. Methods: A total of 126 patients were enrolled in this open-label randomized controlled trial, divided into two parallel arms: Group I (Metformin 750 mg alone per day) and Group II (Metformin 750 mg+Apple Cider Vinegar 2 tablespoons per day) and assessed for weight, Body Mass Index, Fasting Blood Sugar and Hemoglobin A1c after which the post-treatment values of the aforementioned parameters were compared between the two groups. Informed consent from all patients and ethical approval from the institutional ethics board was obtained. A p-value of <0.05 was considered significant. Results: All the parameters underwent a significant reduction in the pre and post intra group comparison of each group (p-value<0.001). Moreover, a significant difference was found in the post-treatment comparisons of the Fasting Blood Sugar (p-value<0.001) and HbA1c (p-value=0.04) in between the two groups. However, no significant difference was obtained in the post-treatment comparisons of weight and Body Mass Index in between the two groups. Conclusion: Apple Cider Vinegar in combination with Metformin appears to be more effective in improving glycemic control versus Metformin monotherapy.
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Background:Diabetes mellitus has remained the major concern for medical sciences researches duetoits deleterious effects on general, physical and mental health of patients. To understand the pathophysiology and to explore better treatment options for such kind of metabolic disorders it is necessary to generate the experimental animal models. To create diabetic animal models, streptozotocin has shown predominance in selectivity as a diabetogenic agent. While studying effects of any intervention in the diabetic animal models, being a cytotoxic drug streptozotocin may affect the study results by inhibiting highly replicating cells especially hematopoietic cells.Original ResearchArticle Aims:The aim of study was to analyze the effects of streptozotocin on various cellular components of blood such as RBCs, WBCs (Lymphocytes, Neutrophils, Eosinophils), Hb%, HCT and Platelets, at baseline,5thday and 15thday without any intervention.Study Design:Animal based Experimentalstudy.Place and duration of Study:The study was conducted at animal house of faculty of Pharmacy Ziauddin University Karachi, while laboratory work was performed at MDRL-1 Ziauddin University.Methodology:In Group A normal saline and in group B and C 60mg / kg streptozotocin diluted in normal saline was administered intraperitoneally. After the confirmation of induction of Diabetes in rats, on fifth day blood samples were drawn from Group A and B and were analyzed. While blood samples from group C weredrawn on fifteenth day.Results:Analysis of various hematological parameters on 5thday revealed that there was a decrease in the levels of Hb, HCT, RBCs and WBCs with an increase in platelet count in group B in comparison to group A (control). On the other hand, in Group C (15th day), blood cell counts (Hb, HCT, RBCs, WBCs, Lymphocytes, Neutrophils and platelets) seemed to recover from streptozotocin induced decline that was observed in group B, however did not reach the baselines as in group A(control).Conclusion:It is concluded that change in hematological parameters of rats after administration of streptozotocin is reversible. The blood parameters may recover near to base line values without any intervention within two weeks
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The present study investigates the antinociceptive, antimicrobial activity and phytochemical assessment of samples from A. pentapomicum. Different microbes were tested using disc diffusion assay at three concentrations [1, 2 and 3 mg/disc]. Antinociceptive activity was determined by acetic acid induced and hot plate methods. The tested plant extracts revealed significant antinociceptive activity at dose dependent manner when measured by acetic acid induced method. The growth of all the tested microbes was inhibited by methanol, butanol, and ethyl acetate extracted samples at all concentrations. Chloroform, n-hexane and aqueous extracts inhibited the growth of the different microbes at high concentration. The most susceptible microbe was P. aeruginosa measuring 94% and 79% zone of inhibition by butanol and ethyl acetate extracts at 3mg /disc. C. fruendii, however, was the most resistant bacterium followed by S. aureus. The presence of alkaloids, proteins, amino acids, carbohydrates, flavonoids, tannins, saponins, and fats were confirmed in phytochemical screening of different extracts
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Objective: to determine the frequency of positive patch tests for nickel in patients suspected of household and occupational metal contact dermatitis
Methods: this was a cross-sectional analytical study carried out in the outpatient department of dermatology unit-II, Mayo Hospital, Lahore. A total of 50 patients were inducted in the study with ages 12 and above and either sex, who were suspected of metal contact dermatitis. The patients were patch tested with the allergen nickel sulphate hexahydrate 5% in petrolatum base from the European standard series
Results: in this study, out of 50 patients, 62% of the patients positively tested for nickel sulphate out of which 38% of the patients showed a strong positive reaction. Only 12% showed a weak positive reaction whereas 12% patients exhibited an extreme positive reaction. Most patients were females i.e. 46 out of 50. The most commonly affected age group was 21 to 30 years. Most patients belonged to middle class. Housewives and students were most commonly affected. Most frequent symptoms encountered were itching 84%, burning 48%, redness 42% and oozing 36%. The dermatitis aggravated in most patients' due to hyperhidrosis and wet work
Conclusion: nickel sulphate is a common allergen in patients suspected of metal contact dermatitis. Nickel contact dermatitis is a very common problem prevalent in our community and the cultural trend towards artificial jewelry predisposes our community to risk
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Objectives: to evaluate the therapeutic efficacy and safety of 0.1% tacrolimus ointment versus mometasone furoate 0.1% ointment in mild to moderate chronic hand eczema
Methods: it was a randomized control trial carried out in dermatology department unit-II, KEMU/ Mayo Hospital, Lahore. Patients with mild to moderate chronic hand eczema were enrolled with age range between 18-70 years, of either sex. We randomized the patients in two groups A and B by balloting. Group A used tacrolimus 0.1% ointment twice daily for 6 weeks. Group B used mometasone furoate 0.1% ointment twice daily for 6 weeks. The data were collected and analyzed by SPSS version 18 and p-value <0.05 was taken as significant
Results: the study was completed by 102 patients, with 51 in each group, with mean age of 32 years and majority were married females. Both the treatment options were found to be equally efficacious with PGA Score showing significant p value at the end of study [p-value = 0.042]. The side effects noted were itching and irritation. Irritation was observed in both treatment groups but did not lead to discontinuation of the treatment, as it was transient. This complaint was seen more among the Group A patients
Conclusion: it is concluded from our study that 0.1% tacrolimus ointment and 0.1% mometasone furoate ointment are equally efficacious and safe in the treatment of mild to moderate chronic hand eczema
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Objective: to determine the effect of dexamethasone administration to women between 37 to 39 weeks of gestation on neonatal outcome in terms of respiratory morbidity and the need for NICU admission
Study Design: an experimental study
Place and Duration of Study: department of Obstetrics and Department of Neonatology, Military Hospital, Rawalpindi, Pakistan, from February to July 2017
Methodology: women with singleton pregnancies, undergoing elective cesarean section between 37-39 weeks. Neonates were evaluated for any respiratory morbidity and need for NICU admission as well as need of mechanical ventilation, length of hospital stay and final outcome
Results: out of 535 patients, 240 [44.8%] patients received steroid cover before their elective cesarean section [group 1]. Two hundred and ninety-five [55.2%] patients who did not receive steroid cover, were allocated group 2. Mean age of mother's in-group 1 was 29.20 +4.50 years and in-group 2, it was 29.34 +4.50 years. The mean gestational ages were 37.56 +0.66 weeks and 38.11 +0.79 weeks in groups 1 and 2, respectively. In-group 2, 14 [4.74%] newborns developed transient tachypnea of newborn [TTN], which was higher than the newborns in-group 1 [04 [1.66%], p = 0.049]. Also the number of neonates being admitted to NICU was greater in group 2 than in group 1 [23 [7.79%] vs. 06 [2.5%] respectively, p = 0.007].However, there was no statistically significant difference between the two groups with regard to final outcome, requirement for mechanical ventilation, length of hospital stay and APGAR scores at one and five minutes
Conclusion: steroid cover significantly reduced the risk of respiratory morbidity in babies delivered by elective cesarean section between 37-39 weeks
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Objective: To evaluate the quality of the observed mini-CEX scores by estimating reliability coefficients and standard errors
Study Design: Quasi-experimental, co relational study
Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi from Sep 2016 to Oct 2017
Material and Methods: This Quasi-experimental, correlational study was conducted with the OBGYN residents through non probability convenience sampling at Pak Emirates Military Hospital with sample size of 40. Twenty residents underwent Mini CEX [in addition to the existing teaching] while 20 had training through existing traditional teaching methods [lectures, SGDs, OPD, ward rounds, journal clubs, CPCs]. Before commencing the study both faculty and Resident trainees were introduced to Mini-CEX. The faculty [CPSP accredited supervisors], were given face to face training in conducting and rating Mini-CEX by a workshop. Each of the 20 trainees took four Mini-CEX sessions over a period of one year. The clinical skills were rated on a standard adapted Mini-CEX proforma. The trainees were given immediate feedback. Action plan was made and documented on the proformas
Results: The Trainees were assessed for improvement in clinical skills over the period of 12 months; and a trend of increased performance was obsessed amongst the trainees with each subsequent evaluation, supporting the construct validity of the instruments
Conclusions: The study showed that the mini-CEX is a potentially powerful tool to provide high-quality, interactive feedback that could contribute to improvement in trainees' clinical skills
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Gestational trophoblastic neoplasia [GTN] is an uncommon complication of pregnancy which can follow any gestational event, molar pregnancy, normal pregnancy, miscarriage or even ectopic pregnancy. Its incidence is high in the region of South East Asia. The curability of GTD is a milestone of success in the history of medicine however we still face challenges in diagnosis and treatment due to myriad of its clinical presentations. The case under discussion is of a patient who presented with unusual symptoms of GTD which posed a diagnostic dilemma but was effectively managed in a tertiary care setting conserving her future fertility and quality of life
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Adams-Oliver syndrome is a rare disease, which presents with cutaneous, cardiac and skeletal defects. We, herein, describe a case of 1-month-old girl with aplasia cutis, cutis marmorata telangiectatica and terminal transverse limb reduction defects with a positive HCV serology. The patient is put on regular follow-up
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Aim: Present hospital based study was carried out at our tertiary care centre with an aim to study the distribution of Cryptosporidium species subtypes in patients with complaints of diarrhea
Background: Cryptosporidium species are one of the important causative agents of parasitic diarrhea, amongst which Cryptosporidium hominis [C.hominis] and Cryptosporidium parvum [C.parvum] are the two major species that are associated with human cryptosporidiosis
Methods: Four hundred and fifty [n=450] diarrheic patients complaining of different types of diarrhea were enrolled in the present study. Both microscopic and molecular diagnostic methods were used for the detection as well as for identification of Cryptosporidium species and its speciation and subtyping
Results: Forty one [n=41] and forty three [n=43] patients were positive for Cryptosporidium species by microscopy and Polymerase chain reaction [PCR] assay respectively. Of these 43 cases, 70% [30/43] were identified as C. hominis and 21% [9/43] was as C. parvum, 7% [3/43] was as Cryptosporidium felis [C.felis] and 2% [1/43] as Cryptopsoridium viatorum [C. viatorum] respectively . Upon subtyping of C. hominis and C. parvum, 16 subtypes belonging to 8 different subtype families could be identified. The frequency of different families were Ia [13%, 5/39], Ib [15%, 6/39], Id [18%, 7/39], Ie [30%, 12/39] and IIa [5%, 2/39], IIc [8%, 3/39], IId [8%, 3/39] and IIe [3%, 1/39]
Conclusion: Our study results strongly suggest and reinforces the fact that most of the human cryptosporidiosis is anthroponotic and we expect that present molecular epidemiological data will provide more insight to unravel the changing clinical paradigm of human cryptosporidiosis at large
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Objective: To assess the association between Follicle-Stimulating Hormone [FSH] and semen parameters in order to evaluate whether the current laboratory reference for abnormal FSH levels should be readjusted
Study Design: Observational, cross-sectional study
Place and Duration of Study: Infertility Clinic of Gynecology Unit 1, Civil Hospital, Karachi, from May 2015 to April 2016
Methodology: The study included 100 sub-fertile males inducted from the clinic. Those above 45 years of age, with hypo gonadotrophic hypogonadism, and those on anabolic steroids were excluded. After history and examination, semen parameters and FSH levels were tested. Abnormal semen values were based on WHO 1999 criteria. Data was analyzed by SPSS 17 and mean, frequencies and percentages were calculated. Chi-square test was applied to check association between variables
Results: The FSH levels had a significant association with abnormal semen sperm concentration, motility and morphology but not with semen volume [p=0.246]. The mean FSH level was 5.8 +/-1.80 IU/L with two-thirds of individuals having value >4.5 IU/L. Frequency of semen abnormalities increased as the level of FSH increased
Conclusion: There is significantly an increased possibility of abnormal semen characteristics at FSH levels >4.5, so the current reference level should be lowered down and adjusted again
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Objective To determine the frequency of positive patch tests for nickel in patients of shoe dermatitis
Methods This was a descriptive study carried out in the outpatient department of Dermatology Unit-II, Mayo Hospital, Lahore. A total of 50 patients were inducted in the study with ages 12 and above and either sex, with shoe dermatitis. The patients were tested using patch tests with the allergen nickel sulfate hexahydrate 5% in petrolatum base using the European standard series
Results Most of the patients were female i.e. 37 out of a total of 50
The mean age of patients was 31 years [14 to 65 years]. Housewives and students were most commonly affected. 18% of the patients positively tested for nickel sulfate
Conclusion Nickel sulfate hexahydrate is a frequent allergen causing shoe dermatitis
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Department of Dermatology, Unit II, King Edward Medical University/ Mayo Hospital, Lahore
Objective To compare the efficacy and safety of calcipotriol ointment versus betamethasone ointment versus calcipotriol plus betamethasone ointment in patients of vitiligo
Methods Patients with vitiligo [n=159] were randomized in three equal groups A, B and C. Group A [n=53] applied topical calcipotriol ointment, group B [n=53] applied topical betamethasone dipropionate ointment and group C [n=53] applied calcipotriol plus betamethasone ointment for a total of three months and were followed up for further 1 month. They were evaluated for improvement in pigmentation using Vitiligo Area Scoring Index [VASI] and side effects
Results Out of a total of 159 patients, females [66.7%] out-numbered male patients [33.3%]. Mean of change in VASI was 38.77 in group C, 26.23 in group B and 18.30 in group A. Overall change in VASI was highest in group C with a statistically significant p = 0.008. All the groups showed few side effects like erythema, burning, atrophy and acneiform eruption, which were not statistically significant
Conclusion All topical therapies were found to be efficacious and safe in the treatment of vitiligo. But out of these three drugs, the combination of calcipotriol and betamethasone was superior in efficacy
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Cutaneous leishmaniasis [CL] is endemic in many areas of Pakistan. The typical clinical presentations of cutaneous leishmaniasis are papulonodular, plaque and ulcer but certain atypical types have also been reported worldwide. Here, we describe eleven patients with uncommon lesions that were difficult to recognize clinically as CL and the diagnosis of CL was made on histopathology. Out of 11 patients, there were 9 males and 2 females. The commonly affected sites were face [55%], upper limbs [36%] and lower limbs [9%]. The morphological patterns noted were lupoid [5], sporotrichoid [2], eczematous [2], furuncle-like [1] and tinea faciei-like [1]