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Background: Chronic urticaria, in many cases, has an unsatisfactory response to antihistamines. The current recommendations in urticaria do not mention the dose and duration for methotrexate. Aims: This study aims to systematically review the use/efficacy of methotrexate in chronic urticaria. Methods: A systematic search in four databases, that is, PubMed/Medline, Cochrane central, Google Scholar and Clinicaltrials.gov was done to identify studies on the use of methotrexate in chronic urticaria using key words “methotrexate [MeSH terms]” and “urticaria” or “urticaria, chronic” or “urticaria, chronic spontaneous.” Results: Nine articles (study participants 127), including three randomized control trials, one prospective interventional trial without control, three retrospective reviews and two case reports, were identified and finally included in the systematic review. There was a paucity of literature and the three randomized control trials did not show any benefit of methotrexate over antihistamines alone. However, in studies where steroid- dependent cases were given methotrexate, marked benefit was reported with steroid-sparing effect, particularly on methotrexate dose escalation. Limitations: Due to a paucity of published literature on methotrexate in urticaria, a meta-analysis could not be done. Conclusion: In chronic recalcitrant or steroid-dependent cases, methotrexate may be a therapeutic agent of interest; however, current evidence does not point to any added advantage in efficacy over antihistamines. More evidence based on larger, well-executed randomized control trials is needed in the future to get more definitive answers
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Background: An observational study was undertaken to study the relationship between maternal serum vitamin D levels during peripartum period and neonatal birth weight.Methods: This study was done on 569 patients to study the relationship between maternal serum vitamin D levels during peripartum period and neonatal birth weight. The data included was maternal serum samples (taken during peri-partum period) and neonatal birth weight. The primary objective of this project was to assess the vitamin D levels in maternal serum and to study its relationship, if any, with birth weight in the neonates.Results: A total of 569 samples of maternal serum were analyzed for serum 25(OH)D levels out of which 457(80%) mothers were found to have sufficient, 101(18%) insufficient and 11(2%) deficient Vitamin D levels as per US Endocrinological society guidelines. Out of total 569 newborns, 104 (18.27%) were low birth weight (LBW) and 465 (81.27%) were normal birth weight (NBW). Out of total LBW (104), 19(18.27%) were born to vitamin D deficient (VDD) mothers and 85 (81.72%) were born to vitamin D sufficient (VDS) mothers. Out of total NBW(465), 86(18.45%) were born to VDD mothers and 379 (81.17%) were born to VDS mothers. These results were not statistically significant (p=0.76456749).Conclusions: Maternal 25(OH)-vitamin D status during late pregnancy did not have any statistically significant effect on the neonatal birth weight.
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Background: Polycystic ovarian syndrome (PCOS) is one of the most frequently encountered endocrine disorders that occurs in as many as 4 to 10% of women of reproductive age group. It presents with a series of skin changes including acne, hirsutism, seborrhea, androgenetic alopecia (AGA) and acanthosis nigricans. Aim of the study was to determine the prevalence and frequency of different cutaneous manifestations in PCOS patients and to correlate them with the degree of hormonal abnormalities.Methods: A total 100 patients with features of PCOS who presented to department of dermatology, gynecology (January 2018-December 2019) with cutaneous manifestations were recorded and diagnosis of PCOS was made using Rotterdam’s criteria. Pregnant women and diagnosed cases of any other endocrine disorder were excluded. Hirsutism was assessed using Ferriman-Gallwey score and AGA according to Ludwig’s classification. Serum hormonal profile including FSH, LH, prolactin, testosterone (free), DHEAS, TSH, FBS, fasting insulin were done. Insulin resistance was determined by calculating HOMA-IR score.Results: Among cutaneous manifestations of PCOS, hirsutism (85%) was the most common finding followed by acne (73%), seborrhea (50%), AGA (36%), acanthosis nigricans (29%) and acrochordons (9%). The most common hormonal abnormality was insulin resistance in 53% patients, followed by raised free testosterone in 19% and serum prolactin in 18% patients. A statistically significant association was present between AGA and insulin resistance, hirsutism and raised prolactin levels, seborrhea and raised body mass index (p < 0.05).Conclusions: Dermatological manifestations of PCOS play a significant role in making the diagnosis and constitute a substantial portion of the symptoms experienced by women with this syndrome.
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Congenital adrenal hyperplasia (CAH) is an autosomal recessive endocrine disorder which can manifest after birth with ambiguousgenitalia and salt-wasting crisis. However, genital ambiguity is not seen in male babies and may be mild in female babies, leading to amissed diagnosis of classical CAH at birth. In this review, we provide a standard operating protocol for routine newborn screening forCAH in Indian settings. A standardization of first tier screening tests with a single consistent set of cut-off values stratified by gestationalage is also suggested. The protocol also recommends a two-tier protocol of initial immunoassay/time resolved fluoroimmunoassayfollowed by liquid chromatography tandem mass spectrometry for confirmation of screen positive babies, wherever feasible. Routinemolecular and genetic testing is not essential for establishing the diagnosis in all screen positive babies, but has significant utility inprenatal diagnosis and genetic counseling for future pregnancy.
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Rimpi Gupta, Editor: C M Francis, Medical Ethics as per revised MCI curriculum. 4th edition. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2020, pp 220, Rs 295 (paperback), ISBN 978-93-89188-62-2. Olinda Timms, Biomedical Ethics AETCOM companion for medical students. 2nd edition. New Delhi: Elsevier – RELX India Pvt. Ltd; 2019. 284 pp, Rs 450 (paperback), ISBN 978- 81-312-5965-8.
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REPORT The first National Award for Medical Humanities in Indore: A report. Sunil K Pandya DOI: 10.20529/IJME.2020.022 Introduction Dr Apoorva Pauranik1, retired Professor of Neurology and Consultant Neurophysician from the Mahatma Gandhi Memorial Medical College (MGMMC) and the affiliated Maharaja Yeshwant Rao Holkar Hospital (MYH) in Indore, Madhya Pradesh, is the Director of Pauranik Academy […]
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Background: Emergence of hypothyroidism as a public health issue apart from a common clinical entity, has gained much attention nowadays. The non-specific features of hypothyroidism lead to incorrect diagnoses, inadequate treatment and complications in the future. The present study was designed to unravel the effects of hypothyroidism on physiological parameters and to highlight the importance of early diagnosis and treatment. This study was done to assess the effects of hypothyroidism on pulse rate, blood pressure and respiratory rate.Methods: This descriptive cross-sectional study was done in 60 hypothyroid patients of 18-45 years age, both males and females, who were either newly detected or on treatment for less than 6 months. Patients with history of other systemic diseases, pregnancy and hyperthyroidism were excluded. After obtaining written consent from the patients, clinical examination was done.Results: Student t-test and ANOVA were used for analysis. Physiological parameters like pulse rate, blood pressure and respiratory rate had variations in the patients and there were changes with age, gender and BMI even though they were not significant. These changes were attributed to increased arterial wall thickness and endothelial dysfunction in blood vessels.Conclusions: The patients showed changes in cardiovascular and respiratory profiles. The variations in systolic and diastolic blood pressures were significant with increase in age. Physiological parameters had variations with gender and BMI also. This proves the cardiovascular and respiratory morbidity in newly detected hypothyroidism, which emphasizes the importance of early diagnosis and treatment in them.
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Background: Preterm labor is a potential cause of preterm birth. Certain demographic and presenting features in pregnant women may correlate to the severity of the problem and progression to delivery. The aim of the study was to find out the clinical profile and fetal outcome in women with preterm labor pains in a tertiary care hospital of North India.Methods: 83 women with preterm labor were included in the study. Antenatal corticosteroids and tocolytic therapy were given. Women who delivered preterm comprised of Group A and who delivered at term were Group B. Clinical profile and fetal outcome was compared and statistically analyzed.Results: 39 (47.0%) women had preterm delivery (Group A) and 44 (53.0%) women delivered at term (Group B). 23.1% women in group A and 4.5% in group B had a previous preterm birth (p=0.021). 16 (41%) women in group A and 4 (9.1%) in group B had a positive microbial growth on high vaginal swab (p=0.001). The odds of having a preterm birth with cervical length of <2 cm was calculated to be 5.281 (p=0.000). A statistically significant difference was observed in the mean birth weight, Apgar score and nursery admissions in both the groups (p=0.000).Conclusions: A prior history of preterm birth, a positive growth on high vaginal swab and a cervical length of less than 2 cm were found to be significantly associated with preterm birth.
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Scrub typhus is one of the three most common causes of prolonged fever in Southeast Asia and Pacific affecting almost 1 million people annually worldwide out of 1 billion exposed. Scrub typhus is a rickettsial infection caused by Orientia Tsutsugamushi transmitted through bite of Chiggers (larval stage of trombiculid mite). It is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure and death. Deaths are attributable to late presentation, delayed diagnosis, and drug resistance. Scrub typhus, though endemic in India; yet is under reported. It should be considered as an important differential diagnosis in a febrile patient with thrombocytopenia, deranged liver or renal functions, and B/L chest opacities. Relapse is not uncommon. Presumptive treatment with Doxycycline can be a suitable option in febrile patients from Typhus pockets. Alert physician should keep an eye on deviation from usual presentation to changing spectrum of the disease. Early diagnosis and appropriate treatment is rewarding and prevents morbidity and mortality.
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Background: Acquired immunodeficiency syndrome (AIDS) has emerged as one of most serious public health problem in the country. ICTC (integrated counseling and testing centre) provides a key entry point for the 'continuum of care in HIV/AIDS' for all segments of the population. This study was conducted to assess knowledge and awareness regarding HIV/AIDS among attendees of ICTC because awareness is only means to reduce prevalence of any disease in absence of availability of treatment and cure.Methods: The study was conducted among attendees of integrated counseling and testing centre who were visited at the centre for HIV testing. It was a cross-sectional, observational study and conducted at ICTC attached to Microbiology Department of Bundelkhand Medical College, Sagar.Results: Majority of study subjects (34.96%) had a relatively poor knowledge about HIV/AIDS. In spite of having awareness, the respondents had lack of complete knowledge about the root cause of HIV/AIDS and had misconceptions about the mode of transmission.Conclusions: Gender, education, residence, caste and socio-economic status showed the significant association with knowledge score regarding HIV/AIDS. IEC activities should be planned in local language incorporating locally derived data pertaining to various social norms, cultural beliefs and sensitivities of community.
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Background: Hypertension once considered a problem of adults only in the high income countries, now dramatically is on the rise in low and middle income countries. An established predictor of adult hypertension and organ damage is childhood hypertension. Thus for the control, effective treatment and prevention of its complications, early diagnosis of hypertension in adolescents in an important strategy. The objective was to study the blood pressure profile and its socio-demographic determinants among school going adolescents in urban Agra.Methods: A cross-sectional survey was done among 534 adolescent in age group of 13-18 years studying in various government and private schools in urban Agra. Socio demographic details, anthropometric measurements and family history of hypertension were obtained. Also the dietary habits, physical activity, mode of transport to school were included in the present study. Blood pressure was measured at 0 and 30 minutes and average of two readings was taken as the final reading of that individual.Results: It was found that 49.82% of the study subjects had above normal blood pressure and among them 21.16% were hypertensive and 28.66% had pre-hypertension. Higher blood pressure showed a statistically significant (p<0.05) association with gender, age, dietary habits, physical activity, body mass index, and parental history of hypertension.Conclusions: Hypertension among the adolescent age group was very high. Prevalence of high blood pressure significantly associated with age, gender, family history of hypertension, physical activity, type of school and dietary habits.
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Dr. Bawaskar’s sensitivity in this matter deserves applause (1). The principle of confidentiality dictates that what is discussed by doctor and patient remains between them and should not be divulged to anyone else without the patient’s express consent.
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Background: Dengue is an arboviral, mosquito borne illness caused by bite of infected aedes mosquitoes which breed commonly on household water containers like cooler tank, fridge trays and flower pots. Though dengue is non fatal illness but it may lead to deaths from dengue hemorrhagic fever and dengue shock syndrome. The objective of the study was to assess the community awareness regarding dengue and practices primarily being used as personal protection measures against mosquito bites and abolition of household breeding sites of mosquitoes.Methods: A cross sectional observational study done in 5 randomly selected wards of the municipal corporation Sagar. 400 households were studied, selecting 80 houses from each ward randomly. Pretested structured questionnaire was used for interview with the head of family/adult member of the family. The data collected was analysed using SPSS software and chi square test was applied as test of significance.Results: The households studied were mostly (28.2%) of lower middle class (modified B G Prasad scale). the dengue awareness in the community was fair (44.25%) and satisfactory (46.25) in Likert scale. Awareness regarding household breeding sites of mosquitoes was absolute (100%) but the use of personal protective measures was partial (50%).Conclusions: The knowledge and awareness to stop the mosquito breeding, biting should be enhanced and should be turned into action.
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Background: Obesity is the major cause of various non-communicable diseases including diabetes mellitus, hypertension. The modifiable factors like stress, sedentary life, consumption of soft drinks and fast foods and lack of physical activity are responsible for it. Objective: to find dietary pattern, physical activity and status of overweight and obesity among medical students.Methods: It was a cross sectional observational study conducted on MBBS undergraduates studying in a g medical college at Sagar district of Madhya Pradesh, India. Out of nearly 500 medical students studying in different semesters, 300 students were participated in the study though the required sample size was 184 only. Structured questionnaire for interview, calibrated portable weight scale for weight measurement and stadiometer for height measurement were used.Results: The students were categorised into underweight, normal and overweight/obese on the basis of their calculated BMI (body mass index) value as per norms of World health organization for south Asian populations. 26.7% medical students were found to be overweight or obese based on BMI cut off value 23.00 kg/m2. There was lack of inclusion of fresh fruits and green vegetables in regular diet in 50% and nearly 95% of medical students respectively. The low level of physical activity was found in more than 85% of the medical students.Conclusions: The involvement of medical students in physical and sports activities is dire need for their good health.
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Background: Health care workers (HCW) are at risk of an occupational exposure to blood borne diseases like HIV and Hepatitis B through accidental needle stick injuries. This study was conducted to assess the awareness regarding needle prick injuries among health care providers and their exposure to NSIs in a tertiary care medical college hospital with 750 bed capacity.Methods: This cross sectional observational study was conducted on 300 voluntarily participated HCWs out of total 650 HCWs. A semi structured questionnaire was used to assess their knowledge about exposure to blood and body fluids, needle stick injuries and associated risks and post exposure prophylaxis. Details of previous exposures to NSIs in last one year (2017-18) were also asked and their opinion about role and responsibilities of hospital administration for management of NSI was also recorded.Results: More than 90% HCWs were aware of exposure to blood and body fluids, 80.7% were aware of needle stick injuries, all 100% were aware of transmission of HIV and Hepatitis B from NSis and 78% were aware of post exposure prophylaxis. 97 cases of NSIs occurred in last one year which was higher than estimated EPInet data. Injection needle was most commonly (93.8%) involved in causing accidental NSIs.Conclusions: Practice of universal precautions and standard injection procedures by HCWs should be followed and education, training, and group insurance should be provided by hospital administration for prevention of NSIs.
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Sorafenib is an oral multi-kinase inhibitor used primarily in the treatment of hepatic cellular carcinoma, renal cell carcinoma, and thyroid carcinoma. Hand-foot syndrome also is known as palmar-plantar erythrodysesthesia causes reddening, numbness, swelling of palms of hands and soles of feet. In this report, a known case of renal cell carcinoma, post right nephrectomy patient on treatment with tab sorafenib had developed the hand-foot syndrome
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Background: Timely referral and safe transport form a crucial link for the survival and safety of sick newborn. Thus the study aimed at assessing referral and transport of sick neonates admitted to NICU of a tertiary care government hospital and the factors associated with direct referral and safe final transport. Methods: A hospital based cross-sectional study was carried out in among 450 neonates and was based on face to face interview with caregivers. The data was analyzed using proportions and mean values Chi square test of significance and independent t test were appropriately applied and p<0.05 was taken to be statistically significant. Odds ratios were calculated for dichotomous variables. Results: 72.6% of high risk pregnancies were transferred timely in utero to district hospitals. Around two thirds (65.8%) of neonates were referred by doctors. Treatment during transportation was administered to 29.6% of the neonates. 50.2% of neonates have used the services of an ambulance at some point of time during their travel. Highly significant association of direct referral was observed with earlier age at admission (2.3 days), early development of neonatal symptoms (1.45 days), lesser gestational age (33.1 weeks) and lesser total distance travelled (15.7 km). The odds of final transport of newborns in ambulance was significantly more in males (OR=1.5), rural residents (OR=1.5) and registered pregnancies (OR=4.3). Conclusions: Wide variations remain in neonatal referral and transport with some glaring gaps which need to be adequately addressed.
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Marcellus’ observation in Shakespeare’s Hamlet (1) that “Something is rotten in the state of Denmark.” (Act 1, Scene 4) could well be applied to medical education in India today. and could be followed up by repeating another statement earlier in the play, “and I am sick at heart.” (Act 1, Scene 1).
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Pulmonary embolism (PE) may be potentially fatal if not diagnosed and treated in time. Although specific electrocardiogram (ECG) findings often suggest the diagnosis of PE, occasionally, the ECG may mimic that of an acute coronary syndrome (ACS). We report an interesting case of a 45-year-old female presenting with sudden onset chest pain and shortness of breath with widespread ST depression in anterior precordial leads. Although initially treated and referred as a case of ACS, careful analysis of the ECG and subsequent echocardiography and computed tomography imaging confirmed the diagnosis of PE. Intensivists and cardiologists need to be aware that diagnostic dilemma between PE and ACS is not uncommon due to such “ischemic-looking” ECG as well as elevated troponin levels in both conditions. The use of multimodality imaging techniques is helpful in arriving at the correct diagnosis.
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Background: Antenatal Care (ANC) utilization facility is available but poorly utilized because of many factors which play indirect role in inadequate utilization of antenatal care facility: low social status of women in the society, less opportunity for basic education, less ability to make decisions. Therefore, the present study is an attempt to study the effect of maternal education on antenatal care utilization, maternal and perinatal outcome in a tertiary care hospital.Methods: A prospective study was carried out on 525 cases delivered during period of one year at Dayanand Medical College and Hospital, Ludhiana, Punjab, India; a tertiary care hospital catering both urban and rural population. All cases were categorized into two groups: booked and unbooked. The age, parity and education of each patient in booked and unbooked cases was noted. Further, its impact on antenatal care utilization, maternal and perinatal outcome was studied.Results: On studying education pattern, among illiterate subjects 50% were booked and 50% were unbooked; For graduate and above were 80.6% and 19.4%respectively. Among mothers who were illiterate 90.9% had low birth weight babies and 13.6% had stillborn. Among those graduates and above 38.7% had low birth weight babies,1.5 % stillborn and 1.2% neonatal deaths.Conclusions: The educational status of the women came out as a significantly important variable and predictor of perinatal outcome. Hence, whole hearted efforts should be directed in educating women population and also improving health care facilities in rural areas to provide early referral to higher centers.