Clinical Profile of Subclinical Hypothyroidism:A Retrospective Study

Background: Subclinical hypothyroidism occurs due to an under functioning thyroid gland and presents with varied symptoms and signs. Thyroid disorders are common in Indian population and the prevalence of subclinical hypothyroidism is high. Objective: This study intended to assess the clinical profile of patients presenting with subclinical hypothyroidism. Materials and Methods: This was a retrospective study that analyzed the medical records of adult patients diagnosed with subclinical hypothyroidism for a period of three years. Results: 71 patients within the age range of 18 years to 77 years were diagnosed with subclinical hypothyroidism. Among these 53 (75%) patients had various clinical symptoms. Body pains were the most common symptom (38 %) followed by weight gain(27%) and tiredness (20%). A significant number of patients were obese (25%). Enlarged thyroid(14%) and dyslipidemia (25%) were also recorded. 63 (75%) patients were initiated on low dose levothyroxine. Conclusion: Patients with subclinical hypothyroidism present with varied non-specific clinical symptoms. Treatment with low dose levothyroxine resulted in lowering of serum TSH to normal range and relief of symptoms

Guidelines on the use of botulinum toxin type A.

Botulinum toxin is available as types A and B. These two different forms need different dosages and hence, the physician needs to be familiar with the formulations. A thorough knowledge of the anatomy and physiology of the muscles in the area to be injected is essential. INDICATIONS FOR BOTULINUM TOXIN: Dynamic wrinkles caused by persistent muscular contractions are the main aesthetic indications for the use of Botulinum toxin. These include forehead lines, glabellar lines, crow's feet, bunny lines, perioral wrinkles, and platysmal bands. Non-aesthetic indications include hyperhidrosis of the palms, soles and axillae. PHYSICIANS' QUALIFICATIONS: Any qualified dermatologist may practice the technique after receiving adequate training in the field. This may be obtained either during post-graduation or at any workshops dedicated to this subject. FACILITY: Botulinum toxin can be administered in the dermatologist's minor procedure room. PREOPERATIVE COUNSELING AND INFORMED CONSENT: Detailed counseling with respect to the treatment, desired effects, and longevity of the results should be discussed with the patient. The patient should be given brochures to study and adequate opportunity to seek information. A detailed consent form needs to be completed by the patient. The consent form should include the type of botulinum toxin, longevity expected and possible postoperative complications. Pre- and postoperative photography is recommended. Dosage depends on the area, muscle mass, gender and other factors outlined in these guidelines. It is recommended that beginners should focus on the basic indications in the upper third of the face and that they treat the middle and lower parts of the face only after garnering adequate experience.

Principles of drug therapy in hypertension.

The most difficult diagnosis in medicine is the diagnosis of hypertension. Since this label encompasses many maladies both known (secondary hypertension), and the unknown, the office recording of blood pressure alone will not suffice to warrant treatment with drugs right away. There are more than 6 major guidelines in the world about the rules of the game of drug therapy in hypertension. The present preoccupation with newer drugs as first line antihypertensive drugs would ruin any economy, if the exchequer is to foot the bill. The stress in drug treatment has been the step-care mode of drug therapy where one starts with one drug in small doses, building the dose gradually, adding the next drug to get cumulative power to lower the pressure. Since the early seventies, the need to step-down therapy is being stressed wherein the doctor starts cutting down the drugs and the dosage, once he achieves the desired blood pressure levels. Diuretics and beta-blockers should be the first choice when drugs are indicated, unless there are positive indications for other drugs, or the first line drugs are contra-indicated. Routine treatment with drugs is recommended by the American JNC for people with sustained blood pressure above 140/90 mm Hg, but the British recommendations put the cut off at the pressure level of 160/100 mm Hg. Indian patients respond to very small doses in the beginning. The Hypertension Optimal Treatment (HOT) study failed to demonstrate a significant difference between the 3 randomised target blood pressure groups for the majority of cardiovascular events, although it did prove the theoretical hypothesis, that more vigorous treatment could certainly bring down the measured blood pressure to greater extent in 90% of patients I Greater importance will be given in the future for the non-pharmacological approaches, as well as to baseline blood pressure values, at which drug treatment should be started.

In vitro susceptibility of multiple drug resistant Salmonella typhimurium to newer fluroquinolone derivatives.

A total of 105 strains of Salmonella typhimurium resistant to Ampicillin, Co-trimoxazole and Nalidixic acid were included in the present study. Among the new line of Fluroquinolones resistance to Ciprofloxacin (3.8%), Norflox (16.19%) and Ofloxacin (24.76%) was very low as compared to older antibiotics. All the 3 fluoroquinolones had MIC values less than 1 mcg/ml.

Antibacterial activity of tea (Camellia sinensis) and coffee (Coffee arabica) with special reference to Salmonella typhimurium.

Extracts of Black tea, Japanese green tea, China tea or Coffee inhibited the growth of various bacteria causing diarrhoeal diseases. Tea or coffee also showed bactericidal activity against Vibrio cholerae, Salmonella typhimurium and Salmonella typhi.

Correlation of phospholipase A & enterotoxin production by Salmonella typhimurium with reference to virulence parameters.

Seventy strains of S. typhimurium along with 10 strains each of S. typhi and S. paratyphi B, 3 strains of S. enteritidis and 2 strains of S. senftenberg were examined for phospholipase A (PLA) activity. S. typhimurium positive for PLA activity (17.14%) were subjected to study of other virulence parameters like enterotoxin production, haemolytic activity, surface hydrophobicity and antibiotic sensitivity. A high degree of correlation was observed between PLA activity and enterotoxin production, antibiotic sensitivity and cell surface hydrophobicity respectively.

Rapid identification of Salmonella typhimurium in stools by using 4-methylumbelliferone derivatives.

A total of 150 stool samples were collected from the Paediatric ward and screened for the presence of Salmonella typhimurium. A comparison of standard biochemical tests and rapid fluorescence method was done. The fluorescence method was found to be rapid, less time consuming and easy to perform whereas identification of Salmonella typhimurium using standard biochemical tests taken 18 to 24 hours.

Salmonella typhimurium isolated from bacteraemia.

During a two year period, a total of 15 strains of S. typhimurium were isolated and analysed by phage typing. Of these, 13 were found untypable, while two strains belonged to phage 76 and 22. All the strains were sensitive to Gentamicin and Cephaloridine. All but one showed multiple drug resistance.

Multiple drug resistant untypable Salmonella typhimurium infection in children & neonates.

Salmonella typhimurium infection in children and neonates is reported. Out of 21 cases, 6 were new-born and 13 were below one year of age. Clinical manifestations included fever, abdominal pain and diarrhoea. All the isolates were from stool, out of the total 21 cases, 4 expired. This study was done at Microbiology Department of Kasturba Medical College over a period of seven months.

Rapid slide haemagglutination test in urinary candidiasis.

Quick diagnosis of urinary candidiasis was done by rapid slide haemagglutination test (SHA) and its efficacy was compared with countercurrent immunoelectrophoresis. This method was found to be much easier, less time consuming and an economical technique. Sera of 50 patients with urinary candidiasis were included for the present study and 50 control cases were also taken. The present study revealed that SHA test was more sensitive and specific than Countercurrent immunoelectrophoresis (the percentage of positive cases being 68% and 56% respectively).