Syndrome Z: Its Response to CPAP Therapy

Background: Metabolic syndrome is a constellation of cardiovascular risk factors and its prevalence in obstructive sleep apnea (OSA) is high. The association of OSA and metabolic syndrome is termed as syndrome Z. The effect of continuous positive airway pressure (CPAP) on metabolic syndrome is still controversial. Materials and methods: A total of 145 newly diagnosed patients with OSA were enrolled in this prospective interventional study, who underwent CPAP therapy for 8 weeks. Baseline data including anthropometric variables, blood pressure, fasting glucose levels, insulin resistance and fasting lipid profile of all the study patients were collected before and after the intervention. We determined prevalence of metabolic syndrome in OSA and the effect of CPAP on the components of metabolic syndrome was determined. Results: One hundred-and-six (73.1%) patients were found to have metabolic syndrome. Eighty-four patients were compliant with CPAP therapy. There was statistically significant reduction in glucose systolic (5.5 mm Hg, p = 0.001) and diastolic blood pressure (3.5 mm Hg, p = 0.002), fasting (4.2 mg/dL, p = 0.02), homeostasis model assessment insulin resistance (1.4, p = 0.04) and triglycerides (17.3 mg/dL, p = 0.008) after CPAP therapy. There was modest reversal of metabolic syndrome manifestations in 22 of 84 patients (26.2%) after CPAP therapy. In the CPAP complaint group, a significant reduction in dyslipidemia (p = 0.04) was noted compared to non-compliant group. Conclusion: In patients with syndrome Z, 8 weeks of CPAP therapy was associated with reduction in both systolic and diastolic blood pressure, insulin resistance and triglycerides and modest reversal of metabolic syndrome manifestations.

Study Of Potential Drug Interactions Among Eight Major Departments-General Medicine, Orthopedics, Gynecology, Pulmonology, General Surgery, Psychiatry, Otolaryngology And Dermatology Of A Tertiary Care Teaching Hospital In Southern India

Objective: To identify frequency, type, severity and predictors of potential drug-drug interactions(pDDIs), potential drug-food interactions(pDFIs), potential drug-alcohol interactions(pDAIs) and potential drug-tobacco interactions(pDTIs) and most frequently interacting drug combination pairs in hospitalized patients from departments(depts) of General Medicine(GM), Orthopedic(Ortho), Gynecology(OBG), Pulmonology(Pulmo), General Surgery (GS), Psychiatry (Psych), Otolaryngology(ENT) and Dermatology (Derm) of study population. Methods: A Prospective Observational Study was conducted in eight major dept's of a tertiary care teaching hospital for a period of 6 mo. A sample size of 650 prescriptions reflecting admission no's for each department were used. Results: A total of 650 patients were included in the study. Among them, 282(43.4%) were males and 368(56.6%) were females. The mean age of the study population was 39.67±15.23. A total of 487 pDDIs, 734 pDFIs, 586 pDAIs and 159 pDTIs were found out of 650 hospitalized episodes. OBG showed the highest pDDIs and pDAIs. Highest pDFIs and pDTIs were seen in Pulmo. The majority of DDIs were minor, DFIs and DAIs were moderate and DTIs were of major in severity. Pharmacokinetic types of interactions were seen in the majority of the depts. Logistic regression analysis showed that Polypharmacy was associated with the occurrence of DIs. Most of the DIs repeated several times in particular depts and a list of these combinations was prepared. Conclusion: With the high occurrence of overall DIs and characteristic patterns of DIs combination pairs among different departments of the hospital, the presence of clinical pharmacists in hospitals can play a great role, especially in developing nations like India where their role in hospitalized settings is always controversial.

Thyroid hormones reference ranges during each trimester of normal pregnancy subjects in Andhra Pradesh, South India

Background: The Thyroid hormones normal levels are very much essential for fetal neural development and good pregnancy outcome. Thyroid insufficiency during pregnancy may be associated with adverse obstetric outcome and fetal neurodevelopmental deficits. The main objective of the study is to estimate and establish the reference ranges of thyroid hormones as it varies from place to place and inter dependent on the iodine levels as the American Thyroid Association strongly recommends to refer to population defined trimester-specific reference ranges.Methods: A longitudinal study was conducted at obstetric clinic, Kakinada city, Andhra Pradesh over a period of 18 months. The total number of normal pregnancy subjects included in this study was 126. Thyroid hormones estimation was done by Competitive electrochemiluminescence (T3 and T4) and Sandwich electrochemiluminescence (TSH) at Thyorocare Laboratory. Only 47 subjects were having all three trimester thyroid hormone levels estimated during each trimester and were followed up to full term. The 2.5th and 97.5th percentiles were calculated as the reference intervals for thyroid hormone levels during each trimester.Results: The thyroid hormone levels during first, second and third trimesters median with reference intervals - Total Triiodothyronine (T3) : 163(100.2-230), 168(121-219.2), 168(110.2-222.6) ng/dl ,Total Thyroxine (T4) : 8.4(4.05-16.64) , 10.2(4.09-18.7), 11.2(3.8-16.7) μg/dl and Thyroid Stimulating Hormone (TSH ):2.52(1.6-7.9) 3.01(1.28-7.6) 3(1.5-8.4) μIU/mlConclusions: The trimester-specific reference intervals and median for thyroid hormones during normal pregnancy have been established for pregnant South Indian women in Andhra Pradesh by full term follow-up during pregnancy using 2.5th and 97.5th percentiles and median.

Iron Status of Pregnant Women and Their Newborns Using a Combination of Hematologic and Biochemical Parameters for the Diagnosis of Iron Deficiency

Background: Iron deficiency anemia is the most common nutritional deficiency in the world; estimates suggest that 2 billion persons worldwide are iron deficient. Because of the increased iron requirements of pregnancy and growth, pregnant women and infants are recognized as the groups most vulnerable to iron deficiency anemia. Aim: To determine the relationship between the iron status of pregnant women and their newborns using a combination of hematologic and biochemical parameters for the diagnosis of iron deficiency.Methods: The study was conducted on 75 pregnant women either prime or second gravida delivering singleton live births at term gestation (37-41 weeks). The subjects (n=61) were divided into 4 groups: Group 1: Hemoglobin ≤ 6.9g/dl, Group 2: Hemoglobin 7-9.9g/dl, Group 3: Hemoglobin 10-10.9g/dl, Group 4: Hemoglobin ≥ 11g/dl. Results: Positive correlation exists between the maternal and the neonatal hemoglobin levels. The serum iron and serum ferritin values of the neonates correlate with the maternal hemoglobin levels and serum ferritin are very low in the neonates of the mothers with severe iron-deficiency. The lower iron and ferritin values of the neonate were not reflected by the neonatal RBC indices, hence they should not be used as a indicator for assessing the iron status. Conclusion: Iron related parameters are correlated between pregnant women and their corresponding newborns meaning that iron is transported from mother to fetus in direct proportion with the levels found in the maternal circulation

Proptosis Secondary to Extracranial Ethmoidal Meningioma: A Case Report.

Meningiomas of sinonasal tract are rare entities. A case of primary extracranial meningioma of the right ethmoid sinus is reported. A 55-year-old female patient presented to the Department of ENT with symptoms of visual disturbance and swelling of right eye since 6 months, progressive nasal obstruction on the right side since 3 months with few episodes of epistaxis. Clinical examination showed a solid mass occupying right nasal cavity. Imaging studies showed a well-defined mass lesion with central cystic and sclerotic margins, in the region of right ethmoid sinus, causing mass effect on surrounding structures and displacing the medial rectus muscle with alteration of course of the optic nerve. Transnasal endoscopic removal of the mass was done in-toto, and histopathological studies including immunohistochemistry proved it to be a psammomatous meningioma.

A Rare Case of Bilateral High Origin of the Testicular Artery with Variations in the Course and Branches

In general, testicular artery (TA) usually arises from the antero-lateral part of the abdominal aorta below the origin of the renal arteries at second lumbar vertebrae level. Very rarely variations in the origin of the testicular arteries are observed. We here report a rare case of bilateral unusual origin and course of the testicular artery. On the right side, testicular artery aroused from the aorta about 0.5cm above the origin of the renal artery and gave off inferior suprarenal artery. In contrast, left testicular artery springs from the pre-hilar branch of the left renal artery, 2cm before reaching the hilum of kidney. On both sides, testicular arteries descended in front of the hilar structures of the kidney. Since, the origin and course of the testicular artery is important to consider during surgical and diagnostic interventions, knowledge of such variation may be helpful in avoiding diagnostic and surgical errors and adverse consequences especially during laparoscopic approaches.

Lymphocytic thyroiditis: a correlation of cytological grades with clinical, biochemical and ultrasound findings.

Background: Hashimoto’s thyroiditis sometimes referred to as goitrous thyroiditis is a synonym of chronic lymphocytic thyroiditis or autoimmune thyroiditis. Chronic lymphocytic thyroiditis (Hashimoto’s thyroiditis) is one of the most common cause of goiter and hypothyroidism, it is found most commonly in middle aged and young female, but can also occur in other age groups, including children. Chronic lymphocytic thyroiditis can be graded based on cytomorphology. In this study an attempt has been made to correlate the grades with clinical findings, biochemical levels and ultrasonography findings. Methods: This is a prospective study conducted on 309 patients in the Department of Pathology, Andhra Medical College, Visakhapatnam. The various parameters like patient’s clinical presentation, biochemical levels and thyroid ultrasound were studied. Fine needle aspiration of thyroid gland and grading of thyroiditis was done on smears. The grades were correlated with above parameters and the correlation indices were evaluated statistically. Chi-square tests were used for statistical correlation and p value of <0.05 was considered significant. Results: Most of the patients were females (297, 96.11%) who commonly presented with a diffuse goiter (263, 85.11%). Asymptomatic cases (193, 62.46%) and elevated TSH (194, 62.78%) were common. Most of the cases had grade I/II disease (299, 96.76%) by cytology. Conclusion: FNAC is a simple, safe and cost effective procedure and is a sensitive and specific diagnostic tool in diagnosing chronic lymphocytic thyroiditis. Cytological grading of chronic lymphocytic thyroiditis helps in assessing the severity of the disease and can predict the thyroid functional status. A combined approach of cytological grading of chronic lymphocytic thyroiditis along with ultrasonography and biochemical levels can detect subclinical hypothyroid states and provide a guide to therapy.

Finger print pattern in different blood groups.

Dermatoglyphics is study of pattern of fine ridges on fingers, palms and soles. The term dermatoglyphics was coined by Cummins. The type of finger print is unique and is based on genetic characters of each individual. They develop between 2nd and 3rd months of intra uterine life and remain unchanged in an individual through out life. Finger prints are regarded as the most reliable tool for personal identification. Due to their immence potential particularly in forensic medicine, the study of finger print pattern was carried out in relation to various ABO blood groups. The study was carried out in the Department of Anatomy, NRI medical college, Chinakakani, Guntur. 506 students of known blood group were selected for the study. The finger prints were collected, studied and analyzed statistically. Thumbs presented high frequency of whorls in A+ves. Index and ring fingers were associated with high frequency of whorls in A-ves and AB+ves.

Interpenetrating polymer network of cross-linked blend microspheres for controlled release of Acebutolol HCl.

Carbohydrate polymeric blend microspheres consisting of chitosan (CS) and poly (vinyl alcohol) (PVA) were prepared by water-in-oil (W/O) emulsion method. These microspheres were crosslinked with glutaraldehyde and loaded with Acebutolol HCl, an anti hypertensive drug. The microspheres were characterized by Fourier transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC), X-Ray diffraction (X-RD) and Scanning electron microscopy (SEM).The FTIR spectroscopy explains the crosslinking between the CS-PVA. DSC& X-RD indicated the molecular level distribution of Acebutolol HCl drug in the polymer matrix. The SEM of the microspheres suggested the formation of spherical particles. Swelling experiments on the microspheres provided important information on drug diffusion properties. Release data have been analyzed using an empirical equation to understand the nature of transport of drug containing solution through the polymeric matrices. The controlled release characteristic of the matrices for Acebutolol HCl was investigated in pH 7.4 media. The results indicate that the drug was released in a controlled manner up to 10 h.

MDT-MB therapy in paucibacillary leprosy: a clinicopathological assessment.

BACKGROUND: The World Health Organization recommends treatment regimens for paucibacillary (PB) and multibacillary (MB) leprosy, which differ in their duration and components. Hence accurate classification of the disease is required. To overcome difficulties in classification Uniform Multi Drug Therapy (U-MDT) has been recommended. AIM : To evaluate the benefit of adding clofazimine to paucibacillary regimens in leprosy patients by measuring clinical and histological resolution. METHODS: Forty-four paucibacillary patients were included in the study. Twenty-two patients were given MDT-PB regimen and the remaining MDT-MB regimen for six months . Skin biopsies were done before the commencement and at the end of treatment. Clinical and histological resolutions were measured according to the standard criteria a laid down. The results were analyzed using Fishers' test and Crammers' V test. RESULTS: Clinical improvement was observed in 90.9% in the MB group as compared to 27.3% in the PB group. Regression in the nerve swelling was observed in 70% in the MB group and in 37.5% in the PB group while histological resolution was observed in 72.8% and 54.5% respectively. CONCLUSIONS: Addition of clofazimine helps to resolve leprosy lesions both clinically and histologically, thus justifying the concept of Uniform MDT regimen for all patients.

Efficacy of crude extracts of Andrographis paniculata nees. on Callosobruchus chinensis L. during post harvest storage of cowpea.

Bioefficacy of different solvent fractions of A. paniculata was tested against the cowpea weevil, C. chinensis in terms of its effect on adult mortality, total egg output and emergence of F1 adults. All the extracts were effective against the weevil, the efficacy was however more significant with respect to methanol and ethyl acetate extracts at the highest concentrations (1,000 ppm) which lead to 72.01 and 67.69% adult mortality respectively. The efficacy was dose dependent. Total egg and percent emergence of Fl adults were lowest for methanol followed by ethyl acetate fractions. Possible role of the principal chemical constituents of this plant in bringing about mortality of the pest, reduction in egg laying and adult emergence are discussed.

Evaluation of efficacy and safety of losartan potassium in the treatment of mild to moderate hypertension as compared to enalapril maleate.

AIM: To study the effect of losartan potassium in the treatment of mild to moderate hypertension and to compare its efficacy and adverse effect profile with enalaparil maleate. MATERIAL AND METHODS: One hundred and forty five patients with mild to moderate essential hypertension were enrolled in this randomized, double blind, controlled, parallel and multicentric study. Seventy two patients received losartan potassium 50 mg and seventy three received enalapril maleate 5 mg. RESULTS: Losartan potassium reduced the DBP to < 90 mm Hg in 59% of the patients at the end of 8 weeks compared to 45% in the enalapril maleate group. DBP was reduced by 10 or > than 10 mm Hg in 89% of the patients with losartan as compared to the baseline whereas it was 80% in the enalapril group. Percentage of side effects seen in losartan and enalapril groups were 12 and 22 respectively. CONCLUSION: Losartan potassium is an efficacious antihypertensive agent in mild to moderate hypertension. It also has fewer side effects when compared to enalapril maleate.