Risk of progression to overt hypothyroidism in Indian patients with subclinical hypothyroidism: a prospective observational study

Background:Subclinical hypothyroidism (SCH) is a common endocrine disorder but spontaneous course of SCH in India is lacking. The aim of the study is to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH).Method: This is a real world prospective observational study. 58 SCH were followed up six monthly for one year to determine the course of SCH.Results: After one year of follow up 11 (18.97%) patients progressed to OH. 37 (63.79%) remained in subclinical hypothyroid category. In 10 (17.29%) patients TSH (thyrotropin) normalized. Rate of progression (odds ratio: 4.58; 95% CI: 1.14, 18.28) was significantly more in anti-thyroid peroxidase (TPO) positive group as compared to anti-TPO negative group. Conclusions: This first data from India clearly shows that SCH has a variable course. Rate of progression to OH is high (18.97%) in Indian SCH patients. In a cohort of 58 patients followed for one year only the presence of anti-TPO antibody waspredictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.

Effect of dexamethasone with granisetron or ondansetron for prevention of post-operative nausea vomiting in patients undergoing laparoscopic gynaecological surgery

Background: Post-operative nausea and vomiting (PONV) is generally self-limiting, associated with high level of patient dissatisfaction and may delay hospital discharge. The anaesthetist is usually blamed, despite evidence that PONV results from a variety of factors and variety of antiemetic drug available in market. With this issue we aim to compare the effectiveness of dexamethasone with granisetron or ondansetron in patients undergoing laparoscopic gynaecological surgery.Methods: 120 patients were registered in this prospective, randomized double blind study. Group I (n=60) received ondansetron 4 mg intravenously (IV)+dexamethasone 8mg I/V or II (n=60) received granisetron 1 mg IV+dexamethasone 8 mg I/V prior to anaesthesia. Post-operative data of PONV was recorded at pre-defined intervals.Results: The majority of the patients were of the age group 20-25 years (55.83%). The mean score of Group I subjects was 0.30±0.72 and that of Group II was 0.20±0.57 (p=0.43).  There are 3.33% of patients in group-I having vomiting episodes, and 1.67% of patients in group-II having vomiting episodes, none of the patients developed 2nd episodes of vomiting in either group. Thus it appears that dexamethasone in combination with ondansetron and granisetron is effective in decreasing the number of episodes of PONV. The occurrence of sickness episodes within 24 hours of surgery revealed no significant different in both groups. Haemodynamic variables showed no significant difference recorded in postoperative care unit between the study groups. The most common complaint was headache 16.67% in both groups.  Conclusions: Dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg showed no significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction.

Awareness and behavior patterns regarding road safety measures among undergraduate medical students of western Uttar Pradesh: a cross-sectional study

Background: More than 1.2 million deaths occur each year on the world's roads. In India, the number of motor vehicles on the road is increasing with the population and economic growth. It has been estimated that if effective and immediate action is not taken, deaths due to road traffic accidents will become the fifth leading cause of deaths by 2020. Objectives was to assess the level of awareness and behavior regarding road safety rules among undergraduate medical students.Methods: The present cross-sectional study was conducted in a Medical College of western Uttar Pradesh. In the present study 200 final and pre-final year, undergraduate medical students were selected with the help of simple random selection, who drive/use vehicles either of their own or others. The study period was from June 2019 to August 2019.Results: About 29 percent of participants responded that they do not follow lane rules while driving. Study showed that 72.1% and 42.0% were aware that what documents to be carried with them while driving among those who attend and did not attend any program on road safety measures respectively. About 58.1 % and 38.2% were aware that penalty for driving without a helmet can be imposed among those who attend and did not attend any program on road safety measures.Conclusions: Awareness of road safety measures among participants was satisfactory, but the gap was also seen between awareness and behavior patterns regarding road safety measures.

A cross sectional study to ascertain various causes of neonatal mortality using verbal autopsy in Etawah district

Background: Neonatal death is defined as no. of deaths during the first 28 completed days of life per 1000 live births in a given year or period. Around 2.6 million deaths or roughly 46% of all under five deaths had occurred during this period in 2016 which means that 7000 newborn deaths occur each day. Most of the neonatal deaths occur on the first day and week accounting to about 1 million dying on the 1st day. Objective of this study was to ascertain various causes of neonatal mortality using verbal autopsy in Etawah district.Methods: The present study was a retrospective cross-sectional study carried out for a period of 1 year (July 17 to June 2018) using WHO verbal autopsy questionnaire by finding out the study subjects from medical information system of UPUMS, Saifai and district hospital, Etawah. A total of 89 neonatal deaths were found out of which 87 were interviewed by going to their residences to get the relevant information regarding the causes of deaths.Results: Most common cause of neonatal mortality came out to be low birth weight with prematurity 44 of 87 (50.6%), followed by birth asphyxia 23 of 87 (26.4%) and sepsis 8 of 87 (9.2%).Conclusions: Effective interventions should be incorporated into policy decisions to reduce neonatal mortality due to these causes.

A Comparative Study of Efficacy of Local Corticosteroid Injection Versus Ultrasound Therapy in the Treatment of Planter Fasciitis

Background: Plantar Fasciitis is a frequent disorder involving the plantar fascia. Usually, syndromes that involvemanifestation of the typical heel pain are called plantar fasciitis. Common treatments can be divided into noninvasive and and invasive treatments, such as corticosteroid injection (CSI), botulinum toxin injection, platelet-rich plasma (PRP) injection and surgery. Methods: Total 80 patients were taken up for the study that completed the follow-up. Patients by random sampling were divided in two groups. Patients were divided in Conservative ultrasound therapy and Local Steroid Injections group of 40 patients each. Results: Treatment outcome was found almost similar in both treatment group, the betterment was found better with ultrasound with more duration of treatment but this is not statistically significant. Conclusion: Findings of our study suggest that As both treatment modalities are at par on comparison of their treatment outcome it is better to go for conservative approach.

Prevalence of Upper Limb Neuropathy in Rehabilitated Spinal Cord Injured Patients in North India

Background: Upper extremities are principally adapted for grasping or seizing activities. In individuals with spinal cord injury, they are additionally used for transfers, wheelchair propulsion, and daily living activities, putting additional strain on the joints. For this reason, it is essential to distinguish the effects of these increased demands in terms of prevalence of peripheral neuropathies in rehabilitated spinal cord injured population from developing countries. Methods: Spinal cord Injury patient with a neurological level below T2, who were independent in activities of daily living was monitored during the yearly follow up. Electrodiagnostic study of median, ulnar, radial nerve was graded in a scale of 0-2 with 0 being normal, 1 being neuropathy of one hand and 2 being an association of both the hands and the final conclusion was based on this study. Results: There were 45 wheelchair users, 5 walker users, 30 elbow crutch users, 10 subjects using sticks and one subject with a unilateral transtibial amputation using an axillary crutches. Thirty eight patients were using tricycle for independent mobility. Among 55 patients using wheel chair CTS was observed in 70% patients. In the same group 24% had ulnar neuropathy and 16% had radial neuropathy.Conclusion: Findings of our study suggest that upper limb compressive neuropathy was highly prevalent among the spinal cord injury patients. Further, current study recorded carpal tunnel syndrome was the most common neuropathy incorporated with paraplegia patients especially using wheel chair and crutches. We strongly advocate for the importance of the modification of in the vocational instruments like light weight or electrical wheelchair etc along with improvement in accessories like grip style, gloves etc to avoid the constant pressure and repetitive trauma to upper limb of paraplegia patients with spinal cord injury

Pattern of dermatologic manifestations in polycystic ovarian disease cases from a tertiary care hospital

Background: Dermatologists often play a significant role in its management. Cutaneous features of hyperandrogenism in Polycystic ovarian syndrome (PCOS) have varied presentation. Aim of this study was the pattern of dermatologic manifestations in polycystic ovarian disease in northern Indian females.Methods: Patients registering for treatment of polycystic ovarian disease at Dermatology outpatients department during April 2016 to March 2017 formed the study population. Residents interviewed the study subjects at the OPD. General physical examination, systemic examination, breast and pelvic examination, along with detailed dermatological examination were conducting after taking the history. Hormonal analysis was performed after an overnight fasting using enzyme immunoassay.Results: FSH and LH levels were 5.05�86 IU/L and 8.14�21 IU/L respectively. Testosterone levels were found to be 61.01�.32 ng/dl. DHEAS levels among them were 130.05�.21?g/dl. Two commonest cutaneous manifestations were hirsutism and acne seen in 83.8% and 59.5% of subjects. Female pattern hair loss was seen in 45.6% females. Three most frequent hormonal abnormalities noted in our study subjects were raised L/H ratio, testosterone and LH levels seen in approximately 45%, 35% and 21% cases.Conclusions: The cutaneous manifestations of PCOS reserve a major role in its management by dermatologists. A lifestyle modification along with systemic treatment remains mainstay of treatment. Monitoring for the foreseen cardiovascular risks should start early to downgrade the morbidity

Testicular cytology indicates differences in Sertoli cell counts between “good freezer” and “poor freezer” bulls.

In artificial insemination, poor quality of semen unsuitable for cryopreservation and susceptibility of spermatozoa to cryodamage in crossbred bulls have been a matter of concern. Present study was designed to identify the testicular cytology indices that might be used to predict the semen quality and cryotolerance of spermatozoa in bulls. Based on the ejaculate rejection rate and sperm cryotolerance, bulls (Holstein Friesian X Tharparkar crossbred) were classified into either good (producing good quality semen with spermatozoa having good cryotolerance; n=4) or poor (producing poor quality semen with spermatozoa having poor cryotolerance; n=4). Testicular cytology was studied in all the 8 bulls using fine needle aspiration technique. Testicular cytology of good bulls and poor bulls differed significantly. The proportion of Sertoli cells was significantly higher in good bulls (25.3±1.6) compared to poor bulls (11.0±0.8). The Sertoli cell index was 46.1±5.0 in good bulls while it was only 13.8±1.3 in poor bulls. The cut off values, as determined using Receiver Operating Characteristics analysis, indicate that the bulls having testicular cytogram comprising of <15.5% Sertoli cells, <24.3 Sertoli cell index and >4.0 spermatogenic cells to Sertoli cell ratio might be a poor bull in terms of semen quality and cryotolerance of spermatozoa. The proportion of Sertoli cells in the testicular cytology had positive (P <0.05) relationship with semen quality and cryotolerance of spermatozoa.

Challenges in conducting communitybased trials of primary prevention of cardiovascular diseases in resourceconstrained rural settings.

Cardiovascular diseases account for almost half of all deaths from noncommunicable diseases, and almost 80% of these deaths occur in low- and middle-income countries such as India. The PrePAre (Primary pREvention strategies at the community level to Promote treatment Adherence to pREvent cardiovascular disease) trial was a primary prevention trial of community health workers aimed at improving adherence to prescribed pharmacological and nonpharmacological therapies in cardiovascular diseases. It was conducted at three geographically, culturally and linguistically diverse sites across India, comprising 28 villages and 5699 households. Planning and implementing large-scale community-based trials is filled with numerous challenges that must be tackled, while keeping in mind the local community dynamics. Some of the challenges are especially pronounced when the focus of the activities is on promoting health in communities where treating disease is considered a priority rather than maintaining health. This report examines the challenges that were encountered while performing the different phases of the trial, along with the solutions and strategies used to tackle those difficulties. We must strive to find feasible and cost-effective solutions to these challenges and thereby develop targeted strategies for primary prevention of cardiovascular diseases in resource-constrained rural settings.

Formulation and optimization of solid dispersion of Clopidogrel with PEG 6000.

Clopidogrel, a non competitive inhibitor of adenosine diphosphate at the platelet receptors, is an anticoagulant drug practically insoluble in water. In order to improve the aqueous solubility of drug and its dissolution rate solid dispersions of clopidogrel were prepared with different proportions of the hydrophilic carrier PEG 6000. A two factor three level statistical design was used to quantify the influence of PEG 6000 and Clopidogrel on the dissolution profile of the solid dispersions prepared where PEG 6000 and Clopidogrel were chosen as independent variables while dissolution rate was chosen as dependent variable. Melt fusion method and solvent evaporation method were used for the preparation of solid dispersion. Results obtained showed that there was a significant increase in the dissolution rate of the drug as well as solubility of the drug in comparison to pure drug. Differential scanning calorimetry. X-ray diffraction and scanning electron microscopy analysis revealed the formation of solid dispersion of the drug with PEG 6000.

Development of meloxicam formulations utilizing ternary complexation for solubility enhancement

Meloxicam [an oxicam derivative], a relatively new cyclo-oxygenase inhibitor, is a member of enolic acid group of non-steroidal anti-inflammatory drugs. It is generally used in the treatment of rheumatoid arthritis, osteoarthritis and other joint pains. Meloxicam is practically insoluble in water [8 microg/ml], which directly influences the C[max], T[max], as well as the bioavailability of the drug. In the present study, an attempt has been made to improve the dissolution of Meloxicam by preparation of its solid dispersion using p-cyclodextrin blended with various water soluble polymer carriers i.e., HPMC [methocel IH], methylcellulose [400cps], PVP K30, HPMC [K[4]M], HPMC [50cps]. It is reported that when small amount of water soluble polymer is added to beta-cyclodextrin, its nature of solubilization significantly increases due to increase in the apparent complex stability constant. Phase solubility studies were carried out to evaluate the solubilizing power of beta-cyclodextrin along with various water soluble polymers. The solid dispersion was prepared and formulated into tablets and suspension, which were evaluated on the basis of various official tests. All the studies suggest that formulations of Meloxicam utilizing solid dispersion technique significantly enhances solubility [90 microg/ml] of the drug and results in superior formulations of the drug by using beta-cyclodextrin blended with 0.12% w/w HPMC [Methocel IH]. Ternary complexation is a valuable tool for solubility enhancement of drugs

Functional And Esthetic Rehabilitation Of Severely Worn Dentition With Shortened Dental Arch Concept.

In the twenty-first century, patterns of dental disease in adults are changing. Surveys of adult dental health indicate that more people are keeping their teeth for longer in life. In many cases, the ravages of dental disease and the cumulative effect of a lifetime of restorative dentistry lead to gradual tooth loss. For many of these patients, restoration of a complete dentition may neither be feasible nor desirable. In recent years, functionally oriented treatment planning has become acceptable in light of recent research findings. Using this approach, treatment efforts and resources are directed principally at retaining the 'strategic' part of the dentition in the long term, ie, the anterior and premolar teeth.