Is there any association between vitamin D deficiency and anti-thyroid peroxidase positive hypothyroidism: A cross-sectional study

Background: Vitamin D deficiency is prevalent worldwide and it is believed to have a role as an immune modulator. However, the association between vitamin D levels and anti-thyroid peroxidase positive (TPOAb) hypothyroidism is still controversial. Aim: To elucidate the association between vitamin D levels and anti-thyroid peroxidase (TPOAb) positive hypothyroidism. Materials and Methods: Serum Vitamin D, thyroid peroxidase antibody, and thyroid function test were measured in 105 patients, who were sub-grouped into the TPOAb positive and TPOAb negative hypothyroidism category. Results: Vitamin D level, was found significantly lower in patients with TPOAb positive hypothyroidism as compared to patients TPOAb negative hypothyroidism (13.275.18vs. 17.746.03ng/ml, respectively, P<0.05), as well as between patients with TPOAb positive hypothyroidism and control group (13.275.18vs. 29.669.41 ng/ml, respectively, P<0.05). Within the patients' group, there was a significant negative correlation between serum 25 (OH) vitamin D and TSH (r=−0.438, P<0.05), anti-TPO (r=−0.275, P<0.05). Furthermore, insignificant positive correlations were recorded between serum 25 (OH) vitamin D, and each of T3, T4 (r=–0.056, 0.097, P>0.05). Conclusion: The current study observed significant low levels of 25(OH)D3 in TPOAb positive hypothyroid patients.

The Impact Of Clinical Pharmacy Services In General Surgery

Objective: The objectives of this study include performing pharmaceutical care-related research and documenting regarding drug-related problems in the surgery department. Further, these types of studies may bring consciousness to both physicians and patients regarding drug use in surgery. Methods: A Prospective interventional study was conducted in a general surgery hospital. The prescriptions were analyzed for the use of inappropriateness of drugs using the classification for drug-related problems. Results: Out of 100 cases, 62 patients were observed with drug-related problems. The number of antibiotics prescribed was 0, 1, 2, 3, 4, 5, 6 in 8, 11, 12, 32, 18, 18, 1 cases respectively. A significant increase in the outcome of antibiotic rationality and cases adhered to guidelines was seen in November compared to October and somewhat decreased in December due to some limitations. The overall study states that prescribing has a more important cause of Drug-related problems compared to dispensing and the use of the drug. Conclusion: Drug-related problems have to be acknowledged as a very important contributing treatment factor for the best health care outcome. Our study shows the importance of clinical pharmacists in every hospital for identifying and resolving drug-related problems and medication errors.

Study of Hemorrhoids – Clinical Features and Risk Factors

Aim: To study the clinical features and risk factors of Hemorrhoids. Materials and Methods: One hundred and eighty-nine adult patients aged between 35 and 65 years were studied. The history of patients was as follows: 57 (30.1%) had constipation, 19 (10%) had chronic cough, 33 (17.4%) had straining, 24 (12.6%) were alcoholic, 17 (8.99%) were smokers, and 39 (20.6%) had sedentary behavior. Result: The clinical manifestations were as follows: 51 (26.9%) had bleeding through rectum, 52 (27.5%) had prolapse, 32 (16.9%) had pain during defecation, and 19 (10%) had pruritis. The hemorrhoids were classified as per their grades. 51 (26.9%) had Grade I, 31 (16.4%) had Grade II, 38 (20.1%) had Grade III, and 69 (36.5%) had Grade IV. Conclusion: This pragmatic approach toward different ages in both sexes will be useful for surgeon to treat efficiently to prevent morbidity and mortality of the patients.

Study of Role of Collagen in Healing Chronic Wounds

Aim: To study the role of collagen in healing of chronic wounds. Materials and Methods: One hundred and twelve patients aged between 25 and 65 years were studied. The etiology of chronic wounds was as follows: 38 (33.9%) were diabetic, 33 (29.4%) had venous wound, 4 (3.57%) had arterial, 19 (16.9%) had trophic, 3 (2.67%) had tubercular, and 15 (13.3%) had traumatic wounds, and complications were as follows: 8 (12.6%) had gangrene, 19 (30%) had sloughing and exposure to tendon, 27 (42.8%) had eczema and dermatitis, 3 (4.76%) had bony changes, 2 (3.17%) had hemorrhages, and 4 (6.34%) had subcalcification of wound. Results: Organisms isolated from the wounds were as follows: 46 (41%) had Staphylococcus aureus , 12 (10.7%) had Streptococcus pyogenes , 15 (13.3%) had Escherichia coli , 7 (6.25%) had Klebsiella, 11 (9.82%) had Proteus mirabilis , and 21 (18.7%) had sterile (no organism). Conclusions: This pragmatic approach to chronic wounds having different etiologies and pathophysiologic conditions will be useful to surgeon to treat such patients efficiently because healing of chronic wounds without amputation (limb saving) is a great medical challenge globally.

Hypoadiponectinemia is associated with increased insulin resistance, dyslipidemia and presence of type 2 diabetes in non obese central Indian population

Background: Accumulating evidence suggests that adiponectin, a major adipocyte secretory protein, has insulin-sensitizing and anti-atherogenic properties and protects against later development of type 2 diabetes. We investigated the association of adiponectin with insulin resistance, blood lipids and type 2 diabetes in non obese central Indian population.Methods: Anthropometric and biochemical parameters were measured in 149 (81 male and 68 female) newly diagnosed non obese type 2 diabetic patients and 157 (85 male and 72 female) age and body mass index (BMI) matched controls.Results: Adiponectin level (p<0.0001) was significantly lower in the diabetic group than in non diabetic control. In an age, gender and BMI adjusted model, adiponectin level was significantly negatively correlated with waist circumference, waist to hip ratio, systolic blood pressure, fasting insulin, homeostasis model assessment-insulin resistance (HOMA-IR) (p= 0.0034), HbA1C, total cholesterol, LDL-cholesterol, and triglycerides (p<0.0001) and positively correlated with HDL-cholesterol (p =0.0014) in non obese type 2 diabetic group. However, there was no significant correlation between adiponectin and glucose in this study. In stepwise linear regression analysis, adjusted for potential confounder, significant inverse association was observed between serum adiponectin level and HOMA-IR (p = 0.0001). In multivariate logistic regression model, adjusted for age, gender, BMI, waist circumference, and waist-hip ratio, lower adiponectin was independently associated with the presence of type 2 diabetes (p<0.0001).Conclusions: Lower adiponectin levels in non obese type 2 diabetic patients were significantly related to the increased insulin resistance, dyslipidemia, and presence of type 2 diabetes, independently of overall and abdominal adiposity, thereby suggesting a direct link between adiponectin and carbohydrate and lipid metabolism in human.

Cross sectional study to know prevalence of depression, anxiety, and stress in chronic obstructive pulmonary disease patients

Background: Chronic obstructive pulmonary disease is a chronic disease with significant disability. Psychiatric co morbidities like depression anxiety and stress will worsen the situation and affect the course of illness and increase the morbidity, mortality. Aim: To study the prevalence of depression, anxiety and stress in COPD patients. Materials and Method: Cross sectional study conducted on 100 patients who were attending Government T.B. and Chest hospital as outpatient and inpatient departments. Study conducted through interview basis with semi structured intake proforma, Depression anxiety stress scale and finally social support assessed with social support questionnaire. Results: Data analyzed using SPSS22. The relation of various factors analyzed using one sample t test. Prevalence of depression anxiety and stress were 48%, 40%, 40% respectively. The age of the patient, duration of the stay in the hospital, duration of illness were significantly associated with depression, anxiety and stress. Conclusion: It is very much needed to assess the depression, anxiety and stress in COPD Patients to improve quality of life in these patients

CHOKING IN A PSYCHIATRIC PATIENT - A CASE REPOR

Choking is one of the important types of asphyxia deaths. The incidences of which are not uncommon. The choking in children could be due toys, coins, marbles, nuts and any other small hard object or even sometimes due to stuffed in plastic bags whereas in adults most of the times food bolus or hard parts of food like bone pieces are responsible. It is mostly accidental in nature. It can cause coughing or sometimes airway obstruction leading to death. We present a case wherein a mentally ill person accidentally choked to death after consumption of food.

Anticonvulsant activity of gap-junctional blocker carbenoxolone in albino rats.

Background: Gap junctions (GJs) are clusters of channels that connect the interiors of adjoining neurons and mediate electrical/electrotonic coupling by transfer of ions and small molecules. Electrotonic coupling between principal neurons via GJs is increasingly recognized as one of the mechanisms in the pathogenesis of the abnormal neuronal synchrony that occurs during seizures. Carbenoxolone the succinyl ester of glycyrrhetinic acid obtained from liquorice has been shown to have the property of blocking gap junctional intercellular communication. The objectives were to study if carbenoxolone has in-vivo anticonvulsive activity in pentylenetetrazole (PTZ) and maximal electroshock (MES) seizure models and to probe the functional role of GJs in seizures. Methods: Carbenoxolone was tested for anticonvulsive effect in albino rats subjected to seizures by the PTZ and MES at three doses 100 m/kg, 200 m/kg, 300 m/kg. In the PTZ model parameters observed were seizure protection, seizure latency and seizure duration. In the MES model parameters observed were seizure protection and seizure duration. Results: The results showed that the carbenoxolone has anticonvulsant activity in both PTZ and MES induced seizures with better protection in the PTZ induced seizures. In the PTZ model carbenoxolone produced a statistically significant increase in seizure latency, decrease in seizure duration and seizure protection. In the MES model carbenoxolone produced a statistically significant decrease in seizure duration. Conclusions: Carbenoxolone has in-vivo anticonvulsive effect and could be useful in both petitmal (absence) seizures and grand mal (generalized tonic-clonic epilepsy) seizures. The protective effect of carbenoxolone could be due to blockade of GJ channels that mediate electro tonic coupling and thereby prevent the neural synchronization that is characteristic of seizures. The study also supports the view that GJs have a functional role in the electrophysiology of seizures and GJ blockers have potential as a new class of antiepileptic drugs.

Raine syndrome.

Raine syndrome is a rare genetic disorder with characteristic features of exophthalmos, choanal atresia or stenosis, osteosclerosis and cerebral calcifications. Most of babies with this disorder die immediately after birth. We report a baby who was 7 weeks old at the time of presentation.

Assessment of knowledge, attitude and practices of traffic policemen regarding the auditory effects of noise.

The objectives of the present study were to (i) estimate noise levels at major traffic junctions in Bengaluru City, and (ii) assess the knowledge, attitude and practices of traffic policemen deputed at those junctions towards the auditory effects caused by noise pollution. The present questionnaire based study was carried among 60 traffic policemen. Road traffic noise was measured at different places in Bengaluru city using Sound level meter and it ranged from 71.2 to 91 dB. The questionnaire included the questions regarding the self assessment of the policemen about their hearing ability, past and present exposure to loud sound and the use of personal protective devices such as ear plugs and ear muffs. The questionnaire was filled by the subjects and the data was analyzed. The mean age was 42.2±7.4 years and the mean year of exposure was 10.82±8.53 yrs. Only 3.33% of the subjects felt that their hearing ability was below average. Thirteen subjects reported that they usually missed some conversation over phone while 25% reported similar condition while talking to someone in crowd. 16.66% had work related tinnitus (> once a day) and experienced it more during working hours. None of them used ear plugs/ ear muffs and the reason for non-usage was nonavailability (100%). The self assessment of hearing by traffic policemen suggests that most of the traffic policemen have normal hearing. However, a systematic study with Audiometry of these subjects is recommended.

Effect of examination stress on mood, performance and cortisol levels in medical students.

Stress produces definable mental and physiological reactions in the body. Mild stress is beneficial in cognitive tasks and performance but persistently high stress may lead to neuropsychiatric illnesses like anxiety and depression. Examinations act as stressor and activate hypothalamicpituitary adrenal axis causing an increase in cortisol level, which is reflected in saliva. Present study was done on 35 medical students. Their mood parameters were assessed, using Depression Anxiety Stress Scale (DASS) scoring, and salivary cortisol levels using quantitative ELISA. Subjects were evaluated for mood parameters two times, one during relaxed state (with no examinations in preceding 2 weeks and in coming 2 weeks) and another during stressed state (on the day of viva voce examination). The levels of mood parameters and salivary cortisol were significantly raised during examination stress. The changes in stress level significantly correlated with change in levels of anxiety and salivary cortisol though there was no significant effect on the performance. Males and females showed similar changes in mood parameters. This study suggests that as examinations act as unavoidable stressors, the medical educators as well as students should be made aware of the negative consequences of stress faced during medical training. Efficient relaxation program as well as counseling services should be provided to stressed students so that they are able to cope better with examination stress.

Victim profile and pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents.

The present research aims to highlight the pattern of thoraco-abdominal injuries sustained by the victims of fatal road traffic accidents (RTA) in Manipal, South India. The study is an autopsy based observation of thoraco-abdominal injuries in victims of fatal road traffic accidents during 1999 – 2003. Road traffic accidents accounted for most of the injury related deaths (77%) during the study period. A male preponderance (86%) was observed with a male-female ratio of 6:1. Individuals in the age group of 21 to 50 years formed the most vulnerable (83%) group. External thoracic injuries were more common than internal thoracic injuries in the thoracic region. In the abdominal region, internal injuries were more common than external injuries. Lungs (61%) and kidneys (23%) were the most commonly involved organs in the thoracic and abdominal regions respectively. Majority of the victims were two wheeler occupants (35%) followed by pedestrians (23%). The study indicates the pattern of thoraco-abdominal injuries sustained along with the trend of road traffic accidents in the region.

Metal Free Prosthodontics.

Metal free or All –ceramic restorations are the term for restorations consisting solely of ceramics without any metal support . They are highly esthetic . This article reviews some of the common metal free ceramics and their application