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.

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

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.