Effect of Maternal Supplementation With Two Different Doses of Vitamin D During Lactation on Vitamin D Status, Anthropometry and Bone Mass of Infants: A Randomized Controlled Trial

Background: There is a high prevalence of vitamin D deficiency (VDD) in exclusively breast-fed infants in the absence of appropriate vitamin D supplementation. Objective: To evaluate the efficacy of two doses of maternal vitamin D supplementation on vitamin D levels of mother-infant pairs and to assess its effect on growth parameters (weight, length and head circumference) and bone mass of infants. Study design: Randomized controlled trial. Participants: Lactating mother-infant pairs (n=220). Intervention: Maternal oral vitamin D supplementation in two doses (group 1: 1,20,000 IU/month and group 2: 12,000 IU/month) for 12 months. Main outcomes: Maternal and infant serum 25OHD levels, and infants’ growth and bone mass. Results: There was high prevalence of VDD at baseline in mothers (94%) as well as infants (98.5%), which was reduced to 43.1% in (mothers) and 46.5% in infants after 12 months. Significantly higher median (IQR) serum 25OHD levels (ng/mL) were observed among mothers in group 1 compared to group 2 [46 (17-159) vs 18 (6-64); P<0.01] and in infants [36.5 (15-160) vs 17 (7-32); P<0.01]. No significant association was observed between growth parameters or bone mass and serum 25OHD levels of mother or infant between the two groups. Four mothers (3.6%) and two infants (1.8%) in group I had serum 25OHD>100 ng/mL, but without hypercalciuria or hypercalcemia. Conclusion: Bolus vitamin D supplementation in the dose of 1,20,000 IU/month was more efficacious in improving maternal and infant vitamin D status at 12 months, as compared to 12,000 IU/month.

Transconjunctival botulinum toxin injection into the lacrimal gland in crocodile tears syndrome

Purpose: To determine the efficacy and safety of botulinum toxin injection into the lacrimal gland as a symptomatic treatment of crocodile tear syndrome (CTS). Methods: Our study included six patients of unilateral gustatory hyper lacrimation following either an episode of facial paralysis or post trauma or any related surgery that posed a risk of damaging the facial nerve. Detailed history regarding previous trauma, duration of facial paralysis, previous significant surgery, and duration of steroid use following facial paralysis was noted. Schirmer抯 test was done at baseline and 3 months follow?up. Patients� consent was taken prior to treatment with botulinum toxin injection in the lacrimal gland. Repeat injection of 5 U botulinum toxin (type A) was administered into the lacrimal gland of all patients transconjunctivally within an interval of 1 week. All patients were followed up with Schirmer抯 test at 6 weeks and 3 months. Any complications during treatment were recorded. Results: All six patients showed complete or partial disappearance of reflex lacrimation while chewing following botulinum injection measured by a significant reduction in Schirmer抯 value. When comparing Schirmer test values before (27.8 � 3.58 mm) and after (11.6 � 2.28 mm) BTX?A injection, the differences observed (P = 0.002) were statistically significant (P < 0.05). Only two patients developed mild transitory ptosis. No other complications were noted. Conclusion: Transconjunctival botulinum toxin injection into the lacrimal gland is an effective and safe method to decrease reflex lacrimation during eating or chewing in CTS or gustatory hyper?lacrimation syndrome.

Status of trace elements zinc, copper, and selenium in transfusion dependent beta thalassemic Indian children: a cross sectional study

Background: Maintenance of normal levels of copper, selenium, and zinc play an important part in lessening the morbidities associated with thalassemia major. Levels of these elements have been found to be altered in this chronic transfusion dependent disease from all over the world, but with widely variable results.' Besides repeated blood transfusions and use of chelating agents, their levels in thalassemics are affected by genetic and dietary factors also, compelling us to undertake this study in our population. The objectives of this study were assessment of serum levels of zinc, copper and selenium in transfusion dependent beta thalassemics. 'Methods: Cross sectional descriptive study conducted at Thalassemia Day-care Centre of a teaching hospital. Total 64 transfusion dependent thalassemics in the age group 3-18 years were subjected to serum levels of zinc, copper and selenium by inductively coupled plasma mass spectrometry technique.' 'Results: Four (6.25%) had hypozincemia, 15 (23.43%) hypocupremia and one (1.565%) had hypercupremia. Two (3.12%) had higher selenium levels (>190 'gm/l).Conclusions: In contrast to previous studies, hypocupremia has been found to be more prevalent than hypozincemia and hyposelenemia in our population.

Fabrication and Evaluation of Ketorolac Loaded Cubosome for Ocular Drug Delivery.

Ophthalmic formulations in terms of eye drops are more frequently used formulation for ocular disorders. But unfortunately this mode of drug instillation into the cul-de-sac of eye shows very poor ocular bioavailability (less than 5%). A large number of carrier systems have been investigated to overcome this problem. In the present study a novel nano-carrier system (Ketorolac loaded cubosomes) is developed and evaluated for the safe and enhance ocular bioavailability. Cubosomes were developed and optimized by utilizing glyceryl mono-oleate, poloxamer 407 and initial drug concentration. Finally developed formulation was evaluated for various In vitro characteristics i.e. particles size, size distribution, shape and morphology, in-vitro release profile, corneal permeation, corneal retention, and ocular tolerance study. The optimized drug loaded cubosomal formulation showed mean particle size, polydispersity index, and entrapment efficiency 127.3±12.23 nm, 0.205±0.011, and 53.27±5.23 %, respectively. Transmission electron microscopic analysis revealed a cubic shape of developed formulation. Further, developed formulation exhibited biphasic release profile. Significant high transcorneal permeation (2.07 folds) and corneal retention (2.24 folds) of ketorolac was observed with cubosomal formulation correspond to Ketorolac solution (p< 0.01). Further safety profile of optimized formulation was evaluated by histopathology of corneal membrane. The developed novel ocular carrier system (cubosomes) might be a promising platform as a vehicle for effective ocular drug delivery.

Screening for Thalassemia Carrier Status in Pregnancy and Pre-Natal Diagnosis.

This hospital-based study reports the results of antenatal screening for thalassemia in pregnant women visiting a hospital in Jodhpur, Rajasthan, India. Eighty-eight (5.9%) of 1500 women screened for thalassemia had thalassemia trait. Twenty at-risk couples were identified and two fetuses were detected to be having thalassemia major.

Neonatal Varicella.

Varicella or chickenpox is primarily an infectious disease of childhood and majority of population is infected upto 15 years of age. Rarely, varicella is seen in newborns as congenital or perinatal infection, but in such cases mortality rate is very high. Here we present two cases of neonatal varicella with secondary complications, one with varicella pneumonia and other developing severe secondary skin infection and sepsis.

A QSAR study on a series of N-methyl pyrimidones acting as HIV integrase inhibitors.

A quantitative structure-activity relationship (QSAR) study has been performed on integrase (IN) inhibition activity of a large series of N-methyl pyrimidones [Gardelli et al. (2007) J Med Chem 50, 4953-4975)] having varying heterocyclic ring substitution at 2-position of pyrimidone ring. The activity is found to be significantly correlated with surface tension and molar volume of the molecules. The whole series of compounds is divided into two subsets: a training set and a test set. A significant correlation is obtained for the training set, which is then used to predict the activity of compounds in the test set. The predicted activities of compounds in the test set are found to be very close to their observed activities. The predicting ability of the correlation obtained is judged by leave-one-out jackknife procedure. The correlation shows the effective role of the surface tension and molar volume of the molecules. From the correlation obtained, the integrase inhibition activities are predicted for some new prospective compounds.

Efficacy of temporalis myofascial flap as an interpositional graft material in the management of tmj ankylosis:.

Temporo-mandibular joint (TMJ) ankylosis is an extremely disabling affliction that causes problems in mastication, digestion, speech, appearance and hygiene. Surgery of TMJ ankylosis needs careful evaluation and planning to yield predictable results. Ankylosis may be corrected surgically by an array of procedures like gap arthroplasty, joint reconstruction and interpositional arthroplasty. Though many types of autogenous grafts and alloplastic materials are available for the interpositioning, the temporalis muscle graft offers significant advantages like ease of harvesting, minimal donor site morbidity and effective coverage of the arthroplasty site. The efficacy of the same is highlighted in this article by its application in four cases of TMJ ankylosis.

Brainstem evoked response audiometry (BAER) in neonates with hyperbilirubinemia.

OBJECTIVES: To evaluate Brainstem Evoked Response Audiometry (BAER) as an objective testing of hearing assessment in icteric babies and correlate the abnormalities with serum bilirubin levels. METHODS: BAER recordings were taken in 30 icteric ferm neonates at birth, at peak of serum bilirubin levels and on a follow-up visit at 2-4 months of age. RESULTS: Mean latency of waves and interwave intervals on the BAER records were prolonged in icteric babies compared to the control group suggesting early bilirubin encephalopathy. Abnormal records were obtained in 73.3% cases and the abnormality persisted in the follow-up tracings of 23.3% of the study group. CONCLUSION: BAER is a sample, reliable and effective technique for determining auditory functions in the neonates especially changes of early bilirubin toxicity.

Renal failure in asphyxiated neonates.

A prospective case controlled study was conducted in the NICU of a tertiary level referral teaching hospital to determine the incidence of renal failure in asphyxiated neonates and to correlate severity and type of renal failure with Apgar score and hypoxic ischemic encephalopathy (HIE) grading of the neonates. Ninety-eight neonates were enrolled 70 asphyxiated babies and 28 healthy controls. Renal functions were assessed using urinary output, urine microscopy, biochemical parameters and sonographic findings. Babies having renal failure were managed on a protocolised plan and followed up till 6 months of age to detect any residual impairment. Blood urea and serum creatinine were significantly higher in asphyxiated babies compared to the control group. Biochemical derangements correlated well with HIE staging and Apgar scores. There was no significant difference in urine output in the control and the study group as significant oliguria was seen in only 7 of the 70 asphyxiated babies and the output did not correlate with severity of asphyxia. Serum sodium level and fractional excretion of sodium showed significantly different values in the asphyxiated babies compared to control. Of the 70 asphyxiated babies 33 (47.1 %) had renal failure, which was of the non-oliguric type in 78 % cases and oliguric type in 22 % cases. Sonographic abnormalities were seen more often in oliguric babies and was associated with a bad prognosis. Renal parameters normalized in all neonates by 6 months of age. Mortality was higher in babies with oliguric renal failure. We conclude that renal failure is a significant problem in asphyxiated neonates with majority of babies having nonoliguric failure. Severity of renal function abnormality correlates well with degree of asphyxia. Oliguria, hyponatremia and abnormal sonographic scan are bad prognostic signs in renal failure secondary to birth asphyxia.