Association of vitamin D deficiency and bone mass with liver and heart iron overload in transfusion dependent thalassemia

Background: Transfusion dependent thalassemia patients are reported to have Vitamin D insufficiency/deficiency in many countries. Vitamin D hydroxylation occurs in the liver; whether liver iron overload interferes with this step has not been addressed till date. This study helps to establish an association between liver iron concentration (LIC) and heart iron concentration (MIC) with vitamin D levels and Bone Mass Density in these patients.Methods: A cross sectional study was done by including transfusion dependent Thalassemia patients (TM) if they had an assessment of Liver and cardiac iron done by T2*MRI and bone mineral density by DEXA. Clinical data regarding age, gender, type of iron chelation therapy and laboratory data of S. ferritin and Vitamin D was collected. Data was assessed using appropriate statistical methods.Results: Among 40 TM patients were taken and mean age was 17.6 years. Vitamin D deficiency was identified in 26(65%). 20 out of them had an LIC>7mg/g DW and 6 had MIC>1.65mg/g DW. There was a significant association between LIC>7mg/g and vitamin D level<20 ng/ml and a significant inverse correlation between LIC and vitamin D, suggesting that liver iron overload may indeed affect vitamin D metabolism. Osteopenia was present in 32.5% and osteoporosis was present in 27.5 % of all TM patients. Reduced Bone Mass Density was also found to be linked with iron over load.Conclusions: Regular monitoring of vitamin D levels and supplementation is required in patients with severe liver and heart iron load. More studies are needed to confirm these results.

Evaluation of pattern and prognostic factors of head injury cases in a tertiary care centre

Background: Head injury is a major public health problem worldwide and requires appropriate attention both regionally and globally. This study was done to find the patterns and to evaluate prognostic factors for final outcome of cranio-cerebral trauma.Methods: A prospective study of 200 cases of head injury was conducted in a tertiary care hospital during one year duration. Apart from patient’s demographic profile detailed history and examination was recorded. Final outcome of all patients was noted at discharge and during follow up, various prognostic factors were studied by taking Glasgow outcome scale (GOS) at 3 months of head injury.Results: This study included 156 (78%) males and 44 (22%) females with average age of 35.95 years. Assault followed by RTI was the main cause of TBI. The factors which correlated with poor prognosis are presence of increasing age, less GCS at admission, alcohol intoxication and multiple lesions on CT scan.Conclusions: Prognostication of patients with head injury will help to provide timely multimodality approach which will ultimately help in improving outcome of these patients.

Anemia in Parasitic Infections in Patients Attending a Tertiary Care Hospital

This study showed the importance of intestinal parasitic infections in developing countries, the present study was undertaken to determine the prevalence of intestinal parasitic infections in general population attending the hospital. Methods: A total of 194 individuals of different age groups were included. The study was conducted in the department of Pathology & Microbiology at G.C.R.G. Institute of Medical Sciences, Lucknow. The duration of study was over a period of one year. Results: In our study, 194 total numbers of cases were included and 117 cases had parasitic infections. Conclusion: The study showed that, most of the affected individuals are generally poor, thus malnutrition may be secondary to poverty, and both in turn play a significant role in the prevalence of parasites causing infection and anemia.

Prevalence of Hypothyroidism in Pregnancy in a Tertiary Care Hospital

Background: Thyroid hormones are critical for thedevelopment of fetal neurological condition and maternalhealth. Hypothyroidism during pregnancy poses a significanthealth challenge because it is associated with several adversehealth outcome of child and mother.Objective: This study was done to assess the prevalence ofhypothyroidism in pregnant women in a tertiary care center.Materials and Methods: The study was done in a tertiary carecenter situated in outer periphery of Lucknow. The study wasconducted over a period of one and a half year. The studyincluded 1695 pregnant women.Results: According to the present study the prevalence ofhypothyroidism were 15.91% in first trimester, 11.90% insecond trimester and 13.82% in third trimester of pregnancyusing a cutoff TSH level of 4.20mIU/l.Conclusion: This study concludes that there is high incidenceof hypothyroidism during pregnancy. Majority of pregnantwomen show features of subclinical hypothyroidism during firsttrimester of pregnancy thus screening of hypothyroidismspecially in first trimester is necessary in our country.

Pattern and Etiology of Patients with Gastrointestinal Perforations: An Observational Prospective Study

Introduction: Perforation peritonitis is the most commonsurgical emergency encountered all over the world. Theobjective of the study was to highlight the spectrum ofperforation peritonitis as encountered in a tertiary care centrein haryana.Material and methods: It was observational prospectivestudy of 100 cases of perforation peritonitis treated in thedepartment of surgery. The maximum number of patients inthe present study were in age group of 21-30 years (26%) witha mean age was 31 years. Male female ratio was 8.09:1.Results: The most common etiology of perforation peritonitiswas peptic ulcer disease (41%) followed by enteric fever (15%)and tuberculosis (13%)The most common site of perforationin this series was gastroduodenal (43%) followed by terminalileum (30%). Mortality rate was 5% and significantly high inpatients coming to the hospital after 24 hours.Conclusion: Early recognition of symptoms and referral isvery important in reducing mortality and morbidity

Study of Prevalence of Diabetic Peripheral Neuropathy in Newly Diagnosed Patients of Type 2 Diabetes Mellitus (T2DM) in a Tertiary Care Hospital

Background: The prevalence of type 2 diabetes mellitus(T2DM) is growing worldwide, and these patients may beasymptomatic and present with complications at the time ofdiagnosis. Diabetic neuropathy is the most commoncomplication affecting the patients who may present with distalpolyneuropathy at the time of diagnosis and also poorglycaemic control. The Diabetic peripheral polyneuropathyaffects approximately 1 in every 10 newly diagnosed patients,whereas two third of patients with diabetes mellitus haveclinical or subclinical neuropathy.Objective: This study is designed to find prevalence of diabeticperipheral neuropathy in Newly Diagnosed Patients of T2DM ina tertiary care hospital.Materials and Methods: This observational study was carriedout in patients diagnosed with T2DM as per ADA criteria. Athorough clinical examination; Nerve conduction velocitytesting; evaluation of plasma glucose and glycosylatedhemoglobin and assessment of neuropathy by using theDiabetic neuropathy index and diabetic neuropathy score wasperformed on all patients.Results: 18% of patients had signs of peripheral neuropathyas shown by NCV testing at the time of diagnosis. Thesepatients had elevated levels of glycosylated hemoglobin,fasting plasma glucose and 2-hour plasma glucose and lowerscores of DNI and DNS which were statistically significant. Themost common type of neuropathy seen in these patients wassensorimotor involvement with demyelinating type ofneuropathy with more involvement of lower limbs. The NCVstudies showed reduced distal latency and prolongedamplitude as well as conduction velocity in patients withdiabetic neuropathy.Conclusion: Our study showed that approximately 1 in 5newly diagnosed patients with type 2 diabetes mellitus are atrisk of developing diabetic peripheral neuropathy.

Cardiovascular reactivity in young adults with hypertensive and normotensive parents: A gender based comparative study

Introduction: Essential hypertension begins due to mutation of specific genes that contribute to the risk of developing hypertension. Genetic contribution was recognized 25 years ago, now formulated from time to time. Some studies have also proven that the hypertension in father had strong contribution in their individual than mother. The aim of the study is to compare the cardiovascular reactivity in male and female subjects with hypertensive and normotensive parents. Materials and methods: This comparative study was conducted in physiology department of Teerthanker Mahaveer medical college and research center, Moradabad. The research work was initiated after taken the ethical clearance from the ethical committee of the college. Three different stressors: cold pressor task, cycling and videogame were used. Total 120 subjects were taken for the study in which 77 were male and 43 were female. Result: Male subjects of normotensive parents had slightly higher HR rate (mean: 76.73/min) compared to the female subjects (mean: 75/min) with p value >0.05. Female subjects of hypertensive parents had higher HR rate (mean: 82.72/min) compared to the male subjects (mean: 73.95/min) with p value <0.001. Conclusion: Male subjects with normotensive parents had higher resting HR, SBP &DBP than Female subjects with normotensive parents, but the difference was significant only in SBP. Female subjects with hypertensive parents group was showing higher resting HR than male subjects with hypertensive parents group, remains higher after stress also with insignificant difference. Thus, subjects with hypertensive parents showing increased CVR to stress are more likely to develop future hypertension, and the risk is greater for male subjects.

A Prospective Comparative Study Comparing Cardiovascular Reactivity in Obese Young Adult Male and Female Individuals.

Background: Cardiovascular reactivity (CVR) is defined as increase in heart rate (tachycardia) and blood pressure (hypertension) due to stress by the activation of sympathetic nervous system. Methods: Students of 18-25 years of age of various courses at Teerthanker Mahaveer Medical College, Body Mass Index (BMI) > 18 kg/m2 and self-reported teetotallers was enrolled for the study. After recording the basal parameters, all subjects underwent various pressor stimuli and haemodynamic parameters were recorded accordingly. Results: All values dPulse was higher in female (0.87/min) than obese male (0.38/min), dSBP & dDBP was higher in Obese male (1.88mmHg &2.14mmHg) than obese female (1.16mmHg &1.09mmHg) with significant difference. HR showed insignificant difference by all stressors except just after 1min of Videogame. Blood pressure was higher in male subject’s after1min/5min of stress with significant difference after 1min.of CPT/cycling/videogame. This is due to progesterone and due to their large musculature body. Conclusion: Obese male individual showing lower resting pulse rate but higher SBP &DBP than obese female subjects.CVR to stress, result was remains same dPulse was higher in female & the blood pressure was higher in obese male group with insignificant difference except 1min after 1min of VG.

Effect of Climatological Variables for all Seasons on the Frequency of Incident Stroke Hospitalizations in Scotland.

Background: Stroke is a disease, which has a complex multi-factorial etiology. Non-modifiable risk factors are genetics, familial history, age, sex, ethnicity and race, whereas smoking, drinking, physical activity and diet can be modified to reduce the risk of stroke significantly. Aims: The aim of the present study was to see the association between climate variations and incidence of stroke in Scotland. Methods: We have obtained the stroke data as SMR01 (Scottish Morbidity Record 01) as 1,57,639 incident stroke hospitalization in Scotland between 1986 and 2005. To observe for variation in weather parameter, with first stroke incidences per day, daily mean temperature, total rainfall and average daily atmospheric pressure were compared with the frequency of incident strokes per day using ANOVA (Analysis of Variance). Result: An overall meteorological analysis of incident strokes per day reveals an inverse statistically significant relationship for average daily temperature (P<0.001) whereas total daily rainfall (P=0.03) and average daily atmospheric pressure (P=0.05) exhibit borderline significance. Correlation of low temperature with stroke might be due to the concurrent occurrence of respiratory infections. We suggest some precautionary measures to minimize the chance of stroke i.e. protection from cold weather, decrease alcohol consumption and maintaining blood pressure within a safe range during winter season. Conclusion: Overall, high stroke incidence during winter season is a combined effect of temperature, rainfall, atmospheric pressure.

Comparison of Urinary Protein Creatinine Index (uPCI) and Dipsticks for the Prediction of Renal Dysfunction in Chronic Cigarette Smokers.

Background: Proteinuria is recognized as one of the earliest sign of renal function deterioration in chronic smokers. Proteinuria occurs due to alteration in glomerular permeability and later due to failure of reabsorption of filtered protein by the tubular cells. Normally, most healthy adults excrete 20 – 150 mg of protein in urine over 24 hours. However, it is difficult to collect 24 hrs urine samples. Objectives: To advocate the use of PCI (protein creatinine index) in assessment of proteinuria and to compare dipstick result with PCI in the assessment of proteinuria in chronic cigarette smokers. Material & Methods: A total of 30 cigarette smokers and 40 age and sex matched controls were included for the study. A random specimen of urine collected from each cigarette smoker and non- smoker was tested quantitatively by manual sulfosalicylic acid colorimetric method for the estimation of protein concentration. Creatinine concentration in each specimen was measured by modified Jaffe’s method and the urinary PCI was calculated. Results: Normal range of PCI which has been established in this study is 50 to 259. Significantly higher amounts of protein were found to be excreted in urine in chronic smokers (9.313 ± 4.003 mg/dl) as compared to healthy non smokers (7.738 ± 2.05 mg/dl). On comparison of PCI between healthy non smoker and chronic smoker subjects, PCI has been found to be significantly elevated in chronic smokers (healthy non smoker- 118.32 ± 56.86, chronic smoker- 180.1 ± 88.23) (p=0.001). Conclusion: PCI of random urine sample can provide a very useful, simple and convenient method for the quantitative assessment of proteinuria to confirm the advent of kidney damage, avoiding the drawbacks of 24 hrs urine collection.

Pharmacognostical and phytochemical standardization of Baladi churna- A polyherbal formulation.

Baladi Churna described by Acharya Bhavprkash in Vandhyatva (infertility). Endometrium dysfunction is the prime cause of Infertility among the world Baladi Churna is useful in patients especially having implantation failure due to defective endometrium, which is known as Kshetra deformity in Ayurveda. So a new pharmaceutical preparation Baladi churna was tried to standardize which is economical in terms of time and machinery usage. The present work was carried out to standardize the finished product of to confirm Baladi Churna entity, quality and purity. The presence of trichomes, spiral vessels, pollen grains were the characteristic features observed in the microscopy of the prepared drug. Phyto-chemical analysis showed Loss on drying 8.24% w/w, ash value 9 %w/w, water soluble extract 46.3 % w/w & pH 6.5. HPTLC of Baladi Churna is the preliminary quantitative analysis which shows 11 prominent spots in UV 254 nm and 10 prominent spots 366 nm. Baladi Churna, a polyherbal formulation of 6 ingredients was prepared and HPTLC finger print profile was developed and it can be considered pharmacopial standard of Baladi Churna.

Genetic diversity amongst landraces of a dioecious vegetatively propagated plant, betelvine (Piper betle L.).

Betelvine (Piper betle L., family Piperaceae) is an important, traditional and widely cultivated crop of India. The cultivators and consumers recognize more than 100 cultivars (landraces) based on regional and organoleptic considerations, while in terms of phytochemical constituents only five groups have been identified for all the landraces. Since betelvine is an obligate vegetatively propagated species, genomic changes, if any, may have become 'fixed' in the landraces. We carried out random amplified polymorphic DNA (RAPD) analysis in several landraces considered in four groups, namely, 'Kapoori', 'Bangla', 'Sanchi' and 'Others' in order to ascertain their genetic diversity. On the basis of the data from eleven RAPD primers, we distinguished genetic variation within and among the four groups of landraces. The results indicate the 'Kapoori' group is the most diverse. The neighbour joining (NJ) tree after a bootstrap (500 replicate) test of robustness clearly shows the four groups to be well separated. Interestingly, all known male or female betelvine landraces have separated in the NJ tree indicating an apparent gender-based distinction among the betelvines.