Selective thyroid hormone receptor modulators.

Thyroid hormone (TH) is known to have many beneficial effects on vital organs, but its extrapolation to be used therapeutically has been restricted by the fact that it does have concurrent adverse effects. Recent finding of various thyroid hormone receptors (TR) isoforms and their differential pattern of tissue distribution has regained interest in possible use of TH analogues in therapeutics. These findings were followed by search of compounds with isoform-specific or tissue-specific action on TR. Studying the structure-activity relationship of TR led to the development of compounds like GC1 and KB141, which preferentially act on the ß1 isoform of TR. More recently, eprotirome was developed and has been studied in humans. It has shown to be effective in dyslipidemia by the lipid-lowering action of TH in the liver and also in obesity. Another compound, 3,5-diiodothyropropionic acid (DITPA), binds to both α- and ß-type TRs with relatively low affinity and has been shown to be effective in heart failure (HF). In postinfarction models of HF and in a pilot clinical study, DITPA increased cardiac performance without affecting the heart rate. TR antagonists like NH3 can be used in thyrotoxicosis and cardiac arrhythmias. However, further larger clinical trials on some of these promising compounds and development of newer compounds with increased selectivity is required to achieve higher precision of action and avoid adverse effects seen with TH.

Maternal Mortality in a Tertiary Care Hospital: A 10-year Review.

BACKGROUND: Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement. METHODS: This was a 10 year retrospective study. Epidemiological data was collected from the hospital register and maternal mortality ratio, epidemiological factors and causes affecting maternal mortality were assessed. RESULTS: A total of 120 maternal deaths occurred. Most maternal deaths occurred in the age group of 20-24 years, multiparous women (56.66%), women from rural areas (69.16%), illiterate women (65%), unbooked patients (83.33%), and patients of low socioeconomic status (83.33%). Direct causes accounted for 72.5% of maternal deaths where as 27.5% of maternal deaths were due to indirect causes. CONCLUSION: There is a wide scope for improvement as a large proportion of the observed deaths are preventable.

Comparison of safety and efficacy of papaya dressing with hydrogen peroxide solution on wound bed preparation in patients with wound gape.

OBJECTIVE: Indian papaya or Carica papaya is known to have de-sloughing and wound-healing properties due to the presence of protease enzymes. The present study was done to compare the efficacy and safety of papaya dressing with hydrogen peroxide solution for preparation of wound bed in patients of postoperative wound gape. MATERIALS AND METHODS: A randomized, open-labeled interventional study was carried out over a period of 8 months at a tertiary care hospital on post-caesarean section patients with wound gape. The efficacy parameters studied were duration of time required to induce development of healthy granulation tissue and total duration of hospitalization. Safety parameters studied were adverse effects reported by patients and development of hypersensitivity reaction. RESULTS: A total of 64 patients were enrolled, of which 32 patients received hydrogen peroxide dressing and 31 patients received papaya dressing (one patient withdrew after randomization). Time required to induce the development of healthy granulation tissue and total duration of hospitalization were 6.2±1.6 days vs 2.5±0.5 days and 19.2±5.8 days vs 12.92±4.6 days in papaya and hydrogen peroxide dressing groups, respectively. Both primary efficacy parameters were significantly shorter in papaya dressing group. The incidence of adverse effects like local irritation and itching were comparable in both groups and the difference was not statistically significant. CONCLUSION: Papaya dressing is more efficacious and equally safe as compared to hydrogen peroxide dressing when used for wound bed preparation in patients with postoperative wound gape.

Evaluation of the efficacy and safety of bromocriptine QR in type 2 diabetes.

CONTEXT: Diabetes mellitus is a chronic metabolic disorder of endocrinal origin with multiorgan involement. Today's physician has a lot many options to choose for treating type 2 diabetes, but does not always manages to achieve optimal glycemic control. The newer drug bromocriptine acts by novel hypothalamic circadian rhythm resetting mechanism. OBJECTIVE: To evaluate the efficacy and safety of bromocriptine QR in type 2 diabetes. MATERIALS AND METHODS: 105 patients according to inclusion and exclusion criteria were randomized into three groups by simple randomization. Group 1 received bromocriprine 2.4 mg once daily, group 2 received metformin 500 mg twice daily while group 3 received bromocriprine 1.6 mg daily and metformin 500 mg twice daily. Baseline measurement of fasting and postprandial blood sugar, HbA1(C) and BMI were followed up at 6(th) and 12(th) weeks. Safety evaluation was done by questioning the patient and also through routine hematological and biochemical parameters. Z test was used for analysis. RESULTS: Group 1 showed significant reduction in fasting and postprandial sugar and HbA(1c) at 12 weeks. While groups 2 and 3 showed even higher reduction in these parameters albeit with slightly more adverse drug events like nausea, vomiting compared to group 1. CONCLUSION: Bromocriptine QR is an effective and safe antidiabetic drug which can be employed as monotherapy or in conjuction with metformin to achieve and maintain optimal glycemic control.

Safety of single-dose nevirapine for prevention of vertical transmission of human immunodeficiency virus infection.

INTRODUCTION: Nevirapine administered as a single dose each to the mother and child within 72 h after birth is used to prevent vertical transmission of human immunodeficiency virus (HIV) under the prevention of parent to child transmission of HIV program (PPTCT). The efficacy of nevirapine in this regard has been proved beyond doubt, but there are unresolved questions about its safety. Hence, the primary objective of this study was to evaluate the safety of this regime. MATERIALS AND METHODS: HIV-positive pregnant women who consented to participate in the study received a single oral dose of 200 mg nevirapine at the onset of labor followed by administration of 2 mg/kg of nevirapine syrup to the newborn within 72 h of birth. Both mother and child were followed up for 1 week postpartum to note the occurrence of any adverse reactions. RESULTS: The mother and child followed up for 1 week postpartum did not show any serious adverse reactions in the present study. Mothers reported adverse reactions like nausea, vomiting, and headache which were self-limiting and did not require any intervention. CONCLUSION: The present study substantiates the safety of nevirapine.

Comparison of the efficacy and tolerability of telmisartan and enalapril in patients of mild to moderate essential hypertension.

BACKGROUND: Theoretically, angiotensin II receptor blockers (ARBs) have certain advantages over angiotensin-converting enzyme inhibitors, but the contribution of these advantages to the clinical effect of ARBs is not known. OBJECTIVE: To compare the efficacy and tolerability of telmisartan with enalapril in patients of essential hypertension. MATERIALS AND METHODS: Patients of mild to moderate hypertension were randomized to receive either 40 mg of telmisartan or enalapril 10 mg once a day orally for 12 weeks. At each visit, the systolic blood pressure (BP), diastolic BP and heart rate of each patient were recorded. Investigations such as hemogram hemoglobin, total leucocytes count (Hb, TLC), serum creatinine, serum glutamic oxaloacetic transaminase, serum glutamic pyruric transaminase (SGOT, SGPT) random blood sugar and urine examination were performed at baseline and after 12 weeks of the treatment period. RESULTS: The mean reduction in systolic BP in the telmisartan/enalapril group was 26.38 ± 10.98/26.74 ± 8.24 mmHg while the mean reduction in diastolic BP in the telmisartan/enalapril group was 14 ± 2.98/9.71 ± 4.23 mmHg, respectively, at 12 weeks. When the reduction in systolic BP in the two groups was compared, there was no significant difference between the groups (P > 0.05). However, the mean reduction in diastolic BP achieved with telmisartan at 12 weeks was significantly higher (P < 0.001) than that achieved with enalapril after the corresponding period. The overall frequency of adverse-effects was similar. However, in the enalapril group, the incidence of dry cough was higher as compared to that in the telmisartan group (11.43% vs. 0%, respectively; P < 0.05). CONCLUSION: Telmisartan produces a greater reduction in diastolic BP than enalapril and is free from the adverse-effect of dry cough that is commonly encountered with enalapril.

Severe irritant contact dermatitis induced by povidone iodine solution.

Albeit uncommon occurrence, irritant contact dermatitis induced by povidone iodine can be an unfortunate adverse reaction complicating its use as an antiseptic. We hereby present the case report of a patient who suffered such a reaction as a result of exposure to povidone iodine, employed as an antiseptic during spinal anesthesia. On conservative management with soframycin ointment, the lesions resembling chemical burns healed in a month without extensive scarring or other complications.