Snakebite envenomation is known to cause local as well as systemic haematological, myotoxic and neurological effects. Adverse effects on the endocrine system following envenomation are rarely reported. Hirata's disease, also known as insulin autoimmune syndrome (IAS) is a rare disorder that causes hypoglycaemia due to excessive production of insulin autoantibodies. This report describes a rare case of IAS which developed in a snakebite victim following envenomation by a common krait and antivenom treatment. The patient was initially treated with dextrose and corticosteroids, although plasmapheresis was required to reduce the concentration of insulin antibodies and normalise the patient's glucose level. The patient then made an uneventful recovery without permanent sequelae. This report demonstrates the impacts of envenomation by a common krait on developing Hirata's disease and creates awareness among clinicians who treat snakebite envenomation.
Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.
Background Curcumin is a polyphenolic compound derived from rhizomes of Curcuma longa, the golden spice. Curcumin has drawn much attention in recent years of biomedical research owing to its wide-variety of biologic and pharmacologic actions. It exerts antiproliferative, antifibrogenic, anti-inflammatory, and antioxidative effects, among various imperative pharmacologic actions. In spite of its well-documented efficacies against numerous disease conditions, the limited systemic bioavailability of curcumin is a continuing concern. Perhaps, the poor bioavailability of curcumin may have curtailed its significant development from kitchen to clinic as a potential therapeutic agent. Subsequently, there have been a considerable number of studies over decades researching the scientific basis of curcumin’s reduced bioavailability, and eventually improvement of its bioavailability employing a variety of therapeutic approaches, for instance, in combination with piperine, the bio-active constituent of black pepper. Piperine has remarkable potentials to modulate the functional activity of metabolic enzymes and drug transporters, and thus there has been a great interest in the therapeutic application of this widely used spice as an alternative medicine and bioavailability enhancer. Growing body of evidence supports the synergistic potential of curcumin against numerous pathologic conditions when administered with piperine. Conclusion Conclusion: In light of current challenges, the major concern pertaining to poor systemic bioavailability of curcumin, its improvement especially in combination with piperine, and necessity of additional research in this setting are together described in this review. Besides, the recent advances on the potential therapeutic rationale and efficacy of curcumin-piperine combination, a promising duo, against various pathologic conditions are delineated.
Introduction: Although in vitro and animal studies have shown that iron loading in pancreatic beta-cells impaired insulin secretion, no human studies have documented the acute effects of oral iron on beta-cell insulin secretory capacity. In this study, we determined beta-cell insulin secretory capacity at baseline and after a single oral dose of iron (ferrous sulphate, 120 mg elemental iron) in healthy male individuals. Methods: Fifteen healthy male volunteers underwent an oral glucose tolerance test (OGTT) to document baseline glucose tolerance and insulin secretion kinetics (baseline OGTT). One week later, the same subjects underwent a second OGTT, two hours after an oral dose of ferrous sulfate (120 mg of elemental iron) (post-iron OGTT). Changes in disposition index, insulin secretion kinetics, glucose tolerance, insulin resistance, insulin clearance, and iron-related parameters in serum were determined. Results: Compared to baseline OGTT, the areas under the curve (AUC) for serum iron and transferrin saturation increased by 125% and 118% respectively, in the post-iron OGTT. The disposition index decreased by 20% (p=0.009) and the AUC for glucose concentrations increased by 5.7% (p<0.001) during the post-iron OGTT. The insulin secretion rate was marginally lower during the first hour (-3.5%, p=0.63), but became significantly higher during the second hour (22%, p=0.005) of the post-iron OGTT. Insulin resistance and insulin clearance rate were not affected by iron intake. Conclusion: The decrease in disposition index and glucose tolerance observed after the oral dose of iron points to an acute iron-induced impairment in pancreatic beta-cell insulin secretory capacity. This article is protected by copyright. All rights reserved.
Mycotic pseudoaneurysm (MPA) is a blind, saccular outpouching of the arterial lumen of infective origin. MPA is a rare life-threatening condition and if not treated early, has a 67% mortality rate due to sepsis and hemorrhage. Major predisposing factors are diabetes mellitus, chronic renal failure, malignancy, steroids, and intravenous drug use. Imaging modalities include Doppler ultrasound, contrast-enhanced computed tomography, and digital subtraction angiography. We report a unique case of Salmonella bacteremia-related MPA of the right common iliac artery complicated by septic inferior vena cava (IVC) thrombosis in a patient with uncontrolled diabetes. Such transcompartmental involvement of IVC has hitherto not been described in the literature and hence makes for interesting documentation. This case ponders upon the aggressiveness of the invasive nontyphoidal Salmonella infection pathogen and the need for early imaging of suspicious patients to reduce morbidity and mortality.
Background Optical diagnosis is one of the upcoming methods in screening and diagnosing oral cancer at the earlier stage. Currently, DNA-based diagnosis is used along with light-based imaging methods to diagnose oral cancer rapidly. Aim The aim of this study was to discriminate oral cancer and oral potentially malignant disorders from normal patient with fluorescence spectroscopic characterization of salivary DNA using ethidium bromide dye. Materials and Methods A total of 40 patients with average age of 20 to 60 years in both the genders were selected and divided into three groups. Group A included clinically proven cases of oral cancer, group B1 included clinically diagnosed cases of leukoplakia, group B2 included clinically diagnosed cases of oral submucous fibrosis, and group C included controls. Salivary DNA fluorescence spectrum obtained after adding ethidium bromide was analyzed using FluoroLog spectrophotometer at 480 nm wavelength. Results The discriminant analysis of fluorescent emission of salivary DNA shows predictive accuracy of 90% between group C and group A, 95% between group C and group B1, and 65% observed between group C and group B2. Conclusion From this study, screening of oral cancer can be done at the earliest with the help of fluorescence spectroscopic characterization of salivary DNA. This method can be done rapidly and noninvasively.
BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) is one of the neurophysiological techniques aimed at reducing pain and disability. This systematic review objective addresses the current evidence on PNF techniques’ effectiveness in chronic low back and neck pain. METHODS: Literature search in PubMed, Scopus, Cochrane, Wiley and Ovid databases were searched until 2021. The content of the titles and the abstracts were analysed to gather information about the effects of PNF in chronic back and neck pain with outcomes of pain and disability. The quality of the studies was analysed by the Joanna Briggs Institute (JBI) critical appraisal score. Meta-analysis was performed on Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) for chronic low back pain and Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ) for disability. RESULTS: Nine studies addressed the different PNF based interventions on chronic low back pain, with a total of 416 participants. The intervention period ranged 3–6 weeks, and two studies conducted 12-weeks follow-up. Many studies measured pain using a VAS and NRS, whereas the disability through ODI and RMDQ. The JBI score ranged from 6/13 to 11/13. None of the PNF studies treated chronic neck pain. CONCLUSION: PNF might be beneficial for reducing low back pain and related disability. The long term effects of PNF on chronic low back pain, and also to determine its benefits on chronic neck pain are warranted in future studies.
Multi-drug resistance (MDR) in Salmonella is one of the major reasons for foodborne outbreaks worldwide. Decreased susceptibility of Salmonella Typhi to first-line drugs such as ceftriaxone, ciprofloxacin, and azithromycin has raised concern. Reduced outer membrane proteins (OMPs) permeability and increased efflux pump transportation are considered to be the main reasons for the emergence of antibiotic resistance in Salmonella. The present study aimed to assess the expression of OMPs at sub-lethal concentrations of ceftriaxone in S. Typhi (Sl5037/BC, and Sl05). The S. Typhi strains were exposed to sub-MIC and half of the sub-MIC concentrations of ceftriaxone at three different time intervals (0 min, 40 min, and 180 min) and analyzed for differential expression of OMPs. Further, the expression variation of OMP encoding genes (yaeT, ompX, lamb, ompA, and ybfM) in response to ceftriaxone was evaluated using real-time PCR. The genes like lamB, ompX, and yaeT showed significant downregulation (p < 0.05) compared to the control without antibiotic exposure, whereas ybfM and ompA showed a moderate downregulation. The expression of omp genes such as lamB, ompA, ompX, ybfM, and yaeT were found to be low in the presence of ceftriaxone, followed by time and dose-dependent. The study provides insights into the possible involvement of OMPs in drug resistance of S. Typhi, which could help develop a therapeutic strategy to combat MDR isolates of S. Typhi.
Objective The objective of this study was to assess the levels of depression among patients with Parkinson’s Disease (PD), the factors influencing their levels, and determine their influence on their Quality of Life (QoL). Materials and Methods The study was conducted at the movement disorders outpatient department, Rajiv Gandhi Government General hospital, where 50 patients with diagnosed PD were enrolled. They were interviewed for their levels of depression and QoL using respective standardized depression and QoL assessment questionnaires. Results Patients with PD were mostly above the age of 50 and were male. Their levels of depression ranged between normal to mild and borderline depression and their QoL scores were also moderate. Among their QoL domains, the emotional well-being, and cognition of patients were found to be more affected when compared to other domains. Conclusion The prevalence and severity of depression among patients with PD were mild, but they play an important role in determining their QoL, especially the emotional well-being and cognitive performance of patients.
Demographic characteristics and stock status of the giant tiger prawn, Penaeus monodon were investigated in Pulicat Lake, southeast coast of India, using the FiSAT II software package. The asymptotic length (L ∞) and growth coefficient (K) were estimated as 20.44 cm and 0.90 year −1 , respectively, by the ELEFAN method. The growth performance index (Ø) was calculated as 2.575. The mortality parameters Z, F and M were computed to be 3.70, 2.15 and 1.55 year −1 , respectively. The recruitment pattern was found to be continuous throughout the year with a peak in June and July. The estimated MSY and annual catch were 81.90 tonnes and 95.18 tonnes, respectively. The current exploitation rate (E) was found to be relatively higher than the optimum level. Hence it is recommended that the current effort level be decreased by 13.9% in order to sustain the fishery of this particular species in Pulicat Lake.
Background: Cerebral Palsy is a neuro developmental disorder caused by non progressive lesion in the developing brain. The aim of the study was to compare the effect of constraint induced movement therapy vs play therapy in cerebral palsy. Method: A sample of 20 patients within the age group of 4-8 years with cerebral palsy were randomly divided into two groups, Group A (n= 10) and group B (n= 10). The subjects in group A was treated with CIMT [Constraint induced movement therapy] and the subjects in group B was treated with Play therapy. The subject’s improvement on hand functions was assessed by Box and Block test (BBT) and Motor Activity Log Scale (MAL) and pre and Post test results were analysed. Result: The study concludes that there was statistically significant improvement of hand function in group A compared to group B in response to treatment Conclusion: Based on the result, this study concluded that child friendly constraint induced movement therapy is effective in spastic hemiplegic cerebral palsy than play therapy in cerebral palsy. Key words: CIMT, PLAY THERAPY, BBT, MAL .
Introduction: Blood transfusion is an independent risk factor for death and perioperative infection in trauma patients. Hospital Length Of Stay (LOS) is an indicator of morbidity and can be used to assess wound healing in burns patients. Aim: To analyse the factors influencing hospital length of stay in burns patients, with relevance to blood transfusion. Materials and Methods: This was a cross-sectional study on burns patients admitted at burns ward, Government Kilpauk Medical College, Tamil Nadu, India, between September 2014 to August 2015. Patients with age more than 16 years with 15-40% Total Burnt Surface Area (TBSA) and had survived treatment were included after obtaining informed consent. Age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, blood component transfusion, storage age of red cells, surgical procedures and wound infection were studied. Results were analysed using Chi-square test, Analysis of Variance (ANOVA) and Pearson correlation. Results: Of the 122 burns patients studied, mean age was 35.38±12.93 years, 54.09% were males, mean LOS was 22.39±1.23 days, mean TBSA was 26.11±0.40%, mean APACHE II score was 5.02±0.06, 85 (69.67%) patients had received red blood cell transfusion, 59 (48.36%) underwent surgical procedures and 103 (84.43%) developed culture proven wound infections. APACHE II score at admission (r-value=0.260, p-value=0.004), blood transfusions (r-value=0.504, p-value
Background: Neonatal skin care practices that are often guided by personal experience and preferences result in substantial variation in the practices being followed across hospital settings. The objective of this consensus recommendations was to provide guidance to health care practitioners on evidence-based neonatal skin care practices for adoption in hospitals: from delivery to discharge. Methods: A Scientific Advisory Board meeting on “Evidence-based Neonatal Skin Care Practices and Protocols” was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynaecologists and a pediatric dermatologist were invited. A comprehensive literature search was performed using the PubMed and Google Scholar databases to source relevant evidence. Results: Recommendations were developed on critical aspects of skin care in healthy full-term neonates, including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, use of cleansers and emollients, and the criteria to choose appropriate skin care products. The newborn’s first bath should occur only once cardiorespiratory and thermal stability have been achieved, anywhere between 6 to 24 hours after birth. Bathing with water alone or water with a mild liquid cleanser demonstrated appropriate for newborn does not impact the developing skin barrier. The use of emollients to maintain and enhance skin barrier function was encouraged for neonates with risk factors that can affect skin barrier integrity. Skin assessment should become an integral part of routine neonatal care. Skin Care Advice with “Do’s and Don’ts” should be a part of the neonatal discharge checklist. The importance of rigorous quality control, high-quality clinical trials to evaluate the safety and efficacy of baby products, usage of products that contain only ingredients and which are formulated appropriately for newborn babies, and full label transparency for baby products were highlighted. The panel further identified gaps in the existing literature and discussed the scope for future research. Conclusions: The consensus recommendations may help standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings. This may also improve the quality of care that the neonates receive in the hospital and facilitate improvement in overall neonatal health outcomes.
The reports on adverse drug reactions(ADR) to self-medication or over-the-counter medication are common across medical literature. However, the occurrence of oral fixed drug eruptions (FDE) to mefenamic acid is unique. We report a case of FDE to a drug obtained over the counter for menstrual pain. The essential findings from history, oral/ dental examination, diagnostic approach, and treatment are briefly discussed along with a note on time and dosing for the oral drug provocation tests. The occurrence of ADR may be avoided by spreading awareness against OTC medication and labeling the specific drug for patients with established ADR.
Introduction: The overall prevalence of obesity among adolescents was estimated to be 9.9% in India. Patients with morbid obesity are at higher risk for health complications, such as diabetes, heart disease, stroke, hypertension, gallbladder disease, osteoarthritis, sleep apnea and other breathing problems and some forms of cancer. They frequently suffer from low self-esteem, impaired body image, and depression. The aim of this study was to determine the effectiveness of Cognitive Health Focused Training (CHF-T) on body mass index and quality of life among obese adults. Methodology: A quasi experimental study was conducted to assess the effectiveness of CHF-T among obese adults in selected community area, Kelambakkam, Chennai. Samples were selected by non-probability convenient sampling as per the inclusion criteria; 30participants were assigned as experimental group and 30 in control group. CHF-T was given and the level of obesity was assessed by calculating the body mass index (BMI), and the quality of life (QOL) was assessed using the adopted Moorhead quality of life questionnaire.Results: In the experimental group, there significant reduction in the mean BMI score and improve in QOL score in post-test compared to pre-test. Sex and hours spend on television had statistically significant association with posttest level of BMI at p <.01 and p <.05 level. No statistically significant association related to QOL. Conclusion: Cognitive Health Focused Training (CHF-T) among obese people was an effective method in reducing the BMI and increasing QOL. It needs commitment of the healthcare professional to create awareness among the public.
Introduction As majority of these cancers are only diagnosed at advanced stages, it has become the reason for increased mortality rates and poor prognosis affecting the quality of life of patients. The delay in cancer diagnosis especially among women may be attributed to various factors both from patients and the healthcare sector. This study thus aims to conduct a comprehensive review of the literature on the factors behind the delay in case detection, that are common and specific for both the cancers, the reasons for the delay and the average time duration and reasons for the delay. Materials and methods A systematic search was conducted over several databases to identify relevant peer-reviewed studies. From eligible studies, data were extracted to summarize, collate, appraise the quality and make a narrative account of the findings. Results Of 581 studies, 29 were reviewed which revealed the commonest factors for delay were patient (presentation delay) followed by the health provider and healthcare sector, and the average time duration of delay was 6 months. Reasons for delay in the presentation were misconception about the disease, perceived stigma and fear of cancer. Poor knowledge of general practitioners, misclassification of disease severity, and long waiting queues in public health facilities were the commonest reasons for healthcare sector delay. Conclusion: Disease awareness among healthy women followed by widespread screening and appropriate interpretation of early clinical presentation by healthcare providers can be improved to reduce delay in cancer diagnosis and ensure better prognosis and quality of life of patients.
Context: Grounded theory has been extensively used in research with women, is a means of generating new knowledge that is situated both within the context of the field and existing theory. Methods: The research design used for our study was substantive grounded theory design. The study was conducted in selected tertiary hospitals at Namakkal. The sample size comprises of 5 women with post partum blues. Based on data saturation, the participants were curtailed and extracted with total 5 women with post partum blues. We recruited participants by adopting purposive typical case sampling technique. Typical participants, who were already experiencing and resolving problems related to post partum blues, were enrolled in our study. Demographic variables were collected. The level of post partum blues were measured by Likert Am I blue? Assessment scale. Observations and semi-structured interviews were conducted. All interviews were recorded and transcribed for the women with post partum blues in order to express core variables (basic social process) related to post partum blues with the help of vignettes. Investigator triangulation strategy was used for collecting the data, coding and making analytic decisions. Results: In our study 3 categories were identified viz biological problems, emotional problems and its ramifications and social network support system. The hypothesis generated from our study is the significant correlation between emotional problems and social support among women with post partum blues.
Hepatocellular carcinoma (HCC) is the most common cause of, and accounts for almost 90% of all liver cancers. Data from India is limited especially due to cancer not being a reportable disease and in view of wide variation in diagnostic modalities. This document is a result of a consensus meeting comprising Hepatologists, Interventional Radiologists, Hepatobiliary surgeons, medical and surgical Oncologists nominated by the Association of Physicians of India and Gastroenterology Research Society of Mumbai. The following Clinical Practice Guidelines for practicing physicians is intended to act as an up to date protocol for clinical management of patients with hepatocellular carcinoma. The document comprises seven sections with statements and sub-statements with strength of evidence and recommendation.
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