Effect of levothyroxine therapy on dyslipidemia in hypothyroid patients

The aims of the present study are to observe the prevalence of hypothyroidism (both subclinical and overt hypothyroidism), its association with dyslipidemia and whether replacement therapy with thyroid hormone has an effect on plasma lipid profile of hypothyroid patients. This prospective study of one-year duration recruited 232 clinically suspected patients belonging to both sexes and age group between 20-70 years attending OPD of endocrinology department of MLN Medical College, Allahabad. Patients were screened for T3, T4 and TSH and those who were euthyroid (52 cases) were excluded from the study. Thus, the present study included only 180 newly diagnosed cases of hypothyroidism. Levothyroxine replacement therapy was administered and patients were assessed every 3-4 months for an effect on lipid profile and body mass index during the study period. In both subclinical and overt hypothyroidism associated with dyslipidemia, replacement therapy with levothyroxine resulted in reversal to normal in significant number of cases. Although majority of hypothyroid cases were overweight yet therapy with  levothyroxine caused no significant changes in BMI in all grades of obesity.Keywords: Levothyroxine therapy; Dyslipidemia; Hypothyroidis

Sources of origin and meteorological importance of hygroscopic and iceforming nuclei

The hygroscopic nuclei whose source region during the monsoon is the sea penetrate far into the interior and play important role in development of precipitation well inland. The fraction of such nuclei present in the total aerosol constitutes a more dependable criterion for distinguishing maritime airmasses from those of others. Development of rain frequently by all-water and ice-crystal mechanisms have been suggested by the large concentrations noticed of the hygroscopic and ice-forming aerosols respectively. While it is seen that there is a major identifiable singular source, which is the sea, for hygroscopic aerosols at Delhi, it does not appear to be so in the case of ice-forming nuclei. The latter are of varied origin and might be maritime, continental, stratospheric etc

Antimicrobial sensitivity pattern of gram positive CSF isolates in children with septic meningitis in a Tertiary Care Hospital

The present study was conducted with the objective to determineantimicrobial susceptibility of Gram positive CSF isolates in septic meningitis in a tertiary care hospital. CSF (3-5 ml) was collected from 638 admitted children clinically suspected of septic meningitis. Bacterial isolates were identified and microbial sensitivity was assessed by the Kirby-Bauer’s disk diffusion method. Of the samples tested 102 (15.99%) were culture positive of which 45 (44.12%) culture positives were found inchildren aged 1-12 years. M: F ratio was 1.62:1. Maximum incidence (51 cases) was in summer-rainy season and in institutional delivery (58 cases). Primary immunization did not protect against septic meningitis. The isolates in 66 (64.71%) cases were Gram positive of which 36 (54.55%) were Streptococcus spp., 24 (36.36%) Staphylococcus aureus and 6 (9.09%) cases coagulase negative Staphylococcus (CONS). Both Streptococci and coagulase negative Staphylococci were highly sensitive (100%) to Linezolid, Vancomycin and Piperacillin-Tazobactam. However, Staphylococcus aureus were 100% sensitive to Linezolid and Vancomycin but were only 87.5% sensitive to Piperacillin-Tazobactam combination. The Streptococcus species showed a high degree of resistance to Tetracyclin91.67%, Co-trimoxazole 88.89% and Penicillin 63.89%. Staphylococcus aureus showed resistance to the tune of 83.33% each to Tetracycline and Co-trimoxazxole and 79.17% with Penicillin. In case of coagulase negative Staphylococcus, Co-trimoxazole showed resistance in 83.33%, Penicillin in 66.67% and Tetracycline in 50% cases. In septic meningitis Gram positive isolates predominate. Therapy should be based on trends of bacterial sensitivity

Randomized, interventional, prospective, comparative study to evaluate the antihypertensive efficacy and tolerability of ramipril versus telmisartan in stage 1 hypertensive patients with diabetes mellitus

Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are keystones for therapy of hypertension in diabetes because they show favourable effects on diabetic nephropathy and cardiovascular disease outcomes. A prospective, randomized, interventional clinical study of one year duration was conducted to comparatively evaluate anti-hypertensive efficacy and tolerability profile of ramipril versus telmisartan in stage 1 hypertensive patients associated with type 2 diabetes mellitus, amongst patients of either sex attending the medicine OPD of Rohilkhand Medical College and Hospital, Bareilly. Clearance from institutional ethical committee and written informed consent of the participants was taken. The enrolled 222 patients were randomized into ramipril and telmisartan groups, of these only 192 patients completed the study. The data obtained were statistically analyzed by paired and unpaired t-test using SPSS software. Prevalence of hypertension in diabetics was more in 41 to 50 years age group, in females (male: female ratio= 0.92:1) and in rural areas (rural: urban ratio= 0.61:1). Baseline BP values were equally matched in both groups. The SBP and DBP were reduced from baseline in all the ten follow-ups and were statistically significant (p <0.0001 for both groups). Regarding adverse effects, both drugs were well tolerated though dry irritating cough and dizziness was more in ramipril group. Both ramipril and telmisartan as monotherapy were equally effective in lowering SBP and DBP on prolonged use in diabetic hypertensives but the incidence of adverse effects was higher with ramipril hence telmisartan be preferred.KEY WORDS: Ramipril; Telmisartan; Systolic; Diastolic blood pressure; Stage 1hypertensive patients; Diabetes mellitu

A comparative evaluation of Losartan/Hydrochlorothiazide (fixed combination) versus Amlodipine monotherapy in patients with hypertension in Rohilkhand region

The aim of this prospective randomized study is to comparatively evaluatethe antihypertensive efficacy of combination therapy   (losartan/hydrochlorothiazide) with monotherapy (amlodipine). This prospective randomized clinical study was carried out for twelve months (July 2012 – June 2013) and enrolled 250 newly diagnosed stage-I hypertensive patients (as per JNC-7 criteria), who attended medicine outdoor department of Rohilkhand Medical College & Hospital, Bareilly. Hypertensive patients between 18 - 70 years of age were included in the study. The patients were randomly divided into two groups. The Losartan / Hydrochlorothiazide (LST/HCTZ) group included 128 patients and amlodipine group (AMLO) included 122 patients. A total of 40 patients, 14 patients of LST/HCTZ group and 26 patients of AMLO group dropped out during the study. M/F ratio was 0.92:1, and urban/rural ratio was 1.06:1. Majority of patients were in the 41-50 years age group. Mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) were comparable between both groups, being 152.97 mm Hg and 95.05mm Hg for LST/HCTZ group and 153.27mm Hg and 95.27 mm Hg for AMLO group. Both mean SBP and mean DBP blood were statistically significantly reduced in each of the six follow ups in both the groups (p<0.001). The mean SBP was reduced from 152.97±0.45 to 121.65±0.81 and mean DBP was reduced from 95.05±0.17 to 76.28±0.51(in the sixth follow-up) in  LST/HCTZ group. Similarly mean baseline SBP 153.270±64 was reduced to120.65±0.93 and mean baseline DBP was reduced from 95.270±38 to 75.54±0.67 after six months of therapy in AMLO group. The comparative evaluation of the two regimens revealed no statistically significant  difference (p>0.05) in both SBP and DBP reduction. Both LST/HCTZ and AMLO regimen were equally effective and well tolerated in lowering blood pressure.KEY WORDS: Anti-hypertensive efficacy, Losartan/ hydrochlorothiazide combination, Amlodipine; Hypertensive patient

Metabolic effects of Olanzapine versus Iloperidone: A 24 weeks randomized, prospective, interventional study

Atypical antipsychotics have become the mainstay of therapy for psychosis. Though extrapyramidal side effects have been reduced with atypical antipsychotics, yet there are increased concerns over metabolic effects. The present study is aimed to comparatively evaluate the metabolic profile of olanzapine and iloperidone in cases of psychosis. A prospective, randomized, open label, observational study of 6 months duration was conducted in the Department of Pharmacology and Department of Psychiatry, Rohilkhand Medical College and Hospital, Bareilly. A total of 62 patients of both sexes newly diagnosed with psychosis (ICD-10, F20- F29) were included in the study, 31 each in olanzapine and iloperidone groups. Demographic parameters were recorded, following which the patient’s body weight, BMI, fasting blood sugar and lipid profile were estimated at baseline. Follow-up of the patients was done periodically after one month, three months and six months. Olanzapine treated patients showed markedly significant rise in body weight up to 7 kg at the endpoint (p<0.0001) at each follow-up, with a significant increase in BMI. Rise in fasting blood sugar (FBS), total cholesterol (TC), triglycerides (TG) and low-density lipoprotein (LDL) levels werealso statistically significant. At the same time, significant decrease in HDL levels was also observed. Iloperidone treated patients showed statistically significant less rise in body weight (upto 1kg, p<0.05) and BMI. No significant changes in fasting blood sugar, total cholesterol, LDL and HDL levels were noted, while TG levels were significantly reduced. Iloperidone caused numerically less rise in bodyweight and BMI, and fewer metabolic adverse effects as compared to olanzapine, and hence should be preferred.Keywords: Atypical antipsychotics; Weight gain; Blood sugar level; Dyslipidemi

Effect of levothyroxine therapy on hypertension in hypothyroid patients

ABSTRACT: The aim of this study was to observe whether levothyroxine replacement therapy has an effect on hypertension in patients of hypothyroidism. This prospective study included all newly diagnosed cases of hypothyroidism (overt or subclinical) with hypertension, of either sex between 21-70 years of age. Levothyroxine replacement therapy was administered continuously during study period. Patients were clinically assessed for blood pressure before and every 3-4 monthly on levothyroxine therapy. Statistical analysis was carried out using a paired Student’s t-test. During one year study period, out of 180 newly diagnosed hypothyroid cases enrolled, 88 had overt hypothyroidism (OH) and 92 subclinical hypothyroidism (SH). Male: female ratio was 1: 6.5. Of these, hypertension was present in 51 (28.33%) patients (33 OH and 18 SH). Only diastolic blood pressure was raised in 28(54.9%) cases, systolic in 12 (23.53%) and both systolic and diastolic in 11 (21.57%) cases. Incidence of only diastolic hypertension was comparatively more in overt hypothyroidism (57.57%) than subclinical hypothyroidism (50%). Complete reversal of hypertension was observed in 8 out of 17 SH and 18 out of 29 OH cases while partial reversal was noted in one case in each category. A statistically significant decrease in mean values of both systolic and diastolic blood pressure was observed in patients of SH as well as OH. Hypertension is fairly common in patients of hypothyroidism. Replacement therapy with levothyroxine is quite helpful in reversing hypertension, a potential cardiovascular risk factor.KEYWORDS: Hypertension; Hypothyroidism; Levothyroxine therapyInternet Journal of Medical Update 2012 January;7(1):13-1

PPAR? Downregulation by TGF in Fibroblast and Impaired Expression and Function in Systemic Sclerosis: A Novel Mechanism for Progressive Fibrogenesis

The nuclear orphan receptor peroxisome proliferator-activated receptor-gamma (PPAR-γ) is expressed in multiple cell types in addition to adipocytes. Upon its activation by natural ligands such as fatty acids and eicosanoids, or by synthetic agonists such as rosiglitazone, PPAR-γ regulates adipogenesis, glucose uptake and inflammatory responses. Recent studies establish a novel role for PPAR-γ signaling as an endogenous mechanism for regulating transforming growth factor-ß (TGF-ß)- dependent fibrogenesis. Here, we sought to characterize PPAR-γ function in the prototypic fibrosing disorder systemic sclerosis (SSc), and delineate the factors governing PPAR-γ expression. We report that PPAR-γ levels were markedly diminished in skin and lung biopsies from patients with SSc, and in fibroblasts explanted from the lesional skin. In normal fibroblasts, treatment with TGF-ß resulted in a time- and dose-dependent down-regulation of PPAR-γ expression. Inhibition occurred at the transcriptional level and was mediated via canonical Smad signal transduction. Genome-wide expression profiling of SSc skin biopsies revealed a marked attenuation of PPAR-γ levels and transcriptional activity in a subset of patients with diffuse cutaneous SSc, which was correlated with the presence of a ''TGF-ß responsive gene signature'' in these biopsies. Together, these results demonstrate that the expression and function of PPAR-γ are impaired in SSc, and reveal the existence of a reciprocal inhibitory cross-talk between TGF-ß activation and PPAR-γ signaling in the context of fibrogenesis. In light of the potent anti-fibrotic effects attributed to PPAR-γ, these observations lead us to propose that excessive TGF-ß activity in SSc accounts for impaired PPAR-γ function, which in turn contributes to unchecked fibroblast activation and progressive fibrosis. © 2010 Wei et al

The unresolved safety concerns of bovine thrombin

A recent review has suggested that bovine thrombin is not associated with an increased risk of bleeding in surgical populations. In spite of extremely limited evidence available, many valuable resources (e.g. safety surveillance and post-marketing programs, case reports) were excluded in reaching this conclusion. While waiting for the adequately powered, controlled clinical trials to address the effects of bovine thrombin on bleeding and thrombotic events, the potential risk cannot be simply ignored. Rather, continued vigilance in the post-surgical setting for bleeding events that may be associated with the development of acquired coagulation factor inhibitors following bovine thrombin administration is warranted