Vitamin D and COVID-19

The ongoing COVID -19 pandemic is caused by severe acute respiratory syndrome corona virus -2 (SARS-CoV-2). Since its emergence in Wuhan in Hubei province of China in December 2019, the virus has spread to every continent except Antartica. Currently, there is no registered treatment or vaccine for the disease. In the current scenario of the deadly virus spreading across continents and the absence of a specific treatment of novel corona virus, there is an urgent need to search for alternative strategies to prevent and control the rapid replication of virus. Vitamin D supplementation may reduce the incidence, severity and risk of death from pneumonia (consequent to the cytokine storm) in the current COVID pandemic. Through its effect on innate and adaptive immunity, vitamin D can reduce the risk of viral respiratory tract infections. 1, 25(OH) vitamin D directly stimulates the production of anti-microbial peptides like defensin and Cathelicidin that can reduce the rate of viral replication. In addition, it can also reduce the concentration of pro-inflammatory cytokines that are responsible for causing cytokine storm and resultant fatal pneumonia. In order to reduce the risk of infection especially in developing country like India, it is recommended that people at risk of COVDI19 may be considered for vitamin D supplementation

Management of hyperthyroidism in pregnancy

Hyperthyroidism in pregnancy is associated with adverse foetal, maternal and obstetrical outcome. Untreated or inadequately treated hyperthyroidism may precipitate pre eclampsia and congestive cardiac failure in mother. It also increases the risk of miscarriage, abruption placentae and premature delivery in such patients. Maintaining euthyroidism in these patients is of utmost importance. Antithyroid medications are used as first line treatment for such patients to restore euthyroid status at the earliest. Radioactive iodine is absolutely contraindicated in pregnancy and surgery often requires pre-treatment with anti thyroid medications. Two drugs are available –carbimazole and propylthiouracil. Use of carbimazole/methimazole in pregnancy is not only associated with increased incidence of scalp defect(aplasia cutis ) in the infants, but some specific congenital malformation like choanal atresia, oesophageal atresia, trachea-oesophageal fistula, patent vitello intestinal duct, omphalocele, dysmorphic facial features and growth retardation do occur. These malformations represent carbimazole /methimazole embryopathy. Due to the association of foetal teratogenicity with carbimazole /methimazole, propylthiouracil is recommended as the drug of choice in first trimester of pregnancy. However, as its use is associated with risk of hepatotoxicity, it should be changed to carbimazole/methimazole thereafter

Laparoscopic evaluation of pelvis in infertile women with previous genital and extra genital tuberculosis

Background: Genital tract tuberculosis causes infertility is a known fact but does past extra genital tuberculosis which had been treated also affects genital tract silently and causes significant genital involvement and infertility. The aim of this study was to study laparoscopic evaluation of pelvis in infertility patients with past history of treated genital and extra genital tuberculosis.Methods: 40 infertile patients with past history of treated genital (11) and extra genital (29) tuberculosis were included in the study. The study was conducted in a tertiary level hospital for one and a half years. After initial evaluation and work up and ruling out any active infection patients were posted for laparoscopic evaluation and proceed.Results: Most common site of extra genital tuberculosis was pulmonary tuberculosis in 52. 50%. Primary infertility was more common in both the groups, around 72%. Menstrual patterns were significantly different. 45.45% in women in group with genital tuberculosis presented with hypo menorrhoea as compared to only 13.79% in women with extra genital tuberculosis. Laparoscopic findings showed evidence of squealae of past tubercular infection like peritubular adhesions, omental adhesions, fibrosed distorted tubes, tubo-ovarian masses, hydrosalpinx, difficulty to visualise the tubes and ovaries and various combinations of these in most of the cases in women with genital tuberculosis (72.73%) of cases. These findings were seen in 37.93% of women with past extra genital tuberculosis.Conclusions: Genital tract may silently get invaded in primary extra genital tuberculosis. It is important for young girls affected by this to be treated diligently which might reverse the changes in time

Thyrotoxic periodic paralysis: a short clinical review

Thyrotoxic Periodic Paralysis (TPP) is a potentially lethal manifestation of hyperthyroidism which is characterized by hypokalemia and muscular weakness. It mainly affects Asian men in the age group of 20 to 40 years. Immediate supplementation with oral or intravenous potassium will help to not only abort the acute attack of paralysis but will also prevent serious and life threatening cardiac arrhythmias. Non selective beta blockers like propranolol can also be used to ameliorate and prevent subsequent paralytic attack. Acetazolamide has no role in the treatment of TPP

Flow with PMD: Past and Future

Measurements of azimuthal distribution of inclusive photons using the fine granularity preshower photon multiplicity detector (PMD) at CERN SPS are used to obtain anisotropy in the azimuthal distributions. These results are used to estimate the anisotropy in the neutral pion distributions. The results are compared with results of charged particle data, both for first order and second order anisotropy. Assuming the same anisotropy for charged and neutral pions, the anisotropy in photons is estimated and compared with the measured anisotropy. The effect of neutral pion decay on the correlation between the first order and the second order event plane is also discussed. Data from PMD can also be used to estimate the reaction plane for studying any anisotropy in particle emission characteristics in the ALICE experiment at the Large Hadron Collider. In particular, we show that using the event plane from the PMD, it will be possible to measure the anisotropy in Jpsi absorption (if any) in the ALICE experiment.Comment: Invited talk in the Fourth International Conference on the Physics and Astrophysics of Quark Gluon Plasma, 26-30 Nov.2001, Jaipur, Indi

Managing paediatric Graves’ disease

Graves’ disease is the most common cause of hyperthyroidism in children. Anti-thyroid drug treatment with carbimazole or its active metabolite methimazole is offered as first line initial treatment but it induces remission in only 30%of children. Propylthiouracil is not recommended in children because of its association with severe hepatic toxicity. For those who relapse after ATD, radioactive iodine can be offered as definitive therapy except in cases with severe Graves’ ophthalmopathy or patients with large goitre who are the candidates for surgery. Total (or near total) thyroidectomy  is the surgical procedure of choice for treating paediatric patients with  Graves’ disease as it reduces the risk of recurrent hyperthyroidism which was seen in patients undergoing subtotal or partial thyroidectomy

Nifedipine versus nitroglycerin for acute tocolysis in preterm labour: a randomised controlled trial

Background: To compare the safety & efficacy of oral nifedipine with transdermal nitroglycerin in the inhibition of preterm labour.Methods: This study included 84 women in preterm labour, randomly divided into two groups, 43 receiving oral nifedipine and 41, transdermal nitroglycerin (NTG). Patients in preterm labour with a single gestation, between the 26th and the 34th week and no contraindication for tocolysis were selected. Women with fetal malformation and medical or obstetric diseases were excluded. The variables analyzed were: delay in delivery for 48 hours, 7 days or more than 7 days, period of gestation at delivery, side effect profile of drugs & neonatal outcomes.Results: Mean prolongation of pregnancy with NTG (29.04 days) was similar to that of nifedipine (34.46 days). Nifedipine was significantly more successful in prolonging pregnancy beyond 48 hours, especially in women with advanced cervical dilatation (>3 cm). Failure of acute tocolysis, defined as delivery within 48 hours, was significantly more common with NTG (31.7 %) as compared to nifedipine (11.6 %). Headache was significantly higher in the NTG group (41.5 %) compared to nifedipine group (4.7 %). The neonatal outcomes in terms of the mean birth weight, incidence of low birth weight and very low birth weight babies, need and duration of neonatal intensive care was similar in both groups.Conclusions: Oral nifedipine is a safe and effective tocolytic with a lower failure rate and better side effect profile as compared with transdermal nitroglycerin

New Oral Anticoagulants: An Overview

Oral anticoagulant therapy is used in the prevention and treatment of venous thromboembolism (VTE), prevention of stroke and other systemic emboli in patients with atrial fibrillation (AF) and artificial heart valves

Scrub typhus in children: Clinical profile and complications at a Tertiary Care Teaching Hospital in Uttarakhand

Background: Scrub typhus is an acute febrile illness caused by rickettsia Orientia tsutsugamushi. Rickettsial infections are grossly underdiagnosed in India because of their non-specific clinical presentation, low index of suspicion among clinicians, and lack of diagnostic facilities. Objective: Objective of the study is to study the clinical profile, complications, and outcome of pediatric scrub typhus. Materials and Methods: This prospective observational study was conducted in the Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India, over a period of 2 years from November 2013 to October 2015. Children up to 18 years of age with signs and symptoms compatible with scrub typhus along with serological confirmation were included in the study. Serological study was conducted using rapid immunochromatographic assay and/or immunoglobulin M enzyme-linked immunosorbent assay technique. Clinical presentation, laboratory findings, complications, and outcome of these children were recorded on a performa. The data were analyzed using SPSS version 20 for windows. Results: About 115 children were diagnosed as scrub typhus during the study period. All children presented with fever. Other common symptoms were myalgia (56%), vomiting (50.5%), abdominal pain (26%), headache (28%), facial puffiness (15%), and seizures (8.7%). Pallor was present in 48% of children. Other common signs were hepatomegaly (29%), splenomegaly (28%), hypotension (24%), edema (21%), oliguria (17%), maculopapular rash (10%), meningeal signs (10.4%), and conjunctivitis (3%). Thrombocytopenia (67%), anemia (51%), pleural effusion (23%), shock (16%), hepatitis (23%), acute kidney injury (17%), meningoencephalitis (10%), myocarditis (7%), and acute respiratory distress syndrome (7%) were the complications observed. Azithromycin, doxycycline or chloramphenicol were used for the treatment. Overall mortality rate was 12.2%. Conclusion: A high degree of suspicion and knowledge of geographicaldistribution of rickettsial diseases is crucial for its early diagnosis and favorable outcome. The presence of an eschar is a valuable clinical clue in the diagnosis of scrub typhus; however, its absence does not rule out the disease

Effect of fungal biocontrol agents on enhancement of drought stress tolerance in rice (Oryza sativa L.)

Rice is the staple food crop for about half of the population of the world. Drought is a major stress limiting factor of this crop. In the recent years, biocontrol agents like Trichoderma spp. have become popular as plant growth promoter and shown to enhance drought tolerance in plants. Therefore, present investigation investigation was undertaken to evaluate the different biocontrol agents i.e. Trichoderma harzinum 1, Trichoderma harzianum 2, Chaetomium globosum and Talaromyces flavus against the drought in resistant (DRR 42 and Sahbhagi Dhan) and susceptible (IR 64) varieties of rice. Prior to sowing seeds were bioprimed separately with each isolates of Trichoderma harzianum @ 10g/kg and were sown in pots. Drought treatment of 4 days, 7 days, 10 days and 13 days were given as per the standard protocol. Biocontrol agent Trichoderma harzianum (T2) was observed most effective for drought tolerance followed by Chaetomium globosum. After 13 days of drought treatment minimum wilting (20%) was observed in Sahbhagi Dhan treated with Trichoderma harzianum 2. Four and 10 days drought stressed plants were subjected to different biochemical analysis. Significantly positive correlation (r = 0.91) was observed between wilting and Malondialdehyde (MDA) content. While negative correlation (r = −0.67) was observed between wilting and average plant weight. Study suggested that Trichoderma harzianum 2 treatment during drought stress in rice plants can delay the drought upto 3-5 days