TO EVALUATE THE EFFECT OF INTRAVITREAL INJECTION OF TRIAMCINOLONE ACETONIDE IN RECALCITRANT MACULAR DISORDERS.

Objectives: Recalcitrant macular disorders are those retinal conditions which, though treated by various medical and surgical modalities, but showedno improvement in symptoms or visual acuity or both. The present study was carried out to evaluate the efficacy of intravitreal triamcinoloneacetonide (TA) injection in patients with these recalcitrant macular disorders.Methods: This prospective and interventional study included 40 patients (40 eyes) having recalcitrant macular disorders. Complete ophthalmicexamination such as measurement of intraocular pressure (IOP), visual acuity (log minimal angle of resolution [MAR] units), fundus photography withfluorescein angiography were carried out before and after intravitreal injection of TA. The patients received an intravitreal injection of TA (10 mg) fordiabetic macular edema (n=14), age-related macular degeneration (n=13), pars plana cystoid macular edema (CME) (n=5), vascular diseases (n=3),central chorioretinopathy (n=3), and idiopathic CME (n=2). The follow-up was done on day 1, day 7, 1 month, 2 month and 4-month intervals.Results: The mean visual acuity at 2 months (1.12±0.45 log MAR units), and 4 months (1.08±0.46 log MAR unit) after the injection were significantlybetter than baseline measurements (1.32±0.3 log MAR units). The mean baseline IOP was 12.5±2.9 mmHg. The IOP significantly increased after theinjection at day 1 and day 7; however, the change in IOP at 1 month, 2 months, and 4 months was not statistically significant.Conclusion: The results indicate that intravitreal injection of TA in patients with recalcitrant macular disorders caused significant improvement ofvisual acuity in 10 mg dose.Keywords: Intravitreal triamcinolone acetonide, Macular edema, Visual acuity, Intraocular pressure

A case control study to evaluate thyroid dysfunction as a risk factor for retinopathy in type 2 diabetes mellitus

AIMS AND OBJECTIVES 1. To assess the prevalence of Thyroid dysfunction among Type 2 DM patients. 2. To assess the prevalence of retinopathy among Type 2 Diabetes patients. 3. To assess whether thyroid dysfunction is associated with increased risk of retinopathy in type 2 diabetes patients. METHODOLOGY STUDY DESIGN: This is a case control study that was conducted among 100 Type II diabetes mellitus patients attending the OP and the wards. INCLUSION CRITERIA: 1. Patients diagnosed with Type 2 Diabetes on treatment. 2. Duration>5 years of diabetes mellitus. 3. Age > 12 years. EXCLUSION CRITERIA: 1. Patients with known history of thyroid disorder. 2. Patients on drugs known to affect thyroid function like Lithium, amiodarone, oral contraceptive pills, etc. 3. Pregnant Patients. 4. Patients in whom fundus cannot be examined. 5. Patients not consenting for the study. 6. Systolic BP>140 and Diastolic BP > 90. 7. Glaucoma patients. 8. Nephropathy patients. Data and Blood samples will be collected from established cases of type two diabetes patients on treatment from which serum shall be extracted for thyroid profile. All the study patients will undergo a detailed ocular examination for detection and grading of retinopathy. ETDRS has classified NPDR into mild, moderate, severe and very severe and PDR into early PDR and high-risk PDR. RESULTS AND INTERPRETATION: According to this study the prevalence of thyroid dysfunction among the 100 Type 2 Diabetes Mellitus patients studied was 23% with the most common problem being sub-clinical hypothyroidism (SCH) at 21% among the study population followed by overt hypothyroidism at 2%. As expected the prevalence of thyroid dysfunction among females (32%) was much more than among males (14%), the odds ratio being 5.06 and p value being less than 0.005

Evaluation of Uterine Biophysical Profile and to Assess its Role in Predicting Conception among Unexplained Primary Infertility Patients

Introduction: Infertility is a devastating disease which affects its victims at a very basic level the ability to reproduce. This can be divisive to the couples involved, their relatives and friends. The influence of infertility can be immense. There are a lot of medical and social consequences of infertility and the psychological sequelae are one of them. Affected patients and their families suffer from loss of esteem, disappointment and depression. Considering the immense effect of infertility on the life of not only the affected couples but also on their families and relatives the present study was conducted with following objective. Objective: To evaluate the Uterine Biophysical Profile and to assess its role in predicting the conception outcome in spontaneous cycles in patients with unexplained primary infertility. Material &Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, U.P. Rural Institute of Medical Sciences & Research, Saifaion 55 women with unexplained primary infertility after standard diagnostic work up. Ultrasound (TVS) measurement of all patients was performed in their midcycle of spontaneous cycle. The Uterine Biophysical Profile (UBP) i.e. certain sonographic qualities of the uterus were noted during the normal mid-cycle of these patients. These included 7 parameters: Endometrial thickness in greatest AP dimension of 7 mm or greater (full-thickness measurement), a layered ("5 line") appearance to the endometrium, myometrial contractions causing a wave like motion of the endometrium, homogeneous myometrial echogenicity, uterine artery blood flow (as measured by PI, less than 3.0), blood flow within zone 3 using color doppler technique, myometrial blood flow seen on gray-scale examination. The Uterine Scoring System for Reproduction ("USSR") was used to evaluate the total score. Results: Among 55 unexplained primary infertility patients 24 i.e. 43.63% conceived by serial ultrasonographic monitoring of spontaneous menstrual cycle and timed intercourse. According to USSR, with a ‘perfect score’ of 20, there was 80% conception rate. While 9 /15 patients (i.e 60%) conceived with a score of 17-19.  With a score of 14-16, 10/23 patients conceived i.e. 43.37%.  Only 8.33% conception rate was seen with a low score of < or = 13.  Highest pregnancy rate (60%) was seen with an endometrial thickness of 7-9mm while zone IV endometrial blood flow gave maximum conception rate of 66.66%. Conclusion: UBP can prove to be a simple, reliable, reproducible, rapid and non-invasive tool to predict uterine environment and hence conception outcome

BENEFICIAL EFFECT OF VITAMIN D ON HIGH-FAT DIET-INDUCED OBESITY IN WISTAR RATS

ABSTRACTObjectives: The aim of the present study was to investigate the antiobesity effects of vitamin D (VD) on high-fat diet (HFD)-induced obesity in Wistarrats.Methods: In the present study, male Wistar rats were selected after 4 weeks feeding of HFD and then treated with different doses of VD(2.5-10 mcg/kg/day, p.o.o.d.) for 6 weeks along with HFD. Orlistat (30 mg/kg/day, p.o.o.d.), which is a lipase inhibitor a standard drug for obesitywas used as a standard control in the present study. The effects of these treatments on body weight parameters, feed intake (Kcal), weight and size offat pads, levels of serum glucose, triglycerides (TGs), total cholesterol (TC), high-density lipoproteins (HDL), and low-density lipoprotein (LDL) wereanalyzed.Results: Treatment with VD (2.5-10 mcg/kg/day, p.o.o.d.) produced significant dose-dependent decrease (p<0.05) in body weight parameters, feedintake (Kcal), weight and size of fat pads, levels of serum glucose, TGs, TC, and LDL as compared to HFD group. Moreover, the level of serum HDLs wasincreased as compared to HFD group.Conclusions: VD treatment ameliorated established obesity and associated biochemical consequences. The results suggest that administration of VDcan inhibit the development of obesity and associated metabolic consequences in HFD-induced obesity.Keywords: Obesity, Vitamin D, High-fat diet

Phytochemical analysis, antioxidant, antidiabetic and anti-inflammatory activity of bark of Gardenia latifolia

Gardenia latifolia (Rubiaceae) is commonly known as Indian boxwood or Ceylon boxwood, is a densely foliaceous small tree that occurs throughout the greater parts of Indian common in deciduous forests along the streams. The stem bark and fruits are reported to be used in the treatment of various ailments such as snake bite, skin diseases, stomach pains, caries in humans and ephemeral fever in live stocks. Many beneficial medicinal products are used to treat various serious diseases and disorders like diabetes, cancer and cardiovascular diseases without side effects. Hence our study focused to investigate the phytochemical analysis, quantification of bioactive compounds, in vitro free radical scavenging activity (DPPH radical method), anti-inflammatory activity (Carrageenan induced hind paw oedema ), in vitro anti-diabetic activity by enzyme inhibition activity of bark of Gardenia latifolia (hydroalcoholic extract) which has boundless medicinal properties. The results of this study showed the evidence that the extracts when tested for their phytochemicals and free radical scavenging activity were found to have considerable antioxidant potential. This plant also exhibit better in vitro enzyme inhibitory activity and anti-inflammatory activity. The results of this study indicate that the hydroalcoholic extract of Gardenia latifolia bark has significant pharmacological properties. Keywords: Gardenia latifolia, Phytochemical analysis, DPPH radical method, Anti-inflammatory activity, Anti-diabetic activit

Comparative analysis of expressed sequence tags (ESTs) between drought-tolerant and -susceptible genotypes of chickpea under terminal drought stress

<p>Abstract</p> <p>Background</p> <p>Chickpea (<it>Cicer arietinum </it>L.) is an important grain-legume crop that is mainly grown in rainfed areas, where terminal drought is a major constraint to its productivity. We generated expressed sequence tags (ESTs) by suppression subtraction hybridization (SSH) to identify differentially expressed genes in drought-tolerant and -susceptible genotypes in chickpea.</p> <p>Results</p> <p>EST libraries were generated by SSH from root and shoot tissues of IC4958 (drought tolerant) and ICC 1882 (drought resistant) exposed to terminal drought conditions by the dry down method. SSH libraries were also constructed by using 2 sets of bulks prepared from the RNA of root tissues from selected recombinant inbred lines (RILs) (10 each) for the extreme high and low root biomass phenotype. A total of 3062 unigenes (638 contigs and 2424 singletons), 51.4% of which were novel in chickpea, were derived by cluster assembly and sequence alignment of 5949 ESTs. Only 2185 (71%) unigenes showed significant BLASTX similarity (<1E-06) in the NCBI non-redundant (nr) database. Gene ontology functional classification terms (BLASTX results and GO term), were retrieved for 2006 (92.0%) sequences, and 656 sequences were further annotated with 812 Enzyme Commission (EC) codes and were mapped to 108 different KEGG pathways. In addition, expression status of 830 unigenes in response to terminal drought stress was evaluated using macro-array (dot blots). The expression of few selected genes was validated by northern blotting and quantitative real-time PCR assay.</p> <p>Conclusion</p> <p>Our study compares not only genes that are up- and down-regulated in a drought-tolerant genotype under terminal drought stress and a drought susceptible genotype but also between the bulks of the selected RILs exhibiting extreme phenotypes. More than 50% of the genes identified have been shown to be associated with drought stress in chickpea for the first time. This study not only serves as resource for marker discovery, but can provide a better insight into the selection of candidate genes (both up- and downregulated) associated with drought tolerance. These results can be used to identify suitable targets for manipulating the drought-tolerance trait in chickpea.</p

Epidemiologic study of myelodysplastic syndromes in a multiethnic, inner city cohort

Little is known about the epidemiology of MDS in minority populations. The IPSS and newly released IPSS-R are important clinical tools in prognostication of patients with MDS. Therefore, we conducted a retrospective epidemiological analysis of MDS in an ethnically diverse cohort of patients. Demographics, disease characteristics, and survival were determined in 161 patients seen at Montefiore Medical Center from 1997 to 2011. We observed that Hispanics presented at a younger age than blacks and whites (68 vs. 73.7 vs. 75.6 years); this difference was significant (p = 0.01). A trend towards greater prevalence of thrombocytopenia in Hispanics was observed, but this was not significant (p = 0.08). No other differences between the groups were observed. Overall median survival after diagnosis was the highest among Hispanics (8.6 years) followed by blacks (6.2 years) and Caucasians (3.7). Adjusted hazard ratios however did not show significant differences in risk of death between the groups. The IPSS-R showed slightly better discrimination when compared to the IPSS in this cohort (Somers Dxy 0.39 vs. 0.35, respectively) but observed survival more was more closely approximated by IPSS than by IPSS-R. Our study highlights the possibility of ethnic differences in the presentation of MDS and raises questions regarding which prognostic system is more predictive in this population

Prescription pattern of alpha blockers in the treatment of benign prostatic hyperplasia in India: a paper based survey

Background: Benign prostatic hyperplasia (BPH) is the most common urological condition. The treatment of BPH depends on the severity of symptoms which aims to improve symptoms, lower the risk of progression and improve quality of life. The aim of this survey was to understand the prescription pattern of alpha blockers in the treatment of BPH among clinicians of India.Methods: A cross-sectional questionnaire-based survey was conducted between September to December 2018. Data regarding the management of BPH using α-blockers were filled by clinicians and collated for data analysis using appropriate statistical test.Results: Total of 1764 clinicians’ responses was collected and the result was analysed. According to the survey, 47.68% of clinicians felt that severity of the BPH symptoms is most common deciding factor for medical management of BPH. For the pharmacological management of BPH patients, around 58% of clinicians opted for α blockers monotherapy as a preferred option. Among α blockers, 65.14% of clinicians preferred tamsulosin as first line therapy for management of BPH patients. In this survey, 81.75% of clinicians believed that tamsulosin offers highest persistence rate among commonly prescribed α blockers. Looking at the switching to a second α-blocker, 75.45% of clinicians felt that tamsulosin shows the highest return rate following initiation of a second α-blocker. More than 90% of clinicians felt that favourable efficacy or tolerability of tamsulosin is due to its highest persistence and highest return rates.Conclusions: Tamsulosin is the most commonly preferred and prescribed α-blocker by Indian clinicians due to its favourable efficacy or tolerability

Development of sunlight-driven eutectic phase change material nanocomposite for applications in solar water heating

Organic phase change materials (PCMs) have been utilized as latent heat energy storage medium for effective thermal management. In this work, a PCM nanocomposite, consisting of a mixture of two organic PCMs (referred to as eutectic gel PCM) and minimal amount (0.5 wt%) of nanographite (NG) as a supporting material, was prepared. Differential scanning calorimeter was used to determine the melting temperature and latent heat of pristine PCM, paraffin (61.5 °C and 161.5 J/g), eutectic gel PCM (54 °C and 158 J/g) and eutectic gel PCM nanocomposite (53.5 °C and 155 J/g). The prepared PCM nanocomposites exhibited enhanced thermal conductivity and ultrafast thermal charging characteristics. The nanocomposites were employed for two different applications: (i) providing hot water using an indigenously fabricated solar water heating (SWH) system and (ii) solar rechargeable glove that can be rapidly warmed and used. Experimental results on SWH system show that the use of PCM nanocomposites helps to increase the charging rate of PCM while reducing the discharging rate of heat by PCM to water, thus enhancing the maximum utilization of solar energy and hence improving the efficiency of the SWH system. The experimental results on solar rechargeable glove revealed that the glove has the ability to retain the temperature up to 3 hours

Patient and provider‐level barriers to hepatitis C screening and linkage to care: A mixed‐methods evaluation

Achieving practice change can be challenging when guidelines shift from a selective risk‐based strategy to a broader population health strategy, as occurred for hepatitis C (HCV) screening (2012‐2013). We aimed to evaluate patient and provider barriers that contributed to suboptimal HCV screening and linkage‐to‐care rates after implementation of an intervention to improve HCV screening and linkage‐to‐care processes in a large, public integrated healthcare system following the guidelines change. As part of a mixed‐methods study, we collected data through patient surveys (n = 159), focus groups (n = 9) and structured observation of providers and staff (n = 9). We used these findings to then inform domains for the second phase, which consisted of semi‐structured interviews with patients across the screening‐treatment continuum (n = 24) and providers and staff at primary care and hepatology clinics (n = 21). We transcribed and thematically analysed interviews using an integrated inductive and deductive framework. We identified lack of clarity about treatment cost, treatment complications and likelihood of cure as ongoing patient‐level barriers to screening and linkage to care. Provider‐level barriers included scepticism about establishing HCV screening as a quality metric given competing clinical priorities, particularly for patients with multiple comorbidities. However, most felt positively about adding HCV as a quality metric to enhance HCV screening and linkage to care. Provider engagement yielded suggestions for process improvements that resulted in increased stakeholder buy‐in and real‐time enhancements to the HCV screening process intervention. Systematic data collection at baseline and during practice change implementation may facilitate adoption and adaptation to improve HCV screening guideline implementation. Findings identified several key opportunities and lessons to enhance the impact of practice change interventions to improve HCV screening and treatment delivery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155892/1/jvh13278.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155892/2/jvh13278_am.pd