Correlation of Vitamin D and Body Mass Index with Modic Changes in Patients with Non-Specific Low Back Pain in a Sub-Tropical Asian Population

Study DesignCross-sectional study by non-probability consecutive sampling.PurposeThe objective of this study was to assess body mass index (BMI) and investigate vitamin D levels in patients with low back pain (LBP) and study a possible relationship with myopathy-related symptoms and Modic changes.Overview of LiteratureLBP is a multifactorial problem and the search for its patho-anatomical causes is ongoing. Modic changes seem to be a cause of back pain but the pathological mechanisms underlying this are not completely defined. Hypovitaminosis D and obesity have also been shown to cause chronic musculoskeletal pain. The relationship between vitamin D deficiency and BMI with Modic changes has not been studied in detail.MethodsThree hundred and sixteen patients with chronic LBP was selected for the study by non-probability consecutive sampling. The study was conducted over a period of 12 months from January 2014 to December 2014 at St. John's Medical College, Banglore. Questionnaires were provided to the participants and demographic information, symptoms, weight and height were recorded from the study subjects. BMI was calculated. Serum vitamin D level was assessed and Modic changes studied on magnetic resonance imaging. Correlations between vitamin D, BMI and Modic changes were studied using correlation coefficients and odds ratios obtained from logistic regression.ResultsTwo hundred and fifty-six out of 316 patients (80%) had low vitamin D. 83% of patients with BMI>25 kg/m2 had low vitamin D levels as compared to 69% with BMI<25 kg/m2. Statistically significant correlation coefficients were found between vitamin D levels, BMI and Modic changes. Significant association was found between low vitamin D levels and Modic changes (odds ratio 1.75).ConclusionsVitamin D deficiency and obesity have significant relations with LBP. Low vitamin D levels is associated with Modic changes but whether they represent a subgroup of patients whose low backpain is associated with low vitamin D needs to be further evaluated

Transient vortex dynamics and evolution of Bose metal from a 2D superconductor on MoS2_2

The true character of physical phenomena is thought to be reinforced as the system becomes disorder-free. In contrast, the two-dimensional (2D) superconductor is predicted to turn fragile and resistive away from the limit I -> 0, B -> 0, in the pinning-free regime. It is intriguing to note that the very vortices responsible for achieving superconductivity by pairing, condensation, and, thereby reducing the classical dissipation, render the state resistive driven by quantum fluctuations in the T -> 0. While cleaner systems are being explored for technological improvements, the 2D superconductor turning resistive when influenced by weak electric and magnetic fields has profound consequences for quantum technologies. A metallic ground state in 2D is beyond the consensus of both Bosonic and Fermionic systems, and its origin and nature warrant a comprehensive theoretical understanding supplemented by in-depth experiments. A real-time observation of the influence of vortex dynamics on transport properties so far has been elusive. We explore the nature and fate of a low-viscous, clean, 2D superconducting state formed on an ionic-liquid gated few-layered MoS$_2$ sample. The vortex-core being dissipative, the elastic depinning, intervortex interaction, and the subsequent dynamics of the vortex-lattice cause the system to behave like an overdamped harmonic oscillator, leaving transient signatures in the transport characteristics. The temperature and magnetic field dependence of the transient nature and the noise characteristics of the magnetoresistance confirm that quantum fluctuations are solely responsible for the Bose metal state and the fragility of the superconducting state

Azilsartan: the novel ARB with unique mechanism of action

Hypertension is attributed to be one of the major risk factors in the pathophysiology of ischemic heart disease, stroke, heart failure and renal dysfunction. Angiotensin receptor blockers (ARBs) are one of the first line drugs recommended for clinical use in hypertension by JNC 8. Azilsartan is the recent addition to this family of ARBs and is perceived as one of the potent antihypertensive drugs today. Azilsartan was developed by replacing the tetrazole ring in candesartan with a 5 member oxo-oxadiazole ring. In India Azisartan was recently approved by DCGI in December 2016 for use in hypertension. In various randomized, double blind clinical studies Azilsartan was found to be to be superior in terms of clinical efficacy over other ARBs like Candesartan, Olmesartan and Valsartan and angiotensin converting enzyme inhibitor like Ramipril. In terms of safety profile Azilsartan appears to be equivalent to the currently available ARBs. Azilsartan due to its superior efficacy and comparative safety profile appear to be a new addition to the armamentarium in the treatment of hypertension.

LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS: LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION: LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures