A case of new-onset vitiligo in a patient on tofacitinib and brief review of paradoxical presentations with other novel targeted therapies

With recent advancements in the understanding of vitiligo pathogenesis, Janus kinase (JAK) inhibitors have emerged as a promising new treatment modality, but their effects remain incompletely elucidated. Tofacitinib, an oral JAK 1/3 inhibitor approved for the treatment of rheumatoid arthritis, has previously been shown to induce significant re-pigmentation in vitiligo. However, as with other novel targeted therapies, cutaneous adverse effects have been observed. We report a 36-year-old woman with a history of rheumatoid arthritis, refractory to multiple pharmacotherapies, who was initiated on tofacitinib and subsequently developed progressive depigmented patches consistent with new-onset vitiligo. Although definitive causation cannot be established in this case without additional studies, it is important to note that many targeted therapies have the potential to induce paradoxical effects, that is, the occurrence or exacerbation of pathologic conditions that have been shown to respond to these medications. Paradoxical findings with other targeted therapies include the occurrence of melanoma during treatment with BRAF inhibitors, keratoacanthomas with PD-1 inhibitors, vitiligo and psoriasis with TNF-alpha inhibitors, and hidradenitis suppurativa with various biologic agents. Although JAK inhibitors hold therapeutic promise in the treatment of inflammatory skin disorders, further research is warranted to more fully comprehend their effects

A case study of corporate social responsibility in nashik MIDC

771/5" paper analyses Che awareness of corporate social responsibility in Nashik MIDC. It also helps to identify the awareness and effectiveness of existing environmental protection programs like Carbon emissions and treading among these companies.The study analyses the corporate responsibility with respect to Customers, Employees, Government, Environment and Society. The study involves opinions of corporate about, problems to implement corporate social responsibility. The study also involves case lets of major corporate in India like J K Tyre's, Infosys, Siemens, Tata group, Godrej Group, Mahindra And Mahindra and many more that are already implementing such programs. The result of the study indicates that in Nashik MIDC, there are few companies that are doing programs periodically. However, there are few companies, which feel that they cannot do these activities individually but there can be collective efforts. The study concludes that in addition to government agencies some management institutes should also take initiatives collectively to motivate and run such programs with these companies. It is found that Nashik Industrial Manufacturing Association (NIMA) are taking lead and arranging social programs for society.Though big Indian companies have started practicing corporate citizenship, the degree to which it is belong done is inadequate. Growing awareness among the academic institutions towards CSR as a subject, to sensitize the future managers of this nation to the societal needs besides generating profits for their organizations with increased efficiency will need a greater deal from the managers to do the balancing act. Keywords

Uterine inversion - an obstetrician’s nightmare: a series of 3 cases of uterine inversion and a review of management options

Acute puerperal uterine inversion is an extremely rare but potentially life-threatening complication in which the uterine fundus collapses within the endometrial cavity and beyond. Although the causes of uterine inversion are unclear, several predisposing factors have been described. Maternal mortality is extremely high unless the condition is recognized and corrected. We present here a series of three cases of uterine inversion managed in our hospital over a period of 3 years. Our first case, Mrs XYZ referred to our hospital after vaginal delivery followed by postpartum collapse. The patient was in hypovolemic shock with 2nd degree uterine inversion. Second case, Mrs ABC referred to our hospital after vaginal delivery and mass coming out of the vagina. The patient had postpartum haemorrhage with 2nd degree uterine inversion. Our third case, Mrs DEF, c/o full term vaginal delivery at our hospital with 2nd degree uterine inversion with postpartum haemorrhage. In all three cases, the patients were explored in the OT under general anaesthesia and uterine reposition was done vaginally. Two of the patients required mechanical ventilation post operatively and all the patients required blood and blood product transfusion. The clinical management, treatment options and surgical nuances of management of uterine inversion are discussed

Mucinous cystadenoma of ovary: are mammoths really extinct?

The most common ovarian tumours are epithelial tumours. 80% of all tumours are benign, 10% borderline and 10% are malignant. Mucinous tumours represent 8-10% of the epithelial tumours; they may reach enormous size filling the entire abdominal cavity. We report here a case of a huge benign mucinous cystadenoma in a 57-year-old female. Ultrasound and MRI scan showed a large left ovarian cyst. CA-125 was 132 IU/ml. She underwent total abdominal hysterectomy and bilateral salpingo-opherectomy with appendicectomy and infracolic omentectomy. Her post-operative course was unremarkable

25-Hydroxy vitamin-D, obesity, and associated variables as predictors of breast cancer risk and tamoxifen benefit in NSABP-P1.

Observational studies suggest that host factors are associated with breast cancer risk. The influence of obesity, vitamin-D status, insulin resistance, inflammation, and elevated adipocytokines in women at high risk of breast cancer is unknown. The NSABP-P1 trial population was used for a nested case-control study. Cases were drawn from those who developed invasive breast cancer and controls selected from unaffected participants (≤4 per case) matched for age, race, 5 year Gail score, and geographic location of clinical center as a surrogate for latitude. Fasting serum banked at trial enrolment was assayed for 25-hydroxy vitamin-D (25OHD), insulin, leptin (adipocytokine), and C-reactive protein (CRP, marker of inflammation). Logistic regression was used to test for associations between study variables and the risk of invasive breast cancer. Two hundred and thirty-one cases were matched with 856 controls. Mean age was 54, and 49% were premenopausal. There were negative correlations for 25OHD with body mass index (BMI), insulin, CRP, and leptin. BMI ≥ 25 kg/m(2) was associated with higher breast cancer risk (odds ratio [OR] 1.45, p = 0.02) and tamoxifen treatment was associated with lower risk (OR = 0.44, p < 0.001). Suboptimal 25OHD (<72 nmol/l) did not influence breast cancer risk (OR = 1.06, p = 0.76). When evaluated as continuous variables, 25OHD, insulin, CRP, and leptin levels were not associated with breast cancer risk (all p > 0.34). In this high risk population, higher BMI was associated with a greater breast cancer risk. Serum levels of 25OHD, insulin, CRP, and leptin were not independent predictors of either breast cancer risk or tamoxifen benefit

Health awareness in female doctors

Background: Managing the hectic schedule, female doctors often neglect their own health. In the present study, we evaluated the awareness, attitude and practices of breast, cervical and ovarian malignancies and also hypertension, diabetes, coronary artery disease and osteoporosis in female doctors.Methods: A cross sectional study was conducted among 100 female doctors of M.B.B.S. and higher degrees of various subjects. Selection of female doctors was done randomly.Results: In present study, out of 100 female doctors, 90 (90%) were doing their self breast examination regularly and 31 (31%) had done their mammography. 54 (54%) female doctors had their own pap smear done while 72 (72%) female doctors had their own ultrasound got done. 82 (82%) had their own blood pressure check up, 74 (74%) had their own blood sugar checked, 62 (62%) had got their own lipid profile done while only 44 (44%) female doctors had their ECG done and 48 (48%) had their bone mineral density done. 23 (23%) female doctors were diagnosed as hypertensive, 14 (14%) as diabetes, 4 (4%) as coronary artery disease, 5 (5%) as breast cancer, 2 (2%) as ovarian cancer, 18 (18%) as thyroid disease while 15 (15%) were detected as having osteopenia.Conclusions: In spite of knowing about all diseases, their complications, screening methods and preventive care, practice of applying screening or preventive methods to themselves is not universal in doctors

Evaluation of efficacy of injection ferric carboxymaltose in pregnant women

Background: Iron deficiency anaemia (IDA) continues to be a very common problem in developing countries leading to a spectrum of adverse events in pregnant women. The objective of this study was to determine the efficacy, side effects and tolerance of ferric carboxymaltose as compared to available iron preparations for the prophylaxis and treatment of mild to moderate iron deficiency anaemia during pregnancy.Methods: One-year clinical study (from June 2017 to May 2018). A total 100 patients were enrolled after matching inclusion and exclusion criteria. The efficacy assessment was performed during 4, 8, and 12 weeks of starting therapy. If the patient is not responding to therapy in either arm as documented by no rise or fall in haemoglobin levels patients may be removed from study for other therapy. Treatment duration up to 12 weeks. Safety and efficacy follow-up visit at 4, 8 and 12 weeks. Institutional ethics committee permission was taken.Results: On intra-group comparisons there was significant increase in haemoglobin levels at 8 and 12 weeks in oral iron group as compared to day 1 haemoglobin levels while there was significant increase in haemoglobin levels at 4, 8 and 12 weeks in IV iron group as compared to day 1 haemoglobin levels. On intergroup comparisons between oral and IV iron group, there was significant increase in haemoglobin levels at 4, 8 and 12 weeks in IV iron group as compared oral iron group haemoglobin levels.Conclusions: Intravenous iron therapy with ferric carboxymaltose causes significant improvement in haemoglobin more quickly and more effective in correcting iron deficiency anaemia in pregnancy compared to oral treatment in terms of increase in haemoglobin levels at 4, 8 and 12 weeks. Intravenous ferric carboxymaltose is safe and effective option for pregnant women with iron deficiency anaemia

Menstrual hygiene practices in young girls of urban India

Background: Menstrual hygiene is an important aspect in the life of young girls.The present study aims at assessing the knowledge regarding menstruation and hygienic practices and perceptions during menstruation.Methods: It was a cross sectional study, conducted among 100 young girls of 20-22 years age to assess the awareness of menstrual hygiene. Data was collected by pre-tested questionnaire. Statistics was calculated in percentages.Results: Out of 100 girls, 71 (71%) knew about menstruation before menarche while 29 (29%) did not have any knowledge. 71 (71%) girls knew the cause of menstruation as physiological, 18 (18%) girls didn’t know the cause, 11 (11%) girls still believe it as curse of God. 68 (68%) girls knew the source of bleeding during menstruation as uterus, 20 (20%) girls thought it as vagina while 12 (12%) thought it as urethra. 64% girls use sanitary pads during menstruation, 19% girls used old cloth while 17% girls used new cloth during menstruation as adsorbent material. 9% girls dispose pads or used cloth in dustbin, 19% girls flush them in toilet while 12% girls throw them roadside. 96% girls avoid going to temple, 68% girls restrict their daily activities, 56% girls avoid going to functions, 50% girls avoid going to kitchen, 50% girls avoid going to kitchen while 45% girls avoid touching things at home.Conclusions: It is very important that young girls should be educated about the importance of maintaining hygiene during menstruation to prevent the risk of reproductive tract infections

ANTIBACTERIAL CAPACITY AND IDENTIFICATION OF BIOACTIVE COMPOUNDS BY GCMS OF ALLIUM CEPA

Objective: Plants offer a novel source for the isolation of a wide variety of medicinal agents. Allium cepa commonly known as onion is very well known medicinal plants and we investigated the antibacterial activity of different extracts and their phytochemical analysis by gas chromatography mass spectrometry (GCMS).Methods: The extracts of A. cepa prepared in six different solvents was analyzed for antibacterial activity against nine American type cell culture (ATCC) reference bacterial strains i.e. Shigella flexneri, Enterococcus faecalis, Staphylococus aureus, Proteus mirabilis, Salmonella typhi, Serratia marcescens, Klebsiella pneumonia, Escherichia coli, Pseudomonas aeruginosa by using the agar well diffusion method. GCMS analysis also has been carried out for their phytochemical analysis.Results: The results obtained from agar well diffusion assay showed the zone of inhibition range from 10±0.76 to 26±0.76 mm for different extracts. The methanol extract was found most potent against K. pneumonia and S. marcescens with the zone of inhibition of 26±0.76 mm for both strains. Minimum inhibitory concentration (MIC) values were in the range of 1.87 to 7.5 mg/ml and the MIC values for K. pneumonia and S. marcescens was 1.87 mg/ml. A total of 43 compounds were identified by GCMS analysis. Out of them dodecanoic acid was found common in all extracts.Conclusion: It is concluded that Allium cepa have good antibacterial activity so it can be used for the treatment of various infectious diseases