Correlation of wrist circumference with waist circumference and body mass index in adults with early-onset type 2 diabetes mellitus

Background: Recent studies have shown that wrist circumference is correlated with insulin resistance, obesity and new onset diabetes. Being easy to measure, it may be useful in identifying individuals at risk for cardio- metabolic disorders.Methods: 112 consecutive subjects with new onset type 2 diabetes in the age group 18-44 years were included in the study. Socio demographic characteristics, anthropometric and biochemical measurements were carried out using standard techniques. Pearson product movement Correlation Coefficient was used to find out correlation with other measures of obesity and ROC curve to determine its cut off values.Results: Wrist circumference showed moderate positive correlation with BMI (r+0.389) and waist circumference (r+0.443). The cut off value of wrist circumference when compared with BMI in defining obesity was 16.5cm in male and 15.7 cm in female. The cut off value of wrist circumference with waist circumference in male was 16.2cm.Conclusions: Measurement of wrist circumference may supplement in assessing obesity especially when other measures of obesity like BMI or Waist circumference measurements are difficult or not feasible

SYNTHESIS AND BIOLOGICAL EVALUATION OF 2-(2'/3'/4'/6'-SUBSTITUTED PHENYL)-1H-INDOLES

Objective: Indole derivatives were reported to a wide range of biological activities. Thus it was our aim to synthesize a series of 2-(2'/3'/4'/6'-substituted phenyl) -1H-indoles using clayzic catalyst and screen for their in vitro anti-inflammatory, antioxidant and antimicrobial activities.Methods: Various substituted acetophenones were reacted with phenylhydrazine in the presence of modified clayzic catalyst and obtained 2-(2'/3'/4'/6'-substituted phenyl)-1H-indoles in a one pot reaction. The cyclized compounds were characterized by FT-IR, NMR, UV-Vis and mass spectral analyses and screened for anti-inflammatory activity against cytokines tumor necrosis factor (TNF-α) and interleukin-6 (IL-6) by measuring cytokine production by performing sandwich ELISA model, antioxidant activity by DPPH assay method and antimicrobial activity by well-diffusion method.Results: An eco-friendly route with better yields for the synthesis of 2-(2'/3'/4'/6'-substituted phenyl)-1H-indoles in the presence of clayzic catalyst was achieved. The biological activity results suggested that compounds (2d, 2e and 2i) have excellent anti-inflammatory activity, compounds (2a-2d and 2j) possessing better antioxidant property and compounds (2b, 2i, 2k and 2m) have promising antibacterial and antifungal activities when compared to the standard drugs.Conclusion: Synthesis of 2-(2'/3'/4'/6'-substituted phenyl)-1H-indoles was successfully achieved in the presence of clayzic catalyst. Compounds bearing amino, methyl, methoxy, hydroxyl and fluoro groups have shown better anti-inflammatory, antioxidant and antimicrobial activities when compared to the other compounds and 1H-indole.Â

A STUDY ON EFFECT OF INDOLE AS A SUBSTITUENT ON A KETO-ENOL TAUTOMER: A SYNTHETIC APPROACH ON β-DIKETONE

Objective: The existence of keto-enol tautomerism in β-diketones can typically study by a choice of analytical technique. The position of the keto-enol equilibrium depends on a number of factors like solvent, temperature, and substituents. Here an attempt was made to examine the effect of indole, a heterocyclic moiety with the moderately high polar surface area to examine its effect on ketonisation of β-diketone.Methods: The β-diketone studied and synthesized is a structural analog of magical drug curcumin. The structural influence of indole on ketonisation of β-diketone is studied to give a hypothesis on factors contributing towards ketonisation. This work involves the synthesis of 6-(1H-Indol-3-yl)-hex-5ene-2, 4-dione and the study on the single crystal structure of indole-3-carboxaldehyde, major functional component to result in the reaction. The tautomer was studied for its ability to bind with tetrahydrofolate reductase enzyme using Discovery Studio 3.5 version to differentiate the pharmacological significance of conformations.Results: The single crystal XRD structure of this compound was deposited in Cambridge crystallographic data center bearing CCDC No.1536311. The structural characterization of synthesized ligand was carried out by using IR, Mass, 1H NMR spectroscopic techniques. The docking study reveals that keto isomer found to exhibit more inhibition of the enzyme tetrahydrofolate reductase hence more pharmacologically active.Conclusion: The experimental evidence proves that indole substitution shifted the keto-enol equilibrium towards keto form of 6-(1H-Indol-3-yl)-hex-5ene-2, 4-dione

Delayed Replantation of Avulsed Incisor with Prolonged Extraoral Dry Storage

Trauma to the anterior teeth mainly affects children and adolescents. Tooth avulsion has become a common dental injury, that can occur at any age with maxillary anteriors being commonly affected. It affects the esthetics and psychological well being of both the child and the parent. Management of tooth avulsion in the permanent dentition often presents a challenge to the dental professional. Definitive treatment planning and consultation with specialists is seldom possible at the time of emergency treatment. Replantation of the avulsed tooth is an immediate procedure, which can restore the esthetics, function and create positive impact on patient if carried out under ideal conditions. This article describes the management of a patient with an avulsed maxillary permanent central incisor, that had been stored in unfavorable conditions for about 48 hours. Adequate space maintenance, esthetics and functional requirements of the patient were totally met till a long-term treatment is planned, when the patient finishes his pubertal growth.&nbsp

The effect of preventive measures to reduce the decision to delivery interval in women undergoing emergency caesarean section

Background: Time interval between the decision to perform an emergency caesarean (ES) section and the actual delivery is known as decision delivery interval (DDI). A third phase delay in the delivery of emergency obstetric care is caused by prolonged DDI. In an effort to reduce maternal morbidity and neonatal morbidity and mortality, it is essential to implement interventions designed to reduce DDI. Methods: This study was carried out to reduce DDI by setting benchmarks for all categories according to Royal College of Obstetricians and Gynaecologists (RCOG) guidelines 2010, in our setup. The study carried out in 2 phases; first phase was a pilot study comprising of 143 women who underwent ES section. The deviation in DDI with possible causes were noted. The benchmarks were set to 8%, 30% and 20% for categories 1, 2, and 3 respectively. Corrective actions were taken including both hospital and patient causes for delay and were discussed at each level. Second phase included total 460 women from January to December 2021 and evaluated for DDI. Results: Out of 460, 87 (18.91%) women had deviated from the set DDI. The percentages in individual categories 1, 2 and 3 were 17.22%, 30.50%, and 29.50%, respectively. The deviation percentage of DDI in category 2, was achieved as per benchmark set in a pilot study, however, it was not achieved for other categories. Conclusions: Since the result that was obtained didn’t reach the set deviation percentage, we have observed that achieved deviation cannot be further reduced as our clinical setup is a teaching institute

Clinically relevant investigation of flattening filter-free skin dose

As flattening filter-free (FFF) photon beams become readily available for treatment delivery in techniques such as SBRT, thorough investigation of skin dose from FFF photon beams is necessary under clinically relevant conditions. Using a parallel-plate PTW Markus chamber placed in a custom water-equivalent phantom, surface-dose measurements were taken at 2 × 2, 3 × 3, 4 × 4, 6 × 6, 8 × 8, 10 × 10, 20 × 20, and 30 × 30 cm2 field sizes, at 80, 90, and 100 cm source-to-surface distances (SSDs), and with fields defined by jaws and multileaf collimator (MLC) using multiple beam energies (6X, 6XFFF, 10X, and 10XFFF). The same set of measurements was repeated with the chamber at a reference depth of 10 cm. Each surface measurement was normalized by its corresponding reference depth measurement for analysis. The FFF surface doses at 100 cm SSD were higher than flattened surface doses by 45% at 2 × 2 cm2 to 13% at 20 × 20 cm2 for 6 MV energy. These surface dose differences varied to a greater degree as energy increased, ranging from +63% at 2 × 2 cm2 to -2% at 20 × 20 cm2 for 10 MV. At small field sizes, higher energy increased FFF surface dose relative to flattened surface dose; while at larger field sizes, relative FFF surface dose was higher for lower energies. At both energies investigated, decreasing SSD caused a decrease in the ratios of FFF-to-flattened surface dose. Variability with SSD of FFF-to flattened surface dose differences increased with field size and ranged from 0% to 6%. The field size at which FFF and flattened beams gave the same skin dose increased with decreasing beam energy. Surface dose was higher with MLC fields compared to jaw fields under most conditions, with the difference reaching its maximum at a field size between 4 × 4 cm2 and 6 × 6 cm2 for a given energy and SSD. This study conveyed the magnitude of surface dose in a clinically meaningful manner by reporting results normalized to 10 cm depth dose instead of depth of dose maximum

Knowledge, attitude and practice toward adverse drug reaction reporting among practicing clinicians at a tertiary care hospital

Background: Pharmacovigilance has evolved as an important tool for dealing with Adverse Drug Reactions (ADRs) both in pre-marketing and post-marketing scenario. Underreporting of ADRs at our Adverse drug reaction Monitoring Centre (AMC) led us to conduct this study to assess Knowledge, Attitude and Practice (KAP) of the practicing clinicians at our tertiary care Pt. J.N.M. Medical College associated Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh, India, towards ADRs reporting.Methods: This was a cross-sectional study using pretested questionnaires consisting of 29 questions related to KAP of the practicing clinicians at Pt. J.N.M. Medical College associated Dr. B.R.A.M.  Hospital, Raipur towards ADRs reporting. The percentage of responders for each question was calculated. All statistical analysis was performed in Microsoft Office Excel 2007.Results: Out of 135 questionnaires distributed only 100 were considered for analysis, so the overall response rate was 74.07%. We calculated the result from the 100 responders. Overall 77% responders were aware of existence of ADR monitoring system in India, while only 40% were aware of its existence at their hospital. Only 8% responders had reported ADRs to the National Pharmacovigilance Centre and 10% to the Adverse drug reaction Monitoring Centre (AMC) at their hospital. Lack of knowledge about where, how and whom to report ADRs, lack of time, inability to decide what to report (known or unknown ADRs) and unavailability of ADR reporting form were the important factors discouraging them reporting ADRs.Conclusions: Creating awareness regarding ADR reporting through CMEs among practicing clinicians and early sensitization at medical undergraduate level for medical students may improve the current ADR reporting rate. 

Functional Impairment and Quality of Life of patients with Major Depressive Disorder in Euthymia

Background: Symptomatic remission has long been the goal of treatment in Major Depressive Disorder. Remission from depression is accompanied by improvements in functioning. Residual symptoms in remission affect their ability to function at work, home, social settings and worsen their quality of life. Objectives: To assess the level of Functional Impairment and Quality of Life of Major Depressive disorder patients in the euthymic state, determine the association between degree of functional impairment with socio demographic variables and clinical parameters and to compare the functional impairment and quality of life at initial assessment and follow up assessment at three and six months. Patients and methods: Cross sectional study of one year duration was done in outpatient setting comprising of subjects on treatment for Major Depressive disorder in euthymia (Hamilton depression rating scale score<7). Sociodemographic, clinical data were obtained, functional impairment was measured using Indian Disability Evaluation Assessment Scale and quality of life assessed with WHO-QOL- BREF questionnaire at initial, three and six month follow up. Statistical analysis was done. Results: 221 subjects were followed up and 19 relapsed and 10 were lost to follow up. Mean IDEAS score was 4.69 and SD 1.67, work and interpersonal activities domain was most affected and mean QOL was 56.67 and SD 4.913 at initial assessment. Age, education and marital status of subjects had significant association with IDEAS score. Duration of illness, number of episodes had a positive correlation and QOL scores had negative correlation with IDEAS score. IDEAS score reduced by an average of 0.401 and QOL scores increased by an average of 4.224 at six months. Conclusion: Measures of functional impairment provide insight into the total impact of Major Depressive Disorder. Symptomatic remission does not necessarily imply functional recovery. Complete clinical and functional recovery should be the aim of treatment

Study the antimicrobial agents sensitivity of methicillin resistant Staphylococcus aureus isolated from patients admitted in RIMS, Ranchi

Background: Methicillin-resistant&nbsp;Staphylococcus aureus&nbsp;(MRSA) is a major cause of hospital-acquired infections that are becoming increasingly difficult to combat because of emerging resistance to all current antibiotic classes. For this, study of MRSA isolated from admitted patients were carried out. These strains were separately tested for their sensitivity to different antibiotics to know which group of antibiotics are most effective particularly for cases of RIMS, Ranchi. Material &amp; Methods: The present study was carried out in the Department of Microbiology, Rajendra Institute of Medical Sciences (RIMS), Ranchi clinical isolates of MRSA strains were obtained from admitted patients of RIMS, Ranchi. The sources of isolate included pus from infected surgical wounds, infected burn wounds, conjunctival swab, aural swab, throat swab, vaginal swab, urine etc for microbiological analysis and antimicrobial sensitivity of MRSA. Disc diffusion method was employed. Results: All the 264 cases of staphylococcal species isolated from different clinical specimens were subjected to coagulase test. It was observed that out of 264 strains of staphylococci isolated from different sites 165 strains (62.5%) were coagulase positive and 99 strains (37.5%) were coagulase negative by tube method. It was observed that out of 165 strains of staph. aureus isolated from different clinical samples 64 strains of staph. aureus were resistant to methicillin (38.78%). Maximum isolation of MRSA were from pus 38 (51.35%), followed by throat swab 19 (36.36%), aural swab (14.28%) and conjunctival swab (44.44%). It was observed that out of 165 strains of s. aureus isolated only 64 strains were resistant to methicillin. All strains of MRSA were 100% sensitive to Vancomycin &amp; linezolid. Similarly 92.3% were sensitive to netilmicin, 89.7% to clindamycin, 82.1% to ciprofloxacin, 74.4% to cephotaxime, 69.2% to azithromycin, 56.4% to roxithromycin &amp; clarithromycin, 17.9% to piperacillin/tazobactam. The most effective antibiotic against MRSA was vancomycin, linezolid, netilmicin &amp; clindamycin. Conclusion: After comparing the effectiveness of antibiotics against MRSA infection it can be concluded that piperacillin/tazobactam, clarithromycin, roxithromycin azithromycin, cefotaxime &amp; ciprofloxacin are of little value in treating the MRSA infection. They should not be used indiscriminately and in a haphazard manner otherwise increment in emergence of resistant strains may not be checked