A comparative study of tranexamic acid and ethamsylate in menorrhagia

Background: Menorrhagia interferes with the woman’s physical, social, emotional, and/or material quality of life. Antifibrinolytic drugs are effective in decreasing excessive menstrual bleeding. The objective of this study was to compare the effects of tranexamic acid and ethamsylate on quality of life in women with menorrhagia.Methods: The 50 women with menorrhagia were randomised to receive either tranexamic acid or ethamsylate. Twenty five patients were allocated to receive tranexamic acid 500 mg six hourly, and 25 patients to receive ethamsylate 500 mg six hourly. Among the parameters measured by the MIQ were impairment in social activities, work performance, physical activities, productivity, hygienic condition, psychological condition. Health-related quality-of-life question scores (MIQ scores) at baseline and after treatment were calculated as mean for tranexamic acid group and ethamsylate group.Results: Tranexamic acid and ethamsylate treatment groups showed mean improvement in MIQ scores compared to baseline. However, the total mean score was higher in tranexamic acid group compared to ethamsylate group after three treatment cycles (21 Vs 17).Conclusions: Use of tranexamic acid and ethamsylate improved health-related quality of life in patients with menorrhagia. Tranexamic acid showed better improvement in health-related quality of life compared to ethamsylate in patients with menorrhagia

A comparative study of different anatomical position, clinical presentation and USG findings with operative findings in patients of appendicitis

Background: The objective was to find out and compare accuracy of USG findings with that of per-operative findings of location & status of appendix, to compare , evaluate & study the signs and symptoms in different varieties of appendicitis, to compare & study pre, per & post op follow up of patients with such different location of appendix undergoing appendicectomy and to study the type of appendicitis responsible for inflammation/infection by histopathological examination of different locations of appendix.Methods: The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet and Informed Consent Form. The present study was carried out in surgery department of C.U. Shah medical college, Surendranagar; Gujarat state. The study was carried out from 1st October 2010 till 31st September 2012. A total of 100 cases were subjected to clinical assessment using signs, symptoms and laboratory criteria, histopathology and also the position of the appendix, which were recorded in the proforma. All patients were subjected to ultrasound examination by a qualified radiologist to exclude any other associated pathology and also to confirm the diagnosis. At surgery the Position of the appendix was first identified before disturbing the structures and the position of the appendix. After completion of the appendectomy the specimen was subjected to histopathological examination by the qualified pathologist only those cases, which were proved as, appendicitis by the histopathology were included in the study.Results: Out of 100 cases, a total of 62 cases presented with clinical features suggestive of retrocaecal appendicitis, out of which 51 had typical presentation & 11 had atypical presentation with overall sensitivity of 72.9%, followed by pelvic position which had a sensitivity of 15.29% in which 8 patients had typical presentation & 5 had atypical presentation. All modalities (clinical presentation + lab investigations + USG + intra operative + histopathology) patients were 47; with clinical presentation + lab investigations + USG + intra operative patients were 51; with clinical presentation + lab investigations + USG patients were 57; with clinical presentation + lab investigations patients were 69 and with only clinical presentation patients were 85.Conclusions: A total of five modalities that were used for the diagnosis of position of appendix & appendicitis, i.e. clinical features, lab Ix, ultrasound, intraoperative findings & histopathology, only 47% of cases all the modalities were positive. So the diagnosis of position of appendix & appendicitis is a combination of all the modalities and not just dependent on one basis

Diabetic foot resulting in amputation: our experience

Background: The aim of our study was to early diagnosis of diabetic foot so that the complications can be prevented, to control the systemic infection and prevent the complications, to study the effectiveness of regular dressing in diabetic foot so as to prevent the local spread of infection and the ulcer and to conclude that early diagnosis, care and proper meticulous treatment of diabetic foot can prevent amputation. Methods: The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet, Informed Consent Form and approval from Ethical Committee. The present study was carried out in surgery department of C.U Shah medical college, Surendranagar; Gujarat state. The study was carried out from 1st August 2011 to 30th September 2013. A total of one hundred patients admitted in surgery ward with diabetes type 1 or 2 with ulcer on foot having grade 1 or 2 of Wagner’s classification without any other co morbid condition. These patients undergo daily dressing with various dressing solutions according to their ulcer characteristics. All the patients given diet/oral hypoglycaemic drug/insulin for control of diabetes. Antibiotics given according to the infective status of the patients. Patients were either completely treated, went under skin grafting or ended up with amputation were recorded.Results: Of 100 cases studied, youngest patient was 32 years and oldest was 80 years of age. Highest number of cases was found in the age group 61-70 years (30%). Of the 100 cases studied in this series 36 (36%) patient were having Wagner’s class 1 ulcer and 64 (64%) patient having class 2 ulcers. Of 100 cases, various surgical treatment given to the patients according to the ulcer. In that 65(65%) debridement, 20 (20%) Incision & drainage, 10 (10%) STG, 5 (5%) fasciotomy. Most of the patients were undergone basic surgical procedure which is debridement on the 7th day follow up, out of 100 cases 70 patients came for follow up. Out of 70, all patients having healing ulcer. Out of 70 patients, 15(21.43%) patients were underwent STG on 15th day and other 55 (71.57%) patients having healing ulcer advised daily dressing with follow up after 1 week. Out of 30 patients, 3 (10%) patients underwent amputation on 7th day of follow up. On the 15th day new 5 (16.67%) patients underwent amputations, so total number of amputation done till date was 8 (26.67%). On 21st day, new 7 (23.34%) patients were underwent amputations and total number of amputations till date were 15 (50%). On 30th day, new 15 (50%) patients underwent amputations.Conclusions: Foot ulceration in diabetic patients is a resource consuming, disabling morbidity that often is the first step towards lower extremity amputation. Prevention is the best treatment.

Comparison of the efficacy and safety of norethisterone vs. combined oral contraceptive pills for the management of puberty menorrhagia

Background: The most common cause of puberty menorrhagia is immaturity of the hypothalamic pituitary ovarian axis. Treatment is directed towards stabilizing the endometrium and treating the hormonal alterations. The objective of this study was to compare the efficacy and safety of norethisterone and combined oral contraceptive (COC) pills for the management of puberty menorrhagia.Methods: A total of 60 young girls from age of menarche to 19 years with menorrhagia were randomized to receive either norethisterone or COC pills. The end points included change from baseline in health-related quality-of-life parameters, estimation of blood loss and effect on hemoglobin level. Health-related quality-of-life question scores at baseline and after treatment were calculated as mean for norethisterone group and COC pills group.Results: Norethisterone and COC pills treatment groups showed mean improvement in Menorrhagia Impact Questionnaire (MIQ) scores compared to baseline. However, the total mean score was higher in norethisterone group compared to COC pills group after three treatment cycles (21 Vs 17). The treatment failure was less in norethisterone group compared to COC pills group.Conclusions: Use of norethisterone was more effective and better tolerated compared to combined oral contraceptive pills for the management of puberty menorrhagia

A cross sectional study on the prevalence of reproductive tract infections amongst married women in the rural area of Surendranagar district

Background: In the recent years, the issue of gynaecological problems of poor women in the developing countries has been receiving increasing attention. High levels of gynaecological morbidity, especially reproductive tract infections and sexually transmitted infections may turn out to be fatal if not treated properly. Objectives of current study were to find out the prevalence of reproductive tract infections amongst married women, to co-relate the disease with certain socio demographic variables and to assess the awareness about reproductive tract infections in the study population. Methods: Sample size - Various community based studies carried out in the different regions world showed the prevalence of reproductive tract infections 36-84%. The sample size of study as per statistical calculation (4pq/l2, where p =50, q=100-p and l= 10% of p) came out to be 400. Method of Sampling - Prior enlisting all villages of Surendranagar district, one village was selected randomly. After random selection the village found was Khodu. Results: 56.5% of women reported either one or more symptoms of reproductive tract infections; vaginal discharge (29.7%) was the commonest symptom. Basic awareness about disease was 64.0%; Maximum prevalence of reproductive tract infections (62.90%) was found in the age group of 25-34 years.Conclusions: There is a significant association between socio-economic class, educational status and women having symptoms of reproductive tract infections.

Health seeking attitude of women regarding reproductive tract infections in a rural area of Surendranagar district

Background:In the recent years, the issue of gynaecological problems of poor women in the developing countries has been receiving increasing attention. High levels of gynaecological morbidity, especially reproductive tract infections and sexually transmitted infections may turn out to be fatal if not treated properly. The objective of this study was to assess the health seeking attitude of women regarding reproductive tract infections, to elicit the past history pertaining to it, to assess the personal hygiene measures relevant to it. Methods: Various community based studies carried out in the different regions world showed the prevalence of reproductive tract infections 36-84%. The sample size of study as per statistical calculation (4pq/l2, where p =50, q=100-p and l= 10% of p) came out to be 400. Prior enlisting all villages of Surendranagar district, one village was selected randomly. After random selection the village found was Khodu. Results: 75.3% of women narrated treatment was necessary; 44% told that preferably to be taken from doctor and 24.7% told treatment should not be taken because of social and personal reason. 56.5% of women having one or the other kind of symptom of reproductive tract infections. Women with poor menstrual and personal hygiene has got 2.5 times chances of reproductive tract infections (OR= 2.35, CI= 1.374-4.01, P value: 0.001). Thus the overall prevalence in our study is 56.5%. On statistical analysis it was found that women who used clothes were two times more symptomatic as compared to women who used sanitary pads, a significant association between women having symptoms of reproductive tract infections and their sexual history. The present study showed 61.94% of women had taken treatment which shows that the health seeking behavior had improved. Conclusions: Women who used sanitary pads during menstrual periods had lower prevalence. Women with complaints of dyspareunia, bleeding during and or after intercourse and history of forceful intercourse had maximum prevalence of reproductive tract infections. 19.8% of women gave past history of reproductive tract infections and out of that 15.16% of women had taken treatment for it. Regarding health seeking attitude of symptomatic women, 61.94% of women had taken treatment and majority of them had taken treatment from doctors. This implies that health intervention measures directed towards reducing morbidity from reproductive tract infections need not focus mainly on treatment of reproductive tract infections but rather on disease preventing strategies

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of nifedipine, methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension.Methods: A total of 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria between 20 and 38 weeks of gestation were randomly allocated to receive nifedipine (n=20), methyldopa (n=20) or labetalol (n=20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period.Results: Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 50 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with nifedipine was associated with reduction in SBP by 54 mmHg and DBP by 30 mmHg. Treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h.Conclusions: Labetalol was more effective than methyldopa and nifedipine in controlling blood pressure in patients with pregnancy-induced hypertension while methyldopa and nifedipine are equally effective in controlling blood pressure

Serum carbon and nitrogen stable isotopes as potential biomarkers of dietary intake and their relation with incident type 2 diabetes: the EPIC-Norfolk study.

BACKGROUND: Stable-isotope ratios of carbon (¹³C/¹²C, expressed as δ¹³C) and nitrogen (¹⁵N/¹⁴N, or δ¹⁵N) have been proposed as potential nutritional biomarkers to distinguish between meat, fish, and plant-based foods. OBJECTIVE: The objective was to investigate dietary correlates of δ¹³C and δ¹⁵N and examine the association of these biomarkers with incident type 2 diabetes in a prospective study. DESIGN: Serum δ¹³C and δ¹⁵N (‰) were measured by using isotope ratio mass spectrometry in a case-cohort study (n = 476 diabetes cases; n = 718 subcohort) nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk population-based cohort. We examined dietary (food-frequency questionnaire) correlates of δ¹³C and δ¹⁵N in the subcohort. HRs and 95% CIs were estimated by using Prentice-weighted Cox regression. RESULTS: Mean (±SD) δ¹³C and δ¹⁵N were -22.8 ± 0.4‰ and 10.2 ± 0.4‰, respectively, and δ¹³C (r = 0.22) and δ¹⁵N (r = 0.20) were positively correlated (P < 0.001) with fish protein intake. Animal protein was not correlated with δ¹³C but was significantly correlated with δ¹⁵N (dairy protein: r = 0.11; meat protein: r = 0.09; terrestrial animal protein: r = 0.12, P ≤ 0.013). δ¹³C was inversely associated with diabetes in adjusted analyses (HR per tertile: 0.74; 95% CI: 0.65, 0.83; P-trend < 0.001], whereas δ¹⁵N was positively associated (HR: 1.23; 95% CI: 1.09, 1.38; P-trend = 0.001). CONCLUSIONS: The isotope ratios δ¹³C and δ¹⁵N may both serve as potential biomarkers of fish protein intake, whereas only δ¹⁵N may reflect broader animal-source protein intake in a European population. The inverse association of δ¹³C but a positive association of δ¹⁵N with incident diabetes should be interpreted in the light of knowledge of dietary intake and may assist in identifying dietary components that are associated with health risks and benefits.The EPIC-Norfolk study is supported by program grants from the Medical Research Council UK and Cancer Research UK. MRC Epidemiology Unit core support is acknowledged (MC_UU_12015/1 and MC_UU_12015/5). TCO and CKK were supported by the Wellcome Trust (grant no. 074229/Z/04/Z).This version is the published accepted manuscript, distributed under a Creative Commons Attribution License 2.0. It can also be found on the publisher's website at: http://ajcn.nutrition.org/content/early/2014/07/02/ajcn.113.068577.abstrac

Identification of antibody neutralization epitopes on the fusion protein of human metapneumovirus

Human metapneumovirus (hMPV) is genetically related to respiratory syncytial virus (RSV); both cause respiratory tract illnesses ranging from a mild cough to bronchiolitis and pneumonia. The F protein-directed monoclonal antibody (mAb) palivizumab has been shown to prevent severe lower respiratory tract RSV infection in animals and humans. We have previously reported on a panel of mAbs against the hMPV F protein that neutralize hMPV in vitro and, in two cases, in vivo. Here we describe the generation of hMPV mAb-resistant mutants (MARMs) to these neutralizing antibodies. Sequencing the F proteins of the hMPV MARMs identified several neutralizing epitopes. Interestingly, some of the epitopes mapped on the hMPV F protein coincide with homologous regions mapped previously on the RSV F protein, including the site against which the broadly protective mAb palivizumab is directed. This suggests that these homologous regions play important, conserved functions in both viruses

A Semi-Physiologically Based Pharmacokinetic Model Describing the Altered Metabolism of Midazolam Due to Inflammation in Mice

This is the author's accepted manuscript.Purpose To investigate influence of inflammation on metabolism and pharmacokinetics (PK) of midazolam (MDZ) and construct a semi-physiologically based pharmacokinetic (PBPK) model to predict PK in mice with inflammatory disease. Methods Glucose-6-phosphate isomerase (GPI)-mediated inflammation was used as a preclinical model of arthritis in DBA/1 mice. CYP3A substrate MDZ was selected to study changes in metabolism and PK during the inflammation. The semi-PBPK model was constructed using mouse physiological parameters, liver microsome metabolism, and healthy animal PK data. In addition, serum cytokine, and liver-CYP (cytochrome P450 enzymes) mRNA levels were examined. Results The in vitro metabolite formation rate was suppressed in liver microsomes prepared from the GPI-treated mice as compared to the healthy mice. Further, clearance of MDZ was reduced during inflammation as compared to the healthy group. Finally, the semi-PBPK model was used to predict PK of MDZ after GPI-mediated inflammation. IL-6 and TNF-α levels were elevated and liver-cyp3a11 mRNA was reduced after GPI treatment. Conclusion The semi-PBPK model successfully predicted PK parameters of MDZ in the disease state. The model may be applied to predict PK of other drugs under disease conditions using healthy animal PK and liver microsomal data as inputs