A CASE OF HYPOTHYROIDISM INDUCED RECURRENT DEPRESSIVE DISORDER

Recurrent depressive disorder is a lifelong illness with relapses and remissions. The aetiology is biopsychosocial, genetic factors contributing and life stressors exaggerating the disease. Due to recurrent episodes the morbidity is quite high both for the patient and the family members. The poor compliance of drugs during the euthymic period acts as a trigger for relapse. The identification of comorbid physical conditions adding fuel to the disease process has to be identified and treated promptly. This case is reported to show the significance of undetected hypothyroidism in a patient with recurrent depressive disorder.Â

A SINGLE CASE REPORT ON HYPERAMMONEMIA INDUCED BY VALPROATE MONOTHERAPY WITHOUT HEPATIC DYSFUNCTION

Valproate is a commonly used mood stabilizer. One of the important and rare side effects of valproate is hyperammonemia leading to delirium and hepatic encephalopathy. Valproate-induced delirium is commonly mistaken for worsening of manic symptoms or psychosis. We hereby report a case of bipolar affective disorder who was on a therapeutic dose of valproate monotherapy developed altered mental status where we found elevated levels of plasma ammonia which decreased after the discontinuation of valproate and with normal levels of serum valproate, LFT's, EEG and imagings. This case report emphasises on the need to consider plasma ammonia levels in patients with altered mental status receiving valproate in addition to other investigations

A cross sectional study of prevalence of depression among patients with cerebrovascular accident

Background: Depression is one of the most common neuropsychiatric condition in patients with stroke. Early identification of depression for stroke patients can improve the outcome leading to better quality of life. Prevalence and determinants of post stroke depression are highly variable and there is paucity of data in Indian literature.Methods: This cross-sectional study was conducted at neurology department of Saveetha Medical College, Chennai. All patients with history of stroke within past one month attending neurology department who fulfilled the inclusion criteria were taken up for the study after getting consent. Neurological examination and CT brain findings were noted with the site of lesion. All patients were evaluated for depression using ICD 10 criteria. MADRS score was used to assess the severity of depression. Chi square was used for statistical analysis.Results: The mean age of subjects in the study was 56.54±10.82 years. The prevalence of depression among patients with stroke in our study was 75.8%. Among classifying those with depression based on severity using MADRS score, 35% had mild depression and 65% had moderate depression. There was no severe depression in our sample. There was no statistically significant difference between prevalence of depression based on side of lesion.Conclusions: In this study the prevalence of depression among patients with cerebrovascular accident was found to be 75.8%. From this study we learn that the prevalence of depression in patients with stroke is high and this shows that regular screening of patients with stroke for depression might help in earlier detection and management of depression

A study on treatment of resistant mastitis in dairy cows

The study was undertaken to determine the prevalence and treatment of antibiotic resistant mastitis in dairy cows. The predominant resistant causative pathogen was Escherichia coli (50.64 %) followed by S. aureus (44.25 %) and Methicillin resistant Staphylococcal aureus (5.11%).These isolates were found sensitive to gentamicin, enrofloxcain, amoxicillin+sulbactam, ceftriaxone and resistant to amoxicillin, oxytetracycline, penicillin G and oxacillin. In all the treatment groups of E. coli, S. aureus and MRSA mastitis, the post treatment pH, SCC was significantly (P < 0.01) decreased when compared to pre treatment pH, SCC values and the post treatment electrical conductivity was significantly (P < 0.01) increased when compared to pre treatment electrical conductivity value. In E. coli mastitis, treated with amoxicillin+sulbactam, ceftriaxone, enrofloxacin and gentamicin showed 74.1%, 67.75 %, 76.67 % and 64.52 % clinical recovery and in S. aureus mastitis, showed 65.25 %, 65.25 %, 72.43 % and 68.98 % clinical recovery. In MRSA mastitis, enrofloxacin was found to be highly effective in comparison to amoxicillin+sulbcactam

Prevalence of dog erythrocyte antigen (DEA) 1 amongst the dog blood donors at Tamil Nadu veterinary and animal sciences university animal blood bank (TABB), India

The study of dog blood groups has increased in the last years. Inherited antigens on the RBC surface define blood groups. There are 7 blood groups in the canine DEA system. Amongst these blood groups, DEA 1 blood group is highly immunogenic and consequently has greater clinical importance. A retrospective study was conducted in 125 purebred and mongrel dog blood donors at the TANUVAS Animal Blood Bank, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University, Chennai, India during the period from January 2010 to January 2011. Donor dogs were screened and typed for the presence of DEA 1 using the monoclonal antibody kit. The prevalence of DEA 1 was 61.6%. The prevalence of DEA 1 dogs in India agrees with most of the data reported in the literature

A study on Methicillin resistant Staphylococcus aureus mastitis in dairy cows

Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious problem in dairy animals suffering from mastitis. The study was carried out to evaluate the incidence of Methicillin resistant S. aureus from clinical mastitis milk samples and their antibiotic resistance profile and characterised with respect to the molecular features that contributed to the resistance in these pathogens. Isolation and identification of Methicillin resistant S. aureus were performed from acute clinical mastitis samples. The isolates were tested using agar disc diffusion method for their antimicrobial susceptibility and modified resazurin assay micro dilution technique for MIC to 8 different antimicrobial drugs. A total of 235 clinical mastitis milk samples from dairy cows were cultured for incidence of S. aureus. Methicillin resistant S. aureus was isolated from a total of 12 (44.25%) of the 116 S. aureus samples. Based on the antimicrobial sensitivity and MIC results, MRSA isolates were found sensitive to gentamicin, enrofloxcain, amoxicillin+sulbactam, ceftriaxone and resistant to amoxicillin, oxytetracycline, penicillin G and oxacillin. Most of MRSA isolates were found to be multi-drug resistant. MRSA alert kit test and mecA and blaZ target gene PCR were found to be useful in the confirmation of MRSA

Cardiovascular Disease Prevention: Training Opportunities, the Challenges, and Future Directions

Purpose: Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide, necessitating major efforts in prevention. This review summarizes the currently available training opportunities in CVD prevention for fellows-in-training (FITs) and residents. We also highlight the challenges and future directions for CVD prevention as a field and propose a structure for an inclusive CVD prevention training program. Recent Findings: At present, there is a lack of centralized training resources for FITs and residents interested in pursuing a career in CVD prevention. Training in CVD prevention is not an accredited subspecialty fellowship by the American Council of Graduate Medical Education (ACGME). Although there are several independent training programs under the broad umbrella of CVD prevention focusing on different aspects of prevention, there is no unified curriculum or training. More collaborative efforts are needed to identify CVD prevention as an ACGME-accredited subspecialty fellowship. Providing more resources can encourage and produce more leaders in this essential field

Frequency and Practice-Level Variation in Inappropriate Aspirin Use for the Primary Prevention of Cardiovascular Disease Insights From the National Cardiovascular Disease Registry’s Practice Innovation and Clinical Excellence Registry

AbstractBackgroundAmong patients without cardiovascular disease (CVD) and low 10-year CVD risk, the risks of gastrointestinal bleeding and hemorrhagic strokes associated with aspirin use outweigh any potential atheroprotective benefit. According to the guidelines on primary prevention of CVD, aspirin use is considered appropriate only in patients with 10-year CVD risk ≥6% and inappropriate in patients with 10-year CVD risk <6%.ObjectivesThe goal of this study was to examine the frequency and practice-level variation in inappropriate aspirin use for primary prevention in a large U.S. nationwide registry.MethodsWithin the National Cardiovascular Disease Registry’s Practice Innovation and Clinical Excellence registry, we assessed 68,808 unique patients receiving aspirin for primary prevention from 119 U.S. practices. The frequency of inappropriate aspirin use was determined for primary prevention (aspirin use in those with 10-year CVD risk <6%). Using hierarchical regression models, the extent of practice-level variation using the median rate ratio (MRR) was assessed.ResultsInappropriate aspirin use frequency was 11.6% (7,972 of 68,808) in the overall cohort. There was significant practice-level variation in inappropriate use (range 0% to 71.8%; median 10.1%; interquartile range 6.4%) for practices; adjusted MRR was 1.63 (95% confidence interval [CI]: 1.47 to 1.77). Results remained consistent after excluding 21,052 women age ≥65 years (inappropriate aspirin use 15.2%; median practice-level inappropriate aspirin use 13.8%; interquartile range 8.2%; adjusted MRR 1.61 [95% CI: 1.46 to 1.75]) and after excluding patients with diabetes (inappropriate aspirin use 13.9%; median practice-level inappropriate aspirin use 12.4%; interquartile range 7.6%; adjusted MRR 1.55 [95% CI: 1.41 to 1.67]).ConclusionsMore than 1 in 10 patients in this national registry were receiving inappropriate aspirin therapy for primary prevention, with significant practice-level variations. Our findings suggest that there are important opportunities to improve evidence-based aspirin use for the primary prevention of CVD