Remission of Grave\u27s disease after oral anti-thyroid drug treatment

OBJECTIVE: To evaluate remission rate of anti-thyroid drug treatment in patients with Grave\u27s disease, and to study the factors associated with remission. STUDY DESIGN: A cross sectional study. ,p\u3ePLACE AND DURATION OF STUDY: The Endocrine Department of the Aga Khan University Hospital, Karachi from 1999 to 2000. METHODOLOGY: Seventy four patients of Grave\u27s disease were recruited who were prescribed medical treatment. Grave\u27s disease was diagnosed in the presence of clinical and biochemical hyperthyroidism along with anti-microsomal (AMA) and anti-thyroglobulin antibodies (ATA) and thyroid scan. These patients were prescribed oral anti-thyroid drugs using titration regime and followed at 3, 6, 12 and 18 months. Patients were categorized into two groups: remission group and treatment failure group and results were compared using a chi-square test, t-test and logistic regression model with significance at p \u3c 0.05. RESULTS: A majority of the patients were females (62.6%, n=46). During the follow-up period of 18 months, 41.9% patients went into remission. Univariate analysis showed that the initial free T4 level was significantly different (p \u3c 0.05) in patients in remission and treatment failure groups. Multivariate analysis showed only initial free T4 level was a significant predictor of outcome. Positive AMA patients (n=27) had higher treatment failure (odds ratio: 2.55: 95%, CI 0.69 - 9:31), although the difference was not statistically significant (p = 0.13). CONCLUSION: Remission rates with oral anti-thyroid agents is markedly high. Patients should be offered alternate treatment options to those who do not enter remission during a period of 12-18 months of treatment, those who develop relapse, and those who have aggressive disease on initial presentation

Vitamin B12 deficiency common in primary hypothyroidism

OBJECTIVE: To assess the prevalence and clinical features of B12 deficiency in hypothyroid patients and to evaluate clinical response in symptoms to B12 replacement therapy. METHODS: One hundred and sixteen hypothyroid patients from our endocrine clinic were evaluated for signs and symptoms of vitamin B12 deficiency. Laboratory parameters including Haemoglobin (Hb), MCV, Vitamin B12 levels and presence of anti thyroid antibodies were analyzed. Patients with low B12 levels were treated with parenteral intramuscular vitamin B12 monthly, and monitored for improvement of symptoms. RESULTS: A total of 116 patients (95 females and 21 males) were evaluated. Forty six (39.6%) hypothyroid patients had low vitamin B12 levels. Males and females had the same prevalence of B12 deficiency. Generalized weakness, impaired memory, depression, numbness and decreased reflexes were more frequently noted in B12 deficient patients, but failed to achieve statistical significance when compared with B12 sufficient patients. The mean Hb in B12 deficient group was 11.9 +/- 1.6 mg/dl and 12.4 +/- 1.7 mg/dl in the B12 sufficient group, however the mean MCV did not differ in the two groups. Patients with B12 deficiency did not have a higher prevalence of anaemia. Thyroid antibodies were checked in half the patients and 67% had positive titers for anti thyroid antibodies. Prevalence of vitamin B12 deficiency did not differ in patients with positive antibodies (43.2%) compared to those with negative antibodies (38.9%) (p= 0.759). Twenty four hypothyroid patients with B12 deficiency received intramuscular vitamin B12 injections monthly and improvement in symptoms was noted in 58.3% of these subjects. Additionally, 21 subjects complained of symptoms consistent with B12 deficiency but who had normal range B12, levels and were prescribed monthly B12 injections and 8 (40%) had good subjective clinical response at 6 months. CONCLUSIONS: There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms, although a placebo effect cannot be excluded, as a number of patients without B12 deficiency also appeared to respond to B12, administration

Individual and organizational barriers faced by physiotherapists in implementing evidence based practice- an analytical study

Objective: The primary objective of the study was to determine the present barriers in EBP implementation and secondary objective was to find out the routine practices other than evidence-based practice. Methods: It was an analytical cross-sectional study with a sample size of 235 participants. Non-probability convenience sampling technique was used. The data was collected after ethical approval on 01 January 2021, using Barrier Scale by Dr. Funk with written permission via email. The data was encoded and analyzed by SPSS version 16. For descriptive data Mean, Standard Deviation, Frequencies, Percentages, and tables were used to present the results and the Chi-Square test was used to show the association. Results: In this study Male 104 (44.3%) and Females were 131(55.7%) with a mean age of 31.5+9.5 years. 64.3% of Physiotherapists were having 2-5 years and 28.1% had 5-7 years of working experience. This study shows that “Insufficient time on the job to implement new ideas” is 1st barrier at the organizational level and second place, according to Mean value is “time to read research” at the individual level. Conclusion: This study shows that PTs faced barriers at both organizational and individual levels. The top barriers faced at the organizational level were inadequate facilities, not authorized to change the patient care procedure, and at the Individual level were research unawareness, limited time and not beneficial effects of variation in practice, and uncertainty of results. Keywords: Evidence Based Practice, Individual Barriers, Organizational Barriers, Physiotherapists