The impact of insulin resistance, dyslipidemia and high sensitivity C-reactivity protein on carotid intima-media thickness in metabolic syndrome

Background: Carotid intima-media thickness (CIMT) is a strong predictor of cardiovascular events and associated with metabolic syndrome (MetS). The CIMT has been widely used as one of the parameters of atherosclerosis. The aim of the study was to evaluate the impact of insulin resistance, dyslipidemia and high sensitivity C-reactive protein on carotid intima-media thickness in metabolic syndrome patients of Western Maharashtra as very sparse data is available.Methods: It was a cross-sectional study of 400 adults (200 cases and 200 control), 18-50 years of age, both the sexes randomly selected from diabetes and obesity OPD at tertiary care hospital. Diagnosis of metabolic syndrome was done according to modified NCEP adult treatment panel III criteria. CIMT was measured by B mode ultrasound (Philips HT-11, Color Doppler), hs-CRP by ELISA method (Cal biotech). Insulin resistance by HOMA-IR (Homeostatic model assessment of insulin resistance). The predictors of CIMT with various variables were studied by multiple linear regression analysis.Results: We found significant increase in CIMT (0.7895±0.110, p<0.001) in MetS and a positive correlation of CIMT with age, waist to hip ratio, triglyceride levels and systolic blood pressure (p<0.001).Conclusions: Increased carotid intima-media thickness in metabolic syndrome may increase the risk of having a stroke and cardiovascular mortality. It was considered an early deterioration in the arterial intima and is a preclinical stage of atherosclerosis. Early diagnosis and prevention may help to reduce the risk of stroke and cardiovascular mortality.

Management of intra-articular fractures of distal end radius in adults

Background: Incidence of intra articular fracture L/3rd radius is significantly on rise due to high velocity accidents in young and adults. Painless wrist function is of vital importance for functioning of upper extremity in almost all activities of daily living and precise function of hand. Intra articular fracture of L/3rd radius has generally gross comminution and so also small articular fragments. Orthopaedic community differ about specific implants to fix this complex injury. The present study was undertaken to know efficacy of different modalities of treatment for different fracture pattern. Comminuted intra articular fracture geometry varies widely, to fix these small fragments to achieve stable anatomical reduction is a challenging task.   Methods: It is a combined i.e. retrospective and prospective study conducted at Hardikar Hospital, Pune, India from 1999 to December 2000. Patients of intra-articular fracture of distal end radius by different modes of treatment are included in the study. 1 patient with unilateral fracture was lost for follow-up. Thus 50 fractures, in 49 patients. were included in study. Clinico-radiological assessment was carried out by Lidstrom's (1959) criteria.Results: Satisfactory early functional end results with plaster treatment is 72.2% whereas with other modality of treatment it rises to 87.5%, indicating superiority of other modalities of treatment as far as early functional end results are concerned.Conclusions: Manipulation and plaster cast method continues to be the treatment of choice in the stable intra articular distal radial fractures. Hence there is a need for a "differentiated therapy for distal radial fractures". The treatment plan for patients must be based not only on fracture pattern identified on plain radiographs but also on factors such as bone quality, bone comminution, energy of injury and associated soft tissue damage. Additional factors to be considered in individual patient are-life style associated medical conditions and compliance

A prospective study of management of tibial plateau fractures by locking compression plate in adults

Background: Tibial plateau fractures are one of the most complex and disabling fractures of the knee. The tibial plateau is important in transmitting load through the knee. These fractures need a meticulous management protocol in order to minimize patient's disability in range of movement, stability and reducing the risk of documented complications. The aim of the present study is to study the outcome of tibial plateau fractures managed with a locked compression plate.Methods: This study was conducted at a tertiary-care medical college and hospital, Aurangabad specializing in post-graduate training, where all patients who underwent surgical treatment between September 2018 and October 2020 were included. Patients were assessed using the knee society score (KSS). These evaluations were done at 1, 3, 6, 9 and 12 months.Results: In our study we included 55 patients out of which we found union in 98% of patients with 83% of patients showing good flexion at knee joint (>110 degrees). 85% patients achieved union within 6 months. An excellent KSS grade was seen in 38.2% patients with another 43.6% showing good outcome. 4 patients showed infection and 1 showed non-union. A single case of malunion was seen in our study.Conclusions: Locked compression plates in tibial plateau fractures has revolutionized the way these fractures are managed. Anatomic reduction is of utmost importance. Early physiotherapy which plays key role in preventing knee stiffness, use of bone grafts and good fixation are important for successful outcome

ENHANCEMENT FOR DATA SECURITY IN CLOUD COMPUTING ENVIRONMENT

Cloud computing, a rapidly developing information technology, has aroused the concern of the whole world. Cloud computing is Internet-based computing, whereby shared resources, software and information, are provided to computers and devices on-demand, like the electricity grid. Cloud computing is the product of the fusion of traditional computing technology and network technology like grid computing, distributed computing parallel computing and so on. It aims to construct a perfect system with powerful computing capability through a large number of relatively low-cost computing entity, and using the advanced business model like SaaS (Software as a Service) to distribute the powerful computing capacity to end users’ hands. To address this longstanding limitation by building a multi-tenant system. Our system provides the environment for the user to perform his tasks, but with very high security. By using further facilities provided in this system user fill secure about his data and his account

Drug utilization study in geriatric patients visiting medicine OPD in tertiary care hospital

Background: Drug utilization study is of utmost importance in the elderly. The consumption of drug amongst elderly segment of society is maximum and many of them use at least three prescribed drugs, concurrently. One of the plausible explanation of usage of large number of medicines is prevalence of multi-morbidities as well as suffer from chronic and degenerative pathology amongst them along with the alteration of pharmacokinetics and pharmacodynamics of many drugs are altered with advanced age. Thus, the aim of this study was to assess current prescribing practices among physicians for geriatric patients in tertiary care hospital.Methods: A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with Department of Medicine in a tertiary healthcare hospital. As per inclusion criteria, patients visiting Medicine outpatient department (OPD) from 01 October 2018 to 31 December 2018 were enrolled in the study.Results: The average number of drugs per encounter was 4.1. 100% of the drugs were prescribed by their generic name and those prescribed from World Health Organization (WHO) list of essential medicines were 70.2%. Analysis of polypharmacy showed maximum 11 and minimum 1 drug was prescribed. Overall analysis of the drugs showed, the most common route of administration was orally. Drugs acting on cardiovascular system (CVS), gastrointestinal system (GI) system, analgesics and anti-inflammatory drugs and vitamins and mineral supplements constitute the major bulk of drug prescribed.Conclusions: In our study, though polypharmacy was found but it was necessary unavoidable, but was within the WHO standards of 1.6 to 4.8. Drugs acting on CVS and GI system were the most common drugs prescribed. Prescriptions with injections and steroids were less in the study population. All the drugs were prescribed by their generic name and most were present in the essential list of medicines

An evaluation of etiology of recurrent pregnancy loss: prospective observational study

Background: Recurrent pregnancy loss (RPL) is a global issue, affecting 1-2% of fertile women. RPL can be explained as two or more pregnancy losses which are documented either by ultrasonography or histopathological examination. This study aimed to evaluate etiology of RPLs.Methods: This prospective observational study was carried out in 40 women with history of RPL attending outpatient department (OPD) and inpatient department (IPD) of the department of obstetrics and gynaecology at the tertiary care centre of Dr. Vitthalrao Vikhe Patil Foundation’s (DVVPF’s) Medical College, Ahmednagar. The study was carried out from April 2020 to May 2021 in 40 women with history of RPL.Results: RPL most commonly occurs due to unexplained causes, followed by endocrinal causes. It was found most commonly in 21-30 years age group.Conclusions

Drug utilization study in patients visiting dermatology outpatient department in tertiary care hospital

Background: With the surge of basic and clinical research activities, and subsequent recognition of newer dermatological disorders; dermatology is now considered to be one of the most important specialties in a healthcare setup. Dermatological problem in India manifests as primary and secondary cutaneous complaints. The aim of this study was to assess current prescribing practices among physicians for dermatology patients in tertiary care hospital.Methods: A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with Department of Dermatology in a tertiary healthcare hospital. As per inclusion criteria, patients visiting Dermatology Outpatient department (OPD) from October 2018 to December 2018 were enrolled in the study.Results: The average number of drugs per encounter was 4.9. 100% of the drugs were prescribed by their generic name and those prescribed from World Health Organization (WHO) list of essential medicines were 68.9%. Analysis of polypharmacy showed maximum 11 and minimum 2 drug was prescribed. Overall analysis of the drugs showed, the most common route of administration was orally. Antihistamines, antifungals and steroids constitute the major bulk of drug prescribed.Conclusions: In our study, though polypharmacy was found but it was necessary as per the conditions. Anti-fungal, antihistamines and steroids were the most common drugs prescribed. Prescriptions with injections and steroids were less in the study population. All the drugs were prescribed by their generic name and most were present in the essential list of medicines. Use of Nonsteroidal anti-inflammatory drugs (NSAIDs) was higher in our study as compared to other studies

Adverse drug reaction profile at psychiatry outpatient department of a tertiary care centre

Background: Monitoring adverse drug reactions (ADRs) helps in alerting physicians and developing strategies to prevent and minimize the risk of developing ADRs. Data regarding pattern of ADRs due to psychotropic medications is scanty. Hence, the study was planned to assess ADRs among psychiatry outpatients of a tertiary care hospital in Maharashtra.Methods: A prospective, observational study was conducted in psychiatry outpatient department of a tertiary care centre for 3 months. Cases were enrolled by active and passive surveillance after obtaining informed consent. Demographic details, adverse event details, history of medications were recorded. Pattern of ADRs was studied according to demographic parameters, drug class, organ system affected, causality (WHO - Uppsala Monitoring Centre Scale) and severity (modified Hartwig and Siegel Scale).Results: Out of total 1200 patients screened, 77 qualified the inclusion and exclusion criteria and 92 ADRs were reported; overall incidence rate of 6.41%. Maximum ADRs were reported in the age group of 31- 40 years. 63.63% subjects received more than 2 psychotropic drugs. Among 24 types of ADRs observed, tremor (13.04%) was the commonest, closely followed by somnolence. Antipsychotics (45.65%) were most frequently incriminated and central nervous system (46.73%) the most often affected. Trifluoperazine (11.96%) was the commonest drug, followed by olanzapine and haloperidol (10.53% each). Causality analysis yielded 66 ADRs as “probable” and on severity analysis 80.43% were mild.Conclusions: The study provides an insight into pattern of ADRs in psychiatry outpatients. It is prudent to communicate this to treating physicians as well as counsel patients (and caregivers). Initiatives and concerted efforts involving all stakeholders in healthcare can go a long way in decreasing drug-related morbidity and health costs

Drug utilization study in patients of hypertension in tertiary care hospital

Background: Hypertension is the most common modifiable risk factor for cardiovascular diseases, stroke and renal failure. Drug utilization research facilitates the rational use of drugs and provides an insight into the pattern of drug use. As such, the present study was conducted to assess the prescribing patterns of antihypertensive agents and to observe the disparity between the recommended and actual practices for pharmacological management of hypertension at a tertiary care hospital.Methods: A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with Department of Medicine in a tertiary healthcare hospital. As per inclusion criteria, patients with hypertension visiting Medicine OPD from 1st October 2018 to 31st December 2018 were enrolled in the study.Results: A total of 390 prescriptions were collected. It was observed that majority of the study patients were female (53.84%) and were >60 years of age. Average number of drugs prescribed per prescription was 4.18. Multiple drug regimen (67.69%) was the mainstay therapy in our study. Prevalence of two drug combination was the highest (46.92%) followed by monotherapy (32.3%). Calcium channel blockers (CCBs) (amlodipine) was the most frequently prescribed class in monotherapy (19.23%). In two drug regimens, the combination of CCB with angiotensin-converting enzyme inhibitors (ACEIs) (combination of amlodipine and enalapril) was prescribed the most (28.46%) whereas prescription of combination of ACEI, beta-blocker (BB) and CCB (enalapril, atenolol and amlodipine combination) was the highest (13.84%) in three drug regimens.Conclusions: The prescription pattern of antihypertensive drugs was found to be rational and mainly in accordance with Joint National Committee VIII guidelines. All the drugs were prescribed by their generic names which suggests awareness among prescribers regarding WHO policies for generic prescribing