Tibial Fracture in an Elderly Female Patient of Rheumatoid Arthritis: A Preventable Iatrogenic Injury

Oral systemic glucocorticoids widely used in the medical practice to treat various diseases like asthma, systemic connective tissue diseases, other autoimmune diseases and in transplantology, are considered the main cause of secondary and iatrogenic osteoporosis. The pathogenesis of glucocorticoid induced bone loss is multifactorial and complex. The exact mechanism remains undefined. The present report describes a case of 65 yr old female presenting with fracture in mid shaft of tibia after a very low velocity trauma. On medical history elicitation, she was found to be treated for rheumatoid arthritis with oral glucocorticoids. Causality, severity and preventability assessment was done for the reaction. Potentiality of glucocorticoids causing fractures is often neglected by professionals and ignored by patient and their caregivers. Given the potential for rapid bone loss with glucocorticoid therapy, frequent monitoring is warranted while bearing in mind that BMD is a surrogate marker for fracture risk and patients on glucocorticoids fracture at higher BMD than other patients. Once treatment is initiated, BMD should be monitored annually to ensure compliance and efficacy

Tibial Fracture in an Elderly Female Patient of Rheumatoid Arthritis: A Preventable Iatrogenic Injury

Oral systemic glucocorticoids widely used in the medical practice to treat various diseases like asthma, systemic connective tissue diseases, other autoimmune diseases and in transplantology, are considered the main cause of secondary and iatrogenic osteoporosis. The pathogenesis of glucocorticoid induced bone loss is multifactorial and complex. The exact mechanism remains undefined. The present report describes a case of 65 yr old female presenting with fracture in mid shaft of tibia after a very low velocity trauma. On medical history elicitation, she was found to be treated for rheumatoid arthritis with oral glucocorticoids. Causality, severity and preventability assessment was done for the reaction. Potentiality of glucocorticoids causing fractures is often neglected by professionals and ignored by patient and their caregivers. Given the potential for rapid bone loss with glucocorticoid therapy, frequent monitoring is warranted while bearing in mind that BMD is a surrogate marker for fracture risk and patients on glucocorticoids fracture at higher BMD than other patients. Once treatment is initiated, BMD should be monitored annually to ensure compliance and efficacy

Digital Doppler-cancellation servo for ultra-stable optical frequency dissemination over fiber

Progress made in optical references, including ultra-stable Fabry-Perot cavities, optical frequency combs and optical atomic clocks, have driven the need for ultra-stable optical fiber networks. Telecom-wavelength ultra-pure optical signal transport has been demonstrated on distances ranging from the laboratory scale to the continental scale. In this manuscript, we present a Doppler-cancellation setup based on a digital phase-locked loop for ultra-stable optical signal dissemination over fiber. The optical phase stabilization setup is based on a usual heterodyne Michelson-interferometer setup, while the Software Defined Radio (SDR) implementation of the phase-locked loop is based on a compact commercial board embedding a field programmable gate array, analog-to-digital and digital-to-analog converters. Using three different configurations including an undersampling method, we demonstrate a 20 m long fiber link with residual fractional frequency instability as low as $10^{-18}$ at 1000 s, and an optical phase noise of $-70$ dBc/Hz at 1 Hz with a telecom frequency carrier.Comment: 11 pages, 6 figure

Effect of Gayatri Mantra Chanting on Attention, Memory, Anxiety and Mental State in Young Athletes: A Prospective Study

Introduction: The Gayatri Mantra (GM) is one of the oldest available divine hymns in ancient vedic literature, a mantra of physical, emotional, mental healing and spiritual awakening or self-realization. GM is a standard, validated, empowerment tool aiding in effective behavioral changes leading to optimal and healthy lifestyle. Effect of vedic chanting on consciousness and mental state has been long researched and has been documented in ancient religious literatures. However, due to its religious connotations, its scientific scrutiny and validation has been not popularized. The present study tried to assess the effect of GM chanting on attention, memory, anxiety and mental state on healthy young athletes. Methodology: The present study was a prospective one which included 45 athletes who were divided into three different study arms of 15 each – two arms were undertaking normal meditation with or without an add on GM Chanting while meditation, while one was control  group. All subjects were evaluated (at baseline and 3 months) for attention (using 6 letter cancellation, digit letter substitution), memory [using digit span test (forward, backward), multiple choice apparatus], anxiety (using state trait anxiety inventory), and mental state using MMSE. Results were statistically analyzed. Results: Subjects with GM chanting showed significant improvement in attention and memory domain. Less failed attempts and prompt response to audio and visual stimuli for multiple choice apparatus was noted for the GM group.  Sustained visual attention, scanning without distraction and better concentration are required for the digit cancellation test. Marked improvements in both state and trait anxiety was noted for the GM chanters. Improved mental state was observed for both meditating group compared with the control.   Conclusion: GM chanting plays a significant role in the well being of the people. GM chanting has significant effects in attention, memory, anxiety and mental state. Regular chanting of GM shall improve learning power, concentration, prosperity, eternal power, peace and improves quality of life. &nbsp

Effect of Gayatri Mantra Chanting on Attention, Memory, Anxiety and Mental State in Young Athletes: A Prospective Study

Introduction: The Gayatri Mantra (GM) is one of the oldest available divine hymns in ancient vedic literature, a mantra of physical, emotional, mental healing and spiritual awakening or self-realization. GM is a standard, validated, empowerment tool aiding in effective behavioral changes leading to optimal and healthy lifestyle. Effect of vedic chanting on consciousness and mental state has been long researched and has been documented in ancient religious literatures. However, due to its religious connotations, its scientific scrutiny and validation has been not popularized. The present study tried to assess the effect of GM chanting on attention, memory, anxiety and mental state on healthy young athletes. Methodology: The present study was a prospective one which included 45 athletes who were divided into three different study arms of 15 each – two arms were undertaking normal meditation with or without an add on GM Chanting while meditation, while one was control  group. All subjects were evaluated (at baseline and 3 months) for attention (using 6 letter cancellation, digit letter substitution), memory [using digit span test (forward, backward), multiple choice apparatus], anxiety (using state trait anxiety inventory), and mental state using MMSE. Results were statistically analyzed. Results: Subjects with GM chanting showed significant improvement in attention and memory domain. Less failed attempts and prompt response to audio and visual stimuli for multiple choice apparatus was noted for the GM group.  Sustained visual attention, scanning without distraction and better concentration are required for the digit cancellation test. Marked improvements in both state and trait anxiety was noted for the GM chanters. Improved mental state was observed for both meditating group compared with the control.   Conclusion: GM chanting plays a significant role in the well being of the people. GM chanting has significant effects in attention, memory, anxiety and mental state. Regular chanting of GM shall improve learning power, concentration, prosperity, eternal power, peace and improves quality of life. &nbsp

Real-world clinical effectiveness on glycaemic parameters, safety and additional benefits of Glargine U300 (Toujeo®) initiation after oral antidiabetic drug failure in insulin-naïve patients with type 2 diabetes mellitus

Background: Several studies have proved the advantages of second-generation insulin analogs in lowering intra-individual variability in plasma insulin levels, flexibility in dosing, a sustained glucose-lowering effect, and decreasing the risk of hypoglycemia. Glargine 300 is one of the newer second-generation basal insulin analogs to have been approved for both type 1 and 2 diabetes. The present study aims to assess the real-world clinical effectiveness and safety of Glargine U300 (Toujeo®) initiation after oral antidiabetic drug failure in insulin-naïve patients with T2DM. Methods: A prospective, observational study was conducted where participants were interviewed regarding their basic demographics, body weight, and treatment details. Glycemic parameters (HbA1C%, Fasting Plasma Glucose, and Post Prandial Blood Glucose) were observed in the initial 6 months, and changes were noted and compared. Any hypoglycemic events or other complications were also noted. Data collected were statistically analyzed. Results: The study included a total of 188 patients. Treatment with glargine 300 significantly reduced the mean HbA1C level from 9.78% at baseline to 7.90% at the end of 6 months of treatment (p < 0.001). 10.60% of patients achieved the glycemic target of ≤7.0% by the end of 6 months, while only 6.90% were within the target range at baseline. Similarly, significant reduction in FPG was observed at the end of 6 months treatment period with Glargine U300. A significant increase in dose requirement was observed throughout the study phase (p < 0.001). Incidence of hypoglycemia was noted in 2.12% of subjects. Conclusion: The lower incidence statistics of hypoglycemia coupled with sustained positive glycemic effects, stands out to be a prominent advantage of Glargine U300 over its other congeners

A Questionnaire based study on practice and safety concerns of hydroxyethyl starch as fluid management among Critical Care Physicians, Gynecologists and Surgeons in India

Introduction: Use of natural and synthetic colloid solutions to replenish intravascular volume depletion is common in diverse clinical settings. Hydroxyethyl starches (HES) are a common choice for fluid resuscitation and are preferred over albumin because of their relatively lower price.However its association with increased risk of bleeding, renal dysfunction and mortality in patients who had sepsis or were critically ill compared with crystalloids usage posed concern. In 2013, the FDA issued a “black box” warning about increased mortality and severe renal injury in critically ill patients, advising that it should not be used in this population. The present study highlights the issue and probes on its current usage in India. Objective: To assess the usage pattern and adverse events of synthetic colloids such as hydroxyethyl starch in fluid management through a questionnaire survey among critical care physicians, gynecologists and surgeons. Methodology: A questionnaire based study was conducted among 156 critical care physicians, gynecologists and surgeonspan-India, where physicians were approached through emails and a pre-designed, pre-tested questionnaire presented in Google form was sent to potential respondents. Data was checked for completeness and then analyzed by appropriate statistical methods as applicable. Results: Majority of the respondents were noted usingHES despite its adverse potential, due to its availability at government hospitals. Surprisingly a few of the interviewed surgeons use HES as a volume expander. Similar results were obtained from the interviewed gynecologists and obstetricians. Among 52 interviewed gynecologists, only 2% use HES as volume expander. Conclusion: Considering the adverse potential of this synthetic colloid and justifying the risk and benefit analysis one has to be very wise in selecting the right synthetic colloid for the right patient. However with current concerns about safety of hydroxyethyl starch products, almost all interviewed physicians recommended regulatory restriction over their use in India

Digital Doppler-cancellation servo for ultra-stable optical frequency dissemination over fiber

International audienceProgress made in optical references, including ultra-stable Fabry-Perot cavities, optical frequency combs and optical atomic clocks, have driven the need for ultra-stable optical fiber networks. Telecom-wavelength ultra-pure optical signal transport has been demonstrated on distances ranging from the laboratory scale to the continental scale. In this manuscript, we present a Doppler-cancellation setup based on a digital phase-locked loop for ultra-stable optical signal dissemination over fiber. The optical phase stabilization setup is based on a usual heterodyne Michelson-interferometer setup, while the Software Defined Radio (SDR) implementation of the phase-locked loop is based on a compact commercial board embedding a field programmable gate array, analog-to-digital and digital-to-analog converters. Using three different configurations including an undersampling method, we demonstrate a 20 m long fiber link with residual fractional frequency instability as low as $10^{-18}$ at 1000 s, and an optical phase noise of $-70$ dBc/Hz at 1 Hz with a telecom frequency carrier

Association between Polypharmacy and Cardiovascular Autonomic Function among Elderly Patients in an Urban Municipality Area of Kolkata, India: A Record-Based Cross-Sectional Study

We assessed the association between polypharmacy and cardiovascular autonomic function among community-dwelling elderly patients having chronic diseases. Three hundred and twenty-one patients from an urban municipality area of Kolkata, India were studied in August 2022. The anticholinergic burden and cardiac autonomic function (Valsalva ratio, orthostatic hypotension, change in diastolic blood pressure after an isometric exercise, and heart rate variability during expiration and inspiration) were evaluated. Binary logistic regression analysis was performed to find out the association of polypharmacy and total anticholinergic burden with cardiac autonomic neuropathy. A total of 305 patients (age, 68.9 &plusmn; 3.4; 65.9% male) were included. Of these patients, 81 (26.6%) were on polypharmacy. Out of these 81 patients, 42 patients were on ninety-eight potential inappropriate medications. The anticholinergic burden and the proportion of patients with cardiac autonomic neuropathy were significantly higher among patients who were on polypharmacy than those who were not (8.1 &plusmn; 2.3 vs. 2.3 &plusmn; 0.9; p = 0.03 and 56.8% vs. 44.6%; p = 0.01). The presence of polypharmacy and a total anticholinergic burden of &gt; 3 was significantly associated with cardiac autonomic neuropathy (aOR, 2.66; 95% CI, 0.91&ndash;3.98 and aOR, 2.51; 95% CI, 0.99&ndash;3.52, respectively). Thus, polypharmacy was significantly associated with cardiac autonomic neuropathy among community-dwelling elderly patients