Metformin is commonly used oral hypoglycaemic agent in the treatment of type-2 Diabetes Mellitus (DM). One of the important side effect of long term metformin therapy is malabsorption of vitamin B 12 which could lead to megaloblastic anemia and peripheral neuropathy. Therefore annual screening of serum vitamin B 12 level or serum methylmalonic acid (MMA)/serum homocysteine level should be done in cases taking metformin for more than four to five years with average dose of >1g per day, even in the absence of haematological or neurological abnormalities. However, as the incidence of type-2 DM is increasing, cost of annual measurement of vitamin B 12 level also increases. Considering cost factor for annual screening, vitamin B 12 supplementation appears to be more cost effective approach rather than annual screening for routine prophylaxis. Routine vitamin preparations available in the market may contain less amount of B 12 and hence are not of much therapeutic use in treatment of B 12 deficiency due to Metformin. Hence there is a need to look for higher doses of approximately 500-2000μg/day.
Objective: The purpose of this study is to identify the patterns, presentations of ocular trauma, todetermine the groups at risk, types of injuries, analyze visual outcomes of ocular trauma in patients presenting at our hospital. Method –It is a prospective hospital based study done over a period of one year on ocular trauma patientsbetween Jan 2020 – Dec 2020.All consecutive, consenting patients with ocular trauma were interviewed with the aid of a questionnaire and underwent a detailed eye examination. Results: The study included 100 patients .Males were affected in 82%cases. The highest incidence of trauma was seen in the age group of 21-30 years( 29%).Children below 10 years were found in 12 % cases.Blunt trauma was found in 49% whereas penetrating injuries were found in 44 %. The most common site of injury was the cornea(30.58%). Keywords: ocular trauma, eye injuries, penetrating eye injuries, hyphaema
Background: The present study was designed to assess awareness regarding rational drug therapy and fixed dose combinations (FDC) amongst interns and II MBBS students in a tertiary-care teaching hospital in Maharashtra, India.Methods: This cross-sectional, questionnaire-based study containing MCQ and analytical questions on rational drug therapy, fixed dose combinations and role of Pharmacist in dispensing correct drug to the patients was carried out in both interns (n=80) and II MBBS students (n=100). The completed questionnaires were then collected and analysed statistically for responses.Results: Mean average score obtained by II MBBS students (score - 36.66marks) was significantly better than interns (score- 20marks) which probably may be due to pharmacology teaching they were undergoing. II MBBS students were found to be better informed as compared to the interns (p<0.05) on questions related to rational drug therapy. On the questions related to rationality of FDC in Yes/No type, interns and II MBBS students were found to be equally informed (p>0.05). However, on question related to justification of FDC, interns were found to be better informed as compared to the II MBBS students (p<0.05). On single question pertaining to role of pharmacist, interns were found to be better informed than II MBBS students possibly due to their better understanding of patient-pharmacist relationship.Conclusions: Our study highlights the significance regarding knowledge of rational drug therapy and fixed dose combination (both rational and irrational), both rational and irrational, amongst both interns and II MBBS students while identifying the possible areas of interventions to make them rational clinicians.
Pharmacovigilance (PV) plays a vital role in the healthcare system through assessment, monitoring and discovery of interactions amongst drugs and their effects in human. Medicines do come with their respective adverse effects. Therefore it is imperative to do Adverse Drug Reaction (ADR) monitoring while they are being marketed. PV is a part of the second MBBS curriculum, but often given less importance by the students. If this Knowledge Attitude & Practice of PV can be made effective during the MBBS course itself, it may make the students better aware about ADR monitoring. Aims & Objective: Our purpose was to find out the knowledge, attitude & practices amongst the second year medical students in a tertiary care hospital in North Maharashtra. Methods: This was an observational based study which had predesigned questions. After seeking the approval from the Institutional Ethics Committee, questionnaire was given to second year students of a tertiary care hospital in north Maharashtra. MS Excel was used for data analysis. Results: The overall response rate was 76%. 30% answered knowledge question correctly whereas 70% answered the attitude questions correctly. Only 4 % had reported an ADR and majority felt that busy duty hours and fear of legal action was the reason for underreporting. Conclusion: Our study revealed that in spite of PV being part of 2nd year MBBS, it still needs more emphasis and attention. The student feedback regarding ADR after they visit wards may help in improving the general awareness. Keywords: Pharmacovigilance, Knowledge, Attitude, ADR.
Background: To assess risk factors for coronary artery disease and their correlation with thyroid hormone profile amongst women with ST segment elevation in acute myocardial infarction. Method: A total number of 78 females having ST elevation myocardial infarction diagnosed through detailed clinical history and ECG evaluations were included after they satisfy the eligibility criteria. Patients were subsequently evaluated for presence of risk factors of ischemic heart disease such age, marital status, parity, and menopause, use of oral contraceptives, family history, obesity, diabetes mellitus, hypertension, hypercholesterolemia and hypertriglyceridemia. Their thyroid hormone profiles (T3, T4, TSH) were done and were correlated with risk factors for ischemic heart disease. Result: A total 78 patient included in the study. Most of the study population belongs to the age group of 40 to 50 years (43.6 %). Hypertension was the most common clinical features amongst study population (59%) followed by Diabetes (50%). most of the study population had Normal Thyroid status (57.69%) followed by Hypothyroidism (25.64%) and Hyperthyroidism (16.67%). and SERUM TSH is the most sensitive test for evaluation. Diabetes Mellitus was statistically significant risk factor (p value <0.05) in patients with STEMI with different levels of thyroid. Conclusion: Patients with coronary artery disease especially in the presence of other risk factors should be screened for diabetes and also for thyroid dysfunction as in our study cases of Hypothyroidism was seen in 25.64% of the population under study. Hence it can be postulated that hypothyroidism may be a predictor for myocardial injury in STEMI. Here we recommend that tests for thyroid disorders in acute coronary syndrome can give predictor for risk of morbidity and mortality in those subjects. These results also may warrant further larger study to investigate whether reversing the hypothyroidism could benefit the STEMI patients. Keywords: STEMI- ST segment elevation myocardial infarction, MI- Myocardial Infarction, Hyperthyroidism, Hypothyroidism, TSH- Thyroid Stimulating Hormone
Aim: To study the relationship between severity of diabetic retinopathy (PDR or NPDR) and systemic complications of diabetes mellitus such as Neuropathy, Nephropathy or Cardiovascular manifestation as hypertension. Methods and Materials: This prospective observational study of 100 patients suffering from diabetic retinopathy. Such patients were recruited as a part of the study and further examined for any other systemic abnormality as neuropathy, nephropathy or hypertension. Statistical Analysis: Chi square test, univariate and multivariate logistic regression analysis was performed. P value < 0.05 was taken as significant. Results: Male: Female ratio of presence of diabetic retinopathy was 2.13: 1. The rate of proliferative diabetic retinopathy (PDR) was 1.47 % in persons who had diabetes for less than 5 years to 7.35 % in persons who had diabetes more than 15 years. In our study, it was seen that nephropathy was present in 35.71 % cases with PDR as compared to 8.93% of cases with Non proliferative diabetic retinopathy (NPDR). Conclusion: Our study showed that there is a significant correlation between severity of retinopathy and duration in type 2 Diabetes mellitus patients. Maximum number of patients with Diabetes mellitus having cardiovascular involvement, had hypertension (68%).In patients suffering from neuropathy as a complication of DM, maximum number of patients had diabetic foot (56%).It was seen that the severity of diabetic retinopathy had some association with presence of nephropathy. Also it can be postulated that patients with severe NPDR and PDR have high risk of developing nephropathy than patients suffering with mild and moderate NPDR. Hence it can be recommended that all patients of diabetes mellitus suffering from clinically significant neuropathy, nephropathy or hypertension as a complication of diabetes should always be screened for presence of retinopathy. Further studies with larger sample size are to be conducted to further look into this association. Keywords: Diabetic retinopathy, Diabetic nephropathy, diabetic neuropathy, complications
In the beginning of 20 th century vitamin D was classified as a vitamin but later considered as a prohormone ("conditional" vitamin) which influences the expression of more than 200 genes in the human body. Worldwide vitamin D insufficiency affects about 50% of the population and in India about 80% of population has vitamin D level less than normal. In India sunshine is abundant but still Indians are deprived of this sunshine vitamin. Minimal exposure to direct sunlight, staying indoors, use of sunscreen lotions, pollution, clothing, dietary and cooking habits are most important factors for vitamin D deficiency in the Indian population. Serum 25 hydroxyvitamin D level is the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D 2 or vitamin D 3 is recommended for patients having deficiency, keeping hypervitaminosis in mind. deficiency. However nobody recognized the vital role of diet or exposure to sunlight in the prevention of this disease. Around 200 years later in 1840 a Polish physician Sniadecki found that rickets occurred in children living in the industrial centre of Warsaw but did not affect children living outside Warsaw. He found that lack of exposure to sunlight in the crowded streets of the city where sunlight is not abundant and there was considerable pollution due to the burning of coal and wood, caused the disease.In 1918 Sir Edward Mellan by discovered that beagles, which are exclusively placed inside house away from natural sunlight and fed a diet of oatmeal, developed rickets but after the addition of cod liver oil to the food cure the disease successfully. In 1921 he demonstrate "The action of fats in rickets is due to a vitamin or a specific food factor which they contain, probably the fat-soluble vitamin.In MetabolismVitamin D 3 is cholecalciferol and vitamin D 2 is ergocalciferol. On exposure to sunlight Vitamin D 3 is produced in the skin. It is derived from 7-dehydrocholesterol by ultraviolet irradiation of the skin. After ingestion vitamin D both D 2 or D 3 , incorporated into chylomicrons which get absorbed into the lymphatic system and enter the venous blood. Vitamin D that comes from the skin or diet is biologically inert and requires its first hydroxylation in the liver and second one in kidneys to form the biologically active form of vitaminD1, 25(OH)2D, 1,25(OH)2D may be responsible for regulating up to 200 genes which may facilitate many of the health benefits 2 . SourcesVitamin D perhaps the one of the vitamin that gets synthesized in the body in the skin with the help of sunlight. Vitamin D 3 is found in animal food e.g., fatty fish (e.g., mackerel, salmon and tuna), cod liver oil, milk. Vitamin D 2 is found in vegetal sources like sun-exposed yeast and mushrooms Causes of Vitamin D Deficiency 2• Inadequate exposure to sunlight -as major source of vitamin D is exposure to natural sunlight.• Skin tone-Dark skin people are more prone for deficiency than white tone as dark skin provide natural sun protection.• Use of sunscreens-reduce...
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