Background:To assess effect of 1,25 dihydroxy vitamin D3 supplementation on pain relief in early rheumatoid arthritis (RA).Materials and Methods:An open-labeled randomized trial was conducted comparing 60,000 IU 1,25 dihydroxy vitamin D3 + calcium (1000 mg/day) combination [Group A] versus calcium (1000 mg/day) only [Group B], as supplement to existing treatment regimen in early RA. Primary outcome included (i) minimum time required for onset of pain relief (Tm) assessed through patients’ visual analog scale (VAS); (ii) % change in VAS score from onset of pain relief to end of 8 weeks. Secondary outcome included change in disease activity score (DAS-28).Results:At the end of 8-weeks, Group A reported 50% higher median pain relief scores (80% vs. 30%; P < 0.001) and DAS-28 scores (2.9 ± 0.6 vs. 3.1 ± 0.4; P = 0.012) compared to Group B; however, Tm remained comparable (19 ± 2 vs. 20 ± 2 days; P = 0.419). Occurrence of hypovitaminosis-D was lower (23.3%) compared to Indian prevalence rates and was a risk factor for developing active disease (Odds Ratio (OR) = 7.52 [95% Confidence Interval (CI) 2.67–21.16], P < 0.0001). Vitamin D deficiency was significantly (P < 0.001) more common in female gender, active disease, and shorter mean disease duration. Vitamin D levels were inversely correlated to disease activity as assessed by DAS-28 (r = –0.604; P < 0.001).Conclusions:Vitamin-D deficiency is a risk factor for developing active disease in RA. Weekly supplementation of 60,000 IU of 1,25 dihydroxy vitamin D3 in early RA results in greater pain relief. The number needed to treat for this additional pain relief was 2.Identifier:CTRI/2018/01/011532 (www.ctri.nic.in).

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We present a rare case of Polymyxin B-induced diffused cutaneous skin hyperpigmentation in a 65-year-old elderly male of Indian origin. This patient had initially presented in the emergency with shortness of breath and low grade intermittent fever for last three months. He was also suffering from persistent productive cough and occasional haemoptysis for same duration. He was a known case of Chronic Obstructive Pulmonary Disease (COPD) for last 3 years and was on oral and inhalational medications.No past history of tuberculosis, significant weight loss, malignancy or cardiac disease could be elicited. Patient was non-smoker, non-alcoholic with no known history of any drug abuse. He was provisionally diagnosed to be in a state of acute exacerbation of COPD with left lower lung pneumonic consolidation and right-sided small pneumothorax.Laboratory investigations revealed: haemoglobin 12.7g/dl, Total Leukocyte Count (TLC) 10,400 with neutrophils 85%, lymphocyte 12%, random plasma glucose levels 156mg/dl, creatinine 0.6mg/ dl, bilirubin 0.9mg/dl, ALT 45IU. Arterial blood gas report showed: pH(7.43), pCO 2 (49.3), pO 2 (62.6), HCO 3 (32.5), SpO 2 (86%) (room air), Na + (130), K + (4). Echocardiogram suggested good preserved ventricular systolic function (ejection fraction 56%) with no regional wall motion abnormality, grade-I diastolic dysfunction with mild tricuspid regurgitation. Chest skiagram showed a thick walled cavity on left side, basal consolidations and increased peri-hilar translucency; sputum was negative for Acid Fast Bacilli (AFB) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) excluding pulmonary tuberculosis.On examination, blood pressure was 100/70mmHg, pulse rate 110/ min, JVP not raised, trachea shifted to left, poor bilateral air entry into lungs and bilateral severe wheeze.Patient was initially started on Fixed Dose Combination (FDC) of Piperacillin-Tazobactum (4.5gm intravenous thrice daily) and later upgraded to Meropenem (1gm thrice daily). Concurrent nebulization with Levo-Salbutamol (2 inhalations; 90mcg 6 hourly) and Ipratropium Bromide (2 inhalations; 36mcg 6 hourly), intravenous injection hydrocortisone (2mg/kg 6 hourly) were also initiated to maintain desired pO2 and SpO 2 .

Background: Little is known about the etiological risk factors of acute pancreatitis (AP) in Eastern India. Aims and Objective: The aim of this study is to assess current trends etiology of AP in Eastern India. Materials and Methods: A retrospective study with cross-sectional design was undertaken based on available medical records of patients admit between January 2014 and January 2017 with physician-assigned diagnoses of AP at KPC Medical College & Hospital, Kolkata (n = 234). Multivariate analyses were done to identify risk factors, and distribution was compared on the basis gender. Groups were selected on the basis of a working diagnosis. A stratified comparison was done in 3 commonest etiology groups identified: ‘alcohol’, ‘non-alcohol’ and ‘idiopathic’.Results: The commonest etiology was attributed to alcohol (29.4%), idiopathic cause (20.5%), and obstructive cause (14.5%). Prevalence of AP was higher with alcoholism in men (37% vs. 10.8%; p < 00.1), however, other causes like idiopathic cause (12.3% vs. 37.8%), duct obstruction (1.2% vs. 43.2%), obesity (6.1% vs. 24.3%), and hypertriglyceridemia (6.1% vs. 14.8%) were higher among females ( p < 0.001 for all comparisons). Compared to non-alcoholics, patients with idiopathic AP were more likely to be overweight ( p = 0.019) and have T2 DM ( p = 0.021). Moreover, impact assessment of T2 DM status further revealed that the risk of AP was even greater with obesity (Odds Ratio [OR] 1.37; 95% Confidence Interval [CI] 0.57 – 3.26; p = 0.047) and smoking (OR 1.72; 95% CI 1.0 – 2.97; p = 0.049). Eighteen cases (7.7%) of ‘severe’ AP were identified, mostly due to: trauma in 6 (2.5%), idiopathic in 6 (2.5%), gallstones in 4 (1.7%), and alcoholism in 2 (0.8%).Conclusion: Alcohol intake is the predominant etiological risk factor for acute pancreatitis in Eastern India. Gender and type 2 diabetes mellitus are important contributory determinants.Asian Journal of Medical Sciences Vol.8(6) 2017 24-29

The advent of digital technologies has been well blended with every aspect of human lives. Despite not being a new concept, the adoption of digital health technologies in clinical research, i.e., digital clinical trial has not been utilized extensively. However, with the prevailing COVID-19 pandemics, such transformation in clinical trial seems imminent. Few components of a trial such as consent, remote site monitoring, recruitment process which can be modified through digital technologies, are further specified by the regulatory authorities such as FDA and EMA. However, such novel method cannot be implemented without facing any limitations. All stakeholders pertinent to virtual clinical trial including the provider of digital technologies should align themselves with the patient-centric approach to propagate this concept. It is expected that such a transition is well accomplished and adopted by the sponsors without any compromise in scientific as well as ethical standard.

Biosurfactants (BS) are amphiphilic compounds of microbial origin that have an advantage of biodegradability, low toxicity, better surface and interfacial activity over conventional surfactants. They have several applications in agriculture, industry, petroleum and medicine. Due to its antimicrobial activity and low toxicity, BS has considerable pharmaceutical applications. Emulsan is an emulsifier for hydrocarbons in water at concentrations as low as 0.001% to 0.01% [20]. Liposan is an extracellular water soluble emulsifier synthesized by C. lipolytica and is made up of 83% carbohydrates and 17% proteins [21].

Antimicrobial resistance (AMR) is an important public health concern globally. For India, undoubtedly, AMR has had profound impact on its health & socioeconomic parameters. Several hospital and community-based surveys have indicated alarming rise in incidence of multidrug resistant microbes, especially ‘superbugs’, having direct links with antibiotic use/misuse. Additionally, paucity in data with regards to quantification of AMR crisis & its determinants has been concerning. However, the national commitment to address AMR has steadily increased of late, with an oft-restated realization – it is time to act. Recent initiatives like National Policy for Containment of AMR (2011), Chennai Declaration (2012), Anti-microbial Resistance Surveillance and Research Network (2013), The Red Line Campaign (2016), National Action Plan (NAP) for AMR (2017), ICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) are promising measures expected to have positive impact on both clinical and economic outcome in India. This paper provides a snapshot of major strategies proposed in recent years, including educational and awareness initiatives, infection control guidelines, audit and feedback, antimicrobial stewardship, surveillance projects etc. It also identifies technical challenges & opportunities for improved AMR mitigation in India.

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