Hypocalcemia and Vitamin D Deficiency amongst Migraine Patients: A Nationwide Retrospective Study.

Background and Objectives: Inadequate vitamin D and calcium intake have been linked to many health issues including chronic headaches. Some studies suggested an association between low vitamin D levels and increase the risk of frequent headaches in middle-aged and older men; however, no single study reported the role of these deficiencies in migraine patients. We aimed to investigate the association of hypocalcemia and vitamin D deficiency with migraine hospitalizations. Materials and Methods: A population-based retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) (years 2003-2014) in migraine hospitalizations was performed. The prevalence, demographic characteristics and All Patient Refined Diagnosis Related Groups severity/disability association were compared in patients with hypocalcemia and vitamin D deficiency to those without deficiencies, using ICD-9-CM codes. Weighted analyses using Chi-Square, paired Student's t-test, and Cochran-Armitage trend test were performed. Survey logistic regression was performed to find an association between deficiencies and migraine hospitalizations and deficiency induced disability amongst migraineurs. Results: Between years 2003 and 2014, of the total 446,446 migraine hospitalizations, 1226 (0.27%) and 2582 (0.58%) presented with hypocalcemia and vitamin D deficiency, respectively. In multivariable analysis, hypocalcemia [Odds Ratio (OR): 6.19; Confidence Interval (CI): 4.40-8.70; p < 0.0001] and vitamin D deficiency (OR: 3.12; CI: 2.38-4.08; p < 0.0001) were associated with markedly elevated odds of major/extreme loss of function. There was higher prevalence (3.0% vs. 1.5% vs. 1.6%; p < 0.0001) and higher odds of migraine among vitamin D deficiency (OR: 1.97; CI: 1.89-2.05; p < 0.0001) patients in comparison to patients with hypocalcemia (OR: 1.11; CI: 1.03-1.20; p = 0.0061) and no-deficiency, respectively. Conclusions: In this study, we demonstrated a significant association between hypocalcemia and vitamin D deficiency with migraine attacks and deficiency induced loss of function among migraineurs. Early preventive measures may reduce the disability in migraineurs.

Therapeutic clinical trials to combat COVID-19 pandemic in India: analysis from trial registry.

OBJECTIVES: With the emergence of Novel corona virus, hunt for finding a preventive and therapeutic treatment options has already begun at a rapid pace with faster clinical development programs. The present study was carried out to give an insight of therapeutic interventional trials registered under clinical trial registry of India (CTRI) for COVID-19 pandemic. METHODS: All trials registered under CTRI were evaluated using keyword "COVID" from its inception till 9th June 2020. Out of which, therapeutic interventional studies were chosen for further analysis. Following information was collected for each trial: type of therapeutic intervention (preventive/therapeutic), treatment given, no. of centers (single center/multicentric), type of institution (government/private), study design (randomized/single-blinded/double-blinded) and sponsors (Government/private). Microsoft Office Excel 2007 was used for tabulation and analysis. RESULTS: The search yielded total of 205 trials, out of which, 127 (62%) trials were interventional trials. Out of these, 71 (56%) were AYUSH interventions, 36 (28.3%) tested drugs, 9 (7%) tested a nondrug intervention, rest were nutraceuticals and vaccines. About 66 (56%) were therapeutic trials. Majority were single-centered trials, i.e. 87 (73.7%). Trials were government funded in 57 (48.3%) studies. Majority were randomized controlled trials, i.e. 67 (56.8%). AYUSH preparations included AYUSH-64, Arsenic Album, SamshamaniVati etc. CONCLUSIONS: The number of therapeutic interventional clinical trials was fair in India. A clear-cut need exists for an increase in both quantity and quality of clinical trials for COVID-19. Drug repurposing approach in all systems of medicine can facilitate prompt clinical decisions at lower costs than de novo drug development.

Adverse Drug Events in Patients with Mental Disorder in an Ambulatory Setting.

BACKGROUND: Although adverse drug events (ADEs) among inpatients occur frequently and are widely studied, few data are available on ADEs among outpatients with mental disorders. AIMS: To determine the rates, types, and severity of ADEs in patients with mental disorder. MATERIALS AND METHODS: Cross-sectional survey of patients with mental disorder attending outpatient department. Data were collected over a period of 6 months. RESULTS: A total of 400 patients (217 schizophrenia patients, 127 bipolar affective disorder patients, and 56 patients of depression) with a mean age of 32.1 ± 9.7(±standard deviation) participated in the study. Patients suffering from schizophrenia and all nonadherent patients reported significantly more ADEs (P < 0.05). Out of 343 patients (86%) who reported at least one ADE, majority (87%) reported central nervous system ADEs followed by weight gain (48%), gastro-intestinal (28%), skin (4%), cardiovascular (1%), and sexual dysfunctions (0.3%). Out of 673 ADEs reported, sedation (41%) and weight gain (25%) were reported most commonly. Most ADEs reported (76%) were mild; however, there were no life-threatening, fatal, or serious ADEs. The medication classes most frequently involved in ADEs were antipsychotics (72%) followed by sedatives (44%), antimanic drugs (32%), and antidepressants (27%). Patients on atypical antipsychotic drugs reported significantly more body weight gain (P < 0.05). More than three drugs were prescribed in 49% of patients who reported ADEs. CONCLUSION: The study data indicate high prevalence of ADEs in the outpatients on psychotropic medications.

Eagle's Syndrome: A New Surgical Technique for Styloidectomy.

The purpose of this paper is to discuss the current diagnosis of Eagle's syndrome (elongated styloid process) and to discuss a new and a much simpler technique for styloidectomy with an intraoral approach which can be used in local anesthesia. Easiness to perform, non-association of any anesthetic complications and avoidance of an extraoral scar dictates that this approach can be practiced much safely in patients with elongated styloid process.

A Comparative Study on Monotherapy with Metformin, Vit-B3, Vit- D, Chromium Piconilate and Lifestyle Modification in development of Type II Diabetes Mellitus in the Metabolic Syndrome Patients

Background: Metabolic syndrome is a combination of multiple risk factors that increases an individual chance of developing cardiovascular or type II diabetes mellitus and most of people with metabolic syndrome have Insulin resistance, which elevates the risk of developing Type II diabetes mellitus. While the pathogenesis of the metabolic syndrome and each of its components is complex and not well understood, central obesity and insulin resistance are acknowledged as important causative factors. Most scrutinized literature was collected from different sources including PubMed. This study was carried out at Govt. Chhattisgarh Institute of medical sciences Bilaspur. Aim: To compare the incidence of progression of metabolic syndrome into type II diabetes mellitus in patient who were put on one of the following treatments along with lifestyle modification :- Metformin, Chromium Piconilate ,Vitamin –D3 and Niacin (Vitamin. - B3). Methods: The objective of this study recruited 250 patient, aged between 35 to 60 years, who fulfilled the inclusion and exclusion criteria of Metabolic syndrome as per study design. Results: 250 Participants was enrolled during 3 years of the study. 125 (50 %) male and 125 (50 %) Female were found metabolic syndrome. A total (8%) of patient were found incidence of progression of metabolic syndrome into Type II Diabetes Mellitus. In different group as Metformin group-(0%), Niacin group (6%), Vit-D3 group (0%), Chromium Piconilate group (16 %) and (18%) in the lifestyle modification group. Conclusions: Metformin and Vit- D3 can reverse the effects of metabolic syndrome due to its broad effects on many of the components of metabolic syndrome; thus preventing diabetes and heart disease.

Comparative Evaluation of Various Treatment Modalities in Treating Diarrhoea Patients at a Tertiary Care Teaching Hospital

Background: Diarrhoea is described as three or more loose orwatery stools a day. Infection commonly causes acuteDiarrhoea. Noninfectious etiologies are more common as theduration of Diarrhoea becomes chronic. Hence; under the lightof above mentioned data, we planned the present study assessand compare the efficacy of various treatment modalities in theTreating diarrhoea patients.Materials & Methods: A total of 160 patients with diarrhoeawere included in the present study. All the patients werebroadly divided into four study groups with 40 patients in eachgroup: group 1- patients who were given Nitazoxanide therapywhile group 2- included patients who were given metronidazoletherapy, group 3- patients who were given cefixime therapy,and group 4 – patients who were given norfloxacin therapy.Stool samples were obtained from patients of both the studygroups for assessing the effectiveness of treatment therapy.Both clinical and microbiological success was recorded. All theresults were recorded and analysed by SPSS software.Results: Clinical success was recorded in 95 percent of thepatients of group 1 and it was recorded in 97.5 percent ofthe patients of group 2. Microbiological and clinical successamong subjects of group 3 was 90 percent and 92.5 percentrespectively. Microbiological and clinical success amongsubjects of group 4 was 92.5 percent and 92.5 percentrespectively. Non-significant results were obtained whilecomparing the efficacy of both the antibiotics in treatingdiarrhoea patients.Conclusion: All the antibiotics can be used with equal efficacyin treating diarrhoea patients.

Knowledge and awareness regarding biomedical waste management in dental teaching institutions in India- A systematic review.

OBJECTIVES: Proper handling, treatment and disposal of biomedical wastes are important elements in any health care setting. Not much attention has been paid to the management of Biomedical Waste (BMW) in recent years, in dental colleges and hospitals in India. The present systematic review was conducted to assess knowledge and awareness regarding BMW management among staff and students of dental teaching institutions in India. MATERIAL AND METHODS: A systematic review of relevant cross-sectional studies was conducted regarding BMW management in India in dental teaching institutions in India. Six studies were finally included in the present review after conducting both electronic and manual search like Pubmed, EMBASE etc. and after making necessary exclusions. Potential biases were addressed and relevant data was extracted by the concerned investigators. RESULTS: Six studies were finally included in the review. Colour coding of wastes was not done by 67% of the subjects in one of the studies conducted in Haryana. Almost all the subjects agreed to the fact that exposure to hazardous health care waste can result in disease or infection in another study. According to another study reports, none of the respondents was able to list the legislative act regarding BMW when asked. CONCLUSIONS: The results of the present review showed that knowledge and awareness level of subjects was inadequate and there is considerable variation in practice and management regarding BMW. There is a great need for continuing education and training programmes to be conducted in dental teaching institutions in India. Key words:Biomedical waste, knowledge, awareness, dentists, institution.

Oral health: How much do you know? - A study on knowledge, attitude and practices of patients visiting a North Indian dental school.

OBJECTIVE: This study was carried out to assess the knowledge, attitude and behavior among patients visiting the out-patient department (OPD) of Gian Sagar Dental College and Hospital, Rajpura. MATERIALS AND METHODS: A cross-sectional study was conducted on 642 subjects who visited the OPD of Gian Sagar Dental College and Hospital. A self-constructed questionnaire was given to each of the participant. Responses from the subjects were calculated in terms of numbers and percentages. RESULT: Three hundred six (48%) of the subjects had never visited a dentist before. 304 (47%) of the subjects still prefer other cleaning aids over toothbrush. 207 (32%) subjects were of the view that dental health has no effect on general health, whereas 219 (34%) subjects were of the opinion that tooth loss is a natural sequel of the aging process. CONCLUSION: There is a dearth of knowledge and careless attitude among people in regard to dental health. People need to be motivated and their concepts regarding the importance of dental health should be made clear through various campaigns and personal counseling.

Study of Prescription Pattern of Antihypertensive Drugs in Medical OPD in SGT Medical College and Hospital, Gurugram

Objectives: Present study was conducted to find out currenttrend of drug prescribing of antihypertensive drugs prescribedeither as monotherapy or in combinations. As well as variationswere seen in prescribing drugs with regards to the age, sex.Materials & Methods: An observational, prospective, crosssectional study involving 120 prescriptions for patients ofessential hypertension was conducted in the outpatientdepartment of Medicine SGT Medical Hospital, Faculty ofMedicine and Health Sciences, Gurugram. The blood pressure(BP) measurement was done at the time of enrolment andother patient information like demographics and the drugdetails were recorded in Performa sheet. Data obtained wereanalyzed and expressed in percentage.Results: 71 males and 49 female of essential hypertensionpatients were included in study. Most of patients were in theage group of 40 -49 years constituting 72.5 % of total 120patients. 52 patients were on mono therapy 64 (53%) ofpatents were put on Dual therapy and few patients 4 (3.33%)were on Triple therapy. Out of 52 patients those were on monotherapy maximum patients were put on angiotensin receptorblocker (38.46%) and 11.54% of patients were takingAngiotensin converting enzyme inhibitor. 64 patients wereprescribed with Dual therapy. Out of these 46.9% of patientswere prescribed with ARB + Diuretics and nearly 2% patientswere on ARB + β blocker combination therapy. Only fourpatients were taking Triple therapy, 50% of patients were onCCB + ARB + Diuretics and 50% were on CCB + ACEI +Diuretics.Conclusions: Hypertension is more prevalent in male patientsthan female patients. ARBs (38.46%) were the most commonsingle drugs used for most of the uncomplicated essentialhypertension followed by CCBs (36.54%) ARB prescription asmonotherapy may be increases because of few or minimal sideeffects caused by them. Most common mode of treatment ofhypertension was Dual therapy or triple therapy combinationtherapy fixed dose combinations (56%). In the FDCs ARB +Diuretics (48%) were most preferred combination for treatmentof hypertension then CCB + β blocker (30%) and only 9% ofpatients were treated on ACEI based FDCs. Only 44% ofpatients were prescribed with drugs mentioned in the nationallist of essential medicine (NLEM). Prescribing drug from NLEMshould be encouraged to reduce the burden of treatment coston the patients. ARB were the most preferred drug for thetreatment of hypertension may be because of low toxicity andfewer side effect, easily available in the market.

A clinical study of cysts of the maxillofacial region; and an assessment of clinico-radiologico-pathological variables affecting the formulation of a comprehensive patient need based treatment plan.

OBJECTIVES: Evaluation of clinical presentation of cystic lesions of the maxillofacial region, their relation to radiological picture, and treatment planning so as to plan and execute a patient need based treatment modality after co-relating it to the eventual histopathological diagnosis. METHODS: 25 cases with clinico-radiological diagnosis of a cyst were selected and treated, and the diagnosis was co-related to the eventual histopathological diagnosis. The patients were followed up for at least 3 months (3-12 months). An attempt was made to underline patient and lesion related variables having a bearing on the choice of treatment modality in each case. RESULTS: Out of 25 patients, 28% were females and 72% males. Commonly affected age groups were 11-20 (40%) and 31-40 years (24%). 76% of 25 patients complained of swelling on the first visit. 96% lesions were related to jaws, of which 15 were in the mandible and 9 were in the maxilla. 58.33% bone lesions had cortical expansion. 92% lesions were confirmed to be cysts histopathologically. Two were ameloblastomas. 80% patients underwent enucleation with various adjunctive procedures. 32% patients faced temporary post operative complications. No recurrences were observed. Radiological presentation of lesions and patient's age were found to be the two most important radiological and clinical variables affecting treatment planning. CONCLUSIONS: A comprehensive patient need based treatment plan can be reached only after taking various patient and lesion related variables (which may manifest as clinical, radiological or histological parameters) into consideration.

Knowledge, awareness and practice regarding needle stick injuries in dental profession in India: A systematic review.

BACKGROUND: Hundreds of thousands of healthcare workers remain susceptible to deadly viruses throughout the year, including blood-borne pathogens. Needle stick injuries (NSI) constitute one of the most common occupational health hazards in healthcare profession. Dental professionals are at more risk of acquiring NSI due to their limited and restricted working area. The present systematic review was carried out to determine knowledge, awareness and practice regarding NSI in dental professionals and students in India. MATERIALS AND METHODS: A systematic review of cross-sectional studies available in the literature on the knowledge, attitude and practice among dental professionals and students in India was carried out. We identified relevant articles through electronic and manual search such as Pubmed and MEDLINE. Two investigators independently identified studies that were included in the review. RESULTS: Four articles were finally selected for inclusion in the review. All the studies were done involving dental students; 89.23% of the students had correct knowledge about NSI and 91.55% of the students had adequate level of awareness regarding its management in one of the studies. Also, 89% of students in one of the studies were aware of taking post-exposure prophylaxis after accidental NSI. In another study, 44% of the students destroyed the needles using a needle destroyer and 15% destroyed them in puncture-resistant containers. CONCLUSION: The knowledge and awareness of the dental students is adequate, although there is considerable variation in practice and management of NSI among different studies. There is a need for more studies involving dental professionals.

Drug utilization study in diabetic patients seeking medical treatment in a north Indian rural medical college hospital

Background: Diabetes Mellitus is a chronic disease and its life-long management causes burden on lifestyle and financial condition of the patients. Drug utilization studies provide useful insights into the current prescribing practices.Methods: To evaluate the drug utilization pattern of anti-diabetic drugs in diabetic patients. A prospective observational study was carried out in adult diabetic patients visiting the Wards and Outpatient Department of General Medicine of a tertiary care hospital. The demographic data and utilization of different classes of anti-diabetic agents as well as individual drugs were analyzed.Results: In 125 patients (Male-65, Female-60), a total of 379 drugs (average 3.032±2.05) were used per day, out of which 76 (20.05%) were rational fixed dose combinations (FDCs) and 261 (68.86%) were prescribed from National List of Essential Medicines (NLEM) 2015. The number of drugs prescribed to be ingested was 326 (86.01%) and 63 (16.62%) were injectables.Conclusions: It was found that the prescription tendencies of the doctors were quite rational. More improvement can be done by sensitizing them to prescribe more drugs from NLEM. The limitations in the affordability of rural population should be taken care of while prescribing drugs for this chronic disease.

Clinical and critical care concerns of cranio-facial trauma: A retrospective study in a tertiary care institute.

BACKGROUND AND OBJECTIVES: Maxillofacial trauma is commonly associated with other injuries, predominantly head injuries. The predictors of outcome in such concomitant injuries have been studied the least. The present study aims at the evaluation of types of injury, management and outcome of patients sustaining maxillofacial trauma and concomitant cranial injuries. MATERIALS AND METHODS: A retrospective study was carried out in the department of anesthesiology and intensive care. A case series of 129 patients was evaluated who were admitted in ICU (Intensive Care Unit) with maxillofacial trauma and head injuries. The data was then compiled systematically and analyzed using SPSS windows and value of P < 0.05 was considered significant and P < 0.001 as highly significant. RESULTS: Among the 129 patients, majority of them had roadside accidents (RSA > 90%) and male gender predominance with male to female ratio of 5: 1. Fracture maxilla and nasal bones were the most commonly encountered injuries (51.93%) followed by mandibular fractures (39.53%) and fracture of zygomatic bones (28.68%). Eighty five patients (65.90%) required mechanical ventilation, tracheostomy was needed in 29 (22.48%) patients and 81 (62.8%) patients were operated for head injuries as well. Majority of the victims were aged between 15 and 40 years. CONCLUSIONS: Maxillofacial trauma and cranial injuries are common among young males and so is the nature of injuries, that is, RSA. Besides facial injuries, head injuries are important determinant of outcome in such patients. Timely resuscitation and surgical interventions at specialized centers are of prime importance as far as a better prognosis is concerned in such injuries.

Monitoring of incidence, severity, and causality of adverse drug reactions in hospitalized patients with cardiovascular disease.

BACKGROUND: Patients admitted to cardiology department are mostly on polypharmacy. So drug-drug interactions and adverse effects of drugs are quite common. Yet, there is a paucity of data regarding adverse drug reaction (ADR) monitoring in cardiology department in India. The present study is an effort to fill up these lacunae. MATERIALS AND METHODS: A prospective, observational study registering 966 indoor cardiology patients according to predetermined inclusion and exclusion criteria was conducted for one year. ADR profile was noted by spontaneous reporting and intensive monitoring. Naranjo ADR probability scale was used to establish the causality. RESULTS: A total of 208 ADRs were reported from 188 patients (19.5%). Of these 188 patients, 62 patients (33%) were hospitalized primarily due to the development of ADRs, while 126 (67%) patients developed ADRs during hospital stay. Nitrates were the most common offender drug group (17.8%). CONCLUSION: Development of ADR in one of every five cardiac patient points toward a grave situation, but a higher incidence of Type A reactions in cardiology department means that these can be avoided.

Dexmedetomidine and fentanyl combination for procedural sedation in a case of Duchenne muscular dystrophy.

Duchenne muscular dystrophy, an X-linked disorder characterized by progressive muscle weakness, is the most common muscular dystrophy among children leading to death before the end of third decade. Anesthesia in such patients pose a great challenge due to various complications associated with it. The dreaded metabolic and clinical complications occur due to various inhalational anesthetics and succinylcholine in this subset of patients. We are reporting a child with diagnosed Duchenne muscular dystrophy who underwent excision of dentigerous cyst in oral cavity under procedural sedation with combination of dexmedetomidine and fentanyl and thus administration of general anesthesia was avoided.

Designing, managing and improving the operative and intensive care in polytrauma.

BACKGROUND AND CONTEXT: Polytrauma is a leading cause of mortality in the developing countries and efforts from various quarters are required to deal with this increasing menace. AIMS AND OBJECTIVES: An attempt has been made by the coordinated efforts of the intensive care and trauma team of a newly established tertiary care institute in designing and improving the trauma care services to realign its functions with national policies by analyzing the profile of polytrauma victims and successfully managing them. MATERIALS AND METHODS: A retrospective analysis was carried out among the 531 polytrauma admissions in the emergency department. The information pertaining to age and gender distribution, locality, time to trauma and initial resuscitation, cause of injury, type of injury, influence of alcohol, drug addiction, presenting clinical picture, Glasgow Coma score on admission and few other variables were also recorded. The indications for various operative interventions and intensive care unit (ICU) admissions were analyzed thoroughly with a concomitant improvement of our trauma care services and thereby augmenting the national policies and programs. A statistical analysis was carried out with chi-square and analysis of variance ANOVA tests, using SPSS software version 10.0 for windows. The value of P<0.05 was considered significant and P<0.0001 as highly significant. RESULTS: Majority of the 531 polytrauma patients hailed from rural areas (63.65%), riding on the two wheelers (38.23%), and predominantly comprised young adult males. Fractures of long bones and head injury was the most common injury pattern (37.85%) and 51.41% of the patients presented with shock and hemorrhage. Airway management and intubation became necessary in 42.93% of the patients, whereas 52.16% of the patients were operated within the first 6 hours of admission for various indications. ICU admission was required for 45.76% of the patients because of their deteriorating clinical condition, and overall,ionotropic support was administered in 55.93% of the patients for successful resuscitation. CONCLUSIONS: There is an urgent need for proper implementation ofpre-hospital and advanced trauma life support measures at grass-root level. Analyzing the profile of polytrauma victims at a national level and simultaneously improving the trauma care services at every health center are very essential to decrease the mortality and morbidity. The improvement can be augmented further by strengthening the rural health infrastructure, strict traffic rules, increasing public awareness and participation and coordination among the various public and private agencies in dealing with polytrauma.