Background: Drug utilization evaluation is conducted to determine the rational use of drug by describing the drug usage pattern. This study aimed to describe the drug utilization pattern of metformin and its oral formulations. Objectives: The objectives of the study were to identify the prescribing pattern of metformin in fixed-dose combination (FDC), along with adjuvant antidiabetic therapy and it is prescribing in different formulations. Methodology: This is an observational study in which a total of 100 type 2 diabetic patients visited to or admitted in General Medicine Department, Dhiraj General Hospital , Piparia, Vadodara, were included as per our inclusion criteria. Result: Among 100 type 2 diabetic patients, 15 patients received monotherapy and 85 patients received combinational therapy of metformin. Out of 120 FDCs of metformin prescribed in 100 patients, plain (conventional release) formulations were most commonly prescribed (39.17%). Among FDC therapy of metformin, glimepiride + metformin, and glimepiride + pioglitazone + metformin combinations were most commonly found. As an adjuvant therapy with metformin, human analog insulin was most commonly prescribed. The sulfonylureas (SUs) were found to be the most commonly prescribed oral antidiabetic drug class along with metformin (SUs). In this study, we found 49% of the patients receiving metformin with low medication adherence. Conclusion: The practice of metformin monotherapy is limited and it is frequently prescribed in combinations with other antidiabetic agents. We observed an almost equal utilization of different oral formulations of metformin. A low medication adherence with metformin emphasizes the need for appropriate patient counseling and therapeutic interventions.

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Introduction: Most patients go to dental offices nowadays looking for an esthetically pleasant smile, being stimulated by the esthetic patterns suggested by the society which associate a beautiful smile to success. The role of a dentist is to provide the best functional as well as esthetic restoration to the child as per his needs. Subjects and Methods: It is a questionnaire-based observational study. Questionnaire-based photographs (six in number) distributed among 400 parents who came with their children (<5 years) to the malls of Vadodara city. Each photograph showed different conditions of smile, namely, nonspaced dentition, spaced dentition, carious teeth, traumatic injury, teeth with plaque, and missing teeth. Each parent was asked to grade them in ascending order of appearance of the photographs as per their esthetic view. The parents were also asked to grade numerically from 1 to 6 in ascending order. Results: A descriptive statistical analysis was carried out in the present study. Results on continuous measurements were presented on mean ± standard deviation and results on categorical measurements were presented in number (%). Perception of esthetics given by parents with preference and position is as follows: nonspaced dentition, teeth with plaque, spaced dentition, traumatic injury, carious teeth, and missing teeth. Conclusions: It was concluded that parents are more concerned about the cleanliness and structure of their child's teeth which can create and play a role in esthetics.

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Background: Muscular flexibility is an essential aspect of normal human function. Flexibility can be gained by a variety of stretching techniques and other techniques, yet little work has been performed to compare these techniques. The objective of this study was to compare the effectiveness of muscle energy technique (MET) and positional release technique (PRT) on hamstring flexibility in healthy individual participants. Methods: Twenty-four healthy participants who met the inclusion criteria were randomly divided into two equal groups. Two groups following a home-based 2 weeks' (five 10 min sessions per week) hamstring stretching protocol (stretching performed by MET or by PRT). The range of motion (ROM) of knee extension was measured before and after stretching program by means of active knee extension test and active straight leg raise using universal goniometer. Results: There was a significant improvement in hamstring flexibility following the application of MET and PRT. However, increase in knee extension ROM was higher in MET compared to PRT. The change in the flexibility from the value at initial evaluation to after 2 weeks' intervention was also higher in the MET. Conclusion: The findings suggest that the MET is more effective than PRT for healthy individuals with normal and limited hamstring flexibility.

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The health care industry is currently undergoing a massive and irreversible transformation and change. Time is approaching when telemedicine/e-health initially shall be visibly practiced in majority of the Indian hospitals as a separate department before eventually fusing into respective medical specialties in spite its slow growth in India. This review appraises current scenario of telemedicine and telehealth in India. Official documents belonging to the Health ministry and finally related literature were examined. Telemedicine can enhance basic/specialty healthcare for India’s population which is predominantly rural. Indian Medical Personals, by large are not computer savvy’s, virtually lack awareness and exposure with regard to the application of information and communication technology in Medicine. These are foremost bottlenecks to the growth of Telemedicine in India. The present study outlines telemedicine strong and weak points. Undoubtedly, the advantages outweigh its disadvantages, but just like any other innovations, it has some drawbacks.

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An 18-day-old female baby presented with a swelling arising from the hard palate; and presenting with a difficult breast feeding and difficult airway or obstruction is a rare condition. It may range from a simple dermoid cyst to malignant neoplasms. Airway management of this baby was very difficult and quite challenging. The airway was secured with inhalation induction and spontaneous ventilation. ta

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Background - Even after more than 60 years of independence, access to safe water and sanitation facilities remains a formidable challenge in developing countries including India. Objectives - To assess the drinking water management practices among residents of urban field practice area of a tertiary care teaching centre in northern India. Methods - The present cross sectional survey was conducted among 405 residents of the urban field practice area of a tertiary care teaching centre located in district Farrukhabad of Uttar Pradesh. After filling the questionnaire, the free chlorine in the drinking water of the households was determined by using O-Toluidine test. Results - Majority (85%) of the households were depending on the municipality water supply. 72.1% of the population does not use any method to treat water in their households. 6.9% of the respondents strained the water through the cloth whereas 2.7% of the houses boiled water before consumption. 43.95% of study subjects dipped a glass into the storage vessel using their hands to take water from storage vessel for drinking purpose whereas only 17.78% of the people used a tap to collect water for drinking. The OT test did not yield any positive result in surveyed households. Conclusion - Safe sources alone do not guarantee of providing safe and healthy water supply to the houses, this should be supported by the safe treatment and storage practices of drinking water at household level. Therefore it is need of the hour to launch IEC activities so as to improve the storage and handling practices of drinking water.

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Dental calculus is defined as an adherent, calcified, or calcifying mass that forms on the surface of teeth and dental appliances. Calculus plays a key role in maintaining and accentuating periodontal disease by withholding the plaque in close contact with the tooth surface and gingival tissue, leading to various pathological changes, thereby creating areas where plaque removal is impossible. The distribution of calculus is very versatile and it differs from individual to individual, from tooth to tooth, and from surface to surface. At certain period of time, the maximum level of calculus formation occurs after which a reversal phenomenon takes place, in reversal phenomenon is the decline from maximal calculus accumulation. This case report describes a case of patient with extensive calculus deposits.

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Fixed drug eruption (FDE) is a form of drug induced dermatosis condition. Drugs which most commonly induce FDE are antibiotics, anticonvulsants, antiviral agents and even nonsteroidal anti-inflammatory drugs. Here, we report a case of 50-year-old male with history of hepatosplenomegaly for which he was treated at a regional hospital and was prescribed with tablet ofloxacin (200 mg). The patient visited the pulmonary medicine department of our hospital for respiratory complaints and a dermatological reference was made for skin lesions. The findings concluded the case as a drug-induced FDE with pulmonary tuberculosis (TB). The offending drug (tablet ofloxacin) was withdrawn and suitable treatment was provided for FDE and pulmonary TB. One-month follow-up visit reported no fresh respiratory complaints and resolution of skin lesions. Based on this case report, it can be concluded that though FDE is not a common ADR of ofloxacin, caution must be addressed before prescribing it to the patient. For confirmed cases, it is essential to provide education and counseling to the patient and care giver to prevent its recurrence in future.

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Introduction: The levels of blood pressure (BP) are important as it is a potential risk factor that predisposes towards cardiovascular disease (CVD) when the levels are high. After the introduction of the term prehypertension by Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) (2004), there are heightened interests on the correlation between high-normal levels of BP with CVD risk factors. Methodology: A questionnaire containing information about eating habits, family history and social habits was given out. Other than that, anthropometric measurements were taken according to the protocol provided by the United States Institutes of Health. Results: There were a total of 87 respondents that participated in the study. The overall prevalence of prehypertension and hypertension was 40.2% (46.9% - males; 32.7% - females) and 2.3% (male) respectively. Also, it was found that 57.1% of male and 40% of female with increased WC and 75% of male and 33.3% of female with increased WHR have prehypertension. It was also found that subjects with a positive family history of hypertension, diabetes and stroke have a higher tendency towards prehypertension. Conclusion: There is a high prevalence of prehypertension among males compared to female and that there are positive correlations between the CVD risk factors with prehypertension.

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Objectives: To assess the incidence rate of OSMF and its etiology in patients attending OPD at GDCH, Jamnagar. Material and Methods: The diagnosis of OSMF was based on clinical examination and evaluating patients “signs and symptoms. Results: The total number of patients affected by OSMF in this time duration was 268. Out of these, 230 (85.82%) were male, while 38 were female (14.18%). Therefore, male: female (M:F) ratio was 6:1. 104 males in the age group of 21-30 years constituted a single majority. Conclusion: This study reveals that the incidence rate of OSMF in patients visiting GDCH, Jamnagar was 1%. Males were more affected than females. It was seen that the major etiological factors in the development of OSMF was areca nut and gutkha usage by the patients.

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Objective: The present investigation aims to study the protective role of n-butanol extract of Nyctanthes arbor- tristis on antioxidant tissue defense system against doxorubicin induced cardiotoxicity in rats. Methods: Wistar rats were divided into various treatment groups. Doxorubicin (3mg/kg, i.p.) (DOX) was used to induce cardiotoxicity. N-butanol extract of Nyctanthes arbor-tristis (100 and 300 mg/kg, p.o.) and Vitamin E (25 mg/kg, p.o.) were administered for 15 days. ECG changes, biochemical parameters (LDH, SGOT, CPK), relative organ weight, antioxidant levels (SOD, GSH, LPO) and histopathological changes were recorded at the end of treatment schedule. Results: DOX treated animals showed elevation of QRS complex and a significant (p<0.05) elevation in levels of SGOT, CPK, LDH and LPO and a significant (p<0.05) reduction in relative organ weight, GSH and SOD. Histopathological changes like nuclear changes, vacuolated myocytes, cell necrosis, dilated vessels, partial loss of myofibrils were observed in the DOX treated group. Animals co-administered with n-butanol extract of Nyctanthes arbor-tristis (100 and 300 mg/kg, p.o) and vitamin E (25 mg/kg, p.o.) in DOX treated animals showed significant (p<0.05) protection of all the above parameters as compared to DOX treated animals alone. Conclusion: The beneficial effect of Nyctanthes arbor-tristis against cardiotoxicity could be attributed to its antioxidant potential.

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Introduction: Nipah virus (NiV) and Hendra virus are the type species of the highly pathogenic paramyxovirus genus Henipavirus, which can cause severe respiratory disease and fatal encephalitis infections in humans. NiV contains two envelope glycoproteins, the receptor-binding G glycoprotein (NiV-G) that facilitates attachment to host cells and the fusion (F) glycoprotein that mediates membrane merger. The attachment glycoprotein (NiV-G) on the surface of the virus is an important virulent factor and a promising antiviral target. In vitro, favipiravir inhibited Nipah and Hendra virus replication and transcriptionat micro molar concentrations. Experimental: In this study, we had designed ten bioisosteres of favipiravir containing pyrazine or quinoxaline moeity to identify novel inhibitors of Nipah virus using different in silico methods. The molecular docking studies were performed using iGEMDOCK2.1. Drug likeness of the compounds was predicted using SwissADME online tool. In silico toxicity studies were performed using ProTox-II. The comparison of in silico results were done with standard drug favipiravir. Results: In the docking studies, eight compounds showed significant inhibitory activity with low docking score as compare to standard drug. All the designed molecules had drug likeness properties and predicted to be nontoxic. Conclusion: These findings indicate that the novel bioisosteres of favipiravir have promising potential to target NiV-G/ephrin interactions to disrupt viral entry and provide the foundation for structure-based antiviral drug design.

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Introduction: Organophosphates (OP) are irreversible cholinesterase inhibitors, producing nicotinic and muscarinic effects. Cardiac complications with these compounds are often fatal. Early recognition of abnormal rhythm protects the patients against acquiring life-threatening arrhythmias. Hence, this study was done to determine the ECG findings in patients with OP poisoning. Aims & Objectives: To determine the various electrocardiographic changes & its importance in acute Organophosphate poisoning. Materials and methods: This prospective observational study of 50 cases was conducted for 2 years in a tertiary care institute. All adults with history of OP poisoning, admitted within 12 hours were enrolled. Patients with cardiac disease or treated from outside were excluded. Diagnosis was made by history, clinical features and confirmed by serum cholinesterase level. ECG analysis of each case was done for rate, rhythm, ST-T changes, PR and QTc intervals, and conduction defects etc. Results: Mean age in the study group was 30.66 ± 11.70(SD). Male:Female ratio was 1.94:1. 78% were suicidal, 22% were accidental and 6(12%) cases expired. Most common mode of poisoning was ingestion 45 cases (90%). Most common ECG abnormality was Sinus Tachycardia in 12(24%) followed by ST-T changes 8(16%), QTc prolongation in 6(12%), Sinus Bradycardia 4(8%), Extrasystole 2(4%), PR Prolongation 1(2%), AF 1(2%) and VT 1(2%). Conclusion: Poisoning with OP compounds can produce significant ECG abnormalities especially sinus tachycardia, non specific ST-T changes and QTc interval prolongation. Since these abnormalities can cause lethal arrhythmia and cardiac damage, careful observation of the electrocardiogram of the patients exposed to OP compound is necessary, parallel to the appropriate medical management.

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Introduction : PAD is an atherosclerotic occlusive condition in which plaque builds up in the distal arteries. Until 10 years ago, conventional angiography and digital subtraction angiography were the only angiographic techniques used in peripheral vascular disease and are considered gold standard. However, the complications and patient discomfort associated with these techniques have prompted the need of less invasive means of assessing the peripheral arterial system. Aim of the study was to compare efficacy of USG and MDCT angiography for investigating the lower limb arterial disease. Method: 40 patients suspected of lower limb PAD were included. Patients with previous amputation surgery were excluded. In all patients color Doppler sonography and multi-detector CT angiography was done. A comparative study of multi-detector CT angiography and color Doppler sonography was undertaken. Result: 50% patients had complaints in left lower limb and 25% in right lower limb. 22% had bilateral lower limb pain which was more on the left side (12%). Three patients examined by angiography showed irregularity of arterial wall on both sides, which appeared as calcifications on CT angiography (sensitivity 100%) while only 2 of them appeared on color coded Doppler examination (sensitivity 75%). Conclusions: Color Doppler USG is the initial modality of choice in PAD. CT Angiography is a better for segmental length assessment, collateral circulation along with a road map reproduction of the arterial system. USG is better than CT angiography in diagnosis of Grade 1 &2 cases, with better assessment of soft plaques, segmental flow and recanalization in PAD.

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Background: Dermatophytosis is a type of superficial fungal infection which is a cause of significant morbidity especially in the Indian subcontinent. One of the major causes of the rising trend in the incidence of dermatophytosis is the unwarranted use of steroids in the management of fungal infection. Methods: A cross sectional study of dermatophytic fungal infections was carried out with research question of ‘Is steroid formulation abused in dermatophytic infections? What are their effects and side effects?’ All patients of dermatophytic infection were primarily selected over period of six months of which patients who had history or findings of some form of steroid use were further analyzed. Quantitative and qualitative data were collected in regards to steroid formulations about type, duration of use, route of administration and their availability by prescription or “over the counter”. Dermatological signs of steroid use were noted. Results: Of total 180 patients of dermatophytosis, 72 patients (40%) had used steroid formulations either topical (52), intralesional (9) or injectable (11) and 108 did not. Most patients (50 of 72) (69%) were from rural background and had long mean duration of illness (24 ± 3 weeks). Multiple site infection of dermatophytosis was present in 60 of 72 (83%) and in 51of 108 (47.22%) in steroid misuse and in non-steroid use patient group respectively. Cutaneous adverse effects were common in steroid modified dermatophysis patients. Unauthorized use of steroid was in form of self application, over the counter availability, use of steroid preparation of relatives and others. Conclusions: Misuse of steroid formulations in dermatophytic infections may lead to adverse effect as well as chronicity. Awareness of this problem is needed for prevention of steroid modified dermatophytosis, which is a rising menace.

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Background: Periodontitis is a multifactorial chronic inflammatory disease. It occurs due to inflammation and tooth-supporting tissues destruction by subgingival microbiota. Anti-infective therapy has been accepted as the cornerstone of periodontal treatment. Aim: The aim of the study was to evaluate the efficacy of doxycycline as adjunct to scaling and root planing in treatment of chronic periodontitis. Materials and Methods: A total of 52 participants having moderate to severe chronic periodontitis were included and divided into 2 groups: Group A (Test group-SRP+Doxycycline) and Group B (Control group-SRP alone). Plaque Index (PI), Gingival Index (GI), Probing Depth (PD) and Clinical Attachment Level (CAL) were assessed at baseline and 3 months interval. Result: Significant differences were seen from baseline to 3 months in both test and control groups in terms of reduction in PI, GI, PD and gain in CAL (P<0.001). Inter-group analysis showed significant differences between the two groups after 3 months, with GI, PD and CAL with P-value <0.001. Conclusion: At the end of 3 months, Doxycycline showed better results after mechanical therapy in the treatment of patients with chronic periodontitis because it has an anticollagenase effect that can inhibit tissue destruction and aid bone regeneration.

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Extranodal filariasis occurs rarely and breast is an uncommon site for filariasis . The present case is of 23 yrs old female with a painless lump in the left breast involving upper outer quadrant. Provisional clinical diagnosis was Fibroadenoma, left breast. However, cytology smears showed clusters of degenerated ductal cells and several Microfilaria larvae. Thus, a definitive diagnosis of Filariasis, left breast was made. Patient was put on conservative treatment and recovery was uneventful. Therefore, simple yet effective mode of cytological diagnosis was able to avert an unnecessary biopsy/ lumpectomy in this patient.

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Porencephaly is an extremely rare disorder of the central nervous system defined as a ‘fluid-filled defect communicating with ventricles or separated from them by a thin layer of brain tissue and covered on the outside by arachnoid’ and is found to be associated with COL4A1 mutation. Its diagnosis depends on demonstrating a well-defined CSF-filled space-occupying lesion communicating with ventricles on CT scan or MRI of brain. There has been no report of porencephaly associated with myesthenia gravis till now. We present a case of porencephaly who presented with altered sensorium and myesthenia gravis to highlight the point that although rare at present, its incidence may increase in future. The best way to contain the increase in incidence of porencephaly is genetic counselling and prenatal testing in affected individuals and those at risk. This will also help in restricting increase in other disorders related to COL4A1 mutation.

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Introduction: Donor corneas obtained by eye banks are steadily increasing all over the world. Proper evaluation of donor cornea is critical to the success of cornea transplantation. Objectives: To analyse results of screening test done before corneal tissue transplantation. Methods: Blood samples were collected at the time of enucleation of the eye from 947 consecutive cornea donors. The samples were tested for Antibodies of Human Immunodeficiency virus I & II (HIV), Hepatitis B virus (HBV), and Hepatitis C virus (HCV) & Treponema pallidum. Results: In our study sero-prevalence of HIV, HBV, HCV & T. pallidum in eye donors are 1.58%, 0.52%, 0.10 and 0.21% respectively. Conclusion: The study suggests that all the cornea donors should be screened for HIV, HBV, HCV & T. pallidum by serological test like standards followed in Blood banks of India.

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Introduction: Diabetes mellitus predisposes to infection. Clinical data on infections in diabetes mellitus patients from rural areas of India are lacking. We intended to determine the clinical profile and pattern of infections in type 2 diabetes mellitus patients in rural area. Methods: This prospective observational study was conducted in type 2 diabetes patients admitted in Medicine department at a tertiary care hospital from December 2014 to November 2015. Results: In this study, 627 patients with diabetes mellitus admitted during December 2014 to November 2015 were observed. Out of these 627 patients 263 had various types of infections. Maximum number of patients belonged to age group of 46 to 60 years and there was male predominance. The commonest comorbidity was hypertension (51.33 %). Common infections encountered were urinary tract infection (40.30 %), respiratory tract infection (28.90 %) and Skin and soft tissue infections (12.93 %). Escherichia coli, Candida, Klebsiella pneumonaie and Staphylococcus aureus were the common causative organisms of all these infections. Conclusion: Physicians should be aware of risk factors and type of infections present in patients with diabetes in order to provide proper care and for their prevention.

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Background: QOL is a wide based subject and multifaceted topic dependent on culture, beliefs, and social and environmental factors etc., it is expected that a comprehensive evaluation with available tools in an Indian population would give more insight and awareness to their problems and limitations. Objective: The main aim of the current study was to asses QOL, Functional independence and functional limitations related to joints of adult Hemophilia patients. Methods: Adult male patients age equal or greater than 18 years with factor viii or ix deficiency and who were willing to participate and given consent were included in the study. The data were collected by getting the self- reported outcome measures filled, the WHOBREF – QOL, and the objective functional instruments Functional independence score of hemophiliacs (FISH) and GILBERT joint score administered by the researcher. The data were analyzed with Pearson correlation analysis, non -parametric test and Regression analysis to find out the variability. Results: The result showed that the functional components like transfer and locomotion were mainly determined by joint bleeds and total joint score respectively. And the moderate bleed groups were different in terms of pain, total joint score, transfer and total functional independence. Conclusion: More the bleed in the joints leads to reduced joint function and functional independence of hemophiliac patients, affects their health related quality of life.

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