Background: Response to corticosteroid therapy remains the single most important determinant of prognosis in primary nephrotic syndrome, yet no biochemical test reliably identifies steroid-resistant patients before treatment is started. Urinary beta-2 microglobulin (B2M), a marker of proximal tubular injury, has been proposed as such a predictor. Methods: In this prospective study conducted in the Department of Nephrology, Bangladesh Medical University from November 2018 to November 2019. It includes 147 adults with biopsy-confirmed primary nephrotic syndrome underwent measurement of urinary B2M, serum creatinine, serum albumin, and 24-hour urinary total protein before and after a sixteen-week course of oral corticosteroid therapy. Steroid responsiveness was determined at the end of treatment. Receiver operating characteristic (ROC) analysis and multivariable logistic regression were used to assess the predictive value of pre-treatment urinary B2M. Results: Thirty-two patients (21.8%) were steroid resistant. Pre-treatment urinary B2M was significantly higher in steroid-resistant than steroid-sensitive patients (median 708.1 versus 531.4 µg/mmol creatinine, p<0.001) and discriminated between the two groups with an area under the ROC curve of 0.83 (95% confidence interval [CI] 0.76–0.89). At a cut-off of 631.2 µg/mmol creatinine, sensitivity was 84.4% and specificity was 73.9%. On multivariable analysis, pre-treatment urinary B2M remained an independent predictor of steroid resistance (adjusted odds ratio 2.12 per 100 µg/mmol increment, 95% CI 1.18–3.82, p=0.012), together with serum albumin and serum creatinine. Conclusion: Pre-treatment urinary B2M is an independent and reasonably accurate, though imperfect, predictor of steroid resistance in primary nephrotic syndrome and could support earlier risk stratification before corticosteroid therapy is started.
Introduction The acquisition and retention of militarily relevant surgical knowledge and skills are vital to enable expert management of combat casualties on operations. Opportunities for skill sustainment have reduced due to the cessation of combat operations in Iraq and Afghanistan and lack of military-relevant trauma in UK civilian practice. Methods A voluntary, anonymous online survey study was sent to all UK Defence Medical Services (DMS) surgical consultants and higher surgical trainees in Trauma and Orthopaedics, Plastic and Reconstructive, and General and Vascular surgical specialties (three largest surgical specialties in the DMS in terms of numbers). The online questionnaire tool included 20 questions using multiple choice and free text to assess respondents’ subjective feelings of preparedness for deployment as surgeons for trauma patients. Results There were 71 of 108 (66%) responses. Sixty-four (90%) respondents were regular armed forces, and 46 (65%) worked in a Major Trauma Centre (MTC). Thirty-three (47%) had never deployed on operations in a surgical role. Nineteen (27%) felt they had sufficient exposure to penetrating trauma. When asked ‘ How well do you feel your training and clinical practice prepares you for a surgical deployment?’ on a scale of 1–10, trainees scored significantly lower than consultants (6 (IQR 4–7) vs 8 (IQR 7–9), respectively; p<0.001). There was no significant difference in scores between regular and reservists, or between those working at an MTC versus non-MTC. Respondents suggested high-volume trauma training and overseas trauma centre fellowships, simulation, cadaveric and live-tissue training would help their preparedness. Conclusions There was a feeling among a sample of UK DMS consultants and trainees that better preparedness is required for them to deploy confidently as a surgeon for combat casualties. The responses suggest that UK DMS surgical training requires urgent attention if current surgeons are to be ready for their role on deployed operations.
Introduction Musculoskeletal injuries sustained during training are not only the major cause of loss of training hours but also lead to attrition of precious workforce. Detailed knowledge of the pattern, type, mechanism of musculoskeletal injury, etc., helps in designing prevention strategies. Hence, the study was conducted to study the epidemiology of injuries sustained by trainees while undergoing training at an institutional training. Materials and Methods The study is a record-based observational study. The data relating to training-related injuries sustained over 5 years (April 2014 to March 2019) were obtained from the record maintained in the medical facility of the training institute in India. The data were extracted using a case record form. The injury data (date of injury, unique identification number, trainee name, diagnosis, and type of treatment taken) were obtained from the medical record register maintained in the medical facility of the training institute. Anthropometric data (height and weight) were obtained from the record of initial medical screening done routinely on the day of joining the training institute. The descriptive analysis of the collected data was done. Results A total of (n = 2946) trainees comprising 2584 male trainees and 362 female trainees underwent training during the period of the study. The total number of visits to the medical facility related to injury during the 5-year study period was 13,579. Most of the injuries are occurring in the 5th–20th week in the first half of training period and 29–44 week in the second half of training period. Among male trainees, the lower limb injuries alone accounted for 72.8% of total injuries, followed by trunk and back injuries (11.97%) and upper limb injuries (11.95%). Among female trainees although lower limb injuries still account for the majority (79.66%) of injuries, among them, hip and groin injuries accounted for the highest percentage of injuries as compared to leg and knee injuries in male trainees. The twisting injuries of the knee, stress fractures, and acute traumatic fractures accounted for the majority (78.34%) of the injuries leading to repetition of the training by 24 weeks. The twisting injuries of the knee, acute traumatic fractures, traumatic shoulder instability, and head injuries accounted for the majority (83.2%) of the injuries leading to dropout from training institution (withdrawal). Conclusion The analysis related to the injuries sustained by trainees during the 5 years found out the timings, severity, and location of injuries. The findings may be important for the formulation of preventive program in an institutional training institute.
BACKGROUND:Body composition and types are often considered essential health indicators for lifestyle-related disease. Assessment of body type based on tridosha is regarded as a prerequisite in Ayurveda.AIM:To correlate body compositions and somatotypes with Prakriti body types.SUBJECTS AND METHODS:A cross-sectional study on 463 adult individuals was done. Anthropometric and body composition parameters were measured. Heath-Carter somatotypes and Prakriti body types were also determined. Tests of association were calculated. Correlation and concordance analysis was also done to infer the correlation between body composition parameters and Prakriti body types.RESULTS:Kapha Prakriti have significantly higher body weight, body mass index (BMI), body fat percentage and body fat mass. Vata have the lowest mean values in all body composition parameters with Pitta in the intermediate position compared to the other Prakriti types. There is a strong and positive statistical association between Prakriti body types and body composition parameters, except height. Cohen's Kappa analysis reveals there is a fair concordance between Prakriti body types and somatotype.CONCLUSIONS:Prakriti assessment can explain an individual's fatness as it correlates with body composition parameters and could be used to predict risk susceptibility to various complex disorders.
INTRODUCTION: Early pregnancy failure (EPF) is an inclusive term that comprises incomplete, complete, or inevitable spontaneous abortion;anembryonic gestation (blighted ovum); and embryonic demise (missed abortion) at less than 14 weeks 1. It is one of the most commoncomplications of pregnancy, accounting for approximately 15% to 20% of clinically recognized pregnancies 1,2. Many EPFs occur beforepregnancies have been clinically recognized (that is, women mistake them for “late cycles”).AIMS & OBJECTIVES: To compare the efcacy between mifepristone 200mg orally followed by misoprostol 800µg vaginally 6 hrs later withmifepristone 200mg orally followed by misoprostol 800µg vaginally 24 hrs later in early pregnancy failure for termination up to 9 weeks ofgestation. To reduce unusual blood loss. To reduce surgical intervention in case of early pregnancy failure.MATERIALS & METHODS: Hospital based Prospective randomiSe comparative single centre study. Department of Obstetrics andGynecology Midnapore Medical College and Hospital. One year from January 2019 to February 2020 for data collection and six month for dataanalysis. Mother attended the Gynae OPD clinic and Obstetrics emergency with features of early pregnancy failure. The sample size was 50, with25 patients in each group.RESULTS:We found that the table 4 shows the distribution according to gestational age. The main indication for which medical abortion was donein our study is early pregnancy failure (Blighted ovum) and missed abortion. Majority of patients were in the gestational age between 8-9 weekswith 48 % of women who underwent 6 hour interval regimen and 40% of women who underwent 24 hour interval regimen. P value documented is0.849 which is not signicant. There was no signicant difference between two groups regarding gestational age (p value=0.849).SUMMARY AND CONCLUSION: Vaginal Misoprostol can be safely administered 6 hours following Mifepristone instead of waiting for 24hours. Efcacy in achieving complete abortion rate is almost equal to 24 hours regimen and most acceptable from patient's side also. Additionally,women are less likely to experience side effects the earlier the misoprostol is used. Women can now have more exibility when using mifepristoneand vaginal misoprostol for medical abortion
