Meher Hospitals

Pyridoxine-dependent epilepsy is an autosomal recessive disorder due to mutations in the ALDH7A1 gene. It usually manifests as neonatal intractable seizures. We report a neonate who presented with uncontrolled seizures at 30 min of life, and neuroimaging showed bilateral intraventricular hemorrhage (IVH) soon after birth. As there was no identifiable history of perinatal asphyxia, a bleeding disorder was considered initially, only to find a clinical response to treatment with pyridoxine. Timely diagnosis will reduce mortality and improve cognitive delays that are common with this treatable disorder. This case report highlights the unusual presentation of a very rare but important cause of refractory neonatal seizures.

The demand for safe and efficacious botanical formulations to increase muscle mass, strength, and stamina is increasing among athletes and the general population. The nutraceutical supplements of medicinal plant origin exert minimal health concern. This randomized, double-blind, placebo-controlled study was aimed to evaluate the ergogenic potential of a proprietary, standardized formulation (LI12542F6) of Sphaeranthus indicus flower head and Mangifera indica stem bark extracts. Forty male participants 18-40 years of age were assigned to receive either a placebo (n = 20) or 650 mg/day LI12542F6 (n = 20) for 56 days. All participants performed a fixed set of resistance exercises during the intervention. The primary endpoint was the change from baseline muscle strength, assessed by one-repetition maximum (1-RM) bench and leg presses, and handgrip strength. The secondary endpoints included cable pull-down repetitions, time to exhaustion on a treadmill, mid-upper arm circumference (MUAC), body composition using dual-energy x-ray absorptiometry (DEXA), and free testosterone and cortisol levels in serum. Fifty-six days supplementation of LI12542F6 significantly improved baseline bench press (P < 0.0001), leg press (P < 0.0001), handgrip strength (P < 0.0006), number of repetitions (P < 0.0001), and time to exhaustion (P < 0.0008), compared to placebo. Post-trial, the LI12542F6 group also showed significantly increased MUAC and improved body composition and serum hormone levels. The participants' hematology, clinical chemistry, and vital signs were within the normal range. No adverse events were observed. This study demonstrates that LI12542F6 supplementation significantly increases muscle strength and size and improves endurance in healthy men. Also, LI12542F6 is well-tolerated by the participants.

The data on the characteristics of patients with idiopathic intracranial hypertension (IIH) following levothyroxine (LT4) replacement are limited. Here, we report a case and systematically review published cases of idiopathic intracranial hypertension (IIH) following levothyroxine (LT4) replacement. The systematic review was performed as per the PRISMA guidelines. Our patient is a 46-year-old lady with hypothyroidism (thyrotropin: 319 mIU/L, free thyroxine: 0.04 ng/dl), treated with 100 μg.d of LT4 and presented a month later with headache, visual diminution, bilateral lateral rectus palsies, and papilledema. Cerebrospinal fluid (CSF) pressure was 32 cmH2O. Drainage of CSF, oral acetazolamide, and modification of LT4 dose resulted in prompt symptomatic improvement and complete reversal of IIH. In the systematic review (n = 21), the median age of patients (7 males) was 13 (IQR: 8.8- 26.5) years. The median duration of hypothyroid symptoms was 4 (n = 10, IQR: 0.44-6.25) years whereas that from initiation of LT4 replacement to the diagnosis of IIH was 2 (n = 20, IQR: 1.17-4) months. Initial median serum thyrotropin and thyroxine were 100 (n = 14, IQR: 72.5-421.6) mIU/L, and 1.13 (n = 12, IQR: 1.0-2.45) μg/dl which changed to 2.2 (n = 7; IQR: 0.23-3.40) mIU/L and 8.90 μg/dl (n = 8, IQR: 6.43-14.85 μg/dl), respectively at diagnosis of IIH after LT4 treatment with median daily LT4 doses of 0.89 (n = 8, IQR: 0.60 - 1.17) times the maximum recommended dose for age. To conclude, we report an adult woman with IIH following LT4 replacement for primary hypothyroidism, a rare entity. Pediatric age, prolonged symptom duration, and use of higher LT4 replacement dose may be associated with IIH following LT4 replacement.

LN18178 is a proprietary herbal blend containing extracts of Punica granatum fruit rind and Theobroma cocoa seeds. The objective of the present study was to evaluate the effect of LN18178 on serum testosterone levels in healthy young adults in a randomized, double-blind, placebo-controlled study. One hundred and twenty male volunteers (age 21-35 years) were randomized into three groups. Each group (n = 40) received a daily dose of either placebo or 200 or 400 mg LN18178 for fifty-six days. An increase in serum testosterone (free and total) was the primary efficacy measure of the study. The secondary measures included dihydrotestosterone (DHT), cortisol, Luteinizing hormone (LH), 17β-Estradiol (E2), hand grip strength, and the mid-upper arm circumferences (MUAC). The vital signs and clinical chemistry parameters in blood and urine were performed to determine product safety. Post-intervention, both doses of LN18178 significantly increased free testosterone (p < 0.0001 vs. baseline; p = 0.0268 and p < 0.0001, respectively vs. placebo). The high dose group showed significant increases in total testosterone (p < 0.0001 vs. baseline; p = 0.0184 vs. placebo) and luteinizing hormone (p < 0.0007 vs. baseline; p = 0.0470 vs. placebo). The changes in other hormones were not significant. At post-trial, the LN18178-400 group showed significant improvements in the hand grip strength and mid-upper arm circumference. The hemato-biochemical parameters, urinalysis, and vital signs of the participants were within the normal range. Together, these observations suggest that LN18178 is a safe and tolerable herbal blend; it increases testosterone level and increases muscle strength and MUAC in young, healthy males. Supplemental data for this article is available online at https://doi.org/10.1080/19390211.2022.2035037 .

Background: Hypertension (HTN) accounts for 9.4 million deaths worldwide every year. A rise in HTN is projected by the global burden of HTN 2005 study, it portrays a grim picture. Community level data for hypertension is scarce in Andhra Pradesh. A cross sectional study was conducted to know the prevalence of hypertension in Vijayawada.Methods: 1009 apparently healthy adults visiting the hospital accompanying patients in outpatient department were screened for hypertension by blood pressure recording. All measurements were obtained by automated blood pressure measuring (AOBPM) systems.Results: Of the total population screened, hypertension accounted for 42.5% (n=429). A multivariate analysis showed that hypertension is more common in age group &gt;50 years [odds ratio (OR)=3.004, 95% confidence interval CI being=2.2707-3.9645], in diabetics (OR=2.9091, 95% CI=2.0595-4.1092), in males (odds ratio=1.3223, 95% CI=1.0214-1.7118) and in smokers (OR=1.7442, 95% CI=1.0469-2.9059). A linear positive association was found between obesity and hypertension. No significant association was found between hypertension and alcohol intake. This study also showed that awareness was present in only 44% and 37% had hypertension under control of known hypertensive subjects.Conclusions: This is the first cross sectional study done with AOBPM. Our study finds that hypertension is an important public health burden in coastal Andhra Pradesh with low awareness, treatment, and control. It implies that strategies need to be developed to improve effective primary care management of hypertension.

Dengue illness is a serious public health problem, contributing to significant morbidity and mortality. Cardiac involvement is common and is encountered in centers handling large numbers of dengue cases. Dengue myocarditis masquerading as ST-segment elevation myocardial infarction (STEMI) is a very rare presentation and only a few cases of dengue myocarditis masquerading as STEMI have been reported; it poses several challenging problems, as these patients are at high-risk bleeding and ischemic complications. Our case highlights the importance of the balance approach in the management of the bleeding and ischemic complications in a rare case of dengue myocarditis presenting as STEMI and the role of cardiac magnetic resonance imaging in determining the prognosis of the patient.

Background: Preterm labor is a common complication of pregnancy which has become a main health concern around the world due to its negative consequences. Objective: To investigate the efficacy of progesterone therapy in the prevention of preterm labor in women with single risk factor. Search strategy: A PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Science Direct, Scopus, OVID, EMBASE, SID, Magiran and Google Scholar search (date last searched April 2016) without any time, language and location restriction was done. Inclusion criteria: All randomized clinical trials of singleton pregnancies with single risk factor (prior preterm labor without short cervical length or short cervical length without prior preterm labor) which were randomized to progesterone and control groups were included in our meta-analysis. Primary outcome: Our primary outcome was gestational age at delivery. Results: 13 studies (1259 subjects and 2653 control women) were included in the meta-analysis. Using random effect model showed that mean gestational age at delivery of progesterone group is 0.74 (0.41-1.06) month longer than that of control group with CI=95% which is significant statically. Conclusions: Progesterone therapy is an effective intervention for the prevention of preterm labor in women with single risk factor.

The clinical effects and tolerability of a novel herbal formulation comprising the extracts of Sphaeranthus indicus and Garcinia mangostana were assessed in two similarly designed randomized, double-blind, placebo-controlled, clinical trials in 100 human subjects with a body mass index (BMI) between 30 and 40 kg/m². Participants were randomized into two groups receiving either 400 mg of herbal blend twice daily or two identical placebo capsules. All subjects received three meals (2000 kcal/day) throughout the study and walked 5 days a week for 30 min. The primary outcome was reduction in body weight. Secondary outcomes were reduction in BMI and in waist and hip circumference. Serum glycemic, lipid, and adiponectin levels were also measured. Ninety-five subjects completed the trials, and data from these two studies were pooled and analyzed. At study conclusion (8 weeks), statistically significant reductions in body weight (5.2 kg; P<.0001), BMI (2.2 kg/m²; P<.0001), as well as waist (11.9 cm; P<.0001) and hip circumferences (6.3 cm; P=.0001) were observed in the herbal group compared with placebo. An increase in serum adiponectin concentration was also found in the herbal group versus placebo (P=.0008) at study conclusion along with reductions in fasting blood glucose (12.2%, P=.01), cholesterol (13.8%, P=.002), and triglyceride (41.6%, P<.0001) concentrations. No changes were seen across organ function panels, multiple vital signs, and no major adverse events were reported. The minor adverse events were equally distributed between the two groups. Our findings suggest that the herbal blend appears to be a well-tolerated and effective ingredient for weight management.