Background: Hidradenitis suppurativa (HS) is a distressing condition for which no satisfactory treatment is available. Studies on hormonal mechanisms responsible for HS point towards altered end-organ sensitivity, probably related to the enzyme 5a reductase that converts testosterone to dihydrotestosterone. Finasteride, an inhibitor of type II 5a reductase, has been reported to be effective in recalcitrant HS. Aim: To study the effectiveness and tolerability of finasteride in patients with HS in a preliminary trial . Methods: Seven patients (five women and two men) with HS that was not responding well to antibiotics were treated with finasteride at a dose of 5 mg/day as monotherapy. Clinical response was assessed at regular intervals. Patients were followed up for periods varying from 8 months to 2 years. Results: Six patients improved significantly and three of them had complete healing of lesions. Two patients who were followed up for more than 1 year experienced remissions lasting 8-18 months. The drug was generally well tolerated; however, two women complained of breast enlargement. Conclusion: The results of this preliminary study suggest that finasteride is an effective therapeutic option in HS.

The baseline results of the IMPROVE study Indian cohort confirm the poor glycemic control and the delayed initiation and/or inadequacy of treatment in subjects with type 2 diabetes. These results also highlight the need for timely and appropriately intensive insulin-based therapy.

Background:The 1μg cosyntropin test has some advantages over the 250μg test as a test of adrenal function. One of the concerns regarding the 1 μg test includes stability of the cosyntropin when reconstituted and stored. Classically the 5th percentile responses to cosyntropin in normal individuals have been used to define a normal response. Recent studies have shown that these normative values should be determined for individual assays.Materials and Methods:We performed a 1μg cosyntropin test using reconstituted and refrigerated (4-8° C) cosyntropin in saline solution in 49 non pregnant adults who were apparently healthy and had no exposure to exogenous glucocorticoids. The cosyntropin solution was stored for up to 60 days following reconstitution. We analysed the data for any association between duration of cosyntropin solution storage and the cortisol responses to cosyntropin administration.Results:The mean ± SD cortisol level at baseline, 30 and 60 min were-12.19 ± 3 μg/dl, 20.72 ± 2.63 μg/dl, 16.86 ± 3.33 μg/dl. The 5th percentile cortisol response at 30 min was 16.5 μg/dl (16.33 μg/dl rounded off). The correlation coefficients between number of days of cosyntropin solution storage and the cortisol responses at 30 and 60 min were (Spear mans rho = 0.06,-0.24 respectively) (P = 0.69 and 0.41). There were no differences in cortisol values whether the storage was for less than 30 days or more than 30 days (mean difference 0.25 μg/dl P = 0.44).Conclusion:The 5th percentile normative values determined for our assay is lower than what is currently being used clinically and in research publications. Prolonged refrigerated storage of cosyntropin solution does not affect the validity of the 1 μg cosyntropin test.

Objectives: To evaluate the effect of guideline adherence in treatment of hypertension in a tertiary care hospital in Calicut. Materials and Methods: A prospective observational study was conducted for a period of 6 months with a follow up of 81 hypertensive prescriptions among 100 patients, who were admitted in PVS Hospital, Calicut. BP was the parameter assessed on the baseline and follow up after one month. The effects of empirical treatment were compared with treatment based on JNC 8 guideline. Results: In a total of 81 prescriptions, 32 (39.5%) prescriptions were found in the age group of ≤60 years, in which 12 (37.5%) were males and 20 (62.5%) were females and 49 (60.5%) prescriptions were comes under the age group of >60 years, in which 34 (69.39%) were males and 15 (30.61%) were females. Among monotherapy, 14 (35%) prescriptions had ARBs as antihypertensive drug followed by diuretics 12 (30%), beta blockers 6 (15%), ACE Inhibitors 4 (10%) and Calcium Channel Blockers 4 (10%). About 59.26% of the medical records showed good level of JNC-8 guideline adherence. This adherence has significant negative association only with diabetes mellitus comorbidity (p=0.0152, Ø= -0.241) not with other co morbidities. Among 81, 69 (85.18%) patients were on goal BP on second visit. However BP control have a positive association with guideline adherence (p= 4.6E-05, Ø=0.275) and negative association with mono therapy (p<0.01, Ø= -0.108). Conclusion: Prescribing practices were fairly compliant with guidelines. Doctors poorly adhered to guidelines in hypertensive patients with Diabetes. Significantly better hypertension control was seen in patients who were on guideline adherent therapy.

Antiepileptic drugs (AEDs) are the cornerstone of epilepsy treatment. The main treatment goal is freedom from seizures, without side effects and a better quality of life. 1 Epileptic seizures can be treated effectively in approximately 60% of patients who become seizure free with first or second AED. 2 Although monotherapy is usually recommended,