Background and aims: Irritable bowel syndrome (IBS) is a disorder of intestinal hypersensitivity and altered motility, exacerbated by stress. Functional magnetic resonance imaging (fMRI) during painful rectal distension in IBS has demonstrated greater activation of the anterior cingulate cortex (ACC), an area relevant to pain and emotions. Tricyclic antidepressants are effective for IBS. The aim of this study was to determine if low dose amitriptyline reduces ACC activation during painful rectal distension in IBS to confer clinical benefits. Secondary aims were to identify other brain regions altered by amitriptyline, and to determine if reductions in cerebral activation are greater during mental stress. Methods: Nineteen women with painful IBS were randomised to amitriptyline 50 mg or placebo for one month and then crossed over to the alternate treatment after washout. Cerebral activation during rectal distension was compared between placebo and amitriptyline groups by fMRI. Distensions were performed alternately during auditory stress and relaxing music. Results: Rectal pain induced significant activation of the perigenual ACC, right insula, and right prefrontal cortex. Amitriptyline was associated with reduced pain related cerebral activations in the perigenual ACC and the left posterior parietal cortex, but only during stress. Conclusions: The tricyclic antidepressant amitriptyline reduces brain activation during pain in the perigenual (limbic) anterior cingulated cortex and parietal association cortex. These reductions are only seen during stress. Amitriptyline is likely to work in the central nervous system rather than peripherally to blunt pain and other symptoms exacerbated by stress in IBS.

Background: In type 2 diabetes mellitus lipid abnormalities are very common and is associated with increased risk of cardiovascular diseases.  This study was conducted to find association of type 2 diabetes and dyslipidemia.Materials and Methods: This cross-sectional study was conducted at KISTMCTH. All the necessary data of patient with type 2 diabetes in the period between December 2016 and May 2017 were studied.Results: Out of 199 patients with diabetes mellitus 30.7% had total cholesterol >200 mg/dl, 64.4% had elevated low density lipoprotein, 53.77% patient had elevated triglyceride and 64% patients had low high density lipoprotein level. Cholesterol showed significant correlation with triglyceride (P < 0.001), low density lipoprotein (P < 0.001). Triglyceride showed a significant negative correlation with high density lipoprotein (P < 0.01), while a highly significant positive correlation was observed with cholesterol and high density lipoprotein (P < 0.001).Conclusion: Diabetes is associated with high incidence of dyslipidemia with elevated level of low density lipoprotein, cholesterol and triglyceride.

No abstract

Background: The enzymes CK-MB & LDH are used as potential predictors of timing and grade of HIE in newborns with perinatal asphyxia. Objectives: To differentiate HIE neonates from non-HIE ones on the basis of significant rise of LDH & CK-MB. Methodology: Prospective cross-sectional analytical study. Among 164 newborns, 82 comprising the cases and 82 neonates comprising the controls met the inclusion and exclusion criteria. The umbilical cord blood samples for CK-MB and LDH was drawn and sent for analysis. A serum CK-MB value >92.6 U/L and LDH value >580 U/L was taken as the cut-off level. Descriptive statistical analyses were done to find the significance between two groups. ROC Curve analysis was performed to find the diagnostic performance of CK-MB and LDH. Results: Out of total 164 neonates studied, 18.3% had moderate HIE & 11%had severe HIE while 56.1%had No HIE. Seventy-two newborns were found to have LDH levels >580 U/L out of which 71 were in case group and 1 was in control group. Among the 164 neonates studied, 7.9% from case group were found to have CK-MB levels >92.6 U/L. Both the results of LDH & CK-MB levels were very significant with P value <0.001. Area under ROC (Receiving operating Characteristic) value of LDH when compared to CK-MB is (0.978 vs. 0.731). Conclusion: Estimation of CK-MB and LDH enzymes can help to distinguish asphyxiated from non-asphyxiated term neonates when correlating with their history and clinical features.

No abstract