An Open Label Pre and Post Test Clinical Evaluation of Efficacy of Tila Taila Abhyanga and Massage of Yoni in Cystocele with Special Reference to Chyuta Avastha of Vasti

Prolapse or downward displacement of pelvic organs especially vagina, uterus and rectum is a common and disabling condition among women of menopausal age group. It affects their quality of life also. Displacement of vaginal anterior compartment results in cystocele. Quoting Acharya Susruta reference, the aim of this study is to find the efficacy of Tila taila yoni Abhya?ga in Cyuta avastha of Vasti with respect to first degree cystocele. 30 subjects were selected satisfying inclusion and exclusion criterias with the approval of Institutional ethical committee. Clinical evaluation is done with the help of relevant subjective and objective parameters. The subjective parameters were assessed before and after the treatment for a period of one month with UDI questionnaire and objective parameter with Baden-Walker system of grading Pelvic Organ Prolapse. Three months follow-up evaluation was also done with same parameters. The Wilcoxon Signed Rank Test is used to statically decompose the clinical data. Subjective parameters showed improvement of the condition viz frequency and urgency of urination, urine leakage with and without any activity, cough, sneeze, small amount of urine leakage, difficult and incomplete bladder emptying, bulging in vagina However, leakage not related to urgency, lower abdominal pressure, painful urination and lower abdomen or genital area, pelvic area heaviness or dullness, pelvic discomfort and burning micturition showed only a little reduction with the treatment. Objective parameter is also highly statistically significant at p value < 0.001.

Autologous cervical tumor lysate pulsed dendritic cell stimulation followed by cisplatin treatment abrogates FOXP3+ cells in vitro / 부인종양

Objective@#Dendritic cells (DCs) are administered as immunotherapeutic adjuvants after the completion of standard treatment in most settings. However, our Phase I trial indicated that one patient out of four, who received autologous tumor lysate-pulsed dendritic cell (TLDC) also received cisplatin chemotherapy and experienced complete regression of her lung lesion, continuing to be disease free till date. Hence, the objective of our current study is to evaluate the sustenance or augmentation of immune responses when autologous human papillomavirus positive cervical tumor lysate pulsed DC- are combined with cisplatin, using co-culture assays in vitro. @*Methods@#Before treatment, peripheral blood and punch biopsy samples were collected from 23 cervical cancer patients after obtaining an informed consent. DC functionality was confirmed through phenotypic and functional assays using autologous peripheral blood mononuclear cells as responders. For cisplatin experiments, the drug was added at 150, 200 (clinical dose equivalent), and 400 µM concentrations to DCs alone or DC-T cell co-cultures. Phenotypic assessment and functional characterization of DCs was done using flow cytometry. Cytokine enzyme-linked immunosorbent assay and interferon (IFN)-γ enzyme-linked immune absorbent spot assays were also performed. @*Results@#The functionality of TLDCs was not compromised upon cisplatin treatment in vitro even at the highest (400 μM) concentration. Even though cisplatin treatment reduced the secretion of IFN-γ and interleukin (IL)-12p40 in co-cultures stimulated with TLDCs, this effect was not significant (p>0.05). A doubling of IFN-γ secretion following cisplatin treatment was observed in at least one of three independent experiments. Additional experiments showed a reduction in both FOXP3+ regulatory T cells and IL-10 levels. @*Conclusion@#Our results provide evidence that cisplatin treatment may be given after autologous TLDC administration to maintain or improve a productive anti-tumor response in vaccinated patients.

Microbial Profile of Ventilator Associated Pneumonia in a Medical Intensive Care Unit of a Tertiary Care Hospital in Bangalore.

Ventilator Associated Pneumonia (VAP) is an important infection most often encountered in mechanical ventilation (MV) patients in intensive care units in hospital. VAP occurs in approximately 9 - 27% of patients who are intubated. The morbidity and mortality associated with VAP is more inspite of recent advances in diagnosis and accurate management. Emergence of multidrug resistance among the pathogens causing VAP is also contributing to the outcome. We wanted to isolate the bacterial pathogens, study the antibiotic susceptibility pattern of the isolates and detect the presence of drug resistance in various pathogens.METHODSThis is a retrospective, cross sectional study done on samples received between 2016 to 2018 among patients on MV for >/= 48 hours. Endotracheal aspirates were collected from 85 patients with assumed VAP, clinical pulmonary infection score (CPIS) was noted and aerobic quantitative cultures were performed on all samples. VAP was diagnosed by count of pathogenic organisms isolated >/= 105 cfu/mL. Identification and antibiotic susceptibility of the isolates were done as per the standard laboratory procedures. Patients with characteristic features i.e. clinical and radiological signs of pneumonia on admission were excluded from the study.RESULTS50 cases were diagnosed as VAP by CPIS. Gender ratio was 30:20 (male to female) higher incidence 42% of VAP was seen in the age group of 46-60 years. Majority were Gram negative bacilli; 96%- Klebsiella 36%, Acinetobacter 26% E. coli 16%, Pseudomonas 14%, and Citrobacter 4% along with coagulase positive Staphylococcus in 4%. Of the 50 VAP patients, single organism was isolated in 92% and polymicrobial in 8%. Most of the isolates showed resistance to Amoxiclav, Cefepime, Cefixime and Meropenem.CONCLUSIONSGood compliance with VAP bundle adopted in critical care areas by the health care workers will reduce the incidence of VAP. Early and accurate diagnosis, appropriate empirical and specific antimicrobial use may significantly improve patient outcome.

Immunohistochemistry of Canine Hair Follicle Stem Cells (cHFSCs) by using CK15 and CK19

Adult body harbors powerful reservoir of stem cells that maintains homeostasis by tissue regeneration and in response to disease and injury. Hair follicle is a dynamic mini organ supporting important biological functions of the body in maintaining homeostasis and skin tissue self-renewal. This study was carried out with the objective of finding the adult stem cells in canine hair follicular tissue. To conduct this study, adult canine skin samples (n=12) irrespective of breed and sex were collected. To characterize the hair follicle stem cells, paraffin sections of canine hair follicles were immunostained with positive hair follicle stem cell markers like Anti- cytokeratin 15 (CK15) and Anti-cytokeratin 19 (CK19) and FITC conjugated and HRP conjugated secondary antibodies were used. Immunoreactivities for CK15 and CK19 were observed in the bulge/isthmus region of hair follicles in between the infundibulum and suprabulbar regions and occupied most part of the peripheral layer of outer root sheath cell. Immunophenotyping of canine Hair Follicle Stem Cells (cHFSCs) in the bulge region of hair follicle helps in confirmation of in vitro culture of cHFSCs from the bulge region which will be further used for translational research

Comparative Study of Uric Acid Levels between Rural and Urban Populations

The most common form of inflammatory arthritis is gout and is typically characterized by hyperuricemia and monosodium urate crystal deposition predominantly in the joints and the urinary tract. High plasma uric acid (UA) is a precipitating factor for gout, renal calculi, metabolic syndrome and cardiovascular disease. The main causes for higher plasma UA are higher synthesis, lower excretion or both. The triglycerides synthesis in the liver is associated with the de novo synthesis of purine, increasing uric acid production. The role played by diet on hyperuricemia has not yet been fully understood, but high intake of alcohol mainly beer and fructose-rich industrialized food seem to influence uric acid production. In developed countries, over the past two decades, the prevalence of gout and hyperuricemia has increased, and research has become progressively more actively carried out in those areas. Although >600 related clinical studies have been published to date regarding gout and hyperuricemia, the quality of care for gout and hyperuricemia remains suboptimal. Hyperuricemia is a risk factor for many diseases that has been poorly researched, in and around Pondicherry in both rural and urban population and its prevalence is largely unknown.METHODSThis is a cross sectional survey involving 100 subjects. 0.5 mL of random blood sample was collected, and serum uric acid was determined by auto analyser method.RESULTSThe uric acid level in rural population area was higher by 9 % when compared to urban population. The mean serum uric acid was higher in rural population. (9.32±1.073).CONCLUSIONSThe prevalence of hyperuricemia is high in rural area in this study. There is a need for more research considering implications. Long term follow-up is needed. Proper control of uric acid to less than 6 mg % is the main aim to prevent comorbidities. Patient education is very important.

Role of stromal CD10 expression in classifying phyllodes tumors

Background: Phyllodes tumor is a rare fibroepithelial tumor of the breast comprising less than 1% of all primary breast tumor. Phyllodes tumors are classified into benign, borderline and malignant based on histological criteria. Grading of phyllodes tumor is important as it determines the biological behaviour of the tumor. The aim of the present study was to identify the incidence, pathological features of benign, borderline and malignant phyllodes tumors and to compare the CD10 expression in benign, borderline and malignant phyllodes, in order to highlight its diagnostic significance.Methods: This is a retrospective study conducted in Department of Pathology, Madras Medical College, Chennai for a period of 3 years. The clinical and pathological findings of phyllodes tumors were retrieved from the surgical pathology records. Totally 50 case were selected randomly (38 benign, 6 borderline and 6 malignant) and their representative formalin fixed paraffin embedded tissue samples were subjected to immunohistochemistry for CD10 expression.Results: In the 38 cases of benign phyllodes tumors, only three cases (7.9%) were CD10 positive. Three out of six cases (50%) of borderline phyllodes tumors showed CD10 positivity, whereas five out of six cases (83.3%) of malignant phyllodes tumor showed CD10 positivity.Conclusions: CD10 expression correlated well with grade of phyllodes tumors, which is of statistical significance and therefore it can be used in the determination of tumor grade and this may pave way for development of targeted therapies.

Evaluation of laboratory request forms submitted to clinical pathology department in tertiary health care hospital

Background: Laboratory diagnostics is the fast-growing field which contributes 70% of clinical diagnosis. Laboratory information has a profound impact on patient diagnosis. Research has demonstrated most of the laboratory errors occur in the pre-analytical phase. Incorrect and incomplete filling of information on the laboratory request forms can significantly impact the quality of laboratory results, and it affects patient outcome and resources. We, therefore, evaluated the extent of incomplete laboratory forms in our center.Methods: The study was a retrospective study conducted on all request forms received over 1 month from June 15, 2018, to July 15, 2018, in the Clinical Pathology Department of ESI hospital, Coimbatore, during working hours were analyzed for the frequency of incomplete data.Results: Only the patient’s name appeared in all the forms. Consultant in charge of requesting laboratory tests (99%) was the most omitted parameter. No clinical details or location/ward details of the patient was provided in 90.7% and 7% of the cases. Age and gender did not appear in 21.9% and 22%, respectively. Date of request, doctor’s signature, and hospital number were missing on 8.4%, 27.6%, and 4.4%, respectively.Conclusions: The study has demonstrated the level completion of laboratory request forms was suboptimal. This may be responsible for many pre-analytical errors. There should be closer interaction between clinicians and laboratory physician to improve the quality of laboratory services and resource management.

Effect of Withania somnifera on forced swimming test induced immobility in mice and its interaction with various drugs.

The objective of the present study was to evaluate the antidepressant action of Withania somnifera (WS) as well as its interaction with the conventional antidepressant drugs and to delineate the possible mechanism of its antidepressant action using forced swimming model in mice. Effect of different doses of WS, fluoxetine and imipramine were studied on forced swimming test induced mean immobility time (MIT). Moreover effect of WS 100 mg/kg, i.p. was observed at different time intervals. Effect produced by combination of sub therapeutic doses of WS with imipramine (2.5 mg/kg, i.p.) as well as fluoxetine (2.5 mg/kg, i.p.) were also observed. Effect of WS (100 mg/kg, i.p.) as well as combination of WS (37.5 mg/kg, i.p.) with either imipramine (2.5 mg/kg, i.p.) or fluoxetine (2.5 mg/kg, i.p.) were observed in mice pretreated with reserpine (2 mg/kg, i.p.) and clonidine (0.15 mg/kg, i.p.). Effects of prazosin (3 mg/kg, i.p.) or haloperidol (0.1 mg/kg, i.p.) pre-treatment were also observed on WS induced decrease in MIT. WS produced dose dependent decrease in MIT. Maximum effect in MIT was observed after 30 min of treatment with WS 100 mg/kg, i.p. Combination of WS (37.5 mg/kg, i.p.) with imipramine (2.5 mg/kg, i.p.) or fluoxetine (2.5 mg/kg, i.p.) also produced significant decrease in the MIT. Clonidine and reserpine induced increase in MIT, was significantly reversed by treatment with WS (100 mg/kg, i.p.) as well as combination of WS (37.5 mg/kg, i.p.) with either imipramine (2.5 mg/kg, i.p.) or fluoxetine (2.5 mg/kg, i.p.). Pre-treatment with prazosin but not haloperidol, significantly antagonized the WS (100 mg/kg, i.p.) induced decrease in MIT. It is concluded that, WS produced significant decrease in MIT in mice which could be mediated partly through a adrenoceptor as well as alteration in the level of central biogenic amines.

Comparative study of beta-adrenoceptor blocking efficacy of two formulations of esmolol in vivo and in vitro.

The objective of the present study was to compare the cardiovascular beta-blocking activity of two different formulations of esmolol. Spontaneously beating guinea-pig isolated atria and the heart rate and blood pressure of anaesthetized cat were employed in the study to compare the beta-blocking efficacy of the two formulations of esmolol using isoprenaline as an agonist. In guinea-pig isolated atria the standard esmolol formulation (Brevibloc) reduced basal atrial rate more significantly than the indigenously formulated esmolol (test formulation). Both the formulations produced similar parallel rightward shift of cumulative concentration response curves of isoprenaline with closely comparable pA2 values. In anaesthetized cats, only indigenous esmolol formulation significantly decreased basal heart rate. Both the formulations did not modify the basal blood pressure and isoprenaline-induced fall in blood pressure, despite significantly blocking isoprenaline-induced tachycardia. It is suggested that both the formulations produced similar degree of beta-1 adrenoceptor blocking activity.

Modification of the antihypertensive effect of indapamide by indomethacin.

Oral treatment with indapamide was found to reduce blood pressure of hypertensive rats but not of normotensive rats. Chronic indomethacin treatment had no effect on blood pressure of untreated normotensive and hypertensive rats. Also indomethacin did not modify the antihypertensive effect of indapamide excluding the direct involvement of PGs in the antihypertensive effect of indapamide. Vascular reactivity to pressor agents NA, ADR and ANG was significantly increased after indomethacin treatment. This may be due to the blockade of the actions of PG in modifying vascular reactivity to vasoconstrictor agents or may be a direct effect of indomethacin on calcium fluxes. Indapamide reduced the reactivity to NA and ANG in the presence of indomethacin suggesting that the antihypertensive effect of indapamide may be through a decrease in reactivity to pressor agents which is independent of increase in the synthesis of vasodilator PGs.

Investigation of some effects of levamisole on dog blood pressure.

The effects of levamisole were investigated on the blood pressure of anaesthetized dog. Levamisole (0.5 to 4.0 mg/kg) elicited a biphasic effect, an initial brief depressor response followed by a pressor response. The pressor response was dose-related and was blocked by phenoxybenzamine. The residual depressor response was blocked by propranolol. Repeated administration of a high dose of levamisole produced tachyphylaxis. The pressor response to levamisole was not modified by either reserpinization, acute bilateral adrenalectomy or pretreatment with cocaine, whereas pretreatment with dexamethasone, nialamide or pyroaallol shifted the dose-response curve to the right. Levamisole potentiated the pressor responses to noradrenaline, angiotensin and acetylcholine. The effects of levamisole are ascribed to inhibition of monoamine oxidase, catechol-O-methyl transferase, catecholamine uptake2 mechanism and cholinesterase.

Role of opioidergic component in the antihypertensive effect of clonidine.

The role of opioidergic system in the antihypertensive effect of clonidine was investigated in albino normotensive and renal-DOCA-salt hypertensive models of rats. Clonidine (2.5, 5 and 10.0 micrograms/kg, iv) produced a dose-related depressor response. Yohimbine (2 mg/kg, ip) blocked the clonidine-induced responses in both normotensive and hypertensive rats. Naloxone (2 mg/kg, iv) blocked the clonidine-induced depressor responses in hypertensive rats, but not in normotensive animals. Morphine (0.11 mg/kg, iv) produced a depressor response in both normotensive and hypertensive rats. Yohimbine (1 mg/kg, iv) did not affect the hypotensive effect of morphine in normotensive or hypertensive rats, whereas pretreatment with naloxone significantly blocked the hypotensive effect of morphine in both groups of animals. It is concluded that the hypotensive effect of clonidine in hypotensive rats could be due to an opioidergic mechanism since it is blocked by both naloxone and yohimbine.

Antagonism of calcium-induced contractions by some non-specific spasmolytics in depolarized smooth muscles.

The effects of papaverine MgCl2, cocaine, DNP, KCN and khellin on responses of some rabbit and rat tissues to CaCl2 were studied in vitro in a depolarizing medium. Guinea pig taenia coli preparation was used for comparison. In rabbit tracheal chain and vas deferens and guinea pig taenia coli preparations all spasmolytics shifted the concentration-response curves of CaCl2 to the right without affecting the maxima or slopes. In rat tracheal chain and vas deferens preparations all spasmolytics shifted the concentration-response curves of CaCl2 to the right. Furthermore all agents (except cocaine in tracheal chain preparations) depressed the maximum responses. The slopes were unaffected in either preparations. The initial competition and subsequent noncompetition observed in certain tissues is discussed in the light of the reported poor capacity of some tissues to retain Ca++ and the absence of releasable firmly bound Ca++ (11).