Diagnostic value of saline infusion sonohysterography for detecting endometrial lesion and comparing it with hysteroscopy and histopathology in postmenopausal bleeding

Background: Different diagnostic tools are available to evaluate endometrial lesion such as hysteroscopy, sonohysterography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with postmenopausal bleeding (PMB).Methods: This cross-sectional study recruited 100 married women with chief complain of PMB referred to gynecologic clinics at the Zenana hospital, Jaipur from March 2019 to February 2020. All participants were in the post-menopausal period that showed abnormal endometrial thickness (>4 mm) or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist.Results: Mean age of women was 57.14 years. It is evident that sensitivity, specificity, positive predictive value and negative predictive value of SIS for the diagnosis of endometrial atrophy was 79.16%, 100%, 100% and 83.87% respectively which is higher than that of hysteroscopy and equivalent to histopathology. SIS and hysteroscopy are equally efficient in diagnosing endometrial polyp and submucous fibroid. And are better than histopathology. Histopathology is better than SIS and hysteroscopy for the diagnosis of endometrial proliferation.Conclusions: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.

Air pollution: Health effects / contaminación del aire: efectos en la salud

Abstract Background: Air contamination happens when unsafe or inordinate amounts of substances including gases, particles, and organic atoms are brought into Earth's climate. Objective: This review article defines air pollution, describes the types of pollutants, enumerates the various causative factors, enumerates the ways it impacts human health and suggests preventive measures to reduce the impact of air pollution on human health. Methods: Literature was studied extensively and effects of air pollution on human health have been described. Results and Conclusion: Air pollution has tremendous effects on human health in the form of respiratory diseases and aggravations in the form of asthma and lung cancer, cardiovascular dysfunctions, and malignant growth. An affiliation has been found to exist between male infertility and air pollution and a relationship has been established between air contamination and higher danger of immune dysfunction, neuroinflammation, neurobehavioral hyperactivity, crime, age-unseemly behaviours, Alzheimer's and Parkinson's disease. Traffic-related air pollutants have been found to affect skin aging and cause pigmented spots on the face. An association exists between air pollution and irritation of the eyes, dry eye syndrome, risk for retinopathy and adverse ocular outcomes. Chronic exposure to air pollutants during pregnancy has been associated with adverse effects on the developing foetus in the form of low birth weight and still birth. Air contamination has been seen as a significant supporter of the expanded predominance of allergic diseases in children.

Knowledge and attitude on the nurse practitioner role of nurses and physicians in two tertiary hospitals in Metro Manila

@#The role of the nurse practitioner (NP) has been successfully implemented globally including in some Southeast Asian countries. However, the Philippines has yet to enact this expanded role, not with standing being faced with the common factors influencing the evolution of the NP role indicated in the literature. With the proposed repeal of the current Philippine Nursing Law to include Advanced Practice Nursing, this study aimed to determine the knowledge and attitudes of nurses and physicians in the Philippines on the NP role. Sixty-six participants (41 nurses and 25 physicians) completed the survey on the knowledge and attitude on the NP role, conducted in two tertiary-level hospitals in Manila. Nurses have statistically higher scores on items regarding general understanding of the NP role, and on the difference of the NP from senior nurses. However, the difference of overall survey scores on the knowledge and attitude on the NP role between nurses and physicians was statistically non-significant. These results support the need to raise awareness on the role of the NPs by educating nurses, physicians, and other healthcare professionals in the Philippine setting.

Genetics of novel brown planthopper Nilaparvata lugens (Stål) resistance genes in derived introgression lines from the interspecific cross O. sativa var. Swarna × O. nivara

The brown planthopper (BPH) Nilaparvata lugens (Stål) (Homoptera: Delphacidae) is considered a threat to rice (Oryza sativa ssp.) crop in many parts of the world including India. Among the BPH-resistance (R) genes so far reported in rice, most of them are ineffective against BPH biotype 4 predominant in the Indian sub-continent. In this study, we show the introgression line RPBio4918-230S was identified as BPH resistant after five years of rigorous screening at seedling stage and two years at tillering and reproductive stages. The inheritance of resistance indicated that two recessive genes are involved at seedling and reproductive stages. The allelic relation with known genes using linked reported markers suggested that the genes present in RPBio4918-230S are different. We report here the genetics of the two newly introgressed BPH resistance genes from O. nivara in the background of Swarna which are effective at all the important growth stages. The genes have been tentatively named as bph39(t) and bph40(t). The honeydew area (feeding rate) and days to wilt parameters observed at 30 days after sowing in BC1F3 indicated that newly introgressed genes have both antibiosis and tolerance mechanisms for resistance. The BPH resistance genes identified in this study would facilitate the breeding of broad spectrum and durable resistance in rice against BPH biotype 4.

A case of elbow dislocation / Un caso de dislocación de codo

Abstract The elbow joint is a stable joint and a significant force is required to disrupt the joint. The elbow joint is the second most commonly dislocated joint. A 29 years old male sustained a fall on outstretched hand and presented with pain, swelling , deformity and inability to move his Right elbow. Closed Reduction was done followed by immobilisation for 3 weeks and thereafter range of movement exercises of the elbow joint. Neurovascular complications , associated fracture around the elbow joint and instability of the joint should be looked for. Associated fractures which are difficult to see on plain X Rays can go for Computerized tomography and unstable fractures where damage to the ligamentous complex is suspected should undergo an Magnetic Resonance imaging study of the involved joint.

Cefixime induce non convulsive status epileptics: a neurotoxic effect

Nonconvulsive status epileptics comprises a group of syndromes that display a great diversity regarding response to anticonvulsants ranging from virtually self-limiting variants to entirely refractory forms cephalosporins are thought to provoke seizure through inhibitory effects on gamma-aminobutyric acid (GABA) transmission and GABA receptors. Interference with GABA transmission result in pre-disposition towards excitatory neurotransmission, which can leads to seizures. Antibiotics can alter the serum concentration of anti-epileptic, resulting in seizures and anti-epileptic drugs toxicity.

Ayurveda A Ray Of Hope For Multiple Sclerosis W.s.r. To Asthi Majja Gata Vata: A Case Study

Multiple sclerosis (MS) is a demyelinating disease in which the insulting covers of nerve cells in the brain and spinal cord are damaged. The course of MS is usually relapsing-remitting and sometimes progressive. It is the commonest inflammatory- demyelinating disease of the CNS and the most frequently occurring cause of non traumatic neurologic disability in young and middle aged adults. Immunosuppressant or cortico­­-steroids as only available treatment in modern science, Ayurveda only the ray of hope. In Ayurveda, multiple Sclerosis can be correlated with Asthi – Majjagatavata. Aim: A case study had been done to find effective management for MS. A 35 year old female patient came to Panchkarma OPD, Dr. S.R. Rajasthan Ayurved University, Jodhpur was suffering from Weakness, Numbness and burning sensation in both arms or legs and Numbness in abdominal region and lack of coordination for 18months.she was diagnosed case of multiple sclerosis (kurtzke disability grade Five) had been given Ayurvedic medicine as well as Panchkarma shown encouraging results. Conclusion: Patient was observed for symptomatic improvement based assessment done by questionnaire, also observed for clinical examination. Patient was also observed for complication during whole course of treatment, untoward complications were not seen. Conservative management of MS through Ayurvedic principles improving the quality of life and decrease dependency of patient. Result: Patient showed improvement kurtzke disability grade Five to grade two.

Antineoplastic potential of the Vitex species: an overview / Potencial antineoplásico de la especie Vitex: una visión general

Irrespective of progressive treatments, cancer remains to have the utmost rate of treatment failure due to numerous reasons associated. In recent years, the use of traditional medicine in cancer research has established considerable interest. Natural products represent an amazing source for cancer therapy and combating associated side-effects. More than thousand plants have been found to possess significant anticancer properties. Vitex is the largest genus in the family Lamiaceae which comprises 250 species distributed throughout world and several species have been reported to have anticancer properties. Despite a long tradition of use of some species, the genus has not been explored properly in terms of its anticancer profile. Here we are reporting the updated knowledge of the antineoplastic profile of this genus available so far. In the concluding part, the future scope of Vitex species has been emphasized with a view to explore its multifarious antineoplastic activities and mode of action.

Independientemente de los tratamientos progresivos, el cáncer sigue teniendo la mayor tasa de fracaso del tratamiento debido a numerosas razones asociadas. En los últimos años, el uso de la medicina tradicional en la investigación del cáncer ha despertado un gran interés. Los productos naturales representan una fuente increíble para la terapia contra el cáncer y la lucha contra los efectos secundarios asociados. Se han encontrado más de mil plantas que poseen propiedades anticancerígenas significativas. Vitex es el género más grande de la familia Lamiaceae, que comprende 250 especies distribuidas en todo el mundo y se ha informado que varias especies tienen propiedades anticancerígenas. A pesar de una larga tradición de uso de algunas especies, el género no ha sido explorado adecuadamente en términos de su perfil contra el cáncer. Aquí presentamos el conocimiento actualizado del perfil antineoplásico de este género disponible hasta el momento. En la parte final, se ha enfatizado el alcance futuro de las especies de Vitex con el objetivo de explorar sus múltiples actividades antineoplásicas y su modo de acción.

Genetic Variations in Asparagus racemosus, an Endangered Medicinal Herb Endemic to India Using RAPD Markers.

Aim: To study the genetic diversity in Asparagus racemosus germplasm using RAPD molecular markers for its better conservation and utilization. Study Design: RAPD markers used to check genetic diversity in Asparagus racemosus using different softwares. Place and Duration of Study: Department of Bio & Nano Technology, Guru Jambheshwar University of Science & Technology, Hisar-125001 between May 2013 to June 2014. Methodology: A total of 60 RAPD markers used to check polymorphism at genetic level among 60 asparagus genotypes. PCR amplified bands were scored as 0 and 1 for absence and presence. The binary data so obtained used to reveal genetic polymorphism via NTSYS, POPGENE and AMOVA analysis. Results: A significant level of genetic diversity (81.48%) among all genotypes was assessed by using RAPD molecular markers. Out of 60, 49 RAPD primers produced 425 polymorphic loci. The value of Jaccard’s coefficient varied from 0.48 to 0.97 for RAPD. OPB-15 primer proved to be the most polymorphic marker among all used. The POPGENE analysis revealed 44.44, 79.01 and 64.20% polymorphism for RAPD analysis in groups with low, intermediate and high saponin content. The overall value of Shannon’s index and Nei’s genetic diversity was 0.3402 & 0.2169 for RAPD marker system. Conclusion: These results showed RAPD marker system useful in detecting significant genetic polymorphism among genotypes which can be used for production and conservation of improved genotypes.

Evaluation of key histologic variables in skin biopsies of patients of borderline leprosy with type 1 lepra reaction.

Background: Leprosy remains an important health problem mainly in the African and South-East Asia regions. Type 1 reaction is an immune-mediated phenomenon known to complicate at least 30% of patients of leprosy. Diagnosing type 1 reaction correctly is important for timely institution of therapy to prevent and treat neuropathy-associated disability and morbidity. There is paucity of literature on definitive criteria for histologic diagnosis of type 1 reaction. This study was conducted to determine the key histologic variables for diagnosing type 1 reaction. Methods: This was a prospective study recruiting 104 patients with borderline leprosy. Three pathologists blinded to the clinical diagnosis independently assessed the cases. The agreement between each histological variable and clinical diagnosis was then calculated by using Cohen's kappa (Κ) coefficient. Results: Histological diagnosis of type 1 reaction was given to 27 (67.5%) of 40 clinically diagnosed cases of type 1reaction cases. Histological variables chosen as key variables for histological diagnosis of type 1 reaction were presence of giant cells, dermal edema, intragranuloma edema, granuloma fraction 31-50%, and presence of medium to large giant cells. Conclusion: This study has shown that T1R are still underdiagnosed histologically in comparison with clinical assessments. The key variables for diagnosing type 1 reaction were proposed

Anaesthetic Considerations and Implications for Non Cardiac Surgery in a Patient Presenting with Aorto Occlusive Disease.

Patients with peripheral vascular disease continue to challenge the anesthesiologist as these patients often have associated coronary artery disease. There is always a danger of myocardial ischemia and cardiac morbidity both intraoperatively and postoperatively in this group of patients. We here report a patient presenting with aorto occlusive disease posted for emergency laparotomy for intestinal obstruction.

Methylprednisolone in hair dye poisoning

Poisoning due to hair dye consumption is relatively rare in India. Compound responsible for hair dye toxicity is paraphenylenediamine [PPD]. Hair dye [PPD] poisoning has high morbidity and mortality and its incidence has increased dramatically in the past 4 years. Prompt recognition and effective management lead to complete recovery. Diagnosis is made solely on the basis of the history given by the attendants and symptoms of cervicofacial edema, black colored urine and muscular pain. The key to successful management is detection and avoidance of triggers, early recognition of attacks, and aggressive airway management when warranted. Initial treatment in a patient presenting with most forms of angioedema includes antihistamines and glucocorticoids if required. Epinephrine should be administered if there is a concern for laryngeal edema.We present here a case report of hair dye poisoning where patient presented as cervicofacial edema not responding to conventional treatment, but responded to metyhlprednisolone intravenously

Formulation and evaluation of herbal antioxidant face cream of Nardostachys jatamansi collected from Indian Himalayan region

Objective:To prepare and evaluate a herbal antioxidant face cream which is made by the ethanol extract of Nardostachys jatamansi (Valerianceae). Methods: Antioxidant activity of ethanol extract was assessed by previously reported 2, 2-Diphenyl-1-picrylhydrazyl method. By discovering different types of formulations, such as oil in water, we were able to create several face creams respectively classified from F1 to F6, by incorporating different concentrations of stearic acid and acetyl alcohol. The evaluation of all formulations (F1 to F6) has been done by the analysis of different parameters like pH, viscosity, spread ability and stability. Results: An ethanol fraction analyzed from a sample of Nardostachys jatamansi showed a significant antioxidant activity with an IC50 value of 58.39 μg/mL while for ascorbic acid the IC50 value was 46.68 μg/mL. Among the six formulations (F1-F6) F5 and F6 showed good spread ability, good consistency, homogeneity, appearance, pH;there is no proof of a separation phase and ease of removal. Also the formulations F5 and F6 showed no redness or edema or erythema and irritation during irritancy studies. Conclusions:These formulations can be safely used on the skin. Hence, the study suggests that the composition of extract and the base of the cream F5 and F6 are more stable and safe, but it may produce synergistic action.

Anestesia regional: todavía una alternativa adecuada en la parturienta con obesidad mórbida / Regional anaesthesia: Still a comfortable choice in morbidly obese parturient

La obesidad se ha identificado como un factor importante de riesgo de morbimortalidad relacionada con anestesia en obstetricia. La obesidad acentúa la mayoría de los cambios fisiológicos del embarazo. Las parturientas obesas tienen un mayor riesgo de presentar problemas médicos concomitantes o enfermedades prenatales, entre ellas la preeclampsia y la diabetes gestacional. Estas pacientes requieren valoración preoperatoria minuciosa, una preparación meticulosa y alistamiento para una vía aérea difícil, puesto que la incidencia de intubación fallida es mucho más alta en ellas. Siempre que sea posible, la anestesia regional es la mejor alternativa en este grupo de pacientes.

Obesity has been identified as a significant risk factor for anaesthesia related morbi-dity/mortality in obstetrics. Obesity compounds most of the physiological changes in pregnancy. The obese parturients are at increased risk of having either concurrent medical problems or superimposed antenatal diseases including preeclampsia and gestational diabetes. These patients need thorough preoperative assessment, meticulous preparation and preparation for difficult airway as incidence of failed intubation is many times higher in these patients. Regional anaesthesia whenever possible is the best choice in this group of patients.

Role of newer methods of diagnosing genital tuberculosis in infertile women.

Genital tuberculosis is an important under-diagnosed factor of infertility. A vast majority of cases are asymptomatic and diagnosing them will help in treating such patients. We conducted a retrospective study in a tertiary care hospital of Delhi with an aim to compare different methods i.e., histopathological examination (HPE), acid-fast bacilli (AFB) smears, Lowenstein-Jensen (LJ) culture, BACTEC culture and polymerase chain reaction deoxyribonucleic acid (PCR-DNA) for diagnosing endometrial tuberculosis in infertile women. The data from 546 samples of endometrial biopsy histopathology, AFB smears and LJ culture was collected and then analyzed. Of these, HPE for tuberculosis was positive in 13, LJ culture in 10, AFB smear was positive in one case. BACTEC and PCR-DNA were feasible for 90 patients and PCR-DNA was positive in 20 and BACTEC in eight patients. Out of 20 patients with PCR positive results, 15 were only PCR positive and were subjected to hyster-laparoscopy and fi ve had evidence of tuberculosis. Thus, none of the available tests can pick up all cases of genital tuberculosis, but conventional methods i.e., histopathology and LJ culture still has an important role in the diagnosis of endometrial tuberculosis in government setups where BACTEC and PCR are not performed routinely due to lack of resources.

Failed ventilation with LMA Proseal [registered sign] in a patient with sleep apnea syndrome

Patients with sleep apnea syndrome [SAS] have excessive adipose tissue in oropharynx which can obstruct the airway. A high prevalence of difficult intubation has been reported in these patients and an association between the severity of SAS and difficult intubation has been suggested. LMA Proseal[registered sign] [LMA Company, USA] has been launched as a better alternative to LMA classic, as it provides good airway seal due to its modified cuff. The improved seal of LMA Proseal[registered sign] [PLMA[registered sign]] has an advantage in obese patients where higher airway pressures are required for positive pressure ventilation. We found that LMA Classic[registered sign] provided better airway management than PLMA[registered sign] in one of our obese patients with SAS

Evaluation of interadductor approach in neurolytic blockade of obturator nerve in spastic patients

Spasticity is a syndrome associated with a persistent increase in involuntary reflex activity of a muscle in response to stretch. Adductor muscle spasticity is a common complication of spinal cord and brain injury. It needs to be treated if it interferes with activities of daily living and self-care. Obturator neurolytic blockade is one of the cost-effective therapeutic possibilities to treat spasticity of adductor group of muscles. In this study, we assessed the efficacy of interadductor approach in alleviating the spasticity. Obturator neurolysis using 8-10 ml 6% phenol was given with the guidance of a peripheral nerve stimulator in 20 spastic patients. Technical evaluation included number of attempted needle insertions, time to accurate location of the nerve, depth of needle insertion, and success rate. Pain, spasticity, hip abduction range of motion [ROM], number of spasms, gait, and hygiene were evaluated at 1[st] hour, 24[th] hour, end of the 1[st] week, and in the 1[st], 2[nd], and 3[rd] months following the intervention. The success rate was 100% with mean time to accurate nerve location 4.9 +/- 2.06 min. Average depth of needle insertion was 2.91 +/- 0.32 cm. Compared with the scores measured immediately before the block, all studied parameters improved significantly. An increase in the Modified Ashworth Scale values was observed in the 2[nd] and 3[rd] months, but they did not reach their initial values. The interadductor approach proved to be accurate and fast, with a high success rate. Phenol blockade is an efficient and cost-effective technique in patients with adductor spasticity. It led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene, with an efficacy lasting for about 3 months

Spasticity - pathogenesis, prevention and treatment strategies

This review of the long-term management of spasticity addresses some of the clinical dilemmas in the management of patients with chronic disability. It is important for clinicians to have clear objectives in patient treatment and the available treatment strategies. The review reiterates the role of physical treatment in the management, and thereafter the maintenance of patients with spasticity. Spasticity is a physiological consequence of an injury to the nervous system. It is a complex problem which can cause profound disability, alone or in combination with the other features of an upper motor neuron syndrome, and can give rise to significant difficulties in the process of rehabilitation. This can be associated with profound restriction to activity and participation due to pain, weakness, and contractures. Optimum management is dependent on an understanding of its underlying physiology, an awareness of its natural history, an appreciation of the impact on the patient, and a comprehensive approach to minimizing that impact. The aim of this article is to highlight the importance, basic approach, and management options available to the general practitioner in such a complex condition

Role of histopathological examination in nontraumatic perforation of colon.

Aim: Nontraumatic perforation of colon is an uncommon cause of peritonitis requiring early surgical intervention. This study was carried out to determine the prevalence patterns of the different etiologies of nontraumatic perforation of colon. Methods and results: A total of 35 patients with segments of colon or perforation margins removed for perforation were included. Most of the perforations occurred in the caecum, of which two were seen at the ileocaecal junction. The commonest cause was infection (amoebiasis :13 cases and tuberculosis : 5 cases) followed by ulcers of non specific ulcers (12 cases). There were three cases of adenocarcinoma causing secondary perforation and one case of idiopathic intestinal gangrene and volvulus each. Conclusion: In tropics, non traumatic perforations of colon most often involves caecal and ileocaecal segment and the most common etiology is amoebiasis.

Obturator neurolysis using 65% alcohol for adductor muscle spasticity

Spasticity is motor alteration characterized by muscle hypertonia and hyperreflexia. It is an important complication of spinal cord injury, traumatic brain injury, cerebral palsy, and multiple sclerosis. If uncorrected, fibrosis and eventually bony deformity lock the joint into a fixed contracture. Chemical neurolysis using various agents is one of the therapeutic possibilities to alleviate spasticity. We are, hereby, reporting 3 patients in whom 65% alcohol was used as neurolytic agent for the treatment of hip adductor spasticity, and the effect lasted for a variable period