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In paediatric population occurrence of ovarian cancer is rare. In this study, an 8-year-old girl was diagnosed mixed malignant ovarian Germ Cell Tumuor (GCT), with predominantly Embryonal Carcinoma component (95%) and focal dysgerminoma component (5%). The patient presented with dull aching pain abdomen and mass in abdomen. On examination mass occupied whole of abdomen, hard in consistency, mobile and lower border per vaginally occupying right fornix. CECT abdomen was done which showed a well-defined solid cystic mass measuring 24.1x 18.7x 14.9 cm mass arising from the right adnexa causing suggestive of malignancy. Uterus, right ovary and rest of the peritoneal cavity was normal. CECT chest was normal. Tumour markers S. Beta-hCG was 27,601.44 mIU/mL, S. LDH was 1735 IU/mL, S. AFP was >400 ng/ mL and S.CA-125 was 114.5IU/mL. After multidisciplinary tumuor board discussion patient was planned for staging ovarian laparotomy (fertility preserving surgery). Intraoperatively ascites was present, right ovary was enlarged measuring about 25x15 cm occupying whole of abdomen, adherent to small bowel, fundus of uterus and right fallopian tube. Left ovary, Fallopian tube and Uterus was normal. Right pelvic and paraaortic lymph nodes was enlarged. Liver, bilateral diaphragm and rest of the peritoneal cavity normal. Procedure done was excision of right ovarian mass with right salpingectomy, bilateral pelvic lymph node dissection, retroperitoneal lymph node dissection, greater omentectomy and peritoneal biopsies. On histopathology right ovary was reported as poorly differentiated neoplasm. In retroperitoneal lymph nodes 1 out 15 lymph nodes showed tumour deposits measuring 0.2cm. Right fallopian tube, bilateral pelvic lymph nodes, greater omentum, peritoneal biopsies and ascitic fluid were free of tumour. On immunohistochemistry (IHC), right ovary tissue was positive for SALL4 and PLAP (germ cell tumour marker). CD30 (Embryonal carcinoma marker) was diffusely positive and CD117 (dysgerminoma marker) was focally positive. It was negative for Beta-hCG (choriocarcinoma marker), AFP (yolk sac tumour marker), EMA (epithelial marker), Calretinin (sex cord stromal tumour marker) and Inhibin (sex cord stromal tumuor marker). From above findings, diagnosis of FIGO stage III A1 (ii) (T1cN1aM0) mixed malignant GCT was made. Patient was advised adjuvant chemotherapy with Bleomycin, Etoposide and Cisplatin (BEP).
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Background: Evaluation of urea and creatinine levels in vaginal wash fluid for the diagnosis of premature rupture of membranes.Methods: The study was conducted on150 pregnant patients, 50 in each group. Confirmed PROM and unconfirmed PROM. Per speculum examination was done to look for pooling, pH tested using the Pehanon paper and vaginal wash fluid was collected. Vaginal wash fluid urea and creatinine levels were tested by a kit based on spectrophotometry.Results: The mean urea levels were 26.35 mg/dl in the study Group 1 and 3.12 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid urea was found to be 8.55 mg/dl. The vaginal wash fluid urea levels of >8.55 mg/dl detected PROM with a sensitivity, specificity, negative and positive predictive value of 100%. The mean creatinine levels were 0.62 mg/dl in study Group 1 and 0.20 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid creatinine was found to be 0.405 mg/dl. Vaginal wash fluid creatinine levels detected PROM with a sensitivity of 76% and specificity of 100%. The negative predictive value and positive predictive values were 80.4% and 100%.Conclusions: Urea can be used as a definite marker of PROM and creatinine can be used as a supportive marker.
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Background: As part of the Sustainable Development Goal 3, the target is to reduce the global maternal mortality ratio to less than 70 per 100 000 live births globally by 2030. Antenatal care (ANC) is an important determinant of maternal mortality and ANC visit is an important component of maternal health care. This study was carried out to assess the utilization of antenatal care services and to understand the factors associated with utilization of antenatal care services in tribal area of Madhya Pradesh.Methods: Community based cross-sectional study carried in tribal dominated district of Madhya Pradesh. A total of 210 mothers who delivered in last one year were selected for study by cluster sampling technique and mothers were interviewed using structured questionnaire after obtaining informed consent.Results: Present study 94.8% antenatal mothers registered and received at least one antenatal check-up and 51.4% mother were registered during first trimester while only 43.4% mothers received four or more ANC visits. Completely utilization of ANC services was found in 39.5% mother. Education of the mother, occupation of mother, income, education of the husband, knowledge of mother about the needs of antenatal care and early ANC registration were found to be significant factors associated with full utilization of ANC services.Conclusions: This study revealed that education of mother and knowledge of mother about the needs of ANC were important contributing factors associated with full utilization of ANC services in tribal area. The education is related with the economic status, awareness of mother about utilization health services, empowerment and decisions making capacity of mothers.
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Background and objectives: NuvaRing is a novel nonoral combined hormonal contraceptive. Present study aims to compare the efficacy, compliance, acceptability and tolerability of NuvaRing with COCs. Method: Prospective randomized, controlled study. Total 430 women fulfilling inclusion and exclusion criteria enrolled for study ,randomly divided in two groups of 215 each. Women in NuvaRing group were given NuvaRing for 12 cycles and women in COC group were given Mala N tablets for 12 cycles. Two groups were compared for efficacy, acceptability, compliance and tolerability by filling questionnaires. Results: There was no significant difference in efficacy, compliance and acceptability. NuvaRing group had more complaints of vaginal discharge and incidence of nausea was significantly higher in COC group. None of the women discontinued use due to side effects. Conclusion: NuvaRing has comparable efficacy, compliance, acceptability and tolerability as compared to COCs with the advantage to once a month dosing
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In the present era, life is full of desires, demands, workloads, deadlines, frustrations, irritations, squabbles etc. which lead into production of stress. Stress may be physical, physiological or psychological. Out of these stresses, psychological stress require specific concern as it may be dangerous to someone’s physical & mental health, personal safety or well being. Incompatibility with others, marital discord, quarrel, torture, abuse, self doubt are various situations related with emotions, anxieties, interpersonal, social or behavioural events and thus producing psychic stress. Small amount of stress is useful as it helps us to perform better under pressure, motivate us to do our best. But beyond a certain limit stress start causing severe destruction to health, mood, productivity, relationship & quality of life. Ayurveda is a science and art of appropriate living which helps us to achieve longevity with a better quality. It has proven to be definitely effective in the management of stress related problems of life caused by several reasons. It includes knowledge of complete balance of body, mind and spirit including emotions and psychology on all levels. It treat stress by various life style modifications e.g. Dincharya, Sadvrit etc. and by use of Medhyadravya, Satvavajaychikitsa, Panchkarma, Shirodhara etc. Ayurvedic methods of treating stress not only maintain the balance in body & mind but also progressively raise the level of inner happiness & satisfaction. This paper focuses review on role of Ayurveda in the management of stress.
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Lymphatic filariasis, commonly called elephantiasis, poses a burden of estimated level of 5.09 million disability adjusted life year. Limitations of its sole drug, diethylcarbamazine (DEC) drive exploration of effective filarial target. A few plant extracts having polyphenolic ingredients and some synthetic compounds possess potential dihydrofolate reductase (DHFR) inhibitory effect. Here, we postulated a plausible link between folates and polyphenolics based on their common precursor in shikimate metabolism. Considering its implication in structural resemblance based antagonism, we have attempted to validate parasitic DHFR protein as a target. The bioinformatics approach, in the absence of crystal structure of the proposed target, used to authenticate and for virtual docking with suitable tested compounds, showed remarkably lower thermodynamic parameters as opposed to the positive control. A comparative docking analysis between human and Brugia malayi DHFR also showed effective binding parameters with lower inhibition constants of these ligands with parasitic target, but not with human counterpart highlighting safety and efficacy. This study suggests that DHFR could be a valid drug target for lymphatic filariasis, and further reveal that bioinformatics may be an effective tool in reverse pharmacological approach for drug design.
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The genetic differentiation in A. stephensi based on haplotype diversity using Restriction Fragment Length Polymorphism and by sequencing of CO II gene across different localities in India has been analyzed. The presence of only one DraI restriction site in CO II gene conferred to haplotype B indicating that the gene is very much conserved and the gene flow is not affected even by a major geographical distance barrier. The sequencing and analysisof various population parameters revealed seven haplotypes in all populations. The West Bengal population was found to be more genetically diverse than others. The geographic distance between populations was found to be contributing to the genetic differentiation. The sign of demographic expansion were found in three of the five populations. The local geographic barriers were found to be ineffective in prevention of gene flow.
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Background: Strabismus adversely affects psychosocial and functional aspects; while its correction impacts positively. Aim: The aim was to evaluate the gains in scores: Overall scores (OASs), psychosocial subscale scores (PSSs) and functional subscale scores (FSSs) following successful surgical alignment. Settings and Design: We evaluated changed scores in the adult strabismus 20 (AS-20) questionnaire, administered before and after successful surgery. Materials and Methods: Thirty adults horizontal strabismics, were administered the AS‑20, at baseline, and at 6‑week and 3‑month. Group‑wise analysis was carried out based on gender, strabismus type (esotropia [ET] or exotropia [XT]), back‑ground and amblyopia. Statistical Analysis: We used Wilcoxon, and Mann-Whitney U‑tests. Significance was set at P ≤ 0.05. Results: At baseline, there were no significant differences within the groups, except that those with amblyopia significantly scored less than nonamblyopes in OAS (median scores: 53.8 vs. 71.3; P = 0.009) and FSS (56.3 vs. 85.3; P = 0.009). OAS, PSS and FSS showed significant gains at 6‑week and 3‑month (all Wilcoxon P < 0.001). Compared with males, females showed significantly more gain at 3‑month (OAS: 37.9 vs. 28.7; P = 0.02), on account of PSS gain (49.6 vs. 37.5; P = 0.01). The ET performed better than XT only on the FSS at 6‑week (28.7 vs. 15.0; P = 0.02). Vis‑à‑vis the nonamblyopes, the amblyopes showed significantly more benefit at 6‑week alone (OAS: 18.7 vs. 28.7; P = 0.04), largely due to gains in PSS. Conclusions: Successful strabismus surgery has demonstrated significant gains in psychosocial, functional and overall functions. There is some evidence that gains may be more in females; with a trend to better outcomes in ET and amblyopes up to 6‑week.
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The present work deigned to prepare graphene oxide nanoparticles and their antimicrobial activity has been evaluated. Graphene oxide is a singal layer of carbon arranged in a hexagonal pattern the basal planes and the edges of graphene oxide nanoparticles contain functional exogenous groups such as hydroxyl, carbonyl and epoxy group, which not only expand the interlayer distance but also make the atomic thick layer hydrophilic. Most important application in area related to transparent conductive film, composite materials, solar energy and biomedical application. Present work based on Hummer’s method which is most common used for preparing graphene oxide. The result graphene oxide was characterized by UV-Vis Spectra and SEM. The graphene oxide nanoparticles absorption peak was occurred at 289nm in UV-Vis spectra. SEM analysis showed the average particles size of 50-60nm corresponding to Hummer’s method respectively. Its antbacterial activity tested against gram negative and gram positive bacterial (Bacillus subtilis, Enterobacter aerogenes, and Staphylococcus epidermis) strain. Graphene oxide nanoparticles of Hummer’s method showed the best inhibitory effect against Staphylococcus epidermis in comparison to other bacterial strain.
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Introduction: Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS) approach with a standard paralimbal strabismus surgery (SPSS) approach in terms of post‑operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post‑operative redness, congestion, chemosis, foreign body sensation (FBS), and drop intolerance (DI) on a graded scale of 0 to 3 on post‑operative day 1, at 2‑3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS). Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon’s signed rank test. Results: On the first post‑operative day, only FBS (P = 0.01) and TIS (P = 0.04) showed significant difference favoring MISS. At 2‑3 weeks, redness (P = 0.04), congestion (P = 0.04), FBS (P = 0.02), and TIS (P = 0.04) were significantly less in MISS eye. At 6 weeks, only redness (P = 0.04) and TIS (P = 0.05) were significantly less. Conclusion: MISS is more comfortable in the immediate post‑operative period and provides better cosmesis in the intermediate period.
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Background: Cervical lymphadenopathy is a common clinical presentation across patients of all age group. The aetiology may range from a benign nonspecific inflammation to lymphoproliferative disorders and metastatic malignancy. Aims & Objective: The present study was undertaken to study non neoplastic and neoplastic lesions of enlarged lymph nodes by Fine needle aspiration cytology (FNAC) in patients presenting with cervical lymphadenopathy referred to cytopathology department from the OPD/IPD of Civil Hospital, Ahmedabad over a period of two years (November 2011 to November 2013). Materials and Methods: A total of 2018 patients were subjected to FNAC of cervical lymph nodes over two years period (November 2011 to November 2013). Since in 113 patients, either the aspirate was inadequate or the opinion equivocal, the remaining 1905 cases were analysed. Results: Overall tuberculous lymphadenitis was the most common finding (898/1905, 46%), followed by reactive hyperplasia (624/1905, 33%). Malignant pathology accounted for 16% (306/1905) of cervical lymph node enlargement, most of which was due to metastatic squamous cell carcinoma (179/306, 58%). Conclusion: FNAC is an excellent first line of investigation and when used with a proper combination of experience and diligence, it can efficiently help at arriving in exact diagnosis.
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Amblyopia screening is often either costly or laborious. We evaluated the Canon Powershot TX1 (CPTX1) digital camera as an efficient screener for amblyogenic risk factors (ARF). We included 138 subjects: 84‑amblyopes and 54‑normal. With the red‑eye‑reduction feature off, we obtained Bruckner reflex photographs of different sized crescents which suggested anisometropia, while asymmetrical brightness indicated strabismus; symmetry implied normalcy. Eight sets of randomly arranged 138 photographs were made. After training, 8 personnel, marked each as normal or abnormal. Of the 84 amblyopes, 42 were strabismus alone (SA), 36 had anisometropia alone (AA) while six were mixed amblyopes (MA). Overall mean sensitivity for amblyopes was 0.86 (95% CI: 0.83‑0.89) and specificity 0.85 (95% CI: 0.77‑0.93). Sub‑group analyses on SA, AA and MA returned sensitivities of 0.86, 0.89 and 0.69, while specificities were 0.85 for all three. Overall Cohen’s Kappa was 0.66 (95% CI: 0.62‑0.71). The CPTX1 appears to be a feasible option to screen for ARF, although results need to be validated on appropriate age groups.
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Malaria is a complex disease that afflicts human today. Malaria epidemiology is associated with drug resistance in parasite and differential distribution and insecticide resistance in vector. Efforts are being made to eradicate malaria but burden of malaria is still increasing. Vector control is essential for malaria prevention strategies. Knowledge of population genetic structure is pre-requisite for determining prevention strategies, particularly using transgenic mosquitoes. Population genetic study can predict level of gene flow between different populations. Anopheles stephensi Liston is urban vector of malaria in Indo-Pakistan subcontinent. About 12% of malaria cases of malaria in India are contributed by A. stephensi. Studies conducted on population genetics of A. stephensi using various markers in different parts of the world are discussed in this communication.