Randomized Control Study of Nebulized Colistin as an Adjunctive Therapy in Ventilator?Associated Pneumonia in Pediatric Postoperative Cardiac Surgical Population

Background:Ventilator?associated pneumonia (VAP) with multidrug?resistant (MDR) gram negative organisms is a common problem in intensive care unit (ICU). Aerosolized antibiotics enhance the efficacy of systemic antibiotics when added as adjuvants. Aim: The primary objective of the study was to compare the clinical and bacteriological outcome of patients with VAP who were administered intravenous (IV) antibiotics alone with those patients who were treated with adjunctive nebulized colistin (NC) along with IV antibiotics. The secondary objective was to study the occurrence of any adverse events during colistin nebulization. Settings and Design: The study was a prospective, randomized, double?blinded controlled study conducted at a tertiary?care teaching institution. Materials and Methods: Ninety?eight children from surgical ICU aged less than 12 years who were diagnosed with VAP due to gram negative bacteria following cardiac surgery were chosen and divided randomly into two groups. The experimental group (NC group) was treated with systemic antibiotics along with NC, whereas the control group (NS group) was administered systemic antibiotics with nebulized normal saline (NS). Clinical and bacteriological outcomes were noted. Statistical analysis was done using SPSS Version 20.0 software. The patient characteristics were compared using independent Student’s t test and Chi?square test. Results: There was a statistically significant reduction in the duration of mechanical ventilation, postoperative ICU and hospital stay (P < 0.05) in the NC group compared with the NS group. Conclusion: Aerosolized colistin may be considered as an adjunct to systemic IV antibiotics in pediatric patients with VAP due to gram negative bacteria susceptible to colistin.

Management of Intra-Uterine Growth Restriction by Ayurvedic Regime: A Case Report

Maternal nutrition and congenital malformation are considered as very important factors for intra uterine growth restriction. Present case deals with these two factors in parallel way. A 32 years young lady second gravida, G2P0A1, housewife, residence of Jaipur, came to NIA OPD with complaint of amenorrhea since a month. According to patient her last menstrual period was on 3/3/20. Her antenatal care was continued in NIA OPD. First fetal wellbeing scan reveals mild ventriculomegaly so she was advised for second level scan and quadruple marker but due to low socioeconomic condition patient was not able to do second level anomaly scan and she continued her pregnancy on her own risk. After 7 months she came to us with the complaints of decreased fetal movements. Fundal height corresponding to period of gestation and fetal heart sound was present which was regular. A color doppler was advised which shows normal fetoplacental and uteroplacental circulation, fetal weight was normal according to period of gestation. On the eighth month the fundal height was found decreased along with maternal weight decreased by 1kg. She was suspected for IUGR and planned for Ksheerbasti. After four episodes Ksheer basti on the 36 weeks of gestation, mother had significant weight gain of 2 kg along with increase in fundal height. USG was done which reveals Single live intra uterine pregnancy of 33 weeks 2 days with lumbar spina bifida with meningomyelocele, CHIARI-II brain malformation, EFW– 2282gm. She delivered a live female child of 2300gm through normal vaginal delivery at maternity hospital. Child was having severe form of myelomeningocele with brain malformation.

Overcoming Primary Cervical Dystocia with Ayurveda Therapeutic Strategy- Case Study

Background: We report a case of primary cervical dystocia managed successfully with Ayurveda therapy. The classical Ayurveda lexicons comprise detailed descriptions regarding Prasava (labor) and its management based on which the present case was intervened which resulted in achieving progressive improvement in cervical dilatation and achieving normal labor. Case Presentation: The case reported in this study is primigravidae, 25 years’ old visited prasutitantra OPD, NIA hospital with 37.2 weeks gestational age complaining of labor pains. Since her contraction and per vaginal findings were suggestive of onset of labor, she was hospitalized for further monitoring and awaited spontaneous progress of labor. Repeated Per vaginal examination revealed no progress in cervical dilatation even after 28 hours and she was diagnosed with primary cervical dystocia. Intervention of Kebuka taila yonipichu-25ml 2 hourly was made which resulted in remarkable cervical dilatation equivalent to mean standard rate following 3 interventions of yonipichu within 6 hours. Conclusion: The status of the cervix during labor is a significant determinant of mode and ease of labor. Ayurveda therapeutic strategy of Kebuka taila yoni-pichu can effectively prime the cervix due to the Garbhashayaka sankochaka and estrogenic properties of Kebuka and the activation of Ferguson's reflex by Yoni-pichu.

Ayurvedic Management of Putraghani Yonivyapada (Recurrent Abortions): A Case Report

Recurrent miscarriages are characterized as three or more spontaneous abortions in a row before the 20th week. In the majority of instances, genetic factors, immunological and endocrine factors, infection, and unknown causes are the most common causes of first trimester abortion. Hormonal therapy, heparin injection, and immunotherapy are the available treatments. In this case study, the patient had three abortions during the first trimester. Because all of the tests came out normal, the diagnosis of unexplained recurrent abortions was made. For 40 days before conception, the patient was treated with Ayurvedic medications such as Indukanta Ghrita, Phalghrita. The patient was conceived with these drugs, and later Phalaghrita and other medicines were given for the duration of the pregnancy. Ayurvedic medicine is an effective way to deal with recurring abortions.

A Study of Pap Smears in Reproductive Age Group Women

The aim of the pap smear to prevent progression to cervical cancer. The Pap test, when combined with a regular program of screening and appropriate follow-up, can reduce cervical cancer deaths by up to 80%. In general, screening starts about the age of 20 or 25 and continues until about the age of 50 or 60, typically recommended every three to five years, if results are normal. Aim: The aim of the present study is a study of cervical pap smears was undertaken to identify the inflammatory, precancerous and cancerous lesions among women catering to the rural and urban population. Methods: Present study was conducted on 530 female patients above 20 years attending the Gynecology OPD in Madha Medical College, Chennai, during September 2016 to August 2018. Pap smear was collected according to guidelines. The modified Papanicolaou stain was used in this study which is still the method of choice. Results: Majority of the cervical pap smears were revealed nonspecific inflammation (86.9%) followed by trihomonas vaginalis (7.7%), ASCUS (5%) and carcinoma (0.1%). In inflammation, leucorrhea (89%)is the most common clinical presentation followed by inter menstrual bleeding and bleeding per vaginum (1%) being the least. In Trichomonas Vaginalis, high incidence of leucorrhea and post coital bleeding (22%) are seen and dysmenorrhea (2.5%) is the least common clinical presentation. In ASCUS and carcinoma, bleeding per vaginum is the most common clinical presentation. Conclusion: Community education regarding cervical carcinoma and regular screening with pap smear among reproductive age group women helps to decrease the incidence of carcinoma of cervix.

Preparation And Physicochemical Evaluation Of Mridu Apamarga Kshara

Ksharakalpana is one of the unique pharmaceutical preparation forms described in Ayurveda. Kshara is ashes of herbal drugs and is alkaline in nature. A detailed description of Kshara Kalpana preparation methods, types, properties and applications of different Kshara are available in Ayurvedic classics. Kshara is the substance having Ksharana and Kshanan properties. Various plants are mentioned as suitable for the preparation of Kshara viz., Apamarga, Arka (Calotropis gigantea Linn.), Mulaka (Raphanus sativus Linn.), Snuhi (Euphorbia nerifolia Linn.) etc. Among these Apamarga, Arka are the most common drugs used for the preparation of Kshara. In the present study whole plant of Apamarga (Achyranthes aspera Linn.) was used for the preparation of Kshara. Different opinions are there about the amount of water to be used, number of filtrations etc., while preparing the Kshara. Generally Apamarga kshara is prepared by decantation process in a single wash. In order to obtain increased yield and to reduce the loss during straining, in the present study it was prepared by the capillary action and three times washing. This method gave 49% more yield of Apamarga kshara and is far more when compared to traditional methods. Physicochemical evaluation of the prepared Kshara complied with the pharmacoepial standards.

Primary chondrosarcoma of breast - cytology with histopathological correlation: A rare case report with review of literature.

Malignant mesenchymal tumors of the breast other than angiosarcoma are extremely rare and comprise <0.5% of breast tumors. Primary chondrosarcoma of the breast is an extremely rare entity and only 10 cases are reported as single case reports in literature until date. A diagnosis of primary mammary sarcoma can be established only after excluding metaplastic carcinomas and malignant phyllodes by extensive sampling for evidence of in situ or invasive carcinoma. Here, we report a primary chondrosarcoma of breast in a 55-yearold lady diagnosed precisely on fi ne-needle aspiration cytology and confi rmed by histopatholigcal examination after total mastectomy. We emphasize on diagnostic diffi culties encountered in cytology smears and discuss differential diagnoses.

Evaluation of Ammannia baccifera Linn. for antiurolithic activity in albino rats.

Ethanolic extract of A. baccifera was tested for its antiurolithic activity in male albino rats. Urinary stones were induced by implantation of zinc discs in the urinary bladder. The stones formed were mainly of magnesium ammonium phosphate with traces of calcium oxalate. Ethanolic extract of A. baccifera (2g/kg/day, po) was found to be effective in reducing the formation of stones as also in dissolving the pre-formed ones. There was a significant increase in the urinary excretion of calcium, magnesium and oxalate, four weeks after implantation of zinc discs. Treatment with A. baccifera has significantly reduced calcium and magnesium levels in the prophylactic group while it has reversed the levels of these ions to normal values in the curative group.

Evaluation of Musa (Paradisiaca Linn. cultivar)--"Puttubale" stem juice for antilithiatic activity in albino rats.

The fresh juice of Musa stem (Puttubale) was tested for its antilithiatic activity. Zinc discs were implanted in the urinary bladder of albino rats to induce urolithiasis. The stones formed were mainly of magnesium ammonium phosphate with traces of calcium oxalate. Musa stem juice (3 mL/rat/day orally) was found to be effective in reducing the formation and also in dissolving the pre-formed stones.