Comparative Study of Physico-Chemical Analysis of Changeri Ghrita Prepared with Murchita and Amurchita Ghrita

Changeri ghrita is a medicated ghee formulation, mentioned in Grahani rog chikitsa. Sneha murchana is a procedure prior to Snehapaka. Snehapaka and Murchana bring changes in Sneha. Materials and Methods: Two batches of Changeri ghrita prepared using Murchita and Amurchit ghrita. Prepared Ghrita subjected to physico-chemical analysis. Result and Discussion: Specific gravity increased in Murchita ghrita. Refractive index, viscosity, saponification value, iodine values were increased. While acid value is decreased. Peroxide value is slightly increased. Unsaponifiable matter remains unchanged. There was change in organoleptic properties after Murchana. Physico-chemical changes have been occurring except in unsaponifiable matter and congealing point. Peroxide was present in both samples of Amurchit and Murchit Changeri ghrita. Saponification value was increased in Murchit Changeri Ghrita Conclusion: It can be concluded that antioxidants were added during Murchana. Murchana maintains stability of lipid preparation and offer good health impact, increases palatability.

HISTOMORPHOLOGICAL EVALUATION OF LESIONS IN NEPHRECTOMY SPECIMENS

Nephrectomy, histopathological examination, neoplastic, renal cell carcinomaBackground: Nephrectomy either partial or radical has become a common procedure in surgical and urological practice. In this study pathological reports were interpreted for the following parameters: age, gender, pathological diagnosis. An indication of nephrectomy depends on type of lesion, extent of damage, general condition of patient and status of contralateral kidney. Method: The present ambiceptive data analysis has been carried out in Department of Pathology in tertiary care centre under Maharashtra University of Health Sciences by histopathological examination of nephrectomy specimens. A Results: total of 59 nephrectomy cases were included in the study. Non neoplastic and neoplastic cases were 44 (75%) and 15 (25%) respectively. Among non-neoplastic lesions, total of 32 cases (72%) were diagnosed as Chronic pyelonephritis with End Stage Renal Disease(ESRD) . Others Chronic Xanthogranulomatous Pyelonephritis with ESRD 9 cases (21%) and Chronic Glomerulonephritis with ESRD 3 cases (7%). Neoplastic lesions constitutes 15 cases with peak in 6th decade. Renal Cell Carcinoma(RCC) is the most common neoplastic lesion. The distribution among the neoplastic lesions include: Clear cell RCC (40%), Papillary RCC (13.34%), Mixed RCC (13.34%), Chromophobe RCC (13.34%), Multicystic nephroma (6.67%), Collecting duct carcinoma (6.67%) and Renal Medullary carcinoma (6.67%). Fuhrman's nuclear grade II is the most common among the RCC. Rare case such as Collecting Duct carcinoma, Renal Medullary carcinoma and Sarcomatoid RCC were diagnosed during the study period. On IHC, Collecting Duct carcinoma is positive for HMW CK, PAX8 and Renal medullary carcinoma is positive for Vimentin. The histopathological Conclusion: examination is essential to differentiate between benign and malignant neoplastic lesions and in grading of malignant lesions which help in treatment and further management of patients.

Serum Magnesium Levels in Critically Ill Patients on Admission in ICU and its Correlation with Outcome

Introduction: Low risk of hypoglycemia and weight neutrality have increased the administration of dipeptidyl peptidase 4 (DPP-4) inhibitors in patients with T2DM in clinical practice.Currently Teneligliptin is prescribed as a second or third add on to the standard treatment with other classes of oral hypoglycemic agents (OHAs) to achieve targeted glycemic control in type 2 DM patients. Methods: An open label, interventional, single arm, 12 weeks study was conducted on160 patients with type 2 DM at MGM Medical College, Aurangabad with Teneligliptin 20 mg once a day as add on to the ongoing standard treatment with other classes of OHAs. Changes in glycemia parameters like FBS, PPBS HbA1C, body weight were assessed and twelve lead ECG was recorded with safety assessment at baseline and follow-up visits.. The QTc was calculated by using the Bazett’s formula (QTc=QT/?RR).The study was conducted with an objective to assess efficacy and safety of Teneligliptin with respect to QT/QTc prolongation in patients with T2DM. Results: A significant reduction was seen in the glycemic parameters like FBS, PPBS HbA1C from the baseline values (P<0.001) but no significant change in the QT interval (P=0.9563) and QTc interval (P=0.5594) from the baseline to the end of study at12 weeks. Conclusion: Tenelegliptin is a promising new drug to help to achieve targeted glycemic control in patients with T2DM without prolonging the QT/QTc interval.

Factors influencing women to participate in cervical cancer screening by providing menstrual pads: A population?based study from rural areas of Maharashtra State, India

Background: India accounts for a quarter of the world cervical cancer burden. Cervical cancer is highly preventable. However, low level of participating women in screening is one of the major issues. The aim of this work was to study the factors that influence women to participate in cervical cancer screening by providing menstrual pads for human papillomavirus (HPV) testing. Methods: Menstrual clothes were collected from two different populations from the rural areas of Maharashtra state for HPV testing to screen for cervical cancer. For this study, out of 945 participated women, 557 (58.9%) provided their menstrual pads. Multivariate logistic regression was applied to calculate the odds ratio (OR) and 95% confidence interval (95% CI). Results: The probability of providing the menstrual pads was high among the women who were highly educated compared to those with less education (OR: 1.4; 95% CI: 1.0–1.9), having mobile phone facilities as compared to those with no mobile phones (OR: 1.4; 95% CI: 1.0–2.0), who were using new cloths as menstrual pads compared to those who did not use the same (OR: 8.5; 95% CI: 5.0–14.3), who did not have tobacco habit as compared to those who had tobacco habit (OR: 1.4; 95% CI: 1.1–1.9) and in the village where health worker was stationed as compared to the village where health worker was not stationed (OR: 1.8; 95% CI: 1.4–2.5). Conclusion: Factors including health worker availability, using mobile phones for communication and high education level facilitate women’s participation. To improve the participation, there is need to apply special strategies for older age group, less educated women and women having tobacco habit.

Transcervical resection of endometrium as a conservative management of dysfunctional uterine bleeding in premenopausal patients

Background: Dysfunctional uterine bleeding (DUB) affects 10% to 15% women of reproductive age group. A prospective observational study was performed to study the efficacy, rate of satisfaction and adverse effects of Transcervical resection of endometrium (TCRE) in the treatment of DUB in premenopausal women.Methods: 30 patients with DUB attending the hospital underwent TCRE and patients were followed up after 6 week, 3 months, 6 months up to 1 year and there bleeding score was calculated. Their response to treatment, complications and satisfaction rate were studied.Results: 43.3% of the women in this study were in the age group of 40-44 years. Post TCRE, 43.33% (n=13) had hypomenorrhea. 33.33% (n=10) had regular cycle, 13.33% (n=4) women had amenorrhea and 10% (n=3) had no response and underwent hysterectomy. 86.66% (n=26) women were satisfied with the treatment whereas 13.33% (n=4) were not satisfied. One patient had uterine perforation and serosal bowel injury due to extended cautery injury. Bleeding reduced considerably and a statistically significant (paired t-test, p-value <0.05) difference was observed in pre and post procedure (6 weeks, 3 months, 6 months and 1 year) bleeding scores.Conclusions: Considering advantages like shorter operative time, uterine conservation and early mobility TCRE is a procedure of choice in patients in whom hysterectomy is either technically difficult or medically contraindicated or in those who are not suitable for long term medical management.

Evaluation of Rapid Immunochromatographic Tests in Comparison to ELISA for Detection of NS1, IgM and IgG Antibodies for Early Detection of Dengue Infection in Pediatric Patients

Dengue fever is one of the most common arthropod-borne viral disease seen in humans. It is one of the major public health problems in developing countries including India. The signs and symptoms of dengue fever may range from moderate fever to thrombocytopenia, hemorrhagic manifestation and shock. Severe untreated cases may even prove to be fatal. The diagnosis of dengue fever may be made on the basis of detection NS1 antigen or IgM and IgG antibodies. This study was aimed at analyzing the sensitivity and specificity of RICT kit with ELISA for NS1 antigen and IgM, IgG detection so as to explore its suitability for regular use in any modest resource constrain laboratory or primary health center as a bedside test. Methods: This was a prospective cohort study conducted from August 2018 to Jan 2019 in a tertiary care private and teaching hospital. Informed written consent was taken from parents or caretakers of patients. The institutional ethical committee approved the study. Samples were collected during the acute phase of illness i.e. 1-5 days of fever. The samples were grouped into 2 categories according to the days of fever - 1-5days and 5-15 days. The NS1 Antigen, IgG and IgM antibodies tests were done by ELISA and ICT in all the cases. EDTA blood samples were collected & the platelet count was done. SSPE 21.0 software was used for statistical purpose. Results: A total of 200 blood samples were studied. Out of the 200 studied sample 132 (66%) belonged to male patients and remaining 68 (34%) belonged to female patients. The M: F ratio was found to be 1:0.51. Most common age group of the patients was between 4-10 years (66%) followed by 15-18 (14.5%) and 11-15 years (10.5%). The least common age group was found to be less than 4 years of age (9%). 102 (51%) patients were having platelet count of less than 1 lac/mm3. The analysis of blood samples for NS1 antigen positivity showed that out of 200 sample NS1 was positive in 51 (25.5%) patients by ELISA and 49 (24.5%) patients by ICT. IgG/IgM ELISA was positive in 81 (40.5%) samples whereas IgG/IgM ICT was positive in 79 (39.50%) samples. Presence of either NS1 antigen or IgG/IgM antibodies was positive in 122 (61%) by ELISA and 119 (59.50%) by ICT. The comparison of NS1 ELISA and NS1 ICT showed that the results were comparable for both the tests with no statistically significant difference (P>0.05). Similarly, there was no statistically significant difference in IgG/IgM ELISA and IgG/IgM ICT and a combination of NS1 and IgG/IgM by ELISA and ICT (P>0.05). Conclusion: Performance of rapid diagnostic tests to detect the presence of Dengue NS1 antigen & IgM & IgG antibodies to dengue virus in comparison to ELISA in present specimen was found to be satisfactory. Even though RDT is treated as screening test places where other advanced diagnostics are not available RDT can be used for the diagnosis of Dengue virus infection.

Association between glycemic control and serum fibrinogen levels in type 2 diabetes mellitus patients

Background: Poor glycemic control has been reported to be associated with increased vascular complications in diabetes mellitus (DM) patients. High fibrinogen level has been described as an independent risk factor for cardiovascular diseases. High fibrinogen has been suggested to be involved in the excess rate of cardiovascular diseases in patients with type 2 DM. The present study was undertaken to find correlation between glycemic control and plasma fibrinogen level in patients with type 2 DM.Methods: Three hundred ten patients aged ≥30 years of either sex were included in this cross sectional study. Estimation of glycated haemoglobin (HbA1c), serum fibrinogen, serum total cholesterol (TC), serum triglycerides (TG), serum high density lipoprotein (HDL) cholesterol, and serum low density lipoprotein (LDL) cholesterol was done. Categorical and continuous variables were tested using Chi-Square test/Fisher’s exact test and unpaired ‘t’ test respectively. Pearson’s correlation was used to study correlation between serum fibrinogen levels and HbA1c, Body mass index (BMI), TC, LDL cholesterol, HDL cholesterol, and TG.Results: Mean serum fibrinogen levels were significantly higher in DM patients whose HbA1c, LDL cholesterol and TG levels were higher. Correlation between serum fibrinogen was 0.59, and 0.45 with HbA1c, and BMI respectively. Multivariate step-wise regression analysis showed higher HbA1c and higher BMI were the independent and significant predictors of higher serum fibrinogen levels. HbA1c was the stronger predictor of serum fibrinogen than BMI.Conclusions: Fibrinogen levels were independently associated with HbA1c value in patients with type 2 DM.

Fine needle aspiration cytology study of HIV lymphadenopathy and its correlation with CD4 count.

Background: HIV-AIDS is considered as a worldwide pandemic with an epicentre in Asia. Lymphadenopathy is the commonest manifestation observed in HIV-AIDS. Although multiple studies have been conducted in western countries, there is need for further studies to evaluate the causes of lymphadenopathy in Indian setting. So the FNAC study of HIV lymphadenopathy and its correlation with CD4 counts was carried out. Methods: Two yrs. observational study was carried out at the Tertiary care centre from Jan 2013 to Dec 2014. All the patients of HIV lymphadenopathy during this period were included in the study. History and clinical details were obtained from medical records. Thorough clinical examination was done in all cases. Thereafter Fine needle aspiration cytology (FNAC), both guided and unguided was performed, as needed. Smears were fixed and stained with H & E stain & special stains, as required. CD4 counts were carried out at the antiretroviral treatment (ART) centre. Results: Out of 64 cases, Tuberculosis (TB) lymphadenitis was the most common lesion with 47.05% cases & its mean CD4 count was 329/ul. There were 4 cases of malignancy; two were that of primary malignancy - lymphoma and other two were metastasis from epithelial malignancies. Conclusions: FNAC is a simple and rapid investigative technique to differentiate and diagnose various causes of lymphadenopathy. TB lymphadenitis is the most common lesion associated with HIV positive patients. CD4 counts correlate well with underlying lymph node pathology, TB lymphadenitis being common in CD4 range of 200-500/ul and HIV associated malignancies seen in CD4 count less than 100/ul.

Primary intratesticular pleomorphic leiomyosarcoma: A rare case report.

Intratesticular leiomyosarcoma is an extremely rare tumor of the genitourinary system. We report a case of intratesticular pleomorphic leiomyosarcoma in a 68-year-old male who presented with gradual painless enlargement of the right scrotal mass over a period of 1-2 years. Radiological examination revealed a right testicular tumor.Right radical orchiectomy was performed with high ligation of the spermatic cord. Histopathological examination along with immunohistochemistry confi rmed the diagnosis of a pleomorphic leiomyosarcoma of the testis. This is, to the best of our knowledge, the 13th case of primary intratesticular leiomyosarcoma and the third case of high-grade (pleomorphic) intratesticular leiomyosarcoma in an elderly male reported in the literature.

Actinobacteriological research in India.

Actinobacteria are important sources of compounds for drug discovery and have attracted considerable pharmaceutical, chemical, agricultural and industrial interests. Actinobacteriological research is still in its infancy in India. Early work on actinobacteria started in the 20th century and mostly focused on studying the diversity, identification and screening for antibiotics, enzymes and enzyme inhibitors. Exploration of diverse habitats for the isolation of actinobacteria, have yielded till date 23 novel species. Screening of actinobacteria for antagonistic activity, has led to the discovery of four novel antibiotics. Research on enzymes mostly covered lipases, amylases, proteases, endoglucanases, α-galactosidases, pectin lyases, xylanases, L-asparaginases, L-glutaminase and cellulases. Research on exploiting actinobacteria for other purposes such as production of enzyme inhibitors, single cell protein, bioemulsifier and biosurfactants is still in the experimental stage. This review compiles the work done in last few years, with an emphasis on actinobacterial diversity and bioprospecting for pharmaceutically important compounds like antibiotics, enzymes and other important applications. The chemical creativity and biotechnological potential of Indian actinobacterial strains are yet to be fully explored. A national strategy is required consistent with the opportunities provided by CBD-Nagoya protocol.

Complications of exodontia: A retrospective study.

Purpose: The purpose of this study was to analyze the incidence of various complications following routine exodontia performed using fixed protocols. Materials and Methods: A total of 22,330 extractions carried out in 14,975 patients, aged between 14 and 82 years, who reported to the Department of Oral and Maxillofacial Surgery at Padmashree Dr. D. Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, were evaluated for various complications. Results: The most common complications encountered were tooth fracture, trismus, fracture of cortical plates and dry socket. Wound dehiscence, postoperative pain and hemorrhage were encountered less frequently. Luxation of adjacent teeth, fracture of maxillary tuberosity, and displacement of tooth into adjacent tissue spaces were rare complications. Conclusion: The practice of exodontia inevitably results in complications from time to time. It is imperative for the clinician to recognize impending complications and manage them accordingly.

Rural cancer registry at Barshi, Maharashtra and its impact on cancer control.

Background. The relevance of population-based cancer registries for planning and implementing cancer control programmes cannot be overemphasized. There are some urban registries in India but very few rural registries despite India being predominantly rural. There are several obstacles to setting up a rural registry including lack of cancer awareness in the rural population and inaccessibility of modern medical facilities. The first rural cancer registry was set up in 1987 at Barshi (population 0.4 million) in western Maharashtra by adopting a methodology suitable for rural areas. Methods. The innovative methodology supplemented the usual registry methodology by regular interaction with the community to educate them on warning signals for cancer, raise cancer awareness and motivate suspected individuals to seek medical attention. Cancer detection clinics were held in villages. Results. The reliability indices show that the registry is of an acceptable standard. The registry activity has increased cancer awareness in this population (p<0.01), increased the frequency of early cervical cancers (stages I and IIa) by more than 2-fold during the past 16 years and significantly decreased the relative risk of death (hazard ratio 0.7 [0.5–0.9]). Conclusion. The innovative methodology has facilitated the process of cancer registration in rural areas. It has had a positive impact on cancer awareness, stage at presentation and survival of cervical cancers—the predominant cancer in the area. The registry has created a resource for epidemiological studies in a rural area where national and international studies are currently being undertaken.

Potter's syndrome: a report of 5 cases.

Bilateral renal agenesis or Potter's Syndrome is an extremely rare congenital anomaly associated with oligohydramnios. The infants die off pulmonary hypoplasia. We herewith report five cases of Potter's Syndrome over a span of one year.

Factors determining successful outcome following pneumatic balloon dilation in achalasia cardia.

BACKGROUND: Pneumatic balloon dilation is a popular method of treating patients with achalasia cardia. It may be useful to know the factors that predict response to this treatment. AIM: To determine predictors of outcome following pneumatic balloon dilation in patients with achalasia cardia. METHODS: Records of 62 patients who had undergone pneumatic dilation using Rigiflex balloon dilators (Boston Scientific, Boston, MA, USA) were reviewed. Follow-up data were available for 52 patients. Data from patients with and without improvement in symptoms were compared. RESULTS: Of the 52 patients (age mean 44 [range 11-68] years; 27 male; median symptom duration 20 [4-90] months], 42 (81%) patients had response in symptoms after balloon dilatation. On univariate analysis, the responders more often had age> 40 years (26/42 [62%] versus 1/10 [10%], p=0.003), and less often had lower esophageal sphincter pressure> 50 mmHg (8/10 [80%] versus 10/42 [24%], p=0.0007) and mid-esophageal body hypocontraction (7/10 [70%] versus 12/24 [29%] p=0.01) than the non-responders. On multivariate analysis only age <or= 40 years (p=0.02) was associated with poor outcome. CONCLUSION: Younger age may predict non-response to balloon dilation using Rigiflex balloon dilators in patients with achalasia cardia.

Anaesthetic management of a patient undergoing whole lung lavage for pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis is a rare disorder characterized by accumulation of amorphous, acellular and lipoproteinaceous material in the lungs. We discuss the anaesthetic management of a patient suffering from this condition who was treated whole lung lavage.