Role of Sthanik Chikitsa in Shweta Pradara Associated with Madhumeha (DM Type- II): A Case Study

Shweta Pradara or excessive vaginal discharge is one of the commonest complaints among women of reproductive age group. An increase in the normal vaginal secretion develops physiologically at puberty, at ovulation, premenstrual phase and during pregnancy. Excessive discharge causes irritation and itching in the genetalia. Ayurveda explained this condition as Shweta Pradara. Shweta Pradara is a symptom which is present in most of the diseases or present as a complication. Shweta Pradara is not a disease it produces as a symptom, hence etiopathogenesis of principal disease and Shweta Pradara would be same. It is a Kaphaja disorder at the place of Apana Vayu. A 47 years old female patient suffering from intermittent Yonigata Shwet Strava since two years with aggravation of symptoms from one week presented to Prasuti Tantra Evam Stree Roga OPD. Yonigat Shwet Strava was associated with Yoni Kandu, Katishool, Yoni Daha. On enquiry, it was found that she was the known case of Type II Diabetes Mellitus since 10 years. She was taking medication for the same but her blood sugar levels were uncontrolled in spite of taking medication as per her recent investigations. In this case Shwet Pradar was the Updrava of Madhumeh, thus line of management was planned to control her sugar level by supplementing Ayurvedic drugs along with allopathic medicine for DM II (Madhumeh) and treated her with Yoniprakshalan with Triphala Kwath followed by Cutis ointment tamponing per vaginum for 14 days. She had followed the schedule of Yoni Prakshalana, oral medicines and Pathya-Apathya properly. It was observed that, symptoms were started to reduce gradually which has been depicted by documentation of investigations and local examination in this case study.

Detection of white blood cells in microscopic leucorrhea images based on deep active learning / 生物医学工程学杂志

The number of white blood cells in the leucorrhea microscopic image can indicate the severity of vaginal inflammation. At present, the detection of white blood cells in leucorrhea mainly relies on manual microscopy by medical experts, which is time-consuming, expensive and error-prone. In recent years, some studies have proposed to implement intelligent detection of leucorrhea white blood cells based on deep learning technology. However, such methods usually require manual labeling of a large number of samples as training sets, and the labeling cost is high. Therefore, this study proposes the use of deep active learning algorithms to achieve intelligent detection of white blood cells in leucorrhea microscopic images. In the active learning framework, a small number of labeled samples were firstly used as the basic training set, and a faster region convolutional neural network (Faster R-CNN) training detection model was performed. Then the most valuable samples were automatically selected for manual annotation, and the training set and the corresponding detection model were iteratively updated, which made the performance of the model continue to increase. The experimental results show that the deep active learning technology can obtain higher detection accuracy under less manual labeling samples, and the average precision of white blood cell detection could reach 90.6%, which meets the requirements of clinical routine examination.

Pattern of cervical lesions, with emphasis on precancer and cancer in a tertiary care hospital of Southern India.

Background: Carcinoma cervix is the most common form of cancer in India. Screening is cost-effective but compliance is an issue. Most women present to hospitals at first visit. We studied the pattern of women with carcinoma cervix who presented to the gynecology outpatient department of a large hospital in southern India. Methods: Women attending the gynecology outpatient department of King George hospital were evaluated for the presence of cervical lesions. A complete history was obtained. Biopsies from the cervix were obtained from the aceto-white areas, fixed in 10% buffered neutral formalin. Results: 860 cervical biopsy specimens were received. By routine hematoxylin eosin stains, 180 had precancerous lesions and cancerous lesions with more than two risk factors; in the study period, a total of 253 cervical neoplasms were recorded: 103 were in the pre-cancerous stage (CINU1: 74; 71.84%, CIN II 20/103; 19.41%, CIN III 9/103; 8.73%). Of the 150 cancerous lesions, maximum were SCC non-keratinising (130; 92%). A subset (viz 45/180; 25%) were tested for HPV DNA using Polymerase Cycle Reaction (PCR). The commonest presenting symptom was leucorrhea (40%). Most women reported age of first intercourse below 30 years. On visual examination of cervix, most (25; 55.55%) had exophytic growth and erosion (14; 31.11%). More than 80% (n: 24) presented in stage II and III cancer (n:27). Conclusion: In this hospital based study from a large institution from Southern India, out of 860 cervical biopsy specimens studied, 180 (32.14%) had precancerous lesions and cancerous lesions with more than two risk factors.

Analysis on results of clinical trials of HPV infection / 国际检验医学杂志

Objective To explore the relationship between human papilloma virus (HPV) infected population and disease occur‐rence in order to provide evidence and some reasonable suggestions for people understanding this disease .Methods A total of 2 508 suspected patients in our hospital from August 2012 to August 2013 were performed the HPV subtype detection by using PCR‐re‐verse dot blot(RDB) ,including 18 kinds of high risk HPV subtypes(HPV16 ,18 ,31 ,33 ,35 ,39 ,45 ,51 ,52 ,53 ,56 ,58 ,59 ,66 ,68 ,73 , 83 ,MM4) and 5 kinds of low risk HPV subtypes (HPV6 ,11 ,42 ,43 ,44) .Finally ,the patients condition was tracked through the hospital information management system and the clinical laboratory information systems .Results The HPV detection rate was 12 .26% ,in which the high risk type was mainly HPV 52 ,accounting for 12 .66% ,followed by HPV 58 ,16 .The low risk types were mainly HPV 43 ,6 ,11 ,accounting for 14 .61% ,10 .39% and 8 .44% respectively .By the follow up observation of clinical outcomes , the homotype positive phenomena were repeatedly appeared in the patients infected by HPV 52 ,16 within 2 years .At the same time ,the thinprep cytologist test(TCT) results in 157 cases of high risk HPV infection (genotype 52 ,58 ,16 ,18 ,66 ,33 ,56 ,68) were performed the tracking analysis ,indicating that high risk HPV infection was closely associated with cervical intraepithelial ne‐oplasia (CIN)Ⅰ ,CIN Ⅱ and canceration .Meanwhile ,their leucorrhea routine detection were followed up ,which manifested by mild to moderate inflammation .Conclusion High risk HPV subtype infection is closely associated with CIN Ⅰ ,CIN Ⅱ and canceration , while the leucorrhea routine shows mild ,moderate inflammation .Therefore ,only conducting the simple leucorrhea routine analysis can not really reflect the infection status ,it is necessary to look for the ways to cooperate with the superior hospital for timely detec‐ting HPV infection situation ,moreover regular follow up of people with HPV positive is the effective pathway to prevent CIN and cervical cancer .

3 103 cases of leucorrhea routine tests for pregnant women and analysis / 国际检验医学杂志

Objective To investigate the difference of leucorrhea routine tests results among 3 periods of pregnancy in pregnant women.Methods Vaginal cleanliness,the presence of clue cells,trichomonas and fungi were tested for 3 103 obstetric outpatients who were pregnant and treated in the hospital.The test results were analyzed and compared.Results Among pregnant women in different periods of pregnancy,the difference in the proportion of vaginal cleanliness degree Ⅲ and fungal infection rates were statis-tically significant(P <0.05).Among pregnant women of different pregnant periods with vaginal cleanliness degree Ⅱ,difference of fungi infection rate was statistically significant(P <0.05).Among pregnant women of different pregnant periods with vaginal clean-liness degree Ⅳ,the difference of positive rates of fungi,trichomonas and clue cells were statistically significant(P <0.05).In addi-tion,there are a number of mixed infections.Conclusion Vaginitis during pregnancy should be early detected,diagnosed and trea-ted.

Leucorrea como signo de infecciones cérvicovaginales / Leucorrhea as a sign of cervico-vaginal infections

Las infecciones vaginales representan uno de los problemas ginecológicos más comunes en mujeres en edad reproductiva. Objetivo: Clasificar la leucorrea fisiológica y patológica de las pacientes investigadas, además de analizar si esta última obedece a infecciones cervico-vaginales. Método: La presente investigación se realizó a población abierta de todas las pacientes que acudieron al laboratorio de biología celular de la Benemérita Universidad Autónoma de Puebla al programa de detección oportuna de cáncer (Papanicolaou) desde enero del 2001 a Diciembre 2012, en las que se obtuvo un total de 1 679 muestras vaginales mismas que fueron teñidas con el tren de tinción de Papanicolaou modificado para su posterior diagnóstico microscópico. Resultados: Se encontró que 923 fueron positivas a leucorrea, de las cuales 489 corresponden a leucorrea fisiológica, 285 leucorrea patológica y las 149 no se ubican en ningún grupo. Discusión: Las infecciones cervico-vaginales se pueden presentar como respuesta a la presencia polimicrobiana que coloniza la cavidad vaginal y que esto conlleva un conjunto de signos y síntomas no específicos de los agentes que las causen, entre los que se encuentra la leucorrea como dato clínico que motiva en muchos casos a la consulta ginecológica. De las infecciones cervico-vaginales, la vaginitis es la causa más común de descarga vaginal patológica o leucorrea seguida de la cervicitis siendo ambas causadas por diversos agentes y de los que se mencionan los más frecuentes.

Vaginal infections are one of the most common gynecological problems in women of reproductive age. Objective: To classify physiological and pathological leucorrhoea in patients investigated, in addition to analyzing whether the latter is due to cervico-vaginal infections. Methods: This research was performed with an open population of all patients who came to the cancer screening program (Pap) at the Cell Biology Laboratory of the Benemérita Universidad Autónoma de Puebla from January 2001 to December 2012, where 1 679 vaginal samples were stained with the Papanicolaou stain set, modified for subsequent microscopic diagnosis. Results: Nine hundred twenty three were found to be positive for leucorrhea; of which 489 correspond to physiological leucorrhea and 285 to pathological leucorrhea; 149 are not located in any group. Discussion: Cervico-vaginal infections may occur in response to polymicrobial presence which colonizes the vaginal cavity; and this entails a set of signs and symptoms produced by nonspecific agents, among which is leucorrhoea as a clinical manifestation that motivates, in many case, a gynecological consultation. Among cervicovaginal infections, vaginitis is the most common cause of pathological vaginal discharge or leucorrhoea; followed by cervicitis; both of which are caused by various agents, of which we mention here those most frequently found.

Diagnóstico clínico presuntivo versus diagnóstico microbiológico en mujeres con leucorrea / Presumptive clinical diagnosis versus microbiological diagnosis in women with leucorrhea

El propósito de esta investigación fue evaluar el grado de concordancia entre el diagnóstico clínico presuntivo y el diagnóstico apoyado en estudios microbiológicos, en 164 pacientes atendidas consecutivamente en dos consultas ginecológicas de Maracaibo-Venezuela; a quienes se les practicó el examen clínico y estudios microbiológicos de las secreciones vaginales (examen al fresco, coloración de Gram y cultivo convencional). Los resultados evidenciaron: a) concordancia débil (56,7%) entre el diagnóstico presuntivo y el diagnóstico definitivo, la cual disminuyó a 38,2% al excluir los casos asintomáticos; b) diagnóstico clínico de vaginosis bacteriana (41,0%) y candidiasis vaginal (64,5%); c) dificultad para diagnosticar clínicamente las infecciones mixtas y los casos compatibles con vaginitis aeróbica o vaginosis citolítica. Estos resultados sugieren que, aunque la sintomatología y las características del flujo vaginal pueden ser orientadoras, el diagnóstico clínico presuntivo de las infecciones vaginales tiene un margen de error elevado y puede conllevar a manejos terapéuticos inadecuados.

The purpose of this study was to evaluate the correlation degree between the presumptive clinical diagnosis and the diagnosis based on microbiological studies in 164 patients attended consecutively in two outpatient gynecological clinics in Maracaibo, Venezuela, who were studied through clinical examination and microbiological examination of vaginal secretions (fresh smear, Gram staining and conventional culture). The results showed: a) a weak correlation (56.7%) between the presumptive diagnosis and the final diagnosis, which decreased to 38.2% when asymptomatic cases were excluded; b) clinical diagnosis of bacterial vaginosis (41.0%) and vaginal candidiasis (64.5%); and c) difficulty for clinically diagnosing mixed infections and cases compatible with aerobic vaginitis or cytolytic vaginosis. These results suggest that, even though the symptoms and characteristics of the vaginal fluid can offer some orientation, the presumptive clinical diagnosis of vaginal infections has a high margin of error and can lead to inadequate therapy.