Use of vaginal misoprostol before endometrial biopsy in premenopausal women: an observational study

Background: It is well-known since long time the beneficial effects of misoprostol particularly as a cervical softening agent in obstetric practice. Keep in view, study aimed to evaluate the efficacy of vaginal misoprostol 400 mcg before endometrial biopsy in premenopausal women.Methods: All the 200 patients were classified into two groups viz. study group (Group I) with 100 patients and control group (Group II) with 100 patients. To Group I patients, 400 mcg of misoprostol was given vaginally, 4 hours prior to the commencement of endometrial biopsy whereas no medication was received by Group II patients.Results: In the present study, the base line cervical dilatation is found to be 5.8±1.3 mm in Group I patients whereas 3.8±0.92 mm in Group II patients which is significantly higher (p<0.05). Only 32 patients in Group I required further dilatation whereas 88 patients in Group II underwent further dilatation. The mean time required for further dilatation in Group I and Group II patients was 42.6±17.4, 64.6±16.8 sec respectively and was significantly higher in Group II patients (p<0.05). Out of 100 patients in Group I, only 2% of patients complained severe pain whereas in Group II 48% of patients experienced intolerable pain and required anesthesia.Conclusions: Vaginal administration of 400 mcg misoprostol 4 hours prior to endometrial biopsy in premenopausal women had a significant effect on cervical resistance and cervical dilatation.

GC-MS Compositional Analysis of Essential Oil of Leaf and Fruit Rind of Citrus maxima (Burm.) Merr. from Coastal Karnataka, India.

Essential oils derived from plants by hydro distillation possess several medicinal properties. Citrus maxima (Burm.) Merr. fruit is nutritive, cardiotonic, refrigerant, in stomach troubles, puerperal sepsis and insanity; while leaves are useful in epilepsy, chorea, convulsive cough and stomach pain due to indigestion. Gas chromatography coupled with mass spectroscopy (GCMS) has been used for detection and identification of volatile components from the hydro-distillate from leaf and rind of Citrus maxima (Burm.) Merr. of Rutaceae. Yield of oil was more in rind (0.12%) compared to leaf (0.07%). Forty two and thirty four compounds were detected from leaf and fruit respectively, among which citronellol (28.26%) was the major component in the leaves while D-limonene (89.04%) in the rind. Volatile compounds responsible for various medicinal properties are identified from hydro-distillate of Citrus maxima (Burm.) Merr. from Dakshina Kannada using GC-MS.

Energy Efficient Clustering in Multi-hop Wireless Sensor Networks Using Differential Evolutionary MOPSO

ABSTRACT The primary challenge in organizing sensor networks is energy efficacy. This requisite for energy efficacy is because sensor nodes capacities are limited and replacing them is not viable. This restriction further decreases network lifetime. Node lifetime varies depending on the requisites expected of its battery. Hence, primary element in constructing sensor networks is resilience to deal with decreasing lifetime of all sensor nodes. Various network infrastructures as well as their routing protocols for reduction of power utilization as well as to prolong network lifetime are studied. After analysis, it is observed that network constructions that depend on clustering are the most effective methods in terms of power utilization. Clustering divides networks into inter-related clusters such that every cluster has several sensor nodes with a Cluster Head (CH) at its head. Sensor gathered information is transmitted to data processing centers through CH hierarchy in clustered environments. The current study utilizes Multi-Objective Particle Swarm Optimization (MOPSO)-Differential Evolution (DE) (MOPSO-DE) technique for optimizing clustering.

Disproportionate rise in serum CA 125 in case of budd chiari syndrome: an unusual presentation.

Ca 125 is used as a diagnostic and prognostic biomarker for ovarian cancer. The level of CA 125 is also elevated in benign conditions like Budd Chiari syndrome, liver cirrhosis and heart failure. But very high level of CA 125 is rarely associated with benign conditions and this can mislead the physician. Here we present a case of budd chiari syndrome in postpartum period associated with very high level of CA 125 which is an unusual presentation.

A case report: primary CNS angiitis.

The primary angiitis of the central nervous system (PACNS) is an entity with a very low incidence and prevalence. It affects small and medium sized arteries of the brain parenchyma, spinal cord and leptomeniges resulting in CNS dysfunction. It is defined by inflammation of the cerebral vasculature without angiitis of other organ. Its clinical manifestations are very heterogeneous and make clinical diagnosis difficult. In most cases, a brain biopsy is required. Only the clinical suspicion and the ability to recognize the possible clinical and imagenological patterns of presentation make an accurate diagnosis possible. We hereby report a case of Primary angiitis of CNS in 35 year old right handed male who presented with ischemic stroke with Left Hemiplegia. The diagnosis of PACNS was made after ruling out most of the causes of secondary CNS angiitis.

Human malaria in C57BL/6J mice: An in vivo model for chemotherapy studies.

The present work deals with the development of Plasmodium falciparum stages in mouse model and its potential for the study of efficacy of antimalarial drugs. C57BL/6J mice were infected with multidrug resistant P. falciparum strain then treated with arteether and artesunate. A response was observed to antimalarial drugs in terms of decrease in parasitemia. Mice infected with P. falciparum strain were successfully cured after treatment with either arteether or artesunate. The speed of parasite clearance time and burden of parasitemia differed for each drug and matched the previously reported observations, hence stressing the relevance of the model. These findings thus suggest that P. falciparum. infected human RBC (iRBC) – C57BL/6J mice can provide a valuable in vivo system and should be included in the short list of animals that can be used for the evaluation of P. falciparum responses to drugs.

Appropriate anthropometric indices to identify cardiometabolic risk in South Asians.

Background: South Asians show an elevated cardiometabolic risk compared to Caucasians. They are clinically metabolically obese but are considered normal weight based on current international cut-off levels of several anthropometric indices. This study has two main objectives: (i) to predict the most sensitive anthropometric measures for commonly studied cardiometabolic risk factors, and (ii) to determine optimal cut-off levels of each of the anthropometric indices in relation to these cardiometabolic risk factors in South Asians. Methods: The study was conducted on a random sample of 1178 adults of 20–80 years of age from an urban population of eastern India. Obesity, as evaluated by standard anthropometric indices of BMI (body mass index), WC (waist circumference), WHpR (waist-to-hip ratio) and WHtR (waist-to-height ratio), was individually correlated with cardiometabolic risk factors. Receiver operating characteristic (ROC) curve analyses were performed which includes: (i) the area under the receiver operating characteristic curve (AUROC) analysis to assess the predictive validity of each cardiometabolic risk factor; and (ii) Youden index to determine optimal cut-off levels of each of the anthropometric indices. Results: Overall, AUROC values for WHtR were the highest, but showed variations within the sexes for each of the cardiometabolic risk factors studied. Further, WHpR cut-offs were higher for men (0.93–0.95) than women (0.85–0.88). WC cut-offs were 84.5–89.5 cm in men and 77.5–82.0 cm in women. For both sexes the optimal WHtR cut-off value was 0.51–0.55. The optimal BMI cut-offs were 23.4–24.2 kg/m2 in men and 23.6–25.3 kg/m2 in women. Conclusion: WHtR may be a better anthropometric marker of cardiometabolic risks in South Asian adults than BMI, WC or WHpR.

Role of colors in prosthodontics: Application of color science in restorative dentistry.

Shade selection procedure depends on various factors including translucency, contour and surface texture. Tooth shade selection using a conventional means involves a high degree of subjectivity. Traditional shade guides are available that use several methods for quantifying shade. Technology-based systems provide with an advantage of natural looking restorations. They include RGB devices, colorimeters, spectrophotometers. The impact of the color science can be seen on various restorative materials ranging from ceramics to maxillofacial prosthetic materials.

The effectiveness of magnesium oxide combined with tissue conditioners in inhibiting the growth of Candida albicans: An in vitro study.

Context : The presence of Candida albicans on the fitting surface of the denture is a major causative factor in denture stomatits. A treatment method is by combining tissue conditioner and antifungal agents. Aims : The main objective of this study is to test the efficacy of magnesium oxide combined with two tissue conditioners (Viscogel and GC Soft), in inhibiting the growth of Candida albicans. Settings and Design : Microbiological study was done in the Department of Microbiology, K S Hegde Medical Academy, Nitte University, Mangalore. Materials and Methods : A total of 154 plates were prepared using Muller Hilton with Glucose and Methylene Blue dye medium and inoculated with 24-hr old standard Candida culture. Plates were divided into control and combination. Test discs with different concentrations of MgO were equidistantly placed in MgO Control, while sterile discs embedded with respective tissue conditioner were equidistantly placed in Viscogel and GC Soft controls. For combination groups, the tissue conditioners were mixed and the discs with MgO (1%, 3%, 5%, and 7%) were embedded in the mix. After 24 h of incubation, inhibition diameters were noted. Statistical Analysis Used : The data was analysed using Mann Whitney U Test, ANOVA, Tukey HSD test. Results : The inhibition effect of magnesium oxide 1% combined with tissue conditioners (VGC and GCC) is not significant in both the groups. The inhibition effect of MgO 5% and 7% combined with tissue conditioners (VGC and GCC) is very highly significant ( P < 0.001). Conclusions : Magnesium oxide in combination with tissue conditioners are effective against Candida albicans; GC soft with magnesium oxide showed a better result than Viscogel with magnesium oxide; Increasing the concentration of magnesium oxide increases the zone of inhibition of Candida albicans.

Definitive magnetic nasal prosthesis for partial nasal defect.

Maxillofacial trauma refers to any injury to the face or jaw caused by physical force, trauma, the presence of foreign objects, animal or human bites, and burns. Facial defects can be devastating in their impact on physical structure and function of the affected individual, leading to potential compromises in quality of life. Restoration of facial defects, especially nasal defects, is a difficult challenge for both the surgeon and the prosthodontist. Here is a case report of partial nasal defect caused by trauma, rehabilitated with a magnetic nasal prosthesis made with silicone elastomers using mechanical and anatomical retentive aids.

Crestal bone preservation: A review of different approaches for successful implant therapy.

The level of bone crest surrounding the implant is of utmost significance to determine osseointegrated implant success, as preservation of marginal bone height is highly important for long-term dental implant survival. Various approaches have been described in the literature to prevent the crestal bone loss, including platform switching, non-submerged approach, scalloped implants, implant design modifications, progressive loading, immediate implant placement, etc. The purpose of this paper is to review all the possible methods to preserve the crestal bone, when each method should be used and their success rates in an attempt to address this complex problem of crestal bone resorption. "PubMed" and "Google Scholar" were used to find out any studies involving platform switching concept from 1990 up to 2009. Twenty-four studies involving methods for preservation of crestal bone were evaluated, which included 26% studies on platform switching, 22% on non-submerged approach, 17% on scalloped implants, 13% on progressive loading and 22% on immediate implant placement. Crestal bone preservation should be thought of starting from the design of the implant to be placed. The technique to be followed in a given case will depend upon the density of bone, force factors by the patient, bone volume and amount of soft tissues, etc. The best possible method or the combination of the methods should be used to preserve the crestal bone for the long-term success of the implants.

Cultivation, phytochemistry, pharmacological actions and therapeutic applications of erythrina indica. Lam.

Medicinal plants are the nature’s gift to human being to make disease free healthy life. It plays a vital role to preserve our health. In our country more than 2000 medicinal plants are recognized. Erythrina indica (Fabaceae) is one of the important medicinal plants of coasts of India and Malaysia. Some of its medicinal usage has been mentioned in traditional system of medicine such as ayurveda, siddha and unani. This review attempts to encompass the available literature of Erythrina indica with respect to traditional uses, phytochemistry and summary of its pharmacological activities and clinical effects. Other aspects such as toxicity are mentioned.

Relation between oral stereognosis and masticatory efficiency in complete denture wearers: an in vivo study

Aim: The purpose of the present study was to evaluate the possible association between the oral stereognostic ability and masticatory efficiency at the time of denture insertion and after 6 months in complete denture wearers. Methods: Sixty edentulous patients were selected. The study was conducted in two parts. First, on the day of denture fit-in oral stereognostic ability test was conducted,followed by masticatory efficiency was carried out. The patients were recalled for check up after 6months and the same test was performed again. Data were tabulated and analyzed statistically by paired t-test and Pearson’s correlation coefficient. Results: There was weak correlation between oral stereognosis and masticatory efficiency. Many opinions have been presented in the literature in the past regarding oral stereognosis. The issue whether oral stereognosis also helps inpatients’ adaptation towards complete denture prosthesis is still ambiguous. No consensus has been reached. This study is further an attempt to understand the basic physiology of oral stereognosis and whether there is any possible relation between oral stereognosis and masticatory efficiency.Conclusions: Within the limitation of this study, it can be concluded that oral stereognostic ability improves with time, which might be due to adaptation to the denture. As adaptation towardsdenture improves masticatory efficiency improves as well. This study showed that there might bea weak association between oral stereognosis and masticatory efficiency.

Endourological Management of Forgotten Encrusted Ureteral Stents

PURPOSE: To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation. MATERIALS AND METHODS: From July 2006 to December 2008, 14 patients (11 men and 3 women) with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12). Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function. RESULTS: In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases. CONCLUSION: Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

Smoking and cardiovascular health: A review of the epidemiology, pathogenesis, prevention and control of tobacco.

The causal associations between cigarette smoking and human diseases are irrefutable. In this review, we focus on the epidemiological pattern of cigarette smoking on cardiovascular risk, the underlying mechanistic process of such a causal link, how to prevent premature cardiovascular morbidity and mortality particularly through smoking cessation, and the health benefits of such cessation measures. Finally, we conclude our review summarizing a few of the proven evidence-based tobacco control strategies and policies from across the globe. We did not conduct a systematic review but followed a similar structure. We abstracted the most relevant published literature on the electronic databases, namely, PubMed, Embase and the Cochrane Library applying specific search terms. We also searched gray literature and consulted experts in the field for cross-references. Smoking has been estimated to cause about 11% of all deaths due to cardiovascular disease. Smoking contributes to the pathogenesis of coronary artery disease and sudden death through a variety of mechanisms, including the promotion of atherosclerosis, the triggering of coronary thrombosis, coronary artery spasm, and cardiac arrhythmias, and through reduced capacity of the blood to deliver oxygen. Smoking cessation also confers substantial benefits on people with serious heart disease. Smoking cessation should be viewed as therapeutic rather than preventive intervention, similar to treating asymptomatic hypertension. Smoking cessation is highly cost-effective relative to other frequently used medical and surgical interventions. Tobacco related illnesses are important public health issues worldwide. It has been estimated that there are1.1 billion smokers worldwide and 250 million of them live in India.

Physical inactivity: a cardiovascular risk factor.

Evidence regarding health benefits of physical activity is overwhelming and plays a critical role in both the primary and secondary prevention of coronary artery disease (CAD). Epidemiological investigations show approximately half the incidence of CAD in active compared to sedentary persons. A sedentary lifestyle is considered by various national and international organizations to be one of the most important modifiable risk factors for cardiovascular morbidity and mortality. Fortunately, a moderate level of occupational or recreational activity appears to confer a significant protective effect. Once coronary artery disease has become manifest, exercise training can clearly improve the functional capacity of patients and reduce overall mortality by decreasing the risk of sudden death. Well-designed clinical investigations, supported by basic animal studies, have demonstrated that the beneficial effects of exercise are related to direct and indirect protective mechanisms. These benefits may result from an improvement in cardiovascular risk factors, enhanced fibrinolysis, improved endothelial function, decreased sympathetic tone, and other as-yet-undetermined factors. Hence physical fitness, more than the absence of ponderosity or other factors, is the major determinant of cardiovascular and metabolic risk and long-term disease-free survival, in effect linking health span to life span. It is obviously in every individual's interest to assume the responsibility for his or her own health and embrace this extremely effective, safe, and inexpensive treatment modality. The need for a comprehensive review of this particular topic has arisen in view of the high prevalence of physical inactivity and overwhelming evidence regarding CVD risk reduction with regular physical activity.

Situs inversus with dextrocardia with multiple cardiac lesions in adult.

Situs inversus with dextrocardia is the malposition most likely to occur with structurally normal heart; generally discovered on routine chest x-ray or physical examination performed for other reasons. These persons experience normal longevity of life and have similar risk of getting acquired disease as that of other person of same age and sex group. Symptoms related to acquired disorder may also lead to discovery of such cardiac malposition. Incidence of congenital cardiac anomalies in dextrocardia with situs inversus is very low globally but its figure in Nepal is not known. We report an adult of 43 years age having situs inversus with dextrocardia associated with multiple cardiac lesions i.e. ventricular septal defect, aortic regurgitation, mitral regurgitation and tricuspid regurgitation. Key words: Situs Inversus Totalis, Dextrocardia, Congenital Cardiac Anomalies, Nepal.

Intracranial subfrontal schwannoma treated with surgery and 3D conformal radiotherapy.

Subfrontal schwannoma not arising from the cranial nerves are rare tumors. A 19-year-old man presented with a large subfrontal extra-axial enhancing mass with a preoperative diagnosis of skull base meningioma. A subtotal resection of the tumor mass was carried out. Microscopic examination revealed it to be a schwannoma. The residual tumor was treated with fractionated three-dimensional conformal radiotherapy (3D CRT). The rationale of treating with radiotherapy in such cases is analyzed.

Carbon monoxide poisoning.

OBJECTIVES: We studied the clinical profile and autopsy findings of carbon monoxide (CO) poisoning encountered at a hospital located at the altitude of 5,000 ft above mean sea level. METHODS: Clinical and postmortem findings in 25 and 15 cases of accidental CO poisoning respectively were evaluated. The diagnosis was made on circumstantial evidences, definite history of "Bukhari" burning and positive Kunkel's test for carboxyhaemoglobin (COHb). Detailed routine investigations including pulse oxymetry, X-ray chest and electrocardiographical monitoring was carried out in all the 25 patients. Oxygen (100%) via an endotracheal tube in all the comatosed patients and by conventional non-rebreathing plastic face masks was the mainstay of treatment. All patients were monitored and followed up for any delayed neurological sequelae. RESULTS: Most of the patients were young adults and the duration of exposure varied between three to eight hours. The initial diagnosis was stroke in three, seizure in one, encephalitis in two and ischaemic heart disease (IHD) in four. Neurological and respiratory signs and symptoms were noted in 19 and 18 of 25 patients respectively. SPO2 measured by pulse oxymetry was normal in all cases. ECG was suggestive of IHD in four patients. No delayed neurological sequelae was noted in any patients. Autopsy revealed deep red discoloration of skin and serous membranes in 80%, pulmonary oedema in 100% and cerebral oedema with widespread multiple pin point haemorrhages mainly in thalamus and globus pallidus in 40%. CONCLUSION: A high level of suspicion and routine history about the kind of indoor heating, specially in cold climate areas during winter will help in early diagnosis and decrease the incidence of misdiagnosis of CO poisoning. Oxygen (100%) or hyperbaric oxygen, if available should be administered without waiting for COHb levels to decrease morbidity and mortality.