Detection of nerve fibers in the eutopic endometrium of women with endometriosis, uterine fibroids and adenomyosis

Objective@#The primary objective of this study was to establish the presence of nerve fibers in the eutopic endometrium of women with endometriosis and to determine whether these nerve fibers are exclusive to endometriosis or are also found in other pelvic pathologies associated with dysmenorrhea. @*Methods@#Endometrial tissue was obtained by aspiration (Pipelle), endometrial curettage, or following hysterectomy in women with endometriosis confirmed through histopathological examination, leiomyomas, and adenomyosis. The eutopic endometrium was subjected to immunohistochemical staining to detect PGP 9.5, which is a highly specific pan-neuronal marker. The nerve fiber density was correlated with the patient’s pain score, as indicated by the Visual Analog Scale. A control group was formed by staining the endometrium of women presenting with dysmenorrhea but without the above-mentioned disorders. @*Results@#Nerve fibers were observed in sections of the endo-myometrium (in the deep endometrium) in 68% of patients with endometriosis who underwent hysterectomy or a deep endometrial biopsy. Nerve fibers were not observed in the aspirated endometrium of women with endometriosis. Only 13.7% of women with adenomyosis and 3.3% of women with fibroids had nerve fibers in their endometrium. Nerve fiber density was correlated with pain score in women with endometriosis. @*Conclusion@#Nerve fibers were found in the functional layer of eutopic endometrium in women with endometriosis; hence, we concluded that the presence of nerve fibers in the eutopic endometrium could diagnose endometriosis with a fairly good specificity of 92.7%. However, the absence of nerve fibers does not always exclude the disease.

Detection of nerve fibers in the eutopic endometrium of women with endometriosis, uterine fibroids and adenomyosis

Objective@#The primary objective of this study was to establish the presence of nerve fibers in the eutopic endometrium of women with endometriosis and to determine whether these nerve fibers are exclusive to endometriosis or are also found in other pelvic pathologies associated with dysmenorrhea. @*Methods@#Endometrial tissue was obtained by aspiration (Pipelle), endometrial curettage, or following hysterectomy in women with endometriosis confirmed through histopathological examination, leiomyomas, and adenomyosis. The eutopic endometrium was subjected to immunohistochemical staining to detect PGP 9.5, which is a highly specific pan-neuronal marker. The nerve fiber density was correlated with the patient’s pain score, as indicated by the Visual Analog Scale. A control group was formed by staining the endometrium of women presenting with dysmenorrhea but without the above-mentioned disorders. @*Results@#Nerve fibers were observed in sections of the endo-myometrium (in the deep endometrium) in 68% of patients with endometriosis who underwent hysterectomy or a deep endometrial biopsy. Nerve fibers were not observed in the aspirated endometrium of women with endometriosis. Only 13.7% of women with adenomyosis and 3.3% of women with fibroids had nerve fibers in their endometrium. Nerve fiber density was correlated with pain score in women with endometriosis. @*Conclusion@#Nerve fibers were found in the functional layer of eutopic endometrium in women with endometriosis; hence, we concluded that the presence of nerve fibers in the eutopic endometrium could diagnose endometriosis with a fairly good specificity of 92.7%. However, the absence of nerve fibers does not always exclude the disease.

Prevalence and factors associated with effective helmet use among motorcyclists in Mysuru City of Southern India

BACKGROUND@#Helmet use reduces the risk and severity of head injury and death due to road traffic crash among motorcyclists. The protective efficacy of different types of helmets varies. Wearing firmly fastened full-face helmet termed as effective helmet use provides greatest protection. This study estimates the prevalence and factors associated with effective helmet use among motorcyclists in Mysuru, a tier II city in Southern India.@*METHODS@#Cross-sectional road side observational study of 3499 motorcyclists (2134 motorcycle riders and 1365 pillion riders) at four traffic intersections was done followed by interview of random sample of 129 of the above riders. Effective helmet use proportion and effective helmet use per 100 person-minute of observation was calculated. Multivariate logistic regression analysis was done to identify factors associated with effective helmet use.@*RESULTS@#Prevalence of effective helmet use was 28 per 100 riders and 19.5 per 100 person-minute of observation in traffic intersections. Prevalence rates of effective helmet use was higher among riders (34.5% vs pillion riders 18.1%), female riders (51.3% vs male riders 26.8%), and male pillion riders (30.5% vs female pillion riders 13.7%). Riders commuting for work and school and those ever stopped by the police in the past 3 months had significantly higher odds of effective helmet use.@*CONCLUSION@#Despite helmet use being compulsory by law for motorcyclists, the effective helmet use was low in Mysore. Strict enforcement and frequent checks by the police are necessary to increase the effective helmet use.

A Study of Prevalence of Etiological Agents of Dermatophytosis in a Tertiary Care Hospital.

Background: Dermatophytoses are commonly encountered fungal diseases prevalent in most parts of the world especially in tropical countries. It is a superficial mycotic infection affecting hair, skin and nails. The present study was carried out to determine the incidence of dermatophytoses and their etiological agent in different age groups attending the Dermatology department. Methods: A total of 200 samples were taken from skin department and processed by direct KOH preparation & fungal culture methods. Identification of the species was done by Lactophenol Cotton Blue mount from colony. Results: Our study shows that males 60 (68.41%) are more infected than females 40 (31.59%) Tinea corporis was the commonest clinical type 59 (55.75%). The commonest fungal isolate is Trichophyton species (51.72%), followed by Micro-sporum 38 (36.92%) and Epidermophyton species 11(9.31 %). Conclusion: Male have higher fungal infection rate than females. Trichophyton rubrum is the common isolate in our geographical area. KOH preparation has higher positivity rate than culture.

First and second line drug resistance among treatment naive pulmonary tuberculosis patients in a district under Revised National Tuberculosis Control Programme [RNTCP] in New Delhi

There is limited information of level of drug resistance to first-line and second line anti-tuberculosis agents in treatment naive pulmonary tuberculosis [PTB] patients from the Indian region. Therefore, the present prospective study was conducted to determine the antimicrobial susceptibility to first-line and second line anti-TB drug resistance in such patients. Sputum samples from consecutive treatment naive PTB cases registered in Lala Ram Sarup [LRS] district, under RNTCP containing 12 Directly Observed Treatment Centre's [DOTS], were enrolled using cluster sampling technology. A total of 453 samples were received from July 2011 to June 2012. All samples were cultured on solid medium followed by drug susceptibility to first and second line anti-tubercular drugs as per RNTCP guidelines. Primary multi-drug resistance [MDR] was found to be 18/453; [4.0%]. Extensively drug resistance [XDR] was found in one strain [0.2%], which was found to be resistant to other antibiotics. Data of drug resistant tuberculosis among treatment naive TB patients are lacking in India. The presence of XDR-TB and high MDR-TB in small population studied, calls for conducting systematic multi-centric surveillance across the country

Increasing incidence of multidrug resistant Pseudomonas aeruginosa in inpatients of a tertiary care hospital.

Background: Pseudomonas aeruginosa is an important pathogen isolated from various clinical infections. The occurrence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains is increasing worldwide and limiting our therapeutic options resulting in high mortality. We aim to study the incidence of multidrug resistant Pseudomonas aeruginosa in inpatients from various departments along with rate of nosocomial infections. Methods: A cross sectional study from January 1, 2013 to December 31, 2013. A total of 167 Pseudomonas aeruginosa were isolated from 764 clinical specimens. The isolates were identified by standard microbiological techniques. The antibiotic susceptibility was done by Kirby Bauer method. Results: The highest number of isolates were from pulmonary samples n=90 (53.89%) followed by pus n=48 (28.74%). Overall, 39 (23.36%) isolates were nosocomial. The nosocomial isolates were mainly isolated from department of surgery, orthopaedics, obstetrics & gynaecology followed by others. Among 167 isolates screened, 53 (31.73%) were found to be MDR (resistant to ≥3 classes of antipseudomonal agents). The resistance was most against cephalosporins [Cefepime (65.26%), cefotaxime (60.47%)], fluoroquinolones [Ciprofloxacin (46.1%), levofloxacin (31.87%)] aminoglycosides [Amikacin (37.72%), gentamicin (31.13%)] followed by ureidopenicillins and carbepenems. About 56.75% isolates were suspected Metallo β lactamases producers. Conclusion: The study suggests that the incidence of nosocomial infection by multidrug resistant Pseudomonas aeruginosa is increasing globally especially the Metallo Beta lactamases producing strains. So there is a continuous need of conduction of surveillance programmes to formulate rational treatment strategies to combat this emerging challenge.

Prevalence of parasitic infestations amongst the food handlers in a city of North Eastern Region of India.

Background & objectives: The objective of this study was to determine the prevalence of intestinal parasitic infections among food handlers in the city of North eastern region of India. Materials and Methods: Three hundred food-handlers were included to in this study. The stool samples were collected from the subjects and examined for intestinal parasites following direct microscopic examination and Formol Ether concentration (Ritchie) technique. Results: The majority (88.63%) of the food-handlers (cases) were young adults and middle aged from 20 to 49 years. Eighty eight (29.33%) stool specimens were positive showing 99 different diagnostic stages of parasites. Some specimens were infected by more than 1 parasite. Ascaris lumbricoides 37(37.37%) was most frequent among the different detected intestinal parasites followed by Entamoeba histolytica 21(21.21%). Other parasites were Trichuris trichiura 10(10.10%), Giardia lamblia 9(9.09%) and Taenia species 5(5.05%). Most of the food handlers were having poor hygiene residing in rural area and slums. Conclusion: Routine screening of food handlers is a valuable tool for prevention of food-borne infections among the public. In addition we should provide health education emphasizing the importance of food handlers as potential sources of infections and suggested health institutions for appropriate hygienic and sanitary control measures.

Unusual case of pulmonary renal syndrome with autopsy findings.

Scleroderma renal crises (SRC) is a serious complication of systemic sclerosis whose prognosis remains serious despite management with angiotensin-converting enzyme inhibitors, antihypertensives and dialysis. Pulmonary renal syndrome (PRS), characterised by diffuse alveolar hemorrhage (DAH) and SRC, is rare and carries a grave prognosis. This case report discusses the clinicopathological features of a 43-year-old male presenting with severe hypertension and rapidly progressive renal failure who subsequently developed DAH and died. The clinical course, exhaustive investigative work-up and autopsy findings led to a diagnosis of diffuse systemic sclerosis with PRS subcategorized into PRS with thrombotic microangiopathy. The index case came without a prior diagnosis of systemic sclerosis, thereby posing a serious diagnostic challenge and management issues.

Rare case of impalement of two occupants of a vehicle by the same object: insights into the management of complex thoracic impalements / 中华创伤杂志(英文版)

Thoracic impalement injuries are very rare and the majority of patients do not survive to reach a medical care facility. In this case report, we describe the successful outcome of a case of double thoracic impalement by two steel tors, of which one steel tor had impaled two patients simultaneously. The case report highlights all aspects of managing such rare and complex cases right from prehospital care; extrication process which happened under controlled environment at the trauma centre itself, till the definitive management of the impaled thoracic objects. Thoracic impalement injuries are dramatic and appear very challenging. However presence of mind of the managing team, coordinated team effort and availability of adequate facilities can lead to a successful outcome.

Spectrum of stones composition: a chemical analysis of renal stones of patients visiting NMCTH.

A general observation of clinicians suggests that the prevalence ofurolithiasis is fairly high in Kathmandu but so far no systematic study has been undertaken here to explore the etiopathogenesis of disease in this region. In this preliminary communication, we present herewith the qualitative composition of 47 renal stones collected from surgical patients admitted to NMCTH over a period of 13 months (July 2005 to July 2006). All stones were of mixed type. Calcium was present in all stones. Oxalate, phosphate and uric acid were present in 95.7%, 87.2% and 34.0% patients respectively. The probable composition, as construed from analysis, suggests that calcium oxalate stones are predominant. Strikingly, the prevalence was very high in e"20 yrs age group.

Epidemiology and etiopathogenesis of urinary calculi in western Nepal (Pokhara).

Urinary stone disease is recorded in the literature from the dawn of the history and has spared no segment of society irrespective of age, gender, occupation and socio-economic status. It is still termed as "Refractory Disease" as complete medical management to prevent occurrence or recurrence is not so far available. We conducted a preliminary survey from the Manipal Teaching Hospital and carried out urinalyses to ascertain risk factors in the local population. This preliminary survey indicates the prevalence of stone disease is in moderate zone. Hyperoxaluria is an important risk factor in more than one fourth of the stone formers; and hypernatriuria is distinctly most common potentiating risk factor.

Rapid progression of hepatitis C-induced liver failure in renal allograft recipients.

Early mortality due to hepatitis C virus (HCV)-related liver failure in renal allograft recipients in the absence of fibrosing cholestatic hepatitis is reported infrequently. We report six renal allograft recipients with HCV infection who died of rapid progression to liver failure. Of these, 2 were detected anti-HCV positive at screening prior to kidney transplantation and 4 were diagnosed after transplantation following derangement of liver function (HCV RNA positive in all 4, anti-HCV positive in 2). Median interval between kidney transplantation and derangement of liver function was 11.8 months (range 2 to 25) and median interval between transplant and death was 27 months (range 11 to 53). Liver biopsy performed during the terminal illness in 3 patients and post-mortem liver histology in 2 patients showed chronic hepatitis with mean grade of 10.2 (range 9 to 12) and stage 2.4 (range 2 to 3). None had features of fibrosing cholestatic hepatitis.

Oxidative stress and antioxidant status in cancer patients and healthy subjects, a case-control study.

Since raised oxidative stress (OS) or weak antioxidant defence or both are considered to be important players in multimechanistic pathogenesis of cancer, the present study was undertaken to evaluate their possible involvement in the pathogenesis of this disease in the local population. Levels of plasma vitamin C, vitamin E, total antioxidant activity (TAA) and thiobarbituric acid reacting substances (TBARS) as a marker of OS were measured in 20 cancer patients (Mean age 63.1 + 9.3 yr.) and 20 age, sex and socioeconomically matched healthy subjects (Mean age 63.7+7.8 yr.). Significantly low level of vitamin C (p <0.001), vitamin E (p <0.001) and TAA (p <0.003) were observed in cancer patients, whereas OS was significantly increased in patients as compared to control (p <0.003). Smokers had significantly lowered TAA and significantly raised OS than non-smokers, in both case and control groups. Tobacco chewer patients had raised OS as compared to control. This study supports the thesis that OS is a risk factor in carcinogenesis and that smoking, an established risk factor in cancer, at least partly appears through it.

Peripheral nerve connections influence the appearance of neurosecretary material in neural sheath of ventral ganglion of the fly Sarcophaga bullata: an immunocytochemical study.

This study examined the role of the brain and peripheral connections with the target organs in the appearance of neurosecretary material within the dorsal neural sheath of the ventral ganglion of the fly S. bullata. Specifically, the accumulation of the neuropeptide FMRFamide (the neurosecretary material) was examined by immunocytochemistry. Immunoreactions were performed on: (1) a normal intact ventral ganglion, (2) an isolated ventral ganglion that was cultured in vivo, and (3) a ventral ganglion that was isolated by transection from the brain, but retained its peripheral nerve connections. The results demonstrate that (a) the neurons of the ganglia survive and exhibit FMRFamide immune reaction independent of their peripheral connections, and (b) the accumulation of neuropeptide in the dorsal neural sheath is controlled by intact peripheral nerve connections with the ganglion. It is suggested that in the absence of their peripheral connections, the axons of FMRFamide immunoreactive neurons fail to invade the neural sheath resulting in the accumulation of neurosecretary material.