Role of anti-tubercular treatment for positive endometrial aspirate DNA-PCR reproductive outcome in infertile patients in Indian setting - A randomized trial.

AIMS: The aim of the study was to determine the effect of anti-tubercular therapy (ATT) versus no ATT on reproductive outcome in patients with positive endometrial aspirate DNA-PCR for tuberculosis. SETTINGS AND DESIGN: Department of Obstetrics and Gynecology in collaboration with the Department of Microbiology at the All India Institute of Medical Sciences, New Delhi, India. METHODS AND MATERIALS: This prospective randomized study was conducted on 100 women in the reproductive age group with primary or secondary infertility, attending the Gynecology OPD at AIIMS. Women with positive endometrial DNA-PCR, patent tubes on laparoscopy, and all other tests being negative for genital TB were randomized into two groups. In Group 1, patients received ATT for 6 months while in Group 2, patients were not given ATT. In patients who did not conceive a repeat endometrial sampling for DNA-PCR was performed at 6 months and 12 months post-laparoscopy. STATISTICAL ANALYSIS: It was carried out using Stata 11.0 (College Station, TX, USA). RESULTS: In Group 1 (ATT), 25 women achieved pregnancy with a pregnancy rate of 50% while in Group 2 (no ATT), 21 women achieved pregnancy with a pregnancy rate of 42% and the difference (95% CI) was 8.0% (-11.5%, 27.5%) which was not statistically significant (p=0.422). Difference (95% CI) in the rate of repeat EA DNA-PCR being positive between the two groups at 6 months was 3.1% (-2.9%, 9.1%), p=0.299, while at the end of 12 months, repeat DNA-PCR remained positive in 23 patients in Group 1 and in 26 patients in Group 2. Difference (95% CI) in the rate of repeat EA DNA-PCR being positive between the two groups at 12 months was 2.3% (-13.0%, 17.7%), p=0.767. CONCLUSION: The present study does not validate ATT for positive DNA-PCR; however, it does provide an evidence to stop over-treating patients on the basis of positive EA DNA-PCR even after they have received a 6 months course of ATT. Repeating PCR at 6 months and at 12 months has no role and ATT should not be repeatedly given to the patient on the basis of repeat DNA-PCR alone. CLINICAL TRIAL REGISTRATION NUMBER: CTRI/2015/10/006235, www.ctri.nic.in.

Primary Plating of Displaced Mid-shaft Clavicular Fractures.

BACKGROUND: Recent studies have shown that displaced mid-shaft clavicular fractures do not have assured favourable outcomes with non-operative management and nonunion rates could be as high as 20%. In addition many malunite with significant shortening. Non-union or malunion causes functional deficit and many of them may benefit from primary internal fixation. METHODS: We reviewed the results of twenty cases of displaced/comminuted midclavicular fractures, which were treated with primary open reduction and internal fixation with a reconstruction plate placed over the superior surface of clavicle. RESULT: All the fractures clinically united by eight weeks. As per Rowe criterion 12 had excellent, six good and two fair results. On an average patients had full functional recovery in four months. CONCLUSION: Primary internal fixation of displaced comminuted mid-shaft clavicular fractures leads to predictable and early return to function thus preventing unacceptably high complication rates of nonoperative management of these fractures.

Role of tranexamic acid in management of dysfunctional uterine bleeding in comparison with medroxyprogesterone acetate.

Currently, tranexamic acid (TXA) is used as 4 g/day in menorrhagia This prospective randomised study included 100 cases to assess efficacy and safety of 2 g/day TXA in dysfunctional uterine bleeding (DUB) vs cyclical 10 mg twice-daily medroxyprogesterone acetate (MPA) for 3 cycles. Follow-ups were made monthly for 3 months during therapy, then 3 months after. Mean pictorial blood loss assessment chart (PBAC) score decreased from 356.9 to 141.6 in the TXA group and from the pre-treatment 370.9 to 156.6 with MPA and mean reduction of blood loss was 60.3% with TXA and 57.7% with MPA after 3 months (p < 0.005 in both groups). Lack of response during treatment was seen in three patients (6.1%) TXA and in 13 patients (28.9%) with MPA (p = 0.003). In patients who reported 3 months after stopping the treatment, 66.7% in TXA group and 50% in MPA had recurrence of menorrhagia, (p = 0.155). During the 6 months study period more hysterectomies were performed in the MPA than in the TXA group (17.8% vs 4%; p = 0.002). We conclude that TXA in 2 g/day dosage is an effective and safe option in DUB.

Experimental aspergillosis in the German cockroach Blattella germanica: a histopathological study.

Inoculation of a spore suspension of Aspergillus flavus in the haemocoel of the German cockroach (Blatella germanica) resulted in large-scale invasion of various internal organs as seen in tissue sections stained with a fungal stain. The organs affected were the alimentary canal, fat bodies, muscle fibres, malpighian tubules and the cerebral neurosecretory cells. No invasion of the trachea and tracheoles was noted.

Aspergillosis in German cockroach Blattella germanica (L.) (Blattoidea: Blattellidae).

Natural infection of Aspergillus flavus was observed in adults of Blattella germanica. Though the adult insects exhibited no external symptoms, they became hypoactive and later died. The dead and experimentally infected insects repeatedly yielded Aspergillus flavus in culture on Czapek's medium. Direct microscopic observation of the tissues of infected insects revealed fungal material. The blood films stained with Giemsa stain showed granulocytes (GRs) engulfing fungal hyphae. A remarkable increase in GR and plasmatocyte (PL) counts occurred in differential haemocyte counts (DHCs) of the infected insects. Two main types of immunological responses of the insect noticed were phagocytosis and encapsulation. DHC showed maximum involvement of GRs and PLs in immune mechanism.

Prevention of oculocardiac reflex (O.C.R) during extraocular muscle surgery.

In the present study the effectiveness of intravenous atropine sulphate which blocks the peripheral muscarinic receptors at the heart and retrobulbar xylocaine hydrochloride which blocks the conduction at ciliary ganglion on the afferent limb of OCR was studied during strabismus surgery. The study was conducted on fifty three patients of either sex having squint of more than ten years duration. The patients were randomly allocated into four groups. No preanaesthetic medication with atropine or retrobulbar block with xylocaine was given in control group of patients. In the second group, only preanaesthetic medication with atropine was given; while in the third group only retrobulbar injection of xylocaine was given five minutes before operation. In the last group both atropine as preanaesthetic medication and xylocaine as retrobulbar block were given. The electrocardiographic recordings were taken before and throughout the operative procedure. It was interesting to note that in the group where atropine and xylocaine were used none of the patients exhibited activation of OCR. Results have been discussed.

Effect of metoclopramide on gastric ulceration and secretion in albino rats.

The antiulcer and antisecretory effects of metoclopramide were studied in aspirin-induced and pylorus-ligated gastric ulcers. The effects were compared with ranitidine (10 mg/kg, orally). The effect of propantheline alone and in combination with metoclopramide was studied against aspirin-induced gastric ulcers only. Metoclopramide (20 mg and 50 mg/kg) produced an ulcer protective effect both in aspirin-induced and pylorus-ligated experimental models. Its ulcer protective effect against aspirin-induced and pylorus-ligated gastric ulcers was comparable to ranitidine. Metoclopramide reduced the volume of gastric secretion but did not alter the total acidity; however, significant reduction in free acidity was noted. The ulcer protective effect of metoclopramide appeared to have multiple mechanisms like reduction in gastric secretion and free acidity, increased gastric emptying and cytoprotective action.

A modified pedigree method of selection.

A dismal 81% failure of newly bulked lines against checks was observed in Indian wheat material evolved by the pedigree method. This is considered to be the consequence of selection in space planting in early generations followed by yield tests in a competitive environment which did not allow any scope of selection for competitive ability. Thus, most of the homozygous lines, which were until now raised and carried forward under space planting, failed to compete with the checks for yield in close planting. It is, therefore, necessary to modify the method to combine both the competitive ability and identity of selected plants. The proposed modified procedure involves raising the population under spaced planting as well as under drilling from F2 onwards. Evaluation for tiller index marks an important step. On the basis of tiller index, single plants are isolated from spaced populations. Steps of the modified procedure are outlined in detail. The modified method, which economises on breeders' workload and other physical inputs, besides having other advantages, can also be used for certain other grain crops. Preliminary results based on the modified method during the past two seasons have indicated its utility.

A new selection criterion for yield in wheat.

The mortality of young tillers to an extent of 36.5% under optimum cultural conditions was recorded in a field experiment. Attention is drawn to the necessity of minimising this loss and to diverting it towards productive tillers by applying selection pressure. Future yield advances may be achieved by selecting genotypes which tiller moderately in the vegetative phase, most of which survive to produce grains. The character association of each variety under consideration was studied for the suitability towards this objective. A modified selection procedure is suggested which may be advantageously applied to achieve this objective. The proposed new methodology may also be effectively applied to such other cereal crops as barley, triticale and oats.

Evidence for the presence of osmoreceptors in medulla of the dog.

Hypertonic solutions of different substances were injected into the vertebral artery of dogs anesthetized with chloralose, preventing their access to the hypothalamic osmoreceptors by ligating the basilar artery and both the external carotid arteries. The hypertonic solution of sodium chloride produced graded inhibition of water diuresis and a concomitant rise in plasma antidiuretic hormone (ADH) level; hypertonic solution of glucose produced lesser effect. Hypertonic urea solution, on the other hand, did not alter the course of water diuresis. It was concluded that osmoreceptors are also present in the medulla which sense the changes in blood osmolarity and accordingly modify the ADH release.

The role of 'Norin 10' dwarfing genes in photosynthetic and respiratory activity of wheat leaves.

A comparative analysis of eight cultivars of spring wheat (Triticum aestivum) classified by height as tall (T), semi-dwarf (D1), dwarf (D2) and very dwarf (D3) was conducted to study their efficiency of oxygen exchange during photosynthesis and dark respiration. Two cultivars were included in each height group.Cultivars carrying 'Norin 10' dwarfing genes (D1, D2 and D3) were found to have a significantly higher photosynthetic rate per unit leaf area than talls (T) that lack these genes. Among the 'Norin' gene carriers, dwarf group (D2) was most efficient, followed by very dwarf (D3) and semi-dwarf (D1).Photosynthetic rate and respiratory rate were found to have a positive relationship.