Awareness of cervical cancer and Pap smear among nursing staff at a rural tertiary care hospital in Central India.

BACKGROUND: Cancer cervix is the leading cause of cancer deaths in females in developing countries and one in five women suffering from cervical cancer lives in India. AIMS: The aim of this study is to determine the awareness about cervical cancer and Pap smear among nurses working in a tertiary care institute. Study Setting and Design: Cross-sectional survey in a tertiary care institute. MATERIALS AND METHODS: Nurses working at our institute excluding those who have worked or working in the Obstetrics and Gynecology department were provided with a pre-designed questionnaire testing their knowledge about cervical cancer. RESULTS: Approximately, 86% were aware about cancer cervix and 69% were aware of a pre-cancerous stage. 42.3% were not aware of any risk factor and 27.6% were not aware of any symptom of cancer cervix. 86.2% were aware about Pap smear, but only 58.6% were aware that facilities of Pap smear were available at our hospital. CONCLUSIONS: Knowledge about cervical cancer and awareness of Pap smear as screening test was inadequate in nursing staff. Awareness programs about cervical cancer and screening are needed to increase awareness for this preventable condition. RECOMMENDATION: There is a need to arrange reorientation programs to sensitize nurses and establish cytology clinics to offer facilities for easily accessible and affordable screening.

Dose-ranging efficacy and safety study of ertugliflozin, a sodium-glucose co-transporter 2 inhibitor, in patients with type 2 diabetes on a background of metformin.

AIM: To investigate the efficacy and safety of ertugliflozin, in a phase II dose-ranging study, in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin. METHODS: A total of 328 patients [mean T2DM duration, 6.3 years; mean glycated haemoglobin (HbA1c), 8.1%] were randomized to once-daily ertugliflozin (1, 5, 10, 25 mg), sitagliptin (100 mg) or placebo, for 12 weeks. The primary efficacy endpoint was change from baseline to week 12 in HbA1c concentration and the secondary efficacy endpoints were changes from baseline to week 12 in body weight, fasting plasma glucose (FPG) and systolic/diastolic blood pressure (SBP/DBP). Safety and tolerability were also monitored. RESULTS: Ertugliflozin (1-25 mg/day) produced significant reductions in HbA1c concentration [placebo-corrected least-squares mean (LSM) -0.45% (1 mg) to -0.72% (25 mg); p ≤ 0.002, similar to sitagliptin (-0.76%; p = 0.0001)], FPG (LSM -1.17 to -1.90 mmol/l; p < 0.0001) and body weight (-1.15 to -2.15%; p < 0.0001). The LSM SBP decreased by -3.4 to -4.0 mmHg from baseline with ertugliflozin 5-25 mg/day. No reductions in body weight or blood pressure were observed with sitagliptin. After randomization, 2.7% of patients (9/328) withdrew because of adverse events (AEs); the frequency of AEs was evenly distributed across groups. No dose-related increase in AE frequency occurred with ertugliflozin. Hypoglycaemia was reported in 5 (1.5%) randomized participants (all in the ertugliflozin group). The frequency of urinary tract infection was 3.2% for ertugliflozin (pooled across groups), 1.8% for sitagliptin, 7.4% for placebo, and the frequency of genital fungal infections was 3.7% for ertugliflozin (pooled) versus 1.9% for placebo. CONCLUSION: Ertugliflozin (1-25 mg/day) improved glycaemic control, body weight and blood pressure in patients with T2DM suboptimally controlled on metformin, and was well tolerated.

Comparison of Gastroprotective Effects of Triphala Formulations on Stress-induced Ulcer in Rats.

Triphala is categorized as rejuvenator and traditionally been used in various gastric disorders including intestinal inflammation. The aim of present study was to examine the comparative gastroprotective effects of Triphala formulations against experimental gastric ulcer in rats to substantiate its traditional claim. Gastric ulcer was induced by water immersion plus stress-induced ulcers in rats. The drug effects were assessed by studying macroscopic gross injury and stomach tissue biochemical parameters. Triphala unequal formulation and Chinnodbhavadi kwath showed significant antiulcer activity and this is evident from reduction of ulcer index, lipid peroxidation and hydroxyl radical levels and concomitantly raised levels of catalase and superoxide dismutase. Though similar kind of activity was observed in Triphala equal formulation the magnitude was much less. Further, Chinnodbhavadi kwath significantly increased the glutathione and ATPase level but Triphala equal formulation significantly increased glutathione level only. Based on the data generated, it is suggested that among the three formulations studied, Chinnodbhavadi kwath and Triphala unequal formulations provides significant protection in gastric ulcer as compared to Triphala equal formulation.

Prandial-basal insulin regimens plus oral antihyperglycaemic agents to improve mealtime glycaemia: initiate and progressively advance insulin therapy in type 2 diabetes.

AIMS: To compare two progressive approaches [once-daily insulin glargine plus ≤3 mealtime lispro (G+L) vs. insulin lispro mix 50/50 (LM50/50) progression once up to thrice daily (premix progression, PP)] of beginning and advancing insulin in patients with type 2 diabetes (T2D) and inadequate glycaemic control on oral therapy, with the aim of showing non-inferiority of PP to G+L. METHODS: Patients were randomized to PP (n = 242) or G+L (n = 242) in a 36-week, multinational, open-label trial. Dinnertime insulin LM 50/50 could be replaced with insulin lispro mix 75/25 if needed for fasting glycaemic control. RESULTS: Baseline haemoglobin A1c (HbA1c) were 9.5% (PP) and 9.3% (G+L); p = 0.095. Change in A1C (baseline to endpoint) was -1.76% (PP) and -1.93% (G+L) (p = 0.097) [between-group difference of 0.17 (95% confidence interval: -0.03, 0.37)]. Non-inferiority of PP to G+L was not shown based on the prespecified non-inferiority margin of 0.3%. A1C was lower with G+L at weeks 12 (7.8 vs. 7.9%; p = 0.042), 24 (7.4 vs. 7.6%; p = 0.046), but not at week 36 (7.5 vs. 7.6%; p = 0.405). There were no significant differences in percentages of patients achieving A1C ≤7%, overall hypoglycaemia incidence and rate or weight change. Total daily insulin dosages at endpoint were higher with PP vs. G+L (0.57 vs. 0.51 U/kg; p = 0.017), likely due to more injections (1.98 vs. 1.79; p = 0.011). CONCLUSIONS: Both treatments progressively improved glycaemic control in patients with T2D on oral therapy, although non-inferiority of PP to G+L was not shown. Higher insulin doses were observed with PP with no between-treatment differences in overall hypoglycaemia or weight gain.

Pathophysiological actions of protease activated receptors (PARs).

Serine proteases such as thrombin, mast cell tryptase, trypsin, or cathepsin G, for example, are highly active mediators with diverse biological activities. So far, proteases have been considered to act primarily as degradative enzymes in the extracellular space. However, their biological actions in tissues and cells suggest important roles as a part of the body's hormonal communication system during inflammation and immune response. These effects can be attributed to the activation of a new subfamily of G protein-coupled receptors, termed protease-activated receptors (PARs). Four members of the PAR family have been cloned so far. Thus, certain proteases act as signaling molecules that specifically regulate cells by activating PARs. After stimulation, PARs couple to various G proteins and activate signal transduction pathways resulting in the rapid transcription of genes that are involved in inflammation. For example, PARs are widely expressed by cells involved in immune responses and inflammation, regulate endothelial-leukocyte interactions, and modulate the secretion of inflammatory mediators or neuropeptides. Together, the PAR family necessitates a paradigm shift in thinking about hormone action, to include proteases as key modulators of biological function. Novel compounds that can modulate PAR function may be potent candidates for the treatment of inflammatory or immune diseases.

Treatment of pemphigus with intravenous pulse cyclophosphamide.

BACKGROUND: The complications associated with the use of systemic corticosteroid therapy have prompted a search for alternative agents. However, these agents are themselves associated with increased risk of myelosuppression or malignancy. METHODS: The present study included twenty patients with recalcitrant pemphigus or steroid induced side effects who were treated with intravenous cyclophosphamide pulse therapy. RESULTS: Out of 18 patients who completed the study, 14 showed good to excellent response. Thirteen were able to decrease their daily dose of steroid to 5-10 mg prednisolone while one could stop steroids altogether. Most patients did not experience serious side effects. DISCUSSION: Thus intravenous pulse cyclophosphamide is a promising form of therapy in pemphigus either recalcitrant or intolerant to steroid therapy. The decreased total cumulative dose of cyclophosphamide with intravenous therapy as compared to oral therapy may reduce the incidence of secondary malignancy.

Sternal retractor for internal mammary artery.

A sternal retractor for easy visualization of the internal mammary artery and retrosternal area is described. We have successfully used this retractor for all internal mammary dissections without sternal or costochondral fractures in the past 6 months.

Anti-inflammatory properties of 3-methylpyrazolin-5-(4 H)-one-4-[3'-methoxy-4' (2'',3'',4'',6''-tetra-O-acetyl-beta-D-glycopyranosyl]benzylidene (compound IIIA).

Oral treatment of compound IIIA exhibited dose related inhibitory action in acute tests of carrageenan, histamine and dextran-induced oedema in rats. Marked inhibitory action of the compound was found when it was administered intraperitoneally in animals. It displayed prominent anti-arthritic activity in chronic tests of adjuvant and formaldehyde-induced arthritis in rats. It prevented the arthritis associated rise in total leucocyte count and erythrocyte sedimentation rate. It also lowered the levels of exudate volume and migration of leucocytes in carrageenan induced pleurisy in rats. It did not exhibit any analgesic, antipyretic or ulcerogenic effect. No mortality was recorded up to 2 g/kg in mice on oral or intraperitoneal treatment over a period of 72 hr.

Enhancement of somatic embryogenesis in Norway spruce (Picea abies L.).

Embryogenic callus developed in 55% of the mature embryo explants of Norway spruce (Picea abies L.) growing on a LP medium minus the amino acids and sugars (except sucrose). This is the highest reported yield of embryogenic callus from mature embryos of P. abies that has ever been reported. Callus induction from either the middle or the end of the hypocotyl of the embryos began after 2-3 weeks. Three types of calli were recovered: (a) globular, (b) light green-compact, (c) white mucilaginous. Only the white mucilaginous calli were embryogenic. The globular and light green-compact calli never become embryogenic, even after several subcultures. The development of somatic embryos was accomplished on half-strength macro-elements of NSIII medium containing 1 µM α-naphthaleneacetic acid, 1 µM abscisic acid, and 3% sucrose. The addition of 10(-7) M buthionine sulfoximine to the medium increased the development of somatic embryos by three fold. These results suggest that there is a great potential for increasing the frequency and development of somatic embryos in P. abies. Careful selection of the genotype and modification of the culture medium is required.

Cytological and histochemical observations on the cortical zone of oocytes of a teleost fish, Nandus nandus (Ham).

The cortical zone of oocyte of Nandus nandus has been studied by cytological and histochemical techniques. In an early stage of oocyte development some granular substances appear in the juxtanuclear region which during oocyte growth move to the peripheral ooplasm and forms a thick cortical granular layer. Cytochemically, this cortical granular layer consists of proteins and carbohydrates along with RNA positive material, lipids, mitochondria and Golgi bodies. This cortical granular layer, later on, converts into the cortical vacuolar layer and ultimately forms the cortical alveolar structures in the vitellogenic oocyte of Nandus nandus. The results suggest that the cortical zone plays an important role in the storage of substances transported from the follicular epithelium to the oocyte. Further, the cortical granular substances which are rich in proteins, carbohydrates and lipoidal material, also help in the formation of jelly layers of the developing oocytes.

Somatic hybridization of an atrazine resistant biotype of Solanum nigrum with Solanum tuberosum : Part 1: Clonal variation in morphology and in atrazine sensitivity.

Plants were regenerated from protoplast fusion experiments with haploid Solanum tuberosum L. and an atrazine resistant biotype of the normally susceptible S. nigrum L. Sixty clones which were unlike the parents were selected by types of hairs and leaf pigmentation of young shoots and characterized by: chromosome numbers, response to atrazine, branching, hairs of the calyx, shapes and pigmentation of leaves, and morphology of flowers. Twenty five clones showed vegetatively stable differences from the parental clones; enough combinations of mixed characters suggested the clear origin from fusants of at least nine clones. Observed diversities within and between protoplastderived clones are interpreted as expressions of variation during the development of the regenerants.

Abnormality in body curvature of Cyprinus carpio after injection of anaesthetics.

Abnormalities in the body curvatures were noticed in Cyprinus carpio after the injection of anaesthetics, viz. paraldehyde, tertiary butyl alcohol and butanol. These abnormalities occurred behind the dorsal fin and progressively developed over a period of four months. The abnormalities affect the locomotion and speed of swimming of the fish and appear to be due to toxic effects of the anaesthetics.