Significance of isolating non-tuberculous mycobacterial organisms in infertile women with tubal disease: an observational study.

OBJECTIVES: To explore whether non-tuberculous mycobacteria (NTM) are associated with tubal disease leading to infertility. DESIGN: Prospective observational study. SETTING: Teaching hospital. POPULATION: Women with tubal factor infertility. METHODS: In all, 173 infertile women with tubal disease were investigated for genital tuberculosis, Chlamydia trachomatis and Neisseria gonorrhoeae using polymerase chain reaction, culture and histopathological examination. On culture, NTM were grown in 23.7% of endometrial samples. The mycolic characteristics of these organisms were analysed. MAIN OUTCOME MEASURE: Whether NTM are associated with tubal disease leading to infertility. RESULTS: The organisms identified in association with tubal disease were Mycobacterium tuberculosis in 30%, gonococci in 1.7%, Chlamydia in 7.5% and NTM in 23.7% of cases. Mycobacterium chelonae was the predominant organism identified by high-performance liquid chromatography. In ten women, for whom there was laparoscopic evidence of tubal disease, the only organism that was grown was NTM, and the tests for other organisms were negative. Tests for possible environment (theatre, instruments) contamination was reported negative. CONCLUSION: While evaluating infertile women for tubal disease, culture studies revealed a high prevalence of NTM in the endometrium. In the absence of M. tuberculosis, gonococci and Chlamydia infection, the presence of NTM suggests the possibility that these organisms may be responsible for tubal damage leading to infertility. TWEETABLE ABSTRACT: On evaluating the causes of tubal disease, NTM were associated with tubal disease.

Effect of intraoperative trypan blue on lens epithelial cells - Histomorphological analysis.

INTRODUCTION: Trypan Blue is an acid azo dye commonly used as a stain to distinguish viable from non-viable cells. It is a vital stain used intra operatively during cataract surgery to stain the external surface of the anterior lens capsule for better visualization. AIM: To analyze the histomorphological effects of trypan blue on Lens Epithelial cells and the Basement Membrane on direct exposure by staining the internal surface of the anterior lens capsule during Small Incision Cataract Surgery. METHODS: Analytical cross sectional case control study. Anterior capsule specimens of 14 Patients undergoing small incision cataract surgery at Department of Ophthalmology, Govt Medical College Hospital, Thrissur were studied. Two specimens of anterior capsule taken from the same eye form the case and control. Control specimen (sample A) was removed first, after the routine external staining with trypan blue 0.06% (w/v) for 10 seconds. The stain was washed off by balanced salt solution in every case. Then trypan blue was injected under the remaining anterior capsule and case (Test) specimen (sample B) was obtained after direct contact of trypan blue to the internal surface (lens epithelial cells) for 1 minute. Histomorphological (qualitative and quantitative) examination of both specimens done. RESULTS: Qualitative data analysis was done by EPI INFO software.v.7. Intactness of LECs throughout the length was statistically significant in Sample A (p = 0.000027). Partial and complete detachment of Lens Epithelial Cells, degeneration, and nuclear smudging were significantly higher in Sample B. Qualitative analysis of the basement membrane showed significant edema of the basement membrane in sample B. Basement membrane splitting observed in sample B was not statistically significant. Quantitative data analyzed using independent t test. There was a statistically significant decrease in cell density in sample B with p value less than 0.05. DISCUSSION: Our study demonstrated that direct staining of the internal surface of anterior capsule with trypan blue affected LECs and the basement membrane. There were reduction in cell density, irreversible degeneration of Lens Epithelial Cells and basement membrane edema. Hence treating the internal surface of capsular bag with trypan blue may reduce incidence of Posterior capsular opacification.

Assessment of cerebral hemodynamics during neurosurgical procedures using laser speckle image analysis.

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe medical condition associated with a significant cause of mortality throughout the world. Cisterna magna injection model is accepted widely to mimic clinical aSAH and is performed on small animal models to study aSAH during neurosurgery. Coherent light scattered from the surface of the rat brain is used to infer information about the variations in blood flow during this condition. We obtained speckle images from the exposed cortex during the entire experiment using an external tissue imaging system. Contrast and fractal analyses are carried out for the recorded speckle pattern time series. Correlation analysis based on Hurst exponent for these images is found to be a more sensitive tool in studying aSAH as compared to routinely used laser speckle contrast analysis for assessing the changes in blood flow velocity. Additionally, our studies provide improved blood flow detection sensitivity with image Hurst exponent in combination with computed fractal dimension, during an event of aSAH.

Development of thin skin mimicking bilayer solid tissue phantoms for optical spectroscopic studies.

In vivo spectroscopic measurements have the proven potential to provide important insight about the changes in tissue during the development of malignancies and thus help to diagnose tissue pathologies. Extraction of intrinsic data in the presence of varying amounts of scatterers and absorbers offers great challenges in the development of such techniques to the clinical level. Fabrication of optical phantoms, tailored to the biochemical as well as morphological features of the target tissue, can help to generate a spectral database for a given optical spectral measurement system. Such databases, along with appropriate pattern matching algorithms, could be integrated with in vivo measurements for any desired quantitative analysis of the target tissue. This paper addresses the fabrication of such soft, photo stable, thin bilayer phantoms, mimicking skin tissue in layer dimensions and optical properties. The performance evaluation of the fabricated set of phantoms is carried out using a portable fluorescence spectral measurement system. The alterations in flavin adenine dinucleotide (FAD)-a tissue fluorophore that provides important information about dysplastic progressions in tissues associated with cancer development based on changes in emission spectra-fluorescence with varied concentrations of absorbers and scatterers present in the phantom are analyzed and the results are presented. Alterations in the emission intensity, shift in emission wavelength and broadening of the emission spectrum were found to be potential markers in the assessment of biochemical changes that occur during the progression of dysplasia.

Influence of monte carlo variance with fluence smoothing in VMAT treatment planning with Monaco TPS.

INTRODUCTION: The study aimed to investigate the interplay between Monte Carlo Variance (MCV) and fluence smoothing factor (FSF) in volumetric modulated arc therapy treatment planning by using a sample set of complex treatment planning cases and a X-ray Voxel Monte Carlo-based treatment planning system equipped with tools to tune fluence smoothness as well as MCV. MATERIALS AND METHODS: The dosimetric (dose to tumor volume, and organ at risk) and physical characteristic (treatment time, number of segments, and so on) of a set 45 treatment plans for all combinations of 1%, 3%, 5% MCV and 1, 3, 5 FSF were evaluated for five carcinoma esophagus cases under the study. RESULT: Increase in FSF reduce the treatment time. Variation of MCV and FSF gives a highest planning target volume (PTV), heart and lung dose variation of 3.6%, 12.8% and 4.3%, respectively. The heart dose variation was highest among all organs at risk. Highest variation of spinal cord dose was 0.6 Gy. CONCLUSION: Variation of MCV and FSF influences the organ at risk (OAR) doses significantly but not PTV coverage and dose homogeneity. Variation in FSF causes difference in dosimetric and physical parameters for the treatment plans but variation of MCV does not. MCV 3% or less do not improve the plan quality significantly (physical and clinical) compared with MCV greater than 3%. The use of MCV between 3% and 5% gives similar results as 1% with lesser calculation time. Minimally detected differences in plan quality suggest that the optimum FSF can be set between 3 and 5.

A mathematical approach to beam matching.

OBJECTIVE: This report provides the mathematical commissioning instructions for the evaluation of beam matching between two different linear accelerators. METHODS: Test packages were first obtained including an open beam profile, a wedge beam profile and a depth-dose curve, each from a 10×10 cm(2) beam. From these plots, a spatial error (SE) and a percentage dose error were introduced to form new plots. These three test package curves and the associated error curves were then differentiated in space with respect to dose for a first and second derivative to determine the slope and curvature of each data set. The derivatives, also known as bandwidths, were analysed to determine the level of acceptability for the beam matching test described in this study. RESULTS: The open and wedged beam profiles and depth-dose curve in the build-up region were determined to match within 1% dose error and 1-mm SE at 71.4% and 70.8% for of all points, respectively. For the depth-dose analysis specifically, beam matching was achieved for 96.8% of all points at 1%/1 mm beyond the depth of maximum dose. CONCLUSION: To quantify the beam matching procedure in any clinic, the user needs to merely generate test packages from their reference linear accelerator. It then follows that if the bandwidths are smooth and continuous across the profile and depth, there is greater likelihood of beam matching. Differentiated spatial and percentage variation analysis is appropriate, ideal and accurate for this commissioning process. ADVANCES IN KNOWLEDGE: We report a mathematically rigorous formulation for the qualitative evaluation of beam matching between linear accelerators.

Effect of a primary postpartum haemorrhage on the "near-miss" morbidity and mortality at a tertiary care hospital in rural bangalore, India.

AIM: To assess the risk factors, the mortality and the "near-miss" morbidity in primary PPH. SETTING AND DESIGN: A retrospective analysis of 124 women with PPH (within 24 hrs of delivery) over 4 consecutive years in a tertiary care hospital in rural bangalore. MATERIAL AND METHODS: The case sheets of the patients, which were identified by the labour record registers as having PPH were reviewed by the same person, to identify the actual impact of the condition. The data was analyzed by Chi-square analysis. RESULT: PPH (the loss of blood that caused significant alterations in the maternal condition or a blood loss of 500 cc in vaginal deliveries or of >1000 cc in caesarean sections) was recorded in 124 women; 60 had delivered in hospitals (Group-A) and 64 had been referred after their deliveries (Group-B) from various peripheral centres, i.e., maternity hospitals, nursing homes and district and community health centres. The maternal mortality ratio during this period was 71/100,000 (4 deaths/5600 live births). Of these 4 deaths, 0 were in group A and 4 were in group B. The "near-miss" morbidity was higher than the mortality (total 20/124; 6/60 in Group-A and 14/64 in Group-B). The delayed referrals and the lack of an active 3rd stage management in Group-B were responsible for most of the adverse events. CONCLUSION: Both the "near-miss" morbidity and the mortality in PPH reflect the level of obstetric care in the developing world. These need to be reduced by strengthening the peripheral delivery facilities, the active 3rd stage management and the timely referrals.

Broad ligament fibroid mimicking as ovarian tumor on ultrasonography and computed tomography scan.

Giant fibroids are known to arise from the uterus, and very rarely from the broad ligament. Large fibroids often undergo hyaline, cystic, and at times, red degeneration. In the present case, cystic degeneration with intervening septations in an adnexal mass raised the suspicion of ovarian neoplasm as the ovaries were not seen as separate from the lesion. The ultrasonographic and contrast-enhanced computed tomographic findings of this case were characteristic of ovarian neoplasm. The differential diagnosis included rare possibility of giant fibroid with cystic degeneration. The diagnosis was confirmed on histopathological examination. The patient underwent excision of the broad ligament fibroid, hysterectomy, and bilateral salpingo-oophorectomy. Magnetic resonance imaging has a role in the diagnosis of such lesions.

Quality assurance of dynamic parameters in volumetric modulated arc therapy.

OBJECTIVES: The purpose of this study was to demonstrate quality assurance checks for accuracy of gantry speed and position, dose rate and multileaf collimator (MLC) speed and position for a volumetric modulated arc treatment (VMAT) modality (Synergy S; Elekta, Stockholm, Sweden), and to check that all the necessary variables and parameters were synchronous. METHODS: Three tests (for gantry position-dose delivery synchronisation, gantry speed-dose delivery synchronisation and MLC leaf speed and positions) were performed. RESULTS: The average error in gantry position was 0.5° and the average difference was 3 MU for a linear and a parabolic relationship between gantry position and delivered dose. In the third part of this test (sawtooth variation), the maximum difference was 9.3 MU, with a gantry position difference of 1.2°. In the sweeping field method test, a linear relationship was observed between recorded doses and distance from the central axis, as expected. In the open field method, errors were encountered at the beginning and at the end of the delivery arc, termed the "beginning" and "end" errors. For MLC position verification, the maximum error was -2.46 mm and the mean error was 0.0153 ±0.4668 mm, and 3.4% of leaves analysed showed errors of >±1 mm. CONCLUSION: This experiment demonstrates that the variables and parameters of the Synergy S are synchronous and that the system is suitable for delivering VMAT using a dynamic MLC.

Clinical evaluation of the efficacy of Shvitrahara kashaya and lepa in vitiligo.

Vitiligo is a progressive, idiopathic, pigmentation disorder of the skin, characterized by hypopigmented white lesions. PUVA therapy is the treatment of choice in the modern system of medicine. In Ayurveda, Shvitra or Kilasa is the term employed to describe hypopigmentation disorders of the skin. Shvitra is caused by various dietic and behavioral factors which aggravate the tridoshas, especially the Kapha dosha vitiating the Meda dhatu. Many Ayurvedic drugs are well known for the regeneration of melanocytes, among which Bakuchi is one. The present study was planned to study its efficacy in the regeneration of melanocytes. The outcome of treatment in 50 cases of Shvitra vis-à-vis vitiligo receiving Shvitrahara kashaya and Shvitrahara lepa was analyzed and compared. Group I (n = 25) patients were treated with Shvitrahara kashaya and Shvitrahara lepa; Group II (n = 15) patients received Shvitrahara lepa only; and the remaining 10 patients of Group III used both (Western medicine) oral psoralens and UV-A therapy. Assessment was done after 6 months with bi-monthly follow-ups. Out of 25 cases in Group I, 17 showed 80% improvement (t = 7.65; P < 0.01) in the surface area, number of lesions, pigmentation and associated symptoms like itching; out of 15 patients in Group II, 10 showed partial repigmentation, i.e. 50% (t = 5.72; P < 0.01) response was observed. In Group III, 90% response (t = 6.14; P < 0.001) in repigmentation and number of lesions as well was noted but eight patients developed adverse effects like sunburn, severe itching and gastric upset on taking oral psoralen. On the basis of results and observations, it can be concluded that Ayurvedic formulation containing Bakuchi is efficacious and has no untoward effects when compared to oral psoralens and UV-A therapy.

Relative dosimetrical verification in high dose rate brachytherapy using two-dimensional detector array IMatriXX.

For high dose rate (HDR) brachytherapy, independent treatment verification is needed to ensure that the treatment is performed as per prescription. This study demonstrates dosimetric quality assurance of the HDR brachytherapy using a commercially available two-dimensional ion chamber array called IMatriXX, which has a detector separation of 0.7619 cm. The reference isodose length, step size, and source dwell positional accuracy were verified. A total of 24 dwell positions, which were verified for positional accuracy gave a total error (systematic and random) of -0.45 mm, with a standard deviation of 1.01 mm and maximum error of 1.8 mm. Using a step size of 5 mm, reference isodose length (the length of 100% isodose line) was verified for single and multiple catheters of same and different source loadings. An error ≤1 mm was measured in 57% of tests analyzed. Step size verification for 2, 3, 4, and 5 cm was performed and 70% of the step size errors were below 1 mm, with maximum of 1.2 mm. The step size ≤1 cm could not be verified by the IMatriXX as it could not resolve the peaks in dose profile.

Effects of Intralipid-10% in fluorescence distortion studies on liquid-tissue phantoms in UV range.

In biomedical optical spectroscopy tissue-mimicking phantoms have been widely used for imitating optical properties of biological tissues. As tissue is a turbid medium involving scatterers, absorbing and fluorescing molecules, modelling a tissue in the form of a phantom should have the same realistic complexity comparable to that of tissues. In optical spectroscopy, fluorescence phenomena have been extensively investigated as an optical technique for disease diagnosis. The fluorescence signal is distorted by optical properties of a biological tissue. The purpose of this study is to investigate whether the use of Intralipid as a scattering agent in a turbid medium containing fluorophores can affect fluorescent intensity by the phenomena of scattering and collisional quenching. The results indicate that phantom sets with different concentrations of Tyrosine and Intralipid have their emission peaks distorted at 300 nm and also show secondary peaks when used for fluorescence studies in UV region.

Reliability of inter-anterior superior iliac spinous distance as compared to foot length for stature estimation in South Indians.

Estimation of stature from isolated body parts is especially important to forensic scientists and anthropologists. The aims of this study were, to evaluate the accuracy of inter-anterior superior iliac spinous distance in determining stature of an individual as compared to foot length, and to note sex differences in the above mentioned parameters. One hundred normal healthy adult subjects from South India consisting of 50 males and 50 females were studied. The height, interspinous distance, and foot length of the subjects were measured. The mean and standard deviation of the height, interspinous distance, foot length and proportions of interspinous distance and foot length to height were calculated and significance testing done for sex differences. The correlation between stature and interspinous distance and stature and foot length was estimated, and linear regression equations for stature estimation were calculated. The height, interspinous distance and foot length were significantly greater in males. The proportion of interspinous distance to stature was significantly greater in females. Foot length showed a stronger positive correlation with stature compared to interspinous distance. When the sexes were considered separately the accuracy of stature estimation from interspinous distance increased greatly. Though interspinous distance is not as reliable as foot length in stature estimation, it could provide valuable data regarding the stature when isolated pelvises are available.

Clinical Evaluation of Shilajatu Rasayana in patients with HIV Infection.

AIDS is one of the serious global health concerns caused by Human Immuno Deficiency(HIV) virus and is predominantly a sexually transmitted disease. Currently there is no vaccine or cure for AIDS still Anti Retroviral Therapy (ART) is successful. It reduces both the mortality and the morbidity of HIV infection, but is expensive and inaccessible in many countries. However intense the therapy may be, HIV virus is rarely eliminated, and drug resistance is a major setback during long-term therapy. The development of new drugs and strategies and exploring alternative systems of medicine for antiviral herbs or drugs is the need of the age to improve treatment outcomes. Ayurveda describes many diseases which incorporate HIV like illness e.g. Rajayakshma, Ojo Kshaya, Sannipata jwara etc. HIV infection affects multisystems, chiefly the Immune System which can be correlated to Ojo Kshaya. Rasayana Chikitsa is the frontline therapy employed to treat Ojus disorders. Therefore Shilajatu (Mineral pitch), Centella asiatica (Mandukaparni), Tinospora cordifolia (Guduchi) and Emblica officinalis (Amalaki), well known for their Immuno-modulator and antioxidant properties were selected to evaluate their role on immune system. The study was carried on 20 patients from OPD and IPD of Kayachikitsa, S.S.Hospital, IMS, BHU and was randomly allocated into Treated group (Shilajatu+ART) and Control group (ART). Treated Group responded better to ART both clinically and biochemically. The results show that Shilajatu decreases the recurrent resistance of HIV virus to ART and improves the outcome of the therapy.

Role of Uttara Vasti with Trivrit and Lasuna oil in the management of primary dysmenorrhea.

Dysmenorrhea is one of the most common clinical entities encountered in regular practice by the gynecologists. Dysmenorrhea means painful menstruation. Fifty percent of the women suffer from dysmenorrhea. Primary dysmenorrhea is correlated with Udavartini yonivyapad in Ayurveda. No successful advances have been made in the line of management till today by western medicine. Therefore, a complete, comprehensive and holistic approach toward its understanding and treatment is the need of the age. In this series, Uttar Vasti, a unique panchakarma procedure, is studied for its role in yonivyapads. A research study was conductedto evaluate the efficacy of Uttar Vasti with Trivrit and Lasuna oil in Primary dysmenorrhea. Thirty-six diagnosed cases of Udavartini Yonivyapad, viz., primary (spasmodic) dysmenorrhea, were selected and randomly allocated into two groups. The effect of Uttar Vasti was compared with the commonly used non steroidal anti inflammatory drug (control group). Uttar Vasti with Operculina turpethum (Trivrit) and Allium sativum (Lasuna) oil has shown encouraging results in Udavartini yonivyapad. Statistically significant relief was seen in the intensity of pain and the successive cycles were less painful in the treated group as compared to control group. The mode of action can be attributed to anti-inflammatory (vatahara), vasodilatory (ushna virya) antispasmodic and laxative (anulomana) properties of the trial drugs. The present study shows Uttar Vasti as a safe and easy technique to treat dysmenorrhea like conditions without any side effects.

All fiber based multispeckle modality endoscopic system for imaging medical cavities.

Disease detection in body cavities, such as the detection of abnormal growths in the colon path, has been illustrated here using an image fiber guided catheter based multispeckle modality endoscopic system. An all fiber-optic approach for the illumination and imaging of the inner cavity walls is adopted here. An endoscope probe to carry the illumination fibers as well as the imaging lens-image fiber unit is designed and custom fabricated in order to operate the probe in its various direction sensitive configurations. This is facilitated by the selection of suitable optical elements such as beam combiner and biprism at the probe proximal end. Experimental investigations were carried out using the endoscope system employing phantom model of colon as the test specimen that has normal and abnormal (representing growth) regions and the obtained results indicated the system effectiveness in identifying the abnormal growths at an early stage.

Variations of the location of the greater palatine foramina in dry human skulls.

Seventy-one adult skulls (58 dentulous skulls: 56 bilateral and 2 unilateral, 13 edentulous: 11 bilateral and 2 unilateral) of unknown sex were examined for the variations of the location of the greater palatine foramen. The location of greater palatine foramen (GPF) was noted with relation to mid sagittal suture (MSS), posterior palatal border (PPB), and maxillary molars by measuring the distances using a sliding caliper to the nearest millimeter. Difference in the distance of the foramen from MSS and PPG in both the skull types was found to be statistically insignificant. Commonest location of the foramen was found to be opposite to third molar tooth (85.95%), followed by the interval between second and third molar teeth (13.15%), and opposite to the second molar tooth (only one case - 0.88%). Well-formed bony canals were found along the groove for the palatine nerves and vessels unilaterally in the right side in two skulls. These observation may be of help to the dental surgeon during the peripheral block of maxillary nerve for the maxillo-facial surgery.

Digital speckle pattern interferometry for deformation analysis of inner surfaces of cylindrical specimens.

Deformation study of curved engineering and technical surfaces, such as pipes and pressure vessels, has gained much importance in the recent past. Speckle interferometric techniques and their electronic and digital analogs, which are whole field techniques, have been effectively applied for practical nondestructive testing applications over the years. However, little work has been done that discusses the speckle fringe formation with a fruitful theoretical formulation to study deformation analysis of curved surfaces. We propose an extended theory for speckle fringe formation on curved surfaces, which can be applied to the study of curved engineering and technical specimens under various loading conditions such as in-plane, out-of-plane, and out-of-plane shear configurations. Simulated contours are generated by use of finite element models with similar loading conditions, and the data are analyzed and compared with the obtained experimental results.

Enzyme immunoassay for aflatoxin B1-lysine adduct and its validation.

A simple procedure was developed for in vitro synthesis and characterization of aflatoxin B1-lysine adduct using aflatoxin B1, N-alpha-acetyl lysine and m-chloroperbenzoic acid (MCPBA). At a molar ratio of 1:16 (aflatoxin B1:N-alpha-cetyl lysine), the recovery of adduct was 62%. Analysis of the adduct by thin-layer chromatography showed a single spot (Rf = 0). Absorption spectra of the adduct showed 2 peaks at 275 and 335 nm. Liquid chromatographic (LC) analysis of the AFB1-lysine adduct showed a relative retention time of 2.1 min. Using the same epoxidation procedure, BSA-AFB1 adduct and ovalbumin-AFB1 adduct were synthesized for production of antibodies and as coating antigen, respectively. Control rat serum, spiked with AFB1-lysine adduct and subjected to LC analysis showed a retention time of 2.1 min, which is similar to that of AFB1-lysine reference standard, synthesized. Further, enzymatically hydrolyzed, control rat serum spiked with BSA-AFB1 adduct showed 2 peaks with retention times of 2.1 and 2.7 min. Based on the LC analysis, recovery of BSA-AFB1 in terms of AFB1-lysine adducts was 67 +/- 5%. The major peak (2.1 min) accounted for 72% of the adduct; the second minor peak (2.7 min) accounted for 28% of the total AFB1-lysine adducts formed. Stability studies on the AFB1-lysine adduct synthesized, indicated that it was stable for 1 month. Antibody capture assay showed an absorbance of 0.9 to 1.0 at a dilution of 1:50,000 when ovalbumin-AFB1 was used as a coating antigen. Indirect competitive ELISA showed 50% displacement (IC50) of the antibodies at a concentration of 13 ng AFB1-lysine, whereas the IC50 for AFB1 was 7 ng. The recovery of AFB1-lysine adduct spiked to control rat serum followed by enzymatic hydrolysis and immunoanalysis (indirect ELISA) was 93 +/- 6%. The enzyme immunoassay was validated by a rodent model, in which the animals were exposed to aflatoxin B1 (20 microg AFB1/kg body mass/day). The level of AFB1-lysine adduct in the rat serum was 27.3 +/- 4.37 microg/mg albumin.