Complex mullarian duct abnormality in a young female: a theraputic dilemma

Genital outflow tract obstruction is a rare cause of primary amenorrhoea. Cervical agenesis is a very rare condition often associated with atresia of vagina. Clinical diagnosis is usually difficult before surgery. Transverse vaginal septum or vaginal agenesis is also a rare condition that results from incomplete fusion between vaginal components of the mullerian ducts and urogenital sinus. If the septum is complete, the menstrual flow will be obstructed causing primary amenorrhoea. The septum is basically a membrane of fibrous connective tissue with both muscular and vascular components formed anywhere along the vagina during embryological development. Here we present a case of 18 year old female who presented with primary amenorrhea, cyclical lower abdominal pain and menouria since 5 years. There was no history of attainment of menarche. The clinical examination revealed a small, blind ending lower vagina with a tough transverse membrane separating the lower portion from the upper genital tract. The ultrasound examination revealed a normal size uterus with hematometra. The magnetic resonance imaging of pelvis confirmed the presence of hematometra and transverse vaginal septum. Transverse vaginal septum resection followed by abdomino-perineal cervicoplasty was done in this patient

Enhanced charge-independent Mitochondrial Free Ca\u3csup\u3e2+\u3c/sup\u3e and Attenuated ADP-induced NADH Oxidation by Isoflurane: Implications for Cardioprotection

Modulation of mitochondrial free Ca2 + ([Ca2 +]m) is implicated as one of the possible upstream factors that initiates anesthetic-mediated cardioprotection against ischemia–reperfusion (IR) injury. To unravel possible mechanisms by which volatile anesthetics modulate [Ca2 +]m and mitochondrial bioenergetics, with implications for cardioprotection, experiments were conducted to spectrofluorometrically measure concentration-dependent effects of isoflurane (0.5, 1, 1.5, 2 mM) on the magnitudes and time-courses of [Ca2 +]m and mitochondrial redox state (NADH), membrane potential (ΔΨm), respiration, and matrix volume. Isolated mitochondria from rat hearts were energized with 10 mM Na+- or K+-pyruvate/malate (NaPM or KPM) or Na+-succinate (NaSuc) followed by additions of isoflurane, 0.5 mM CaCl2 (≈ 200 nM free Ca2 + with 1 mM EGTA buffer), and 250 μM ADP. Isoflurane stepwise: (a) increased [Ca2 +]m in state 2 with NaPM, but not with KPM substrate, despite an isoflurane-induced slight fall in ΔΨm and a mild matrix expansion, and (b) decreased NADH oxidation, respiration, ΔΨm, and matrix volume in state 3, while prolonging the duration of state 3 NADH oxidation, respiration, ΔΨm, and matrix contraction with PM substrates. These findings suggest that isoflurane\u27s effects are mediated in part at the mitochondrial level: (1) to enhance the net rate of state 2 Ca2 + uptake by inhibiting the Na+/Ca2 + exchanger (NCE), independent of changes in ΔΨm and matrix volume, and (2) to decrease the rates of state 3 electron transfer and ADP phosphorylation by inhibiting complex I. These direct effects of isoflurane to increase [Ca2 +]m, while depressing NCE activity and oxidative phosphorylation, could underlie the mechanisms by which isoflurane provides cardioprotection against IR injury at the mitochondrial level

Isoflurane Modulates Cardiac Mitochondrial Bioenergetics by Selectively Attenuating Respiratory Complexes

Mitochondrial dysfunction contributes to cardiac ischemia–reperfusion (IR) injury but volatile anesthetics (VA) may alter mitochondrial function to trigger cardioprotection. We hypothesized that the VA isoflurane (ISO) mediates cardioprotection in part by altering the function of several respiratory and transport proteins involved in oxidative phosphorylation (OxPhos). To test this we used fluorescence spectrophotometry to measure the effects of ISO (0, 0.5, 1, 2 mM) on the time-course of interlinked mitochondrial bioenergetic variables during states 2, 3 and 4 respiration in the presence of either complex I substrate K+-pyruvate/malate (PM) or complex II substrate K+-succinate (SUC) at physiological levels of extra-matrix free Ca2 + (~ 200 nM) and Na+ (10 mM). To mimic ISO effects on mitochondrial functions and to clearly delineate the possible ISO targets, the observed actions of ISO were interpreted by comparing effects of ISO to those elicited by low concentrations of inhibitors that act at each respiratory complex, e.g. rotenone (ROT) at complex I or antimycin A (AA) at complex III. Our conclusions are based primarily on the similar responses of ISO and titrated concentrations of ETC. inhibitors during state 3. We found that with the substrate PM, ISO and ROT similarly decreased the magnitude of state 3 NADH oxidation and increased the duration of state 3 NADH oxidation, ΔΨm depolarization, and respiration in a concentration-dependent manner, whereas with substrate SUC, ISO and ROT decreased the duration of state 3 NADH oxidation, ΔΨm depolarization and respiration. Unlike AA, ISO reduced the magnitude of state 3 NADH oxidation with PM or SUC as substrate. With substrate SUC, after complete block of complex I with ROT, ISO and AA similarly increased the duration of state 3 ΔΨm depolarization and respiration. This study provides a mechanistic understanding in how ISO alters mitochondrial function in a way that may lead to cardioprotection

Clinical efficacy of Esmolol, Lignocaine and Diltiazem as premedicant for attenuation of hemodynamic responses of laryngoscopy and endotracheal intubation- a comparative evaluation

Background: Direct laryngoscopy and endotracheal intubation after induction of anesthesia is almost always associated with hemodynamic stress response. The aim of this study was to compare esmolol, lignocaine and diltiazem for suppression of laryngoscopy and intubation response.Methods: This randomized prospective double-blind control study was performed on 120 patients of either sex, aged between 18 and 58 years of ASA physical status I and II with Mallampatti grade I and II, undergoing elective surgeries under general anesthesia with endotracheal intubation. Patients were randomized in four groups, Group N (normal saline), Group E (esmolol) 1.5mg/kg I.V, Group D (diltiazem) 0.2mg/kg I.V, and Group L (lignocaine) 1.5mg/kg I.V with 30 patients in each group. Hemodynamic parameters were recorded during the basal period, preinduction, during intubation and at specified intervals.Results: There was significant increase in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate in the control group (Group N) in association with tracheal intubation. The heart rate was significantly lower in Group E (Esmolol group), followed by Group D (Diltiazem group) and Group L (Lignocaine group). Rate pressure product was significantly lower in group E as compared to other groups, followed by group D and group L. Maximum increase in rate pressure product (RPP) just after laryngoscopy and intubation was ±74.29% in group N, ±16.11% in group E, 25.38% in group D and 38.77%in group L.Conclusions: Esmolol was better than diltiazem and they both were better than lignocaine for preventing the hemodynamic response after laryngoscopy and intubation

CRISPR-Cas9: Role in Processing of Modular Metabolic Engineered Bio-Based Products

Biogenetic engineering is a significant technology to sensibly manage microbial metabolic product factories. Genome modification methods for efficiently controlling and modifying genes at the genome level have progressed in biogenetic engineering during the last decade. CRISPR is genome editing technology that allows for the modification of organisms’ genomes. CRISPR and its related RNA-guided endonuclease are versatile advanced immune system frameworks for defending against foreign DNA and RNAs. CRISPR is efficient, accessible, and trustworthy genomic modification tool in unparalleled resolution. At present, CRISPR-Cas9 method is expanded to industrially manipulate cells. Metabolically modified organisms are quickly becoming interested in the production of different bio-based components. Here, chapter explore about the control productivity of targeted biomolecules in divergent cells based on the use of different CRISPR-related Cas9

Role of Ayurveda Modalities in the Management of Urdhwag Amlapitta (Gastro Esophageal Reflux Disease): A Critical Review

For long time various types of communicable diseases were biggest killer diseases globally. But now a days trend become changing towards increased prevalence of chronic diseases due to changing their diet pattern, lifestyle and behavioral pattern. In these chronic diseases Gastro Esophageal Reflux Disease (GERD) is the Gastro-intestinal disorder defined by recurrent troublesome heart-burn and regurgitation. Patient with GERD can be medicated empirically with Antacids and proton pump Inhibitor’s but in most of the cases patient do not respond to such treatment absolutely and several adverse effects arises after prolonged use. Ayurvedic texts classifies the broad spectrum of Amlapitta into Urdhwag and Adhog Amlapitta in which GERD shows similarity with Urdhwag Amlapitta on the basis of causes and symptoms. Aim and Objectives: The current review article illustrates the mode of action of Ayurvedic procedures (Shodhana Chikitsa) and formulations (Shamana Chikitsa) which is safe and effective for GERD (Urdhwag Amlapitta) Material and Methods: Ayurvedic texts referred are Charak Samhita, Yog Ratnakar, Bhaisjya ratnavali and contemporary modern texts and published manuscripts. Discussion: Detailed protocol treatment for Amlapitta in the form of Shodhana and Shamana Chikitsa discussed in terms of drugs and diet, should be applied considering the association of Dosha. Conclusion:  This review article will helpful to Ayurveda scholars, academicians, clinicians and researchers for the future prospect to plan the research work on same topics

Unilateral multicystic dysplastic kidney with ipsilateral grade V vesicoureteral reflux: A case report of a rare association

Multicystic renal dysplasia is a common cause of childhood end-stage renal failure and is categorized under the entity known as congenital anomalies of kidney and urinary tract. With the increasing knowledge about their natural history, it is now known that most of the cases of unilateral multicystic dysplastic kidney undergo spontaneous involution; thus, most of the pediatric urologists now prefer conservative management with long-term nephrological and urological observation. However, the presence of recurrent urinary tract infection as in the present case report due to associated ipsilateral Grade V vesicoureteral reflux, a rare associated finding mandates nephrectomy