Ultrasound guided detection of position of post partum intra uterine contraceptive device and its relation to complications

Background: Worldwide, Intrauterine Contraceptive Device (IUCD) is one of the most commonly used reversible methods of contraception among married women of reproductive age. It is the second most commonly used forms of contraception, ranking second only to female sterilization. Proper positioning of Copper containing IUCD is of utmost importance for efficacy and safety. The immediate postpartum period, after a birth but prior to discharge from the hospital is an important but under utilized time frame to initiate contraceptives, specially long acting contraceptives such as intrauterine contraceptive device (IUCD). To study the location of Copper IUCD by ultrasound, relationship between position and complaints, failure rate and expulsion rate in post-partum IUCD cases.Methods: The study was prospective, analytical study conducted on 200 women for one year.  IUCD insertion was done in two groups; group A (normal delivery, postplacental) and group B (caesarean section, intracaesarean). On ultrasonography, position and distance of IUCD from fundus of uterus was measured. Outcome measures were expulsion, complication and failure rate upto six months. Informed consent was taken from each participant and ethical justification for the study was sought.Results: Majority of the patients were in age group of 21-25 years. Multigravidae patients had more acceptability of IUCD than primigravidae. More than half of IUCD insertion was done by senior residents (56%). Malpositions were more common in vaginal delivery (62%) than caesarean section (28%). Most common malposition was mid cavity and least common was oblique. Most common complaint was pain abdomen and least common was expulsion.Conclusions: Sonography can be used as an adjunct to clinical examination to examine the position of the IUCD. Ultrasonography done after PPIUCD insertion helps in determining, whether PPIUCDs are placed in normal position or malposition. Malpositioned PPIUCDs have more complications as compared to normally placed IUCD

A PROSPECTIVE STUDY ON ANAEMIA AS A MORTALITY RISK FACTOR IN DIABETIC AND NON-DIABETIC PATIENTS FOLLOWING ACUTE MYOCARDIAL INFARCTION.

Introduction: Short-term mortality is related to hyperglycemia, acute myocardial infarction (AMI), and anemia. Diabetes patients are more likely to suffer from anemia. To investigate the impact of diabetes patients also having anemia on myocardial infarction outcomes, we conducted a retrospective study. Methodology: From a registry that is disease-specific and population-based, information about every patient consecutively hospitalized with AMI was gathered. Diabetes and anemia were present in four groups of patients. Results: 32.2% of Group A, 16% of Group B, 21.45% of Group C, and 6.6% of Group D experienced 30-day mortality (all p < 0.001). Groups A, B, C, and D had, in that order, 31 days to 36 months mortality rates of 47.6%, 20.8%, 34.3%, and 10.4% (all p < 0.001). At 36 months, the odds ratios for diabetes and anemia were 1.61 (1.40–1.84, p < 0.001) and 1.58 (1.37–1.86, p < 0.001), respectively, suggesting that both illnesses remained independent risk factors for death. Of the deaths that occurred between 31 days and 36 months, 43.7% in Group A were due to cardiovascular causes, 54.0% in Group B, 47.1% in Group C, and 50.9% in Group D (p < 0.05, A vs. B). Conclusion: When compared to either diabetes or anemia patients alone, patients who have diabetes and anemia both have a greater death rate. In all groups, cardiovascular death continued to be the most common death cause. Recommendation: According to our findings, individuals with anemia who have experienced a myocardial infarction with or without diabetes may safely have prompt primary percutaneous coronary intervention; nevertheless, they should take extra care to maintain hemoglobin levels

A PROSPECTIVE COHORT STUDY OF PROTEINURIA CHANGES AND MYOCARDIAL INFARCTION RISKS IN DIABETIC OR PRE-DIABETIC PATIENTS.

Objective:  This prospective cohort study aimed to investigate the relationship between changes in proteinuria and the risk of myocardial infarction (MI) in individuals with diabetes or pre-diabetes. Methodology: The prospective study was conducted involving 200 participants in India, with data collection occurring during routine medical examinations from 2020 to 2022. The participants were followed up, and data collection concluded in 2023. Results: Among the participants, those with persistent proteinuria exhibited a significantly higher risk of MI, with a 2.5-fold increased hazard compared to those without proteinuria. Furthermore, a reduction in proteinuria over time was associated with a 21% decrease in MI incidence. This relationship was not observed in individuals without proteinuria, highlighting the importance of persistent proteinuria in influencing MI risk.  Conclusion: The findings emphasize the critical role of persistent proteinuria as a predictor of elevated MI risk in individuals with diabetes and pre-diabetes. Monitoring and managing proteinuria could potentially mitigate the risk of future heart attacks in this population. Recommendations: Healthcare professionals should consider routine monitoring of proteinuria levels in outpatient settings for individuals with diabetes and pre-diabetes. Exploring interventions to lower proteinuria levels for heart attack prevention is recommended, including lifestyle modifications, medications, or targeted therapies. Improved comprehension of the mechanisms connecting proteinuria to the risk of MI is essential for the formulation of efficient preventive approaches. This study underscores the significance of early detection and management of proteinuria in diabetic patients and pre-diabetics to reduce the risk of myocardial infarction

Resensitization of Akt induced docetaxel resistance in breast cancer by ‘Iturin A’ a lipopeptide molecule from marine bacteria bacillus megaterium

Development of the resistance is the major problem in cancer therapy. Docetaxel is a taxol alkaloid that is frequently used in metastatic breast cancer. However, resistance often limits the usefulness of this drug in many breast cancer patients. Manipulation of resistant cells to re-sensitize to the therapeutic effect of docetaxel is current strategy to overcome this problem. Here, we have introduced ‘Iturin A’ as a potent chemosensitizer in docetaxel resistant breast cancer cells. Combination of Iturin A and docetaxel treatment significantly hampered the proliferation of docetaxel resistant MDA-MB-231 and MDA-MB-468 breast cancer cells. Cell cycle analysis also showed massive amount of apoptotic population (Sub G0G1) in combination therapy. A number of apoptotic and anti-apoptotic proteins were significantly altered in dual drug treated groups. Caspase 3 dependent cell death was observed in dual treatment. Molecular mechanism study showed that over-expression of Akt and its downstream signaling pathway was associated with docetaxel resistance. Iturin A significantly reduced Akt signaling pathway in resistant cells. This mechanistic action might be the reason behind the chemo-sensitization effect of Iturin A in docetaxel resistant breast cancer cells. In conclusion, Iturin A resensitized the resistant breast cancer cells to docetaxel therapy by inhibiting Akt activity

Antimicrobial Resistance with Special Emphasis on Pathogens in Agriculture

Antibiotics have been used globally to manage the bacterial plant diseases irrespective of the expense involved. Although plant pathogenesis by bacteria is far lower than fungal counterparts, disrupted monitoring and surveillance for drug resistance with respect to human health raise serious concerns. The resistance derived by the plant as the host by the antibiotics used for many generations has now posed as a problem in phyto-systems. Although we currently lack the molecular understanding of the pathogens rendering antibiotic resistance to plants, robust resistance management strategies are critical to ensure management of critically important diseases that specifically target crops of high value and/or global agrarian importance. This chapter discusses evolution of plant-pathogenic bacteria, application of antibiotics and its repercussions on the microbiome of plant agricultural systems, and sustainable crop disease management by genetic engineering

Disseminated peritoneal leiomyomatosis: a rare entity with diagnostic conundrum

Disseminated peritoneal leiomyomatosis (DPL) is a rare, usually benign disease primarily affecting premenopausal women. It is signalized by multiple smooth muscle nodules which grossly or radiologically may simulate peritoneal carcinomatosis or disseminated intraabdominal malignancies. A case study of 45 year female who presented with DPL after 8 years of hysterectomy is reported here

Marine lipopeptide Iturin A inhibits Akt mediated GSK3β and FoxO3a signaling and triggers apoptosis in breast cancer

Akt kinase is a critical component of the PI3K/Akt signaling pathway, which is frequently over expressed in human cancers including breast. Therapeutic regimens for inhibiting breast cancer with aberrant Akt activity are essential. Here, we evaluated antitumor effect of a marine bacteria derived lipopeptide ‘Iturin A’ on human breast cancer in vitro and in vivo through disrupting Akt pathway. Proliferation of MDA-MB-231 and MCF-7 breast cancer cells were significantly inhibited by Iturin A and it induced apoptosis as confirmed by increased Sub G1 populations, DNA fragmentation, morphological changes and western blot analysis. Furthermore, Iturin A inhibited EGF induced Akt phosphorylation (Ser473 and Thr308) and its downstream targets GSK3β and FoxO3a. Iturin A inactivated MAPK as well as Akt kinase leading to the translocation of FoxO3a to the nucleus. Gene silencing of Akt in MDA-MB-231 and MCF-7 cells reduced the sensitivity of cancer cells to Iturin A. Interestingly, overexpression of Akt with Akt plasmid in cancer cells caused highly susceptible to induce apoptosis by Iturin A treatment. In a xenograft model, Iturin A inhibited tumor growth with reduced expressions of Ki-67, CD-31, P-Akt, P-GSK3β, P-FoxO3a and P-MAPK. Collectively, these findings imply that Iturin A has potential anticancer effect on breast cancer

Pre-clinical risk assessment and therapeutic potential of antitumor lipopeptide ‘Iturin A’ in an in vivo and in vitro model

Lipopeptides are versatile bio-active weapons having antifungal, antibacterial, antimycoplasma and anticancer properties. In this study, the therapeutic potential and safety assessment of a lipopeptide molecule ‘Iturin A’ were evaluated. Iturin A was found to inhibit in vivo tumor growth in a sarcoma 180 mouse xenograft model. The antitumor efficacy of Iturin A was correlated with increased DNA fragmentation and modulation of CD-31, Ki-67, P-Akt, P-MAPK, apoptotic and anti-apoptotic proteins. Further, safety assessment was carried out in Sprague Dawley rats by 28 days repeated dose (28 days) toxicity and a bio-distribution study. In the toxicity study, Iturin A (10, 20 and 50 mg per kg per day) was administered to the animals for 28 days. Another group was kept for another 14 days without drug exposure after 28 days of treatment to access the reversibility of the toxicity. At the end of the treatment, body weight, food and water intake, organ weight, motility, hematology, serum biochemistry and histopathology of the major organs were evaluated. The bio-distribution of Iturin A was also performed in plasma as well as in different major organs by a well-developed and validated administration of Iturin A radiolabeled with 99mTc. The in vitro cytotoxic effect of Iturin A was also evaluated in BRL-3A rat liver cells. In the treated groups, various toxicities were found in the liver and spleen. However, these adverse effects were transient and reversible after discontinuation of Iturin A treatment. In conclusion, this pre-clinical study offered a preliminary investigation regarding the efficacy and safety assessment of Iturin A