MRKH syndrome: a review of literature

Primary amenorrhea is defined as failure to achieve menarche till age of 14 years in absence of normal secondary sexual characters or till 16 years irrespective of secondary sexual characters. The most common cause of primary amenorrhea is gonadal pathology followed by Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome). MRKH syndrome is a rare congenital disorder characterised by uterine and vaginal aplasia. It occurs due to failure of development of Müllerian duct. Its incidence is 1 per 4500 female births. Mostly girls present with primary amenorrhea. It is characterised by presence of normal secondary sexual characteristics, normal 46 XX genotype, normal ovarian function in most of the cases and absent or underdeveloped uterus and upper part (2/3) of vagina. It is of two types: type A is isolated type while type B is associated with other renal/skeletal/cardiac anomalies. Treatment includes psychological counselling and vaginoplasty. Vaginoplasty can be done by various non-surgical and surgical techniques. The authors hereby review the literature of MRKH syndrome regarding its embryology, etiopathogenesis, approach to work up and management

Comparison of the conventional CMAC and the D-blade CMAC with the direct laryngoscopes in simulated cervical spine injury—a manikin study

AbstractBackgroundCMAC videolaryngoscope has recently been introduced for videoscope guided intubation. The aim of our study was to compare and evaluate the efficacy of the conventional blade and the angulated D blade of the CMAC videolaryngoscope with the direct laryngoscopes in simulated cervical spine injury patients on the airway manikin.Materials and methodsFollowing power analysis, 33 resident doctors were enrolled to perform endotracheal intubation using all the 4 different laryngoscopes namely the Macintosh laryngoscope, McCoy laryngoscope, conventional CMAC videolaryngoscope and the D blade of the CMAC videolaryngoscopes on the airway manikin in simulated cervical spine injury. The demographic variables of the resident doctors were recorded. The outcomes measured included vocal cord visualization (Cormack–Lehane grading), time taken to intubate, number of attempts for successful intubation and optimizing maneuvers required.ResultsThe use of indirect videolaryngoscopes resulted in better glottic visualization in comparison to the direct laryngoscopes (CL-I) in 20/33 (60.6%) in the Macintosh group, 24/33 (72.7%) in McCoy group, 30/33 in (90.9%) in Vlc group and 32/33 (96.9%) in Vld group. The time taken to intubate averaged to 15.54±2.6 in Macintosh group, 18.90±4.47 in McCoy group, 20.21±7.9 in Vlc group and 27.42±9.09 in Vld group. The 1st attempt intubation success rate was 84.8% (Macintosh), 72.7% (McCoy), 90.9% (Vlc) and, 78.7% (Vld).ConclusionsThe overall performance of the conventional CMAC blade proved to be the best when compared with the D-blade CMAC, Macintosh blade and the McCoy blade for intubation in simulated cervical spine patients by anesthesia residents

Neglected vaginal pessary

Vaginal pessary may be opted for management of uterine prolapse as a safe option, but to avoid complications regular follow-up is a must. We are reporting a case of neglected vaginal pessary in a 72 year old female which got embedded in vaginal mucosa and required excision of vaginal band for its removal

Comparative study of transperineal and transvaginal sonography for localization of placenta in antepartum haermorrhage

Background: Haemorrhage is one of the leading causes of maternal mortality and morbidity in world in pregnant patients.Patients with antepartum haemorrhage confirmation of location of placenta by sonography is must for management. Transvaginal sonography(TVS) has main disadvantage of need of penetration of vagina and  provoking vaginal haemorrhage It can also result in uterine contraction & requirement of special transducer. Transperineal sonography(TPS) is more convenient and safer means of imaging the cervix and lower uterine segment overcoming the short coming of transabdominal sonography and eliminating the risk associated with Transvaginal sonography.  Thus present study was undertaken with a view to evulate patients of antepartum haemorrhage by Transvaginal as well as by transperineal sonography to compare accuracy of transperineal with Transvaginal sonography.Methods: Transvaginal probe was gently introduced for about 3-4 cm beyond the introitus. Distance between internal os and lower edge of placenta was measured. The diagnosis of placenta previa was made if placental edge was located within 5cm of internal os. Transperineal sonography was performed with convex transducer. Bladder was kept empty The transducer was positioned directly on perineum in sagittal orientation over the labia minora with center of transducer typically posterior to urethra and anterior to vaginal orifice and measurement taken.Results: TPS diagnosed placenta previa in 31 cases, 30 of which had placenta previa. TPS  negated placenta previa in 19 cases, none of which had placenta previa. So false positive rate of TPS was found to 4.7%, false negative 0% sensitivity 100% specificity 95.2%. Positive predictive value of TPS was found to be 96.7% and negative predictive value of TVS was found to be 100%.Conclusions: So, to conclude transperineal sonography is easy to perform, well tolerated accurate diagnostic tool with high sensitivity specificity, positive and negative predictive values for localisation of placenta cases of APH. TVS can be replaced by TPS in cases of APH for localisation of placenta

Abdominopelvic mass in postmenopausal female: a diagnostic dilemma

Abdominopelvic masses have varied presentations and pose a diagnostic challenge especially in postmenopausal women where a detailed evaluation is needed to rule out malignancy. Here we report a case of postmenopausal woman with diagnostic discrepancies in clinical findings, radiological investigations and histopathological observation

Improved methods for analyzing MRI brain images

Image segmentation is a part of image processing for region or object extraction from the background area. Owing to the complex background, contrast of the infected portion, low intensity difference values, intricate inner body parts etc.; the problem of region extraction in segmentation is very challenging. Among various image segmentation techniques, thresholding is one of the simplest techniques, in which the region of interest is extracted from the background by comparing the pixel values with the threshold value. The threshold value is obtained from histogram of the image. The technique presented in the paper involves graph cut method in which the initial centroids are automatically selected by exploiting the symmetrical nature of the MRI images. The results obtained by the thresholding technique in this research work shows that any abnormality can be localized easily in horizontal divided MRI brain image rather than in vertical divided MRI image. Graph cut results show better segmentation than thresholding technique which is justified by PSNR and SSIM values

Synergistic Actions of Hematopoietic and Mesenchymal Stem/Progenitor Cells in Vascularizing Bioengineered Tissues

Poor angiogenesis is a major road block for tissue repair. The regeneration of virtually all tissues is limited by angiogenesis, given the diffusion of nutrients, oxygen, and waste products is limited to a few hundred micrometers. We postulated that co-transplantation of hematopoietic and mesenchymal stem/progenitor cells improves angiogenesis of tissue repair and hence the outcome of regeneration. In this study, we tested this hypothesis by using bone as a model whose regeneration is impaired unless it is vascularized. Hematopoietic stem/progenitor cells (HSCs) and mesenchymal stem/progenitor cells (MSCs) were isolated from each of three healthy human bone marrow samples and reconstituted in a porous scaffold. MSCs were seeded in micropores of 3D calcium phosphate (CP) scaffolds, followed by infusion of gel-suspended CD34+ hematopoietic cells. Co-transplantation of CD34+ HSCs and CD34− MSCs in microporous CP scaffolds subcutaneously in the dorsum of immunocompromized mice yielded vascularized tissue. The average vascular number of co-transplanted CD34+ and MSC scaffolds was substantially greater than MSC transplantation alone. Human osteocalcin was expressed in the micropores of CP scaffolds and was significantly increased upon co-transplantation of MSCs and CD34+ cells. Human nuclear staining revealed the engraftment of transplanted human cells in vascular endothelium upon co-transplantation of MSCs and CD34+ cells. Based on additional in vitro results of endothelial differentiation of CD34+ cells by vascular endothelial growth factor (VEGF), we adsorbed VEGF with co-transplanted CD34+ and MSCs in the microporous CP scaffolds in vivo, and discovered that vascular number and diameter further increased, likely owing to the promotion of endothelial differentiation of CD34+ cells by VEGF. Together, co-transplantation of hematopoietic and mesenchymal stem/progenitor cells may improve the regeneration of vascular dependent tissues such as bone, adipose, muscle and dermal grafts, and may have implications in the regeneration of internal organs

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Inhibitive effect of PEG on the corrosion of aluminium in acidic medium

2784-2787The mechanism of corrosion of aluminium and the effect of polyethylene glycol (PEG) polymer as corrosion inhibitor in acidic medium has been studied using the weight loss method, potentiodynamic and galvanostatic polarization measurements. Differential pulse polarography (DPP) and differential pulse anodic stripping voltammetry have been used for the study of corrosion rates for the corrosion of aluminium in acidic medium at short time interval s. Corrosion of B-265 aluminium in 60% HNO3 solution with and without polyethylene glycol inhibitor at short time interval has been reported. The corrosion inhibition efficiency of PEG is 94% after 24 h