Rare and atypical presentations of endometriosis causing diagnostic dilemma and management challenges: an experience at a tertiary center

Endometriosis is a disease that most of the times is diagnosed by its common presenting sign and symptoms, but can have varied presentations and may come as a surprise during surgery. We here present a case series of unusual presentations of endometriosis, which created diagnostic dilemma and challenges in the management of the cases at this tertiary center and share our experience. Endometriosis must be kept as a differential diagnosis whenever patient presents with acute pelvic or abdominal pain with adnexal masses and things are not fitting into straight forward diagnosis

Successful clinical outcome in complicated monochorionic twins: case series

Monochorionic twins have some unique complications like twin-to-twin transfusion syndrome (TTTS), twin anemia polycythemia sequence (TAPS), twin reverse arterial perfusion syndrome (TRAP) and conjoined twins which are otherwise not seen in dichorionic twins. In this case series, we report 3 cases of monochorionic twins who had complications. Our first case had monochorionic twin with a pump fetus and a TRAP. The second case had TTTS stage I and after spontaneous preterm premature rupture of membranes at 32 weeks, delivered both fetuses vaginally at an interval of about 3 hours. Our third case had TTTS stage II and she underwent selective fetoscopic laser photocoagulation of intertwin anastomotic vessels at about 25 weeks and subsequently multiple episodes of amnioreduction till 31 weeks when she underwent emergency caesarean delivery. Our study highlights the need for constant vigilance in patients with monochorionic twins to look for complications like TTTS and TRAP

Dental Cones: A Novel Stratagem for Dental Drug Delivery

Dental Cones are little pills that are used after tooth extraction to reduce bleeding and halt the formation of germs. They should be made to dissolve or erode during a 20–40-minute period in the presence of a modest volume of serum or fluid. To determine if the local administration into the periodontal pocket could help in boosting medication concentration and reducing systemic adverse effects. d-PTFE membranes, painkillers, mouthwash, sutures, and CT scanners are some of the techniques employed in dental extraction and biomaterial insertion procedures. For this study, 39 Articles in total were included and examined. By having antibacterial, anti-inflammatory, and antioxidant properties, local drug delivery methods can aid in the management of periodontitis

Asymmetric radiation-induced toroidal flow and improved confinement in tokamaks

The role of impurity radiation in influencing the toroidal flow and radial electric fields (parameters critical for determining turbulent transport) has been studied on the edge of a tokamak plasma. It is demonstrated for the first time that the impurities distributed in an asymmetric (poloidally) manner may lead to significant density and temperature perturbations on magnetic surfaces. These, in turn, interact with the θ dependent toroidal field variations and yield a mean divergence of the stress tensor driving strong neoclassical toroidal flows. A self-consistent theory of interplay of equilibrium, fluctuations, neoclassical flows, and E→×B→ shear rotation in a tokamak is also presented. It is shown that the resulting enhanced toroidal velocity shear on the outer radiative layers produces a stabilizing effect on the well known instabilities (which determine edge transport) such as the drift resistive ballooning mode, the drift trapped electron mode, and the ion temperature gradient mode. For various values of the radiation asymmetry parameter, investigation of the turbulent particle flux as a function of the density gradient shows that the plasma can undergo a bifurcation into a better-confined state with a peaked density

Assessment of ovarian function by clinical, hormonal and sonological parameters in post hysterectomy premenopausal women

Background: Hysterectomy with or without ovarian preservation is one of the common gynaecological major surgery performed worldwide. Ovarian function in future life therefore remains a contentious subject when ovaries are preserved. Assessment of ovarian function was done by clinical, hormonal and sonological parameters in post hysterectomy premenopausal women to assess, onset of menopausal symptoms, serum hormonal levels, and anatomical status.Methods: The study was a prospective observational study of 110 premenopausal patients of 30 to 50 years of age undergoing hysterectomy for benign uterine conditions carried out from September 2014 to August 2016. Patients were followed up after operation at 3 months, 6 months and 1 year. Serum LH, serum FSH, serum Estrogen, bilateral ovarian volume and bilateral ovarian Doppler study were done at baseline and each visit. Patients were interviewed at each visit for menopausal symptoms. Menopausal Rating scale (MRS) questionnaire was used as a basis for assessing menopausal symptoms.Results: Significant difference noted in all the parameters like serum FSH, right and left ovarian volume and right and left ovarian pulsatility index at period of one year compared to preoperative values. No significant difference seen for serum LH and serum estrogen at period of one year. At 1 year 34 patients (34%) developed menopausal symptoms.Conclusions: For all premenopausal patients who undergo hysterectomy for benign conditions of uterus with their ovaries preserved, proper follow up should be done after the surgery for assessing ovarian function at intervals

Knowing your HIV/AIDS epidemic and tailoring an effective response: how did India do it?

Tremendous global efforts have been made to collect data on the HIV/AIDS epidemic. Yet, significant challenges remain for generating and analysing evidence to allocate resources efficiently and implement an effective AIDS response. India offers important lessons and a model for intelligent and integrated use of data on HIV/AIDS for an evidence-based response. Over the past 15 years, the number of data sources has expanded and the geographical unit of data generation, analysis and use for planning has shifted from the national to the state, district and now subdistrict level. The authors describe and critically analyse the evolution of data sets in India and how they have been utilised to better understand the epidemic, advance policy, and plan and implement an increasingly effective, well-targeted and decentralised national response to HIV and AIDS. The authors argue that India is an example of how ‘know your epidemic, know your response’ message can effectively be implemented at scale and presents important lessons to help other countries design their evidence generation systems

Recombinant fusion protein identified by lepromatous sera mimics native Mycobacterium leprae in T-cell responses across the leprosy spectrum

Pooled polyvalent sera from lepromatous leprosy patients were used to screen a lambda gt11 recombinant DNA expression library of Mycobacterium leprae in order to identify the relevant antigens recognized by the human immune response. Of the 300,000 phages screened, 4 clones were identified that coded for fusion proteins of the same molecular mass. The fusion protein from clone LSR2 was tested for immunoreactivity in assays using peripheral blood cells and sera from 11 laboratory personnel and 105 patients across the leprosy spectrum. LSR2 protein appears to be predominantly a T-cell antigen. It evokes similar lymphoproliferative responses as the native bacillus both at the individual level and in the leprosy spectrum as a whole. Though only 50% of patient sera with anti-M. leprae antibodies reacted with the fusion protein, the pattern of reactivity in the antibody responses was also similar for the various clinical types. The coding regions of clones LSR1 and LSR2 are identical. They show no homology with sequences stored in data banks and encode a protein of 89 amino acids with a calculated molecular mass of approximately 10 kDa

A national surveillance project on chronic kidney disease management in Canadian primary care: a study protocol.

INTRODUCTION: Effective chronic disease care is dependent on well-organised quality improvement (QI) strategies that monitor processes of care and outcomes for optimal care delivery. Although healthcare is provincially/territorially structured in Canada, there are national networks such as the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) as important facilitators for national QI-based studies to improve chronic disease care. The goal of our study is to improve the understanding of how patients with chronic kidney disease (CKD) are managed in primary care and the variation across practices and provinces and territories to drive improvements in care delivery. METHODS AND ANALYSIS: The CPCSSN database contains anonymised health information from the electronic medical records for patients of participating primary care practices (PCPs) across Canada (n=1200). The dataset includes information on patient sociodemographics, medications, laboratory results and comorbidities. Leveraging validated algorithms, case definitions and guidelines will help define CKD and the related processes of care, and these enable us to: (1) determine prevalent CKD burden; (2) ascertain the current practice pattern on risk identification and management of CKD and (3) study variation in care indicators (eg, achievement of blood pressure and proteinuria targets) and referral pattern for specialist kidney care. The process of care outcomes will be stratified across patients' demographics as well as provider and regional (provincial/territorial) characteristics. The prevalence of CKD stages 3-5 will be presented as age-sex standardised prevalence estimates stratified by province and as weighted averages for population rates with 95% CIs using census data. For each PCP, age-sex standardised prevalence will be calculated and compared with expected standardised prevalence estimates. The process-based outcomes will be defined using established methods. ETHICS AND DISSEMINATION: The CPCSSN is committed to high ethical standards when dealing with individual data collected, and this work is reviewed and approved by the Network Scientific Committee. The results will be published in peer-reviewed journals and presented at relevant national and international scientific meetings

Trends in anemia management in US hemodialysis patients 2004-2010.

BACKGROUND: There have been major changes in the management of anemia in US hemodialysis patients in recent years. We sought to determine the influence of clinical trial results, safety regulations, and changes in reimbursement policy on practice. METHODS: We examined indicators of anemia management among incident and prevalent hemodialysis patients from a medium-sized dialysis provider over three time periods: (1) 2004 to 2006 (2) 2007 to 2009, and (3) 2010. Trends across the three time periods were compared using generalized estimating equations. RESULTS: Prior to 2007, the median proportion of patients with monthly hemoglobin >12 g/dL for patients on dialysis 0 to 3, 4 to 6 and 7 to 18 months, respectively, was 42%, 55% and 46% declined to 41%, 54%, and 40% after 2007, and declined more sharply in 2010 to 34%, 41%, and 30%. Median weekly Epoeitin alpha doses over the same periods were 18,000, 12,400, and 9,100 units before 2007; remained relatively unchanged from 2007 to 2009; and decreased sharply in the patients 3-6 and 6-18 months on dialysis to 10,200 and 7,800 units, respectively in 2010. Iron doses, serum ferritin, and transferrin saturation levels increased over time with more pronounced increases in 2010. CONCLUSION: Modest changes in anemia management occurred between 2007 and 2009, followed by more dramatic changes in 2010. Studies are needed to examine the effects of declining erythropoietin use and hemoglobin levels and increasing intravenous iron use on quality of life, transplantation rates, infection rates and survival