Epidemiology of pre invasive and invasive lesions of the cervix at tertiary health centre in Punjab

Background: Cervical cancer is the fourth most frequent cancer in women globally, next to breast, colorectal and lung cancer and it is also the fourth most common cause of cancer death in women. According to the Indian council of medical research (ICMR), in India one woman dies of cervical cancer every 9 minutes. This study used PAP smear and histopathology to find out about the epidemiology of pre invasive and invasive lesions of the cervix at tertiary health centre in Punjab and their correlation with various social and demographic features.Methods: This prospective clinical study was carried out in the Department of Obstetrics and Gynaecology in Amritsar Medical College from May 2018 to April 2020, after taking approval from the Institutional Ethical Committee. The study selected 500 women randomly among the patients attending the Gynaecology OPD who met the inclusion criteria. Detailed history and PAP smear was taken at first visit followed by cervical biopsy amongst women with abnormal cytology report or with frank lesions of cervix.Results: Out of 500 women included in the study, majority of women (82.5%) were Negative for intraepithelial lesion or malignancy (NILM), 4% women had Atypical squamous cells of undetermined significance (ASCUS), 6.1% had low grade squamous intraepithelial lesion (LSIL) and 16 (3.2%) had High grade squamous intraepithelial lesion (HSIL). Amongst the histopathology reporting 15.62% patients had cervical intraepithelial neoplasia 1 (CIN I), 6.25% patients had cervical intraepithelial neoplasia II (CIN II), 3.12% patients had cervical intraepithelial neoplasia III (CIN III), 6.3% patients had squamous cell carcinoma and 3.1% patient had adenocarcinoma of cervix. Age, low level of education, poor socioeconomic status, early marriage and multiparity are the risk factors found to be associated with pre invasive and invasive lesions of the cervix. (p<0.001).Conclusions: Though infection with human papilloma virus (HPV) is essential for the development of the disease, there are other high-risk factors like age, poor education, low socioeconomic status, early age at marriage and high parity which are significantly associated with the occurrence of the disease. Therefore, our primary and secondary preventive measures must include the women who come under these high-risk categories.

Curcumin, a diferuloylmethane, attenuates cyclosporine-induced renal dysfunction and oxidative stress in rat kidneys

BACKGROUND: In India, Curcumin (CMN) is popularly known as "Haldi", and has been well studied due to its economic importance. Traditional Indian medicine claims the use of its powder against biliary disorders, anorexia, coryza, cough, diabetic wounds, hepatic disorder, rheumatism and sinusitis. This study was designed to examine the possible beneficial effect of CMN in preventing the acute renal failure and related oxidative stress caused by chronic administration of cyclosporine (CsA) in rats. CMN was administered concurrently with CsA (20 mg/kg/day s.c) for 21 days. Oxidative stress in kidney tissue homogenates was estimated using thiobarbituric acid reactive substances (TBARS), reduced glutathione (GSH) content, superoxide dismutase (SOD), and Catalase (CAT). Nitrite levels were estimated in serum and tissue homogenates. RESULTS: CsA administration for 21 days produced elevated levels of TBARS and marked depletion of renal endogenous antioxidant enzymes and deteriorated the renal function as assessed by increased serum creatinine, Blood Urea Nitrogen (BUN) and decreased creatinine and urea clearance as compared to vehicle treated rats. CMN markedly reduced elevated levels of TBARS, significantly attenuated renal dysfunction increased the levels of antioxidant enzymes in CsA treated rats and normalized the altered renal morphology. CONCLUSION: In conclusion our study showed that CMN through its antioxidant activity effectively salvaged CsA nephrotoxicity

Bioadhezivne vaginalete s klotrimazolom: priprava i evaluacija

In this study, a bioadhesive dosage form of clotrimazole was designed using a combination of bioadhesive polymers Carbopol 934P, sodium carboxymethylcellulose and sodium alginate in different ratios. The bioadhesive strength was evaluated by measuring the force required to detach the tablets from porcine vaginal mucosal membrane. The strong interaction between polymer and mucus lining of the tissue helps in increasing the contact time and permits localization of activity. Carbopol 934P showed maximum bioadhesion and required maximum force for detachment; the force required for detachment was directly proportional to its content. The formulations were tested for their swelling behavior using agar gel plate method. The swelling index was a function of the concentration of the hydrophilic polymer and the formulations containing Carbopol 934 P and sodium carboxy methylcellulose were found to swell to a greater extent than those containing carbopol and sodium alginate. In vitro release studies showed that the batch consisting 2: 1 ratio of Carbopol 934P: sodium alginate (batch C3) released clotrimazole over 24 h. The similarity factor showed that the dissolution profiles of fresh and aged tablets was similar, suggesting good stability of vaginal tablets prepared using a combination of Carbopol 934P and sodium alginate.U radu je opisana priprava bioadhezivnih vaginaleta s klotrimazolom, kombinacijom nekoliko bioadhezivnih polimera u različitim omjerima (Carbopol 934P, natrijeva sol karboksimetilceluloze i natrijev alginat). Bioadhesivnost je određena mjerenjem sile koja je potrebna za odvajanje tablete s vaginalne mukozne membrane svinje. Zbog jake interakcije između polimera i mukoze produljilo se vrijeme kontakta pripravka s kožom i lokaliziralo djelovanje lijeka. Maksimum bioadhezije postignut je uz Carbopol 934P, a sila potrebna za odvajanje pripravka bila je proporcionalna njegovom udjelu. Pripravcima je ispitana sposobnost bubrenja koristeći metodu s agarnim pločama. Indeks bubrenja ovisio je o koncentraciji hidrofilnog polimera. Pripravci s karbopolom i karboksimetilcelulozom jače su bubrili od pripravaka s karbopolom i natrijevim alginatom. In vitro ispitivanja pokazala su da se iz pripravaka s omjerom karbopola i natrijevog alginata u omjeru 2 : 1 (pripravak C3) oslobađao klotrimazol tijekom 24 h. Profil oslobađanja bio je sličan iz svježe pripravljenih i starih vaginaleta, što ukazuje na njihovu stabilnost

Human leptospirosis in patients with undifferentiated acute febrile illness in a tertiary care hospital in New Delhi

Background: Leptospirosis is an important cause of febrile illness with a widespread global distribution. Although endemic in the southern and western states of India, its true incidence in the northern states of the country remains underreported. The main objective of this study was to estimate the seropositivity of infections by Leptospira in patients presenting with undifferentiated acute fever, in a tertiary care hospital in New Delhi.Methods: This prospective observational study was conducted from November 2016 to March 2018 in a tertiary care hospital in New Delhi. Blood samples of the patients (n=370) having fever for more than one week and seronegative for typhoid, dengue, chikungunya and malaria were subjected to Leptospira IgM ELISA (DRG International Inc., USA). Data was analyzed using statistical software SPSS version 21.Results: Out of 370 patients, 142 (38.4%) were males and 228 (61.6%) were females; the mean age was 32.18 years. The most common symptom was headache (55.5%) and icterus (55.55%) whereas increased ALT/AST was the most common laboratory finding (88.8%) followed by anaemia (77.7%). On employing Leptospira IgM ELISA, 2.43% (9 cases, n=370) were strongly reactive (>1.0 OD) whereas 15.1% (56 cases) were weakly reactive (1.15-1.00 OD).Conclusions: There is a need to increase awareness and suspicion regarding diagnosis of leptospirosis. A positive IgM ELISA when correlated with patient’s clinical profile and epidemiological factors can aid in the timely diagnosis and treatment of these infections.

COST ANALYSIS OF ORAL ANTIHYPERTENSIVE DRUGS: ASSESSING THE EFFECT OF DRUG PRICE CONTROL ORDER IN INDIA

Objective: The study focuses on cost analysis of different available brands of oral antihypertensive drugs in India and assesses compliance with their ceiling prices fixed by drug price control order (DPCO). Methods: This is an observational study conducted in the Department of Pharmacology, GSVM Medical College Kanpur, from May to June 2022. The ceiling price of oral antihypertensive drugs was obtained from the DPCO price list 2021 and dosage and prices of the different brands of antihypertensive drugs available in India were obtained from medguideindia.com and Current Index of Medical Specialities-CIMS (Jan–April 2022 edition, India). Thereafter, data analysis of oral antihypertensive drugs was done on Microsoft Excel Office 2019 version. Results: Our study found a total 1575 brands of oral antihypertensive drugs available in market, 34% brands were having prices more than DPCO recommended ceiling price. Maximum price violation was noticed with capsule nifedipine 10 mg (83.33%) and tablet telmisartan 80 mg (60.98%). The maximum cost variation and cost ratio was seen with tablet propranolol 10 mg, that is, 3233.33% and 33.33, respectively, followed by tablet amlodipine 5 mg, that is, 2123.33% and 22.23. Conclusion: Stringent regulation and monitoring of the DPCO price list should be done to ensure that all drugs and especially oral antihypertensive drugs are not sold above the ceiling price set by the order so that the compliance for the drugs is optimized and India could achieve its objective of reducing the prevalence of hypertension to &lt;25% by 2025

Strategizing quality implementation in intensive care unit: a statistically-sound, novel approach using Delphi technique

Background: Ascendancy of Intensive Care Medicine in the realm of healthcare has made Continuous Quality Improvement (CQI) in Intensive Care Units (ICUs) most imperative for hospital administrators worldwide. Perspicuous identification of all clinical and non-clinical drivers warranting contemplation is the most arduous step in achieving the same. This study avers the effectiveness of a statistically-sound, novel approach using Delphi technique in identifying various drivers to be prioritized for strategizing CQI in the postoperative ICU of a premier tertiary care hospital in Asia. Methods: Three rounds of Delphi survey were initially planned. Mean Rank Scores (MRS) was used to rank the opinions in this study. Results: Statistically validated consensus was reached among expert participants on five drivers that should galvanize hospital administration vis-à-vis strategizing quality implementation in the post-operative ICU. Foremost among these was adequate staff that is tantamount to desirable staff-patient ratio (MRS: 9.4), and regular medical audit for sustainable quality in healthcare delivery (MRS: 9.1). Experts further concurred that communication skills of ICU staff (MRS: 8.9), continuous medical education and training of these staff (MRS: 7.6) along with perspicuous ‘Standard Operating Procedures’ (MRS: 7.1) were other points to be considered. Conclusions: With regard to the process of planning, identification of correct drivers holds the crux in strategizing quality implementation in any setup. Implementing change management is equally imperative. This approach can be used to realize both of these.

Pregnancy outcome in isolated oligohydramnios diagnosed in third trimester

Background: The aim of this study was to compare the outcomes of pregnancies complicated by isolated oligohydramnios with the low risk pregnancies with normal amniotic fluid volume.Methods: The present study is a retrospective cohort study of singleton pregnancies diagnosed with Isolated oligohydramnios (AFI≤5) in their third trimester (N=35). Pregnancy outcome was compared with a matched control group of low risk pregnancies with amniotic fluid volume >5 (N=30).Results: The overall incidence of Isolated oligohydramnios was 0.7-0.8%. In oligohydramnios group, significant association were found in null-parity (60% vs 23.33%, p-value<0.005), Fetal growth retardation (25.71% vs 0% p-value<0.02), preterm delivery (22.85% vs 3.33%, p-value 0.025), rate of Induction of labor (40% vs 10%) and cesarean rate for non-reassuring fetal heart rate (20% vs 3.33%, p-value<0.001). Likewise, the incidence of low birth weight was (54.28% vs 13.33%, p-value<0.001) and NICU admissions was (20% vs 0%, p-value<0.01), but there was no difference in Apgar score finding. NICU stay was of short duration and all babies discharged in stable condition, there were no stillbirth or early neonatal death in both groups.Conclusions: Isolated oligohydramnios has an adverse influence on pregnancy and neonatal outcome in the form of FGR, preterm delivery, increased rate of Induction and cesarean section. Despite the high incidence of low birth weight and NICU admissions, the overall early neonatal outcome was similar to the other low risk pregnancies

Taguchi based Design of Sequential Convolution Neural Network for Classification of Defective Fasteners

Fasteners play a critical role in securing various parts of machinery. Deformations such as dents, cracks, and scratches on the surface of fasteners are caused by material properties and incorrect handling of equipment during production processes. As a result, quality control is required to ensure safe and reliable operations. The existing defect inspection method relies on manual examination, which consumes a significant amount of time, money, and other resources; also, accuracy cannot be guaranteed due to human error. Automatic defect detection systems have proven impactful over the manual inspection technique for defect analysis. However, computational techniques such as convolutional neural networks (CNN) and deep learning-based approaches are evolutionary methods. By carefully selecting the design parameter values, the full potential of CNN can be realised. Using Taguchi-based design of experiments and analysis, an attempt has been made to develop a robust automatic system in this study. The dataset used to train the system has been created manually for M14 size nuts having two labeled classes: Defective and Non-defective. There are a total of 264 images in the dataset. The proposed sequential CNN comes up with a 96.3% validation accuracy, 0.277 validation loss at 0.001 learning rate.Comment: 13 pages, 6 figure

Rapid Label-free Detection of E. coli using Antimicrobial Peptide Assisted Impedance Spectroscopy

There is an increasing demand for rapid detection of waterborne pathogens to monitor drinking water safety. We demonstrate a compact, label-free sensor array for rapid detection of Escherichia coli (E. coli) in contaminated water samples using antimicrobial peptide assisted impedimetric sensor platform. Interdigitated electrode arrays immobilized with the antimicrobial peptide Colicin V (ColV) were used to screen the affinity towards different bacterial strains by monitoring impedance variations in real-time. This ColV assisted impedance biosensor exhibited high selectivity towards Gram-negative strains particularly towards E. coli strains. This selective detection of E. coli from other strains was observed at 102 cfu mL−1, which is clinically relevant. The sensor can detect E. coli from 102 to 106 cfu mL−1 in water sample at pH 7 to 9. These results show that the antimicrobial peptide ColV assisted impedimetric array is capable of rapid, specific detection of E. coli in contaminated water samples

Efficacy of fecal microbiota therapy in steroid dependent ulcerative colitis: a real world intention-to-treat analysis

Background/Aims Four high-quality randomized controlled trials have proven the efficacy of fecal microbiota transplantation (FMT) in active ulcerative colitis (UC). We assessed the efficacy of FMT in a real-world setting involving steroid-dependent patients with UC. Methods This was a single-center prospective analysis of data from steroid-dependent patients with UC treated with FMT from September 2015 to September 2017 at the Dayanand Medical College, a tertiary care center in India. Fecal samples from random unrelated donors were administered through colonoscopy at weeks 0, 2, 6, 10, 14, 18, and 22. The primary outcome was achievement of steroid-free clinical remission, and the secondary outcomes were clinical response and endoscopic remission at 24 weeks. Modified intention-to-treat analysis was performed, which included subjects who underwent at least 1 FMT. Results Of 345 patients with UC treated during the study period, 49 (14.2%) had steroid-dependent UC. Of these 49 patients, 41 underwent FMT: 33 completed 7 sessions over 22 weeks according to the protocol, and 8 discontinued treatment (non-response, 5; lost to follow-up, 2; and fear of adverse effects, 1). At week 24, steroid-free clinical remission was achieved in 19 out of 41 (46.3%) patients, whereas clinical response and endoscopic remission were achieved in 31 out of 41 (75.6%) and 26 out of 41 (63.4%) patients, respectively. All patients with clinical response were able to withdraw steroids. There were no serious adverse events necessitating discontinuation. Conclusions A multisession FMT via the colonoscopic route is a promising therapeutic option for patients with steroid-dependent UC, as it can induce clinical remission and aid in steroid withdrawal