CPK: The new tool in the diagnosis of ectopic pregnancy

Background: Ectopic pregnancy is still a diagnostic dilemma presenting with various complaints. The classic triad of amenorrhea, abdominal pain, vaginal bleeding and /or syncope is not always seen. Misdiagnosis can lead to delay in treatment, blood loss is found to be the major cause of death. Early and accurate diagnosis is critical in bringing down the maternal mortality and morbidity. Prompt and effective treatment of an ectopic pregnancy can help preserve the chances of future healthy pregnancies. Aim of present study was to investigate whether creatinine phosphokinase (cpk) can be used as an effective diagnostic tool in the early diagnosis of ectopic pregnancy which can help in decreasing the maternal mortality and morbidityMethods: This observational comparative three group clinical study was conducted at Chinmaya Mission Hospital, Bangalore, between May 2016 to January 2017.120 women in their early trimester were studied of which 40 were diagnosed cases of ectopic pregnancies, 40 women presented with intrauterine abortive pregnancies and 40 women had normal healthy pregnancies. Serum CPK, serum B-HCG, vaginal scans were done in all, along with routine investigations.Results: The mean CPK values in normal, abortive and ectopic pregnancies were 36.92±6.44, 43.95±11.96 and 91.55±30.43 respectively. It was found to be significantly higher in ectopic Pregnancies. Also, the mean CPK in ruptured and unruptured ectopic pregnancy were 97.26±25.97 and 63.82±34.92 respectively.Conclusions: Present study shows that maternal CPK levels are significantly higher in women with ectopic pregnancies. CPK can serve as the reliable biochemical marker to diagnose ectopic pregnancy particularly ruptured. CPK can be used to increase the diagnostic efficacy in ectopic pregnancy, which followed by rapid and appropriate treatment can reduce the mortality, morbidity and preserve future fertility

Mechanisms and Action of Drug Resistance on <em>Mycobacterium tuberculosis</em>

Tuberculosis (TB) remains the most challenging infection to treat worldwide. The contemporary TB regimens consist of 6–9 months of daily doses of four drugs in the existing regimen that is extremely toxic to patients. The purpose of these longer treatments is to eliminate Mycobacterium tuberculosis, notorious for its ability to resist most antimycobacterial drugs, thereby preventing the formation of drug-resistant clinical strains. On the contrary, prolonged therapies have led to impoverished patient adherence. Furthermore, the severe limitations of drug choices have resulted in the emergence of drug-resistant strains. Unfortunately, the lack of great lethargy toward developing effective antituberculosis regimens with a large-scale prevalence rate is a tremendous challenge to controlling the pandemic. In fact, the current improvement in genomic studies for early diagnosis and understanding of drug resistance mechanisms, and the identification of newer drug targets, is remarkable and promising. Identifying genetic factors, chromosomal mutations, and associated pathways give new hope to current antituberculosis drug discovery. This focused review renders insights into understanding molecular mechanisms underlying the profound drug resistance. This knowledge is essential for developing effective, potent antibiotics against drug-resistant strains and helps shorten the current treatment courses required for drug-susceptible tuberculosis

Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series

Warts are generally managed using cryosurgery, keratolytic ointments, curettage and electrodessication. Warts, vis-a-vis Charmakila, in Ayurvedic classical texts are classified into different types depending on the dominance of dosha. Ayurveda prescribes oral medications, topical use of Kshara (alkaline ash of herbs), Agni (thermal cautery) and Shastrakarma (surgery) for removal of Charmakila. Use of topical Kshara in the form of powder, aqueous solution i.e. Ksharodaka and Ksharasutra (thread smeared with Kshara) for warts has been reported. However, these methods necessitate multiple sittings and takea longer duration for removal of the warts. Herewith, we report a case series of different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK), i.e. aqueous solution of Apamarga (Achyranthes aspera) Kshara. We observed that all these warts took a minimum of 2-6 days to shed off, leaving minor scars. There were no adverse reactions reported in any of these cases

Risk of prostate cancer mortality in men with a history of prior cancer

To describe outcomes of patients with prostate cancer diagnosed after another malignancy and identify factors associated with prostate cancer death in this population, as little is known about the clinical significance of prostate cancer as a subsequent malignancy. We studied 18 225 men diagnosed with prostate cancer after another malignancy from 1973 to 2006. We compared demographic and clinical variables, and the proportion of death from prostate cancer vs prior malignancy with t-test and chi-squared analyses. Fine and Gray's regression was used to consider the effect of treatment on prostate cancer death. We then studied a second cohort of 88 013 men with prostate cancer as a first or second malignancy to describe current diagnostic and treatment patterns. One in seven men died from prostate cancer in our first cohort. More died from prostate cancer following colorectal cancer (16.8% vs 13.7%), melanoma (13.4% vs 7.56%), and oral cancer (19.1% vs 4.04%), but fewer following bladder cancer, kidney cancer, lung cancer, leukaemia and non-Hodgkin's lymphoma (all P < 0.001). Prostate cancer treatment was associated with a nearly 50% lower risk of death when high-grade or high-stage (adjusted hazard ratio 0.55, 95% confidence interval [CI] 0.47-0.64). Patients who died from prostate cancer had higher grade and stage disease, and received less treatment than patients who died from prior malignancy. The second cohort showed subsequent prostate cancer had more high-risk disease (36.3% vs 22.2%, P < 0.001) and less prostate cancer treatment (adjusted odds ratio 0.872, 95% CI 0.818-0.930) than primary prostate cancer. Prostate cancer remains a significant cause of mortality when diagnosed as a subsequent cancer. These results suggest prostate cancer treatment should be seriously considered in patients with prior malignancies, especially those with high-grade or locally advanced prostate cancer

Incidence and predictors of prostate cancer death in men with other prior malignancies: An analysis from SEER Database

34 Background: Men with cancer are screened 22% more for prostate cancer (PCa) than men without cancer, yet very little has been published on their prostate cancer outcomes. We aim to describe PCa death and clinical factors associated with dying from PCa in this population. Methods: We studied 22,769 men in the Surveillance, Epidemiology, and End Results database diagnosed with PCa as a second cancer from 1973 to 2006. Proportions of PCa death versus primary-cancer death were calculated, stratified by the nine primary cancers with highest incidence among US men and then further stratified by PCa grade and interval between primary and PCa diagnoses. Results: Urinary-bladder (30.4%), colorectal (27.9%) and lung cancer (10.5%) were the most common primary cancers. Overall, 12.4% of men died from PCa. A greater proportion of patients died from PCa than their first cancer with primary melanoma (11.7 vs 6.97%) and oral cavity/pharynx cancer (15.3 vs 6.98%), a similar proportion for colorectal (14.8% vs 13.7%) and kidney/renal pelvis cancer (11.1 vs 12.7%), but a lower proportion for lung (11.3 vs 42.1%) and bladder cancer (10.8 vs 17.4%). When the interval between cancer diagnoses was more than 5 years, PCa was the leading cause of death for five of the nine cancers. Patients who died from PCa compared to those who died from their primary had higher baseline PSA (39.5 vs 16.9 ng/mL, p<0.001), more Gleason 8-10 (36.7 vs 18.2%, p<0.001), more N1/M1 PCa (2.35 vs 0.30%, p<0.001), were older at PCa diagnosis (74.7 vs 71.9 years, p=0.015), and had a longer interval between diagnoses (63.9 vs 28.8 months, p<0.001). Conclusions: PCa remains a significant cause of mortality when diagnosed as a second cancer, especially if the interval from prior cancer is greater than 5 years, suggesting that treatment of aggressive prostate cancer may be reasonable for many patients with prior cancers

Shifting brachytherapy monotherapy case mix toward intermediate-risk prostate cancer

The relative use of brachytherapy (BT) for prostate cancer has declined in recent years. In this setting, we sought to determine whether the case mix of BT monotherapy–treated men has changed over time in terms of risk group composition. The Surveillance, Epidemiology, and End Results database was used to identify 30,939 patients diagnosed with prostate adenocarcinoma between 2004 and 2011 who received BT monotherapy. The case mix of BT monotherapy patients was calculated by patient risk group and year of diagnosis. Between 2004 and 2011, the use of BT monotherapy declined overall. The relative percentage of men undergoing BT with low-risk disease declined by 4.5%, whereas the relative percentage of patients with intermediate-risk disease increased by 4.7%. Non-white patients and those from poorer counties did not show shifts in the risk group makeup of BT monotherapy patients, whereas white patients and those from wealthier counties did. Although fewer patients with prostate cancer are undergoing BT monotherapy, men with intermediate-risk disease comprised a significantly larger portion of the BT case mix in 2011 compared with 2004. Future research efforts by brachytherapists should be directed toward improving BT technique, optimizing radiation doses, and obtaining long-term followup data for patients with intermediate-risk prostate cancer

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