Comparative study of the efficacy methotrexate and mifepristone with methotrexate medical management of ectopic pregnancy

BACKGROUND: Now a days ectopic pregnancy is on a raising trend. Increase in number of patients with infertility going for assisted reproductive techniques and increasing sterilization procedure and tubal Re anastomosis procedures has contributed to this rise. With advent of transvaginal ultrasound and beta hCG measurement early diagnosis ectopic pregnancy is possible. Hence medical management of ectopic and alternate adjuvant drugs for medical management is the topic of research. OBJECTIVES: The objective of this study is to compare the efficacy of mifiprestone in combination with methotrexate vs methotrexate alone for medical management of ectopic pregnancy. PERIOD OF STUDY: 2 years. STUDY DESIGN: Prospective and retrospective comparative study. INCLUSION CRITERIA: Haemodynamically stable patients , Sac size less than 4cm on usg , Beta HCG < 10,000mIU/ml , Absent cardiac activity in the sac and Patient willing for follow up. EXCLUSION CRITERIA: Haemodynamically unstable patients , Ectopic of diameter greater than 4 cm on usg , Patients with hepatic and renal dysfunction , Smokers over the age of 35 yrs , Long term corticosteroid users , Patients with hemorrhagic disorder on anticoagulant , Patients who did not consent. MATERIAL AND METHOD: 20 patients with ectopic pregnancy full filling the criteria of medical management will be chosen and given a single dose of 200 mg mifepriostone along with single im injection of methotrexate 50mg/sq.m body surface area. Baseline serum beta HCG level, UPT and USG will be done for all pts, detailed history of symptoms and past medical h/o will be recorded, examination findings and vital parameters recorded. Complete haemogram, renal function tests and liver function test also done for all patients. Following treatment women will be reviewed on day 4 and day 7. All women had beta HCG estimations hepatic and renal function tests and full blood count on each visit. If the HCG concentration dropped by more than 15% between day 4 to 7 the women will then be reviewed weekly until the HCG concentrations were below 12IU/L. If the decrease was less than 15% between day 4 to 7 then a second dose of methotrexate will be administered. In these cases blood HCG concentrations will be estimated also on day 11 and 14. The results of the combination therapy will be compared retrospectively with patients treated with single dose i.m methotrexate alone in the past. COMPARISON CRITERIA: Resuts will be compared based on the following criteria. Time interval between drug administration and complete resolution.No of pts requiring 2nd dose methotrexate.No of pts undergoing laprotomy due to haemodynamic instability and worsening of symptoms and duration of hospital stay. RESULT: 20 cases where treated with mefipristone and methotrexate combination. Out of which 17 cases resolved completely which is 85% success. Three patients needed laprotomy due to failure of medical management which is 15%. Three patients needed second dose of methotrexate. The average time taken for complete resolution 21 days. The average duration of hospital stay 7 days. Results where compared retrospectively with 20 patients with methotrexate alone. Out of these 14 cases resolved completely with medical management which account to 70% success rate.Six cases needed emergency laprotomy 30% failure rate.Five cases needed second dose of methotrexate. The average time taken for complete resolution is 28 days. Average duration of hospital stay 12 days. CONCLUSION: This study done in our hospital compared the efficacy of methotrexate with mifepristone in combination Vs methotrexate alone in medical management of ectopic pregnancy. The results were compared based on the success rate , patients needing second dose methotrexate , time taken for complete resolution and average duration of hospital stay. The combination of methotraxate and mefepristone gave a success rate of 85% as against methotrexate alone which had only 70% success rate. On applying chi square test and P value was 0.255989 and hence this was not statistically significant. 15% of patients in combination group needed a second dose of methotrexate as against 25% in the control group. On applying chi square test P value was 0.252595 which was also not statistically significant. 65 % patients Beta HCG in the combination group resolved < 3 weeks as compared to 15 % in the methotrexate alone group. on applying chi square test P value was 0.002275. Result was significant as P value is less than 0.05. The average duration of hospital stay was five days less in the combination group than cases treated with methotrexate alone. According to my study, there is earlier resolution of ectopic pregnancy and reduced duration of hospital stay when combination of mifepristone and methotrexate is used as compared to methotrexate alone for medical management. Larger studies are needed to prove the effectiveness of the combination group in terms of success rate

Cystic nephroma in a 14-year-old-a rare case report

Cystic nephroma (CN) is an uncommon benign renal tumor with a bimodal age distribution. It often presents with non-specific presenting symptoms. In this study, we report a case of a 14-year-old female patient who presented with a painless abdominal mass, and a left renal cystic lesion was detected on CECT KUB. Left partial nephrectomy was done and a diagnosis of CN made following the histopathological examination of specimen. Owing to its non-specific clinical presentation and radiological findings, it is difficult to distinguish CN from other cystic lesions of kidney like cystic partially differentiated nephroblastoma, tubule-cystic renal cell carcinoma, cystic Wilm’s tumor etc., pre-op. This study emphasizes importance of histopathological examination in diagnosis of CN to prevent misdiagnosis and overtreatment. Although it has good prognosis, long term follow-up for local recurrence is recommended

A STUDY ON EFFECTIVENESS OF THE RURAL DEVELOPMENT PROJECT PROVIDING RURAL EMPLOYMENT, MANDYA

The Shri Kshethra Dharmasthala Rural Development Project (SKDRDP) has been a cornerstone of rural development efforts in India aimed at improving the socio-economic conditions of rural communities. This study explores the effectiveness of the SKDRDP in providing rural employment opportunities and the impact it has had on the livelihoods of the beneficiaries. The study indicates that the SKDRDP has played a pivotal role in providing rural employment opportunities to the local population. Through various initiatives, including skill development programs, micro-enterprise support, and infrastructure development projects, the project has significantly increased rural employment. Beneficiaries reported improved income levels and quality of result of their involvement in SKDRDP activities. The SKDRDP has proven to be effective in providing rural employment opportunities and enhancing the livelihoods of the rural population. It acts as a model for comprehensive rural development, emphasizing skill-building, self-reliance, and community empowerment. The study's conclusions underscore the importance of continued support for such initiatives to further rural development and reduce poverty in India

Tamoxifen may contribute to preserve cardiac function in Duchenne muscular dystrophy.

UNLABELLED Duchenne muscular dystrophy is life-limiting. Cardiomyopathy, which mostly ensues in the second decade of life, is the main cause of death. Treatment options are still limited. The TAMDMD (NCT03354039) trial assessed motor function, muscle strength and structure, laboratory biomarkers, and safety in 79 ambulant boys with genetically confirmed Duchenne muscular dystrophy, 6.5-12 years of age, receiving either daily tamoxifen 20 mg or placebo for 48 weeks. In this post-hoc analysis, available echocardiographic data of ambulant patients recruited at one study centre were retrieved and compared before and after treatment. Data from 14 patients, median 11 (interquartile range, IQR, 11-12) years of age was available. Baseline demographic characteristics were similar in participants assigned to placebo (n = 7) or tamoxifen (n = 7). Left ventricular end-diastolic diameter in the placebo group (median and IQR) was 39 (38-41) mm at baseline and 43 (38-44) mm at study end, while it was 44 (41-46) mm at baseline and 41 (37-46) mm after treatment in the tamoxifen group. Left ventricular fractional shortening in the placebo group was 35% (32-38%) before and 33% (32-36%) after treatment, while in the tamoxifen group it was 34% (33-34%) at baseline and 35% (33-35%) at study end. No safety signals were detected. CONCLUSION This hypothesis-generating post-hoc analysis suggests that tamoxifen over 48 weeks is well tolerated and may help preserving cardiac structure and function in Duchenne muscular dystrophy. Further studies are justified. CLINICALTRIALS gov Identifier: EudraCT 2017-004554-42, NCT03354039 What is known: • Duchenne muscular dystrophy (DMD) is life-limiting. Cardiomyopathy ensues in the second decade of life and is the main cause of death. Treatment options are still limited. • Tamoxifen reduced cardiac fibrosis in mice and improved cardiomyocyte function in human-induced pluripotent stem cell-derived cardiomyocytes. WHAT IS NEW • In this post-hoc analysis of the TAMDMD trial among 14 boys, median 11 years of age, treated with either tamoxifen or placebo for 48 weeks, treatment was well-tolerated. • A visual trend of improved left-ventricular dimensions and better systolic function preservation generates the hypothesis of a potential beneficial effect of tamoxifen in DMD cardiomyopathy

Antibiogram resistance pattern of extended-spectrum beta-lactamase-positive bacterial isolates

Objectives: To identify the antibiogram resistance pattern of extended-spectrum beta-lactamase (ESBL)-positive bacterial isolates. Materials and Methods: This prospective, observational study was conducted in Rajarajeswari Medical College and Hospital, Bangalore, over a period of 12 months. The clinical samples were inoculated on the standard recommended media. Inoculated plates were incubated aerobically at 37°C for 24 h, and organisms were identified by culture and appropriate biochemical reactions. Antimicrobial sensitivity was performed by Kirby-Bauer disk diffusion method on Mueller-Hinton agar using commercially available antibiotic discs as per the Clinical and Laboratory Standards Institute Guidelines-2014. Results: Escherichia coli were the most common ESBL-producing organisms isolated from the study population accounting to 45% of the total cases. The next most common organisms were Klebsiella species and Pseudomonas. Ceftriaxone was the most commonly used empirical antibiotic (33.3% cases). Piperacillin and meropenem were used in combination with tazobactam or sulbactam, respectively, as per the culture and sensitivity reports. Conclusion: The association of change in antibiotic to mortality was found to have significance. The change in antibiotic in deterioration of the illness showed decrease in mortality

Metabolic markers of short and long-term exogenous DL-beta-hydroxybutyrate supplementation in episodic migraine patients: an exploratory analysis of a randomized-controlled-trial

Background: Emerging findings propose that the pathophysiology of migraine may be associated with dysfunctional metabolic mechanisms. Recent findings suggest that migraine attacks are a response to the cerebral energy deficit, and ingestion of ketone bodies stabilizes the generation of a migraine attack. Based on these findings, ketone body supplementation is postulated as a prophylactic treatment approach to restore cerebral metabolism deficiency. Metabolic markers are unexplored after exogenous ketone body supplementation in episodic migraineurs. Therefore, the present single-arm uncontrolled explorative analysis evaluated blood ketone body and glucose concentration after short and long-term 6 g exogenous DL-Mg-Ca-beta-hydroxybutyrate (DL-βHB) supplementation.Methods: The presented data are part of the MigraKet randomized-control cross-over clinical trial of 41 episodic migraineurs (Number NCT03132233). Patients were given a single dose of 6 g DL-βHB. Ketone body and glucose blood concentration were assessed before intake, 20, and 40 min after DL-βHB intake. Ketone body, glucose concentration and glycated hemoglobin values were evaluated after 12 weeks of 18 g DL-βHB ingestion (total dose), taken three times daily (6g/dose; 3x/day). Linear models explored the association between the ketone body and glucose levels.Results: Ketone body concentration increased within-group to a mean of 0.46 (0.30) mmol/L after 40 min post- DL-βHB supplementation [estimate = 0.24 mmol/L, CI = (0.20.0.27), p &lt; 0.01]. This within-group increase of ketone body concentration did not change after repeated daily intake of DL-βHB supplementation over 12 weeks [estimate = 0.00 mmol/L, CI = (−0.03.0.04), p = 0.794]. DL-βHB intake significantly reduced blood glucose concentration within-group from a mean baseline of 4.91 (0.42) mmol/L to 4.75 (0.47) mmol/L 40 min post-DL-βHB supplementation [estimate = −0.16 mmol/L, CI = (−0.15, 0.03), p &lt; 0.01]. Repeated DL-βHB supplementation for 12 weeks showed no change within-group in acute ketone bodies concentration [estimate = 0.00 mmol/L, CI = (−0.03.0.04), p = 0.794] and in the HbA1c value [estimate = 0.02, CI = (−0.07.0.11), p = 0.69].Conclusion: A single dose of 6 g DL-βHB significantly elevated blood ketone bodies and decreased blood glucose concentration within-group in episodic migraineurs. Long-term DL-βHB supplementation for 12 weeks showed no effect within-group on acute ketone body concentration and had not impact on HbA1c. The elevation of the ketone body concentration was moderate, indicating that nutritional ketosis was not reached. Therefore, a dose higher than 6 g of DL-βHB is required to reach the nutritional level of ketosis. ClinicalTrials.gov Identifier: NCT03132233

Multi-center feasibility study evaluating recruitment, variability in risk factors and biomarkers for a diet and cancer cohort in India

<p>Abstract</p> <p>Background</p> <p>India's population exhibits diverse dietary habits and chronic disease patterns. Nutritional epidemiologic studies in India are primarily of cross-sectional or case-control design and subject to biases, including differential recall of past diet. The aim of this feasibility study was to evaluate whether a diet-focused cohort study of cancer could be established in India, providing insight into potentially unique diet and lifestyle exposures.</p> <p>Methods</p> <p>Field staff contacted 7,064 households within three regions of India (New Delhi, Mumbai, and Trivandrum) and found 4,671 eligible adults aged 35-69 years. Participants completed interviewer-administered questionnaires (demographic, diet history, physical activity, medical/reproductive history, tobacco/alcohol use, and occupational history), and staff collected biological samples (blood, urine, and toenail clippings), anthropometric measurements (weight, standing and sitting height; waist, hip, and thigh circumference; triceps, sub-scapula and supra-patella skin fold), and blood pressure measurements.</p> <p>Results</p> <p>Eighty-eight percent of eligible subjects completed all questionnaires and 67% provided biological samples. Unique protein sources by region were fish in Trivandrum, dairy in New Delhi, and pulses (legumes) in Mumbai. Consumption of meat, alcohol, fast food, and soft drinks was scarce in all three regions. A large percentage of the participants were centrally obese and had elevated blood glucose levels. New Delhi participants were also the least physically active and had elevated lipids levels, suggesting a high prevalence of metabolic syndrome.</p> <p>Conclusions</p> <p>A high percentage of participants complied with study procedures including biological sample collection. Epidemiologic expertise and sufficient infrastructure exists at these three sites in India to successfully carry out a modest sized population-based study; however, we identified some potential problems in conducting a cohort study, such as limited number of facilities to handle biological samples.</p

A cross-sectional investigation of regional patterns of diet and cardio-metabolic risk in India

<p>Abstract</p> <p>Background</p> <p>The role of diet in India's rapidly progressing chronic disease epidemic is unclear; moreover, diet may vary considerably across North-South regions.</p> <p>Methods</p> <p>The India Health Study was a multicenter study of men and women aged 35-69, who provided diet, lifestyle, and medical histories, as well as blood pressure, fasting blood, urine, and anthropometric measurements. In each region (Delhi, n = 824; Mumbai, n = 743; Trivandrum, n = 2,247), we identified two dietary patterns with factor analysis. In multiple logistic regression models adjusted for age, gender, education, income, marital status, religion, physical activity, tobacco, alcohol, and total energy intake, we investigated associations between regional dietary patterns and abdominal adiposity, hypertension, diabetes, and dyslipidemia.</p> <p>Results</p> <p>Across the regions, more than 80% of the participants met the criteria for abdominal adiposity and 10 to 28% of participants were considered diabetic. In Delhi, the "fruit and dairy" dietary pattern was positively associated with abdominal adiposity [highest versus lowest tertile, multivariate-adjusted OR and 95% CI: 2.32 (1.03-5.23); P_trend= 0.008] and hypertension [2.20 (1.47-3.31); P_trend< 0.0001]. In Trivandrum, the "pulses and rice" pattern was inversely related to diabetes [0.70 (0.51-0.95); P_trend= 0.03] and the "snacks and sweets" pattern was positively associated with abdominal adiposity [2.05 (1.34-3.14); P_trend= 0.03]. In Mumbai, the "fruit and vegetable" pattern was inversely associated with hypertension [0.63 (0.40-0.99); P_trend= 0.05] and the "snack and meat" pattern appeared to be positively associated with abdominal adiposity.</p> <p>Conclusions</p> <p>Cardio-metabolic risk factors were highly prevalent in this population. Across all regions, we found little evidence of a Westernized diet; however, dietary patterns characterized by animal products, fried snacks, or sweets appeared to be positively associated with abdominal adiposity. Conversely, more traditional diets in the Southern regions were inversely related to diabetes and hypertension. Continued investigation of diet, as well as other environmental and biological factors, will be needed to better understand the risk profile in this population and potential means of prevention.</p

Rhenium and yttrium ions as antimicrobial agents against multidrug resistant Klebsiella pneumoniae and Acinetobacter baumannii biofilms

© 2019 The Authors. Letters in Applied Microbiology published by John Wiley & Sons Ltd on behalf of Society for Applied Microbiology. Antimicrobial resistance presents major global concerns to patient health. In this study, metal ions of molybdenum, rhenium, yttrium and thallium were tested against bacteria in planktonic and biofilm form using one strain of Klebsiella pneumoniae and Acinetobacter baumannii. The antimicrobial efficacy of the metal ions was evaluated against the planktonic bacterial strains using minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations, whilst the efficacy of the metal ions against biofilms was tested using a crystal violet biofilm assay. Live Dead staining was used to visualize the antimicrobial activity elicited by the metal ions on the bacterial cell. The results showed that higher concentrations of the metals were required to inhibit the growth of biofilms (72·9 mg l −1 to 416·7 mg l −1 ), in comparison to their planktonic counterparts. MICs of the metal ions (<46·9 mg l −1 ) (planktonic cells) did not affect biofilm formation. Overall, rhenium and yttrium were effective antimicrobial agents. Molybdenum demonstrated the greatest level of biotoxicity. When taking into account these results and the known toxicity of thallium, it is possible that rhenium or yttrium ions could be developed as effective biocidal formulations in order to prevent transmission in healthcare environments. Significance and Impact of the Study: The metal ions, molybdenum, rhenium, thallium and yttrium were tested against both Klebsiella pneumoniae and Acinetobacter baumannii in planktonic and biofilm forms. This research demonstrated that all the metal ions may be effective antimicrobial agents. However, molybdenum induced high levels of cytotoxicity, whilst, there was no significant difference in the toxicity of the other metal ions tested. When considering the results for the antimicrobial efficacy and biotoxicity of the metal ions, in conjunction with the known toxicity of thallium in certain chemical compositions, it was concluded that overall rhenium or yttrium ions may be effective antimicrobial agents, one potential application may be utilizing these metal ions in hospital surface cleaning formulations