Remote preconditioning by aortic constriction: affords cardioprotection as classical or other remote ischemic preconditioning? Role of iNOS

Dose remote preconditioning by aortic constriction (RPAC) affords cardioprotection similar to classical or other remote ischemic preconditioning stimulus? Moreover study was also designed to investigate role of inducible nitric oxide synthase in remote preconditioning by aortic constriction. There are sufficient evidences that "ischemic preconditioning" has surgical applications and afford clinically relevant cardioprotection. Transient occlusion of circumflex artery, renal artery, limb artery or mesenteric artery preconditions the myocardium against ischemia reperfusion injury in case of ischemic heart disease leading to myocardial infraction. Here abdominal aorta was selected to produce RPAC. Four episodes of Ischemia-reperfusion of 5 min each to abdominal aorta produced RPAC by assessment of infract size, LDH and CK. These studies suggest RPAC produced acute (FWOP) and delayed (SWOP) cardioprotective effect. RPAC demonstrated a significant decrease in Ischemia-reperfusion induced release of LDH, CK and extent of myocardial infract size. L-NAME (10 mg/Kg i.v.), Aminoguanidine (150 mg/Kg s.c.), Aminoguanidine (300 mg/Kg s.c.), S-methyl isothiourea (3 mg/Kg i.v.), 1400W (1 mg/Kg i.v.) administered 10 min. before global ischemia reperfusion produced no marked effect. Aminoguanidine (150 mg/Kg s.c.), Aminoguanidine (300 mg/Kg s.c.), S-methyl isothiourea (3 mg/Kg i.v.), 1400W (1 mg/Kg i.v.) pretreatment after RPAC produced no significant effect on acute RPAC induced decrease in LDH, CK and infract size, whereas L-NAME (10 mg/Kg i.v.) increased RPAC induced decrease in LDH, CK and infract size. Most interesting observation is in delayed RPAC, where all NOS inhibitors pretreatment attenuate RPAC induced decrease in LDH, CK and infract size. In conclusions, "Remote preconditioning by aortic constriction" (RPAC) affords cardioprotection similar to classical or other remote ischemic preconditioning stimulus. Moreover, late or delayed phase of RPAC has been mediated by inducible nitric oxide synthase (iNOS) whereas it has not involved in acute RPAC

Androgen insensitivity syndrome: discussion based on three cases

Androgen insensitivity syndrome is an X-linked recessive condition due to a complete or partial insensitivity to androgen, resulting in a failure of normal masculinisation of the external genitalia in chromosomally male individuals. This failure of virilisation can be either complete or partial depending on the amount of residual androgen receptor function. It is classified into three categories depending upon the degree of genital masculinisation into complete, partial and mild insensitivity with phenotype variation from normal female at one end to normal male on other end.Here we described two cases of partial and one case of complete androgen insensitivity syndrome. The presenting feature in partial androgen insensitivity patients was amenorrhea in 16 year female and ambiguous genitalia in 7 months baby. The complete androgen insensitivity case presented with inguinal hernia only at 6 years of age. All the three cases were classified according to Quigley scale with Karyotyping confirming 46 XY genotype. After full evaluation two patients had undergone gonadectomy while in third case parents opted to take definitive decision in future. The role of psychological support and counselling is also emphasized with timing of disease disclosure to patient left over to the parents for appropriate age

High resolution ultrasonography in isolated soft tissue and intramuscular cysticercosis

Background: Cysticercosis is a common parasitic public health issue especially in developing countries. Though the extraneural tissues are usually involved synchronously or metachronously with the brain, isolated infestation of soft tissue and muscle in the absence of neural involvement is more common than previously thought. High resolution ultrasonography has evolved now as an investigation of choice with proven sonological patterns of soft tissue cysticercosis which can entirely negate the need for invasive interventions.The aim of the study is to: a) evaluate the diagnostic utility of HRUSG in isolated soft tissue- intramuscular    cysticercosis; and b) evaluate and emphasized the role of the non-surgical conservative medical management in these cases.Methods: Prospective evaluation of total 15 cases of extraneural cysticercosis over a period of 2 years at DMIMS Sawangi. HRUSG analysis of 15 cases was done to evaluate and classify the various classic sonomorphological features of isolated cysticercosis involving soft tissue and muscles. FNAC was done in 3 cases. 12 out of 15 patients were followed up closely over serial ultrasound after initiation of medical therapy at 15 days, 1 month and at 3 months interval. Tablet Albendazole with or without steroid cover was given to each of 12 patients and treatment response was recorded.Results: Out of 15 cases, 7 were male and 8 were female patients. Nine individuals were vegetarian and six were non vegetarian. Mean age was 28 years. All cases were diagnosed on HRUSG. Intramuscular lesion was identified in 11 cases and 4 cases had subcutaneous involvement with anterior abdominal wall in muscular plane as the commonest site in three patients. FNAC was done in 3 cases confirming the cysticercosis and was treated surgically. 12 patients were treated with medical therapy and showed complete resolution at 3 month ultrasound follow up.Conclusions: With the advent of high resolution ultrasonography and increased clinical awareness of the isolated soft tissue-intramuscular cysticercosis especially in endemic zone, a more conservative non-invasive approach can be applied both in diagnosis and treatment of these isolated cases of cysticercosis

Fetal transcerebellar diameter and transcerebellar diameter – abdominal circumference ratio as a menstrual age independent parameter for gestational age estimation with grading of cerebellar

Background: It is important for achieving an uneventful gestation to have a sensitive, specific and age independent obstetric biometric parameter which stays constant throughout the gestation. Transcerebellar diameters (TCD), TCD/ abdominal circumference (AC) ratio are reliable, constant predictors to assess the gestational age and to evaluate fetal growth. Along with TCD, the morphology of the cerebellum also changes gradually with the advancing gestation. The aim of the study was to evaluate TCD and TCD/AC ratio in singleton uncomplicated pregnancy in assessing fetal gestational age and growth and to evaluate the morphological changes in the appearance of the cerebellum with advancing gestation and categorizing it into three grades system.Methods: Prospective cross sectional study carried out in 100 singletons uncomplicated pregnancy between 12-40 weeks of gestation attending antenatal ultrasound clinics of DMIMS Sawangi, Wardha. Morphology of cerebellum was studied and categorized on USG with measurement of TCD, AC, and TCD/AC ratio.Results: There was a significant linear correlation of TCD; AC with GA.TCD/AC ratio for normal fetal growth with gestational age from 12-40weeks was found to be constant with a mean of 13.75.Cerebellar grading was 27% in grade I, 40% in grade II and 33% in grade III. The median GA and TCD was 18 weeks and 17mm for grade I, 27 weeks and 27mm for grade II and 34 weeks and 42mm for grade III.Conclusions: Significant linear relation of TCD with GA indicating the reliability of this biometry in estimating gestational age and assessing fetal growth. TCD/AC ratio remains fairly constant throughout the gestation and is a sensitive gestational age independent parameter and a good predictor for fetal growth monitoring. Ultrasonography of posterior fossa demonstrated gradual morphological changes in the cerebellum

Production of alkaline pectinase by bacteria (Cocci sps.) isolated from decomposing fruit materials

Bacterial production of commercial enzymes, including pectinase, has always been the industrial choice. Two decomposing fruit materials (apple and oranges) were enriched to isolate pectinase producing bacteria and were screened for their pectinolytic activity. The best producer (O1, i.e. Orange 1) was characterized as Cocci sp. and studied for pectinase activity. The culture conditions were optimized for maximum enzyme production by isolate O1 and was found to be 350C at an alkaline pH of 8.0 with 120 rpm agitation (supporting aerobic conditions) and 72 hours of incubation time and required surfactant for achieving maximum enzyme activity of 13.96 U/ml in crude enzyme extracts. The study provides a strong bacterial candidate for potential industrial production of pectinase

Correlation of mature mean follicle on transvaginal ultrasound and serum estradiol levels on day of trigger injection of ovulation in ovarian stimulation cycle of in vitro fertilization with retrieved oocytes

Background: Controlled ovarian hyperstimulation aims to obtain mature follicles. The present study was conducted to assess the correlation of mature follicle in transvaginal ultrasound scanning (TVS) and serum estradiol levels on day of trigger injection in ovarian stimulation cycle for IVF with the oocyte yield.Methods: In this prospective study, we evaluated oocyte donor 19 to 45 years of age who underwent oocyte retrieval at our clinic. Outcome variables like number of mature follicles visualized on TVS on the last day of stimulation was noted for all patients. On the same day, serum estradiol levels and number of mature follicles seen on TVS were noted and correlated with the number of oocytes retrieved. Ultrasound guided transvaginal oocyte retrieval was performed and total number of oocytes were noted.Results: During the study period, 20 oocytes donors were included. Mean age of the patients was 27.9±4.7 years. Mean BMI was 26.8±2.3 kg/m2. Mean FSH level was 6.89±1.79 IU/L and mean antral follicle count on day 3 was 14.06±3.56. On the day of trigger, mean mature follicle count seen on TVS was 20.4±13.8, ranging from 8 to 50. On an average, 17.2 oocytes were retrieved. On the day of trigger, mean estradiol level was 4970±203, ranging from 500 to 15,665 pg/ml. It was observed that the number of retrieved oocytes correlated significantly with the serum estradiol levels, (Pearson’s coefficient 0.94, p value<0.001) and number of mature follicles seen on TVS ((Pearson’s coefficient 0.92, p value<0.001).Conclusions: Number of retrieved oocytes correlated significantly with the serum estradiol levels and number of mature follicles seen on TVS on the day of trigger

Outcome of vaginal sildinafil in assisted reproductive technology cycles

Background: The present study assessed the role of sildenafil in endometrial blood flow and successful pregnancy in IVF done in surrogate mothers.Methods: In the present study surrogate mothers were included. Thirty patients were randomized to receive sildenafil 25 mg thrice a day vaginally in addition to standard drugs and technique and another 30 were not given sildenafil.Results: Mean age, anthropometry, duration of infertility and pre-treatment endometrial thickness was similar in the two study groups.  After treatment completion, it was observed that the endometrial pattern in ultrasound was similar in the two study groups (p value=0.58). Heterogenic endometrial pattern was observed in 6.7% of the Sildenafil patients and 3.3% in the control patients, while echogenic pattern was seen in 10% of the sildenafil patients and 6.7% of the control patients. Similarly, endometrial thickness was 10.2±1.7 and 9.7±1.8 mm in sildenafil and control group respectively, p value=0.62. Using doppler ultrasound, uterine artery PI was significantly lower in Sildenafil group patients as compared to control group patients. Similarly, we found uterine artery RI was also significantly lower in the Sildenafil group patients as compared to control group patients. We followed the patients and found that clinical pregnancy rate was significantly higher among Sildenafil group (60%) as compared to control group (26.6%), p value<0.05.Conclusions: Vaginal sildenafil resulted in significantly higher pregnancy rates in our study population. The uterine artery PI and RI were significantly lower in patients taking sildenafil