Endosalpingiosis with concurrent endometriosis of ovary masquerading as ovarian malignancy

Endosalpingiosis is a rare gynecological disorder of müllerian origin, characterized by the presence of tubal epithelium outside the fallopian tube, which involves structures of the female genital tract, peritoneum, and sub-peritoneal tissues. Endosalpingiosis can be associated with endometriosis or endocervicosis, although it often appears alone. Authors report a case of endosalpingiosis with concurrent endometriosis in a 42-year-old P2L1 patient. The patient presented to us with complaints of heaviness in lower abdomen, a feeling a lump in the lower abdomen and low-grade fever for 15 days. On per abdominal examination, a large solid cystic mass up to 20 weeks size was felt, which was more on the left side. Cervix was normal on speculum examination, the same mass was felt on per vaginal examination, separate from the uterus, the right fornix appeared free. Patient was asked to get a set of investigations done and to review as early as possible. An exploratory laparotomy with peritoneal wash cytology, total abdominal hysterectomy, bilateral salpingo-ophorectomy with supracolic and infracolic omentectomy and bilateral pelvic lymph nodes dissection was done on 18/07/18. Per operatively, there was a large cystic mass occupying the abdominal cavity adhered to the bowel and to posterior wall of the uterus, adhesiolysis followed by staging laparotomy was done.Patient’s postoperative course was uneventful and she was discharged on the 5th day of surgery in stable condition. The final histopathology report was suggestive of endosalpingiosis with concurrent endometriosis

Screening of N-Benzoyl Isoserine Methyl Ester (N-bime) for anti-inflammatory analgesic activity and toxicity profile in animals

Background: Pain and inflammation are the basic processes involved in the pathogenesis of many diseases. Non-steroidal anti-inflammatory drugs are often used to treat rheumatic diseases. The study compound N-Benzoyl Isoserine Methyl Ester (N-bime) is a newly synthesized propionic acid derivative by National Chemical Laboratory, Pune. Since the biological data of this compound is not available, the present study has been planned to screen this compound for anti-inflammatory, analgesic activity and its toxicity profile in animals.Methods: Single dose toxicity study was carried out in rats. Anti-inflammatory activity was tested by Rat Hind Paw Oedema and Cotton Pellet Implantation method. For Analgesic activity, Acetic acid induced writhing and Tail Pinch method was used. Yeast induced Pyrexia was used for evaluation of anti-pyretic activity. Ibuprofen was the positive control. Data are presented as mean±SEM. Statistical analysis was performed by analysis of variance and students unpaired‘t’ test.Results: The test compound N-bime did not show any apparent adverse effects or mortality in the dose range 1mg - 500mg / 100gm body weight in animals. It showed better anti-inflammatory actions in higher doses as compared to Ibuprofen (p˂ 0.05). In acetic acid induced writhing test N-bime offered better protection against writhes, than Ibuprofen. But, both failed to demonstrate analgesic activity in the Tail Pinch method. N-bime showed a gradual decrease in temperature in the anti-pyretic test (P<0.001).Conclusions: The present study indicates that N-bime does possess anti-inflammatory, analgesic and weak anti-pyretic properties like the NSAIDs. It has proved to be safe in the dose range of 1mg - 500mg / 100gm body weight in rats and mice

Management of a case of thromboembolism post spine surgery: a case report

Postoperative deep vein thrombosis (DVT) of lower limbs is often asymptomatic. In many patients, fatal pulmonary embolism (PE) is the first clinical manifestation of postoperative venous thromboembolism (VTE). Routine screening for asymptomatic DVT of the lower limbs has a low sensitivity and is quite impractical. For these reasons, routine and systematic prophylaxis in patients at risk, is the strategy of choice to reduce the burden of VTE after surgery. If used appropriately such prophylaxis is cost effective since it reduces the incidence of symptomatic thromboembolic events, which require costly diagnostic procedures and prolonged anticoagulation therapy. Here we report the post-operative course of a spine surgery patient, presenting with DVT in calf veins, which lodged into pulmonary artery and was managed successfully with low molecular weight heparin (LMWH), embolectomy, inferior vena cava (IVC) filter, and dabigatran

Assessment of knowledge of pharmacovigilance among the nurses of tertiary care hospital

Background: The Pharmacovigilance Programme of India envisages that “All” health care professionals will play an important role in making the program a success. Nurses and midwives have better population outreach as compared to physicians alone. The objectives were to assess the knowledge of pharmacovigilance among the nurses of a tertiary care hospital.Methods: The study was conducted from the month of March 2015 to July 2015. Nurses were provided pre-structured questionnaire for filling after explaining the aim and objectives of the study. Responses were pooled and analyzed.Results: 100 nurses returned completed forms. 63% respondents had heard about the term pharmacovigilance. 41% of these could correctly define it. All the respondents had heard about adverse drug reaction (ADR), 39% could correctly define it. 35% of the participants were of the opinion that both doctors and nurses should report ADR. 76% were not aware of any National Programme of Pharmacovigilance. 72% of nurses claimed to be aware of common ADRs of the drugs they routinely administered by them. 81% of the nurses were not routinely informed to be on lookout for specific drug reactions by the treating physicians. 91% of nurses were of the opinion that periodic pharmacovigilance training will benefit ADR reporting with 58% favoring yearly workshops.Conclusion: The present study focused on the major lacunae in efficient ADR reporting. Nurses being a major stakeholder in healthcare delivery, can be mobilized in the field of ADR reporting, which currently is not the norm, albeit with adequate training

Pharmacovigilance programme of India: revival of the renaissance

Adverse drug reactions (ADRs) are the fourth leading cause of morbidity in the world. In order to safeguard the health of the community, Pharmacovigilance Programme of India (PvPI) is implemented as the monitoring body by Indian Pharmacopoeia Commission (IPC). It is leading national authority. National Coordinating Centre (NCC) PvPI works as the World Health Organization (WHO) collaborating centre for pharmacovigilance. Adverse drug reactions are reported to NCC PvPI which are then directed towards WHO Uppsala Monitoring Centre (UMC) Sweden which is the global monitoring centre for worldwide data. Central Drugs Standard Control Organization (CDSCO) is the regulatory authority of India under the Ministry of Health and Family Welfare (MOHFW), Government of India. This article focusses on the various strands of pharmacovigilance at the healthcare professional and consumer level. It also discusses the pitfalls in the journey of pharmacovigilance thus helping in enhancing the quality of health safety. Even a minuscule contribution by a health care professional or a consumer can voluminously help in promotion of drug safety. Therefore, there is a need of inculcating the culture of adverse drug reaction reporting for the welfare of the vulnerable masses

Is Cerebrospinal Fluid C-reactive Protein a Better Tool than Blood C-reactive Protein in Laboratory Diagnosis of Meningitis in Children?

Objectives: This study aimed to test whether C-reactive protein (CRP) measurement could differentiate between different types of meningitis and become a routine test. Methods: A prospective study included 140 children admitted to Manipal Teaching Hospital, Pokhara, Nepal, between July 2009 and June 2011. The subjects had a blood test and detailed cerebrospinal fluid (CSF) analysis, including blood and CSF CRP levels. Results: Of those admitted, 31.1% had pyogenic meningitis (PM), 26.2% partially treated meningitis (PPM), 33% viral meningitis (VM), and 9.7% tubercular meningitis (TBM), with 26.4% controls. Organisms were isolated in 12.5% of the cases by blood culture and 25% of cases through CSF culture. Blood CRP was positive in all groups, with the highest values in PM (53.12 ± 28.88 mg/dl) and PPM (47.55 ± 34.34 mg/dl); this was not statistically significant (P = 0.08). The CSF CRP levels were significantly higher (P &lt;0.001) in PM (45.75 ± 28.50 mg/dl) and PPM (23.11 ± 23.98 mg/dl). The sensitivity and specificity of blood CRP was 90.62%, 88.88%, 64.7%, 70% and 32.4%, 30.97%, 24.52%, 26.12% and that of CSF CRP was 96.87%, 66.66%, 20.58%, 10% and 74.73%, 63.71%, 50.94%, 55.35% for PM, PPM, VM and TBM, respectively. Conclusion: Because of its high sensitivity, both CSF CRP and blood CRP can be used to screen for bacterial meningitis (both PM and PPM). CSF CRP screening yielded results with a higher specificity than blood CRP; hence, it can be a supportive test along with CSF cytology, biochemistry, and microbiology for diagnosing meningitis

Intravenous verses oral iron supplementation for anaemia of pregnancy in the arid region of Western India: a retrospective cohort study

Background: India has a high prevalence of anemia in pregnant females, resulting greater risk of blood transfusion and its associated complications during the peripartum period. Administration of intravenous iron sucrose may reduce such a risk. Due to a greater prevalence in western arid region of India, this study was planned to compare efficacy and safety of intravenous iron sucrose and oral ferrous ascorbate in the treatment of iron deficiency anemia of pregnancy in a community health center of rural Jodhpur.Methods: A retrospective cohort study was conducted in Community Health Center of Jodhpur to review the heamoglobin values of pregnant females in 28 to 37 weeks of gestation, treated with either intravenous iron sucrose or oral iron ascorbate. Cohorts were matched based on parity and age, and the hemoglobin values after 2, 4 and 6 weeks of start of therapy were compared using independent t-test.  Results: Of the 152 pregnant females’ records included in the study, 82 were provided intravenous therapy and 70 were given oral iron therapy. Both the modes of administration showed marked increase in heamoglobin values, with statistically more significant rise through parenteral route at each point of measurement. Overall change in mean heamoglobin was 2.43 g/dl through iv route and 0.61 g/dl through oral route (p<0.001). Adverse events following therapy were reported by 9 females from intravenous group and 31 women from oral group.Conclusions: The study provided evidence that parenterally administered iron sucrose elevated hemoglobin and restored iron stores better than oral ferrous ascorbate with lesser adverse reactions

A comparative study of efficacy and safety of vildagliptin against metformin in newly diagnosed patients of type 2 diabetes mellitus

Background: Diabetes mellitus is a progressive disease characterised by declining β-cell function. Cornerstone of effective management of T2DM is maintaining strict glycaemic control through agency of various oral hypo-glycaemic agents (OHAs). Metformin (a biguanide) currently forms the preferred treatment in newly diagnosed patients of T2DM. Vildagliptin is a potent, orally administered, competitive and reversible inhibitor of DPP-4, which was launched in 2006 and is now approved in more than 70 countries worldwide.Methods: The study was a single blinded study conducted in a district level tertiary care hospital attached to a medical teaching institute. Newly diagnosed patients were screened and randomised in two groups. Group 1 received metformin (500 mg) twice daily and group 2 received vildagliptin (50 mg) twice daily. FPG, PPPG, HbA1c and Weight were assessed on week 0 and week 12.Results: At the end of 12 weeks, ∆FPG was 39.33±4.72mg/dL and 37.84±6.58mg/dL with metformin and vildagliptin respectively. ∆PPPG was 73.88±13.80 mg/dL and 65.08±13.00mg/dL with metformin and vildagliptin. ∆HbA1c was 1.12±0.46 and 0.95±0.32 with metformin and vildagliptin. ∆Weight was 1.02±0.90 Kg with metformin and 0.69±1.33 Kg.Conclusions: Vildagliptin offers an alternative mode of therapy for newly diagnosed, obese patients of type 2 DM, especially those with impaired fasting plasma glucose

Investigation of Neolamarckia cadamba phytoconstituents against SARS-CoV-2 3CL Pro: An In-Silico Approach

In present study, the inhibitory potential of Neolamarckia cadamba phytoconstituents was investigated against SARS-CoV-2 3CL protease (3CL pro) (PDB ID: 6M2N). Molecular docking was analyzed using AutoDock Vina software by setting the grid parameter as X= -33.163, Y= -65.074 and Z= 41.434 with dimensions of the grid box 25 × 25 × 25 Å. Remdesivir was taken as the standard for comparative analysis along with inhibitor 5, 6, 7-trihydroxy-2-phenyl-4H-chromen-4-one. Furthermore, the exploration of 2 D Hydrogen-bond interactions was performed by Biovia Discovery Studio 4.5 program to identify the interactions between an amino acid of target and ligand followed by assessment of physicochemical properties using Lipinski’s rule and Swiss ADME database. The decent bonding scores of secondary metabolites owing to hydrogen bonding with catalytic residues suggest the effectiveness of these phytochemicals towards 3CLpro. The results are further consolidated positively by Lipinski’s rule and Swiss ADME prediction. Thus reasonably, observations with docking studies suggest possibility of phytochemicals from Neolamarckia cadamba to inhibit the 3CLpro and consequently would be explored further as agents for preventing COVID-19

Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India

BACKGROUND: While many studies have compared the efficacy of Pap cytology, visual inspection with acetic acid (VIA) and human papillomavirus (HPV) DNA assays for the detection cervical intraepithelial neoplasia and cancer, few have evaluated the program effectiveness. METHODS AND FINDINGS: A population-based sample of 5603 women from Medchal Mandal in Andhra Pradesh, India were invited to participate in a study comparing Pap cytology, VIA, and HPV DNA screening for the detection of CIN3+. Participation in primary screening and all subsequent follow-up visits was rigorously tracked. A 20% random sample of all women screened, in addition to all women with a positive screening test result underwent colposcopy with directed biopsy for final diagnosis. Sensitivity, specificity, positive and negative predictive values were adjusted for verification bias. HPV testing had a higher sensitivity (100%) and specificity (90.6%) compared to Pap cytology (sensitivity  =  78.2%; specificity = 86.0%) and VIA (sensitivity = 31.6%; specificity = 87.5%). Since 58% of the sample refused involvement and another 28% refused colposcopy or biopsy, we estimated that potentially 87.6% of the total underlying cases of CIN3 and cancer may have been missed due to program failures. CONCLUSIONS: We conclude that despite our use of available resources, infrastructure, and guidelines for cervical cancer screening implementation in resource limited areas, community participation and non-compliance remain the major obstacles to successful reduction in cervical cancer mortality in this Indian population. HPV DNA testing was both more sensitive and specific than Pap cytology and VIA. The use of a less invasive and more user-friendly primary screening strategy (such as self-collected swabs for HPV DNA testing) may be required to achieve the coverage necessary for effective reduction in cervical cancer mortality