Role of low dose danazol therapy for endometriosis related infertility and its comparison with laparoscopic fulguration in low resources

Background: The objective was to study the role of laparoscopic fulguration and danazol therapy for endometriosis in case of infertility followed by comparison of both therapies.Methods: The present cross–sectional study was conducted in the department of obstetrics and gynecology SN Medical College Agra. Over the period from December 2010 to November 2013. Symptomatic women (n=50) of age group 20-39 yrs coming to gynecology OPD were selected for study group. The study group was subjected to detailed history, physical examination laboratory test, ultrasound examination, and laparoscopy. Then 50 patients were allotted for laparoscopic fulguration and 50 for danazol treatment.Results: Out of 100 on transvaginal sonography, 10%of patient have cyst 2cm size, rest 70% have normal scan. On laparoscopy 52% of patient have red lesion, 16% have bluish black lesion, 20% have yellow brown lesion rest 22% have normal findings. On danazol therapy pelvic pain and dysmenorrhoea was relieved in 64% and 52% conceived .on laparoscopic fulguration symptom were relieved in 69% and 60% conceived.Conclusions: Based on this study it can be concluded that choice of therapy depend on age of patient,  duration of infertility, physical findings, goal of surgery, experience of surgeon and most important the  availability of resources. In this study result was comparable

Should Sputum Smear Examination Be Carried Out at the End of the Intensive Phase and End of Treatment in Sputum Smear Negative Pulmonary TB Patients?

The Indian guidelines on following up sputum smear-negative Pulmonary tuberculosis (PTB) patients differ from the current World Health Organization (WHO) guidelines in that the former recommends two follow up sputum examinations (once at the end of intensive phase and the other at the end of treatment) while the latter recommends only one follow up sputum smear microscopy examination, which is done at the end of the intensive phase. This study was conducted to examine if there was any added value in performing an additional sputum smear examination at the end of treatment within the context of a national TB program

Real-world outcomes among US Merkel cell carcinoma patients initiating immune checkpoint inhibitors or chemotherapy.

Aim: Retrospectively assessed treatment patterns and clinical and economic outcomes in Merkel cell carcinoma (MCC) patients receiving recommended first-line regimens. Materials & methods: MCC patients newly treated with either immune checkpoint inhibitors (ICIs) or chemotherapies (CTs) were selected from the Veterans Health Administration database (2013–2018); 74 patients (ICIs: 20 and CTs: 54) were selected. Results: Median duration of therapy was 300 days for ICIs and 91 days for CTs. Time to next treatment was 245 and 184 days, respectively. Mean total (per patient per month) costs were $15,306 (ICIs) and$10,957 (CTs), of which 51% and 86%, respectively, were non-MCC therapy-related costs. Conclusion: Despite higher costs, utilization of ICIs in first-line MCC shows clinical advantages over CTs in the real world

The Diversity Analysis of the Microbial Community in Wastewater by Amplified rDNA Restriction Analysis (ARDRA)ï€

AbstractActivated sludge, a common biological treatment method for both municipal and industrial waste water, represents a complex microbial community.  Due to intricate interactions within the microbial community, process control of waste water treatment plants can be difficult.  Population shifts within the microbial community may results from the changes in the plant operating conditions and cause sludge quality problems such as poor sludge settling, compaction and dewatering.  Monitoring of the microbial populations may help in the diagnosis and correction of such sludge problems. This study employed a PCR-based 16S rDNA, amplified rDNA restriction analysis (ARDRA) approach to characterize the microbial community structure in wastewater. Samples were collected from two wastewater treatment plants, in Jaipur City, India. Each PCR product was obtained by PCR with eubacteria 16S rDNA. After amplification, the 16S rDNA PCR products were digested with 4-base site specific restriction endonucleases. Restriction pattern was analyzed with four endonucleases (AluI, MspI, HhaI, and HaeIII). The result of the bacterial community analysis, by ARDRA revealed that the two wastewater treatment plants carry significantly different microbial population, whereas the diversity among the samples of same plant is not much. These results suggests that Amplified rDNA restriction analysis (ARDRA) is an extremely valuable tool for assessing the diversity from waste water treatment plants. Key words: ARDRA, Microbial community, Wastewater1Birla Inst of Scientific Research, Statue Circle, Jaipur, Rajasthan, India2Deptt of  Botany, University of Rajasthan, Jaipur, India---Please Cite This Article As: Shivani Chandra, Sivaramaiah Nalapeta, Sampat Nehra, Alok Kumar Varshney, Nupur Mathur, P C. Trivedi, Krishna Mohan Medicherla. 2010. The Diversity Analysis of the Microbial Community in Wastewater by Amplified rDNA Restriction Analysis (ARDRA). J. Ecobiotechnol. 2(4):51-55.Â

Effect of Syzygium cumini (jamun) seed powder on dyslipidemia: a double blind randomized control trial

Background: Diabetes is a metabolic syndrome characterized by disturbance in carbohydrate, fat and protein metabolism. Dyslipidemia, commonly associated in diabetes, is major risk factor for macrovascular complications leading to CAD, major contributor to mortality associated with diabetes. Managing DM without side effects is challenge that attracts researchers toward plant based new products. Many studies have found anti-diabetic and anti-hyperlipidemic properties of seeds of Syzygium cumini, attributed to saponins, glycosides and flavonoids. So it should be further explored for its benefits.  The aim was to study the effect of jamun seed powder on dyslipidemia in type 2 DM. Methods: Patients with type 2 DM were randomly divided in two groups- group A was supplemented with 10 gms/day jamun seed powder and group B was given placebo powder. Patients and investigators were blinded about treatment allocated. Lipid profile was noted at baseline and 30th, 60th and 90th day. All the data was collected and analyzed at the end of study.Results: Improvement in dyslipidemia was seen after 60 days of supplementation with S. cumini seed powder. Statistically significant decrease in cholesterol levels by 10.55% and 15.79% in mean triglyceride levels by 8.28% and 13.66%, LDL-c levels by 10.29% and 14.50% was noticed at 60th and 90th day, respectively, reduction in VLDL-c levels by 9.38%, 12.90% and 20.69% was noted at 30th, 60th and 90th day. HDL-c increased significantly by 11.11% and 13.89% in males and 10.81% and 16.21% in females after 60 and 90 days of supplementation with S. cumini seed powder.Conclusions: A significant overall effect of S. cumini supplementation was found in improvement of lipid profile in type 2 diabetes subjects. However, above results are seen in small number subjects, further multicenter studies with larger sample size, supplementation dose and time should be planned and its effects in detail should be explored.

Relationship of ethnicity and CD4 Count with glucose metabolism among HIV patients on Highly-Active Antiretroviral Therapy (HAART)

Background HIV patients on HAART are prone to metabolic abnormalities, including insulin resistance, lipodystrophy and diabetes. This study purports to investigate the relationship of ethnicity and CD4+ T cell count attained after stable highly-active antiretroviral treatment (HAART) with glucose metabolism in hyperrtriglyceridemic HIV patients without a history of diabetes. Methods Demographic, anthropometric, clinical, endocrinologic, energy expenditure and metabolic measures were obtained in 199 multiethnic, healthy but hypertriglyceridemic HIV-infected patients [46% Hispanic, 17% African-American, 37% Non-Hispanic White (NHW)] on stable HAART without a history of diabetes. The relationship of glucose and insulin responses to ethnicity, CD4 strata (low (\u3c300/cc) or moderate-to-high (≥ 300/cc)), and their interaction was determined. Results African-Americans had significantly greater impairment of glucose tolerance (P \u3c 0.05) and HbA1c levels (P \u3c .001) than either Hispanics or NHWs. In multivariate models, after adjusting for confounders (age, sex, HIV/HAART duration, smoking, obesity, glucose, insulin and lipids), African-Americans and Hispanics had significantly higher HbA1c and 2-hour glucose levels than NHW’s. Demonstrating a significant interaction between ethnicity and CD4 count (P = 0.023), African Americans with CD4 \u3c300/cc and Hispanics with CD4 ≥300/cc had the most impaired glucose response following oral glucose challenge. Conclusions Among hypertriglyceridemic HIV patients on HAART, African-Americans and Hispanics are at increased risk of developing diabetes. Ethnicity also interacts with CD4+ T cell count attained on stable HAART to affect post-challenge glycemic response

Equity Promoting Integrated Care: Definition and Future Development

Over the last three decades, integrated care has emerged as an important health system strategy to improve population health while addressing the unique needs of structurally marginalised communities. However, less attention has been given to the role of integrated care in addressing issues related to inequities in health and health care. In this commentary we introduce the concept of Equity Promoting Integrated Care (EPIC) that situates integrated care in a social justice context to frame the actions necessary to center equity as a priority for integrated care. We suggest that efforts to advance the design and implementation of integrated care should focus on three avenues for future research and practice, namely, the collaborative mobilization of a global network of integrated care stakeholders to advocate for social justice and health equity, investing in equity-focused approaches to implementation science that highlight the importance of social concepts such as colonialism and intersectionality to advance the theory and practice of implementing EPIC models of care, and leveraging innovative approaches to measuring equity-related aspects of integrated care to inform continuous improvement of health systems

Spectacular Nucleosynthesis from Early Massive Stars

Stars that formed with an initial mass of over 50 M ⊙ are very rare today, but they are thought to be more common in the early Universe. The fates of those early, metal-poor, massive stars are highly uncertain. Most are expected to directly collapse to black holes, while some may explode as a result of rotationally powered engines or the pair-creation instability. We present the chemical abundances of J0931+0038, a nearby low-mass star identified in early follow-up of the SDSS-V Milky Way Mapper, which preserves the signature of unusual nucleosynthesis from a massive star in the early Universe. J0931+0038 has a relatively high metallicity ([Fe/H] = −1.76 ± 0.13) but an extreme odd–even abundance pattern, with some of the lowest known abundance ratios of [N/Fe], [Na/Fe], [K/Fe], [Sc/Fe], and [Ba/Fe]. The implication is that a majority of its metals originated in a single extremely metal-poor nucleosynthetic source. An extensive search through nucleosynthesis predictions finds a clear preference for progenitors with initial mass >50 M ⊙, making J0931+0038 one of the first observational constraints on nucleosynthesis in this mass range. However, the full abundance pattern is not matched by any models in the literature. J0931+0038 thus presents a challenge for the next generation of nucleosynthesis models and motivates the study of high-mass progenitor stars impacted by convection, rotation, jets, and/or binary companions. Though rare, more examples of unusual early nucleosynthesis in metal-poor stars should be found in upcoming large spectroscopic surveys