Success of medical management of tubal ectopic pregnancy with Methotrexate in a tertiary hospital in North India

Background: Unruptured ectopic pregnancy can be managed with surgery as well as systemic methotrexate. We aimed to study efficacy of medical management and factors affecting success in strictly selected patients.Methods: It was a three-year prospective observational study. 171 patients with ectopic pregnancy were screened and those fulfilling the strict study criteria were given systemic methotrexate. The single dose regimen was followed. Patients were observed for side effects and signs of rupture. Serial measurement of HCG levels was done to determine success or failure. Various factors were studied which had potential bearing on results.Results: Thirty-one patients received methotrexate. We had an overall success rate of 93%. Two of the participants had surgery due to failure. No major side effects were observed.Conclusions: Carefully selected patients of unruptured ectopic pregnancy can be safely and successfully treated with systemic methotrexate

Metaplastic Carcinoma of the Left Breast with Extensive Chondroid Differentiation

Metaplastic breast carcinoma is very rare neoplasm which contains mixture of carcinomatous (epithelial) and sarcomatous (mesenchymal) elements in variable proportion. Metaplastic carcinoma with chondroid differentiation is even rarer. We report a case of metaplastic carcinoma with extensive chondroid differentiation as there is paucity of information regarding pathological features and clinical outcomes for these rare tumors. Tumor had characteristic definite areas of classic infiltrating duct carcinoma with abundant chondromyxoid matrix, focal areas of chondrosarcoma and cartilagenous metaplasia. Tumour cells were immunoreactive for S-100, ER, and PR. When pathologist encounter breast tumor with chondroid differentiation, careful gross sampling, histopathology and immunoreactivity for mesenchymal and epithelial component are most useful to differentiate metaplastic carcinoma from malignant phylloides tumors and malignant adenomyoepithelioma

Dynamics of Team Teaching and Research in a Management School: Learning and Imperatives

This paper discusses the experience of team teaching to address the issues of integration of academic inputs by bringing multi-disciplinary perspective together and thereby enhance learning experience of participants. The paper delves on the process, events and outcome of team teaching by four faculty members at IIM Ahmedabad who collaborated in teaching, writing cases, and doing research for a period of more than three years. The experience has been summarized using the following dimensions: need for team-teaching, existing mechanisms and barriers, opportunities and potential, imperatives, fall-outs and challenges experienced in the process. The cohesion, trust and mutual respect are key imperatives. The other factors contributing to the success of team-teaching are strong felt need by the members for integration in programmes, complementary skills and experiences of team members, frequent programmes with integrated components that provided continuous opportunities for learning, co-location of the instructors, and off-site programmes that provided opportunities for close get-togethers. The autonomy granted by the institution to instructors and co-coordinators to design and execute learning opportunities was also instrumental in the success. In an environment where the rule of the game is individualism, forming teams creates fears of loss of importance and recognition. The experience shows that the competency of the members and the overall effectiveness of the tasks are strengthened if the team believes in “reciprocating interdependence”. This can be possible only if members allow themselves opportunities to experiment, improvise and review

Clinical Aspects of Behavioural and Psychological Symptoms in Vascular Dementia

Dementia is a growing problem that presents increasing challenges for health services worldwide. Vascular dementia is the 2nd most common type of dementia after Alzheimer dementia. The aim of the study is to describe the clinical aspects of behavioural and psychological symptoms in patients aged ≥ 60 years diagnosed with vascular dementia. A cross sectional study was carried out in the Psychiatric Centre at tertiary care hospital from Dec 2018 to May 2019 involving elderly (≥ 60 years) with vascular dementia. Patients with other dementia types, condition and medication that stimulate cognitive disturbances were excluded. The tools used were Hindi mini mental status examination (HMSE), Zarit Burden Interview and the 12- item Neuropsychiatric inventory (NPI). All patients presented with two or more behavioural symptoms, Irritability was the most common symptom (80 %) followed by Night-time behaviour (60 %) and Agitation/ aggression (50 %). There was a significant association between Zarit Score and Behavioural Symptoms (p = 0.023), as well as HMSE and Zarit score (p = 0.03). Caregiver burden showed significant correlation with delusion, hallucination, disinhibition, aberrant motor behaviour and night-time behaviour. Most of the patients had multiple behavioural symptoms. Irritability was the most common symptom followed by night-time behaviour and Agitation

ChemTextMiner: An open source tool kit for mining medical literature abstracts

Text mining involves recognizing patterns from a wealth of information hidden latent in unstructured text and deducing explicit relationships among data entities by using data mining tools. Text mining of Biomedical literature is essential for building biological network connecting genes, proteins, drugs, therapeutic categories, side effects etc. related to diseases of interest. We present an approach for textmining biomedical literature mostly in terms of not so obvious hidden relationships and build biological network applied for the textmining of important human diseases like MTB, Malaria, Alzheimer and Diabetes. The methods, tools and data used for building biological networks using a distributed computing environment previously used for ChemXtreme[1] and ChemStar[2] applications are also described

Combat Casualty Care for Children: <em>Peculiarities, Problems, and Provisions</em>

Armed Forces doctors are often required to treat children affected in war, combat, and disasters. Tender care & comprehensive tact is needed for children. Acquisition of these qualities comes with knowledge, its application, and practicing skills. Throughout history, children have been victims of armed conflict. War-related injuries are more severe as compared to the civilian sector injuries. Penetrating injuries are associated with significant damage to local structures, whereas blast injuries are associated with less local injury and more multisystem trauma. Children are not small adults. The differences have important practice implications. Identifying and correcting physiological compromise improves outcomes. The examination and vital sign data can be interpreted only if the caregiver has a thorough understanding of normal values. Identification & treatment of what is killing the patient is done in primary survey. Secondary survey, extremity trauma, fracture biomechanics, & burns peculiarities need attention. Care of the injured patient is a dynamic process. Frequent monitoring required for proper response. Small infants have a narrow margin for error. Combat trauma provides multiple opportunities for improvement. Continuation of research will ensure ongoing progress and further improvement in the outcomes of both military and civilian casualties