Efficacy of SEVISTA (Ormeloxifene) in treatment of mastalgia and fibrocystic breast disease

Background: Mastalgia and fibrocystic breast disease is common in women. Ormeloxifene (SEVISTA) is a weak oestrogen receptor (ER) agonist, a strong ER antagonist (SERA) and therefore a selective ER modulator (SERM) used in the treatment of the disease. Aim of study was to see the efficacy of ormeloxifene in women with pain in breast associated with or without fibrocystic breast disease.Methods: This was a randomized control trial of oral ormeloxifene 30 mg alternate day for 3 month in patients of 20 – 50 years old with breast pain and fibrocystic (without cancer). The pain was accessed by visual analogue scale and nodularity grade on a 5 – point.Results: Total 203 patients were completed the study. The mean age was 32.8 ± 8.35 years. The mean pain level was continuously decrease over 5 visit (5.8 to 0.86) and there was significant improvement was observed in the nodularity grades i.e. at beginning of treatment 1 and 2 nodularity were seen in 62 (30.5%) patients where as grades 3, 4 and 5 were seen in 141(69.5%) and at the end of six month it was 188 (92.6%) patients had grades 1 and 2 and only 15 (7.4%) had grade 3, 4 and 5 nodularity.Conclusion: SEVISTA (Ormeloxifene) showed significant efficacy for the treatment of mastalgia and fibrocystic breast disease

Comparison between bipolar vessel sealer (LigaSure vessel sealer) and harmonic scalpel in total laparoscopic hysterectomy

Background: The aim of the present study was to compare the use of bipolar Vessel Sealer with Harmonic Scalpel (HS) during total laparoscopic hysterectomy with respect to estimated blood loss and related postoperative complications.Methods: A retrospective study was conducted in the Jeevan Jyoti hospital and Guru Gobind Singh Memorial Vanadana Women’s hospital, Allahabad, U.P., India. Two forty two patients were enrolled who underwent total laparoscopic hysterectomy and were randomized into two homogenous groups: bipolar vessel sealer and harmonic scalpel.Results: Estimated blood loss was significantly less in bipolar vessel sealer when compared with harmonic scalpel. No significant difference was observed in postoperative complications.Conclusions: The bipolar vessel sealer is a reliable and safe tool for reducing intraoperative blood loss in patients undergoing total laparoscopic hysterectomy. More randomized studies need to be done to confirm the advantages of this technique.

Cesarean scar pregnancy: clinicians challenge

A case of caesarean scar ectopic pregnancy managed diagnosed early on transvaginal ultrasound and managed successfully by sequential approach of methotrexate and hysteroscopic removal preserving the woman’s fertility is discussed below. Ectopic pregnancy i.e. implantation of the blastocyst outside the endometrium of the uterine cavity occurs in 1.9% of reported pregnancies

Prenatal diagnosis of fetal cholelithiasis: a rare case

Fetal gallstones are a rare ultrasonography finding. Authors came across a similar case of fetal gallstones detected in routine third trimester scan. Patient had Rh negative blood group which might be the cause of fetal gallstone in this case however in most cases, the cause is undefined. Case was confirmed to have gallstones in postnatal scan which eventually resolved spontaneously within 1 month. The presence of gallstones in the fetus does not alter the fetal prognosis or obstetrical management since complete resolution is seen in most of the cases in late third trimester or neonatal period which may be due to either spontaneous passage of gallstones during early neonatal period or dilution of cholesterol crystals with postnatal hydration

Prenatal diagnosis of congenital megalourethra: a rare anomaly

Congenital megalourethra is a rare urogenital malformation characterised by pathological elongation and dilatation of penile urethra. It is a form of functional obstructive uropathy which is associated with significant urological and sexual dysfunction secondary to hypoplasia or absence of corpora cavernosa and spongiosa. We report a case of megalourethra in one of the dichorionic diamniotic twin diagnosed prenatally in a young primigravida. Initial ultrasound report suggested two different diagnoses i.e. omphalocoele and gastroschisis. Later, diagnosis of congenital megalourethra was made on detailed ultrasound examination by our fetal medicine consultant. Postnatal gross and ultrasonographic examination confirmed the prenatal diagnosis. In the present case report, we have emphasized proper perineal anatomical ultrasound examination which revealed a megalourethra. Although this anomaly is not lethal in isolation, but it has worse prognosis in presence of other associated structural anomalies. This anomaly also raises the controversy regarding disclosure of sex of foetus in countries like India where sex disclosure is prohibited by law. As this condition typically affects male foetuses and significantly affects sexual function, it may be necessary to reveal fetal sex for appropriate counselling and prognostication to prospective parents. Ethical dilemma arises for practising clinicians while dealing with isolated forms of megalourethra whether to offer termination of pregnancy on the grounds of having significant impact on sexual life due to erectile dysfunction. Anorectal malformation is often associated with megalourethra, although suspected in the present case, can be difficult to identify antenatally prior to 20 weeks (the time limit up to which legal termination can be performed in India). These issues have been highlighted in the present report

Skin capillary density in pregnancy induced hypertension and normotensive pregnant participants

Background: Pre-eclampsia is a vascular related disorder of pregnancy, Despite the increasing research efforts in the field, the etiology and pathogenesis of this disorder remain elusive, resulting in failure to develop specific screening, preventive and treatment strategies. Peripheral vasodilatation and angiogenesis are critical components of physiological adaptation in normal pregnancy. Women who have later developed preeclampsia had significant structural capillary density rarefaction early in the pregnancy before the onset of preeclampsia.Methods: Case control, comparative study was carried out at our institute. 30 pregnant participants were recruited in each group after satisfying the inclusion criteria. Data was collected by using dermatoscope (200X magnification). Statistical analysis was done by non-parametric test- Mann-Whitney test as blood pressure was not normally distributed among participants. Spearman’s correlation coefficient was used to make correlation between skin capillary densities and blood pressures.Results: On applying Mann-Whitney test, mean rank for systolic and diastolic blood pressure at 20 weeks for both groups were not significant statistically, mean rank for systolic and diastolic blood pressure between 28-36 weeks of gestation for both groups were significant statistically. After testing, skin capillary density came significantly less in hypertensive group as compare to normotensive pregnant participant of same gestational ages. Spearman’s correlation coefficient came negative for systolic and positive for diastolic blood pressure at 28-36 weeks of gestation.Conclusions: Authors conclude that estimating the skin capillary density provides a potentially useful clinical marker in the prediction of preeclampsia and dermatoscope is an especially attractive clinical tool

Foetal arrhythmias: an enigma of the missed beats

Background: The synchronised depolarization and repolarisation of the atria and ventricles is achieved by specialised cardiac cells that generate an electrical impulse and propagate it along the conducting system in the myocardial tissue, leading to rhythmic activity of the atria and ventricles. Abnormalities of these rhythms lead to foetal arrhythmia.Methods: A retrospective observational study was conducted in a tertiary care hospital over period of one year to study the course and perinatal outcome of women with foetal arrhythmias.Results: The confinement in the study period was N=4302, of which 207(4.81%) women had foetal congenital malformations. Among them 21(0.48%) women had foetal cardiovascular abnormalities and 6(0.14%) women had foetal arrhythmias. There were two cases of maternal primary Sjogrens syndrome: one with foetal 2nddegree atrioventricular (AV) heart block with 2:1 AV conduction and another with foetal 3rd degree or complete heart block. Others were a case of Atrial premature contractions with compensatory pause, a case of Supraventricular tachycardia, one case of sinus tachycardia with non-immune hydrops and a case of foetal bradyarrhythmia with regular ectopic beats in a case of complex congenital heart disease. The course of these pregnancies, treatment options and perinatal outcome was studied.Conclusions: Foetal echocardiography and Doppler are effective tools for detection and monitoring of foetal arrhythmias. Early and correct diagnoses of arrhythmias help in management of foetal arrhythmias and multidisciplinary team-based approach gives optimum treatment results

Variable Immunogenic Potential of Wheat: Prospective for Selection of Innocuous Varieties for Celiac Disease Patients via in vitro Approach

Celiac Disease (CD) is a multifactorial, autoimmune enteropathy activated by cereal proteins in genetically predisposed individuals carrying HLA DQ2/8 genes. A heterogenous gene combination of the cereal prolamins is documented in different wheat genotypes, which is suggestive of their variable immunogenic potential. In the current study, four wheat varieties (C591, C273, 9D, and K78) identified via in silico analysis were analyzed for immunogenicity by measuring T-cell proliferation rate and levels of inflammatory cytokines (Interferon-γ and Tumor Necrosis Factor-α). Peripheral Blood Mononuclear Cells and biopsy derived T-cell lines isolated from four CD patients in complete remission and two controls were stimulated and cultured in the presence of tissue transglutaminase activated pepsin-trypsin (PT) digest of total gliadin extract from test varieties. The immunogenicity was compared with PBW 621, one of the widely cultivated wheat varieties. Phytohaemagglutinin-p was taken as positive control, along with unstimulated cells as negative control. Rate of cell proliferation (0.318, 0.482; 0.369, 0.337), concentration of IFN- γ (107.4, 99.2; 117.9, 99.7 pg/ml), and TNF- α (453.8, 514.2; 463.8, 514.2 pg/ml) was minimum in cultures supplemented with wheat antigen from C273, when compared with other test varieties and unstimulated cells. Significant difference in toxicity levels among different wheat genotypes to stimulate celiac mucosal T-cells and PBMC's was observed; where C273 manifested least immunogenic response amongst the test varieties analyzed

RISK FACTOR ASSOCIATED WITH GALLBLADDER MALIGNANCY IN NORTH INDIA: A PROSPECTIVE STUDY

ABSTRACT Introduction: Carcinoma of the gallbladder is the most common malignancy of the biliary tract and the third most common gastrointestinal malignancy in and around the Northern region of India. Owing to its nonspecific symptoms, gallbladder carcinoma is generally diagnosed late in the disease course, but if a patient with gallstones experiences a sudden change of symptoms, then a cancer diagnosis should be considered. There are several factors which is associated with gallbladder malignancy such as gallstone, porcelain gallbladder, obesity, gallbladder polyps, gender, family history of gallbladder cancer and several carcinogens (chemicals). Objective: Objective of the study was to evaluate the different risk factor associated with gallbladder malignancy. It is an important to assess the risk factor for gall bladder malignancy take into account the confounding effect of gallstone. Materials and Methods: This prospective study carried out on 115 patients having evidence of gallbladder malignancy. The diagnosis was made accordance of sign and symptom, abdominal ultrasonography (USG) and a computed tomography (CT) scan of the abdomen, and was confirmed by histology. Results: Gallstone (83.5%) was the major risk factor for malignancy followed by Choledochal cysts (73%), use of tobacco (71.3%), Primary sclerosing cholangitis (36.5%), porcelain gallbladder (29.6%), obesity (24.3%), family history (23.5%), alcohol (20.9%), Gallbladder polyps (13.9%), bile duct abnormality (7.8%) and infection with typhoid (4.3%). The female were more susceptible to gallbladder bladder cancer the male female ratio was (1:2.7)

Multidisciplinary Perspectives Towards Building a Digitally Competent Society

Используемые программы Adobe AcrobatМир претерпевает трансформацию, поскольку технологии проникают в каждую экосистему. Следовательно, существует необходимость развивать цифровые навыки более высокого порядка, чтобы обеспечить возможность трудоустройства, поскольку профессионалам необходимо развивать цифровые компетенции, чтобы оставаться конкурентоспособными в текущей рабочей среде. Кроме того, предприятия также должны продолжать обновлять свои цифровые методы, чтобы оставаться актуальными. В книге «Многодисциплинарные перспективы построения общества, компетентного в цифровых технологиях», исследуются междисциплинарные перспективы построения общества, более компетентного в цифровых технологиях, рассматриваются новые бизнес-модели и необходимость для организаций и отдельных лиц развивать правильное мышление для внедрения цифровизации, а также обсуждается, как социальный капитал может стать ключевым фактором в развитии цифрового общества. создание совершенно новой цифровой социальной структуры. Этот справочный материал, охватывающий такие темы,The world is undergoing a transformation as technology enters every ecosystem. Subsequently, there is a need to develop higher-order digital skills to ensure one's employability as professionals need to build digital competencies to remain competitive in the current work environment. Additionally, businesses must also continue to update their digital practices in order to remain relevant. Multidisciplinary Perspectives Towards Building a Digitally Competent Society explores multidisciplinary perspectives towards building a more digitally competent society, considers new business models and the need for organizations and individuals to develop the right mindset to embrace digitalization, and discusses how social capital can become a key driver in crafting a whole new digitally competent social fabric. Covering topics such as technological transformation, social media, and corporate social responsibility, this reference work is ideal for corporate practitioners, business owners, policymakers, scholars, researc