A comparative study of ferric carboxymaltose and iron sucrose as a parenteral iron treatment in iron deficiency anaemia during pregnancy

Background: Iron deficiency anemia during pregnancy is a serious global concern specially in developing country, which is preventable with effective measures. In women who cannot tolerate oral iron or have moderate to severe anemia, parenteral iron in the form of iron sucrose or ferric carboxymaltose can be very much useful. This study aimed to compare efficacy and safety of iron sucrose and ferric carboxymaltose in iron deficiency anemia during pregnancy.Methods: This prospective interventional comparative study was conducted during May 2016 to April 2018 at tertiary care hospital and total 100 antenatal women from 28 to 34 weeks of gestation having moderate to severe anemia were included in this study and all women were divided in to 2 groups randomly and were given either iron sucrose or ferric carboxymaltose according to iron requirement. Rise in haemoglobin and serum ferritin were noted and data analysed statistically.Results: The mean rise of haemoglobin with iron sucrose was 1.8 gm% and with ferric carboxymaltose was 2.6 gm%. The mean rise of serum ferritin with iron sucrose was 82.4 ng/ml and with ferric carboxymaltose was 100.9 ng/ml. Other than minimal local reaction one woman had developed severe anaphylactic reaction after receiving iron sucrose.Conclusions: Intravenous ferric carboxymaltose is better and safe molecule than iron sucrose and it has advantage of ability to administer large dose in single sitting which reduce overall cost of therapy.  Hence ferric carboxymaltose is a drug of choice as parenteral iron therapy in iron deficiency anemia during second trimester of pregnancy.

FORMULATION AND DEVELOPMENT OF CURCUMIN BASED EMULGEL IN TREATMENT AND RECURRENCE OF VAGINAL CANDIDIASIS

Objective: The main causative agent of vaginal candidiasis is Candida albicans and it develops resistance against several synthetic antifungal drugs and it has a high rate of infection in women. According to WHO report, around 75% of women are infected by Candida albicans and 50 % are infected a second time by Candida albicans. Therefore, we choose Curcumin an antifungal agent that had reported antifungal properties against the various fungal species. The Curcumin-containing emulgel based microemulsion system was prepared for greater retention time and penetration across the vaginal mucosa. Methods: The screening of oil phase, surfactant, and cosurfactant for microemulsion formulation was selected based on the solubility study and followed by the construction of the pseudoternary phase diagram. The oil phase, surfactant and co-surfactant are selected from the pseudoternary phase diagram for the formulation of a stable microemulsion. The prepared Curcumin-loaded microemulsion was characterized by globule size, polydispersity index, Zeta potential, accelerated stability study, drug content, percent transmittance and antifungal assay by broth microdilution technique. The formulated microemulsion was converted into a vaginal emulgel by using Pluronic@F127. The formulated curcumin-loaded emulgel was characterized by different evaluation parameters and antifungal study by agar well diffusion method. Results: The result showed that the average globule size of emulgel was 286.3 nm, polydispersity index was 0.241, Zeta potential was+19.20 mv, conductivity was 0.0390 mS/cm, and drug content was found to be 95.58%. The texture of formulated emulgel was found to be soft and smooth, with shear-thinning, pseudoplastic behavior, and easily spreadable. The in vitro permeability study of emulgel shows slow and complete release of curcumin in 10 h. The microemulsion and developed emulgel showed promising antifungal activity against Candida albicans. Conclusion: The developed curcumin-loaded emulgel showed promising antifungal activity against Candida albicans as compared to the Fluconazole as an standard antifungal antibiotic. Our formulated Curcumin-containing emulgel can be a potential alternative as compared to the conventional dosage form for the treatment of vaginal candidiasis

Applications of indocyanine green in robotic urology

Peer reviewedPublisher PD

A study of vaginismus in patients presenting with infertility

Background: Vaginismus is an uncommonly reported entity, most of the patients present to the gynaecologist with complaint of inability to conceive. Female sexual dysfunctions are a common entity but difficult to diagnose and treat, Vaginismus is one of the categories of female sexual dysfunction.Methods: Total 25 patients out of 900 patients attending the outdoor of Shivanjali Women’s Hospital for infertility from the year 2008 to 2016 were found to be having vaginismus. With couple’s consent females were treated for vaginismus. This is a retrospective study of 25 patients identified having vaginismus.Results: Maximum 11 patients were in age group of 20 to 25 years. Forty percent 10 patients improved with counselling and education, lubricant gel and analgesic gel. Total 84% (21) patients conceived with different modes of treatment.Conclusions: Vaginismus is uncommonly reported. With proper history and counselling of the couple vaginismus can be revealed, managed and conception can be achieved

Histopathologic Outcomes of Robotic Radical Prostatectomy

Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and shortterm PSA outcomes of 500 robotic radical prostatectomies. Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM stage, Gleason’s grade, tumor location, volume, specimen weight, seminal vesicle involvement, and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data were collected every 3 months for the first year, then every 6 months for a year, then yearly. The average preoperative PSA was 6.9 (1–90) with Gleason’s score of 5 (2%), 6 (52%), 7 (40%), 8 (4%), and 9 (2%); postoperatively, histopathologic analysis showed Gleason's 6 (44%), 7 (42%), 8 (10%), and 9 (4%); 10, 5, 63, 15, 5, and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b, and T4, respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1–100), 8% (101–200), 13% (201–300), 5% (301–400), and 8% (401–500). By stage, it was 2, 4, and 2.5% for T2a, T2b, T2c tumors; 23% (T3a), 46% (T3b), and 53% (T4a). For organ-confined disease (T2), the margin rate was 2.5% and it was 31% for nonorgan-confined disease. There were a total of 47 positive margins, 26 (56%) posterolateral, 4 (8.5%) apical, 4 (8.5%) bladder neck, 2 (4%) seminal vesicle, and 11 (23%) multifocal. Ninety-five percent of patients (n = 500) have undetectable PSA (<0.1) at average follow-up of 9.7 months. Recurrence has only been seen with nonorgan-confined tumors. Of those patients with a minimum follow-up of 1 year (average 15.7 months), 95% have undetectable PSA (<0.1). Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall, positive margin rate. Shortterm biochemical recurrence-free survival has also been good. We believe that the precise dissection allowed by the advantages of laparoscopic robotic surgery will translate into excellent long-term oncologic outcomes. At this time, the lack of maturity of the PSA data prevent definitive comparison to the open approach

Comparative Study of Interval Type-2 and Type-1 Fuzzy Genetic and Flower Pollination Algorithms in Optimization of Fuzzy Fractional Order <em>PI^λD^μ </em> Controllers

In this chapter, a comparison between fuzzy genetic optimization algorithm (FGOA) and fuzzy flower pollination optimization algorithm (FFPOA) is bestowed. In extension, the prime parameters of each algorithm adapted using interval type-2 and type-1 fuzzy logic system (FLS) are presented. The key feature of type-2 fuzzy system is alimenting the modeling uncertainty to the algorithms, and hence it is a prime motivation of using interval type-2 fuzzy systems for dynamic parameter adaption. These fuzzy algorithms (type-1 and type-2 fuzzy system versions) are compared with the design of fuzzy control systems used for controlling the dihybrid level control process subject to system component (leak) fault. Simulation results reveal that interval type-2 fuzzy-based FPO algorithm outperforms the results of the type-1 and type-2 fuzzy GO algorithm

A passive fault-tolerant control strategy for a non-linear system: An application to the two tank conical non-interacting level control system

In practical engineering systems, unknown actuator, sensor or system component faults frequently occur, which results from component and interconnection failures, degrade control performance, system stability, and profitability, and even arise hazardous situation. To avoid abnormal activity like faults and maintain system control performance subject to faults occurring into the system, the Fault-tolerant Control (FTC) is a realistic approach to address the unwanted situation. The two-tank conical system is widely used in chemical and food process industries because of its greater advantages. The non-interacting configuration of the two-tank conical system is highly nonlinear due to its shape and varying area of the tank thought the height of the tank, as a consequence level control of this system is extremely difficult. The paper attributes to design a Passive Fault-tolerant Control Strategy (PFTCS) for a Two-tank conical Non Interacting Level Control System (TTCNILCS) subject to the major system (leak), sensor, and actuator faults with external process disturbances. PFTC will increase system control performance and system stability acceptable level in the presence of sensor, system, and actuator faults. The simulation results demonstrate the proposed PFTC strategy has definite fault tolerant ability against the system and actuator faults also it has good disturbance rejection capability. To verify the efficacy of the proposed PFTC strategy Mean Square Error (MSE) and Root Mean Square Error (RMSE) Integral Absolute Error (IAE) indices are used

A Novel Repair Technique for the Internal Thermal Control System Dual-Membrane Gas Trap

A dual-membrane gas trap is currently used to remove gas bubbles from the Internal Thermal Control System (ITCS) coolant on board the International Space Station (ISS). The gas trap consists of concentric tube membrane pairs, comprised of outer hydrophilic tubes and inner hydrophobic fibers. Liquid coolant passes through the outer hydrophilic membrane, which traps the gas bubbles. The inner hydrophobic fiber allows the trapped gas bubbles to pass through and vent to the ambient atmosphere in the cabin. The gas trap was designed to last for the entire lifetime of the ISS, and therefore was not designed to be repaired. However, repair of these gas traps is now a necessity due to contamination from the on-orbit ITCS fluid and other sources on the ground as well as a limited supply of flight gas traps. This paper describes a novel repair technique that has been developed that will allow the refurbishment of contaminated gas traps and their return to flight use

Dehydrated Human Amnion/Chorion Membrane Allograft Nerve Wrap Around the Prostatic Neurovascular Bundle Accelerates Early Return to Continence and Potency Following Robot-assisted Radical Prostatectomy: Propensity Score–matched Analysis

Abstract We present a propensity-matched analysis of patients undergoing placement of dehydrated human amnion/chorion membrane (dHACM) around the neurovascular bundle (NVB) during nerve-sparing (NS) robot-assisted laparoscopic prostatectomy (RARP). From March 2013 to July 2014, 58 patients who were preoperatively potent (Sexual Health Inventory for Men [SHIM] score >19) and continent (no pads) underwent full NS RARP. Postoperative outcomes were analyzed between propensity-matched graft and no-graft groups, including time to return to continence, potency, and biochemical recurrence. dHACM use was not associated with increased operative time or blood loss or negative oncologic outcomes ( p >0.500). Continence at 8 wk returned in 81.0% of the dHACM group and 74.1% of the no-dHACM group ( p =0.373). Mean time to continence was enhanced in group 1 patients (1.21 mo) versus (1.83 mo; p =0.033). Potency at 8 wk returned in 65.5% of the dHACM patients and 51.7% of the no-dHACM group ( p =0.132). Mean time to potency was enhanced in group 1, (1.34 mo), compared to group 2 (3.39 mo; p =0.007). Graft placement enhanced mean time to continence and potency. Postoperative SHIM scores were higher in the dHACM group at maximal follow-up (mean score 16.2 vs 9.1). dHACM allograft use appears to hasten the early return of continence and potency in patients following RARP