APRI scoring as a predictor of Hepatic Fibrosis in patients with Chronic Hepatitis B and / or C Infection in comparison with Fibroscan

INTRODUCTION: Chronic liver disease is a global issue leading on to cirrhosis and hepatocellular carcinoma. Liver biopsy even though a standard criterion for the determination of fibrosis, is an invasive approach, thus, noninvasive simple laboratory markers were used to predict fibrosis in patients with chronic hepatitis B / and C infection. AIMS AND OBJECTIVES: Comparison of the accuracy between Aspartate aminotransferase (AST) to platelet count ratio index (APRI) value to Fibroscan to predict fibrosis of liver in patients with chronic Hepatitis B / and C infection. MATERIALS AND METHODS: An observational study was conducted among 100 patients attending Hepatology OP department with inclusion criteria – chronic Hepatitis B /and C infection in the age group of 18 – 60 years and exclusion criteria being coinfection with HIV, chronic renal failure, thrombocytopenia of < 75,000 cells/ul, other etiologies of chronic liver disease. Demographic data and medical history were collected from the patient and were subjected to platelet count estimation, liver function tests and Fibroscan. RESULTS: From the study, it was evidenced that the Aspartate aminotransferase (AST) to platelet count ratio index (APRI) value was correlating with Fibroscan value. Out of 72 patients with normal liver architecture identified on fibroscan, 68 patients correlate well with APRI score. Similarly, out of 14 patients with fibrosis detected on Fibroscan, 9 patients correlate well with APRI score. CONCLUSION: It was concluded from our study that, ASPARTATE AMINOTRANSFERASE (AST) TO PLATELET COUNT RATIO INDEX (APRI) value was correlating with FIBROSCAN value with sensitivity and specificity around 88 -90%.Thus, it could be used as a non-invasive tool to detect fibrosis in patients with chronic Hepatitis B / and C infection

The effect of baseline serum luteinizing hormone levels on follicular development, ovulation, conception and pregnancy outcome in infertile patients with polycystic ovarian syndrome

Background: Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder in infertile women. Raised tonic levels of luteinizing hormone (LH) is one of the main endocrinological disturbances in PCOS patients. Objective of present study was to evaluate the effect of baseline serum luteinizing hormone levels on follicular development, ovulation and conception and pregnancy outcome in infertile patients with PCOS.Methods: This is a prospective study conducted on 50 consecutive infertile patients with PCOS. Baseline Day 2 serum luteinizing hormone concentration was done in selected patients. Ovulation induction was done with clomiphene citrate 100 mg from Day 3 to Day 7 of the cycle. Then patients were monitored for follicular development, ovulation, conception and early pregnancy loss.Results: The mean age of the patients is 25±3.6 yrs. The average duration of infertility is 5.4 yrs (2-10). The mean basal serum LH concentration in patients who ovulated was significantly low (5.6 IU) in comparison with patients who did not ovulate (10.1 IU).  The mean basal serum LH concentration in patients who conceived was 3.9 IU in comparison with patients who did not conceive (5.9 IU) which was statistically significant (p=0.04).  Out of 15 patients who conceived, 3 patients (20%) had early pregnancy loss.Conclusions: Tonic hyper secretion of LH results in premature oocyte maturation, causing the problems with fertilization and miscarriage. Inappropriately raised LH appears to have deleterious effects on the pregnancy outcome

Effect of IAYT (Integrated Approach of Yoga Therapy) on motor nerve conductivity in spastic hemiplegic men

BACKGROUND: Hemiplegia, or paralysis of one side of the body, is caused by injury or illness (for example, a stroke), and leads to other disabilities. People with hemiplegia are limited physically in their daily activities. This limitation affects their social well-being and thus can lead to depression. This study was planned to evaluate the effect of IAYT on the changes in motor conductivity in spastic hemiplegic men. METHODS: A total of seventy-five subjects, mean aged (48.04±11.28) were randomly assigned into two groups after satisfying the inclusion and exclusion criteria. Experimental group (EG, n=40) and Control group (CG, n=35). Both groups were assessed at baseline and after 56 days for MNC. During these 56 days the experimental group practiced Sushma Vyayama, Nadishuddhi pranayama, AUM chanting and DRT once daily and no intervention for control group. Finally experimental group (n=33) and control group (n=31) completed the study. RESULTS: The Experiment group showed significantly improvement in the Median Nerve Conductivity (p 0.05) in the Motor Nerve Conductivity of Median and Deep-peroneal nerve, in the control group. Yoga group patients showed a significant (p < 0.05) reduction in the resting cardiovascular parameters such as SBP from 122.1±14.53 to 117.6±10.23 mmHg, RPP from 9525±1160 to 9178±835 bpm-mmHg and DoP from 5403±1832 to 4748±1137 bpm- mmHg. INTERPRETATION AND CONCLUSION: 56 days practice of IAYT in Spastic Hemiplegic men showed dominance of parasympathetic activity and suppression of sympathetic activity

Evaluation of tubal patency in infertile patients with saline infusion sonosalpingogram

Background: The incidence of tubal disease in infertility in India is as high as 40%. The aim of our study is to evaluate the diagnostic accuracy of Saline Infusion Sonosalpingogram (SSG) in the assessment of tubal patency in infertile patients with laparoscopy as the gold standard.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology on 50 consecutive infertile patients. Patients with acute pelvic inflammatory disease were excluded from the study. After complete examination and basic infertility work up, the tubal patency testing by Saline Infusion Sonosalpingogram was performed on day 8 of the cycle, followed by diagnostic laparoscopy with chromopertubation to confirm the tubal patency.Results: Out of 50 enrolled patients, 3 were excluded during the course of study. Thus, the study population comprised of 47 infertile women. During our study, 42 patients had tubes patent on SSG, out of which 41 patients had patent tubes on laparoscopy. 2 patients with blocked tubes on SSG had patent tubes on laparoscopy. 3 patients had blocked tubes on both SSG and laparoscopy. On statistical analysis, the sensitivity of SSG in diagnosing tubal patency is 95.34%, specificity 75%, positive predictive value 97.65% and negative predictive value 60%.Conclusions: Saline Infusion Sonosalpingogram is a simple, safe, convenient procedure for assessment of tubal patency in infertile women. It can be included in basic infertility work up. Hence, laparoscopy can be reserved for patients with tubal block, suspected pelvic pathology and unexplained infertility

Comparative study of Doppler USG changes – Cerebro Placental Ratio between IUGR and and AGA Foetus, Its implication on Perinatal Outcome

INTRODUCTION: FETAL GROWTH RESTRICTION- Intrauterine fetal growth which results in the birth of an infant weighing less than its genetic growth potential. SGA is often defined as an estimated fetal weight or abdominal circumference less than 10th centile and severe SGA as EFW or abdominal circumference less than the 3rd centile. Fetal growth restriction is defined as “SGA with abnormal Doppler indices such as umbilical artery pulsatality index above the 95th centile or mean uterine artery PI above 95th centile. (CPR) is the ratio of the fetal middle cerebral artery (MCA) pulsatility index (PI) to umbilical artery (UA) PI. Recent studies indicate that an abnormal CPR appears to identify IUGR fetuses at increased risk for adverse intrapartum and neonatal complications. It is believed to be a proxy for suboptimal fetal growth given it quantifies both suboptimal placental function and subsequent fetal circulatory adaptations. It is believed that the CPR better predicts adverse perinatal outcomes than its individual components and better than conventional anthropometry. AIMS AND OBJECTIVES: 1. To evaluate the distribution of Ratio of Doppler pulsatility index (PI) measurements of the middle cerebral artery to umbilical artery (Cerebroplacental ratio) values in patient IUGR and AGA coming to Tertiary Care Centre, Government Theni Medical College. 2. To evaluate the distribution of this Doppler parameter between these two groups with neonatal outcome. 3. To emphasize on the importance of altered cerebroplacental ratio in predicting the adverse perinatal outcome in patients with abnormal cerebroplacental ratio and timely intervention in these fetus to prevent adverse perinatal outcome. Study Design: Comparative Case Control Study. STUDY PERIOD: October 2016 - Sepember 2018. Place of Study Government Theni Medical College Hospital, Theni. Study Population: All Booked Cases of 32-40wks. Case Group (100) Patients with Growth Restriction & Associated risk factors like GES. HT, Chronicht, Non Severe Pre Ecclampsia, GDM H/O IUGR, Heart Disease, Severe Anaemia. Control Group: (100) Patients with AGA Fetus willing to Participate in Study. Sample Size: 200. METHODOLOGY: Using a 3.5-MHz duplex Doppler system, growth-retarded fetuses will be studied between 30 to 41 weeks gestation. Velocity recordings were obtained from the middle cerebral artery and umbilical artery to calculate the ratio between the two pulsatality indexes. The cerebral-umbilical Doppler ratio is usually constant during the last 10 weeks of gestation. Therefore, a single cut off value (1.0) was used, above which velocimetry was considered normal and below which it was considered abnormal. RESULTS: Abnormal CPR at term was associated with increased need for operative delivery 77% for presumed fetal compromise and admission to the NICU. The CPR has been shown to be a good predictor of the fetal oxygenation status at birth and can be used to identify pregnancies that are at risk for adverse outcomes. 68% has low APGAR scores even @5min Study suggest that the CPR is superior to the MCA pulsatility index alone in predicting adverse perinatal outcomes because it reflects acute changes more accurately. Accurate measurement of the CPR is important. CPR is more effective in predicting adverse perinatal outcomes compared 72% babies need NICU admission as against only 8% in patients with normal CPR need NICU admission with the individual doppler parameters of MCA and UA. CPR being an independent predictor any operative delivery for intrapartum fetal compromise, irrespective of fetal size. Conversely, a normal CPR was more likely to be associated with spontaneous vaginal delivery 76%. This study indicate that an abnormal CPR appears to identify IUGR fetuses at increased risk for adverse intrapartum and neonatal complications. Because the majority of these AGA foetuses have a normal Doppler resistance (PI, RI, or S/D ratio) of the UA, the physician may falsely conclude that there is no increased risk for adverse outcome, even though an abnormal CPR may be present but not measured. Therefore, it is imperative that Doppler assessment of the MCA must be done. To identify those at risk for perinatal complications. There a role for late third-trimester evaluation of all fetuses, given the ability to detect AGA fetuses outcome when they have an abnormal CPR. Because these fetuses may not be identified using traditional clinical tools such as fundal height measurements, evaluation of the amniotic fluid, or antepartum testing. CONCLUSION: The data from the would suggest that third-trimester routine ultrasound might be of value for identifying those fetuses at risk for adverse outcome during labor and subsequent neonatal complications. Whose weights are greater than the 10th centile but are at risk for adverse outcome because of an abnormal CPR. CPR identified more fetuses with adverse outcome than did the biophysical profile. Because the cost of ultrasound equipment is decreasing, portable ultrasound machines can be purchased these machines allow the clinician to use color Doppler to identify the UA and MCA and acquire pulsed Doppler waveforms in which the UA and MCA PI and are automatically measured and the CPR computed. Although further studies may be considered before this becomes accepted protocol, clinicians might consider this as an option to refine the predictability of adverse outcome high-risk fetuses undergoing antepartum testing. In conclusion, the CPR should be considered as an assessment tool in fetuses undergoing third-trimester ultrasound examination, irrespective of the findings of the individual umbilical artery and middle cerebral artery measurements in all fetuses

Cystic Lymphangioma of Adrenal Gland

An 18 year old female presented with vaginal bleeding at 2 months of gestation. Ultrasonography revealed a large retroperitoneal cyst. Histopathological examination of the excised cyst showed features suggestive of a cystic adrenal lymphangioma. This case is reported because of its rarity and detection during pregnancy.Key Words: Retroperitoneal cyst, adrenal cystic lymphangioma

Clinicopathological profile of colorectal polyps: retrospective analysis from tertiary care center in Southern India

Background: Colorectal Cancer is the fourth most commonly diagnosed and chronological changes in colorectal polyps and cancer is important in efficacy of screening strategies. In this study, we aimed to compare clinicopathological features of colorectal polyps and also aimed to characterise the distribution and the pathological features of polyps during an 18-year period divided in to two groups.Methods: This is retrospective analysis of cases that underwent colonoscopy and found to have colorectal polyps were re-viewed retrospectively for 18 year period are retrieved. 18 year period was divided in to 2001 to 2010 and 2011 to 2018.Results: Among 4230 patients underwent colonoscopy between January 2001 and September 2018, 1356 were excluded; of the remaining 2874, 986 were found to have 1,272 polyps. 306 patients had 412 polyps in 2001 to 2010 group and 680 patients had 860 polyps in 2011 to 2018 group. Adenomas on the left sided colon were significantly higher in the first time period (40.2% vs 30%, p <0.0003). Polyps on the right sided colon were significantly higher in the second time period (37.3% vs 36.9%, p <0.0005). The most common histology in the both periods is tubular adenoma. Histology of adenomas with high grade dysplasia were significantly more in first period (12.4% vs 7.6%, p <0.005).Conclusions: Our data shows shift in polyps from left side to right side colon in recent years. There was no significant change in shift in advanced adenomas from left side to right side of colon

Integral solutions of the heptic equation with five unknowns

The non-homogeneous Diophantine equation of degree seven with five variables represented by is analyzed for its non-zero distinct integer solutions. A few interesting relation between the solutions and special numbers namely Polygonal numbers, Pyramidal numbers, centered Polygonal numbers are exhibited

On The System Of Double Equations

Thisnbsp papernbsp concernsnbsp with thenbsp problem of obtain infinitely many non-zero distinct integers N1, N2nbspsuch that N1-N2 = 4k + 2(kgt0)and nbspN1N2 = (2k+1)a2 where 2k+1 is square-free. A fewnbsp examplesnbsp arenbsp given.nbsp Some observations among N1, N2nbspare presented