Analysis of case series of milky urine: A single center and departmental clinical experience with emphasis on management perspectives: A prospective observational study

Background:

Milky urine can be due to chyluria or lipiduria due to nephrotic syndrome. Filarial chyluria usually responds to medical management while non-filarial cases may require surgical intervention.

Aim:

To perform a prospective observational study in patients presenting with milky urine in our centre over a period of one year from July 2011 to June 2012, a complete biochemical work up and imaging to find out the site of leakage of lymph if it is a case of chyluria, its response to medical management and the requirement of surgical intervention.

Materials and Methods:

Routine blood and urine investigations, 24 hour urine protein excretion, USG abdomen, serum lipid profile and rapid filarial antigen test were done in all. MRI abdomen was done in affordable patients. Renal biopsy was done in some chyluria patients for academic purpose and in milky urine with negative urine ether test. Sclerotherapy was done with 50% dextrose and 0.2% povidone iodine. Patients were followed up with 24 hour urine protein and triglyceride estimation.

Results:

18 cases of milky urine were encountered. 8 were filarial chyluria, 9 non- filarial and 1 MCD. Mean urine TG level and median 24 hour urinary protein excretion were 37.2 ± 24.6 mg% and 4.96 g respectively. The mean age for filariasis (22.9 ± 4.5 years) was significantly different from that of non-filarial etiology (31.5 ± 4.8 years) (P = 0.005). The mean 24 hour urinary protein for normal MRI cases (4.64 ± 0.70 g) was significantly different from those with dilated lymphatics (8.15 ± 2.55 g) (P = 0.02). All the non- filarial and 4 filarial cases required sclerotherapy. One patient required a second sitting.

Conclusion:

Milky urine is most commonly due to chyluria and occasionally due to nephrotic syndrome. Nephrotic syndrome is managed in its own way while chyluria not amenable to pharmacological intervention is managed with sclerotherapy.

Anti mullerian hormone: a potential marker for recruited non growing follicle of ovarian pool in women with polycystic ovarian syndrome

BACKGROUND

Polycystic ovarian disease is one of the most common causes of infertility in women of reproductive age. Anti- mullerian hormone (AMH), a member of transforming growth factor (TGF) family which is secreted by granulosa cells of growing follicle, is found to be increased to three to four fold in Poly Cystic Ovarian Syndrome (PCOS) patients as evidenced by previous studies. But the level of AMH in relation to the infertile status of PCOS was not studied yet. The present study was focused to determine the discriminative power of AMH in infertility subjects with regular cycles and infertility subjects associated with PCOS.

METHODS

The subjects under study were one hundred and twenty infertile women of age group ranging from 27-35 years. Subjects, were further divided into sixty infertile with regular cycles as controls (Group1) and sixty infertile subjects with PCOS as cases (Group 2). Hormones like FSH, E2 and AMH were assayed for all the subjects. Mean and student t- test for all hormones were compared between controls and cases. The diagnostic power of AMH pertaining to sensitivity and specificity was evaluated by Receiver operating characteristic (ROC) curve.

RESULTS

Serum AMH level were two fold higher in PCOS patients than in controls. The mean value of AMH also shows a test of significance between the two groups. The area under the receiver operating characteristic curve for the AMH assay was 0.95 in infertile group when 3.34ng/ml was used as cut off point indicating its better discriminative power and good diagnostic potency. Setting the AMH value at 3.34ng/ml sensitivity, specificity,Positive Predictive Value(PPV) and Negative Predictive Value(NPV) were observed 98% ,93%, 93% and 98% respectively.

CONCLUSION

The diagnostic potency of Area Under Curve (AUC) for AMH in infertile subjects reflects that AMH is a potential marker for recruited non growing follicles rather than a simple marker for ovarian reserve as it is predominantly produced by small follicles rather than a simple marker for ovarian reserve.

Comparison of the efficiency of photography-assisted shade selection to visual shade selection

This study sought to compare the efficacy of digital photographs and graphic software for shade matching to that of conventional visual shade selection. Thirty-one postgraduate students were used and shade selection was analyzed through 1 of 4 different techniques: digital spectrophotometer, conventional visual shade selection, visual shade selection assisted by digital photography, and shade selection by color difference formulas and computer software. Shade selection done with digital photography and graphic software using color difference formulas offered better and statistically significant shade matching compared to conventional visual shade selection and visual shade selection assisted by digital photography.

Placental thickness & its correlation to gestational age & foetal growth parameters- a cross sectional ultrasonographic study

BACKGROUND

The Gestational Age (GA) is frequently over or under estimated, as the conventional gestational estimation is based on the Last Menstrual Period (LMP) and on ultrasonography (USG). Many people are unaware of their LMP and irregular menstruations and USG is bound to have a bias, thereby posing difficulties in the GA estimation.

AIM

This study was aimed at estimating the (Placental Thickness) PT and at investigating the relationship between PT and the foetal growth parameters in normal singleton pregnancies.

MATERIALS AND METHODS

Two hundred eleven pregnant women were recruited in a cross sectional prospective study. The pregnancies were between 11 to 40 weeks and they were not complicated by either maternal or foetal diseases. The Biparietal Diameter (BPD), the Abdominal Circumference (AC), the Head Circumference (HC), the Femur Length (FL) and the PT were measured by USG by using a 3.5 MHz transducer.

RESULTS

The maximum mean PT in the 1st, 2nd, 3rd and the combined trimesters were 16.5 mm, 23.78 mm, 35.81 mm and 28.49 mm respectively. The correlation between PT and the other foetal parameters was investigated by Pearson's correlation analysis. The values were expressed as mean + standard deviation. The statistical tests were two-tailed, with a p value of < 0.01, which indicated the statistical significance. There was a strong positive correlation between PT and GA, with the correlation coefficient values for the 1st, 2nd and 3rd trimesters being r = 0.609, r = 0.812 and r = 0.814 respectively. There was a significant positive correlation between PT and BPD, AC, FL, ABC, HC and FW also. The mathematical relationships between PT and GA, BPD, AC, FL, ABC, HC, FW were derived by regression analysis. The regression equation which was derived was (x - 22.92) = (0.3604) (w-27.86446) + (1.0256)(y-1.1678) + (0.0015)(z-216.2841) + (0.1047) (t-43.1555) + (0.027) (u.192.79000) + (0.0042) (v-60.3725), where x = GA in weeks, w = PT in mm, y = FW in kg, z = HC in mm, t = FL in mm, u = AC in mm and v = BPD in mm.

CONCLUSION

We conclude that PT can be used as a predictor of the GA. The subnormal PT for the corresponding GA should be evaluated for any disease condition. So, the measurement of PT should therefore be carried out routinely during the obstetric USGs.

Cerebroprotective effect of Eclipta alba against global model of cerebral ischemia induced oxidative stress in rats

Oxidative stress is believed to contribute to neuronal damage induced by cerebral ischemia/reperfusion (I/R) injury. The present study was undertaken to evaluate the possible cerebroprotective and antioxidant effect of hydroalcoholic extract of Eclipta alba against global cerebral ischemia in the rat. Adult Wistar albino rats were treated with extract of Eclipta alba (250 and 500mg/kg/day, p.o.) for 10 days. The global cerebral ischemia-reperfusion injury was induced by occluding bilateral common carotid arteries (BCCA) for 30min, followed by 4h reperfusion. Quercetin (20mg/kg, i.p.) was used for the reference compound. After that, animals were sacrificed by decapitation, brain was removed, various biochemical estimations, cerebral edema, assessment of cerebral infarct size, and histopathological examinations were carried out. BCCA caused significant depletion in superoxide dismutase (SOD), glutathione peroxidase (GPx), reduced glutathione (GSH), catalase (CAT), glutahione-S-transferase (GST), glutathione ruductase (GR) and significant increase in malondialdehyde (MDA) in brain. Pretreatment with hydroalcoholic extract of Eclipta alba significantly reversed the levels of biochemical parameters and significantly reduced the edema and cerebral infarct size as compared to the ischemic control group. Eclipta alba at higher dose markedly reduced ischemia-induced neuronal loss of the brain. Reduction of cerebral edema, an early symptom of ischemia, is one of the most important remedies for reducing subsequent chronic neural damage in stroke. The results of the study show that Eclipta alba pretreatment ameliorates cerebral ischemia/reperfusion injury and enhances the antioxidant defense against BCCA occlusion induced I/R in rats; so it exhibits cerebroprotective property. HPLC fingerprint of hydroalcoholic extract of Eclipta alba was performed for conforming the coumestan present in the plant extract.

Significance of serum butyrylcholinesterase levels in oral cancer

BACKGROUND

Oral squamous cell carcinoma (OSCC) is a relatively common epithelial malignancy, and thus represents a significant public health problem. Early detection improves quality of life for affected patients. Identification of molecular markers (or biomarkers) which can predict disease progression is necessary for better management of these disorders. A correlation of cholinesterase with tumourigenesis, cell proliferation and cell differentiation has been observed. Butyrylcholinesterase (BChE; pseudocholinesterase) has been shown to be a biochemical marker for cervical cancer which is also an epithelial malignancy. In this study, we sought to estimate and compare serum BChE levels in healthy controls and patients with biopsy-proven oral squamous cell cancer (also an epithelial malignancy) before definitive therapy as radiotherapy or chemotherapy may alter the levels of BChE and may act as a confounding variable.

METHOD

After obtaining consent from biopsy proven oral cancer patients (n= 39) (before onset of any definitive treatment), and from age- and sex-matched healthy controls (n = 20), 2ml of blood was collected. After clot formation samples were centrifuged, serum was collected for estimation of BChE.

RESULTS

Pre-treatment serum BChE levels were significantly elevated (p < 0.0001) in oral cancer patients compared to that of controls. BChE levels showed a significant increase (p = 0.005) with advancing stage in oral cancer patients.

CONCLUSION

Our results show there could be a role for serum BChE in determining the prognosis of oral cancer.

Serum phosphodiesterase levels in oral cancer

BACKGROUND

Oral squamous cell carcinoma (OSCC) is one of the most common malignancies recognized nowadays. Its early detection is the better alternative to provide a good quality of life for the patients. During the last years, several studies have identified potential biomarkers of OSCC progression and prognosis. The phosphodiesterases (PDEs) are responsible for the hydrolysis of the second messengers with a fundamental role in the transduction of the intracellular signals. Variations in PDE activity have been correlated to different pathological mechanisms, such as cellular differentiation, apoptosis, and tumor invasivity. PDEs are also known to play a role in tumor growth by influencing angiogenesis.

AIM

To estimate and compare serum PDE levels in healthy controls and biopsy-proven oral cancer patients before definitive therapy.

MATERIALS AND METHODS

Institutional Ethics Committee gave us the permission to conduct this study. After obtaining consent from biopsy-proven oral cancer patients (n = 39) (before onset of any definitive treatment) and age- and sex-matched healthy controls (n = 20), 2 ml of blood was collected in plain vacutainers. After clot formation, samples were centrifuged and serum was collected for estimation of PDE.

STATISTICAL ANALYSIS

Kruskal-Wallis test; Mann-Whitney Test.

RESULTS AND DISCUSSION

Pretreatment PDE levels were significantly elevated in oral cancer patients (P<0.0001) as compared with the controls and also there was a significant increase in PDE levels (P<0.001) with advancing stage in oral cancer patients. This may implicate a role for serum PDE in pathophysiology of oral cancer.

Antiulcer and Anti-inflammatory Activity of Aerial Parts Enicostemma littorale Blume

The antiulcer and in vitro anti-inflammatory activities of the aerial parts of Enicostemma littorale against aspirin, ethanol, and pyloric ligation-induced ulcers in rats and bovine serum albumin denaturation were studied. The extract (200 mg/kg and 400 mg/kg po) was administered to the overnight fasted rats, one hour prior to aspirin / alcohol / pyloric ligation challenge. The ulcer index, tissue GSH levels, and lipid peroxidation levels were estimated in all the models of ulcers and the volume of gastric secretion, acidity, and pH, were estimated in the pyloric ligation model of ulcers. Pretreatment with the extract showed a dose-dependent decrease in the ulcer index (Against Aspirin, ethanol challenge, and pyloric ligation. The prior administration of the extract also reduced the total acidity, free acidity, and volume of gastric secretion, and elevated the gastric pH. In addition, it was also observed that the extract inhibited the serum albumin denaturation in a dose-dependent manner. It may be concluded that the methanolic extract possesses antiulcer activity, and the anti-inflammatory activity of the extract may be attributed to the antioxidant potential, as reported earlier.

Hepatoprotective effect of leaves of Peltophorum pterocarpum against paracetamol Induced acute liver damage in rats

The 70% ethanolic extract of Peltophorum pterocarpum leaves were investigated for its hepatoprotective effect against paracetamol induced acute liver damage on albino wister rats. Paracetamol (2gm/kg, po) significantly elevated the serum levels of biochemical markers like SGPT, SGOT, ALP, bilirubin (total and direct), total cholesterol, triglycerides and depleted tissue GSH and increased the lipid peroxidation. upon administration of paracetamol (2mg/kg p.o.) to albino rats. This indicated that there The 70% ethanolic extract of leaves of Peltophorum pterocarpum at 100mg/kg and 200mg/kg doses significantly reduced the elevated levels of biochemical markers mentioned above. Test extract treatment also increased the level of tissue GSH and significantly decreased tissue lipid preoxidation. The effect of 70% ethanolic extract (ELPP) was comparable with that of the standard silymarin 100mg/kg. These results suggest that 70% ELPP may have the potential therapeutic value in the treatment of paracetamol induced hepatic damage and some liver diseases. Hepatoprotective activity of the study plant may be attributed to the anti-oxidant principles in it.