The role of thyroid in clinical disorders of hypothalamo-pituitary adrenocortical axis--a prelminary communication

The study of thyroid function in clinical conditions associated with the disorders of the hypothalamio-pituitary-adrenocortical axis indicated overt hypofunction of thyroid in all the three cases of Cushing's disease and subclinical hypo-or low normal function of thyroid in most of the cases of adrenogenital syndrome. It was suggested that hypo or low normal function of thyroid might facilitate excess elaboration of ACTH through CRF by swaying the balance of neurotransmitters at hypothalamus in favour of serotonin.

An operator-induced conformational change in the C-terminal domain of the lambda repressor

4,4'-bis(1-anilino-8-naphthalenesulfonic acid (Bis-ANS), an environment-sensitive fluorescent probe for hydrophobic region of proteins, binds specifically to the C-terminal domain of lambda repressor. The binding is characterized by positive cooperativity, the magnitude of which is dependent on protein concentration in the concentration range where dimeric repressor aggregates to a tetramer. In this range, positive cooperativity becomes more pronounced at higher protein concentrations. This suggests a preferential binding of Bis-ANS to the dimeric form of the repressor. Binding of single operator OR1 to the N-terminal domain of the repressor causes enhancement of fluorescence of the C-terminal domain bound Bis-ANS. The binding of single operator OR1 also leads to quenching of fluorescence of tryptophan residues, all of which are located in the hinge or the C-terminal domain. Thus two different fluorescent probes indicate an operator-induced conformational change which affects the C-terminal domain. The significance of this conformational change with respect to the function of lambda repressor has been discussed.

Incidence of summer associated symptoms, host susceptibility and their effect on quality of life among women 18 to 40 years of age in an urban slum of Delhi

OBJECTIVES

To study whether individual susceptibility plays a role in the occurrence of summer associated symptoms (dizziness, giddiness, fainting and weakness) among women 18-40 years of age and their effect on the quality of life.

METHODS

It was a prospective community based study carried out in an urban slum of Delhi as a follow up of an earlier study. All women who had "given symptoms" during summer in the earlier study and a sample of those who were asymptomatic were included in the current study. Both the groups were studied for the occurrence of "given symptoms" and quality of life during next summer and winter using a pre structured questionnaire and WHOQOL-BREF.

RESULTS

Incidence of "given symptoms" during summer was more than three times among women who were symptomatic earlier compared to women who were asymptomatic. The incidence of these symptoms was significantly higher among the former across different age groups and BMI categories. Their physical domain of quality of life was also adversely affected.

CONCLUSIONS

Continued high incidence of summer associated symptoms with adverse effect on their physical quality of life, among women who were symptomatic earlier too, points to individual susceptibility rather than random occurrence. This aspect requires for further studies.

Changing routes of hysterectomy: a cross sectional and comparative study

Hysterectomy is one of the most frequently performed major surgical procedure in women. Traditionally, the uterus has been removed either by abdominal or vaginal route. In spite of the recommendations in favor of vaginal hysterectomy majority of the hysterectomies are still done by the means of abdominal route and vaginal route is utilized mostly for prolapsed uterus. This study was done to see the current trend of routes of hysterectomy for benign condition at Kathmandu Medical College Teaching Hospital and its indication. This was a cross-sectional and comparative study done for 24 months (Jan 2008- Dec 2009). Data for the year 2009 was collected prospectively and for the year 2008 case notes of all the cases of hysterectomy was reviewed. Total 317 cases of hysterectomy were done for benign condition in KMCTH during the 2 year study period. Of the 317 cases 124 was done during the year 2008 and 193 during 2009. Three major route namely vaginal hysterectomy (VH), Abdominal Hysterectomy (AH), and Laparoscopic hysterectomy (LH) was utilized for performing hysterectomy. Major indication for hysterectomy was pelvic organ prolapse (POP) followed by abnormal uterine bleeding (AUB), and fibroid uterus during both the years. Route of hysterectomy in the cases with non prolapsed pelvic organ were AH (94.0%) and LH (6.0%) during the year 2008 and VH (6.0%), AH (76%) and LH (18.0%) during the year 2009. Major indications for hysterectomy are POP, AUB, and fibroid uterus. VH is mainly done for the cases of POP. AH is still the major route for indications other than POP. Minimally invasive approach like VH for non descent uterus and LH although is rising needs to be practiced more.

Bilayered skin substitute incorporating rutin nanoparticles for antioxidant, anti-inflammatory, and anti-fibrotic effect

Hypertrophic scarring in large burns and delayed healing in chronic wounds are consequences of prolonged and aggravated inflammation, sustained infiltration of immune cells, free radical generation, and abundance of inflammatory mediators. Therefore, it is imperative to curb hyperinflammation to expedite wound healing. In this study, rutin nanoparticles (RNPs) were synthesized without an encapsulant and incorporated into eggshell membrane powder-crosslinked gelatin-chitosan cryogels to impart antioxidant and anti-inflammatory properties for treating hyperinflammation. The resultant nanoparticles were found to be 17.53 ± 4.03 nm in size and were stable at room temperature for a month with no visible sedimentation. RNPs were found to be non-cytotoxic and exhibited anti-inflammatory (by increasing IL-10 levels) and antioxidant properties (by controlling the generation of reactive oxygen species and enhancing catalase production in human macrophages). Additionally, RNPs were found to reduce α-SMA expression in fibroblasts, thereby demonstrating their anti-scarring effect. In vivo studies with a bilayered skin substitute constituting an RNP-incorporated cryogel proved that it is biocompatible, does not induce renal toxicity, aids wound healing, and induces better re-epithelialization than the control groups at the initial stages. Thus, RNP-incorporated cryogels containing bilayered skin substitutes are an advanced and novel alternative to commercial dermo-epidermal substitutes that lack anti-inflammatory or anti-scarring properties.

Production of an Innovative, Surface Area-Enhanced and Biodegradable Biofilm-Generating Device by 3D Printing

The enhanced surface cylindrical flask (ESCF) consists of an eight-striped inner arrangement holding 16 standard microscopic slides placed inside a cylindrical vessel. The specially designed spatula-accessible slides can be withdrawn from the vessel during cultivation without disturbing biofilm formation through an innovative window-flap accessibility mechanism. The vessel and its accessories were three-dimensional (3D) printed by applying a fused deposition modeling technique utilizing biodegradable polylactic acid. Biofilms of clinically relevant bacteria namely Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli were successfully grown in the ESCF and observed through confocal laser scanning microscopy. Advantages of the device include an enhanced surface area for biofilm formation, ease of insertion and removal of microscopic slides, convenient fitting into standard rotary shaker platforms, creation of anoxic/microaerophilic environment inside the vessel as well as the feasibility of pH, dissolved gases, and metabolite measurements in the liquid surrounding the biofilm. The ESCF will find widespread application in medical, industrial, and environmental disciplines.

Quantitative evaluation of large granular lymphocytes in mice on ascorbic acid supplement diet

The mechanism of ascorbic acid as an immunostimulatory agent is still clearly unknown. It is speculated in the present study that the host resistance may be due in part to ascorbic acid potentiation of the host immune system through stimulation and activation large granular lymphocytes.

Contribution to the macromycetes of West Bengal, India: 63–68

West Bengal, a significant landmass of eastern India with its varied topography, edaphic, and climatic conditions facilitates diversified forest types and conducive microhabitats for a wide array of macro-fungal wealth and the members of Aphyllophorales in particular.  Detailed macro-microscopic characterizations and chemical reactions were performed to systematically identify the specimens using standard key and literatures.  Six members of Aphyllophorales collected from different parts of West Bengal, India and four species belonging to the family Polyporaceae [Hexagonia tenuis (Fr.) Fr., Polyporus arcularius (Batsch) Fr., P. tricholoma Mont. and Lenzites elegans (Spreng.) Pat.] were identified, and a single species was identified under Meripiliaceae [Physisporinus lineatus (Pers.) F. Wu, Jia J. Chen & Y.C. Dai] and Meruliaceae [Bjerkandera fumosa (Pers.) P. Karst.].  The detailed description along with field and herbarium photographs, macro-morphology, and microscopic features of six species are provided in this article. 

The impact of an IEC campaign on tuberculosis awareness and health seeking behaviour in Delhi, India

OBJECTIVE

To study the impact of an intensive IEC campaign regarding the Revised National Tuberculosis Control Programme launched by the Government of Delhi on awareness generation among the general population and improvement in self-reporting by symptomatic cases in Delhi, India.

DESIGN

Cross-sectional study.

RESULTS

A pilot study wherein 1008 persons selected by systematic random sampling from the general population and 1012 patients selected from symptomatic cases reporting to DOTS centres were interviewed. Among the general population, 716 (71.0%) had been exposed to one or more IEC message through the media. The core message regarding symptoms, diagnosis, treatment centre and free treatment was recalled correctly by 144 (14.3%), 449 (44.5%), 659 (65.4%) and 900 (89.2%), respectively. In the post IEC period, a significant increase (P < 0.01) was seen in individuals self-reporting with symptoms to DOTS centres: the media message reportedly encouraged 36.3% of these to self-report. Prior to the IEC campaign only 49 (9.8%) patients had chosen a DOTS centre as first source of treatment, which increased significantly (P < 0.0001) to 104 (20.4%) post IEC.

CONCLUSION

The IEC campaign launched by the Government of Delhi has been effective in raising awareness and improving self-reporting, but it requires intensification with suitable modification to reach all sectors.

Hysterectomy: an analysis of perioperative and post operative complication

OBJECTIVE

To document peri operative and post operative complication observed after hysterectomy, regardless of route on the operator.

MATERIAL AND METHODS

A hospital based prospective study was carried out in department of obstetrics and gynaecology, KMCTH Sinamangal for six months. The study was carried out in patients undergoing hysterectomy who were followed from the time of admission to the time of discharge and two weeks thereafter. And followings were noted--Indication; route of hysterectomy, intraoperative and postoperative morbidities during hospital stay and after two weeks of discharge was noted.

RESULT

Total number of hysterectomy carried out was 50. 31 (62%) were Total abdominal hysterectomy, and 19 (38%) were vaginal hysterectomy. Indication for total abdominal hysterectomy were fibroid uterus 12 (24%), DUB 8 (16%), CIN 4 (8%), chronic cervicitis 1 (2%). II U-V prolapse with previous LSCS 1 (2%), endometriosis 1 (2%). Prophylactic for Ca breast 1 (2%), Postmenopausal bleeding 1 (2%). All cases of vaginal hysterectomy were performed for 2nd degree U-V prolapse. Intra operative complication during surgery were two cases of haemorrhage (4%) each in both total abdominal hysterectomy and vaginal hysterectomy. There was one case of bladder injury during abdominal hysterectomy. Postoperative complication noted were febrile morbidity 1 (2%) in abdominal hysterectomy. Urinary tract infection remains the single most common febrile morbidity. There was one case of secondary haemorrhage in both type of hysterectomy. One was managed conservatively and other required laparotomy. There were three (6%) cases of wound infection in abdominal hysterectomy of two which were sanguineous discharge and one was frank pus which required secondary suture.

Correlation of cervical cytology with cervical histology

OBJECTIVE

To correlate cervical cytology with Cervical histology.

METHODOLOGY

A hospital based prospective study was carried out in consecutive total forty-three patient attending oncology clinic of Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal from 1st Bhadra 2061 to end of Falgun 2061 (18th August 2004-12th February 2005) during authors posting in this clinic. All patients who underwent cervical biopsy on either indication of clinically suspected lesions or abnormal cytology were correlated with Pap smear report. Pap smear was carried out in conventional technique using Ayre's spatula. Cervical biopsy was carried out with help of punch biopsy forceps in operation Theatre without the guidance of colposcopy. All pertinent information regarding patient profile in terms of their age, parity, age at marriage, age at 1st child birth, smoking habit, contraceptive use, and symptom of vaginal discharge was taken. Reports of Pap smear and cervical biopsy of these patients were collected from oncology clinic during their follow up visit and all these information and finding were entered in structured questionnaire. The reporting of Pap smear was done in Bethesda system. The average duration between performing Pap smear and biopsy was of one month. Statistical analysis was carried out by EPI-INFOS6 system.

RESULT

Of forty three patients who underwent cervical cytology 22 cases were of Benign lesion, 8 cases of LSIL, 9 cases of HSIL, 3 cases of invasive carcinoma and 1 of ASCUS. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in benign grade was 76%, 83.3%, 86.4%, 71.4%, 79.1%, 0.0004 respectively. Similarly sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in LSIL was 60%, 93.9%, 75%, 88.6%, 86%,0 .0008 respectively. For HSIL it was 100%, 89.5%, 55.6%, 100%, 90.7 0.0001 respectively. Respectively for carcinoma it was 100% for sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy p-value was 0.00008.

CONCLUSION

Pap smear significantly correlated with cervical histology.

B-Lynch brace suture simple surgical technique for managing post-partum haemorrhage - report of three cases

Post-partum haemorrhage is a major contributor to maternal morbidity and mortality. Numerous medical and surgical therapies have been used but none has been uniformly successful. Three cases which were managed successfully with brace suture following failure of medical management for post-partum haemorrhage are being presented. The ease and usefulness of this procedure as a life saving measure, its relative safety and its capacity for preserving the uterus and thus fertility is high lighted.

Comprehensive abortion care service at Kathmandu Medical College--an experience

INTRODUCTION

His Majesty's Government amended the Nepal Criminal Code (Muluki Ain)--for Liberalising abortion law in the month of Chaitra 2058 (March 2002) and Royal Assent was given on 10th Asoj 2059 (27th September 2002). Accordingly Comprehensive Abortion Care (CAC) Services was initiated in the country. Kathmandu Medical College after enlisting with Ministry of Health started this service from June 2004.

OBJECTIVE

This study was carried out to know--1. Reasons for undergoing CAC service. 2. The complications after the CAC services. 3. The various contraceptive methods adopted by the client following CAC.

METHODOLOGY

Hospital based prospective study was carried out in Department of Obstetrics & Gynaecology at KMCTH from the period July 2004 to April 2005. Total 160 patients who asked for CAC were enrolled in the study. Counselling, history taking and general examination and per vaginal examination was carried out at the visit. CAC was performed with premedication with Doxycycline 100 mg and Ibuprofen 400 mg half an hour before the procedure. Paracervical block was also given with 1% xylocaine. MVA was performed as described in standard techniques. Patient was discharged after 1-2 hours of observation and with contraception opted by the clients.

RESULTS

Main reason for performing CAC was unwanted pregnancy in 66.75%. Complication following CAC was 1.25%. Post CAC contraception was adopted by 93%. Most preferred method was Inj. Depoprovera

CONCLUSION

The reason for CAC service asked by the patients was unwanted pregnancy. CAC service performed had minimal complication and also gave the opportunity for contraception.

Perimortem caesarean delivery (PMCD)

When a woman in late pregnancy has cardiac arrest and resuscitation fails, should an attempt be made to deliver the baby by Caesarean section? Many obstetricians would hesitate to operate in these circumstances for fear of delivery a baby who survives but shows profound neurological handicap. Obstetricians need to have a clear view on whether and when to operate in such cases. Here we report two cases of PMCD.

Assessment of noise level in Burdwan town, West Bengal

Cities and towns of the world are now facing enormous rise of noise pollution problem due to very high population rise, transport congestion and associated commercial and industrial activities. Burdwan, a district headquarter (100 km away from Kolkata) is one such town where noise pollution is very frequent. In order to assess noise level, noise data were collected from various places of the town by sound level meter with a duration of 30 minutes/location during specified time like 6.00 am, 10.00 am, 1.00 pm, 4.00 pm and 6.00 pm. Most of the monitoring places either belongs to silence category or commercial category areas. From the tabulated data, it was found that sound level lies within the range of 64-85 dB or above in different time at different places. The locations that belong to the silence zone have the noise level up to 90 dB. Statistically noise level in all these zones differ significantly at their peak hours. Noise pollution adversely affects our environment as well as human beings. Sound causes both pathological and psychological disorders in human beings. Implementation of rules and regulations under section 20, 21J, 41, 68(I), 70, 90, 111A of Environment Protection Act, 1986 and of course various technological methods and public awareness are very essential to check noise pollution in Burdwan town.

Crystal structure of a mycobacterial secretory protein Rv0398c and in silico prediction of its export pathway

Secretory proteins are used by pathogenic bacteria to manipulate the host systems and compete with other microorganisms, thereby enabling their survival in their host. Similar to other bacteria, secretory proteins of Mycobacterium tuberculosis also play a pivotal role in evading immune response within hosts, thereby leading to acute and latent tuberculosis infection. Prokaryotes have several classes of bacterial secretory systems out of which the Sec and Tat pathways are the most conserved in Mtb to transport proteins across the cytoplasmic membrane. Here, we report the crystal structure of a secretory protein, Rv0398c determined to 1.9 Å resolution. The protein comprises a core of antiparallel β sheets surrounded by α helices adopting a unique β sandwich fold. Structural comparison with other secretory proteins in Mtb and other pathogenic bacteria reveals that Rv0398c may be secreted via the Sec pathway. Our structural and in silico analyses thus provide mechanistic insights into the pathway adopted by Mtb to transport out secretory protein, Rv0398c which will facilitate the invasion to the host immune system.

Therapeutic Scrutiny of Lentinus polychrous with Attention to Its Antioxidant, Antimicrobial, and Anticancer Attributes

Mushrooms, being a source of therapeutically active compounds, are of great interest to researchers due to their historical usage in traditional therapies and the significant role that natural products have played in the development of contemporary medications. Lentinus polychrous is one underutilized mushroom species collected from the laterites of West Bengal, India. Our study aims toward its taxonomic validation, deciphering the secondary metabolic fingerprint, and testing its efficiency in countering many clinical issues, including oxidative stress, growing microbial drug resistance, and cancer. In vitro investigations have shown that the methanolic extract of the mushroom has a broad spectrum of antioxidant activities with effective concentration (EC50) ranging from 403.6 ± 3.8 to 841.2 ± 10.7 µg/mL depending on the type of free radicals and is effective in combating human pathogenic bacterial strains where MIC50 varies from as low as 302.2 ± 3.8 to 570.6 ± 1.8 µg/mL, mediated likely through inducing the breakdown of the outer coat and inducing increased porosity. The fraction was also shown to possess anticancer properties against A549 cells (LD50 120.9 ± 1.83 µg/mL) by triggering apoptosis. The modulation of Bcl-2 family gene expression was found to be the primary factor responsible for the induction of apoptosis in A549 cells during the experimental approaches. The findings revealed that the mushroom exhibits significant antioxidant, antibacterial, and particular cytotoxic effects on lung cancer cells, indicating its potential medical importance. These results provide essential insights into possibilities for the development of new therapeutic medicines derived from this mushroom.