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Introduction: Chronic Suppurative Otitis Media (CSOM) is a chronic and persistent inflammation of the mucosal lining of middle ear cleft which presents with recurrent ear discharge through a tympanic membrane perforation. CSOM is a worldwide disease and has higher prevalence in developing countries causing serious local damage and threatening complications. Aim: To determine the profile of CSOM, its causative agents and their antibiotic susceptibility pattern. Materials and Methods: The present study was a retrospective study in which data for culture and antimicrobial susceptibility profile of CSOM cases was retrieved from Microbiology department of Government Medical College, Kannauj, Uttar Pradesh, India, from January 2019 to October 2019 the analysis of data was done in February 2020. Two hundred pus swabs from discharging ears were processed during the study period for aerobic bacterial culture and antimicrobial susceptibility pattern in Microbiology department using standard microbiological techniques. The result analysis of the study was expressed as percentage and proportion for distribution of CSOM cases. Results: Out of 200 patients, 114 (57%) were males and 86 (43%) females. Among the 200 cases, 147 (73.5%) cases showed growth and 53 (26.5%) showed no growth. The most common organism isolated in this study was Pseudomonas aeruginosa, 67 (42.40%) followed by Staphylococcus aureus.48 (30.37%) and Klebsiella spp. 23 (14.55%). Gentamicin (85%) and amikacin (83%) had high level of antibacterial activity on all the isolates. Meropenem was found to be most effective drug for gram negative isolates. All Staphylococcus spp isolates were sensitive to vancomycin (100%). Conclusion:Pseudomonas aeruginosa was the most predominant organism isolated in otitis media patients. Most of the isolates were sensitive to meropenem.

Steroid cell tumours of the ovary are uncommon sex-hormone-secreting tumours characterized by steroid cell proliferation. The incidence of steroid cell tumour of the ovary is only 0.5% of all ovarian tumours. Here, we present a case of a 59-year-old post-hysterectomy patient who presented with complaints of excessive hair growth, hoarseness of voice and male pattern baldness for 1 year. Transvaginal ultrasonography revealed a well-defined solid 4 × 3 cm hypoechoic lesion, and there was increased heterogeneous vascularity on colour doppler suggestive of neoplastic solid mass lesion of the right ovary. A blood examination showed total serum testosterone of 76 ng/dL, DHEAS—310 ug/dL, and 17-OH progesterone—1025 ng/dL. Her haemoglobin in the preoperative period was 18 gm/dL, though erythropoietin levels were normal. The patient was found positive for JAK2 gene mutation, which is strongly associated with polycythaemia vera. Laparotomy followed by bilateral salpingo-oophorectomy and frozen section was planned. Since frozen section was positive for malignancy in right ovarian mass, omentectomy, bilateral pelvic and para-aortic lymphadenectomy with multiple peritoneal biopsies were performed. The result of histopathology confirmed the diagnosis of steroid cell tumour, probably Leydig cell tumour. A blood examination after a month revealed a marked decline in serum testosterone, i.e. 4.9 ng/dL, DHEAS—15.3 ug/dL, and 17-OH progesterone—0.13 ng/dL.

Posterior eye segment diseases have been a crucial health ailment for years due to the anatomical structure of the human eye and the challenges to deliver drugs to certain tissues in the eye. This chapter discusses the parts of the posterior segment and its functions along with the possible barriers to conventional treatments. Topical and systematic drug delivery systems are traditional ways of treating most ocular diseases. However, these are not as effective due to low absorption, degradation of the therapeutic agents via enzymes, and toxicity due to higher drug doses to compensate for the low permeability. On the other hand, intravitreal, transscleral diffusion and iontophoresis along with ocular implants are novel techniques that increase the bioavailability as well as precision of the drug delivery.

ACTH-dependent Cushing syndrome (CS) due to an ectopic source is responsible for approximately 10-15% cases of Cushing’s syndrome. It is associated with various tumors such as small cell lung cancer and well-differentiated bronchial or gastrointestinal neuroendocrine tumors. Many a times ectopic ACTH production is difficult to manage, and identification of the source may take many years. Hormonal diagnostics include assessments in basic conditions as well as dynamic tests, such as the high-dose dexamethasone suppression test and corticotrophin releasing hormone (CRH) stimulation test. Treatment selection depends on the type of tumor and its extent. In the case of neuroendocrine tumors, the main treatments are surgery and administration of somatostatin analogues or bilateral adrenalectomy in refractory cases and if the source remains unidentified. Here, we report a case who presented with features of Cushing’s syndrome which eventually through workup led us to a diagnosis of duodenal carcinoid producing ectopic ACTH which is extremely rare and was successfully treated.

Mullerian duct anomalies represent a heterogenous group of congenital malformations resulting from abnormal formation or incomplete fusion of Mullerian ducts. Most cases present at puberty or early adulthood with primary amenorrhea or fertility problems although many are asymptomatic and remain undiagnosed. The reported frequency of these anomalies varies, consequent mainly to the inaccuracy of diagnostic methods used and the lack of a uniform classification system. The actual reproductive impact of each anomaly continues to remain ill defined. In addition, radiologic and endoscopic advances appear to have increased the number of unnecessary surgical corrections for these defects. This article attempts to review the reproductive impact of various Mullerian anomalies in a simplified manner. (J GYNECOL SURG 28:127)

Background: Premature ovarian failure (PMOF) affects 1% of women and is most often idiopathic. Women experiencing this disorder at a very young age are subjected to prolonged periods of hypoestrogenism and its adverse consequences. Objective: The present study was designed to highlight this disorder and its effects in 5 women aged

Osteoporosis, a skeletal disorder that adversely affects bone strength , is common among postmenopausal women primarily due to reduced ovarian estrogens.The present study was taken up to evaluate the role of isosorbide mononitrate (IMN) in the management of postmenopausal osteoporosis and to compare its efficacy with that of alendronate.This prospective systematic randomized study was conducted on 90 postmenopausal women with lumbar spine BMD2.5 SD below the young adult reference range. The participants received either Tab Alendronate 70 mg orally, once weekly (Group I) or Tab IMN 40 mg orally once daily (Group II) for 9 months, in addition to 500 mg of oral calcium daily. The BMD of the lumbar spine was measured using DEXA scan at enrolment and after 9 months. The data was analyzed by Student's t test and Chi-square test.The mean baseline BMD was 0.67 + 0.097 and 0.68 + 0.067 g/cm(2) in Group I and II, respectively. An increase of 11.94% in the mean BMD was noted after 9 months of treatment with alendronate as against 8.82% with IMN. Headache, flushing and palpitations in Group II and nausea, epigastric pain and heart burn in Group I were the most common adverse effects.IMN has a beneficial effect on bone turnover in cases of postmenopausal osteoporosis and that the effect is comparable to that of alendronate. IMN is a promising and safe alternative to alendronate for the management of postmenopausal osteoporosis.

Background: Typhoid fever is a major public health problem associated with significant morbidity and mortality in many countries. The Widal slide agglutination test is a commonly used test for diagnosing enteric fever. Limited literature is available on its diagnostic ability in comparison to the tube agglutination test. Aim of this study was carried out to evaluate the efficacy of the Widal slide agglutination test for the diagnosis of enteric fever.Methods: This cross-sectional study was done in department of microbiology in Jawahar Lal Nehru medical college and hospital, Ajmer over a period of six months from September 2013 to March 2014. A total of 640 serum samples received in the microbiology department were processed for detecting the presence of anti O and anti H agglutinins against S. typhi, S. Paratyphi A and S. Paratyphi B by slide and tube Widal agglutination tests as per standard protocols. The significant titre for O and H agglutinin, 1:160 was taken as positive.Results: Of the 154 slide Widal positive samples, 115 (18%) samples tested negative by the tube agglutination test whereas only 39 (6%) samples were positive by both slide and tube agglutination.Conclusions: Slide Widal test has high sensitivity and NPV (100%) can be used as a screening tool but due to low specificity (83.93%) any positive sample should be confirmed by tube Widal test.

A variety of biological, biochemical, and biophysical markers implicated in the pathophysiology of pre-eclampsia during the last two decades have instigated the growing interest in this study to include both βhCG and lipid profile studies in the early second trimester as early predictors of pregnancy-induced hypertension. Early identification of at-risk women may help in taking timely preventive and curative management to prevent or delay complications associated with pregnancy-induced hypertension.A prospective study was performed on 120 patients attending the outpatient department of the Obstetrics and Gynaecology of the Maharaja Agrasen Hospital. All the patients were screened for serum βhCG and serum lipid profile in their early second trimester (14-20 weeks) and followed up till their delivery. Comparative studies of serum βhCG and serum lipid profile were performed between those who remain normotensive (group I) and those who developed pregnancy-induced hypertension (group II).TG, total cholesterol, VLDL, and LDL values for those women who developed PIH (group II) were significantly higher than those who remain normotensive (group I), with p value of0.05 which is statistically significant. HDL and βhCG values for group II were not higher than those in group I with p value0.05 which is statistically insignificant.Maternal lipid profile in second trimester is very good noninvasive test which can be used for prediction of pregnancy-induced hypertension before its clinical onset. However, there is no correlation between maternal serum βhCG and pregnancy-induced hypertension.

Cervical cancer has a long latency period and established role of HPV lead to interest in development of HPV vaccine. Main goal of HPV vaccination is to decrease cervical cancer incidence. There are two vaccines available, for the prevention of HPV infection - gardasil and cervarix. Gardasil is quadrivalent and cervarix is bivalent. The FDA has approved gardasil in 2006 and cervarix in 2009 based on their efficacy in phase 3 trails. When recommending HPV immunization of females, it should be offered to girls 11 to 12 years of age, but can be administered as early as nine years. Catch-up vaccination should be offered for females aged 13 to 26 years who have not been previously vaccinated. HPV immunization is not effective in clearing cytological evident disease or HPV infection that is already present and it does not provide immunization for serotypes other than included in vaccine. Cervical cancer screening is recommended to continue as per guidelines.