1 ) If we don't understand the pathogenesis of a particular bacteria, by doing several research by scientists from different parts of the world then question of clinical benefits does not arise. In that sense, this study has importance to the scientists, who are doing research in this aspects , and from the outcomes, questions of clinical impacts/importance/significance etc will arise....... 2 ) while giving benefits of bacterial diseases, to our patients, knowledge of bacteria, their virulence factors, toxins, mode of transmissions, clinical presentations, mechanism of escaping our immune system, type of sample/s for method/s of laboratory diagnosis, prophylaxis, selection of appropriate antibiotics etc etc, all matters....... ** Not all strains of Neisseria gonorrhoeae are betalactamase producers.......some strains are sensitive to Penicillin also. Strains may be deficient of enzyme which have nothing to do with beta-lactam ring of Penicillin ...... All of these , we came to know today are derived through different research including studies of Staphylococcus aureus which were resistant to Penicillin before the discovery of Penicillin....... ** Similarly, many strains of Neisseria gonorrhoeae produce IgA protease enzymes, that split secretory IgA, locally....... and evade local immunity............. ** DGI (Disseminated Gonococcal Infection ) cases are also found....... 3 ) This study has got merit to some extent , that it is the first laboratory demonstration of the penetration of Neisseria gonorrhoeae into the human endocervix and provides new insights into gonorrhea infection....... 4 ) How Neisseria gonorrhoeae reaches fallopian tube & ovary and produce salpingitis, öophoritis and salpingo-öophoritis leading to infertility AND many a times blockage / strictures may be polymicrobial or due to other organism/s ....... We came to know through different researchers and their findings, where a small finding (appearntly) may prove a huge impact on future research ....... Here is a publication from....... which will speak itself :- American Journal of Obstetrics and Gynecology 1 December 1980, Vol.138(7):985–989, doi:10.1016/0002-9378(80)91093-5 International Symposium on Pelvic Inflammatory Disease Microbiology and pathogenesis of acute salpingitis as determined by laparoscopy: What is the appropriate site to sample ? ABSTRACT Acute salpingitis is a POLYMICROBIAL disease. Neisseria gonorrhoeae and anaerobic gram-positive cocci were the predominant microorganisms isolated from the fallopian tubes of salpingitis patients. GONOCOCCI were isolated from the fallopian tubes in eight of 35 (23%) PATIENTS; ANAEROBIC BACTERIA were recovered from 10 of 35 (28.5%). Although CHLAMYDIA TRACHOMATIS was not recovered from the fallopian tube exudate, there was abundant serologic evidence of chlamydial infection in the salpingitis patients. TWENTY-THREE PERCENT of patients with PAIRED SEA had a FOURFOLD RISE in IgM AND IgG TITRE, which was CONSISTENT WITH systemic CHLAMYDIAL INFECTION. Comparison of cultures obtained via laparoscopy and culdocentesis suggested that culdocentesis is not an accurate reflection of the microbial milieu in the fallopian tube....... IN MEDICAL SCIENCE / MEDICINE DIFFERENT DISCIPLINES ARE INTERRELATED, AND SAME IS TRUE FOR RESEARCH ALSO. MANY A TIMES, RESEARCH IN ONE DISCIPLINE MAY HELP FURTHER RESEARCH IN ANOTHER DISCIPLINE AND MAY BE BENEFICIAL eg. FOR THE DEVELOPMENT OF NEW DRUGS, VACANCIES etc etc....... @Dr. Asv Prasad
Thank you @Dr. Asv Prasad, nice to know your work on 'Betalactamase strains in and around Visakhapatnam' , and the views you have shared with me and amongst Curofians. I understand your statement of 90 % and 'EAT THE FRUITS.......' But please keep in mind of those 10 % ....... Anyway, thanks a lot for the interaction....... @Dr. Asv Prasad .
Dear Dr Saha Thaks for ur spirited reply. I lke it. No body denies that research about any disease is multideciplinary .This per.haps need not be eloberated. Contobution of eah such ss a micro biologist, a pathologist, an immunologest, a biochmist , a molecular biologist, a genecist, an epidimiolpgist, and clinician etc contibution of each to the understanding of a disease fo ussed now on gonnorhea. Ur post is a testimony to involvement of each of the groups as to their respective fields. The opening sentence in this way was not slight the microbiological break through than it's immediate relevence from a clinician's point of view. For instace varios cell signalling pathways and their cross talk say for ex in insulin resistance r illuminating but not to an average clinician. So the oulook factor makez difference. I worked on " beta lactmating strains in around visakhapatnam" and produed a thesis in 1980.The same was published in IMA journal say in 1982. Perhaps u may not get a ref. Dating b 4 in India as I happened to review world wide oncidence/ prevalance with the help of WHO and CDC updates. As u r aware there r many mechanisms of resistane which I dummerised in the said work including step - wise mutation causing resistance ( to prncillinThe then wonder drug) Though that all strains of GC donot produce, their incidence sharply rose mor so in far east between 1975 on wards and reached epidemic prportions. Dose of p.pencillin rose from 8 lacks to 1 2, 2.4 And 4.8 megsunits when WHo recommended not to use it where the treatment failures were more than 5%.from public health point of view. The continuing threat of betala tmase is that it is plasmid mediated and starting with shigela- E COLI- GONOCOCCUS- STAPHYLOCOCCUS SO ON AND SO FORTH. THERE IS MUCH MORE EE CAN TALK BUT FOR OUR FELLOE CUROFIANCE 90% OF THEM PERHAPS SKIP THIS LENGTHY APPARENTLY USELESS TALK, EVEN THOUGH THE FACTS MIGHT BE LITTLE KNOWN. MY POINT IS THAT IS READY TO HAND OVER THE FRUITS OF RESERACH AT THIS MOMENT R MORE RELEVANT THAN FUNDAMENTAL RESEARCH WHICH IS LIKELY TO BEAR FRUITS DECADES LATER. EVEN THEN COLLEGUES LIKE TO "EAT THE FRUITS" THAN 'BOTHER ABOUT ITS SEED'- AN UNDENIABLE FACT. SO MY POINT IS THAT WE " DELIVER THE FRUITS THAN SEEDS" TO READERS OF CUROFY OF VARIOUS SHADES OF INTEREST IN WHAT GOES AROUND IN THEIR CLINIC THAN AROUND THE WORLD OVER. THAT PERHAPS MAKE MY APPROACH SEEM NEGATIVE TO SUCH POSTS SIR. I RECOLLECT HOW I MISSED MY MEDAL IN MICROBIOLOGY BECAUSE WE AS STUDENTS WERE ENCOURAGED HERE TO FILLOW BOOK BY Dr Pandale being an ex professor of my collage which became outdate in 1967 itself and new commer might not have even heard the name. Gonococcus and microbology take me back to my student days. Iresepect all pre and paraclinical subjects as they gave us strengh to stand on our legs even today in understanding the "behind the scene .of what we discuss today in curofy. I do not know how much what I intended to say has been translated by my " unfaithful mobile ..with regards Dr Saha for making me live again ib yrs bygone. " U LIVE ONLY TWICE (J.BOND) AND U HAVE GIVEN IPPERTUNITY TO LIVE TWICE OFCOURS ' AT THE EXPENCE OF CUROFIANS PATIENCE...SIR ETC...
The research is of limited clinical application .However it enters, it causes edocervicitis the aftermath of which is more important.... salpingo- oopharitis...causing stricture in uterine tubeand causing infertility. The resistance to Gonococcus is mainly beta lactimase induced. That it penetrates between epithelial cells of urthra in male was known more than 3 decades b 4. It stays in submucosa in the urethra. What is now shown is that it invoves non-musscle myosin 2 to reach the sub mucosa and entry into endocervix aided by genes which promote or inhibit this penetration. There is no identification as to what henes actually control this and in absence of which the mechanism is only speculative and not of any use. If true they should cite the gene locii and the on and of mechanisms of promotor and repressor regions as is elucidatedin some of the bacteria. It is of bacterialogical Interest having no immediate clinical impact. Any thing that adds to our knowledge 'is useful information'.
Yes sir. For the 10% ....seeds sre as good as fruits! But If seeds or eaten where will be fruits.? All in light vein sit. Thank u for recommendation to curofy.sir- I am grateful...regards sir.
Very nice update and discussions.
Informative @Dr. Puranjoy Saha
... If so...better B 17 sir, than seeds ! G ...more seedful and fruitful intersctions sir.
... If so...better B 17 sir, than seeds ! G ...more seedful and fruitful intersctions sir.
Very nice and informative study.
Cases that would interest you
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Pelvic Inflammatory Disease(PID) Pelvic inflammatory disease (PID) may be the inflammation of the upper genital tract relating to the fallopian tubes as well as the ovaries. The soreness is often bilateral because most from the PID is caused by the ascending or blood borne infection and also the close anatomic association from the ovaries with the fallopian tubes favors the bilateral involvement, though one tube might be more affected compared to other. The Pelvic inflammatory disease treatment aims to lessen this inflammation and stop further damage to the organs. Pelvic inflammatory disease causes The most typical cause of PID is std's (STD) Most common being gonococcal and chlamydial infections 60-75% of PID is brought on by STD, of which gonorrhea accounts for about 30% within the developed countries Gonoccoci and Chlamydia travel in the genital tract across the mucous membrane to reach the fallopian salpingo-oophoritis Other organisms directly ascend across the lining of the genital tract Other organisms that create PID include mycoplasma, tubercular bacillus, viruses and E. coli. Both aerobes and anaerobes are implicated in PID Pelvic inflammatory disease Pathology Acute Salpingitis The fallopian tube is swollen, edematous and hyperaemic with visible dilated vessels around the peritoneal surfaces. The sure manifestation of salpingitis (inflammation of the fallopian tube) may be the discharge of seropurulent fluid in the fimbrial end of the tube. The inflammatory exudate is discharged in to the lumen of the tube resulting in adhesions and tubal blockage or narrowing from the lumen which may be the cause of ectopic pregnancy or infertility. Pelvic abscess might be formed due to pus collection within the pelvic cavity. The ovaries are participating and a tubo ovarian abscess or mass may result. In rare cases the problem may spread upwards to result in generalized peritonitis, paralytic ileus and even sub diaphragmatic and perinephric abscess. In PID following postabortal and puerperal infection, the problem spreads through the cervix via lymphatics towards the cellular tissue causing cellulitis. The fallopian tube is affected externally and the mucous membrane last but not least. Pelvic inflammatory disease treatment within the acute stage helps limit the problem and prevent long term harm to the fallopian tube and ovaries resulting in adhesions formation, infertility etc. In early stage pelvic inflammatory disease treatment may require administration from the antibiotics but in the later stage surgical drainage from the abscess and adhesions breakdown may be required. Pelvic inflammatory disease symptoms and signs The most typical symptom of acute PID is gloomier pelvic pain. Pain is bilateral and limited to lower abdomen. Pain spreads upwards if general peritonitis ensues. Pain is severe in acute stage and it is followed by a high temperature. Vomiting could also follow. Discharge from the vagina and dysuria also occur. Menstrual irregularity if any, is a result of preceding endometritis in case of ascending infection in order to the antecedent abortion or delivery. The patient may develop uterine bleeding at any given time when menstruation isn't expected and the bleeding is usually profuse and prolonged. In case of pelvic abscess, the individual develops severe diarrhea because of rectal irritation. Investigations in Pelvic inflammatory disease Haemoglobin, leucocyte count and ESR. Cervical and vaginal swab culture for both aerobic and anaerobic organisms. Blood culture if bacteraemia takes hold. C reactive protein distinguishes between infective and non infective mass. Ultrasound: Tubo-ovarian abscess appears around the ultrasound. Computed tomography shows a spherical or tubular structure having a low attenuation center. Pelvic inflammatory disease treatment Pelvic inflammatory disease treatment aims to lessen the inflammatory process thereby arresting the development of the organisms resulting in the disease. Since 60-75% of PID come from Sexually transmitted diseases, treatment consists of pharmacological therapy (antibiotics) to eradicate the causative organisms together with supportive therapy for the control over other symptoms. Surgical treatment are usually necesary in case of extensive damage. Pelvic inflammatory disease treatment in Acute stage: Pelvic inflammatory disease treatment within the acute stage includes removal of the causative organisms by proper administration from the antibiotics. Mild cases are treated at home with antibiotics. Moderate and severe cases of Pelvic inflammatory diseases may require hospitalization. Hospital management includes: Rest Intravenous fluids within the presence of dehydration or vomiting and correction of electrolytic imbalance. Antibiotics are mandatory to become instituted at the earliest for the pelvic inflammatory disease treatment before the diagnosis is made. Initially, intravenous route is resorted to, however when the infection settles down, oral therapy might be started. Antibiotics like tetracycline, erythromycin, doxycycline, clindamycin work against both aerobic and anaerobic bacteria. Newer antibiotics include cefoxitin, cefotetan, doxycycline etc can be utilized for the pelvic inflammatory disease treatment. Surgical treatment may be required in the following conditions: Drainage of the pelvic abscess. Dilatation and evacuation of septic products of conception or for haemorrhage in postabortal sepsis. Acute spreading peritonitis and intestinal obstruction. Physiotherapy management within the acute pelvic inflammatory disease aims to lower the pain and inflammation combined with the pharmacological therapy. In mild and moderate cases of Pelvic inflammatory disease in which the patient does not need hospitalization, pain relieving modality like short wave diathermy could be given. Short wave diathermy is really a deep heating modality, produces heat both in deep and superficial tissues. Within the acute stage very mild or pulsed short wave diathermy can be used to promote healing and lower pain. For the Pelvic inflammatory disease treatment short wave diathermy could be given for 5-10 minutes for a time of three days a week while using cross- fire method of diathermy. Cross-fire method involves moving the electrodes to some position at right angles for their previous position midway through the treatment. Half the Pelvic inflammatory disease treatment is offered antero-posteriorly through the pelvis using the patients in the lying position and 2nd half in the side lying using the legs curled up or perhaps in sitting position and also the electrodes placed over the pelvic outlets and also the lumbo-sacral area of the spine. Pelvic inflammatory disease treatment in Chronic stage: Physiotherapy control over the pelvic inflammatory disease within the chronic stage is aimed at:- Relieving pain. Promote healing round the area. Treat existing musculoskeletal dysfunction or prevent further musculoskeletal dysfunction. Increase function. Pelvic inflammatory disease treatment modalities contain:- Short wave diathermy: it's widely known that short wave diathermy may be used to reduce pain and swelling, accelerate the soreness process and promote healing in tissues with chronic inflammation. It results in increased circulation round the area by vasodilatation resulting in better healing. Additionally, it increases the metabolic activity from the area leading to more nutrients, more cellular activity and healing and increasing collagen extensibility. It will help in the repair of pelvic microcirculation, thus enabling lysis of scar tissues, relaxation of contracted muscles within the pelvis and pelvic floor. For the pelvic inflammatory disease treatment within the chronic stage short wave diathermy is offered for 15-30 minutes, two times a day for thrice per week using the cross-fire method of treatment. Electrical stimulation as Transcutaneous electrical nerve stimulation (TENS) towards the low back for the symptomatic elimination of low back pain can be given. TENS works at both spinal-cord level and higher brain centres to inhibit the transmission of nocioceptors thus relieving the thought of pain. Moist hot pack could be given the low back to alleviate pain in the back. The pelvic floor muscles in females in the chronic PID might be in the hypertonic state because of pain, delayed healing, scarring adhesions or generalized spasm through the pelvic floor tissues. Pelvic floor rehabilitation is suggested for the pelvic inflammatory disease treatment such patients. Teaching control and relaxation from the pelvic floor musculature is important during these patients. Biofeedback including surface EMG may be used to induce relaxation during these muscles. For strengthening the pelvic floor musculature instruct the individual to tighten the pelvic floor as though attempting to stop the the flow of urine. Hold for 3-5 seconds and relax. Repeat Ten times per session. These exercises are through with empty bladder. Elevator exercises : instruct the girl to visually imagine traveling in an elevator. As the elevator goes in one floor to the other, contract the muscles a bit more. Relax the muscles gradually, as though the elevator were descending one floor at any given time. For treating a woman with hypertonus, boost the rest time between your pelvic floor contractions and sets. Focus on relaxation is equally important for weight training in these clients. Utilization of surface EMG for feedback is invaluable for enhancing understanding of holding patterns and resting tone. Instruct the girl to contract the pelvic floor as with the strengthening exercises then allow total voluntary release and relaxation from the pelvic floor muscles. This activity could be coordinated with breathing. Instruct the girl to concentrate on a slow deep breath slowly and allow the pelvic floor to totally relax. Surgical treatment might be indicated in the chronic pelvic inflammatory disease in which the extent of damage is much more. Tubal damage may require tuboplasty. Laproscopic breaking of adhesions is indicated when the tubal blockage is due to external adhesions. Overall surgery depends on the age and parity from the patient, the symptoms and pelvic pathology.For prevention against Pelvic inflammatory disease, delivery should be conducted in the hospitals, contraceptive devices like barrier methods can be used to prevent sexually transmitted diseases and also the young women should be educated concerning the risk of STDs and its preventionDr. Kirti Yadav (Pt)17 Likes26 Answers
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A PRACTICAL APPROACH TO THE DIAGNOSIS OF PELVIC INFLAMMATORY DISEASE: The diagnosis of PID is usually based on clinical criteria.Although diagnostic accuracy is advocated,antibiotic therapy should be instituted if there is a diagnosis of cervicitis or suspicion of acute PID. The clinician should maintain a high index of suspicion for the diagnosis as she evaluates the lower genital tract for inflammation and pelvic organs for tenderness in women with genital tract symptoms and a risk for sexually transmitted infections. This approach should minimize treating women without PID with antibiotics and optimize the diagnosis in a practical and cost effective way. Acute PID is associated with cervicitis, endometritis,salpingitis and peritonitis. The sigificant sequelae are tubal factor infertility,ectopic pregnancy and chronic pelvic pain. If pelvic examination fails to reveal evidence of inflammation(if there is no leukorrhoea),then the diagnosis of PID is much less likely and antibiotic treatment can be withheld while the remaining diagnostic workup defines the diagnosis. EVIDENCE OF LOWER GENITAL TRACT INFLAMMATION AND PELVIC ORGAN TENDERNESS SUGGESTS THE ADVISABILITY OF INITIATING THE ANTIMICROBIAL THERAPY SYMPTOMS: 1.Abdominal pain. 2.Abnormal discharge. 3.Metrorrhagia. 4.Post coital bleeding. 5.Fever. 6.Dysuria. 7.Low back ache. 8.Nausea,vomiting. CLINICAL CRITERIA: The diagnosis of PID should be considered in all sexually active women. Abdominal tenderness may/may not be present. Bimanual pelvic examination reveals pelvic organ tenderness. Uterine tenderness=endometritis. Adnexal tenderness=salpingitis. Cervical tenderness=cervicitis. Per speculum examination:look for green/yellow mucopus and friability. Microsopy of vaginal secretions should be performed looking for leucorrhea. (>>1 LEUCOCYTE/EPITHELIAL CELL) Evaluation of bacterial vaginosis (vaginal pH,clue cells&whiff test) Nucleic acid amplification test(NAAT) for gonorrhea and chlamydia should be performed. Empiric antibiotic treatment should be initiated in sexually active women,especially those at risk for STDs with lower abdominal or elvic pain ,if no other causes other than PID can be identified and if the following minimum criteria are present on pelvic examination. 1.Lower genital tract inflammation. cervicitis on clinical examination. More than one leukocyte/epithelial cell on microscopy of vaginal secretions. 2.Pelvic organ tenderness. cervical motion tenderness. Uterine tenderness. Adnexal tenderness.Dr. Suvarchala Pratap10 Likes10 Answers
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PELVIC INFLAMMATORY DISEASE : DEFINITION : PID is defined as a spectrum of inflammatory disorders of the upper female genital tract , including any combination of endometritis, salpingitis,tubo-ovarian abscess and pelvic peritonitis. It is a serious complication of some STD's , especially chlamydia and gonorrhea. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. PID leads to serious consequences including infertility ,ectopic pregnancy,abscess formation and chronic pelvic pain. CAUSATIVE ORGANISMS : Causative organisms are bacteria ,fungi,virus and parasites Sexually transmitted organisms are implicated in most cases.especially N.GONORRHEA & C.TRACHOMATIS. Microorganisms that comprise the vaginal flora also have been associated with PID. Gardnerella vaginalis. Haemophilus influenza. Enteric gram negative rods. Streptococcus agalactiae. Other organisms involved are Cytomegalovirus. M.hominis. U.urealyticum. M.genitilium. RISK FACTORS : *H/O STDs,especially gonorrhea &chlamydia. *Teenage sex. *Multiple sexual partners. *Intra uterine device. *Prior episodes of PID. *HIV. TYPES: ACUTE PID : Patient has generalized symptoms. Lasts few days. May recur in episodes. Very infectious. CHRONIC PID : Patient may be asymptomatic. Occurs over months and years. Progressive organ damage. SYMPTOMS : 1.Lower abdominal pain,may worse when move 2.Dyspareunia 3.Dysuria. 4.Dysmenorrhoea. 5.Post coital bleeding /metrorrhagia. 6.Low back ache. 7.Fever . 8.Feeling of tiredness. 9.Abnormal vaginal discharge. 10.Nausea ,vomiting . SIGNS : 1.Lower abdominal tenderness. 2.Adnexal and cervical tenderness on bimanual palpation. 3.Muco purulent vaginal discharge. 4.Cervicitis seen on speculum examination. 5.May find palpable adnexal mass. 6.Pyrexia.Dr. Suvarchala Pratap15 Likes24 Answers
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26 yr old lady with secondary infertility of 5 years duration.Hysterosalpingogram was done,which shows right fallopian tube running upwards along transverse processes of L1 to L5 vertebrae,Left tube was normal. what may be the cause?Dr. Vinod Kumar Rai0 Like3 Answers
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A 28 year old female came to my clinic with inability to conceive since the last 4 years. She has a 6 year old healthy child. She has also got tested for other common reasons – TORCH (Toxoplasma, Rubella, Cytomegalovirus, and Herpes) and tested negative for all. She is not a known Hypertensive, diabetic nor sickle cell disease patient and has no family history of the same. She informs that all the members of the household have not been diagnosed with any major sickness, apart from her mother-in-law who received almost a year-long treatment almost 5 years ago. She was unable to mention the nature of sickness except that mother would cough, have difficulty in breathing and eating, and evening fever. An HSG was done and the image is attached. Few questions for discussions: 1. Differential diagnosis for her secondary infertility 2. Interpret HSG 3. Which test would you do to confirm the diagnosisDr. Pallavi Mittal5 Likes22 Answers