A 55 year old postmenopausal woman presented with complaints of sudden onset of right sided abdominal pain restricting her daily activities. Physical examination showed a large, smooth and tender immovable mass, extending from right lumbar region to the right anterior superior iliac spine and extending beyond the midline of the abdomen. On per speculum examination the cervix could not be visualised and to the extent vagina was seen, appeared normal. On per vaginal and rectal examination, cervix was pulled up. Uterus felt atrophic and retroverted, both the fornices were free. On the left in a plane above the adnexa, a firm mass could be tipped on downward displacement of the abdominal mass. On per rectal examination, rectal mucosa was free, bilateral parametrium were supple, pouch of Douglas was free and the same mass could be tipped with the middle finger. Complete haemogram and biochemical investigations were within normal limts.CA-125-was 8 IU/L. A CT scan of abdomen and pelvis was done with contrast. It showed a large retroperitoneal mixed attenuation mass 18.7×12.7×15.5 cms with density value of +20-30Hounsfeild units (Fig. 1).During surgery, minimal haemorrhagic ascites was seen in the peritoneal cavity. A well encapsulated retroperitoneal mass between the leaves of the broad ligament was completely resected, clamping its attachments to the parametrial and lateral pelvic wall and other soft tissues (Fig. 2). Frozen section was reported as lipomatous tumour. Total hysterectomy with bilateral salphingo-oophorectomy was then performed. PathologyGrossly the tumour was irregular, whitish yellowish, bosselated with surface vessels and measuring 30×23.5×25 cms. Cut section showed lobules of fatty tissue, white fibrous and myxoid areas (Fig. 3). Uterus and bilateral tubes and ovaries were normal grossly and histologically.Histology of the tumor consisted of interlacing bundles of spindle cells and foci of thick and thin walled blood vessels in a background of mature adipocytes suggestive of angiomyolipoma (Fig. 4). Interestingly immunohistochemistry with antihuman melanoma HMB-45 was negative.Post operative period was uneventful. Patient is on follow up for the last 13 months and does not have a recurrence clinically or sonographically. DiscussionThe incidence of renal and extra renal angiomyolipoma is 0.3-3 % [1] and that of angiomyolipoma occurring between the leaves of the broad ligament is very rare, only one case by Rajan and et al has been published [2]. Probably ours is the second case reported till date. Acute pain could be due to ischemia of the tumour mass or an impending rupture of the vessel. On reviewing the literature extra renal angiomyolipoma occurring in the female genital tract has been reported
Background: Diabetes mellitus has a significant impact on public health. Oxidative stress plays a major role in the pathophysiology of type 2 diabetes mellitus (T2DM), leading to various complications of T2DM. Yoga is being widely used in the management of T2DM. The primary objective of this systematic review and meta-analysis is to understand the effects of yoga on oxidative stress parameters among adult patients diagnosed with T2DM. Materials and methods: Electronic databases such as PubMed, Scopus, Cochrane Library and Science direct from inception till March 2020 were searched to obtain eligible studies. Study designs of all nature were included (except case studies and reviews). The primary outcome was malondialdehyde (MDA) and secondary outcomes included fasting plasma glucose, HbA1C and superoxide dismutase (SOD) levels. Results: A total of four trials with a total of 440 patients met the inclusion criteria. The results of meta-analysis indicated that yoga significantly reduced MDA (SMD: -1.4 ; 95% CI -2.66 to -0.13; P = 0.03; I2 = 97%), fasting plasma glucose levels (SMD: –1.87: 95% CI -3.83 to -0.09; P = 0.06;I2= 99%), and HbA1c (SMD: -1.92; 95% CI - 3.03 to -0.81; P = 0.0007; I2 = 92%) in patients with T2DM. No such effect was found for SOD (SMD: -1.01; 95% CI -4.41 to 2.38; P = 0.56; I2= 99%). Conclusion: The available evidence suggests that yoga reduces MDA, fasting plasma glucose and HbA1C, and thus would be beneficial in the management of T2DM as a complementary therapy. However, considering the limited number of studies and its heterogeneity, further robust studies are necessary to strengthen our findings and investigate the long-term benefits of yoga.
Background: In December 2019, a new corona-virus (COVID-19) infection broke out in the Chinese province of Wuhan. With the rampant spread of virus around the world, COVID-19 was declared as a global pandemic in the following year. Many complementary and alternate therapies (CAM) were used experimentally alongside conventional treatments for effective management of COVID-19. Aim: This paper presents a protocol for the systematic review and meta-analysis of the studies with various CAM therapies for the management of COVID-19 pneumonia. Methods: Electronic databases such as PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) could be used for searching the relevant trials and studies with keywords related to COVID-19 and CAM therapies. Two independent reviewers would screen a list of all the trials and extract the relevant variables. Additionally, we would also evaluate the risk of bias of the selected studies. Review Manager software (RevMan; version 5.3.5) and R statistical software (version 3.6.1) would be used for the data analysis. Results: Risk ratio (RR) would be estimated for dichotomous outcomes, and the mean differences (MD) would be measured for continuous outcomes. Heterogeneity with the help of I2 statistic would be used for the assessment of inconsistency across studies with the level of significance at P< 0.10. We would also assess publication bias using funnel plots and Egger’s test for the selected studies. Conclusion: The protocol for systematic review and meta-analysis would investigate the beneficial and possible adverse effects of various CAM therapies in the prevention and management of COVID-19 associated pneumonia.
In this paper, Modified Teaching Learning BasedOptimisation is used to solve the Economic Dispatch problems of the generating units considering valve point loadings effects. The formulation of the objective function is carried out in such a way that the losses are neglected and a clarified solution is obtained from the generating units. A recently developed optimisation is the Teaching Learning Based Optimisation which operates on two different phases-teacher phase and learner phase. A modification is done in the Teaching Learning Based Optimisation and is used in this paper as Modified Teaching Learning Based Optimisation. Here, in addition to the two phases, an mutation phase is also introduced. In contrast to the other Optimisation methods this proposed method does not require any algorithm specific parameters, it does not depend on any tuning parameters of algorithm and it enables global optimum solution and also avoids premature convergence to local optima of the objective function. The proposed method finds an optimum solution, such that minimum fuel cost solution can be obtained with extraordinary convergence rates and high consistency. The proposed method is tested on standard IEEE bus with 13 generating unit system, 40 generating unit system with valve point effects. The effectiveness of this method is demonstrated by comparing the results with other optimization techniques. Also, the result confirms that this proposed method has a great potential in determining the optimum solution.
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