ABSTRACT
Background & objectives: High-risk human papilloma virus (HR-HPV) infection and its integration in host genome is a key event in malignant transformation of cervical cells. HPV16 being a dominant HR-HPV type, we undertook this study to analyze if viral load and physical state of the virus correlated with each other in the absence of other confounding variables and examined their potential as predictors of progressive cervical lesions. Methods: Both, viral load and integration status of HPV16 were determined by real time URR PCR and estimation of E2:E6 ratio in a total of 130 PGMY-RLB -confirmed, monotypic HPV16-infected cervical DNA samples from biopsies of cytology-confirmed low grade (LSIL, 30) and high grade (HSIL, 30), and invasive carcinoma, (squamous cell carcinoma SCC, 70) cases. Results: Investigation of DNA samples revealed a gradual increase in HPV16 viral load over several magnitudes and increased frequency of integration from LSIL to HSIL and HSIL to invasive cancer in relation to the severity of lesions in monotypic HPV16-infected cervical tissues. In a substantial number of precancer (11/60) and cancer cases (29/70), HPV16 was detected in concomitant mixed form. The concomitant form of HPV16 genome carried significantly higher viral load. Interpretation & conclusions: Overall, viral load and integration increased with disease severity and could be useful biomarkers in disease progression, at least, in HPV16-infected cervical pre-cancer and cancer lesions.
ABSTRACT
Aim: To assess the efficacy, safety and acceptability of mifepristone followed by vaginal misoprostol for medical termination of pregnancy (MTP) between 13-20 weeks of gestation. Material and methods: Forty women who fulfilled the criteria of MTP Act of India, were given 200 mg oral mifepristone, followed after 36-48 hours by 800 μg vaginal misoprostol and subsequently 400 μg vaginal misoprostol 3-hourly (maximum 2,400 μg). Success was taken as complete expulsion of fetus and placenta within 15 hours of first dose of misoprostol. Results: Success rate of complete abortion was 92.5%, which increased to 95% at 24 hours and successful expulsion of fetus was seen in 100% cases within 24 hours of first dose of misoprostol. Median induction-abortion interval was 6 hours. There were no major side effects. Nulliparous women took significantly longer time to abortion and required more analgesia than multiparous women. Conclusion: Mifepristone followed by vaginal misoprostol is a safe, effective and acceptable method for second trimester termination of pregnancy.
Subject(s)
Clinical Trials as Topic/standards , Female , Humans , India , Informed Consent , Labor Pain , PregnancyABSTRACT
Background: Hyoscine N-butyl bromide (HBB) acts by inhibiting cholinergic transmission in the abdomino-pelvic parasympathetic ganglia, thus relieving spasm in the smooth muscles of gastrointestinal, biliary, urinary tract and female genital organs, especially the cervico-uterine plexus and aiding cervical dilatation. AIM: The study was undertaken to observe the effects of 40 mg intravenous HBB as a labor analgesic and labor accelerant. Settings and Design: This prospective randomized control trial was carried out on 104 primigravidae with single live fetus in cephalic presentation, with spontaneous onset of labor, between 37-40 weeks of gestation. Materials and Methods: Women were consecutively randomized into study (group I) and control (group II) groups, each with 52 patients after excluding high risk factors like preeclampsia, antepartum hemorrhage, previous uterine scar, and any contraindications to vaginal delivery. Group I received 40 mg HBB as a slow intravenous injection in the active phase of labor while Group II received 2mL normal saline. Pain scores were assessed at baseline and two hours later. Secondary outcome measures compared were progress of labor based on injection delivery interval, mode of delivery and neonatal condition at birth. Statistical Analysis: Statistical significance was assessed by using Student's t-test and Chi-square test. P-value < 0.05 was taken as significant. Results: Pain relief of 35.6% was noted on visual analog score with the use of HBB. Mean duration of labor was 3 hours 46 minutes in Group I compared to 8 hours 16 minutes in Group II (P value: < 0.001). Mode of delivery and neonatal outcome were comparable. No adverse maternal effects were noted. Conclusions: Intravenous Hyoscine N-Butyl Bromide causes pain relief of up to 36% and shortens the duration of active phase without any untoward short term fetal or maternal effects.