Episiotomy scar endometriosis: A case report and review of literature

Endometriosis is defined as the presence and growth of endometrial tissue implants, outside the uterine cavity. It is in a episiotomy scar endometriosis that is extremely rare but can lead to significant morbidity in patients due to local infiltration. This condition usually presents with a clinical triad of history of episiotomy, tender nodule at the scar site, and cyclical pain. Here, we report one such rare case of episiotomy scar endometriosis in the perineum of a 30-year-old young female (P1L1) who presented with swelling and pain in the perineal region. The clinical examination and ultrasonography corroborate with the diagnosis of episiotomy scar endometriosis. Excision was done and histopathological examination confirmed the diagnosis. Episiotomy scar endometriosis should always be kept in the differential diagnosis when a lady presents with painful perineal swelling which increases during menstruation. Wide local excision is the treatment of choice and confirmation of the lesion can be done with histopathological examination. If the lesion is not diagnosed within a stipulated period of time, can progress with the involvement of the anal sphincters, and may also turn into a malignant lesion.

Primary extraneural ependymoma of the broad ligament: A rare entity

Extraneural broad ligament ependymoma is a rare entity. Herein, we present a case of unusually large broad ligament ependymoma in a 32-year-old female with pain and lump in the lower abdomen. Contrast-enhanced computed tomography abdomen revealed multiple heterogeneously enhancing pelvic masses with lobulated surface in bilateral adnexa along with multiple peritoneal nodules. Her relevant serum tumor markers were unremarkable. Core biopsy revealed tumor composed of elongated cells arranged predominantly in true and pseudoperivascular rosettes. The histopathological differentials included ependymoma, primitive neuroectodermal tumor, and teratoma with neural differentiation. Results of immunohistochemistry favored the diagnosis of ependymoma. Surgical exploration and optimal cytoreduction were done, and a final diagnosis of primary broad ligament ependymoma with peritoneal metastasis was made. The patient received six cycles of adjuvant chemotherapy and is doing well after 8-month follow-up. The present case highlights the diagnostic workup and management of a rare and an unusually large broad ligament ependymoma with peritoneal metastasis

Sequential Therapy with Induction Chemotherapy Followed by Concurrent Chemoradiation in Locally Advanced Squamous Cell Carcinomas of the Head and Neck

Introduction: Induction chemotherapy in locally advancedhead and neck cancers prior to local therapy has beendemonstrated to be non-inferior to concurrent chemoradiationin terms of overall survival (OS). Despite possible lack ofsurvival advantage, downsizing of tumours, allowing organpreservation along with the possible benefit of eradication ofmicrometastases earlier in the course of therapy makes thisa desirable approach for many heads and neck oncologistsworldwide. Study aimed to assess the immediate locoregionalresponse rates and to assess the toxicity profile of sequentialtherapy with three cycles of induction PFT followed byConcurrent Chemo-Radiation with weekly Cisplatin inLocally Advanced Head and Neck Cancers.Material and methods: 30 consecutive patients with locallyadvanced head and neck cancers attending the OPD at ourinstitute were included in the study. All patients were treatedwith 3 cycles of Induction chemotherapy with PFT regimen(Paclitaxel 175mg/m2 Day1, Cisplatin 100 mg/m² split to(Day 1-3), 5-FU 750 mg/m² Day 1 to 3) every 21 days. Thepatients were then taken up for concurrent chemoradiation(66 Gy RT along with weekly Cisplatin 40mg/sq.m.). Theimmediate locoregional response rates were assessed byclinical and radiological imaging. The toxicity profile of thetreatment was assessed with RTOG acute morbidity scoringcriteria and CTCAE Version 4.Results: 30 patients (3 female) were recruited for the study.Among them 3 were laryngeal cancer patients and thehypopharyngeal, oropharyngeal and the oral cavity cancerswere 9 each. 63% of them had complete response and 30%had partial response. The sub-sites of the hypopharynx andthe oropharynx had the best outcomes from this treatmentprotocol. 2 patients did not complete the planned treatment.11patients had grade 3 leukopenia and 2 patients had grade 4/febrile neutropenia. There was no grade 3 thrombocytopeniain the study group.Conclusion: Sequential therapy with three cycles of inductionPFT followed by concurrent chemoradiation is a feasiblealternative for moderately advanced and very advanced headand neck cancer. Patient selection and supportive care duringtreatment are very important for successful outcome.

Treatment of Locally Advanced Squamous Cell Carcinoma of Head and Neck with Hybrid Accelerated Radiotherapy and Concurrent Chemotherapy

Introduction: Head and neck cancer is the most common cancer in India. Overall, 57.5% of global head and neck cancersoccur in Asia, especially in India. Even though anatomical subsites of head and neck regions are accessible to clinicalexamination, 60–80% of patients in India report with locally advanced disease in comparison with developed countries whichis 40% only.Concurrent chemoradiation remains the standard treatment approach in locally advanced head and neck cancers.Conventional radiation schemes with 3 weekly cisplatin produce a response rate of 50–60% only in locally advanced head andneck cancer. Studies reveal that tumor clonogen repopulation might be one of the most important factors determining treatmentoutcome. Various retrospective studies and clinical trials have shown that an increase in tumor control can be achieved byshortening treatment time using altered fractionation schemas.Aim: In this present work, we made an attempt to improve the therapeutic ratio by hyperfractionation and accelerated radiationregimens.Methods: To achieve the above, 30 patients of locally advanced squamous cell carcinoma with different disease status werechosen. Patients subjected to hybrid accelerated radiotherapy with total dose of 72 Gy along with cisplatin 100 mg/m2 were givenon day 1 and day 22. Complete response rate in primary T2, T3, and T4 tumors is 100%, 86.95%, and 16.67%, respectively.Results: Complete response rates attained by N0, N1, and N2 nodes are 100%, 100%, and 50%, respectively. 16.6% hadGrade 2 mucositis and 50% had Grade 3 mucositis. 80% had Grade 3 and 20% had Grade 2 skin toxicities. No Grades 3 and4 hematological toxicities such as anemia, leucopenia, or thrombocytopenia were observed.Conclusion: Hence, we suggest that combination of hybrid accelerated radiotherapy and cisplatin mono-chemotherapy, withmanageable, although substantial, toxicity as an effective alternative regimen to treat head and neck cancer

Socio-demographic profile of multi-drug resistant tuberculosis patients and its association with severity of adverse drug reactions in DOTS plus centre at tertiary hospital in Himachal Pradesh, India

Background: Multi-drug resistant tuberculosis has become major public health problem and obstacle to effective control of tuberculosis. Objectives was to study the socio-demographic profile of multi- drug resistant tuberculosis patients and its association with severity of ADR (adverse drug reactions) in DOTS plus centre at tertiary hospital in Himachal Pradesh.Methods: It was a prospective observational study carried out from November 2012 to October 2013 on multi-drug resistant tuberculosis (MDR-TB) patients after approved from Institutional Ethics Committee.Results: Out of 104 patients the mean age of patients was 39.9 ±14.26 years. Majority of the patients were in the economically productive age groups. Multi-drug resistant tuberculosis was more in male (76%) than female (24%) and 96% of patients were belonged to rural area. The educational status of the MDR-TB shows 24% patients were illiterate. 63.46% MDR-TB patients were underweight (BMI<18.5%) according to WHO guidelines for obesity. Severity of ADR assessed by Hart wig and Siegel’s scale showed 21% patients experienced mild ADRs, 49% patients had moderate and 17% patients had severe ADRs. Severity of ADR is seen more in male, economically productive age group, subjects on vegetarian diet, patients who were underweight (BMI<18.5%) and with lower educational status.Conclusions: MDR-TB is a rapidly increasing health problem with major socio-economic and individual consequences. Multi-drug resistant tuberculosis mainly affects middle age that is in the economically productive age group which hampers the social and economic development of individual, society and nation.

Comparison of conventional Pap smear and liquid-based cytology: A study of cervical cancer screening at a tertiary care center in Bihar

Background: Cervical cancer is the fourth leading cause of cancer in women in the world and it is the second most common cancer in women 15–44 years of age. Strict implementation of screening programs has led to a large decrease in cervical cancer incidence and mortality in the developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening programs. Conventional Pap smear method has been the mainstay of most of the screening programs for many decades. However, this technique is not without limitations, and the sensitivity and specificity of cervical cytology are relatively low. To overcome the limitations of conventional Pap smear (CPS), liquid-based cytology (LBC) was introduced in 1990s as a better tool for processing cervical samples. Objectives: This study was undertaken to compare CPS with liquid-based methods, to assess the effectiveness and feasibility of LBC over CPS in our setting, and also to evaluate the prevalence of human papillomavirus (HPV) in our population. Materials and Methods: This study was conducted in Gynecological Oncology Unit of Regional Cancer Center at Indira Gandhi Institute of Medical Sciences, Patna, Bihar. About 310 women were enrolled in this study and the sample was taken for both conventional cytology and LBC. The smears were studied in detail and were interpreted as per the Bethesda system of reporting Pap smears. The results were compared and analyzed statistically. Results: Unsatisfactory smears were more commonly reported by conventional method (7.1%) than with liquid-based method (1.61%), and this difference is statistically significant. There was no difference in the detection of epithelial cell abnormalities using both the methods. HPV DNA for high-risk oncogenic strains (16 and 18) was detected in 6.45% of women in this study. Conclusion: LBC has been found to be more superior to conventional smears only with respect to lesser number of unsatisfactory smears, but considering the economic implications of LBC, conventional Pap is more feasible in our setting

Retrospective analysis of patients of cervical cancer a tertiary center in Bihar

Objective: A retrospective analysis of all patients with cancer of the cervix attending regional cancer center of Indira Gandhi Institute of Medical Sciences, Patna, from June 2015 to June 2017. The aim of this study was to know patient demographics, histology, age, stage and status of presentation, compliance with treatment and follow-up. Materials and Methods: Five hundred and eighteen consecutively registered patients with cancer of the cervix were included in the study. Results: The prevalence of cervical cancer among gynecological malignancy was 52%. It is the second most common cancer after breast cancer at our center. Patients hailed from the various districts of Bihar (89%), India, and from Nepal (10.61%). The majority (>50%) were aged 40–59 years. Stage information was available for 71.81% of the patients, of which Stage I comprised 12.36%, Stage II, 35.21%; Stage III, 50%; and Stage IV, 2.41%. Squamous cell carcinoma was the most common reported histopathology (~90%). A significant proportion of the women defaulted after registration, or after undergoing investigations (17%). Of the 68% cases planned for treatment, 50% initiated it, but only 38% completed it, About 11% of cases underwent Wertheim's hysterectomy and rest of patients were treated by radiotherapy with or without chemotherapy. Conclusion: The incidence of cervical cancer is still unacceptably high at our center. Organized cervical cancer screening needs to be adopted for early diagnosis.

Diagnostic utility of Wilms’ tumour-1 protein (WT-1) immunostaining in paediatric renal tumours.

Background & objectives: Renal tumours constitute about 7 per cent of all neoplasms in children. It is important to differentiate Wilms’ tumour (commonest tumour) from non-Wilms’ tumours. The aim of this study was to evaluate the immunoexpression and diagnostic role of Wilms’ tumour-1 protein (WT1) in paediatric renal tumours. Methods: A total of 53 cases of renal tumours in children (below 18 yr) who underwent total nephrectomy were included in this retrospective study. WT1 immunostaining was done using mouse monoclonal WT1 antibody (clone: 6F-H2). Results: Of the 53 cases, 38 (72%) were of Wilms’ tumour. Non-Wilms’ group (15) included six cases of mesoblastic nephroma (MN), two each of clear cell sarcoma (CCSK), renal cell carcinoma (RCC) and peripheral neuroectodermal tumour (PNET) and one each of angiomyolipoma (AML), rhabdomyosarcoma (RMS) and malignant rhabdoid tumour (MRT). Proportion of WT1 positivity in Wilms’ tumour was 100 per cent in contrast to 26.7 per cent in non-Wilms’ tumours (P<0.001). Epithelial and blastemal components of Wilms’ tumour showed moderate (2+) nuclear and cytoplasmic staining in 80 (24/30) and 75 per cent (24/32) cases, respectively. MN, PNET, CCSK and AML were negative for WT1. RMS, RCC and MRT showed cytoplasmic staining, strongest in RMS. No significant association was seen between WT1 expression and NWTSG (National Wilms’ Tumor Study Group) stage. Interpretation & conclusions: WT1 helps to differentiate Wilms’ tumour from other paediatric renal tumours. It may help in differentiating the two subgroups of Wilms’ tumour which have distinct molecular pathogenesis and biological behaviour, however, further prospective studies are required for validation of this hypothesis.

Use of the Computer and Internet by Teachers in Medical Education: A Study at a Medical College of North India.

Background: The computer and internet are used widely by the education community. A number of studies carried out in different parts of the world including India, have clearly shown that medical students use this technology freely and frequently. However, the situation with regard to medical teachers is not very clear as little information is available. The present study was conducted to determine the extent of the use of computers and internet by teachers in medical education. Methods: A questionnaire based study was conducted among all available teachers working at S.R.M.S. Institute of Medical Sciences, Bareilly (U.P.), India between March and June, 2012. Total of 142 medical teachers participated. Results and Conclusion: The majority (83.09%) use computers and internet for teaching. These teachers use computers for PowerPoint presentations while teaching, a vast majority of them (88.13%) use the internet to prepare their teaching materials. A significant statistical correlation was observed between computer and internet use and the younger age of teachers (p<0.001). Similarly, a significant correlation (p<0.001) was noted with the rank of teachers; non-users are predominantly professors, while users belonged to lower ranks (assistant professor or associate professor).

Unique pattern of mutations in β-thalassemia patients in Western Uttar Pradesh.

CONTEXT: β-thalassemia is one of the most common heterogeneous inherited single gene disorders. The disease results from one or more of 380 different mutations in the β-globin gene. Uttar Pradesh (U.P.) is the most populous state of India, comprising various ethnic groups and Bareilly is one of the largest cities situated in Western U.P. AIMS: To examine the prevalence of five common β-thalassemian mutations: Intervening Sequence IVS 1-5 (c. 92 + 5 G > C), codon 8/9 (c. 27_28insG), codon 41/42 (c. 124_127delTTCT), IVS 1-1 (c. 92 + 1 G > T) and codon 26 G-A (c. 79G > A) in Western U.P. SETTINGS AND DESIGN: Patients attending camps organized by the Thalassemia Society, Bareilly were selected for the study. MATERIALS AND METHODS: A total of 48 blood samples were collected from the patients of transfusion dependent β-thalassemia from July 2011 to May 2012. All the samples were analyzed for five common mutations by using the Amplification Refractory Mutation System (ARMS)-hot start-polymerase chain reaction (PCR) technique. RESULTS: Among the five common mutations prevalent in India, we were able to detect all except codon 26 G-A (c. 79G > A), which is prevalent in northeast India. These four mutations accounted for 58% of the total number of our patients. The IVS 1-5 (G-C) was found to be the most common mutation with a frequency of 46% and the 2 ndmost common mutation was Fr8/9 (+G) with a frequency of 21%. The frequency of other mutations was IVS1-1 (12%) and Cd 41/42 (4%). CONCLUSION: This study provides evidence that the pattern of mutations in Western U.P. is different from the rest of India and even from the neighboring states (Delhi and Punjab). To the best of our knowledge, mutation Fr8/9, the 2ndmost common mutation in our study has never been reported to be so common from anywhere in India. Some mutations, which are prevalent in other regions are absent in our region (mutation for ε-globin). Hence, these findings can be called unique to Western U.P.

Evaluation of preliminary phytochemical and pharmacognostic studies on the bark of Randia spinosa thund. .

The bark of Randia spinosa (Madanphal) is reported to have great medicinal value. Pharmacognostic evaluation including examinations of morphological and microscopic characters, ash value, powder analysis, and extractive values were carried out.