Obstructive Sleep Apnea and Sleep Quality in Women with Polycystic Ovary Syndrome: A Cross-sectional Study

Background: Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age. Although PCOS patients have a high prevalence of obstructive sleep apnea (OSA), there is limited data on sleep quality and abnormalities in sleep architecture among this patient population. We conducted a study to assess the frequency of OSA and poor sleep quality in women with PCOS and to assess any association between these sleep disorders and metabolic abnormalities. Materials and methods: An observational study of adults with PCOS (by revised Rotterdam criteria) from May 2015 to June 2017 was conducted. Patients with thyroid disorders, pre-existing depression, current pregnancy, and recent drug use (benzodiazepines, antidiabetics, antiepileptics, steroids, and androgens) were excluded. The evaluations included the following: overnight polysomnography (PSG), lipid profile, testosterone, fasting insulin, fasting glucose levels, free androgen index (FAI), and homeostatic model assessment for insulin resistance (HOMA-IR); sleep quality [Pittsburgh Sleep Quality Index (PSQI), Jenkins Sleep Scale (JSS)], daytime sleepiness and possible depression were assessed by standard questionnaires. Descriptive statistics, t-test/Mann朩hitney test, Chi-squared test/Fischer's test were used as appropriate; p <0.05 was considered statistically significant. Results: A total of 65 patients, mean age 24.3 � 4.0 years; mean body mass index (BMI) 26.4 � 5.3 kg/m2 were included. Frequencies of sleep disorders were evaluated as follows: Obstructive sleep apnea 10.9% (7/64) [95% confidence interval (CI): 5.4�.9%], poor sleep quality 35.0% (21/60) (95% CI: 24.2�.6%) by JSS, 54.2% (32/59) (95% CI: 41.6�.3%) by PSQI. The PSG indicators of sleep quality were abnormal in arousal index, 96.8% (62); %wake time, 62.5% (40); sleep latency, 40.6% (26); and sleep efficiency, 12.5% (8). Anthropometric indicators of obesity were higher in OSA vs non-OSA patients (p <0.05). The OSA patients had lower total sleep time and %N2 stage, and higher desaturation index than non-OSA patients. When patients with good and poor sleep quality were compared, poor sleepers (by JSS and PSQI) had higher depression scores; poor sleepers by JSS had a lower waist杊ip ratio (p <0.05). Daytime sleepiness scores were similar in OSA and non-OSA patients, and in good and poor sleepers. Conclusion: Sleep disorders, particularly poor sleep quality, are frequent in women with PCOS. Patients should be screened for these disorders using specific questionnaires. Further research into the metabolic consequences of these sleep disorders is mandated.

Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR)

@#Introduction: Few authors have addressed risk factors related to an ipsilateral graft rupture and contralateral anterior cruciate ligament (ACL) injury after return to sports (RTS) following primary ACL reconstruction. Material and Methods: Patients with ACL re-injury to either knee after successful primary ACLR were included in Group I and those with no further re-injury were included in Group II. Variables including age, gender, side, body mass index (BMI), thigh atrophy, anterior knee laxity difference between both knees measured by KT-1000 arthrometer, mean time of return to sports (RTS), graft type, type of game, mode of injury, Tegner Activity Score, hormone levels, femoral tunnel length (FTL), posterior tibial slope (PTS) and notch width index (NWI) were studied. Binary logistic regression was used to measure the relative association. Results: A total of 128 athletes were included with 64 in each group. Mean age in Group I and II were 24.90 and 26.47 years respectively. Mean follow-up of Group I and Group II were 24.5 and 20.11 months respectively. Significant correlation was present between ACL re-injury and following risk factors; PTS of >10º, KT difference of >3.0mm, thigh atrophy of >2.50cm and time to RTS <9.50 months P value <0.05). No correlation was found with age, sex, BMI, type of game, Tegner Activity Score, mode of injury, NWI, size of graft, FTL and hormone levels. Conclusion: Possible risk factors include PTS of ≥ 10º, KT difference of ≥ 3.0mm at 1 year follow-up, thigh atrophy of ≥ 2.50cm at 1 year follow-up and RTS <9.5 months after primary ACLR.

FLI1 and MIC2 expression in precursor B-lymphoblastic leukemia with Burkitt-like morphology and extensive extramedullary involvement: A diagnostic challenge in pediatric small round cell tumor

Pediatric small round cell tumors (PSRCTs) constitute a large proportion of childhood malignancies with overlapping diagnostic and clinical features but radically different therapies. Here, we report a case of 16-year-old male child presenting with diffuse abdominal and mediastinal mass, axillary lymphadenopathy, and pleural effusion. Bone marrow aspirate showed near total replacement by small round malignant cells. The bone marrow biopsy showed interstitial infiltration by malignant cells, which were CD45? CD3? CD20? MIC2+ FLI1+ and diagnosis of Ewing's sarcoma was established. In contrast, flowcytometric immunophenotyping of the bone marrow aspirate showed CD45? cells, which were CD19+ cytCD79a+ CD10+ CD81+ CD38+ HLA-DR+ CD22+ CD20? consistent with B-cell acute lymphoblastic leukemia (B-ALL). The extended immunostaining panel on bone marrow biopsy also showed positivity for cytCD79a, CD10, CD19, and BCL-2, whereas fluorescent in-situ hybridization for EWSR1 gene rearrangement was negative. Thus, a final diagnosis of CD45? FLI1+ MIC2+ B-ALL was established. Rare cases of CD45? B-ALL with immunoreactivity for MIC2 and Friend leukemia virus integration 1 (FLI1) have posed a diagnostic challenge for PSRCTs in the recent past. This case report highlights the role of multimodality approach in establishing a correct diagnosis in CD45? PSRCTs to ensure definitive therapy and better clinical outcome.

In Situ Fixation of Symptomatic Fibrous Non-union Hoffa Fracture: A Case Report

@#Femoral condyle fracture in coronal plane, also known as Hoffa fracture, is a rare fracture. Non-union of Hoffa fracture is even rarer. We present a case of fibrous nonunion of a Hoffa fracture in which the fractured fragment, though not freely movable, led to painful walking. Since the fragment was un-displaced and non-movable we fixed the fractured fragment in situ. Patient regained full range of motion of the knee and was asymptomatic on follow-up.

Role of 18F-fluorodeoxy glucose PET-CT in asymptomatic epithelial ovarian cancer with rising serum CA-125: A pilot study.

Background. We evaluated the role of 18F-fluorodeoxy glucose (FDG) PET-CT scan in the diagnosis of early relapse in patients with epithelial ovarian cancer (EOC) who were asymptomatic but had a rising serum CA-125 level. Methods. Between May 2006 and July 2008, 16 patients with advanced EOC (stages III and IV) who had achieved complete response after cytoreductive surgery and platinumbased chemotherapy were included. These patients were asymptomatic but had a rising serum CA-125 level with normal physical examination and contrast-enhanced CT scan of the abdomen and pelvis. Patients were evaluated with 18F-FDG PET-CT scan. Written informed consent was taken. Patients with a positive PET-CT scan were advised ultrasoundguided fine-needle aspiration cytology (FNAC) from the area showing increased uptake. Patients in whom FNAC was negative or inconclusive or those with negative PET-CT scan were followed up closely for the next 6 months with repeat clinical evaluation and CT scan. Results. Fifteen patients (15/16) had a positive PET-CT scan. In 9 patients the positive PET lesion was confirmed on FNAC, while in 5 patients this was confirmed on follow-up CT scan after 6 months. One patient who had a single positive lesion in the pelvis on PET-CT was initially considered falsepositive because a follow-up CT scan at 6 months did not show the lesion. However, on regular follow-up after 2 years, she was detected to have an isolated lesion in the PET-positive area which was confirmed on secondary cytoreduction. This patient was considered as true-positive in the current analysis. One patient, who had a negative PET-CT scan and a negative CT scan at 6 months’ follow-up was considered true-negative. The sensitivity and specificity of PET-CT scan was 100%. We could confirm positivity on histopathology/FNAC in 10 of the 15 (66.7%) true-positive cases. Conclusion. 18F-FDG PET-CT scan is a sensitive and specific technique for early diagnosis of relapse in asymptomatic EOC patients with rising CA-125. However, its role in the management of recurrent ovarian cancers needs further evaluation.

Antenatal and Perinatal Care in an ICDS Area: Progress Made in 19 Years.

ICDS program has made significant improvement in availability and utilization of antenatal and natal care including IFA supplementation, TT administration and delivery by trained personnel. However, postnatal care and promotion and initiation of breastfeeding within 2 hours of birth still remain deficit areas.

Clinical applications of positron emission tomography-computed tomography in oncology.

Positron emission computed tomography (PET) is a functional diagnostic imaging technique, which can accurately measure in vivo distribution of a variety of radiopharmaceuticals. The ability of PET to study various biological processes (glucose, amino acid, phospholipids, receptors etc.) opens up new possibilities for both day-to-day clinical use and research applications in the practice of oncology. Addition of CT to PET has resulted in better specificity and sensitivity than either of the modalities alone, as the combined approach has the ability to demonstrate functional and structural details in the same setting. F-18 fluoro-2-deoxy-D-glucose (FDG), an analogue of glucose, is the most commonly used radiotracer in PET-CT imaging. The F-18 FDG uptake in tumor cells is directly proportional to glucose metabolism in the cells. Since glucose metabolism is increased several folds in the malignant tumors, PET-CT images show preferential higher FDG uptake in malignant cells as compared to normal cells. F-18 FDG PET-CT has been found to be useful in the initial staging, detection of recurrent disease and monitoring the response to the therapy in malignancies including lung cancer, colorectal cancer, lymphoma, melanoma, esophageal cancer, head and neck cancer, breast cancer.

Metastatic ovarian tumour in patient of carcinoma stomach.

Krukenberg tumour (KT) is a metastatic ovarian tumour with primary usually seen in the gastrointestinal tract. Here we report the case of a 50-year old menopausal patient with gastric tumour presenting with solitary metastasis to the ovary within 5 months of primary gastric surgery, for which total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. This case stresses the urgent need for early detection and surveillance of treatable tumours metastasising to the ovary.

Effect of simulated ascent to 3500 meter on neuro-endocrine functions.

Ascent to extreme High Altitude (HA) is in steps and it entails acclimatization at moderately HA locations. In terms of acclimatization, it is pertinent to understand the physiological changes, which occur on immediate ascent to moderate HA. The study aimed to evaluate the effect of ascent to 3500 m on neuro-endocrine responses in the first hour of induction. The plasma levels of catecholamines and cortisol were measured before and after one hour of ascent to high altitude. The peripheral oxygen saturation (SpO2), Galvanic Skin Resistance (GSR), Heart Rate (HR) and Blood Pressure (BP) were simultaneously monitored. The plasma epinephrine, norepinephrine, dopamine and cortisol were increased after one-hour exposure to 3500 m altitude as compared to before exposure. The SpO2 showed a significant decrease during and after high altitude induction. The heart rate and diastolic BP increased at 3500 m whereas the GSR did not show significant changes. There are changes in neuroendocrine responses, which reflect a sympathetic over activity in the first hour of exposure to 3500 m.

Samarium-153 ethylenediamine tetramethylene phosphonate therapy for bone pain palliation in skeletal metastases.

BACKGROUND: Systemic therapy with radionuclides may be used for the treatment of patients with painful skeletal metastases owing to its efficacy, low cost and low toxicity. Imported radionuclides for pain palliation, like Strontium-89 are expensive; particularly for developing countries. In the Indian scenario, Samarium-153 (Sm-153) is produced in our own reactors and as a result, it is readily available and economical. AIM: We undertook this study to determine the efficacy and toxicity of single-dose Sm-153 ethylenediamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases. MATERIALS AND METHODS: Eightysix patients with painful skeletal metastases from various primaries, were treated with Sm-153 EDTMP at a dose of 37 MBq/kg. The effects were evaluated according to change in visual analogue pain score, analgesic consumption, Karnofsky performance score, mobility score and blood count tests, conducted regularly for 16 weeks. STATISTICS: Repeated measures analysis. RESULTS: The overall response rates were 73%, while complete response was seen in 12.4%. Reduction in analgesic consumption with improvement in Karnofsky performance score and mobility score, was seen in all responders. Response rates were 80.3 and 80.5% in breast and prostate cancer, respectively. One case, each of Wilms tumor, ovarian cancer, germ cell tumor testis, multiple myeloma, primitive neuroectodermal tumor and oesophageal cancer, did not respond to therapy. No serious side-effects were noted, except for fall in white blood cell, platelet and haemoglobin counts, which gradually returned to normal levels by six-eight weeks. CONCLUSION: Sm-153 EDTMP provided effective palliation in 73% patients with painful bone metastases: the major toxicity was temporary myelosuppression.

Neurofibromatosis I with unusual hypopigmentation masquerading as leprosy.

A case of Neurofibromatosis I (NFI) occurring in association with symmetrical peripheral nerve enlargement and multiple hypopigmented macules strikingly limited to the neurofibromas, with normal to minimally reduced sensations, evoking a strong clinical suspicion of co-existent lepromatous leprosy, is being reported. Leprosy was ruled out by microbiological, histopathological and electrophysiological studies. The case is interesting in view of the hypopigmented macules overlying the neurofibromas, which is an unreported feature of NFI.

Does I-131-MIBG underestimate skeletal disease burden in neuroblastoma?

BACKGROUND: Controversy persists as to the need for both MIBG and bone scanning in routine evaluation of neuroblastoma. AIM: To compare the efficacy of I-131- metaiodobenzylguanidine (MIBG) scan against that of conventional Tc99m- methylene diphosphonate (MDP) bone scan for the detection of skeletal deposition of neuroblastoma. METHODS AND MATERIAL: The study included 57 patients (36 boys, 21 girls: age range 1-14 years) of neuroblastoma who underwent both bone scan with Tc99m-MDP and I-131-MIBG scan within 15 days of each other at presentation and during follow-up. RESULTS: At presentation 11(19.2%) patients had evidence of skeletal metastases on MDP scan against 7 patients who showed bony secondaries on MIBG scan. Of the 7 patients, with positive MIBG and MDP scans, MDP scan detected 11 sites whereas MIBG scan detected 7 sites. On follow-up study, 3 patients with initial abnormal MDP scan but normal MIBG scan, developed skeletal metastases detectable on MIBG scan, whereas 3 of the 46 patients who had normal MDP and MIBG scan at presentation; developed skeletal metastases detectable on MDP scan. MIBG scan was concordant in 2 of them but was normal in the third patient. CONCLUSION: I-131-MIBG underestimates skeletal disease burden in neuroblastoma. Therefore, Tc99m-MDP bone scan should remain a part of routine assessment of patients with neuroblastoma.

Imaging using Tc99m-tetrofosmin for the detection of the recurrence of brain tumour: a comparative study with Tc99m-glucoheptonate.

BACKGROUND: In the past "blood-brain barrier" agents such as Tc99m-glucoheptonate were routinely used for the diagnosis of brain tumours. Of late, agents used for studying myocardial perfusion namely, Tc99m-tetrofosmin, Thallium-201, and Tc99m-sestamibi have replaced the "blood-brain barrier agents " when imaging is undertaken for the detection of the recurrence of brain tumours. However, the incremental diagnostic information provided by Tc99m-tetrofosmin when compared with a blood brain barrier agent in the diagnosis of recurrent brain tumour has not been evaluated till date. AIMS: The study was carried out to substantiate whether Tc99m-tetrofosmin provides any incremental diagnostic information not provided by the blood brain barrier agent Tc99m-glucoheptonate. MATERIAL AND METHODS: Brain SPECT scans were performed using Tc99m-tetrofosmin and Tc99m-glucoheptonate in 126 patients of recurrent brain tumour. Bio-distribution and uptake properties of both the tracers were analysed by measuring relative uptake of both the tracers in tumour compared to background (T/B ratio), nasopharynx (T/N ratio) and scalp (T/S ratio). STATISTICAL ANALYSIS: Descriptive statistics were calculated for each variable. Pearson's correlation coefficient was applied to see agreement of the continuous variables. Paired t test was used to evaluate the difference between two means. RESULTS: Uptake properties of both the tracers were analysed in 105 patients in whom both Tc99m-tetrofosmin and Tc99m-glucoheptonate showed concentration. The remaining 21 patients in whom the tumour mass did not show Tc99m-tetrofosmin concentration were excluded from the study. Mean T/B ratio, T/N ratio and T/S ratio was 5.83 + 2.09 and 5.99 + 2.26, 0.53 + 0.21 and 0.55 + 0.22 and 1.11 + 0.60 and 1.26 + 0.52 for Tc99m-tetrofosmin and Tc99m-glucoheptonate respectively. No statistically significant difference between T/B ratio and T/N ratio of Tc99m-tetrofosmin and Tc99m-glucoheptonate was found; p values were 0.25 and 0.83 respectively. However there was significant difference (P=0.006) between the T/S ratio of Tc99m-tetrofosmin and that of Tc99m-glucoheptonate. CONCLUSION: Tc99m-tetrofosmin does not provide any incremental diagnostic information not provided by the blood brain barrier agent Tc99m-glucoheptonate.

Evaluation of single photon emission computerised tomography (SPECT) using Tc99m-tetrofosmin as a diagnostic modality for recurrent posterior fossa tumours.

BACKGROUND: Brain Single Photon Emission Computerised Tomography (SPECT) has been established as a potentially useful tool for the assessment of recurrent brain tumours. Though brain SPECT is exquisitely sensitive in detecting viable tumour tissue in the supratentorial region, its efficacy has not been evaluated till date in case of infratentorial posterior fossa tumours. AIM OF THE STUDY: To evaluate the diagnostic utility of brain SPECT in differentiating recurrence of tumour from post-radiation gliosis in the posterior fossa of the brain. SUBJECTS AND METHODS: Twenty-one patients with primary malignant posterior fossa brain tumour were evaluated by brain SPECT with Tc99m-Tetrofosmin as the tumour-seeking agent. Clinical behaviour of the tumour observed for a minimum period of one year after the SPECT study was taken as the gold standard. STATISTICAL ANALYSIS: The Chi-square test has been used to note the significance of the association between the clinical outcome and the SPECT finding. In addition, the sensitivity and specificity of brain SPECT were also calculated. RESULT: Brain SPECT in 4 patients revealed increased tracer concentration over the primary tumour bed, which was consistent with recurrent tumour. The clinical course was consistent with tumour recurrence in 13 of the 21 patients, which included 3 patients with positive SPECT study and 10 patients with negative SPECT study. Brain SPECT revealed recurrent tumour in 4 patients whereas clinical follow-up suggested recurrence in 13 patients. The clinical course was consistent with radiation necrosis in the remaining 8 patients. In 1 brain SPECT positive patient the clinical course was consistent with post-radiation gliosis. CONCLUSION: This study demonstrates that brain SPECT is not a sensitive diagnostic modality to differentiate recurrent tumour from post-radiation gliosis in the posterior fossa of the brain.

Lipid peroxidation in haemorrhagic shock and after transfusion of blood in dogs.

The present study was carried out on mongrel dogs. Haemorrhagic shock of different severities and duration was produced by exsanguination from an artery. After the required duration of shock, two third of the volume of blood withdrawn was transfused back into the animal. Effect of haemorrhage and reperfusion of blood after haemorrhagic shock on lipid peroxidation was assessed by measuring plasma malondialdehyde (MDA). Severity of shock was assessed from the haematocrit values. There was a significant increase (P < 0.05) in plasma MDA level after blood transfusion in a group having 40 mm Hg blood pressure as magnitude of shock and one hour as duration of shock (Group II) only. Haemotocrit value was also significantly low (P < 0.05) in this group after haemorrhagic shock. Results are suggestive of lipid peroxidation with ischaemic reperfusion in severe and long duration of shock.

Bone scanning for bone metastasis in carcinoma cervix.

AIM: Bone metastasis in cervical cancer is rare. With the aim of defining the frequency of bony metastasis in patients of carcinoma cervix, with clinical suspicion of metastasis, we performed bone scan in 38 such patients. RESULTS: Twelve out of the 38 patients were confirmed as having metastasis. All the patients were also detected by bone scan (100% sensitivity). CONCLUSION: Bone scan should be investigation of choice for screening patients of carcinoma cervix with symptoms suggestive of metastasis in all stage of the disease. Bone scan is the most sensitive method for detection of bone metastasis. Bone scan offers the additional advantages of allowing a review of the kidney size to look for ureteric involvement and subsequent hydronephrosis.

Subtypes of codeine cough syrup abusers.

This paper highlights the abuse potential of the codeine containing cough syrups, which may take two forms. One, experimental abuse in school or college students which later persists in a dependent pattern. Two, pre-existing opioid abusers, as a substitute which starts after the school or college years. The short term treatment outcome is better in the former group in that they are able to maintain abstinence for a relatively longer period.