A prospective study of comparison between transvaginal sonogram and histopathological examination in perimenopausal women with abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the most frequently encountered conditions in gynaecology practice and forms about 10% of all gynaecological admissions, the main concern in perimenopausal bleeding is that the bleeding could be the only external manifestation of many hidden serious pathologies of uterine-cavity. The objective of this study was to compare the results of transvaginal sonography (TVS) and drug and cosmetic (D and C) with histopathological examination (HPE) report of hysterectomy specimen in perimenopausal women with AUB.Methods: A prospective comparative study where 100 perimenopausal women with AUB were subjected to TVS then D and C and then the results were compared with histopathological report of the hysterectomized specimen.Results: With an endometrial thickness less than or equal to 15 mm the histopathology report is normal endometrium. When the endometrial thickness more than or equal to 15 mm the histopathology report is hyperplasia or carcinoma. Findings of TVS correlated well with histopathological report after hysterectomy. 14 cases of adenomyosis, 16 cases of myomatous polyp, and 6 cases of endometrial polyp missed by dilatation and curettage.Conclusions: TVS is a simple, non-invasive test to indirectly visualize the endometrial cavity and is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. Dilatation and curettage lags in detecting adenomyosis, endometrial and myomatous polyps, When TVS combined with dilatation and curettage, it can supplement the shortcomings of dilatation and curettage.

Glutathione S-transferase and metallothionein levels in the freshwater prawn Macrobrachium malcolmsonii exposed to mercury.

Healthy juveniles of M. malcolmsonii were exposed to 24.1 <g l-1 of mercury (96 hr LC50: 145 <g l-1 Hg) for a period of 21 days. The hepatopancreas and gills of the prawns were sampled on 8th, 15th and 22nd day of exposure. Accumulation and elimination of Hg, activity of glutathione S-transferase (GST), content of glutathione (GSH) and metallothionein (MT) level were studied. Mercury accumulation was found to be higher in the hepatopancreas (88.60 <g g-1) and lower in the gills (67.8 <g g-1). However, Hg elimination was found to be faster in the gills (62%) and slower in the hepatopancreas (58%). Therefore, the rate of Hg elimination did not match the rate of its uptake. The activity of GST was found to be higher in tissues of test prawns (5.94-9.13 nmol mg-1 protein min-1) on all sampling days when compared with controls (3.45-4.23 nmol mg-1 protein min-1). Similarly, the content of GSH was found to be higher in tissues of test prawns (0.80-1.43 <mol g-1 protein) on all sampling days when compared with controls (0.55-1.00 <mol g-1 protein). These results indicate the formation of glutathione conjugate in test prawns to eliminate Hg. The induction of MT level was also found to be higher in tissues of test prawns (57.50-75.76 nmol g-1 protein) on all sampling days when compared with control (20.24-45.22 nmol g-1 protein). This indicates the fact that sequestration of Hg has occurred for its easy elimination. Thus, induction of GST-GSH and MT ensured protection and adaptation of test prawns to thrive in Hg contaminated environment.

Ultrastructural observations in gills and hepatopancreas of prawn Macrobrachium malcolmsonii exposed to mercury.

The juveniles of M. malcolmsonii were exposed to 24.1 µg l-1 of Hg for a period of 21 days. The gills and hepatopancreas of test prawns were sampled and processed for electron microscopic observations. Mitochondria are the organelle most affected in the gills of test prawns. The number of mitochondria and the electron-density of the matrix were found to be less in test prawns. The in-folding of cell membrane associated with mitochondria was absent in test prawns. This suggests that operation of the mitochondrial pumps was affected in the gills of test prawns. Vacuoles with crystalline granular inclusions were noted in the gills of test prawns. These are suggestive of metal-rich inorganic deposits or granules representing detoxified dumps of Hg. In the hepatopancreas of test prawns, the tubules exhibit vacuoles with granular inclusion and the cell cytoplasm contains electron-dense granules, which indicate a storage detoxification of Hg. The mitochondria were shrunken in the hepatopancreas of test prawns. This suggests attenuation of its function. The rough endoplasmic reticulum appeared vesiculated and dilated. These reactions denote the hyperactivity of the rough endoplasmic reticulum. Membranous whorl-like structures with myelin fibers and residual bodies were seen in the hepatopancreas of test prawns. Such structures indicate the involvement of lysosomal breakdown in detoxification process. The ultrastructural alterations are suggestive of the operation of compensatory mechanisms within the test prawns to enable it to tolerate Hg toxicity. However, these alterations would have an impact on the cellular integrity of the gills and hepatopancreas and such alterations can be taken as ‘biomarkers’ for assessing Hg pollution in the aquatic environment.

Population based study of quality of diabetes care in southern India.

OBJECTIVES: To analyse and compare the clinical profile and glycaemic outcome in known diabetic cases in South Indian urban and periurban populations. MATERIAL AND METHODS: Details of known type 2 diabetic cases identified in a population survey of diabetes in Chennai city, Kanchipuram town and Periurban Villages (PUV) of Panruti in Tamil Nadu were analyzed (n=524, M:F, 256:268). Glycaemic outcome, prevalence of hypertension, dyslipidaemia and obesity, and treatment details were studied and compared between the areas. RESULTS: Mean age at diagnosis was 45.3 +/- 10.1 years, prevalence of hypertension was 57.4% (32% known), 48% were obese and a larger percentage (63.3%) had abdominal obesity Dyslipidaemia was present in nearly 50%. Abnormalities were more in urban areas than in PUV. Glycaemic target (post prandial glucose < or =160 mg/dl) was met by 28.8% only; better results were seen in PUV. In PUV 46% were not taking any diabetic treatment. As expected, majority of patients in all areas were treated with oral drugs. CONCLUSIONS: This population-based data indicated that the clinical outcome in known diabetic cases was far from satisfactory even in the city, where specialized diabetes care was available.

High prevalence of cardiometabolic risk factors among young physicians in India.

AIM: To assess the health status of young Indian doctors engaged in clinical practice compared with the general population. MATERIALS AND METHODS: During a continuing medical education programme on diabetes, data from 2499 doctors from urban and semiurban areas, (mean age 39.0 + 9.0 yrs), were collected and was compared with 3278 subjects from general population (mean age 37.0 +/- 8.0 yrs). Prevalence of diabetes, hypertension, obesity, dyslipidaemia, metabolic syndrome, smoking and alcohol consumption were analysed. RESULTS: Doctors had significantly higher (p<0.001) prevalence of all abnormalities except diabetes, compared with the general population (diabetes 13.3 Vs 14.8%, impaired glucose tolerance 10.7 Vs 7.4%, hypertension 35.6% Vs 27.0%, obesity 55.5% Vs 35.8%, metabolic syndrome 29.0% Vs 24.8%). Undetected cases of diabetes and hypertension were similar in both groups. Use of alcohol was more common among doctors. Other illness was less common among doctors (13.2% Vs 21.8%, p < 0.001). CONCLUSIONS: In India, doctors had high prevalence of metabolic disorders showing that they had not taken good care of their health. Doctors need to be motivated to practise good healthcare habits that they advocate to their clients.

Stress and undetected hyperglycemia in southern Indian coastal population affected by tsunami.

AIM: Natural calamities are known to result in higher stress conditions and also result in adverse health outcomes including development of non-communicable diseases. The impact of tsunami on mental stress and prevalence of hyperglycemic conditions was assessed in a population affected by the calamity in coastal populations of southern India. METHODS: Two populations similar in demography and physical characteristics, but, one affected by tsunami were selected for a comparative study. Subjects aged 20 years or above were randomly selected (control population n = 1176; tsunami population n = 1184). Details of stress were assessed using Harvard trauma questionnaire and scores were assigned. Glucose tolerance was assessed using 2h capillary blood glucose (75gms glucose load) and diagnosis was made using WHO criteria. RESULTS: Stress score was significantly higher in tsunami population. Although the total prevalence of diabetes was similar (control - 10.0 %; tsunami population - 10.5 %) prevalence of undetected diabetes (5.7 % vs. 3.8 %; Z = 9.54, P < 0.001) and impaired glucose tolerance (9.8 % vs. 8.3 %; Z = 12.83, P < 0.001) higher in the tsunami area. Stress score was higher in women and in the young in the tsunami area. CONCLUSION: Population affected by tsunami was under high stress and also showed a high prevalence of undetected diabetes and impaired glucose tolerance.

Effects of Hg and Cu on hemocytes-mediated functions in the prawn, Macrobrachium malcolmsonii.

Sublethal effects of Hg (9.6, 14.5 and 24.1 microg/l) and Cu (60.5, 90.8 and 150.5 microg/l) on the hemocytes-mediated functions in the juveniles of the economically important freshwater prawns, Macrobrachium malcolmsonii were investigated. The population of total hemocytes, percentile phagocytosis and superoxide anion production were found to be increased in test prawns exposed to the lowest sublethal concentration of these two metals in comparison to controls. This indicates the fact that a mechanism of host-defence was in an active state to encounter metal toxicity. The total hemocytes population, percentile phagocytosis and superoxide anion production were found to be decreased in test prawns exposed to intermediate as well as the highest sublethal concentrations of Hg and Cu when compared with controls. This suggests that high concentrations of both Hg and Cu have inhibitory effects on the immune functions of the hemocytes in the prawn, M. malcolmsonii.

Expression of heat shock protein 70 in freshwater prawn Macrobrachium malcolmsonii (H. Milne Edwards) following exposure to Hg and Cu.

Juveniles of freshwater prawn M. malcolmsonii were exposed to 1/6th concentration of LC50 of Hg and Cu for 48 hr. Sampling was done at 1 8, 12, 16, 24, 30, 36, 42 and 48 hr of exposure. Gill and hepatopancreas were dissected and subjected to one-dimensional electrophoresis. Western blotting was employed to determine the relative concentration of heat shock protein, hsp 70 (stress-70) in each sample. In the gill tissue of the prawn that had been exposed to Hg (0.024 mgHg 1(-1)), stress-70 was detected from the 1st hr till the 16th hr of exposure. But in the gills of Cu exposed prawn, synthesis of stress-70 appeared from the 1st hr till the 24th hr. Synthesis of hsp70 was not recorded after the 24th hr in the gills of exposed prawns. Synthesis of stress-70 was also found to be tissue-specific for both metals in this prawn. When the antibody probe raised against stress-70 was used, synthesis of stress-70 was not observed in hepatopancreas of prawns exposed to Hg or Cu, during the entire period of exposure of 48 hr. The expression of stress-70 in M. malcolmsonii following exposure to Hg and Cu is apparently only transient, and also a differential expression of stress-70 between gill and hepatopancreas was observed for both the metals.