Fertility preservation in women undergoing treatment for malignancies: a narrative review

Incidence of cancer is increasing in young patients with simultaneous improvement in survival secondary to advances in cancer treatment. Fertility preservation in this young population is often overlooked in view of priority of cancer treatment, however it is important to avoid distress and provide a good quality of life in these young patients of child bearing age. Fertility might be affected due to systemic therapy like chemotherapy, radiotherapy and surgery involving reproductive organs. Timely referral to reproductive specialist during the narrow window after diagnosis and before starting cytotoxic treatment is required. Embryo and oocyte cryopreservation remains the gold standard with ovarian tissue cryopreservation and re-transplantation undertaken for special situations. Patients undergoing pelvic or abdominal radiotherapy benefit from ovarian transposition and ovarian shielding. Medical gonado-protection with Gonadotropin releasing hormone agonist during cytotoxic chemotherapy remains an area of controversy with conflicting results with recent consensus for use in premenopausal breast cancer patients. Patients requiring surgery for endometrial cancer, ovarian cancer or cervical cancer may be considered for conservative management including conservative surgery for early stage cancers with specific indications with the intent to allow patients to complete family. Adequate patient counselling for oncology outcomes and fertility preservation are required to enable the patients to take informed decisions to choose the unconventional path of cancer management and uncertainty involving pregnancy and live births.

The role of cerebro placental ratio as a predictor of adverse perinatal outcome in uncomplicated term pregnancies

Background: Aim of the study was to study role of cerebro placental ratio (CPR) as a predictor of adverse perinatal outcome in uncomplicated term pregnancies.Methods: This prospective observational study took place at the Department of Obstetrics and Gynecology in SNMC Agra. We enrolled 140 uncomplicated antenatal cases with gestational age between 37 to 41 weeks, based on specific inclusion and exclusion criteria. Each participant underwent comprehensive assessments, including history-taking, examinations, and ultrasound color Doppler evaluations. We then analyzed perinatal outcomes in correlation with CPR.Results: Adverse perinatal outcomes i.e., asphyxia and NICU admissions were found to be significantly higher in patients with CPR<1. We also observed APGAR<7 at 1 and 5 minutes, cord blood ABG with pH<7.3, pO2<50, PCO2>45 in patients with CPR<1.Conclusions: CPR serves as a noninvasive means to identify fetal compromise in seemingly healthy pregnancies, aiding in the decision-making process regarding the mode of delivery. Clinical significance-CPR can assist in stratifying at risk pregnancies, subsequently influencing decisions regarding the mode and place of delivery.

A goat eye, wet lab model for training in Descemet membrane endothelial keratoplasty

Here we describe a new, non-human, ex-vivo model (goat eye model) for training surgeons in DMEK surgeons. In a wet lab setting, goat eyes were used to obtain a pseudo-DMEK graft of 8 mm from the goat lens capsule that was injected into another goat eye with the same maneuvers described for human DMEK. The DMEK pseudo-graft can be easily prepared, stained, loaded, injected, and unfolded into the goat eye model reproducing the similar maneuvers used for DMEK in a human eye, except for the descemetorhexis, which cannot be performed. The pseudo-DMEK graft behaves similar to human DMEK graft and useful for surgeons to experience and understand steps of DMEK early in learning curve. The concept of a non-human ex-vivo eye model is simple and reproducible and obviates the need for human tissue and the issues of poor visibility in stored corneal tissue.

Our experience on non-descent vaginal hysterectomy: a forgotten skill

Background: Hysterectomy is the most commonly performed major gynecological procedure. It can be done by different routes like abdominal or vaginal or laparoscopic route. Vaginal route of hysterectomy is undoubtedly less popular these days due to inclination towards laparoscopic route by both surgeon as well as patients. Keeping this is mind we have planned this paper to share our experience of Non Descent Vaginal Hysterectomy at a tertiary level hospital.Methods: A retrospective study was conducted at the department of obstetrics and gynecology of Vardhmann Mahavir Medical College & Safdarjung hospital, New Delhi over the period of one year. All the patients undergoing non -descent vaginal hysterectomy for benign indication with adequate vaginal access, without suspected adnexal pathology, who did not have any uterine descent were included in the study. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing was used to remove the uterus. Intraoperative findings and post-operative complications were recorded. Statistical analysis was done.Results: During the study period total 138 hysterectomies were performed. Most of the women were in the age group of 46 to 50 years (50%). All patients were parous. In 56% patients, uterine size was 8-10 weeks. Fibroid uterus (37%) followed by adenomyosis (27%) was the commonest indication for hysterectomy. The most common complication was febrile morbidity (n=13) followed by urinary tract infection (n=9).Conclusions: Non descent vaginal hysterectomy procedure in hand of a skilled surgeon can be done upto 14 weeks uterine size.

Preferred practice patterns and review on rosacea

Rosacea is a chronic, inflammatory facial dermatosis commonly found in fair skin tone population. Recent studies have shown the increasing prevalence in the dark skin tone population as well. Ocular involvement is very common and can occur without cutaneous features. Common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring, and rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. The management ranges from local therapy to systemic treatment, depending on the severity of the disease. There is a positive association between demodicosis and rosacea; however, causality is always argued. In this review, we describe the epidemiology, clinical features, and treatment of rosacea and ocular rosacea.

Analysis of success of vaginal birth after cesarean in relation to indication of primary caesarean section: a tertiary care experience

Background: Apprehensions related to vaginal birth after caesarean (VBAC) has reduced rates of successful vaginal trials over last decade. The objective of this study was to identify the indications of first caesarean section that can lead to a successful trial of labour in subsequent pregnancy.Methods: Retrospective cohort study was done between November 2014 and October 2017. Data from the case records was analysed.Results: Study over 3 years from 2014 to 2017 revealed fetal distress (82.7%),  breech (72.2%), transverse lie (66.7%), antepartum haemorrhage (56.2%) and twins with first non-cephalic (57.9%) have successful outcome of VBAC whereas obstructed labour (19.2%) and failed induction (18.4%) in previous pregnancy have poor outcome for VBAC.Conclusions: Attempts to allow trial of labour after one previous caesarean section with fetal distress, malpresentation and twins as indications of caesarean in previous pregnancy are safe and should be encouraged.

Knowledge, attitude and practice of people regarding rabies in rural area of Jammu: a cross sectional study

Background: Rabies although a fatal disease, remains a disease of low public health priority. India, about 18,000 to 20,000 cases is reported every year. Awareness about rabies is very poor among Indian population particularly in rural areas, due to which India and Bangladesh belongs to a high incident countriesMethods: Present study was descriptive and cross sectional in nature conducted in village Sai of block R.S. Pura. Data was collected by face to face interview of 200 participants using a pre structured questionnaire.Results: Knowledge about rabies was intermediate as majority of the people (78.5%) have heard about the diseases. About 144 persons enumerated hydrophobia as the most common symptom. Only 48.5% of the study participants knew that it is important to wash the wound with soap and running water and 53.5% respondents were in favor of consulting a doctor. 123 (61.5%) persons understood that rabies can be prevented by proper treatment of animal bite.Conclusions: Our study found that most of the respondents knew that dogs were mainly responsible for transmitting rabies. The recommended first aid for rabies is immediate flushing and washing of the wound with soap and water for a minimum of 15 minutes. This study revealed that most people placed the responsibility for controlling the dog population on the government.

Nonkeratinizing squamous cell carcinoma: A rare case report with oral involvement

Transitional cell carcinoma also known as nonkeratinizing carcinoma (NKCa) of sinonasal tract comprises 15%–20% of malignant sinonasal carcinoma. We are reporting the case of 48-year-old male with a history of tooth extraction. A computed tomography was done which showed opacity in the right nasal cavity. Incisional biopsy was taken which revealed NKCa (transitional type). Very few reported cases of this type of malignancy were found. A possible reason could be multiple synonyms such as cylindrical cell carcinoma, Schneiderian carcinoma, and transitional cell carcinoma

The effect and safety of placental blood drainage as a part of active management of third stage of labour in spontaneous vaginal delivery

Background: In placental cord drainage facilitates placental delivery in both vaginal and caesarean section deliveries. The present study was done to evaluate the effect and safety of placental blood drainage as a part of active management of third stage of labour to reduce the duration and blood loss during third stage of labour.Methods: The study was conducted in department of Obstetrics and, SN Medical College, Agra, Uttar Pradesh, India on 400 term pregnant women, with single live intrauterine fetus in cephalic presentation, without any complication. They were randomly divided into to study and control group. Study group: It comprised of 200 Gynaecology cases, underwent active management of third stage of labour with placental blood drainage. Control group: It comprised of 200 cases, underwent active management of third stage of labour (AMTSL) alone. Duration and blood loss during third stage were noted.Results: The mean duration of third stage of labour was 3.61±0.972mins in study group and 8.15±1.711mins in control group. The mean blood loss during third stage of labour was 168.14±76.703ml and 287.40±85.808ml in study and control group respectively.Conclusions: Duration of third stage, blood loss during third stage, and hemoglobin deference between pre and post-delivery were reduced significantly in study group than control group.

A prospective observational study conducted in tertiary teaching hospital of Uttar Pradesh to compare safety and efficacy of PPIUCD and interval IUCD (380A)

Background: The objective of this study was to compare the efficacy and safety of PPIUCD and interval IUCD.Methods: This was a prospective observational study conducted on women attending the OPD and indoor services of S.N. Medical college, Agra. 800 women willing for PPIUCD insertion were included in the study after informed consent excluding chorioamnionitis, PROM>18 hours, unresolved PPH and puerperal sepsis. Another 200 willing women were inserted interval IUCD according to MEC criteria of WHO. All were followed up for 1 year.Results: It was found that rate of expulsion was more in PPIUCD group compared to interval IUCD group (6%vs 1.5% p value <.05),rate of removal was almost similar in both groups (11.5%inPPIUCD and 14%in interval IUCD group), cause of removal was mainly social in PPIUCD group while bleeding was more in interval IUCD group compared to PPIUCD (85.7%vs26%).Conclusions: Postpartum insertion of IUCD is a safe effective, feasible and reversible method of contraception.

Renal Cell Carcinoma With Three Types Of Morphologies- A Rare Entity

Renal cell carcinomas(RCC) are the most common solid lesions of kidney with commonest subtype being clear cell type. Very few studies have reported synchronous presentation of three different morphological variants of RCC. We present a case of renal cell carcinoma in a 50 year old female presenting with renal mass. Microscopic examination showed presence of papillary, clear cell and collecting duct types of morphologies, which is a rare finding. Hence thorough sectioning and microscopic examination should be done to rule out possibility of simultaneous presence of different morphological varieties of RCC.

Prevalence of cardiovascular diseases in patients hospitalized for acute exacerbation of COPD: prospective observational study

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has considerable cardiovascular risk. Various cardiovascular diseases are common during exacerbations. Both diseases share several similarities such as older age of the patient, smoking as a common risk factor and symptoms of exertional dyspnea. Knowledge regarding the magnitude of underlying cardiovascular diseases during AECOPD is limited. Authors performed this study to assess the presence of different associated cardiovascular diseases (CVDs) in patients hospitalized for AECOPD and its effect on the outcome.Methods: It was a prospective observational study involving 436 patients of AECOPD divided to Group 1 (AECOPD with CVD- 137 (31.4%) patients) and Group 2 (AECOPD without CVD 299 (68.6%) patients). All the patients were subjected to full history taking, clinical examination, chest X-ray, spirometry, ECG and echocardiography.Results: COPD patients in exacerbation with CVD, were significantly more likely to have longer duration of hospital stay (p < 0.0001), high CRP level (p<0.001), more frequent mechanical ventilations (p < 0.001), two or more exacerbations per year (p <0.0001) and the mortality was (p<0.0001). Also, they have GOLD grade III/IV severe (43.5%) and very severe (19.5%) air flow limitation. The high percentage of them had (64.8%) pulmonary hypertension, (37.3%) systemic arterial hypertension, (31.5%) arrhythmia, (27.8%) ischemic heart diseases and (21.3%) heart failure.Conclusions: The prevalence of cardiovascular diseases (CVD) in patients hospitalized for COPD was high. Age, sex and CVD trends, as well as life style changes, should be considered when prevention and control strategies are formulated.

An epidemiological study to determine the prevalence and risk assessment of gingivitis in 5-, 12- and 15-year-old children of rural and urban area of Panchkula (Haryana).

Objective: The aim and objective of the present study was to determine the prevalence and severity of gingivitis and evaluate the factors associated with gingivitis in children residing in rural and urban areas of Panchkula. Materials and Methods: The present study was carried out on a sample of 1269 school children, aged 5, 12 and 15 years, randomly selected from the rural and the urban schools of Panchkula and gingival index was recorded as devised by Loe and Silness (1963) to assess the severity of gingivitis. A standardized questionnaire was self prepared, which was filled by the examiner prior to the clinical examination. The data were subjected to SPSS, version 13, and statistically analyzed using Chi test, F test, ANOVA test. Results: In the age group of 5 years, the children affected with gingivitis in the rural and the urban areas were 67 and 33%, respectively, which was statistically highly significant (P = 0.0001). In the age group of 12 years, the children affected with gingivitis in the rural and the urban areas were 94 and 92%, respectively (P = 0.537), whereas in 15‑year olds, the children affected with gingivitis in the rural and the urban areas were 98 and 64%, respectively (P = 0.0001). The children who brushed once a day had higher prevalence of gingivitis as compared to children who brushed more than once per day in all the age groups. Conclusion: The results showed that the percentage of children affected with gingivitis was significantly higher in the rural areas in 5‑ and 15‑year‑old children, but this trend was not seen in 12‑year age group, reflecting the lack of awareness in rural areas.

Corneal changes following collagen cross linking and simultaneous topography guided photoablation with collagen cross linking for keratoconus.

Purpose: To compare the outcome of Collagen cross‑linking (CXL) with that following topography‑guided customized ablation treatment (T‑CAT) with simultaneous CXL in eyes with progressive keratoconus. Materials and Methods: This was a prospective, non‑randomized single centre study of 66 eyes with progressive keratoconus. Of these, 40 eyes underwent CXL and 26 eyes underwent T‑CAT + CXL. The refractive, topographic, tomographic and aberrometric changes measured at baseline, 1, 3 and 6 months post‑operatively were compared between both groups. Results: After a mean follow‑up of 7.7 ± 1.3 months, the mean retinoscopic cylinder decreased by 1.02 ± 3.16 D in the CXL group (P = 0.1) and 2.87 ± 3.22 D in the T‑CAT + CXL group (P = 0.04). The Best corrected visual acuity increased by 2 lines or more in 10% of eyes in the CXL group and in 23.3% of eyes in the T‑CAT + CXL group. The mean steepest‑K reduced by 0.40 ± 3.71 D (P = 0.77) in the CXL group and by 2.91 ± 2.01D (P = 0.03) in the T‑CAT + CXL group. The sag factor and surface asymmetry index showed no significant change in the CXL group but reduced by 3.59 ± 5.94 D (P = 0.01) and 0.72 ± 1.18 (P = 0.02) respectively in the T‑CAT + CXL group. There was a significant increase in the highest posterior corneal elevation in both groups (9.57 ± 14.93 μ in the CXL group and 7.85 ± 9.25 μ in the T‑CAT + CXL group, P ≤ 0.001 for both). There was significantly greater reduction of mean coma (P < 0.001) and mean higher‑order aberrations (P = 0.01) following T‑CAT + CXL compared to CXL. Conclusions: CAT + CXL is an effective approach to confer biomechanical stability and to improve the corneal contour in eyes with keratoconus and results in better refractive, topographic and aberrometric outcomes than CXL alone.

Pantoea dispersa: an unusual cause of neonatal sepsis

Neonatal septicemia is the most important cause of neonatal mortality. A wide variety of bacteria both aerobic and anaerobic can cause neonatal sepsis. Genus Pantoea is a member of Enterobacteriaceae family that inhabits plants, soil and water and rarely causes human infections, however, Pantoea dispersa has not been reported as a causative organism for neonatal sepsis. We hereby report two neonates with early onset sepsis caused by Pantoea dispersa. Early detection and appropriate antibiotic therapy can improve overall outcome of this rare infection in neonates.

Crystal violet stain as a selective stain for the assessment of mitotic figures in oral epithelial dysplasia and oral squamous cell carcinoma.

Background: Assessment of mitotic figures (MFs) is routinely practiced as prognostic indicator in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC), but identification of MFs poses a problem in terms of staining characteristics. Aim: To evaluate effectiveness of crystal violet stain for staining of MFs and its comparison with hematoxylin and eosin (H and E) stain. Materials and Methods: Study sample includes archival tissues embedded in paraffin blocks diagnosed as OED (n = 30) and OSCC (n = 30). The control group comprised of tissue specimen from oral mucosa of healthy volunteers (n = 30). Two serial sections of each tissue specimen were stained separately with H and E stain and 1% crystal violet stain. The stained sections were observed under microscope for identification and counting of MFs. Data obtained was statistically analyzed by using the Man-Whitney U test. Results: A significant increase in number of MFs was observed in OED and OSCC in comparison with normal oral mucosa. There was a highly significant increase in number of MFs in crystal violet stained tissue sections when compared with H and E stain. Metaphase is the most commonly observed phase of mitosis in crystal violet stain when compared with H and E stain for all three groups. Conclusion: Crystal violet stain can be considered as selective stain for mitotic figures.

Palateless custom bar supported overdenture: A treatment modality to treat patient with severe gag reflex.

Objective: To suggest a custom bar supported overdenture treatment modality for prosthodontic management of patients with severe gag reflex. Background: Some patients have a severe gag reflex and cannot tolerate conventional maxillary complete dentures with maximum palatal coverage and extensions of all borders. The condition further gets complicated in patients suffering from respiratory problems along with severe gag reflex. Severe gagging acts as a barrier to treat such patients with accepted clinical procedures and prevent patients from wearing the prosthesis. By saving some of the remaining natural teeth and fabricating, a horse shoe shape palateless simple tooth or bar supported overdenture can be successfully used for treating such patients. Materials and Methods: The remaining maxillary right and left canines were prepared with the tapered round end diamond bur to receive copings of custom bar after intentional root canal treatment of same teeth. Impression was made with light body and putty of the polyvinyl siloxane elastomer with double step putty wash technique. Impression was poured with die stone. Wax pattern of copings with bar was fabricated with inlay wax which was invested and casted. After retrieving the bar, it was finished and its fit was evaluated. The coping-bar assembly was finally cemented with the glass ionomer cement. Palateless overdenture was fabricated by conventional technique used for the fabrication of complete denture. Conclusion: Palateless custom bar supported overdenture procedure can be successfully used for the management of patients with severe gag reflex with improved denture retention, stability, chewing efficiency and comfort of the patient.

Childhood Chronic Myeloid Leukemia with Monocytosis.

We report two cases of chronic myeloid leukemia (CML) in childhood presenting with monocytosis. History, physical examination and laboratory findings were in favor of juvenile myelomonocytic leukemia in both the cases, but reverse transcriptase polymerase chain reaction (RT-PCR) detected b2a2 and b3a2 transcript of p210 bcr-abl protein characteristic of major BCR breakpoint. Presence of monocytosis in early childhood suggests a viral infection or JMML but a possibility of CML with monocytosis needs to be considered.

HER-2/neu expression in lesions of uterine cervix: Is it reliable and consistent.

This study was conducted to evaluate the expression of HER-2/neu oncogene in the lesions of the uterine cervix and to determine its correlation with histological type of malignancy, grade and clinical stage of presentation. One hundred cervical specimens were included in this study. These comprised cases with diagnosis of benign epithelial lesions, squamous cell carcinoma, adenocarcinoma, carcinoma cervix with glandular differentiation and cervical intraepithelial neoplasia. HER-2/neu immunostaining was performed by streptovidin-biotin peroxidase method. Higher expression of HER-2/neu was noted in malignant lesions as compared to benign lesions. Intensity of staining also correlated with clinical stage of presentation, lymph node metastasis and presence of parametrial extension. The over-expression of HER-2 oncoprotein is associated with poor prognosis, metastatic potential and aggressive biological behavior.

Paraoxonases : Structure, gene polymorphism & role in coronary artery disease.

Paraoxonases (PONs) i.e. PON1, PON2, PON3 are basically lactonases. Of these, PON1 in addition has an efficient esterase activity and can hydrolyze organophosphates. The PONs prevent low density lipoprotein cholesterol (LDL-C) from peroxidation, thereby preventing atherosclerosis. The PON1 is exclusively associated with high density lipoprotein cholesterol (HDL-C) and its antioxidant activity is largely attributed to PON1 located on it. At present, PON1 status i.e. its activity and concentration, is considered to be more important than polymorphism alone, in prevention of coronary artery disease (CAD). Its activity has been found to be affected by a number of pharmacological agents, diet and other factors, thereby becoming a promising target for pharmacological intervention. The PON2 prevents cell mediated lipid peroxidation. However, little is known about the role of PON3. This review describes the structure, gene polymorphism, and factors affecting the activity of PONs, and their role in prevention of CAD.