Evaluation of maternal and perinatal morbidity and mortality in eclampsia by early termination of pregnancy

 Background: Eclampsia is one of the leading causes of maternal mortality in India.Methods: A prospective observational study was done on 200 pregnant women admitted with antepartum eclampsia in Malda Medical College from 1 April 2017 to 30 October 2019. Group A included patients who delivered through vaginal route within 10 to 12 hrs of eclampsia by stabilisation of patients while Group B included subjects who underwent early caesarean section for uncontrolled convulsions or poor Bishop score. Maternal and perinatal outcomes were compared between the groups. Data was recorded in a pretested performa and was analyzed using appropriate statistical methods with SPSS.Results: Caesarean section (group B) was done in 130 cases (65%) while vaginal delivery (group A) was done in 65 cases (37.5%). Group A had higher maternal mortality (10.7%) in comparison to group B (4.6%) which was statistically not significant (p=0.1075). There were 32 neonatal deaths (24.6%) and 11 still births (8.46%) in group A while there were 12 neonatal deaths (18.46%) and 3 still births (4.61%) in group B. There was a statistically significant difference (p<0.0001) between the groups with respect to total perinatal deaths.Conclusions: Antenatal and intranatal eclampsia should be managed by early termination of pregnancy preferably with Caesarean section. Early presentation and timely decision to terminate pregnancy will improve the maternal and perinatal outcome.

Combined modality treatment: Outcome in patients with Hodgkin's lymphoma

Background: Hodgkin's lymphoma (HL) can be treated with combined modality treatment (CMT) to limit long-term toxicities in the early favorable stage. Early unfavorable and advanced stage HL is mainly treated with chemotherapy followed by radiation to the bulky site. This study examines the impact of CMT in early as well as advanced stage HL. Materials and Methods: From 2001 to 2011, 125 patients with Stage I to IV HL were analyzed. Median age of the patients was 25 years (range 12–68 years). CMT, chemotherapy, and radiation alone were given to 51, 64, and 10 patients, respectively. Chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) was given to 100 patients, 6 patients received ABVD-like regimen, and 9 patients received cyclophosphamide, vincristine, procarbazine, and prednisone regimen. Radiotherapy (RT) was given to 61 (49%) patients, involved field RT to 55 (90%), and extended-field RT to 6 (10%) patients, respectively. Median radiation dose was 30 Gy (18–40 Gy). Results: All 25 patients with early-stage achieved complete response (CR) with CMT. At a median follow-up of 70 months (range 12–230 months), relapse was seen in two patients (1 local and 1 distant). Of 26 patients with advanced stage, 25 achieved a CR and 1 had stable disease with CMT. Relapse occurred in one patient (distant). In patients with early-stage treated with chemotherapy only ( n = 30, 24%), 9 patients had relapse (4 local and 5 distant) while in those with RT only ( n = 10, 8%), 4 developed distant relapse. In patients with advanced stage treated with chemotherapy only ( n = 34, 27%), 8 relapsed (5 local and distant, 3 distant only). Patients with relapse were salvaged with CMT ( n = 6), chemotherapy ( n = 15), or RT ( n = 3). Two patients have died. Five years' disease-free survival (DFS) in patients with early favorable stage, early unfavorable stage, and advanced stage was 91%, 82%, and 73%, respectively ( P = 0.026). DFS was significantly better with CMT than chemotherapy or radiation alone. Five years' overall survival (OS) was 93%, 92%, and 84%, respectively ( P = 0.139). Second malignancy occurred in 3 (2.4%) patients; carcinoma of the tongue, pseudomyxoma peritonei, and non-HL each, respectively. None of these patients had received prior radiation. Conclusion: CMT improved DFS in patients with HL. OS was similar in all patients irrespective of treatment combinations. The incidence of second malignancy was 2.4%

Ultrasonography guided fine needle aspiration cytology in patients with laryngo-hypopharyngeal lesions / Punção aspirativa por agulha fina guiada por ultrassonografia em pacientes com lesões laríngeo-hipofaríngeas

Abstract Introduction: Laryngeal lesions are usually evaluated by microlaryngoscopy/direct laryngoscopy under anaesthesia for disease mapping and tissue diagnosis. However patients with anticipated airway compromise due to laryngeal mass may require either a protective tracheotomy or emergency tracheotomy to secure the airway. To minimise risk of unplanned tracheotomy and expedite the diagnosis we performed ultrasound-guided transcutaneous fine needle aspiration cytology. Objective: To evaluate the feasibility and performance of ultrasound-guided transcutaneous fine needle aspiration cytology of suspicious/recurrent laryngo-hypopharyngeal masses. Methods: Fine needle aspiration cytology was performed under ultrasound guidance. Twenty- four patients were recruited, of which 17 had a pure laryngeal lesion; 6 patients had laryngo-pharyngeal, and one patient had a base tongue lesion with supra-glottis extension. Results: Out of 24 patients, 21 had positive cytology for squamous cell carcinoma, 2 patients had non-diagnostic cytology (atypical cells) and the other had inadequate tissue for definitive diagnosis. Patients with negative and inconclusive cytology underwent direct laryngoscopy biopsy, which was positive for squamous malignancy. All patients tolerated the procedure well and no adverse events were noted. Conclusion: Although direct laryngoscopy remains the standard of care in evaluation of laryngo-hypopharyngeal lesions, this pilot study has shown that ultrasound-guided transcutaneous fine needle aspiration cytology was feasible as an out-patient procedure, employing safe and sensitive technique enabling rapid diagnosis and avoiding the need for direct laryngoscopy under GA for tissue diagnosis.

Resumo Introdução: As lesões laríngeas são geralmente avaliadas por microlaringoscopia/laringoscopia direta sob anestesia para mapeamento da doença e diagnóstico tecidual. No entanto, em pacientes com comprometimento prévio das vias aéreas devido à lesão laríngea, pode ser necessária uma traqueostomia protetora ou traqueostomia de emergência para assegurar as vias aéreas. Para minimizar o risco de uma traqueostomia não planejada e facilitar o diagnóstico, realizamos punção aspirativa por agulha fina guiada por ultrassonografia transcutânea. Objetivo: Avaliar a viabilidade e o desempenho da punção aspirativa por agulha fina guiada por ultrassonografia transcutânea em lesões laríngeo-hipofaríngeas suspeitas/recorrentes. Método: A punção aspirativa por agulha fina foi realizada sob orientação ultrassonográfica. Foram recrutados 24 pacientes, 17 com lesão laríngea apenas, 6 com lesão laríngeo-faríngea e um com lesão na base da língua com extensão supraglótica. Resultados: Dos 24 pacientes, 21 apresentaram citologia positiva para carcinoma espinocelular, 2 citologia não diagnóstica (células atípicas) e o outro tecido inadequado para o diagnóstico definitivo. Os pacientes com citologia negativa e inconclusiva foram submetidos à biópsia através de laringoscopia direta, que foi positiva para lesão maligna espinocelular. Todos os pacientes toleraram bem o procedimento e nenhum evento adverso foi observado. Conclusão: Embora a laringoscopia direta continue a ser o padrão de cuidado na avaliação das lesões laríngeo-hipofaríngeas, este estudo piloto demonstrou que a punção aspirativa por agulha fina guiada por ultrassonografia transcutânea é uma técnica viável, ambulatorial, segura e sensível, permite rápido diagnóstico e evita a necessidade de laringoscopia direta sob anestesia geral para diagnóstico tecidual.

Knowledge and attitude regarding HIV/AIDS among patients attending medicine outpatient department in C. C. M. Medical College and Hospital, Durg

Background: Acquired immunodeficiency syndrome (AIDS) is one of the deadliest diseases that modern medicine has ever had to tackle. Understanding the knowledge about HIV/AIDS in general populations will help in formulating strategy for prevention and treatment. With this background, this study was conducted to assess the knowledge and awareness about HIV/AIDS among general population.Methods: A cross sectional study was conducted at C.C.M. Medical College and Hospital, Durg during December 2018 to January 2019. The data was collected from 450 patients attending the medicine outpatient department. Study subjects were selected using convenient sampling technique. Patients giving consent and willing to participate were included in the study. The data was collected in predesigned and pretested questionnaire.Results: 77.11% study participants were aware that unprotected sex can lead to transmission of HIV, 73.78% knew that shaking hands will not transmit the disease. 79.8% knew that use of condom can prevent transmission of HIV/AIDS. Overall males had better knowledge than females. 76.85% said they would behave friendly with people having HIV/AIDS and 69.78% were willing to take care of relatives with HIV.Conclusions: This study indicates that majority participants have good knowledge about difference between HIV and AIDS, modes of transmission and prevention though they were not completely aware of it. The proportion of those with lack of correct knowledge though comparatively less, needs to be taken as a challenge and addressed through well planned health educational activities at various platforms including teaching hospital premises.

Role of narrow band imaging in the diagnosis of laryngeal lesions: Pilot study from India

INTRODUCTION: Narrow band imaging (NBI) is a new imaging technique developed to improve the diagnostic accuracy of head and neck cancers by depiction of tumor-specific neo-angiogenesis. The purpose of this study was to assess the value of NBI in the diagnosis of laryngeal lesions. AIM: To assess the sensitivity and specificity of combined white light endoscopy (WLE) and NBI compared with WLE alone in the diagnosis of laryngeal lesions. SETTINGS AND DESIGN: Prospective study. MATERIALS AND METHODS: Thirty consecutive patients with various laryngeal lesions scheduled for microlaryngoscopic evaluation underwent WLE followed by NBI. Endoscopic NBI findings were classified into five types (I–V) according to the intraepithelial papillary capillary loop features. Types I–IV are considered benign, whereas type V is considered malignant. The observations were compared with histopathology. STATISTICAL ANALYSIS: Sensitivity, specificity, and positive and negative predictive values for the diagnosis of malignancy (i.e., invasive carcinoma and carcinoma in situ) by means of NBI with WLE were calculated. RESULTS: The sensitivity of WLE combined with NBI (100%) was higher than WLE alone (82.6%) in detecting laryngeal cancers. NBI helped in identifying four malignant lesions missed by WLE alone. Two children with respiratory papillomatosis also demonstrated type V pattern, a potential pitfall, leading to an overall positive predictive value of 92% and a negative predictive value of 100%. CONCLUSION: Combining NBI with WLE increases the sensitivity of detection of laryngeal cancer and its precursor lesions. NBI is also useful in some benign lesions as well as in post-radiotherapy patients.

Endobronchial Smooth Muscle Tumors: A Series of Five Cases Highlighting Pitfalls in Diagnosis

BACKGROUND: Primary endobronchial smooth muscle tumors (SMTs), which are extremely rare, include endobronchial leiomyomas and leiomyosarcomas. Clinically, SMTs present with signs and symptoms of bronchial obstruction, and lack specific radiological findings. Thus, histopathological examination is required for accurate diagnosis as well as for tumor grading. We examined the histomorphological and immunohistochemical features of endobronchial SMTs and highlighted pitfalls in diagnosis, particularly when using small biopsies. METHODS: Cases of primary endobronchial SMTs diagnosed at our Institute over the last 6 years (2012–2017) were retrieved from the departmental archives. Histopathological features and immunohistochemistry performed for establishing the diagnosis were reviewed. RESULTS: Five cases of SMTs occurring in endobronchial locations were identified. These included three cases of leiomyoma, and two cases of leiomyosarcoma. The age distribution of patients ranged from 13 to 65 years. Leiomyomas showed more consistent staining with smooth muscle markers (smooth muscle actin, desmin, and smooth muscle myosin heavy chain), while tumors of higher grade showed variable, focal staining, leading to erroneous diagnosis, especially on small biopsies. CONCLUSIONS: The diagnosis of endobronchial SMTs relies on histopathological examination, for both confirmation of smooth muscle lineage and determination of the malignant potential of the lesion. Appropriate immunohistochemical panels including more than one marker of smooth muscle differentiation are extremely valuable for differential diagnosis from morphological mimics, which is necessary for instituting appropriate management.

Current updates on laboratory techniques for the diagnosis of male reproductive failure / 亚洲男科学杂志(英文版)

The incidence of male reproductive failure leading to infertility, whether due to delayed parenthood, environmental issues, genetic factors, drugs, etc., is increasing throughout the world. The diagnosis and prognosis of male subfertility have become a challenge. While the basic semen assessment has been performed for many years, a number of studies question the value of the traditional semen characteristics. This is partly due to inadequate methods and standardization, limited knowledge of technical requirements for quality assurance, and an incomplete understanding of what clinical information a semen assessment can provide. Laboratories currently performing semen and endocrine assessment show great variability. The World Health Organization (WHO) manual for the evaluation of semen has been the core of andrology and fertility evaluation that has helped in further development of this field over many years. These include the physical appearance of the ejaculate, assessments of sperm count, motility, vitality, morphology, and functional aspects of the sperm and semen sample. These tests also include male endocrine profile, biochemical evaluation of the semen, detection of antisperm antibodies in serum, the use of computer-aided sperm analysis (CASA), sperm DNA integrity, and its damage due to oxidative stress. Assisted reproductive techniques (e.g., IVF, ICSI) have shown great success but are too expensive. Further development in this field with newer techniques and extensive training/instructions can improve accuracy and reduce variability, thus maintaining the quality and standards of such an evaluation. There is an urgent need to have standardized training centers and increased awareness in this area of men's health for reproductive success.

Bilateral congenital alveolar synechiae?a rare cause of trismus / 대한악안면성형재건외과학회지

Congenital alveolar synechiae is a rare anomaly mostly presenting in association with cleft palate. Owing to reduced mouth opening, feeding difficulties, and compromised airway in extreme cases along with presentation in early neonatal period, these patients present unique challenges to the surgeon as well as the anesthetist. Here, we discuss the surgical and anesthetic management of this entity in a 12-month-old female child.

Super Vasmol Hair Dye: An Emerging Fatal Poison.

Hair dye poisoning is not rare, but is an emerging poisoning in India. The main component of super vasmol hair dye causing toxicity is paraphenylenediamine (PPD) and can cause rhabdomyolysis, laryngeal edema, severe metabolic acidosis, acute renal failure (ARF) and myocarditis. There is no specific antidote for hair dye poisoning and treatment is mainly supportive. We report a case of suicidal ingestion of hair dye that presented with angioneurotic edema, rhabdomyolysis and ARF. Our patient improved completely with dialysis and symptomatic management. Various pathogenesis of its complications are also explained in this case report.

Green Synthesis of AgNPs Stabilized with biowaste and their antimicrobial activities

In the present study, rapid reduction and stabilization of Ag+ ions with different NaOH molar concentration (0.5 mM, 1.0 mM and 1.5 mM) has been carried out in the aqueous solution of silver nitrate by the bio waste peel extract of P.granatum. Generally, chemical methods used for the synthesis of AgNPs are quite toxic, flammable and have adverse effect in medical application but green synthesis is a better option due to eco-friendliness, non-toxicity and safe for human. Stable AgNPs were synthesized by treating 90 mL aqueous solution of 2 mM AgNO3 with the 5 mL plant peels extract (0.4% w/v) at different NaOH concentration (5 mL). The synthesized AgNPs were characterized by UV-Vis spectroscopy, TEM and SEM. Further, antimicrobial activities of AgNPs were performed on Gram positive i.e. Staphylococcus aureus, Bacillus subtilius and Gram negative i.e. E. coli, Pseudomonas aeruginosa bacteria. The AgNPs synthesized at 1.5 mM NaOH concentration had shown maximum zone of inhibition (ZOI) i.e. 49 ± 0.64 in E. coli, whereas Pseudomonas aeruginosa, Staphylococcus aureus and Bacillus subtilius had shown 40 ± 0.29 mm, 28 ± 0.13 and 42 ± 0.49 mm ZOI respectively. The MIC value of 30 g/mL observed for E. coli Whereas, Staphylococcus aureus, Bacillus subtilius and Pseudomonas aeruginosa had shown 45 µg/mL, 38 µg/mL, 35 µg/mL respectively. The study revealed that AgNPs had shown significant antimicrobial activity as compared to Streptomycin.

Response of aerobic rice to Piriformospora indica.

Rice cultivation under aerobic condition not only saves water but also opens up a splendid scope for effective application of beneficial root symbionts in rice crop unlike conventional puddled rice cultivation where water logged condition acts as constraint for easy proliferation of various beneficial soil microorganisms like arbuscular mycorrhizal (AM) fungi. Keeping these in view, an in silico investigation were carried out to explore the interaction of hydrogen phosphate with phosphate transporter protein (PTP) from P. indica. This was followed by greenhouse investigation to study the response of aerobic rice to Glomus fasciculatum, a conventional P biofertilizer and P. indica, an alternative to AM fungi. Computational studies using ClustalW tool revealed several conserved motifs between the phosphate transporters from Piriformospora indica and 8 other Glomus species. The 3D model of PTP from P.indica resembling “Mayan temple” was successfully docked onto hydrogen phosphate, indicating the affinity of this protein for inorganic phosphorus. Greenhouse studies revealed inoculation of aerobic rice either with P. indica, G. fasciculatum or both significantly enhanced the plant growth, biomass and yield with higher NPK, chlorophyll and sugar compared to uninoculated ones, P. indica inoculated plants being superior. A significantly enhanced activity of acid phosphatase and alkaline phosphatase were noticed in the rhizosphere soil of rice plants inoculated either with P. indica, G. fasciculatum or both, contributing to higher P uptake. Further, inoculation of aerobic rice plants with P. indica proved to be a better choice as a potential biofertilizer over mycorrhiza.

In vitro and In vivo Effects of the Leaf Extracts of Cassia tora and Cassia sophera in Reducing the Cytotoxicity and Angiogenesis.

Aim: Consumption of C. tora and C. sophera of family caesalpinaceae as leafy vegetables by local folklore has initiated this study to investigate the cytotoxic effect and antiangiogenic effect of their leaf extracts on human cancer cell lines and chick embryo respectively. Study Design: For in vitro studies colon and hepatocarcinoma cell lines were used. For in vivo studies chicken egg chorioallantoic membrane (CAM) assay is used. Methodology: Methanol, ethyl acetate and petroleum ether extracts of leaves were tested for antiproliferative activity using MTT assay, on HCT15 and Hep G2 cell lines. In vivo CAM model was used to study anti-angiogenesis activity of extracts using filter paper discs. Results: All extracts of both plants were toxic to tested cell lines with increasing concentrations and time. Ethyl extract of Cassia tora was found to be most toxic on Hep G2 cell line, though ethyl extract and methanol extracts of both plants were found to give strong antiproliferative activity. Hep G2 was found to be most sensitive to all extracts than HCT15 as inhibited by low IC50 values. Ethyl acetate extracts of both plants exhibited greater anti-angiogenesis activity than other extracts.

Sphincter preservation in anal cancer: a brief review

Management of anal cancer is a challenge. The goal of treatment is to eradicate tumor without sacrificing the anal sphincters. The idea of organ preservation emerged following the discovery of a high complete response rate from preoperative combined chemoradiation [CRT] prior to abdominoperineal resection. CRT is widely accepted as the standard therapy for treating anal squamous cell cancer. The combination of external beam radiotherapy with interstitial brachytherapy increases the dose to the tumor volume and decreases dose to normal tissues. The current goal is to avoid colostomy, and surgery has become a salvage or secondary therapy. In this article, we review the non-surgical management of anal cancer with special emphasis on CRT, role of intensity modulated radiation therapy and brachytherapy

Fas receptor (CD95) & Fas ligand (CD178) expression in patients with tobacco-related intraoral squamous cell carcinoma.

Background & objectives: Fas receptor and Fas Ligand (FasL) system has been implicated in the resistance to apoptosis, insensitivity to chemotherapy and in providing immune privileged status to most of the tumours. However, no reports are available on Fas and FasL expression in patients with tobacco-related oral carcinoma. Therefore, the present study was undertaken to observe Fas and FasL expression and their correlation with clinicopathological features as well as cell cycle parameters. Methods: Immunohistochemistry for Fas, FasL and DNA flow cytometry for cell cycle parameters was successfully done on 41 paraffin embedded tumour and 10 normal samples. The results were evaluated for possible association of Fas and FasL with clinicopathological features and cell cycle parameters. Results: Weak Fas expression was observed on the cell membrane only in 2 of 41 (5%) oral tumours while FasL immunoreactivity was seen in 26 of 41 (63.4%) tumours. In contrast, all ten normal oral tissues exhibited strong cytoplasmic and membrane Fas receptor immunoreactivity but absence of FasL staining. Older patients, greater tumour size and lymph node positivity were found to be associated with high expression of FasL. Significantly higher (P<0.01) expression of FasL was observed in oral tumours with aggressive DNA pattern like aneuploidy and high S-phase fraction. Interpretation & conclusions: Downregulation of Fas receptor and up-regulation of Fas ligand appear to be an important feature of tobacco-related intraoral carcinoma. Association of FasL expression with advanced clinical stage and aggressive DNA pattern suggests that the Fas and FasL system may be used as an important prognostic variable in patients with tobacco-related intraoral squamous cell carcinoma.

Correlation of cyclin D1 expression with aggressive DNA pattern in patients with tobacco-related intraoral squamous cell carcinoma.

Background & objectives: Cyclin D1 has been strongly implicated in cell proliferation particularly in the G1/S checkpoint of the cell cycle, and prognoses in human malignancies. We investigated the correlation between cyclin D1 overexpression and clinicopathological features as well as cell cycle parameters to understand its clinical significance in patients with tobacco-related oral squamous cell carcinoma (OSCC). Methods: Immunohistochemistry for cyclin D1 and DNA flowcytometry for cell cycle parameters was done on paraffin embedded tumour samples from 45 patients with OSCC Results: Higher expression of cyclin D1 was observed only in 30 (66.6%) of 45 cases that correlated with advanced age (P <0.02), higher tumour stage ((P<0.01), histological differentiation and lymph node metastasis (P <0.01). Analysis of nuclear DNA pattern revealed cyclin D1 immunoreactivity in tumours with aggressive DNA pattern such as aneuploidy ((P<0.05) and higher S phase fraction ((P<0.04). Interpretation & conclusions: Higher expression of cyclin D1 in oral cancer appears to be closely linked to cell proliferation, differentiation and lymph node invasion. Pre-operative evaluation of cyclin D1 in biopsy specimen may be useful in planning the most appropriate treatment strategies in patients with tobacco-related OSCC.

Role of PPAR, a Nuclear Hormone Receptor in Neuroprotection.

Peroxisome proliferator-activated receptors (PPARs) belong to the nuclear receptor superfamily. PPAR-alpha is involved in wound healing, stimulation of lipid and folic acid catabolism, inflammation control, inhibition of ureagenesis and peroxisome proliferation. The PPAR/ is involved wound healing, cell proliferation, embryo implantation, adipocyte differentiation, myelination alteration and apoptosis. The PPAR is involved in fat, lipid and calorie utilization, sugar control, inflammation control and macrophage (MQ) matutation. Homocysteine (Hcy) binds to nuclear peroxisome proliferator activated receptor. Increase in PPAR expression decreases the level of nitrotyrosine and increases endothelial nitric oxide concentration, decreases metalloproteinase activity and expression as well as elastinolysis and reverses Hcy-mediated vascular dysfunction. The PPAR initially recognized as a regulator of adipocyte development has become a potential therapeutic target for the treatment of diverse disorders. In addition, the activation of PPAR receptor ameliorates neurodegenerative disease. This review focuses on the recent knowledge of PPAR in neuroprotection and deals with the mechanism of neuroprotection of central nervous system disorder by PPAR.