A Study of Matrix Metalloproteinase-2 and Interleukin-18 in Preinvasive and Invasive Lesions of Cancer Cervix.

INTRODUCTION: Human Papilloma-Virus infection is the major event for cervical carcinogenesis, whereas host physiological changes may confer individual susceptibility and prognosis. So here, we aimed to compare serum levels of matrix metalloproteinase-2 (MMP-2) and interleukin-18 (IL-18) between cervical cancer patients and healthy controls. MATERIALS AND METHODS: In the present study, we enrolled 168 subjects (10 CIN I, 10 CIN II, 10 CIN III, and 54 invasive cervical cancers with 84 age-matched healthy controls). Serum levels were estimated by enzyme-linked immunosorbent assay. RESULTS AND DISCUSSION: The levels of serum MMP-2 showed a characteristic pattern of increasing trend with statistically significant P value on comparing pre-invasive lesions and cervical cancer versus healthy controls. However, IL-18 levels showed a decreasing trend in serum levels of controls versus cases with a statistically significant P value (P < 0.05). CONCLUSION: MMP-2 accentuates tissue damage and controls many interleukins secretion, which leads invasion and malignancy. Increased levels of MMP-2 and decreased circulating levels of IL-18 were found in cases. Hence, we raise an issue to study MMP-2 and IL-18 further for their diagnostic and prognostic marker role.

Factors affecting quality of life of cervical cancer patients: A multivariate analysis.

OBJECTIVE: The aim of good management for cancer survivors should not be limited to only clinical care, but rather it should also include best quality of life (QOL). The objective of this study was to find out various factors affecting QOL in cervical cancer patients so that by modifying these factors, the best QOL can be provided to them. MATERIALS AND METHODS: This was a prospective cohort study conducted in the Department of Obstetrics and Gynaecology and Department of Radiotherapy, King George's Medical University (KGMU), Lucknow, from May 2015 to July 2016. The cases were selected from patients visiting the outpatient department or who were admitted to the Department of Obstetrics and Gynaecology and Department of Radiotherapy, KGMU. The data information was collected in the form of face-to-face interview using European Organization for Research and Treatment of Cancer general cancer QOL Score 30 (EORTC QLQ C-30) and EORTC QOL questionnaire cervical cancer module (QLQ CX-24) questionnaire. RESULTS: QOL was assessed in 85 patients. Health-related QOL was separately studied in terms of overall general QOL and cancer cervix-specific QOL, and various factors affecting QOL were studied by multivariate analysis. CONCLUSION: Education, tobacco use, degree of differentiation of tumor, and size of tumor were the independent factors found to have statistically significant effect on QOL of cervical cancer survivors.

Prevalence of reproductive tract infections in women attending a tertiary care center in Northern India with special focus on associated risk factors.

BACKGROUND: Reproductive tract infections (RTIs) continue to present major health, social, and economic problems worldwide, and their complications are the most important causes of morbidity and mortality for women, especially in developing countries. Interest in RTIs and their management has increased tremendously because the presence of a RTI in the sexual partner increases the risk of acquisition of HIV. AIMS: The aim of this study is to know the prevalence of RTIs, its correlation with clinical features and associated risk factors in women of reproductive age group attending a tertiary care center in Lucknow. MATERIALS AND METHODS: The present study was conducted on 318 women of the reproductive age group (18-45 years) attending the RTI/sexually transmitted infection clinic at our center; they were evaluated for the prevalence of following RTIs: Chlamydia, gonorrhea, syphilis, bacterial vaginosis, trichomoniasis, and candidiasis; their correlation with clinical features and associated risk factors. RESULTS: The prevalence of reproductive tract infections in women attending our centre reported 9.7%. The prevalence of candidiasis was maximum (11.5%) followed by chlamydia (4.1%), syphilis (4.1%), bacterial vaginosis (1.73%), and trichomoniasis (0.57%). None of the women were found positive for gonorrhea. The most common presentation was genital discharge (52.8%) followed by lower abdominal pain (45.2%). CONCLUSION: The factors found to be significantly associated with RTI were illiteracy (P < 0.05), unemployment (P < 0.05), history of RTI in patient (P = 0.001), and the presence of RTI in their partner (P < 0.05). The genital discharge was the most common presentation.

Comparative study between liquid-based cytology & conventional Pap smear for cytological follow up of treated patients of cancer cervix.

Background & objectives: Cancer cervix is one of the most common forms of genital malignancy among Indian women. Recurrence is seen in a significant number of cases. The conventional cervical smear technique has inherent problems and screening and interpretation errors. This study was undertaken to assess the efficacy of liquid-based cytology (LBC) as a method for cytological follow up and detection of recurrence in treated cases of cancer cervix and to compare it with conventional Pap smear technique to find the best screening method for detection of recurrence in these patients. Methods: This cross-sectional study was conducted over a period of one year. Patients attending Gynecology and Radiotherapy outpatient departments for follow up after treatment of cancer cervix were included. Pap smear and LBC were taken in all cases. Colposcopy and biopsy were done for those having epithelial cell abnormality in cytology report. Colposcopy and biopsy were taken as gold standard for diagnosis of cancer cervix recurrence. Results: Ninety four treated patients of carcinoma cervix were studied. The diagnostic accuracy for detection of recurrence of conventional Pap smear was 79.16 per cent, and that of LBC was 97.6 per cent. The difference between the two methods was significant (P<0.001). Interpretation & conclusions: Our findings showed that LBC performed better than the conventional method of cytology to detect recurrence of squamous cell carcinoma. Its sensitivity, specificity as well as accuracy were much higher than conventional method. LBC can be a better method of cytological follow up of post-treated patients of cancer cervix.

Assessment of Quality of Life in Treated Patients of Cancer Cervix.

AIM: The aim of the study was to assess the quality of life (QoL) in women suffering from cancer cervix before and after the treatment, to study various factors affecting the QoL in these women, and to evaluate the impact of treatment modalities on the QoL. MATERIALS AND METHODS: Women with cervical cancer attending Department of Obstetrics and Gynecology and Department of Radiotherapy who met the eligibility criteria were interviewed with a structured questionnaire of QoL, the European Organization for Research and Treatment of Cancer QLQ30, and its Cervical Cancer Module (Cx24). The baseline observations were recorded when the patient first reported, second evaluation was done at 3 months posttreatment, and the third evaluation at 6 months posttreatment. QoL domains along with sociodemographic and clinicopathological variables were analyzed. RESULTS: A total of ninety patients were included for analysis, of which 5 were lost to follow up. A statistically significant improvement was found in physical, emotional function, pain, fatigue, and vaginal symptoms of the participants; however, there was no significant improvement in social, cognitive, or role functioning, body image, sexual activity, or sexual enjoyment. Vaginal and sexual function worsened significantly. Multivariate analysis showed that young women and those with a higher level of education had better QoL. Stage and type of cancer had little impact on the general QoL, but participants with earlier stage and well-differentiated cancer had better cancer cervix-specific QoL. CONCLUSION: The QoL of the participants in terms of physical (P = 0.04) and emotional functioning (P = 0.001) improved with treatment. Women with a higher level of education and early stage of disease had better QoL.

Efficacy of concurrent administration of mifepristone and misoprostol for termination of pregnancy.

In this prospective randomized parallel group study, subjects with a pregnancy of less than 63 d were randomized to receive either (i) 200 mg oral mifepristone plus 400 µg misoprostol per vaginally concurrently (group A); (ii) or the administration of misoprostol after 48 h (group B). Transvaginal sonography was performed on the 14th day of misoprostol administration to confirm complete abortion. The primary outcome was to compare the rates of complete abortion in two groups. Secondary outcomes were to compare induction abortion interval, side effects and compliance. A total of 200 subjects included in the study were randomized into groups A and B (100 each). Both the groups were comparable for age, parity, gestational age and history of previous abortion. The complete expulsion rate in group A was 96% (95% confidence interval (CI) 95.1-98.2%) and group B was 95% (95% CI 93.0-96.8%) (p > 0.100). A gestational age of more than 56 d was found to predict failure of treatment in both groups. The adverse effect profile in the two groups was the same. Efficacy of concurrent mifepristone and misoprostol in combination is similar to that when misoprostol is given 48 h later (ctri.nic.in CTRI/2010/091/001422).

The efficacy and safety of neoadjuvant chemotherapy in treatment of locally advanced carcinoma cervix.

OBJECTIVE: A prospective cohort study in a teaching hospital to assess the efficacy and safety of neoadjuvant chemotherapy in the treatment of locally advanced carcinoma cervix. METHOD: Neoadjuvant chemotherapy in the form of cisplatin 75 mg/m(2) and paclitaxel 135 mg/m(2) on day 1 and repeated at 14 days' interval for up to a maximum of three courses. RESULTS: Neoadjuvant chemotherapy in cervical cancer was effective in the downstaging of the disease. Downstaging was observed in 19.23 % of patients after two cycles and in 50 % of patients after three cycle of NACT. Operability increases to 33.3 and 38.4 % after two and three cycles of NACT, respectively. Complete pathological response was observed in 37.5 % of patients after NACT. No significant adverse effect in the feasibility of surgery was observed. CONCLUSION: The present study showed that neoadjuvant chemotherapy was an effective and well-tolerated mode of therapy with significantly less morbidity and mortality.

Post-placental intrauterine device insertion--a five year experience at a tertiary care centre in north India.

BACKGROUND & OBJECTIVES: In view of high rate of unintended pregnancy in our country, particularly in post-partum women, there is a need for reliable, effective, long-term contraception such as intrauterine device (IUD) in post-partum women. The present study was planned to evaluate the safety and efficacy of immediate post-partum IUD insertion in women delivering vaginally or by caesarian section in a tertiary care centre facility in north India during a period of five years. METHODS: The women recruited had CuT 200B insertion immediately after delivery of placenta in vaginal or caesarean delivery. Women having post-partum haemorrhage (PPH), anaemia, pre-labour rupture of membranes >18 h, obstructed labour and distorted uterine cavity by fibroid or by congenital malformation were excluded from the study. The women were followed up at 6 wk and 6 months after delivery. RESULTS: A total of 1317 women were included in the study. Of these, 1037 (78.7%) came for first follow up. The cumulative expulsion rate at the end of 6 months was 10.68 per cent. There was no case of misplaced IUD. INTERPRETATION & CONCLUSIONS: Although the expulsion rate for immediate post-partum insertion was higher than for interval insertion, the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in country where women have limited access to medical care.

Evaluation of visual inspection with acetic acid and Lugol's iodine as cervical cancer screening tools in a low-resource setting.

In view of the failure of cytology screening programmes for cervical cancer in developing countries, the World Health Organization suggested unaided visual inspection of the cervix after an application of acetic acid (VIA) and Lugol's iodine (VILI) as alternative screening methods. Our study evaluates the effectiveness of VIA and VILI compared to Pap smear as screening methods for carcinoma of the cervix in a low-resource setting. Three hundred and twenty-eight women were subjected to a Pap smear test, VIA, VILI and colposcopy. The results were as follows: Pap smear test (20.83%, specificity 98.38%), VIA (55.5%, 71.39%) and VILI (86.84%, 48.93%). Although VIA and VILI are less specific in comparison to the Pap smear test, they are more sensitive in detecting pre-invasive lesions. Hence VIA and VILI can be used as cervical cancer screening tools in low-resource settings.