PET/CT in the Evaluation of CAR-T Cell Immunotherapy in Hematological Malignancies.

Chimeric antigen receptor (CAR)-T cell-based immunotherapy has emerged as a path-breaking strategy for certain hematological malignancies. Assessment of the response to CAR-T therapy using quantitative imaging techniques such as positron emission tomography/computed tomography (PET/CT) has been broadly investigated. However, the definitive role of PET/CT in CAR-T therapy remains to be established. [18F]FDG PET/CT has demonstrated high sensitivity and specificity for differentiating patients with a partial and complete response after CAR-T therapy in lymphoma. The early therapeutic response and immune-related adverse effects such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome can also be detected on [18F]FDG PET images. In otherwise asymptomatic lymphoma patients with partial response following CAR-T therapy, the only positive findings could be abnormal PET/CT results. In multiple myeloma, a negative [18F]FDG PET/CT after receiving B-cell maturation antigen-directed CAR-T therapy has been associated with a favorable prognosis. In leukemia, [18F]FDG PET/CT can detect extramedullary metastases and treatment responses after therapy. Hence, PET/CT is a valuable imaging tool for patients undergoing CAR-T therapy for pretreatment evaluation, monitoring treatment response, assessing safety, and guiding therapeutic strategies. Developing guidelines with standardized cutoff values for various PET parameters and tumor cell-specific tracers may improve the efficacy and safety of CAR-T therapy.

Standardising the role of a digital navigator in behavioural health: a systematic review.

As the number and availability of digital mental health tools increases, patients and clinicians see benefit only when these tools are engaging and well integrated into care. Digital navigators-ie, members of health-care teams who are dedicated to supporting patient use of digital resources-offer one solution and continue to be piloted in behavioural health; however, little is known about the core features of this position. The aims of this systematic review were to assess how digital navigators are implemented in behavioural health, and to provide a standardised definition of this position. In January, 2023, we conducted a systematic literature search resulting in 48 articles included in this systematic review. Results showed high heterogeneity between four attributes of digital navigators: training specifications, educational background, frequency of communication, and method of communication with patients. Reported effect sizes for depression and anxiety were medium to large, but could not be synthesised due to study heterogeneity and small study sample size. This systematic review was registered with PROSPERO (CRD42023391696). Results suggest that digital navigator support can probably increase access to, engagement with, and clinical integration of digital health technology, with standards for training and defined responsibilities now emerging.

Nutritional Assessment of Lactarius drassinus and L. controversus from the Cold Desert Region of the Northwest Himalayas for Their Potential as Food Supplements.

Kargil is a cold desert with hostile ecological conditions such as low temperature and precipitation, as well as difficult terrains. However, several wild mushrooms thrive well under such an extreme environment. Despite their abundance, the chemical composition of indigenous mushrooms has not been explored. This study aimed to assess the potential of two wild edible mushrooms from Kargil, Lactarius drassinus and Lactarius controversus, as food supplements by evaluating their nutritional and nutraceutical properties. Nutritional attributes such as total protein, available carbohydrates, soluble sugars, and vitamins were found to be high in the mushroom species. Furthermore, high mineral accumulation and relatively lower antinutrient concentrations resulted in higher bioavailabilities of Zn, Fe, Ca, and Mg. Gas-chromatography-mass-spectrometry-based metabolite profiling revealed that although the two mushroom species showed similar metabolite compositions, their relative concentrations differed. Sugars were the predominant compounds identified in both the species, with sugar alcohols being the major contributor. The second most abundant class of compound in L. drassinus was amino acids, with 5-oxoproline as the major contributor. On the other hand, fatty acids were the second most abundant compounds in L. controversus, with high oleic and linoleic acid concentrations. In the ultra-performance-liquid-chromatography-based quantification of phenolic compounds, chlorogenic acid was found to be highest in in terms of its concentration in both the mushrooms studied, followed by quercetin dihydrate and gallic acid in L. drassinus and L. controversus, respectively. Moreover, high antioxidant activities attributable to their high phenol, flavonoid, and carotenoid concentrations were observed. Overall, the two mushrooms offer well-balanced sources of nutritional and nutraceutical compounds, making them healthy foods.

Comparative Evaluation of Instrumentation Time and Quality of Obturation amongst Pediatric Rotary Endodontic System: An In Vivo Study.

Aim: This study assesses the instrumentation time and quality of obturation of three pediatric rotary endodontic systems-GT nickel-titanium (NiTi) (Prime Pedo), controlled memory (CM) NiTi (Pro-AF-Baby Gold) and NiTi-titanium oxide (NiTi-TiO) (Kedo SG Blue). Materials and methods: A total of 60 children aged 4-8 were chosen at random for the study based on inclusion criteria that required pulpectomy in any of the primary molars and were separated into three groups of 20 samples, each based on the file system employed. The instrumentation time during the preparation of the canal is recorded using a stopwatch. An expert dentist was blinded to the instrumentation type and showed the periapical radiograph, which he or she graded depending on the quality of the obturation by categorizing it as underfill, optimal fill, or overfill. The observations were then recorded, tabulated, and statistically analyzed for the results. Results: The least amount of instrumentation time was needed for NiTi-TiO (group III) files, followed by NiTi-CM (group II) and NiTi-GT (group I). NiTi-TiO (group III) has the most optimally filled and least underfilled obturations among the three rotary endodontic systems mentioned. Also, NiTi-TiO (group III) and NiTi-CM (group II) have the least similar overfilled obturations when compared with NiTi-GT (Group I). Conclusion: We conclude that NiTi-TiO needed the least amount of instrumentation time and generated the maximum optimally filled obturations based on our observations. Clinical significance: Pediatric rotary endodontic systems are more convenient to use and reduce chairside time; thus, their use in children with behavior control issues might be more suitable. How to cite this article: Kohli A, Chhabra J, Sharma K, et al. Comparative Evaluation of Instrumentation Time and Quality of Obturation amongst Pediatric Rotary Endodontic System: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):338-343.

Arbuscular mycorrhiza differentially adjusts central carbon metabolism in two contrasting genotypes of Vigna radiata (L.) Wilczek in response to salt stress.

The study aimed at investigating Arbuscular Mycorrhiza (AM) mediated metabolic changes in two genotypes of mungbean (Vigna radiata) differing in their salt tolerance in presence of salt stress (100 mM NaCl). Colonisation by Claroideoglomus etunicatum resulted in higher growth, photosynthetic efficiency, total protein content, and lower levels of stress markers, indicating alleviation of stress in mungbean plants. AM differentially upregulated the components of Tricarboxylic acid (TCA) cycle in salt tolerant (ST) and salt sensitive (SS) genotypes that could be correlated to AM-mediated moderation in nutrient uptake. Under salt stress, while maximum increase in the activity of α-ketoglutarate dehydrogenase (65%) was observed in mycorrhizal (M)-ST; the increase in isocitrate dehydrogenase (79%) and fumarase (133%) activities was maximum in M-SS plants over their non-mycorrhizal (NM) counterparts. Apart from TCA, AM also affected gamma-aminobutyric acid (GABA) and glyoxylate pathways. Activities of enzymes implicated in GABA shunt increased in both the genotypes under stress resulting in increase in GABA concentration (46%). Notably, glyoxylate pathway was induced by AM in SS only, wherein M-SS exhibited significantly higher isocitrate lyase (49%) and malate synthase (104%) activities, reflected in higher malic acid concentration (84%), than NM under stress. The results suggest that AM moderates the central carbon metabolism and strategizes towards boosting the formation of stress-alleviating metabolites such as GABA and malic acid, especially in SS, bypassing the steps catalysed by salt-sensitive enzymes in TCA cycle. The study, therefore, advances the understanding on mechanisms by which AM ameliorates salt stress.

Comparative Evaluation between Lavender Essential Oil and Patchouli Essential Oil in Aromatherapy and Its Effect on Dental Anxiety in Children.

Introduction: Dental fear and anxiety is the most common distressing problem for children. Management of dental anxiety in children is one of the most difficult tasks in dentistry. Recently, alternative and contemporary medical approaches such as aromatherapy have received much attention. The potential effects of essential oils such as lavender and patchouli have been found to reduce anxiety, improve mood, and increase sedation. Thus, the study was conducted to compare the evaluation of lavender and patchouli essential oils used in aromatherapy and their effect on dental anxiety in children. Aim: To compare the efficacy of lavender and patchouli essential oils in aromatherapy and its effect on dental anxiety in children. Materials and methods: A total of 60 children between 6 and 12 years were randomly allocated to either an experimental or control group that received lavender and patchouli before dental treatment. Child anxiety was measured by using the Chotta Bheem-Chutki scale. A pulse oximeter was used to record the pulse rate. Data was tabulated and analyzed by Statistical Package for the Social Sciences (SPSS) software. Results: There was a significant reduction in anxiety score and pulse rate between the intervals. Statistical differences were observed in the lavender group compared to patchouli oil. Conclusion: The positive effects of both lavender and patchouli oil on children can be used to reduce anxiety in children. In our study, lavender oil showed slightly better results than patchouli oil. How to cite this article: Tripathy S, Kohli A, Sharma K, et al. Comparative Evaluation between Lavender Essential Oil and Patchouli Essential Oil in Aromatherapy and Its Effect on Dental Anxiety in Children. Int J Clin Pediatr Dent 2023;16(5):681-685.

Evaluation of obturation techniques in primary teeth among Indians.

Evaluation of four distinct obturating methods namely endodontic pressure syringe (n=40), reamers (n=40), Lentulo spirals driven through slow-speed handpiece (n=40) and incremental filling technique (n=4) using zinc oxide eugenol (ZOE) paste as obturating material in deciduous teeth is of interest to dentist. Hence, we are interested determining the effective obturation methodology using CBCT. Handpiece driven lentuspirals helped in optimum obturation in high percentage of root canals. Low percentage of optimally filled root canals was observed in reamers technique. Moreover, under filled root canals was low in lentuspirals technique of obturation. Thus, overfilled root canals were high in endodontic pressure syringe and reamers obturation technique.

Insights into the molecular aspects of salt stress tolerance in mycorrhizal plants.

Salt stress is one of the major abiotic stresses that severely affect plant growth and yield, and also affect the livelihood of people all around the world. Arbuscular mycorrhizal fungi (AMF) colonize majority of terrestrial plants, including halophytes, xerophytes and glycophytes, and facilitate their functioning by various physiological, biochemical and molecular processes. In the past two decades, significant progress has been made to understand the role of AMF in mitigating salt stress and improving plant growth and productivity under saline conditions. Several studies focusing on the biochemical and physiological mechanisms that mycorrhizal plants employ to combat salt stress have been carried out. This review reinforces such studies and gives further insights into the molecular aspects of tolerance to salt stress in the plants colonized by AMF. It emphasises on the role of AMF in sensing and signalling salt stress, expression of aquaporin-encoding genes, Na+/H+ antiporters and transporters involved in Na+ exclusion, CNGCs and late embryogenesis abundant proteins in relation to salt stress tolerance. Further, this paper also reviews the accrual of compatible osmolytes, phytohormones and nitric oxide for understanding the benefits of this symbiosis under saline environment, and provides a benchmark information to understand the contribution of mycorrhizal symbiosis at molecular level and will attract attention of researchers to develop and highlight the future research programs in this field.

Arbuscular Mycorrhiza-Mediated Regulation of Polyamines and Aquaporins During Abiotic Stress: Deep Insights on the Recondite Players.

Environmental stresses of (a)biotic origin induce the production of multitudinous compounds (metabolites and proteins) as protective defense mechanisms in plants. On account of the regulation of some of these compounds, arbuscular mycorrhizal fungi (AMF) reinforce the inherent tolerance of plants toward the stress of different origins and kind. This article reviews two specific fundamental mechanisms that are categorically associated with mycorrhiza in alleviating major abiotic stresses, salt, drought, and heavy metal (HM) toxicity. It puts emphasis on aquaporins (AQPs), the conduits of water and stress signals; and polyamines (PAs), the primordial stress molecules, which are regulated by AMF to assure water, nutrient, ion, and redox homeostasis. Under stressful conditions, AMF-mediated host AQP responses register distinct patterns: an upregulation to encourage water and nutrient uptake; a downregulation to restrict water loss and HM uptake; or no alterations. The patterns thereof are apparently an integrative outcome of the duration, intensity, and type of stress, AMF species, the interaction of fungal AQPs with that of plants, and the host type. However, the cellular and molecular bases of mycorrhizal influence on host AQPs are largely unexplored. The roles of PAs in augmenting the antioxidant defense system and improving the tolerance against oxidative stress are well-evident. However, the precise mechanism by which mycorrhiza accords stress tolerance by influencing the PA metabolism per se is abstruse and broadly variable under different stresses and plant species. This review comprehensively analyzes the current state-of-art of the involvement of AMF in "PA and AQP modulation" under abiotic stress and identifies the lesser-explored landscapes, gaps in understanding, and the accompanying challenges. Finally, this review outlines the prospects of AMF in realizing sustainable agriculture and provides insights into potential thrust areas of research on AMF and abiotic stress.

Comparative Evaluation of Chemo-mechanical and Rotary-mechanical Methods in Removal of Caries with Respect to Time Consumption and Pain Perception in Pediatrc Dental Patients.

AIM AND OBJECTIVE: To compare the clinical efficiency in removal of caries by the two different methods of caries removal.To compare the treatment time between chemomechanical and rotary mechanical methods of caries removal.To compare the pain perception of the patient during the two different methods (chemomechanical and rotary mechanical) of dentin caries removal. MATERIALS AND METHODS: The Carisolv system for caries removal, consisting of a solvent gel and a specially designed hand instrument, as compared to the conventional method of caries removal, i.e., Airotor. Sixty patients in the age-group of 6-14 years, having Black's class I dentinal caries with the cavity in the molars, were enrolled for the study. RESULTS: The time for caries removal with Carisolv and Airotor was, respectively, 7.17 ± 1.57 and 8.00 ± 1.56 minutes. Thus, the mean time taken was also significantly higher in group II as compared to group I (t = 4.805; p < 0.001). HOW TO CITE THIS ARTICLE: Katiyar A, Gupta S, Gupta K, et al. Comparative Evaluation of Chemo-mechanical and Rotary-mechanical Methods in Removal of Caries with Respect to Time Consumption and Pain Perception in Pediatrc Dental Patients. Int J Clin Pediatr Dent 2021;14(1):115-119.

Secreted in Xylem Genes: Drivers of Host Adaptation in Fusarium oxysporum.

Fusarium oxysporum (Fo) is a notorious pathogen that significantly contributes to yield losses in crops of high economic status. It is responsible for vascular wilt characterized by the browning of conductive tissue, wilting, and plant death. Individual strains of Fo are host specific (formae speciales), and approximately, 150 forms have been documented so far. The pathogen secretes small effector proteins in the xylem, termed as Secreted in Xylem (Six), that contribute to its virulence. Most of these proteins contain cysteine residues in even numbers. These proteins are encoded by SIX genes that reside on mobile pathogenicity chromosomes. So far, 14 proteins have been reported. However, formae speciales vary in SIX protein profile and their respective gene sequence. Thus, SIX genes have been employed as ideal markers for pathogen identification. Acquisition of SIX-encoding mobile pathogenicity chromosomes by non-pathogenic lines, through horizontal transfer, results in the evolution of new virulent lines. Recently, some SIX genes present on these pathogenicity chromosomes have been shown to be involved in defining variation in host specificity among formae speciales. Along these lines, the review entails the variability (formae speciales, races, and vegetative compatibility groups) and evolutionary relationships among members of F. oxysporum species complex (FOSC). It provides updated information on the diversity, structure, regulation, and (a)virulence functions of SIX genes. The improved understanding of roles of SIX in variability and virulence of Fo has significant implication in establishment of molecular framework and techniques for disease management. Finally, the review identifies the gaps in current knowledge and provides insights into potential research landscapes that can be explored to strengthen the understanding of functions of SIX genes.

Therapeutic potential of nanolipoidal α-terpineol in combating keratitis induced by Pseudomonas aeruginosa in the murine model.

Developing non-antibiotic alternatives is one of the top priorities in healthcare and community settings, especially for combating biofilm-associated infections caused by multi-drug resistant pathogens. The therapeutic efficacy of nanolipoidal α-terpineol was explored against Pseudomonas aeruginosa induced keratitis using the mice model in the present study. Topical administration of nanostructured lipid carriers (NLCs) containing α-terpineol (αT) resulted in significant reduction in bacterial count in corneal tissue by 4 log10 on 5th post infection day. The protective efficacy of αT-NLCs demonstrated improvement in corneal histopathology, decreased the levels of various inflammatory markers including myeloperoxidase (MPO) and reactive nitrogen intermediates (RNI). Further, αT-NLCs treatment showed immunomodulatory effects by manipulating the production of inflammatory cytokines, tumor necrotic factor (TNF-α), macrophage inhibitory protein-2 (MIP-2) and interleukin-2 (IL-2) in infected eyes. In addition, ex vivo studies exhibited enhanced susceptibility of P. aeruginosa towards serum and macrophages in presence of αT-NLCs. A potent antibiofilm effect was also observed by αT-NLCs against P. aeruginosa which was confirmed by fluorescent microscopic analysis. Hence, based on the results of the present study, a novel therapeutic is being proposed for the treatment of biofilm associated keratitis caused by P. aeruginosa.

Exploring the Therapeutic Efficacy of Zingerone Nanoparticles in Treating Biofilm-Associated Pyelonephritis Caused by Pseudomonas aeruginosa in the Murine Model.

Biofilms of Pseudomonas aeruginosa can cause complicated urinary tract infections especially in people with indwelling catheters which may result in pyelonephritis. Microorganisms in biofilm demonstrate high resistance to both antibiotics and host protection mechanisms, often resulting in chronic and difficult-to-treat infections. This study is aimed to assess in vivo and ex vivo efficacy of Zingerone nanoparticles (Z-NPs) against P. aeruginosa biofilm-associated murine acute pyelonephritis. In the present study, Zingerone and chitosan acted synergistically in the form of Z-NPs and found to be nontoxic to the kidney cell lines as depicted in MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] assay demonstrating their cytocompatibility. In vivo experiments indicated that Z-NPs (100 mg/kg) treatment reduced P. aeruginosa pathogenicity and enhanced the clearance of bacterial count from the renal and bladder tissue. Z-NPs improved the disease outcome by lowering the levels of various inflammatory markers, and histopathological examination revealed better recovery in renal and bladder tissue. Besides, ex vivo efficacy also confirmed that Z-NPs enhanced serum bactericidal effect along with increased phagocytic uptake and intracellular killing of P. aeruginosa as confirmed by fluorescent microscopy. To the best of our knowledge, this is the first study to provide evidence that Z-NPs are effective therapeutic agents for combating P. aeruginosa associated pyelonephritis.

Controlled hypotension for FESS: A randomised double-blinded comparison of magnesium sulphate and dexmedetomidine.

BACKGROUND AND AIMS: Intense bleeding during general anaesthesia (GA) is the major limitation during functional endoscopic sinus surgery (FESS). This study was aimed to compare the efficacy of dexmedetomidine and magnesium sulphate (MgSO4) for controlled hypotension in FESS. METHODS: Sixty eight patients undergoing FESS were randomised to receive either dexmedetomidine 1 µg/kg over 10 min followed by infusion at 0.2 to 0.7 µg/kg/h (Group D) or MgSO4 40 mg/kg over 10 min followed by an infusion at 10 to 15 mg/kg/h (Group M). Anaesthesia and infusion rates for study drugs were maintained with sevoflurane to keep MAP between 60-70 mmHg throughout the surgery. The time to reach the target MAP, the number of patients requiring a minimum and maximum infusion doses of study drugs were noted. RESULTS: The mean time to achieve target mean arterial pressure (MAP) was less in group D (10.59 ± 2.04) as compared with (21.32 ± 4.65 min) group M (P < 0.001). The target MAP was achieved between 5-15 min in 73.52% patients (Group D) with an infusion dose of 0.2-0.4 µg/kg/h of dexmedetomidine without the use of sevoflurane, while 82.35% patients in group M required 4% sevoflurane along with >12-15 mg/kg/hr infusion of MgSO4 to achieve target MAP in 10-20 min. CONCLUSION: Dexmedetomidine is superior to MgSO4 in achieving target MAP in lesser time with minimum infusion dose.

First-Trimester Inflammatory Markers for Risk Evaluation of Pregnancy Hypertension.

Introduction: Hypertension in pregnancy is one of the potential causes of maternal and fetal morbidity and mortality. It complicates 7-10% of pregnancies. As of today, prediction of pregnancy hypertension is not possible. Aim and Objectives: Evaluation of pregnancy associated plasma protein-A (PAPP-A), free ß-human chorionic gonadotropin, tumor necrosis factor-α (TNF-α) and interferon gamma (INF-γ) in establishing a biomarker or combination of biomarkers for the early identification of pregnancy hypertension. Methodology: This prospective study was carried out in two phases. Phase I was a cohort study in which 2000 pregnant women were enrolled in their first trimester (11 + 0 to 13 + 6 weeks of gestation) and followed till delivery. Women who developed hypertension were compared with normotensive cohort (women who remained normotensive till term). Phase II was a case-control study. The women who were diagnosed with hypertension in phase I were cases and their controls were matched for gestational age and sample storage time from normotensive cohort population. Two additional proinflammatory markers TNF-α and INF-γ were evaluated in this case-control population. Results: Out of 2000 women, 199 women developed hypertension and 1454 women remained normotensive throughout their pregnancy. Among 199 hypertensive women, 151 (9.13%) cases had gestational hypertension, 45 (2.72%) had preeclampsia (PE) and 3 (0.18%) had eclampsia (E). First trimester mean arterial pressure (MAP) (p < 0.001) and body mass index (BMI) (p < 0.001) were found significantly higher in hypertensive women when compared with normotensive women. Maternal serum levels of PAPP-A (p < 0.001) were significantly low in hypertensive women as compared to normotensive women, while free ß-hCG (p = 0.59) was high, but the difference was not statistically significant. TNF-α (p < 0.001) and INF-γ (p = 0.014) both were high in hypertensive women. When all biomarkers were combined we found the positive predictive value (PPV) of 51.6% an negative predictive value (NPV) of 71.4%. Conclusion: Increased levels of proinflammatory cytokines suggest the role of underlying inflammation in pathogenesis of pregnancy hypertension, and low PAPP-A may be attributed to impaired implantation. Combining biomarkers may improve the prediction of pregnancy hypertension in the early stages of gestation. NPV of 71.4% depicts that if woman has all biomarkers in normal ranges during first trimester, she will have 71.4% chances of remaining normotensive during pregnancy.

Reference centile charts of first-trimester aneuploidy screening & Doppler parameters for Indian population.

BACKGROUND & OBJECTIVES: The risk estimation for foetal aneuploidies in the first trimester of pregnancy uses reference curves based on western data. The objective of this study was to construct the reference curves of first-trimester foetal aneuploidy screening parameters for the Indian women. METHODS: : Cross-sectional data were obtained from 1204 singleton pregnancies between the crown-rump length (CRL) of 40-84 mm. Linear regression models were constructed; the mean, median and standard deviation were derived as a function of CRL. RESULTS: The mean value of CRL was 61.3 mm. The regression analysis showed a significant correlation between all variables and CRL (P< 0.001). There was a positive correlation of CRL with nuchal translucency (NT) (y=0.010x+0.629, R2=0.116) and pregnancy-associated plasma protein-A (PAPP-A) (y=0.107x-1.079, R2=0.173), whereas inverse correlation was seen with free ß-human chorionic gonadotropin (ß-hCG) (y=-0.409x+75.025, R2=0.018) and Doppler parameters pulsatility index (PI) (y=-0.008x+1.924 R2=0.053). The centile charts of NT, PAPP-A, free ß-hCG and uterine artery (Ut A) Doppler PI were constructed. INTERPRETATION & CONCLUSIONS: The reference centile charts of first trimester aneuploidy screening along with Doppler parameters were derived in Indian pregnant women. These centile charts may be used as a reference for clinical use in Indian population.

Use of first-trimester placenta growth factor concentration to predict hypertensive disorders of pregnancy in a low-risk Asian population.

OBJECTIVE: To determine the value of placenta growth factor (PlGF) for predicting hypertensive disorders of pregnancy (HDP) in a low-risk population when used either alone or in combination with other markers. METHODS: A prospective observational cohort study was conducted among women with singleton pregnancy in the first trimester in New Delhi, India, between October 1, 2013, and September 30, 2016. First-trimester measures included maternal history, body mass index (BMI), mean arterial pressure (MAP), Doppler uterine artery pulsatility index, and serum levels of biomarkers (including PlGF). RESULTS: Among 1725 women, 208 (12.1%) developed HDP; 74 (35.6%) of these cases were early onset. Mean PlGF levels were significantly lower among cases than among controls (30.42 ± 10.22 vs 37.31 ± 13.28 pg/mL; P<0.001). As a biomarker for prediction of HDP, PlGF fared better than pregnancy-associated plasma protein A (PAPP-A): area under the curve 0.685 (95% confidence interval [CI] 0.620-0.750; P<0.001) versus 0.659 (95% CI 0.593-0.726; P<0.001). The highest odds ratio was found for MAP (8.369, 95% CI 5.752-12.215). The combination of PlGF, PAPP-A, BMI, MAP, and Doppler uterine artery pulsatility index provided an area under the receiver operating characteristic curve of 0.876 (95% CI 0.833-0.919; P<0.001). CONCLUSION: Combining PlGF concentration with biochemical and biophysical markers provided a good screening test for HDP during the first trimester.

First-trimester reference centiles of fetal biometry in Indian population.

AIM AND OBJECTIVE: To create crown-rump length (CRL)-based biometric chart for fetus in the first trimester among the Indian population. MATERIAL AND METHODS: Cross-sectional data were obtained from 400 singleton pregnancies between 11 and 14 weeks gestation with a normal outcome. Linear regression models were constructed; the mean and SD were derived as a function of CRL. RESULTS: There was a positive correlation of CRL with nuchal translucency (NT) (y = 0.0102x + 0.6307 R2 = 0.1177), biparietal diameter (BPD) (BPD = 0.032*CRL +0.185 R2 = 0.765), occipito-frontal diameter (OFD), lateral ventricular diameter (LV), abdominal circumference (AC) (AC = 0.944*CRL +9.684 R2 = 0.668), femur length (FL) (FL = 0.222*CRL -4.734 R2 = 0.661), fetal weight (FW) (FW = 1.328*CRL -10.41 R2 = 0.662). The regression models and centile charts of NT, BPD, OFD, LV, AC, and FW were constructed. Taking FW as the independent variable, a linear equation of BPD, AC, and FL to calculate weight was constructed. CONCLUSIONS: The first-trimester centile charts of fetal parameters can be used as a reference for Indian population in the determination of gestational age or other adverse outcomes.

Adverse fetal outcome: is first trimester ultrasound and Doppler better predictor than biomarkers?

AIMS AND OBJECTIVES: To evaluate the predictive value of first trimester biomarkers and ultrasound in determining adverse fetal outcomes in a low risk Asian population. MATERIAL AND METHOD: All low risk, singleton pregnancies between 11 and 14 weeks gestation underwent ultrasound with uterine artery Doppler along with PAPP-A and free ß-hCG estimation, and were followed till delivery to observe the outcome. The adverse fetal outcomes detected were structural anomaly, aneuploidy, intrauterine growth restriction, preterm birth and stillbirth (SB). RESULTS: Out of 3500 women screened, 417 cases had adverse fetal outcome in the absence of maternal complication, 2151 had normal outcome. Major structural anomaly was detected in first trimester in 17/28 (60.7%) cases. The most important markers for adverse fetal outcome were increased uterine artery pulsatility index (UPI) (p = 0.028, OR 1.5, 95% CI: 1.05-2.38, AUC 0.56) for IUGR, nuchal translucency (p = 0.001, OR 1.7, 95% CI: 1.11-2.77, AUC 0.60) for major anomaly and low PAPP-A (p = 0.017, OR -0.075, 95% CI: 0.87-0.98, AUC 0.621) for SB. CONCLUSION: UPI, NT and PAPP-A in the first trimester are significant markers of adverse fetal outcome, although the sensitivity and specificity are not high they have a high negative predictive value.

Role of maternal factors, PAPP-A, and Doppler in screening for early- and late-onset pregnancy hypertension in Asian population.

OBJECTIVE: To determine the predictive value of biochemical markers, uterine artery Doppler, and maternal factors in predicting early-onset (EO) and late-onset (LO) pregnancy hypertension. METHODOLOGY: All singleton pregnancies between 11 and 13 weeks and 6 days gestation underwent estimation of body mass index (BMI), mean arterial pressure (MAP), uterine artery Doppler pulsatality index (PI, and resistance index), biomarker PAPP-A, and free ß-hCG. Women who developed hypertension were treated as cases and normotensives were taken as controls. The cases were further divided into EO and LO hypertension. The comparison was undertaken by appropriate statistical analysis. RESULTS: Pregnancy hypertension was seen in 399 (13.2%) women. EO hypertension was seen in 153 (38.3%), whereas LO was observed in 246 (61.7%). The significant markers for predicting hypertension in pregnancy were maternal age, BMI, MAP, uterine artery Doppler PI, and PAPP-A. A combination of MAP and BMI was a better predictor (sensitivity and specificity 80% and 52%, respectively) than PAPP-A and Doppler combined (sensitivity and specificity 62% and 52%, respectively). When all the above markers were combined, the sensitivity and specificity of the test was 73% and 70%, respectively. EO hypertension was better predicted compared with LO. The negative predictive value (NPV) of the test was above 90%, suggesting that if a woman had the marker below the cutoff, there was more than 90% chance that she would not develop hypertension later in pregnancy. CONCLUSION: A combination of variables increased the sensitivity and specificity of the test for hypertension in pregnancy. The markers examined were a predictor of EO hypertension, with a high NPV, making it a good screening test.