Study of Prevalence of Abnormal Pap Smear and its Associated Risk Factors in HIV Positive Women: A Cross-sectional Study.

Objective: 1. To determine the prevalence of pre malignant cervical lesions in HIV positive women using conventional Pap smear. 2. To determine the association between various risk factors in HIV positive women and abnormal cytology on Pap smear. Design: A cross-sectional study was conducted in Bangalore Medical College in which eligible HIV-positive women underwent Pap smear, human papillomavirus (HPV) testing and cervical biopsy. Methods: Retropositive women attending gynaec OPD during the study period were taken into the study after taking informed consent. Women who fulfilled the inclusion criteria were subjected to Pap smear. Bethesda system of classification was used for reporting the Pap smear. Women with abnormal Pap smear were further evaluated by HPV DNA testing and cervical biopsy. Results: Cervical cytology was abnormal in 30% of the HIV-positive women, out of which 10% had HSIL, 15% had LSIL and 5% had ASCUS. Age at first sexual intercourse < 17 years (p = 0.009), past H/O STI (p = 0.0001), women with husband's having multiple sexual partners (p = 0.0001), women with CD4 count < 350 cells/micro-litre (p = 0.0001) were significant risk factors associated with abnormal Pap smear. Conclusion: Invasive cervical cancer is considered a preventable disease because of its long preinvasive state. Therefore, screening for premalignant cervical lesions represents an opportunity to prevent women developing cervical carcinoma.

Multimodality management of leiomyosarcoma of the cervix.

We present the case of a young female patient who presented to the outpatient department with a history of bleeding per vagina, diagnosed with leiomyosarcoma of the cervix; the patient underwent total abdominal hysterectomy with pelvic lymph node dissection. In this article, we mainly discuss multimodality therapy in the management of an unusual variety of tumour in the uterine cervix.

Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study.

BACKGROUND: Anemia is one of the most common nutritional deficiency disorders affecting the pregnant women in the developing countries. Anemia during pregnancy is commonly associated with poor pregnancy outcome and can result in complications that threaten the life of both mother and fetus. OBJECTIVE: The objective of the study was to estimate the prevalence of anemia among pregnant women and to determine its association with maternal and fetal outcomes. SETTINGS AND DESIGN: This study design was a prospective, observational, community-based study. SUBJECTS AND METHODS: Four hundred and forty-six pregnant women were included in the study from three primary health centers in Kolar district by multistage sampling technique and were followed up till 1 week after delivery. STATISTICAL ANALYSIS: The data were analyzed using SPSS version 22; correlation coefficient, Chi-square test, and logistic regression were used. RESULTS: There was a significant overall improvement in the hemoglobin levels of pregnant during the follow-up (10.3-10.72 gm%). About 35.6% of the women had maternal or fetal morbidity. Anemia was one of the main pregnancy-related complications (62.3%), other complications include difficult labor (3%), postpartum hemorrhage, and preeclampsia 1.6% each abortions/stillbirths (3.5%). The fetal complications include low birth weight (25.5%) followed by premature delivery (0.2%) and birth asphyxia (0.5%). CONCLUSIONS: A high prevalence of anemia in pregnant women apparently increases the maternal and fetal risks. To improve maternal and fetal outcome, it is recommended that the primary health care has to be strengthened, prevention, early diagnosis, and treatment of anemia in pregnancy to be given priority.

Primary tubercular mastitis masquerading as malignancy.

The significance of primary tubercular mastitis is due to rare occurrence and often overlooked and misdiagnosed as pyogenic breast abscess or malignancy. Despite the high incidence of tuberculosis in India, reports of breast tuberculosis among the total number of mammary conditions varies between 0.64% and 3.59%. We report a case of a 35-year-old lady with breast lump of 3 months duration, which simulated malignancy on clinical examination but fine needle aspiration cytology revealed granulomatous mastitis secondary to tuberculosis. High level of suspicion and simple fine needle aspiration procedure with micro-biological tests will clinch the final diagnosis.

Fine needle aspiration cytology in pediatric age group with special reference to pediatric tumors: a retrospective study evaluating its diagnostic role and efficacy.

BACKGROUND: Fine needle aspiration cytology (FNAC) is a well-established diagnostic technique in adult mass lesions but a comparatively new technique to pediatric lesions. AIM: The current study aims to evaluate the role of FNAC in pediatric age with special reference to pediatric tumors. SUBJECTS AND METHODS: A retrospective study of FNAC in children ≤ 18 years of age presenting with mass lesions was studied for 5 years. Distribution of cases in different age groups, sex, and site of lesion was analyzed. Pediatric lesions were categorized into non-neoplastic, benign, and malignant conditions. Diagnostic efficacy was assessed by comparing subsequent histopathological examination wherever possible. STATISTICAL ANALYSIS: Epi info 07 (Centers for Disease Control and Prevention in Atlanta, Georgia (USA) 07) and values were presented as simple percentages. RESULTS: FNAC was performed on 2903 cases in 5 years out of which 327 cases 11.3% (327/2903) were ≤ 18 years of age. Out of 327 cases, 180 cases 55% (180/327) were between 11 and 18 years. Male to female ratio was 1.15:1. The commonest site for FNAC was cervical lymph node swelling 48.3% (158/327). Reactive lymphadenitis was the commonest diagnosis among all mass lesions 38.8% (103/265), whereas Fibroadenoma 20.8% (10/49) was commonest diagnosis among benign lesions and among malignant lesions there were two cases 15.3% (2/13) each of Hodgkins and non-Hodgkins lymphoma and one case of chondrosarcoma. The positive predictive value of diagnosing malignant lesions on FNAC was 100%. CONCLUSIONS: The ease of FNAC along with its high diagnostic accuracy makes it a desirable method for diagnosing lesions in children.

Outcome of alcohol dependence: the role of continued care.

AIMS: This study attempted to determine the effects of continued care on subjects with alcohol dependence. MATERIALS AND METHODS: Study patients were recruited from a slum in Bangalore. The control group comprised individuals from a lower socio-economic status. Both groups received identical treatment from a specialised de-addiction facility. The study group also received weekly continued care in the community, either at a clinic located within the slum or through home visits. Those patients without stable jobs were referred for employment. The control group was given routine hospital follow-up visits. Both groups were evaluated on the Alcohol Problem Questionnaire and quantity/frequency of drinking at baseline and every 3 month interval for one year after discharge. RESULTS: Both groups showed improvement in terms of reduction of drinking at 3 months, with the study group showing a 64% improvement with respect to the number of non drinking days and the control group showed a 50% improvement. However, at 6 months, 9 months, and 12 months, the study group continued to maintain these gains while the control group showed a downward slide (differences significant at P< 0.05). At the end of 12 months, the study group maintained a 53% improvement with respect to the number of non drinking days as compared with baseline, while the control group had an improvement of only 28%. CONCLUSIONS: Follow-up support and continued care appear to significantly improve longer-term recovery in alcohol dependents.

Blood lipid profile and myocardial superoxide dismutase in swim-trained young and middle-aged rats: comparison between left and right ventricular adaptations to oxidative stress.

Region-wise interactive effects of age, swim intensity, and duration on exercise performance in the myocardium and serum lipid profile in young (4 months) and middle-aged (12 months) rats were examined. Animals were allocated to the sedentary control (SE-C) or one of the nine trainee groups. Swim training was for 6 days/week and for 4 weeks at 3 durations (20, 40, and 60 min/day) and intensities (2%, low; 3%, medium; 5%, high). Swim velocity and external work showed an age-related decline with low-intensity of 20 min/day in the middle aged. Reduction in serum cholesterol, low-density lipoproteins (LDLs), and triglycerides were accompanied by elevated levels in high-density lipoprotein in the low-to-moderately trained ones for 20 and 40 min/day. Training at 2%, intensity for 20 min/day was sufficient to alter the blood lipid profile and improve swim performance, and endurance in terms of blood lactate. A concomitant increase in Mn-superoxide dismutase (Mn-SOD) activity and reduced malondialdehyde in the left ventricle (LV) and right ventricle (RV) were evident. Lipofuscin was higher in the LV compared to RV. Our results reflect the minimization of free radical generation through appropriate exercise protocols. Our findings on improved blood lipid profile could be related to lower free radicals, which would otherwise oxidize LDLs. Further, swim training when initiated in the young and middle age for as low as 20 min/day at 2% intensity improves the Mn-SOD in the LV and RV. However, the adaptive response of the LV was weaker when compared to the RV, more so in the middle aged.

Identifying and modulating disulfide formation in the biopharmaceutical production of a recombinant protein vaccine candidate.

Structural conversion of the serotype A recombinant botulinum neurotoxin heavy chain fragment (rBoNTA(Hc)) produced intracellularly in Pichia pastoris yeast was observed and characterized during purification development efforts. A pH screening study captured the transformation stages of the original recovered species into its derived counterpart and a number of analytical tools such as peptide mapping by LC/MS confirmed the formation of a disulfide bond, especially in samples of neutral to basic pH. A cation exchange chromatographic method proved useful in following the incidence of the reaction in various rBoNTA(Hc) samples. The disulfide formation kinetics were characterized using a one-quarter quadratic factorial design, following the investigation and development of controlled oxidation conditions using cysteine and cystamine as the redox pair. Temperature, pH and concentration of the redox pair had a significant effect on the yield and rate of the disulfide formation. This controlled reaction was eventually introduced as a functional unit operation in the purification process. The summation of preliminary scale-up and potency data showed scalability and robustness in the production of an active disulfide-bonded form of a recombinant botulism vaccine candidate. The presence of the disulfide bond did not effect the vaccine potency and it enhanced the molecule's thermal stability.

Dietary vitamin E and physical exercise: I. Altered endurance capacity and plasma lipid profile in ageing rats.

The effect of vitamin E on the exercise performance and plasma lipid profile was studied in male Wistar rats of 4-(young adults), 8-(old adults), 12-(middle-age) and 22-months (old) of age. Animals were orally supplemented with vitamin E and allowed to swim for 30 min/day, 5 days/week and for a total period of 60 days. Swim velocity (S(v)), external work done (W(ext)) and endurance (E) capacity were the parameters that were used to assess the exercise performance of the trained rats that were either supplemented or non-supplemented with the dietary antioxidant. Plasma lipid profile analyses were in terms of low-density lipoprotein (LDL-C), high-density lipoprotein, (HDL-C) cholesterol and total cholesterol (C). Age-related decline in S(v) was noticeable in the 22-months old rats. However, the effect of vitamin E on the S(v) between the trained groups was not evident in any of the age groups. W(ext) increased linearly with age with no significant variations between the trainees. Trainee rats, when allowed to swim to exhaustion, showed a higher endurance capacity when supplemented with vitamin E. However, this capacity declined with age. There was a significant age-associated elevation in plasma C with corresponding increase in LDL-C. Exercise training in conjunction with vitamin E supplementation was most effective in elevating HDL-C levels in all age groups. These changes were accompanied by significant reductions in cholesterol/HDL-C ratios in animals receiving vitamin E, sedentary or otherwise. Our data suggests that it may be important to consider vitamin E while attempting to derive the benefits of swim training, both in terms of favorably altering the plasma lipid profile as well as enhancing the endurance capacity of exercise trainees. Dietary supplementation by vitamin E could attenuate the early onset of fatigue in the old.

Dietary vitamin E and physical exercise: II. Antioxidant status and lipofuscin-like substances in aging rat heart.

The heart faces a high risk of free radical injury owing to a slow generation of antioxidant (AO) enzymes by its cells. A general decline in this system may be another reason for the development of age-related diseases. Although the correlation between aging and exercise has been studied extensively, these studies have produced conflicting data on the effects of vitamin E on the aging heart, when it is introduced as an intervening factor. To investigate these effects, we determined the activities of antioxidant enzymes (AOEs) such as superoxide dismutase (SOD) and catalase (CAT), lipid peroxidation (LP), lipofuscin (LF)-like autofluorescent substances and vitamin E content in the left and right ventricles (LV and RV) of the heart in male Wistar albino rats of 4-(young adults), 8-(old adults), 12-(middle-age) and 22-mos(old) of age. Animals were orally supplemented with vitamin E and allowed to swim for 30 min/day, 5 days/week and for a total period of 60 days. Exercise training in all the age groups except the old was effective in upregulating the SOD activity. Old trainees showed an increase in SOD activity when supplemented with vitamin E. In the 22-mo-olds, a remarkable decrease in CAT activity was seen. Exercise by itself upregulated the CAT as well as SOD activity in all age groups except the old wherein vitamin E was effective in increasing the activities of AOEs. Supplementation significantly reduced LP as evidenced by lowered malondialdehyde (MDA) and LF-like autofluorescent substances in the trained as well as sedentary rats. Tissue vitamin E content was low in the swim trainees that were not supplemented. This change, well emphasized in the trainee groups of 22-mo-old suggests the probable utilization of vitamin E in keeping free radicals at bay. Our results suggest that vitamin E can stand out as a significant tool in ameliorating the declining AO defense in the old rats.

Temperature-induced changes in anaerobic capacity of interventricular septum in trained young and middle-aged rats.

The interventricular site has been proposed as one of the sites for the myocyte cell death with aging and thereby enhancing the possibility of ventricular dysfunction with aging. Variations in lactate dehydrogenase (LDH), a key glycolytic regulatory enzyme along with its isomers were used as indices to evaluate the anaerobic capacity of the interventricular septum (IVS) in 2-month-old (young) and 12-month-old (middle-aged) rats trained to swim at 25 degrees C (cold, C) and 35 degrees C (thermo neutral, N) temperatures. Blood lactate (La) and LDH along with its isoenzymes in the IVS were assessed and compared with untrained and sedentary rats. Increased septal and heart weight was indicative of age-related hypertrophy accompanied by increased septal thickness. Elevated total LDH activity was evident in both the trained groups in the young. The middle-aged animals exhibited lesser variations in LDH and, H and M subunits. The data suggest an efficient adaptability of the IVS of young rats to physical training in contrast to a poor response by the IVS of middle-aged animals.

Adaptations in lactate dehydrogenase and its isozymes in aging mammalian myocardium: interaction of exercise and temperature.

The responses of the left and right ventricles (LV and RV) to physical conditioning in cold (25 degrees C) and thermoneutral temperatures (35 degrees C), with special reference to lactate dehydrogenase (LDH) and its isoenzyme profile, were studied in the 2-month (young)- and 12-month (middle-aged)-old rats. Moderate hypertrophy was a common observation irrespective of age, region and swim temperature. LV, however, hypertrophied to a significantly lesser extent in the middle-aged, than the RV. Blood Lactate (La) content showed a decline in the trained rather than their untrained counterparts. LDH activity decreased with age. Swim training induced elevations in the enzyme activity. The isoenzyme profile was suitably and efficiently altered in the LV and RV of trained animals to meet the arising O2 demands. The above adaptations were best seen in the young and in the animals trained at thermoneutral temperatures. Thus it is suggested that young age is very apt for initiation of training programs although middle-age is not so late. Swimming in water near body temperature is emphasised as a more preferred environment to cold water, in order to derive maximal exercise-associated beneficial effects.