Is Nuchal Cord a Perfect Scapegoat: A Retrospective Analysis from Northwest India?

Background: Entanglement of the umbilical cord around the fetal neck (nuchal cord) is quite a common fi nding at delivery. It is often assumed that nuchal cord causes cord compression and thus low birth weight and intrapartum complications. Aim: The aim of this article is to study the eff ect of nuchal cord on the mode of delivery, complications and fetal outcome. Materials and Methods: A retrospective study was carried out on 386 deliveries, 60 of them with nuchal cord, during 1 year from November 2009 through October 2010. Their mode of delivery, complications and fetal outcome were studied and a comparison was established between nuchal cord group and the rest of the deliveries. Nuchal cord group was subdivided into loose nuchal cord (cord could easily be uncoiled before complete delivery of the baby) group and tight nuchal cord (cord was needed to be clamped and cut before delivery of the baby) group. Furthermore, the mode of delivery and fetal outcome were compared between these subgroups. Statistical analyses were performed using SPSS statistical soft ware version 12.0 (Chicago Illinios, USA). The results were expressed as percentages. Test for significance was done using Chi-square, and a P<0.05 was considered as significant.Results: The nuchal cord group did not have any signifi cant diff erence in the mode of delivery or fetal outcome compared with the control group. However, the subgroup having tight cord around the neck had significantly higher proportion of low Apgar scores and meconium staining at birth.Conclusions: Nuchal cord does not increase the chances of cesarean delivery. However, tight cord around the neck may result in low Apgar scores and increased incidence of fetal distress leading to cesarean section.  Keywords: Apgar score, cesarean delivery, meconium staining, north west India, nuchal cord, perinatal outcom

Development of a Nomogram to Evaluate the Usefulness of Sonographic Measurement of Placental Thickness for the Estimation of Fetal Gestational Age

Background: An accurate assessment of gestational age (GA) and evaluation of fetal growth is fundamental to prenatal care. Aim: To evaluate placental thickness (PT) as an indicator of GA. Subjects and Methods: A prospective study was carried out on 300 antenatal patients with known last menstrual period (LMP), 100 each in first, second, and third trimester, respectively, with GA more than 10 weeks till term in a study period of one year. Patients with GA more than 20 weeks detected with pregnancy‑induced hypertension (PIH) and/or diabetes mellitus (DM) and/or intrauterine growth retardation (IUGR) and/or hydrops fetalis and/or congenital malformation were excluded from the study. Twin pregnancy of any gestation was excluded from the study. The PT was measured at the level of insertion of the cord and the values thus measured in millimeters was correlated with GA as ascertained vis a vis the LMP. GA and PT were represented as mean and standard deviation. Correlation between them was evaluated using Pearson’s product moment correlation coefficient. Results: The study showed a positive correlation between GA and PT. PT in millimeter accurately matched the GA in weeks from 14 to 21 weeks of gestation after which it was seen to be lesser than GA by 1-4 mm. Conclusions: PT promises to be an accurate parameter for estimating fetal GA in singleton pregnancies.Keywords: Fetal Gestational age, nomogram, placental thicknes

Nuclear medicine procedures and the evaluation of male sexual organs: a short review

Sexuality consists of three aspects that are interrelated and inseparable, biological, physiological and social. The biological aspect considers the individual's capability to give and to receive pleasure. In consequence, it covers the functionality of the sexual organs and the physiology of human sexual response cycle. Diagnostic imaging modalities, such as single photon emission computed tomography (SPECT) and positron emission tomography (PET) have been used to evaluate clinical disorders of the male reproductive system. PET and SPECT procedures basically involve the administration of a radiopharmaceutical that has a higher uptake in a specific tumor or tissue. The aim of this brief review is to present some radiopharmaceuticals that have been used in the clinical evaluation of the male sexual organs (testes, prostate, seminal vesicles, penis) related with male sexuality. This information could be useful in better understanding the male sexual response cycle, as well as the sexual disorders, when considering the male sexual organs and the pelvic floor. Moreover, the findings obtained with PET and SPECT imaging could help to evaluate the efficacy of clinical results of therapeutic procedures. In conclusion, the knowledge from these images could aid in better understanding the physiology of the different organs related with sexuality. Furthermore, they could be important tools to evaluate the physiological integrity of the involved organs, to improve clinical strategies and to accompany the patients under treatment

Trabectedin plus pegylated liposomal doxorubicin in relapsed ovarian cancer delays third-line chemotherapy and prolongs the platinum-free interval

Background: OVA-301 is a large randomized trial that showed superiority of trabectedin plus pegylated liposomal doxorubicin (PLD; CentoCor Ortho Biotech Products L.P., Raritan, NJ, USA). over single-agent PLD in 672 patients with relapsed ovarian cancer, particularly in the partially platinum-sensitive subgroup [platinum-free interval (PFI) of 6–12 months]. This superiority has been suggested to be due to the differential impact of subsequent (platinum) therapy

Effects of Anesthetic Agents on Brain Blood Oxygenation Level Revealed with Ultra-High Field MRI

During general anesthesia it is crucial to control systemic hemodynamics and oxygenation levels. However, anesthetic agents can affect cerebral hemodynamics and metabolism in a drug-dependent manner, while systemic hemodynamics is stable. Brain-wide monitoring of this effect remains highly challenging. Because T2*-weighted imaging at ultra-high magnetic field strengths benefits from a dramatic increase in contrast to noise ratio, we hypothesized that it could monitor anesthesia effects on brain blood oxygenation. We scanned rat brains at 7T and 17.2T under general anesthesia using different anesthetics (isoflurane, ketamine-xylazine, medetomidine). We showed that the brain/vessels contrast in T2*-weighted images at 17.2T varied directly according to the applied pharmacological anesthetic agent, a phenomenon that was visible, but to a much smaller extent at 7T. This variation is in agreement with the mechanism of action of these agents. These data demonstrate that preclinical ultra-high field MRI can monitor the effects of a given drug on brain blood oxygenation level in the absence of systemic blood oxygenation changes and of any neural stimulation

Potent antitumor effects of bevacizumab in a microenvironment-dependent human lymphoma mouse model

We established a mouse model of microenvironment-dependent human lymphoma, and assessed the therapeutic potential of bevacizumab, an antitumor agent acting on the microenvironment. NOD/Shi-scid, IL-2Rγnull (NOG) mice were used as recipients of primary tumor cells from a patient with diffuse large B-cell lymphoma (DLBCL), which engraft and proliferate in a microenvironment-dependent manner. The lymphoma cells could be serially transplanted in NOG mice, but could not be maintained in in vitro cultures. Injection of bevacizumab together with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) significantly increased necrosis and decreased vascularization in the tumor, compared with CHOP alone. Levels of human soluble interleukin-2 receptor (sIL2R) in the serum of bevacizumab+CHOP-treated mice (reflecting the DLBCL tumor burden) were significantly lower than in CHOP recipients. Mice receiving bevacizumab monotherapy also showed significant benefit in terms of tumor necrosis and vascularization, as well as decreased serum sIL2R concentrations. The present DLBCL model reflects the human DLBCL in vivo environment more appropriately than current mouse models using established tumor cell lines. This is the first report to evaluate the efficacy of bevacizumab in such a tumor microenvironment-dependent model. Bevacizumab may be a potential treatment strategy for DLBCL patients

AAPS Workshop Report: Strategies to Address Therapeutic Protein–Drug Interactions during Clinical Development

Therapeutic proteins (TPs) are increasingly combined with small molecules and/or with other TPs. However preclinical tools and in vitro test systems for assessing drug interaction potential of TPs such as monoclonal antibodies, cytokines and cytokine modulators are limited. Published data suggests that clinically relevant TP-drug interactions (TP-DI) are likely from overlap in mechanisms of action, alteration in target and/or drug-disease interaction. Clinical drug interaction studies are not routinely conducted for TPs because of the logistical constraints in study design to address pharmacokinetic (PK)- and pharmacodynamic (PD)-based interactions. Different pharmaceutical companies have developed their respective question- and/or risk-based approaches for TP-DI based on the TP mechanism of action as well as patient population. During the workshop both company strategies and regulatory perspectives were discussed in depth using case studies; knowledge gaps and best practices were subsequently identified and discussed. Understanding the functional role of target, target expression and their downstream consequences were identified as important for assessing the potential for a TP-DI. Therefore, a question-and/or risk-based approach based upon the mechanism of action and patient population was proposed as a reasonable TP-DI strategy. This field continues to evolve as companies generate additional preclinical and clinical data to improve their understanding of possible mechanisms for drug interactions. Regulatory agencies are in the process of updating their recommendations to sponsors regarding the conduct of in vitro and in vivo interaction studies for new drug applications (NDAs) and biologics license applications (BLAs)