A study of cytology and colposcopy in VIA (visual inspection of cervix with 5% acetic acid) positive women

Background: Cervical cancer is the most common cancer among Indian women. Cervical cancer is preventable in pre-invasive state when effective programmes are implemented to detect and treat its precursor lesions. "Single Visit" screen and treat strategy that uses VIA and colposcopy alone that eliminates the need for repeated visits due to delays in diagnostic results, will be highly attractive in terms of cost effectiveness and compliance to treatment, which is crucial to bring down the incidence and mortality due to cervical cancer. The present study evaluates the performance of colposcopy vs conventional cytology in estimating the presence and grade of cervical disease against the reference standard of histopathology as a secondary test modality to triage women found positive on primary screening by visual inspection with 5% acetic acid (VIA).Methods: This is a retrospective study carried out on 50 women aged between 18-50 years who tested positive on VIA between August 2013 to November 2015. Data were entered in the institution using standard computer software [EPIINFO software]. Diagnostic accuracy for single test was calculated using 2*2 tables and standard formulae.Results: The diagnostic accuracy of Pap smear was found to be 77% and that of Colposcopy was 87%. The accuracy of colposcopy was higher than that of Pap smear.Conclusions: Invasive cervical cancer is preceded by pre-invasive disease in most women. There is a lag time of 10-20 years before the disease progresses from pre-invasive to invasive disease. Prevention of invasive cancer is by screening, diagnosis and treatment of pre-invasive diseases. Thus, early diagnosis of CIN (cervical intraepithelial neoplasia) in adult women is a desirable goal

Diagnostic accuracy of HE4 and risk of ovarian malignancy algorithm in prediction of ovarian cancer in patients with pelvic mass: a regional cancer centre experience

Background: The current study was performed with an objective to evaluate the diagnostic accuracy of HE4 (human epididymis protein) and ROMA in prediction of ovarian cancer in patients with pelvic mass and to compare HE4 and ROMA with CA-125, and RMI (risk of malignancy index) for ovarian cancer prediction in women with pelvic mass.Methods: This was a diagnostic study enrolling 200 patients with pelvic mass who had been scheduled for Primary surgery. Serum HE4 and CA 125 levels were measured. HE4, CA 125 and ROMA, RMI were evaluated for sensitivity, specificity, positive predictive value and negative predictive value. The receiver operating characteristic (ROC) plots were graphed and area under the curve (AUC) values was calculated to investigate the accuracy of each marker for predicting ovarian malignancy.Results: Overall, ROMA showed the highest accuracy as it correctly classified 139/200 (69.5%) patients compared with 133/200 (66.5%) in HE4 and 109/200 (54.5%) in CA 125 and RMI. There were more patients with benign tumors being correctly identified by HE4 (89/119, 74.7%) and ROMA (74/119, 62.1%), than CA 125 which identified 39/119 (32.7%) patients. In our study in premenopausal women ROMA and HE4 have comparable sensitivity (80%and 75%) but higher specificity (64% and 65%) and NPV (86% and 83%) as compared to CA125 which has sensitivity of (83%) but very low specificity (46%) in differentiating benign from malignant masses. In postmenopausal women, HE4 had highest specificity (88%) and, CA125 has highest sensitivity (86%) in detecting ovarian malignancy.Conclusions: HE4 and ROMA showed a high specificity, but were less sensitivity than CA-125 and RMI in premenopausal women. However, ROMA is of comparable sensitivity and HE4 has highest specificity as compared to CA125 in postmenopausal women

Primary retroperitoneal mucinous cystadenocarcinoma: a rare surgico-pathological entity

Ovarian cancer (OC) is the seventh most common cancer for females in the world. Epithelial OC is the most predominant pathologic subtype (85%-90%), with five major histotypes- serous, mucinous, endometrioid, brenner and clear cell tumour. Each have three pathological subtypes ie benign, borderline and malignant. Mucinous cystadenomas and carcinomas of the ovary are well-established and common tumors. Primary retroperitoneal mucinous cystadenomas and carcinomas are being very rare and histopathogenesis of which is still uncertain. Most pathologists suggest their origin through mucinous metaplasia in a pre-existing mesothelium-lined cyst. An accurate preoperative diagnosis of these tumors is challenging due to lack of established effective diagnostic measures. Hereby presenting a 50-year-old woman, who visited to the hospital with abdominal distension and discomfort since two months. Sonography and computed tomography scans were performed and showed large predominantly cystic lesion arising from right adnexa. Patient underwent exploratory laparotomy for removal of the tumor. Histology and immunohistochemistry revealed primary retroperitoneal mucinous cystadenocarcinoma

Early stage cervical cancer with negative pelvic lymph nodes: morbidity and survival patterns following radical hysterectomy and postoperative adjuvant radiotherapy

Background: The objective of the present study was to optimize the role of adjuvant radiotherapy in lymph node negative cervical cancer treated with radical hysterectomy and pelvic lymph node dissection, and to analyse patterns of failure and complication following surgery and radiotherapy in same patients.Methods: This is retrospective analysis of 98 patients of cancer cervix FIGO Stage IB; IIA treated with radical hysterectomy with bilateral lymphadenectomy and adjuvant radiotherapy between the years 2000 and 2007at our hospital. Among all node negative patients who were operated during this period 97 patients were high risk. [High risk-Two or more of following risk factors: primary tumor size >4 cm, cervical stromal invasion ≥1/2, lymph-vascular space invasion, Unfavorable histology,>].Results: Median follow up: 79 months [6 months to 109 months], Recurrence rate: 13.26% [2 Pelvic and 11 distant recurrence] Pelvic control rate: 98 %Radiotherapy Complications: 4 % [Grade 3-4].Conclusions: Adjuvant radiotherapy following radical hysterectomy in high risk node negative early cervical cancer is effective treatment. It reduces pelvic recurrence with acceptable morbidity

Study of epidemiology, clinicopathological correlation, prognostic factors and management in squamous cell carcinoma of vulva

Background: Carcinoma of the vulva is rare cancer, pruritus is the most common and long-lasting reported symptom. It is found to be associated with HPV and HIV infection. Currently, a more individualized and less radical treatment is suggested. In this study we evaluated epidemiology, clinicopathological prognostic factors, HPV distribution and risk factors for metastases to lymph nodes. We also reviewed multidisciplinary clinical management carried out at our institute.Methods: It is a prospective study of 25 biopsy proven cases of Squamous Cell Carcinoma of Vulva, treated at our center from September 2014 to September 2016. We collected the data regarding the clinical presentation, histological details, treatment given, survival and complications. HPV 16 and 18 testing were done using PCR method. Median follow up of the patients are for 24 months.Results: The mean age of patients was 54.6 years. Commonest presentation was perineal itching (36%). HPV 16/18 were positive in 25% of the patients. Radical vulvectomy with bilateral groin dissection was done in 14/25 (56%) patients. Among these 14 patients, 35.7 % (5/14) has lymph node metastases, disease free survival was 63.6% and overall survival was 81.1% for median follow up of 24 months. About one third of the patient presented with locally advanced disease.  Six (24%) patients received only chemo radiation as a treatment.Conclusions: HPV and HIV infection increase the risk of vulvar cancer. Individualization of treatment is necessary. The use of preoperative chemoradiation in locally advanced disease might have promising results in future

Chemo-resistant gestational trophoblastic neoplasia: a review of cases at a tertiary cancer centre

Background: Gestational trophoblastic neoplasia (GTN) was earlier a dreaded malignancy with high mortality rates. GTN is now considered to be one of the most curable solid tumours in women with cure rates greater than 90% even in the presence of metastases. Despite the high chemo sensitivity, treatment failure or drug resistance has been described in both groups.Methods: In this study, available records of GTN cases over 6 years were reviewed with emphasis on those who were resistant to the first line of chemotherapy. Of these, 37(34.58%) were resistant to the first line of chemotherapy. These cases were studied with respect to age, parity, antecedent pregnancy, interval from antecedent pregnancy, pretreatment β hCG, risk score and presence of metastases. The data was analyzed in order to find any risk factors associated with chemo-resistance.Results: Total number of cases of GTN was 107. Out of these 107 cases, 63 (58.88%) were low risk and 44 (41.12%) were high risk according to FIGO scoring system. Complete response was achieved with first line chemotherapy in 70 (65.42%) patients. The remaining 37 (34.57%) were resistant to first line chemotherapy. In the low risk group, 30 (47.62%) cases, and in the high-risk group, 7(15.91%) were resistant to first line of chemotherapy.Conclusions: Despite the high chemo sensitivity of GTN, resistance to first line chemotherapy may be encountered in up to 40% of cases.  It is important to identify the patients who are at risk to develop resistance, early identification of resistance and change of chemotherapy so as to minimize the exposure of these patients to ineffective chemotherapy

Recent advances made in the synthesis of small drug molecules for clinical applications : An insight

Over decades dependency of humans on the drugs has become indispensable and irreplaceable. Thus, each year many new drugs are licensed. Nonetheless, drugs undergo rigorous testing and analysis to be available globally in economic price for the suitability of patients with different age and physiological conditions. The testing of drugs include phase I clinical trial using small group of 20–100 healthy volunteers for safety, pharmacology and efficacy; phase II clinical trial using 100–500 volunteer patients to optimize effective dose, dose interval, safety analysis and mode of delivery such as oral or intravenous; phase III clinical trial using 1000–5000 in a larger population of patients globally at different international places to collect sufficient safety and efficacy data for patenting and licencing. Moreover, thousands of drugs fail to achieve these objectives. Therefore, this mini-review intends to critically examine and assimilate the clinical applications of selected complex repurposed small drug molecules which are in different phase of trials for treating viral infection including complications due to COVID-19: (a) Remdesivir, (b) Galidesivir, (c) Favipiravir, (d) Baricitinib, and (e) Baloxavir

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia