Pap smear screening in antenatal women: an opportunistic way to save life

Background: Cancer cervix is the most common genital tract malignancy encountered in developing countries. In India, first visit to the gynaecologist for most women is during pregnancy and it may be the only visit. Hence, prenatal care offers an excellent opportunity to implement cervical screening in patients of young age, especially in women who do not seek routine health care. Therefore, this study was conducted to know the prevalence of abnormal Pap smear among the ante-natal women and to evaluate the result in relation to various risk factors.Methods: Cross sectional observational study conducted on 425 ante-natal women attending the antenatal clinic using questioner addressing various socio-demographic variables. Measures of central tendency calculated and result was tabulated by using chi-square test.Results: Maximum number of cases in our study was NILM i.e.314 (74%) followed by 68 cases of Candida (16%), 30 cases of Bacterial vaginosis (7.1%) and 10 cases of Trichomonas vaginalis (2.4%). Only 3 cases of abnormal Pap smear was reported i.e. 2 of ASCUS and 1 of LSIL. Thus, prevalence of abnormal Pap smear was 0.7%.Conclusions: In country like India where organised screening programme are not available, as well as the awareness and uptake of available services by the target population is also poor; screening in pregnancy is worthwhile and may be a viable option to reduce the burden of cervical carcinoma.

Role of chromohysteroscopy in detection of endometrial pathology in abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the most common clinical problems encountered in gynaecological practice. Chromohysteroscopy is thought to improve the diagnostic accuracy of hysteroscopy and reach the final diagnosis in AUB and is the subject matter of this study.Methods: A prospective cross-sectional study was performed on 35 women with AUB, who presented to the Dept. of Obstetrics and Gynecology, JNMCH, Aligarh, over a period of 2 years (2014-2016). After transvaginal sonography, all cases underwent hysteroscopy followed by chromohysteroscopy using 5% methylene blue dye. Differentially stained pattern of the uterine cavity was observed and hysteroscopic guided biopsy was taken from stained and unstained areas, followed by endometrial aspiration biopsy. All three samples were sent for histopathological examination. Results were analyzed and compared.Results: Out of 35 cases studied, 13 cases showed diffuse light staining, while 22 cases had focal dark staining. Histopathology results from diffuse light stained group showed 9 (69.2%) had normal endometrium. Out of 22 cases with focal dark staining, 20 (90.0%) cases had abnormal histopathology. It was found that focal dark staining to detect endometrial pathology had a sensitivity of 83.3%, specificity of 81.8%, positive predictive value of 90.9 %, negative predictive value of 69.2% and accuracy 82.8%. The difference in the diagnostic ability of stained tissue biopsy was highly significant (p< 0.001) when compared to blind endometrial aspiration biopsy.Conclusions: Chromohysteroscopy is an efficacious simple tool for detecting endometrial pathology in cases of AUB

The lncRNA NRON modulates HIV-1 replication in a NFAT-dependent manner and is differentially regulated by early and late viral proteins

A majority of the human genome is transcribed into noncoding RNAs, of which the functions of long noncoding RNAs (lncRNAs) are poorly understood. Many host proteins and RNAs have been characterized for their roles in HIV/AIDS pathogenesis, but there is only one lncRNA, NEAT1, which is shown to affect the HIV-1 life cycle. We profiled 90 disease-related lncRNAs and found NRON (noncoding repressor of Nuclear Factor of Activated T cells [NFAT]) to be one of several lncRNAs whose expression was significantly altered following HIV-1 infection. The regulation of NRON expression during the HIV-1 life cycle was complex; its levels were reduced by the early viral accessory protein Nef and increased by the late protein Vpu. Consequently, Nef and Vpu also modulated activity of the transcription factor NFAT. The knockdown of NRON enhanced HIV-1 replication through increased activity of NFAT and the viral LTR. Using siRNA-mediated NFAT knockdown, we show the effects of NRON on HIV-1 replication to be mediated by NFAT, and the viral Nef and Vpu proteins to modulate NFAT activity through their effects on NRON. These findings add the lncRNA, NRON to the vast repertoire of host factors utilized by HIV for infection and persistence

Efficacy of 25 mcg sublingual versus vaginal misoprostol for induction of labor

Background: Currently, to decrease the incidence of contractility disturbances and neonatal complications, 25 mcg of vaginal misoprostol is recommended for induction of labor. American College of Obstetrics and Gynecology suggested 25 mcg every 4-6 hourly by vaginal route. But till date, there is no consensus either for route or dosage. The present study was to compare the efficacy and suitability of low dose (25 μg) sublingual misoprostol for induction of labor in term pregnancy as compared with the same dose given vaginally.Methods: This was a hospital based unblinded randomized prospective study conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh from February 2015 to November 2016.The study involved pregnant women attending O.P.D. or admitted in the labor room. Patients were randomly allocated into two groups: Group 1 received 25 mcg of misoprostol sublingually and Group 2 received 25 mcg of misoprostol 4 hourly vaginally to a maximum of 5 doses. Maternal and neonatal outcomes were analysed.Results: There is no difference between groups for indications for induction of labor, mean induction to the onset of contraction interval and mean interval from the initiation of induction to the delivery. No significant difference in indication for caesarean section and number of doses. No significant differences in neonatal outcomes.Conclusions: 25µg misoprostol administered by sublingual route is equally efficacious as by vaginal route for induction of labor at term.

Comparison of Nonstress Test and Light stimulation Test and their correlation with fetal outcome

Introduction: Non Stress Test serves an important function in assessment of fetal wellbeing, but false positive results limit its role. Light stimulation stimulates the fetus, speeds up the test and catalyses its rate limiting step. This study has compared simple Non Stress Test and Light stimulation test and there correlation with various fetal outcomes. This study helps us to assess whether light stimulation be used as a better alternative or an adjunct to traditional Nonstress test. Material and Methods: A total of 220 patients above 34 weeks of pregnancy were taken.110 pts underwent 20 minutes of Nonstress test and 110 underwent Halogen light stimulation which was given transabdominally for 10 seconds and it was repeated every 10 minutes for a maximum up to three times. This allocation was done randomly. Non reactive Nonstress test were then stimulated with Halogen light. Results: The test showed that sensitivity of Nonstress test is greater than Light stimulation test, but specificity, positive predictive value, and negative predictive value is lesser than Light stimulation test .Out of 36 Non reactive NSTs after stimulation with light 18 became reactive. Conclusion Nonstress test is considered as a screening test and Light stimulation test can be used as an adjunct to Nonstress test as it decreases the number of false positive results and increases the specificity of the test. Clinical outcomes are more closely related with LST, but more studies are required to arrive at the final conclusions

Expression of Angiopoetin-Like Protein-4 and Kidney Injury Molecule-1 as Preliminary Diagnostic Markers for Diabetes-Related Kidney Disease: A Single Center-Based Cross-Sectional Study

The purpose of the study was to examine the urinary levels of kidney injury molecule-1 (KIM-1) and angiopoietin-like protein-4 (ANGPTL-4) in individuals with diabetic kidney disease (DKD) and their association with established DKD diagnostic markers such as albuminuria and estimated glomerular filtration rate (eGFR). Levels of ANGPTL-4 and KIM-1 were estimated in urine samples. A total of 135 participants were recruited into three groups: 45 diabetes type 2 patients in the control group and 90 DKD patients in two disease groups. Concentrations of ANGPTL-4 and KIM-1 were conclusively related to the urinary albumin-creatinine ratio (UACR). Also, the levels of both ANGPTL-4 and KIM-1 were negatively associated with the eGFR. Multivariable Poisson regression analysis showed that urinary ANGPTL-4 (PR: 3.40; 95% CI: 2.32 to 4.98; p < 0.001) and KIM-1 (PR: 1.25; 95% CI: 1.14 to 1.38; p < 0.001) were prevalent in DKD patients. Receiver operating characteristic (ROC) analysis of urinary ANGPTL-4 and KIM-1 in the combined form resulted in an area under curve (AUC) of 0.967 (95%CI: 0.932-1.000; p < 0.0001) in the microalbuminuria group and 1 (95%CI: 1.000-1.000; p < 0.0001) in the macroalbuminuria group. The association of urinary levels of ANGPTL-4 and KIM-1 with UACR and eGFR and significant prevalence in the diabetic kidney disease population illustrates the diagnostic potential of these biomarkers

Outcomes of COVID-19 infection in patients with hematological malignancies- A multicenter analysis from Pakistan

Purpose: COVID-19 infection resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began to spread across the globe in early 2020. Patients with hematologic malignancies are supposed to have an increased risk of mortality from coronavirus disease of 2019 (COVID-19) infection. From Pakistan, we report the analysis of the outcome and interaction between patient demographics and tumor subtype and COVID-19 infection and hematological malignancy. Patients and methods: This multicenter, retrospective study included adult patients with a history of histologically proven hematological malignancies who were tested positive for COVID-19 via PCR presented at the oncology department of 5 tertiary care hospitals in Pakistan from February to August 2020. A patient with any known hematological malignancy who was positive for COVID-19 on RT-PCR, was included in the study. Chi-square test and Cox-regression hazard regression model was applied considering p ≤ 0.05 significant. Results: A total of 107 patients with hematological malignancies were diagnosed with COVID-19, out of which 82 (76.64%) were alive, and 25 (23.36%) were dead. The significant hematological malignancy was B-cell Lymphoma in dead 4 (16.00%) and alive group 21 (25.61%), respectively. The majority of the patients in both the dead and alive group were on active treatment for hematological malignancy while they came positive for COVID-19 [21 (84.00%) & 48 (58.54%) p 0.020]. All patients in the dead group were admitted to the hospital 25 (100.00%), and among these, 14 (56.00%) were admitted in ICU with a median 11 (6-16.5) number of days. Among those who had contact exposure, the hazard of survival or death in patients with hematological malignancies and COVID-19 positive was 2.18 (CI: 1.90-4.44) times and 3.10 (CI: 2.73-4.60) times in patients with travel history compared to no exposure history (p 0.001). Conclusion: Taken together, this data supports the emerging consensus that patients with hematologic malignancies experience significant morbidity and mortality resulting from COVID-19 infection