Obstetric and perinatal outcome of twin pregnancy: a prospective study in a tertiary care hospital in North India

Background: Multiple pregnancy constitutes an important portion of high risk pregnancies and is a matter of grave concern to obstetricians and paediatricians owing to maternal and perinatal morbidity and mortality associated to it. Objective of present study was to evaluate maternal and perinatal outcome of twin pregnancy.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and perinatal outcomes were studied.Results: The incidence of twin pregnancy was 2.8 % with maximum incidence in age group of 20 -29 years and in multigravida. Mean gestational age was 34.2 weeks. Vertex - vertex fetal presentation was most common presentation. Most frequent mode of delivery was ceserean section (54%). Preterm labour was most common maternal complication (74%), followed by anaemia (62%). Complications in perinatal period were birth hypoxia (58 %), intrauterine growth restriction (15 %), hyper-bilirubinemia (11%) and neonatal sepsis (10 %). 88% of the newborns were LBW. Perinatal mortality in our study was 17%.Conclusions: Twin pregnancies are associated with significant maternal and perinatal morbidity which is more so for second twin. Effective antenatal care planned delivery and good pediatric facilities help decrease the complications. Managment of twin pregnancy requires multidisciplinary approach and involvement of skilled obstetricians and paediatricians

Computed tomography- guided percutaneous core needle biopsy for diagnosis of intathoracic mass lesions: experience at a tertiary care centre of North India

Background: CT guided core needle biopsy is a less invasive method for initial diagnostic workup in the assessment of intrathoracic masses. This study was conducted to evaluate the diagnostic yield of the procedure as well as to demonstrate the spectrum of various disease in our population.Methods: Present study was conducted in a tertiary care hospital for a study period of two years. Patients with intrathoracic mass were included and CT guided biopsies were performed following a protocol. The CT guided biopsies received were examined for histological diagnosis. Immunohistochemistry was carried out where ever routine histopathology was not sufficient for diagnosis. Relevant immunohistochemical panels were applied for lung, mediastinal and pleural tumours according to the histological differential diagnosis. Detailed demographic and clinical profiles along with radiological findings were noted.Results: Total of 138 cases were taken for CT guided FNAC procedure and 123 (89.1%) cases yielded diagnostic biopsy. Lung was the most commonly involved organ followed by mediastinum. Bronchogenic carcinoma was the most common lesion reported in lung and Non-Hodgkin Lymphoma was the most common mediastinal lesion. Lung collapse was most common radiological feature.Conclusions: CT guided percutaneous biopsy is a valuable diagnostic technique providing for early accurate diagnosis and being minimally invasive procedure. Care should be taken while tissue processing and section cutting of intrathoracic biopsies as the biopsies are small and tissue loss should be prevented so that sufficient material is available for immunohistochemistry

Cytological spectrum of granulomatous mastitis: diagnostic and treatment challenges

Background: Granulomatous mastitis (GM) is an inflammatory disease of the breast which clinico- radiologically mimics both inflammatory and malignant lesions. This leads to diagnostic dilemmas and delay in treatment. The aim of the present study was to review the cases diagnosed as granulomatous mastitis on Fine Needle Aspiration Cytology (FNAC) with an objective to co-relate their clinico-radiological findings, histology review where available and follow up treatment received to establish etiology and study the treatment outcome.Methods: Cytologically diagnosed cases of granulomatous mastitis were retrieved and reviewed from August 2015 - July 2017 records. Clinico-radiological co-relation, histology review where available and follow up treatment records were sought for.Results: Around 31.7% (530/1670) cases were reported as malignant, 60.3% (1009/1670) as benign proliferative and 7.9% (131/1670) as inflammatory lesions by breast FNA. 3.1% (51/1670) cases were reported as GM of all breast FNAC and 38% (51/131) of all inflammatory lesions. Follow up was available for 47 cases. Of which 26 (55.3%) cases were diagnosed as Tubercular Granulomatous mastitis (TGM) and 21(44.7%) were idiopathic granulomatous mastitis (IGM).Conclusions: Countries where tuberculosis is endemic, high degree of clinical suspicion and detailed work-up to rule out TGM is essential for all cases of granulomatous mastitis. Authors recommend a multidisciplinary workup with microbiological culture and molecular based tests on FNA material. This retrospective study illustrates that the cause of GM needs to be determined accurately for timely treatment, to avoid unnecessary delays and treatment dilemma in these patients

Dynamic Structure-Based Pharmacophore Model Development: A New and Effective Addition in the Histone Deacetylase 8 (HDAC8) Inhibitor Discovery

Histone deacetylase 8 (HDAC8) is an enzyme involved in deacetylating the amino groups of terminal lysine residues, thereby repressing the transcription of various genes including tumor suppressor gene. The over expression of HDAC8 was observed in many cancers and thus inhibition of this enzyme has emerged as an efficient cancer therapeutic strategy. In an effort to facilitate the future discovery of HDAC8 inhibitors, we developed two pharmacophore models containing six and five pharmacophoric features, respectively, using the representative structures from two molecular dynamic (MD) simulations performed in Gromacs 4.0.5 package. Various analyses of trajectories obtained from MD simulations have displayed the changes upon inhibitor binding. Thus utilization of the dynamically-responded protein structures in pharmacophore development has the added advantage of considering the conformational flexibility of protein. The MD trajectories were clustered based on single-linkage method and representative structures were taken to be used in the pharmacophore model development. Active site complimenting structure-based pharmacophore models were developed using Discovery Studio 2.5 program and validated using a dataset of known HDAC8 inhibitors. Virtual screening of chemical database coupled with drug-like filter has identified drug-like hit compounds that match the pharmacophore models. Molecular docking of these hits reduced the false positives and identified two potential compounds to be used in future HDAC8 inhibitor design

Primary fallopian tube carcinoma: Preoperative diagnostic dilemma

Primary fallopian tube carcinoma is an uncommon female genital tract malignancy that resembles epithelial ovarian neoplasm clinically and radiologically. We present a case of 49-year-old woman with postmenopausal intermittent vaginal bleeding, lower abdominal pain, and pelvic mass for 3 months. On physical examination, lower abdominal tenderness was found. Ultrasound examination revealed bilateral hydrosalpinx with hematometra. Her serum cancer antigen-125 was raised (190.0 U/ml). With the clinical diagnosis of endometrial cancer, patient underwent total abdominal hysterectomy with bilateral salpingo-oopherectomy, infracolic omentectomy and rectal deposit biopsy. Microscopic examination showed features of serous adenocarcinoma of the fallopian tube. Histologically, it is indistinguishable from primary ovarian malignancy. On post-surgical follow up at one year the patient is disease free. Here we report this rare entity and review the literature to highlight the preoperative clinical diagnostic difficulties

Obstetric and perinatal outcome of twin pregnancy: a prospective study in a tertiary care hospital in North India

Background: Multiple pregnancy constitutes an important portion of high risk pregnancies and is a matter of grave concern to obstetricians and paediatricians owing to maternal and perinatal morbidity and mortality associated to it. Objective of present study was to evaluate maternal and perinatal outcome of twin pregnancy.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and perinatal outcomes were studied.Results: The incidence of twin pregnancy was 2.8 % with maximum incidence in age group of 20 -29 years and in multigravida. Mean gestational age was 34.2 weeks. Vertex - vertex fetal presentation was most common presentation. Most frequent mode of delivery was ceserean section (54%). Preterm labour was most common maternal complication (74%), followed by anaemia (62%). Complications in perinatal period were birth hypoxia (58 %), intrauterine growth restriction (15 %), hyper-bilirubinemia (11%) and neonatal sepsis (10 %). 88% of the newborns were LBW. Perinatal mortality in our study was 17%.Conclusions: Twin pregnancies are associated with significant maternal and perinatal morbidity which is more so for second twin. Effective antenatal care planned delivery and good pediatric facilities help decrease the complications. Managment of twin pregnancy requires multidisciplinary approach and involvement of skilled obstetricians and paediatricians

Proliferating cell nuclear antigen, p53 and micro vessel density: Grade II vs. Grade III astrocytoma

Histological classification and grading are prime procedures in the management of patients with astrocytoma, providing vital data for therapeutic decision making and prognostication. However, it has limitations in assessing biological tumor behavior. This can be overcome by using newer immunohistochemical techniques. This study was carried out to compare proliferative indices using proliferating cell nuclear antigen (PCNA), extent of p53 expression and micro vessel morphometric parameters in patients with low grade and anaplastic astrocytoma. Twenty-five patients, each of grade II and grade III astrocytoma were evaluated using monoclonal antibodies to PCNA, p53 protein and factor VIII related antigen. PCNA, p53-labeling indices were calculated along with micro vessel morphometric analysis using Biovis Image plus Software.<b> </b> Patients with grade III astrocytoma had higher PCNA and p53 labeling indices as compared with grade II astrocytoma (29.14 plus/minus 9.87&#x0025; vs. 16.84 plus/minus 6.57&#x0025;, p 0.001; 18.18 plus/minus 6.14&#x0025; vs. 6.14 plus/minus 7.23&#x0025;, p 0.001, respectively). Micro vessel percentage area of patients with grade III astrocytoma was also (4.26 plus/minus 3.70 vs. 1.05 plus/minus 0.56, p 0.001), higher along with other micro vessel morphometric parameters. Discordance between histology and one or more IHC parameters was seen in 5/25 (20&#x0025;) of patients with grade III astrocytoma and 9/25 (36&#x0025;) of patients with grade II disease. PCNA and p53 labeling indices were positively correlated with Pearson&#x2032;s correlation, p less than 0.001 for both). Increased proliferative fraction, genetic alterations and neovascularization mark biological aggressiveness in astrocytoma. Immunohistochemical evaluation scores over meet the challenge of accurate prognostication of this potentially fatal malignancy