A comparative study of perineal morbidity in vaginal delivery with and without episiotomy

Background: The objective was to determine the occurrence of perineal morbidity in women who delivered vaginally with an episiotomy versus those who delivered without.Methods: Primigravid women were enrolled into the study on documentation of full dilatation of the cervix and randomized into either the study group (delivered without an episiotomy) or Control Group (delivered with an episiotomy). All labours were carefully monitored with intermittent auscultation of foetal heart rate and partograph was plotted for everyone. Labour was augmented with oxytocin infusion if required. Good perineal and para urethral support at the time of crowning of the head and during delivery of the baby was given for patients of both the groups. Right mediolateral episiotomy was given for the control group. Perineum was then examined and if any lacerations were noted it was sutured, if necessary, as per standard protocol (vicryl rapide was used). Episiotomy was sutured in 3 layers with vicryl rapide.Results: The total number of patients studied was 300 – equally distributed in both the groups. The age group of the patients and birth weight of the babies were comparable. In the study group, 22.0% patients had no lacerations in the perineum. Inspite of an episiotomy, 15.34% had anterior and posterior perineal lacerations and in that 4.67% patients had anal sphincter tear. 9 patients had more than 50% of EAS torn but none of them complained of incontinence during their follow-up. 68.37% patients in the control group had persistent perineal pain for more than one week versus 19.42% in the study group. 4.27% patients in the control group had persistent pain whereas no patients in the study group had pain more than 2 months.Conclusions: Short term perineal morbidity is significantly lower in parturients who delivered without an episiotomy and that episiotomy did not offer protection against sustaining severe perineal lacerations

Classification, reduction and stability of toric principal bundles

Let $X$ be a complex toric variety equipped with the action of an algebraic torus $T$, and let $G$ be a complex linear algebraic group. We classify all $T$-equivariant principal $G$-bundles $\mathcal{E}$ over $X$ and the morphisms between them. When $G$ is connected and reductive, we characterize the equivariant automorphism group $\text{Aut}_T(\mathcal{E} )$ of $\mathcal{E}$ as the intersection of certain parabolic subgroups of $G$ that arise naturally from the $T$-action on $\mathcal{E}$. We then give a criterion for the equivariant reduction of the structure group of $\mathcal{E}$ to a Levi subgroup of $G$ in terms of $\text{Aut}_T(\mathcal{E} )$. We use it to prove a principal bundle analogue of Kaneyama's theorem on equivariant splitting of torus equivariant vector bundles of small rank over a projective space. When $X$ is projective and $G$ is connected and reductive, we show that the notions of stability and equivariant stability are equivalent for any $T$-equivariant principal $G$-bundle over $X$.Comment: 47 page

Efficacy and safety of the trans-obturator tape for female stress urinary incontinence

Background: To assess the safety and efficacy of Trans-obturator tape (TVT-O) for female stress urinary incontinence (SUI).Methods: A cohort of 35 cases of SUI and underwent TVT-O procedure over a period of 4 years. Pre-operative evaluation included pelvic examination, one hour pad test, urodynamic study, urinary diary and baseline haematological tests. Post-operatively all women had post-void residual volume and were followed up for 3 years.Results: The mean age of the patients was 47±9.5 years. TVT-O alone was done in 58.1% of cases. 41.9% of cases had TVT-O done as a concomitant procedure. The median duration of follow-up was 48 months. The overall objective and subjective cure rate was 92.3% with failure rate of 7.7%, 12.9% of women reported post-operative thigh pain and 6.5% patients had immediate post-operative urinary retention. 16.1% of the patients had post-operative voiding dysfunction. No major complications were encountered in these patients.Conclusions: TVT-O is a safe, easy and effective minimally invasive procedure for female SUI with minimal acceptable complications

Prospective observational study on Pazopanib in patients treated for advanced or metastatic renal cell carcinoma in countries in Asia Pacific, North Africa, and Middle East regions: PARACHUTE study (vol 21, 1021, 2021) [Correction]

[No Abstract Available

Autologous stem cell transplantation for multiple myeloma: identification of prognostic factors

Introduction: The purpose of this study was to evaluate the effect of prognostic factors on the outcome of patients with MM after ASCT. Patients and Methods: We analyzed results of 170 consecutive patients (121 male and 49 female) of MM who underwent ASCT. Patients' median age was 52 years (range, 26-68 years). High dose melphalan (200 mg/m2) was used for conditioning. One hundred thirty-two patients (77.6%) had evidence of chemosensitive disease before transplant. Response was assessed using European Group for Blood and Bone Marrow Transplantation criteria. Results: Post ASCT 44.7% of patients achieved CR, 24.7% had very good partial response (VGPR), and 21.2% had partial response (PR). Presence of pretransplant chemosensitive disease (CR, VGPR, and PR) and transplant within 12 months of diagnosis for years before 2006 were associated with higher response rates on multivariate analysis. At a median follow-up of 84 months, median overall (OS) and event-free survival (EFS) is 85.5 and 41 months, respectively. Estimated OS and EFS at 60 months is 62 ± 0.04% and 41 ± 0.04%, respectively. Patients who responded to transplant (CR, VGPR, and PR) had a longer OS (P < .001) and EFS (P < .001). Additionally, patients who achieved CR post transplant had a longer OS (P < .001) and EFS (P < .001). Patients who received novel agents for induction pretransplant had a longer OS (P < .001) and EFS (P < .002). Conclusion: Outcome after ASCT is better for myeloma patients with pretransplant chemosensitive disease and those who achieve CR after transplant

Expression of Cathepsin L in tumor cells and tumor-associated macrophages in patients with Ewing sarcoma family of tumors: A pilot study

Background: Cysteine protease Cathepsin L is involved in bone remodeling and expressed in activated macrophages. It is highly expressed in metastatic tumor tissue, especially with bone metastases. Aims: We evaluated immunohistochemical expression of Cathepsin L in tumor cells and tumor-associated macrophages (TAMs) in chemo-naive Ewing sarcoma. Settings and Design: Retrospective evaluation of archived specimens of Ewing sarcoma. Materials and Methods: Immunohistochemical staining was performed on archived blocks of chemo-naive patients with Ewing sarcoma treated with uniform chemotherapy at our institute between January 2009 and November 2011. Statistical Analysis: Immunohistochemical expression was co-related with baseline demographics and survival. Results: During the study period, we had evaluable baseline samples from 62 patients with median age 15 years (range: 2-40); 26 (42%) had metastases. Cathepsin L expression in tumor cells was observed in 8/62 (13%) specimens. None of the baseline clinical characteristics correlated with Cathepsin L expression. Cathepsin L positivity was associated with poor response to neoadjuvant chemotherapy (NACT) (P = 0.05), but did not influence either event-free-survival (EFS) or overall survival. Cathepsin L was expressed in TAMs in all specimens. Grade 3 TAMs (>10 TAMs/high power field) was associated with better response to NACT (P = 0.05). On univariate analysis Grade 3 TAMs predicted superior EFS (median EFS 28.5 months in those with Grade 3 TAMs versus 14.8 months in those with grade ½ TAMs [P = 0.04]). Conclusions: Cathepsin L expression by immunohistochemistry was low in our patient cohort, and it did not affect the outcome. In addition, Grade 3 TAMs with Cathepsin L expression was associated with improved EFS