A comparative analytical study of clinical outcome of oligohydramnios at or beyond 34 weeks of gestation

Background: Amniotic fluid volume measurement forms an integral part of the antenatal fetal monitoring. It is widely used as an indicator of fetal wellbeing during third trimester. The four quadrant method of calculating AFI as described by Phelan et al is accepted by most of the authors. Oligohydramnios in pregnancy without a renal abnormality or genitourinary obstruction represents “chronic in utero stress”. Perinatal morbidity and mortality are significantly increased in oligohydramnios. So oligohydramnios was taken up for further study in order to devise methods and means to know the cause, diagnose and manage it in a better way. The aim of the study was to study the maternal and perinatal outcome in oligohydramnios at or beyond 34 weeks of gestation.Methods: This comparative analytical study was done in pregnant women with AFI < 5cm diagnosed at/after 34 weeks of gestation attending antenatal clinic at department of OBG, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad from November 2012 to October 2013. Clinical outcome was compared with pregnant women having normal AFI (6-24 cm) at/after 34 weeks of gestation. For all women AFI and NST were done. UAD was done in women with oligohydramnios. Patients with abnormal NST and/or Doppler studies at the time of diagnosis or any time during fetal surveillance were considered for termination of pregnancy. In pregnant women with normal AFI, NST was done once in two weeks or as necessity demanded. Various clinical outcomes were measured using appropriate statistical measurements.Results: In presence of oligohydramnios, the occurrence of non-reactive NST, meconium stained liquor, development of fetal distress, LSCS rate; low Apgar score, low birth weight babies, NICU admissions and early neonatal deaths were high.Conclusions: Determination of AFI is a valuable parameter, which can be used as an adjunct to other fetal surveillance methods. It helps to identify neonates at risk of poor perinatal outcome

DEVELOPMENT AND VALIDATION OF FIRST ORDER DERIVATIVE SPECTROPHOTOMETRIC METHOD FOR SIMULTANEOUS ESTIMATION OF PARACETAMOL AND TAPENTADOL HYDROCHLORIDE IN TABLET DOSAGE FORM

A simple, precise, accurate and reproducible spectrophotometric method has been developed forSimultaneous estimation of Paracetamol and Tapentadol Hydrochloride by employing first order derivativezero crossing method in 0.1 N Sodium Hydroxide. The first order derivative absorption at 257.1 nm (zerocross point of Paracetamol) was used for quantification of Tapentadol HCl and 289.0 nm (zero cross point ofTapentadol HCl) for quantification of Paracetamol. The linearity was established over the concentrationrange of 15-3

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Role of Protein Kinase C-iota in Glioblastoma

The focus of this research was to investigate the role of protein kinase C-iota (PKC-é) in the regulation of Bad function, a pro-apoptotic member of the Bcl-2 family and Cdk7 function, a master cell cycle regulator in glioblastoma. The results were obtained from the human glial tumor derived cell lines, T98G and U87MG. In these cells, PKC-é co-localized and directly associated with Bad as shown by immunofluorescence, immunoprecipitation, and Western blotting. Furthermore, in-vitro kinase activity assay showed that PKC-é directly phosphorylated Bad at phospho specific residues, S112, S136 and S155 which in turn induced inactivation of Bad and disruption of the Bad/Bcl-XL dimer. Knockdown of PKC-é by siRNA exhibited a corresponding reduction in Bad phosphorylation suggesting that PKC-é may be a Bad kinase. Since, PKC-é is an essential downstream mediator of the PI (3)-kinase, we hypothesize that glioma cell survival is mediated via a PI (3)-kinase/PDK1/PKC-é/Bad pathway. Treatment with PI(3)-kinase inhibitors Wortmannin and LY294002, as well as PDK1 siRNA, inhibited PKC-é activity and subsequent phosphorylation of Bad suggesting that PKC-é regulates the activity of Bad in a PI (3)-kinase dependent manner. Robust expression of PKC-é is a hallmark of human glioma and benign and malignant meningiomas, however, little is understood about its role in glioma cell proliferation. The cyclin dependent kinase activating kinase complex (CAK), comprises of cyclin dependent kinase 7 (Cdk7), cyclin H and MAT1, is the master cell regulator. Cdk7 phosphorylates its downstream cyclin dependent kinases (cdks) and promotes cell proliferation. Results show that PKC-é directly associated and phosphorylated Cdk7 at T170. Furthermore, Cdk7 phosphorylated its downstream target, cyclin dependent kinase 2 (cdk2) at T160. Purified PKC-é was also observed to phosphorylate endogenous as well as exogenous Cdk7. PKC-é knockdown with siRNA, PDK1 siRNA and (PI) 3-kinase inhibitors, Wortmannin and LY294002 treatment exhibited corresponding reduction in phosphorylation of Cdk7 and subsequently cdk2. In addition, PKC-é knockdown reduced cell proliferation; led to cell cycle arrest and also induced apoptosis. Thus, these findings suggest the presence of a novel PI (3)-kinase/PKC-é/BAD mediated cell survival and PI (3)-kinase/PKC-é/Cdk7 mediated cell proliferation pathway

Role of Protein Kinase C-iota in Glioblastoma

The focus of this research was to investigate the role of protein kinase C-iota (PKC-é) in the regulation of Bad function, a pro-apoptotic member of the Bcl-2 family and Cdk7 function, a master cell cycle regulator in glioblastoma. The results were obtained from the human glial tumor derived cell lines, T98G and U87MG. In these cells, PKC-é co-localized and directly associated with Bad as shown by immunofluorescence, immunoprecipitation, and Western blotting. Furthermore, in-vitro kinase activity assay showed that PKC-é directly phosphorylated Bad at phospho specific residues, S112, S136 and S155 which in turn induced inactivation of Bad and disruption of the Bad/Bcl-XL dimer. Knockdown of PKC-é by siRNA exhibited a corresponding reduction in Bad phosphorylation suggesting that PKC-é may be a Bad kinase. Since, PKC-é is an essential downstream mediator of the PI (3)-kinase, we hypothesize that glioma cell survival is mediated via a PI (3)-kinase/PDK1/PKC-é/Bad pathway. Treatment with PI(3)-kinase inhibitors Wortmannin and LY294002, as well as PDK1 siRNA, inhibited PKC-é activity and subsequent phosphorylation of Bad suggesting that PKC-é regulates the activity of Bad in a PI (3)-kinase dependent manner. Robust expression of PKC-é is a hallmark of human glioma and benign and malignant meningiomas, however, little is understood about its role in glioma cell proliferation. The cyclin dependent kinase activating kinase complex (CAK), comprises of cyclin dependent kinase 7 (Cdk7), cyclin H and MAT1, is the master cell regulator. Cdk7 phosphorylates its downstream cyclin dependent kinases (cdks) and promotes cell proliferation. Results show that PKC-é directly associated and phosphorylated Cdk7 at T170. Furthermore, Cdk7 phosphorylated its downstream target, cyclin dependent kinase 2 (cdk2) at T160. Purified PKC-é was also observed to phosphorylate endogenous as well as exogenous Cdk7. PKC-é knockdown with siRNA, PDK1 siRNA and (PI) 3-kinase inhibitors, Wortmannin and LY294002 treatment exhibited corresponding reduction in phosphorylation of Cdk7 and subsequently cdk2. In addition, PKC-é knockdown reduced cell proliferation; led to cell cycle arrest and also induced apoptosis. Thus, these findings suggest the presence of a novel PI (3)-kinase/PKC-é/BAD mediated cell survival and PI (3)-kinase/PKC-é/Cdk7 mediated cell proliferation pathway

Hereditary leiomyomatosis and renal cell cancer syndrome associated renal cell carcinoma

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a recently described entity with unknown exact prevalence. The affected individuals are predisposed to have multiple leiomyomas and renal cancer due to germline mutation in fumarate hydratase gene on chromosome 1. The knowledge of this rare tumour is essential for early recognition and institution of appropriate therapy, since they have a grave prognosis. Herein, we present the first case from India of HLRCC in a 42 year old lady who presented with a renal mass and metastasis with consequent fulminant course of disease. We discuss the detailed histomorphologic features and iunique immunohistochemical signature of this unusual renal tumour with discussion of differential diagnosis

Corn Should Be a Food, Not a Fuel

Use natural gas as a transportation fuelSummer 201

Angiomatoid fibrous histiocytoma: Clinicopathological spectrum of five cases, including EWSR1-CREB1 positive result in a single case

Background: Angiomatoid fibrous histiocytoma (AFH) is an unusual soft tissue tumor (STT), characterized by recurrences, but rarely metastasis. Later, certain molecular signatures have been identified underlying this tumor, which at times, is either underdiagnosed as a benign vascular tumor, or over diagnosed as a high-grade pleomorphic sarcoma, including a malignant fibrous histiocytoma. Materials and Methods: Over a 14-year-period, five diagnosed cases of AFH were analyzed. Results: Five tumors occurred in three males and two females, over a wide age-range (median = 21, mean = 30 years); mostly in the extremities (4) (80%). Microscopically, most tumors were circumscribed, comprising large, blood-filed spaces with surrounding histiocytic cells and a “cuff” of lymphoplasmacytic cells. Three tumors revealed solid growth pattern with polygonal to spindle cells, including myxoid matrix in one of these tumors. On molecular analysis, this tumor exhibited EWS-CREB transcript. Immunohistochemically, various tumors were positive for CD68 (n = 2/2), epithelial membrane antigen (n = 3/4), CD99/MIC2 (n = 2/3), and desmin (n = 1/4). All tumors were surgically excised. On follow-up (n = 2), a single patient, who underwent wide-excision was free-of-disease (24 months), while another patient had a recurrence 4 months post tumor excision. Conclusions: This forms as the first documented series on clinicopathological features of AFH, a rare STT, from our country. Significant clinicopathological features include younger age, extremities as commonest site and histopathological appearance of blood-filled spaces with surrounding “cuff” of histiocytic cells and lymphocytes. Tumors with unusual histopathological tumor patterns require molecular confirmation. Surgical resection remains the treatment mainstay

Audiometry Analysis for the Assessment of Hearing Deficit in Patients with Oral Submucous Fibrosis

Introduction: Oral Submucous Fibrosis (OSMF) is a slowly progressive chronic fibrotic disease of the oral cavity extending to pharynx. Function and patency of eustachian tube gets altered when the palatal and paratubal muscles which regulate the patency of pharyngeal orifice gets affected. This leads to pain in ear along with mild to moderate conductive loss of hearing. Aim: To evaluate hearing deficit in OSMF patients and to correlate clinical stages of OSMF with degree of hearing deficits in patients. Materials and Methods: It was a cross-sectional study. The study comprised of a total of 50 subjects (100 ears). Forty patients diagnosed with OSMF who reported to Department of Oral Medicine and Radiology constituted the study group. Ten normal individuals with no deleterious habits and without any previously diagnosed ear disorders constituted the control group. Pure Tone Audiometry (PTA) was used for evaluating all the subjects for air conduction and bone conduction hearing loss. Values on qualitative characteristics were shown as n (% prevalence) across five study groups. Values on quantitative variables were shown as Mean±SD across five study groups. Inter group comparison for qualitative and quantitative variables was done using chi-square test and analysis of variance (ANOVA) test respectively with Post-Hoc Bonferroni’s correction for multiple group comparisons. Results: The OSMF group showed a marked degree of hearing loss compared to the control group. The distribution of mean PTA in quantitative assessment was significantly higher in group D compared to group A and group B (p-value<0.05 for both) and also the distribution of qualitative hearing loss was significantly higher in group C and group D (p-value<0.05). Conclusion: There was a significant association between OSMF and hearing deficit in this study. Fibrosis of the oropharynx and palatal/paratubal muscles which are affected in OSMF and theses muscles are attached to eustachian tube, the patency of the eustachian tube gets affected. As a result, patients with mainly advanced cases of OSMF should be assessed for hearing deficit

Pulmonary hemangioendothelioma with osteoclast-like giant cells: A rare observation

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular neoplasm, predominantly encountered in women, more often in the age group of 40 years and below. It is a tumor of borderline malignant potential with a clinical course intermediate between hemangioma and angiosarcoma. The tumor has variable prognosis, and treatment options include surgical excision in operable cases and chemotherapy in disseminated ones. The present report describes complete clinical, radiological, and histopathological features of PEH with osteoclast-like giant cells and metaplastic ossification in a 20-year-old boy who presented with dyspnea and episodes of hemoptysis with review of literature