Histopathological evaluation of abnormal uterine bleeding with immunohistochemical study of significant estrogen receptor expression in endometrium of women with different age groups

Background: Abnormal uterine bleeding is symptom, not disease. Bleeding per vaginum is labelled to be pathological when there is constant irregularity in pattern and flow of bleeding, altered duration or increased amount of menstrual blood. Histopathological examination of endometrium biopsies remains a gold standard diagnostic tool. Methods: A prospective study was done on 150 patients presenting with AUB over the period January 2022 to December 2022 in the department of pathology, Hind institute of medical sciences, Sitapur, Uttar Pradesh, India. The sections were stained with hematoxylin and eosin and special stain estrogen receptor was used. Results: Majority of the patients were seen in the perimenopausal age group and most common complaint was menorrhagia in 73 patients (48%). The commonest pathology observed in our study was proliferative phase endometrium in 48 patients (32%). Most of the endometrial carcinoma (4%) were presented after the age of 50 years. The association between histopathological patterns and estrogen receptor category were found to be statistically significant as the p<0.05. Conclusions: Disease burden on a global scale is witnessed by women affected by AUB thus having a detrimental impact. Accurate diagnosis of AUB in women over the age of 35yrs is important to rule out preneoplastic lesions and malignancies so that surgical interventions can be avoided by initiating proper medical management. Comparing the hyperplastic and neoplastic endometrium to that of the proliferative phase, ER expression was lower. Endometrial carcinoma with advanced stage often lacks the expression of the receptors

Variations in anesthetic requirements with body mass index in patients undergoing trans vaginal oocyte retrieval

Background: Various techniques have been described for ultrasound guided trans-vaginal oocyte retrieval (TVOR). No single technique has been found to be superior to others. In many centers, paracervical block (PCB) is used, either alone or in conjunction with sedation for pain relief during TVOR. This aim of this study is to evaluate the variations in anaesthetic requirements with body mass index (BMI) in patients undergoing transvaginal oocyte retrieval (TVOR).Methods: This study comprised of 70 women aged between 20 to 40 years. All patients were classified according to WHO classification into four groups on the basis of their BMI. Parameters like effectiveness of paracervical block (PCB), requirement of additional anesthetic drug (propofol), time required for surgery and numbers of oocytes retrieved were studied for each group. The correlation of all these parameters with BMI was noted and statistically evaluated.Results: PCB alone was not sufficient and all patients required additional propofol for successfully completing the procedure. The requirement of propofol increased with increase in BMI of the patients. The amount of rescue propofol required in patients with BMI>30 was significantly higher as compared to females with BMI<30, irrespective of the time taken during the procedure or the oocyte retrieved. A positive correlation was also observed between number of oocyte retrieved and time taken for surgery.Conclusions: PCB is quite useful in patients with normal BMI, but it proved to be totally ineffective in obese patients (BMI>30) undergoing TVOR. The requirement of additional propofol and time taken to successfully conduct the procedure is significantly high in patients with high BMI. These alterations in anesthetic parameters with change in BMI have vital implications and they should be taken into consideration while managing obese patients undergoing TVOR

Role of 0.5 M mannitol as an adjuvant with lidocaine with or without epinephrine for inferior alveolar nerve block : a randomized control trial

Background: The most commonly used local anesthetic in dentistry is lidocaine. For decades, mannitol is the most widely used agent in the management of raised intracranial pressure and as prophylaxis against acute renal failure surgeries. Material and Methods: 120 patients were randomly divided into four groups, 30 patients in each group. Group A was administered 2% lidocaine with 1:80000 epinephrine; group B, 2% lidocaine with 1:80000 epinephrine and 0.5 M mannitol; group C, 2% lidocaine and 0.5 M mannitol; and group D (control group), 2% lidocaine for achieving local anesthesia. Extraction of lower erupted tooth was done under inferior alveolar nerve block. Parameters taken were onset of anesthesia, duration of anesthesia and pain. Heft-Parker visual analogue scale was taken to evaluate the pain response during procedure after every 10 minutes until complete return of sensation by probing. The Chi-square test was used to compare the pain among the groups. The continuous variables were compared among the groups by one way analysis of variance (ANOVA) followed by Tukey?s post-hoc comparison tests. The p-value 0.05). The total time in return of sensation was higher among the patients of group C (70.30±4.34) than group A (65.94±3.45), group B (62.23±7.47) and group D (47.70±8.04) but difference among the groups was found to be statistically significant (p=0.0001). There was no significant (p>0.05) difference in the pain at baseline and at start. No pain was found among all the patients from 10 minutes to subsequent time intervals. Conclusions: Mannitol was effective in increasing the efficacy of lidocaine as an adjuvant to local anesthetic solution in inferior alveolar nerve block

Death from mantle cell lymphoma limits sequential therapy, particularly after first relapse: Patterns of care and outcomes in a series from Australia and the United Kingdom

Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma characterised by a heterogeneous clinical course. Patients can often receive sequential treatments, yet these typically yield diminishing periods of disease control, raising questions about optimal therapy sequencing. Novel agents, such as chimeric antigen receptor T-cell therapies and bispecific antibodies, show promise in relapsed MCL, but are often reserved for later treatment lines, which may underserve patients with aggressive disease phenotypes who die early in the treatment journey. To assess the problem of patient attrition from lymphoma-related death limiting sequential treatment, we performed a multicentre retrospective cohort analysis of 389 patients treated at Australian and UK centres over a 10-year period. Deaths from MCL increased after each treatment line, with 7%, 23% and 26% of patients dying from uncontrolled MCL after first, second and third lines respectively. Patients with older age at diagnosis and early relapse after induction therapy were at particular risk of death after second-line treatment. This limitation of sequential treatment by lymphoma-related death provides support for the trial of novel therapies in earlier treatment lines, particularly in high-risk patient populations

Impact and utility of follicular lymphoma GELF criteria in routine care: an Australasian Lymphoma Alliance study

Follicular Lymphoma (FL) treatment initiation is largely determined by tumor burden and symptoms. In the pre-rituximab era, the Group d’Etude des Lymphomes Folliculaires (GELF) developed widely adopted criteria to identify high tumor burden FL patients to harmonize clinical trial populations. The utilization of GELF criteria (GELFc) in routine therapeutic decision-making is poorly described. This multicenter retrospective study evaluated patterns of GELFc at presentation and GELFc utilization in therapeutic decision-making in newly diagnosed, advanced stage rituximab-era FL. Associations between GELFc, treatment given, and patient survival were analyzed in 300 eligible cases identified between 2002-2019. 163 (54%) had ≥1 GELFc at diagnosis. The presence or cumulative number of GELFc did not predict PFS in patients undergoing watch-and-wait (WW) or those receiving systemic treatment. Of interest, in patients with ≥1 GELFc, 16/163 (10%) underwent initial watch-and-wait (comprising 22% of the watchand- wait cohort). In those receiving systemic therapy +/- radiotherapy, 74/215 (34%) met no GELFc. Our data suggest clinicians are using adjunctive measures to make decisions regarding treatment initiation in a significant proportion of patients. By restricting FL clinical trial eligibility only to those meeting GELFc, reported outcomes may not be applicable to a significant proportion of patients treated in routine care settings

The effects of transcutaneous electric nerve stimulation (TENS) on salivary flow: A study

Aim: This study was undertaken to evaluate the effectiveness of transcutaneous electric nerve stimulation (TENS) as a means of stimulating salivary function in healthy adult subjects. Materials and Methods: Fifty healthy adult subjects with no history of salivary gland disorder were enrolled in the protocol. The TENS electrode pads were placed externally on the skin overlying the parotid glands. Unstimulated saliva was collected for 5 min into graduated tubes. TENS unit was then activated and the stimulated saliva collected for an additional 5 min. Statistical Analysis Used: A paired "t" test was applied to look for statistically significant differences as a group between the amount of unstimulated and TENS-stimulated samples of saliva. Results: Forty-three out of 50 subjects demonstrated increased salivary flow when stimulated via the TENS unit. The mean unstimulated salivary flow rate was 0.354 ml/min (SD 0.19) and the mean stimulated salivary flow rate was 0.49 ml/min (SD 0.24). Statistical analysis of flow rates utilizing the paired t test demonstrated the difference to be statistically significant (P < 0.001). Conclusion: The TENS unit was effective in increasing the salivary flow in two-thirds of healthy adult subjects. A further study in a cohort of patients with salivary gland disorders is warranted

Lycopene and intralesional betamethasone injections in the management of oral submucous fibrosis

Aims and Objectives: This study was conducted to determine the efficacy of lycopene in the management of oral submucous fibrosis (OSMF) and to compare its efficacy with intralesional betamethasone injections. Materials and Methods: Forty-four patients were divided randomly into two groups. Group I subjects were treated with 10,000 mcg of lycopene (Lyconex) daily, in two equally divided doses, for two months. Group II subjects were given intralesional injections of betamethasone. Both the groups were assessed in terms of mouth opening and burning sensation. Results: A significant improvement in mouth opening was seen in both the groups and the improvement was better in Group I. The mean improvement in mouth opening in Group I was 37.62% (12 mm) at the end of the study, which was statistically highly significant and weekly evaluation revealed that this high significance was from the third week onward, and Group II patients (only intralesional steroids) showed an average improvement of 13% (3.9 mm) at the final follow-up visit. Conclusion: Lycopene (Lyconex) is better than intralesional betamethasone injections in improving mouth opening and decreasing burning sensation

Rare carcinoma ex-pleomorphic adenoma of buccal mucosa: case report and review of literature

Carcinoma ex pleomorphic adenoma (CXPA) is exceedingly rare in minor salivary glands of oral cavity. We present a case of CXPA arising from buccal mucosa in a 44-year-old male patient. The man presented to surgery outpatient department with right buccal mucosa swelling. Clinical impression suggests a neoplasm of buccal mucosa and the patient was sent for fine needle aspiration cytology. By examining the cytological smears, possibility of carcinoma was revealed. The mass was dissected and excised with safety margins. Examining Hematoxylin and Eosin slides, final diagnosis of CXPA was given. Patient did not turn for regular follow-ups and presented 1 year after surgery with recurrence at the same site. CXPA is an uncommon malignant tumor with highly aggressive biological behavior. Its occurrence in sites like buccal mucosa is rare. Hence, quite a diagnostic challenge at such sites cause diagnostic difficulties