Role of Uterine Artery Doppler in earlier Prediction of resolution in Post Molar Pregnancy surveillance

BACKGROUND: Gestational trophoblastic disease (GTD) is an uncommon complication of pregnancy, worldwide the incidence of GTD varies reportedly between 0.5 & 0.8 cases per 1000 live births. β-hCG has been used as standard tool for monitoring the biological activity of trophoblastic diseases and as a tumour marker. The abundant vascular supply of the tumour makes Colour Doppler Ultrasound a potentially useful tool to study the correlation of tumour’s blood flow and its clinical behaviour. OBJECTIVE: To study the changes in the Doppler blood flow velocity of the uterine artery, the correlation between resistance indices & β-hCG level before and after evacuation of molar pregnancy as well as the value of Doppler flow in assessing the course of the disease. PATIENTS AND METHODS: A prospective longitudinal study was conducted in Government Rajaji Hospital, Department of Obstetrics & Gynaecology, Madurai from august 2015 through august 2016. Forty cases of vesicular mole entered the study and were assessed before and after evacuation of the uterus by measuring serum β-hCG level and finding its relation with changes in the blood flow of the uterine artery using Doppler Resistance Index. RESULTS: Out of 40 patients, 36 patients had resolution of molar pregnancy, while 4 patients had progression to invasive mole and were started on chemotherapy. 36 out 40 cases showed continuous decrease of their β-hCG serum level from pre-evacuation mean value of 3013.75 IU/L until it reached a mean value of 0.27 IU/L in the 8th week after evacuation. (P value < 0.0001), The 36 cases also showed continuous increase of Doppler resistance indices increases from pre-evacuation mean value of 0.57 to 48 hours after evacuation mean value of 0.85. 4 patients showed no consistent decrease or plateauing of β-hCG with decrease in Doppler resistance indices for which chemotherapy was started. Fall in post evacuation βhCG value was associated with rise in post evacuation UARI and vice versa. Variation in UARI measurement in relation to ẞHCG levels correlates strongly, inversely and negatively. CONCLUSION: Finding such a significant correlation between β-hCG serum level and Doppler indices suggest that colour Doppler may be used to predict the course of the disease and define its course

Pregnancy outcome in women with polycystic ovary syndrome

Background: To compare the pregnancy outcome in polycystic ovary syndrome (PCOS) women with normal women and to study the incidence of pregnancy complications like spontaneous abortions, preterm labour, gestational diabetes, gestational hypertension, preeclampsia, pregnancy and neonatal outcome in women with PCOS.Methods: Prospective comparative study done on 160 pregnant women to compare the pregnancy outcome in PCOS and normal women. All patients were subjected to detailed history, general and obstetric examination, antenatal investigations, routine dating scan, glucose challenge test at 24 to 28 weeks in study and control groups, blood pressure recording and urine for proteinuria after 20 weeks to evaluate preeclampsia. After delivery, birth weight and apgar score at 1 and 5 minutes are recorded. Body mass index is calculated and pregnancy outcome studied and compared.Results: Out of 80 pregnancies with PCOS, 8 had spontaneous abortions, 11 Gestational diabetes mellitus (GDM), 9 gestational hypertension, 5 preeclampsia and 3 had preterm labour. GDM is 3 times, Spontaneous Abortion is 4.33 times, gestational hypertension is 3.25 times and neonatal intensive care unit (NICU) admission is 3.25 times more in PCOD women.Conclusions: Pregnancy complications like spontaneous abortions, gestational diabetes, gestational hypertension and neonatal complications requiring NICU admissions are significantly higher in pregnant women with PCOD. Pregnant women with PCOD may become a high risk pregnancy at any time. Hence proper antenatal care is mandatory to prevent and treat the complications.

Metastatic Status of Lymphnodes from Radical Surgical Resections: Role of Cytokeratin as an Adjuvant to Standard Staining Method

BACKGROUND: Even after curative surgical resection of an early cancer, some patients get recurrence and die of cancer. So it is our view that those with an early stage of malignancy and died, might have got occult metastasis in their nodes. Those occult metastases can be identified using IHC with epithelial markers such as cytokeratin. OBJECTIVE: To determine the effectiveness of immunohistochemistry (Pan cytokeratin) as an adjuvant in detecting occult metastasis in lymph nodes. METHODS: Study material includes cases of radical resections diagnosed as malignancy. Among the cases, 50 cases which were diagnosed as epithelial malignancies on H&E were separated and chosen for study. Grading was performed, followed by TNM staging was done. And the nodes which were negative for metastasis, were taken for immunohistochemistry. The observations were recorded, compared and analyzed. RESULTS: Out of 498 nodes, 54 nodes are detected as positive for metastasis by H&E, whereas additional 14 nodes are detected as positive for metastasis by pan cytokeratin method. Among 50 cases studied, TNM stage is modified for 6 cases, among which 4/20 cases of breast malignancies (1/2 of invasive lobular carcinoma, 3/18 of invasive ductal carcinoma) and 2/8 cases of gastric malignancies. CONCLUSIONS: A routine screening of lymph nodal slides with Pan ck – IHC could highlight the nodal status exactly as an occult metastasis are readily identified. It leads to categorise the additional metastatic nodal load, so that improved therapeutic decision can be made

Synthesis of 1-Substituted-4-(Pyridin-4-yl) [1,2,4] Triazolo [4,3-a] Quinazolin-5(4H)-ones as a New Class of H1- Antihistaminic Agents

Purpose: To synthesize a new series of 1-substituted-4-(pyridin-4-yl) [1,2,4] triazolo [4,3-a]quinazolin- 5(4H)-ones and evaluate them for H1-antihistaminic activity with negligible side effects in guinea pigs.Methods: The synthesized compounds were characterized by Infrared spectroscopy (IR), proton nuclear magnetic resonance (1H-NMR) and mass spectrometry (MS) data. The purity of the compounds was determined by elemental analysis. The antihistaminic activity of the compounds was evaluated in guinea pigs by histamine-induced bronchoconstriction method.Results: Among the series, 1-methyl-4-(pyridin-4-yl) [1,2,4] triazolo [4,3-a] quinazolin-5(4H)-one (S5) was the most potent with 72.85 % protection and its potency was comparable to that of the reference, chlorpheniramine maleate (70.09 %). Interestingly, the sedative property of compound S5 was negligible (5.09 %) when compared to chlorpheniramine maleate (29.58 %).Conclusion: Compound S5 can serve as a lead molecule for further development into a new class of H1-antihistaminic agents.Keywords: Quinazolin-5-ones, Antihistaminic activity, Histamine, Bronchoconstrictio

POTENTIAL OF URAI MATHIRAI (PEDIATRIC SIDDHA FORMULATION) FOR THE PROPHYLAXIS AND MANAGEMENT OF COVID-19 IN CHILDREN

The World Health Organization (WHO) data proposes that 8.5% of reported COVID-19 cases belong to pediatric population who are aged less than 18 years. Supportive care alone is recommended in asymptomatic, mild, or moderate pediatric COVID-19 patients by the panel of pediatric infectious diseases physicians and pharmacists from 20 geographically diverse North American institutions. This review article focuses on the prophylactic and therapeutic potential of Urai mathirai in the management of pediatric COVID-19 patients. The literature was looked, in databases such as Medline/PubMed Central/PubMed, Google Scholar, Science Direct, Web of science, Directory of open access journals (DOAJ), and reference lists to distinguish published manuscripts relevant to the use of Urai mathirai to prevent or treat COVID-19 in children. The herbs found in Urai Mathirai and their bioactive phytoconstituents possess antiviral, anti-inflammatory, antioxidant, immunomodulatory, bronchodilatory and other pharmacological effects relevant to the management of signs and manifestations of COVID-19. The viability of Urai Mathirai in the prophylaxis and management of pediatric COVID-19 patients could further be established by future clinical studies

Functional balance between Tcf21-Slug defines cellular plasticity and migratory modalities in high grade serous ovarian cancer cell lines.

Cellular plasticity and transitional phenotypes add to complexities of cancer metastasis that can be initiated by single cell epithelial to mesenchymal transition (EMT) or cooperative cell migration (CCM). Our study identifies novel regulatory cross-talks between Tcf21 and Slug in mediating phenotypic and migration plasticity in high-grade serous ovarian adenocarcinoma (HGSC). Differential expression and sub-cellular localization associate Tcf21, Slug with epithelial, mesenchymal phenotypes respectively; however gene manipulation approaches identify their association with additional intermediate phenotypic states, implying the existence of a multi-step epithelial-mesenchymal transition program. Live imaging further associated distinct migratory modalities with the Tcf21/Slug status of cell systems and discerned proliferative/passive CCM, active CCM and EMT modes of migration. Tcf21-Slug balance identified across a phenotypic spectrum in HGSC cell lines, associated with micro-environment induced transitions and the emergence of an epithelial phenotype following drug exposure. Phenotypic transitions and associated functionalities following drug exposure were affirmed to ensue from occupancy of Slug promoter E-box sequences by Tcf21. Our study effectively provides a framework for understanding the relevance of ovarian cancer plasticity as a function of two transcription factors

KAP survey on dental waste management among dentists: A questionnaire based study

Dental waste can be hazardous to humans and the environment. Care should be taken while disposing of clinical waste in order to protect and maintain the environment from contamination and ensure safety of those who come in contact with it. Aim of the study is to determine the awareness on knowledge, attitude and practice among dentists on dental waste management. A questionnaire-based survey was conducted.203 questionnaires were distributed to dentists in and around Saveetha Dental College, Chennai. Data was collected and were tabulated, statistically analysed using SPSS software. Based on the study, it was found that 95.1% of the dentists knew protocol for waste management. However, only 55.2% sent amalgam waste to recycler, and 62.6% of the dentists rinse amalgam containing traps or containers in the sink.Based on the study we can conclude that though majority of the dentists were aware of waste management protocol and however almost half the number of dentists did not practice proper disposal of amalgam waste

Study of effectiveness of combined test Pap smear, visual inspection with acetic acid and Lugols iodine for mass screening of premalignant and malignant lesions of cervix

Background: Cancer cervix is the leading cause of morbidity and mortality in developing nations. This study aims to evaluate the usefulness of visual inspection with acetic acid (VIA) and Lugols iodine (VILI) as adjunct to improve the sensitivity of cervical cytology with Pap smear and to enhance the test performance.Methods: Study was conducted in Gynaec OPD clinic in SVMCH & RC, Ariyur, Pondicherry during the period of January 2015 to June 2015. 350 patients enrolled in the study, 10 patients (2.8%) had positive Pap smear, 96 patients (27.4%) had inflammatory smears and 244 (69.7%) had normal smear. VIA was positive in 29 patients (8.2%). VILI was positive in 50 patients (14.2%).Results: Sensitivity of Pap smear = 40% (CI 19.82-64.25%), sensitivity of VIA=40% (CI 19.82-64.25%), sensitivity of VILI = 86.66% (CI 62.12-92.26%), sensitivity of VIA+VILI tests = 86.66% (CI 62.12-96.26), sensitivity of combination tests (Pap + VIA + VILI) = 100% (CI 79.60-100.00). As shown by our study, VILI picked up the maximum premalignant lesions confirmed by cervical biopsy (15 premalignant lesions on cervical biopsy, and VILI is positive in 13 cases) and 6 were picked up by VIA, whereas Pap was positive in 6 patients.Conclusions: This study concludes that the effectiveness of cervical cancer screening can be improved by a combination test of Pap, VILI and VIA, even in tertiary centers in India

Study of effectiveness of combined test Pap smear, visual inspection with acetic acid and Lugols iodine for mass screening of premalignant and malignant lesions of cervix

Background: Cancer cervix is the leading cause of morbidity and mortality in developing nations. This study aims to evaluate the usefulness of visual inspection with acetic acid (VIA) and Lugols iodine (VILI) as adjunct to improve the sensitivity of cervical cytology with Pap smear and to enhance the test performance.Methods: Study was conducted in Gynaec OPD clinic in SVMCH &amp; RC, Ariyur, Pondicherry during the period of January 2015 to June 2015. 350 patients enrolled in the study, 10 patients (2.8%) had positive Pap smear, 96 patients (27.4%) had inflammatory smears and 244 (69.7%) had normal smear. VIA was positive in 29 patients (8.2%). VILI was positive in 50 patients (14.2%).Results: Sensitivity of Pap smear = 40% (CI 19.82-64.25%), sensitivity of VIA=40% (CI 19.82-64.25%), sensitivity of VILI = 86.66% (CI 62.12-92.26%), sensitivity of VIA+VILI tests = 86.66% (CI 62.12-96.26), sensitivity of combination tests (Pap + VIA + VILI) = 100% (CI 79.60-100.00). As shown by our study, VILI picked up the maximum premalignant lesions confirmed by cervical biopsy (15 premalignant lesions on cervical biopsy, and VILI is positive in 13 cases) and 6 were picked up by VIA, whereas Pap was positive in 6 patients.Conclusions: This study concludes that the effectiveness of cervical cancer screening can be improved by a combination test of Pap, VILI and VIA, even in tertiary centers in India