Study of incidence and different aspects of cervical malignancy in tertiary centre of Jharkhand, India

ackground: Among the various killers of women of developing world, cervical cancer remains high in the list. Cervical cancer is the second most common cancer in women worldwide and the most common cancer in developing nations. The aim of the study was to determine the incidence of cervical cancer in post-menopausal women in Jharkhand and to determine various risk factors.Methods: The study was conducted on post-menopausal females presenting in outpatient department, emergency and indoor patients admitted in the department of Gynecology and Obstetrics at Rajendra Institute of Medical Sciences, Ranchi from March 2015 to September 2016. All post-menopausal women patients with suspected or proved cervical malignancy were included in the study.Results: The incidence of cervical cancer in this study was 16%. Maximum number of cases with cervical malignancy was in the age of 51-60 (45.83%). 45.83% of cases belonged to Hindu community. Maximum number of cases belonged to low socio-economic group (66.66%).  45.83% of cases were para 5 or more Most of the patient had more than one complains. Post-menopausal bleeding was commonest complain present in 66.66%, 77.08% came in advance stage (stage IIb+ III+ IV).Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted

Clampless non descent vaginal hysterectomy: “A novel art”

Background: Objective of this study was to assess feasibility and safety of clampless non descent vaginal hysterectomy of uterus up to 16 weeks size and identifying factors that determine success of surgery.Methods: Study was conducted in 50 women with non-prolapsed uteri, with clear cut indication of hysterectomy for a benign cause, without suspected adnexal pathology. Operating time, estimated blood loss, surgical techniques, difficulties encountered during operation, operative and post-operative complications and conversion to laparotomy when needed were recorded.Results: Vaginal hysterectomy was successful in 47 cases. Bisection was required in 60% cases, myomectomy in 24% cases and morcellation in 16% cases. Amount of blood loss and operating time was proportional to size of uterus.Conclusions: Clampless non descent vaginal hysterectomy is a safe and effective procedure and for success not only size of the uterus but its all dimensions and location of fibroid should be taken into consideration.

Neurofilament phosphorylation is increased in ventral horn neurons of neonatal rat spinal cord exposed to cerebrospinal fluid from patients with Amyotrophic Lateral Sclerosis

Aberrant neurofilament (NF) phosphorylation in the soma of the ventral horn neurons of neo-natal rat spinal cord is observed following exposure to cerebrospinal fluid (CSF) of patients suffering from Amyotrophic Lateral Sclerosis (ALS). CSF samples from ALS and non-ALS neurological patients were injected into the spinal subarachnoid space of 3 day old rat pups. After 48 h, sections of spinal cords were stained for the presence of phosphorylated NF epitopes with SMI-31 antibody. The number of neuronal soma staining with this antibody in the ventral and dorsal horns sides of the spinal cord was counted. There was a significant 3-fold increase in the number of soma stained with SMI-31 antibody in the ventral horns of rat spinal cords exposed to CSF of patients with ALS compared to cords from rats exposed to CSF of non-ALS patients and those which were not exposed to any CSF samples. Such an increase in staining of neuronal soma was not observed in the dorsal horns. Hyperphosphorylation of neuronal soma suggests an initial stage of degenerative changes occurring in the motor (ventral horn) neurons following exposure to circulating factor(s) in the CSF of patients with ALS

(−)-Deprenyl alleviates the degenerative changes induced in the neonatal rat spinal cord by CSF from amyotrophic lateral sclerosis patients

Previous studies from our laboratory suggest the presence of toxic factor(s) in the cerebrospinal fluid (CSF) of patients with amyotrophic lateral sclerosis (ALS) which induces degenerative changes in the spinal cord neurons. The present work was carried out to investigate the role of (−)-deprenyl in attenuating these degenerative changes. CSF samples from ALS and non-ALS neurological patients were injected into the spinal subarachnoid space of 3-day-old rat pups, followed by a single dose (0.01/mg/kg body weight) of (−)-deprenyl, administered 24 h after CSF injection. After a further period of 24 h, the rats were sacrificed and the spinal cord sections were stained with antibodies against phosphorylated neurofilament (NF, SMI-31 antibody) and glial fibrillary acidic protein (GFAP). Activity of lactate dehydrogenase (LDH) was also measured. (−)-Deprenyl injection resulted in a significant (61%) decrease in the number of SMI-31 stained neuronal soma in the ventral horn of the spinal cord of ALS CSF exposed rats. This was accompanied by a reduction in the astrocytes immunoreactive for GFAP. There was also a significant (35%) decrease in the LDH activity following (−)-deprenyl treatment. These results suggest that (−)-deprenyl may confer neuroprotection against the toxic factor(s) present in ALS CSF

Down regulation of trophic factors in neonatal rat spinal cord after administration of cerebrospinal fluid from sporadic amyotrophic lateral sclerosis patients

Accumulating evidence supports neuroprotective role of trophic factors in amyotrophic lateral sclerosis (ALS). Previous studies from our laboratory report that the CSF of patients with sporadic ALS (ALS-CSF) induces degenerative changes in the rat spinal motor neurons and reactive astrogliosis in the surrounding gray matter. The present study was aimed to investigate if the ALS-CSF affected the expression of trophic factors namely, brain-derived neurotrophic factor (BDNF), fibroblast growth factor 2 (FGF2) and insulin-like growth factor 1 (IGF1) in the newborn rat spinal cords. ALS-CSF was intrathecally injected into the neonatal rats and the mRNA levels of the trophic factors were determined by quantitative real-time polymerase chain reaction. Here, we report significant down regulation in the gene expression of trophic factors for BDNF, FGF2 and IGF1. BDNF mRNA levels were found to be reduced by 6.8-fold in the ALS-CSF injected group compared to control groups. The levels of IGF1 and FGF2 mRNA were also decreased by 3.91- and 2.13-fold, respectively, in the ALS group. We further found that exogenous supplementation of BDNF considerably reduced the aberrant phosphorylation of neurofilaments, complementing our earlier findings of restored expression of voltage gated sodium channel. Reduced expression of trophic factors indicates an altered microenvironment of the motor neurons and could possibly be one of the contributing factors in the degeneration process

Duration of post-operative hypocortisolism predicts sustained remission after pituitary surgery for Cushing’s disease

Purpose: Transsphenoidal surgery (TSS) is the primary treatment modality for Cushing’s disease (CD). However, the predictors of post-operative remission and recurrence remain debatable. Thus, we studied the post-operative remission and long-term recurrence rates, as well as their respective predictive factors. Methods: A retrospective analysis of case records of 230 CD patients who underwent primary microscopic TSS at our tertiary care referral centre between 1987 and 2015 was undertaken. Demographic features, pre- and post-operative hormonal values, MRI findings, histopathological features and follow-up data were recorded. Remission and recurrence rates as well as their respective predictive factors were studied. Results: Overall, the post-operative remission rate was 65.6% (early remission 46%; delayed remission 19.6%), while the recurrence rate was 41% at mean follow-up of 74 ± 61.1 months (12–270 months). Significantly higher early remission rates were observed in patients with microadenoma vs macroadenoma (51.7% vs 30.6%, P = 0.005) and those with unequivocal vs equivocal MRI for microadenoma (55.8% vs 38.5%, P = 0.007). Patients with invasive macroadenoma had poorer (4.5% vs 45%, P = 0.001) remission rates. Recurrence rates were higher in patients with delayed remission than those with early remission (61.5% vs 30.8%, P = 0.001). Duration of post-operative hypocortisolemia ≥13 months predicted sustained remission with 100% specificity and 46.4% sensitivity. Recurrence could be detected significantly earlier (27.7 vs 69.2 months, P < 0.001) in patients with available serial follow-up biochemistry as compared to those with infrequent follow-up after remission. Conclusion: In our study, remission and recurrence rates were similar to that of reported literature, but proportion of delayed remission was relatively higher. Negative/equivocal MRI findings and presence of macroadenoma, especially those with cavernous sinus invasion were predictors of poor remission rates. In addition to early remission, longer duration of post-operative hypocortisolism is an important predictor of sustained remission. Regular biochemical surveillance may help in identifying recurrence early