Laparoscopy: the tool for infertility

Background: Most of the healthy couples conceive within a year after marriage. The infertility patients have become important part of clinical practice. Diagnostic and therapeutic Laparoscopy plays major role in the management of these cases. We investigated hale 50 infertile women with laparoscopy. This study was undertaken to ascertain the diagnostic and therapeutic role of Laparoscopy in female infertility.Methods: We evaluated 50 couples having infertility. The cases of primary and secondary infertility were evaluated. The laparoscopy was done under general anaesthesia. The pelvic organs were examined, and tubal patency was tested with chromo-perturbation by using Methylene blue dye. The findings were noted. The therapeutic intervention was done in the cases where it was necessary.Results: Total 50 cases of infertility were studied. Thirty were of primary infertility and 20 were of secondary infertility. The patients with primary infertility were younger with mean age of 20 years. The duration of infertility ranged from 1.5 to 8 years. We detected total 21 (42%) patients with ovarian pathology, 5 (10%) with tubal, four (8%) with peritoneal factor 3 (6%) with endometriosis. One patient had uterine fibroid and 16 (32%) cases had normal laparoscopic findings.Conclusion: This study supported the diagnostic and therapeutic value of laparoscopy in managing infertile women. It helped in detection of pelvic pathology. It also helped to plan further management in the form of IUI or IVF

The prevalence of thyroid disorder in pregnancy

Background: The development of maternal thyroid disorders during early pregnancy can influence the pregnancy outcome and fetal development. The present study was conducted to know the prevalence of thyroid disorders in the Indian pregnant population and the obstetric outcomes of those women suffering from thyroid disorders. Methods: The present study was conducted on 100 women who came for an antenatal check-up in the first trimester, with Singleton Pregnancy. A detailed history was taken followed by a thorough general physical examination. Patients were sent for TSH (Thyroid Stimulating Hormone) testing. Patients were sent for TSH (Thyroid Stimulating Hormone) testing. If TSH (Thyroid Stimulating Hormone) was deranged, then FT3 and FT4 levels were checked. Depending upon the FT3 and FT4 values they are grouped as subclinical/overt hypothyroidism or hyperthyroidism. Results: Most of the patients in the present study were from the age group 21 to 30 years. The prevalence of thyroid disorders in the present study was 38%, including hypo and hyperthyroidism. 28% of patients were found to be hypothyroid; 10% of patients were hyperthyroid. Conclusions: The prevalence of thyroid disorders, especially hypothyroidism (28%) was high. Further studies are needed to assess adverse effects on maternal and fetal outcomes. Routine antenatal thyroid screening should be done.

Prediction of preterm labour by cervical length

Background: Preterm birth is one of the commonest causes of perinatal mortality. Cervical length is one of the major determinants of preterm delivery.Methods: This prospective observational study of 100 pregnant women attending ANC OPD was carried out at D.Y. Patil Hospital, Kolhapur. The pregnant women were scanned for cervical length between 11-14 weeks and 20-22 weeks of gestation, using USG machine with TVS probe (mindray DC-7).Results: The mean value of cervical length in pregnant women at 11-14 weeks was 3.94 cm and at 20-22 weeks of gestation it was 3.38 cm. There was shortening in the pregnant cervix from first to second trimester. In the study 12% of patients delivered prematurely who had reduction in cervical length from first trimester to second trimester. The inverse relation between the cervical length during pregnancy and frequency of preterm delivery was confirmed. The decrease in cervical length at 11-14 weeks of gestation and 20-22 weeks of gestation was useful for identifying patients at increased risk for pre-trerm.Conclusions: Our findings confirm those of previous studies that have found an inverse relation between the length of the cervix, as measured by transvaginal ultrasonography during pregnancy, and the frequency of preterm delivery. We found that the cervical length measured at 11-14 weeks and 20-22 weeks gestation was decreased in asymptomatic women with single to n pregnancies was useful for identifying patients at increased risk for preterm delivery

Host cell killing by the West Nile Virus NS2B–NS3 proteolytic complex: NS3 alone is sufficient to recruit caspase-8-based apoptotic pathway

AbstractThe West Nile Virus (WNV) non-structural proteins 2B and 3 (NS2B–NS3) constitute the proteolytic complex that mediates the cleavage and processing of the viral polyprotein. NS3 recruits NS2B and NS5 proteins to direct protease and replication activities. In an effort to investigate the biology of the viral protease, we cloned cDNA encoding the NS2B–NS3 proteolytic complex from brain tissue of a WNV-infected dead crow, collected from the Lower Merion area (Merion strain). Expression of the NS2B–NS3 gene cassette induced apoptosis within 48 h of transfection. Electron microscopic analysis of NS2B–NS3-transfected cells revealed ultra-structural changes that are typical of apoptotic cells including membrane blebbing, nuclear disintegration and cytoplasmic vacuolations. The role of NS3 or NS2B in contributing to host cell apoptosis was examined. NS3 alone triggers the apoptotic pathways involving caspases-8 and -3. Experimental results from the use of caspase-specific inhibitors and caspase-8 siRNA demonstrated that the activation of caspase-8 was essential to initiate apoptotic signaling in NS3-expressing cells. Downstream of caspase-3 activation, we observed nuclear membrane ruptures and cleavage of the DNA-repair enzyme, PARP in NS3-expressing cells. Nuclear herniations due to NS3 expression were absent in the cells treated with a caspase-3 inhibitor. Expression of protease and helicase domains themselves was sufficient to trigger apoptosis generating insight into the apoptotic pathways triggered by NS3 from WNV

A novel tissue-specific meta-analysis approach for gene expression predictions, initiated with a mammalian gene expression testis database

<p>Abstract</p> <p>Background</p> <p>In the recent years, there has been a rise in gene expression profiling reports. Unfortunately, it has not been possible to make maximum use of available gene expression data. Many databases and programs can be used to derive the possible expression patterns of mammalian genes, based on existing data. However, these available resources have limitations. For example, it is not possible to obtain a list of genes that are expressed in certain conditions. To overcome such limitations, we have taken up a new strategy to predict gene expression patterns using available information, for one tissue at a time.</p> <p>Results</p> <p>The first step of this approach involved manual collection of maximum data derived from large-scale (genome-wide) gene expression studies, pertaining to mammalian testis. These data have been compiled into a Mammalian Gene Expression Testis-database (MGEx-Tdb). This process resulted in a richer collection of gene expression data compared to other databases/resources, for multiple testicular conditions. The gene-lists collected this way in turn were exploited to derive a 'consensus' expression status for each gene, across studies. The expression information obtained from the newly developed database mostly agreed with results from multiple small-scale studies on selected genes. A comparative analysis showed that MGEx-Tdb can retrieve the gene expression information more efficiently than other commonly used databases. It has the ability to provide a clear expression status (transcribed or dormant) for most genes, in the testis tissue, under several specific physiological/experimental conditions and/or cell-types.</p> <p>Conclusions</p> <p>Manual compilation of gene expression data, which can be a painstaking process, followed by a consensus expression status determination for specific locations and conditions, can be a reliable way of making use of the existing data to predict gene expression patterns. MGEx-Tdb provides expression information for 14 different combinations of specific locations and conditions in humans (25,158 genes), 79 in mice (22,919 genes) and 23 in rats (14,108 genes). It is also the first system that can predict expression of genes with a 'reliability-score', which is calculated based on the extent of agreements and contradictions across gene-sets/studies. This new platform is publicly available at the following web address: <url>http://resource.ibab.ac.in/MGEx-Tdb/</url></p

Epidemiology of malaria and anemia in high and low malaria-endemic North-Eastern districts of India

Anemia and malaria are the two major public health problems that lead to substantial morbidity and mortality. Malaria infection destroys erythrocytes, resulting in low hemoglobin (Hb) levels known as anemia. Here we report the determinants of anemia in high and low malaria-endemic areas that would help understand which parasite densities, age, and gender-associated low Hb levels. Therefore, a cross-sectional mass survey (n = 8,233) was conducted to screen anemia and malaria in high and low malaria-endemic districts (HMED and LMED) of North-East India. Axillary body temperature was measured using a digital thermometer. The prevalence of anemia was found to be 55.3% (4,547/8,233), of which 45.1% had mild (2,049/4,547), 52.1% moderate (2,367/4,547) and 2.9% had severe anemia (131/4,547). Among anemic, 70.8% (3,219/4,547) resided in LMED and the rest in HMED. The median age of the anemic population was 12 years (IQR: 7–30). Overall, malaria positivity was 8.9% (734/8,233), of which HMED shared 79.6% (584/734) and LMED 20.4% (150/734) malaria burden. The village-wise malaria frequency was concordant to asymptomatic malaria (10–20%), which showed that apparently all of the malaria cases were asymptomatic in HMED. LMED population had significantly lower Hb than HMED [standardized beta (β) = −0.067, p &lt; 0.0001] and low-density Plasmodium infections had higher Hb levels than high-density infections (β = 0.113; p = 0.031). Women of reproductive age had higher odds for malaria (OR: 1.42; 95% CI: 1.00–2.05; p = 0.04). Females (β = −0.193; p &lt; 0.0001) and febrile individuals (β = −0.029; p = 0.008) have shown lower Hb levels, but malaria positivity did not show any effect on Hb. Young children and women of reproductive age are prone to anemia and malaria. Although there was no relation between malaria with the occurrence of anemia, we found low-density Plasmodium infections, female gender, and LMED were potential determinants of Hb

Positive predictive value of ERBB2 copy number gain by tissue or circulating tumor DNA next-generation sequencing across advanced cancers

BACKGROUND: The correlation of ERBB2 copy number gain (CNG) from tissue or circulating tumor DNA (ctDNA) by next-generation sequencing (NGS) with standard HER2 tissue evaluation is not well understood. MATERIALS AND METHODS: We retrospectively identified patients with ERBB2 CNG on commercial NGS. We described their clinical-pathologic features and calculated the positive predictive value (PPV) of ERBB2 CNG by NGS for HER2-positivity by IHC and FISH testing. RESULTS: 176 patients had NGS revealing an ERBB2 CNG (112 by tumor tissue and 91 by ctDNA). The cancer subtypes with the most cases with ERBB2 CNG by NGS were breast ( CONCLUSIONS: ERBB2 CNG by NGS is detected in numerous malignancies for which HER2 testing is not standard. Detection of ERBB2 CNG by tissue NGS and ctDNA has a high PPV for true HER2-positivity by standard IHC and/or FISH testing in breast cancer

Prescription practices and availability of artemisinin monotherapy in India: where do we stand?

<p>Abstract</p> <p>Background</p> <p>The World Health Organization has urged all member states to deploy artemisinin-based combination therapy and progressively withdraw oral artemisinin monotherapies from the market due to their high recrudescence rates and to reduce the risk of drug resistance. Prescription practices by physicians and the availability of oral artemisinin monotherapies with pharmacists directly affect the pattern of their use. Thus, treatment practices for malaria, with special reference to artemisinin monotherapy prescription, in selected states of India were evaluated.</p> <p>Methods</p> <p>Structured, tested questionnaires were used to conduct convenience surveys of physicians and pharmacists in eleven purposively selected districts across six states in 2008. In addition, exit interviews of patients with a diagnosis of uncomplicated malaria or a prescription for an anti-malarial drug were also performed. Logistic regression was used to determine patient clinical care, and institutional factors associated with artemisinin monotherapy prescription.</p> <p>Results</p> <p>Five hundred and eleven physicians from 196 health facilities, 530 pharmacists, and 1, 832 patients were interviewed. Artemisinin monotherapy was available in 72.6% of pharmacies and was prescribed by physicians for uncomplicated malaria in all study states. Exit interviews among patients confirmed the high rate of use of artemisinin monotherapy with 14.8% receiving such a prescription. Case management, i.e. method of diagnosis and overall treatment, varied by state and public or private sector. Treatment in the private sector (OR 8.0, 95%CI: 3.8, 17) was the strongest predictor of artemisinin monotherapy prescription when accounting for other factors. Use of the combination therapy recommended by the national drug policy, artesunate + sulphadoxine-pyrimethamine, was minimal (4.9%), with the exception of one state.</p> <p>Conclusions</p> <p>Artemisinin monotherapy use was widespread across India in 2008. The accessible sale of oral artemisinin monotherapy in retail market and an inadequate supply of recommended drugs in the public sector health facilities promoted its prescription. This study resulted in notifications to all state drug controllers in India to withdraw the oral artemisinin formulations from the market. In 2010, artesunate + sulphadoxine-pyrimethamine became the universal first-line treatment for confirmed <it>Plasmodium falciparum </it>malaria and was deployed at full scale.</p

Nonrandomized Controlled Trial of Artesunate plus Sulfadoxine-Pyrimethamine with or without Primaquine for Preventing Posttreatment Circulation of Plasmodium falciparum Gametocytes

ABSTRACT Artemisinin combination therapies eliminate immature Plasmodium falciparum gametocytes but not mature gametocytes, which may persist for up to 1 month posttreatment. A single dose of primaquine, which is inexpensive and effective against mature gametocytes, could be added to further reduce the potential for posttreatment parasite transmission. Currently, we have few data regarding the effectiveness or safety of doing so. We collected data from 21 therapeutic efficacy trials of the National Antimalarial Drug Resistance Monitoring System of India conducted during 2009 to 2010, wherein 9 sites used single-dose primaquine (0.75 mg/kg of body weight) administered on day 2 along with artesunate plus sulfadoxine-pyrimethamine (AS+SP) while 12 did not. We estimated the effect of primaquine on posttreatment gametocyte clearance and the total number of gametocyte-weeks as determined by microscopy. We compared the median area under the curve for gametocyte density and reported adverse events. One thousand three hundred thirty-five patients completed the antimalarial drug treatment. Adjusting for region, primaquine increased the rate of gametocyte clearance (hazard ratio, 1.9; 95% confidence interval [CI], 1.1 to 3.3), prevented 45% (95% CI, 19 to 62) of posttreatment gametocyte-weeks, and decreased the area under the gametocyte density curve over the 28-day follow-up compared to AS+SP alone ( P value = 0.01). The results were robust to other adjustment sets, and the estimated effect of primaquine increased during sensitivity analysis on the measurement of exposure time. No serious adverse events were detected. In conclusion, the addition of primaquine to AS+SP was effective in reducing the posttreatment presence of P. falciparum gametocytes. Primaquine was well tolerated and could be administered along with an artemisinin combination therapy as the first-line therapy