Metabolic syndrome and insulin resistance in PCOS phenotypes

Background: Polycystic ovary syndrome(PCOS) is an endocrine metabolic disorder which is rapidly gaining epidemic proportions. Hyperinsulinemia and insulin resistance (IR) are thought to be key pathological factors. This study was undertaken to characterize the phenotypes of PCOS and to determine the prevalence of metabolic syndrome (MetS) and insulin resistance in them.Methods: This observational cross-sectional study was undertaken to assess the distribution of the Rotterdam PCOS phenotypes and to report the prevalence and risk factors for MetS syndrome and insulin resistance using homeostasis model assesment for insulin resistance (HOMA-IR). 90 women aged 18-35 years newly diagnosed with PCOS were classified into one of the four potential PCOS phenotypes based on history, examination and investigations.Results: Phenotype A was the most prevalent phenotype (45.5%). Prevalence of insulin resistance in our study was 31% using HOMA- IR cutoff of 2.5, with highest prevalence in phenotype A and least in phenotype D. The overall prevalence of MetS was 36% with a two- to six-fold higher prevalence in hyperandrogenic phenotypes compared to the non-hyperandrogenic phenotype. Highest mean hs- CRP was found in phenotype A which could possibly indicate greater cardiovascular risk in future. Univariate logistic regression for predictive association of MetS parameters was significantly high for deranged parameters i.e. WC≥80cm, fasting plasma glucose ≥100mg/dl, HDL ≤50mg/dl and WHR ≥0.85. Strong positive association was found with all these parameters (p<0.001) Hirsutism (modified Ferriman Gallwey score ≥8) was strongly associated with MetS (p=0.005).Conclusions: An appropriate diagnosis of PCOS and accurate dentification of phenotype is important as it has long-term health implications for women. We recommend screening all hyperandrogenic PCOS women for IR and metabolic abnormalities. This study has shown that HOMA-IR is a valuable tool in identifying PCOS women with metabolic syndrome and also serve to identify PCOS subtype at high risk of future metabolic syndrome

An insight into the placental morphology in a case of Edwards syndrome

Certain histomorphological features of the placenta can suggest, although not diagnose, the presence of abnormal karyotype in cases of chromosomal anomalies in the fetus. However, data correlating placental histology and abnormal fetal karyotype is scarce. Here, in this article, we wanted to enlighten the readers about the importance of the placental morphology in chromosomal aberrations by presenting a case of a 22-year-old primigravida who at 8 weeks of gestation had a regular prenatal check-up. Over a period of time, the ultrasound study at 21 weeks of gestation revealed a single live intrauterine fetus in a breech position with polyhydramnios, strawberry-shaped skull, and other features. Amniocentesis revealed that the fetus was having Edwards syndrome (trisomy 18). The placental examination showed areas of sclerosis and congestion with a single umbilical artery

Haemoglobin measurement by point-of-care devices- a need of the hour: study conducted on antenatal females

Background: Haemoglobin measurement in antenatal care can help in timely detection and treatment of anaemia, which is a major contributory factor to maternal mortality in developing countries. The transport of samples for haemoglobin assessment may delay the treatment, resulting in preventable deaths. Haemoglobin measurement by point of care testing (POCT) devices is easy, quick and less invasive. There are very few studies which compare the capillary blood haemoglobin using point of care devices with venous blood samples. This study was conducted to compare capillary blood haemoglobin using POCT device with venous blood haemoglobin using haematology analysers in antenatal Indian females.Methods: One hundred pregnant women were recruited during their first trimester antenatal visits. Hemoglobin by finger prick capillary sample (POCT) was compared with haemoglobin of venous sample analysed by the haematology analyser (Beckman coulter) which was considered as gold standard. Intraclass correlation co-efficient based on Bland Altman analysis was computed using SPSS v21. A p value less than 0.05 was considered statistically significant.Results: The intraclass correlation coefficient of 0.97 was recorded with central laboratory reference standard, with a mean difference of -0.481 gm% and -0.482 gm% by capillary and venous blood samples, respectively (p&lt;0.0001).Conclusions: A good agreement between capillary blood haemoglobin (POCT device) and venous blood (haematology analyser) was achieved

Correlation of lipid profile of infertile men with abnormal semen parameters

Background: Male’s inability to impregnate a fertile female is referred as male factor infertility. It accounts for 40-50% of infertile couples and affects almost 7% of all men. Male comorbidities and conditions, which negatively affect men’s health, have been repeatedly associated with impaired reproductive functioning. Cholesterol is the main substrate for steroid synthesis and it plays crucial role in formation of sperm plasma membrane and thus in spermatogenesis, highlighting the role of serum lipids in male fecundity. Purpose of the study is to evaluate correlation lipid profile of male partners with abnormal semen parameters in infertile couples. Methods: A cross sectional study was carried out in the infertility clinic of a tertiary care hospital for over 18 months and 151 infertile men with abnormal semen parameters (as per WHO 2010 criteria) were enrolled. Evaluation of lipid profile was done and its relationship with abnormal semen parameters was analyzed. Results: Significant positive correlation was seen between LDL and Triglyceride with sperm concentration and total sperm count. However, significant negative correlation was seen between Triglyceride and sperm motility and TMSC. Total and progressive motility was found to be significantly associated with total cholesterol (p&lt;0.05). Infertile men having higher total cholesterol were found to have better total and progressive motility compared to men with less total cholesterol. Conclusions: Our findings demonstrated that lipid profile has significant correlation with semen parameters, specifically sperm concentration, count and motility

Evidence-based national vaccine policy

India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form

Giant cell variant of extraskeletal osteosarcoma

The giant cell-rich (GCR) variant of extraskeletal osteosarcoma (ESOS) is a malignant soft-tissue lesion without primary bony involvement. The tumor cells are highly pleomorphic and produce an osteoid matrix, whereas numerous giant cells are present throughout the mass. We describe an unusual case of a 38-year-old female patient who presented with a recurrent gluteal mass. With the help of histomorphological findings and immunohistochemistry (IHC), a final diagnosis of a GCR variant of ESOS arises from the gluteal soft tissue with bony involvement. These malignancies are extremely aggressive and have a high likelihood of recurrence and metastasis; therefore, early detection is crucial for successful management. Standard treatment options include surgery and chemotherapy, and patients should be closely monitored following treatment. With the help of histomorphological findings and IHC, a final diagnosis of a GCR variant of ESOS arises from the gluteal soft tissue with bony involvement. This case is reported to highlight the fact that similar morphology of giant cell osteosarcoma can rarely be seen in soft tissue, and this entity should be kept in mind by the reporting pathologist

The role of the formation of neutrophil extracellular traps (NETosis) in the pathophysiology and the complications of COVID-19: A review of the literature

Coronavirus disease 2019 (COVID-19) pandemic which caused a significant disaster globally, has long term health implication known as long COVID. Long COVID refers to a wide range of symptoms that persist or develop after the acute phase of COVID-19 infection, which can last for weeks or months. Some of the symptoms associated with long COVID include fatigue, shortness of breath, chest pain, joint pain, cognitive impairment, and depression. Recent studies have also shown that long COVID can lead to various cardiovascular complications, including myocarditis, pericarditis, heart failure, and arrhythmias. These can significantly increase morbidity and mortality rates in COVID-19 patients, particularly those with preexisting cardiovascular conditions. The exact mechanisms underlying the cardiovascular complications associated with long COVID are not yet fully understood. However, it is believed that the persistent inflammation and immune dysregulation associated with COVID-19 may contribute to endothelial dysfunction, oxidative stress, and fibrosis in the cardiovascular system, leading to long-term cardiovascular complications. Neutrophils play a crucial role in immune system's response to infection. Upon encountering pathogens, neutrophils release neutrophil extracellular traps (NETs) to trap and kill microbes. The severity of COVID-19 has been linked to various factors, including the role of neutrophils and NETs. These extracellular webs, composed of chromatin, microbicidal proteins, and oxidant enzymes, are released by neutrophils to fight infections. However, excessive or dysregulated NET formation can lead to damage to surrounding tissues and organs, contributing to the development of inflammatory and thrombotic complications in various diseases, including COVID-19. COVID-19 patients with severe disease have increased levels of NETs in their blood, suggesting that NETs contribute to the disease's pathogenesis. NETs have been implicated in COVID-19-associated coagulopathy, acute respiratory distress syndrome, and multi-organ failure. Moreover, the presence of autoantibodies that target NET components has been reported in COVID-19 patients with severe disease, indicating that these autoantibodies may contribute to the development of hyperinflammation and thrombosis. Several potential therapeutic interventions targeting NETs have been proposed for COVID-19 patients, including the use of agents that inhibit NET formation or degradation. The role of NETs in the pathogenesis of COVID-19 and its associated complications is an active area of research. Further studies are needed to elucidate the mechanisms underlying NET dysregulation in COVID-19 and to evaluate the potential of NET-targeting therapies as a treatment strategy for COVID-19 patients. The purpose of this review is to analyze the potential contribution of NETosis in the pathophysiology of COVID-19 and its subsequent complications apart from its beneficial effect. This may provide insight into potential therapeutic interventions for COVID-19 patients

Cellular leiomyoma of the broad ligament masquerading an ovarian malignancy

Leiomyoma of the uterus is a common mesenchymal tumor of the female pelvis. Broad ligament leiomyoma is a relatively uncommon neoplasm comprising <1% of cases of leiomyoma. We present a case of a huge cellular broad ligament leiomyoma with cystic, myxoid, and hyaline degeneration clinically presenting as an ovarian tumor. Broad ligament leiomyoma is asymptomatic, but if neglected for a long time and it reaches an enormous size, it may result in chronic pelvic pain, compression of the bladder neck, and may even cause bowel dysfunction. They can sometimes clinically and radiologically mimic ovarian neoplasm. Therefore, histopathology plays a pivotal role in the definitive diagnosis. The diagnostic dilemma arises especially when leiomyomas undergo various degenerations. This case is being presented not just because of its rarity and the diagnostic dilemma it causes but to highlight the role of frozen section and histopathology in confirming the diagnosis