Role of hysteroscopy and histopathology in evaluating patients with abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the leading causes for seeking gynaecological advice. The aim and objectives of the study was to determine the pattern of hysteroscopic abnormalities and histopathological features of Abnormal Uterine Bleeding and to correlate hysteroscopic findings with histopathological findings.Methods: The present study “Role of Hysteroscopy and Histopathology in Evaluating patients with Abnormal Uterine Bleeding” was an observational study carried out in the Postgraduate Department of Obstetrics and Gynaecology and Postgraduate Department of Pathology of Government Medical college, Srinagar after obtaining clearance from the institutional ethical committee. The period of the study was One and a Half Years from April 2014 to September 2015.Results: The most common abnormality detected by hysteroscopy was Endometrial Hyperplasia (27 cases, 27%) followed by endometrial polyps (21 cases, 21%). Endometrial Hyperplasia was the most common abnormality found in Menorrhagia followed by polyps while polyps were the most common finding in polymenorrhea and endometrial hyperplasia was the most common pathology in postmenopausal bleeding. Hysteroscopy had a sensitivity of 93.2%, specificity of 83.9%, positive predictive value of 82%, Negative Predictive Value of 94% in diagnosing etiology of abnormal uterine bleeding.Conclusions: This study confirms that hysteroscopy has a definitive role in evaluating patients with abnormal uterine bleeding and hysteroscopy and histopathology complement each other in the evaluation of a patient with Abnormal uterine bleeding

Some Immunologic Evaluations of Toxoplasmosis in Iraqi Aborted Females

Forty-eight aborted women (Iraqi Arab Muslims) at the first trimester with a serological evidence of toxoplasmosis were investigated. Two age- and ethnic-matched control groups were included: 40 aborted women due to accidental events (Control I), and 40 unmarried (virgin) women (Control II). The subjects were evaluated for the following parameters: HLA-class I antigens (A, B and Cw), blood groups, total and differential counts of leukocytes, lymphocyte subpopulations (CD3+, CD4+ and CD20+ cells), phagocytosis of heat-killed yeast (phagocytic index and NBT index), and total serum levels of immunoglobulins (IgA, IgG and IgM) and complement components (C3 and C4). The HLA-A2 and -Cw8 antigens were significantly increased in the patients, while A3 antigen was significantly decreased. Blood group phenotypes in patients and controls also showed significant variations. The total and differential counts of leukocytes showed no significant differences between patients and controls, with the exception of lymphocytes, which showed a significant decreased count in the patients compared to control II. However, the lymphocyte subpopulations showed a significant increased percentage in patients. The phagocytic index was approximated in patients and controls, while NBT index was significantly decreased. Total serum level of IgG was significantly increased in the patients, while IgA, IgM, C3 and C4 levels did not maintain such variation

Study of lipid profiles high and normal body mass index in polycystic ovary syndrome women in Aljouf, Saudi Arabia

Background: For women of reproductive age, polycystic ovary syndrome (PCOS) is the most prevalent endocrinological condition. Hyperandrogenism, persistent ovulatory dysfunction, obesity, and insulin resistance have all been associated with PCOS. However, recently PCOS is detected in high-body weight and normal-body-weight women. No information was available to evaluate specific lipid profiles. The goal of this study is to analyze the lipid profiles of women with polycystic ovarian syndrome who have high or normal body weight. Methods: This polycystic ovarian syndrome (PCOS) retrospective study was carried out between January 2021 and January 2022 at Sakaka’s Maternity and Children Hospital (MCH), Aljouf, Saudi Arabia. A total of 68 PCOS women were included in the study; we divided them into high (n=34) and normal body weight (n=34) according to the calculation of BMI. We obtain the test results of lipid profiles and demographic data from hospital record files. Results: We noticed changes but no significance in our research of lipid profiles in high and normal PCOS participants. The CHOL, TG, HDL, and LDL, 159.30±4.193, 97.89±7.140, 60.91±9.564, and 99.47±9.22 shown in the high BMI PCOS women respectively. While, 129.28±3.702, 83.69±4.49, 46.84±1.68 and86.53±4.36 were detected in normal BMI PCOS women respectively. There were none that were statistically significant, with the exception of cholesterol p=0.001. Conclusions: Our results show that POCS women with normal body weight and PCOS women with high BMI have different changes in their lipid profiles, but no significance has been found other than higher cholesterol levels. Therefore, losing weight can stop lipid profiles from altering, which may reduce difficulties in the future

Resistance pattern and molecular characterization of enterotoxigenic Escherichia coli (ETEC) strains isolated in Bangladesh

Enterotoxigenic Escherichia coli (ETEC) is a common cause of bacterial infection leading to acute watery diarrhea in infants and young children as well as in travellers to ETEC endemic countries. Ciprofloxacin is a broad-spectrum antimicrobial agent nowadays used for the treatment of diarrhea. This study aimed to characterize ciprofloxacin resistant ETEC strains isolated from diarrheal patients in Bangladesh.A total of 8580 stool specimens from diarrheal patients attending the icddr,b Dhaka hospital was screened for ETEC between 2005 and 2009. PCR and Ganglioside GM1- Enzyme Linked Immuno sorbent Assay (ELISA) was used for detection of Heat labile (LT) and Heat stable (ST) toxins of ETEC. Antimicrobial susceptibilities for commonly used antibiotics and the minimum inhibitory concentration (MIC) of nalidixic acid, ciprofloxacin and azithromycin were examined. DNA sequencing of representative ciprofloxacin resistant strains was performed to analyze mutations of the quinolone resistance-determining region of gyrA, gyrB, parC and parE. PCR was used for the detection of qnr, a plasmid mediated ciprofloxacin resistance gene. Clonal variations among ciprofloxacin resistant (CipR) and ciprofloxacin susceptible (CipS) strains were determined by Pulsed-field gel electrophoresis (PFGE).Among 1067 (12%) ETEC isolates identified, 42% produced LT/ST, 28% ST and 30% LT alone. Forty nine percent (n = 523) of the ETEC strains expressed one or more of the 13 tested colonization factors (CFs) as determined by dot blot immunoassay. Antibiotic resistance of the ETEC strains was observed as follows: ampicillin 66%, azithromycin 27%, ciprofloxacin 27%, ceftriazone 13%, cotrimaxazole 46%, doxycycline 44%, erythromycin 96%, nalidixic acid 83%, norfloxacin 27%, streptomycin 48% and tetracycline 42%. Resistance to ciprofloxacin increased from 13% in 2005 to 34% in 2009. None of the strains was resistant to mecillinam. The MIC of the nalidixic acid and ciprofloxacin of representative CipR strains were 256 μg/ml and 32μg/ml respectively. A single mutation (Ser83-Leu) in gyrA was observed in the nalidixic acid resistant ETEC strains. In contrast, double mutation in gyrA (Ser83-Leu, Asp87-Asn) and a single mutation in parC (Glu84-Ly) were found in ciprofloxacin resistant strains. Mutation of gyrB was not found in either the nalidixic acid or ciprofloxacin resistant strains. None of the ciprofloxacin resistant strains was found to be positive for the qnr gene. Diverse clones were identified from all ciprofloxacin resistant strains by PFGE analysis in both CF positive and CF negative ETEC strains.Emergence of ciprofloxacin resistant ETEC strains results in a major challenge in current treatment strategies of ETEC diarrhea

Cellular and Cytokine Responses to Salmonella enterica Serotype Typhi Proteins in Patients with Typhoid Fever in Bangladesh

We assessed interferon-gamma (IFN-γ) responses via enzyme-linked immunosorbent spot (ELISPOT) to a number of S. Typhi antigens in samples from humans with S. Typhi bacteremia and typhoid fever in Bangladesh. Compared with responses in healthy endemic zone controls, there were significantly increased IFN-γ responses at the time of clinical presentation (acute phase) and at convalescence 14–28 days later. The majority (80–90%) of IFN-γ expressing T cells were CD4+. We observed a significant increase in interleukin-17 (IL-17) positive CD4 + T cells at convalescent versus acute stage of infection using an intracellular cytokine staining assay. We also found that stimulated peripheral blood mononuclear cells (PBMCs) produced significantly increased levels of a number of cytokines at the convalescent versus acute phase of infection, including IFN-γ, MIP-1β, sCD40L, TNF-β, IL-13, and IL-9. These results suggest that S. Typhi antigens induce a predominantly Th1 response, but that elevations in other cytokines may be modulatory

Causes of elective cesarean delivery on maternal request in Aljouf, Saudi Arabia

Background: Recently observed there is a steadily higher rate of cesarean delivery worldwide mostly due to the increasing number of women requesting an elective cesarean section on maternal request without valid indication. The aim of the study was to determine the causes of elective cesarean delivery on maternal requests in Aljouf Saudi Arabia.Methods: This was a descriptive cross-sectional study and data was evaluated by completing seven questionnaires and interviews with laboratory reports who were admitted for cesarean delivery at the Obstetrics department of Maternity and Children Hospital (MCH) Aljouf, Saudi Arabia from January 2020 to December 2020. A total of 141 Saudi women of age between 18 and over 35 years were enrolled, including those who have singleton pregnancy, no complications during pregnancy, and no medical indication for cesarean delivery.Results: 141 women reported willingness to request cesarean delivery. The mean systolic 120±6.23, diastolic 75±2.45 blood pressure mm of Hg, and fasting blood sugar level 4.1±1.1 mmol/l have been found within the normal limit. The ultrasound (US) confirmed singleton pregnancy without any abnormalities.  Data reveals that common causes of elective cesarean section on maternal request to avoid the episiotomy 77.3%, fear of labor pain 69.5%, trauma to the vagina 79.4%, uncertainty about timing 61.7%, losing a baby during vaginal delivery 54.6%, experience other members 41.8%, the risk for baby 39%, prolapse or incontinence24.1%, unsatisfactory sexual intercourse 17.7% and the undesirable experience of the previous vaginal delivery 12%.Conclusions: Maternal request for cesarean delivery is considered one of the reasons for increasing the rate of cesarean delivery in Saudi Arabia. To avoid the episiotomy and fear of labor pain may strong causes for choosing cesarean delivery

A multicentre validation of Metasin: a molecular assay for the intraoperative assessment of sentinel lymph nodes from breast cancer patients

Aims: Treatment strategies for breast cancer continue to evolve. No uniformity exists in the UK for the management of node‐positive breast cancer patients. Most centres continue to use conventional histopathology of sampled sentinel lymph nodes (SLNs), which requires delayed axillary clearance in up to 25% of patients. Some use touch imprint cytology or frozen section for intraoperative testing, although both have inherent sensitivity issues. An intraoperative molecular diagnostic approach helps to overcome some of these limitations. The aim of this study was to assess the clinical effectiveness of Metasin, a molecular method for the intraoperative evaluation of SLNs. Methods and results: RNA from 3296 lymph nodes from 1836 patients undergoing SLN assessment was analysed with Metasin. Alternate slices of tissue were examined in parallel by histology. Cases deemed to be discordant were analysed by protein gel electrophoresis. There was concordance between Metasin and histology in 94.1% of cases, with a sensitivity of 92% [95% confidence interval (CI) 88–94%] and a specificity of 97% (95% CI 95–97%). Positive and negative predictive values were 88% and 98%, respectively. Over half of the discordant cases (4.4%) were ascribed to tissue allocation bias (TAB). Conclusions: Clinical validation of the Metasin assay suggests that it is sufficiently sensitive and specific to make it fit for purpose in the intraoperative setting