Comparison of diagnostic accuracy of hysteroscopy and ultrasonography in relation to histopathology in cases of postmenopausal bleeding

Background: To evaluate the role of hysteroscopy and ultrasound in relation to histological findings in patients of postmenopausal bleeding and to find out the sensitivity, specificity, positive predictive, negative predictive values and accuracy of ultrasound and hysteroscopy.Methods: A retrospective analysis of the 30 women who underwent hysteroscopic evaluation out of total 103 patients of postmenopausal bleeding over the period of one year (August 2017 and July 2018) was done. Records were taken out to collect the relevant information. USG and hysteroscopic findings were correlated with histopathology for the comparative analysis.Results: Indications of hysteroscopy cases were suspected polyp (5), fractional curettage (F/C) technically not feasible (7), inconclusive USG reports (5), recurrent bleeding with normal fractional curettage report (4), no tissue on F/C (1), removal of intra-uterine contraceptive device (1). Causes of postmenopausal uterine bleeding were found to be atrophic endometrium including one case of senile cystic atrophy (33.3%), secretory endometrium and endometrial polyps (23.3% each) and endometrial malignancy (20.0%) cases. Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy values of USG in various endometrial conditions was found to be 57.1%, 85.2%, 55.1%, 86.2% and 78.5% respectively and for hysteroscopy was 87.1%, 97.5%, 90.0%, 96.7% and 95.3% respectively.Conclusions: Hysteroscopy is a minimally invasive, safe and effective modality with least complications and morbidity rate and an ideal method for establishing the pathology as well as offering therapeutic intervention simultaneously

Genetic diversity of Cryptosporidium isolates from patients in North India

SummaryBackgroundCryptosporidiosis is a significant cause of diarrheal illness in both immunocompetent and immunocompromised populations. Cryptosporidium species infect a wide range of hosts including humans. Different species are morphologically indistinguishable, and molecular techniques have become the key to detection and source tracking. The present study was designed to study the genetic diversity of human Cryptosporidium isolates in North India.MethodsCryptosporidium oocysts were detected in stool samples by special staining of fecal smears. DNA was extracted with a Qiagen kit and all samples were genotyped by small subunit ribosomal ribonucleic acid (SSU rRNA)-based nested PCR-restriction fragment length polymorphism (RFLP) tool using enzymes SspI and VspI. Cryptosporidium hominis and Cryptosporidium parvum isolates were subtyped by sequence analysis of the nested PCR amplified gp60 gene.ResultsFifty-three fecal samples were found to be positive for Cryptosporidium oocysts. RFLP analysis revealed 39 isolates as C. hominis and 13 isolates of C. parvum; one sample failed amplification. gp60-based sequencing of C. hominis and C. parvum divided them into eight subgenotype families and 17 subtypes. gp60-based sequencing identified seven cases of mixed infection with C. hominis and C. parvum/Cryptosporidium meleagridis and showed the presence of C. meleagridis in six HIV-positive patients that were indistinguishable in RFLP.ConclusionsCryptosporidium isolates obtained in the present study from patients in North India belonged to three species, eight subgenotype families, and 17 subtypes. The existence of many Cryptosporidium species, subgenotypes, and subtypes along with mixed infections reveals the complexity of Cryptosporidium transmission; this heterogeneity indicates stable cryptosporidiosis transmission in North India. The results may have further implications in understanding the epidemiology and control of this infection

Ectopic pregnancy: a diagnostic dilemma

Background: To study the etiology, varied clinical presentations and misdiagnosis in ectopic pregnancy.Methods: A retrospective analysis of all operated ectopic pregnancies over a 7 year period at Government Medical College & hospital, Chandigarh was done.  Details of clinical findings and misdiagnosis were noted.  Surgically confirmed cases were included in this study. Expectant management and Medical management cases were excluded in this study.Results: Two hundred eighty two cases of ectopic gestation were analyzed. Identifiable risk factor present in 221 cases (78.3%). Pain was the commonest presenting symptom and 78 cases (27%) were misdiagnosed before the correct diagnosis was made by our department.Conclusions: Ectopic pregnancy can have varied presentations and misdiagnosis can be seen in Surgical, Medical and Gynaecology Departments. A young female with amenorrhea, pain abdomen with or without vaginal bleeding in early pregnancy diagnosis of ectopic pregnancy must be kept in mind. Early diagnosis would help early intervention and thus reduce the morbidity

Chromatin and Cancer: Implications of Disrupted Chromatin Organization in Tumorigenesis and Its Diversification

A hallmark of cancers is uncontrolled cell proliferation, frequently associated with an underlying imbalance in gene expression. This transcriptional dysregulation observed in cancers is multifaceted and involves chromosomal rearrangements, chimeric transcription factors, or altered epigenetic marks. Traditionally, chromatin dysregulation in cancers has been considered a downstream effect of driver mutations. However, here we present a broader perspective on the alteration of chromatin organization in the establishment, diversification, and therapeutic resistance of cancers. We hypothesize that the chromatin organization controls the accessibility of the transcriptional machinery to regulate gene expression in cancerous cells and preserves the structural integrity of the nucleus by regulating nuclear volume. Disruption of this large-scale chromatin in proliferating cancerous cells in conventional chemotherapies induces DNA damage and provides a positive feedback loop for chromatin rearrangements and tumor diversification. Consequently, the surviving cells from these chemotherapies become tolerant to higher doses of the therapeutic reagents, which are significantly toxic to normal cells. Furthermore, the disorganization of chromatin induced by these therapies accentuates nuclear fragility, thereby increasing the invasive potential of these tumors. Therefore, we believe that understanding the changes in chromatin organization in cancerous cells is expected to deliver more effective pharmacological interventions with minimal effects on non-cancerous cells

Analysis of pluripotency markers in lamin A/C haploinsufficient ES cells.

<p>(<b>A</b>) Immunoblot analysis of wild-type and <i>Lmna^+/−</i> ES cells with antibodies to pluripotency markers Oct3/4, Sox2 and Nanog, as well as lamin A/C and emerin. α-tubulin was used as the loading control. Data is representative of two independent experiments. (<b>B</b>) Immunofluorescence analysis of pluripotency markers SSEA1, Sox2 and Oct3/4 in wild-type and <i>Lmna^+/−</i> ES cells. The cells were counterstained with DAPI. Bar, 10 µm. (<b>C</b>) Quantitative RT-PCR analysis of transcripts for the indicated pluripotency markers in <i>Lmna^+/−</i> ES cells. The fold-change values were normalized to wild-type ES cells. (<b>D</b>) Flow cytometric analysis of wild-type and <i>Lmna^+/−</i> ES cells in presence (left panel) and absence (right panel) of MEF feeders. Percentages of cells in different phases of the cell cycle are indicated. Values represent mean±SD of three independent experiments.</p

Analysis of mesodermal markers in lamin A/C haploinsufficient EBs.

<p>(<b>A</b>) Quantitative RT-PCR analysis of transcripts for the indicated mesodermal markers from day 2 to day 10 in wild-type (open bars) and <i>Lmna^+/−</i> EBs (solid black bars), normalized to GAPDH. (<b>B</b>) Immunoblot analysis of expression of mesodermal markers during the differentiation of wild-type and <i>Lmna^+/−</i> EBs from day 2 to day 20. Data is representative of two independent experiments. (<b>C</b>) Immunofluorescence analysis of brachyury (day 4) and myogenin (day 20) expression in whole EBs. Bar, 100 µm. (<b>D</b>) Oil red-O and Alizarin red staining of wild-type and <i>Lmna^+/−</i> EBs on day 20 of differentiation. Bar, 100 µm. Values represent mean±SD of three independent experiments for quantitation of staining. ** P≤0.01, *** P≤0.001.</p