A rare case of placental site trophoblastic tumor

Placental site trophoblastic tumor (PSTT) is a very rare tumor of young women and unique form of gestational trophoblastic disease (GTD) representing a neoplastic transformation of intermediate trophoblastic cells that play a critical role in implantation. It accounts for 1-2% of all GTNs, incidence of it being 1 in 1,00,000 pregnancies. It displays a wide clinical spectrum from benign lesion within uterus to highly metastatic features with widespread features of metastasis and can be difficult to control even with surgery and chemotherapy. Unlike other forms of GTD, it is characterized by low β-hCG levels because it is a neoplastic proliferation of intermediate trophoblastic cells. PSTT can develop following all kind of pregnancies, whereas approximately 50% of PSTT cases occur after a normal pregnancy and other cases follow abortion, term delivery, ectopic pregnancy and molar pregnancy. Histopathologically, PSTT has proliferation of intermediate trophoblastic cells and absence of villi. It shows less invasion of vascular tissue and using immune histochemistry revealed that PSTT cells expressed HPL more than β-hCG, characterized by increased expression of the HPL in histological section as well as serum. The most common presenting symptoms of PSTT are irregular vaginal bleeding associated with uterine sub involution. Patient can also be presented with amenorrhea, nephritic syndrome, abdominal pain, galactorrhea and hemoptysis. Hence any case of unusual bleeding should be investigated with dilation and curettage and βHCG levels. Although the majority of patients of the non-metastatic PSTT are cured by hysterectomy but in metastatic cases, it requires aggressive treatment with chemotherapy and radiation. Due to its seldom occurrence and uncharacteristic clinical presentation, to reach a correct diagnosis and management is a surgeon’s nightmare and can be very challenging

ETHICAL GUIDELINES AND STUDY DESIGN FOR BIOAVAILABILITY AND BIOEQUIVALENCE STUDY

Unusual growth in pharma industry has provoked regulatory agencies to establish regulations regarding bioavailability (BA) and bioequivalence(BE) studies. The BA and BE testing are essential in drug development process, provides the information regarding the kinetics (area under the curve[AUC], Cmax, Tmax, λz, t½, AUC0→Tss, Cmaxss, Cminss, Cavgss, T) of single and multiple dose studies and the comparison of medicinal products. Indian Councilof Medical Research (ICMR), Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA), Indian National ScienceAcademy (INSA), Institutional Animal Care and Use Committee Guidebook (IACUC), National Institutes of Health, Food and Drug Administration,World Health Organization (WHO) provides the informations for strengthening the ethical guidelines for using humans and animals in clinical trialsglobally. Experimental design will help for better selection of models, number of subjects/animals, study conditions, randomizations, selection ofcontrol groups. Statistical evaluation parameters like Analysis of Variance help for the better interpretation of the data. The present study was aimedto study the need for BA and BE studies, ethical guidelines, experimental designs, pharmacokinetic endpoints, and their statistical evaluations.maxssKeywords: Ethical guidelines, Study design, Bioavailability, Bioequivalence

Incidentally detected solid pseudopapillary neoplasm of pancreas in a child with an ovarian cyst: a case report

Solid pseudopapillary neoplasms (SPN) are the most common as well as very rare pediatric tumors of the pancreas. Most of the literature is derived from adult SPNs. As per world health organization, these tumors considered as low grade malignant with excellent survival outcomes after complete surgical resection. We report a case of incidentally detected SPN in a 16-year-old female child with an ovarian cyst. She underwent pylorus preserving pancreaticoduodenectomy and ovarian cystectomy. Histopathology revealed well differentiated SPN of the pancreas head and ovarian cystadenoma. She is symptom-free at the 6th month follow up

Primary Hepatic Leiomyosarcoma Report of a rare case with review of literature

Primary hepatic leiomyosarcoma is an extremely rare tumor with a dismal prognosis and difficulty in diagnosis. We present a 36-year-old female who presented with complaints of pain in right hypochondrium and epigastric region. Real-time ultrasonography revealed an enlarged liver with multiple hypoechoic lesions of varying sizes in both the lobes of the liver. USG guided core biopsy from the lesion showed an infiltrating malignant spindle cell neoplasm positive for smooth muscle actin and caldesmon-H confirming the diagnosis of leiomyosarcoma. It is vital to diagnose these lesions even on limited biopsies as early diagnosis can reduce hospital and operative morbidity and mortality rates in the patients

Zinc oxide nanoparticles prepared through microbial mediated synthesis for therapeutic applications: a possible alternative for plants

Zinc oxide nanoparticles (ZnO-NPs) synthesized through biogenic methods have gained significant attention due to their unique properties and potential applications in various biological fields. Unlike chemical and physical approaches that may lead to environmental pollution, biogenic synthesis offers a greener alternative, minimizing hazardous environmental impacts. During biogenic synthesis, metabolites present in the biotic sources (like plants and microbes) serve as bio-reductants and bio-stabilizers. Among the biotic sources, microbes have emerged as a promising option for ZnO-NPs synthesis due to their numerous advantages, such as being environmentally friendly, non-toxic, biodegradable, and biocompatible. Various microbes like bacteria, actinomycetes, fungi, and yeast can be employed to synthesize ZnO-NPs. The synthesis can occur either intracellularly, within the microbial cells, or extracellularly, using proteins, enzymes, and other biomolecules secreted by the microbes. The main key advantage of biogenic synthesis is manipulating the reaction conditions to optimize the preferred shape and size of the ZnO-NPs. This control over the synthesis process allows tailoring the NPs for specific applications in various fields, including medicine, agriculture, environmental remediation, and more. Some potential applications include drug delivery systems, antibacterial agents, bioimaging, biosensors, and nano-fertilizers for improved crop growth. While the green synthesis of ZnO-NPs through microbes offers numerous benefits, it is essential to assess their toxicological effects, a critical aspect that requires thorough investigation to ensure their safe use in various applications. Overall, the presented review highlights the mechanism of biogenic synthesis of ZnO-NPs using microbes and their exploration of potential applications while emphasizing the importance of studying their toxicological effects to ensure a viable and environmentally friendly green strategy

Factors governing the performance of Auxiliary Nurse Midwives in India: a study in Pune district

Background: The Auxiliary nurse midwife (ANM) cadre was created to focus on maternal and child health. ANMs are respected members of their communities and established providers of maternal and child health care within the community and at the facility level. Over time, additional roles and responsibilities have been added. Despite the importance of ANMs in the primary healthcare system in India, studies that consider factors governing the performance of ANMs in their workplaces are limited. We aimed to study factors governing performance of ANMs in Pune district, India. Methods: Semi-structured interviews were conducted with 13 purposely selected key informants at facility, district, state, and national levels. Focus group discussions were conducted with 41 ANMs and 25 members of the community. Non-participatory observations with eight ANMs provided information to expand on and scrutinise findings that emerged from the other lines of inquiry. A realist lens was applied to identify ANMs’ performance as a result of “mechanisms” (training, supervision, accountability mechanisms) within the given “context” (regulatory system, infrastructure and resources, ANMs’ expanded scope of work, gender roles and norms). Results: Weak enforcement of regulatory system led to poor standardisation of training quality among training institutions. Challenges in internal accountability mechanisms governing ANMs within the health system hierarchy made it difficult to ensure individual accountability. Training and supervision received were inadequate to address current responsibilities. The supervisory approach focused on comparing information in periodic reports against expected outputs. Clinical support in workplaces was insufficient, with very little problem identification and solving. Conclusion: Focusing on the tasks of ANMs with technical inputs alone is insufficient to achieve the full potential of ANMs in a changing context. Systematic efforts tackling factors governing ANMs in their workplaces can produce a useful cadre, that can play an important role in achieving universal health coverage in India

Association of Vegetable and Animal Flesh Intake with Inflammation in Pregnant Women from India

In pregnant women, studies are lacking on the relationship of vegetable and animal flesh (poultry, red meat and seafood) intake with inflammation, especially in low- and middle-income countries. We conducted a cohort study of pregnant women receiving antenatal care at BJ Medical College in Pune, India. The dietary intake of pregnant women was queried in the third trimester using a validated food frequency questionnaire. Twelve inflammatory markers were measured in plasma samples using immunoassays. Only 12% of the study population were vegetarians, although animal flesh intake levels were lower compared to Western populations. In multivariable models, higher intakes of total vegetables were associated with lower levels of the T-helper (Th) 17 cytokine interleukin (IL)-17a (p = 0.03) and the monocyte/macrophage activation marker soluble CD163 (sCD163) (p = 0.02). Additionally, higher intakes of poultry were negatively associated with intestinal fatty-acid binding protein (I-FABP) levels (p = 0.01), a marker of intestinal barrier dysfunction and Th2 cytokine IL-13 (p = 0.03), and higher seafood was associated with lower IL-13 (p = 0.005). Our data from pregnant women in India suggest that a higher quality diet emphasizing vegetables and with some animal flesh is associated with lower inflammation. Future studies should confirm these findings and test if modulating vegetables and animal flesh intake could impact specific aspects of immunity and perinatal health