Comparison of maternal serum CA-125 and ultrasonography findings as a prognostic marker in threatened abortion

Background: WHO defines abortion as pregnancy termination before 20 week gestation or with fetus born weighing <500 gms. Early pregnancy markers in patients with threatened abortion including biochemical marker like raised maternal serum CA-125 (cancer antigen-125, carcinoma antigen 125 or carbohydrate antigen 125) and USG parameters that is, fetal crown-rump length (CRL), the presence/absence of sub-chorionic hematoma and fetal heart rate (FHR) are good predictors of outcome.Methods: The study was conducted in the department of obstetrics and gynaecology, S.P. medical college and associated group of hospital, Bikaner, Rajasthan. This was a hospital based prospective comparative study. The study group comprise of pregnant females attending obstetrics and gynaecology OPD. A total of 200 pregnant women were examined in this study. We divided these patients into 2 groups, group A and group B. Group A consists of 100 pregnant females with threatened abortion and group B with 100 normal pregnant female.Results: Maternal serum CA-125 at cut off level 61.64 U/ml is 84.21% sensitive, 96.77% specific in predicting abortion with 94.12% positive predictive value and 90.91% negative predictive value while FHR at 115 bpm is 76.32% sensitive, 90.32% specific in predicting abortion with 82.86% PPV and 86.15% negative predictive value.Conclusions: Single raised value of maternal serum CA-125 has best predictive value followed by USG parameters (FHR, sub-chorionic hematoma and CRL ) in threatened abortion which results in loss of pregnancy

Epidemiological study of uterine fibroids: our experience from urban Maharashtra

Background: Uterine fibroids or myomas or leiomyoma of uterus are the most common type of benign tumour of uterus and also most common pelvic tumour in women. Exact etiology is not known but the cause estimated to be is oestrogen and progesterone which proliferate tumour growth as fibroid rarely occur before menarche and reduces after menopause.Risk factors for developing fibroids are age, early age at menarche, reduced fertility, frequent alcohol and caffeine consumption, obesity, hypertension, diabetes mellitus, and previous pelvic inflammatory disease.  Objective of the research was to study the epidemiological factors associated with uterine fibroids.Methods: This present cross sectional descriptive observational study carried at Vilasrao Deshmukh Government Medical College (VDGMC), Latur from October 2019 to October 2021 among all cases of fibroid admitted at our tertiary care hospital. Data was analysed by using statistical package for the social sciences (SPSS) 24.0 version IBM United States of America (USA) and results are mentioned in percentages.Results: Out of 166 women, majority were from 31-40 years age group i.e. 58 (34.9%). Majority of the women were from urban area i.e. 57.2%. 13.2% were nullipara and 14.5% were multipara and grand multipara. 19.3% women were not practicing any contraceptive method. Abdominal lump complained by 41%, abnormal uterine bleeding 24.1%, metrorrhagia in 21.7%. Ultrasonography (USG) findings of the study population revealed submucosal fibroids in 64(38.6%), and intramural fibroids in 32 (19.3%).Conclusions: Incidence of fibroids is most common in 31-40 years of age i.e. 34.9%. Commonly observed symptom was abdominal lump (41%) and abnormal uterine bleeding (24.1%). Prevalence of submucosal fibroids was 38.6%, intramural fibroids 19.3%, submucosal polyp 14.5%, seedling fibroid 13.9% and subserosal fibroid 10.2%

Immunogenicity and Protective Efficacy of T-Cell Epitopes Derived From Potential Th1 Stimulatory Proteins of Leishmania (Leishmania) donovani

Development of a suitable vaccine against visceral leishmaniasis (VL), a fatal parasitic disease, is considered to be vital for maintaining the success of kala-azar control programs. The fact that Leishmania-infected individuals generate life-long immunity offers a viable proposition in this direction. Our prior studies demonstrated that T-helper1 (Th1) type of cellular response was generated by six potential recombinant proteins viz. elongation factor-2 (elF-2), enolase, aldolase, triose phosphate isomerase (TPI), protein disulfide isomerase (PDI) and p45, derived from a soluble antigenic fraction (89.9–97.1 kDa) of Leishmania (Leishmania) donovani promastigote, in treated Leishmania patients and golden hamsters and showed significant prophylactic potential against experimental VL. Moreover, since, it is well-known that our immune system, in general, triggers production of specific protective immunity in response to a small number of amino acids (peptide), this led to the identification of antigenic epitopes of the above-stated proteins utilizing immunoinformatics. Out of thirty-six, three peptides-P-10 (enolase), P-14, and P-15 (TPI) elicited common significant lymphoproliferative as well as Th1-biased cytokine responses both in golden hamsters and human subjects. Further, immunization with these peptides plus BCG offered 75% prophylactic efficacy with boosted cellular immune response in golden hamsters against Leishmania challenge which is indicative of their candidature as potential vaccine candidates

Adrenocortical carcinoma with inferior vena cava thrombus: Renal preserving surgery

Adrenocortical carcinoma with tumor thrombus extending via an adrenal vein into the inferior vena cava is uncommon. We describe a left side kidney-preserving surgery in such a patient where, after transection of the main renal vein at the point of insertion of the adrenal vein, the left kidney was being drained by lumbar and gonadal veins

A Chimera of Th1 Stimulatory Proteins of Leishmania donovani Offers Moderate Immunotherapeutic Efficacy with a Th1-Inclined Immune Response against Visceral Leishmaniasis

Immunotherapy, a treatment based on host immune system activation, has been shown to provide a substitute for marginally effective conventional chemotherapy in controlling visceral leishmaniasis (VL), the deadliest form of leishmaniasis. As the majority of endemic inhabitants exhibit either subclinical or asymptomatic infection which often develops into the active disease state, therapeutic intervention seems to be an important avenue for combating infections by stimulating the natural defense system of infected individuals. With this perspective, the present study focuses on two immunodominant Leishmania (L.) donovani antigens (triosephosphate isomerase and enolase) previously proved to be potent prophylactic VL vaccine candidates, for generating a recombinant chimeric antigen. This is based on the premise that in a heterogeneous population, a multivalent antigen vaccine would be required for an effective response against leishmaniasis (a complex parasitic disease). The resulting molecule rLdT-E chimeric protein was evaluated for its immunogenicity and immunotherapeutic efficacy. A Th1 stimulating adjuvant BCG was employed with the protein which showed a remarkable 70% inhibition of splenic parasitic multiplication positively correlated with boosted Th1 dominant immune response against lethal L. donovani challenge in hamsters as evidenced by high IFN-γ and TNF-α and low IL-10. In addition, immunological analysis of antibody subclass presented IgG2-based humoral response besides considerable delayed-type hypersensitivity and lymphocyte proliferative responses in rLdT-E/BCG-treated animals. Our observations indicate the potential of the chimera towards its candidature for an effective vaccine against Leishmania donovani infection

Kidney transplant in patients with abnormal bladder: Experience of tertiary care center in developing country-Is the outcome same?

Background: Fifteen percent of adults and 20%–30% of pediatric patients develop renal failure, results from structural urological abnormalities. Successful renal transplantation depends partly on a bladder which has adequate capacity, good compliance, and efficient voluntary emptying. Urinary bladder rehabilitation with augmentation or diversion is necessary before transplant in these patients to achieve good graft outcome. We, hereby report our last 10 years' experience of such patients undergoing kidney transplant in abnormal bladder. Materials and Methods: A total of 14 patients underwent renal transplantation in rehabilitated bladder from 2006 to 2016. Demographic details, prereconstruction bladder and urodynamic findings, and type of pretransplant reconstruction were recorded. Posttransplant creatinine levels, graft survival at 7 days, 3 months, 1 year, and 3 years were recorded. Results: Mean (± standard deviation) serum creatinine posttransplant at 7 days, 3 months, 1 year, and 3 years was 0.9 (±0.20), 1.58 (±0.65), 1.92 (±1.02), and 2.47 (1.17) mg/dl, respectively. Four patients developed rejection within 6 months of transplant. Kidney biopsy was suggestive of acute cellular rejection in all cases, which was treated successfully. At three years follow-up, four patients who had rejection-have rising creatinine levels and diminishing renal functions. No patient needed dialysis support till last follow-up. All these four patients had rejection, urinary tract infection (UTI) episodes and pyelonephritis in the past. Conclusion: Native bladder is the best reservoir for urinary storage and drainage. The main cause of graft dysfunction in rehabilitated bladder is UTI as a result of poor hygiene, contamination during clean intermittent self-catheterization (CISC) and noncompliance for CISC leading to high residual urine. Controlling frequent attacks of UTI posttransplant is essential, otherwise long-term graft survival and function will deteriorate faster and might trigger rejection