Comparison of acceptability & efficacy of thermal ablation (thermocoagulation) & cryotherapy in VIA positive cervical lesions: A pilot study.

BACKGROUND OBJECTIVES: The World Health Organization (WHO) has endorsed thermal ablation (thermocoagulation) as an efficient and safe modality for treatment of cervical pre-cancer lesions. More evidence is being looked up by WHO through rigorous studies for health delivery models using screen-and-treat strategies incorporating thermal ablation and studies comparing it against the conventional standard modality cryotherapy. The objective of this study was to assess the acceptability of thermal ablation both among the providers and clients and compare the same with cryotherapy. METHODS: A randomized control trial was conducted for one year from September 2019 to October 2020 after obtaining ethics approval. Computer-generated random number table was used for randomization, and eligible candidates were divided into two groups following informed consent. Women with visual inspection with acetic acid (VIA) positive cervical lesions in Group A received cryotherapy and Group B received thermal ablation. After the procedure, the acceptability of the provider and the client were assessed using the International Agency for Research on Cancer-validated questionnaire for both the procedures. Immediate side effects and problems at six weeks and at six months were assessed as well. Efficacy was decided by the absence of VIA positivity at six months. RESULTS: The overall VIA positivity in this study was 11.8 per cent. Thermal ablation (thermocoagulation) had better provision and client acceptability than cryotherapy (significant difference). The efficacy of thermal ablation was 97.6 per cent, while, it was 92 per cent for cryotherapy (not significant). INTERPRETATION CONCLUSIONS: In the context of screen-and-treat programme in settings such as India, thermal ablation appears to be a better method of treatment than cryotherapy for cervical pre-cancerous lesions particularly in terms of better provision and client acceptability.

Urinary Neutrophil Gelatinase-associated Lipocalin as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Hospitalized Cirrhotic Patients: A Study from North Indian Population.

Background: A serious problem in cirrhosis is acute renal injury. The study aimed to examine the urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a diagnostic and prognostic marker of acute kidney injury (AKI) in cirrhotic patients. Methods: A prospective study was carried out over a period of 1 year. A total of 490 patients suffering from cirrhosis who visited an indoor hospital were screened, and after the exclusion, a total of 90 subjects admitted to the medicine intensive care unit (MICU) fulfilling inclusion criteria were enrolled. Those having a history of renal diseases, on nephrotoxic drugs, in septic shock, peritonitis, UTI, and no urine output were excluded. On admission, for the estimation of uNGAL, urinary levels of sodium, creatinine, fresh urine samples were obtained, and blood samples were taken for serum creatinine estimation. Results: Out of 90 patients, 33.3% did not develop AKI, and 66.7% developed AKI. Urinary neutrophil gelatinase-associated lipocalin levels were six times higher in patients with acute tubular necrosis (259.08 ± 118.41 ng/mL) and three times higher in Hepatorenal syndrome (HRS)-AKI (124.97 ± 16.38) as compared with patients with normal kidney function (39.76 + 5.7). Those who died had a higher uNGAL (171.6 ng/mL) in comparison to those who survived (133.7 ng/mL). At a cutoff value of ≥114.9 (ng/mL), urinary NGAL represents a sensitivity of 86.92% and specificity of 100% to diagnose AKI and AUC 0.966 (95% CI: 0.919-0.990) in cirrhotic patients. Conclusion: Urinary NGAL is good for diagnosing AKI and is a marker to distinguish the types of AKI in liver cirrhosis. How to cite this article: Patel ML, Shyam R, Chaudhary A, Sachan R, Ali W. Urinary Neutrophil Gelatinase-associated Lipocalin as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Hospitalized Cirrhotic Patients: A Study from North Indian Population. Indian J Crit Care Med 2023;27(8):545-551.

Correlation of C-reactive Protein with Delirium in Obstetrics Intensive Care Unit: A Tertiary Center Experience.

Background: Delirium is a neuropsychiatric illness. It affects critically ill patients on ventilator and increases mortality. The aim of this study was to evaluate the association of C-reactive protein (CRP) level with delirium in critically obstetrics women and its role in prediction of delirium. Materials and methods: Arospective observational study was conducted in the intensive care unit (ICU), and the duration of study was one year. Total 145 subjects were recruited, 33 patients were excluded, and 112 subjects were studied. For study, group A (n = 36) includes critically ill obstetric women who had delirium on admission; group B (n = 37) includes critically ill obstetric women who developed delirium within 7 days; and group C (n = 39) that includes critically ill obstetric women who did not develop delirium after follow-up of 7 days was served as control. Disease severity was assessed by using acute physiologic assessment and chronic health evaluation (APACHE) II score, and Richmond Agitation-Sedation Scale (RASS) was used to assess awakeness. In awake patients (RASS of ≥3), delirium was assessed by the use of confusion assessment method for ICU tools. C-reactive protein measured by particle enhanced turbidimetric immunoassay-two point kinetic method. Results: The mean ages of group A, B, and C were 26.44 ± 4.72, 27.46 ± 4.97, and 28.26 ± 5.67 years, respectively. C-reactive protein levels on the day of delirium development (group B) were found to be significantly higher than day 1 CRP levels of groups A and C. The mean Global Attentiveness Rating (GAR) was significantly lower in groups A and B as compared to that in group C (p < 0.001). On evaluating the correlation of CRP with GAR, it was found to be inverse and mild in strength for the correlation between CRP and GAR (r = -0.403, p < 0.001). At a cut-off value of >181 mg/L, CRP had sensitivity of 93.2% and specificity of 69.2%. The positive predictive value was 85% and the negative predictive value was 84.4% that differentiate delirium from non-delirium. Conclusion: C-reactive protein is a useful tool for screening and prediction of delirium in critically ill obstetric patients. How to cite this article: Shyam R, Patel ML, Solanki M, Sachan R, Ali W. Correlation of C-reactive Protein with Delirium in Obstetrics Intensive Care Unit: A Tertiary Center Experience. Indian J Crit Care Med 2023;27(5):315-321.

Evaluation of Serum Cystatin C as an Early Biomarker of Acute Kidney Injury in Patients with Acute Pancreatitis.

INTRODUCTION: Acute pancreatitis (AP) is an inflammatory process of pancreas with varying degree of involvement of regional tissues. The aim of this study was to investigate the potential use of serum cystatin C (Cys-C) for the early and accurate diagnosis of acute kidney injury (AKI) in patients of AP. MATERIALS AND METHODS: This was a prospective study conducted in 1 year. Total of 215 cases of AP fulfilling the inclusion criteria were enrolled in this study. Patients suffering from chronic pancreatitis, neoplasm, chronic liver disease, and chronic kidney disease were excluded from the study. Diagnosis of AP was based on the Atlanta classification 2012. All patients were classified into a non-AKI group (n = 152) and an AKI group (n = 38) according to the dynamic changes in serum creatinine levels. Serum Cys-C was measured by particle-enhanced immune nephelometric assay. RESULTS: By univariate logistic regression analysis, body mass index (BMI) (OR = 1.44, 95% CI: 1.23-1.68; p < 0.001), blood urea (OR = 1.15, 95% CI: 1.06-1.23; p < 0.001), Cys-C (OR = 1.04, 95% CI: 1.01-1.07; p < 0.05), serum calcium (OR = 0.59, 95% CI: 0.41-0.86; p < 0.05), and serum lactate dehydrogenase (LDH) (OR = 1.001, 95% CI: 1.0-1.001; p < 0.05) were the significant indicators for AKI in patients with AP. Using multivariate logistic regression analysis, urinary albumin and Cys-C were independent and significant indicators of AKI in patients with AP (OR = 1.026, 95% CI: 1.01-1.07; p < 0.01). Receiver operating characteristic (ROC) curve of serum Cys-C, for AKI in patient with AP could be identified with a sensitivity of 92.06% at specificity of 96.0% [area under the curve (AUC) = 0.96, 95% CI: 0.92-0.98] by baseline serum Cys-C (cutoff value = >32.32 mg/L). CONCLUSION: Increase of baseline serum Cys-C was associated with AKI in patients with AP. HOW TO CITE THIS ARTICLE: Patel ML, Shyam R, Bharti H, Sachan R, Gupta KK, Parihar A. Evaluation of Serum Cystatin C as an Early Biomarker of Acute Kidney Injury in Patients with Acute Pancreatitis. Indian J Crit Care Med 2020;24(9):777-782.

Role of Urinary Neutrophil Gelatinase-associated Lipocalin as a Biomarker of Acute Kidney Injury in Patients with Circulatory Shock.

BACKGROUND: The early prediction of acute kidney injury (AKI) by the current clinical and laboratory methods remains inadequate. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising noninvasive biomarker of kidney injury in shock. The aim of this study was to assess the ability of urinary NGAL (uNGAL) to predict AKI in adult Intensive Care Unit (ICU) patients. MATERIALS AND METHODS: We prospectively studied 70 patients with circulatory shock admitted to the ICU over a period of 1 year. uNGAL was analyzed at ICU admission and after 24 h. Risk, injury, failure, loss, and end-stage kidney criteria were calculated at admission and for consecutive 4 days. The primary outcome was AKI defined as an increase in creatinine of at least 50% from baseline or a reduction in urine output to <0.5 ml/kg/h for 6 h. RESULTS: uNGAL was a good diagnostic marker for AKI development; at day 1, the cutoff value 48.54 ng/mL had a sensitivity and specificity of 79.49 and 73.14, respectively, and the area under the curve (AUC) of 0.82 (95% confidence interval [CI], 0.75-0.87) for predicting AKI. At day 2, the cutoff value 190.92 ng/mL had a sensitivity and specificity of 90.0 and 64.66, respectively, and the AUC of 0.76 (95% CI, 0.70-0.88) for predicting AKI. CONCLUSION: uNGAL could be a good early predictor biomarker of AKI following circulatory shock.

A Comparative Study of Community-acquired Acute Kidney Injury and Hospital-acquired Acute Kidney Injury from a Tertiary Care Hospital in North India.

BACKGROUND: In this observational study, clinical characteristics, etiologies, and outcomes of patients admitted to the hospital with community-acquired acute kidney injury (CAAKI) have been compared in contrast to those who hospital-acquired Acute Kidney Injury (HAAKI). METHODS: This was a prospective study of adults aged 18 years or above diagnosed with acute kidney injury (AKI) over a period of 17 months at a tertiary care hospital. RESULTS: 230 patients had AKI with the mean age of the study population being 45.33 ± 12.68 years. 178 (77.4%) patients were enrolled from medical unit, 25 (10.7%) from surgical unit, and 27 (11.7%) from obstetrical unit. The observed incidence of AKI was 15/1000 admissions. About 58.2% had CAAKI and 96 (43.7%) had HAAKI. Out of 230 patients, 170 (73.9%) patients were male and 60 (26.1%) were female. Sepsis was the most common (52.1%) etiology of AKI among the medical cases. Urosepsis, scrub typhus, and pneumonia were the most common causes of AKI. Sixty percent of AKI was Kidney Disease Improving Global Outcomes Stage 1 or 2 and 40% was in Stage 3. Oliguria was seen in 56.5%, hyperkalemia in 34.7%, fluid overload in 6.1%, and metabolic acidosis in 22.6%. The majority of patients had multiple organ involvement (52.1%) at the time of enrollment. About 116 (50.4%) had lung injury requiring mechanical ventilation and 95 (41.3%) were on inotropes. Mortality occurred in 19.5%. Anemia, the use of vasopressor drugs, and the need for intensive care support were independent predictive factors for mortality. CONCLUSION: AKI was common in hospitalized patients and leads to significant inhospital mortality. AKI is largely a CAAKI, and the lesser extent is due to HAAKI. Many causes are potentially preventable. Early fluid resuscitation, effective antibiotics, appropriate antidotes, and timely referral of established AKI patients to centers with dialysis facilities can improve AKI outcomes.

Résumé Contexte:Dans cette étude observationnelle, les caractéristiques cliniques, les étiologies et les résultats des patients admis à l'hôpital pour des affections aiguës d'origine communautaire. les lésions rénales (CAAKI) ont été comparées à celles qui ont contracté une lésion rénale aiguë à l'hôpital (HAAKI).Méthodes:Il s'agissait d'une étude prospective portant sur des adultes âgés de 18 ans ou plus ayant reçu un diagnostic d'insuffisance rénale aiguë (IRA) sur une période de 17 mois dans un hôpital de soins tertiaires.Résultats:230 patients avaient une IRA, l'âge moyen de la population étudiée étant de 45,33 ± 12,68 ans. 178 (77,4 %) patientes ont été recrutées dans l'unité médicale, 25 (10,7 %) dans l'unité chirurgicale et 27 (11,7 %) dans l'unité obstétricale. L'incidence observée de l'IRA était de 15/1 000 admissions. Environ 58,2 % avaient CAAKI et 96 (43,7 %) avaient HAAKI. Sur 230 patients, 170 (73,9 %) étaient des hommes et 60 (26,1 %) étaient des femmes. Le sepsis était l'étiologie d'IRA la plus courante (52,1 %) parmi les cas médicaux. L'urosepsie, le typhus des broussailles et la pneumonie étaient les causes les plus fréquentes d'AKI. Soixante pour cent des AKI étaient des maladies rénales améliorant les résultats globaux de stade 1 ou 2 et 40 % étaient au stade 3. Une oligurie a été observée dans 56,5 %, une hyperkaliémie dans 34,7 %, une surcharge hydrique dans 6,1 % et une acidose métabolique dans 22,6 %. La majorité des patients présentaient une atteinte de plusieurs organes (52,1 %) au moment de l'inscription. Environ 116 (50,4 %) souffraient de lésions pulmonaires nécessitant une ventilation mécanique et 95 (41,3 %) prenaient des inotropes. La mortalité est survenue dans 19,5%. L'anémie, l'utilisation de médicaments vasopresseurs et la nécessité d'un soutien en soins intensifs étaient des facteurs prédictifs indépendants de mortalité.Conclusion:L'IRA était fréquente chez les patients hospitalisés et entraîne une mortalité hospitalière significative. AKI est en grande partie un CAAKI, et dans une moindre mesure est dû au HAAKI. De nombreuses causes sont potentiellement évitables. Une réanimation liquidienne précoce, des antibiotiques efficaces, des antidotes appropriés et une orientation rapide des patients atteints d'IRA établis vers des centres dotés d'installations de dialyse peuvent améliorer les résultats de l'IRA.

Comparison of flow-mediated dilation (FMD) of the brachial artery in normotensive versus preeclamptic pregnant females.

Introduction: Flow-mediated dilation (FMD) of the brachial artery is an ultrasonography test that assesses the endothelial response to reactive hyperemia. The aim of this study was to assess the changes in FMD in preeclamptic pregnant patients and compare them with normotensive pregnant females. Methods: An analytical cross-sectional comparative study was conducted in the Department of Obstetrics and Gynaecology at King George's Medical University (KGMU) after obtaining ethical approval. A total of 110 normotensive and 100 preeclamptic patients were recruited for the study. Using a Toshiba Ultrasound Machine with a 7-12 MHz probe, the baseline diameter of the brachial artery D1 was measured. Afterward, the cuff of the sphygmomanometer was placed distally on the forearm and it was inflated up to ≥250 mm of Hg pressure and later slowly deflated. At 90th seconds after cuff deflation, the mean of three measurements of vessel caliber (D2) was obtained. The FMD% was obtained by the following equation: FMD (%) = [(D2 - D1)/D1] ×100, where D1 = basal diameter and D2 = post-occlusion diameter. All patients were followed till delivery for maternofetal outcome. Results: FMD% was significantly lower in the preeclampsia group, and it went on decreasing with increasing severity of preeclampsia. At the cutoff of 9.4 for FMD%, its sensitivity for the prediction of preeclampsia was 65.3%, specificity was 89.3%, positive predictive value (PPV) was 94%, and negative predictive value (NPV) was 50%. Discussion: FMD is a noninvasive test, and it gets decreased before clinical signs of preeclampsia, so it can be used as a predictor of preeclampsia.

Diagnostic Accuracy of Serum Glycosylated Fibronectin in Prediction of Preeclampsia: A Nested Case-Control Study.

BACKGROUND: Preeclampsia is a life-threatening complication of pregnancy that occurs in approximately 7% of all pregnancies. In India, the incidence of preeclampsia is 8%-10% and the prevalence is 5.4%, whereas the prevalence of hypertensive disorders of pregnancy is 7.8%. AIM AND OBJECTIVES: This study was aimed at evaluating the diagnostic accuracy of serum glycosylated fibronectin (S. GlyFn) in the prediction of preeclampsia. METHODS: A nested case-control study was carried out for 16 months in the department of obstetrics and gynecology. A total of 240 women were recruited and followed after written consent and ethical clearance. Six were lost to follow-up, 15 had second-trimester abortions (excluded from the study), and 32 women developed hypertensive disorders of pregnancy (cases), out of which 1 woman developed antepartum eclampsia, 10 women developed preeclampsia with severe features, and 21 women developed preeclampsia without severe features. One hundred and eighty-seven women remained normotensive throughout the pregnancy until 6 weeks postpartum. After randomization, out of these samples, 54 were analyzed and considered controls. Levels of S. GlyFn were estimated using an ELISA kit using the ELISA technique. RESULTS: The mean S. GlyFn level was significantly higher at the time of enrollment among those women who later developed preeclampsia (127.59 ± 27.68 ng/m) as compared to controls (107.79-53.51 ng/mL). GlyFn at a cutoff value of 126.70 ng/mL significantly (P = 0.034) discriminates cases of preeclampsia with severe features from healthy controls with a sensitivity of 90.00%, a specificity of 63.00%, a 31.03% positive predictive value, and 97.14% negative predictive value. CONCLUSION: S. GlyFn, at a cutoff value of 126.70 ng/mL, had good sensitivity to discriminate PE from normotensive and was also a good prognostic marker.

Résumé Contexte:La prééclampsie est une complication potentiellement mortelle de la grossesse qui survient dans environ 7 % de toutes les grossesses. En Inde, l'incidence de la prééclampsie est de 8 % à 10 % et la prévalence est de 5,4 %, alors que la prévalence des troubles hypertensifs de la grossesse est 7,8 %. But et objectifs : Cette étude visait à évaluer la précision diagnostique de la fibronectine sérique glycosylée (S. GlyFn) chez la prédiction de la prééclampsie.Méthodes:Une étude cas-témoin nichée a été menée pendant 16 mois dans le service d'obstétrique et gynécologie. Au total, 240 femmes ont été recrutées et suivies après consentement écrit et autorisation éthique. Six ont été perdus de vue, 15 avaient avortements au deuxième trimestre (exclus de l'étude), et 32 femmes ont développé des troubles hypertensifs de la grossesse (cas), dont 1 femme a développé une éclampsie antepartum, 10 femmes ont développé une prééclampsie avec des caractéristiques sévères et 21 femmes ont développé une prééclampsie sans traits sévères. Cent quatre-vingt sept femmes sont restées normotendues tout au long de la grossesse jusqu'à 6 semaines après l'accouchement. Après randomisation, sur ces échantillons, 54 ont été analysés et considérés comme témoins. Les niveaux de S. GlyFn ont été estimés à l'aide d'un kit ELISA en utilisant la technique ELISA.Résultats:Le niveau moyen de S. GlyFn était significativement plus élevé au moment de l'inscription chez les femmes qui ont développé plus tard une prééclampsie (127,59 ± 27,68 ng/m) par rapport aux témoins (107,79­53,51 ng/mL). GlyFn à une valeur seuil de 126,70 ng/mL de manière significative (P = 0,034) discrimine les cas de prééclampsie avec des caractéristiques sévères des témoins sains avec une sensibilité de 90,00 %, un spécificité de 63,00 %, une valeur prédictive positive de 31,03 % et une valeur prédictive négative de 97,14 %.Conclusion:S. GlyFn, à une valeur seuil de 126,70 ng/mL, avait une bonne sensibilité pour distinguer l'EP du normotendu et était également un bon marqueur pronostique.

Effect of vaginal douching with normal saline before insertion of dinoprostone vaginal insert for labor induction.

Objective: Vaginal pH has been suggested to be one of the causative factors, responsible for variation in prostaglandin efficacy for induction of labour. The purpose of this study was to analyse the effect of vaginal douching with normal saline before insertion of dinoprostone vaginal insert for induction of labour. Methods: This randomised controlled study was done in the Department of Obstetrics and Gynaecology for a period of 1 year. Using a computer-generated random number table, subjects were allocated in two groups. In group A (study group), vaginal douching was done with 20 cc of sterile 0.9% NaCl and vaginal pH was again measured with pH paper strips just before inserting dinoprostone pessary. Dinoprostone pessary was inserted without douching in group B (control group). Results: There was a significant increase in the vaginal pH after douching with normal saline (4.91 vs 5.52, P < 0.001). Mean intrinsic vaginal pH (pH before inserting dinoprostone insert) in women who delivered vaginally was significantly higher than that of the women who had a caesarean section (5.10 vs 4.63, P < 0.001). Time interval between dinoprostone insertion to active phase of labour, duration of active phase of labour, time interval between dinoprostone insertion, and complete cervical dilatation and mode of delivery were not significantly different between the two groups. Conclusion: Although douching with normal saline increases vaginal pH, douching does not help in increasing the chances of vaginal delivery because it gives a transient effect. Rather, it is intrinsic vaginal pH, which is a better decisive factor for successful vaginal delivery.

S100B as a predictor of delirium in critically ill obstetric patients: A nested case-control study.

Background: Delirium is a neuropsychiatric illness that lasts for a short period of time. The incidence of delirium in the intensive care unit (ICU) varies from 20% to 80%. Methods: A nested case-control study was carried out in the obstetric ICU. Individuals were divided into three groups: critically ill obstetric women who had delirium on admission (Group A), women who developed delirium within follow-up of 7 days (Group B), and women who did not develop delirium after follow-up of 7 days (Group C). The APACHE II score was used to assess critical illness severity. The Richmond Agitation-Sedation Scale was used to assess the alertness or sedation level of patients, and the Confusion Assessment Method (ICU scale) was used to assess the presence of delirium. S100B was measured by human S100B calcium-binding protein B ELISA kit (Elabscience Biotechnology, Houston, USA). Results: Severe preeclampsia and antepartum eclampsia were significantly associated with delirium. S100B levels in Group B were found to be significantly higher than those in Group C. S100B levels were higher in patients with >2 morbidities in comparison to patients with two morbidities. At a cutoff value of >169.25 pg/ml, S100B had a sensitivity of 74% and a specificity of 87.2% to discriminate cases of delirium from nondelirium. Conclusion: The rise in S100B levels was approximately three times greater in those who developed delirium as compared to those who did not. It is a more specific predictor of delirium.

Diagnostic Accuracy of Plasma Cystatin C and Renal Resistive Index for Acute Kidney Injury in Critically Ill Patients: A Prospective Observational Study.

Background: Acute kidney injury (AKI) is a quite common problem in critically ill patients. Serum cystatin C has emerged as a marker of AKI. This study was aimed to evaluate the diagnostic ability of serum Cystatin-C and Renal Resistive Index in prediction of AKI among critically ill patients. Methodology: This prospective observational study was carried out in the department of Medicine, over a period of one year. After informed consent and ethical clearance total 120 critically ill patients suffering from sepsis were enrolled, out of which 70 patients developed AKI while 50 did not develop AKI during treatment in Intensive care unit (ICU). Serum cystatin C was measured on day 1 by particle-enhanced immune nephelometric assay, Renal resistive index (RRI) calculated by ratio of the velocities of arterial perfusion throughout the cardiac phase and glomerular filtration rate was measured on days 1, 3, and 7 respectively. Results: S. cystatin C value was significantly higher(>3times) in AKI patients (14.07±4.8 mcg/ml) as compared to those who did not develop AKI (4.28±3.27 mcg/ml) (p<0.001). After ROC analysis it was found that day1, S. cystatin C, at cut off value of ≥9.29 mcg/ml had diagnostic accuracy 90% with sensitivity 91%, specificity89% and PPV 95.5%. While RRI value on day 7, at cut-off value of ≥0.72, had diagnostic accuracy 98%, sensitivity (98.6%) and specificity (96.7%) for AKI with 98.6% PPV, 96.7% NPV. Conclusion: Serum cystatin C appears to be a promising bio- markers for early diagnosis of AKI in critically ill patients. Whereas, RRI although non-invasive had good diagnostic accuracy but it diagnosed AKI after few days thus diagnosis of kidney injury delayed.

A protocol for stripping and reprobing of Western blots originally developed with colorimetric substrate TMB.

Western blotting is a widely used analytical technique for detection of specific protein(s) in a given sample of tissue/cell homogenate or extract. Both chemiluminescence (CL) and colorimetric detections can be used for imaging Western blots. Colorimetric substrates offer background free, sensitive, and clean imaging results directly on the blotted membrane and provides more accurate profile with respect to prestained marker. However, blots stained with colorimetric substrates cannot be reused since no stripping protocols have been reported for such blots, thus limiting their reuse for detection of another protein. In the present study, for the first time, we report a novel method of stripping Western blots developed with the colorimetric substrate TMB for detection of a low-abundant protein and reprobing of these blots after stripping for detection of a more abundant protein through CL procedure. The stripping procedure utilizes a stripping buffer consisting of ß-mercaptoethanol, SDS, and Tris-HCl and a washing buffer consisting of PBS added with 0.1% Tween-20 involves a series of steps and facilitates accurate detection of the second protein (i.e., more abundant protein) in the stripped blot through CL. The protocol is reproducible and facilitates saving of precious clinical samples, in addition to saving cost and time as compared to the existing procedures.

ROC-Analysis Derived Immunohistochemical P53 Cut-Off Scores as an Adjunct to Routine Histopathology for Better Diagnostic Compartmentalisation of Cervical Lesions.

Objective: The aim of this study was to evaluate the predictive value of Immunohistochemical p53 cut-off scores as an adjunct to routine histopathology for better diagnosis of cervical lesions. Materials and Methods: Prospective study carried out for 1 year. After ethical approval and informed consent, a total of 100 cervical tissue samples were analyzed; chronic cervicitis (CC)-15, cervical intraepithelial neoplasia (CIN)-40, and squamous cell carcinoma cervix (SCC)-45 (FIGO 2018 clinical staging). After routine processing of tissue specimen, hematoxylin and eosin (HE) staining was done. Grading of cervical precancerous lesions (CIN) was done as per World Health Organisation criteria as CIN 1,2 or 3. Broder's grading was assigned for every SCC sample. Results: Mean p53 scores of CC, CIN, and SCC cases were 0.0, 1.70, and 4.38, respectively, CIN 1, 2, and 3 were 1.07, 1.63, and 2.22, respectively. SCC was differentiated from CIN3 with p53 ≥4.5 as predictor for SCC, sensitivity and specificity were 57.8% and 88.9%, respectively. Overall diagnostic accuracy of the proposed scoring system for differentiating CC, CIN, and SCC was 61%, while the accuracy of previous methods of interpreting p53 immunoreactivity as immunoscore >2 or arbitrary cut-off of >10% cells with nuclear positivity was only 48%. Conclusion: ROC-derived immunoscore cut-offs can provide the much-needed objectivity and optimal decision thresholds to immunohistochemistry interpretation.

Role of renal replacement therapy in pregnancy related acute kidney injury and its outcome.

Background: Pregnancy-related acute kidney injury (PRAKI) has bimodal distribution. The rates of maternal mortality and perinatal mortality in patients with PRAKI have increased. The aim of this study was to evaluate magnitude of PRAKI in North Indian women and to assess morbidity, mortality, and outcomes in patients who received renal replacement therapy. Materials and Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynaecology, in collaboration with nephrology. A total of 150 women suffering from PRAKI were recruited and total 98 obstetrics AKI, requiring renal replacement therapy, classified as per KDIGO guidelines 2012 were enrolled for dialysis. Six patients were lost to follow up before final analysis. Haemodialysis was carried out by B. Brawn machine. Results: Approximately 82% cases of PRAKI diagnosed in postpartum period. Mean cycles of dialysis was 9.06 ± 7.75 approximately half of the females required 1-5 cycles of dialysis. Higher percentages of maternal deaths were observed within 1-5 cycles of dialysis. Women received dialysis after 72 h showed increased chances of partial recovery. After 3 months of follow-up, rate of complete recovery was significantly higher in Stage I (100%) and Stage II (84.6%) PRAKI while rate of partial recovery and deaths were significantly higher in Stage III PRAKI (37.3%). Stage of AKI, baseline K+ levels, treatment modality, duration of ICU stay and use of Vasopressure showed significant association with adverse outcome. Conclusion: Higher percentages of deaths were observed in those who referred late and delay in initiation of dialysis and it was observed within 1-5 cycles of dialysis.

Clinical profile, etiology, and outcome of acute pancreatitis: Experience at a tertiary care center.

Background: Acute pancreatitis (AP) is an inflammatory process of the pancreas with varying degree of involvement of regional tissues. This was a population-based study on the incidence of AP. We aimed to determine the incidence, etiology, and outcome of AP. Materials and Methodology: This prospective study was conducted in the Department of Medicine, King George's Medical University, Lucknow, India, on 120 patients of AP. Clinical history, examination, and laboratory investigations were done. Severity of AP was assessed using the modified Atlanta classification. Results: A total of 120 patients comprising of 88 men (73.33%) and 32 women (26.66%) were recruited. The mean age of study participant was 36.96 ± 13.44 years. The most common presentation was abdominal pain followed by vomiting. The leading etiological factors were alcohol in 85 patients (70.8%) and gallstones in 25 (20.8%). It was idiopathic 5 patients (4.1%). Mortality was seen in three (2.5%) patients, all of which had severe pancreatitis. Patients with body mass index (BMI) ≥25 kg/m2, Hematocrit (HCT) ≥44% and C-reactive protein (CRP) ≥150 mg/l had an increased risk of developing a severe AP. Conclusions: Alcohol and gallstones were the most common etiological factors of AP, whereas HCT, CRP, and BMI were the useful predictors of severe pancreatitis.

RésuméContexte: La pancréatite aiguë (PA) est un processus inflammatoire du pancréas avec divers degrés d'implication des tissus. Il s'agissait d'une étude basée sur la population sur l'incidence de la PA. Nous visions à déterminer l'incidence, l'étiologie et le résultat de la PA. Matériaux et méthodologie: Cette étude prospective a été menée au Département de médecine de l'Université de médecine du roi George, Lucknow, Inde, sur 120 patients atteints de PA. Les antécédents cliniques, les examens et les analyses de laboratoire ont été effectués. La gravité de la PA a été évaluée en utilisant la classification modifiée d'Atlanta. Résultats: Un total de 120 patients comprenant 88 hommes (73,33%) et 32 femmes (26,66%) ont été recrutés. L'âge moyen des participants à l'étude était de 36,96 ± 13,44 ans. La présentation la plus courante était une douleur abdominale suivie de vomissements. le Les principaux facteurs étiologiques étaient l'alcool chez 85 patients (70,8%) et les calculs biliaires chez 25 (20,8%). Il s'agissait de patients idiopathiques 5 (4,1%). Mortalité a été observée chez trois (2,5%) patients, tous atteints de pancréatite sévère. Patients ayant un indice de masse corporelle (IMC) ≥ 25 kg / m2, HCT ≥ 44% et La protéine C-réactive (CRP) ≥ 150 mg / l avait un risque accru de développer une PA sévère. Conclusions: L'alcool et les calculs biliaires étaient les plus facteurs étiologiques communs de la PA, tandis que la HCT, la CRP et l'IMC étaient les prédicteurs utiles de la pancréatite sévère. Mots-clés: pancréatite aiguë, profil clinique, étiologie, issue.

Single step "See and Treat" strategy might be replacing the "conventional three step strategy" in management of preinvasive cervical lesions at tertiary center: A North Indian study.

Introduction: The aim of this study was to compare overtreatment rates of see and treat colposcopy-based single step protocol with cytology and colposcopy-guided biopsy-based conventional three-step protocol using loop electrosurgical excision procedure (LEEP) for treatment of preinvasive lesions of cervix. Materials and Methods: Prospective interventional study was carried out over a period of 1 year. Recruitment of cases was done from the 664 diagnostic colposcopies performed for various gynecological indications. Among 496 colposcopies performed exclusively for unhealthy cervix on per speculum examination, 74 women had high-grade colposcopy (Swede score ≥5). Subsequently, 50 women were enrolled under the see and treat arm, arm 1 and underwent LEEP. In study arm 2, conventional three-step strategy, concurrently 22 women with abnormal cytology. ≥ Atypical squamous cells of undetermined significance and unhealthy cervix were enrolled for colposcopy and if indicated, guided biopsy was obtained and tissue was sent for histopathology. Only 12 such women having HPE reports of cervical intraepithelial neoplasia (CIN) 2 or 3 were subjected to LEEP. Overtreatment was defined as CIN 1 or less on final LEEP tissue histopathology. Results: The overtreatment rate in See and Treat protocol was 44% when colposcopy Swede score cutoff was considered 5, which fell down to 0% when Swede score cutoff was taken 7. Conventional three step protocol had an overtreatment rate of 8.3%. Incidentally diagnosed high-grade CIN or invasive cancer was found in 24%. Discrepancy between biopsy tissue and LEEP tissue histopathology was 50% in conventional arm. Conclusion: Women with unhealthy cervix having high-grade colposcopy (Swede score ≥7) can be directly subjected to LEEP without waiting for results of any initial screening modality. Advantages include minimal over treatment coupled with reduced patient visits and interventions.

Randomized controlled study for comparison of efficacy and safety between thermocoagulation and cryotherapy in visual inspection with acetic acid positive cervical lesions.

Background: Less literature is available on the performance of thermocoagulation for treatment of premalignant cervical lesions and its comparison with cryotherapy from low- and middle-income countries like India. Materials and Methods: : A prospective randomized controlled study was done in the Department of Obstetrics and Gynecology from August 2018 to September 2019 after obtaining ethical clearance from Institutional Review Board (Reg no: ECR/262/Inst/Up/2013/RR/16) Ref no: 278/Ethics/R. cell-18). A total of 68 women with Visual inspection with acetic acid (VIA) positive cervical lesion were randomized into two groups. Group A was treated with cryotherapy and Group B was treated with thermocoagulation. Estimates of cure, adverse effects or complications were presented as frequencies, percentages, and mean ± standard deviation. Results: Out of 667 patients, 624 patients underwent VIA testing among which 68 were VIA positive (10.89%, 68/624). The efficacy of thermocoagulation was 93.54% and that of cryotherapy was 90.32%. Immediate side effects were significantly lesser in thermocoagulation group (P = 0.008) in comparison to cryotherapy. Conclusion: Thermocoagulation is better treatment modality than cryotherapy for VIA-positive cervical lesions may not be in terms of efficacy but definitely in terms of patient comfort and safety.

Feto-maternal outcome of pregnancy related acute kidney injury in a North Indian population.

BACKGROUND: Acute kidney injury (AKI) is a serious complication in pregnancy, resulting in significant maternal and fetal morbidity/mortality. The aim of this study was to evaluate the magnitude of pregnancy-related AKI (PRAKI) in a North Indian population, and its contributing factors. MATERIALS AND METHODS: This prospective study was carried out at the department of obstetrics and gynecology in collaboration with the nephrology unit and internal medicine department at King George Medical University from June 2019 to October 2020. After informed consent and ethical clearance, a total of 150 PRAKI women were enrolled, and 98 women were subjected to renal replacement therapy as per Kidney Disease Improving Global Outcomes 2012 guideline and were followed for 3 months for renal and fetomaternal outcome. RESULTS: There was a high incidence (1.02%) of AKI during pregnancy and puerperium. Majority (57.3%) of the women were aged 26-30 years, and 93.3% had institutional deliveries. About 49% of the women suffering from PRAKI were multipara, and most were identified in the postpartum period (82%). Hypertensive disorder of pregnancy (48%), puerperal sepsis (45%), and hemorrhage (34%) were the associated causes for PRAKI. Stillbirth/intrauterine death (IUD) was higher in Stage II (53.8%) and Stage III AKI (37.7%) (none in Stage I AKI). The majority of the neonates were born with a birth weight of ≤2500 g irrespective of the stages of AKI. Preterm deliveries were significantly higher in Stage II AKI (53.8%) than in Stage I (33.3%) and Stage III (20.0%). Thirty-seven cases of PRAKI were managed conservatively, while 98 required dialysis. Complete recovery occurred in 27.3% and partial renal recovery in 31.3%. However, 3.3% progressed to chronic kidney disease, 34% expired, and 4% were lost to follow-up. High maternal mortality of 30.1% was observed in those dialyzed. CONCLUSION: AKI is associated with fetal growth restriction and preterm deliveries. Stillbirth/IUD is higher in Stage II and Stage III AKI.

Placental Growth Factor in First Trimester of Pregnancy for Prediction of Maternal and Perinatal Adverse Outcomes.

Purpose of the study: Placental growth factor (PLGF) is an angiogenic factor in pregnancy. To find out correlation of plasma levels of placental growth factor in first trimester of pregnancy in Indian women who develop maternal and perinatal adverse outcomes was the aim of the study. Methods: A prospective longitudinal noninterventional study was done in the department of Obstetrics and Gynecology after obtaining ethics approval. After enrolling patients in the first trimester (11 weeks to 13 weeks 6 days), a questionnaire was filled for demographic characteristics. Uterine artery doppler was done for every patient and blood sample (5 ml) was taken by venu puncture of median cubital vein. Serum levels of PLGF were measured by enzyme linked immunosorbent assay using Thermo Scientific Pierce Human PLGF kit (Thermo Fisher Scientific, Inc., Waltham, MA, USA). Patients were followed for their whole antenatal period and delivery outcomes. Results: Incidence of preeclampsia in our study was 9.3% (15/161) and fetal growth restriction (FGR) was 19.8% (32/161). Neither BMI nor nulliparity was found to have statistically significant correlation with development of preeclampsia. However, history of preeclampsia was found to be significant risk factor for prediction of preeclampsia (p value < 0.04). Plasma levels of PLGF were significantly lower in preeclampsia and FGR group and this difference was statistically significant (p value < 0.04). 7.5% still born occurred in complicated group and 10% needed NNU/NICU admission in this group. Conclusion: Measuring PLGF levels in first trimester of pregnancy can help in prediction of preeclampsia and FGR.

Spectrum of Ectopic Pregnancies at a Tertiary Care Center of Northern India: A Retrospective Cross-sectional Study.

Objectives: Diagnosis of ectopic pregnancy (EP) needs high index of clinical suspicion. If EP is timely diagnosed and timely intervened, i.e., before rupture, it may cause reduction of serious morbidity and mortality. We aimed to analyze the profile of patients of ectopic pregnancies and their outcome. Materials and Methods: The sample for this retrospective cross-sectional study was derived from the database from January 2017 to December 2020. Data from outdoor patient registers, case record files, discharge summaries and hospital admission/discharge registers were screened. Parameters age, parity, risk factors, clinical presentation, per-operative findings, and maternal outcome in terms of morbidity and mortality were assessed. Results: Totally 27,525 deliveries occurred during the study period of 3 years, of which 640 were ectopic pregnancies, i.e., 2.3%. Out of 640, 415 (64.8%) were acute ruptured ectopic pregnancies, 62 (9.6%) were chronic ruptured pregnancies, and 163 (25.4%) patients were unruptured ectopic pregnancies. The mean age was 28.67 years (range: 29.5-27.8). The most common site of rupture was ampullary (54%, 225/415). 14.8% (95/640) of cases were in hemorrhagic shock out of total ectopic patients, and in ruptured group, they comprised 22.8% (95/415). Success for medical management with single-dose methotrexate in our study was 90.2% (147/163). Conclusion: Pelvic inflammatory disease and history of induced abortion were found to be the most important etiological factor in ectopic pregnancies. Comprehensive clinical examination is 100% sensitive in diagnosis of EP. In ultrasound, the presence of adnexal mass is the most common finding which is additive to clinical findings and not substitute. Although multiple management options are available, best outcome is attained if management of EP is done at earliest without any delay.