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The original version of this article unfortunately contained a mistake. Ambika Devi K was not listed among the authors. The corrected authorship is given below.
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Multicomponent molecular modifications such as DNA methylation may offer sensitive and specific cervical intraepithelial neoplasia and cervical cancer biomarkers. In this study, we tested cervical tissues at various stages of tumor progression for 5-methylcytosine and 5-hydroxymethylcytosine levels and also DNA promoter methylation profile of a panel of genes for its diagnostic potential. In total, 5-methylcytosine, 5-hydroxymethylcytosine, and promoter methylation of 33 genes were evaluated by reversed-phase high-performance liquid chromatography, enzyme-linked immunosorbent assay based technique, and bisulfate-based next generation sequencing. The 5-methylcytosine and 5-hydroxymethylcytosine contents were significantly reduced in squamous cell carcinoma and receiver operating characteristic curve analysis showed a significant difference in (1) 5-methylcytosine between normal and squamous cell carcinoma tissues (area under the curve = 0.946) and (2) 5-hydroxymethylcytosine levels among normal, squamous intraepithelial lesions and squamous cell carcinoma. Analyses of our next generation sequencing results and data from five independent published studies consisting of 191 normal, 10 low-grade squamous intraepithelial lesions, 21 high-grade squamous intraepithelial lesions, and 335 malignant tissues identified a panel of nine genes ( ARHGAP6, DAPK1, HAND2, NKX2-2, NNAT, PCDH10, PROX1, PITX2, and RAB6C) which could effectively discriminate among the various groups with sensitivity and specificity of 80%-100% (p < 0.05). Furthermore, 12 gene promoters (ARHGAP6, HAND2, LHX9, HEY2, NKX2-2, PCDH10, PITX2, PROX1, TBX3, IKBKG, RAB6C, and DAPK1) were also methylated in one or more of the cervical cancer cell lines tested. The global and gene-specific methylation of the panel of genes identified in our study may serve as useful biomarkers for the early detection and clinical management of cervical cancer.
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Biomarcadores Tumorais/genética , Carcinoma de Células Escamosas/genética , Metilação de DNA/genética , Neoplasias do Colo do Útero/genética , 5-Metilcitosina/análogos & derivados , 5-Metilcitosina/metabolismo , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Feminino , Genótipo , Sequenciamento de Nucleotídeos em Larga Escala , Proteína Homeobox Nkx-2.2 , Proteínas de Homeodomínio , Humanos , Pessoa de Meia-Idade , Proteínas de Neoplasias/genética , Proteínas Nucleares , Papillomaviridae/genética , Papillomaviridae/patogenicidade , Regiões Promotoras Genéticas , Fatores de Transcrição , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologiaRESUMO
Double C2-like domain ß (DOC2B) gene encodes for a calcium-binding protein, which is involved in neurotransmitter release, sorting, and exocytosis. We have identified the promoter region of the DOC2B gene as hypermethylated in pre-malignant, malignant cervical tissues, and cervical cancer cell lines by methylation-sensitive dimethyl sulfoxide-polymerase chain reaction and bisulfite genome sequencing; whereas, it was unmethylated in normal cervical tissues (p < 0.05). The promoter hypermethylation was inversely associated with mRNA expression in SiHa, CaSki, and HeLa cells and treatment with demethylating agent 5-aza-2-deoxycytidine restored DOC2B expression. The region -630 to +25 bp of the DOC2B gene showed robust promoter activity by a luciferase reporter assay and was inhibited by in vitro artificial methylation with Sss1 methylase prior to transient transfections. Overexpression of the DOC2B gene in SiHa cells when compared with controls showed significantly reduced colony formation, cell proliferation, induced cell cycle arrest, and repressed cell migration and invasion (p < 0.05). Ectopic expression of DOC2B resulted in anoikis-mediated cell death and repressed tumor growth in a nude mice xenograft model (p < 0.05). DOC2B expressing cells showed a significant increase in intracellular calcium level (p < 0.05), impaired AKT1 and ERK1/2 signaling, and induced actin cytoskeleton remodeling. Our results show that promoter hypermethylation and silencing of the DOC2B gene is an early and frequent event during cervical carcinogenesis and whose reduced expression due to DNA promoter methylation may lead to selective cervical tumor growth.
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Proteínas de Ligação ao Cálcio/genética , Metilação de DNA , Regulação Neoplásica da Expressão Gênica , Proteínas do Tecido Nervoso/genética , Regiões Promotoras Genéticas , Neoplasias do Colo do Útero/metabolismo , Actinas/metabolismo , Animais , Apoptose , Cálcio/química , Cálcio/metabolismo , Proteínas de Ligação ao Cálcio/metabolismo , Ciclo Celular , Linhagem Celular Tumoral , Movimento Celular , Proliferação de Células , Ilhas de CpG , Feminino , Genótipo , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Invasividade Neoplásica , Transplante de Neoplasias , Proteínas do Tecido Nervoso/metabolismo , Papillomaviridae/metabolismo , Estrutura Terciária de Proteína , Transdução de Sinais , Sulfitos/químicaRESUMO
BACKGROUND: There is significant increase in proportion of cases with previous cesarean delivery requiring obstetric care. The available literature fails to provide uniform opinion on each woman's characteristics to identify risk of uterine rupture while planning trial of labor after cesarean. OBJECTIVE: To study the association of abnormal lower uterine segment with some of the present and previous obstetric variables including patient characteristics and surgical techniques at previous cesarean operation. MATERIALS AND METHODS: Consenting consecutive 96 post-cesarean singleton pregnancies admitting after 36 weeks gestation at the same facility from July 2011 to December 2012 for repeat cesarean, were studied. Only the cases with cephalic presentation and vertex as presenting part, having no placenta previa, polyhydramnios, uterine anomaly or fibroid and those who had previous one lower segment cesarean were recruited. Based on the intra-operative finding the lower uterine segment (LUS) was categorized into those having a normal and abnormal (grades 2-4) LUS. Sonographic assessment of LUS thickness and any abnormalities if any were noted. The findings of abnormal LUS (direct observation at surgery and sonographic impression within a week before surgery) were looked for association with some of the present and previous obstetric variables including patient characteristics and surgical techniques at previous cesarean operation using Student t, Chi square or Fisher's exact test for analysis as appropriate. Receiver operating curve analysis was used to determine the optimal cut off value for prediction of LUS integrity by ultrasound. RESULTS: Of the women recruited for the study, 36 were admitted in early labor and ultrasound evaluation of LUS was performed in 48 of the remaining 60 women admitted antenatal for elective cesarean delivery. There were 38 abnormal LUS (39.6%) with 22 of them (57.9%) graded as 'thinned out LUS'. The incidence of scar dehiscence (grade 3, cases 5) was 5.2% of 96 cases and there were no cases of scar rupture. Proportion of cases with abnormal LUS was significantly high when primary cesarean was done in preterm (p = 0.02); it was a single layer uterine closure (p = 0.02), and inter-cesarean interval was 54 months (p = 0.01). Abnormal LUS was also seen to be associated with maternal age beyond 35 years (p = 0.2), when cesarean was performed in labor (p = 0.5), following 18 h of rupture of membranes (p = 0.75), for a baby weight more than 3 kg (p = 0.4), and different suture materials (polyglactin 910 and chromic catgut) were used to close uterus at primary cesarean delivery (p = 0.1), and also if they had post-partum fever (p = 0.3). Ultrasound measurement of LUS by abdominal scan correlated with the intra-operative LUS grading and a thickness of more than 3.2 mm within a week before delivery and was seen to be the safe cut off above which most of the women had a normal LUS (sensitivity 92.3%, specificity 81.1%). CONCLUSION: Factors at primary cesarean operation significantly influence the state of LUS at term in subsequent pregnancy .
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Cesárea/efeitos adversos , Cicatriz/complicações , Útero/diagnóstico por imagem , Adulto , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Trabalho de Parto , Idade Materna , Período Pós-Parto , Gravidez , Sensibilidade e Especificidade , Suturas , Ultrassonografia Pré-Natal/métodos , Anormalidades Urogenitais , Ruptura Uterina/diagnóstico por imagem , Ruptura Uterina/prevenção & controle , Útero/anormalidadesRESUMO
Background: To start perinatal death auditing, doctors should have good knowledge about it. Objectives: To know the awareness and perceptions of doctors about different aspects of perinatal death auditing like 1) different types of contributors; 2) high-risk approach; 3) consequences; 4) documentary requirements; and 5) existing system of mortality meeting/child death reviews. Methodology: The perinatal death auditing project was implemented in two districts of Karnataka state. As a part of the pre-intervention survey, awareness and perceptions of doctors and a few health care administrators were explored. They were requested to participate in the study. Those who consented were approached in their hospitals and interviewed. Trained medical social workers conducted the interviews. Awareness was scored from 0 to 3 with 0 being no knowledge and 3 being good knowledge. Perceptions were scored from 0 to 3 with 0 being no negative perceptions and 3 being fear of legal consequences. The responses were documented, scored, and described. Results: Though 22 doctors were eligible, only 16 consented to participate in the study. Knowledge of doctors about different contributors was inadequate. They were apprehensive about legal consequences. They knew that documentation could protect them and be useful in a court of law. They were not clear about the conduct of mortality meeting/existing system of child death reviews. Conclusion: Knowledge was inadequate. They were apprehensive about legal consequences. Training of doctors and allaying apprehensions are required for starting perinatal death auditing.
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Cesarean section rates worldwide are rising, driven by medically unnecessary cesarean use. The new World Health Organization Labour Care Guide (LCG) aims to improve the quality of care for women during labor and childbirth. Using the LCG might reduce overuse of cesarean; however, its effects have not been evaluated in randomized trials. We conducted a stepped-wedge, cluster-randomized pilot trial in four hospitals in India to evaluate the implementation of an LCG strategy intervention, compared with routine care. We performed this trial to pilot the intervention and obtain preliminary effectiveness data, informing future research. Eligible clusters were four hospitals with >4,000 births annually and cesarean rates ≥30%. Eligible women were those giving birth at ≥20 weeks' gestation. One hospital transitioned to intervention every 2 months, according to a random sequence. The primary outcome was the cesarean rate among women in Robson Group 1 (that is, those who were nulliparous and gave birth to a singleton, term pregnancy in cephalic presentation and in spontaneous labor). A total of 26,331 participants gave birth. A 5.5% crude absolute reduction in the primary outcome was observed (45.2% versus 39.7%; relative risk 0.85, 95% confidence interval 0.54-1.33). Maternal process-of-care outcomes were not significantly different, though labor augmentation with oxytocin was 18.0% lower with the LCG strategy. No differences were observed for other health outcomes or women's birth experiences. These findings can guide future definitive effectiveness trials, particularly in settings where urgent reversal of rising cesarean section rates is needed. Clinical Trials Registry India number: CTRI/2021/01/030695 .
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Cesárea , Parto Obstétrico , Feminino , Humanos , Gravidez , Idade Gestacional , Ocitocina/uso terapêutico , Projetos PilotoRESUMO
BACKGROUND: There are many studies documenting increased prevalence of periodontal infection in women with preeclampsia. But, very few studies have attempted to establish causal relationship between the two. OBJECTIVE: To find out causal circumstantial evidence by isolating specific periodontal pathogens in oral and placental samples. MATERIALS AND METHODS: Antenatal periodontal screening and subgingival plaque collection was carried out in ten women with hypertension in pregnancy and ten normotensive controls on their hospital admission at term for cesarean delivery. Placental biopsy was obtained after aseptic placental collection at the time of elective cesarean delivery. Subgingival plaque and placental biopsy were studied for Porphyromonas gingivalis, Fusobacterium nucleatum, Treponema denticola, Prevotella intermedia and Aggregatibacter actinomycetemcomitans using quantitative polymerase chain reaction technique. Periodontist and laboratory personnel were unaware of case or control status. Periodontal status was not informed to the obstetrician recruiting the cases and laboratory. Microbiology report was not revealed till end of the study. RESULTS: Periodontal pathogens were found to be high in the group with hypertension than the controls. P gingivalis was found in all the samples from subgingival plaque and placenta, irrespective of the periodontal disease status. CONCLUSION: In cases with hypertension, periodontal pathogens are present in higher proportion in subgingival plaque and placenta.
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Placa Dentária/microbiologia , Gengivite/microbiologia , Hipertensão Induzida pela Gravidez/microbiologia , Doenças Periodontais/microbiologia , Doenças Placentárias/microbiologia , Adulto , Aggregatibacter actinomycetemcomitans/isolamento & purificação , Cesárea , Feminino , Fusobacterium nucleatum/isolamento & purificação , Humanos , Porphyromonas gingivalis/isolamento & purificação , Gravidez , Prevotella intermedia/isolamento & purificação , Treponema denticola/isolamento & purificação , Adulto JovemRESUMO
OBJECTIVE: To correlate lower uterine segment (LUS) thickness measured by abdominal sonography at term pregnancy with that measured manually using caliper at cesarean delivery and to find out minimum LUS thickness indicative of its integrity in women with previous cesarean. METHODS: In 106 women with previous cesarean delivery and 68 with unscarred uterus, abdominal sonographic assessment of LUS was carried out within a week of delivery. Sonographic measurements were correlated with manual measurement of lower flap of LUS using Vernier calipers in 96 of these women (64 with previous cesarean and 32 of unscarred uterus) who had elective cesarean delivery. RESULTS: Sonographically determined LUS was thinner among women with previous cesarean delivery than in those without (4.58 SD 1.05 vs. 4.8 SD 0.8; t = 1.986; p = 0.04). Women with vaginal birth after cesarean had thicker LUS than women with repeat cesarean delivery (4.4 SD 0.97 vs. 4.48 SD 1.0). The findings were not influenced by engaged fetal head status or amount of bladder fullness. Directly measured LUS thickness using Vernier calipers before delivery of the baby confirmed ultrasound measurements, but showed smaller differences between them. There were eight cases with defective uterine scar at cesarean. LUS thickness at term of 3 mm provided 87.5% sensitivity and specificity, and was found to have negative predictive value of 98%. But in two of seven cases the actual LUS was not measurable despite sonographic measurement of 3 mm, and there were two records of scar dehiscence in those with 3 and 4 mm of LUS thickness. CONCLUSION: LUS thickness of 3 mm measured by abdominal ultrasonography prior to delivery at term in women with previous cesarean is suggestive of stronger LUS but is not a reliable safeguard for trial of labor.
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Cesárea , Útero/diagnóstico por imagem , Adulto , Cicatriz/diagnóstico por imagem , Feminino , Humanos , Tamanho do Órgão , Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Útero/anatomia & histologiaRESUMO
BACKGROUND: The presently used perinatal death certificate devised by the World Health Organization is incomplete and does not help in identifying "preventability." OBJECTIVE: To develop tools that can help identify (1) preventable perinatal death and (2) preventable and/or avoidable cause for perinatal deaths. MATERIALS AND METHODS: As a prerequisite for conduct of a community-based interventional study in two different districts of Karnataka state, two information tools, Perinatal death reporting form (PeNDReF) and perinatal death audit report (PeNDAR), were designed. The process involved series of preparatory and review meetings, before and after the field work to list facilities available, categorize facilities, identify causality, assess risk factors, and assert preventability of a perinatal death. The process was repeated over a period of 6 months and the information tools, PeNDReF and PeNDAR, were finalized. Doctors and paramedical personnel of both the districts were trained to fill the tools, which were analyzed to ascertain contributing risk factors and identify preventable perinatal death. RESULTS: The use of PeNDAR led to identification of 5.7% of perinatal deaths as "preventable" and 19% as "possibly preventable." The use of PeNDReF helped in the identification of risk factors (maternal anemia 49.6%, age of marriage <20 years 18.7%, and maternal weight <50 kg 9.1%), avoidable/preventable factors related to quality of care, transport, and referral. CONCLUSIONS: These tools are useful for identifying "preventable" perinatal deaths and avoidable/preventable factors.
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OBJECTIVE: In Karnataka state, perinatal mortality rate is almost equal to infant mortality rate. This preliminary study was conducted in two districts of Karnataka to study potential problems to start of perinatal death audit. METHODS: Hospitals providing maternal and child health care services, which met study inclusion criteria, in Dakshina Kannada and Koppal Districts were included. Following variables were studied: (i) Documentation and reporting systems in these hospitals; (ii) Role of health care personnel in documentation and reporting (iii) Existing system of audit, if any. RESULTS: Totally 94 hospitals met our criteria with Dakshina Kannda District having 63 (67.02%) and the rest in Koppal District. Documentation and reporting was poor in Koppal District and inadequate in Dakshina Kannada district. Health care personnel were apprehensive about perinatal death audit. CONCLUSION: Problems identified need to be addressed before starting perinatal death audit.
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Morte Perinatal , Criança , Documentação , Feminino , Humanos , Índia/epidemiologia , Lactente , Mortalidade Infantil , Mortalidade Perinatal , GravidezRESUMO
The analgesic efficacy of subcutaneous injection of sterile water compared to isotonic saline was investigated in a randomized, controlled study on a total of 100 women in the active phase of labor and who complained of low back pain. Pain perception was rated on a numerical rating scale before and at 10 and 45 minutes after the injection. The initial pain score was the same in both groups and pain relief was expressed by both groups irrespective of the solution injected, but the sterile water group had significantly higher relief scores compared to those receiving saline. This was not influenced by maternal age, parity, education, body mass index, cervical dilatation at intervention or fetal size, suggesting that subcutaneous injection of sterile water to the lower back provides relief from back pain during labor.
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Dor do Parto/terapia , Dor Lombar/terapia , Água/administração & dosagem , Adulto , Feminino , Humanos , Injeções Subcutâneas , Dor Lombar/etiologia , Medição da Dor , GravidezRESUMO
Aceclofenac agglomerates were prepared by spherical crystallization technique using a three solvent system comprising acetone: dichloromethane (DCM): water (bridging liquid, good solvent and bad solvent, respectively). Hydroxypropyl methylcellulose-50cps (HPMC) in different concentrations was used as hydrophilic polymer. The effect of speed of rotation and amount of bridging liquid on spherical agglomeration were studied. The agglomerates were subjected to various physicochemical evaluations such as practical yield, drug content, particle size, loss on drying, porosity, IR spectroscopy, differential scanning calorimetry, X-ray diffraction studies, relative crystallinity, scanning electron microscopy, micromeritic properties, solubility and dissolution studies. The agglomerates showed improved micromeritic properties as well as dissolution behaviour in comparison to conventional drug crystals. The optimized agglomerates (F-9) showed good sphericity as well as high drug release, and hence they were compressed into tablets by direct compression. The tablets were found within the limits with respect to various physicochemical parameters. The dissolution rate of prepared tablets was better than that of marketed tablet and pure drug. The optimized agglomerates and tablet formulations were found to be stable for 6 months under accelerated conditions. The in vivo studies (preclinical pharmacokinetics, pharmacodynamics and toxicity studies, and clinical pharmacokinetics) of optimized agglomerates were carried out. The results of preclinical studies revealed that the agglomerates provided improved pharmacodynamic and pharmacokinetic profiles of drug besides being nontoxic. The results of pharmacokinetic studies of optimized tablet in human subjects indicated improved pharmacokinetic parameters of drug in comparison with that of marketed tablet.
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Anti-Inflamatórios não Esteroides/química , Diclofenaco/análogos & derivados , Adulto , Animais , Diclofenaco/química , Diclofenaco/farmacocinética , Diclofenaco/farmacologia , Estabilidade de Medicamentos , Humanos , Masculino , Ratos , Ratos Wistar , Solubilidade , Comprimidos , Tecnologia FarmacêuticaRESUMO
OBJECTIVE: To assess the efficacy of conventional Raman spectroscopy in combination with discriminating parameters, Mahalanobis distance, spectral residuals, and "limit test" methodology in differentiation of normal and malignant ovarian tissues. BACKGROUND DATA: Ovarian cancer is the second most common cancer among women and the leading cause of death among gynecologic malignancies. Initial laparotomy and subsequent frozen section analysis can influence the surgical management of ovarian cancers. Although frozen section pathology is sensitive and specific enough, interpretation is often subjective, time consuming, and requires highly skilled personnel. Raman spectroscopy is sensitive to biochemical variations in the samples, rapid, more objective, and amenable to multivariate statistical tools. It can therefore be an ideal tool for discrimination between normal and malignant ovarian tissues. METHODS: 72 Spectra from eight normal and seven malignant ovarian tissues were recorded by conventional near-infrared (NIR) Raman spectroscopy (excitation wavelength of 785 nm). Spectral data were analyzed by principal components analysis (PCA) and other discriminating parameters such as Mahalanobis distance, spectral residuals, and a multiparametric limit test approach. RESULTS: A mean malignant spectrum exhibits a broader amide I band, a stronger amide III band, a minor blue shift in the delta CH2 band, and a hump around 1480 cm(-1) compared to a normal spectrum. The normal spectra show relatively stronger peaks around the 855 and 940 cm(-1) region. Scores of factor 1 as well as Mahalanobis distance and spectral residuals gave good classification among the tissue types. The limit test approach provided unambiguous and objective discrimination. CONCLUSION: The findings of this study demonstrate the efficacy of conventional Raman spectroscopy and our statistical methodologies in discrimination of normal from malignant ovarian tissues. Prospectively, by evaluating the models and developing suitable fiberoptic probes, this technique could be useful in diagnosis during initial laparotomy.
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Neoplasias Ovarianas/diagnóstico , Análise Espectral Raman , Algoritmos , Estudos de Coortes , Feminino , Humanos , Neoplasias Ovarianas/patologia , Projetos Piloto , Valor Preditivo dos Testes , Análise de Componente PrincipalRESUMO
The purpose of this study was to develop a once daily sustained release tablet of aceclofenac using chitosan and an enteric coating polymer (hydroxypropyl methylcellulose phthalate or cellulose acetate phthalate). Overall sustained release for 24 h was achieved by preparing a double-layer tablet in which the immediate release layer was formulated for a prompt release of the drug and the sustained release layer was designed to achieve a prolonged release of drug. The preformulation studies like IR spectroscopic and differential scanning calorimetry showed the absence of drug-excipient interactions. The tablets were found within the permissible limits for various physicochemical parameters. Scanning electron microscopy was used to visualize the surface morphology of the tablets and to confirm drug release mechanisms. Good equivalence in the drug release profile was observed when drug release pattern of the tablet containing chitosan and hydroxypropyl methylcellulose phthalate (M-7) was compared with that of marketed tablet. The optimized tablets were stable at accelerated storage conditions for 6 months with respect to drug content and physical appearance. The results of pharmacokinetic studies in human volunteers showed that the optimized tablet (M-7) exhibited no difference in the in vivo drug release in comparison with marketed tablet. No significant difference between the values of pharmacokinetic parameters of M-7 and marketed tablets was observed (p > 0.05; 95% confidence intervals). However the clinical studies in large scale and, long term and extensive stability studies at different conditions are required to confirm these results.
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Anti-Inflamatórios não Esteroides/administração & dosagem , Celulose/análogos & derivados , Quitosana/química , Diclofenaco/análogos & derivados , Portadores de Fármacos , Metilcelulose/análogos & derivados , Administração Oral , Anti-Inflamatórios não Esteroides/química , Anti-Inflamatórios não Esteroides/farmacocinética , Varredura Diferencial de Calorimetria , Celulose/química , Química Farmacêutica , Estudos Cross-Over , Preparações de Ação Retardada , Diclofenaco/administração & dosagem , Diclofenaco/química , Diclofenaco/farmacocinética , Método Duplo-Cego , Esquema de Medicação , Composição de Medicamentos , Estabilidade de Medicamentos , Humanos , Concentração de Íons de Hidrogênio , Metilcelulose/química , Microscopia Eletrônica de Varredura , Solubilidade , Espectrofotometria Infravermelho , Propriedades de Superfície , Comprimidos com Revestimento Entérico , Tecnologia Farmacêutica/métodos , Equivalência TerapêuticaRESUMO
OBJECTIVE: To compare the value of ovarian crescent sign (OCS) and various sonomorphologic scoring systems in consolidating pre-operative suspicion of ovarian malignancy in adnexal masses. MATERIALS AND METHODS: A prospective study was carried out in 60 consenting women with an undiagnosed adnexal mass requiring operative intervention. OCS was considered to be present if normal ovarian tissue was seen adjacent to the tumor area on ultrasound. Various other sonological parameters were noted to calculate five morphological scoring systems. Doppler velocimetry study values were available in 27 cases. The results were compared for correctness of suspicion with histopathologic examination report of the tumor obtained at surgery. RESULTS: Eleven of 60 specimens showed histopathologic diagnosis of malignancy. OCS was identified in 97% of the benign masses. The sign was not seen in 10 of the 11 cases with malignancy. Sensitivity and negative predictive value of crescent sign was better than values obtained for the compared sonomorphological indices and Doppler velocimetry studies. CONCLUSION: Ovarian crescent sign is a reliable and simple sonographic indicator comparable to sonomorphological indices and Doppler flow velocimetric studies for the preoperative detection of malignancy in adnexal masses.
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Anexos Uterinos/diagnóstico por imagem , Doenças dos Anexos/diagnóstico , Neoplasias dos Genitais Femininos/diagnóstico , Doenças dos Anexos/diagnóstico por imagem , Doenças dos Anexos/patologia , Adulto , Idoso , Biomarcadores Tumorais , Feminino , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Neoplasias dos Genitais Femininos/patologia , Humanos , Fluxometria por Laser-Doppler , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia , Adulto JovemRESUMO
CONTEXT: Periodontal disease and endometriosis are seen to share a common pathogenesis. There is only one report suggesting the possible association between the two conditions. AIMS: To study the association between endometriosis and periodontal disease. SETTINGS AND DESIGN: This was a case-control study. SUBJECTS AND METHODS: Periodontal screening was carried out in 25 women with endometriosis and 25 women without endometriosis. Severity of periodontal disease was classified based on the extent of loss of attachment. STATISTICAL ANALYSIS USED: Student's t-test, Mann-Whitney U test, and Karl Pearson correlation coefficient tests were used for statistical analysis. Results: The proportion of women with severe periodontitis was seen to be higher among women with endometriosis (70%). CONCLUSIONS: The results of the present study indicate the existence of a relationship between endometriosis and periodontal disease. However, further studies among larger cohorts of endometriosis may provide evidence about the association.
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OBJECTIVES: This study aimed to examine the association between indicators of arterial resistance occurring late in the first trimester and the subsequent development of pregnancy-related hypertension. METHODS: This study took place between May 2014 and August 2015 and included 329 consecutive women with singleton pregnancies attending the antenatal clinics of a medical college in Karnataka, India, during this period. Pulse pressure (PP) and uterine artery Doppler parameters were recorded between 11-14 gestational weeks. Consequently, women were followed-up until after delivery for subsequent hypertension. RESULTS: Hypertension occurred more frequently if PP was high (17.6% versus 14.4% of pregnancies without high PP; P = 0.713), if a diastolic notch (DN) was present (15.1% versus 12.8% of pregnancies with an absent DN; P = 0.612) and if the resistive index (RI) was raised (22.2% versus 14.3% of pregnancies without raised RI; P = 0.366). A raised pulsatility index (PI) was significantly associated with hypertension (P = 0.013). The risk of hypertension was approximately seven-fold higher if two or more arterial resistance indicators were used, except with a present DN plus a raised RI or a present DN plus high PP. All arterial resistance indicators showed negative predictability (>85.6%) and good specificity (≥95.0%), except for the presence of a DN. A population-specific cut-off PI value of 1.72 had high negative predictability (92.8%) and good sensitivity (70.8%) and specificity (65.1%). CONCLUSION: Raised PI in the late first trimester was a significant predictor of hypertension later in pregnancy. A combination of arterial resistance indicators may enhance prediction of subsequent hypertension.
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BACKGROUND: The human papillomavirus (HPV) and its variants show wide geographical distribution and have been reported to cause cervical lesions. With cervical neoplasia as the leading cancer in Indian women, the aim of the present study was to evaluate the multiple infection HPV type distribution and variant genotypes in cervical samples from the coastal Karnataka region, India. MATERIALS AND METHODS: A total of 212 samples were screened by nested polymerase chain reaction using PGMY9/11 and GP5+/6+ primers. HPV positive samples were sequenced to identify the types and a phylogenetic tree was constructed using the neighbor-joining method. RESULTS: Sequence analysis identified a total of 14 HPV types distributed in 20%, 73.3% and 82.5% of non-malignant, pre-malignant [low grade squamous intraepithelial lesion (LSIL) and high grade squamous intraepithelial lesion (HSIL)] and cervical cancer samples. The distribution of high risk HPV in cancer samples was HPV 16, 76.4%, HPV18, 11.7%, HPV81, 2.9%, HPV31, 1.4%, HPV35, 1.4% and HPV 45, 1.4%. Multiple infections were observed in 11.8% of tumor samples with HPV 16 contributing to 62.5% of cases. In non-malignant samples, 20% of HPV positive samples were detected with HPV16, 82.3%, HPV33, 5.8% and HPV58, 5.8% and very low incidence of multiple infections. Comparative phylogenetic analysis of HPV variants identified 9 HPV sequences as new papillomavirus species, predominantly classified as European lineage type. CONCLUSIONS: The findings for HPV infections associated with progression of cervical cancer in coastal Karnataka region and HPV variant analysis provide baseline data for prevention and HPV vaccination programs.