Large uterine neurofibroma.

Herein we report a rare case of a large uterine neurofibroma. The patient reported infertility and nonspecific pelvic symptoms. Physical examination and ultrasonography revealed a mass of uterine origin with echo texture similar to that of a myoma. With a provisional diagnosis of a myomatous uterus, laparoscopic myomectomy was attempted. The mass, which measured 13 × 9 × 8 cm, was noted to be arising from the uterine fundus and extending into the left broad ligament. Histopathologic examination revealed a neurofibroma, which was confirmed at immunohistochemical analysis of the specimen. Most neurofibromas arise as subcutaneous swellings, and large neurofibromas arising from the myometrium are rare. Deep-tissue neurofibromas are known to recur and are associated with a higher probability of becoming malignant.

Evaluation of adjustment methods used to determine prevalence of low birth-weight babies at a rural hospital in Andhra Pradesh, India.

Accurate reporting of prevalence of low birth weight (LBW) is important for monitoring health of a population. LBW is often underestimated in developing countries due to heaping of the data at 2.5 kg. UNICEF uses an average adjustment factor of 25% to re-classify babies listed as exactly 2.5 kg into the LBW category. From October 2009 to February 2010, we weighed 859 consecutive live births at a rural hospital in Andhra Pradesh, India, using analog and digital scales to evaluate the relative validity of the adjustment factor. Significantly more babies weighed exactly 2.5 kg on analog (13.4%) versus digital (2.2%) scales, showing heaping. Percentage of LBW by digital method (29.5%) was significantly higher compared to the analog method (23%) and with adjustment factors (26.4%). Conventional methods of adjusting birth-weight data underestimate the prevalence of LBW. Sensitive digital weighing machines or better adjustment methods are needed to monitor LBW in developing countries.

Integrated approaches for the recognition of small molecule inhibitors for Toll-like receptor 4.

Toll-like receptors (TLRs) are pattern recognition receptors present on the surface of cells playing a crucial role in innate immunity. One of the TLRs, TLR4, recognizes LPS (Lipopolysaccharide) as its ligand leading to the release of anti-inflammatory mediators as well as pro-inflammatory cytokines through signal transduction and domain recruitment. TLR4 homodimerizes at its intracellular TIR (Toll/interleukin-1 receptor) domain that helps in the recruitment of the TRAM/TICAM2 (TIR domain-containing adaptor molecule 2) molecule. TRAM also contains TIR domain which in turn, dimerizes and functions as an adapter protein to further recruit TRIF/TICAM1 (TIR domain-containing adaptor molecule 1) protein for mediating downstream signaling. Apart from LPS, TLR4 also recognizes endogenous ligands like fibrinogen, HMGB1, and hyaluronan in autoimmune conditions and sepsis. We employed computational approaches to target TRAM and recognize small molecule inhibitors from small molecules of natural origin, as contained in the Super Natural II database. Finally, cell reporter assays and NMR studies enabled the identification of promising lead compounds. Hence, this study aims to attenuate the signaling of the TLR4-TRAM-TRIF cascade in these auto-inflammatory conditions.

Primary hepatic lymphoma- A diagnostic dilemma.

Primary non-Hodgkin lymphoma of liver is a very rare malignancy. Here we report the case of a 50 year old female who presented with dull ache in the right hypochondrium and decreased appetite since 1 month. CT scan of abdomen and pelvis showed an enlarged liver with an ill- defined soft tissue lesion arising from left lobe measuring 13 × 9 cm suggestive of primary hepatic neoplasm. CT scan of chest, abdomen, and pelvis and whole body positron emission tomography showed no involvement of bone marrow, lymph nodes, spleen, or any other organ. Her liver function tests, alpha fetoprotein and carcinoembryonic antigen levels were normal. Serology was negative for viruses. Pathological examination favored diagnosis of Burkitt's lymphoma. Cytogenetic studies for MYC translocation t (8;14) is suggested for confirming the diagnosis since Ki 67 index is > 70% and not nearly 100% which is characteristic of Burkitt's lymphoma.

Proportionality of Clinical Outcome and Placental Changes to the Increasing Severity of Maternal Hypertension- An Observational Study.

OBJECTIVE: Preeclampsia and eclampsia remain the major causes of maternal and perinatal mortality and morbidity worldwide, causing 12-15% of direct maternal deaths. Although preeclampsia and related hypertensive disorders of pregnancy continue to affect 8% of all pregnancies, the incidence of preeclampsia has increased 40% in recent years. This study was carried out to analyse the different placental lesions and fetal outcome in different grades of maternal hypertension and to see if there is a linear relationship of the same. MATERIAL AND METHOD: A total of 539 placenta specimens received at the department of Pathology from October 2017 to March 2019 were collected after obtaining informed consent. Of the 539 placentas, 87 hypertensive cases were graded and grouped according to the severity as gestational hypertension, mild preeclampsia, severe preeclampsia, eclampsia, and chronic hypertension and compared with 88 normotensive cases. The gross and microscopic findings were tabulated and analysed using the Statistical Package for the Social Sciences (SPSS) software. RESULTS: Incidence of fetal death and growth restriction increased with increasing grade of maternal hypertension (p= 0.001). Abnormal shape of placenta (p= 0.034) and abnormal umbilical cord insertion (p= 0.028) were seen significantly more in the hypertensive group than in the normotensive group. Infarct and abnormal vasculo-syncytial membrane (p < 0.05) and abnormal villous maturation (p= 0. 039) were significantly increased in the hypertensive group than the normotensive group. CONCLUSION: The incidence of adverse fetal outcome and placental changes suggestive of feto-maternal malperfusions shows a proportional trend with the increasing grade of maternal hypertension.

Safety and efficacy of the new CryoPop® cryotherapy device for cervical dysplasia in low- and middle-income countries: study protocol for a multicenter open-label non-inferiority clinical trial with historical controls.

BACKGROUND: Cervical cancer is the fourth most common cancer in the world, affecting mainly women residing in low- and middle-income countries. Progression from a pre-invasive phase to that of an invasive phase generally takes years and provides a window of opportunity to screen for and treat precancerous lesions. METHODS: This study is being conducted at four sites in north Karnataka, India. Community sensitization activities have been organized in the study areas to create awareness among stakeholders, including elected representatives, physicians, health care workers, and potential participants. Organized community based as well as hospital-based screening is being conducted using visual inspection with acetic acid (VIA). Screen positive women are referred to respective study hospitals for colposcopy and directed biopsy. Participants with confirmed high-grade cervical dysplasia (high-grade squamous intraepithelial lesions or HSIL) who fit all other eligibility criteria will be recruited to the study and will receive cryotherapy using CryoPop®, an innovative new cryotherapy device. DISCUSSION: There is a need to develop an inexpensive, simple, and effective cryotherapy device for use by frontline health care providers at locations where screening and timely treatment can be given, accelerating access to cervical cancer prevention services and minimizing loss to follow-up of women with precancerous lesions who need treatment. TRIAL REGISTRATION: Clinical Trial Registry - India CTRI/2019/01/017289 ClinicalTrials.Gov number NCT04154644 . Registered on November 6, 2019.