bluuebunny/crossref_metadata_2025 huggingface dataset:
Chemerin Peptides Promote Phagocytosis in a ChemR23- and Syk-Dependent Manner
Authors: Cash Jenna L. , Christian Annabel R. , Greaves David R.
Published: April 2010

Chemerin peptides represent a recently identified component of the endogenous anti-inflammatory network that act via the G protein-coupled receptor ChemR23. The role of the chemerin peptide/ChemR23 pathway in phagocytosis, the clearance of apoptotic cells (efferocytosis), and the resolution of inflammation is unknown. In this article, we report that low picomolar concentrations of the chemerin peptide chemerin15 (C15) enhance macrophage (MΦ) phagocytosis of microbial particles and apoptotic cells by up to 360% in vitro. These prophagocytic effects of C15 are significantly impaired in ChemR23−/− MΦs and are associated with increased actin polymerization and localization of F-actin to the phagocytic cup. Importantly, pharmacological inhibition of Syk activity completely abrogates the prophagocytic activities of C15 and associated changes in actin polymerization and phagocytic cup formation, suggesting that C15 promotes phagocytosis by facilitating phagocytic cup development in a Syk-dependent manner. During peritoneal inflammation, C15 administration (8 pg/mouse) enhances microbial particle clearance and apoptotic neutrophil ingestion by MΦs in wild-type but not ChemR23−/− mice, such that levels of apoptotic and necrotic cells at the inflammatory site are profoundly reduced. In contrast, neutralization of endogenous chemerin species during peritoneal inflammation significantly impairs MΦ ingestion of apoptotic neutrophils and zymosan. Our data identify a key role of the chemerin peptide/ChemR23 axis in the efficient clearance of foreign material, efferocytosis, and, hence, the resolution of inflammation. Manipulation of the chemerin peptide/ChemR23 axis may represent a novel therapeutic approach for the treatment of inflammatory pathologies, especially if failure to efficiently clear phagocytic targets has been implicated in their pathogenesis.
IFN-γ Promotes Complement Expression and Attenuates Amyloid Plaque Deposition in Amyloid β Precursor Protein Transgenic Mice
Authors: Chakrabarty Paramita , Ceballos-Diaz Carolina , Beccard Amanda , Janus Christopher , Dickson Dennis , Golde Todd E. , Das Pritam
Published: April 2010

Reactive gliosis surrounding amyloid β (Aβ) plaques is an early feature of Alzheimer’s disease pathogenesis and has been postulated to represent activation of the innate immune system in an apparently ineffective attempt to clear or neutralize Aβ aggregates. To evaluate the role of IFN-γ–mediated neuroinflammation on the evolution of Aβ pathology in transgenic (Tg) mice, we have expressed murine IFN-γ (mIFN-γ) in the brains of Aβ precursor protein (APP) Tg mice using recombinant adeno-associated virus serotype 1. Expression of mIFN-γ in brains of APP TgCRND8 mice results in robust noncell autonomous activation of microglia and astrocytes, and a concomitant significant suppression of Aβ deposition. In these mice, mIFN-γ expression upregulated multiple glial activation markers, early components of the complement cascade as well as led to infiltration of Ly-6c positive peripheral monocytes but no significant effects on APP levels, APP processing or steady-state Aβ levels were noticed in vivo. Taken together, these results suggest that mIFN-γ expression in the brain suppresses Aβ accumulation through synergistic effects of activated glia and components of the innate immune system that enhance Aβ aggregate phagocytosis.
Interdisciplinary Analysis of HIV-Specific CD8+ T Cell Responses against Variant Epitopes Reveals Restricted TCR Promiscuity
Authors: Hoof Ilka , Pérez Carina L. , Buggert Marcus , Gustafsson Rasmus K. L. , Nielsen Morten , Lund Ole , Karlsson Annika C.
Published: April 2010

HIV-1–specific CTL responses play a key role in limiting viral replication. CTL responses are sensitive to viral escape mutations, which influence recognition of the virus. Although CTLs have been shown to recognize epitope variants, the extent of this cross-reactivity has not been quantitatively investigated in a genetically diverse cohort of HIV-1–infected patients. Using a novel bioinformatic binding prediction method, we aimed to explain the pattern of epitope-specific CTL responses based on the patients’ HLA genotype and autologous virus sequence quantitatively. Sequences covering predicted and tested HLA class I-restricted epitopes (peptides) within the HIV-Gag, Pol, and Nef regions were obtained from 26 study subjects resulting in 1492 patient-specific peptide pairs. Epitopes that were recognized in ELISPOT assays were found to be significantly more similar to the autologous virus than those that did not elicit a response. A single substitution in the presented epitope decreased the chance of a CTL response by 40%. The impact of sequence similarity on cross-recognition was confirmed by testing immune responses against multiple variants of six selected epitopes. Substitutions at central positions in the epitope were particularly likely to result in abrogation of recognition. In summary, the presented data demonstrate a highly restricted promiscuity of HIV-1–specific CTL in the recognition of variant epitopes. In addition, our results illustrate that bioinformatic prediction methods are useful to study the complex pattern of CTL responses exhibited by an HIV-1–infected patient cohort and for identification of optimal targets for novel therapeutic or vaccine approaches.
Ezrin, Maspin, Peroxiredoxin 2, and Heat Shock Protein 27: Potential Targets of a Streptococcal-Induced Autoimmune Response in Psoriasis
Authors: Besgen Petra , Trommler Paul , Vollmer Sigrid , Prinz Joerg Christoph
Published: April 2010

Psoriasis is an HLA-Cw6–associated T cell-mediated autoimmune disease of the skin that is often triggered by streptococcal angina. To identify keratinocyte proteins, which may become psoriatic autoantigens as the result of an immune response against streptococci, rabbits were immunized with heat-killed Streptococcus pyogenes. Streptococcal immunization induced Ab formation against various human keratinocyte proteins. Sera from psoriasis patients reacted against several of these proteins as well. Common serologic reactivities of rabbits and patients included the proteins ezrin, maspin, peroxiredoxin 2 (PRDX2), heat shock protein (hsp)27, and keratin 6. When used for stimulation of blood lymphocytes, ezrin, maspin, PRDX2, and hsp27 induced increased T cell activation in psoriasis patients, which was particularly evident for HLA-Cw6+ individuals. Ag-specific T cell lines generated with these proteins consisted predominantly of CD8+ T cells and used TCR β-chain rearrangements, which were highly homologous to those expanded within the corresponding skin lesion. Several immunodominant epitopes on the different proteins could be defined according to sequence alignments with the whole genome of S. pyogenes. Our data indicate that maspin, ezrin, PRDX2, hsp27, and potentially keratin 6 could act as autoantigens of a streptococcal-induced autoimmune response and represent targets of the exaggerated T cell response in psoriasis. Additionally, ezrin and hsp27 might constitute antigenic links between psoriasis and inflammatory bowel disease, uveitis, or arteriosclerosis, which are clinically associated.
Nonobese Diabetic Congenic Strain Analysis of Autoimmune Diabetes Reveals Genetic Complexity of the Idd18 Locus and Identifies Vav3 as a Candidate Gene
Authors: Fraser Heather I. , Dendrou Calliope A. , Healy Barry , Rainbow Daniel B. , Howlett Sarah , Smink Luc J. , Gregory Simon , Steward Charles A. , Todd John A. , Peterson Laurence B. , Wicker Linda S.
Published: April 2010

We have used the public sequencing and annotation of the mouse genome to delimit the previously resolved type 1 diabetes (T1D) insulin-dependent diabetes (Idd)18 interval to a region on chromosome 3 that includes the immunologically relevant candidate gene, Vav3. To test the candidacy of Vav3, we developed a novel congenic strain that enabled the resolution of Idd18 to a 604-kb interval, designated Idd18.1, which contains only two annotated genes: the complete sequence of Vav3 and the last exon of the gene encoding NETRIN G1, Ntng1. Targeted sequencing of Idd18.1 in the NOD mouse strain revealed that allelic variation between NOD and C57BL/6J (B6) occurs in noncoding regions with 138 single nucleotide polymorphisms concentrated in the introns between exons 20 and 27 and immediately after the 3′ untranslated region. We observed differential expression of VAV3 RNA transcripts in thymocytes when comparing congenic mouse strains with B6 or NOD alleles at Idd18.1. The T1D protection associated with B6 alleles of Idd18.1/Vav3 requires the presence of B6 protective alleles at Idd3, which are correlated with increased IL-2 production and regulatory T cell function. In the absence of B6 protective alleles at Idd3, we detected a second T1D protective B6 locus, Idd18.3, which is closely linked to, but distinct from, Idd18.1. Therefore, genetic mapping, sequencing, and gene expression evidence indicate that alteration of VAV3 expression is an etiological factor in the development of autoimmune β-cell destruction in NOD mice. This study also demonstrates that a congenic strain mapping approach can isolate closely linked susceptibility genes.
Cutting Edge: IL-21 and TLR Signaling Regulate Germinal Center Responses in a B Cell-Intrinsic Manner
Authors: Bessa Juliana , Kopf Manfred , Bachmann Martin F.
Published: April 2010

IL-21 produced by follicular Th (Tfh) cells is an important regulator of Tfh cell development and B cell responses, including germinal center (GC) formation. However, whether defective GC formation and Ab responses are a consequence of impaired Tfh cells development or a B cell-intrinsic defect in IL-21–deficient mice requires clarification. To address this question, we generated chimeric mice lacking IL-21R exclusively on B cells. In this study, we demonstrate that GC reaction and B cell responses induced by immunization with virus-like particles were strongly reduced in both global and B cell-specific IL-21R–deficient mice. Interestingly, the presence of TLR7 ligand within virus-like particles largely restored defective GC reaction and Ab responses in global as well as in B cell-specific IL-21R–deficient mice. Hence, IL-21 acts directly on B cells and cooperates with TLR signaling for optimal B cell responses.
PU.1 Binds to a Distal Regulatory Element That Is Necessary for B Cell-Specific Expression of CIITA
Authors: Yoon Hyesuk , Boss Jeremy M.
Published: April 2010

The transcriptional coactivator CIITA regulates MHC class II genes. In the mouse, CIITA is expressed from three distinct promoters (pI, pIII, and pIV) in a developmental and cell type-specific manner with pIII being responsible for B lymphocyte-specific expression. Although the promoter proximal sequences that regulate CIITA in B cells have been described, nothing is known about additional distal elements that may regulate its expression in B cells. Sequence homology comparisons, DNase I hypersensitivity assays, and histone modification analysis revealed a potential regulatory element located 11 kb upstream of pIII. Deletion of this element, termed hypersensitive site 1 (HSS1), in a bacterial artificial chromosome encoding the entire CIITA locus and surrounding genes, resulted in a complete loss of CIITA expression from the bacterial artificial chromosome following transfection into B cells. HSS1 and pIII displayed open chromatin architecture features in B cell but not in plasma cell lines, which are silenced for CIITA expression. PU.1 was found to bind HSS1 and pIII in B cells but not in plasma cells. Depletion of PU.1 by short hairpin RNA reduced CIITA expression. Chromatin conformation capture assays showed that HSS1 interacted directly with pIII in B cells and that PU.1 was important for this interaction. These results provide evidence that HSS1 is required for B cell-specific expression of CIITA and that HSS1 functions by interacting with pIII, forming a long-distance chromatin loop that is partly mediated through PU.1.
Fas-Activated Serine/Threonine Phosphoprotein Promotes Immune-Mediated Pulmonary Inflammation
Authors: Simarro Maria , Giannattasio Giorgio , De la Fuente Miguel A. , Benarafa Charaf , Subramanian Kulandayan K. , Ishizawar Rumey , Balestrieri Barbara , Andersson Emma M. , Luo Hongbo R. , Orduña Antonio , Boyce Joshua , Anderson Paul
Published: April 2010

We generated Fas-activated serine threonine phosphoprotein (FAST)-deficient mice (FAST−/−) to study the in vivo role of FAST in immune system function. In a model of house dust mite-induced allergic pulmonary inflammation, wild type mice develop a mixed cellular infiltrate composed of eosinophils, lymphocytes, and neutrophils. FAST−/− mice develop airway inflammation that is distinguished by the near absence of neutrophils. Similarly, LPS-induced alveolar neutrophil recruitment is markedly reduced in FAST−/− mice compared with wild type controls. This is accompanied by reduced concentrations of cytokines (TNF-α and IL-6 and -23) and chemoattractants (MIP-2 and keratinocyte chemoattractant) in bronchoalveolar lavage fluids. Because FAST−/− neutrophils exhibit normal chemotaxis and survival, impaired neutrophil recruitment is likely to be due to reduced production of chemoattractants within the pulmonary parenchyma. Studies using bone marrow chimeras implicate lung resident hematopoietic cells (e.g., pulmonary dendritic cells and/or alveolar macrophages) in this process. In conclusion, our results introduce FAST as a proinflammatory factor that modulates the function of lung resident hematopoietic cells to promote neutrophil recruitment and pulmonary inflammation.
Cutting Edge: Critical Role for PYCARD/ASC in the Development of Experimental Autoimmune Encephalomyelitis
Authors: Shaw Patrick J. , Lukens John R. , Burns Samir , Chi Hongbo , McGargill Maureen A. , Kanneganti Thirumala-Devi
Published: April 2010

Multiple sclerosis is an autoimmune disease in which self-reactive T cells attack oligodendrocytes that myelinate axons in the CNS. Experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis, is dependent on caspase-1; however, the role of Nod-like receptors upstream of caspase-1 is unknown. Danger- and pathogen-associated molecular patterns activate Nod-like receptor 3, which activates caspase-1 through the adaptor protein, apoptosis-associated speck-like protein containing CARD (ASC). We report that the progression of EAE is dependent on ASC and caspase-1 but not Nod-like receptor 3. ASC−/− mice were even more protected from the progression of EAE than were caspase-1−/− mice, suggesting that an inflammasome-independent function of ASC contributes to the progression of EAE. We found that CD4+ T cells deficient in ASC exhibited impaired survival; accordingly, ASC−/− mice had fewer myelin oligodendrocyte glycoprotein–specific T cells in the draining lymph nodes and CNS.
Fine needle aspiration biopsy diagnosis of dedifferentiated liposarcoma: Cytomorphology and MDM2 amplification by FISH
Authors: Al-Maghraby Hatem Q. , Khalbuss Walid E. , Rao Uma N. M. , Cieply Kathleen , Dacic Sanja , Monaco Sara E.
Published: April 2010

Lipomatous mesenchymal tumors constitute the most common type of soft tissue tumors. Well-differentiated liposarcoma (WDLS) can undergo dedifferentiation to a nonlipogenic sarcoma of variable histologic grade. In the recent literature, amplification of the murine double minute 2 (MDM2) oncogene, which has a role in cell cycle control, has been successful in distinguishing WDLS from benign lesions. We present a case of dedifferentiated liposarcoma diagnosed by fine-needle aspiration (FNA), using cytomorphology and ancillary studies (immunocytochemistry and fluorescent in-situ hybridization). An 85-year old female presented to our institution with a firm soft tissue mass of the right buttock. The FNA showed atypical spindle cells, osteoclast-like giant cells and extracellular dense matrix material. The cell block showed cellular groups of highly atypical spindle cells with osteoid and adipose tissue. Fluorescence in situ hybridization (FISH) studies performed on the cell block demonstrated amplification of the MDM2 gene. In addition, the findings were morphologically compatible with the previously resected retroperitoneal dedifferentiated liposarcoma with areas of osteosarcoma. This rare case illustrates the usefulness of FNA and ancillary studies in the diagnosis and subclassification of soft tissue tumors. To the best of our knowledge, this is the first report of MDM2 FISH positivity in a liposarcoma diagnosed by FNA.
Preterm Labor: A Review
Authors: Dhumale Hema , Bellad MB , Shravage Jyotsna C
Published: April 2010

Introduction

Preterm labor (PTL) is one of the leading causes of perinatal morbidity and mortality. It is one of the major public health problems, especially with reference to mortality, disability and health care expenses.

Incidence

The overall incidence of PTL is around 10-15% (6-15% Range)3 (The incidence of PTL in our institute (JNMC) was 10.2% during 2006-2007. Out of all PTL 50% occur spontaneously, 25% following preterm prelabor rupture of membranes (PPROM) and another 25% iatrogenic (Induced due to maternal and/or fetal risks).

Risk factors

Previous history of preterm labor is one of the important risk factor(risk of PTL in subsequent pregnancies is 14.3% and 28% after one and two preterm births. Others include multiple pregnancy, uterine over distension (polyhydramnios, macrosomia and fibroids), uterine anomalies, cervical incompetence, bacterial vaginosis, bleeding in early pregnancy, poor socioeconomic status, elderly and adolescent age group and tobacco use.

Predictors

Cervical length assessment by USG, fetal fibronectin, vaginal pH are being used.

Prevention

Progesterone and clindamycin (abnormal vaginal flora) antibiotic is being used with reasonable evidence.

Treatment

Corticosteroids and antibiotics help in reducing neonatal morbidity and mortality and tocolytics (nifedepine and atosiban are recommended) helps in allowing the steroids to act.

Newer developments

New predictors like higher vaginal pH (> 4.5) and Gram stain score of 9 to 10 with Nugent criteria in early pregnancy is increasingly associated with preterm labor. Search for selective and safe tocolytic is also under consideration, specially the prostaglandin synthetase inhibitors and the role of potassium channels in myometrium.

Conclusion

Successful prediction, prevention and treatment of preterm labor has significant influence on the perinatal outcome, health care expenditure and quality of life. As the cause for preterm labor is still an enigma, it is difficult to predict, prevent and treat PTL successfully. At present the treatment of PTL is mainly antibiotics, tocolytics and corticosteroids with varied success.
Fertility Preservation in Female Cancer Patients: A Review
Authors: Talwar Pankaj
Published: April 2010

Cancer ART is one of the fast developing subspecialties in the ever expanding field of Assisted Reproductive Techniques. It is well documented that both chemotherapy and radiotherapy can have a deleterious effect on the gonads. Onco-ART targets this unfortunate population and provides a chance to the patient to produce their biological offspring. Cryopreservation of the ovaries is a step towards this goal. A properly preserved ovarian cortex can be later grafted in the body to enhance fertility. Even though this novel technique is still in its infancy stage, it holds a lot of promise that can be favorably explored.
Uterine Artery Embolization: A Nonsurgical Cure for Fibroids
Authors: Naredi Nikita , Bhattacharyya TK
Published: April 2010

Uterine leiomyomata commonly known as fibroids are benign tumors of the uterus that are a common cause of heavy menstrual bleeding, pelvic pain and pressure symptoms in women. The traditional method of treatment for these benign tumors has been surgery as long-term medical therapies have not shown to be effective. Uterine artery embolization (UAE) a minimally invasive, interventional radiological technique, wherein complete occlusion of both the uterine arteries with particulate emboli are carried out, has been found to be an effective and safe alternative in the treatment of menorrhagia and other fibroid-related symptoms in women not desiring future fertility or who are poor surgical candidates. This treatment modality available in all major institutions may be instituted as an alternative to hysterectomy in young women wishing to preserve the uterus. UAE a cost-effective modality associated with a short hospital stay has significant advantages over conventional surgeries in the treatment of myomas.
Oral Misoprostol: A Safe and Effective Alternative in Comparison to Conventional Uterotonic Agents in the Active Management of Third Stage of Labor
Authors: Ghazala Mahmud , Nasira Tasnim , Saba Fatima
Published: April 2010

Objective

To determine the efficacy and safety of oral misoprostol with intravenous oxytocin and syntometrine in the active management of third stage of labor.

Methodology

325 women were randomly allocated by convenient sampling to receive either 10 IU of intravenous oxytocin or 10 IU of oxytocin with 0.2 mg of Methergine (syntometrine) or 400 mcg of oral misoprostol at the delivery of anterior shoulder. Main outcome measures were estimation of blood loss > 500 ml, drop in hemoglobin/hematocrit levels and adverse effects of drugs.

Results

Estimated blood loss was significantly higher in group misoprostol group (p = 0.016) but comparable to oxytocin group (p = 0.40). Drop in hemoglobin level was comparable in all the three groups (p = 0.106). Drop in hematocrit value was significant for misoprostol and syntometrine (p = 0.022) but comparable to oxytocin. Nausea and vomiting was common in oxytocin and syntometrine group whereas fever and shivering was the leading adverse effect in misoprostol group.

Conclusion

Misoprostol is an effective and safe alternative to intravenous uterotonic agents in the active management of third stage of labor both at tertiary and community level.
Maternal and Perinatal Outcome in Severe Pre-eclampsia and Eclampsia
Authors: LNU Anshu , LNU Deepika
Published: April 2010

Background

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Present study was planned to find the maternal and perinatal outcome in patients of severe pre-eclampsia and eclampsia.

Methodology

It is a prospective study, carried out on 100 pregnant women admitted with severe pre-eclampsia and eclampsia at a tertiary care referral unit. Detailed history and examination was carried out. Investigations like complete hemogram, liver function tests, renal function tests, coagulation profile, fundus and 24 hours urine for protein were done. Obstetric management was done as per existing protocol in the department, magnesium sulphate was the drug of choice for controlling convulsions, and blood pressure was controlled either by oral nefidipene or methyl dopa. Maternal and perinatal complications were noted down.

Results

The majority of the patients was unbooked (82%), belonged to lower socioeconomic status (84%) and had rural background (84%). Headache was the most common antecedent symptom (44%) followed by epigastric pain (20%), oliguria (9%), blurring of vision (8%) and ascitis (5%). There was high incidence of maternal complications like PPH (31%), abruption placentae (11%), renal dysfunction (8%), pulmonary edema (8%), pulmonary embolism (4%), HELLP syndrome (2%) and DIC (2%). Maternal mortality was 8% and the causes were pulmonary embolism in four women, DIC in two, HELLP and pulmonary edema in one each. Perinatal complications were also high 71.43% were low birth weight, 66% had preterm delivery, 52.4% babies had birth asphyxia and 28.57% were still born. Maternal and perinatal outcome was much poorer in eclampsia as compared to severe pre-eclampsia.

Conclusion

There is a very high maternal and perinatal morbidity and mortality and 82% patients had no antenatal care. Good antenatal care could have been prevented severe pre-eclampsia and eclampsia to some extent. Thus it is suggested that developing countries have to go a long way to create awareness about importance of antenatal check ups and take measures for implementation.
Mother to Child Transmission of HIV; Are We Doing Enough?
Authors: Irfan Ahmed , Seiglinde Muller , Firas Saadeh
Published: April 2010

Aim

A retrospective audit was conducted from 1st January 1996 to 31st December 2006 to assess the incidence of mother to child transmission of HIV and to assess changing trends over the last 10 years as well as the ethnicity of the patients.

Methods

All cases of HIV positive women delivered during the time period were considered. Age distribution, marital status women, parity, pregnancy planning, coinfection with Hepatitis B, Hepatitis C and Syphilis, gestational age at delivery, duration of rupture of membranes, mode of delivery and sex of the child were analyzed. Babies were followed up with HIV PCR at 6, 12 and 18 months.

Results

Of a total of 31 cases and 23 mothers, 3 cases were lost to follow-up. From the remaining 28 cases, only one infant tested HIV positive; hence, mother to child transmission rate was 3.6%. Of the 23 mothers, 22 (96%) are of African origin and 1 (4%) is ethnic irish. Most patients were primigravida or para 1.

Conclusion

The known correlation between the longer duration of rupture of membranes and the increased transmission of HIV was evident in the one case where mother to child transmission took place.
Can Early hCG Levels be a Marker for Pregnancy Outcome in ART Cycles?
Authors: Parihar Mandakini
Published: April 2010

With advancing technology of assisted reproduction, physicians today have the ability to achieve conception in many couples who would have been totally incapable doing so only a few years ago. The anxiety and the uncertainty of pregnancy outcomes using ART procedures is widely accepted as one of the main psychological stresses the couples. The ability to predict outcome as soon as possible after assisted conception treatment is important for clinic staff and patients.

The aim of this observational study is to highlight the importance of hCG values in predicting the outcome of ART cycle and counseling the patients in case of adverse result. The ultimate aim is to improve the take home baby rate and initial hCG value can help us counsel our patients towards the ultimate outcome.

Embryo development in early pregnancy follows a preprogrammed-timing schedule and depends mainly on the embryonic age of the healthy, successfully implanted conceptus. The appearance of hCG in maternal serum is used to assess the time of clinically detectable implantation. bhCG has provided the best sensitivity and specificity for detection of normal and pathological pregnancies. After IVF, early pregnancy loss or multiple gestations may be predicted with high sensitivity and specificity by using cut-off values of serum hCG. The median HCG concentration was 116 IU/l in viable pregnancies and 31 IU/l in nonviable pregnancies.

The median hCG concentration in twin pregnancies was almost double that in singleton pregnancies (201 IU/l vs 116 IU/l). Thus we can reassure normally pregnant patients as well as filter and manage those with nonviable outcomes more efficiently.
Teenage Pregnancy: Too Much Too Soon
Authors: Grover Namita , Sandhu Keerat K
Published: April 2010

Teenage pregnancy is a major cause of concern to health professionals. They are high-risk groups because of the pervasive effects of early motherhood on physical and mental health. It is intended in the present study to discuss the obstetric and neonatal outcome in teenage pregnancies vis-a-vis primigravidae aged between 20-29 years. It is undeniable that teenage mothers do not understand the social reality of early pregnancy and do not realize that biologic maturity does not license activating this capacity at will. Responsibility is immense. A concerted effort is needed on the part of the doctors, family and society as a whole to counsel them and to bring down the incidence of this social menace.
Endometrioid Carcinoma and Ectopic Pregnancy Coexisting in an Ovarian Endometrioma
Authors: Rasool Sabahat , Rabbani Tamkin , Akhtar Omar S , Sherwani Rana K
Published: April 2010

A 28 years old female presented to our OPD with the complaints of inability to conceive for the last 13 years and a lump in abdomen for the past month. Perspeculum examination revealed a healthy cervix and vagina and a per-vaginum examination revealed a uterus that was normal in size but a lump was palpable in the right adnexa. There was no cervical motion tenderness. Routine investigations were normal. Ultrasonography showed a complex right-sided adnexal mass of 165 by 78 mm with heterogenous echotexture. Tumor markers were within normal range except serum β-hCG, which was raised. Urine pregnancy test was positive. CT scan reported a welldefined large solid-cystic moderately enhancing pelvic mass with internal septations, seemingly arising from right adnexa. The patient was taken up for a staging laparotomy. Peroperatively, the picture was suggestive of a chronic ectopic pregnancy. Histopathological analysis from the lesion showed an ovarian endometrioid carcinoma and ectopic pregnancy coexisting in the endometrioma complete surgical staging was done, followed by chemotherapy. The patient has responded well to the treatment.
Cardiovascular Collapse Under Spinal Anesthesia
Authors: Puri Randhir , Anand Shankar K , Singh Y
Published: April 2010

A 20 years old ASA I full term primigravida in labor, underwent an emergency lower segment cesarean section under spinal anesthesia, the indication being fetal distress. Immediately following delivery of fetus, she complained of severe breathlessness and suffered a cardiovascular collapse. A presumptive diagnosis of high spinal anesthesia was made and she was managed accordingly. Thirty minutes later she developed angioedema which increased in severity over the next two hours and a diagnosis of anaphylactic reaction was made. The patient responded to intravenous adrenaline and recovered over next 24 hours.

The aim of this case report is to discuss cardiovascular collapse and its etiological factors, such as anaphylaxis, amniotic fluid embolism and high spinal anesthesia during cesarean section.
An Unusual Presentation of Tuberculous Pericardial Effusion
Authors: LNU Shaheen , Sharma Rajyashri , Anjum Parvez , Jayshree Pathak
Published: April 2010

Tuberculosis accounts for upto 4% of acute pericarditis and 7% cases of cardiac tamponade. 19% of women with tuberculosis can present with menorrhagia. Prompt treatment can be life saving but requires accurate diagnosis. We report a case of 25-year-old women who presented with severe bleeding per vaginum for four days. She was in shock. Echocardiography showed moderate pericardial effusion with features of cardiac tamponade. ADA was positive in aspirated pericardial fluid. The patient responded well to antitubercular treatment.
Chorioangioma from Poly to Oligohydramnios
Authors: Shah Pranay
Published: April 2010

We describe a case of chorioangioma in which the tumor was vascular initially leading to acute hydramnios. However, spontaneous decrease in vascularity of the tumor (autoembolization) lead to a gradual decrease in liquor volume allowing expectant management.
Partial Hydatidiform Mole with a Live Fetus— A Rare Entity
Authors: Koregol Mahesh , Bellad Mrutyunjaya , Malapati Chandana
Published: April 2010

Partial hydatidiform mole (PHM) with a singleton live fetus is a rare condition. A live baby of 2000 grams with many external congenital anomalies like hydrocephalus, bilateral congenital talipus equino varus (CTEV), meningomyelocele and spina bifida was delivered. Placenta weighed 700 grams and PHM was confirmed by histopathological examination. Baby expired one hour after birth. Baby was sent for autopsy which documented various anomalies. Partial hydatidiform mole is a histopathological entity characterized by focal trophoblastic hyperplasia with villous hydrops together with identifiable fetal tissue. PHM with a single live fetus is a rare condition which is reported by very few authors. Not all the cases of partial mole can be detected by USG/Doppler. If any anomalies are detected, PHM should be thought among the conditions possible. MShCG and karyotyping can be done to rule out this condition. Placenta has to be sent for histopathological examination to confirm the diagnosis of PHM. These patients are prone to go in preterm labor and preterm premature rupture of membranes (PPROM). There is possibility of malpresentations like transverse lie among these cases.
Knowledge and Attitude Regarding ‘Perinatal Bereavement Care’ among Nurses Working in the Maternity Unit and Neonatal Intensive Care Unit
Authors: Sheetal Samson CP , Kharde Sangeeta N
Published: April 2010

Perinatal bereavement is a unique mourning situation, as the parent's expectation and joy at the prospect of a new life change into a despair and grief. IUFD may represent a significant loss of the mother's perception of her body's functional adequacy associated with body image and feelings of self-wroth.

Objectives

To assess the knowledge and identify attitude regarding perinatal bereavement care among nurses.

To find the correlation between knowledge and attitude among the nurses regarding perinatal bereavement care.

Methods

The research approach for the study was descriptive survey. The sample size considered for the study was 30 registered nurses working in maternity and NICU. The sampling technique used for the study was purposive. The tool used for gathering relevant data was a structured knowledge questionnaire.

Results

The results revealed that majority of the nurses 23(76.6%) belonged to a age group of 21-23 years.

Majority 17(56.6%) of the nurses had experience of less than one year in maternity unit and NICU.

Maximum nurses 25(83.3%) had no previous experience in managing perinatal bereavement.

None of the nurses 30(100%) had attended any in service education. Majority 15(50%) of nurses had poor knowledge about the concept of perinatal bereavement. Maximum 13(43%) of the nurses had average knowledge of perinatal bereavement care, while minimum 5 (16.6%) had fair knowledge of the specified area. Half 15(50%) of the nurses possessed a positive attitude towards perinatal bereavement care. There is no correlation between knowledge and attitude of nurses with regards to perinatal bereavement care.

Conclusion

In order to facilitate a normal grieving process among bereaved families, the nurse should be equipped with adequate knowledge, a positive attitude and skill in rendering such care.
Effectiveness of a Structured Teaching Program on the Knowledge of Self-care Behavior among HIV Infected Women Attending a Selected Voluntary Organization
Authors: Sheetal Samson CP , Kharde Sangeeta N
Published: April 2010

Objectives

To assess the knowledge of self-care behavior, identify high-risk behavior among HIV infected women and evaluate the effectiveness of structured teaching program on the knowledge of HIV infected women regarding self-care behavior.

Methods

The research approach for the study was that of an evaluative one with one group pretest post-test design. The sample size considered for the study was 40 HIV infected women. The sampling technique used for the study was purposive sampling which is a type of nonprobability sampling. The tool used for gathering relevant data was a structured questionnaire on knowledge of self care behavior among HIV infected women.

Results

Analysis of data was done on the basis of objectives and hypotheses. Data analysis of level of knowledge revealed that during the pretest minimum 5(12.5%) of the HIV infected women had good knowledge of self-care behavior, 28(70%) had average knowledge, while 7(17.5%) had poor knowledge. It was worth noting that only a minimum of 2(5%) women had poor level of positive thinking towards self-care while majority of 21(52.5%) had good level of positive thinking. While assessing the effectiveness of the structured teaching program on self care behavior, the pretest and post-test data analysis revealed the mean post-test score (57 ± 4.7) was higher than the mean pretest score (39 ± 7.7). Analysis of variance showed no homogeneity in the scores of subjects in the different areas of knowledge of self-care behavior and indicated more scope for knowledge gain in the area of health promoting behavior.

Conclusion

Based on the analyses, the following inference was drawn. There was evident increase in the knowledge scores in all the areas included in the study after administration of structured teaching program. Thus it was inferred that the structured teaching program was effective and while the gain in knowledge score is commendable, there is still room for improvement.
Peripartum Hysterectomy: A Review of 70 Cases
Authors: LNU Shaheen , Sharma Rajyashri , Pathak Jayshree
Published: April 2010

Objectives

To study the incidence, indications and complications of peripartum hysterectomy.

Methods

A retrospective analysis of 70 cases of emergency peripartum hysterectomy performed over a period of five years from January 2004 to September 2008. At JN Medical College and Hospital AMU Aligarh was done.

Results

The incidence of emergency hysterectomy was 0.54%. The main indications were uterine atony 26 (37.12%) and Rupture uterus 19 (26.7%). Thirty six (51.43%) were in the age group of 26-35 years and majority of cases 61 (67.14%) were unbooked. The maternal and perinatal mortality was four (5.7%) and 44 (62.86%) respectively. The average period of hospital stay was 10 days.

Conclusion

Prompt performance of obstetric hysterectomy before the patient's clinical condition deteriorates is the main key to success and less postoperative complications.
Clinical and Hormonal Profile of Polycystic Ovary Syndrome
Authors: Begum Ferdousi
Published: April 2010

Objectives

The objectives of the study were to find out the clinical features, biochemical and hormonal profile of patients with polycystic ovary syndrome (PCOS) in Bangladesh.

Material and Methods

A case control and cross-sectional study was undertaken among 78 PCOS patients attending infertility clinic and 33 controls at BIRDEM Hospital, Dhaka. Inclusion criteria for cases were oligo/amenorrhea, transvaginal sonography suggesting PCO and/ or features of hyperandrogenemia with exclusion of other causes. Controls were women with regular menstrual cycle.

Results

Age and height of cases and controls were similar. BMI >25 was 67% among cases and 19% among controls (P<0.001); waist hip ratio >0.8 was 64% among cases and 29% among controls (P<0.001). Mean BMI of cases was 28.2 + 4.5 and that of cases was 21.05 + 4.1; mean fasting glucose among cases was 5.93 + 1.08 and among controls was 4.4 + 1.11 mmol/L (P<0.01); mean fasting serum insulin level was 32.15+ 12.13 among cases was 11.32 +10.02 ìU/ml among controls(P<.001); insulin resistance (fasting HOMA-IR>6.8) was 42.32% in cases and 12% in control (P<.001). Patients with PCOS had following clinical and biochemical parameters: oligomenorrhea- 74%, amenorrhea- 26%, mean Ferriman-Galaway score -19.89 + 5.06. At day 3 of menstrual cycle meanserum LH was 12.79+7.1 mmol/L, serum FSH was 5.23 + 2.5 miu/ml and serum prolactin was 415.15+180.5 mmol/L; 30% had biochemical hyperandrogenemia.

Conclusions

PCOS patient in Bangladesh are usually overweight, hirsute (grade I and II), hyperandrogenemic, insulin resitant and have altered LH to FSH ratio.
Safety of Scar on Repeat Second Cesarean Section in Patients with Previous One Cesarean Section
Authors: Kouser Shahnaz , Kouser Shaheen , Anwar Bushra
Published: April 2010

Objective

To evaluate the safety and integrity of scar at repeat cesarean section, in patients with previous one cesarean section performed at different settings.

Study design

A reterospective study in a tertiary care obstetric unit over a period of one year (2006).

Material and methods

All patients with previous one cesarean section, undergoing emergency and elective cesarean sections were enrolled at our institution. The variables noted were age, parity, residential area, location of previous cesarean section and associated complaints, e.g uterine contractions, vaginal leaking/ bleeding and comorbid medical disorders.

Outcome measures

Operative findings in terms of thinning of scar, dehiscence or rupture were recorded. The effects of skill level of surgeon and set-up of previous cesarean section were analyzed.

Results

Two hundred and seventy cesarean sections were performed for different indications in patients with previous one cesarean section over a period of one year. Out of all patients, extreme thinning of scar was noted in 36 (13.3%) patients. Seven patients(2.6%) had scar dehiscence. Only 3 (42.8%) patients with scar dehiscence had associated complaint of scar tenderness, while 22 (61%)of 36 cases of scar thinning were having scar tenderness. All 7 cases of scar dehiscence had their previous cesarean sections at teaching hospitals. No patient underwent hysterectomy and all patients with scar dehiscence had successful repair.

Conclusion

The study concludes relatively inadequate scar thickness rate but at the same time relatively acceptable scar dehiscence rate. Thus it will still be safe to subject the patients to trial of labor after meticulous scrutinization and individualization. At the same time adequate surgical training of doctors (trainees and community doctors) through different formats is recommended.
Cervical Screening Awareness and Practice among Medical Personnel
Authors: Kouser Shahnaz , Zareen Amtullah , Begum Altaf
Published: April 2010

Objective

The objective of this study was to assess awareness about cervical screening among medical and paramedical personnel.

Design

This was a cross-sectional study.

Place and duration

The study was conducted by Gyne unit-II, Jinnah Hospital/ AIMC Lahore, over a period of one month.

Material and methods

Three hundred and thirty personnel were interviewed. Out of them 243 were doctors and 87 were nurses. Each subject was asked to fill up a proforma designed to assess the knowledge about screening, source of information, associated risk factors, e.g age at first coitus, vaginal discharge, vulvo-vaginal warts, postcoital bleeding and/ or family history of cervical malignancy. Reasons for not doing cervical smear and future plans for screening were also evaluated.

Results

The majority of doctors (241 = 99%) had good knowledge about cervical screening, while only 53 nurses (60.9%) had some information mainly through discussion with doctors. Despite good knowledge only 27 doctors (11.0%) and 5 nurses (5.7%) underwent screening. Nearly 77% of all subjects intended to have future screening provided facility is easily accessible.

Conclusion

Our group included medical and paramedical staff who are definitely more educated than general public regarding importance of cervical screening, yet results revealed only 9.9% compliance rate among both doctors and nurses. There is intense need for mass media campaign for public awareness and clinical workshops for medical personnel.
Effectiveness of a Planned Teaching Program on Knowledge and Skill in the Use of Partograph among Nurses Working in Maternity Unit
Authors: Raddi Sudha A , Metgud MC , Saviola Arez
Published: April 2010

Objectives

To assess the knowledge and skills of nurses regarding the use of partograph and evaluate the effectiveness of a planned teaching program in the use of partograph among nurses.

Methods

The research approach for the study was that of an evaluative one with one group pre-test post-test design. The study comprised of 30 nurses working in maternity unit of KLES Dr Prabhakar Kore Hospital and Medical Research Center, Belgaum. The tool used for gathering relevant data was a structured questionnaire on knowledge and skill in the use of partograph.

Results

Analysis of data was done on the basis of objectives and hypotheses. It was found that the overall pre-test mean knowledge scores was 13.9, whereas post-test mean knowledge scores was 21.83. The range between highest score and the lowest score in the pre-test was 15 which was decrease to 5 after administration on planned teaching program in the post-test. The overall pre-test mean skill scores was 5.57, whereas post-test mean skill scores was 12.63. The range between highest scores and lowest scores in the pre-test was 9 which was decrease to 7 after administration of planned teaching program in the post-test.

Conclusion

Based on the analyses of the findings of the study, the following inference was drawn. There was evident increase in the knowledge and scores in all the areas included in the study after administration of planned teaching program. Thus it was inferred that the planned teaching program was effective and while the gain in knowledge and skill score is commendable, there is still room for improvement.
Effectiveness OD Self Instructional Module on the Knowledge of Obstetric Drugs among Nurses Working in Maternity Unit
Authors: Saviola Arez , Manisha Bijapurkar
Published: April 2010

Objectives

To assess the knowledge of nurses regarding obstetric drugs.

Methods

The research approach for the study was an evaluative approach with one group pre-test/post-test design. The study comprised of 30 nurses working in maternity unit of KLES Dr Prabhakar Kore Hospital and Medical Research Center, Belgaum. The tool used for gathering relevant data was a structured questionnaire on knowledge regarding obstetric drugs.

Results

Analysis of data was done on the basis of objectives and hypothesis. It was found that the overall pre-test mean knowledge scores was 21.63, whereas post-test mean knowledge scores was 38.26. The range between highest score and the lowest sore in the pre-test was 26 which was to decrease to 15, after administration of self instructional module in the post-test.

Conclusion

Based on the analysis of the findings of the study, the following inference was drawn. There was increase in the knowledge scores in all the areas included in the study after administration of self instructional module. Thus it was inferred that self instructional module was effective in increasing the knowledge of nurses.
Recurrent Urinary Tract Infection (UTI) in Women
Authors: Puri Randhir
Published: April 2010

Recurrent lower urinary tract infections (UTIs) are usually defined as two or more episodes of such infection occurring in the preceding 12 months. In most cases, such infections are the result of sexual habits and hygiene (e.g., women who are sexually active, especially those using diaphragms and/or spermatocides).

A clean-catch or catheterized specimen for culture typically reveals greater than 100,000 organisms per milliliter of urine. The typical infecting organism is Escherichia coli. The route of infection is ascending from the perianal area and vagina via the urethra and into the bladder.

However, in uncomplicated lower UTIs, there is complete clearing of bacteriuria and hematuria with appropriate antimicrobial therapy. In some cases, single-dose antimicrobial therapy after intercourse or at the onset of irritative voiding symptoms is adequate to control frequent recurrences of cystitis.

Uncomplicated recurrent lower UTIs in women must be differentiated from “reinfection,” which may indicate causes such as a vesicovaginal or vesicoenteric fistula or a paravesical abscess with fistula to the bladder. Furthermore, “bacterial persistence” is defined as an infection with the same organism, typically from a site within the urinary tract, after the bacteriuria has resolved for at least several days and antimicrobial therapy has ceased. Causes of bacterial persistence include calculi, foreign bodies, urethral or bladder diverticula, infected urachal cyst, and postoperative changes such as a remaining ureteral stump that retains urine and results in stasis. In such patients with frequent recurrences and reinfections with the same bacteria, imaging is indicated to detect a treatable condition and monitor its progress. Compromised immunity needs attention to avoid longstanding morbidity. Vaccine developed will lead more prevention in future.