bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of TNF-α rs-281865419 polymorphism with reproductive tract infections in Indian population
Authors: Sharma Vineeta , Singhal Pallavi , Kumar Anoop , Ramachandran V. G. , Das Shukla , Bharadwaj Mausumi 
Published: February 2021

Aim: To investigate the presence of reproductive tract infections (RTIs) in symptomatic and asymptomatic women in North India and association of SNPs in TNFα gene (rs-281865419 C/T) with susceptibility to these RTIs.
Methods: We collected 100 symptomatic (cases) and 100 asymptomatic women (controls) samples and screened them for RTIs. Then genotyping of TNF-α gene was performed by PCR-RFLP.
Results: Among cases the frequencies of RTIs infection is higher than control. The prevalence of HPV, C. trachomatis, T. vaginalis, Bacterial vaginosis and N. gonorrhoeae are 28% & 6%; 11%, 32% respectively while in controls it was 5%, 2%, 1% and 8% & 1%. In the present study we found that the frequency of wild homozygous genotype (TT) was lower in cases 30% (6/20) as compared to controls 60% (12/20). The frequency of the heterozygous polymorphic genotype (CT) was higher in cases 65% (65/100) as compared to controls 32% (32/100). It was interesting to note that the frequency of the polymorphic homozygous genotype (CC) was higher in cases 15% (15/100) than controls 2% (2/100). While the frequency of the carrier genotype (CT + TT) was found to be more in cases 70% (70/100) than in controls 40/100 (40%). This study shows that T allele may be risk factor for Reproductive tract infections as its percentage is higher in cases as compare to normal controls.
Conclusion: TNF-? rs-281865419 locus may serve as an important biomarker for RTIs predisposition in Indian population though larger sample size is needed to validate the findings.
To evaluate the role of training session on ‘Cervical Cancer Screening’ in improving knowledge and attitude of Accredited Social Health Activists (ASHA) in East Delhi population
Authors: Singh Nilanchali , Rajaram Shalini , Gupta Bindiya , Mendiratta Anita , Kumar Sanjay 
Published: February 2021

Background: India has the world’s largest load of cervical malignancy. A lot of it can be attributed to lack of cervical cancer screening awareness among the general population. The Accredited Social Health Activists (ASHA) are grass root workers who have good reach in the remote areas, where health care facilities are lacking. Training these ASHAs may increasethe general awareness about cervical cancer screening.
Methods: We organized a training programme of 250 ASHA workers in a tertiary care hospital with aim of improving their knowledge and attitude about cervical cancer screening which will eventually improve their practise of training women in general population. It comprised of 5 lectures in language they understand, slogans, posters, question answer session etc. A test comprising of 17 questions was conducted before and after session to check their knowledge and attitude.
Results: There was an overall improvement of 25% in knowledge of the ASHAs i.e. 38% answers were correct in pre-test and 63% were correct in post-test. Questions were pertaining to symptomatology, risk factors, screening methods, their utility and prerequisites of performing the screening tests, when and how often to repeat. Improvement was seen in all the areas. There was improvement in attitude too and most of them wanted themselves (98%), their relatives (100%) and the woman within their area (98%) to be screened for cancer cervix.
Conclusion: It was a small initiative and successful result was obtained after the training session of ASHAs. The impact on general population needs further evaluation.
Radiotherapy after hysterectomy in carcinoma cervix: Audit from a tertiary care cancer hospital in India’s largest state “Rajasthan”
Authors: Soni Tej Prakash , Prakash Aaditya , Takia Tinku , Goyal Jaishree 
Published: February 2021

Purpose: To explore the reasons of hysterectomy and indications of post-hysterectomy radiotherapy in carcinoma cervix cases.
Methods: From January 2013 to May 2015, medical records of 64 cases of carcinoma cervix (post-hysterectomy) who were referred for radiotherapy to our hospital were analyzed retrospectively.
Results: Medical records of 64 cases were reviewed. The median age was 47 years. In 45% of females hysterectomy was done in towns, but in majority of cases (55%) hysterectomy was done in different cities of Rajasthan. Simple hysterectomy was done in 31 of (48%) cases. Wertheim’s hysterectomy was done in remaining 33 cases (52%). 15 cases (23%) were treated by IMRT technique, while remaining 87% cases were treated by 3DCRT technique to dose of 50 Gy in 25 fractions followed by CVS brachytherapy. All cases also received concurrent chemotherapy. Reason for hysterectomy was analyzed. In 32 (50%) cases, biopsy from gross lesion at cervix or PAP smear test was not done before surgery. In 32 cases (50%) understaging of the tumor or inadequate staging before hysterectomy was performed. Histopathology report analysis revealed that in 9 cases (14%) primary tumor size was less than 4 cm, in 27 cases (64%) there was no comment on pT size, in 22% cases primary tumor was larger than 4 cm. Surprisingly in one case the pT size was 7 cm. LVSI was not seen in 18 cases (28%), positive in 20 case (31%) and with no comment in 26 cases. More than 50% of stroma thickness was involved in 54 cases (84%), and in remaining 10 cases there was no comment on stroma invasion. In 33 cases (52%) pelvic lymphadenectomy was done, in 48% cases lymph nodes were not addressed in surgery. In 36 cases (56%) pelvic lymph node metastasis was seen either in preoperative imaging (USG/CT scan) or in histopathology. Median follow-up duration was 6 months. Locoregional failure was seen in 10 cases (16%), 6 cases (9%) also developed distant metastasis.
Conclusion: Failure to perform biopsy from gross lesion at or under staging/inadequate staging before surgery was the main reasons for inappropriate hysterectomy for carcinoma cervix. Inappropriate hysterectomy followed by chemo-radiotherapy resulted in poor tumor control rate as in our study, 1 out of every 4 patients failed loco-regionally with median follow up of 6 months. Strict adherence to guidelines for cervical cancer diagnosis and treatment is advised to prevent inappropriate hysterectomy.
Cervical cancer screening of female of rural community of Nepal: Knowledge, attitude and practices
Authors: Shrestha Anju 
Published: February 2021

Purpose and Objectives: Cervical cancer is leading female cancer in Nepal. Despite the existence of effective screening using Pap smear, the uptake of screening is poor. This is mainly due to lack of knowledge, lack of availability of services in rural area and low priority of women’s health issue. Objectives of this study were to determine the baseline information about the knowledge of cervical cancer and explore attitude and practice of Pap smear screening among the women of rural community of Nepal.
Materials and Methods: A cross sectional population based descriptive study of female attending free health camp in different rural community of Nepal organized by Nepal Cancer Hospital was conducted using self-administered questionnaire to elicit information on demographic characteristics, knowledge, screening behaviors and determinants of cervical cancer. Knowledge is elicited about eligibility for screening and screening interval according to American Congress of Obstetricians and Gynecologists (ACOG) guidelines. Practices are evaluated as having ever been screened themselves. Attitudes referred to the various reasons for not getting screened themselves.
Results: A total of 500 women participated in this study, out of which 44.4% (228) were either illiterate or just educated up to primary school. Mean age of participates were 40.6±10.3 yrs. 47.4% (238) of women married before age of 18 and 57% (258) women had their first childbirth before age of 21 years. Only 33.8% (169) female knew that cervical cancer is preventable and is curable in early stage. Although 42.6% (213) women heard about Pap smear, only 38.2% (191) knew about eligibility of screening and 11% (55) knew about screening interval. However, knowledge of risk factors for cervical cancer was found in 8.2% (41). About 26.8% (134) women had done Pap test at least once. The most common reason for not doing Pap test is they never heard about it (41.8%: 209). The other reason includes do not know where to do (9.6%: 48); never adviced by doctor (9%: 45); embarrassment (2.4%: 12); fear of finding out cancer (3.2%: 16) and do not have any symptoms (2.4%: 12).
Conclusions: The study revealed low cervical cancer knowledge and poor screening behavior among the women. This may be suggestive of even poorer awareness and screening and practices among older women who are less educated or with no education.
Diagnostic dilemma of mesonephric adenocarcinoma cervix
Authors: Soni Abhishek , Bansal Nupur , Dhull A. K. , Kaushal Vivek , Atri Rajeev , Verma Monica 
Published: February 2021

Introduction: Mesonephric carcinoma is a rare type of epithelial tumor of the uterine cervix which derive from the remnants of the paired mesonephric (Wolff’s) ducts. The incidence of such neoplasms is difficult to determine due to rarity, previous misclassification of clear cell carcinomas and yolk sac tumours as mesonephric carcinomas and potential underreporting due to misclassification of mesonephric carcinoma as Mullerian tumours or mesonephric hyperplasia. The evidence regarding the clinical course, prognosis and optimal treatment is limited.
Materials and Methods: Searches were performed on MEDLINE, EMBASE and Google Scholarly articles. All the relevant articles were included in the study. Only approximate 40 cases have been reported till now.
Discussion: Mesonephric adenocarcinoma cervix has different morphologies like ductal, tubular, solid, retiform, sex-cord like pattern, clear cell and serous papillary structures. IHC assessment is helpful in differentiating it from Mullerian counterpart, as it is negative for CEA, CK20, p16, PAX2, ER/PR and vimentin and positive for CD10, calretinin, CK7, CAM5.2 and EMA. It has no relation with HPV infection. Unlike squamous epithelial carcinoma, it is rarely presenting with the abnormal cervical smear result, has more advanced age at presentation and its incidence does not appear to decline with age. The diagnosis has been supported by endometrial curettings, directed/cone cervical biopsies and hysterectomy specimens. The majority of patients are diagnosed at stage IB with mean DFS of 48.6 months. Recurrence rate is 23%, with a mean interval of 40 months. Hysterectomy is the primary treatment. Advanced stage disease of adenocarcinoma seemed to respond to radiotherapy, but for the MMMTs the combination of chemotherapy with radiotherapy appears to be preferable.
Conclusion: Rarity of the neoplasm, varied morphology, mix presentation and very low number of cases leads to difficulty in correct diagnosis in a small biopsy specimen. IHC helpful in differentiating it from other lesions.
Implementing quality indicators for cytoreductive surgery in ovarian cancer: Experience from a tertiary referral center in Eastern India
Authors: Mukhopadhyay Asima , Chakraborti Basumita , Ghosh Anik , Bhaumik Jaydip 
Published: February 2021

Background: Debate continues whether primary surgery or neo-adjuvant chemotherapy (NACT) or primary debulking surgery (PDS) should be offered in advanced epithelial ovarian cancer as frontline therapy. Since 2015, there has been a paradigm shift at Tata Medical center, whereas increasing number of patients are being offered PDS and a quality improvement programme was initiated. Recently, ESGO in October 2015 has published a document indicating 10 quality indicators for cytoreductive surgery in advanced ovarian cancer surgery.
Aim: We compared our performance against all 10 quality indicators.
Results: Primary cytoreduction rate has increased from 20% in 2012 to >70% at the end of 2015. Optimal cytoreduction rates were obtained in 90% cases and recently complete (CCO/CC1) cytoreduction rates are being achieved in >80% cases. All 10 quality indicators were achieved successfully including prospective documentation of morbidity and surgical findings in all cases. Morbidity figures are showing a downwards trend after the initial learning curve.
Conclusions: Implementation of a quality improvement programme is the key to overcome the barriers of implementing a cytoreductive program in advanced ovarian cancer. However, standards similar to developed countries can be achieved through a dedicated team effort.
Role of CA 19-9 in complex ovarian tumors
Authors: Thomas Dhanya S. , Sebastian Ajit , Thomas Vinotha , Thomas Anitha , Chandy Rachel , Peedicayil Abraham 
Published: February 2021

Background: Cancer antigen 19-9 (CA 19-9) is a tumor-associated mucin glycoprotein antigen that may be elevated in healthy individuals as well as in patients with benign and malignant tumors. It is useful in the management of pancreatic and other gastrointestinal tumors. CA 19-9 is also elevated in benign and malignant ovarian tumors.
Aim: To study the pattern of serum CA19-9 in complex ovarian tumors.
Methods: The study design was descriptive, based on data collected from medical records. Patients with a complex ovarian mass, who were investigated with CA 19-9 and had undergone surgery, wereincluded in the study. The study duration was 2 years from January 2014 to December 2015. A total of 273 patients (119 - benign and 154 malignant) with complex ovarian mass and elevated CA 19-9 underwent surgery during the study period.
Results: CA 19-9 was elevated in 55 patients (20%). Of these, 23 patients had benign tumors while 32 had malignant tumors.Among patients with benign tumors, 21 had dermoid, 23 had mucinous tumors and 75 had other types of tumors. CA 19-9 was elevated in 10 (47.6%) of the dermoids, 7 (30.4%) of the mucinous tumors and 6 (8%) of the other benign tumors. Among patients with malignant tumors, 138 were epithelial and 16 were non epithelial tumors. Of the epithelial tumors, 31 were mucinous and 107 were non mucinous types. Overall, 29 (21%) had elevated CA 19-9. Of the epithelial tumors, 22.6% of the mucinous type and 20.6% of the non mucinous type had elevated CA 19-9. Among the non-epithelial tumors, 3 (18.8%) had elevated CA19-9.
Conclusion: CA 19-9 is elevated in several conditions but most likely to be raised in dermoid cysts and mucinous tumours. CA19-9 levels need to be interpreted along with clinical and radiological findings.
Audit on the role and efficacy of PET/CT in recurrent ovarian cancer settings in a tertiary care centre in India
Authors: Suhas K. R. 
Published: February 2021

Ovarian cancers tend to recur in 15-70% cases. CA-125 - is a tumor marker used for monitoring therapeutic response, and in surveillance, for recurrent disease. However, it has a limited role as a persistent high level can signify either recurrence or persistence of residual tumor. Metastases from ovarian cancer primarily involve the peritoneum rather than parenchymal sites; thus, the presence of small-volume recurrence or metastatic deposits on the visceral surfaces poses a challenge for interpretation of CT and MR images. PET/CT utilizes its property of higher accumulation in malignant cells to provide both anatomic and functional information for diagnosing malignant tumors.
Objectives: The objectives of the study were to find the correlation between PET/CT findings and final histopathological diagnosis after a secondary cytoreductive surgery in suspected ovarian cancer recurrences.
Materials and Methods: PET/CT was done in cases with rising or above normal CA-125 and no radiological findings. These patients with abnormal PET/CT findings were taken up for a secondary cytoreductive surgery and histopathological proven were taken as the standard against which PET/CT positive findings was compared.
Results: The mean age in our group of patients with suspected recurrence was 53 years (Range 39-74 years). Of the 52 patients with suspected recurrence, 40 patietnts with a PET-CT scan with findings suggestive of an avid uptake underwent surgery. 22 patients had serous histology, 12 mucinous and 8 had clear cell carcinoma. Stage-wise distribution at the time of primary surgery is as follows stage I-3, stage II-7, stage III-26, stage IV-4. Of the 40 patients who underwent a second look surgery 32 had histopathologically confirmed recurrence. PET-CT detected a total of 86 lesions in the 40 patients who underwent surgery. Of these, 38 were in the lymph nodes 28 in para-aortic and 10 in pelvic, 32 were peritoneal lesions and 14 were pelvic, 2 were metastatic in the parenchyma of liver. Detection of the lesion on PET-CT was size dependant, of the 9 lesions were missed on PET-CT, 7 were less than 0.5 cm. The mean diameter of the lesions detected was 2.2 cm (range 0.3-6.2 cm). PET-CT accurately identified 62 of 70 histopathologically proven lesions. The overall lesion-based sensitivity of PET-CT is 88.6%, specificity 56.2%, Positive predictive value being 72.1%, negative predictive value of 69.2%. Accuracy of detecting lesions greater than 1 cm is 78.6% (44 of 56 lesions).
Conclusions: Corelation between PET/CT and histopathologicaldisease: k (cohen value) = 0.81 which suggests excellent correlation. For selected patients with ovarian cancer recurrence may benefit from a comprehensive radiographic imaging survey (PET-CT) at the time of even no or minimal CA-125 elevation in early detection and successful cytoreductive surgical resection and an increase in overall survival.
Role of human epididymis protein 4 for detection of ovarian carcinoma in adnexal masses: A pilot study
Authors: Bansal Nidhi , Suneja A. , Guleria K. , Vaid N. B. , Mishra K. , Bhatt S. , Mehndiratta M. 
Published: February 2021

Introduction: HE4 is a novel tumour biomarker used for early diagnosis of ovarian cancer. This study evaluated the diagnostic accuracy of HE4 alone and in combination with CA125, risk of malignancy index (RMI), risk of malignancy algorithm (ROMA).
Methods: It was a cross sectional study conducted recruiting 88 women with adnexal masses who were planned for surgery. After baseline work up and ultrasound examination, serum samples were collected for estimation of CA 125 and HE4 levels. Serum HE4 levels were estimated using ELISA kit. RMI and ROMA score were calculated and diagnostic accuracy of HE4, CA 125, RMI, ROMA and their combination were compared. Cut off for HE4 and ROMA score were calculated using ROC curve.
Results: Of 88 subjects, 66 were analyzed with 19 malignant (including 5 LMP) and 47 benign cases. The median value of HE4 among malignant cases was found to be significantly higher than among the benign cases. PPV and NPV of HE4 at a cut off 130.8 pMol/ml was 85.7% and 77.9% respectively. Highest PPV (88.9%) with acceptable NPV (80.7%) was found with ROMA followed by HE4 (PPV 85.7%; NPV 77.97%), RMI (PPV 76.92%; NPV 83%) and CA125 (PPV 52%; NPV 80.85%).
Conclusion: HE4 levels were lower in Indian population both in malignant and benign tumours as compared to other studies. HE4 is a good discriminator and gives best accuracy when it is combined with CA125 in a logistic algorithm, ROMA.
Preoperative and intraoperative assesment of myometrial invasion and histological grade in endometrial cancer: Role of MRI and frozen section
Authors: Ranade Rohit Raghunath 
Published: February 2021

Introduction: The role of systematic lymphadenectomy in clinically early stage endometrial cancer is controversial. A number of factors can predict lymph node metastasis including myometrial invasion, tumor grade in endometrial cancers. The purpose of the present study is to evaluate the accuracy of preoperative MRI and intraoperative frozen section in determining the depth of myometrial invasion, cervical involvement, tumor size and lymph nodal status. We also studied the accuracy of preoperative endometrial biopsy and intraoperative frozen section in determining the grade of the tumor.
Materials and Methods: Medical records of 235 consecutive cases of clinically early stage endometrial cancer were reviewed retrospectively. A record of depth of myometrial invasion, tumor size, cervical involvement and presence of enlarged lymph nodes was made on a preoperative MRI. Similarly depth of myometrial invasion, tumor size, cervical involvement and grade of the tumor were recorded on an intraoperative frozen section. The grade of the tumor was also recorded on a preoperative endometrial biopsy. Standard statistical calculations were used.
Results: The sensitivity and specificity of MRI for myometrial invasion for the first 160 cases were 81.3 and 75%, respectively while that for frozen section were 80 and 96.2%, respectively. For tumor grade the sensitivity and specificity of preoperative endometrial biopsy were 60 and 95.6%, respectively while that of frozen section were 53.8 and 97.6%, respectively. For cervical involvement the sensitivity of MRI and frozen section was 62.5 and 98.4%, respectively. Updated results of the entire cohort of 235 cases will be presented at the conference if selected.
Conclusion: Although the sensitivity of both frozen section and MRI for predicting deep myometrial invasion was similar (80 vs 81.3%) but the specificity (96.2 vs 75%) and negative predictive value (92.7 vs 88.2%) of frozen section were superior to MRI. Both preoperative biopsy and intraoperative frozen section had low sensitivity (60 vs 53.8%) for detecting a high grade lesion.
A rare case of ovarian and endometrial adenocarcinoma metastasized from carcinoma of jejunum
Authors: Agrawal Sonam , Dahiya Pushpa 
Published: February 2021

Introduction: Krukenberg tumor of ovary is a rare clinical entity and accounts for 1-2% of all ovarian tumor. Stomach is most common primary site but other organs can also serve as a primary site. Accurate diagnosis of krukenberg tumor requires thorough endoscopic and histopathological examination to exclude primary tumor.
Case Report: 32 years old female presented with AUB for 2 months and history of jejunum carcinoma which was an incidental finding on biopsy after a surgery for intestinal obstruction. Endometrial biopsy showed endometrial carcinoma of mucin secreting signet ring type. CECT showed bilateral adnexal masses. Staging laparotomy was planned but due to dense adhesion and bladder and bowel infiltration optimal debulking could not be done and tumor was removed as much as possible. Patient was reffered for chemotherapy.
Conclusion: Krukenberg tumor is uncommon metastatic signet ring cell adenocarcinoma of ovary with transcoelomic spread. It is essential to rule out other ovarian malignancy to avoid the misdiagnosis and management of krukenberg tumor.