Aparna Sharma

Granulocytic Sarcoma of Uterine Cervix as Presentation of Acute Myeloid Leukemia: A Case Report and Review of Literature

Localized extramedulary collection of leukemic cells is termed as granulocytic sarcoma. Incidences of 2–8% in acute myeloid leukemia have been reported in various autopsy studies. In female it usually involves ovary. Since most of such tumors are asymptomatic, they are detected only at autopsy. We report here a case who manifested as abnormal vaginal bleeding, large cervical mass, renal failure, and aspergillous fungaemia. The patient died before she could be treated. From the present report it would appear that granulocytic sarcoma at times may precede other manifestations of leukemia.

Laser prepulse induced plasma channel formation in air and relativistic self focusing of an intense short pulse

An analytical formalism is developed and particle-in-cell simulations are carried out to study plasma channel formation in air by a two pulse technique and subsequent relativistic self focusing of the third intense laser through it. The first prepulse causes tunnel ionization of air. The second pulse heats the plasma electrons and establishes a prolonged channel. The third pulse focuses under the combined effect of density nonuniformity of the channel and relativistic mass nonlinearity. A channel with 20% density variation over the spot size of the third pulse is seen to strongly influence relativistic self focusing at normalized laser amplitude ∼0.4–1. In deeper plasma channels, self focusing is less sensitive to laser amplitude variation. These results are reproduced in particle-in-cell simulations. The present treatment is valid for millimeter range plasma channels.

Interrelationship between angiogenesis, inflammation and oxidative stress in Indian patients with multiple myeloma

BackgroundMultiple myeloma (MM) is a B-cell malignancy characterized by the accumulation of clonal population of plasma cells in the bone marrow (BM). A variety of angiogenic factors, proteases, reactive oxygen species and inflammatory cytokines induce the formation of an extensive and suitable BM microenvironment. Previous studies have established the importance of angiogenic factors, inflammatory molecules and oxidative stress in MM but their interplay and effect on each other are not being taken together.MethodsCirculatory levels of VEGF, angiopoietin-2 (Ang-2), IL-6 and TNF-α along with the activity of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were investigated in 112 subjects including 62 MM patients and 50 healthy controls. Inter-stage analysis was done to evaluate the association of these molecules with the severity of disease. Pearson correlation was determined to find interrelationship, if any, between these molecules.ResultsWe have observed elevated levels of VEGF, Ang-2, IL-6, TNF-α and decreased activity of SOD, GPx in MM patients in comparison to controls. All these molecules also showed a trend with the severity of disease. We have found strong association between these factors upon their correlation and regression analysis.ConclusionThis study is a step toward understanding the indepth contribution of angiogenesis, inflammation and oxidative stress together in making BM microenvironment suitable for growth, survival and proliferation of malignant plasma cells in MM.

Juvenile Cystic Adenomyoma Mimicking a Uterine Anomaly: a Report of Two Cases

Juvenile cystic adenomyoma is a rare form of adenomyosis and described as a new type of mullerian anomaly in literature. We are presenting two cases of juvenile cystic adenomyoma which were misdiagnosed preoperatively as unicornuate uterus with haematometra in a non-communicating rudimentary horn. The mainstay of treatment is complete resection of lesion.

Pregnancy Outcomes in HIV-Infected Women: Experience from a Tertiary Care Center in India

Background and Objectives: There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women. Methods: This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed. Results: HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR. Conclusion and Global Health Implications: Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.

Pathological studies of female reproductive tract in goats

A total of 660 samples of female reproductive tract were collected and examined, from various abattoirs of Bareilly and Agra city of Uttar Pradesh, Palwal town of Haryana state and Delhi, India and from post-mortem house at Central Institute for Research on Goats, Makhdoom, Mathura, Uttar Pradesh. Of these, 154 (23.33%) tracts revealed gross and microscopic pathological lesions including ovary (40), fallopian tube (8), uterus (82), cervix (17) and vagina (7). The highest affected organ was uterus followed by ovary, cervix, fallopian tubes and vagina. Endometritis was the major pathological condition observed in 37 cases of affected uteri. Based on microscopic examination, endometritis was categorised into acute endometritis, non-purulent chronic endometritis, purulent chronic endometritis and chronic granulomatous endometritis. Ovary was the second most affected organ after uterus, with pathological conditions like ovarian cysts, including par ovarian cysts, polycystic ovary, follicular cysts and luteal cysts, and ovarian tumour were encountered. Other portions of genitalia revealed hydrosalpinx, hydrometra, cervicitis, vaginitis and congenital anomalies like uterus unicornis, double cervix and duplex vagina. The pathological lesions could result into infertility or sterility of the goats leading to economic losses to the farmers.

The Role of GnRH Analogues in Improving Outcome in Women Undergoing Superovulation and Intrauterine Insemination after Surgical Correction of Mild Endometriosis: A Randomized Controlled Trial

Objective Treatment with laparoscopic surgery, gonadotropin-releasing hormone analog (GnRHa) therapy, superovulation (SO), and intrauterine insemination (IUI) have individual benefits in improving fertility outcomes in women with endometriosis. The aim of the study was to evaluate the role of GnRHa in improving outcome in women undergoing SO and IUI after surgical correction of mild endometriosis. Materials and Methods This was a randomized controlled trial conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India, over a period of 2 years and 6 months. Ninety women who were diagnosed with mild endometriosis on laparoscopy using the revised American Society for Reproductive Medicine criteria were included in the study. The patients in the study group (n=45) received a single dose of 3.75 mg GnRHa subcutaneously within 48 h of the surgery, and those in the control group (n=45) did not receive GnRHa. Thereafter, patients in both arms received SO and IUI from the next menstrual cycle. Four patients in the study group and three patients in the control group were lost to follow-up before the first cycle of ovulation induction. Primary outcomes measured in our study were live birth rates and clinical pregnancy rate. Secondary outcome measures were number of follicles >18 mm, endometrial thickness, dose and days of gonadotropin stimulation. Results Baseline characteristics, such as age and body mass index, were comparable in both groups. The SO and IUI cycles were comparable between the two groups with regard to the secondary outcome parameters. Pregnancy rate in the first cycle was 17.1% in the study group and 19.1% in the control group (p=0.81). The overall pregnancy rate was similar in both groups (study group=21.9%, control group=23.8%; p=1). As no patient had miscarriage or any other complication during pregnancy, live birth rate was similar to the clinical pregnancy rate. Conclusion Adding GnRHa for the suppression of mild endometriosis has shown no significant improvement in the surgical management of women undergoing SO and IUI.

Role of Trace Elements, Oxidative Stress and Immune System: a Triad in Premature Ovarian Failure

The risk of premature ovarian failure (POF) increases in association with alteration in immunological parameters and oxidative stress (OS). Adequate intake of trace elements is required for antioxidant property and immune defense mechanism. The aim of this study was to explore the involvement of trace elements, OS, and immunological parameters in POF. This was a cross-sectional, case-control study, involving 65 participants divided into the POF (n = 35) and control (n = 30) groups. Serum levels of Se, Zn, and Cu were determined along with hormonal, OS, and immunological markers. POF group had significantly lower levels of Zn, Cu, Se, and Zn:Cu ratio. However, Se:Cu ratio was not significant between the groups. FSH and LH levels were negatively correlated with Zn and Cu levels and positively correlated with Se levels. Estrogen levels were negatively correlated with all the studied trace elements. Inter-element association between Zn and Se was significant in POF (r = − 0.39, p = 0.02) compared to control group (r = − 0.078, p = 0.65). In all the POF patients, SOD and GPx activities were significantly (p < 0.05) lower and MDA level was higher (p > 0.05) than control group. B cell marker CD19 was significantly (p < 0.0001) high in POF group. There are involvement of trace elements in hormonal regulation and antioxidant defense mechanism, which once gets altered leads to high ROS generation and affect functions of the immune system. Exaggereative immune system causing higher expression of B cell associated markers (CD19) leading to autoimmune condition in POF.

Molecular etiopathology of naturally occurring reproductive diseases in female goats

Aim: The aim of the present study was to investigate the molecular etiopathology of occurrence of reproductive diseases in female goats. Reproductive diseases in goats account for major economic losses to goat farmers in terms of valuable loss of offspring and animal productivity. Materials and Methods: A total of 660 female genitalia were examined for pathological conditions (macroscopic and microscopic lesions). The etiopathological study was carried out for the presence of pathogenic organisms such as Brucella, Chlamydia, and Campylobacter in the uterus and ovary. Based on the microscopic lesions, suspected samples were subjected to diagnostic polymerase chain reaction (PCR) for various etiological agents employing 16srRNA genus specific primers for Campylobacter and Chlamydophila and OMP31 gene-based PCR for Brucella melitensis and nested PCR using ITS-1 gene primers for Toxoplasma gondii. For Brucella suspected samples, immunohistochemistry (IHC) was also performed. Results: In studied female genitalia, 108 (16.30%) showed gross abnormalities with overall 23.32% occurrence of pathological conditions (macroscopic and microscopic lesions). Pathological involvement of the uterus was the highest 68 (62.96%), followed by the ovaries 27 (25%) and other organs. Major uterine condition observed was endometritis (5.60%). In uterine infections, 35 (5.30%) samples were found positive for Campylobacter spp., 12 (1.81%) samples for B. melitensis, and 3 (0.45%) samples were positive for Chlamydophila spp. Among the samples positive for B. melitensis by PCR, 3 were found positive by IHC also. Corynebacterium ovis was detected by PCR using specific primers in a case of hydrosalpinx. It was concluded that many pathological lesions in female genitalia of functional significance play a major role in infertility in goats. Conclusion: The present study concluded that many pathological lesions in female genitalia of functional significance play a major role in infertility in goats.

Case ReportEpisiotomy scar endometriosis

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine endometrial cavity. It is a benign, chronic, and estrogen-dependent disorder. It generally occurs in pelvic sites such as ovaries, posterior cul-de-sac, pelvic peritoneum, bowel, and rectovaginal septum. Extrapelvic endometriosis has been described in various sites such as nervous system, thorax, urinary tract, gastrointestinal tract and in cutaneous tissues. Endometriosis at scar site can be found after cesarean, hysterectomy, amniocentesis, laparoscopic trocar tract, or perineal episiotomy.1 Episiotomy scar endometriosis is a relatively uncommon condition and usually diagnosed late because of unawareness about the condition among general surgeons, resulting in prolonged suffering to the patient and increased morbidity.