Harish Shetty

Diagnostic value of acetic acid comparing with conventional Pap smear in the detection of colposcopic biopsy-proved CIN

AIM To assess the role of visual inspection with acetic acid as an alternative to Pap smear and in screening program for cervical cancer in low resource settings. MATERIALS AND METHODS A total of 225 women in the reproductive age group attending the Department of Gynecology were enrolled in the study. A Papanicolaou smear and visual inspection of the cervix with acetic acid was done. All patients who tested positive on screening then underwent a colposcopy-guided biopsy. The Pap smear of a low-grade squamous intraepithelial lesion (LSIL) and above was taken as abnormal. The statistical test used was the chi-square test and results were computed using Statistical Package for the Social Sciences (SPSS) version 12.0. RESULTS Out of 225 patients, acetic acid (VIA) was positive in 27 (12%) patients and the Pap smear was abnormal in 26 (11.7%). There were 15 LSIL, 6 high grade squamous intraepithelial lesions (HSIL) and 5 were squamous cell carcinoma. On biopsy, there were 15 mild dysplasia, 2 moderate dysplasia, 4 severe dysplasia, and 3 squamous cancers. The Pap smear had a sensitivity of 83%, specificity of 98%, and positive predictive value of 80% and negative predictive value of 97.9%. VIA had a sensitivity of 70.8%, specificity of 95%, and positive predictive value of 62.9% and negative predictive value of 96.5%. CONCLUSION Since diagnostic values of VIA is comparable to Pap smear, and it performs well in detecting a high grade lesion, we conclude that VIA can be used as a screening modality for cervical cancer in low resource settings.

Levels of Serum Calcium and Magnesium in Pre-eclamptic and Normal Pregnancy: A Study from Coastal India

BACKGROUND Pre-eclampsia is one of the major causes of maternal and fetal morbidity and mortality. Though the aetiology is obscure, recent studies indicate that serum levels of calcium and magnesium may have a role in pre-eclampsia. AIM The aim of this study was to find out the relationship of serum levels of calcium and magnesium in pre-eclamptic pregnancies compared to normal pregnancies in women from southern coastal India. SETTINGS AND DESIGN This study was done in a medical college hospital in southern coastal India. MATERIALS AND METHODS The blood samples from 60 pre-eclamptic women and an equal number of controls were analysed for calcium and magnesium levels. Data on Body Mass Index, maternal and gestational ages, serum calcium and magnesium were compared between the two groups. Outcome of pregnancy was analysed in both the groups and compared. STATISTICAL ANALYSIS Data was expressed as Mean ± Standard Deviation. Data analysis was done by SPSS version 20. Comparison of serum levels of the elements between the two groups was performed by Independent t-test and Chi-square test and P-value of < 0.05 was considered as statistically significant. RESULTS The serum calcium concentration was significantly lower in the pre-eclamptic group compared to normotensives (7.84 ± 0.87 mg/dl Vs 8.97± 0.69 mg/dl, p<0.001) whereas the levels of serum magnesium showed a marginal difference in both the groups. (1.43± 0.55 mg/dl Vs, 1.57 ± 0.72 mg/dl P 0.257) The study also showed that pre-eclamptic women were older, their BMI was higher and birth weight of babies lower compared to normotensives. CONCLUSION According to the results of our research, intake of supplements, mainly calcium may help in the reduction of incidence of pre-eclampsia especially in a population of a developing country like ours where the nutrition is poor. Not many studies have been done in developing countries to assess the role of these elements in pre-eclampsia. The actual role of magnesium and calcium supplements needs further investigation.

Human Papilloma Virus Associated Squamous Cell Carcinoma of the Head and Neck

Oral cancer is one of the commonest causes for mortality and morbidity with squamous cell carcinoma being the sixth most frequent malignant tumour worldwide. In addition to tobacco and alcohol, human papilloma virus (HPV) is associated with a proportion of head and neck cancers. As in cervical cancers, HPV types 16 and 18 are the cause of malignant transformation. HPV-positive cancers of head and neck have unique characteristics such as occurrence in a younger age group, distinct clinical and molecular features, and better prognosis as compared to HPV-negative carcinomas. They also possess the potential for prevention by using vaccination. The present review describes in detail the salient features of HPV associated oral squamous cell carcinoma (OSCC), its differences from HPV-negative OSCC, diagnostic features, and recent strategies in prevention and management.

Ovarian Gonadoblastoma with Dysgerminoma in a Young Girl with 46, XX Karyotype: A Case Report

Gonadoblastoma is a rare gonadal tumour consisting of a mixture of germ cells and sex cord stromal derivatives resembling immature granulosa and Sertoli cells. It usually arises in various types of gonadal dysgenesis containing Y chromosome like pure or mixed gonadal dysgenesis. Occurrence in phenotypically and chromosomally normal women is very rare. We report here a case of gonadoblastoma with dysgerminoma in a 14-years-old girl who presented with a huge tumour, virilisation and normal 46XX karyotype. Association of dysgerminoma is seen in 50% cases of gonadoblastomas. Elevated tumour markers like hCG and alpha Fetoprotein may make the diagnosis challenging.

Prevalence of Vaginal Candidiasis in Pregnancy among Coastal South Indian Women

Prevalence of Vaginal Candidiasis in Pregnancy among Coastal South Indian Women Vulvovaginal candidiasis is characterized by curd like vaginal discharge and itching. It is associated with considerable distress to the patient. The incidence is increased in pregnancy and may lead to complications like abortions, preterm delivery, candida chorioamnionitis and others. This study was done to determine the prevalence of vaginal candidiasis in pregnant women in Mangalore, a coastal city in South India

Cyclical hematuria-ureteral endometriosis: a case report

Endometriosis is a benign gynaecological condition characterised by the presence of the functional endometrial tissue outside the uterus. It usually involves the ovaries, fallopian tubes, rectovaginal septum, cul-desac, and pelvic peritoneum. Various other sites of involvement of endometriosis has also been observed, such as, skin, lungs, brain, gastrointestinal tract, umbilicus and the genitourinary tract.

Calcifying epithelial odontogenic tumor of the posterior maxilla

Calcifying epithelial odontogenic tumor (CEOT) is a rare odontogenic neoplasm comprising <1% of all odontogenic tumors. It is commonly seen in the third to fifth decades of life without any gender predilection. It usually occurs in the mandibular posterior region. A painless, slow growing swelling with bone expansion is the most common clinical feature of CEOT. Radiographically, it presents as a mixed lesion with or without an associated impacted tooth. Confirmation of the diagnosis is by histopathological examination. We describe an unusual case of CEOT occurring in the maxillary posterior region and involving the maxillary sinus. The associated impacted third molar was displaced to the lateral wall of the nose and root resorption was seen in all the teeth associated with the lesion. There was no evidence of calcification in conventional as well as computed tomography images.

Goldenhar syndrome- A case report

Goldenhar syndrome is a birth defect resulting from the maldevelopment of the first two branchial arches with the incomplete development of the ear, nose, soft palate, lip and mandible. Goldenhar syndrome is a rare inherited condition, which has a multifactorial ethiopathology that includes nutritional and environmental factors which can result in developmental disturbances. Goldenhar first described this condition in 1952 as a disease that presents a combination of several anomalies such as microtia, hemifacial microsomia, pre-auricular skin tags, epibulbar dermoids, and vertebral malformations. In this case report we report a case of 30 year old male patient with a mild variant of Goldenhar syndrome with review of literature.