Lakhbir Kaur Dhaliwal

Severe anaemia in pregnancy: A tertiary hospital experience from northern India

Anaemia is a major health problem among woman of reproductive age group, particularly in developing countries. We undertook this study to determine the maternal and perinatal outcome in patients with severe anaemia in pregnancy, with a haemoglobin concentration of <7 g/dl. The in-hospital data were analysed for 12 months between January 2007 and December 2007 and 2.15% (n = 96) of women were found to have severe anaemia. Out of these, 18.75% had pre-term premature rupture of membranes and 5.12% of all deliveries were pre-term. Hypertensive diseases of pregnancy were seen in 17.7%; abruption in 3.12% and 9.37% had congestive cardiac failure. Postpartum haemorrhage was seen in 25.5% of the patients and 8.33% had puerperal pyrexia. Fetal distress was seen in 26% of and 33.33% had small for gestational age neonates; there were 16.66% stillbirths and 4.16% neonatal deaths. Of the 96 severely anaemic women, six died after admission. Our study shows that efforts must be taken towards safe motherhood and spreading awareness about the various consequences of anaemia, which is usually preventable with early correction.

Role of 8-iso-prostaglandin f2α and 25-hydroxycholesterol in the pathophysiology of endometriosis

OBJECTIVE To investigate the involvement of 8-iso-PGF(2alpha) and 25-hydroxycholesterol (25-OH-Chol) in the pathophysiology of endometriosis. DESIGN Observational case-control study using enzyme immunoassay and high-performance liquid chromatography (HPLC). SETTING Postgraduate Institute of Medical Education and Research. PATIENT(S) Forty-five women undergoing laparoscopy (n = 25), laparotomy (n = 19), or tubal ligation (n =1). INTERVENTION(S) Venipuncture and laparoscopic peritoneal fluid (PF) collection. MAIN OUTCOME MEASURE(S) The levels of 8-iso-PGF(2alpha) were determined both in urine and PF of all the patients using enzyme immunoassay. The levels of 25-OH-Chol were determined by using reversed phase HPLC both in the plasma and PF samples. Oxidative damage to DNA was assessed by agarose gel electrophoresis. RESULT(S) Significantly increased levels of 8-iso-PGF(2alpha) were observed both in urine and PF of women with endometriosis compared with control women. Similarly, higher levels of 25-OH-Chol were observed both in plasma and PF of patients compared with controls and the difference was statistically significant. A clear-cut tailing pattern was observed in DNA of patients with endometriosis, indicating significant DNA damage. CONCLUSION(S) Our observations implicate oxidative stress in the pathophysiology of endometriosis. For the first time, we demonstrate that 8-iso-PGF(2alpha) and oxysterols (the known promoters of steroidogenesis) might be the culprits in this disease.

In vitro effects of atorvastatin on lipopolysaccharide-induced gene expression in endometriotic stromal cells

OBJECTIVE To investigate the in vitro effects of atorvastatin on lipopolysaccharide (LPS)-induced gene expression in endometrial-endometriotic stromal cells. DESIGN In vitro experimental study using flow cytometry, ELISA, semiquantitative reverse transcriptase polymerase chain reaction, and Western blot. SETTING Postgraduate Institute of Medical Education and Research. PATIENT(S) Twenty-five women undergoing laparoscopy (n = 10) and laparotomy (n = 15). INTERVENTION(S) Endometriotic cyst wall (group I) and endometrial biopsy (group II) collection. MAIN OUTCOME MEASURE(S) The endometrial-endometriotic stromal cells were isolated from ectopic (group I) and eutopic (group II) endometrium by established methods, cultured, and stimulated with LPS (1 μg/mL), followed by atorvastatin treatment in a time- and dose-dependent manner to investigate the effects of LPS on proliferation (Ki-67) and expression of cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF), receptor for advanced glycation end products (RAGE), extracellular newly identified RAGE binding protein (EN-RAGE), peroxisome proliferator activated receptor-γ (PPAR-γ), and liver X receptor-α (LXR-α) genes in endometrial-endometriotic stromal cells and on levels of insulin-like growth factor binding protein-1 (IGFBP-1) and 17β-E(2) in endometrial-endometriotic stromal cell culture supernatant. RESULT(S) Significant inhibition of Ki-67 and LPS-induced expression of inflammatory and angiogenic genes (COX-2, VEGF, RAGE, and EN-RAGE) was observed in atorvastatin-treated endometrial-endometriotic stromal cells. In contrast, a significant dose- and time-dependent increase in expression of anti-inflammatory genes (PPAR-γ and LXR-α) and levels of IGFBP-1 was observed after atorvastatin treatment in both the groups. However, atorvastatin treatment had no effect on 17β-E(2) levels in endometrial/endometriotic stromal cell culture supernatant. CONCLUSION(S) The data of the present study provide new insights for the implication of atorvastatin treatment for endometriosis in humans.

Prevalence and related risk factors of osteoporosis in peri- and postmenopausal Indian women

Aim: We undertook this study involving 200 peri- and postmenopausal women to determine the prevalence of osteoporosis, and in turn increase the awareness, education, prevention, and treatment of osteoporosis. Setting and Design: Postgraduate Institute of Medical Education and Research, UT Chandigarh, India, and a clinical study. Materials and Methods: A detailed medical, obstetrical, menstrual, and drug history was recorded in a proforma designated for the study. Height and weight was measured, weight-bearing exercise was assessed, and sunlight exposure per day for each woman was recorded. Food intake was estimated by using the 24-hour dietary recall method, and calcium and vitamin D consumption pattern was assessed. Bone mineral density (BMD) at postero-anterior lumbar spine and dual femurs was assessed by densitometer. Women were classified according to the WHO criteria. Statistical Analysis Used: Students t-test, multiple logistic regression analysis. Results: The prevalence of low BMD was found in more than half of this population (53%). The mean age in group I (normal BMD) was found to be 50.56 ± 5.74 years as compared to 52.50 ± 5.94 in group II with low BMD (P=0.02). The two groups were similar with respect to parity, education, socioeconomic status, family history of osteoporosis, hormone replacement therapy, and thyroid disorders. 46.8% of the women in group I and 33% of the women in group II had low physical activity and there was no statistically significant difference in sunlight exposure between the groups. Parity or the number of children and type of menopause was not seen to have much association with low BMD in our study. Lack of exercise and low calcium diet were significantly associated with low BMD. Multiple logistic regression analysis showed that age, exercise, menopause, and low calcium diet acted as significant predictors of low bone density. Conclusion: The findings from the study suggest the need for large community-based studies so that high-risk population can be picked up and early interventions and other life style changes can be instituted if there is delay in implementing national or international health strategies to tackle this increasing global health problem. Strategies to identify and manage low BMD in the primary care setting need to be established and implemented.

Minimal stimulation protocol for use with intrauterine insemination in the treatment of infertility.

Objective: To determine whether minimal stimulation with clomiphene and one injection of 150 IU of human menopausal gonadotrophin (hMG) provides pregnancy rates comparable with those in a conventional full hMG stimulation protocol for infertile patients undergoing intrauterine insemination (IUI).

Adenosarcoma of the uterine cervix with heterologous elements: a case report and review of literature

IntroductionAdenosarcoma of the uterus is a rare tumor composed of benign epithelial and malignant stromal components, usually encountered in young women. Till date, more than 100 cases of mullerian adenosarcoma of the cervix with homologous elements have been reported. However, only 15 cases of mullerian adenosarcoma of the cervix with heterologous elements are reported.Materials and methodsWe describe a case of mullerian adenosarcoma with heterologous elements of rhabdomyosarcoma and benign cartilage presenting as a cervical polyp in a young girl. The clinicopathological features and management of this rare entity is reviewed.ConclusionCervical adenosarcomas are rare tumors that may appear in reproductive age. Optimal therapy is still unclear, and a long-term follow-up is essential. Such cases need to be reported as accumulation of individual cases will be able to provide knowledge about its optimal therapy and prognosis.

Declining trends in syphilis prevalence among antenatal women in northern India: a 10-year analysis from a tertiary healthcare centre.

Syphilis is a disease that has been around for a long time and that continues to challenge clinicians, including obstetricians.1 Maternal syphilis has a severe impact on pregnancy outcome, primarily as spontaneous abortion, still birth and congenital syphilis.2 Screening of asymptomatic antenatal women is recommended to prevent perinatal complications.3 In developing countries such as India, screening for syphilis during pregnancy is carried out by Veneral Disease Research Laboratory (VDRL) tests. We undertook this retrospective study to analyse trends in syphilis prevalence among antenatal women in a tertiary care hospital of north India. Laboratory log books of antenatal syphilis testing from 1996–2005 were reviewed. A total of 40 511 serum samples were obtained from pregnant women attending (during the period January 1996 to …

Pregnancy complicated by severe chronic hypertension: a 10-year analysis from a developing country.

Objective: To assess pregnancy outcome in patients with severe chronic hypertension. Methods: A retrospective analysis of a 10-year period (1995–2004) in a referral hospital in northern India. The outcome was compared with those women with mild chronic hypertension who registered in the hypertensive disorders with pregnancy clinic immediately before and after each woman with severe chronic hypertension. Results: Hospital data identified 25 such women. Superimposed preeclampsia (36.4% versus 8%), preterm delivery (86.4% versus 42%), and perinatal mortality (27.2% versus none) were increased in patients with severe chronic hypertension as compared to those with mild hypertension. Conclusions: The small number of cases reflects the lack of antenatal supervision in developing countries. A much larger number of women are referred in the third trimester with eclampsia or severe preeclampsia, at which time it is not possible to identify whether or not they had underlying hypertension. Adverse events were found to occur more often in patients with severe chronic hypertension compared with those with mild hypertension.

Juvenile granulosa cell tumor of the ovary presenting with pleural effusion and ascites

Juvenile granulosa cell tumor (GCT) is a rare tumor, and the majority (90%) are reported in the prepubertal or under-30-year age group, in contrast to the adult type, which is more common in the fifth decade. On histopathological examination, juvenile GCTs are distinct from the adult type of GCT, and have a lower risk for late recurrences than the latter. Being solid tumors, they may be associated with ascites and pleural effusion (Meigs’ syndrome), which resolve after surgical removal of the tumor. Tumor markers for GCT are still investigational (inhibin) and of not much use in making a preoperative diagnosis, unlike in the case of germ cell tumors. In most of the reports about the initial surgical management of GCT, retroperitoneal lymph node sampling was not performed, and it was not done in the patient we report here. However, lymph node sampling is advocated for complete staging of these tumors, as a significant number of recurrences are reported in the retroperitoneum, as well as in incompletely staged patients. In the present patient, because of the association of Meigs’ syndrome, a preoperative diagnosis of benign tumors such as fibroma/thecoma was also considered. We report this rare tumor with an aim of reviewing the diagnosis and management from the reported literature.

Implication of the RAGE-EN-RAGE axis in endometriosis.

To investigate the involvement of the receptor gene for advanced glycation (RAGE), its ligand EN‐RAGE, and COX‐2 in endometriosis.