Ml Patel

correlation of serum neutrophil gelatinase- associated lipocalin with acute kidney injury in hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy (HDP) remain one of the largest single causes of maternal and fetal morbidity and mortality, accounting for 16.1% of maternal deaths in developed countries. The aim of the study was to evaluate acute kidney injury (AKI) in hypertensive disorders of pregnancy and to examine the correlation of serum neutrophil gelatinase-associated lipocalin (NGAL) with acute kidney injury. This prospective case control study was carried out over a period of 1 year. After written, informed consent and ethical clearance, 149 cases of hypertensive disorders of pregnancy were screened, and seven were lost to follow-up. Acute kidney injury was detected in 88 cases and acute renal failure in 30 cases of HDP. Thirty-one healthy pregnant nonhypertensive women were enrolled as controls. Quantitative measurement of serum NGAL levels was done by enzyme linked immunosorbent assay technique using a sandwich enzyme-linked immunosorbent assay kit. As per the Kidney Diseases Improving Global Outcomes International guidelines acute kidney injury network (AKIN), 50 cases (42.37%) of AKI stage I, 38 (32.2%) cases of AKI stage II, and 30 (25.42%) cases of renal failure were detected. Serum NGAL had a positive association with increasing proteinuria. It also had a positive correlation with systolic blood pressure (r∼0.36), diastolic blood pressure (r∼0.37), and serum creatinine (r∼0.4). NGAL was found to be significantly correlated with creatinine in the cases with the value of the correlation coefficient being 0.4. This direct correlation might be a consequence of endothelial dysfunction on which hypertension and proteinuria probably depends.

Ischemic Stroke in Young due to Combined Protein C and S Deficiency

WHO defines stroke as an event caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue [1]. Globally, stroke is the third commonest cause of mortality [2] and the fourth leading cause of disease burden [3]. Ischemic stroke is the most common cerebrovascular disease, most often due to atherothrombotic diseases and uncommonly by disorders of hypercoagulation. Disorders of coagulation leading to thrombotic disorders are approximately 1% of all ischemic strokes and 4-8% of young strokes. Similarly combined deficiency of protein C and S can lead to hypercoagulable state and rarely present as cerebrovascular accident. We describe here a rare case of 27 year old male who presented with right middle cerebral artery territory infarct due to combined protein C and S deficiency.

Complete axial torsion of pregnant uterus with leiomyoma.

Uterine torsion is defined as a rotation of the uterus of more than 45° along its long axis. It is a rare complication during pregnancy; a common cause of torsion can be uterine myoma. Here we describe the case of a 27-year-old G2P1+0 woman at 15u2005weeks 3u2005day pregnancy, who presented to our outpatient department as a case of acute abdomen, in a state of shock. Clinical findings did not correlate with investigation. On lapratomy she was diagnosed as a case of complete axial torsion of pregnant uterus with fundal myoma with massive abruption. Early diagnosis and timely intervention would help in improving both maternal and fetal outcome.

Correlation of serum neutrophil gelatinase associated lipocalin with disease severity in hypertensive disorders of pregnancy

Background: Vascular endothelial dysfunction is considered central to the pathogenesis of hypertensive disorders of pregnancy (HDP). Serum level of neutrophil gelatinase-associated lipocalin (NGAL) is closely related to endothelial injury. The aim of this study was to examine the correlation of serum NGAL with disease severity in HDP. Materials and Methods: This prospective case-control study was carried out for one year. After informed consent, ethical clearance, total 1,850 pregnant women were screened. Analysis was performed on 142 cases of HDP and 31 healthy controls. Quantitative measurement of serum NGAL levels was done by the enzyme linked immunosorbent assay (ELISA) technique, by using sandwich ELISA kit. Results: Mean serum NGAL value in patients with oliguria was significantly higher when compared with non-oliguric patients (P < 0.001). Serum NGAL had a positive correlation with systolic blood pressure (r ~ 0.5973), diastolic blood pressure (r ~ 0.6195), blood urea (r ~ 0.4392), serum creatinine (r ~ 0.6112), serum uric acid (r ~ 0.3878). Sensitivity and specificity of serum NGAL using a cut-off value of 545 pg/ml, for the diagnosis of HDP, was 97.89% and 93.55% respectively, using 95% confidence interval. Conclusion: Between the two groups, we found that serum NGAL had a positive correlation with disease severity and better sensitivity and specificity in the evaluation of HDP.

A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation

Objective: The objective of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions. Methods: All women who visited the outpatient gynecology clinic of the Department of Obstetrics and Gynaecology at King Georges Medical University, Lucknow, UP, India, over 1 year for different clinical problems were recruited for the study. A total of 1650 women who were sexually active and over 21 years of age were enrolled in the study. A clinical examination, an examination per speculum, and a vaginal examination were performed and a history taken for all women. A Pap smear was used for all women to screen for cervical cancer. The smear was obtained using an Ayre spatula and spread over a marked glass slide, which was placed in 95% ethyl alcohol and sent to the Department of Pathology for cytopathological examination. All data were recorded using a predetermined pro forma. Women who had visible malignant cervical lesions were excluded from the study. Results: Most women were in the age range of 30–50 years and multiparous. Vaginal discharge was the most common complaint, occurring in 36.96% of the women. An irregular menstrual cycle was the complaint of 12.78% and abdominal pain of 25.63% of women, while 15.15% were asymptomatic. The Pap smear test of 93.57% of the women was adequately taken, while 6.42% of the individuals had an inadequate sample. The test was negative for malignancy in 48.84%, and 42.66% had infection or inflammation. Atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL) were detected in 2.90%, 5.09%, and 0.48%, respectively. Women with Pap tests positive for ASCUS, LSIL, and HSIL underwent a colposcopy and guided biopsy. Conclusions: Women with an abnormal Pap test should undergo a colposcopy, and those with abnormal colposcopy findings should be advised to undergo a biopsy. A Pap smear is simple, noninvasive, cost-effective, and easy to perform for detection of precancerous lesions in a gynecological patient.

Symmetrical peripheral gangrene: Unusual complication of dengue fever.

Symmetrical peripheral gangrene (SPG) is a rare clinical entity, infective, and noninfective both types of etiologies are responsible. The basic underlying pathology in SPG is being disseminated intravascular coagulation and carries a high mortality. Here, we describe a 52-year-old male with dengue fever, who developed bilateral symmetrical dry gangrene of both hand and feet. His dengue IgM antibody was positive. All the peripheral pulses of the affected limbs were palpable. Color Doppler study of upper and lower limb vessels showed normal flow. The patient was managed with intravenous fluids, low molecular weight heparin, and fresh frozen plasma. His general condition was improved within 72 h with no further progression of gangrene. Clinician should suspect the possibility of SPG while dealing a case of dengue fever presenting as peripheral gangrene.

Various neurological manifestations in HIV positive patients, their outcome and its correlation with CD 4 counts- A tertiary centre experience in North Indian population

The central nervous system (CNS) is among the most frequent and main target of HIV infection in severely immunocompromised patients. Neurological m anifestations occur due to either primary pathologic process of HIV or secondary to opportuni stic infection. The present study was conducted to ascertain the prevalence of various neurological ma nifestations in HIV positive patients, correlation of CD4 levels in CNS opportunistic infection and their ou tcome. This was a prospective observational study of 105 HIV infected patients with clinical ev idence of CNS involvement. A detailed clinical hist ory and CNS examination was carried out. CD 4 counts was measured by flow cytometry method and o ther investigations like magnetic resonance imaging (MRI ), brain/electromyography, nerve conduction studies and cerebrospinal fluid (CSF) examination w ere done as required for diagnosis. HIV induced primary illness was present in about 30% cases whil e 70% associated with secondary CNS manifestations were mainly due to opportunistic inf ection. The most common primary illness was distal symmetrical polyneuropathy (20.9%), followed by AID S dementia complex (3.8%), acute inflammatory demyelinating neuropathy (3.8%). On the other hand, the most common secondary CNS infection was tuberculous bacterial (TBM; 32.3%), followed by cry ptococcal meningitis (13.3%), progressive multifoca l leukoencephalopathy (PML; 11.4%), and cerebral toxo plasmosis (9.5%). The commonest presenting symptoms of TBM were fever (72.38%), while headache and vomiting was 27.62 and 28.57%, respectively. Mean CD 4 count was 172 ± 81.2 in distal symmetrical polyneu ropathy (DSPN), 282 ± 75.3 in acute inflammatory demyelinating neuropathy (AIDP) and 95 ± 6.5 for AIDS dementia complex.

Squamous cell carcinoma antigen reproducible marker and its clinicopathological correlation with preinvasive and invasive cervical cancer

Background: Squamous cell carcinoma antigen (SCC-Ag) is a serologic tumor marker detected in SCC of the cervix. The aim of this study is clinical features and their histopathological correlation between preinvasive and invasive cervical cancer and its association with SCC-Ag levels. Materials and Methods: This case–control study was carried out over a period of 1 year in the Department of Obstetrics and Gynaecology, with collaboration of pathology and medicine. After informed consent and ethical clearance, totally 3200 women were recruited. Out of these, 76 women who were histopathological proven, 30 preinvasive, and 46 of invasive cervical malignancy (International Federation of Gynecology and Obstetrics Stage I–IV) enrolled for study. 15 healthy cytology negative were considered as controls. Per speculum, per vaginam examination was done in every women and pap smear was obtained. Pretreatment 5 ml venous blood samples were drawn into sterile vials. SCC-Ag levels were measured by enzyme-linked immunosorbent assay (ELISA) technique using ELISA Kit as per producer protocol. Results: Among preinvasive group, 35.46% women complained white discharge per vaginam. Blood mixed discharge and postcoital bleeding were observed in 3.4% and 0.71%, respectively. In malignant group, foul smelling discharge and postmenopausal bleeding were reported in 1.68% and 1.87% women, respectively. Serum SCC-Ag levels were increased from controls to cases. In controls, 0.27 ± 0.12 ng/ml, preinvasive 0.85 ± 0.37 ng/ml and in invasive malignancy Stage I, II, III, IV, 2.10 ± 0.55 ng/ml, 3.15 ± 0.84 ng/ml, 4.12 ± 0.89 ng/ml, and 2.71 ± 1.05 ng/ml, respectively. Moderately differentiated and poorly differentiated SCC were reported in 80.43% and 19.56%, respectively. Expired patients had significantly (P < 0.01) higher premean SCC Ag level as compared to those who remain alive. Conclusion: Serum SCC-Ag is not only useful in the detection of preinvasive lesions and early invasive cases of cervical cancer but also a definite indicator for advanced Stage malignancy. Its value was quite high in late stages of cervical malignancy, thus it can be used as reproducible marker in cervical cancer.

Uterine leiomyosarcoma presenting as chronic inversion of uterus- A rare case report

Sarcomatous change in uterine fibroid is termed leiomyosarcoma. The tumor originates from smooth muscle cells and is rare, accounting for 2 to 5% of all uterine malignancies. The said patient had the history of irregular bleeding, but not typical menorrhagia, which is the usual presentation in this tumor. A 40 year old, P4+0 women of North Indian origin, was admitted with huge polypoidal fungating mass with bosselated surface and variegated mass protruding from introitus consistently. It was 12 ×10 cm in size with fundal cuping and cervical rim around the mass, which indicates inversion of the uterus. Total abdominal hysterectomy with bilateral salpingoophorectomy and bladder repair was done via abdomino-perineal route and the histopathology confirmed the diagnosis of leiomyosarcoma. Because of their rarity, uterine sarcomas are not recommended for routine screening. Surgery is the only treatment modality of leiomyosarcoma and prognosis depends upon the stage of the cancer. Key words: Leiomyosarcoma, inversion, hysterectomy.