Showing papers by "Neerja Bhatla published in 2010"

Role of oxidative stress markers and antioxidants in the placenta of preeclamptic patients

Abstract: Aim: The present study aimed to evaluate and compare the placental variables of oxidative stress markers in preeclamptic women. Methods: A total of 60 placentas were collected. Of these, 30 were obtained from normotensive pregnancies, and 30 from pregnancies with preeclampsia as per International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Each placental tissue was analyzed for levels of pro-oxidant (malondialdehyde) and antioxidants (glutathione and superoxide dismutase) using the standard enzymatic assays. Results: Malondialdehyde levels were significantly higher (12.21 ± 4.1 versus 4.7 ± 2.1 nmol/g tissue, P < 0.0001) and glutathione (GSH) levels were significantly lower (0.46 ± 0.37 versus 1.03 ± 0.43 µmol/g tissue, P < 0.0001) in the placentas of preeclamptic women when compared to those of normal pregnancies. Though not statistically significant, decreases in superoxide dismutase levels were observed in placentas of preeclamptic women (4.14 ± 2.25 versus 5.22 ± 2.0 units/mg tissue protein, P < 0.055). Receiver operator characteristic curve analysis of malondialdehyde revealed a sensitivity of 87% and specificity of 87%, at a cutoff value 6.5 nmol/g. Similarly, GSH had a sensitivity of 77% and a specificity of 77% at a cutoff value 0.62 µmol/g. Conclusion: The present study demonstrated that increased placental lipid peroxidation and decreased levels of antioxidants may play an important role in the pathogenesis of preeclampsia. These findings are suggestive of involvement of oxidative stress markers in preeclamptic patients.

Immunogenicity and safety of human papillomavirus-16/18 AS04-adjuvanted cervical cancer vaccine in healthy Indian women

Abstract: Aim: India has the highest number of annual incident cases and mortality rates for cervical cancer worldwide. This study was conducted to assess the immunogenicity and safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted cervical cancer vaccine in healthy Indian women aged 18–35 years old. Methods: This double-blind, randomized (1:1), controlled and multicenter trial with two parallel groups, the Vaccine and Placebo groups, included 354 subjects in four centers across India. Subjects were given GlaxoSmithKline's HPV-16/18 AS04-adjuvanted cervical cancer vaccine or aluminum hydroxide placebo according to a 0, 1 and 6 month schedule and followed up until month 7. Serum samples were drawn at pre-vaccination and at month 7. Safety data were collected throughout the study. Results: A total of 330 subjects completed the study. One month post-Dose 3, all initially seronegative subjects in the Vaccine group had seroconverted for HPV-16 and HPV-18 antibodies with anti-HPV-16 and anti-HPV-18 geometric mean titer levels of 10226.5 EL.U/ml (95% confidence interval: 8847.1–11821.0) and 3953.0 EL.U/ml (95% confidence interval: 3421.8–4566.8), respectively. Initially seropositive subjects also showed an increase to similar geometric mean titer levels. Six serious adverse events (two in the Vaccine group and four in the Placebo group), all unrelated to vaccination, were reported. Commonly reported solicited local (injection-site pain) and general (fatigue, headache and fever) symptoms were similar in both groups. Compliance to the three-dose vaccination course was >97%. Conclusions: The AS04-adjuvanted HPV-16/18 cervical cancer vaccine was highly immunogenic and generally well-tolerated making it a potential tool for prevention and control of cervical cancer in India.

Circulating angiogenic factors in pregnancies complicated by pre-eclampsia.

Abstract: Background. Pre-eclampsia is an inflammatory disorder characterized by diffuse endothelial dysfunction possibly secondary to impaired trophoblast invasion of the spiral arteries during implantation. It is associated with alterations in maternal serum concentrations of vascular endothelial growth factor (VEGF), placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1). We did a case–control study to ascertain whether pre-eclampsia is associated with changes in serum concentrations of VEGF, PlGF and sFlt-1 in Indian patients. Methods. Serum samples were obtained from 40 women with pre-eclampsia and 40 normotensive, non-proteinuric pregnant women. The levels of VEGF, PlGF and sFlt-1 were analysed using ELISA. Results. In the sera of pregnant women with pre-eclampsia, the levels of sFlt-1 were significantly higher than those in the sera of normotensive, non-proteinuric pregnant women (median 11 295.25 v. 2936.2 pg/ml, p<0.0001), whereas there was a significant reduction in the levels of free VEGF (mean [SD] 170.53 [36.56] pg/ml v. 254.61 [47.39] pg/ml, p<0.0001) and PlGF (mean [SD] 236.77 [93.70] pg/ml v. 744.98 [168.55] pg/ml, p<0.0001). Conclusion. An increase in sFlt-1 levels and a simultaneous decrease in free VEGF and PlGF levels in the sera of women with pre-eclampsia as compared with normotensive, nonproteinuric pregnant women suggest that an imbalance between the levels of these pro- and anti-angiogenic factors may have a role to play in the pathogenesis of pre-eclampsia. Natl Med J India 2010;23:77–81

Treatment outcome of patients with carcinoma of vulva: Experience from a tertiary cancer center of India

Abstract: Purpose: The aim of our retrospective study was to analyze and report the clinical outcome of patients with vulvar carcinoma (VC) treated at our center. Materials and Methods: We retrieved the information regarding patients' clinical details, treatment given, survival and complications from the case records of all VC patients who were treated at our center during the year 1998-2005. Overall survival (OS) was determined with respect to age, histopathological grade, stage of disease, treatment group, pathological lymph node status, etc. Results: A total of 60 case records were retrieved for this retrospective analysis. Age ranged from 24 to 92 years (median 63 years). International Federation of Gynecology and Obstetrics (FIGO) stage distribution was as follows: stage I: 2 patients; stage II: 17 patients; stage III: 31 patients; stage IV: 9 patients; and unknown stage: 1 patient. Thirty-three patients underwent surgery (wide local excision 3, radical vulvectomy 30). Eleven patients received postoperative radiation therapy (PORT), 12 received palliative radiation therapy (RT) and 15 underwent definitive RT (5 of them received concurrent chemotherapy). Median follow-up period was 23 months (range 2-144 months). The 5-year OS for all stages was 41%. FIGO stage and pathological node positivity were found to be statistically significant prognostic factors for survival. Conclusion: Despite the majority of patients presenting in advanced stage, the 5-year OS of 41% in our series reflects a decent therapeutic outcome. The results have shown FIGO stage and pathological node positivity to be significant prognostic factors for survival. The use of preoperative chemotherapy/RT needs to be studied in our setup.

Textiloma, a rare pelvic tumor.

Abstract: Introduction Foreign bodies in the abdominal cavity are extremely rare findings. Their incidence is not known exactly because of under reporting of cases and they go unrecognized at times.