Comparison of Office Hysteroscopy, Transvaginal Ultrasonography and Endometrial Biopsy in Evaluation of Abnormal Uterine Bleeding

Objective:

A comparison between office hysteroscopy, transvaginal ultrasonography and endometrial biopsy was performed, in terms of detection of intrauterine lesions. A secondary objective was assessment of evaluatory approach in the management of abnormal uterine bleeding in an outpatient setting.

Design:

Prospective observational study.

Material and Methods:

A total of 54 women were evaluated for abnormal uterine bleeding. Assessment included performance of an endometrial biopsy, a transvaginal ultra-sound scan followed by office hysteroscopy. Results of hysteroscopy were taken as the gold standard. Sensitivity and specificity of the investigations were assessed. The bleeding pattern was classified as heavy regular, irregular, postmenopausal and heavy or unscheduled bleeding on hormone replacement therapy.

Results:

The incidence of focal intrauterine lesions in patients presenting with abnormal bleeding was 52% for all ages and 31% for the postmenopausal group. Seventy-five percent of the patients with Hb < 11 gm% and 67% with an enlarged uterus harbored a focal pathology. The incidence of lesions in patients with heavy regular bleeding was 74%. The sensitivity and specificity of transvaginal ultrasound when compared with results of hysteroscopy was 0.60 and 0.88 respectively. A normal endometrial biopsy had a negative predictive value of 51%. The sensitivity and specificity of endometrial biopsy were 0.04 and 0.83, respectively.

Conclusion:

Both transvaginal ultrasound and endometrial biopsy exhibited poor sensitivity for detection of focal intrauterine lesions. Considering the significantly high incidence of intrauterine lesions in patients presenting with abnormal bleeding, the most cost-effective approach appears to be proceeding with hysteroscopy early in assessment.     

Serum malondialdehyde levels in Indian women

Mean MDA level in the fifty women was 3.41 +/- 0.75 nmol/ml [table: see text]     

Optimization of Ultrasonic Extraction of Major Phenolic Components from Flowers of Ghav-Patta (Argyreia Speciosa Linn.) Via Response Surface Model

Pharmaceutical Chemistry Journal - Ultrasound-assisted extraction (UAE) or ultrasonic extraction technology has been used for the isolation of bioactive compounds from Argyreia speciosa (Linn. f.)...     

New butyrylcholinesterase inhibitory steroid and peroxy acid from Leucas urticifolia

A new steroid leucisterol (1) and a new peroxy acid urticic acid (2) along with methoxybenzyl benzoate (3), 4-hydroxy benzoic acid (4), beta-sitosterol (5), and ursolic acid (6), have been isolated from the chloroform soluble fraction of the whole plant of Leucas urticifolia. Their structures were elucidated on the basis of nuclear magnetic resonance (1D and 2D NMR) spectral data. Leucisterol showed potent inhibitory activity against butyrylcholinesterase enzyme.     

Artemisinins and immune system

Artemisinins in combination with other antimalarial drugs remain the mainstay of current antimalarial armamentarium. It is interesting to note that many traditional drugs with antiprotozoal background can wield immunomodulation on the recipient's immune system in a positive or negative direction. Artemisinins also attribute immunomodulatory distensions. For instance, they demonstrate predominant immunosuppressive traits toward different immune components by particularly regulating the cellular proliferation and cytokine release, which indicates that they possess some additional mechanisms and features demanding deliberate attentions. This article reviews the data-based immunomodulatory effects of artemisinins on different immune cells including neutrophils, macrophages, splenocytes, T and B cells in conjunction with their therapeutic prospective with regard to inflammation, autoimmunity and delayed-type hypersensitivity.     

Ecotoxicological risks associated with tannery effluent wastewater

The problem of water pollution acquires greater relevance in the context of a developing agrarian economy like Pakistan. Even though, the leather industry is a leading economic sector in Pakistan, there is an increasing environmental concern regarding tanneries because they produce large amounts of potentially toxic wastewater containing both trivalent and hexavalent chromium, which are equally hazardous for human population, aquaculture and agricultural activities in the area. Therefore, we defined the scope of the present study as to employ different bioassays to determine the eco-toxic potential of tannery effluent wastewater (TW) and its chromium based components, i.e., potassium dichromate (K(2)Cr(2)O(7)) and chromium sulfate Cr(2)(SO(4))(3). Particle-induced X-ray emission (PIXE) analysis of TW was carried out to determine the concentration of chromium in TW and then equal concentrations of hexavalent (K(2)Cr(2)O(7)) and trivalent chromium Cr(2)(SO(4))(3) were obtained for this study. Cytotoxicity assay, artemia bioassay and phytotoxicity assay was utilized to investigate the eco-toxicological potential of different concentrations of TW, K(2)Cr(2)O(7) and Cr(2)(SO(4))(3). All the dilutions of TW, K(2)Cr(2)O(7) and Cr(2)(SO(4))(3) presented concentration dependent cytotoxic effects in these assays. The data clearly represents that among all three tested materials, different dilutions of K(2)Cr(2)O(7) caused significantly more damage (P<0.001) to vero cell, brine shrimp and germination of maize seeds. Interestingly, the overall toxicity effects of TW treated groups were subsequent to K(2)Cr(2)O(7) treated group. Based on biological evidences presented in this article, it is concluded that hexavalent chromium (K(2)Cr(2)O(7)) and TW has got significant eco-damaging potential clearly elaborating that environmental burden in district Kasur is numerous and high levels of chromium is posing a considerable risk to the human population, aquaculture and agricultural industry that can obliterate ecosystem surrounding the tanneries.     

Sleep in women

The timing and continuity of sleep in healthy individuals is regulated by the synchronous function of the sleep homeostasis and the endogenous circadian rhythms. Multiple factors affect these two processes and the way they interact. Sleep disorders may manifest differently in men and women and these differences are particularly notable during pregnancy, lactation, and menopause. Insomnia may occur relatively commonly during pregnancy and in the postpartum, and may be the result of either a primary sleep disorder, such as obstructive sleep apnea (OSA), movement disorders such as restless legs syndrome (RLS), or sometimes depression, especially in the postpartum period. Obstructive sleep apnea may contribute to a higher risk of hypertension during pregnancy and doubles the risk for preeclampsia and preterm birth. Snoring, a frequent symptom of OSA, increases in frequency during pregnancy. Restless legs syndrome is more common in pregnant women, is more frequent in the third trimester of pregnancy, and tends to improve dramatically after delivery. Factors associated with increased RLS in pregnancy may be related to iron and folate metabolism. Risk for OSA increases after menopause and presentation with insomnia can delay the diagnosis of OSA. Various treatment options for sleep disorders in women are discussed.