Diagnosing Cervical Lesions Through LLETZ – A Reliable and Effective Tool

Background: Cervical dysplasia is the most common gynecological disorder of modern era. It initiates around the squamocolumnar junction of the cervix commonly due to the infection of human papilloma virus. Large loop excision of transitional zone is globally a standard procedure of choice both for diagnosing and treating cervical dysplasia. Pap smear is a fast and easy assessment tool for detecting cervical lesions, but it is relatively unreliable. Methodology: Fifty patients of age group 35 to 65 years patients having normal looking cervix with abnormal pap smear or suspicious looking cervix with or without abnormal pap smear, were selected for the study after informed consent. The procedure for LLTEZ was performed under strict aseptic measures in the procedural room and the biopsy specimen was sent for histopathological examination. The pathological findings were presented as percentages. Results: 66% cervical biopsy specimens were suggestive of chronic cervicitis and 24% samples were suggestive of chronic cervicitis with squamous metaplasia. Mild dysplasia in 4% samples, moderate and severe dysplasia were seen in 2% samples. Conclusion: LLETZ is an efficient procedure to deal with cervical dysplasia. It must be recommended for the work-up of uncertain gynecological presentations. The expertise of professionals must be improved through training to obtain maximum benefits. Introduction Cervical dysplasia, which is the abnormal growth of epithelial tissue around the squamocolumnar junction (transformation zone) of cervix ranges from cervical intraepithelial neoplasm (CIN) stage I (mild) to stage III (severe). It evolves throughout the life span of a sexually active women. As the cervix is directly exposed to human papilloma virus (HPV), this is the most vulnerable site for dysplasia and carcinoma at a younger age. (1) HPV is the most common sexually transmitted infection among the sexually active women and HPV type 16 & 18 are precisely related to 70% of cervical cancers. (2) Supplementary risk factors comprise of unprotected sex at an early age, multiple sexual partners, multiparity etc. (3) Although it can be prevented through a vaccine and cured efficiently at a pre-invasive stage, it is the 4 most prevalent source of cancer related deaths worldwide with 85% share in the developing countries like Pakistan. (4) The aggravating factors are more socio-economical like lack of awareness and resources, guilt and anxiety. (5,3) Large loop excision of transformation zone (LLETZ) is the current gold standard treatment for all the patients with CIN. It is a dependable, inexpensive and minor surgical procedure, routinely used in outpatient department for diagnosis as well as treatment of the cervical lesions. LLETZ not only ensures the removal of abnormal tissue and provision of an adequate sample for histopathological studies but also doesn’t harm fertility. (6,7,8) Vaginal bleeding and discharge are its common complications while hemorrhage and cervical stenosis are the rare one. Pap smear is a cytology based highly sensitive screening test for the diagnosis of cervical cancerous and pre-cancerous lesions. Mitchell et al concluded that inadequate sampling and errors make the pap smear conclusion doubtful whether it is negative or positive for cytology hence the practice of relying on cytology should be discouraged and must be followed by histopathology through cervical biopsy. (9) Present study is conducted to observe its practicability, fruitfulness of the procedure and to find out the frequency of the cervical lesions in biopsy samples according to histopathological findings. Patients and Methods A hospital based descriptive study was conducted over fifty patients of age group 35 to 65 years at the Department of Obstetrics & Gynecology, Nishtar Hospital, Multan, Pakistan. In the outpatient clinic, the patients having normal looking cervix with abnormal 1. Department of Gynecology, Combined Military Hospital, Risalpur, Pakistan 2. Department of Gynecology, PAF Hospital, Musaf. Sargodha, Pakistan 3. Primary and Secondary Healthcare Department, Punjab, Pakistan 4. Department of Anatomy, Multan Medical and Dental College, Multan, Pakistan *Correspondence: zahrawasim1973@gmail. com

Doxorubicin Induced Histomorphometric Changes in the Kidney of Albino Rats and Protective Role of Nigella Sativa

Objective: Doxorubicin is presently a leading antineoplastic drug with promising efficacy. This study was designed to investigate the histological effects of doxorubicin toxicity on rat kidneys and how much protection is provided by Nigella Sativa. Materials & Methods: A randomized controlled trial conducted on thirty adult male wistar rats divided randomly into three equal groups. Group A served as a control. Group B was injected with weekly intraperitoneal injections of doxorubicin at a dose of 3mg/kg b.w. Group C rats received doxorubicin along with nigella sativa at a dose of 1000mg/kg b.w. orally daily. At the end of these interventions, animals were sacrificed and kidneys were removed for the purpose of histological staining. Renal glomerular and tubules related histopathological parameters were assessed qualitatively as mild, moderate & severe. Renal glomerular diameter was digitally measured by microscope. Ethical approval was taken from Ethical Committee, Jinnah Postgraduate Medical Centre (JPMC), Karachi. All the parameters were statistically analyzed. Results: Group B rats’ renal tissue was adversely affected by the drug showing marked necrosis of tubules and the glomeruli along with interstitial cells’ infiltration. Glomerular diameter was also significantly decreased in group B as compared to group A. These histological features in group C rats’ renal tissue were milder and glomerular diameter was close to that of group A. Conclusion: According to our study doxorubicin treatment proved noxious for the renal tissue, both tubules and glomeruli, while nigella sativa significantly competed against these pathological alterations.

Correlation between Calcium Phosphorus Product and Mean Arterial Pressure among Hemodialysis Patients with End Stage Renal Disease

Background: The mean arterial pressure serves as an expression of blood pressure in patients on chronic hemodialysis. Serum calcium phosphorus product is considered as a risk factor of vascular calcification that is associated with hypertension in the patients of end stage renal disease. The literature regarding this relationship is inconsistent therefore this study is designed to determine the correlation between calcium phosphorus product and mean arterial pressure among hemodialysis patients with end stage renal disease. Methods: A total of 110 patients of end stage renal disease on hemodialysis for at least one year, 20 to 60 years of age were included. Patients with primary or tertiary hyperparathyroidism, peripheral vascular disease, malignancy, hypertension secondary to any cause other than kidney disease were excluded. Mean arterial pressure was calculated according to the standard protocol in lying position. Blood samples for estimation of serum calcium and phosphorous were taken and was sent immediately to the laboratory for serum analysis. Results: Mean age was 44.17 ± 10.94 years. Mean calcium phosphorous product was 46.71 ± 7.36 mg/dl and mean arterial pressure was 103.61 ± 12.77 mmHg. The values of Pearson correlation co-efficient (r) were 0.863 for age group 20 to 40 years and 0.589 for age group 41 to 60 years. This strong positive correlation means that high calcium phosphorous product goes with high mean arterial pressure (and vice versa) for both the age groups. Conclusion: A strong positive relationship exists between the mean arterial pressure and calcium phosphorous product and is independent of patients’ age.

Quality of Nursing care in the perspective of Nurses at Tertiary Care Public Hospital, Karachi

Image Thresholding Using the Complement Feature

A new feature (the complement feature) is proposed in an Eigen formulations for performing global image thresholding. The goal is to find an intensity or gray-level value below which is the background while above it is the foreground (object). Each pixel in the image is represented by a (2D) unit vector where the x-component is the normalized (to [0,1] or [-1,1]) intensity of the pixel, while the y-component is its complement (e.g., Euclidian L2-Norm). The correlation matrix can then constructed to find the cross-correlation, Eigen vectors (axes of inertia) and Eigen values (description of respective sizes). Several implementations for each of the three previously mentioned categories are proposed to perform image thresholding. Interestingly, some of the proposed implementations do not require exhaustive search and a direct solution can be obtained. The results are promising on a wide range of images as demonstrated by comparison with the well-known Otsu method.

Local Features Supported by the Complement Feature for Image Segmentation

An Eigen formulation is proposed for image thresholding/segmentation. A vector composed of local features, normalized intensity of each pixel and that of the neighboring pixels, is used to represent each pixel. A “complement” component is appended to this vector to produce a “unit” vector. The auto-correlation matrix is computed for each pixel in the image using this unit vector. The first component (corresponding to the intensity of the current pixel) from all Eigen vectors, obtained from the auto-correlation matrix, are used as multi-level thresholds. Similar procedure can be adopted using powers of the current pixel intensity value. In general, more than one threshold can be obtained. Results on a wide range of images are demonstrated to show the effectiveness of the proposed schemes.

Multilevel Image Thresholding Using the Complement Feature

A novel Eigen formulation is proposed for image segmentation. Each pixel is represented by a unit vector having the x-component as the normalized gray value of the pixel. The axes of inertia are simply the Eigen vectors of the auto-correlation matrix. The largest Eigen vector is used as the point of split. Each sub-image is further split in the same way. The ratio of the smallest Eigen value to the sum of Eigen values represents the percentage of the minority and was used to control further splitting. The process continues until no sub-image is larger in size than this ratio. The results are very encouraging on a wide range of images.

c‑Abl‑mediated tyrosine phosphorylation of DNA damage response proteins and implications in important cellular functions (Review)

Tyrosine phosphorylation is an essential post‑translational protein modification catalyzed by tyrosine kinases. c‑Abl is a crucial non‑receptor tyrosine kinase, which is most commonly activated by auto‑phosphorylation, DNA damage and by interacting with other protein kinases. DNA damage response (DDR) proteins stimulated by DNA lesions or chromatin alterations recruit the DNA repair and cell cycle checkpoint machinery to restore genome integrity and cellular homeostasis. The fundamental roles of activated c‑Abl tyrosine kinase in cellular response pathways have been intensively and extensively investigated and in recent years, a number of c‑Abl protein binding partners have been determined; however, the functional roles of these molecules remain to be determined. The present review aimed to summarize the DDR proteins phosphorylated by c‑Abl tyrosine kinase that have been identified to date, in addition to the functional outcomes of these phosphotyrosine events. Notably, it has been discovered that c‑Abl tyrosine kinase can bind with and phosphorylate DDR proteins at different tyrosine sites, which serve distinct roles in various cellular contexts.

Estimation of time-parameters of Barker binary phase coded radar signal using instantaneous power based methods

Using Morphological Operation and Watershed Techniques for Breast Cancer Detection

Breast cancer is one of the leading causes of mortality between women, with one in eight women diagnosed with the disease, but early detection can reduce death rates. Therefore, continuous effort is being made to advance more effective methods for the early and effective diagnosis of breast cancer with high accuracy without human intervention. Classical attempts were manual, time- consuming and ineffective in many situations. The purpose of this work is to detect and locate the presence of malignant tissues in the breast using the morphological technique in mammogram images to diagnose breast cancer because morphology is one of the most reliable methods for early detection of breast cancer. The proposed algorithm is developed using watershed segmentation after the preprocessing is completed by the median filter to eliminate any expected noise, and contouring the tumor by morphological techniques to take the best diagnostic for breast cancer in a mammogram image. Good results are obtained for the measurements used like MSE, PSNR, SNR, entropy for the mammogram images.