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Breast cancer is the most common malignancy in female patients with Li–Fraumeni syndrome (LFS), a rare autosomal dominant hereditary syndrome characterized by germline TP53 mutations. Recent studies have shown that the majority of these tumors are estrogen receptor (ER) positive with frequent HER2 co-expression. However, the morphologic features of these tumors have not been as well studied as other germline-associated breast cancers. We evaluated the pathologic features of 27 invasive and in situ carcinomas from patients with known germline TP53 mutations collected through the Li–Fraumeni Consortium. Overall, 60% of cases were HER2 positive and 44% showed ER co-expression. Most DCIS was high nuclear grade with central necrosis and associated periductal fibrosis and lymphocytic response. Invasive carcinomas were mostly of ductal type (NOS), modified Scarff–Bloom–Richardson (mSBR) high grade, with marked nuclear atypia and high mitotic rate. Prominent tumor infiltrating lymphocytes, syncytial growth pattern, or pushing borders were not seen in these tumors. High p53 IHC expression was seen in tumors from individuals with germline TP53 missense mutations whereas little or no protein expression (

Purpose: Exercise after breast cancer diagnosis is associated with lower cancer-specific mortality, but the biological mechanisms through which exercise impacts breast cancer are not fully understood. The Pre-Operative Health and Body (PreHAB) Study was a randomized window-of-opportunity trial designed to test the impact of exercise on Ki-67, gene expression, and other biomarkers in women with breast cancer. Experimental Design: Inactive women with newly diagnosed breast cancer were randomized to an exercise intervention or mind–body control group, and participated in the study between enrollment and surgery (mean 29.3 days). Tumor and serum were collected at baseline and surgery. Results: Forty-nine women were randomized (27 exercise, 22 control). At baseline, mean age was 52.6, body mass index was 30.2 kg/m2, and exercise was 49 minutes/week. Exercise participants significantly increased exercise versus controls (203 vs. 23 minutes/week, P < 0.0001). There were no differences in changes of expression of Ki-67, insulin receptor, and cleaved caspase-3 in exercise participants versus controls. KEGG pathway analysis demonstrated significant upregulation of 18 unique pathways between the baseline biopsy and surgical excision in exercise participants and none in control participants (q < 0.1). Top-ranked pathways included several implicated in immunity and inflammation. Exploratory analysis of tumor immune infiltrates demonstrated a trend toward a decrease in FOXP3+ cells in exercise versus control participants over the intervention period (P = 0.08). Conclusions: A window-of-opportunity exercise intervention did not impact proliferation but led to alterations in gene expression in breast tumors, suggesting that exercise may have a direct effect on breast cancer. See related commentary by Koelwyn and Jones, p. 5179

Objective: To find out the situation and causes of anaemia in pregnant women at MMIMSR during the study period with special reference to the severity of the disease and to find out foetal outcome in pregnant women with anaemia. Methods: The study was conducted in Department of Obstetrics and Gynaecology, MMIMSR, Mullana, Ambala(India). The study was carried out between the period of october 2012 to September 2014.A total of 200 cases of moderate and severe anaemia were included in the study on the basis of simple random sampling method and 200 cases of non anaemic subjects were included to serve as controls for the anaemic group, during the study period. Hb gm/dl was taken as criteria for deciding anaemia cases and also to classify them according to the severity. Cases were classified according to WHO criteria. Results: Out of 200 cases of anaemia, 70% were moderately anaemic (Hb 7 – 9.9gm/dl) and 30% were severly anaemic (Hb < 7gm/dl). Microcytic hypochromic type of anaemia (82.5%) was more prevalent suggesting nutritional inadequacies as cause of anaemia. Adverse foetal outcome in the form of preterm birth (17%), still birth (3.5%), low birth weight babies (27.5%), neonatal morbidity (23.3%) was more in the anaemic group than non anaemic controls Conclusion: Anaemia in pregnancy has adverse foetal outcome in the form of decreased birth weight, increased perinatal morbidity and mortality. Bangladesh Journal of Medical Science Vol.18(1) 2019 p.63-72

Background: Anaemia in pregnancy is one of the most important and common public health problem not only in India but also in most of the South East Asian countries. Anaemia is the most common nutritional deficiency disorder in the world. There is predominance of iron deficiency anaemia (nutritional anaemia). In pregnancy, it is one of the leading causes responsible for maternal and perinatal morbidity and mortality.Objective: To find out the risk factors associated with anaemia in pregnant women at MMIMSR during the study period with special reference to the severity of the disease.Methods: The study was conducted in Department of Obstetrics and Gynaecology, MMIMSR, Mullana, Ambala. The study was carried out between the period of october 2012 to September 2014.A total of 200 cases of moderate and severe anaemia were included in the study on the basis of simple random sampling method and 200 cases of non anaemic subjects were included to serve as controls for the anaemic group, during the study period. Hb gm/dl was taken as criteria for deciding anaemia cases and also to classify them according to the severity. Cases were classified according to WHO criteria.Results: Out of 200 cases of anaemia, 70% were moderately anaemic (Hb 7 – 9.9gm/dl) and 30% were severly anaemic (Hb < 7gm/dl). Microcytic hypochromic type of anaemia (82.5%) was more prevalent suggesting nutritional inadequacies as cause of anaemia.Conclusion: In the present study maternal illiteracy, low SES, inadequate antenatal care, close birth spacing, poor nutrition were all risk factors for anaemia in pregnancy Microcytic hypochromic type of anaemia (82.5%) was more prevalent suggesting nutritional inadequacies as cause of anaemia.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.583-592

Background: Anaemia in pregnancy is one of the most important and common public health problem not only in India but also in most of the South East Asian countries. Anaemia is the most common nutritional deficiency disorder in the world. There is predominance of iron deficiency anaemia (nutritional anaemia). In pregnancy, it is one of the leading causes responsible for maternal morbidity and mortality.Objective: To find out the maternal outcome in pregnant women with anaemia at MMIMSR during the study period with special reference to the severity of the disease.Methods: The study was conducted in Department of Obstetrics and Gynaecology, MMIMSR, Mullana, Ambala(India). The study was carried out between the period of october 2012 to September 2014.A total of 200 cases of moderate and severe anaemia were included in the study on the basis of simple random sampling method and 200 cases of non anaemic subjects were included to serve as controls for the anaemic group, during the study period. Hb gm/dl was taken as criteria for deciding anaemia cases and also to classify them according to the severity. Cases were classified according to WHO criteria.Results: Out of 200 cases of anaemia, 70% were moderately anaemic (Hb 7 – 9.9gm/dl) and 30% were severly anaemic (Hb < 7gm/dl). Microcytic hypochromic type of anaemia (82.5%) was more prevalent suggesting nutritional inadequacies as cause of anaemia. Higher incidence of preterm (17%), PPH (7.5%), maternal morbidity (14.5%) was found in anaemic group as compared to non anaemic controls.Conclusion: Anaemia in pregnancy has adverse maternal outcome in the form of maternal morbidity, preterm labour, and increased incidence of operative delivery.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.446-454

Background: The objective of the study was to evaluate the safety and efficacy of immediate postpartum intrauterine contraceptive device (PPIUCD) insertion in women delivering vaginally or by cesarean section. Methods: This prospective study was carried out at General Hospital [Tertiary care] from August 2014 to September 2015. All antenatal patients admitted for delivery to our hospital were counseled for PPIUCD. Also consent was taken from those who opted for PPIUCD insertion. Results: A total of 2016 women were counseled for PPIUCD adoption. Out of this, 1312 women accepted this method. Total number of deliveries during the study period was 2835. Total acceptance rate was 46.27%. The expulsion rate was 10.63% while removal rate was 7.74%. Out of 555 women who came for follow up, 453 women continued PPIUCD. Thus, continuation rate was 81.62%. Conclusions: PPIUCD is easily accessible, reversible and cost effective contraceptive method for most postpartum women specially lactating women.

Background: The objective of the study was to correlate hysteroscopic findings with histopathological findings in women with abnormal uterine bleeding and to study the accuracy of hysteroscopy in abnormal uterine bleeding. Methods: Settings: tertiary care hospital. Study design: prospective study. A prospective study was carried out in the Department of Obstetrics and Gynaecology at MMIMSR, Mullana, Ambala, from May 2011 to September 2013. 100 cases were selected for this study from patients who were admitted with history of abnormal uterine bleeding. Hysteroscopic examination was done in all patients post-menstrually, whenever possible, except in those cases where menstrual cycles were grossly irregular or patients came with continuous bleeding per vaginum. The patients then underwent dilatation and curettage and curettings was sent for histopathological examination. The correlation between findings on hysteroscopy and histopathological examination was done. Results: On hysteroscopy, 48% of the patients had either proliferative or secretory picture which was grouped as normal. The rest 52% of patients had some abnormality. Hyperplasia was the most common finding which was seen in 26% patients. The other findings included endometrial polyp 8%, myoma or myomatous polyp 7%, atrophic endometrium 4%, endometrial carcinoma, misplaced IUCD, and synechiae comprising 2% each and tubercular endometritis 1%. Conclusions: Hysteroscopy has a high sensitivity i.e. it can supplement and enhance the accuracy of tissue diagnosis. So, hysteroscopically directed biopsy would be an ideal procedure in abnormal uterine bleeding wherever facilities are available.

A broad ligament pregnancy is an extremely rare condition. Diagnosis is often missed and finally made during laparotomy. We present a case which remained undiagnosed throughout her pregnancy till she reached term and unfortunately had intrauterine foetal demise when she reported to our hospital. On clinical suspicion, ultrasound and magnetic resonance imaging evaluation was done which picked up the diagnosis of abdominal pregnancy. On laparotomy a broad ligament pregnancy was found with a rent in the previous Cesarean scar towards the gestational sac in the broad ligament.

To compare the efficacy of different intervals of misoprostol administration (simultaneously vis-a-vis 24 h), after mifepristone, in women undergoing medical termination of pregnancy up to gestation of 49 days. Eighty eligible women with single intrauterine pregnancy of ≤7 weeks of gestation requesting abortion were randomized to receive either 200 mg of mifepristone orally and 400 μg of misoprostol vaginally simultaneously (Group 1) or at 24-h interval (Group 2).Women who had no bleeding after the drugs were offered a second dose of misoprostol 24 h after the first dose. All patients were followed up on day 14. Primary outcome measure was the complete abortion rate. Secondary outcome measures were the induction–abortion interval, adverse effects, especially bleeding, and treatment acceptability rate. Treatment was considered a failure if surgical intervention was needed for any indication. Complete abortion was achieved in 38 women [95%; 95% confidence interval (CI) 88%, 100%] in Group 1 and 39 women (97.50%; 95% CI 93%,100%) in Group 2 (p = 0.56). A second dose of misoprostol was needed in two patients in Group 1 and in only one patient in Group 2. The induction–abortion interval was 6.50 ± 1.48 h in Group 1 and 5.95 ± 1.81 h in Group 2 (p = 0.13). The difference in frequency of adverse effects in the two groups was statistically insignificant (p = 0.18). The treatment acceptability rate was 97.50% in Group 1 and 95% in Group 2 (p = 0.56). Simultaneous administration of mifepristone and 400 μg vaginal misoprostol is an effective alternative to standard regimens for medical abortion up to 49 days of gestation.

A broad ligament pregnancy is an extremely rare condition. The eventuality of such pregnancies reaching full term is even rarer. A full-term broad ligament pregnancy occurring through a rent in a previous lower segment caesarean scar has only been mentioned in literature but not reported. Our patient is an unbooked case, reported to us at 39 weeks of pregnancy. On clinical examination, an ultrasound and an MRI, a diagnosis of abdominal pregnancy was made. Ultimately the final diagnosis was made only on laparotomy. A broad ligament pregnancy was found with a rent in the previous caesarean scar communicating the fetal sac.

Pyometrocolpos resulting from congenital obstructing lesions can present during early childhood and adolescence with varying signs and symptoms. Children with pyometrocolpos due to distal vaginal obstruction may present as acutely ill with obstructive uropathy and septicaemia. We present a case of a two year old girl with pyometrocolpos in whom drainage under anaesthesia lead to marked improvement of her clinical symptoms. Hydrometrocolpos is a condition in which the uterus and vagina are distended by retained fl other than blood in the presence of distal vaginal outlet obstruction. Secondary infection of hydro- metrocolpos leads to pyometrocolpos (pyometra). The condition is rarely diagnosed in the neonate or infant until the obstruction causes a significant fluid collection in the vagina above the ob- structing septum and cause compression effect to the surrounding structures. Diagnosis is made initially by abdominal ultrasonogra- phy but magnetic resonance imaging (MRI) is used for defi nitive diagnosis. It can be diagnosed prenatally, during the third trimes- ter by transabdominal sonography (1). In children the hydrometro- colpos present usually as suprapubic cystic mass with or without retention of urine which may be an acute emergency (2). Urgent drainage of the infected cystic mass leads to marked improvement in the clinical course of such patients who require defi nitive sur- gery at a later stage (3). Rarity and variable presentations can lead to delayed diagnosis and erroneous management.

Hydatidosis is a common zoonosis that affects a large number of humans and animals, especially in poorly developed countries. Mesenteric hydatid cysts are rare intra abdominal lesions with variable clinical symptoms and signs that make preoperative diagnosis diffi cult. The treatment is surgical excision followed by mebendazole for four months. We report this unusual case where preoperative diagnosis of right tubo-ovarian mass was made and the diagnosis of mesenteric hydatid cyst could be made only on laprotomy and microscopic examination after surgery.