SummaryBackgroundLithium has neuroprotective effects in cell and animal models of amyotrophic lateral sclerosis (ALS), and a small pilot study in patients with ALS showed a significant effect of lithium on survival. We aimed to assess whether lithium improves survival in patients with ALS.MethodsThe lithium carbonate in amyotrophic lateral sclerosis (LiCALS) trial is a randomised, double-blind, placebo-controlled trial of oral lithium taken daily for 18 months in patients with ALS. Patients aged at least 18 years who had ALS according to the revised El Escorial criteria, had disease duration between 6 and 36 months, and were taking riluzole were recruited from ten centres in the UK. Patients were randomly assigned (1:1) to receive either lithium or matched placebo tablets. Randomisation was via an online system done at the level of the individual by block randomisation with randomly varying block sizes, stratified by study centre and site of disease onset (limb or bulbar). All patients and assessing study personnel were masked to treatment assignment. The primary endpoint was the rate of survival at 18 months and was analysed by intention to treat. This study is registered with Eudract, number 2008-006891-31.FindingsBetween May 26, 2009, and Nov 10, 2011, 243 patients were screened, 214 of whom were randomly assigned to receive lithium (107 patients) or placebo (107 patients). Two patients discontinued treatment and one died before the target therapeutic lithium concentration could be achieved. 63 (59%) of 107 patients in the placebo group and 54 (50%) of 107 patients in the lithium group were alive at 18 months. The survival functions did not differ significantly between groups (Mantel-Cox log-rank χ2 on 1 df=1·64; p=0·20). After adjusting for study centre and site of onset using logistic regression, the relative odds of survival at 18 months (lithium vs placebo) was 0·71 (95% CI 0·40–1·24). 56 patients in the placebo group and 61 in the lithium group had at least one serious adverse event.InterpretationWe found no evidence of benefit of lithium on survival in patients with ALS, but nor were there safety concerns, which had been identified in previous studies with less conventional designs. This finding emphasises the importance of pursuing adequately powered trials with clear endpoints when testing new treatments.FundingThe Motor Neurone Disease Association of Great Britain and Northern Ireland.

Cervical cancer is second most common cancer of women in India. Screening of cervical cytology by simple papinocolou smear is an effective tool to detect premalignant lesions of cervix. Present study was retrospectively done to determine the cytomorphological spectrum of various cervical lesions and categorize them according to Bethesda system .All the patients presenting in gynaecological OPD and health camps with gynaecological complaints were included and subjected for PAP smear. Most common complaint and physical examination finding was abnormal vaginal discharge (46.3%) and erosion on cervix (46%) respectively. A total of 300 cervical smears were evaluated out of which 22 (7.3%) cases were unsatisfactory for evaluation, 49 (16.3%) were Negative for intraepithelial lesion or malignancy (NILM) and 196(65.3%) of NILM inflammatory category. Epithelial cell abnormality were seen in 33 (11%) with ASCUS in 15 (5%), LSIL in 12 (4%) and HSIL in 6(2%) cases. Maximum number of abnormal cases 15 (5.3%) were in age range 40-49. Cases of carcinoma were not encountered. The study enforces the significance of PAP smear screening in all the women at appropriate interval for reducing prevelance of cervical cancer in developing country like India. INTRODUCTIONCancer cervix is a disease of global burden and stands as third most common cancer in women worldwide (Sreedevi A et al 2015). In India it is second most common cancer with a peak incidence 55-59 years (Dhananjaya S et al 2014) Mortality varies eighteen fold between the different regions of the world, with rates ranging from less than 2 per 100,000 in Western Asia, Western Europe and Australia/New Zealand to more than 20 per 100,000 in Melanesia, Middle and Eastern Africa as per GLOBACON cancer fact sheet. According to world health organization approximately 80% of cervical cancer deaths occurred in developing countries. In India the mortality rate varies between 9.8-17.5 per 100,00. Without urgent intervention, deaths due to cervical cancer are projected to rise by almost 25% over the next 10 years. (Consul S et al 2012) The high mortality rates is attributable to the presentation of patient at later stages of disease. It is partly contributed because of subtle clinical features of disease.Most of the disease comes into attention only after the onset of symptoms and unfortunately in late stages. One of the major management challenges encountered is late presentation, as more than 56.0% of the cases present in stages III and IV. (Eze JN et al 2013). Data suggest that more than half of cervical cancer cases could be prevented through adequate screening. Fifty percent of women diagnosed with cervical cancer have never undergone cervical cytology testing and another 10% have not received screening in the five years preceding their diagnosis. Furthermore, cervical cancer is very rare among screened women as less than 10 per 100,000 annual (Sokol RJ et al2003). This outlines the significance of regular and periodic screening of all sexually active women. The cancer in spite o...

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