A Journey to Safe Motherhood in Pregnancy with Severe Cardiac Dysfunction- A Maternal Near Miss.

Worldwide about 287,000 maternal deaths occur every year, and significant variation exists between low/high/middle-income populations.[1] Maternal death has direct and indirect causes. Indirect maternal deaths result from conditions existing before maternity or recently developed not related to maternity, e.g. cardiovascular diseases, HIV/AIDS, anaemia, infections. World Health Organization (WHO) outlined it as a condition within which “a woman nearly died, however survived throughout pregnancy, childbirth or within 42 days of termination of pregnancy, just by a chance or good hospital care.”[2] Heart conditions presently represent the most common reason behind indirect maternal obstetrics deaths. Pregnancy is related to substantial and progressive hemodynamic changes beginning early in maternity, reaching their peak at the end of 2nd trimester and remaining comparatively constant till child-birth. Major alterations in maternity include a 30 to 50 percent increase in blood volume and cardiac output and decreased blood pressure. In cardiac pregnant patients, these modifications might cause clinical decompensation, exposing these patients to probably life-threatening situations.[3] Here we represent a similar case of a maternal near miss due to severe cardiac dysfunction reported at 8 months amenorrhea.

Tricuspid Valve Endocarditis Following Septic Abortion.

In patients of infective endocarditis, aortic valve is most commonly involved followed by the mitral valve. Pulmonary and tricuspid valves are the least involved valves. Multiple valves can also be involved and are seen in 17-22% cases.[1] Right sided infective endocarditis is seen in approximately 10% of the total cases.[2] Isolated tricuspid valve prevalence has been reported in the range of 2.5–3.1 % and isolated pulmonary valve involvement has been reported to be 2%.[3,4] Tricuspid valve (TV) endocarditis commonly occurs in intravenous drug users (IVDU) or any abnormality of the TV. The other causes could be, patients with implantable cardiac defibrillators (ICD), central venous catheter or right sided cardiac anomalies.[5] We report a case of a previously healthy young woman, who was neither an intravenous (IV) drug user nor had any congenital heart disease, who developed TV endocarditis after an induced abortion. This case exemplifies the need for strong suspicion for right-sided IE in patients presenting with pyrexia of unknown origin (PUO) or cardiorespiratory symptoms after gynaecological interventions.

Effect of Dhat Syndrome on Body and Mind

Introduction: Physical and mental issues related with loss ofsemen or "dhat" results in a disorder called as Dhat syndrome.It is a culture-bound disorder portrayed by unseemly and overthe top pain of losing semen from one's body. Aim: The aimof the study was to find the socio-demographic determinantsassociated with this disorder along with finding out variousphysical complaints and co-morbid psychiatric disorders. Thestudy also focused on evaluating the quality of life of patients.Material and Methods: 100 patients were included in thisstudy with selective sampling technique. Diagnosis of Dhatsyndrome was made according to ICD-10 DCR criteria.Socio-demographic determinants, physical complaints werenoted down. HAM-A, BDI II inventory and SF36 scales wereapplied.Results: Age less than 24 years, illiteracy, marriage andpeople living in rural area were strong factors associated withDhat Syndrome. Generalized weakness and body pain weretwo complaints which were present in all the patients. Almostall the patients had moderate to severe score on HAM-A andBECK’s II inventory. SF36 PCS and MCS showed scores lessthan 11.Conclusion: Socio-demographic variables play a pivotal rolein Dhat syndrome. Physical symptoms and mental disorderwere common amongst people suffering from Dhat syndrome.The quality of life of these patients were hampered. It is aserious entity which affects the whole body and mind. It alsodisrupts the quality of life

Effect of Adjunctive Sodium Valproate in Patients of Acute Schizophrenia

Introduction: Sodium valproate is an anticonvulsantwidely prescribed as a mood stabilizer for treating bipolardisorders. It’s role in treating schizoaffective disorders iswell documented. There are controversies regarding sodiumvalproate efficacy in schizophrenia. Although, some studieshave reported that it is effective in the management of positivesymptoms in acute psychosis, others have not found such anassociation. Study aimed at assessment the effect of adjunctivesodium valproate in acute stage of schizophrenia.Material and Methods: A total of 60 schizophrenic patients(age 18-45 years) were taken. They were randomly allocatedinto two groups, A and B. Patients in group A receivedatypical antipsychotic with placebo and in group B atypicalantipsychotic with adjunctive sodium valproate. Olanzapinewas taken as atypical antipsychotic in both groups.A diagnosis of schizophrenia was established based on ICD10 DCR criteria. All patients were assessed by PANSS andCGI-S at baseline and at 6 weeks. The collected data wereanalyzed by Student and Paired t-tests through SPSS.Results: Comparison of mean PANSS scores showedstatistically significant improvement in positive symptoms(p<0.014), general psychopathology (p<0.036) and total score(p<0.018) in group B patients as compared to group A. CGI-Sscores were also statistically significantly less in (p<0.011)group B patients as compared to group A after 6 weeks.Conclusion: Our study shows that if used as an adjunctive toantipsychotic in the management of acute psychosis, sodiumvalproate will speed up the recovery of positive symptoms

Unrelated renal transplantation: an ethical enigma.

End-stage renal disease (ESRD) is a condition better discussed than suffered. People suffering from ESRD are at a disadvantage not only financially, but also emotionally and in terms of the quality of their lives. The majority of their productive time is spent in hospital, on dialysis machines, or in the search for a suitable kidney donor, so that they may be able to improve upon the quality of their remaining lifespan. Only a “lucky few” are able to find a suitable matching donor, be it living (related) or a cadaver, whilst the others are left to fend for themselves. As the supply fails to cope with the demand, people go to the extent of exploring the pool of “unrelated donors”. Though not legalised yet, this is one domain yet to be explored in its entirety, both on humanitarian as well as ethical grounds. Our current work hopes to highlight this scenario and also provides a few options that may well become “ethically acceptable” in the not-so-far future.

Comprehensive analysis of etiology on the prognosis of urethral strictures

INTRODUCTION: Urethral strictures remain a reconstructive dilemma, due to high incidence of recurrence and less than satisfactory outcomes. Even experienced surgeons following strict surgical principles have not achieved optimal results, leading us to think whether the etiology of strictures dictate the outcome . We evaluated this "cause-effect" relationship highlighting the significance of the etiology on the overall prognosis of urethral strictures. MATERIALS AND METHODS: A total of 302 males with urethral strictures were assessed (both retrospectively and prospectively) over a period of ten years. The preoperative evaluation was performed by retrograde urethrogram, urethrosonogram, and uroflowmetry and categorized, based on etiology: a) as post traumatic, b) post infective, c) iatrogenic or d) unknown. Traumatic strictures were subjected to pelvic X-ray and sub-categorized into grades A, B and C, following the TILE classification. Patients were operated; with tunica albuginea urethroplasty for anterior strictures and U shape prostato-bulbar anastomosis for posterior strictures. RESULTS: Traumatic strictures accounted for 54 percent of cases. 127 of the 302 patients were treated using Tunica Albuginea Urethroplasty, while U shaped Prostatobulbar Anastomosis was performed on others. Post traumatic strictures had best outcome whereas post infective strictures had the worse outcome. Among strictures following pelvic fractures, TILE grades A and B had a better post operative course as compared to TILE C. Overall complication rate was 13.24 percent. CONCLUSION: Our study demonstrated that etiology of urethral strictures may play a vital role for the overall prognosis of urethral strictures.

Domestic cooking fuel exposure and tuberculosis in Indian women.

Background. A case-controlled study was undertaken to find out the possible relationship of biomass fuel and pulmonary tuberculosis. Methods. Ninety-five non-smoking females with sputum positive tuberculosis (TB) and 109 healthy controls were interviewed using a questionnaire to obtain detailed information on type of fuel used in homes, duration of cooking, passive smoking, location of kitchen, socio-economic status, adequacy of ventilation, number of people per room and respiratory symptoms occurring during cooking. Odds ratio (OR) was ascertained by logistic regression analysis. Results. The cases were from a low socio-economic status and the kitchens used by them were inadequately ventilated. Controls had less smoke accumulation in the rooms while cooking and cases had associated respiratory symptoms more often. Logistic regression analysis revealed that TB was significantly influenced by the location of the kitchen (OR 0.201, 95% confidence interval [CI] 0.08-0.51) and the presence of respiratory symptoms while cooking (OR 10.70, 95% CI 2.90- 39.56). The odds of having TB did not differ significantly among various fuel types either on univariate (OR 0.99, 95% CI 0.45- 2.22) or multivariate analysis (OR 0.60, 95% CI 0.22-1.63). Conclusions. No association was found between type of fuel used and TB. However, low socio-economic status, smoky rooms, location of the kitchen, ventilation and associated respiratory symptoms during cooking are likely to be important contributors.

Gastro-intestinal stromal tumour--a case report.

Gastro-intestinal stromal tumours are a heterogenous group of mesenchymal tumours mostly arising from the stomach and small intestine which may be benign or malignant. A 32-year female presented with abdominal pain and progressive distension of abdomen. On examination liver was enlarged 10 cm below right coastal margin, spleen was also enlarged and non-tender. Shehad marked pallor. On CT scan a hypervascular mass was seen in close relation to the duodenum and is continuous with the lumen of the 2nd part of duodenum. Upper GI scopy showed a proliferative growth in periampullary region with the histopathology of the growth showed features of gastrointestinal stromal tumour. There was no signs of malignant changes. Blood transfusion along with iron and folic acid tablet was the choice of treatment.