Retrospective study of placenta accreta, placenta increta and placenta percreta in Peripartum hysterectomy specimens

Background: Abnormal placentations such as placenta accreta, placenta increta and placenta percreta are important causes of hemorrhage after delivery causing maternal morbidity and mortality. Risk factors for abnormal placentation are prior caesarean section, placenta previa and pre-eclampsia. There is a need for reliable antenatal diagnosis for these serious conditions. If these pregnancies can be identified, antepartum, site and time of delivery as well as the surgical approach can be planned ahead; this decreases the incidence of maternal mortality due to massive hemorrhage. Aim: (1) To study the incidence of abnormal placentation in emergency peripartum hysterectomy specimen. (2) To evaluate various risk factors associated with abnormal placentation. Materials and Method: Retrospective cross-section study done in patients with abnormal placentation leading to emergency peripartum hysterectomy during a course of eight-year period. Result: We received total of 18 emergency hysterectomy specimens during eight-year period of which placenta accreta accounts 55.5 percent (10/18), placenta increta upto 38.8 percent (7/18) and placenta percreta 5.5 percent (1/18). Analysis of result with parity shows uniparous women up to 22.2 percent (4/18), and multiparous women 77.7 percent (14/18). Risk factor analysis shows previous caesarean section in 55.5 percent (10/18), placenta previa in 33.3 percent (6/18) and pre-eclampsia in 11.1 percent (2/18). Conclusion: In our study, among abnormal placentation, incidence of placenta accreta accounts for 55.5 percent and it is more common in multiparous women than uniparous women. Among risk factors in our study, previous caesarean section is commonly associated with abnormal placentation followed by a placenta previa and pre-eclampsia.

A Cross Sectional Study on Quality of Life Measurements for Patients with Chronic Suppurative Otitis Media in a Tertiary Care Centre - A Chronic Ear Survey.

Introduction: Chronic suppurative otitis media (CSOM) is achronic suppurative inflammation of mucoperiosteal layer ofthe middle ear cleft appreciated by perforation of the tympanicmembrane. CSOM can severely impact quality of life (QoL)of patients. QoL is the latest indicator of health care. The aimwas to assess the quality of life in CSOM (Chronic suppurativeotitis media) patients in a tertiary care centre.Materials and methods: It was a descriptive epidemiologicalstudy and sample size is approximately 60 using aQuestionnaire by interview method - the CES questionnaire(Activity Restriction, Symptom and Medical Resource).Results: In the end we came to know QoL is not affected inCSOM patients (p<.05) in terms of age, gender with activityrestriction, symptom and medical resource.Conclusion: Hence concluded that quality of life is notaffected in csom patients and though the health seekingbehavior has increased, the knowledge about the disease isminimum. We have to promote health education about thedisease. Further studies with larger sample size necessary toget significant correlation in QoL of csom patients.

Prevalence Of Urinary Tract Infection In Febrile Children Admitted In Pediatric Wards In Government Medical College, Srikakulam

INTRODUCTION: Urinary Tract Infection (UTI) is a common bacterial infection in children with variable symptomatology. Urinary tract infection is the third most common bacterial infection in children in developing countries after those of gastrointestinal and respiratory tract MATERIALAND METHODS: This hospital based observational study was conducted prospectively for one and half years between March 2017and Sep 2018 at government general hospital, pediatric ward, srikakulam. RESULT:Atotal number of 312 febrile children fulfilling the inclusion criteria (n=312). In the study group, 65 children were diagnosed to have UTI, on basis of a positive culture test. There were 121 male children and 191 female children in the study group. There were 65 cases of UTI accounting for an overall prevalence of 20.83%. Out of 121 male children 23 had culture positivity (19%) whereas out of 191 female children 42 had culture positivity (21.98%). In the age group of 1-5 years 27 [19.85%] cases were culture positive. Among 6-12years 38 cases were positive [21.59%]. This difference is not statistically significant with p value 0.86. CONCLUSIONS :The prevalence of culture positive UTI in febrile children presenting with a clinical features other than urinary tract symptoms is 16.28%, which represents a high yield .Most of the organisms isolated are sensitive to cefotaxime {75.38%}, amikacin{73.84%}, gentamycin{64.61%},ciprofloxacin{63.07%}.

Idiopathic granulomatous hypophysitis: A report of an uncommon disorder

Hypophysitis of the pituitary gland is a rare inflammatory disorder and broadly classified as primary and secondary hypophysitis. Primary hypophysitis is mainly of lymphocytic, granulomatous, and xanthomatous types. Among the various primary hypophysitis, granulomatous hypophysitis is rare type with an incidence of 1 in 10 million. The various forms of hypophysitis are misdiagnosed as pituitary adenoma in 40% cases. Idiopathic granulomatous hypophysitis is even rarer inflammatory disorder accounting for <1% of cases involving panhypopituitarism with headache and visual disturbances. We report idiopathic granulomatous hypophysitis in a 28-year-old female presenting with blurring of vision and headache.

Neck swelling after sneezing.

A 29-year-old, non-smoker male presented with a painless neck swelling with a sudden onset after a bout of violent sneezing two days ago. He had no other remarkable medical history except for seasonal allergic rhinitis for the past three years. He was referred for evaluation after being advised an antihistaminic drug for the relief of nasal symptoms. Bilateral crepitant swelling was found in the neck on physical examination.

Onychomycosis: a significant medical problem.

The importance of onychomycosis is often underestimated. Far more than being a simple cosmetic problem, infected nails serve as a chronic reservoir of infection which can give rise to repeated mycotic infections of the skin. 448 patients with nail abnormalities attending Skin O. P. D of King George Hospital, Visakhapatnam during a 1 (one) year period between November'98-October'99, were subjected to detailed clinical, epidemiological study. Diagnosis was confirmed in 204 cases by direct microscopy or culture or by both. Females (51.96%) were slightly more than the males (48.04%). Majority of the cases were between 21-40 years age group. Housewives (33.33%) were most frequently affected. Trauma was a predisposing factor in 11.27% of the cases. The duration of lesions varied from 3 months to 15 years. In the majority (38.23%) it was less than one year. Candidal onychomycosis was the most prevalent clinical type (58.82%) followed by distal subungual onychomycosis (38.72%). Disease was limited only to finger nails in 57.35% and toe nails in 32.35%. Predominant isolates obtained were candida spp. (56.7%), followed by dermatophytes (38.2%) and non-dermatophyte molds (3.37%). 26.96% of the patients had experienced physical, psychosocial and occupational problems.

Changing anaerobic spectrum in suppurative lung disease: a case report.

A spectrum of three different anaerobes were isolated from a debilitated patient with suppurative lung disease, within a two-year period. Repeated isolation from three consecutive samples and symptomatic relief with metronidazole provide clinical evidence of anaerobic lung infection. This case emphasizes the importance of anaerobic culture in cases of protracted pulmonary suppurative disease.

Fungal colonization in gastric ulcers.

Until now studies on fungal colonization of gastric ulcers were retrospective involving small series of patients. This prospective study of 50 patients with gastric ulcers (25 benign and 25 malignant) revealed colonization by Candida in 17 (34%) cases. There was no significant difference in colonization between benign and malignant ulcers. Follow up revealed no difference in healing of ulcers with or without fungal colonization.

Bacteriological study of bronchoalveolar lavage in immunocompromised hosts.

Sixty bronchoalveolar lavage samples collected from lung cancer patients attending the Pulmonary Tuberculosis and Chest Diseases Unit of the Kasturba Medical College Hospital, Manipal; were cultured for both the aerobic and anaerobic organisms. Fifty nine samples yielded bacteria in pure culture. Pseudomonas aeruginosa (34.8%) was the commonest aerobe, Peptostreptococcus was the commonest anaerobe (45.2%) isolated. Bacteroides fragilis was isolated in (23.8%) of cases. Gentamycin was found to be effective against aerobes, Metronidazole and Rifampicin against anaerobes.

Bacteriology of bile in obstructive jaundice.

Bile from 25 patients with obstructive jaundice was cultured for both aerobic and anaerobic organisms. Twenty one samples were positive for culture. Mixed bacterial growth was seen in 5 (20%) of the bile samples 25 aerobes and one anaerobic were isolated. Escherichia coli was the commonest aerobic isolate and Bacteroides fragilis was the single anaerobe isolated. Majority of the aerobes isolated were sensitive to gentamycin.

Bacteriology of peritoneal fluid in paediatric surgical emergencies.

This study deals with the incidence of aerobic and anaerobic organisms of the peritoneal fluid of 60 consecutive children subjected to emergency celiotomy. Two-thirds of the cases were below the age of year. Peritoneal fluid was collected immediately after entering the peritoneal cavity and inoculated both for aerobic an anaerobic cultures. Bacterial growth occurred in 34 (57%) of the specimens. Anaerobic bacteria alone grew in 3 (5%) of the specimens, aerobes alone in 22 (37%) of specimens. A mixed aerobic and anaerobic bacteria grew in 9 (15%) of the specimens. There were 44 aerobic and 19 anaerobic isolates. All anaerobes were sensitive to metronidazole while most of the aerobes were sensitive to gentamycin. Culture was positive in 20 out of 42 (47.6%) specimens, where the peritoneal fluid was clear and there was no evidence of peritoneal contamination at the time of surgery.

Role of follicle stimulating hormone in the induction of hyperplasia during compensatory ovarian hypertrophy.

In adult rats, removal of one ovary leads to an acute albeit transient rise in serum follicle stimulating hormone and an increase in the weight of the remaining ovary. In an attempt to correlate the high titre of endogenous follicle stimulating hormone with the changes taking place at the macromolecular level, the phenomenon of compensatory ovarian hypertrophy was studied for one cycle after hemiovariectomy at metoestrus in the adult, cycling female rats derived from the Holtzman strain. The significant finding with respect to hormonal changes was an acute follicle stimulating hormone surge commencing 6h post-unilateral ovariectomy, reaching a maximum at 12 h and declining thereafter, hitherto not reported in the Holtzman strain. Serum luteinizing hormone, prolactin, oestradiol-17ß and testosterone remained unaltered while progesterone showed a decline at 6 h after surgery. There was an increase in the number of healthy class III (> 350 μm) follicles with a concomitant drop in atretic class III follicles 24 h post-unilateral ovariectomy. Analysis for DNA, RNA and protein content showed that all three constituents registered a continuous rise in the hypertrophying ovary up to 120h after surgery. When expressed as μg/mg ovarian weight, the increase in DNA reached a maximum at 24 h and declined thereafter. The kinetics of DNA synthesis was followed by pulse labelling with [3H] thymidine at 18, 24, 36 and 48 h after unilateral ovariectomy. Maximum incorporation occurred at 36 h. Autoradiographic studies showed that the granulosa cells of healthy follicles preferentially incorporated the label. In an extension of this study, it was found that labelling index registered a significant increase following ovariectomy, the maximum being reached at 24 h especially in class III follicles. The results clearly point out the crucial role of hyperplasia in the response of the contralateral ovary to the surgery and implicate the rise in follicle stimulating hormone as the primary signal for initiation of such a response. This raises the question whether in compensatory ovarian hypertrophy follicle stimulating hormone has a mitogenic role.

Hepatitis B surface antigen, hepatocellular carcinoma and cirrhosis in south India--an autopsy study.

This study is aimed at finding the association of hepatocellular carcinoma and cirrhosis with hepatitis B surface antigen in a particular geographical area, Andhra Pradesh State in South India. In total, 206 cases of autopsy livers were studied for the presence of hepatitis B surface antigen by orcein staining. Of the 114 cases of cirrhosis 67.54% were positive for the antigen. There were 13 cases of macronodular, 55 cases of mixed and 46 cases of micronodular cirrhosis. The antigen positivity was 100%, 98.7% and 21.74% respectively. The difference in positivity between micronodular and the other two types of cirrhosis was statistically significant (P less than 0.01). Of the 58 cases of hepatocellular carcinoma, 50 were associated with cirrhosis. In 80% of these cases, hepatitis B surface antigen was demonstrated, whereas 75% of cases of hepatocellular carcinoma not associated with cirrhosis, were positive for hepatitis B surface antigen. The geographical importance of these findings was discussed.

Affinity chromatography of estrogen- and progesterone-binding proteins of human uterus.

The purification of estrogen- and progesterone-binding proteins of human uterus by employing affinity resins coupled with steroid-bovine serum albumin conjugates, led to the isolation of preparations with estrogen- and progesterone-binding sites having Kd values in the range of 0·96 to 1·20 × 10–9 M. These were different from the Kd values of 10–10 Μ and 10–8 Μ obtained for two types of binding sites present in the crude cytosolic and nuclear fractions. The purified proteins sedimented on sucrose gradient with S values in the range of 3·6–4·4. The cytosolic and nuclear estrogen- and progesterone-binding proteins, thus purified, showed differences in specificity of binding to the hormone. While the cytoplasmic proteins were more specific in their binding to estradiol or progesterone, the nuclear proteins bound Cortisol with equal or moderate affnity. These results demonstrate the presence of distinct physiological forms of estrogen- and progesterone-binding proteins in the cytoplasm and nucleus, thus pointing to the importance of both these compartments in hormone action. Keywords. Human.

Effect of para-chlorophenylalanine on male rats: histopathological and biochemical changes in the testes.

Spermatogenically active testes of rat challenged by 100 mg/kg body weight of p- Chlorophenylalanine for 45 days displayed marked and drastic changes in the seminiferous epithelium. Degenerative changes followed by immense necrosis of germ cells lead to complete breakdown of seminiferous tubules. Leydig cells, however, remained unaffected histologically in the treated animals. Among the accessory sex organs, epididymis alone showed a marked decrease in its weight. A biochemical study in the drug treated rats revealed a significant accumulation of glycogen in the testes accompanied by increase in the activities of enzymes like the succinic dehydrogenase, glucose-6-phosphatase, ATP-ase and acid phosphatases. However, a marked decrease was noticed in the activities of enzymes like alkaline phosphatase, phosphohexose isomerase and lactate dehydrogenase. No significant change was found in the protein, DNA and RNA concentrations in the drug treated testes. The histological and biochemical changes induced in the testes by p-CPA suggest the deleterious effect of the drug on the seminiferous tubules of the testes.