RIGHT ATRIAL MASSES – A SERIES OF THREE CASES

Cardiac masses are rare, and they pose an interesting diagnostic and therapeutic challenge. The differentials vary from tumours – both primary and secondary, thrombus, infective vegetations, artifacts to cysts. They can present with obstructive symptoms, embolisation, constitutional symptoms or pericardial effusions. Multimodality imaging with echocardiogram, computed tomography (CT) and magnetic resonance imaging (MRI) help in diagnosis. Complete surgical resection is often the modality of choice in cases of tumours. Thrombolysis or surgical extraction is suitable in cases of thrombus in the right heart.

Use of vaginal misoprostol before endometrial biopsy in premenopausal women: an observational study

Background: It is well-known since long time the beneficial effects of misoprostol particularly as a cervical softening agent in obstetric practice. Keep in view, study aimed to evaluate the efficacy of vaginal misoprostol 400 mcg before endometrial biopsy in premenopausal women.Methods: All the 200 patients were classified into two groups viz. study group (Group I) with 100 patients and control group (Group II) with 100 patients. To Group I patients, 400 mcg of misoprostol was given vaginally, 4 hours prior to the commencement of endometrial biopsy whereas no medication was received by Group II patients.Results: In the present study, the base line cervical dilatation is found to be 5.8±1.3 mm in Group I patients whereas 3.8±0.92 mm in Group II patients which is significantly higher (p<0.05). Only 32 patients in Group I required further dilatation whereas 88 patients in Group II underwent further dilatation. The mean time required for further dilatation in Group I and Group II patients was 42.6±17.4, 64.6±16.8 sec respectively and was significantly higher in Group II patients (p<0.05). Out of 100 patients in Group I, only 2% of patients complained severe pain whereas in Group II 48% of patients experienced intolerable pain and required anesthesia.Conclusions: Vaginal administration of 400 mcg misoprostol 4 hours prior to endometrial biopsy in premenopausal women had a significant effect on cervical resistance and cervical dilatation.

A study on clinico social impact of teenage pregnancy in a tertiary care hospital

Background: In India, teenage pregnancy is an important public-health problem, although the national policy of the Government of India advocates the minimum legal age of marriage for girls to be 18 years. Data of the National Family Health Survey (NFHS)-3 revealed that 16% of women, aged 15-19 years, have already started childbearing. Teenage pregnancies represent a high-risk group in reproductive terms because of the double burden of reproduction and growth. Complications of pregnancy and childbirth are the leading cause of mortality among girls aged 15-19 years in developing countries. Aim and objective of the study was to study the prevalence of teenage pregnancies and to study the clinic social impact of teenage pregnancies.Methods: The observational cross-sectional study was conducted in Government General Hospital, Guntur in the department of Obstetrics and Gynaecology over three Months from August to October 2018. All pregnant women coming to either OPD or directly to the labour room were included in the study group. History was taken and examination was done.Results: Among the 709 deliveries in the institute, 138 are teenage pregnancies contributing to 19.4%. Prevalence of anaemia in teenage mothers is as high as 63.7%, pregnancy induced hypertension contributing to 26.8% and abortions 9.4%. The neonatal outcome is poor in teenage mothers, low birth weight 20.2% contributing to the main morbidity.Conclusions: Teenage pregnancy is associated with an increased incidence of preeclampsia, eclampsia, preterm delivery, increased incidence of instrumental deliveries and lower segment caesarean sections due to cephalopelvic disproportion, neonatal complications, increased neonatal morbidity and mortality mainly due to low birth weight was noted in babies delivered to teenage mothers.

Incidence, predictors, clinical profile, management and outcome of patients with isolated left main coronary artery ostial disease

Objectives Isolated left main coronary artery (LMCA) ostial disease is a rare variant of LMCA disease. Earlier studies on this disease are limited by small number of patients enrolled. The aim of the present study was to analyze the incidence, risk factors, clinical profile and long term outcome of patients with isolated LMCA ostial disease. Methods 15,553 patients who underwent coronary angiogram in a single tertiary care cardiac hospital were analyzed for LMCA disease. 351(2.2%) patients were found to have significant LMCA disease out of which 28(0.18%) had isolated LMCA ostial disease. These 28 patients were compared with 323 non-ostial and non-isolated LMCA disease patients. Results The mean age of isolated LMCA ostial disease group was significantly less than the other group (p=0.009). Females were more affected than males (p=0.008). They also had low incidence of coronary risk factors (especially dyslipidemia, p=0.04). They tend to present more with stable angina and less with myocardial infarction. They had higher ejection fraction and normal regional wall motion (p=0.04). There was no mortality difference between two groups at the end of 1 year (p=0.234). Conclusion In one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity.

Prevalence of asymptomatic bacteriuria among antenatal women and its effects on maternal and perinatal outcome in northern Andhra Pradesh population

xBackground: The pregnant women are more commonly affected with asymptomatic bacteriuria (ASB) than non-pregnant women and its progression could lead to adverse maternal and perinatal outcomes. The study was designed with an aim to know the prevalence of ASB and its effects on maternal and perinatal outcome.Methods: In this prospective study, 300 antenatal women attending Anil Neerukonda Hospital were screened for ASB. Urine culture was performed using standardized Kirby-Bauer disc diffusion method on blood agar, Mac Conkey抯 agar for antibiotic sensitivity testing. The screened antenatal women were divided into two subgroups viz. asymptomatic bacteriuria positive (Group I) and asymptomatic bacteriuria negative (Group II) depending on the culture study and were followed till delivery for maternal and perinatal outcomes.Results: The prevalence of ASB was 11.33%. Out of 34 cases of ASB positive, 8 cases (23.5%) were delivered with birth weight <2500 grams as compared to 11 cases (4.1%) in unexposed cases (RR 5.68, 95% CI; 2.46-13.15; p<0.05). Preterm low birth was noticed in 5 (14.7%) cases of ASB positive pregnant women with compared to unexposed cases (RR 1.5, 95% CI; 0.61-3.65, p=0.36). Regarding maternal outcomes, premature labour was observed in 8 cases (23.5%) of ASB exposed women whereas 22 (8.3%) in non-exposed cases (RR 2.84, 95% CI; 1.37-5.88, p=0.004). A significant number of women have developed hypertension (17.6%) and preeclampsia (8.8%) in ASB positive cases as compared to ASB negative cases (4.9% and 2.3% respectively).Conclusions: The prevalence of ASB was 11.33% in the present study. As one third of the cases were identified in early and late trimesters, regular and trimester wise screening need to be incorporated in routine antenatal screening for safe motherhood and new born health.

Infantile Cardiac Rhabdomyoma–Pearls Inside the Heart.

Cardiac rhabdomyoma is the most common primary pediatric tumor of the heart. We report a 1- month old male infant who presented to our institute for routine cardiac evaluation since he was diagnosed to have a cardiac mass in the right ventricle (RV) in utero. After he was born, an echocardiogram showed two large cardiac masses occupying entire RV cavity and origin of right ventricular outflow tract (RVOT). Although our patient was asymptomatic, surgical removal of these two masses was done due to its proximity to RVOT and also because it was almost obliterating the entire RV cavity.

Multiple Cardiac Myxomas-Unusual Locations- Flowers in the Cardia.

Myxomas represent the most frequent benign tumor in adult population. It accounts for 25% of all cardiac tumors. Multiple myxomas within the cardia at unusual sites is very rare. We report a 60 year old lady who presented with myxomas in left atrium, right atrium, and pulmonary artery. Myxomas in the pulmonary artery is a very rare entity.

A Study of Somatic Status and Complications Among Female Hospitalized and Non-hospitalized Diabetic Patients from Mysore Urban Area.

In recent years, India has undergone rapid urbanization and socioeconomic development. Changes in time trends have resulted in erratic lifestyle, characterized by physical inactivity, unhealthy eating habits and resultant increase in obesity and diabetes. Diabetes is a major cause of mortality and morbidity in India and its prevalence is increasing at an alarming rate. Chronic complications of diabetes, especially coronary artery diseases and chronic renal diseases results in frequent hospitalization. The main aim of the investigation was to study the somatic status and diabetic complications among the female hospitalized and nonhospitalized patients. A total of 80 female volunteers (40 hospitalized and 40 nonhospitalized) of a private hospital in Mysore, with known history of type 2 diabetes mellitus for more than two years, were recruited for the study. The tools were developed to collect information on personal history, demography, socioeconomic status, dietary habits, and anthropometric measurements. Suitable statistical analysis was applied to the data. The results projected that majority of the patients were hospitalized on an average of at least three times a year. More than 90% of the subjects exhibited blood sugar >300 mg on admission. The reason for high morbidity status included poor dietary habits and erratic lifestyle practices among the female hospitalized patients as compared to nonhospitalized patients. Adapting a healthy lifestyle and maintenance of normal blood sugar level can reduce the incidence of complications and hospitalization among the subjects.

Socio-demographic correlates of mothers given birth to normal and low birth weight babies

To observe the pattern of morbidity affecting fetal growth among the low socio economic group women. One hundred and fifty pregnant women who were in 2[nd] and 3[rd] trimester were selected from government maternity hospital which catered to the low socio economic group. The selected subjects were followed up till delivery. Morbidity profile was monitored every fortnightly throughout pregnancy. The women were grouped into two, based on birth weight of neonates. Those women who had babies with normal birth weight were referred as normal birth weight group [NBW] and those with low birth weight infants were referred as low birth weight group [LBW]. Significant differences in the morbidity pattern in the two groups were seen. The major sicknesses among normal birth weight [NBW] group were low back pain, Urinary tract infection, and allergy, while the low birth weight [LBW] groups were found to suffer from urinary tract infection, constipation, allergy, low back pain, diarrhea, and stomach ache. Incidence rate of the common sickness were significantly lower in NBW women as compared to the LBW group

Electrocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction.

BACKGROUND: The site of occlusion of left anterior descending coronary artery is important in acute anterior myocardial infarction because, proximal occlusion is associated with less favorable outcome and prognosis. The present study attempted to evaluate the electrocardiographic correlate of the location of the site of the left anterior descending coronary artery occlusion with respect to first septal perforator and/or the first diagonal branch. METHODS AND RESULTS: The study included 50 patients with a first acute anterior myocardial infarction. The electrocardiogram with the most pronounced ST segment deviation before the start of reperfusion therapy was evaluated and correlated with the left anterior descending occlusion site as determined by coronary angiography. ST segment elevation in lead aVR, ST segment depression in lead V5 and ST segment elevation in V1>2.5 mm strongly predicted left anterior descending occlusion proximal to first septal, whereas abnormal Q wave in V4-6 was associated with occlusion distal to first septal. Abnormal Q wave in lead aVL was associated with occlusion proximal to first diagonal, whereas ST depression in lead aVL was suggestive of occlusion distal to first diagonal branch. For both first septal and first diagonal, ST segment depression > or =1 mm in inferior leads strongly predicted proximal left anterior descending artery occlusion, whereas absence of ST segment depression in inferior leads predicted occlusion distal to first septal and first diagonal. All the patients were followed during their in-hospital stay (median of 7 days), during which four patients in the proximal to first septal and first diagonal group and one patient in the distal to first septal and first diagonal group died (p < or = 0.001). CONCLUSIONS: In acute myocardial infarction electrocardiogram is useful to predict the left anterior descending occlusion site in relation to its major side branches and such localization has prognostic significance.

Echocardiograms in the New Nizwa Hospital

Echocardiographic results of 1100 patients who underwent echocardiogram during the first 15 months after the opening of the cardiology department in new Nizwa hospital were analysed. There were 601 females and 499 males of all age groups. 37.5% of echocardiograms were normal. 11.6% had evidence of ischaemic heart disease [IHD]. There were 111 cases of dilated cardiomyopathis [DCM] without obvious cause. Other common diagnoses were hypertensive heart disease [HHD] - 10%, congenital heart disease [CHD] - 8.3%, rheumatic heart disease [RHD] - 7% and mitral valve prolapse [MVP] - 4.5%. Though this analysis dose not indicate the true prevalence of the disease in the community, it detected a large number of patients with idiopathic dilated cardiomyopathy

Rearrangements of nitrogen fixation (nif) genes in the heterocystous cyanobacteria.

In the vegetative cells of heterocystous cyanobacteria, such as Anabaena, two Operons harbouring the nitrogen fixation (nif) genes contain two separate intervening DNA elements resulting in the dispersion of genes and impaired gene expression. A 11 kb element disrupts the nifD gene in the nifH, D-K operon. It contains a 11 bp sequence (GGATTACTCCG) directly repeated at its ends and harbours a gene, xisA, which encodes a site-specific recombinase. A large 55 kb element interrupts the fdxN gene in the nifB fdxN-nifS-nifU operon. It contains two 5 bp direct repeats (TATTC) at its ends and accommodates at least one gene, xisF, which encodes another site-specific recombinase. During heterocyst differentiation both the discontinuities are precisely excised by two distinct site-specific recombination events. One of them is brought about by the XisA protein between the 11 bp direct repeats. The second one is caused by the XisF protein and occurs between the 5 bp direct repeats. As a consequence the 11kb and 55 kb elements are removed from the chromosome as circles and functional nif Operons are created. Nitrogenase proteins are then expressed from the rearranged genes in heterocysts and aerobic nitrogen fixation ensues. How these elements intruded the nif genes and how and why are they maintained in heterocystous cyanobacteria are exciting puzzles engaging considerable research effort currently. The unique developmental regulation of these gene rearrangements in heterocystous cyanobacteria is discussed.

Clinical profile of acute myocardial infarction in women.

Three hundred fifty women with acute myocardial infarction who formed 17% of total myocardial infarction cases admitted were studied. Only 7.7% were below 40 years. Infarction occurred mostly (80%) in postmenopausal period. History of previous illness was present in 73% cases. Risk factors were present in majority (75%) of the cases. Common risk factors in Indian women were hypertension in 49% cases and diabetes mellitus in 34% cases. None were using oral contraceptives and it occurred mostly (77%) in multiparous women. Majority (94%) presented with typical chest pain. Premonitory symptoms occurred in only a few patients (14%). Complications occurred more frequently in 40% cases. Mortality rate appears to be high (18%); the commonest cause being cardiogenic shock.