Phenotypic heterogeneity in family members of patients with retinitis pigmentosa

Purpose: To describe the phenotypic variations in family members of patients with retinitis pigmentosa (RP) with different modes of inheritance and to assess the ocular abnormalities in RP families. Methods: A descriptive analysis of three types of inheritance of RP was carried out, where 64 family members were examined at a tertiary eye care center, South India. They underwent comprehensive eye examination, fundus photography, fundus autofluorescence (FAF), full?field electroretinogram (FFERG), and spectral domain optical coherence tomography (SD?OCT). Analysis was performed between mild and severe forms of abnormalities to delineate retinal structural and functional defects in RP families. Results: The mean age was 38.55 ± 17.95 years. Males were 48.4%. In autosomal recessive and X?linked recessive groups, 74.2% and 77.3%, respectively, were asymptomatic, whereas in autosomal dominant group, 27.3% were asymptomatic. The proportion of the cases with abnormalities in all three groups was higher on ERG (59.6%), followed by OCT (57.5%), visual acuity (43.7%), peripheral FAF (23.5%), and macular FAF (11.8%). However, these abnormalities and the clinical pictures of the family members had no statistical difference across the three groups of inheritance. Conclusion: Structural and functional retinal alterations were noted in four out of five asymptomatic members, suggesting the need for careful screening of RP families and the pressing need for pre?test (genetic) counseling

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated With COVID-19 – Single-Center Experience

Objectives: To describe the clinical presentation, phenotype and outcome of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) from a tertiary care center in southern India. Methods: 257 children fulfilling the inclusion criteria of MIS-C were prospectively enrolled from June, 2020 to March, 2022. Results: Median (range) age at presentation was 6 year (35 day to 12 years). Presenting features were fever (98%), vomiting (75.8%), red eyes (63%), rashes (49%), pain abdomen (49%), shock (45.9%), lymphopenia (73%, thrombocytopenia (58.3%) and anemia (45%). 103 (39.7%) children required intensive care admission. Shock phenotype, Kawasaki-like phenotype and no specific phenotype were diagnosed in 45.9%, 44.4%, and 36.6% children, respectively. Left ventricular dysfunction (30.3%), acute kidney injury (13%), acute liver failure (17.4%), and hemophagolymphohistiocytosis (HLH) (13.6%) were the major system involvement in MIS-C. Mitral regurgitation (P=0.029), hyperechogenic coronaries (P=0.006), left ventricular dysfunction (P=0.001) and low ejection fraction (P=0.007) were significantly associated with shock. Overall mortality was 11.7%. Conclusions: Kawasaki-like and shock-like presentation were common in MIS-C. Coronary abnormalities were seen in 118 (45.9%) children. Children with acute kidney injury, HLH, need for mechanical ventilation, and echocardiogram evidence of mitral regurgitation in MIS-C have a poor outcome.

Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2

Objectives To know the clinical presentation and outcome of children with pediatric infammatory multisystem syndrome temporally associated with SARS-CoV- 2 (PIMS-TS) at a pediatric tertiary care center in Chennai. Methods Clinical and biochemical parameters of 65 children with PIMS-TS treated between July and October 2020 were studied. All children had their COVID RT-PCR and IgG COVID antibodies tests done. Results Mean age of the study group was 5.65±3.68 y. Fever with red eyes, rash, vomiting, abdominal pain, and shock were common presenting features. Sixty percent of the study group had Kawasaki/incomplete Kawasaki features. Sixty-seven percent of the study group had coronary dilatation, 41% presented with shock, and 25% had left ventricular dysfunction. Coronary aneurysms were documented in 58% of the study group (z score more than 2.5). Respiratory presentation with pneumonia was seen in 10%. Four children presented with acute abdomen. Acute kidney injury, acute liver failure, hemolysis, pancytopenia, macrophage activation syndrome, encephalopathy, and multiorgan dysfunction syndrome (MODS) were other features. Forty-three percent required noninvasive oxygen support and 15.4% required mechanical ventilation. Intravenous immunoglobulin (73.8%) and methylprednisolone (49.8%) were used for therapy. Mortality in the study was 6%, which was due to MODS. Conclusions Acute febrile illness with mucocutaneous and gastrointestinal manifestations should have PIMS-TS as a possible diferential diagnosis and needs evaluation with infammatory markers and SARS-CoV-2 antibodies.

Diethylcarbamazine citrate-fortified salt for lymphatic filariasis elimination in India

Lymphatic filariasis (LF) is a vector-borne neglected tropical disease, causing permanent disability. The disease is debilitating and widespread, leading to tremendous productivity and economic loss. The Government of India (GOI) prioritized the elimination of LF through the annual mass drug administration (MDA) programme in 2004 and continued with a single dose of diethylcarbamazine citrate (DEC), 6 mg/kg of body weight, plus albendazole annually over a period of 5-6 years. The GOI had set the target to achieve LF elimination by 2015 and now by 2030. The progress so far has been suboptimal. Much remains to be done as about 84 per cent of the total 328 endemic districts are still under MDA. The major challenge in implementing MDA is poor compliance. It is necessary to have a feasible alternative strategy addressing the above challenge to achieve the desired goal of LF elimination. At this juncture, a well-researched approach, i.e. the use of DEC-fortified salt, also advocated by the World Health Organization, as a unique form of MDA, is proposed. As per this strategy, a low dose of DEC (0.2% w/w) is added to the cooking salt at the manufacturing facility of iodized salt and consumed by the LF-endemic communities for about two years. Many examples of successful use of this strategy for LF elimination in small- and large-scale trials have been documented in India and several other endemic countries in the world. Implementing DEC–iodine-fortified salt is a safe, less expensive, more efficient and prompt approach for achieving the elimination of LF in India. Adverse effects are none or minor and self-limiting. The DEC-fortified salt strategy can easily piggyback on the existing countrywide deployment of iodized salt under the National Iodine Deficiency Disorders Control Programme (NIDDCP), which has achieved a great success in reducing iodine-deficiency disorders such as hypothyroidism. This existing robust programme can be leveraged to launch DEC-fortified salt for the community. If implemented appropriately, this strategy will ensure the complete cessation of LF transmission within two years from its introduction. If the said strategy is implemented in 2022, it is expected that India will be able to achieve the LF elimination by 2024, much before the global target of 2030.

Evaluating the factors influencing perinatal outcome in breech presentation

Background: The objective of this study was to analyse the current obstetric practice regarding breech presentation, document the incidence, perinatal outcome and the factors influencing perinatal outcome in breech deliveries.Methods: It was a retrospective observational study including 252 cases of breech presentation during January 2018 to December 2019 in a tertiary teaching institute in Vidarbha region of Maharashtra.Results: Total number of breech deliveries 252 (incidence is 2.5%). Caesarean section for breech presentation 95 (37.6%). With vaginal deliveries the Apgar score at 5 min below 7 were among 48 out of 157 breech deliveries whereas with LSCS it was only amongst 7 out of 95 deliveries. The maximum percentage of perinatal mortality is seen with birth weight below 2000 gm. Maximum mortality is seen prior to 32 weeks and in babies who delivered by vaginal route. Respiratory distress with prematurity and severe birth asphyxia are the common causes of perinatal deaths. Total 32 (12.69%) babies were transferred to NICU. 20.38% of the total vaginal breech deliveries and 5.26% of the total LSCS were transferred to NICU. Out of total 32 NICU admissions 22 are for the preterm babies and babies with birth weight below 2000 gm.Conclusions: The perinatal outcome does not depend only on the mode of delivery, it is also affected by the weight of the baby, its maturity, associated congenital anomalies, equipped neonatal intensive care unit and also substantially on the expertise of the obstetrician and the neonatologist.

Evaluate The Efficacy And Safety Of Intrathecal Plain 0.75% Ropivacaine Solution For Elective Caesarean Section

Background:A prospective, randomised double blind study to evaluate the efcacy and safety of intrathecal plain 0.75% ropivacaine solution for elective caesarean section and also to study its side effects and complicationsMaterial and Methods:80 patients planned under spinal anaesthesia requiring sensory level upto T4-T6 & duration of 1-2 hours were included in the study. They were divided into two groups of 40 each & received one of the 2 drugs intrathecally. Group R - 2.4ml isobaric plain 0.75% ropivacaine(18 mg) Group B - 2ml hyperbaric 0.5% bupivacaine(10 mg)Results:In our present study, duration of sensory block was shorter in Group R (141.87±13.57 mins)than in Group B (203±18.83 mins) and it was statistically signicant. The mean duration of analgesia was less in Group R 189.25±17.30 mins than in Group B 296.25 ± 13.33 mins and the difference was statistically signicant. Mean(±SD) onset of motor block was slower in Group R (207.25±38.89 secs) as against Group B (115.12±26.34 secs) and the difference was statistically signicant. The time needed to reach Grade 3 motor block was delayed in Group R 6.19±0.88 mins, compared to Group B 4.09±0.86 mins, which is also signicant. The mean duration of motor block was signicantly less in Group R(174±24.36min) as compared to Group B (252.5±18.63mins).Conclusion:Use of Ropivacaine in caesarean section patients is associated with shorter duration of both sensory and motor block .Therefore ,ropivacaine is safe and effective without any adverse effect on maternal and neonatal outcome.

Emerging nanoparticulate systems: Preparation techniques and stimuli responsive release characteristics

Nanotechnology has become an outgrowing field in novel drug delivery system. It confers several merits overconventional formulations like increased solubility and bioavailability, targeted drug delivery and a decreaseddose of the drug. The selection of appropriate method for the preparation of nanoparticulate system depends on thephysicochemical characteristics of the drug to be loaded and polymer. This review has covered the most widelyacceptable preparation techniques for polymeric and lipidic nanoparticles including nanoprecipitation, milling,extrusion, supercritical fluid technology, salting out, gelation, sonication, high-pressure homogenization, and solventemulsification methods. Nanocarriers, the traditional nano-formulation drug delivery systems, encountered somemajor problems in process scale-up, reproducibility, and stability during storage. To circumvent these problems a newapproach has emerged which are “In situ or self-assembled nanoparticles drug delivery system.” Such approachescomprise experimentation with different types of polymers, surfactants or novel process in order to prepare a preconcentrate of drug formulation, which on entering into an aqueous medium (gastrointestinal fluid, blood) will formnanoparticles. The in situ nanoformulations can be the futuristic approach in nanocarriers to overcome the problemsassociated with the scale-up process and also minimize the cost of production. This review focuses on differentpreparation techniques for polymeric and lipidic nanocarriers preparation, in situ nanoformulation approaches andrelease characteristics of stimuli responsive nanoformulation

A Comparative Study Of Efficacy Of Topical Difluprednate Ophthalmic Emulsion 0.05% Eyedrops With Betamethasone Suspension 0.1% In Postoperative Small Incision Cataract Surgery

Postoperative operative inflammation following cataract surgery is common occurrence may be due to severalsurgery-dependent factors such as surgical trauma, intraocular lens type, and due to various physical, chemicaland biological agents introduced during surgery and also on patient-dependent factors such as history ofinflammatory disease and degree of iris pigmentation. Anti-inflammatory agents are routinely prescribedfollowing cataract extraction surgery to resolve signs and symptoms of inflammation more rapidly and toimprove patient comfort. For the treatment of postoperative ocular inflammation and pain the most widelyprescribed topical corticosteroid is betamethasone 0.1%, and Difluprednate ophthalmic emulsion 0.05% astrong topical steroid. Hence, this study was to compare the efficacy and safety of topical corticosteroidsDifluprednate 0.05% and betamethasone 0.1%, in managing inflammation and pain following post cataractextraction surgery. In a total 100 patients were randomized into two groups Group –A (50 patients) prescribingtopical Difluprednate emulsion 0.05% and Group-B (50 patients) prescribing betamethasone phosphate 0.1%.in our observation after 15 days no pain in group-A, after 30 days no one are having corneal oedema in groupA. Difluprednate emulsion 0.05% drug was efficient in the reduction of anterior chamber cells and flare withbetamethasone phosphate 0.1% being more rapid. Based on our findings and previous study results,Difluprednate emulsion 0.05% can be used in post-operative management post cataract surgery, however,further clinical trials with long follow- up periods are required.

A Study Of Corneal Injuries In Rims Teaching Hospital

Corneal injuries remain an important cause of avoidable and, predominantly, monocular visual morbidity, themain strategy to prevent these injuries has been to educate people to identify high-risk situations and to takecorrect action to avoid danger. Present study conducted in the department of ophthalmology of Raichur instituteof Medical sciences teaching Hospital, with 49 patients of ocular trauma above 14 years of either sex wassubjected to slit lamp examination to ensure the cornea is involved the etiology of the injury was noted. Then thepattern of the corneal injury was studied under the slit lamp examination. The Prevalence of corneal blindnesswas 10.20% (5) were had corneal blindness in both eyes and 24.49% (12) were had corneal blindness in one eyein Raichur. The majority of corneal injuries are avoidable. Eye health promotion strategies are warranted toraise awareness about the causes and prevention of corneal blindness.

Prevalence And Evaluation Of Refractive Errors In Children Between The Ages 10-15 Years In Rims Teaching Hospital Raichur

Purpose: Prevalence, diagnosis and treatment of refractive error is relativity simple and easiest way to reduceimpaired vision, population-based data in children are not sufficiently available for India. In view of importance of detecting the refractive error in children an effort is going to be made in this study. To find out the extentof problem of refractive errors among children in Raichur.Materials and Methods: the prospective study was conducted with 100 number 10-15 years children from theRaichur. All the children were examined with visual acuity by snellen’s chart, Examination of anterior andposterior segment, Retinoscope, trail set and cycloplegic refraction followed by subjective correction will bedone.Results: The prevalence of Refractive error in the 10-15 years children was found to be 11%, higher in 15 years(3%), more in girls (6%) and in urban area children had more prevalence (7%). Myopia was the commonest typeof refractive error in this study which constitutes 55%, Astigmatism 27% and 18% of hypermetropia was seen inthe 10-15yrs children.Conclusion: Most of the children are unaware of Refractive error, so screening of children is very important.Parents have to take the responsibility of this screening for vision error and they should monitor the their visionvial watching tv, reading books. The screening system should be yearly at least 3 time a year to every childespecially 14-15 years student.

Comparision Of Pleural Fluid Cytology And Cell Block In Pleural Effusion

AIMS AND OBJECTIVES To assess the diagnostic utility of cell block technique in comparison to conventional cytosmear, in the study of pleural fluids. To compare our results with existing literature. MATERIAL AND METHODS The present prospective study was done for a period of two years from 1st August 2015 to July 31st 2017 in the Department of Pathology, Kakatiya Medical College, Warangal. During this period, pleural fluids obtained by aspiration were analyzed. A total of 53 cases were studied RESULTS Out of the total 53 cases included in our study of pleural effusion males were 32 and female were 21 contributing 60.3% and 39.6% respectively. Age range of our patient was from 18years to oldest patient being 68 years with the dominant age group being 31–40 years. Cytosmear analysis showed 35 (66.05%) benign/inflammatory effusions, 11 (20.75%) suspicious of malignancy, 7 (13.20%) malignant cytology’s. On cell block analysis 43 (81.20%) were diagnosed as benign/ inflammatory effusions, 10 (18.8%) were diagnosed to be malignant. CONCLUSION The present study demonstrates that the pleural fluid cytology is the most useful test in establishing the diagnosis of pleural effusion. From the results it can be concluded that cell block technique demonstrates a higher diagnostic rate of malignant effusions compared to cytosmear as the morphological features were better identified by this method. We conclude that the cell block technique method when used as an adjuvant to routine smear examination increases the diagnostic yield and also carries the advantage of carrying further IHC studies.

Role of magnesium sulphate in preterm labour

Introduction: Magnesium sulphate has been the drug of choice for the prophylaxis of convulsions in women with preeclampsia for many years. The use of this drug for the treatment of preterm labour originated in the observation that it causes a decrease in frequency and intensity of contractions in preeclampsia women in labour. The present study is conducted to study the effectiveness of intravenous magnesium sulphate in arrest of preterm labour. Materials and methods: The present study was conducted among 50 patients admitted in labor wards of obstetrics and gynecology department. Study was conducted at Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam. Study duration was from February 2016 to March 2017. Fifty patients with a diagnosis of preterm labor between 28 to 36 weeks period of gestation were included. A loading dose of intravenous magnesium sulfate 4 gm bolus over 20mins followed by 2g/hour infusion was administered until uterine quiescence was achieved. Results: The mean time taken for uterine quiescence was 74 mins after starting treatment. The magnesium sulfate dosage requirement for uterine quiescence was 1-2 gm/hour in 87.5% cases. Majority of the mothers experienced mild side effects but none were as serious as to discontinue the drug. Toxicity features were observed in 4% of cases, which need to discontinue the drug. Conclusion: Intravenous magnesium sulphate is effective in postponement of preterm labour at least for 48 hours. This is the minimum time considered sufficient to allow benefit if corticosteroids are administered to decrease the possibility of respiratory distress syndrome in premature infants. Thus magnesium sulphate plays a vital role in preterm labour

Phenotypic characterization of X‑linked retinoschisis: Clinical, electroretinography, and optical coherence tomography variables.

Aims: To study the phenotypic characteristics of X‑linked retinoschisis (XLRS) and report the clinical, electroretinogram (ERG), and optical coherence tomography (OCT) variables in Indian eyes. Design: A retrospective study. Materials and Methods: Medical records of 21 patients with retinoschisis who were genetically confirmed to have RS1 mutation were reviewed. The phenotype characterization included the age of onset, best‑corrected visual acuity, refractive error, fundus findings, OCT, and ERG. Statistical Analysis Used: Data from both the eyes were used for analysis. A P < 0.05 was set as statistical significance. Data were not normally distributed (P < 0.05, Shapiro wilk); hence, nonparametric tests were used for statistical analysis. Results: All were males whose mean age of presentation was 9 years. Visual acuity was moderately impaired (median 0.6 logMAR, interquartile range: 0.47, 1) in these eyes with a hyperopic refractive error of median +1.75 Ds (interquartile range: +0.50 Ds, +4.25 Ds). About 54.7% of the eyes had both foveal and peripheral schisis, isolated foveal schisis was seen in 28.5% of the eyes, and schisis with retinal detachment was seen in 16.6% of the eyes. The inner nuclear layer was found to be commonly involved in the schisis, followed by outer nuclear and plexiform layers as evident on OCT. On ERG, a‑ and b‑wave amplitudes were significantly reduced in eyes with foveal and peripheral schisis when compared to the eyes with only foveal schisis (P < 0.05). Conclusions: XLRS has phenotypic heterogeneity as evident on OCT, ERG, and clinical findings.

Prenatal genetic diagnosis of retinoblastoma – clinical correlates on follow‑up.

Retinoblastoma is the most common malignant intraocular tumor in pediatric age group if undetected leads to ocular mortality. Prenatal diagnosis is an emerging technology to detect fatal diseases in utero such that subsequent management is planned to reduce the ocular morbidity. We describe a case demonstrating the importance of prenatal diagnosis in a child with a strong family history of retinoblastoma and importance of a long‑term clinical follow‑up in these cases.

Microperimetry biofeedback training in a patient with bilateral myopic macular degeneration with central scotoma.

Microperimetry‑1 (MP‑1) evaluation and MP‑1 biofeedback training were done in a case of bilateral myopic macular degeneration with a central scotoma. Fixation behavior, location and stability of preferred retinal locus, eye movement speed, and mean sensitivity were assessed. The mean retinal sensitivities before, after and at 1‑year after training in the right eye were 2.9 dB, 2.9 dB and 3.7 dB and in the left eye were 3.5 dB, 3.7 dB and 1.8 dB. The fixation point in the 2° gravitation circle, improved from 40% to 50% in the right eye and from 43% to 67% in the left eye. The average eye speed before, after and at 1‑year after training in right eye were 0.19°/s, 0.26°/s and 0.25°/s and in left eye were 0.36°/s, 0.25°/s and 0.27°/s. Thus, biofeedback training using MP‑1 can improve the visual function in patients with macular diseases and central scotoma.

Pulmonary tuberculosis among tribals in India: A systematic review & meta-analysis.

Background & objectives: There has been limited investigation on the prevalence of tuberculosis (TB) in tribal communities in India, a vulnerable section of Indian society. The lack of a population-based estimate prompted us to conduct a meta-analysis of existing studies to provide a single, population-based estimate of the TB prevalence for tribals. Methods: Literature search was conducted in PubMed using the keywords - “tuberculosis”, “tribals”, “India”, “prevalence”, and “survey”. References cited in the articles retrieved were also reviewed, and those found relevant were selected. TB prevalence rates estimated by the studies were used for our calculation of a pooled-estimate. Results: The pooled estimate, based on the random effects model, was 703 per 100,000 population with a 95 % CI of 386-1011. The associated heterogeneity measures in terms of Cochran’s Q was significant (p=0.08 <0.1) and I2 was moderate at 48 per cent. Interpretation & conclusions: The meta-analysis demonstrated a large variability in pulmonary TB prevalence estimates among the different studies with poor representation of the various tribal groups. The moderate level of heterogeneity found across the studies suggests that the pooled-estimate needs to be treated with caution. Our findings also highlight the need to assess the pulmonary TB burden in India.

Penicillin induced toxic epidermal necrolysis with secondary impetiginization: a rare case.

Drug induced allergic reactions can be categorized into IgE-mediated and non-IgE mediated hypersensitivity reactions. Symptoms of IgE-mediated reactions are angioedema, bronchospasm, anaphylaxis, and urticaria that appears within 72 hours and those which are Non-IgE mediated hypersensitivity reactions include morbilliform eruptions, interstitial nephritis, hemolytic anemia, serum sickness, thrombocytopenia, and erythema multiforme, after 72 hours. TEN is defined as an extensive detachment of full-thickness epidermis most often related to an adverse drug reaction. We report a rare case of penicillin induced toxic epidermal necrolysis with Secondary Impetigination in a 38-year-old male patient with complaints of rashes all over the body, chest pain and dry tongue since seven days. Based on history and clinical examination patient was diagnosed as of penicillin induced toxic epidermal necrolysis with secondary impetigination and was successfully treated with antihistamines, parenteral antibiotics and corticosteroids.

Agrowaste-based Polyhydroxyalkanoate (PHA) production using hydrolytic potential of Bacillus thuringiensis IAM 12077

The study identified the innate enzymatic potential (amylase) of the PHB producing strain B.thuringiensis IAM 12077 and explored the same for cost-effective production of PHB using agrowastes, eliminating the need for pretreatment (acid hydrolysis and/or commercial enzyme). Comparative polyhydroxyalkanoate (PHA) production by B. thuringiensis IAM 12077 in biphasic growth conditions using glucose and starch showed appreciable levels of growth (5.7 and 6.8 g/L) and PHA production (58.5 and 41.5%) with a PHA yield of 3.3 and 2.8 g/L, respectively. Nitrogen deficiency supported maximum PHA yield (2.46 g/L) and accumulation (53.3%). Maximum growth (3.6 g/L), PHB yield (2.6 g/L) and PHA accumulation (72.8%) was obtained with C:N ratio of 8:1 using starch as the carbon source (10 g/L). Nine substrates (agro and food wastes) viz. rice husk, wheat bran, ragi husk, jowar husk, jackfruit seed powder, mango peel, potato peel, bagasse and straw were subjected to two treatments- acid hydrolysis and hydrolysis by innate enzymes, and the reducing sugars released thereby were utilized for polymer production. All the substrates tested supported comparable PHB production with acid hydrolysis (0.96 g/L-8.03 g/L) and enzyme hydrolysis (0.96 g/L -5.16 g/L). Mango peel yielded the highest PHB (4.03 g/L; 51.3%), followed by jackfruit seed powder (3.93 g/L; 29.32%). Varied levels of amylase activity (0.25U-10U) in all the substrates suggested the enzymatic hydrolysis of agrowastes.

The Effects of Passive Smoking on the Placental Barrier: A Light Microscopic Study.

Passive exposure to tobacco smoke causes ultrastructural changes in placental vasculature. It was endeavoured to observe under the light microscope, the endothelial cells of the capillaries and to look for microscopic changes in the vasculosyncytial membranes in the terminal villi of placentae of passive smokers exposed largely to bidi smoke. To study effect of passive smoking on placental vasculature a total of 150 placentae were selected from healthy full term gravidas with no history of tobacco use. They were divided into two group viz; passive smokers (n=87) and non passive smokerscontrol (n=63). Three micron thick sections were cut, stained and examined under light microscope. The study revealed that endothelial cells of stromal capillaries of the placental villi were oedematous resulting in irregular capillary lumina (p=0.0007) and vasculosyncytial membrane was significantly absent in terminal villi of passive smokers in comparison to control (p=0.0000).