Placental Thickness- A Sonographic Evaluation of Gestational Age

Background: Ultrasound is being used in obstetrics for assessment of fetal well-being and for accurate assessment of gestational age. The various parameters used in ultrasonography are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL), crown-rump length (CRL) etc. The present study is conducted to assess the relationship of placental thickness with gestational age.Methods: A total of 100 normal pregnant cases were subjected to ultrasonographic examination and gestational age was calculated by measuring biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) by ultrasonography. Placental thickness was measured at the level of cord insertion with 3 Mhz sector probe. Symphysio-fundal height was also measured and gestational age was calculated by comparing with the standard chart. Results: A high degree of correlation is found between the gestational age and the fundal height (r=0.991, p< 0.001), bi-parietal diameter(r=0.964, p< 0.001), head circumference (r=0.979, p<0.001), femur length (r=0.99, p< 0.001), abdominal circumference (r=0.975, p<0.001). Conclusion: In this work placental thickness was taken as a new parameter for predicting gestational age and a good correlation between them was marked (r=0.993, p<0.001).

Bone turnover markers in women can predict low bone mineral density.

Background: Morbidity and mortality associated with osteoporosis continues to be high in India due to late diagnosis. This study aims to find the difference in the levels of bone turn over markers in premenopausal and postmenopausal women, in order to assess whether these markers can be used as predictors of low bone mineral density which can develop in later life. Methods: Study was conducted on 350 women aged 30-65 years. Women were classified into premenopausal and postmenopausal groups based on their menstrual history. Serum samples were analyzed for osteocalcin and telopeptide-C. Student’s t-test and logistic regression are used for statistical confirmations. Results: Levels of these markers (ng/ml) were found to be lower in premenopausal women (Osteocalcin = 9.0 ± 1.0; telopeptide-C = 0.270 ± 0.099) than in postmenopausal women (Osteocalcin = 9.8 ± 1.7; telopeptide-C = 0.490 ± 0.135) and this difference was found to be significant (P <0.001) for both the markers. In both the groups, telopeptide-C made significant contribution to prediction of low BMD [(Premenopausal group - odds ratio (OR) = 2.9; 95% confidence interval (95%CI) = 1.3-6.5 and postmenopausal group - OR = 9.6; 95%CI = 6.0-13.23) but osteocalcin could not (premenopausal group - OR = 0.91; 95%CI = 0.58-1.42 and postmenopausal group - OR = 0.87; 95%CI = 0.54-1.4)]. In premenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 2.9 times while in postmenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 9.6 times. Conclusion: Women with higher levels of telopeptide-C need to be identified at an early stage as it provides with an early warning of the possibility of future development of osteoporosis so that preventive measures can be taken timely.

Correlation Of Bone Turnover Markers With Age, BMI And Serum Oestradiol In Pre And Postmenopausal Urban Women.

Abstracts: Background: Rapid bone loss occurs in women after menopause due to hormonal factors that lead to an increased susceptibility to fractures. This study was done to find out the correlation of osteocalcin and telopeptide-C with age, body mass index (BMI) and oestradiol in premenopausal and postmenopausal women. Methodology: Study was conducted on 350 women aged 30–65 years who were classified into premenopausal and postmenopausal groups. Serum samples were analysed for oestradiol, osteocalcin and telopeptide-C. Pearsons correlation was used for statistical confirmations. Results: Osteocalcin was found to be correlated with age (r= +0.56, p<0.001), BMI (r= -0.39, p<0.001), oestradiol (r= -0.21, p<0.01) and telopeptide-C (r= +0.18, p<0.05) in postmenopausal women but no correlation was found in premenopausal women. Telopeptide-C was found to be correlated with age (r= +0.39,p<0.001), BMI (r= -0.29,p<0.001) and oestradiol (r= -0.48,p<0.001) in postmenopausal women; in premenopausal women it was found to be correlated with BMI (r= -0.30,p<0.001) and oestradiol (r= -0.29,p<0.001). Conclusion: Inverse correlation of Telopeptide-C with BMI and serum oestradiol in premenopausal and postmenopausal women suggests that their increased bone turnover was linked to low BMI and oestrogen deficiency.

Effect of long term supplementation of tomatoes (cooked) on levels of antioxidant enzymes, lipid peroxidation rate, lipid profile and glycated haemoglobin in Type 2 diabetes mellitus / Efectos de la suplementación a largo plazo con tomates (cocidos) en los niveles de enzimas antioxidantes, el indice de peroxidación lipídica, el perfil lipídico, y la hemoglobina glicada en la diabetes de tipo 2

The objective of the present study is to evaluate the beneficial effect of tomatoes, which are a rich source of lycopene, a relatively new carotenoid known to play an important role in human health. In this study, the lipid peroxidation rate was investigated by estimating malondialdehyde (TBARS) levels of antioxidant enzymes like SOD, GSH-Px, GR, GSH, lipid profile, which includes total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein, very low density lipoprotein, and glycated haemoglobin HbA1c in (n = 40) the Type 2 diabetic group (n = 40) and an age-matched control group (n = 50). Significantly lower levels of antioxidant enzymes and very high lipid peroxidation rate in the Type 2 diabetic group were observed when compared to controls (p 0.10). These findings suggest that tomato lycopene may have considerable therapeutic potential as an antioxidant but there was no significant lipid lowering effect in Type 2 diabetes mellitus.

El objetivo del presente estudio es evaluar el efecto beneficioso del tomate como fuente rica en licopeno – un carotenoide relativamente nuevo, del cual se sabe que juega un importante papel en la salud humana. En este estudio, investigamos el índice de peroxidación lipídica, estimando los niveles MDA (TBARS) de las enzimas antioxidantes como SOD, GSH-Px, GR, GSH, el perfil lipídico, que incluye el colesterol total, los triglicéridos, los HDL, LDL, VLDL, y la hemoglobina glicada (HbA1c) en (n = 40) en el grupo diabético tipo 2 (n = 40) y el grupo de control pareado por edad (n = 50). En este estudio, observamos niveles significativamente más bajos de enzimas antioxidantes e índices de peroxidación lipídica muy altos en el grupo diabético tipo 2, en comparación con el grupo control (p < 0.001). Asimismo observamos niveles significativamente más altos de perfil lipídico y hemoglobina glicada (HbA1c) en el grupo diabético al comparársele con el grupo control (p < 0.001).

Study of fifty human tali for calcaneal articular facets.

Fifty adult dry human tali from the Department of anatomy, Nepalgunj Medical College Chisapani, were studied. Observations were made on different types of articular facets of calcaneus for the tali. They were classified into four groups and their percentages of incidences were calculated. These findings were well correlated and compared with the literatures available.

Triple-drug therapy of Helicobacter pylori infection in duodenal ulcer disease.

OBJECTIVE: To evaluate the efficacy of triple-drug therapy for Helicobacter pylori infection and the effect of its eradication on relapse of ulcer in patients with duodenal ulcer (DU) disease. METHODS: Patients with uncomplicated DU who were H. pylori-positive on urease test or histology were given triple-drug therapy (metronidazole, tetracycline, colloidal bismuth subcitrate). Ulcer healing and H. pylori status were assessed one month after completion of therapy. Those with healed ulcers were followed up endoscopically for ulcer recurrence at 3-month intervals for one year or more. RESULTS: Fifty seven of 60 consecutive DU patients (95%) who were H. pylori-positive were taken up for the study; 46 patients (36 men; median age 40 years, range 13-70) completed the study. Thirty one of them (67%) eradicated H. pylori and had healed ulcers at one month post therapy; of 15 patients with persistent H. pylori infection, ulcers healed in 12 (p = ns). After an average follow up of 11 months, 8 of 12 H. pylori-positive patients had relapse of DU compared to 5 of 31 (16%) H. pylori-negative patients (p < 0.01). CONCLUSIONS: Triple-drug therapy was effective and safe for H. pylori infection, the lower rate of eradication observed compared to results elsewhere probably being related to bacterial resistance. Eradication of H. pylori was associated with healing of ulcers, resolution of antral gastritis and a significant fall in the rate of ulcer relapse.

Bifid pancreas: an endoscopic retrograde pancreaticographic curiosity.

Bifid pancreas, representing a major bifurcation of the main pancreatic duct, has rarely been reported. We report four such cases where this condition was picked up incidentally.

Combination of anticholinergic agent and H2 receptor antagonist in duodenal ulcer treatment--a randomized, double blind multicenter study.

BACKGROUND: The acid suppressive abilities of H2 receptor antagonists and anticholinergics have been claimed to be additive. METHODS: A multicenter, double-blind, randomized trial comparing ranitidine (150 mg) plus propantheline bromide 15 mg at bedtime to ranitidine 300 mg alone at bedtime was conducted in 161 patients with endoscopically confirmed uncomplicated duodenal ulcer. RESULTS: After six weeks of therapy, ulcer healing rates in the two groups were comparable ie 80% in the combination group (ranitidine + propantheline) and 79.4% in the ranitidine group. Pain relief after one, two and four weeks of treatment was also comparable in the two groups. Side effects to drugs were minor and comparable in both the groups. CONCLUSION: A combination of 150 mg ranitidine and 15 mg propantheline bromide is as efficacious as 300 mg ranitidine in inducing healing of uncomplicated duodenal ulcers, with similar side-effects but at greatly reduced cost.

End point for sclerosis of esophageal varices.

BACKGROUND: Small esophageal varices are difficult to inject intravariceally and complete eradication of varices may not be therapeutically necessary. METHODS: A prospective study designed to compare the use of different end points of sclerotherapy ie (i) total eradication (grade 0) (ii) grade I varices or (iii) grade II white (IIw) varices, by stopping variceal injection when one of these was reached. The patients were followed endoscopically and clinically at 3-4 mo intervals. OUTCOME MEASURES: Variceal recurrence and rebleeding rates. RESULTS: Of 266 patients with portal hypertension (147 cirrhosis, 51 non-cirrhotic portal fibrosis, 68 extra-hepatic portal venous obstruction), 232 (87.2%) reached one of the three end points--six to grade 0, 96 to grade I and 130 to grade IIw. Among 212 patients followed up for a mean post-sclerotherapy period of 12.2 mo (range 3-48 mo), variceal recurrence rates, time intervals to recurrence and rebleed rates were comparable in patients with endpoints of grade I and grade II (white) varices (28.5% vs 38.9%, 10.8 mo vs 9.2 mo, and 7.7% vs 7.8%, respectively; all p = ns). Overall, 51 patients had interval bleed before reaching the end point--50 (98%) of them bled from grade III and IV varices while only one patient (2%) bled with grade IIw varices. CONCLUSION: Grade I or grade IIw varices should be acceptable as the end points for endoscopic sclerotherapy of esophageal varices.

Endoscopic removal of ascaris from biliary tree.

Hepatobiliary ascariasis is an uncommon condition outside the Kashmir valley. We report here a patient with this disease from the eastern part of India.

Upper gastrointestinal mucosal lesions in chronic renal failure.

The upper gastrointestinal mucosa was studied endoscopically in 182 patients (140 males, 42 females) with chronic renal failure prior to hemodialysis. Endoscopy revealed normal mucosa in 77 patients (42.3%), inflammatory mucosal lesions in 88 (48.4%), peptic ulcer in 16 (8.8%; duodenal 15, gastric 1) and Barrett's ulcer in one patient. Upper gastrointestinal bleeding was noted at presentation in 16 (8.8%) cases and was associated with erosive gastritis, duodenitis and duodenal ulcer in 11, 3 and 2 patients respectively. Thus patients with chronic renal failure had a high prevalence of inflammatory mucosal changes.

Cerebrospinal fluid N-acetyl neuraminic acid estimation for early diagnosis and differentiation of bacterial meningitis.

Cerebrospinal fluid (CSF) analysis for free, bound and total N-Acetyl Neuraminic Acid (NANA) as well as serum NANA was done in 68 patients of bacterial meningitis, of which 37 cases were of pyrogenic meningitis and 31 of tuberculous meningitis. Ten patients were included in the control group. The free NANA levels were increased in only pyogenic meningitis, independent of protein levels but the bound form increased with the increase in CSF proteins. The increase of free NANA in CSF of pyogenic meningitis patients was not related to the cell count or sugar content in CSF or to the duration or severity of illness. This finding can be of great help in differentiating cases of pyogenic meningitis, particularly partially treated patients, who may have ambiguous pictures of CSF analysis, from the cases of tuberculous meningitis.

A comparative therapeutic trial of sucralfate and ranitidine in initial healing and relapse rate of duodenal ulcer.

The present study was carried out to examine the comparative efficacy of sucralfate and ranitidine in the treatment of duodenal ulcer. Sixty-six patients with endoscopically diagnosed duodenal ulcer were studied in a 4-6 weeks randomised, single blind trial comparing sucralfate 1 gm T.D.S. one hour before meal and 1 gm nocte (34 pts) with ranitidine 300 mg nocte (32 pts). Six patients (four on sucralfate and 2 on ranitidine) failed to complete the study. Endoscopy after four weeks of treatment showed an ulcer healing rate of 57% in the sucralfate group compared with 73% in ranitidine group (p greater than 0.1). At six weeks these figures had risen to 87% and 90% respectively (p less than 0.5). After one year followup study 69% of sucralfate treated ulcers relapsed whereas the relapse rate was 82% in ranitidine treated ulcer group (p less than 0.1). It was observed that the relapse was earlier in the ranitidine group as compared to sucralfate group (p less than 0.01 at 3 months and p less than 0.05 at 6 months). Asymptomatic recurrence was seen in 15% (6/40) patients. Sucralfate was not only as effective as ranitidine in short term healing of duod. ulcer but also delayed the relapse of ulcer in long term followup after initial healing with the drug.

Post sclerotherapy esophageal ulcers: a prospective analysis of their behaviour.

The reported incidence of post sclerotherapy esophageal ulcers has shown marked variation, possibly due to lack of uniform criteria for their diagnosis. Using fixed criteria (size greater than or equal to 5 mm, duration greater than or equal to 2 weeks), we prospectively studied 82 patients with portal hypertension, who underwent four or more sessions of endoscopic sclerotherapy (EST), for the occurrence and behaviour of these ulcers. Post sclerotherapy ulcers occurred after 43 (9.2%) of 465 EST sessions in 30 (36.6%) of 82 patients. Ulcers were significantly associated with two complications: rebleed during the course of sclerotherapy (33% of ulcers bled compared to 3% from variceal rupture; p less than 0.001) and esophageal stricture formation (66.7% of strictures occurred in patients who had ulcers; p less than 0.05). Ulcers occurred more frequently in patients with poor liver function (61.5% in Child's C grade compared with 31.9% in Child's A or B grades; p less than 0.05) and after injection into larger varices (83.7% in varices grades 3 and 4, 16.3% in lower grades; p less than 0.005). Severe persistent chest pain (p less than 0.001) and pyrexia (p less than 0.01) after sclerotherapy were clinical pointers of ulcerogenesis.