Unusual presentation of gestational trophoblastic disease

Gestational trophoblastic neoplasia [GTN] is an uncommon complication of pregnancy which can follow any gestational event, molar pregnancy, normal pregnancy, miscarriage or even ectopic pregnancy. Its incidence is high in the region of South East Asia. The curability of GTD is a milestone of success in the history of medicine however we still face challenges in diagnosis and treatment due to myriad of its clinical presentations. The case under discussion is of a patient who presented with unusual symptoms of GTD which posed a diagnostic dilemma but was effectively managed in a tertiary care setting conserving her future fertility and quality of life

Near miss obstetric events as a reflection of quality of maternal health care

Objective: To determine frequency and nature of near-miss cases in obstetric patients in a tertiary care hospital

Study Design: Cross-sectional descriptive study

Place and Duration of Study: The study was conducted in obstetrics unit of Combined Military Hospital [CMH] Kharian from Jan 2013 to June 2013

Material and Methods: The WHO near miss criteria 2009 was followed including clinical, laboratory and management based criteria for case identification. Main outcome measures were frequency of near miss and maternal mortality cases, near miss on arrival and during hospitalization, ICU admission and total hospital stay, calculating the mortality indices, maternal mortality ratio, mortality to near miss ratio, near miss cases/1000 deliveries were calculated

Results: There were 76 near miss cases. Maternal mortality ratio was 676. Near miss cases were 70.3%. Maternal death to near miss ratio was 1:10. Mortality index for near miss cases was 8.4%. In near miss group most significant was cardiovascular 46% and hematologic system 32%. Interventions, renal, neurological and respiratory were 9.2%, 5.2%,3.9% and 2.6%respectively. In near miss cases 86% were referred and 14% booked

Conclusion: This study showed that uniform criteria for identifying near miss cases can be used in a tertiary referral hospital setting especially for comparison of results and audit. Near misses provide relevant controls for maternal deaths since most women who die presumably pass through a phase of organ dysfunction before dying and evaluation of circumstances leading to this can help in formulating and revising health care protocols

Depressive symptoms in pregnancy only frequency and association among wives of deployed military soldiers

Objective: To determine the frequency and association of depressive symptoms during pregnancy among wives of deployed Military soldiers

Study Design: Cross-sectional study

Place and Duration of Study: Combined Military Hospital Kharian from Oct 2013 to Dec 2013

Material and Methods: The sample population comprised of pregnant ladies who were wives of deployed military soldiers reporting for ante natal checkup at Combined Military Hospital Kharian. Beck Depression Inventory [BDI] was used to record the presence and severity of depressive symptoms. Age, gestation, parity, planned or unplanned pregnancy, education, level of family income, tobacco smoking, Family history of depression, Infertility treatments, previous pregnancy loss or complications, partner support and history of abuse or trauma were associated with depressive symptoms

Results: Out of 188, 41.5% had no depressive symptoms, 25.5% had mild, 20.2% had moderate and 12.8% had severe depressive symptoms. Advancing age, family history of psychiatric Illness, partner abuse, low family income and education, lack of partner support, smoking, increasing parity and gestation age are all significantly related to presence of depressive symptoms

Conclusion: This study showed a high frequency of depressive symptoms among wives of military soldiers during pregnancy. Special attention should be paid in elderly, multiparous and less educated ladies. Partner should avoid abuse and provide good support especially as the pregnancy advances. Declaration of interest: No conflict of interest for any author

Role of nutrients and environmental conditions for the production of dextransucrase from L. mesenteroides KIBGE-IB26

The bacterial strains capable of producing dextransucrase enzyme were isolated from different fruits and vegetables sources. In primary screening, five strains were selected on the basis dextransucrase production and among them L. mesenteroides KIBGE- IB26 isolated from bottle gourd [Lagenaria Vulgaris] was selected for further studies. For the enhancement of enzyme production, different physicochemical parameters were optimized. Maximum production of dextransucrase was achieved after 06 hrs using sucrose [20.0g/l] as a substrate at 25[degree]C. Maximum dextransucrase production was achieved when medium pH was kept 7.5 before sterilization. In addition, medium was also supplemented with CaCl[2] and K[2]HPO[4] and maximum enzyme production was achieved at 0.0025g/dl calcium chloride and 2.0g/dl K[2]HPO[4] with enzyme activity of 87 DSU/ml/hr. Production of dextransucrase in shorter period of time makes this strain an attractive candidate for commercial production of dextransucrase

Plasmid borne BAC-IB 17: localization of a potential antibacterial positive marker [Bac[+]] encoded broad inhibitory spectrum bacteriocin

Production of antimicrobial compounds is considered as ubiquitous anti-competitor strategy in bacterial ecosystem. Bacteriocins are heterogeneous; highly specific and efficient anti-competitor agents and the gene responsible for the production of bacteriocins mostly exist in an autosomal state and associated with plasmids. BAC-IB17 is a broad spectrum bacteriocin and its production was observed at different stages of the growth cycle from Bacillus subtilis KIBGE-IB17. Growth kinetics of B. subtilis KIBGE-IB17 along with the production of BAC-IB17 showed that it exhibited secondary metabolite kinetics. Plasmid curing technique revealed that the gene responsible for the bacteriocinogenecity in B. subtilis KIBGE-IB17 was located on the plasmid of the bacterium. Overlay method also demonstrated the plasmid-mediated bacteriocinogenesis of the isolated colonies. With the advancement in genomics and proteomics, the plasmid borne BAG-IB 17 can play a significant role in the transfer of bacteriocinogenic factor to other incompetent cells and also in the maintenance of plasmid in bacterial population

Induction of labour; routive induction at 40 weeks of pregnancy

The aim of this study to justify induction of labour at 40 weeks of pregnancy in our population. Quasi experimental study. Combined Military hospital Attock, Obstetric and Gynaecology Department from 1.6.2011 to 1.2.2012. 100 patients were selected from outpatient department, and divided into two groups, group A, with 50 patients at 40 weeks and group B with 50 patients at 41 weeks. Booked or unbooked patients with singleton pregnancy with cephalic presentation, were selected by non propability consecutive sampling technique. Pregnancy with previous scar, medical disorder, polyhydramnios, multiple fetal and uterine abnormality and intrauterine death, placenta previa, were ruled out excluded from study. Postdate pregnancy was confirmed clinically by last menstrual period and early dating ultrasound. Patients were clinically followed for fundal height, presentations and FHR. Bishop scoring was done and patients were induced mechanically with cervical foley and vaginal pessary PGE2 according to bishop score. Amniotomy was done at bishop score more than 7. Labour was monitored with full protocol. Same procedure was repeated for group B of 50 patients who were selected according to criteria, for induction of labour at 40 weeks of pregnancy. Maternal and fetal outcome was analysed in term of mode of delivery and APGAR score respectively. Out of 100 patients, 50 patients with age 20 to 35 year, presenting at 40 weeks were included in group A. Spontaneous vaginal delivery was seen in 30 patients [60%], 4 by vaccum[8%], 3 by forcep delivery [6%], 13 patients ended up into emergency LSCS [26%]. In group B of 50 women, planned for induction at 41 weeks, emergency cesareans were 23 [46%]. MAS was in 9[18%] babies as compared to 2% in group A and, Fetal distress [type 2 dips] were found in 3[6%] cases. Neonatal outcome was assessed with help of APGAR score. Babies delivered with good APGAR were 47 in group A, as compared to 41 in group B. Rate of vaginal delivery was high in group A [74%] induced at 40 weeks. Results were analysed by using SPSS 10 and p-value was found to 0.024. No difference was found in the incidence of fetal outcome with APGAR SCORE 10, and fewer babies were with poor APGAR SCORE and p=0.051. Induction at 40 weeks may reduce perinatal mortality and incidence of MAS. It does not increase risk of caesarean section when compared with induction at or beyond 41 weeks

Antibacterial potential of Calotropis procera [flower] extract against various pathogens

Increased bacterial resistance towards commonly used antibiotics has become a debated issue all over the world in a last few decades. Due to this, consumer demand towards natural anti-microbial agents is increasing day by day

Natural anti-microbial agents have gained enormous attention as an alternative therapeutic agent in pharmaceutical industry

Current study is an effort to explore and identify a bactericidal potential of various solvent extracts of Calotropis procera flower

Flowers of C. procera were extracted with hexane, butanol, ethyl acetate and aqua to evaluate the antibacterial activity by agar well diffusion method against the various human pathogens. The microorganisms used in this study includes Salmonella typhi, Escherichia coll [O157:H7], Micrococcus luteus KJBGE-IB20 [Gen Bank accession: JQ250612] and methicillin resistant Staphylococcus aureus [MRSA] KIBGE-IB23 [Gen Bank accession: KC465400]

Zones of inhibition were observed against all four pathogenic strains. Fraction soluble in hexane showed broad spectrum of inhibition against all the studied pathogens. However, fractions soluble in ethyl acetate inhibited the growth of E. coll, MRSA, and M. luteus. In case of butanol and aqueous extracts only growth of M. luteus was inhibited. Results revealed that the flower extracts of C. procera have a potential to be used as an antibacterial agent against these pathogenic organisms

Isolation and characterization of different strains of bacillus licheniformis for the production of commercially significant enzymes

Utilization of highly specific enzymes for various industrial processes and applications has gained huge momentum in the field of white biotechnology. Selection of a strain by efficient plate-screening method for a specific purpose has also favored and boosted the isolation of several industrially feasible microorganisms and screening of a large number of microorganisms is an important step in selecting a potent culture for multipurpose usage. Five new bacterial isolates of Bacillus licheniformis were discovered from indigenous sources and characterized on the basis of phylogeny using 16S rDNA gene analysis. Studies on morphological and physiological characteristics showed that these isolates can easily be cultivated at different temperatures ranging from 30°C to 55°C with a wide pH values from 3.0 to 11.0 All these 05 isolates are salt tolerant and can grow even in the presences of high salt concentration ranging from 7.0 to 12.0%. All these predominant isolates of B. licheniformis strains showed significant capability of producing some of the major industrially important extracellular hydrolytic enzymes including alpha-amylase, glucoamylase, protease, pectinase and cellulase in varying titers. All these isolates hold great potential as commercial strains when provided with optimum fermentation conditions

Bacteriocin [BAC-IB17]: screening, isolation and production from Bacillus subtilis KIBGE IB-17

Bacteriocins are peptides produced by a variety of different microbes and have antimicrobial activity against closely related species. These antimicrobial agents are gaining more and more attention as an alternative therapeutics not only in pharmaceutical but also as a preservative in food industries. In this study several bacterial strains were isolated from soil and screened for bacteriocin production. Among them, one strain identified as Bacillus subtilis KIBGE IB-17 on the basis of taxonomic studies and confirmed by 16S rDNA analysis. This newly isolated strain showed antibacterial activity against several Gram positive and Gram negative bacteria. Different concentrations of tryptone, yeast extract and NaCl and physiochemical factors such as temperature, pH and incubation period were selected as variables for maximum production of bacteriocin by using agar well diffusion method and significant effects of variables were observed on the production of Bac-IB17. A newly designed modified TY medium showed maximum bacteriocin production containing 1.0% tryptone, 0.5% yeast extract and 0.5% NaCl. Maximum Bac-IB17 production was observed at 37°C after 24 hours with initial medium pH 7.0. Bacillus subtilis KIBGE IB-17 is capable of producing a bacteriocin at a wide range of pH and temperature that makes it an ideal strain that can be used for the production of bacteriocin on industrial scale level. The identification and production of such bacteriocin like compound against a wide spectrum of microbial species is very important for food and pharmaceutical industry

Pregnant women with low BMI [<19]; frequency of preterm Labour and low birth weight

A strong relationship between maternal weight and birth weight has been demonstrated consistently and low maternal weight is considered as a preventable risk factor for low birth weight. To determine the frequency of preterm labour and fetal outcome in terms of low birth weight in pregnant women with low body mass index<19. Descriptive case series. Setting: Outpatient Department of Obstetrics and Gynaecology, Combined Military Hospital, Quetta, a tertiary care hospital. Duration of study: Six months from 01-05-2009 to 01-11-2009. Subjects and Total 114 pregnant women at 16 weeks of gestational age with singleton pregnancy reporting to obstetrics and Gynaecology Department Combined Military Hospital, Quetta were selected. Mean age was observed 27.6 +/- 3.9 year. Out of total 114 patients, 15 [13.1%] belonged to<37 weeks of gestation while 99 [86.9%] patients had>37 weeks gestation. Mean gestational age observed 38.5 +/- 4.1. Out of 15 preterm deliveries, 10 [66.7%] had uterine contractions>4/10 min 5 and [33.3%] patients had Cervical dilatation>2cm. Out of 114 patients, 12 [10.5%] cases had fetal weight<2.5 kg and while remaining 102 cases [89.5%] had fetal weight 2.5-4 Kg. In conclusion, this study demonstrates that low BMI is associated with preterm delivery and low birth weight babies

Causes and management of high fetal head in primigravidae at term

To determine the causes of high foetal head and their relative frequencies in primigravidae presenting at term and to determine the proportion of these patients undergoing lower segment caesarean section or vaginal delivery. A descriptive study. The study was carried out at CMIH Rawalpindi from April 2002 to March 2003. A total of 100 primigravidae patients presenting at term and having a single pregnancy were randomly selected. On the basis of history, Physical examination and abdominal ultrasonography, patients having a high foetal head were recognized and their causes documented. Out of 100 primigravidae, 58 had high foetal head. A discernable cause was found in the 39 [67.2%] patients. Cephalopelvic disproportion [20.7%] and foetal ma! position [17.2%] were the leading cause of high foetal head Lower segment Caesarian section [50%] was the management of choice in half of the patients with high foetal head. Cephalopelvic disproportion and foetal malposition were the major cause of high foetal head in this study and lower segment Caesarean section was the mode of delivery in only 50% of these high risk subjects