ABSTRACT
Background: Placenta accreta is a severe pregnancy complication and is currently the most common indication for peri partum hysterectomy. It is becoming an increasingly common complication mainly due to the increasing rate of cesarean delivery. Placenta accreta is considered a severe pregnancy complication that may be associated with massive and potentially life-threatening intrapartum and postpartum hemorrhage. It has become the leading cause of emergency hysterectomy. Maternal morbidity had been reported to occur in up to 60% and mortality in up to 7% of women with placenta accreta. In addition, the incidence of perinatal complications is also increased mainly due to preterm birth and small for gestational age fetuses. Placenta cretas are defined as abnormal adherences and/or ingrowths of the placenta to the uterine wall. Placenta creta is currently classified according to the depth of abnormal adhesion and invasion of the chorionic villi to the myometrium in the absence/deficiency of decidualization. The incidence of placenta accreta, defined as the abnormal adherence of the placenta to the uterine wall, has been increasing alarmingly in the developed as well as the developing world.. The exact pathogenesis of placenta accreta is unknown. Generally, placenta B. Bheeshma, B.S. Nithyananda, Sumaiyya Fatima, Fatima Anjum. A Retrospective Study of Placenta cretas: A 4 year experience at Modern Government Maternity Hospital, Hyderabad. IAIM, 2017; 4(5): 31-36. Page 32 accreta has been diagnosed on hysterectomy specimens when an area of accretion showed chorionic villi in direct contact with the myometrium and an absence of decidua or in placental basal plate. Aim: The aim of this study was to determine the incidence of placentas cretas in our hospital and to profile the associated risk factors. Materials and Methods: The patients who underwent gravid hysterectomies for placenta creta at Modern Government Maternity Hospital from 2013 to 2016 were included in study. A total of 25 cases during 4 year period were included out of 33063 deliveries. The indications for hysterectomy in majority of cases were heavy bleeding after removal of placenta or inability to remove the placenta manually either partially or totally. The specimens received in pathology department were thoroughly examined grossly and the representative sections were taken from all the specimens after proper fixation which was submitted for tissue processing and H&E stained sections were studied for final diagnosis. Results: Amongst 33093 deliveries which occurred at our institute from January 2013 to December 2016, there were a total of 25 patients with placenta accreta diagnosed by histopathology, which was a rate of 0.7% cases per 1,000 . This total included 2 cases of focal placenta accreta (8%), 10 cases of placenta accreta vera (40%), 9 cases of placenta increta (36%), and 4 cases of placenta percreta (16%). Conclusion: The incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia. Therefore it is important to have a high index of suspicion in such cases. Women with a placenta previa overlying a uterine scar should be evaluated for the potential diagnosis of placenta accreta and arrangements should be made for delivery accordingly to reduce maternal and fetal morbidity and mortality
ABSTRACT
Background: Construction of a question is a very important step in setting up of a question paper in written assessment of students during II M.B.B.S course. The most important aspect of this assessment is framing the question paper. At present long essay type of questions is one of the methods to assess cognitive skills in examinations. The two major categories of assessment are structured and unstructured questions, each of which serves different purposes to draw inferences about a subject’s capability. Objectives: To evaluate II year M.B.B.S students in answering structured essay question versus unstructured essay question and to compare and assess reliability of the structured essay question in Pathology examinations. Materials and methods: Present study was conducted in Gandhi Medical College, for a batch of 205 students i.e. II year students before University examinations. Students were initially tested with unstructured essay question, and then same group of students subsequently tested after one week with structured essay. Marks were tabulated and analyzed. Mean difference in the score of each answer was calculated by Chi square test. Results: A total of 205 students were evaluated for formative assessment by giving two different types of essay questions in Pathology in pre final examinations. 47.8% of students with unstructured essay question evaluation scored less than 10 marks (74.63%) and only 15.61% of students scored 16 and above marks in this group. In structured essay question evaluation (second phase) had higher percentage of student who scored more than 10 marks (73.17%). More than 38% of students scored 16 and above marks in this group. B. Bheeshma, Shyamala Srujana, Padma Sunethri. Comparison of the outcome of structured essay versus unstructured essay questions used as assessment tool in pathology. IAIM, 2016; 3(6): 148-151. Page 149 Conclusion: In this repeated measures study, students administered with structured essay method scored significantly better marks than the unstructured essay method, suggesting a need for introducing structured essay method for better evaluation of students in the examination.
ABSTRACT
Cardiac deaths account for 50% of all deaths in developed and 25% in the developing world. One-sixth of world’s population lives in india and heart diseas accounts for 24% of all deaths. Sudden death accounts for two-thirds of all autopsies in Forensic Medicine Actual detection of histological. sequence of the infected myocardium will develop only after significant time of, between onsets of myocardial infarction (MI) in death. Cardiac Troponin-T is not normally present in serum unless cardiac necrosis has occurred therefore cardiac Troponin levels act as a specific and sensitive indication of myocardial infarction. The present study was conducted on cases coming for medico legal autopsy to the Forensic Medicine Department at Gandhi Medical College/Hospital, Hyderabad, Andhra Pradesh, India for a period of 1 year from January 2014 to December 2014. Total 12 cases with 6 controls were analyzed. Cardiac Troponin-T was markedly elevated >2.000 ng/ml in all except one case of suspected MI. Sensitivity was found to be 91.66% and specificity 66.66%.