Graves hyperthyroidism in pregnancy: a rare presentation

Hyperthyroidism in pregnancy is much less common occurring in 0.1-0.2% of women with Grave’s disease being the most common cause accounting for 90% of the cases. It is important to diagnose hyperthyroidism in pregnancy because fetal loss in untreated patients is high and may even be life threatening for the mother. We are presenting a case of 29 years old G3P2L1 who presented to our emergency with amenorrhea of 7 months and history of loose stools for the last 20 days. It was associated with generalized weakness. She also had history of palpitations, weight loss and sleep disturbances. She was a known case of hyperthyroidism for the past 1-2 years and was already taking anti-thyroid drugs. B/L exophthalmos was apparently present. Patient was severly anaemic with haemoglobin of 5.5gms/dl. Ultrasound showed fetal demise at 28weeks. Patient was given 3 units of blood transfusion and was induced with prostaglandins. She delivered a dead male baby weighing 1.2kgs. Her postpartum period was uneventful. Timely diagnosis of graves hyperthyroidism and its optimal treatment throughout pregnancy is vital in reducing maternal, fetal and neonatal complications.

Comparison of Amsel’s criteria and Nugent’s criteria for diagnosis of bacterial vaginosis in tertiary care centre

Background: Bacterial vaginosis is an imbalance in the ecology of the normal vaginal flora which is characterized by depletion of lactobacilli, and proliferation of anaerobic bacteria. It most often manifests clinically as a vaginal pH of > 4.5, presence of thin whitish homogenous vaginal discharge, detection of “clue” cells and presence of an amine odour after the addition of 10 percent potassium hydroxide. These anaerobic bacteria through specific products stimulate the decidual tissue causing an increase of cytokine level, release of phospholipase A2 and prostaglandins leading to preterm labor, premature rupture of membranes, chorioamnionitis and development of PID following abortion. To compare Amsel Criteria and Nugent Criteria for diagnosis of bacterial vaginosis.Methods: A cross sectional study involving 260 patients with preterm and term labour was conducted at a tertiary care hospital in North India. BV was determined to be present or absent on the basis of Amsel’s criteria and Nugent’s criteria. Pearson’s chi-square test was used to demonstrate the difference between both groups with respect to various categorical data.Results: Amsel’s criteria and Nugent’s criteria were reliable diagnostic methods. As compared to Nugent scoring system, Amsel’s criteria had sensitivity of 75%, specificity of 95%, positive predictive value of 90% and negative predictive value of 86%.Conclusions: Although the Amsel’s criteria is a convenient and inexpensive method of diagnosing bacterial vaginosis, it is not always reliable. Nugent’s criteria is considered as a gold standard for the diagnosis of bacterial vaginosis but it requires an experienced slide reader and considerable time and skill. If lab equipment is not available as in many developing countries, the diagnosis of BV can be simplified by using a combination of any two Amsel’s criteria like vaginal pH and whiff test which had highest sensitivity and specificity (90.19% and 97.78%) respectively as seen in present study.

Role of laparoscopy in Hydatid cyst disease.

Management of hydatid cyst disease is basically of excision of cyst wall and removal of all daughter cysts which was previously done by open technique. With proper selection of patient our strategy was going for laparoscopic approach first with conversion to open approach in accordance with difficulties encountered. Aim : To study the role of Laparoscopy in Hydatid Cyst Disease. Method : In this study, we present 30 cases where all cases were planned for initial laparoscopic trial and conversion to open if difficulties were encountered. This is an observational study to evaluate the role of laparoscopy in hydatidosis. All the patients underwent thorough clinical examination with detailed history and investigation as per protocol. Written informed consent was obtained before enrolling for the study. All patients were followed for 3 months. Result : Conversion to open surgery was done in 40% of cases due to number of cysts more than 3 and GHARBI type IV cysts followed by biliary communication of cysts and then peritoneal cysts and unfavourble location of cysts. Rest 60% patients were managed laparoscopically with good postoperative outcome and shorter hospital stay. Conclusion : laparoscopic treatment of hydatid cyst disease is a safe and effective procedure; with an excellent learning curve; provided strict selection criteria are observed. Most common reason for conversion to open approach was cyst number more than 3 and GHARBI type IV cysts, which were not diagnosed preoperatively. Complication rate was less with laparoscopic approach as compared to patients undergoing open surgery. Postoperative recovery was excellent in patients operated laparoscopically with shorter hospital stay.

Bacterial Vaginosis in Pregnancy (<28 Weeks) and its Effect on Pregnancy Outcome: A Study from a Western UP City.

Introduction: Bacterial vaginosis (BV) is a vaginal infection involving a reduction in the amount of hydrogen-peroxideproducing Lactobacillus and an overgrowth of anaerobic and gram-negative or gram-variable bacteria. Its prevalence in pregnancy is upto 15-30% and it can have a bearing on pregnancy outcome. It has been associated with preterm labor and preterm delivery, premature rupture of membranes (PROM), amniotic fluid infections and postpartum endometritis. Material and methods: Five hundred antenatal patients admitted or attending antenatal outpatient clinic in Dept. of Obstetrics and Gynecology, LLRMMC and associated SVBP Hospital, Meerut, Uttar Pradesh in last one year were enrolled after a written and informed consent. Patients included were <28 weeks gestation and without any known risk factors for premature delivery. BV was diagnosed by Nugent’s criteria and correlated with occurrence of preterm labor, PROM and postpartum endometritis. Result: BV was found in 98 of the 500 patients studied. Twenty-three of the 98 BV patients had preterm delivery and this association was significant (p < 0.0001). Fourteen patients of BV had PROM and this association was also significant (p < 0.001). Six patients of BV also had postpartum endometritis. Conclusion: The above results suggest that screening for BV should start in early pregnancy and a high index of suspicion for preterm delivery should be kept in antenatal patients with BV.

Association Between ABO Blood Groups And Myocardial Infarction In Jodhpur City of India.

Background: Many reports have appeared in recent years showing an association between blood groups and Myocardial Infarction. Clinical studies have shown a significant association between MI and blood group B. Objective: To investigate correlation of ABO blood groups with risk of MI. Methods: The present cross sectional study analyzed ABO blood group among total 400 subjects of any age from the local population of Jodhpur city from July to December 2011.Among them 200 subjects were normal healthy(135 male and 65 female) students of Dr. S.N. Medical College, Jodhpur and another 200(135male, 65female) were MI patients admitted in the CCU of Mathura Das Memorial(MDM) Hospital, Jodhpur. ABO blood group of all subjects were determined by slide agglutination method. Risk of MI was expressed by risk ratio. Data were analyzed by one sample chi square test. Results: The results obtained in this study showed that the prevalence of MI in blood group B is significantly higher than in all other ABO blood groups. Conclusion: The results may conclude that there is a significant association between MI and blood group B. So this study reveals MI risk is associated with the blood group B.