Fetomaternal outcome in pregnancy with thrombocytopenia: A prospective study from one of the teaching health-care institutes of Ahmedabad, Gujarat

Background: During pregnancy, hemodilution of plasma volume leads to reduction in platelets count by approximately 6–7% during 3rd trimester. Pregnant women with thrombocytopenia have higher risk of bleeding excessively during pregnancy, labor, and puerperium. The present study focuses on fetomaternal outcome among pregnant women having thrombocytopenia. Aims and Objectives: This study aims to study the incidence of thrombocytopenia in pregnancy, to identify various factors responsible for thrombocytopenia in pregnancy, and to evaluate fetomaternal outcome in patients with thrombocytopenia in pregnancy. Materials and Methods: A prospective study was conducted in the department of obstetrics and gynecology at tertiary care center of Ahmedabad. A total of 96 cases of thrombocytopenia in pregnancy were included in the study. Fetomaternal outcome was assessed among the study participants. Results: The incidence of thrombocytopenia in the present study was 0.77%. Obstetric causes (53.12%) accounted for most common cause of thrombocytopenia, followed by gestational thrombocytopenia (27.08%), dengue (10.41%), malaria (4.16%), and immune thrombocytopenia (4.16%). Postpartum hemorrhage (15.62%), eclampsia (14.58%), disseminated intravascular coagulation (11.45%), and abruption (8.33%) were the most common maternal complications. The most common neonatal complication was prematurity (67.7%) followed by intrauterine growth retardation (23.95%) and birth asphyxia (9.3%). Conclusion: Hypertensive disorders of pregnancy including severe preeclampsia, eclampsia, and HELLP syndrome are found to be the most common cause of thrombocytopenia followed by gestational thrombocytopenia and infectious causes. The present study widened the spectrum of the causes for thrombocytopenia in pregnant women. Gestational thrombocytopenia is associated with mild-to-moderate thrombocytopenia and hardly having any complications.

A Five Year Retrospective Study of Profile of Leprosy Patients in a Teaching Tertiary Care Centre in Uttarakhand

Despite India reaching elimination levelsas a public health problem, leprosy still remains a major health care problem. The aim of our study is to determine the morphological pattern and the trend of acid-fast bacilli (AFB) positivity of the disease in the post eradication phase. A retrospective study was conducted of skin biopsies clinically diagnosed as leprosy from January 2015 to December 2019. Relevant clinical history was obtained from records. Majority were in the age group of 31-40 years (20%), with male predominance (61.25%). 10.62% cases were of children below the age of 15 years. Histologically, 38.75% of cases were diagnosed as indeterminate leprosy followed by 20% cases of lepromatous leprosy. Hypopigmentation (35.62) was the most common clinical feature. Clinical-histological concordance was highest for histioid leprosy cases (100%) followed by lepromatous leprosy (90.62%). Majority of our cases were multibacillary (71.25%). BI 1+ was seen in 51.75%, whereas BI 6+ was 11.4%. Predominance of multibacillary forms specially with high bacterial load indicates late reporting and need to diagnose and treat early for stopping its transmission. Histopathological examination of skin biopsy is important for early and proper treatment of the patients with early inderminate/atypical clinical manifestations. The health care policies need to be reconsidered and revised both at the national and global levels

Risk factors assessment in non-insulin-dependent diabetes mellitus women: a cross sectional study from Telangana

Background: The prevalence of women with type-2 diabetes mellitus in Karnataka is 22.04%. Many people are diagnosed type-2 diabetes in their teens or early 20s. And with advancing age, the risk of getting type-2 diabetes goes up too, especially if you don’t change any of the diabetes risk factors like your weight and physical activity level. Women who get type-2 diabetes are at greater risk than men of cardiovascular disease and blindness. The objective of the study was to study the risk profile amongst diabetic females.Methods: The hospital-based descriptive observational study was carried out in 75 non-insulin-dependent diabetes mellitus (NIDDM) women at Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from June 2010 to December 2010. Detailed history and anthropometric assessment was done and data analysed with SPSS software.Results: Majority of the diabetic women were from 40-50 years age group i.e. 33 (44%). Mean age was seen as 52±12.4 years. 57 women having sedentary lifestyle (76%). Mean BMI was found to be 24.58±5.27 kg/m2. Waist circumference was 83.42±9.35 cm. Hip circumference was 95.05±9.1 cm and waist/hip ratio was 0.877±0.041.Conclusions: Increasing age, sedentary lifestyle, obesity especially central and obstetric events were found to be important risk factors in our study.

Concept of clinical pharmacology and therapeutics sensitization and training for interns

Background: Rational prescribing of the medicines is an essential skill required by all the doctors. Interns are not prepared or confident in rational prescription either because of inadequate training or knowledge is not retained by the time they come to internship or due to fast change in the concepts or protocols in pharmacology. The objectives of the study were to introduce and assess a short sensitization and training for interns regarding clinical pharmacology and therapeutics (CPT).Methods: It was a quasi-experimental type of interventional study done on 30 pediatrics interns. A short sensitization and training was given regarding CPT using flipped classroom model. Pre-test and post-test was conducted to know the effectiveness of the sensitization/training. Students’ opinion was also taken regarding the training and incorporation of similar training in other departments.Results: The mean percentage scores of the objective type questions in the pretest was 40.6±3.25 which increased significantly (p<0.05) to 74±2.95 in post-test. The mean percentage scores of the problem solving type questions in the pretest was 30.78±5.25 which increased significantly (p<0.05) to 65.21±4.65 in post-test.Conclusions: The sensitization and training was effective and there was overall satisfaction of conduct of such training among pediatrics interns. Further detailed research has to be conducted in different departments and faculties’ opinion regarding incorporation of CPT training and feasibility has to be considered before we recommend such training during internship.

Unmet need for family planning of married women in rural areas of Kalaburagi: an application of multiple logistic regression model

Background: Unmet need for family planning, which refers to the condition in which there is the desire to avoid or post-pone child bearing, without the use of any means of contraception, has been a core concept in the field of international population. This study aimed to determine the factors affecting for unmet need for family planning among married women in the age group of 15-49 years of rural areas of Kalaburagi. By multiple logistic regression model and stepwise forward logistic regression model to estimate the parameters of the model, odds ratios and log likelihood values are computed. Testing of hypothesis of goodness of fit of the model is carried out by Hosmer and Lemeshow test.Methods: 600 married women in the age group of 15-49 years were the study participants who were selected randomly from the 7 taluks of rural areas by using multistage sampling techniques.Results: Total of 26 explanatory variables are included in the model, in which only 5 explanatory variables (19.00%) are found to be significant regression coefficients i.e., education of married women, abortion, physical deformities baby, ideal gap between children, contraceptive used in past normal level of significance (p<0.05).Conclusions: The test statistic of all five models, only model 4 and model 5 fit well with response variable for the rural sample data.

Incidence of thyroid dysfunction in antenatal women and its effect on fetomaternal outcome

Background: Thyroid dysfunction is the second most common endocrine disease in pregnant women. Hypothyroidism is a more common dysfunction encountered in pregnancy. Aim: To study the incidence of thyroid dysfunction in antenatal cases and its effect on fetomaternal outcome. Materials and methods: Total 50 cases of pregnancy with thyroid disorder were selected. Detailed history was taken and full clinical and general examination was performed using a predesigned proforma including clinical feature suggestive of thyroid dysfunction. Serum TSH, T3, T4, fT3, fT4 was measured by CLIA (Chemiluminescence Immunoassay) in all the cases as initial hormonal screening investigations. Results: The overall percentage in our study was 15.97% and out of this 74% was without any symptom i.e. subclinical and only 26% had symptoms. Caesarian section rate was (30% v/s 0%), 18% with subclinical hypothyroidism were detected. In controls, 9% with subclinical hypothyroidism were detected. The most common complication associated with hypothyroidism was abortion (14%) and PIH (16% v/s 56%) hyperemesis gravidarum (9% v/s 3%) and hemorrhage in early pregnancy (22% v/s 8%) We also observed that hypothyroidism is associated with more complications even if it is subclinical (42%). Conclusion: The study concludes that thyroid dysfunction in pregnancy is often significantly associated with maternal complications most commonly abortions, anemia, preterm labour and abruption. Higher caesarean rates are also observed among hypothyroid mothers. Low Apgar scores, increased NICU admissions, low birth weight mainly due to prematurity are usually noted in the Joshi K, Bhatt M, Saxena R. Incidence of thyroid dysfunction in antenatal women and its effect on fetomaternal outcome. IAIM, 2016; 3(11): 136-142. Page 137 neonate. The early administration of treatment and maintenance of a normal level of thyroid hormones significantly minimize the risk of maternal and fetal complications.

High frequency of loss of allelic integrity at Wilms' tumor suppressor gene-1 locus in advanced breast tumors associated with aggressiveness of the tumor.

Background: The product of Wilms' tumor suppressor gene (WT1), a nuclear transcription factor, regulates the expression of the insulin-like growth factor (IGF) and transforming growth factor (TGF) systems, both of which are implicated in breast tumorigenesis and are known to facilitate angiogenesis. In the present study, WT1 allelic integrity was examined by Loss of Heterozygosity (LOH) studies in infiltrating breast carcinoma (n=60), ductal carcinoma in situ (DCIS) (n=10) and benign breast disease (n=5) patients, to determine its possible association with tumor progression. Methods: LOH at the WT1 locus (11p13) as determined by PCR-RFLP for Hinf1 restriction site and was subsequently examined for its association with intratumoral expression of various growth factors i.e. TGF-β1, IGF-II, IGF-1R and angiogenesis (VEGF and Intratumoral micro-vessel density) in breast carcinoma. Results: Six of 22 (27.2%) genetically heterozygous of infiltrating breast carcinoma and 1 of 4 DCIS cases showed loss of one allele at WT1 locus. Histologically, the tumors with LOH at WT1 were Intraductal carcinoma (IDC) and were of grade II and III. There was no correlation in the appearance of LOH at WT1 locus with age, tumor stage, menopausal status, chemotherapy status and lymph node metastasis. The expression of factor IGF-II and its receptor, IGF-1R was significantly higher in carcinoma having LOH at WT1 locus. A positive correlation was observed between the TGF-β1, VEGF expression and IMD scores in infiltrating carcinoma. Conclusions: The current study indicates that the high frequency of loss of allelic integrity at Wilms' tumor suppressor gene-1 locus in high-graded breast tumors is associated with aggressiveness of the tumor.

Meckel-Gruber syndrome.

Meckel- Gruber syndrome is a rare lethal, autosomal disorder. It has been linked to chromosome 17. It consists of a triad of occipital meningoencephalocoele, large polycystic kidneys and post-axial polydactyly. Death is mainly due to pulmonary hypoplasia. We report this rare case which presented with many associated defects.

Glomerular basement membrane thickness in normal adults and its application to the diagnosis of thin basement membrane disease: an Indian study.

Microscopic hematuria of non-urologic origin warrants ultrastructural study of renal biopsy. Thinning and variations in the texture of glomerular basement membrane (GBM) are difficult to be recognized under light microscope; transmission electron microscope (TEM) therefore plays a vital role in identifying such changes. Ultrastructural morphometry is a valuable diagnostic aid when GBM is suspected of being abnormally thin. In an effort to determine the normal GBM thickness (GBMT) in Indian adults and to determine the cutoff value of GBMT for a diagnosis of thin basement membrane disease (TBMD), we determined GBM thickness in 25 normal adults. Postmortem biopsies of 25 normal adults (16 males and 9 females) aging between 18-58 years were included in the study. GBM thickness was determined through ultrastructural morphometry on accurately enlarged electron micrographs as harmonic mean of 50 orthogonal intercepts across the GBM in each case. Study revealed a mean GBM thickness of 321 nm with a standard deviation (SD) of 28 nm. Mean-2SD (321-56), that is 265 nm, was fixed as cutoff value of GBMT for the diagnosis of TBMD. A systematic split study of control subjects revealed thicker GBM (329+/-38 nm) in higher age group (35-60 years) as compared to GBMT (316+/-21 nm) in lower age group (18-30 years). Males in higher age group also revealed thicker GBM (males: 343+/-39 nm versus females: 300+/-12 nm). Ten patients with non-urologic hematuria and having GBMT<265 nm were diagnosed as cases of TBMD. Patients with TBMD revealed significantly attenuated GBM as compared to age and sex matched controls (214 +/- 40 nm versus 311 +/- 17 nm; p<0.0005). No overlap was observed in the distribution of GBMT in patients of TBMD and age and sex matched controls. Ultrastructural morphometry is the ultimate and appropriate method for diagnosing TBMD.

Small cell carcinoma of the ovary presenting as bone marrow metastasis: a rare presenting feature.

Small cell carcinoma (SCC) of ovary-hypercalcaemic type is a rare cancer of young pre-menopausal women of unclear histogenesis. Bone metastasis and bone marrow infiltration by ovarian carcinomas is a rare feature and only a few case reports are available in the literature. Herein we report a case of small cell carcinoma-hypercalcaemic type of both the ovaries with bone marrow infiltration and features of metastatic calcification in various organs.

Precursor lesions of adenocarcinoma lung--two case reports.

Although precursor lesions of bronchogenic squamous cell carcinoma are well documented, the preinvasive lesions of pulmonary adenocarcinoma are seen very rarely. It has been hypothesized that there is a stepwise progression of alveolar epithelial hyperplasia to atypical alveolar hyperplasia and subsequently to malignancy in the pathogenesis of peripheral adenocarcinoma of the lung. In the present paper we would like to share our experience of two cases of pulmonary adenocarcinoma with their precursor lesions in the form of atypical alveolar hyperplasia.

Fibrosing cholestatic hepatitis-like syndrome in a hepatitis B virus and hepatitis C virus-negative renal transplant recipient: a case report with autopsy findings.

We report a patient with fibrosing cholestatic hepatitis (FCH)-like syndrome in renal transplant recipient, who was negative for hepatitis-B and C-virus infection. The patient presented initially with extrahepatic biliary obstruction due to stricture at the lower end of the common bile duct. Cholestasis persisted inspite of effective biliary drainage. He was operated for empyema of the gallbladder and histological examination showed the presence of cytomegalovirus inclusions in the wall of the gallbladder. The patient died inspite of aggressive management; autopsy examination of the liver revealed evidence of FCH-like changes.

Shah Waardenberg syndrome.

Intermittent or partial small bowel obstruction in a neonate may be a rare presentation of total aganglionosis. The presence of partial albinism and white forelock should alert the clinician to the possibility of associated Hirschsprung disease as a cause of bowel symptoms. Such a rare association has been called Shah Waardenberg syndrome and is being reported.

Effect of eradication of Helicobacter pylori on gastric antrum histology.

BACKGROUND: Helicobacter pylori is a leading cause of gastritis. Some of the histological changes revert after eradication of H. pylori. There is paucity of reports from India. AIM: To study the effect of H. pylori eradication on the histopathological changes. METHODS: Endoscopically obtained antral biopsies from 164 consecutive H. pylori positive cases of dyspepsia were analysed before and 4 weeks after completion of treatment. RESULTS: Treatment for H. pylori resulted in eradication of the organism as confirmed histologically in 123 out of 164 (76.22%) cases. Analysis of histopathological changes in pre and post treatment biopsies from the same patient revealed a significant reduction in neutrophils, eosinophils, chronic inflammatory cells, acute epithelial changes and regenerative foveolar hyperplasia (p < 0.001) There was no difference in these findings in cases where H. pylori eradication failed when compared with their pre-treatment biopsies (p > 0.05). Similarly the pre and post treatment biopsies revealed, no difference in frequency of intestinal metaplasia and gastric atrophy in cases where H. pylori was eradicated or persisted after treatment. CONCLUSION: There was significant reduction in neutrophils, eosinophils, chronic inflammatory cells, acute epithelial changes and regenerative foveolar hyperplasia, following eradication of H. pylori.

In vitro immunity of rat peritoneal macrophages to Candida albicans.

Phagocytic, germ tube inducing and candidacidal activities were investigated in monolayers of peritoneal macrophages of rats. The phagocytic activities observed in macrophages of the healthy rats in the presence of normal serum, those in the presence of immune serum and of immunized rats in the presence of normal serum were 40%, 45.3% and 44.8% respectively. The percent of macrophages in which intracellular Candida formed germ tubes in the above three situations were 10, 9.59 and 10.19, respectively and the percent of intracellular Candida that formed germ tubes were 6.6, 3.7 and 4.1, respectively. The candidacidal activity observed in the above three sets of macrophages were 5.33%, 22.66% and 19.88%, respectively. Induction of germ tube in C. albicans in supplemented tissue culture medium containing normal serum was 15 per cent. These observations indicate that immunisation/sensitisation of individuals with C. albicans organisms does provide some degree of cell mediated immunity by activating macrophages. This may partly be due to the appearance of specific antibodies. It is likely that this type of immunity can be produced by subclinical infections during invasion by the commensal organism thus preventing further invasion establishment of infection and keeping the organism (C. albicans) in a state of commensalism. However, the degree of immunity so produced is so low that predisposing factors suppress it and allow establishment of infection.