ABSTRACT
Background: Vitamin D is a fat-soluble vitamin, a sunshine vitamin. Vitamin D deficiency is now recognized as a pandemic. Fetus depends on mother for its need of vitamin D, thus there is growing concern for its impact on neonates. This study was designed to determine the correlation between 25-hydroxyvitamin D (vitamin D3) levels in maternal blood and in cord blood.Methods: A total 50 term pregnant women attending antenatal clinic at SVS medical college, Telangana and their neonates were included in the study. At term after taking written consent, maternal and cord blood vitamin D3 were measured, and values were correlated. Antenatal and neonatal complications were noted, and correlated with vitamin D3 levels.Results: In this study 80% of pregnant women and 88% of neonates were vitamin D3 deficient. Mean maternal blood vitamin D3 was 17.62±10.01 and cord blood vitamin D3 was 12.84±7.68. Maternal blood vitamin D3 correlated positively with cord blood vitamin D3 (r=0.951, p<0.001). Antenatal and neonatal complications were observed, but statistically significant association with vitamin D3 deficiency could not be established.Conclusions: This study has demonstrated a very high prevalence of vitamin D deficiency in apparently healthy, young, pregnant women despite abundant sunlight leading to deficiency in their neonates. To establish strong association between vitamin D3 deficiency and various antenatal and neonatal complications further studies with large subject groups are required.
ABSTRACT
Background: This study was aimed at observing the outcomes of pregnancies with sonographically detected nuchal cord or cord around the neck at term. Early studies on nuchal cord showed many maternal and neonatal complications. But several recent studies have suggested that maternal and neonatal complications do not increase with nuchal cord at delivery. This ambiguity increases anxiety in treating obstetricians and relatives of pregnant women, thus leading to unnecessary caesarean sections. This study is intended to observe the maternal and neonatal outcomes of 300 pregnant women with sonographically detected nuchal cord at term.Methods: Prospective observational study where 300 term pregnant women with sonographically detected nuchal cord were observed through delivery at Shri Venkata Sai Medical College, Mahabubnagar, Telangana, during October 2016 to April 2018.Results: In this study 80.6% women had normal vaginal delivery, 8.3% had LSCS, 11% had instrumental deliveries. 54% had loose nuchal cord, 46% had tight loop of cord.60% had normal CTG, 8% had variable deceleration, 2% late deceleration. Neonatal morbidity was 9.6% and zero neonatal mortality.Conclusions: The study concluded that the presence of nuchal cord does not adversely affect the mother and the neonate. Presence of nuchal cord per se is not an indication for LSCS. Effect of nuchal cord on neonate is only transient. These women can be allowed for vaginal delivery with routine labour room protocols. Routine sonographycal detection of nuchal cord is not required and if it is reported, it should not dictate obstetric management.
ABSTRACT
Background: Cerebrospinal fluid (CSF) rhinorrhea is the result of an osseous defect in the skull base coupled with a disruption of duramater and arachnoid mater with a resultant pressure gradient, leading to CSF leak. CSF leak can be categorized into spontaneous(idiopathic), traumatic, and non-traumatic. Endoscopic transnasal approach is an extracranial approach which has the advantage ofbeing less invasive, no external scar, excellent site localization with preservation of the surrounding anatomy, and shorter hospital stay.Aim of the Study: The aim of the study was to assess the outcome of repair, cause, site of leak, and efficacy of materials usedfor the repair, elucidate the advantages of endoscopic approach.Materials and Methods: A total of 25 patients with CSF rhinorrhea arising from anterior and middle cranial fossa not subsidingwith medical management were included in this prospective study. Patients of all ages and gender were included in the study.Patients with recent history of meningitis were excluded from the study. All the patients were evaluated for CSF rhinorrhea usingbattery of tests including clinical examination for reservoir sign, biochemical and microbiological analysis of fluid, radiologicalinvestigations, and diagnostic nasal endoscopy to assess the site of leak. The demographic data, CSF leak site and size, etiology,complications, surgical closure techniques, complications of surgery, and recurrences and its management were observed andrecorded. All the data were analyzed using standard statistical methods.Observation and Results: Among the 25 patients, 14/25 (56%) patients were aged below 30 years followed by 11/25 (44%)patients who were aged between 30 and 60 years. The mean age was 34.20 ± 2.35 years. 16/25 (64%) patients were (64%)female and 9/25 (36%) patients were male. 22/25 patients (88%) had spontaneous leaks and 3 patients (12%) had traumaticleaks. In 18/25 (72%) of the patients, the site of leak was in the cribriform plate, 4/25 (16%) from fovea ethmoidalis, 2/25(8%)from the sphenoid, and 1/25 (4%) from the frontal sinus. Immediate post-operative results were observed in 23/25 (92%) of thepatients and there was no CSF leak. 2/25 (8%) patients had CSF leak for 10 days which later subsided.Conclusions: The most common etiology of CSF rhinorrhea was spontaneous, most common site being the cribriform plate.Autologous fat graft was used as the first layer of underlay technique in most of the cases which act as a good sealant. The efficacyof transnasal endoscopic CSF leak repair in our study was found to be 100%, and it is a highly successful and safe procedure.
ABSTRACT
Introduction: Anencephaly accounts for one of the most common birth defects & is associated with a highmortality & morbidity. The objective was to determine frequency of anencephaly and its associated anomalies,risk factors, clinical presentations & assess maternal awareness on folic acid supplementation and its preventiverole in occurrence of anencephaly.Materials and Methods: The study includes 60 anencephalic fetuses (23 males & 37 females) of 20-30 weeks. Thefetuses were examined for external abnormalities & dissected. Measurements of crown heel, crown rump, headcircumference, foot length, & weight were taken. All the major organs were weighed & data recorded. The sampleswere fixed with 10% buffered formaldehyde. The internal anomalies were noted.Results: The number of deliveries was 57429 deliveries. 23(38.4%) were males & 37(61.6%) were females. Thefrequency of anencephaly in 2014 was 15134/9 (0.06%), in 2015 16361/21 (0.13%). Weight of 40% were <500gms,35% were between 500-1000gms & 25% <1000. Maternal age in 83.4% were 21-35 years, in <20 years & >40 yearswere 1.6% & in 36-40 years were 13.4%. Associated anomalies were present in 42 (70%) fetuses. Out of 42fetuses, those who had associated anomalies were 17 (40.4%) males and 25 (59.6%) were females. All the fetuseshad Acrania (100%) & 19 (45.3%) fetuses had spina bifida; there were no anomalies found in reproductivesystem.
ABSTRACT
Insulin resistance is characterized by alterations in insulin signaling components thereby resulting in reduced glucose uptake. The mechanistic role of [3beta]-stigmast-5-en-3-ol in augmenting glucose uptake to overcome insulin resistance is deciphered in this study. 16 myotubes, rat skeletal muscle model have been used to check the effect of [3beta]-stig-mast-5-en-3-ol, a plant phytosterol isolated from the ethyl acetate extract of Adathoda vasica on glucose transport. The influence of [3beta]-stigmast-5-en-3-ol on various cellular targets of insulin signaling cascade has been evaluated using inhibitors on glucose uptake as well as gene and protein expression to unravel the mechanistic action in triggering glucose uptake. [3beta]-stigmast-5-en-3-ol promoted glucose uptake in a dose dependent manner under insulin resistant condition. As assessed by inhibitor studies using Genistein [IRTK inhibitor] and Wortmannin [PI3K inhibitor], gene expression and protein expression studies using specific primers and antibodies, an activation of IR-[3, IRS-1, PI3K, AKT/PKB, PKC by both the crude and [3beta] stigmast-5-en-3-ol were observed. This suggested that [3beta]-stigmast-5-en-3-ol induced glucose uptake functions through the PI3K dependent pathway in L6 myotubes. Both, the crude and [3beta]-stigmast-5-en-3-ol activates GLUT 4 transport [evident from increased mRNA levels and redistribution of GLUT4 from intracellular membrane to plasma membrane through translocation studies]. Confocal microscopy revealed a substantial increase in redistribution of FITC tagged GLUT4 throughout the cells. Our results emphasize the insulin-like effect of [3beta]-stigmast-5-en-3-ol in stimulating glucose transport in vitro and provide evidence in its beneficial role possessing antidiabetic property apart from its existing cholesterol lowering efficacy