Urogenital myiasis - An atypical presentation

The infestation of the human body by maggots has been reported worldwide and occurs most commonly in people of lower socioeconomic status and poor personal hygiene. Urogenital is the rarest site of myiasis presentations. Here we report the case of a 20-year-old, sexually inactive female student who presented with a necrotic growth in the paraurethral region infested with numerous maggots. The lesion involved the urethra and the bladder base. She was treated with debridement and bladder irrigation. The cystoscopy and local examination performed 2 weeks after admission, confirmed the complete healing of the urogenital lesion. Managing this patient's unique challenge was to assess the extent of the involvement and removal of all maggots from the deepest wound portion. The female internal and external urogenital myiasis is a very occasional and under-reported health hazard. Reporting such cases increases the public and physician awareness about the mode of presentation, right diagnosis, and available treatment options.

Prevalence and distribution of various human papillomavirus genotypes in women with high risk for cervical carcinoma

Background: In India, cervical cancer is second most common cancer in women and is the second most common cause of death due to cancers in women. Human papillomavirus (HPV), mainly genotype 16 and 18, are responsible for most of the precancerous lesions of cervix and for cervical cancer. Therefore, it is necessary to prevent the spread of HPV infection and its early treatment to decrease cervical cancer associated morbidity and mortality. Aims of this study was to find out the prevalence and distribution of various HPV genotypes in women high risk for cervical carcinoma. To find correlation between HPV DNA test and cytology report.Methods: An observational study was done on a total of 384 women who were at a high risk for cervical cancer.  Ectocervix and endocervix samples for conventional cytology along with cervical swab collection for HPV DNA isolation were obtained from women aged 21-65 years. Multiplex real time PCR used for HPV DNA isolation and genotyping and Bethseda classification 2014 was used for reporting cytology. Statistical analysis was done using SPSS version 22 and Microsoft excel 2010 software. Data assessment was done using independent t-test, Chi-square test or Fisher’s exact test.Results: Prevalence of HPV in women high risk for cervical cancer in our study was 14.58%. Most common high-risk genotypes were HPV 18 (7.03%) followed by HPV 16 (6.51%). All genotypes except genotype 31, were more frequently seen as a single infection rather than a multiple infection. In 323 subjects which were negative for Pap smear, 31 were positive for HPV DNA showing a statistically significant result with a p value of <0.0001.Conclusions: It was analysed that infection with HPV is very common (9.60%) even in women who had a negative Pap smear test showing a positive correlation between the two tests. HPV DNA testing can improve the detection rate of cervical intraepithelial lesions.

A longitudinal study of near-miss and maternal mortality at a tertiary centre in rural Uttarakhand: addressing the fourth delay

Background: India is a signatory of the sustainable development goals and is committed to reduce the maternal mortality ratio to less than 70 per lakh live births. Review of maternal deaths and near miss cases is a very important step towards achieving this aim.Methods: A prospective observational study was carried out in a tertiary care centre in rural Uttarakhand for a period of one and half year using WHO criteria for maternal near-miss, in an attempt to assess the quality of obstetric care in the region and to identify the possible delays leading to this.Results: Haemorrhage was the most common cause leading to severe maternal outcome, followed by early pregnancy complications and hypertensive disorders of pregnancy. The mortality index was 15% and maternal near miss to mortality ratio was 7:1. We could identify some type of delay in at least 70% of near miss and mortality cases. Although delay in seeking healthcare was the most common, lack of community participation was identified as an important fourth delay.Conclusions: For substantive reduction of maternal mortality in this region of Uttarakhand, the main action needed is strengthening of primary health care, educating the patients regarding warning signs of pregnancy and strengthening the social status of women in society, increasing community support in women health care.

Evaluation of severe acute maternal morbidity and mortality at a tertiary referral center of Uttarakhand, India

Background: Maternal mortality is an area of concern for the Governments across the globe. India is signatory to millennium declaration and is committed to achieving the target of millennium development goals by reducing MMR to 100. Known obstacles to reducing the MMR in developing countries, include lack of material and human resources, as well as difficulties in accessing services due to financial, geographical, and cultural limitations.Methods: It was a descriptive cross-sectional study conducted at a tertiary care centre in Uttarakhand for a period of one year. WHO’s near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.Results: During the period of this study there were 2243 total antenatal admissions, 1675 deliveries, 1591 live births and 59 near miss cases. Prevalence of SAMM in the present study is 3.52%. Out of every 9-10 women who survived a life-threatening condition 1 died. Mortality Index is 10.17%. Maternal mortality ratio is 377.12 per 1 lakh live births. A total of 43 patients with potentially life-threatening conditions were admitted in ICU out of which 26 were near miss cases. The leading cause of near miss in this tertiary health facility is obstetric haemorrhage (45.8%).Conclusions: Prompt identification of complications and timed intervention remains the key determinant in making mothers survive a life-threatening complication.

Placental location and development of preeclampsia: a longitudinal study

Background: Preeclampsia is one of the leading causes of morbidity and mortality worldwide. A number of pregnant women suffer from it after 20 weeks of their pregnancy. The study was designed to know the association between location of placenta and the development of preeclampsia in pregnant women. the purpose of the study is to determine the incidence of lateral location of placenta and to study the relation between placental location and development of preeclampsia.Methods: A prospective study conducted on pregnant women who attended the antenatal clinic of SRHU Hospital over period of 12 months. The study was hospital based longitudinal study with a sample size of 100 cases presenting over a period of 12 months in Obstetrics and Gynecology Department. Simple Random Sampling was used for random selection of antenatal case at 18 to 24 weeks gestation with singleton pregnancy, after taking written consent and agreeing for follow-up till delivery.Results: Out of the total 100 cases taken for the study, there were 68 cases of lateral placenta and 32 cases of central placenta. Most of the cases belonged to middle class living in urban areas. The development of preeclampsia is mainly due to mineral deficiency and high systolic BP.Conclusions: In present study, 48.5% patients with lateral placenta and 46.9% with central placenta developed pre-eclampsia.  There was a significant association that was found between laterality of placenta and development of PIH. The laterally located placenta is associated with increased risk of developing preeclampsia. Therefore, looking for placental laterality at the time of a mandatory antenatal ultrasound scanning (level II) may serve as a non-invasive test to predict pre-eclampsia.

Effect of hypovitaminosis D and its related factors in pregnant women and their newborns

Background: Maternal and fetal vitamin D deficiency has nowadays emerged as a frequent morbidity. Adequate vitamin D concentrations during pregnancy are necessary to maintain neonatal calcium homeostasis, bone maturation and mineralization. Objectives of this study were to evaluate serum vitamin D concentration in mothers and its correlation with neonatal cord blood vitamin D at the time of delivery and to study the impact of hypovitaminosis on neonatal anthropometry. Effect of related factors like calcium (Ca), alkaline phosphatase (ALP) and parathyroid hormone (PTH) on maternal vitamin D levels were to be evaluated.Methods: Cross sectional study was done on a total of 220 healthy uncomplicated antenatal females with singleton pregnancy attending labor room at the time of delivery. Maternal and neonatal cord blood samples were drawn in the delivery room and analyzed. Neonatal anthropometry was recorded. Correlations among various maternal and neonatal factors were studied.Results: Widespread vitamin D deficiency was observed in expectant subjects and neonates with 70.91% having deficient levels which were also reflected in newborns (71.82%). Maternal ALP (r= -0.5503, p=0.000) bears a weak negative correlation (p<0.05), maternal serum Ca positive correlation (r = 0.7486, p=0.000) and plasma PTH levels a negative correlation (r = -2.084, p=0.000) with hypovitaminosis. No significant correlation was observed between neonatal anthropometry and vitamin D levels.Conclusions: High prevalence of hypovitaminosis was observed among pregnant women and their neonates in this study. A positive linear relationship was seen between maternal and cord blood vitamin D (r 0.974, p 0.0001).