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Introduction: Pregnancy-induced hypertension (PIH) is one of the risk factor in pregnancy leading to placental insufficiency which in turn is responsible for maternal and foetal morbidity and mortality. PIH causes morphological changes in placenta. Decreased placental surface area and variation in the attachment of umbilical cord on placenta are more commonly noted in PIH which hampers the uteroplacental perfusion resulting in foetal mortality and morbidity. Hence afforts were made to study the incidence of reduced placental surface area and mode of cord attachment on placenta. Materials and methods: The study was conducted in the Department of Anatomy, Sri Siddhartha medical college and Hospital, Tumakuru, Karnataka. A total of 100 (50 normal and 50 PIH) human placentae were studied. Placental surface area and mode of attachment of umbilical cord in normal and PIH pregnancy were measured and noted. This study was analysed statistically by using Unpaired t-test and Chi-square test. Results: The study revealed significantly decrease in placental surface area and also there is increased incidence of central and marginal attachment of umbilical cord in PIH cases. Conclusion: Study reveals, PIH cause morphological changes in placenta, it decreasing the uteroplacental blood flow which reduces foetal nutrition ultimately decreasing the neonatal weight.
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Background: There is conflicting evidence with regards to the impact of supraphysiologic estradiol levels in in-vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles on pregnancy outcomes such as oocyte quality, implantation, and clinical pregnancy. The objective of our study was to evaluate the effect of serum estradiol levels on the day of ovulation trigger on pregnancy outcomes in IVF-ICSI cycles.Methods: We performed a retrospective cohort study, which included eighty-three women who underwent IVF-ICSI and experienced fresh embryo transfer (ET) over one year period. The women included in the study were divided into four groups according to the serum estradiol level on the day of ovulation trigger; Group I: <2000pg/ml, Group II: 2000-3000pg/ml, Group III: 3000-4000pg/ml and Group IV: >4000pg/ml. The outcome measures including number of oocytes retrieved, MII (metaphase II) oocytes, fertilization rate, embryo quality, overall pregnancy rate, implantation rate and clinical pregnancy rate were compared among these four groups.Results: The total number of oocytes, MII oocytes as well as good quality embryos significantly increased from group 1 to group 4. The implantation rate was lowest in group 4 compared to all other groups, although not statistically significant. There was no significant difference in overall and clinical pregnancy rate between the groups.Conclusions: Serum estradiol level shows a positive correlation with the number of oocytes retrieved and good quality embryos. A higher estradiol level does not have a significant negative impact on the implantation rate, overall or clinical pregnancy rate.
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Background: Endometriosis still remains an enigmatic disease. There are important reasons to stage endometriosis and to prognosticate the chances of pregnancy after a surgical management. The currently used revised AFS system has poor correlation with pregnancy rate. A scoring system-Endometriosis fertility index (EFI) to prognosticate the outcome was proposed few years back. The objective was to assess the usefulness of the EFI system in predicting pregnancy in patients with surgically documented endometriosis who attempt Non-IVF conception.Methods: Retrospective data was collected from 77 subjects with endometriosis who underwent laparoscopy and had documented least function (LF) score and EFI score. All were followed up until 12 months for the occurrence of a non IVF pregnancy.Results: Our study showed that the pregnancy rate was clearly higher in those with high EFI scores than those with low scores. A score of less than 4 was associated with significantly lower pregnancy rates than those with score above 5 (n=26, pregnancy rate- 11.54%) vs. (n=51, pregnancy rate 50.1%); p = 0.001)). Similarly, the pregnancy rate was significantly lower in those with LF score 1-3 (21.2%) as opposed to those with higher LF scores (p =0.029). Also, sensitivity analysis showed that higher EFI score was significantly associated with higher LF score (P <0.001).Conclusions: EFI is a useful clinical tool that predicts pregnancy with reasonable accuracy after endometriosis surgery. Its use clearly provides reassurance to those patients with good prognosis.
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A 5 1/2-yr-old boy presented with high grade fever for 4 days, and cervical adenitis, body ache, arthralgia, followed by sudden onset of breathlessness. He had clinical, electrocardiographic and echo evidence of myocarditis and congestive cardiac failure. An enzymelinked immunosorbent assay (MAC-IgM ELISA) with serum collected 5 days after disease onset showed IgM antibodies to CHIKV. He was managed conservatively and started showing symptomatic improvement by 3 days. At discharge, a repeat Echocardiogram (a week later) showed normal left ventricular (LV) function with mild Mitral regurgitation. On follow up, after 2 months, child remains asymptomatic. Other common aetiological agents were screened for and found negative. This may indicate a probable cardiac tropism for the virus.
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Objective: To compare the effectiveness of intermittent with daily chemotherapy (both containing rifampicin) in childhood tuberculosis (age ≤16yrs) in achieving cure/ significant improvement. Design: Systematic Review and Meta-analysis. Methods: MEDLINE and the Cochrane Library were searched for randomized trials of antitubercular regimens containing rifampicin, in children 16 yrs or less with tuberculosis. Two reviewers independently assessed trial eligibility and quality. Data from full articles of selected studies were independently extracted by two authors and analyzed. The odds ratio was obtained for the pooled data in two groups (intermittent and daily therapy). Outcome variables: Cure/significant improvement, relapse rate and adverse events. Results: Four randomized controlled trials comparing twice weekly and daily therapy including 466 children (pulmonary 439; extrapulmonary 27) met the inclusion criteria. Baseline data were comparable. On quality assessment, 3 studies scored 2 and one study scored 3 out of 5 points. Per protocol analysis showed that children receiving intermittent regimen were less likely to be cured than those receiving daily therapy (OR 0.27; 95% CI: 0.14, 0.51). The results of intention to treat analysis suggest similar trend towards lower cure rates with twice weekly regimen (OR 0.66; 95% CI: 0.23-1.84). Conclusion: Twice weekly intermittent short course therapy is less likely to cure tuberculosis in children as compared to daily therapy. There is a need for better quality randomized controlled trials for assessing efficacy of alternate schedule for intermittent therapy for childhood tuberculosis.
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Animals , Cattle , Child, Preschool , Colostrum/immunology , Humans , Infant , Infant, Newborn , Milk/immunology , Respiratory Tract Diseases/therapyABSTRACT
The Revised National Tuberculosis Control Program (RNTCP) has initiated provision of antitubercular therapy for children with strategy of patient-wise boxes for the 4 different weight bands (6- 10 kg; 11- 17 kg; 18- 25 kg; 26- 30 kg). We evaluated the dose of individual drugs delivered by this approach to children of varying weights. The following areas of concern were identified: underdosing of individual antitubercular drugs for many weights; lack of provision to modify doses when child gains weight and moves to another weight band; and, inappropriate formulations, particularly for infants. We conclude that the current dosing strategy used in RNTCP needs modification to prevent the significant risk of underdosing and undertreatment.