Maternal and fetal outcome in placenta previa: our experience

Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was done with the intent of developing insight into risk factors, clinical presentation, various interventions and management for overall improvement in maternal and fetal outcome in placenta previa.Methods: A prospective observational study, where 30 cases of placenta previa confirmed after 28 weeks POG, treated in a public sector tertiary care hospital from June 2016 to June 2018 were included. Authors analyzed the data to evaluate the potential risks factors and maternal and fetal outcome in placenta previa.Results: In this study, major contributing risk factors for placenta previa were associated with multiparity (76.7%), maternal age >30 in 50%, previous LSCS in 46.7%, repeated uterine procedure like suction evacuation/curretage. There was a high rate of maternal morbidity mainly due to haemorrhage. Perioperative uterine artery embolization (UAE) in 3 (10%), intra-operative procedures namely devascularization, internal iliac ligation in 66.6% cases, peripartum hysterectomy in 2 (6.66%) were done to control haemorrhage. Blood and blood products transfusion required in 26.7% of cases. Fetal morbidity included prematurity in 9 (33.3%), NICU admission in 11 (36.6%) majority of which included 8 (26.7%) babies of birth weight <2000 grams.Conclusions: Placenta previa contributes to significant maternal and neonatal morbidity. Multiparity, post LSCS pregnancy constitute major factor for placenta previa. Management requires high-risk obstetrical care with frequent antenatal visits. Serial ultrasonography in reported cases of low-lying placenta is mandatory to exclude over diagnosis or migration. All cases of placenta previa need to be managed in a higher centre with facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity.

Histological Patterns of Ovarian Neoplasms – A Five Year Experience in North-East India

Ovary is one of the common sites of neoplasm in females. They manifest in wide spectrum of clinical, morphological and histological features. Ovary is the second most common site of primary malignancy in female genital tract.

Histological Patterns of Ovarian Neoplasms – A Five Year Experience in North-East India

Ovary is one of the common sites of neoplasm in females. They manifest in wide spectrum of clinical, morphological and histological features. Ovary is the second most common site of primary malignancy in female genital tract.

Serum lipoprotein ratios as markers of insulin resistance: A study among non-diabetic acute coronary syndrome patients with impaired fasting glucose.

Background & objectives: Recent data suggest that insulin resistance can predict cardiovascular disease independently of the other risk factors, such as hypertension, visceral obesity or dyslipidaemia. However, the majority of available methods to evaluate insulin resistance are complicated to operate, expensive, and time consuming. This study was undertaken to assess whether serum lipoprotein ratios could predict insulin resistance in non-diabetic acute coronary syndrome (ACS) patients. Methods: Ninety non-diabetic patients with impaired fasting glucose admitted with a diagnosis of ACS were included in the study. At the time of admission fasting glucose and insulin concentrations were measured. The homeostatic model assessment-insulin resistance (HOMA-IR) was used for insulin resistance. The fasting serum total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-C) levels were checked, and then TC/HDL-C and TG/HDL-C ratios were calculated. The areas under the curves (AUC) of the receiver operating characteristic (ROC) curves were used to compare the power of these serum lipoprotein ratios as markers. Results: Lipoprotein ratios were significantly higher in patients with HOMA-IR index > 2.5 as compared to patients with index <2.5 (P < 0.05). Both TG/HDL-C and TC/HDL-C ratios were significantly correlated with HOMA-IR (P<0.05). The area under the ROC curve of the TG/HDL-C and TC/HDL-C ratio for predicting insulin resistance was 0.80 (95% CI, 0.67 to 0.93), 0.78 (95% CI, 0.65 to 0.91), respectively. Interpretation & conclusions: The findings of this study demonstrate that serum lipoprotein ratios can provide a simple means of identifying insulin resistance and can be used as markers of insulin resistance and cardiovascular diseases risk in adult non-diabetic patients.

Effect of Formulation Variables on the Release of Letrozole from Natural Biodegradable Polymeric Implants.

Aim: Letrozole, a non-steroidal aromatase inhibitor, prevents the body from producing its own estrogen. The objective of the present study was to explore the fabrication and evaluation of natural biodegradable polymeric Letrozole implant for long term drug release targeting postmenopausal women with metastatic breast cancer. Methodology: The effect of different formulation variables i.e. different types of excipients and different hardening times (6 hrs, 12 hrs and 24 hrs) with exposure to formaldehyde vapour was investigated on drug loading efficiency and drug release profile. The result of in-vitro dissolution study was fitted to different kinetic models to evaluate the kinetic data. Results: Letrozole release was studied for 10 to 19 days with some excipients. The in vitro Letrozole release from Gelatin-Sodium Alginate biodegradable polymeric implant was maximum, about 19 days, where Cetyl alcohol was incorporated as excipient. The release kinetics was explored and explained using Higuchi, zero and first order while the mechanism of release was confirmed with Korsmeyer-peppas model. Implants were found to follow Higuchi model the best in most cases. Good correlations were also obtained with Korsmeyere-Peppas model. According to these models, the drug released from implants were of diffusion controlled, where the drug was found to leave the matrix through pores and channels formed by entry of dissolution medium. Conclusion: The addition of different excipients and variation in hardening times were found to influence the drug loading efficiency and drug release significantly. Further investigation would confirm its potential in breast cancer therapy.

Isolated tubercular splenic abscess: Can we defer splenectomy? Our single experience with anti-tuberculous therapy alone.

Isolated splenic tuberculosis is an exceedingly rare clinical condition. Microbiological confirmation of diagnosis in such cases is quite difficult. We encountered the case of a 35-year-old female, who presented with persistent low-grade fever and weight loss. The CT scan of the abdomen revealed multiple hypodense splenic lesions. No primary focus of infection was detected in any other organs. Fine needle aspiration of splenic lesion revealed acid-fast bacilli on Ziehl-Neelsen stain. With anti-tuberculous therapy, the lesions regressed significantly in size. We stress that splenic tuberculosis should be considered as a diagnostic possibility even in immunocompetent individuals and choose combination antituberculous therapy as the first line treatment with consideration of splenectomy depending on response.

Epidemiology of HIV infection among brothel-based sex workers in Kolkata, India.

A cross-sectional study was carried out during January-June 2004 to assess the status of HIV infection among brothel-based sex workers in Kolkata city, India. Six hundred and twenty-two sex workers, selected from six brothels, were included in the study to assess their HIV status, and 362 sex workers, a subset of the above population, were interviewed to study their risk behaviour and practices. Blood samples were collected from each sex worker for testing HIV by an unlinked anonymous method. The prevalence of HIV infection was 9.6%, but was much higher among younger sex workers aged 20 years or less (27.7%) compared to the older age group (8.4%). This difference was statistically significant, indicating an association of younger ages with HIV infection [p = 0.006 and odds ratio (OR) = 4.18; (95% confidence interval (CI) 1.2-13.8)]. HIV was not associated with duration of sex work, average number of clients entertained per day, condom use, practice of sex during menstruation, pre-coital examination of penis for visible ulcer/discharge, suffering from sexually transmitted infections, and entertaining clients outside the brothel. There was a big gap between the reported and the evaluated condom use by sex workers. The results suggest that there is a need to develop suitable HIV intervention strategies, considering the socioeconomic and cultural aspects of city sex workers, with a provision for continuous monitoring and evaluation.

Goblet cell status in idiopathic ulcerative colitis--implication in surveillance program.

Idiopathic ulcerative colitis (IUC) patients have higher incidence of dysplasia and malignancy. Close follow-up with biopsy at regular interval is mandatory. The study was done to correlate incidence of atypical epithelium, goblet cell hyperplasia (GCH) and disease duration (DD) with Ki67, AgNOR and p53 expression in IUC with disease for 5 or more years. Ki67 and AgNOR are good indicators of cellular proliferation and p53 tumour suppressor protein is a marker for neoplastic cell. Of 130 cases studied, 40 cases showed atypical epithelium and were selected for further study. DD in these 40 cases ranged from 60 to 228 months. All had GCH and showed histological features of chronicity. Low-grade dysplasia (LGD) was seen in 15 cases, indefinite for dysplasia (ID) in 8 and inflammatory atypia in 17 cases. Disease duration showed no influence in the type of atypical epithelium. A positive staining of lining epithelium by Ki67 and p53 was not restricted to dysplasia. LGD and ID showed stronger p53 nuclear staining. AgNOR appeared to be a more sensitive marker than Ki67. GCH showed a positive correlation with DD and AgNOR index. p53 expression correlated positively with goblet cell hyperplasia. Conclusion- goblet cell hyperplasia could indicate presence of epithelial cell dysplasia.

A prospective study of phage types & biotypes of Salmonella enterica serotype Typhi isolated from hospitalized children in Kolkata, India.

BACKGROUND & OBJECTIVES: Kolkata and its suburbs in eastern India faced an epidemic of typhoid fever in 1990. A prospective, hospital and laboratory based study over a period of 12 yr (1990-2001), on the phage typing and biotyping pattern of Salmonella enterica serotype Typhi was carried out, to see if there has been a change. METHODS: A total of 338 S. enterica serotype Typhi isolates from 1491 blood samples were phage typed and biotyped. The mean age of isolation was calculated. RESULTS: The age distribution of subjects (neonates to 12 yr) has been analysed. Of the 338 (22.7%) isolates obtained, eight different S. enterica serotype Typhi phage types were detected. Biotype I (95.8%) was more prevalent as compared to biotype II (4.1%). Phage type E1 was the commonest phage type in Kolkata and its suburbs. INTERPRETATION & CONCLUSION: The mean age at isolation was found to be 6.7 +/- 3.3 yr. Biotype I was predominant and it was of interest that all strains of phage type E1 belonged to biotype I.

Parathyroid carcinoma: difficult management options.

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism and these tumours are usually hyperfunctional as opposed to other malignant endocrine tumors. Surgery is the only effective treatment while nonsurgical modalities yield poor results. We report a patient, who presented with palpable mass in the neck and severe hypercalcemia. He underwent debulking surgery and received allendronate, calcitonin, dacarbazine followed by in- situ alcohol instillation with some success.

Decreasing trend in the occurrence of Salmonella enterica serotype Typhi amongst hospitalised children in Kolkata, India during 1990-2000.

In a prospective hospital based surveillance, 1454 children clinically diagnosed as typhoid fever were enrolled during the period between 1990 to 2000. Of them 336 (23.1%) children were positive for Salmonella enterica serotype Typhi by blood culture. A declining trend of hospitalization and identification of the pathogen was observed from 1992 to 2000 as compared to 1990-1991. A declining trend of resistance to the commonly used anti-typhoid drugs was seen in the S. enterica serotype Typhi isolates. Recently in 2000, nine strains were detected as ciprofloxacin resistant. Misuse and overuse of ciprofloxacin for the treatment of typhoid fever influenced the development of ciprofloxacin resistant strains of S. enterica serotype Typhi in and around Kolkata.

Isolation of Salmonella enterica serotypes from children with diarrhoea in Calcutta, India.

The prevalence of Salmonella enterica serotypes, antimicrobial susceptibility, and phage typing of serovers were studied. Clinical presentations of the infected cases were also examined. The study was carried out during August 1993-September 1996 in and around Calcutta, India. In total, 1,025 faecal samples from hospitalized diarrhoeal children were screened for enteropathogens. Four S. enterica serotypes were identified in 157 (15.3%) cases as a single pathogen. S. enterica serotype Typhimurium was detected in 110 (70%) cases. S. Seftenberg, S. Infantis, and S. Virchow were detected in 28 (17.8%), 14 (8.9%), and 5 (3.2%) cases respectively. S. Typhimurium was isolated from 11 (3.2%) non-diarrhoeal control children. All of these children had acute watery diarrhoea, and 5% of them had severe dehydration, 40% had some dehydration, and 55% had no dehydration. Vomiting, fever, and diffused pain in abdomen were the associated presentations of these children. Most (95%) of them recovered with oral rehydration therapy only and without any antibiotics. In-vitro susceptibility testing showed that 120 of the 121 S. Typhimurium strains isolated from cases and controls were resistant to the commonly-used drugs. Thirteen of the 121 strains were phage-typeable and belonged to the phage type 193. However, no clinical or epidemiological significance could be established with these typeable strains. The findings of the study indicate that diarrhoeagenic Salmonella is one of the major pathogens causing diarrhoeal diseases in eastern India.

Gallstone disease in a rural Bangladeshi community.

BACKGROUND: The prevalence of gallstone disease (GSD) in Bangladesh is not known. We evaluated the prevalence of GSD and its relation with certain factors in a rural community in Bangladesh. METHODS: A total of 1332 persons aged 15 years and above from two villages were invited to participate in the study; 1,058 (80%) subjects responded after three invitations. Each subject answered a questionnaire, including demographic features, and underwent an upper abdominal ultrasound examination. RESULTS: GSD (current cholelithiasis and history of cholecystectomy) was detected in 5.4% of subjects. The prevalence was higher in women (7.7%) than in men (3.3%; p=0.002) The prevalence rates increased from 0.9% to 10% (p=0.0124) from those aged <30 years to those >50 years. A larger proportion of obese subjects (25/52; 48.1%) had GSD than non-obese subjects (32/1006; 3.2%). Prevalence in low, middle and high socio-economic classes was 1.5%, 5.7% and 13.4%, respectively (p=0.000). A majority (71.9%) of subjects with GSD were asymptomatic. CONCLUSION: Approximately 5% of the Bangladeshi rural community evaluated have GSD. Higher age, female gender, presence of obesity and higher socio-economic class were associated with higher prevalence of GSD.

Interface between drug use and sex work in Manipur.

BACKGROUND: In India, drug use is seen predominantly as a problem among men. This study attempts to address the interface between drug use and sex work among women drug users in Manipur and the prevalence of HIV, hepatitis B and other sexually transmitted infections in them. METHODS: This cross-sectional survey was conducted between April and October 1997 at the time of an ethnic clash in imphal, the capital of Manipur. Sixty-nine women drug users were interviewed through street-based outreach workers; 38 women (55%) were injecting drug users. Data were generated with the help of a semi-structured questionnaire on sociodemography, drug use practice and health issues after obtaining informed consent from the participants. Subsequently, consent was also obtained from 60 respondents for collecting blood for unlinked anonymous tests for HIV and hepatitis B surface antigen. Clinical examination for reproductive tract infections, offered to all the study participants, generated data on sexually transmitted diseases. RESULTS: The prevalence of HIV infection in injecting drug users was 57% (20/35) compared to 20% (5/25) among non-injecting drug users (p = 0.001), although the prevalence of hepatitis B surface antigen was similar in the two groups, 48% v. 56%, respectively. Eighty per cent of the respondents, many of whom migrated following the ethnic clash, reported having sex with non-regular partners, two-thirds reported sex in exchange for money or drugs. Eighty-one per cent (29/36) of women who agreed to have a clinical examination had abnormal vaginal discharge, of which 10 had endocervical discharge. The presence of infection was confirmed in only 24% of those with vaginal discharge--4 had bacterial vaginosis and 3 trichomoniasis. CONCLUSION: Environmental interventions to reduce civil unrest and forced migration have an important role to play in HIV containment. The high rate of HIV infection, and the probability of a high rate of sexually transmitted infections in women drug users suggests that a targeted intervention in this population group is a public health need. An innovative outreach strategy should be designed for effective implementation of interventions among women injecting drug users and non-injecting drug users who operate from the streets as sex workers to support their drug habit as well as livelihood.

Etiology and management of obscure gastrointestinal bleed--an appraisal from eastern India.

OBJECTIVES AND METHOD: Forty patients (mean age 45 years; 24 men) attending a tertiary care hospital in eastern India during the period 1996-2000 were investigated to evaluate the etiology and clinical spectrum of obscure gastrointestinal bleed. RESULTS: The patients presented to hospital after mean symptom duration of 2.5 years. They had received an average of 15 units of blood transfusion. Most patients presented with recurrent melena (85%); all had iron-deficiency anemia. A total of 230 investigations (89 gastroscopies, 54 colonoscopies, 25 double-contrast meal and follow-through studies, 14 small bowel enemas, 24 radionuclide scans, 16 mesenteric angiographies and 8 intraoperative endoscopies) yielded positive diagnosis in 87.5% of cases. The diseases encountered were small bowel and colonic angiodysplasias (32.5%), ileal Crohn's disease (20%), intestinal tuberculosis (10%), intestinal tumors (10%), nonspecific small bowel ulcers and strictures (7.5%), Meckel's diverticulum (5%) and hemobilia (2.5%). The etiology remained obscure in 5 (12.5%) cases. Overall success of surgery was 63%; in-hospital mortality was 7.5%. CONCLUSION: Though obscure gastrointestinal bleed is commonly caused by angiodysplasias, it can be an atypical presentation of Crohn's disease.

Prevalence of HCV & HBV infection amongst HIV seropositive intravenous drug users & their non-injecting wives in Manipur, India.

Hepatitis C virus (HCV) and hepatitis B virus (HBV) infections were evaluated among 77 Manipuri couples of whom all husbands were both intravenous drug users (IDUs) and human immunodeficiency virus (HIV) positive. This study showed for the first time a high prevalence of HCV (92%) and HBV (100%) infection amongst the IDUs in Manipur. Stringent control measures to prevent the transmission of hepatitis viruses (B and C) are urgently required in Manipur.

Possibility of public health hazards by contamination of toxin producing Vibrio cholerae through fishes reared in sewage fed fishery.

This study was undertaken to explore the possibility of contamination of Vibrio cholerae serogroups 01 and 0139, the most important causative organisms for life threatening acute secretory diarrhoea and also potential public health importance, by isolating these organisms from body surface, gill and intestine of common table fishes like Labeo rhoita, Catla Catla, Cirrhinus mirgala and Tilapia mosambica which were reared in sewage and raw human excrita enriched fishery ponds. Vibrio Cholerae 01 or 0139 were not isolated from body surface swabs, gills and intestine of these common table fishes. Water samples of sewage enriched fishery ponds and sewage of Calcutta municipal corporation were also processed for isolation of these organisms, however, these samples were also negative for V. Cholerae 01, 0139 and non 01-0139 serogroups. Present study indicated that there was less chance of contamination of toxigenic and disease producing strains of V. cholerae by common table fishes which were reared in sewage and raw faecal matter enriched fishery ponds.

Spectral studies on the interaction of iodine and anthracene sulfonate with bacterial phospholipids from different mutants of Salmonella minnesota.

Using spectrophotometric and spectrofluorometric techniques, the interaction of iodine and 2-anthracene sulfonate (ANS) with the phospholipids (PL) isolated from four genetically correlated Salmonella minnesota isolates viz., a smooth form (S), a deeply rough mutant (Rc) and two intermediate forms (Ra and Rb) were studied. Appearance of an isosbestic point and a new band in absorption spectra indicated charge-transfer (C-T) interaction of iodine with the PL through the formation of 1:1 complex. Stern-Volmer type fluorescence quenching of PL was observed with the addition of iodine to PL, while PL enhanced the fluorescence of anionic dye ANS. The values of the binding constants between iodine/PL and ANS/PL, measured by using suitable equations, showed a systematic gradation in the molecular properties of the PL in the membrane structure in smooth (S) and rough (Ra, Rb and Rc) mutants of Salmonella minnesota.

Comparison between the multiplex PCR, sensitivity to biotype specific phages & polymyxin B for biotyping of Vibrio cholerae O1.

A total of 196 Vibrio cholerae O1 strains isolated between 1970 and 1996 were biotyped by multiplex PCR, susceptibility to polymyxin B and sensitivity to biotype specific phages. We modified the multiplex PCR by increasing the primer concentration of tcpA to improve the results. Comparison of the results of modified multiplex PCR and sensitivity to biotype specific phages and to polymyxin B showed that multiplex PCR was as efficient as phage typing for biotyping of V. cholerae O1. All the strains of V. cholerae O1 could be accurately distinguished based on polymyxin B sensitivity. Thus our results show that susceptibility of strains of V. cholerae O1 to polymyxin B is the easiest method to biotype V. cholerae O1 and is feasible in most laboratories when compared with multiplex PCR and sensitivity to biotype specific phages.