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Background: Cervical discharge as part of cervicitis and pelvic inflammatory disease is a cause of significant morbidity in sexually active women worldwide. Non-gonococcal and non- chlamydial bacterial pathogens are becoming more prevalent. Aims: This study aims to determine bacterial pathogens causing cervical discharge using culture and/or polymerase chain reaction and assess the clinical and laboratory response to the conventional syndromic kit regimen established by the World Health Organisation. Methods: A retrospective review of records of women with cervical discharge over one year period. Culture and/or polymerase chain reaction results of endocervical swabs of various bacterial pathogens at baseline and after four weeks of treatment with syndromic kit regimen were recorded. Results: A total of 70 case records were reviewed for clinical details, out of which results of bacterial culture and polymerase chain reaction were available for 67 cases. Infectious aetiology was found in 30 (44.7%) patients with Ureaplasma species being the most common organism isolated on culture (18, 26.8%) and polymerase chain reaction (25, 37.3%), respectively. Polymerase chain reaction for Chlamydia trachomatis and Mycoplasma hominis was positive in ten (14.9%) and four (6%) cases, respectively. None of the patients showed positive culture for Neisseria gonorrhoeae. Coinfection was seen in eight (11.9%) patients with the majority showing Chlamydia trachomatis and Ureaplasma spp. coinfection (five patients). Forty one cases (58.5%) received tab. cefixime 400 mg and tab. azithromycin one gram stat (kit 1), while 29 cases (43.3%) received tab. cefixime 400 mg stat, tab. metronidazole 400 mg and cap. doxycycline 100 mg, both twice daily for 14 days (kit 6). Minimal to no clinical improvement with treatment was seen in 14 out of 32 cases (44%) at the end of four weeks with the conventional kit regimen. Post-treatment culture and/or polymerase chain reaction were positive in nine out of 28 cases (32.1%) with Ureaplasma spp. being the most common. Limitations: Retrospective study design, small sample size and fewer cases with follow-up data were the main limitations. Conclusion: Ureaplasma spp. was the most common infectious cause of cervical discharge in our patients. Treatment given as part of syndromic management led to a clinical and microbiological response in around half and two-third cases, respectively.
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Susceptibility to low temperature stress is the major threat to papaya cultivation. Here, we studied a low temperature stress tolerance in papaya plant. We have investigated the effect of different low temperature regimes, 28°/18°C (day/night) to 16°/06°C (day/night) with a gradual decrease of 2°C on every two days and one set with direct exposure to the low temperature of 18°/08°C (day/night), called the acclimatized plant, in five diverse papaya genotypes (Pusa Nanha, Red Lady P-7-2, P-7-9, and P-7-14) and cold tolerant wild relative of cultivated papaya genotype (Vasconcellea cundinamarcensis V.M. Badillo) under controlled regulated conditions. It was observed that there were significant variations in the physiological and biochemical parameters like photosynthetic gas exchange parameters, chlorophyll content, fluorescence parameters, relative water content (RWC), membrane stability index (MSI), total sugars content, total soluble proteins content, lipid peroxidation, and proline accumulation in leaf tissues. Maximum stomatal conductance, chlorophyll fluorescence, RWC, MSI, total sugars, total soluble proteins, proline and lowest MDA contents were observed in Vasconcellea cundinamarcensis followed by inbred P-7-9 as compared to other genotypes under low temperature stress. Among all the papaya genotypes, P-7-9 showed more adaptability to low temperature stress and it further give new insights for developing low temperature tolerant papaya genotypes, especially under changing climate situations.
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Background: India is having 27% of the world’s drug resistant TB burden. To address this emerging public health concern PMDT services were rolled out in the year 2007 and the nationwide coverage was achieved in the year 2013. In India, MDR RR TB patients started on se cond - line treatment in the years 2018 and 2020 under PMDT had favorable treatment outcomes of 56% and 57% respectively. Therefore, th is study was conducted to determine the treatment outcomes in patients of DR TB & MDR RR TB in Bengaluru city Karnataka, In dia. Methods: This was a descriptive cross - sectional study using programmatic data among the notified TB cases during the year 2017 - 2020 under NTEP of Bengaluru city. Socio - demographic data, clinical characteristics and diagnostic data were studied. Data analysis was conducted in Python (version 3.9.4) to ascertain the treatment outcomes and its trend in the study area. Results: A total of 689 patients were identified as DR TB cases having resistance to any first line anti TB drug during the year 2017 - 2020 . The mean age of the DR TB patients was observed as 36.7 years (95% CI: 22.3 - 51.1). Among them 434(63.0%) were male, 254(36.9%) were female and 01(0.1%) were transgender. The study revealed the favourable treatment outcomes of 56.6% among the overall DR T B patients and 42.2% among the MDR RR TB patients in Bengaluru city. Conclusion: The study depicted trends of improvements in the successful treatment outcomes among overall DR TB patients from the year 2017 to 2020, but on the other hand the same among th e MDR RR TB patients is a cause of concern. The study highlights adopting a multipronged scheme focusing on End TB strategy by improving diagnostic capability, assuring high - quality treatment and averting drug resistance propagation among
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The present study focused on alleviating the issue of premature abscission of micro-shoots emerged from the cultured nodal segments in Kinnow mandarin. To resolve the problem, explants of different maturity stages, culture media, growth regulator combinations and ethylene inhibitors (silver compounds) were evaluated. Hardwood stage was observed to be the most efficient explant maturity stage to boost the vigorous early shoot emergence on MS (Murashige and Skoog) medium. Addition of GA3 (Gibberellic acid) 10 mg L?1 resulted in delayed abscission. Further reduction in abscission rate and healthy shoot growth were observed when subculturing of micro-shoots was done on MS medium supplemented with BAP 2.5 mg L?1, GA3 10 mg L?1 and silver thiosulfate 5 mg L?1. This modified procedure could be effectively utilized for mass multiplication as well as crop improvement in Kinnow mandarin.
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Third molar surgery is the most common minor oral surgical procedure performed in dental clinics. Displacement of maxillary third molar tooth into adjacent spaces such as infratemporal fossa, maxillary sinus has been reported earlier. We present an unusual case of iatrogenic displacement of maxillary third molar into pterygomandibular space.A 24 year old dental undergraduate reported to Department of Oral surgery with complaints of trismus and swelling in the check region after unsuccessful attempt at extraction of maxillary right third molar tooth. Computed tomography scan localized the tooth in the pterygomandibular space. A surgical removal of the displaced tooth was performed under general anesthesia.Displaced tooth was approached by an intraoral vertical incision along the anterior border of ramus of mandible. Correlating with computed tomography scan, tooth was located and removed followed bysuturing of the surgical site. A good knowledge of the operating area and adjoining spaces is essential to avoid iatrogenic damage to tissues during minor oral surgery procedures. Adequate exposure and appropriate instrumentation during surgery can prevent undue complications and ensure quality patient care
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Post-operative ascites following caesarean section is rarely reported in pregnancy. Ascites has multiple etiologies including malignancies, liver cirrhosis, intraperitoneal infections and trauma. Authors report a case of post-operative ascites following caesarean section performed at around 37 weeks of gestation. The patient was normotensive. The diagnosis and treatment of ascites as well as the pregnancy outcome is presented. Literature review of ascites in pregnancy is discussed as well. This case was that of an idiopathic ascites with no definitive cause. An allergic or inflammatory peritoneal reaction may be the most likely cause for this complication.
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Background: Breech delivery is associated with poor perinatal outcomes irrespective of the route of delivery. External cephalic version can be a useful tool in management of breech presentation at term by converting it to a cephalic presentation. A study was conducted to evaluate maternal and neonatal outcome of external cephalic version in singleton pregnancies with breech presentation in third trimester.Methods: A prospective observational study was carried out at a tertiary care hospital over a period of 2 years. This study included a total of 65 uncomplicated cases of breech presentation who fulfilled the inclusion criteria. External cephalic version was carried out after 36 weeks of period of gestation in primigravida and after 37 weeks in multigravida women. These patients were followed up till delivery and data was collected and analysed regarding the mode of delivery, maternal and fetal outcome.Results: External cephalic version was successful in 41 patients with a success rate of 63%. Out of them, vaginal delivery could be achieved in 31 cases (75.6%) and LSCS was done for rest of the 10 cases. The success rate was higher in multigravida ladies compared to primigravida ladies. No major procedure related adverse event was noticed in our study.Conclusions: External cephalic version is a very safe and easy procedure which can reduce the rate of cesarean delivery in singleton pregnancies with breech presentation. The results of this study are in favor of wider practice of this procedure in selected cases.
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Entero-uterine fistula is a very rare type of fistula between the small intestine and the genital tract. They may result from obstetric or gynaecological procedures like post D and C perforation of the uterus. Timely detection and management reduce morbidity and mortality of the patients. We present a case of entero uterine fistula in a lady which was diagnosed on second postnatal day when she complained of passage of stool per vaginum. She had a previous history of mid trimester abortion followed by D and C after which she remained hospitalised for a week for pain abdomen. The diagnosis of this fistula was based on her symptoms and clinical evaluation of passage of intestinal content through the cervix and CT scan finding of gas in the abdomen. Intraoperatively an ileal loop was found adherent to the posterior wall of uterus with large fistula between bowel and the uterus. There was no intraperitoneal faecal contamination. Adherent small bowel was separated from the posterior wall of the uterus and fistula dismantled. Side to side functional end to end anastomosis was done using TLC 75 stapler. Repair of the uterine rent was also done. Post op recovery was uneventful.
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Background: Nephrolithiasis is the most common chronic kidney condition, is globally increasing in both sexes. Five main types of renal stones viz., calcium oxalate stones, calcium phosphate stones, uric acid stones, struvite stones and cystine stones. Purpose of the study is to evaluate various metabolic factors contributing to recurrent renal stone and determining appropriate medical treatment and diet modification to prevent recurrent renal stone disease.Methods: This study was carried out in P.G. Department of Surgery, S.R.N. Hospital associated with M.L.N. Medical College, Allahabad. A total of 120 cases of recurrent renal calculi in and outpatient between August 2017 and July 2019 were included in the study. All patients were stone free at the time of metabolic urine evaluation.Results: Most of the patients in the study were in the age 21 to 50 years. 80% were males and 20% were females. In 24-hour urine analysis most common metabolic abnormality seems to be hyperoxaluria (92.5%) followed by hypercalciuria (82.5%), high pH (67.5%), and least common seems to be hypocitraturia (15%), followed by hyperphosphaturia (20%), hypernatreturia (25%), and low level of potassium (25%).Conclusions: All patient of recurrent stone formation are advised increase fluid intake. In patient with hypercalciuria and hypocitraturia, dietary restriction of protein, oxalate and sodium, treatment includes thiazides supplemented with potassium citrate. In patient with hyperoxaluria dietary restriction of oxalate rich food and in hyperuricosuria dietary restriction of animal protein is advised.
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Background: Ectopic pregnancy is one of the most important causes of maternal mortality and morbidity in the first trimester of pregnancy. Objective of this study was to compare the safety, feasibility and advantage of laparoscopic approach with that of laparotomy in management of ectopic pregnancy.Methods: A retrospective study was conducted at two tertiary hospitals over a period of two years i.e.; from Aug 2015 to July 2017. Seventy-five patients who had histopathology confirmed tubal ectopic pregnancy were divided into two groups; laparoscopy (Group I, no-39) and laparotomy (Group II no-36). The main outcome measures were operative time, blood loss, and requirement of blood transfusion, requirement of analgesia and duration of hospital stay.Results: Seventy-five patients of ectopic pregnancy who were managed surgically were studied. There were 39 cases in laparoscopy group and 36 cases in laparotomy group. The incidence of ectopic pregnancy was 1.56% (out of all deliveries over 2 years). Ampullary region was the commonest site of ectopic pregnancy (74.6%). No difference was found in the two groups regarding age, site of tubal pregnancy, pre op Hb status and haemoperitoneum. Mean operating time was significantly shorter in the laparoscopy group 39 min (range 30 - 52 min) versus 50 min (range 40-60 min) in the laparotomy group. There was no difference between the groups regarding the treatment with blood products and perioperative complications. Hospital stay was significantly longer in the laparotomy group (3.5 days) as compared to 2 days in laparoscopy group. The duration of post op analgesia requirement was also longer in laparotomy group (4 days) as compared to 2 days in laparoscopy group.Conclusions: Laparoscopic management of ectopic pregnancy is a safe, effective and beneficial option in the hands of an experienced laparoscopic surgeon even in cases of massive haemoperitoneum. It definitely offers the advantage of shorter duration of surgery, faster post op recovery, shorter duration of hospital stays and lesser requirement of post op analgesia.
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Isolated torsion of fallopian tube is a rare occurrence. Diagnostic difficulty gets compounded in adolescents because the most commonly used imaging study in young, usually sexually inactive, population is transabdominal ultrasonography which may show normal ovaries, leading clinicians to abandon a diagnosis of adnexal torsion. Other imaging modalities such as CT scan or MRI are less useful for a rapid diagnosis because of the risk of radiation exposure, cost, or lack of ready availability. Delays in diagnosis may increase the likelihood of necrosis of the fallopian tube which would result in salpingectomy as was the case in our case report. Here authors present one such case, wherein one 12 year old girl who attained menarche at 10 years of age presented with acute paraumblical pain and vomiting without any fever, bowel and bladder disturbances. On examination there was tenderness in right iliac fossa. Her USG report was unremarkable. She initially was put-on broad-spectrum antibiotics but without any amelioration of symptoms. Diagnosed as appendicitis by surgeon, she was taken up for laparoscopic appendicectomy. However, it turned out to be a case of fallopian tube torsion, wherein the tube had become gangrenous for which salpingectomy was done.
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The second stage of labor begins with full dilatation of cervix and ends with delivery of the fetus. In most of the cases the labor progresses uneventfully, without any need of an active intervention but in few cases complications may occur. With passage of time there has been better understanding about second stage of labor, still there are several grey areas yet to be resolved. This review endeavours to scrutinize a variety of care practices including positions, time and type of pushing, use of epidural analgesia, and perineal support techniques etc and discuss evidence based management of second stage of labor. The review was carried out in the period of 1900-2019 by searching in Pub Med, Embase, Scopus, Google scholar, Web of sciences using relevant key words. Reports, articles, fact sheets and official publications of World health Organization (WHO), Ministry of health and family welfare-Govt of India and various other countries were also reviewed.
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Fetal macrosomia is an upcoming challenge in the field of obstetrics due to its rising incidence. The incidence varies according to ethnicity, genetic differences and anthropometric discrepancies between populations. Obesity, previous history of macrosomia, multiparity, diabetes and post-dated pregnancy are few risk factors associated with macrosomia. Management of macrosomia is a big challenge as no precise guidelines have been set. Macrosomia is associated with multiple maternal and foetal complications like operative delivery, post partum haemorrhage, perineal trauma, shoulder dystocia, brachial plexus injury, skeletal injury, birth asphyxia etc. We report a case of foetal macrosomia, weighing 5.5kg which was delivered by LSCS to a woman having BMI - 26.6kg/m² with 39 weeks of pregnancy with history of previous LSCS. There was no maternal or foetal complication. There was no history of diabetes in present pregnancy and inter conception period. Because of rarity of this condition we report this case of foetal macrosomia with a short review of literature.
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A 28-yr-old P2L2 lady, with history of two previous caesarean deliveries and tubal ligation, presented at 6weeks of amenorrhea with pain lower abdomen. The operative notes from her previous caesarean section stated that she had a unicornuate uterus without a rudimentary horn (ASRM Class II D Mullerian anomaly)5 and only right fallopian tube was visualised, which was ligated by Parkland’s method.On workup, she had a positive urine pregnancy test and ultrasound showed a left adnexal mass without any evidence of intraperitoneal collection, possibly an unruptured left ovarian ectopic pregnancy secondary to failed tubal ligation. Further investigation by MRI revealed an entirely new finding. The suspicious left adnexal mass was the left horn of bicornuate uterus which had an intrauterine gestational sac. Hence, her revised diagnosis was G3P2L2, post LSCS, bicornuate uterus (ASRM class IV B) with 6 weeks of intrauterine left horn pregnancy following failed tubal ligation.She underwent a medical followed by surgical evacuation of intrauterine pregnancy as patient was unwilling to continue the pregnancy.This case highlights the importance of a comprehensive evaluation, whenever a lady is diagnosed with a Mullerian anomaly, in order to correctly classify the patient and identify associated anomalies of urogenital tract which would avoid such erroneous diagnosis of site of pregnancy as illustrated in our case.
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Background: Iron deficiency Anemia in pregnancy is one of the most common and intractable nutritional problems in the world today. The objective of this study was to investigate the therapeutic efficacy and safety of rHuEPO combined with IV iron sucrose, in the treatment of pregnant women in third trimester with moderate and severe iron deficiency anemia and whether addition of erythropoietin will increase the rate of rise of Hb without compromising on the safety of the therapy.Methods: 60 pregnant women in the third trimester, diagnosed as cases of moderate and severe iron deficiency anemia were enrolled in this study with 30 subjects in each of the 2 groups. Recombinant Erythropoietin 2000 IU s/c and Inj Iron sucrose 100 mg slow intravenously in 100 ml 0.9% NS over 1 hr on alternate days was administered to the case group and the control group was administered only iron sucrose slow IV in the same dose on alternate days till target Hb (11gm%) was reached. Efficacy measures were reticulocyte count, increase in Hb/week, time to target Hb level and need for continued therapy after 4 weeks.Results: In the case group, the increases in Hb were greater after 1 week of treatment and this was found to be significant (P < .01), the median duration of therapy was shorter in the case group (22 versus 34 days), with more patients reaching the target hemoglobin level by 4 weeks as opposed to 7 weeks in the control group. Average rise in Hb/week was much more in the case group. The groups did not differ with respect to maternal and fetal safety parameters.Conclusions: Iron sucrose plus rhEPO is an effective treatment for iron deficiency anemia in pregnancy probably because of a synergistic action, with rhEPO stimulating erythropoiesis and iron sucrose delivering iron for hemoglobin synthesis.
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A 25 year old lady presented on day 22 of an uneventful caesarean delivery, in a state of class IV haemorrhagic shock, secondary to sudden onset of vaginal bleeding without any inciting cause. Immediate resuscitation was initiated and the cause for massive secondary post-partum haemorrhage (PPH) was identified as an actively bleeding vessel at 3 ‘O’ clock position on a visibly healthy cervix with a well contracted uterus. This was the descending branch of left uterine artery, which was ligated after pulling the cervix with a sponge holder towards the introitus and application of Vicryl No 1-0 suture. The bleeding decreased significantly post vascular ligation. Further exploration of vagina and cervix did not reveal any active bleeding or laceration and no retained placental tissue was found inside uterine cavity on ultrasound examination. This is a rare case of Massive Secondary PPH in a post-caesarean patient due to spontaneous giving way of descending branch of uterine artery.
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Meckel Gruber syndrome (MGS) is a rare lethal autosomal recessive disorder. It is characterized by triad of features having occipital meningoencephalocele, polycystic kidneys and post-axial polydactyly. We report an antenatal patient detected with occipital meningoencephalocele in foetus on early anomaly scan at 15 weeks of gestation followed by foetal MRI which revealed the typical triad features strongly suggestive of MGS. The patient opted for medical termination of pregnancy and the abortus was autopsied, with the permission of the patient, for detailed evaluation of anomalies which were consistent with MGS. This case highlights the importance of a detailed foetal evaluation antenatally to detect anomalies which are incompatible with life and proper diagnosis as it has bearing on patient’s future obstetric outcome.
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Background: Iron deficiency is the most common cause of anaemia in pregnancy amounting to almost 50% of pregnant ladies in India. All pregnant women, irrespective of haemoglobin status, should receive prophylactic doses of iron from second trimester. Iron sucrose has an advantage of being cost effective and readily available. The objective of this was to study the efficacy of injection Iron Sucrose in treatment of iron deficiency anaemia in pregnancy.Methods: About106 patients were given in injection iron sucrose in pregnancy, who had intolerance to oral iron or were non-compliant, in pre calculated (Ganzoni’s formula) doses and were followed up with rise in hemoglobin and ferritin after 6 weeks and at term.Results: Statistically significant increase in hemoglobin levels was observed at 6 weeks after initiation of treatment (9.689±0.821 gm% vs 10.906±0.775 gm%) as well as at term (mean 10.981±0.690 gm%). The serum ferritin levels too increased significantly at term (26.7 ng/mL±12.92 vs 65.34 ng/mL±15.73).Conclusions: Present study demonstrates that iron sucrose is an excellent option to treat iron deficiency anemia in patients where oral iron therapy has either failed or not suitable. It significantly increases hemoglobin levels in the study population. It is readily available in the market and can be infused on an outpatient basis.