ABSTRACT
Pelvic organ prolapses (POP), particularly cystocele, presents significant challenges in postmenopausal women, exacerbated in those with multiple caesarean sections (LSCS) and comorbidities like diabetes mellitus. This case report details the successful management of a 62-year-old woman with a large cystocele, three LSCS, and diabetes mellitus. Thorough preoperative evaluation, including ultrasound and diagnostic laparoscopy, guided surgical planning. Anterior colporrhaphy restored support to the anterior vaginal wall. Perioperative care included strict glycemic control and antibiotic prophylaxis. Multidisciplinary collaboration ensured comprehensive management. This case highlights the importance of advanced diagnostics, meticulous surgical planning, and multidisciplinary care in complex cystocele cases.
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This case report delves into the diagnostic challenges faced when differentiating between sepsis and dengue shock syndrome (DSS), particularly in regions where both are endemic. A 23-year-old female initially diagnosed with DSS presented with fever, thrombocytopenia, and multi-organ dysfunction. Despite aggressive DSS management, the patient's condition worsened, prompting further investigation. Blood cultures eventually revealed Klebsiella pneumoniae, leading to a shift in diagnosis to sepsis. This case underscores the importance of comprehensive diagnostic evaluation, which included blood cultures, serological tests, and imaging. Prompt initiation of targeted antibiotics and comprehensive critical care resulted in significant improvement, highlighting the critical role of early recognition and intervention in optimizing outcomes. The complexities in distinguishing between sepsis and DSS underscore the need for continuous vigilance and a thorough diagnostic approach in similar clinical scenarios.
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Autoimmune connective tissue diseases (CTDs) in pregnancy present a complex interplay between maternal health and fetal outcomes. While historically discouraged due to potential complications, proper preconception counselling and disease control offer the prospect of safe pregnancies. This case report focuses on mixed connective tissue disease (MCTD), a rare condition combining features of SLE, systemic sclerosis, rheumatoid arthritis, and polymyositis, presenting during pregnancy. A 29-year-old woman, gravida 2, para 1, with a history of rheumatoid arthritis, was referred at 31+4 weeks with a deranged coagulation profile, fetal growth restriction (FGR), and oligohydramnios. Extensive laboratory and imaging investigations confirmed MCTD diagnosis. Treatment involved LMWH, aspirin, hydroxychloroquine, and prednisolone. Comprehensive monitoring and multidisciplinary care were maintained throughout. Despite initial improvement, the patient faced complications at 35+3 weeks, leading to an emergency caesarean section at 36 weeks due to preterm FGR, oligohydramnios, and breech presentation. A male infant weighing 2.1 kgs was delivered, requiring neonatal intensive care due to prematurity and respiratory distress. Postoperatively, the mother resumed medication and was discharged with her baby. This case highlights successful MCTD management during pregnancy through meticulous monitoring and a multidisciplinary approach. The risk of complications necessitates informed preconception counselling, emphasizing the importance of disease remission, close surveillance, and prompt intervention in disease relapse. Comprehensive care, including medications and careful planning, contributes to improved maternal and neonatal outcomes in this rare and challenging scenario.
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The use of Trichogramma as a tool in the scientific management of pest insects emerges as a vital element to promote sustainability in agriculture. Having suitable storage methods for parasitoids is a valuable asset within biological control programs. The quality of Trichogramma is affected by cold storage with an acclimation period. Prepupae were subjected to storage for 50, 75, and 100 days at 5°C, preceded by acclimation periods of 10 or 20 days at 12°C. The research revealed the potential to halt the development of Trichogramma. Treatments with a 10-day acclimation period resulted in emergence values below 10%, rendering them unsuitable for establishing a cold storage protocol. In contrast, a 20-day acclimation period benefitted cold storage tolerance for the 50- and 75-day storage periods. The storage of Trichogramma, using a 20-day acclimation period and up to 50 days under cold temperatures, did not adversely affect adult emergence, emergence time, sex ratio, parasitism, or progeny quality.
ABSTRACT
Cardiovascular disease is estimated to occur in 0.4-4.1% of pregnant women, whereas coronary heart disease complicates only 0.01% of all pregnancies. In recent times, MI has been observed to occur more frequently in young women. This might be attributed to the fact that women are deciding to become pregnant at advanced age. In such high-risk cases, proper pre-pregnancy, antenatal, intrapartum and post-partum care should be taken. Pregnant women with heart disease should be managed by a multidisciplinary team approach comprising of obstetricians, intensivists, cardiologists and neonatologists. Here, a case of pregnant woman with past history of MI; treated with coronary artery bypass grafting (CABG) is presented and the management is highlighted.
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Background: One of the major threats to the COVID-19 vaccines rollout and successful mitigation of the pandemic is vaccine hesitancy. Vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. The COVID-19 vaccine trials generated very limited data on safety and efficacy for pregnant women and children, since pregnant women were not included in any of the phase I/II or III trials. Hence the authors made an attempt to understand vaccine hesitancy among women healthcare and frontline workers with a focus on vaccination during pregnancy and lactation.Methods: The recruitment of participants was done by purposive snowballing technique over a period of 15 days. The data collection was done through an online questionnaire generated with the help of Google forms. After excluding women who exceeded the age criteria and incompletely filled questionnaires, 101 responses were considered for analysis. Data analysis was done using SPSS software version 22.Results: From a total of 101 responses for analysis, 26% had comorbidities. Of the 9 women who were pregnant, majority was in the second trimester (55.6%). Majority of the women, 63.6% had been feeding for more than six months. Of the respondents who had refused vaccination, most wanted to wait longer for further research on safety and efficacy (47.8%).Conclusions: The reasons for pregnant women to decline COVID-19 vaccination during pregnancy even if the vaccine were safe and free were that they did not want to expose their developing baby to any possible harmful side effects, would like to see more safety data among pregnant women and unclear recommendations from the healthcare provider. As HCWs are envoys for evidence based medical interventions, and they are critical in promoting vaccine acceptance amongst the general population, it is important to design effective strategies to improve vaccine acceptance amongst this population.
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Background: Intrahepatic cholestasis of pregnancy (IHCP) is one of the commonest pregnancy related liver disorder. Although the maternal course is usually benign, there is an increased risk of spontaneous preterm delivery, fetal compromise, meconium stained amniotic fluid and even intrauterine fetal demise. The objective of this study was to study the incidence of IHCP and its impact on maternal and perinatal outcome.Methods: A prospective study carried out in 68 number of IHCP cases. Diagnosis was done on the basis of clinical and laboratory parameters. All the cases were followed up to the puerperium to find out maternal and perinatal outcome.Results: The incidence of cholestasis of pregnancy was 2.73%. Most (88%) of the cases were presented with generalized pruritus, relived with ursodeoxycholic acid and complete recovery was observed after delivery. The rate of instrumental delivery was 8.82% and caesarean section rate was 30.88%. Most common indication of caesarean section was fetal distress and non-progress of labour. There was one stillbirth at 35 weeks however none of the mother had complication during labour or puerperal period.Conclusions: Increased level of liver enzymes in patients of IHCP associated with poor perinatal outcome. Therefore, careful monitoring during antenatal period and termination of pregnancy at term will result in favourable outcome of both mother and baby.
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Background: Induction of labor is the most common intervention in modern obstetrics. The pre-induction ‘favourability’ of the cervix as assessed by the bishop score is very subjective. Transvaginal sonography appears to be a feasible alternative to the traditional bishop’s score. Aim of this study, was to compare cervical assessment by transvaginal sonography and digital examination in prediction of outcome of labor induction.Methods: Three hundred women at term with maternal and foetal indications for labor induction were included in the study. Modified Bishop score was assessed by digital examination and the cervical length was measured by Transvaginal sonography (TVS). Successful labor induction was taken as a vaginal delivery within 24 hours from the start of induction. Data were analyzed using SPSS for Windows 15.0.Results: Labour induction was successful in 81.33% of patients. Mean cervical length by digital examination was 2.6 cm, whereas the mean sonographic cervical length was 3.4cm. There was a significant difference of 0.8cm in mean cervical length measured by two methods (P=0.01). The best cut off point for predicting successful induction of labor was ≤3.4cm for sonographic cervical length (sensitivity 0.82, specificity 0.87, positive predictive value 0.77 and negative predictive value 0.25). The best cut off point for Modified Bishop score was 2 (sensitivity 0.95, specificity 0.93). The ROC curve showed that compared to TVS cervical length, Modified Bishop score was the best parameter for predicting successful induction of labor.Conclusions: Transvaginal sonographic cervical length measurement can be used as an adjunct tool to the traditional Bishop score for predicting successful labor induction in high risk pregnancies.
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A well-organized micropropagation protocol has been designed for Salvia hispanica L., which bears high nutritional and medicinal value. Seeds of S. hispanica L. were germinated aseptically on half strength MS medium. Nodal explants obtained from in vitro germinated seedling were cultured on MS medium fortified with 6-benzyladenine (BAP) (1–5 mg/l) or Kinetin (Kin) (1–5 mg/l) individually or with α-naphthalene acetic acid (0.1–1 mg/l) and indole3-acetic acid (IAA) (0.1–1 mg/l) for clonal propagation. It was observed that maximum amount of shoots per explant (9.02 ± 2.65) was achieved on culture medium fortified with 3 mg/l BAP which was also optimum for subculturing of the regenerated shoots. Rooting was achieved on medium supplemented with 1 mg/l IBA. The rooted plantlets were acclimatized and transferred to field conditions, with 75% survival rate. Genetic fidelity studies were carried out on regenerated plantlets by 30 random amplified polymorphic DNA and 10 intersimple sequence repeat (ISSR) as molecular markers
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Tannin acyl hydrolase commonly known as tannase is an industrially important enzyme having a wide range of applications, so there is always a scope for novel tannase with better characteristics. A newly isolated tannase-yielding fungal strain identified as Penicillium atramentosum KM was used for tannase production under solid-state fermentation (SSF) using different agro residues like amla (Phyllanthus emblica), ber (Zyzyphus mauritiana), jamun (Syzygium cumini), Jamoa (Eugenia cuspidate) and keekar (Acacia nilotica) leaves. Among these substrates, maximal extracellular tannase production i.e. 170.75 U/gds and 165.56 U/gds was obtained with jamun and keekar leaves respectively at 28ºC after 96 h. A substrate to distilled water ratio of 1:2 (w/v) was found to be the best for tannase production. Supplementation of sodium nitrate (NaNO3) as nitrogen source had enhanced tannase production both in jamun and keekar leaves. Applications of the enzyme were studied in wine clarification and tea cream solubilization. It resulted in 38.05 percent reduction of tannic acid content in case of jamun wine, 43.59 percent reduction in case of grape wine and 74 percent reduction in the tea extract after 3 h at 35ºC.