Role of uterine artery doppler at 18-22 weeks in the prediction of pre-eclampsia: a prospective study

Background: Pre-eclampsia is the most common pregnancy complication associated with serious maternal and fetal morbidity. Uterine artery Doppler reflects the impaired trophoblastic invasion of the uterine spiral arteries, which is involved in the aetiology of preeclampsia. Thus, uterine artery Doppler was proposed as a screening test for pre-eclampsia.Methods: A prospective cohort study of 100 singleton pregnancies was conducted in a tertiary centre and the study population were subjected to uterine artery Doppler study at 18-22 weeks gestation. Uterine artery Doppler indices of pulsatility index (PI), resistance index (RI) and persistence of diastolic notch was obtained and the outcome of pre-eclampsia was studied.Results: Out of 100 women, 14 women developed pre-eclampsia in which the resistance index showed a sensitivity of 21.4%, specificity of 91.8%, positive predictive value of 30% and negative predictive value of 87.7% and pulsatility index showed sensitivity of 35.7%, specificity of 90.6%, positive predictive value of 38.4% and negative predictive value of 89.6%. Diastolic notch had a sensitivity of 35.7%, specificity of 98.8%, positive predictive value of 83.3% and a negative predictive value of 90.4%.Conclusions: The high negative predictive values, indicated that women with normal Doppler velocimetry were unlikely to develop preeclampsia. Uterine artery Doppler, being non-invasive can be included during routine sonography to identify patients at risk of developing pre-eclampsia. Early, screening for pre-eclampsia will help in individualized antenatal surveillance and initiation of prophylactic therapy, early to reduce the adverse maternal and foetal complications of preeclampsia.

A clinical study of primary caesarean section at a tertiary care hospital in coastal city: an observational study

Background: Caesarean section represents the most significant operative intervention in obstetrics and its development and application has saved the lives of countless mothers and infants. However there has been a steady increase in the rate of caesarean sections worldwide. In this study, we aim to find the primary caesarean section rates and strategies to cut it down.Methods: This was a prospective observational study done from January 2018 to June 2019 at Justice K. S. Hegde Charitable Hospital, Deralakatte, Mangaluru which included 379 cases of primary cesarean sections. All patients undergoing primary caesarean section with gestational age >28 weeks confirmed by dates, clinical examination and ultrasound were included in this study. Patients who had undergone previous caesarean section or were less than 18 years of age or were less than 28 weeks of gestation were excluded from the study.Results: In this study the rate of primary caesarean section was found to be 14.5% and the majority of the study subjects belonged to the age group of 18-27 years (62.3%). With respect to parity, primigravida were high in number (71.2%), followed by multigravida. The number of emergency caesarean sections were (79%) more than elective (21%). The most common intra-operative complication was post-partum haemorrhage (PPH) in 2.8% and the most common postoperative complication was wound gape in 2.1%.Conclusions: Maximum efforts should be made to allow progression of vaginal delivery in primigravida which helps us to bring down the primary caesarean rate.

Occurrence of Intestinal and Caecal Coccidiosis in Rajasri Birds

Coccidiosis in poultry is still considered as one of the main diseases affecting performance of poultry reared under intensive production systems. Coccidiosis was diagnosed in Rajasri birds upon routine postmortem examination conducted at Department of Veterinary Pathology, College of Veterinary Science, Hyderabad. PM examination of 423 birds conducted during a period of one month, out of which 136 birds were diagnosed with intestinal coccidiosis (32.15%) and 120 birds with caecal coccidiosis (28.36%). Clinically birds showed weakness, somnolence, ruffled feathers, pale comb, mucoid bloody diarrhea and death. Coccidiosis was initially diagnosed on the basis of faecal smear examination and histopathological alterations in intestines. Gross examination of birds showed pale muscle, dehydrated and emaciated carcass. Extremely ballooned intestine and caeca and haemorrhages in intestinal mucosa were seen. Upon opening of the small intestines and caeca, watery ingesta mixed with mucus and blood was observed. Faecal smears made from duodenum, jejunum, ileum and caecum revealed coccidial oocysts. Histopathological examination of intestine and caecum revealed coccidia lifecycle stages with destruction of different layers of the intestine and caecum with infiltration of heterophils and mononuclear cells (MNC)

Fatty Liver Haemorrhagic Syndrome (FLHS) in Broilers

Fatty liver haemorrhagic syndrome (FLHS) in poultry is a metabolic disease. An outbreak of fatty liver haemorrhagic syndrome (FLHS) was detected by post mortem examination of broilers in a commercial farm. There was severe loss of production and sudden deaths with moderate mortality. Post mortem of the dead birds were performed and histopathological examination was done as per standard procedure. At necropsy, dead birds had pale combs and wattles with significant liver lesions. The liver was enlarged, friable and greasy, yellowish brown with firm fatty layer deposits and haematoma was noticed in abdominal cavity. Fat vacuoles were seen in liver sections which was also confirmed by special stain. Multiple factors like high dietary energy and stress of production may have precipitated the FLHS in broilers

Predictors of treatment failure in severe pneumonia treated with Ampicillin in tertiary care center

Background: Pneumonia affects 156 million children under five years every year and is the leading cause of mortality in this age group. It emphasizes the need to identify high risk factors for Treatment Failure so as to treat them aggressively. The objective of this study was to assess factors influencing treatment failure in severe pneumonia treated with Ampicillin.Methods: Prospective observational study, in which 235 children with severe pneumonia between 2 months to 60 months were enrolled and started with intravenous Ampicillin as per WHO protocol. If no clinical improvement was seen after 48 hours, it was taken as treatment failure and managed accordingly.Results: Among 235 children, 43(18.2%) did not respond to Ampicillin. Among treatment failure cases males were 20 (46.5%) and females were 23 (53.6%). All the following parameters were statistically significant(p<0.05). Majority of 23(53.4%) were between 2 to 12 months. 13(30.2%) were incompletely immunized. MAM were 23(53.4%) and 22(51.1%) cases had signs of Rickets. 34(79.1%) had Anemia out of which 22(64%) had moderate anemia. 39(90.6%) children had fever and hypoxia at admission.Conclusions: Infancy, malnutrition, severity of anemia, rickets, lack of immunization, hypoxia at baseline were significant predictors of treatment failure in severe pneumonia. Strengthening immunization and improving nutritional status may improve the outcome. Children with above risk factors require vigilant monitoring.

Awareness Of Periconceptional Folic Acid Consumption

OBJECTIVE:The purpose of this study was to determine awareness of Periconceptional folic acid consumption amongst Indian women. MATERIALS AND METHODS:We selected 100 women attending OPD in the OBGYdepartment of ASRAM. Data was gathered on the basis of questionnaire and interview. Statistical analysis was performed. The value of p<0.05 was considered as significant. RESULTS:The obtained information showed that knowledge of most respondents (86%) was below normal (lack of knowledge), 10% had intermediate knowledge and only 4% had high knowledge. There is a significant relationship between Periconceptional Folic acid awareness and education, employment, time of prenatal care, gravidity and sources of health information. The number of women with high level of knowledge was more among those with higher level of education, employment. CONCLUSION:There is need to increase awareness of periconceptional folic acid supplementation among reproductive aged women and women planning pregnancy. Different strategies are required to elevate the knowledge about folic acid.

A Rare Variant of Oral Lichen Planus-Bullous Form.

Lichen planus (LP) is an immune-mediated chronic inflammatory disease that is seen mainly affecting the skin, nails, hair, and mucous membranes. Oral LP (OLP) has about 0.4‑5.3% potential to be malignant. If the disease is sufficiently characterized, the diagnosis can be made from the clinical features alone; but a biopsy is recommended to confirm the diagnosis and to exclude the presence of dysplasia and malignancy. OLP seems to be mediated by an antigen-specific mechanism, thereby activating the cytotoxic T-cells and non-specific mechanisms such as degranulation of mast cells and activation of matrix metalloproteinase. Pathogenesis of OLP may involve both antigen-specific and nonspecific mechanisms. Here, we report a case of bullous LP in a 44-year-old female patient, discussing clinical features and etiopathogenesis.

Study of Magnesium, Copper, Zinc, Iron and Ceruloplasmin in Liver Cirrhosis and Ovarian Cancer Ascitic Patients.

Introduction: The excess accumulation of free fluid in the peritoneal cavity is due to its multitude causes. Certain cytological and biochemical markers are reported for the differential diagnosis of ascites. In the present study, ascitic patients with liver cirrhosis and ovarian carcinoma are investigated. Aim: To study the concentrations of certain trace elements and ceruloplasmin levels in ascitic fluid and in serum of patients with liver cirrhosis in comparison to ovarian cancer patients. Study Design: The study includes 170 patients with liver cirrhosis, 95 patients with ovarian cancer and 100 serum controls. Place and Duration of Study: The study is performed in the department of Gastroenterology, Osmania General Hospital Hyderabad, A.P, INDIA, between December 2011 to July 2013. Methodology: The trace elements such as magnesium, copper, zinc, iron and ceruloplasmin were investigated in 170 patients with liver cirrhosis (120 males, 50 females, 22-75 years; mean age 46.2±11.2) and 95 ovarian cancer patients (19-84 years; mean age 50.2±12.2). All the analysts were measured in serum and ascitic fluid by using standard commercial kits. 100 serum samples from healthy controls were also included in the study. Results: The mean serum concentrations of copper and ceruloplasmin were significantly increased in ovarian cancer patients when compared to that of liver cirrhosis and healthy controls (P<. 001, P<. 001) respectively. The mean zinc levels in serum samples were low in both the groups when compared to controls (P<. 001). The ascitic fluid zinc levels in ovarian cancer were higher when compared to that of liver cirrhosis (P<. 001). Similar results were noted in the serum iron levels in both the groups. The serum magnesium levels in liver cirrhosis are comparable to that of controls but the levels of magnesium in ovarian cancer ascitic patients are high when compared to that of controls. Conclusion: Our results showed that there are differences in trace elements and ceruloplasmin levels in liver cirrhosis and ovarian cancer patients in both serum and ascitic fluid samples. The cutoff value of copper and ceruloplasmin in serum samples are 134.5 μg/dl and 43.5 mg/dl, while in ascitic fluid were 46.5 μg/dl and 21.0 mg/dl respectively. As the diagnostic efficiency of copper and ceruloplasmin in serum and ascitic fluid samples are 97% to 99% with highest sensitivity and specificity, analysis of trace elements with ceruloplasmin in depth with their ratios may be helpful in differentiating the cirrhotic and neoplastic illness.

High origin of left testicular artery associated with accessory renal artery and renal cyst; a cadaveric observation.

The variation in origin of the testicular artery is not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. The renal artery is known to exhibit variations in its number and position. The knowledge of this variation will help the radiologists and surgeons in avoiding clinical complication during interventions. During routine dissection teaching to first year MBBS students at Sapthagiri Medical College, Bangalore we found variation in vascular pattern of testicular and renal artery associated with renal cyst. Photographs of the variations were taken. There was high origin of left testicular artery and accessory left renal artery associated with bilateral simple renal cyst in adult Male cadaver aged around 60years.There was also prehilar division of right renal artery associated with renal cyst. Anomalies in the origin, course and number of testicular artery were observed in 4.7 percent of cases. Additional renal vessels are known as the accessory renal artery and their incidence varies between 9-76%. In the present case there was high origin of left testicular artery associated with accessory renal artery and renal cyst. This anatomical knowledge of the presence of accessory renal artery and high origin of testicular artery in this case is important for radiologists, surgeons and urologist in their clinical practice.

Neural stem cells & supporting cells - The new therapeutic tools for the treatment of spinal cord injury.

Stem cells play important role in the development and in the maintenance of specific tissues. They have been identified in majority of the organs like liver, blood, skin and intestine. Role of stem cells in regenerative medicine have been implicated in many chronic diseases. Stem cell research is a new opportunity to those patients whose organs are damaged or diseased. The discovery of stem cells in central and peripheral nervous system is relatively recent. Spinal cord injury is one of the major neurological disaster affecting mostly young lives. Stem cell transplantation in spinal cord injury patients have shown encouraging results. Different sources of stem cells are being exploited for spinal cord injury as well as other neurological disorders.

Coronary atherosclerosis in sudden cardiac death: An autopsy study.

Background: The incidence of ischemic heart disease (IHD) has markedly increased in India over the past few years. Considering the variations in racial, dietary and lifestyle patterns in our population, it is essential to study the biology of coronary atherosclerosis in our patients. Vulnerable plaques have a large number of foam cells, extracellular lipid, thin fibrous caps and clusters of inflammatory cells and are more prone to rupture. These plaques are nourished by the microvessels arising from the vasa vasorum of the blood vessels and by lumen-derived microvessels through the fibrous cap. This autopsy study was designed to analyse the coronary arterial tree in cases of sudden cardiac death, classify coronary atherosclerotic plaques and to assess the factors contributing to vulnerability of the plaques including inflammation, calcification and microvascular density. Materials and Methods: Seven cases of sudden cardiac death were included in the study. The hearts were perfusion-fixed and the coronary arteries along with their main branches were dissected and studied. The location of the plaques, type of plaques, presence of inflammation and calcification were assessed. The cap thickness and microvessel density per 1000um 2 were assessed. The statistical significance was estimated. Results and Conclusions: Extensive high-grade coronary atherosclerotic disease was seen in all sudden cardiac death cases. Majority of the plaques were vulnerable. High-grade inflammation was seen in most of the vulnerable and ruptured plaques. All the ruptured plaques were uncalcified indicating that calcification probably stabilizes the plaques and protects against rupture. Increased microvessel density was noted in ruptured plaques compared to vulnerable plaques. However, it was not statistically significant.