Study to compare the effectiveness of intravaginal misoprostol alone with combined use of intravaginal misoprostol and intracervical foley’s catheter for termination of mid trimester pregnancy

Background: The main concern of obstetrician is to provide the most effective and safest regimen for mid trimester termination of pregnancy which combines the shortest expulsion interval with least side effects. The combination of intravaginal misoprostol and intracervical Foley catheter for second trimester pregnancy termination has been described in previous studies with conflicting results. Hence gap exists in literature and not adequate evidence available so this study is undertaken.Methods: A prospective and interventional randomized comparative study was conducted in the department of obstetrics and gynecology, tertiary care centre, New Delhi. A total 60 pregnant female of 14 to 20 weeks of gestation who were admitted for termination of pregnancy due to any indication included in the study. Patients were divided into two groups (30 patients in each group). Group A (misoprostol and foleys combination group) and Group B (misoprostol group). Quantitative variables were compared with unpaired t-test/Mann-whitney test (when the data sets were not normally distributed) between the two groups and qualitative variables were compared by using chi-square test/Fisher’s exact test.Results: The mean induction to abortion interval was 18.31±1.95 hours in the female where misoprostol and foleys combination was used and 21.90±2.62 hours in the women where misoprostol alone used group. Authors found a significant reduction in induction to expulsion time in misoprostol and foleys combination group as compared to misoprostol alone group for mid-trimester termination of pregnancy. Total required dose of misoprostol use for termination of pregnancy was significantly less (p 0.008) in the women where both misoprostol and foleys was used than misoprostol alone.Conclusions: With the use of intracervical Foley’s catheter, the duration from induction to expulsion of abortus gets shortened and required dose of misoprostol is also reduced without any significant increase of side effects.

Materanal and neonatal outcomes of triplet gestation in a tertiary care centre: a retrospective study

Background: A significant rise in triplet pregnancy rate has occurred recently. This rise is of concern, as these infants are frequently reported as a risk factor of adverse outcome. The aim of this study was to retrospectively study the outcomes of triplet births.Methods: A retrospective study was undertaken to analyze the clinical data of all patients with triplet gestation admitted to the labour room of Dr. Baba Saheb Ambedkar Hospital, Delhi to study the maternal and fetal outcomes. Authors retrospectively observed and analyzed the database to examine triplet gestations delivered between January 2014 and December 2018.Results: Over the five-year study period, there were total 44,011 deliveries. Out of these, there were 35 (0.079%) triplet pregnancies. Of all the triplet pregnancies studied 80% resulted from ovulation induction and assisted reproductive technology. The mean gestational age at delivery was 31.6±3.0 weeks, and the mean birth weight was 1,594±460 gm. The most common maternal complications were Preterm labour in 32 pregnancies (92%), anemia in 17 (49%), pre-eclampsia in 11 (31%), post-partum hemorrhage in 8 (22%). Of the total deliveries neonatal complications included Respiratory distress syndrome in 44 (42.2%), Hyperbilirubinemia in 41 (39%), Intrauterine growth restriction in 19 (18.1%). The perinatal mortality rate was 10.5%.Conclusions: Higher order pregnancies are associated with maternal and neonatal complications. These high risk women need more care and the neonates require intensive care and monitoring after birth, most commonly due to prematurity and low birth weight.

Study of ABO Blood Groups and Subgroups A1, A2, A1B and A2B in Blood Donors and Recipients

Blood transfusion in modern era is possible only due to the knowledge of exact blood groups and sub blood groups. Over 700 erythrocyte antigens have been reported and are organized into 35 blood group systems by International Society of Blood Transfusion. These antigens may be proteins, glycoproteins or glycolipids and are controlled by single or more gene locus. Some antigens are specific to red cells; whereas, others are found on other cells throughout the body. The ABO blood group was the first human blood group to be discovered by Landsteiner in 1900 and it served the beginning of Blood Banking and Transfusion Medicine. Numerous mutations are found in A, B and O genes, but the most common mutation is A2. The A2 gene has two nucleotides different from the A1 gene which results in diminished enzymatic activity and consequently, weakened antigen expression. Distinction between A1 & A2 made by testing red cells with the lectin from Dolichos biflorus. Prospective study on 2000 cases to find the frequency of ABO and sub blood groups to reduce the blood transfusion related reactions. Methods: The present study included 2000 blood sample collected in the Department of Blood Banking, Govt. Medical College and Hospital, Amritsar and in voluntary blood donation camps organized by the department. 4 ml of venous blood sample collected. 2ml of blood put into ethylene diamine tetra acetic acid (EDTA) vial and remaining 2ml transferred to test tube and allowed to clot. The EDTA sample used for forward grouping and serum used for reverse grouping. Results: In our study the frequency of blood group B was the highest 37.8%, blood group O was 31.8%, blood group A was 21.2% and group AB was the least common with 9.2%age. In case of sub groups, A1 was 20.10% (highest in sub groups) and A2B was 0.85% (Lowest). The Rh +ve blood group was 94.1% and Rh –ve was 5.9%. Conclusion: The study is concluded with the suggestion that, as already being carried out, ABO, Rh blood grouping and sub grouping should be done in each and every case to reduce the blood transfusion related complications. More work should be carried out in different parts of state to know the distribution pattern of ABO, Rh blood groups and sub groups. This will also help the Blood Banks to estimate the requirement of different blood groups and sub groups.

To Estimate and Compare the Incidence of Dentin Hypersensitivity Among Men and Women Before and After Tooth Preparation

Dentin hypersensitivity following tooth preparation is a frequently encountered oral health problem. The present study was conducted to estimate and compare the incidence of dentin hypersensitivity among men and women in an adult population sample who required replacement of missing tooth/teeth with a fixed partial prosthesis. Methods: The present study was conducted among 32 participants in which 16 were male and 16 were females who want replacement of missing tooth/teeth with a fixed partial prosthesis. The informed consent of all the participants who participated in this study was obtained. Detailed clinical and radiographic investigations were performed on all participants to exclude conditions of teeth, which might have caused pain similar to dentin hypersensitivity. There was at least one vital abutment tooth in each FPD. Each abutment tooth received two stimuli: tactile stimulus and thermal stimulus. Sensitive teeth were identified with an explorer passed cervically over the abutment tooth. Immediately following stimulation, the participants were asked to grade their overall sensitivity using a 10 cm Visual Analogue Scale (VAS). After the VAS was recorded before tooth preparation, the subjects underwent tooth preparation of the abutment teeth for the fixed partial denture. The VAS was recorded immediately after tooth preparation. The data was compiled and subjected to statistical analysis. Statistical analysis was done by using SPSS, version 22 (SPSS, Inc., Chicago, IL) and p<0.05 was considered statistically significant. Results: In the present study; total participants were 32, out of which 16 were male and 16 were females. The comparison of dentin hypersensitivity between men and women in which women reported more dentin hypersensitivity than men, although results were statistically non-significant. Conclusion: It was concluded that women reported more dentin hypersensitivity than men before and after tooth preparation

Can single plasma glucose value 2 hours after 75g glucose (DIPSI criteria) replace the gold standard OGTT for the diagnosis of gestational diabetes mellitus?

Background: Gestational diabetes mellitus is a common medical complication of pregnancy associated with several fetal and maternal complications. There are several screening tools for detecting gestational diabetes mellitus including recent DIPSI criteria of non-fasting single plasma 2-hour value after 75 grams glucose (single step test). The  present study was aimed at calculating  prevalence of GDM, sensitivity and specificity using  non-fasting single plasma 2-hour value after 75 grams glucose for screening and diagnosis of gestational diabetes mellitus and to study the high-risk characteristics for GDM in this study population.Methods: This was a prospective study conducted for a period of one year. 750 antenatal women attending Antenatal outpatient department(OPD) with period of gestation 24-28 weeks were enrolled in the study. All women  were first tested by 75 gm glucose and then by OGTT for confirmation. Prevalence rates, sensitivity, specificity, positive predictive value and negative predictive value were studied. History based questionnaire was used to study the risk characteristics for GDM.Results: Prevalence rate, sensitivity, specificity, positive predictive value and negative predictive value for patients were 14.13%, 73.58%, 95.03%, 70.90% and 95.67%. Among the risk factors 7.2% patients were more than 30 years in age. 0.93% had GDM in previous pregnancy.4.21% had GCA in previous pregnancy, 12.4% had SB/IUD/NND in previous pregnancy. 1.17% had previous pregnancy with birth weight more than 3.5 kg and 9.73% had family history of diabetes mellitus. Past history of GDM (50%) was the most common risk factor in GDM group followed by age > 30 years (29.6%), and family history (24.6%).Conclusions: Screening using DIPSI criteria has good sensitivity and negative predictive values. It can serve as both screening and diagnostic test besides being simple, user friendly, cost effective and evidence-based test in less resource countries like India.

Study of the Serum Levels of C-Reactive Proteins as an Indicator of Disease Activity in Pulmonary Tuberculosis and Monitoring Response to Treatment.

Background: Pulmonary Tuberculosis is caused by mycobacterium tuberculosis. C-reactive proteins (CRP) are produced in the body by liver in response to inflammation caused by Mycobacterial infection. Insufficient information is available in medical literature, correlating serum CRP levels to the severity of pulmonary tuberculosis. The present study was undertaken to correlate the validity of serum CRP levels to clinical findings. Severity of pulmonary tuberculosis, need for ventilator support, response to anti-tubercular therapy and mortality. Objectives: To correlate the serum CRP levels with clinical findings, mortality, radiological severity and response to anti-tubercular treatment in patients suffering from pulmonary tuberculosis. Methods: The present study was conducted in 50 new sputum positive pulmonary TB patients and 50 healthy individuals. The patients were evaluated for clinical and radiological findings, which were correlated to baseline CRP levels. CRP levels were measured at 2 months and after completion of treatment and correlated to treatment end results. Results: Mean baseline CRP levels in pulmonary tuberculosis patients were 55.32mg/L (range 16- 144mg/L).CRP levels among normal healthy individuals were 4.46 mg/L (range 2-8mg/L). CRP levels were significantly higher in TB patients with fever, tachycardia, tachypnea, hypotension, respiratory distress and the need for ventilatory support when compared to patients without these features. The study showed significant correlation between CRP levels and radiological extent of disease. Baseline CRP levels were significantly higher in mortality group when compared to survivor group.CRP levels showed progressive decline in patients who were cured. Conclusion: The CRP levels in pulmonary tuberculosis patients before initiating anti-tubercular therapy showed a positive correlation with features like presence of fever, tachycardia, tachypnea, hypotension, respiratory distress, need for ventilator support, radiological severity and in patients who died. Thus, serum CRP levels can be used as a surrogate marker for severity of pulmonary tuberculosis in the patients. This is probably the first study conducted in North India correlating CRP levels and disease severity of pulmonary Tuberculosis to the best of our knowledge.

Testicular embryonal cell carcinoma presenting as haemoptysis and skin nodules.

Embryonal cell carcinoma affects young males in the prime of their life with majority of tumours already having metastasised at the time of diagnosis. Subcutaneous metastasis from embryonal carcinoma is rare and is associated with widespread disease and poor prognosis. We report a case of 22-year-old male who presented with haemoptysis and skin nodules. Fine needle aspiration cytology of skin nodules and the lung lesion led to the diognosis of testicular embryonal cell carcinoma.

Goldenhar syndrome.

Goldenhar syndrome is a syndrome of complex structures developing from first and second branchial arches during blastogenesis. The etiology of this rare disease is not fully understood, as it has shown itself variable genetically and of unclear causes. The disorder is characterized by a wide spectrum of symptoms and physical features that may vary greatly in range and severity from case to case. Here we present a unique case of Goldenhar syndrome with absence of left condyle, hypoplasia of the zygomatic bone, no pneumatization of the mastoid process, underdeveloped mandible, bifid tongue and the skin tags in the preauricular area.

Biological activities of [1,2,4] triazolo-[3,4-b],[1,3,4]-thiadiazole-6-yl) (o-tolyamino) methylazetidin-2-one.

Synthesis of 4-amino-5-(3-bromophenyl)-4H-1,2,4-triazole-3-thiol (1), 3-(3-bromophenyl) [1,2,4]-triazolo[3,4- b][1,3,4]thiadiazol-6-amine (2), N-substituted benzylidene -3-(3-bromophenyl)-[1,2,4]triazolo-[3,4-b] [1,3,4]- thiadiazole-6-amine (3-7),1-(3-(3-bromophenyl )-[1,2,4]triazolo-[3,4-b] [1,3,4]-thiadiazole-6-yl)-4- substitutedphenyl azetidin-2-one (8-12), 3-(3-(3-bromophenyl)-[1,2,4]triazolo-[3,4-b] [1,3,4]-thiadiazole-6-yl)- 2-phenylthia zolidin-4-one (13-17), 1-(3-(3-bromophenyl)-[1,2,4]triazolo-[3,4-b],[1,3,4]-thiadiazole-6-yl)-4- substi- tutedphenyl-3-((o-tolyamino)methyl)azetidin-2-one (18-27).Among all the synthesized compounds, Mannich products were found to possess wide spectrum of antibactderial and antifungal activities with lesser potency and among the mannich products, 22 and 26 were found most potent compound of the series.

Scrub Typhus:Jammu Outbreak-2009.

This is a first report of 20 adult cases describing clinical feature, epidemiological profile and treatment outcome of clinically diagnosed scrub typhus confirmed by test for antibodies (IgM) to O.tsutsugamushi using ELISA kit. Majority of the cases belonged to the district Rajouri (45%) froming hilly & rural belts.Outbreak was Autumn Winter type as all cases reported in month of September and October. The common clinical features were fever 100%, myalgia 50%, headache 30%, conjunctival congestion 30%, eschar 35%, rash 25%, lymphadenopathy 45%, splenomegaly 40%, hepatomegaly 40%, edema 25%, ARDS 35%, altered sensorium 10%, hypotension 20% & metrorrhagia in 5% of patients. Use of Immunological test helped to establish diagnosis of scrub typhus.Thus all the cases were managed successfully without any mortality with doxycycline and or azithromycine & one with addition of rifampicin.

Membrane fluidity and lipid composition of fluconazole resistant and susceptible strains of Candida albicans isolated from diabetic patients / Fluidez e composição lipídica da membrana de cepas de Candida albicans resistentes e sensíveis ao fluconazol, isoladas de pacientes diabéticos

Ten clinical isolates of Candida albicans, five strains belonging to each of fluconazole resistant and susceptible groups isolated from diabetic patients, were studied for the membrane fluidity and lipid composition. Compared to fluconazole susceptible strains, fluconazole resistant ones exhibited enhanced membrane fluidity as measured by fluorescence polarization technique. The increased membrane fluidity was reflected in the decreased p-values exhibited by the resistant strains. On the other hand, susceptible isolates contained higher amount of ergosterol, almost twice as compared to resistant isolates which might have contributed to their lower membrane fluidity. However, no significant alteration was observed in the phospholipid and fatty acid composition of these isolates. Labeling experiments with fluorescamine dye revealed that the percentage of the exposed aminophospholipid, phosphatidylethanolamine was highest in the resistant strains as compared to the susceptible strains, indicating a possible overexpression of CDR1 and CDR2 genes in resistant strains. The results presented here suggest that the changes in the ergosterol content and overexpression of ABC transporter genes CDR1 and CDR2 could contributeto fluconazole resistance in C. albicans isolated from diabetic patients.

Dez isolados clínicos, sendo cinco resistentes e cinco sensíveis ao fluconazol, obtidos de pacientes diabéticos, foram estudados quanto à fluidez e composição química da membrana. Quando comparados aos isolados sensíveis ao fluconazol, os isolados resistentes apresentaram fluidez de membrana aumentada, conforme mensurado pela técnica de polarização fluorescente. A fluidez de membrana aumentada refletiu-se pelos valores mais baixos de p. Por outro lado, os isolados sensíveis continham quantidades mais elevadas de ergosterol, quase o dobro dos isolados resistentes, o que pode ter contribuído para a fluidez de membrana mais baixa. Entretanto, não se observou alteração significativa na composição fosfolipídica e de ácidos graxos nesses isolados. Experimentos de marcação com corante fluorescamina indicaram que a porcentagem de aminofosfolípides e fosfatidiletanolamina expostos foi mais elevada nos isolados resistentes do que nos sensíveis, indicando uma possível superexpressão dos genes CDR1 e CDR2 nos isolados resistentes. Os resultados aqui apresentados sugerem que alterações no teor de ergosterol e superexpressão dos genes ABC transportadores CDR1 e CDR2 podem contribuir na resistência ao fluconazol em isolados de C. albicans de pacientes diabéticos.