A study of neurological disorders in pregnancy and puerperium

Background: Neurological diseases contribute to 20% of maternal deaths. The objective of this study was to find the prevalence of primary and secondary neurological disorders in pregnant and postpartum patients, to study their clinical features, feto-maternal outcome and diagnosis using radiological imaging.Methods: This is a prospective cross-sectional study done over a period of 1 year. Pregnant and postpartum women with neurological disorders except eclampsia were enrolled. A total of 100 cases were analysed out of which 92 underwent radiological imaging to confirm diagnosis. Primary outcome in the form of prevalence of neurological disorders and secondary outcome in the form of maternal and foetal outcome was assessed.Results: The prevalence of neurological disorders in pregnancy is 1150/100000 deliveries. 75 cases were classified as primary neurological disorders (prevalence of 862/100000) which included epilepsy, cerebrovascular accidents, CNS infections, neoplasm, neuropathies and miscellaneous. 25 cases were secondary neurological disorders (prevalence of 287/100000) which included hepatic and septic encephalopathy. Among primary disorders the prevalence of cerebrovascular accidents was found to be highest (33.3%) followed by epilepsy (32%) while that among secondary neurological disorder was of Hepatic encephalopathy (92%). Majority (68%) had recovery while 15%of women had residual deficit. There were 17 (17%) cases of maternal mortality.Conclusions: Neurological disorders were significantly associated with poor feto- maternal outcome. Radiological imaging in the form of MRI is an excellent diagnostic tool for confirming diagnosis of neurological disorders.

Role of bundled intervention in reducing surgical site infection rate in gynecologic surgeries

Background: Surgical site infection (SSI) is most common nosocomial infection (15%) among surgical patient’s and contributes significantly to morbidity and mortality. CDC (2015) provides “bundled intervention for prevention of SSI. The present study was planned to evaluate the feasibility and usefulness of these bundled intervention in reducing SSI in our setup. Objectives of this study to study the effect of bundled interventions on SSI in gynaecologic surgery.Methods: A total 50 cases  undergoing gynecological surgery in elective OT included in pilot group and bundled intervention followed  these pilot group cases compared with 50 control group operated in same OT in which bundled intervention not followed outcome measures recorded were Incidence of SSI, type of SSI, need for antibiotic usage, need for secondary suturing, duration of hospital stay.Results: Out of 50 subjects in pilot group, five developed signs and symptoms of SSI giving an SSI rate of 10%. Out of those five, two had superficial SSI and three had deep SSI, none of the patient had organ space SSI.SSI rate in 50 cases operated in the same operating room during the same time period without use of bundled interventions (control group) was 12%.Conclusions: Bundled approach is easy and feasible in all setups. It adds only three extra minutes to the total duration of the surgery with risk reduction of SSI.

Neutrophil Lymphocyte Ratio (NLR) as a Bio Inflammatory Marker in Pre-eclampsia

Introduction: Pre-eclampsia, a systemic disease unique topregnancy, affects 3–14% of pregnant women. The aim ofthe present study was to evaluate Neutrophil LymphocyteRatio (NLR) as a bio inflammatory marker of pre-eclampsia(PE), a hypertensive disorder of pregnancy characterized byhypertension and proteinuria after 20 weeks of gestation.Material and Methods: This case control study was carriedout over a period of 10 months after informed consent andethical clearance. The study population included 70 pregnantwomen (35 pre-eclampsia cases and 35 normotensive pregnantsubjects as controls). 3 ml venous blood samples were obtainedfrom both the cases and controls. Complete blood count wasdone using semi-automated three part haematology analyserwhich gives the reading of cell counts, NLR was calculatedmanually.Results: The case group (subjects with pre-eclampsia) werefound to have higher neutrophil to lymphocyte ratio (NLR)than that of the control group. This difference was statisticallysignificant (p<0.001). The receiver operating curve (ROC)analysis showed significant diagnostic accuracy of NLR todiscriminate cases and controls (area under the curve [AUC]= 0.73, P < 0.001) at cutoff value of >= 4.86, 68.6% sensitivityand 80% specificity.Conclusion: Unlike many other inflammatory markers, NLRproves to be an inexpensive and readily available biomarkers,obtained from routinely done complete blood counts that maybe useful for prediction and diagnosis of pre-eclampsia.

Study of knowledge, attitude, practices regarding PPIUCD among antenatal women at a tertiary care centre in Northern India

Background: PPIUCD has been introduced in the national family welfare program since March 2010 in several states. AN IUCD can be inserted in 48 hours postpartum, referred to here as postpartum intrauterine contraceptive device. This study was done to assess the Knowledge, attitude and practice of postpartum Intrauterine contraceptive device in antenatal patients at a tertiary care centre in Northern India.Methods: This is a questionnaire based cross sectional observational study including 350 antenatal women attending antenatal OPD over a period of 6 months.Results: Out of these 350 women, 126 women (36%) had knowledge of PPIUCD. only 30 % of women had previous knowledge about PPIUCD however only 10 % of women practiced it in the past. After appropriate counselling 18% of women agreed for insertion of PPIUCD after this delivery.Conclusions: The study concludes that the antenatal women had poor knowledge regarding PPIUCD. Practices were even worse. This might be attributed to low education ,  refusal by family especially male partner, and religious beliefs. But once appropriate knowledge and information is provided, attitude gradually changes.

Generation of transgenic mesenchymal stem cells expressing green fluorescent protein as reporter gene using no viral vector in caprine.

Mesenchymal stromal cells (MSC) are multipotent cells that can be derived from many different organs and tissues. While there are many ways to label and track cells each with strengths and weakness, the green fluorescent protein (GFP) is a reporter gene commonly employed. In the present study, caprine MSC were collected from bone marrow and cells were characterised with MSC specific markers. Passage 10 (P10) MSC cells were transfected using plasmid vector containing GFP as reporter gene with different concentrations of DNA and lipofectamine. Six different concentrations of DNA and lipofectamine as 1 µg DNA: 2 µL lipofectamine, 1 µg DNA: 2.5 µL lipofectamine, 1.2 µg DNA: 2.2 µL lipofectamine, 1.2 µg DNA: 2.5 µL lipofectamine, 1.5 µg DNA: 2.5 µL lipofectamine, 1.5 µg DNA: 3 µL lipofectamine were used. After 24 h and 48 h of transfection, caprine MSC were observed under florescent microscope. Highest transfection rate indicating green flourecscent MSC were found when the cells were transfected with 1.2 µg DNA: 2.2 µL lipofectamine and 1.5 µg DNA: 2.5 µL lipofectamine than other combinations. These cells have been propagated beyond 4th passage maintaining GFP expression. The results indicated that stable GFP positive MSC cells can be generated using the above protocol. These cells are being used for transplantation studies.

Utilization of Agro-industrial Wastes for the Simultaneous Production of Amylase and Xylanase by Thermophilic Actinomycetes

Agro-industrial wastes such as sugarcane bagasse, wheat bran, rice bran, corn cob and wheat straw are cheapest and abundantly available natural carbon sources. The present study was aimed to production of amylase and xylanase simultaneously using agro-industrial waste as the sole carbon source. Seven thermophilic strains of actinomycete were isolated from the mushroom compost. Among of these, strain designated MSC702 having high potential to utilize agro-industrial wastes for the production of amylase and xylanase. Strain MSC702 was identified as novel species of Streptomyces through morphological characterization and 16S rRNA gene sequence. Enzyme production was determined using 1% (w/v) of various agro-industrial waste in production medium containing (g/100mL): K2HPO4(0.1), (NH4)2SO4(0.1), NaCl (0.1), MgSO4(0.1) at pH 7.0 after incubation of 48 h at 50°C. The amylase activity (373.89 IU/mL) and xylanase activity (30.15 IU/mL) was maximum in rice bran. The decreasing order of amylase and xylanase activity in different type of agro-industrial wastes were found rice bran (RB) > corn cob (CC) > wheat bran (WB) > wheat straw (WS) > sugarcane bagasse (SB) and rice bran (RB) > wheat bran (WB) > wheat straw (WS) > sugarcane bagasse (SB) > corn cob (CC), respectively. Mixed effect of different agro-industrial wastes was examined in different ratios. Enzyme yield of amylase and xylanase was ~1.3 and ~2.0 fold higher with RB: WB in 1:2 ratio.

Esophageal function tests in clinical practice: A review.

Diseases of esophagus are common in gastroenterology practice. Improvement in diagnosis and better understanding in pathophysiology of these diseases have been possible recently due to advancement in technology. Advancement made in the field of computer softwares is another key development aiding further improvement in these instruments. In this article, we review techniques, interpretation and clinical utility of various tests of esophageal function with special reference to manometry, ambulatory pH and impedance monitoring. Esophageal manometry is simple to perform. Recent, availability of commercial user-friendly software has made analysis of recorded data easy. High resolution spatio-temporal manometry is advancement over conventional manometry. Manometry is a useful tool for diagnosis, followup and research in esophageal motility disorders. Ambulatory 24-h pH metry and impedance monitoring are also easily analyzed by commercially available software. 24-h impedance combined with pH-metry is currently considered as the gold standard for diagnosis of gastroesophageal reflux disease (GERD). All patients with GERD may not require these investigations, but those with atypical symptoms, those refractory to medical treatment and requiring surgery do. Esophageal transit study is useful in understanding functional correlates of abnormalities in manometry and is particularly useful during follow up studies and in research.

Fraser syndrome: recurrence in a family.

Fraser syndrome is a rare, autosomal recessive condition with classical features of cryptophthalmos, syndactyly, ambiguous genitalia, genitourinary mal-formations and mental retardation. We report a family with affected child where the pregnant woman was referred at 24 weeks of gestation for termination of pregnancy. The aborted fetus showed typical findings suggestive of Fraser syndrome.

Spectrum of holoprosencephaly.

OBJECTIVE: To conduct a clinical study of holoprosencephaly (HPE). METHOD: Thirteen cases of HPE were studied regarding their clinical features, family history, and prenatal and imaging studies. Chromosomal analysis was done whenever fresh sample was available. RESULTS: Six cases were antenatally detected by ultrasound; four cases were stillborn. Three cases were identified by neuroimaging done a part of evaluation of developmental delay or cleft lip. Eleven of them had facial anomalies characteristics of HPE. Two of these had subtle facial features and microcephaly. Karyotype was abnormal in 2 of 7 cases studied. CONCLUSION: Most of the cases of HPE present antenatally or at birth. Milder forms like lobar and semilobar can present as developmental delay during infancy. Facial anomalies are usually associated with HPE. Chromosomal study of the case and clinical examination of the parents is essential for providing information regarding risk of recurrence to the family.