Patterns of Medication Use and Their Determinants in Pregnancy among Women Admitted to the Obstetrics Wards of a Tertiary Care Hospital: A Cross-Sectional Study: Patterns of Medication Use and Their Determinants in Pregnancy

Objective To assess the patterns and factors affecting medication use during antenatal and perinatal periods and to examine maternal and fetal outcomes among pregnant women admitted to a tertiary care hospital in a developing country. Methods A cross-sectional study was conducted in the obstetrics wards from 2017 to 2019. Data on patient demographics, co-existent medical conditions, medications, and patient outcomes were collected. Descriptive statistics were used to analyze baseline data, chi-square test was used for categorical variables, and multivariate logistic regression was used for factors influencing drug prescription. Results Out of 442 pregnant women, 56% were primigravida with a mean age of 24.7 ± 3.9 years. Approximately 32% experienced at least one disease condition during pregnancy; hypothyroidism (9.7%) was the commonest. The mean number of medications was 2.7 and 38.9% received drugs for a disease condition. Antimicrobials (24.5%) were the commonest drug class. Maternal age of over 25 [(OR (CI): 1.508 (1.191–2.716) (p = .005)] and maternal illness [OR (CI) 2.934 (1.8–4.7) (p = .00)] were identified as factors affecting drug prescription. Approximately 39.8% of deliveries were cesarean. Of the newborns, 12.6% had low birth weight, 9.2% were admitted to the newborn intensive care unit, and 14.9% were premature. Conclusions Most patients were primigravida and under 25 years. Antimicrobials were the most prescribed drug class. Maternal age over 25 years and maternal illness were identified as the factors affecting medication use. The prevalence of cesareans and prematurity was similar to previous studies.

Histopathological Evaluation of Solitary Nodules of Thyroid

Introduction: Solitary Thyroid nodules (STNs) can be ofboth non-neoplastic or neoplastic in nature and it is difficultto assess whether an STN is neoplastic or non-neoplasticby clinical examination alone. Imaging technique mayhelp in differentiating them preoperatively but histologicalexamination offers the final diagnosis. This study was aimedat studying the incidence rates of various types of STNs as itvaries from one geographical area to another.Material and methods: A total of 58 cases of STNsreceived over the period of 18 months were studied andhistopathological features were analysed.Results: In this study, non-neoplastic STNs were 32 (55.17%)and neoplastic were 26 (44.82%), the former being morecommon. There was a female preponderance in both nonneoplastic and neoplastic STNs with an incidence of 90.62%and 84.61% respectively. Mean age of presentation of STNswas 42.09 years. Non-neoplastic lesions of thyroid were; 18cases of colloid nodules, 10 cases of hyperplastic nodulargoitre, 04 cases of Hashimoto Thyroiditis and the neoplasticlesions were; 05 cases of follicular adenoma, 11 cases oftypical/conventional papillary carcinoma of thyroid (PTC),6 cases of papillary carcinoma thyroid variants, 01 case offollicular carcinoma 01 case of Undifferentiated carcinoma,01 case of Squamous cell carcinoma and 01 case of medullarycarcinoma.Conclusion: STNs are not so uncommon and comprise of agamut of both non-neoplastic and neoplastic lesions. Colloidnodule and PTC are the most common of non-neoplastic andneoplastic STNs respectively.

Migrating foreign body in an adult bronchus: An aspirated denture

As a safety measure, dentures are routinely removed before surgery. Aspiration of a denture could be catastrophic, with medicolegal implications. Foreign body aspiration is uncommon in adults; however, aspirations may remain asymptomatic and undiagnosed for long periods of time. We report an adult male who presented with a cough for more than 6 months. On radiography, a foreign body was found migrating within the tracheobronchial tree from one mainstem bronchus to the other, at different time points. The foreign body was later found to be a portion of his denture. The aspiration may have occurred at the time of a surgical procedure.

Synthesis, spectroscopic characterization and biological applications of Cu(II) and Ni(II) complexes with 2-butyl-4-chloro-5-formylimidazole thiosemicarbazone.

Cu(II) and Ni(II) complexes of 2-butyl-4-chloro-5-formylimidazole thiosemicarbazone (L) are synthesized and characterized by using spectroscopic techniques like elemental analysis, FT-IR, mass spectrometry, electronic and EPR spectra. The complexes are found to have characteristic electronic spectra and the geometry of the complexes are identified as octahedron. Both the complexes are found to exhibit similar anti-microbial activity against the gram –ve and gram +ve bacteria. Anti-cancer activity against the cancer cell lines (MDA-MB 231 cell lines) among the compounds studied for % of viability, the inhibition concentration 50 values were shown by Cu(II)-L complex at 80 mg/ml and by Ni(II)-L complex at 100 mg/ml.

Oral contraceptives and oral health: an insight.

Oral contraceptive pills are a safe and effective means of avoiding pregnancy followed by women worldwide. These drugs were first introduced in 1960s and 70s and contained higher dose of estrogen and progesterone and were reported to cause unwanted side effects like gingival inflammation, localized osteitis, alterations in salivary flow rate, changes in salivary components and gingival melanosis in oral tissues. With the advent of new generation formulations of low dose oral contraceptive pills, the effects on oral health is minimized and presently users are not considered as risk group for developing gingival and periodontal disease. This review briefs the effects of oral contraceptive pills on general health and oral health in particular and controversies surrounding their use.

Role of mast cells and neuronal hypertrophy in acute appendicitis

Acute appendicitis is a common surgical emergency. Appendix continues to be the major chunk of surgical specimens received in Pathology laboratory. However, pathogenesis of appendicitis remains poorly understood. Obstruction and inflammation is implied in pathogenesis of acute appendicitis. Presently there is increasing evidence of involvement of enteric nervous system in immune regulation and in inflammatory responses. The present study combines routine histopathology and immunohistochemistry to study the role of mast cells and enteric nervous system in pathophysiology of acute appendicitis. We have done a prospective study for a period of one and half years from January 2014 to July 2015. Appendicectomy specimens from patients who are clinically diagnosed as acute appendicitis were included in study group as cases. Appendix specimens removed at Forensic autopsies were used as controls. Study was conducted on total 138 appendix specimens of which 118 were surgically removed from patients with acute appendicitis, taken as study group. 20 specimens from Forensic autopsy, were used as comparison group (normal control group). We found a consistent increase in mast cell and neuronal counts along with prominence of ganglion cells in specimens with acute appendicitis compared to the control group.

Significance of fibrotic bands in utero ‑ Amniotic band sequence with limb body wall complex: A rare case of fetal autopsy.

Amniotic band sequence (ABS) includes a wide spectrum of abnormalities resulting from entrapment of various fetal parts from a disrupted amnion, ranging from a mere constriction ring affecting a finger to a fatal form called limb body wall complex (LBWC). Reported cases of ABS with LBWC are very few. The spectrum of anomalies depends on which part gets entrapped and at what point of gestation. Hence, the clinical presentation can be extremely variable. Early detection of such cases using sonology is really challenging due to the small size of the fibrotic bands. Here, we present a case of amniotic band syndrome with LBWC in a fetus at 24 weeks of gestation, which was referred for an autopsy. The fetus also showed scoliosis, gastroschisis, lumbosacral meningocele, congenital talipes equinovarus, and cleft palate, thus having features of placenta cranial and placenta abdominal phenotype which is very rare.

Uterine low grade endometrial stromal sarcoma: a case report with review of literature.

Endometrial stromal sarcomas are rare uterine tumours usually seen in perimenopausal females. We report here a case of low grade endometrial stromal sarcoma in a 45 year female with a clinical diagnosis of fibroid uterus and final histological diagnosis of low grade endometrial stromal sarcoma.

Detection of vancomycin susceptibility among clinical isolates of MRSA by using minimum inhibitory concentration method.

Background: Staphylococcus aureus is considered as a major pathogen causing a diversity of infections including bacteremia, pneumonia, skin and soft tissue including osteoarticular infections. Since 1961, Methicillin Resistant Staphylococci aureus (MRSA) emerged has one of the major and common cause of hospital acquired infection. However, due to wide spread usage of vancomycin for MRSA infections resulted in reduced susceptibility of S. aureus to vancomycin has been identified as a serious public health concern. The aim of the study is to identify the Methicillin Resistant Staphylococcus aureus (MRSA) from various clinical samples and to detect vancomycin susceptibility by Minimum Inhibitory Concentration (MIC) method. Methods: This study was conducted over period of one year December 2013 to November 2014. Clinical samples like pus, blood, sputum, urine and cerebrospinal fluid were collected from various clinical departments in Narayana General Hospital for selective isolation of Staphylococcus aureus. A total of 100 Staphylococcal aureus isolates were isolatedby using standard laboratory procedures. MRSA were detected using Oxacillin Disc on Muller Hinton Agar with 4% NaCl. Sensitivity pattern for vancomycin (30 μg) disc and for other recommended antibiotics was determined by Kirby-Bauer’s disk diffusion method. Minimum Inhibitory Concentration (MIC) was done for vancomycin sensitive isolates by standard agar dilution method. Results: Out of 100 S. aureus isolates, all were susceptible to vancomycin (30 μg) by disk diffusion method. But, 82 isolates of MRSA were susceptible to vancomycin at the concentration of 0.5-2 μg/ml of agar. 17 isolates showed intermediate sensitivity to vancomycin, in which 13 isolates with MIC 4μg/ml and 4 isolates with MIC 8 μg/ml and one isolate was resistant to vancomycin even with MIC of 16 μg/ml. Conclusions: The present study reveals the emergence of Vancomycin Intermediate Sensitive Staphylococcus aureus (VISA) and Vancomycin Resistant Staphylococcus aureus (VRSA). Disc diffusion method should not be employed for detection of vancomycin sensitivity for MRSA stains. The major cause may be attributed to unawareness and irrational usage of broad spectrum antibiotics.

Incidence of carbapenem resistant nonfermenting gram negative bacilli from patients with respiratory tract infections among intensive care units.

Background: Non fermenting gram negative bacilli that were considered to be contaminants in the past have now emerged as important healthcare- associated pathogens. Pseudomonas aeruginosa and Acinetobacter species are now known to be the common nosocomial pathogens. Carbapenems are one of the essential antibiotics in the armamentarium against, serious nosocomial infections. Development of resistance against these is a cause of concern. Misuse and inappropriate duration of antibiotic therapy helps in development of resistance. Methods: A total of 200 endo tracheal aspirates and sputum samples were collected from patients of all age groups with clinical evidence of lower respiratory tract infection from Medical, surgical, pediatric ICUS. Non fermenting gram negative bacilli isolated and identified according to CLSI guidelines and antibiotic sensitivity test was performed by Kirby Bauer disc diffusion method. Results: Out of 200 samples 50 Acinetobacter spp. and 38 Pseudomonas aeruginosa were isolated. Among 38 Pseudomonas isolates (42%) 16 were resistant to imipenem and 11 (29%) were resistant to meropenem. Among 50 Acinetobacter isolates 14 (28%) were resistant to imipenem and 12 (24%) were resistant to meropenem. Conclusions: Our study documents an increase in the carbapenem resistance. Reduction in antimicrobial resistance in the ICUS has been a goal for all ICUS as it improves outcome and cost of patient care. Carbapenem must be used judiciously to prevent further resistance or else this would erode the strength of life saving antibiotics.

Tamsulosin vs Naftopidil in Medical Expulsive Therapy for Ureteral Stones — A Randomized Controlled Study.

The aim of the present study was to compare the efficacy of naftopidil and tamsulosin in the management of ureteral stones. A total of 92 patients with symptomatic, single < 10 mm ureteral stone, were enrolled in a prospective study and randomized into two groups. Group 1, received 0.4 mg tamsulosin daily, whereas Group 2, received 50 mg naftopidil daily. Patients were followed –up for up to 6 weeks. The primary end point was stone expulsion rate and secondary end points were stone expulsion time , the rate of interventions such as uretero-renoscopy, ureteric stenting and extracorporeal shock wave lithotripsy and side effects. There were no significant differences between the groups with respect to age, sex, stone size and location. Stone expulsion rate were 76% and 56% in the tamsulosin and naftopidil group respectively. No significant difference in the stone expulsion time and the rate of interventions between the two groups. The finding suggest that tamsulosin is superior to naftopidil for stone expulsion therapy.

A study of correlation of expression of ER, PR and HER2/neu receptor status with clinico-pathological parameters in breast carcinoma at a tertiary care centre.

Background: In English literature it is documented that the expression of ER and PR is low in Asian countries when compared to that of Western countries. HER2/neu over expression is uniform throughout the world. Studies have shown that triple-negative breast carcinomas are aggressive, likely to spread beyond the breast and recur after treatment. Aims and objectives: To correlate the expression of ER, PR and HER 2/neu with clinico-pathological parameters in infiltrating ductal carcinoma and other variants of breast carcinoma. To determine the clinicopathological parameters in triple negative cases. Methods: This is a prospective study for a period of two years in the Department of Pathology, Andhra Medical College, a tertiary care centre. We received 111 mastectomy specimens during this period out of which 52 patients were funded under Arogyasri and were subjected for ER, PR, HER2/neu receptor study. Results: In the present study total cases analyzed were 52. Infiltrating ductal carcinoma was 41/52 (78.84%) and other variants were 11/52 (21.15%). In our institute infiltrating duct cell carcinoma (NOS) type was the commonest type of carcinoma breast with significant group occurring in less than 45 years of age, 95 % of women were multipara with two or more children and triple negative tumors being 54.83%.In infiltrating ductal carcinoma ER, PR positive expression has no association with age and size of tumor. Their expression was higher in grade 1 tumors 83.3%.The ER,PR negative expression was more in size of tumor being greater than 2 cm; (92.5%),positive lymph nodes (51.8%) and stage II and stage III tumors (96.2%). HER2/neu negative expression was seen in 51.61% of cases. Triple negative receptor expression was seen in 54.83% of infiltrating ductal carcinoma. In the English literature medullary carcinoma is negative for HER2/neu expression but in the present study in 2 cases the expression for HER2/neu was positive. Conclusion: In the present study significant group occurred in less than 45 years of age presenting in advanced stage of the disease. Triple negative cases were seen in 54.8% cases of infiltrating duct cell carcinoma indicating bad prognosis.

Effect of Nutrients on Biological Nitrification.

Biological nitrification is the most commonly used process for nitrogen removal from wastewater. Nitrification is carried out in two steps. First ammonia is converted to nitrite by ammonia oxidizing bacteria. In the second step nitrite oxidizing bacteria convert nitrite to nitrate. The study involves the effect of nutrients (both organic and inorganic components) on biological nitrification and the optimum concentrations of di-sodium hydrogen phosphate, potassium di-hydrogen phosphate, sodium hydrogen phosphate, sucrose and ferric chloride were observed over ammonium ion removal. The effect of dissolved oxygen also was studied and maximum percentage removal of ammonium ion was found to be 89.2%.

Biological Nitrification of Waste Water.

Nitrification has been studied extensively as a result of its significance within the biological process and at intervals the necessity for treatment of waste water. In the last decade, the treatment of high ammonical concentration effluents has become a matter of nice interest. Many effluents will contain some hundred milligrams of nitrogen per liter (supernatants from anaerobic digestion, lechates from municipal water, etc.) may have specific treatment before utilization them to the plant recycling process. Sometimes this reaction is applied by maintaining robust ammonical concentrations which have the role of inhibiting the nitrite – oxidizing population responsible for the reaction of nitrites into nitrates (final stage of nitrification). However the nitrification methods served as a very important basis for the development of today understands and mathematical models for several waste treatment processes (activated sludge process using biofilm reactors) and self – purification in rivers. Often nitrogen removal from sea wastewater is problematic due to the low rate of bacteria concerned. Immobilization is an economical technique to retain slow growing organisms in continuous flow reactors. Immobilized cells can be classified into “naturally” attached cells (biofilms) and “artificially” immobilized cells. The simultaneous nitrification and denitrification within the step feeding biological nitrogen removal method were investigated below different inflowing substrate and aeration flow rates. The experimental results showed that there was additionally linear relationship between simultaneous nitrification and denitrification and DO concentration below the conditions of low and high aeration rate.

Acinic cell carcinoma of parotid with predominant follicular pattern mimicking follicular neoplasm of thyroid.

Acinic Cell Carcinoma (ACC) was previously called acinic cell tumor and it is a neoplasm demonstrating cytological differentiation towards serous acinar cells. The histological architecture of ACC is diverse and classification consists of various histological subtypes. This is a case of acinic cell carcinoma of parotid gland in a 45 years female patient which showed predominant follicular variant of ACC. It is a least frequent variant of ACC occurring in only 5% and it mimics follicular neoplasm of thyroid.

Role of urine sediment cytology in the diagnosis of renal disorders in comparison with biochemical and histopathological findings.

Background: The functional reserve of the kidney being large, serum biochemical parameters do not show abnormality until late. The need to recognize minimal damage in the kidneys is hence valuable. Urine sediment examination is cost effective, time saving and is called “liquid renal biopsy”. The present study was aimed to evaluate the role of urine sediment examination in predicting the severity of renal damage and compare the results with serum biochemical parameters, 24 hour urine protein values and renal biopsy findings. Methods: A total of 149 patients presenting with symptoms pertaining to renal disease were included in the study. Clinical information and serum biochemical parameters were obtained. Urine examination was done and renal biopsy performed in all the cases. 2 scoring systems were adopted to grade the urine sediment findings and renal biopsy grading devised by A. Z. Gyory et al. was used to grade the renal injury. 24 hour urine protein was estimated by Esbach’s method. Urine sediment scores, serum biochemical parameters, 24 hour urine protein values were compared with the grades of renal injury on renal biopsies and statistical significance calculated. Results: 32.8% of patients with renal disease were in the age group of 31-40 years. Nephrotic syndrome was the most common clinical presentation (33.5%) followed by nephritic syndrome (21.4%). The most common histopathological diagnosis was post infectious glomerulonephritis (n = 26) followed by acute interstitial nephritis (n = 17). 14 cases of lupus nephritis were diagnosed all of which were confirmed by “full house” pattern of immunofluorescence. Both the urine sediment scores had high specificity and positive predictive values in predicting the severity of renal injury. 24 hour urine protein had high positive predictive value in predicting the severity of renal injury. Serum biochemical parameters were insignificant in predicting the severity of renal injury. Conclusion: Urine sediment examination can be used as an effective diagnostic test for predicting the severity of renal injury. The decision of further investigations and follow-up can be certainly decided by taking urine microscopy findings and 24 hour urine protein values into consideration.

Giant pleomorphic adenoma of parotid gland.

Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenomas are the most common benign neoplasms of the parotid gland. The vast majority are 2-6cms in size, when resected. Untreated pleomorphic adenomas can enlarge in size and weigh several kilograms. There are only few cases of giant pleomorphic adenomas reported in the literature. Here we present one of such case.

Giant congenital melanocytic nevus scalp: report of a rare case.

Giant congenital melanocytic nevus (garment nevus) is a kind of congenital malformation of neural crest cells with size greater than 20 cm. Malignant melanoma may develop in 2-31% of these lesions. The objective of this paper is to present a unique case of giant nevus which is rare.

Hypocholesterolemic Effects of Lactobacillus acidophilus as a Dietary Supplement.

To study the effect of supplementation of Lactobacillus acidophilus on lipid profile in hypercholesterolemia individuals. Thirty hypercholesterolemia subjects (15 men and 15 women) with ages ranging between 42-53 years old were included in the study and the intervention was performed for a period of 60 days. During the intervention all 30 subjects were divided into three groups comprising of 10 individuals in each group. Group A and B were given 10 × 106 and 20 × 106 viable L. acidophilus organisms and Group C served as a nonsupplemented group. However, they were on medication to lower the cholesterol levels. Fasting blood samples were drawn initially at 0, 30 and after 60 days of supplementation, analyzed for lipid profile which included total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol. All the recruited subjects completed the study. Comparisons were made on lipid profile at different time periods i.e., 0, 30 and after 60 days of treatment. The supplementation of either 10 × 106 or 20 × 106 viable L. acidophilus showed significant reduction in cholesterol, triglycerides and increase of HDL cholesterol levels. The supplementation of L. acidophilus is found to be beneficial in altering the levels of lipid profile in hypercholesterolemic subjects.