Association between maternal serum beta human chorionic gonadotropin levels and hypertensive disorders of pregnancy

Background: A major challenge in obstetrics is early identification of hypertensive disorders of pregnancy (HDP). This study was performed to determine the association between elevated maternal serum β-hCG levels and HDP, the correlation between serum β-hCG level and severity of preeclampsia and to determine the value of serum β-hCG level as a diagnostic marker for early diagnosis of HDP.Methods: This was a hospital based observational study conducted in the department of obstetrics and gynecology, Rajendra Institute of Medical Sciences, Ranchi on 375 pregnant women with period of gestation more than 20 weeks, including 250 pregnant women with HDP as study group and 125 normotensive pregnant women as controls. Serum β-hCG concentration was measured and its level was compared between two groups.Results: The maternal mean serum β-hCG levels (51161.08±30038.21 IU/L) of study group of HDP were higher than the normotensive control group (17603.23±16748.21 IU/L). In non-severe preeclampsia, the mean serum levels were 36417.32±23876.74 IU/L while in severe preeclampsia, 60030.34±28771.31 IU/L. There was statistically significant difference (p<0.001) with higher levels in early onset preeclamptic mothers than late onset preeclampsia. The cut-off point of β-hCG for predicting HDP was 32077 IU/L with sensitivity of 65% and specificity of 86%.Conclusions: Serum β-hCG level is higher in HDP when compared to normotensive women. Higher levels of β-hCG are associated with increasing severity of hypertensive disorders of pregnancy. The utility of serum β-hCG as a diagnostic test is limited because of low sensitivity and difficulty in deciding the cut-off value.

Gestational trophoblastic diseases: an observational study at a tertiary care teaching hospital in Jharkhand, India

Background: Gestational Trophoblastic Diseases (GTD) encompass a wide spectrum of proliferative disorders of trophoblast tissue, which hold a good prognosis if diagnosed and treated on time. A close understanding of the disease spectrum is therefore needed to reduce morbidity and mortality.Methods: This is an observational study (both prospective and retrospective analysis) conducted in Rajendra Institute of Medical Sciences, a tertiary care teaching hospital in Ranchi, Jharkhand over a period of 2 years from 1st January 2017 to 31st December 2018.Results: A total of 162 cases of GTD were identified during the study period. Disease spectrum comprised of complete molar pregnancy in 146 (90.12%) and partial molar pregnancy in 7 (4.3%), GTN in 9 out of 162 cases (5.5%). Bleeding per vaginum preceded by amenorrhea was the most common symptom, observed in 95.4% of the cases. Uterine size was more than period of amenorrhea in almost 50% of the cases. Theca lutein cysts were found in 39.8% of the cases, hypertension in 21.5%, hyperthyroidism in 6.5% cases. Overall, there were nine (5.56%) cases of choriocarcinoma and six (3.7%) cases of Invasive mole. Remission rate in GTN was 86.7% with chemotherapy.Conclusions: Women complaining of vaginal bleeding in first half of pregnancy with uterine size more than period of amenorrhea must be evaluated for GTD by ultrasound and serum beta HCG. For cases of molar pregnancies, suction and evacuation remains the treatment of choice but need for regular follow-up and strict compliance to contraception during entire follow up has to be emphasized. Cases of GTN have excellent remission with chemotherapy.

Comparison of modified biophysical profile and Doppler ultrasound in prediction of perinatal outcome in high-risk pregnancies

Background: The objective of this present study was to compare MBPP and umbilical artery Doppler flow in high-risk pregnant women in prediction of perinatal outcome.Methods: A cohort study was done on 150 high-risk pregnant women over 16 months. Antenatal women with singleton pregnancy who delivered within 48 hours of performing MBPP and Doppler USG, with presence of ≥1 high-risk factor like pre-eclampsia/gestational HTN, BOH, post-dated pregnancy, FGR, GDM, maternal heart disease, anaemia, hypothyroidism and IHCP were included in the study. MBPP (NST and AFI) and umbilical artery Doppler was performed. Perinatal outcome was measured in terms of stillbirth/IUD, LBW, Apgar <7 at 5 minutes, admission to NICU, neonatal death within 48 hours of delivery, MSL and neonatal seizures within 24-48 hours. Quantitative variables were compared using independent t-test/Mann Whitney test. Qualitative variables were correlated using Chi square test/Fisher exact test. Sensitivity, specificity, NPV, PPV were calculated and p-value <0.05 was considered statistically significant. Data analysis was done using social sciences (SPSS) licensed version 21.0.Results: Majority belonged to the age group 21-25 years and were between 37-40 weeks of gestation. It was found that highest perinatal complications occurred in those with both abnormal MBPP and Doppler followed by those with only abnormal MBPP (p-value<0.0001).Conclusions: MBPP is a better predictor of perinatal outcome compared to umbilical artery Doppler USG in high-risk pregnant women. MBPP should be done in all high-risk pregnancies even if Doppler is normal. Both the tests must be performed in all high-risk pregnancies to improve perinatal outcome.

Clinical Profile of Patients Presenting with Ovarian Tumors at a Tertiary Care Teaching Hospital in Jharkhand, India

Introduction: Ovary is a common site for tumors, both benignand malignant which causes great morbidity and mortality.The study was undertaken to analyse the clinical profile andhistologic pattern of ovarian tumors.Material and methods: A prospective observational study ofcases presenting with ovarian tumors was done over a periodof 14 months from December 2016 to January 2018.Results: Ovarian tumors accounted for 3.32% of allgynecologic admissions (68/2045) during the study period.There were 50 benign (73.52%) and 18 malignant tumors(26.47%). Age of patients ranged from 12-72 years. Mostof the cases were in the reproductive age group. Surfaceepithelial tumors dominated other types (81.25%). Mucinouscystadenoma was the commonest (35.93%) benign tumorfollowed by serous cystadenoma (23.43%), dermoid cyst(15.6%) and granulosa cell tumor (1.56%). Commonestmalignant tumor was serous cystadenocarcinoma (15.6%),followed by mucinous cystadenocarcinoma (6.25%) andKrukenberg tumor (1.56%). Clinical symptoms and signs werevague but were present for more than one year in majority.Significant number of malignant tumors presented at earlierage (30-50 years) and in later stages (stage 3).Conclusion: Among malignant tumors, younger age ofpresentation, relatively long duration of symptoms for morethan 1 year, and advance stage of disease was more common.This emphasizes the need for early attention to symptoms andsigns and proper evaluation with detailed investigations forexclusion of ovarian malignancy in all age groups.

A comparative study of the effect of induction of labour with vaginal misoprostol versus prostaglandin E2 gel on the incidence of pathological cardiotocography tracing

Background: The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.Methods: This is prospective case-control study conducted in department of obstetrics and gynecology, RIMS, Ranchi over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Results: Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.Conclusions: While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.

An analysis of relaparotomy in operative obstetrics

Background: Relaparotomy in obstetrics following caesarean section or laparotomy is associated with high morbidity and mortality and hence, considered as maternal near miss. Selection of patient for the same is crucial. This study was done to know the incidence, indications, the risk factors, intraoperative procedures and mortality rates of relaparotomy.Methods: A retrospective analysis of relaparotomy after primary obstetric surgery over a period of two and half years (June 2016 to November 2018) was done in department of obstetrics and gynecology of Rajendra Institute of Medical Sciences, Ranchi, India.Results: During study period 28 cases of relaparotomy (18 inhouse and 10 referred cases) were identified. The incidence of relaparotomy was 0.24%. Intraperitoneal hemorrhage (39.2%) was commonest indication of reoperations followed by PPH (17.8%), rectus sheath hematoma (14.8%) and burst abdomen (10.7%). Obstructed labor (32.1%) was commonest indication of primary cesarean. Hysterectomy was required in 8 cases (25.7%), evacuation of blood for hemoperitoneum was required in another 8 cases. Most cases of hemorrhage were reopened within 24 hours, whereas most case of the rectus sheath hematoma, burst abdomen, and broad ligament hematoma were reopened between 5-9 days.Conclusions: Relaparotomy is often a lifesaving procedure. Decision to perform and manage relaparotomy should always be done by senior obstetricians. Meticulous surgical techniques to secure hemostasis at time of primary surgery should be adopted. Strict postoperative vigilance, is of utmost importance for early detection of intraperitoneal hemorrhage and other complications requiring relaparotomy as timely intervention.

Clinical and surgical outcomes of 3 cycles versus 6 cycles of neoadjuvant chemotherapy in advanced ovarian carcinoma

Background: Epithelial cancers are the most common ovarian malignancy accounting for 90% of all type of ovarian cancer. Objective of this study was to evaluate the surgical morbidity and to study clinical outcomes of 3 cycles versus 6 cycles of neoadjuvant chemotherapy.Methods: A total 30 women with diagnosis of advanced epithelial ovarian cancer were randomly divided equally to receive either 3 cycles (Group 1) or 6 cycles (Group 2) of neoadjuvant chemotherapy. End points noted were duration of surgery, extent of surgery, perioperative complications and length of stay.Results: Both groups had comparable demographic profile. Surgery was more difficult in early IDS group with lesser percentage of patients achieving minimum intended surgery in early IDS (61.53% versus 80. 47%) peri-operative complications were seen more commonly in early IDS group compared to late IDS group (26.66% versus 69.2%). However mean duration of surgery was similar in both groups. Mean duration of stay in hospital was 5.4 days in late IDS group and 7.6 days in early IDS group. The mean follow-up period in late IDS was 7 months and in early IDS was 5 months. Survival in both groups when patients were followed up till the end of study period (12 months) was similar (p=0.186).Conclusions: Authors conclude that late IDS may be used as a treatment option in the high-risk group of patients. Though there was no significant difference at 6 months follow up, higher percent of women were disease free in late IDS.

Oviposition Deterrents in Herbivorous Insects and their potential use in Integrated Pest Management.

In the life cycle of insects, oviposition is an important phenomenon, and it is influenced by many intrinsic and extrinsic factors, especially in relation to suitable hosts for completion of their life-cycle. Oviposition deterrents which deter an insect from laying eggs are important in the management of insect pests. Proper understanding of these deterrents shall provide necessary insight into new vistas for Insect Pest Management. Chemicals from plants and insects play an important role in attracting phytophagous insects for selecting host for oviposition. Considerable research has been done on oviposition deterrents and their mode of actions. In the present review, we have consolidated the updated information on this important aspect of insect behavior.

Mucoepidermoid Carcinoma of Parotid as a Second Malignancy in Acute Lymphoblastic Leukemia.

Background: Improved survival seen in Acute Lymphoblastic Leukemia (ALL) cases has led to increased reports of second malignant neoplasms. Case characteristics: A 12-yearold female treated for ALL using UK ALL XI protocol nine years back presented with progressively increasing pre-auricular swelling. Observation: Investigations revealed it to be a Mucoepidermoid carcinoma. Message: Mucoepidermoid carcinoma should be a differential in any parotid swelling of treated case of pediatric ALL.

Physical state & copy number of high risk human papillomavirus type 16 DNA in progression of cervical cancer.

Background & objectives: High-risk human papilloma virus (HR-HPV) infection and its integration in host genome is a key event in malignant transformation of cervical cells. HPV16 being a dominant HR-HPV type, we undertook this study to analyze if viral load and physical state of the virus correlated with each other in the absence of other confounding variables and examined their potential as predictors of progressive cervical lesions. Methods: Both, viral load and integration status of HPV16 were determined by real time URR PCR and estimation of E2:E6 ratio in a total of 130 PGMY-RLB -confirmed, monotypic HPV16-infected cervical DNA samples from biopsies of cytology-confirmed low grade (LSIL, 30) and high grade (HSIL, 30), and invasive carcinoma, (squamous cell carcinoma SCC, 70) cases. Results: Investigation of DNA samples revealed a gradual increase in HPV16 viral load over several magnitudes and increased frequency of integration from LSIL to HSIL and HSIL to invasive cancer in relation to the severity of lesions in monotypic HPV16-infected cervical tissues. In a substantial number of precancer (11/60) and cancer cases (29/70), HPV16 was detected in concomitant mixed form. The concomitant form of HPV16 genome carried significantly higher viral load. Interpretation & conclusions: Overall, viral load and integration increased with disease severity and could be useful biomarkers in disease progression, at least, in HPV16-infected cervical pre-cancer and cancer lesions.

A study of acceptability & feasibility of integrating humanities based study modules in undergraduate curriculum.

Background & objectives: The field of medical education in our country remains deeply fragmented and polarised between the biomedical technical domains which are overrepresented and the humanitarian domains which are under-represented within the universe of medical pedagogy. To overcome this imbalance, we designed a module that integrates the two domains in a holistic biomedical and socio-cultural framework with the objective of providing unified field of learning experience to the undergraduate medical students attending rotatory clinical postings in a medical college in New Delhi, India. Methods: Undergraduate medical students of 6th and 8th semesters were enrolled in humanities based study module (HSM) on voluntary basis for a total duration of six months. During their compulsory rotatory medicine ward posting, they were introduced and exposed to learning bedside experience of HSM with various tools of art and literature in the form of poem, short narratives, paintings, sketches and group discussions to express their feelings about patients’ sufferings. Students’ feed-back was recorded through an anonymized questionnaire. Result: Of the 235 students, 223 (95%) enrolled themselves voluntarily and 94 per cent (210 of 223) of them completed the total six month duration of the study module. Seventy three per cent of the students found HSM effective in improving their affective motivational behavior, 82 per cent found it effective in motivating them to learn more about core medical subjects, and 85 per cent wanted its continuation as part of medical curriculum. Interpretation & conclusions: The positive response of the students towards the HSM was an indicator of the potential for integrating the module within the undergraduate medical curriculum.

Potentiation of insecticidal activity of Bacillus thuringiensis subsp. kurstaki HD-1 by proteinase inhibitors in the American bollworm, Helicoverpa armigera (Hübner).

The effect of crude proteinase inhibitor extracts from seeds of different crop plants (black gram, chickpea, chickling vetch, finger millet, French bean, green gram, horse gram, lentil, pea and soybean) on the insecticidal activity of B. thuringiensis var. kurstaki HD-1 was investigated against neonate larvae of H. armigera by diet incorporation method. The larval mortality due to crude proteinase inhibitors alone (5% seed weight equivalent) ranged from 4.1 to 19.1%; the maximum mortality with finger millet and the minimum with pea var. DDR-23. A mixture of B. thuringiensis var. kurstaki HD-1 (10 ppm) and proteinase inhibitor (5% seed weight equivalent) was synergistic in larval mortality with respect to proteinase inhibitors of pea var. DMR-16, chickling vetch var. RLK-1098 and B101-212, lentil var. ILL-8095 and L-4076, soybean var. PK-1042, PK-416 and Pusa-22, chickpea var. Pusa-413, French bean (Chitra) and black gram; and antagonistic with respect to those of finger millet, horse gram and kidney bean. The larval growth reduction with crude proteinase inhibitors alone ranged from 17.9 to 53.1%; the maximum growth reduction with soybean var. PK-1042 and minimum with lentil var. L-4076. A mixture of B. thuringiensis var. kurstaki and proteinase inhibitor was synergistic in growth reduction with respect to proteinase inhibitors of lentil var. ILL-8095, and L-4626 and antagonistic with respect to that of finger millet. The midgut proteinase inhibition with crude seed extracts (3.3% seed weight equivalent) ranged from 9.3 to 60.9% and was negatively correlated with larval mortality. These results showed that interactive effect of B. thuringiensis var. kurstaki HD-1 and proteinase inhibitors in the larvae of H. armigera depended upon the quality and quantity of proteinase inhibitors, which vary widely in different plants.