THE ASSOCIATION IN SERUM VITAMIN D3 LEVELS IN PATIENTS WITH EARLY PREGNANCY LOSS

AIM: To find out the association between vitamin D levels in normal pregnancy and pregnancy loss in the first trimester. METHODOLOGY: -The present study was a hospital based comparative study conducted in 40 pregnant (7-9 weeks) women having pregnancy loss (Group I) and 40 pregnant (7-9 weeks) women having normal pregnancy coming to department of Obstetrics and Gynaecology, SMS medical college and associated hospitals, Jaipur, Rajasthan. The mean Vitamin D3 level in pregnancy loss cases RESULTS: was 17.77±6.56 ng/ml and in normal pregnancy group was 24.85±7.55 ng/ml. So the results showed that the mean Vitamin D3 level was significantly higher in normal pregnancy group compare to early pregnancy loss cases. Pre CONCLUSION: sent study concluded that vitamin D has a significant role during pregnancy started from early implantation and decidulization phase till late pregnancy.

A Prospective Interventional Study to Evaluate the Efficacy of Nepafenac 0.1% for Prevention of Macular Oedema Associated with Cataract Surgery in Patients with Diabetes

Pseudophakic cystoid macular oedema is a significant cause of suboptimal visual acuity post phacoemulsification.Diabetics are at greater risk of developing PCME following cataract surgery. Topical nepafenac ophthalmic suspension 0.1% is used to prevent inflammation postoperatively. We wanted to study the effect of Topical Nepafenac 0.1% eye suspension on macular thickness following phacoemulsification in patients of diabetes mellitus and correlate the final visual acuity and macular thickness.METHODSThis prospective interventional study was conducted between January 2018 and May 2019 in the Department of Ophthalmology, MMIMSR, Mullana, Ambala. 100 patients based on the inclusion and exclusion criteria were included in the study and phacoemulsification was done. They were divided in to two groups of 50 each. Group 1 received topical Nepafenac 0.1% ophthalmic suspension thrice daily along with the routine post-op medications whereas Group 2 received routine post-op medications. The groups were analysed preoperatively and at 2, 4, 6, 8 weeks postoperatively and their CMT was recorded using a SD-OCT. The change in BCVA was analysed with the help of ETDRS letter chart. The data was entered in Microsoft Excel and analysed using SPSS-PC-20 version. Quantitative data was expressed by mean and standard deviation while qualitative data was expressed as percentage. Difference between the proportions was tested with Chi Square Test or Fisher’s Exact test while difference between quantitative variable between the two groups was tested with students ’t’ test or Mann Whitney U test. For comparison of quantitative data between more than two groups, ANOVA or Kruskal Wallis ‘H’ test followed by post hoc test was used. A ‘p’ value of less than 0.05 was considered statistically significant.RESULTSA lower percentage of patients in Group 1 developed ME relative to Group 2 (2% vs. 8%; p-value= 0.36). The mean CMT was significantly lower in Group 1 at 2 (p-value<0.01), 4 (p-value<0.001), 6 (p-value<0.001) and 8 weeks (p-value<0.001). A greater percentage of patients in Group 1 (60%) experienced a gain of >15 letters as compared to the baseline (p-value<0.01)

Intussusception associated with celiac disease in a child: case report and review of literature

Intussusception and celiac disease both are common in children.' Intussusception has been rarely associated with celiac disease in children, which mostly involved small bowel, are transient without classical symptoms, reduced spontaneously and rarely needs intervention. Authors are reporting a 2-year girl who presented initially as gastroenteritis and later on intestinal obstruction and on investigation revealed ileo-ileal intussusception which resolved spontaneously during laparotomy preparation. The patient had growth retardation and microcytic hypochromic anemia and on further evaluation diagnosed with celiac disease. This case report highlights the need of celiac testing in children with intussusception, and such intussusception resolved spontaneously with gluten free diet and rarely needs any active intervention, thus preventing from undue nonsurgical or surgical interventions for intussusception.

Risk-adjusted analysis of patients undergoing emergency laparotomy using POSSUM and P-POSSUM score: a prospective study

Background: Comparison of operative morbidity rates after emergency laparotomy between units may be misleading because it does not take into account the physiological variables of patients' conditions. Surgical risk scores have been created, and the most commonly used is the Physiological and Operative Severity Score for the enumeration of Mortality (POSSUM) or one of its modifications, the Portsmouth-POSSUM (P-POSSUM), usually requires intraoperative information. Objective: The objective of this study is to evaluate the POSSUM and P-POSSUM scores in predicting postoperative morbidity and mortality in patients undergoing emergency laparotomy. Methodology: This is a prospective, cross-sectional, and hospital-based study that was conducted at J.L.N. Medical College and Hospital, Ajmer, Rajasthan, India, from April 2017 to December 2017. Adult patients who presented at the causality and underwent emergency laparotomy were included in the study. Observed and predicted mortality and morbidity were calculated using POSSUM and P-POSSUM equations, and statistical significance was calculated using Chi-square test. Results: A total of 100 patients were included in this study, with a mean age of 42.83 ± 18.21 years. The observed (O) mortality was 12 (12.0%), while POSSUM predicted 40 (40%) and P-POSSUM 27 (27%). The O/E ratio for POSSUM was 0.29 and for P-POSSUM was 0.44, and this means that they both overestimate mortality. When the results were tested by Chi-square test, the P value was found to be 0.55 and 0.85 for POSSUM and P-POSSUM, respectively, which showed no significant correlation for observed and expected mortality. The observed morbidity was 69 (69%), while POSSUM expected morbidity was 79 (79%), O/E ratio is 0.87, and this again overestimates the morbidity. POSSUM is overpredicting the rate of morbidity, and test of correlation showed no significance with P = 0.75. Conclusion: POSSUM and P-POSSUM were found to overestimate mortality and morbidity in our patient's population

A Study of Psychiatric Disorders and Chronic Urticaria

Background: Chronic urticaria is one of the commonest skin disease characterized by rashes or lesions or wheals which may last from one day to six months. psychological disorders have been found associated with quality of life. Poor quality of life may lead to diverse psychological disorders. Therefore, the present study was designed to assess if there is any relation between chronic urticaria and psychological disorders. Methods: This was a cross-sectional type of study conducted at Department of Psychiatry & Department of Dermatology in the FH Medical College, Tundla. Standardized self-assessment psychological questionnaires (General health questionnaires-GHQ-28) were used to assess the mental state of all the participants of both groups. Results: Anxiety was found in 75 group I patients in comparison of 19 subjects of group II healthy subjects. Depression was found in 62 chronic urticaria patients and in 12 healthy subjects of group I and group II respectively (p<0.01). Further, out of 100 chronic urticaria patients, 65 patients were suffering from psychosomatic disorders; whereas, psychosomatic disorders were found in 17 healthy subjects of group II (p<0.01). It is evident from figure 1 that disability in social functions was established in 73 chronic urticaria patients and 15 healthy subjects of group I and group II correspondingly (p<0.01). Conclusion: Findings of the current study conclude that psychological disorders are found as comorbidity in chronic urticaria patients. Therefore, Psychiatrist assistance is unavoidable for the patients suffering from chronic urticaria to avoid as well as treatment of psychological disorders. However, studies on larger population are required to establish relationship between chronic urticaria and psychiatric disorders

Genetic diversity of Mycobacterium tuberculosis isolates from central India.

Background & objectives: There is a paucity of data available on genetic biodiversity of Mycobacterium tuberculosis isolates from central India. The present study was carried out on isolates of M. tuberculosis cultured from diagnostic clinical samples of patients from Bhopal, central India, using spoligotyping as a method of molecular typing. Methods: DNA was extracted from 340 isolates of M. tuberculosis from culture, confirmed as M. tuberculosis by molecular and biochemical methods and subjected to spoligotyping. The results were compared with the international SITVIT2 database. Results: Sixty five different spoligo international type (SIT) patterns were observed. A total of 239 (70.3%) isolates could be clustered into 25 SITs. The Central Asian (CAS) and East African Indian (EAI) families were found to be the two major circulating families in this region. SIT26/CAS1_DEL was identified as the most predominant type, followed by SIT11/EAI3_IND and SIT288/CAS2. Forty (11.8%) unique (non-clustered) and 61 (17.9%) orphan isolates were identified in the study. There was no significant association of clustering with clinical and demographic characteristics of patients. Interpretation & conclusions: Well established SITs were found to be predominant in our study. SIT26/CAS1_DEL was the most predominant type. However, the occurrence of a substantial number of orphan isolates may indicate the presence of active spatial and temporal evolutionary dynamics within the isolates of M. tuberculosis.

Predictive value of subendometrial – endometrial blood flow assessment by transvaginal 3D power doppler on the day of HCG on clinical outcome of IVF cycles.

Background: The objective of the study was to evaluate the role of subendometrial-endometrial blood flow assessment by 3D Tran-vaginal Power Doppler in predicting pregnancy outcome in IVF-ET cycles. The study was a prospective, non-randomized clinical study. Methods: A total of 107 infertile women undergoing their first IVF-ET cycle with good response were taken for study (From March 2014 to Nov 2014 at Jaipur Fertility Centre, ART unit of Mahatma Gandhi University of Medical Sciences & Technology). Women with Tubal factor, Male factor and unexplained infertility were included in the study. Those with past h/o Genital Koch’s and hypo menorrhea were excluded. Assessment of subendometrial-endometrial blood flow was done on the day of HCG with endometrial thickness ≥ 6.5mm by Tran-vaginal 3D- Power Doppler. Results: There was no significant difference in mean age, duration of infertility, BMI, cause of infertility, stimulation protocol, serological hormone levels, number of mature oocytes, number of good quality embryos and mean endometrial thickness on the day of HCG. According to Doppler study (3D-Power Doppler), women with blood flow to zones 1, 2 and 3 were categorized in to groups A (n=15), B (n=36) and C (n=56). Overall pregnancy rate was 32.71%. The clinical pregnancy rate was significantly higher in Group C in comparison of Group B and A (42.85% vs. 27.77% and 6.66%). Similarly implantation rate was also higher in group C (23.20% vs. 11.22% and 2.38%). Conclusions: The presence of good subendometrial-endometrial vascularity significantly improves pregnancy outcome in IVF-ET cycles in our study.

Comparison of vitrification and slow freezing for cryopreservation of cleavage stage embryos (Day 3) and its impact on clinical outcome.

Background: The objective of this retrospective study was to compare the efficacy of slow freezing and Vitrification for the cryopreservation of supernumerary cleavage stage embryos on day 3 after IVF and its impact on clinical outcome. Methods: 485 supernumerary embryos of IVF cycles (from Oct 2011 to Dec 2012) were cryopreserved by slow freezing method while 502 embryos (from Jan 2013 to April 2014) by Vitrification method. 362/485 and 230/502 embryos were thawed for FET cycles (65 patients in each group).After warming the survival rate, post warmed embryo morphology, clinical pregnancy and implantation rates were evaluated and compared between the two groups. Results: There were 65 frozen thawed cycles in each group. The percentage of excellent and good morphology embryos before cryopreservation were same in both the groups, but after thawing the results were significantly in favour of Vitrification as compared to Slow freezing. In Vitrification group versus Slow freezing group, the different outcomes were survival rate (96.95% vs. 69.06%, p-0.000), post warmed excellent morphology embryos (94.17% vs. 60.8%, p-0.000) clinical pregnancy rate (41.53% vs. 21.53%, p-0.043) and the implantation rate (14.41% vs. 7.01%, p-0.024). Conclusions: Vitrification is a promising alternate to the conventional slow freezing method in terms of not only excellent survival and post warmed excellent morphology embryo rate but also higher clinical pregnancy and implantation rate.

Frequency of undiagnosed diabetes mellitus in patient with herpes zoster

Objective: To determine frequency of undiagnosed diabetes mellitus in patients with herpes zoster. [HZ]

Methods: This cross-sectional study was performed at PNS Shifa hospital, Karachi from June, 2013 to December, 2013. A total of 89 patients suffering from HZ from age 40-70 years were included in this study after taking informed consent. All patients underwent fasting blood sugar evaluation from hospital laboratory

Results: 34 [38.2%] patients were of 40-55 years of age while 55 [61.8%] were of 56-70 year age group. Mean age was 56.93 +/- 8.24 years, 48 [53.9] were male and 41 [46.1%] were females while undiagnosed diabetes mellitus in patients with HZ occurred in 36 [40.5%] while 53 [59. 5%] had no findings of the morbidity

Conclusion: Frequency of undiagnosed diabetes mellitus is higher among patients with herpes zoster. So, it is recommended that every patient who present with HZ, should be evaluated for diabetes mellitus

Protective effect of Lannea coromandelica Houtt. Merrill. against three common pathogens.

Background: Ayurvedic text reports suggested Lannea coromandelica is used in various microbial origin disorders like dysentery, sore eyes and leprosy, genital wounds. Objective: The present study was designed to investigate the antimicrobial effect of L. coromandelica Houtt. Merrill. (Anacardiaceae) on microbes which cause female reproductive tract infection. Materials and Methods: Ethanolic and aqueous bark extract (Ext.) of L. coromandelica were screened against strains of Streptococcus pyogens, Staphylococcus aureus, and Candida albicans. Antimicrobial assay had been done with agar well diffusion method. Results: Ethanolic extracts [100% (16 mg), 75% (12 mg) and 50% (8 mg)] of L. coromandelica exhibited zone of inhibition (ZI) 19.21 mm, 18.45 mm, 16.41 mm and 18.12 mm, 17.35 mm, 16.35 mm against S. aureus and S. pyogens, respectively. However, only 100% and 75% ethanolic extract showed (ZI-19.18 mm, 16.29 mm) activity against C. albicans. Nevertheless, aqueous extract (100%) showed higher antifungal activity (ZI-16.97 mm). Ciprofl oxacin and amphotericin B were used as a standard drugs in the present study. Conclusion: The results demonstrated that L. coromandelica Houtt. Merrill. have antibacterial activity against S. pyogens, S. aureus and antifungal property against C. albicans. Our fi ndings corroborate the ethnobotanical use of L. coromandelica in traditional medicine system (Ayurveda) of India.

Anti-Toxoplasma gondii antibody detection in serum and urine samples by enzyme-linked immunosorbent assay in HIV-infected patients.

Background: Toxoplasmosis is a common parasitic infection of man, and reactivation of latent disease in HIV-infected patients can cause fatal encephalitis. Diagnosis depends on demonstration of parasite-specific antibodies in serum. In HIV-infected patients, IgM is often undetectable, whereas IgG remains detectable in the majority. Urine sample is very easily available and has not been evaluated for immunodiagnosis of toxoplasmosis. Aim: The study was an effort to find whether urine sample can be used in place of serum for immunodiagnosis of toxoplasmosis. Materials and Methods: Enzyme-linked immunosorbent assay (ELISA) was carried out in serum and urine samples collected from 100 HIV-infected patients to detect anti-toxoplasma IgG and IgM antibodies and whether positivity correlated with the CD4 T-cell counts of patients. Results: In this study, we observed that there was no significant difference in positivity of anti-toxoplasma IgM and IgG between serum and urine samples of HIV-infected patients by ELISA. There was a negative correlation between CD4 count and seropositivity. Conclusion: Urine sample can be satisfactorily used in place of serum for immunodiagnosis of toxoplasmosis.

Intestinal obstruction due to ascaris lumbricoides infestation in adult presenting as lump in right lliac fossa

Ascaris lumbricoides [AL] is a common resident of intestine especially in low socioeconomic areas of the world. Ascariasis can cause serious intra-abdominal complications such as intestinal obstruction, biliary obstruction, pancreatitis, acute appendicitis, intestinal perforation etc. We report an adult with intestinal obstruction due to entangled mass of AL, that presented as a lump in right iliac fossa, managed by laparotomy and milking the worms into colon without enterotomy

Isolation, characterization and mapping of temperature-sensitive mutants of mycobacteriophage I3.

Eighteen temperature-sensitive mutants of mycobacteriophage I3 have been isolated and partially characterized. All the mutants were defective in vegetative replication. Based on temperature shift experiments with the temperature sensitive mutants, the thermosensitive phase of the phage development period has been characterized for each mutant. The genes have been mapped by recombination analysis. The early, continuous and middle genes seem to cluster on the genetic map.