Accuracy and reliability of ultrasound estimation of fetal weight in women with a singleton term pregnancy

Background: Prenatal estimation of birth-weight is of utmost importance to predict the mode of delivery. This is also an important parameter of antenatal care. This study was conducted to evaluate the accuracy of estimated fetal weight by ultrasound, compared with actual birth weight.Methods: This was a prospective and comparative study comprising 110 pregnant women at term. Patients who had their sonography done within 7 days from date of delivery were included. Fetal weight was estimated by Hadlock 2 formula, the software of which was preinstalled in ultrasound-machine. The estimated fetal weight was compared to the post-delivery birth-weight. The Pearson's correlation coefficient was used and the accuracy of sonographic fetal weight estimation was evaluated using mean error, mean absolute error, mean percentage error, mean absolute percentage error and proportion of estimates within 10% of actual birth weight.Results: Mean estimated and actual birth weights were 3120.8±349.4 gm and 3088.2±404.5 g respectively. There was strong positive correlation between estimated fetal weight and actual birth weight (r = 0.58, p<0.001). The mean percentage error and mean absolute percentage error of ultrasound fetal weight estimations were 1.96±11.8% and 8.7±8.2% respectively. The percentage of estimates within ±10% of the actual birth weight was found to be 67.3%. In 23% of the cases, ultrasound overestimated the birth weight. In 13% of the cases, ultrasound underestimated the birth weight.Conclusions: There was strong positive correlation between actual and sonographically estimated fetal weight. So, ultrasonography can be considered as useful tool for estimating the fetal weight for improving the perinatal outcome.

Posterior segment manifestations in human immunodeficiency virus/acquired immunodeficiency syndrome patients in rural population of central india

Background: Ocular manifestations of HIV infections are common in the developing countries with lacking data in rural areas. The aim of study was to assess the prevalence of ophthalmic manifestations among HIV infected individuals in rural population and to find the relationship between CD4 count and ocular manifestations among these individuals.Methods: Authors have included 400 HIV patients of age more than 15 years that were registered in ART center of our institute. Ocular examination was done with slit lamp biomicroscope and indirect ophthalmoscope. Blood sample was sent for CD4 count analysis.Results: The mean age of patients ware 31.9±9.3 years, the ocular manifestations were more commonly found in the age group 25-35 years. 51 % were males and 49% were females. Most common mode of transmission was heterosexual contact (51%).55 % patients had CD4 count >150 cell/cumm. Cotton wool spots (36%) and intra-retinal haemorrhages (32%) was most common posterior segment findings followed by ocular toxoplasmosis (13%), CMV retinitis (10%), acute retinal necrosis (3 %).Conclusions: The prevalence of ocular manifestations in HIV patients is high and is a burden for our society, authors recommend screening of all the HIV patients to detect any vision threatening ocular lesions at the earliest.

Dilemma in Diagnosing Cervical Tuberculosis

Genital tuberculosis in females is found in 0.75 to 1% of gynecological admissions in India with considerable variation from place to place. Tuberculosis (TB) can affect any organ in the body (exceptions being skeletal muscle, cardiac muscles, pancreas) can exist without any clinical manifestation and can recur. The disease is almost always secondary to primary pulmonary TB, responsible for 5% of all female pelvic infections and occurs in 10% cases of pulmonary tuberculosis. Female genital tuberculosis (FGTB) is typically understood as a disease of young women, especially in developing countries, with 80-90% of cases diagnosed in patients 20–40 years old, often during workup for infertility. The disease has been reported in postmenopausal females as well. We are here presenting two rare case reports of cervical tuberculosis misdiagnosed as carcinoma cervix.

Vaginal Obstruction after Excision of a Transverse Vaginal Septum: A Rare Case Report

A vaginal obstruction often occurs as a result of complication in women who had previously undergone an excision of a transverse vaginal septum. Her we are reporting a case of 12 years old unmarried girl presented with complaint of secondary amenorrhea and cyclic pain lower abdomen since two months. She was operated for cryptomenorrhea four months back. On examination under anaesthesia Thick scarred septum was present in vaginal canal about 6-7 cm from vaginal introitus .After sharp dissection hematocopos bulge seen and drained, residual scar tissue excised , posterior and anterior vaginal wall reconstructed. Vaginal mould inserted to maintain patency

Mesenteric Leiomyosarcoma Mistaken as Subserosal Fibroid: A Rare Case Report.

Mesenteric leiomyosarcoma is a rare entity. It is usually seen in middle-aged individuals. The tumor usually remains asymptomatic for longer duration until it acquires a big size. Surgical removal is the main modality of treatment. Common symptoms of the patients are usually pain or distension abdomen. Pre-operative diagnosis is usually difficult. Ultrasonography and computed tomography scan can help in the diagnosis. In this case, the tumor was mistaken for subserosal fibroid but intraoperatively turned out a mesenteric mass with retroperitoneal extension. On histopathological examination, it was a leiomyosarcoma. Reoccurrence can occur. Early diagnosis and wide surgical resection can improve the prognosis of the patient.

A case of nevirapine-induced exfoliative dermatitis in an immunocompromised patient: a case report.

Nevirapine is a non-nucleoside reverse transcriptase inhibitor used as one of the first-line drugs for the highly active antiretroviral therapy (HAART) in human immunodeficiency virus positive patients. The side effects range from skin rashes to fulminant hepatotoxicity. The most of the side effects are manifested in the first 6-10 weeks indicating a need for close monitoring and follow-up of the patient in first few weeks. We hereby are presenting a case of a 41-year-old female who developed exfoliative dermatitis after 4 weeks of therapy. Keywords: Highly active antiretroviral therapy, Human immunodeficiency virus, Exfoliative dermatitis, Non-nucleoside reverse transcriptase inhibitors, Nucleoside reverse transcriptase inhibitor.

Carbamazepine-induced Stevens Johnson syndrome: a case series of three case reports.

Carbamazepine is an iminostilbene derivative that was initially used as an antiepileptic but has been used with increased frequency for different indications including chronic pain, trigeminal neuralgia, and herpetic neuralgias. This has resulted in increased incidence of carbamazepine related adverse effects such as nausea, vomiting, and serious hematological toxicities such as aplastic anemia, agranulocytosis, eosinophilia, lymphadenopathy, and splenomegaly. Life-threatening hypersensitivity reactions such as Steven Johnson syndrome (SJS) and toxic epidermal necrolysis can also occur. We hereby present a series of three cases that were prescribed carbamazepine for different indications and presented with SJS.

The efficacy of azithromycin in pityriasis rosea: A randomized, double-blind, placebo-controlled trial.

Background: Macrolides are prescribed in the treatment of pityriasis rosea despite conflicting results of the limited number of studies evaluating their role in its treatment. Aim: A randomized double-blind placebo-controlled trial was conducted to evaluate the effect of azithromycin on the clinical course of pityriasis rosea. Methods: Seventy patients of pityriasis rosea were given either azithromycin (n = 35) or placebo (n = 35) and were followed-up at 2, 4 and 6 weeks. Pruritus was assessed in both groups using the visual analogue scale (VAS) . Change in the pityriasis rosea severity score (PRSS) and in the VAS were recorded as outcome measures and were compared statistically. Results: The decrease in PRSS from baseline through 2, 4 and 6 weeks within both treatment (P < 0.001) and placebo (P < 0.001) arms was found to be statistically significant; however, this change was not significantly different in the two groups (P = 0.179). Similarly, the decrease in VAS was found to be statistically significant within both groups (P < 0.001); however, the change was comparable between the two groups (P < 0.937). Analysis by Fisher's exact test did not find a significant difference between the two groups for PRSS and VAS. Conclusion: Azithromycin is not effective in pityriasis rosea and the use of macrolides for this disease should not be encouraged in clinical practice.

Epidermal nevus syndrome associated with unusual neurological, ocular, and skeletal features.

Epidermal nevus syndrome (ENS) is a rare disease, the pathogenesis of which is largely elusive. We, hereby, report an exclusive case of a 20-year-old man with verrucous ENS presented with dark colored papules and plaques along the Blaschko's lines present over the head and neck area along with fleshy growth in both eyes since birth. Limb length discrepancy and kyphoscoliosis were remarkable. Skin biopsy was compatible with verrucous epidermal nevus while the biopsy of the ocular lesion confirmed complex choristoma. MRI brain revealed calcification in the right temporal lobe. Bilateral arachnoid cyst in the middle cranial fossa, scleral osteoma in the posterior part of the right eyeball, and deformed calvarium were evident on CECT skull and orbit. The present illustration emphasizes the importance of a punctilious work up of the case.

Topical permethrin and oral ivermectin in the management of scabies: A prospective, randomized, double blind, controlled study.

Background: Scabies is a highly contagious and intensely pruritic parasitic infestation. It is a re-emerging infection in the new millennium especially with HIV pandemic and a significant health problem in developing countries. Various treatment modalities have been used since time immemorial but the search for an ideal scabicide is ongoing. Aims: In this study, we compared the therapeutic efficacy of single application of topical 5% permethrin with oral ivermectin (200 μg/kg/dose) in a single-dose and a two-dose regimen in patients with scabies. Methods: 120 clinically diagnosed cases of scabies (>5 years of age and/or >15 kg) were randomized into three treatment groups A, B, C of 40 patients each; receiving either topical 5% permethrin (group A) or oral ivermectin (200 μg/kg/dose) in a single dose (group B) or double dose regimen (group C) repeated at 2 weeks interval. Patients were followed up at 1, 2, and 4 weeks interval. At each visit, cure rate (>50% improvement in lesion count and pruritus and negative microscopy) was assessed and compared. Results: Cure rate in three treatment groups at the end of 4 weeks was 94.7% (A), 90% (B), 89.7%(C), and thus all three treatment modalities were equally efficacious. However, at 1 week follow up, group A patients reported better improvement in both lesion count and pruritus. Conclusions: Both permethrin and ivermectin in both single and two dose regimen are equally efficacious and well tolerated in scabies. However, permethrin has a rapid onset of action.

Toxic optic neuropathy.

Toxic optic neuropathy (TON) is a disease entity which is not only underdiagnosed, but also often diagnosed at a stage when recovery of vision is not possible. This article gives an overview of common causes, clinical features, and management of TON.