Diagnostic Accuracy of Gestosis Score in Comparison to multi-marker Screening as a Predictor of Preeclampsia at 11-14 Weeks of Pregnancy: A Cohort Study.

BACKGROUND: Pre-eclampsia is a pregnancy-specific multisystemic disorder associated with adverse feto-maternal outcomes. Low-dose Aspirin therapy started in early pregnancy in high-risk women, has significantly reduced the chances of developing PE. Therefore, screening and identification of at-risk mothers are crucial. The present study was planned to study the predictive ability of gestosis score in predicting early-onset pre-eclampsia by comparing it with the multi-marker model. MATERIAL AND METHODS: One hundred sixteen women, more than 19 years of age, with live singleton pregnancy at 11-13 weeks of gestation were recruited from the antenatal outpatient department and formed the study cohort. After a detailed history, screening for pre-eclampsia was performed both by multi-marker screening and by gestosis score. Diagnostic accuracy was compared for the two methods of screening. RESULTS: The incidence of pre-eclampsia in the present study cohort was 26.7%. The sensitivity of gestosis score >/= 3 was 84.38% (67.21-94.72) and specificity was 93.18% (85.75-97.46 %). The positive predictive value was 81.82% (67.2%-90.81%), and the negative predictive value was 94.25 (87.98 - 97.35%). The diagnostic accuracy of the gestosis score was 90.83%. CONCLUSION: Gestosis scoring is a potential tool that can be used as a cost-effective screening method for pre-eclampsia at 11-14 weeks of gestation in low-resource settings. The sensitivity and negative predictive value of the gestosis score is comparable to multi-marker screening using maternal factors, MAP, Uterine artery PI, PAPP-A, and PlGF.

Emerging Major Role of Organic Aerosols in Explaining the Occurrence, Frequency, and Magnitude of Haze and Fog Episodes during Wintertime in the Indo Gangetic Plain.

Aerosols are an important part of Earth's atmosphere. They can absorb, scatter, or reflect the incoming solar radiation, which results in heating or cooling of Earth, thus impacting its climate. It affects the health of exposed human population adversely, reduces visibility, disturbs environmental systems, and causes material damage. This study summarizes the research carried out to understand the role of aerosol load and its physicochemical characteristics on occurrence, frequency, and magnitude of haze and fog events during wintertime within the Indo Gangetic Plain (IGP) in the past decade. For most species, the highest concentration was measured during foggy events at night-time over the winter season. A few species such as water-soluble organic and inorganic carbon (WSOC and WSIC), K+, SO4 2-, and NO3 -, owing to their hygroscopic nature, were efficiently scavenged, resulting in their lower concentration within the interstitial aerosol during fog episodes. Oligomerization with hydroxy and carbonyl functional groups during AFP (activating fog period) and DFP (dissipating fog period), respectively, accompanied by acidic aerosol (having catalytic ability) and high aerosol liquid water content conditions was found to be significant. Whereas the fragmentation process was dominant along with functionalization of -RCOOH or carbonyl (aldehyde/ketone) and -RCOOH moieties during FP (fog period) and PoFP (post-fog period), respectively. Transition metals play an important role in aqueous production of secondary organic aerosol (SOA) especially during the night-time. Crustal sources had the highest scavenging efficiency along with WSOC playing an important role in nucleation scavenging. Fine droplets had a higher concentration of species with a larger fraction of highly oxidized organic matter (OM) as compared to coarse or medium size droplets. Also, a new approach to calculate absorption by black carbon (BC) and brown carbon (BrC) was proposed, which found the water-soluble brown carbon (WSBrC) absorption value in aerosol to be up to 1.8 times higher than that measured in their corresponding aqueous extracts. Organic aerosol plays a vital role in facilitating fog formation and is responsible for the longer residence time in the ambient atmosphere. Ammonia plays an important role in stabilizing organic aerosol and aids to this recurring haze-fog-haze cycle that is dominant during wintertime in the IGP. Therefore, controlling the major anthropogenic sources of organic aerosol and ammonia should be our top priority in this part of the world.

Clinical spectrum and outcome of pregnancy with liver diseases - A prospective study.

Objective: Liver diseases constitute a family of diseases in pregnancy which are less often studied individually. Spectrum of liver diseases directly or indirectly related to pregnancy comprise 3% of all pregnancies. The biggest challenge is to arrive at a diagnosis in such cases. With this study we aimed to study the prevalence of different Liver diseases in pregnancy in our population and its effect on fetomaternal outcome. Material and Methods: This was a prospective observational study carried out from March 2018 to March 2020. A total of 184 pregnant women with diagnosis of some form of liver disease as evident from their symptoms, signs or biochemical investigations were included in study cohort. Result: Primigravida accounted for majority of study cohort (44.02%). Approximately 90.21% belonged to 20-35 yrs. Age group. Intrahepatic cholestasis of pregnancy (IHCP) was the most common liver ailment (66.84%) followed by viral hepatitis (10.32%), Hyperemesis gravidarum (7.06%) and HELLP syndrome (6.52%). There was one case of Acute fatty liver of pregnancy (0.54%), four cases of Pre-eclampsia with liver dysfunction (2.17%), seven cases of Jaundice in pregnancy (3.80%) and 3 cases of pre-existing liver diseases (1.63%). 5 cases (2.71%) of antepartum eclampsia, 5 cases (2.71%) of postpartum eclampsia and 1 case (0.54%) of post-partum HELLP was seen. 33.33% patients were delivered early by induction or caesarean section because of liver dysfunction.14.67% required blood or blood products transfusion.1.63% had postpartum hemorrhage.1.08% mothers required intensive care admissions. Neonatal outcome was poor with 6.41% being growth restricted, 9.61% premature, 8.97% were intrauterine dead fetuses, 2.56% had early neonatal deaths and 7.05% needed neonatal intensive care unit admissions. Conclusion: Timely admission, quick diagnosis and appropriate management of patients with liver diseases in pregnancy can make a significant difference in mortality and morbidity rates due to liver ailments in pregnancy.

Annular cervical detachment during caesarean section.

Annular cervical detachment is a rare complication mostly associated with prolonged labour and the resultant vascular impairment. Although a remote possibility, such a complication is not unheard of with caesarean section. Here is one such case of annular detachment of cervix during caesarean section due to difficult delivery of fetus which was managed by repair of cut edges.

Efonidipine Exerts Cerebroprotective Effect by Down-regulation of TGF-ß/SMAD-2-Dependent Signaling Pathway in Diabetic Rats.

Calcium overload and hyperglycemia are risks of stroke onset in diabetics. Our study was designed to elucidate the beneficial role of calcium channel blockers by targeting voltage-gated calcium channels in diabetes-associated cerebrovascular complications. Diabetes was induced using the neonatal streptozotocin rat model. After confirmation of diabetes, middle cerebral artery occlusion (MCAO) was carried out. The pre-treatment with 1 mg/kg/day efonidipine was administered for the period of 4 weeks. After 24 h of ischemic induction surgery, the neurological score was determined, and blood was collected for determination of biochemical parameters. Treatment with efonidipine showed a significant reduction in post-ischemic brain infract volume, brain hemisphere weight difference, neurological score, Na+-K+ ATPase activity, serum CK-MB, and LDH levels in normoglycemic and hyperglycemic MCAO-induced animals. While no significant changes in glucose and lipid levels were observed by treatment, efonidipine significantly decreased the levels of malondialdehyde, acetylcholine esterase, and nitrite levels and increased the levels of antioxidant markers in both normoglycemic and hyperglycemic MCAO animals. TGF-ß and VEGF were found to be down-regulated after treatment with efonidipine in gene expression study. In conclusion, the study data supports the cerebroprotective role of efonidipine in diabetic animals possibly through TGF-ß/SMAD-2 signaling pathway.

Prevalence of metabolic syndrome among women with different PCOS phenotypes - a prospective study.

OBJECTIVE: To study prevalence of different polycystic ovary syndrome (PCOS) phenotypes in our population and to compare the anthropometric measurements and metabolic syndrome (MetS) risk factors among different phenotypes. MATERIAL AND METHODS: Two hundred and forty-eight PCOS women were prospectively classified into four phenotypes based on Rotterdam criteria, over a period of 18 months from June 2018 to November 2019. MetS was defined as per International diabetes federation consensus held in 2009. To evaluate the prevalence of MetS, we measured serum triglyceride levels, HDL cholesterol, fasting blood glucose, blood pressure, and waist circumference. RESULTS: The mean age group of the study population was 23.16 ± 4.42, with maximum cases belonging to 20-25 years age group (40.72%). The prevalence of Phenotypes A, B, C, and D were 36.7%, 10.1%, 4.4%, and 48.8%, respectively. Phenotype D had the highest prevalence of MetS (14.9%). Phenotype A had significantly higher waist circumference, hip circumference, cholesterol, triglycerides, and LDL values as compared to Phenotype D (p<.05). CONCLUSIONS: Phenotype A was at higher risk of adverse MetS risk profile. The overall prevalence of MetS was quite low as compared to similar Indian studies. A substantial proportion of study cohort had higher waist circumference (almost 60%) and lower HDL levels (88.70% cases), hence all women with PCOS should be screened for metabolic profile risk factors at a young age itself.

Incidental detection of disseminated peritoneal tuberculosis-varied presentation.

BACKGROUND: Incidental peritoneal tuberculosis represents an uncommon variety of peritoneal tuberculosis and surgeons must be aware of this entity particularly in tuberculosis endemic zones. METHODS: We prospectively analysed cases of incidental peritoneal tuberculosis detected during surgery over a period of last six months. RESULTS: We herein describe three such cases of incidental peritoneal TB detected during surgical exploration for other reasons. CONCLUSION: Diagnosis of disseminated peritoneal tuberculosis often remains a challenging task owing to its non specific clinical presentation and difficulty arises on seeing such a picture intraoperative and raises a question whether to proceed with the decided surgery or not. Frozen section can help in guiding further management but it is not definitive.

Evaluation of Ratnaprash for its effect on strength, stamina and fatigue using swim endurance test and biochemical estimation in swiss albino mice.

CONTEXT: Traditional medicines have been considered as important resources for postponing fatigue, accelerating elimination of fatigue related metabolites and improving physical ability. Rasayanas or rejuvenative therapies are mentioned as one of the eight clinical specialties in Ayurveda for attaining longevity, healthy life and regulation of bodily balance. Eventhough more detailed studies are needed to confirm the claims of benefits in the light of evidence based research, Ratnaprash, a herbo-mineral rasayana formulation, is proposed here to be an antifatigue supplement that is good in promoting strength and stamina. MATERIALS AND METHODS: In the present study, anti fatigue, strength and stamina enhancing properties of Ratnaprash were examined based on swim endurance capacity and the change in biochemical parameters in Swiss Albino mice. Treatment groups were orally administered Ratnaprash at various test doses (500, 1000, 2000 mg/Kg per day), while the control group received distilled water at similar dose volumes. Effect of therapy was evaluated after 28 days of treatment. RESULTS: At the end of study period, the swimming times to exhaustion were longer in the treated groups than in the control group. Plasma lactate levels of treated groups were lower than those of the control group (P < 0.05) while tissue ATP levels were higher. These effects were dose dependent and the strongest effect was seen in groups treated at 1000 mg/Kg. CONCLUSION: Ratnaprash enhanced the forced swimming capacity of mice and exhibited elevated anti-fatigue activity, reduced blood lactate levels and increased tissue ATP levels in preclinical models in comparison to vehicle control, exhibiting possible role in increasing strength and stamina and contributing anti-fatigue activity.