bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal and fetal outcome in cardiac disease in pregnancy: a retrospective study at tertiary care center
Authors: Behera Ritanjali , Moharana Jayashree J.
Published: October 2018

Background: Cardiac disease in pregnancy is a high-risk pregnancy and major problem worldwide particularly developing countries. In present scenario the incidence of pregnancy with congenital heart disease is high in developed countries and they are landing with favourable outcome due to advance surgical correction of the defects. In developing countries, the incidence of RHD is still high. Therefore, in this study we aim to analyse the incidence of cardiac disease in pregnancy in our hospital and to assess the obstetric outcome.Methods: A retrospective study carried out in 22 number of patients with cardiac disease at tertiary care center during the period of 2 years.Results: In present study the incidence of cardiac disease in pregnancy was observed to be 0.15%.Among them the prevalence of RHD was high (68.1%).Out of which the most common valvular lesion was mitral stenosis (46.6%) followed by mitral stenosis with mitral regurgitation (26.6%).50% of the patients were in NYHA class 2.Majority delivered vaginally with instrumental application in second stage (95.4%).Obstetric complications observed in form of anaemia, preeclampsia, abruption placentae and preterm labour and one maternal  mortality. Perinatal morbidities observed in form of prematurity, SGA, birth asphyxia, MSAF, NICU admission.Conclusions: cardiac disease has major impact on pregnancy and its outcome. It is a team effort by obstetrician, cardiologist, neonatologist to achieve successful pregnancy. Regular antenatal checkup and strict vigilance during the risk period when patient may develop complications as a result of haemodynamic changes can avoid the complications.
Intrahepatic cholestasis of pregnancy: maternal and fetal outcome and its correlation with serum bile acid levels
Authors: Sharma Bhawna , Arora Neetu , Dogra Kusum , Negi Kamal S.
Published: October 2018

Background: Maternal, fetal, and neonatal outcomes in parturients with intrahepatic cholestasis of pregnancy (ICP) have been retrospectively documented. We aimed to present pregnancy outcomes of parturients with ICP who underwent delivery. The study was conducted during a 1-year period in a tertiary care centre.Methods: Data from 1 January to 31 December 2017 were collected to identify parturients with ICP.Results: Almost 3/4th of births came to a vaginal delivery (76.74%) and only 10 parturients had cesarean delivery. 4 of 10 parturients underwent nonelective cesarean section, while 6 had elective cesarean delivery. 15.15 % vaginal deliveries were instrumental. The most common indications for emergency LSCS and instrumental deliveries was fetal distress followed by failure to progress of labour. Most births occurred at or after 37 weeks of gestation (65%).  Regarding neonatal outcomes in terms of birth weight and Apgar scores at 1 and 5 min, they were positive, as well.  None of the babies had Apgar score < 7 at 5 minutes. No case of perinatal death was observed.Conclusions: Although the results were generally positive, larger studies need to be conducted to evaluate the maternal and fetal outcomes in ICP and correlation with serum bile acid levels.
The effects of maternal age and parity on birth weight in a tribal community of Kinwat, Nanded, Maharashtra, India
Authors: Narwade Ramdas G. , More Uttam B.
Published: October 2018

Background: Low birth weight is an important determinant of childhood morbidity and mortality. Birth weight is a significant factor that determines vulnerability of risk of childhood illness and survival. Objective of the study was to correlate the maternal age and parity on birth weight in a tribal community.Methods: A cross-sectional study was carried out during April 2012 to June 2014 in More Nursing Home, Kinwat Dist. Nanded, Maharashtra. A total of 1611 patients from tribal area who delivered in the nursing home were enclosed for the study. Data was analyzed by using SSPS version-18.0.Results: In this study low birth weight babies were seen in 18.56% and 17.78% and 21.47% of female and male babies had low birth weight respectively, which was statistically significant.  Mean birth weight increased as parity of mother increased. Low birth weight babies were born to the mother of younger age which was statistically significant.Conclusions: Health care of young age tribal mothers is important factor in curbing low birth weight babies.
Learning internal iliac artery ligation and pelvic ureter course through cadaveric dissections
Authors: Mahale Arun R. , Gosavi Anjali G. , Ugale Mahesh S. , Diwan Chaya V. , Sukre Shivaji B.
Published: October 2018

Background: Few surgical procedures, although vital, are not learnt and mastered during postgraduate courses in Obstetrics and Gynecology. Internal iliac artery ligation and tracing course of ureter are few of such surgical procedures. Cadaveric dissection sessions organized during postgraduate courses and as CME sessions (continued medical education) have proved useful in learning such unlearnt procedures. This article shares experiences from teaching internal iliac artery ligation, pelvic ureter course tracing and principles of many other unusual gynaecological surgical procedures to Obstetrics and Gynecology specialists and postgraduate students through CME programs involving cadaveric dissection.Methods: This involved organizing and conducting four cadaveric dissection CME workshops at three different teaching institutions. The components of these CMEs were lectures with power point presentations and two-way audio-visual interactive sessions while pelvic anatomy was demonstrated on cadavers through live dissections. Each CME was concluded by tactile experience to each delegate by handling the dissected cadavers; this was made possible by limiting delegate registration to 50 at each CME.Results: The surgical skills of internal iliac artery ligation and tracing course of pelvic ureter, which are not adequately and confidently learnt in routine postgraduate tenure, could be effectively transferred through cadaveric dissection.Conclusions: Revisiting anatomy dissection halls helps in learning rare but lifesaving surgical techniques. This can be achieved by arranging cadaveric dissection CMEs for practicing specialists. Such CMEs should be organized regularly and should be integrated into postgraduate curriculum.
Neonatal mortality rate (NMR) in intensive care unit (ICU) of Ardabil city hospitals and related factors
Authors: Mirzarahimi Mehrdad , Moghaddam Afsaneh Enteshari- , Khademi Sepideh
Published: October 2018

Background: Neonatal mortality rate (NMR) is one of the important parameters in assessing quality of life in societies. NMR are often used as a standard index for evaluation health, education and social systems, nutritional status and health programs for neonates in countries and the first step in reducing mortality rate and promoting the level of this indicator is to identify the causes of mortality. Therefore, this study was conducted to determine the NMR in new born infants admitted to the ICU of Ardabil city hospitals.Methods: This study was a descriptive cross-sectional study that has been done on 184 dead neonates in Ardabil city hospital during 2016-2017. The necessary information was extracted from the hospital records of neonates and entered in a provided checklist and then analyzed by statistical methods such as tables in SPSS version 19.Results: The mortality rate of hospitalized infants in this research was 6.6%. Of all patients, in 65.2% CBC were impaired and 58.7% of patients had impaired serologic and biochemical tests. 68.5% of patients had prematurity, 62.5% RDS and 20.7% had congenital anomalies.Conclusions: Prematurity, RDS and congenital anomalies are the most important causes of NMR and we should programing to decreasing the NMR rate in future.
A retrospective analysis on acceptability and complications of PPIUCD insertion
Authors: Lal Prabha , Pandey Nihita , Singh Abha
Published: October 2018

Background: In India, 65% of women in the first year postpartum have an unmet need for family planning but only 26% of women are using any method of family planning during the first year postpartum. This leaves a huge gap which needs to be addressed if maternal health is to be optimized. This calls for a method which is both effective and acceptable immediately post-partum. This is where the role of PPIUCD needs to be studied.Methods: This study was a retrospective observational study conducted in a tertiary care hospital. All deliveries during the time period from September 2016 to August 2017 were included in the study and the women accepting PPIUCD were studied for analysed for their age, parity, booking status and complaints during the follow up visit.Results: A total of 13,039 deliveries took place in one year between Sept 2016 to Aug 2017 out of which, 1118 (8.6%) accepted PPIUCD as a method of contraception. 44.3% PPIUCD users were in the age group of 21-25 years. 57% of PPIUCD users were primigravidas. 84% of PPIUCD users were booked cases. Missing threads was the most common complication, with 8.4% patients reporting it at follow up. There were no major complications noted in the study.Conclusions: PPIUCD is a safe and effective long acting reversible contraception method. Is particularly beneficial in a setting where women do not return for contraceptive advice. With low expulsion rates and high continuation rate, authors can conclude that PPIUCD can be the solution to a country like India currently facing population crisis and high unmet need.
Fetomaternal outcome in morbidly adherent placenta in a tertiary referral hospital
Authors: Paneerselvam Amudha , Sundaram Asha
Published: October 2018

Background: Morbidly adherent placenta is often associated with major pregnancy complications requiring massive blood transfusions, peripartum hysterectomy, etc. The prior number of caesarean sections and placenta previa are the critical risk factors. The aim of this study is to evaluate the fetomaternal outcome in women with morbidly adherent placenta and to quantify the risk factors predisposing to it.Methods: This is a retrospective cohort study. The study population comprises women, who had C-section for placenta accreta, increta and percreta at Government Raja Mirasudhar Hospital, Thanjavur from May 2016 to September 2017.Results: Eighteen women out of 21,083 who delivered during the study period had morbidly adherent placenta with an incidence of 0.085%. The mean gestational age at the time of C-section was 32.4 weeks. Twelve (66.66%) out of eighteen women had prior one C-section, two (11.11%) women had prior 2 C-section and two (11.11%) women had prior 3 C-section.10 cases were diagnosed antenatally by radiological imaging. Seventeen out of eighteen women underwent caesarean hysterectomy (94.44%). Average blood loss was 1.8 litres. The mean intraoperative blood transfusions were 3 units of PRBC, 3 units of FFP and 1.4 units of platelet. There was no maternal mortality. The average total hospital stay was 20.46 days. 11 neonates were preterm (61%) and 5 neonates were term (27.74%). FGR was seen in 2 preterm neonates (12.5%). The NICU admission rate was 81% (n=13). The perinatal mortality rate was 31.25% (n=5).Conclusions: As most of the women ended up in caesarean hysterectomy, early diagnosis will enable appropriate planning for blood components, anaesthetic and surgical resources, thereby reducing adverse fetomaternal outcomes. This will also allow adequate preoperative counselling of the women involved.
Randomized clinical trial to evaluate ferric carboxymaltose and iron sucrose for treatment of postpartum anaemia in a tertiary hospital
Authors: H. S. Sheela , Neelakanthi Ashwini , C. P. Nikitha
Published: October 2018

Background: Ferric carboxymaltose and iron sucrose are two iron carbohydrate complexes optimized for iron delivery and extensively used in postpartum anaemia. This study compares the efficacy and safety of ferric carboxymaltose with that of iron sucrose in patients with postpartum anaemia.Methods: One hundred women diagnosed with postpartum anaemia were randomized prospectively in a 1:1 ratio to receive either ferric carboxymaltose or iron sucrose. Fifty patients received intravenous iron carboxymaltose depending on the iron deficit at rate of 1000 mg/week and fifty patients received intravenous iron sucrose at a rate of 200 mg/day on alternate days till the calculated dose is given.Results: Fifty patients were enrolled in each treatment group. Both groups showed increases in mean haemoglobin from baseline at 2 weeks and 6 weeks. The increase in haemoglobin was significantly higher in ferric carboxymaltose group compared to iron sucrose at both week 2 (2.64±0.91 versus 2.17±0.76; p=0.010) and week 6 timepoints (4.65±1.17 versus 3.96±1.06; p=0.005). The proportion of patients achieving target haemoglobin of 12 gm/dl was significantly higher in ferric carboxymaltose group compared to iron sucrose at week 6 (77.3% versus 50.0%; p=0.013). The incidence of adverse events was similar across treatment groups and no specific safety concerns were observed.Conclusions: Both ferric carboxymaltose and iron sucrose caused increase in baseline haemoglobin. Ferric carboxymaltose had significantly higher increases in haemoglobin compared to iron sucrose at both follow up timepoints (week 2 and week 6). It was more likely to achieve target haemoglobin with ferric carboxymaltose within 6 weeks compared to iron sucrose. Ferric carboxymaltose may be considered in women with postpartum anaemia for faster rise in haemoglobin while requiring fewer injections compared to iron sucrose.
A prospective, randomized, cross sectional study of manual versus vacuum extraction of mobile head in caesarean section
Authors: A. Bhagyashree , Thomas Julie , Gudi Shobha N.
Published: October 2018

Background: Considering the high rate of caesarean section, and the difficulty during delivery of the floating foetal head even by the most experienced obstetrician, the use of vacuum has been described. The present study was undertaken with the hypothesis that, vacuum assisted foetal head delivery during caesarean section is safe and effective without increasing maternal and neonatal complications. The outcomes enumerated by the limited literature available need to be evaluated before it is used routinely.Methods: A prospective, randomized, comparative, cross sectional Hospital based study was conducted at St. Philomena’s Hospital, Bangalore. Every woman randomized for the study received either conventional method or ventouse extraction of fetal head at cesarean section. 200 women were enrolled into the study with 100 in each arm. The primary outcome measures were percentage of successful extractions and I-D interval. The secondary outcome measures were, uterine incision extension, estimated blood loss, Apgar scores, neonatal hyperbilirubinemia and neonatal scalp or head injury.Results: Successful extraction was done in 89 % and 98 % cases in manual and vacuum extraction cases. (p =0.0184). U-D interval in the manual extraction group was 66.59±4.64 seconds and in the Vacuum extraction group it was 56.06±3.46 seconds (P<0.001). The mean pre-delivery hemoglobin levels in group I was 11.6±0.73 compared to 11.36±0.49 gm% in group II. The mean post-delivery hemoglobin levels in group I was 10.29±0.79 compared to 10.21±0.53 gm% in group II (p <0.001). The uterine incision extensions were significantly higher in manual extraction group, 18 of the 100 women (18 %), whereas only 2 of the 100 women in vacuum group had uterine extensions (p=0.0002).Conclusions: Authors conclude that the routine use of ventouse is safe and effective for mobile fetal head extraction at cesarean section.
Epidemiology of ovarian cancer in Assiut Governorate, Egypt
Authors: Gharib Mahmoud Ahmed , El-Shoeiby Mahmoud Hussein , Metwally Nagy Mohammed , Rashid Yostina Maher
Published: October 2018

Background: The aim of this study is to assess ovarian cancer epidemiology and detect its prognostic factors in Assuit, Egypt.Methods: This retrospective study was performed between January 2010 and December 2015, on all cases attending to Obstetrics and Gynecology Outpatient Clinic in all central hospitals in Assiut. 378 females (≥40 years old) came to Obstetrics and Gynecology Outpatient Clinic from January 2010 to December 2015. Inclusion criteria: All females (≥40 years old), history of current acute or chronic pelvic pain, mass; fixed, hard consistency, history of previous similar condition.Results: Mean age for whole ovarian cancer cases in this study was 56.44±10.08 (range, 40-85). Nulliparity was found in one case (0.3%), while multiparity was found in 252 cases (66.7%). Grand multiparity was found in 113 cases (29.9%). Twelve cases (3.2%) were virgin. Vaginal ultrasound can find all ovarian cancer cases. Regarding the serum levels of the tumor biomarker, CA-125, the average level of CA-125 is 300-1000 U/ml with 34.9% of cases had readings below to 300-1000 U/ml and 6.1% of cases had readings above to this average level. Regarding treatment, treatment combining surgery with chemotherapy was the main line of management in present study (46.3%). About 33.3% of cases underwent surgery, while only 18.3% took the chance of chemotherapy. Eight cases (2.1%) had no treatment.Conclusions: Epithelial ovarian cancer is a lethal disease. The age incidence of ovarian cancer in present patients is ten years younger than what is re¬ported in US SEER data and other Western countries. CA-125 level and ultrasonography are increasing the rate of suspicious for diagnosis of malignant tumors.
Study of pregnancy outcome of threatened abortion and its correlation with risk factors in a tertiary care hospital of Mumbai, India
Authors: Sivasane Dipali S. , Daver Rekha G.
Published: October 2018

Background: Early pregnancy loss is very common and, in most cases, it can be considered as nature’s method to select for a genetically normal offspring. Threatened abortion is a relatively common complication during pregnancy, occurring in approximately 20% of all pregnancies. Maternal age, Outcome of previous pregnancies, health of mother, any infection etc can be decisive factors in the risk of pregnancy loss.Methods: The present study was a cross sectional study where patients admitted with threatened abortion were interviewed using pretested semi-structured questionnaire after the treatment. Outcome of pregnancy was recorded. Their basic socio-demographic data along with possible risk factors were recorded. TORCH Ig M and Ig G were done in all patients.Results: Out of 95 patients admitted with threatened abortion, 42 (44%) patients undergone abortion whereas in 53 (56%) patients, pregnancy was continued. Out of total 60 patients admitted with the complain of only vaginal spotting, in 39 pregnancy continued and in 21 patients pregnancy was aborted. (p-value<0.05). 50.52% were from age group of 21 to 25 years of age. It was also seen that after 35 years of age, significant number of patients aborted. Out of these 11 patients with high BMI, pregnancy was continued only one patient. Out of total 20 patients positive for IgM of toxoplasma infection, pregnancy was aborted in 13 (65%) patients. Out of total 15 patients positive for IgM of cytomegalo virus infection, pregnancy was continued in 11 (73.3%) patients.Conclusions: Patients of threatened abortion with only symptom of spotting per vagina have good chances of continuation of the pregnancy. Increased maternal age above 35, Overweight and bad obstetric history are also associated with pregnancy loss. Though there was no statistically significant difference it was evident that among all TORCH infections, IgM toxoplasma and Rubella are associated more with pregnancy loss.
Placental thickness: an important parameter in determining gestational age and fetal growth during ANC scan
Authors: Kadam Dipali , Patil Saurabh , Jain Meenal
Published: October 2018

Background: Gestational Age (GA) is one of the most imperative parameters required for proper management in pregnancy. Routinely GA is estimated by sonography utilising Biparietal Diameter (BPD), Femur Length (FL), Abdominal Circumference (AC) and Head Circumference (HC). In any case, these parameters have some limitations. Hence, there is need to find other parameters that may complement the established fetal biometric parameters in predicting GA. The objective of the present study was to assess placental thickness in second and third trimester pregnancies and its relationship with fetal gestational age and its role in detecting LBW and IUGRMethods: A cross sectional prospective study was carried out in three hundred pregnant women between 13 to 40 weeks of gestation, who came for routine antenatal sonography. Placental thickness was measured along with routine parameters. Placental thickness was measured at the level of umbilical cord insertion by two-dimensional ultrasonography.Results: Correlation between the GA by LMP and Placental thickness by ultrasound was done by using Karl Pearson's Correlation(r). The values were expressed as mean + standard deviation. Correlation between placental thickness and gestational age was statistically significant as p value is <0.01. Placental thickness measured in millimetres increases with gestational age in second and third trimester.Conclusions: The correlation between the placental thickness and gestational age was linear and direct. Therefore, Placental thickness is used as a predictor for estimation of gestational age of the fetus in cases where LMP is not known and in detecting developing IUGR and low birth weight.
Prevalence of gestational diabetes mellitus and its feto-maternal outcome in Kamla Nehru state hospital for mother and child, IGMC, Shimla, India
Authors: Pal Aleeza , Dhiman Bishan , Mittal Rita , J. Paul Bhaskar
Published: October 2018

Background: Gestational Diabetes Mellitus (GDM) is defined as carbohydrate intolerance of variable severity with the onset or first recognition during pregnancy. It is a disease entity that adversely affects maternal as well as fetal outcome. DIPSI guideline having suggested one-time plasma glucose level has emerged as a simple, practical and cheap method to detect GDM. This study was done to evaluate the prevalence of gestational diabetes using Diabetes in Pregnancy Study Group India (DIPSI) criteria and further assess its feto maternal outcome in Kamla Nehru State Hospital for Mother and Child, IGMC, Shimla.Methods: This study was conducted in 500 patients between 24 and 28 weeks of gestation, attending the antenatal OPD. These patients were given 75g oral glucose irrespective of last meal and their plasma glucose was estimated at 2h. Patients with plasma glucose ≥140mg/dl were diagnosed as GDM and the rest as control or the non GDM group. The GDM patients were followed up and treated with medical nutrition therapy (MNT) and/or insulin therapy till delivery and maternal and fetal outcomes were then noted.Results: The prevalence of GDM in this study was 6%. Maternal and fetal complications were more in the GDM patients. Vaginal candidiasis and PROM were the common maternal complications, while hypoglycemia and hyperbilirubinemia were common in the fetuses.Conclusions: GDM adversely affects the mother as well as fetus. DIPSI guideline having suggested a single plasma glucose level test has emerged as a practical and economical method to detect GDM.
Classification of cesarean section through Robson criteria: an emerging concept to audit the increasing cesarean section rate
Authors: Kant Anita , Mendiratta Shweta
Published: October 2018

Background: There has been an increase in rate of cesarean section over last five decades. This is a matter of international public health concern as it increases the cesarean section related maternal morbidity. The aim of the present study was to audit the increasing rate of caesarean section.Methods: In the present study, all cases delivered by cesarean section during the period of six months were recorded and classified according to Robson's 10 group classification system. This was an attempt to see which clinically relevant groups contributed most to the cesarean deliveries.Results: There was a trend of increased percentage of cesarean section in group 5 and 2 respectively in present study. Increasingly sedentary lifestyle and poor tolerance to pain are adding to cesarean delivery on maternal request.Conclusions: We should judiciously make use of vaginal birth after cesarean section but not at the cost of maternal or fetal health. Standardization of indication of cesarean deliveries, regular audits and definite protocols in                                                                                                                                                                                                                                                                                                                                 hospital will aid in curbing the rate of cesarean deliveries in hospitals.
Study of significance of elevated maternal serum β-human chorionic gonadotropin (β-hCG) level in 16 to 20 weeks pregnant women as predictor of hypertensive disorder of pregnancy
Authors: Pawar Preeti , Goyal Ritu , Kaur Harvinder , Singal Neelam
Published: October 2018

Background: Hypertensive disorder of pregnancy affects both mother and fetus, leading their high morbidity and mortality and a major killer of women in developing country. The etiologic of preeclampsia is still not clear. It seems that placenta plays main role in path-physiology of preeclampsia, but there is strict relationship between hypertensive disorder of pregnancy and elevated β-hCG level, indicating there should be an abnormal placental secretary function in patients with severe preeclampsia.Methods: 245 patients were recruited from our institute (OPD) and Prospective analytical study was started with 16-20 weeks pregnant women. Cases were subjected to detailed history and thorough physical examination including baseline blood pressure. β-hCG measurement was done between 16-20 weeks and cases were followed at regular interval for the development of hypertensive disorder of pregnancy. Statistical testing was conducted with appropriate tests.Results: Total 245 women were enrolled in the study, only 208 were followed till delivery, 24 were developed hypertension. On analysis of data, maximum cases were younger, primigravida and of lower class. β-hCG levels (Mean ± SD) were also significantly higher (30100±16250 V/S 74700±23790; p<0.001) in subjects who later developed hypertension. Cut off value of β-hCG was 45755 mIU/ml, and analysis establishes validity of β-hCG as predictor of hypertensive disorder of pregnancy with sensitivity, specificity, positive and negative predictive value for β hCG were 87.5, 83.2, 70.4 and 83.7% respectively.Conclusions: Present study shows that elevated serum β-hCG in early second trimester can be considered as predictor of subsequent hypertensive disorder of pregnancy.
Knowledge, attitude and experiences of menopause in the postmenopausal women at a tertiary care center: a cross sectional study
Authors: More Shivraj , P. Sujatha , Karthiga Karthiga
Published: October 2018

Background: Menopause is an inevitable milestone in the reproductive life of every woman. The objective is to investigate menopausal knowledge, attitude, symptoms and management among the participants, to identify the differences according to their educational status and to examine correlations of knowledge, attitude and symptoms pertaining to menopause.Methods: This cross-sectional study was conducted for a period of 10 months in postmenopausal women attending a tertiary care center in Pondicherry, India with a structured questionnaire developed on the basis of the objective of the study.Results: 330 postmenopausal women were recruited, and all were aware of their postmenopausal status. Mean age at menopause was 45.91±2.66 years. 54.5% were aware about what menopause was while 5.5% were unaware. 12.1% had proper knowledge about cause of menopause, whereas 3.6% said it is due to god’s decision / turning point. Most prevalent symptoms were tiredness (89.6%) followed by vasomotor symptoms like hot flushes (88.5%) and night sweats (80.3%). Only 2.1% had used HRT for menopausal symptoms.Conclusions: Depth of knowledge is more important when concern is about greater health disrupter which tends to be imperceptible for a long time such as bone health and cardiovascular risk profile. Thus, the government could concentrate on providing health services to women in post reproductive age group also besides women in the reproductive age.
Limb amputation secondary to pseudoamniotic band syndrome after selective fetoscopic laser photocoagulation: case report
Authors: Cunha Soraia S. , Coutada Rosália S. , Neiva Ana R. , Ribeiro Domingos C.
Published: October 2018

Pseudoamniotic band syndrome (PABS) is a rare iatrogenic complication that occurs after invasive procedures in monochorionic twins for treatment of twin-twin transfusion syndrome (TTTS). Selective fetoscopic laser photocoagulation (SFLP) is a commonly performed procedure for the treatment of severe TTTS that may lead to complications such as preterm labor, preterm rupture of membranes, cerebral lesions and fetal death. PABS has been reported to occur in up to 3% of cases of TTTS treated with laser, leading to limb abnormalities. There are no identifiable risk factors and antenatal detection of PABS is rare, but possible.  Thus, obstetricians should be aware of this possibility in pregnancies treated by laser therapy for TTTS.  The authors report a case of a monochorionic biamniotic twin pregnancy submitted to SFLP for TTTS at 19 weeks of gestation with postnatal diagnosis of PABS, presenting with amputation of a fetal limb.
Youssef’s syndrome following caesarean section: a rare case with review of literature
Authors: Devkare Vikas , Gothwal Meenakshi , Gaikwad Nandkishor , Pawar Sushil , Agrawal Neha , Desai Ashwini
Published: October 2018

Youssef’s syndrome is a rare condition characterized by vesicouterine fistula with cyclic haematuria, amenorrhoea and incontinence of urine. A vesicouterine fistula is an abnormal connection between the uterus and bladder that most commonly occur due to inadvertent injury to the bladder during lower segment caesarean section. Vesicouterine fistula leads to psychological and has the negative impact on quality of life. A high suspicion should be kept in mind if the patient presents with urinary incontinence even many years after caesarean section. However, conservative management may be appropriate in some cases, but the definitive mode of management is surgery. Hereby authors present a 22-year-old para 2 live 2 (previous 2 caesarean section) with vesicouterine fistula with the complaint of urinary incontinence, cyclical haematuria (menouria) and amenorrhoea a year after caesarean section done due to obstructed labour.
Acardia anceps: the monster twin; twin reversed arterial perfusion (TRAP) syndrome
Authors: Khan Shazia , Singh Tina , Maiti Gunadhar
Published: October 2018

Twin reversed arterial perfusion (TRAP) sequence is an extremely rare complication of monochorionic multi-foetal pregnancy, occurring once in 35,000 births. It is characterized by a malformed foetus without a heart being perfused by a structurally normal (pump) twin via an artery-to-artery anastomosis in a reverse direction. We report one such case where ultrasound imaging revealed monochorionic twin pregnancy with a viable, normal-appearing first twin and a structurally aberrant second twin with absent cardiac activity. The patient was monitored with two weekly ultrasonography and Doppler ultrasound examination to ascertain the well-being of the pump twin. She delivered successfully at term a normal live baby and an acardius anceps foetus. The perinatal mortality of the pump twin ranges from 35 to 55%; making it essential to diagnose the presence of a pump twin at an early gestational age through improved imaging techniques to plan effective intervention at appropriate time.
The effect of body mass index on bone mineral density in postmenopausal women
Authors: Gürlek Yusuf Serdar , Kalaycıoğlu Ahmet , Gurlek Beril
Published: October 2018

Background: The aim of this study was to evaluate the association between BMI and BMD among postmenopausal women.Methods: A total of 121 healthy female patients, aged 65.67±8.59 years, previously menopaused, were enrolled. Subjects were divided into five subgroups according to their BMI. History of fracture and BMD were recorded and compared between groups.Results: Among the 121 subjects, 77 (63.6%) individuals had a normal BMD, 32 (26.4%) had osteopenia, and 12 (9.9%) were diagnosed with osteoporosis. Mean of waist circumference was 96.1±8.52cm. The prevalence of fractures was 29.8% in this study. A simple correlation analysis revealed that waist circumference was negatively related to lumbar spine BMD (r= -0.374, p=0.03) and lumbar spine BMD T score (r= -0,352 p=0.002) whereas body weight was positively related to BMD of lumbar spine BMD (r=0.41, p=0.0001) and lumbar spine BMD T score (r=0,31 p=0.001). Age and years since menopause (YSM) were negatively correlated with BMD and T score (p=0.001, p=0.0001, respectively).Conclusions: Even though higher BMI seems to have positive impact on bone density thanks to hormonal and mechanical reasons, increased waist circumference is a sign of a metabolic syndrome and systemic inflammation which are known as having negative effect on bone density. Therefore, postmenopausal women specifically with abdominal obesity should be evaluated for osteoporosis.
The incidence of type 2 diabetes in patients presenting for bariatric metabolic surgery at a tertiary bariatric surgery centre in India
Authors: Bhandari Mahak , Bhandari Mohit , Mathur Winnie , Behl Simran , Kosta Susmit
Published: October 2018

Background: In recent years, there has been a marked change in life-style of developing countries caused by economic growth, affluence, urbanization and dietary westernization. Few studies on the prevalence of obesity with diabetes in the Indian population have been reported. Therefore, this study was planned to estimate the prevalence of type 2 diabetes (T2D) in patients presenting for at a tertiary bariatric surgery centre in India.Methods: In this retrospective study, authors estimated the prevalence of T2D by analyzing the hospital-based data, who were came for bariatric surgery at tertiary bariatric surgery centre in India from January 2010 to June 2018.Results: From the hospital-based data of eight years the incidence of T2D was found 24% of the Indian population in series, who came for bariatric metabolic surgery (BMS). There was slight male preponderance in incidence of T2D based on gender. The higher incidence of T2D was found mostly in 45-60 years age group in both the male and female patients. Incidence of T2D in class of obesity was 4.3% of class I, 18.6% of class II and 77.1% in class III. The incidence of hypertension was seen 41.8% and co-prevalence of both obstructive sleep apnea syndrome and hypertension was 16.2%.Conclusions: Age and higher BMI are strongly and independently associated with the risk of being diagnosed with T2D. The association of BMI class on the risk of T2D is stronger for people with a higher BMI relative to people with a lower BMI.
Real time 3D echocardiography for evaluation of systolic dyssynchrony index in patients with dilated cardiomyopathy and acute myocardial infarction
Authors: Khetan Divij
Published: October 2018

Background: In recent years, real time 3D echocardiography (RT3DE), a novel and non-invasive method has catched the eyes of various cardiologists for evaluating ventricular dyssynchrony. The main aim of the present study was to establish applicability of RT3DE for the assessment of ventricular dyssynchrony in patients with dilated cardiomyopathy (DCMP) and acute myocardial infarction (AMI).Methods: It was a hospital based observational and comparative study which included total 105 patients. Among all the patients, 35 with DCMP, 35 with AMI and 35 healthy patients were included. Various electrocardiographic, 2D and 3D echocardiography parameters were evaluated. Percentage ventricular systolic dyssynchrony index (SDI) was estimated using RT3DE to define ventricular dyssynchrony. The correlation of SDI with left ventricular ejection fraction (LVEF) and QRS duration of all patients was calculated using Pearson correlation co-efficient and regression equation.Results: Age distribution among all three groups was non-significant with mean age 53.56±12.11 years. The RT3DE displayed significantly higher SDI (p=0.001) in DCMP group (16.67±5.81 %) followed by AMI group (8.6±2.2%) and control group (3.14±1.0%). The value of QRS duration was also higher (>140ms) in DCMP patients (142.40±34.71ms) and lower (>120ms) in AMI (108.85±20.67ms) and healthy patients (91.08±8.88ms). No significant correlation of SDI with LVEF among all three groups was observed.Conclusions: The results added more practicality of RT3DE for estimation of ventricular dyssynchrony in patients with varied cardiac conditions and also displayed its utility as an appropriate guide for cardiac resynchronization therapy.
The diagnostic utility of ancillary CD117 immunomarker compared with cell block cytology of thyroid lesions based on Bethesda grading system
Authors: Khoso Muhammad Yousif , Fahim Amin , Qureshi Aneela , Ali Syed Naqeeb
Published: October 2018

Background: This is a cross sectional multicenter study carried out from July 2017 to December 2017. The aim of the present study is to evaluate the fine needle aspiration cytology and cell block of thyroid lesions on the basis of Bethesda grading system. Also, expression of CD117 immunostaining in thyroid lesions was evaluated. Finally, the results of cell block were compared with expression of CD117 immunomarker for diagnostic confirmation of different thyroid lesions.Methods: Total one hundred (100) patients presenting with thyroid swelling underwent fine needle aspiration, cell block preparation to diagnose and categorize thyroid lesion on the basis of Bethesda grading system and finally immunostaining with CD117 was carried out.Results: FNAC results showed 71% patients with benign thyroid morphology and about 23% cases were categorized as atypical to fairly malignant. In cell block study benign lesions diagnosed were 77%, 17% cases as suspicious and 6% were malignant thyroid nodules. Whereas expression of ancillary CD117 immunomarker, confirmed 83% as benign lesions and 17% cases as malignant. Overall ancillary CD117 immunomarker established the better diagnosis to manage and differentiate thyroid lesions.Conclusions: Cell block results are more accurate than FNAC in thyroid patients. The CD117 immunomarkers can be used as better diagnostic tool for confirmation of thyroid lesions and thus it can reduce unnecessary surgical intervention.
Clinical presentations of colorectal cancer at initial presentation to hospital and its site specific correlation
Authors: Bhat Rauf Ahmad , Bari Shams Ul
Published: October 2018

Background: Colorectal cancer is one of the leading cause of death all over the world. It progresses slowly and may be asymptomatic for as many as 5 years. Aim of this study was to find the incidence and the initial clinical presentations of patients with colorectal cancer and its site specific correlationMethods: This was a prospective hospital-based study conducted over a period of two years from August 2015 to September 2017 in the postgraduate department of surgery, Government medical college, Srinagar. Total of fifty three patients in the age group of 10 years to 80 years were included in the study. Colorectal tumors were divided into right colon growths (caecum, ascending colon and hepatic flexure), left colon growths (splenic flexure, descending colon and sigmoid colon) and rectal growths. Data was collected from their hospital records and analysed using SPSS computer program.Results: In present study incidence of colorectal cancer was 0.2 per 100,000 people. Thirty percent of our patients were found to be in the sixth decade of their life with male preponderance in almost every age group. Mean age of presentation being 46.44 years (males= 48.5years, females= 43.76years). Out of 53 patients, rectal growths constituted 36%, left colonic growths 36% followed by 28% cases of right colonic growths. More than one symptom was present in several patients. Maximum number of patients (43%) presented with anemia (microcytic hypochromic) with Hb of <9gm% followed by constipation 38% and bleeding per rectum 28%. Pain abdomen was present in 23% of patients. Loss of weight and diarrhoea was equally seen in 19% of patients. Diarrhoea was seen in 6 males and 4 females and was statistically significant (p<0.05).Conclusions: Colorectal cancer was found to affect the Kashmiri patients at younger age (38% were 40 years or less) with peak incidence at sixth decade. Males were affected more than females. Anaemia, constipation and bleeding per rectum were the most common predominant clinical features in right colon, left colon and rectal growths respectively.
Study of urinary tract infection in febrile children below 2 years of age
Authors: Prasad P. L. , Gupta Aditi , Mukhija Gaurav
Published: October 2018

Background: Urinary Tract Infection (UTI) in age group 0-2 years is of special interest to clinicians and assumes importance as it can lead to pyelonephritis, septicemia or meningitis in newborn and infants which can be fatal. This study is undertaken to calculate the incidence of UTI in febrile children less than 2 years of age and to compare the incidence with afebrile children visiting pediatric OPD and IPD of SRMS IMS.Methods: Two hundred and two febrile infants and children constituted the case group. A control group, constituted of one hundred and ninety seven, age and sex matched afebrile patients from IPD/OPD. Urine collected was subjected to microscopic and microbiological examination.Results: There were ten cases of UTI in the study group and none was found in the control group. The overall incidence of UTI in febrile infants and children less than 2 years was 4.95%. Infants and children admitted with diagnosis other than UTI were screened for UTI and it was found in 4.6% of the cases whereas babies admitted without definite focus had an incidence of 5.56% which signifies that UTI should be screened in all febrile infants irrespective of their other etiologies of fever. Maternal illiteracy was found to be statistically significant as 5 out of 10 cases of UTI were associated with illiterate mothers.Conclusions: In the present study, we found that the screening of the infants for identification of UTI is useful irrespective of the presence of other etiologies thus early initiation of treatment prevents most complications of UTI, so the importance of early diagnosis cannot be overemphasized.
Immunization status of students of Nishtar medical university against hepatitis B
Authors: Khan Dilawar , Shakeel Hassan Abdullah , Maqsood Hamza , Aziz Hafiz Muhammad Ahmar , Qazi Muhammad Jahantab , Shah Syed Asfand Yar
Published: October 2018

Background: Hepatitis B virus (HBV) infection causes significant morbidity and mortality worldwide. Occupational exposure of health care workers and medical students increase their risk of acquiring HBV infection, and many authorities recommend vaccination. However, significant proportions of health care workers do not receive HBV immunization, and remain at increased risk to HBV infection. The present study was conducted on medical students to evaluate their knowledge regarding HBV and to know their vaccination status.Methods: This cross sectional, randomized, observational study was done at Nishtar medical university, Multan from November 2017 to July 2018. A pre-structured and tested questionnaire was given to 150 medical students from first year to final year. Out of these students 75 were males and 75 were females. The students were also interviewed about age, gender, year of study, screening before vaccination, history of vaccination, completion of all 3 doses and reasons for not getting vaccinated.Results: Out of 150 participants, 117 (78%) were vaccinated against HBV. In the vaccinated group, 90 (77%) completed all the three doses of their vaccination schedule and remaining 27 (23%) students were incompletely vaccinated. Rate of vaccine uptake was higher in females; 63 (84%) than in males: 53 (71%). Reasons of not being vaccinated were lack of knowledge about consequences (15.5%), casual behaviour (36%), not knowing from where to get vaccine (12%), fear of injection (10%), busy in studies (10%) and financial problems (8%). Prior screening was done in 74 (63%) students before the vaccination.Conclusions: Despite the availability and accessibility of a cost-effective hepatitis B vaccine since mid80's, the vaccination coverage among medical students is low. Health education needs to be improved in all medical students. The orientation and awareness programmes should be held to create awareness regarding HBV infection.
Study of serum lipid profile in Plasmodium falciparum malaria
Authors: Dungdung Ajith , Jalawadi Vishwanath Malakappa , Yadav Upendra Prasad
Published: October 2018

Background: Malaria is a major public health problem in India with wide-ranging haematological and biochemical alterations. Plasmodium falciparum (P. falciparum) is one of four distinct species of the malaria parasite that afflict humans and pose a threat to public health. Under normal physiological conditions, liver ensures homeostasis of lipid and lipoprotein metabolism.  Therefore, the aim of this study was to assess malaria infection and its association with lipid parameters changes. Hepatocellular damage often associated with severe and acute P. falciparum infections impairs these processes, leading to alteration in plasma lipid profile and lipoprotein patterns. An observation on the nature of dyslipidaemia in confirmed cases of P. falciparum malaria patients with reference to correlation if any that exists between malaria and lipid profile in these patients was performed.Methods: A case-control study was carried out on clinically and laboratory confirmed P. falciparum malaria positive patients attending the outpatient and inpatient department of RIMS Ranchi for a period of six months i.e. from January 2018 to June 2018, 100 participants were enrolled for the present study. 50 participants were P. falciparum malaria confirmed cases and 50 participants were without any clinical or laboratory evidence of malaria served as the control.Results: It revealed that the total cholesterol, HDL and LDL were significantly decreased -(P ≤0.05) while triglyceride and VLDL were not significantly changed in P. falciparum malaria patients (P ≥0.05).Conclusions: It can be concluded that alteration in lipid profile can be an index of severe malaria infection that may leads to poor prognosis, but specificity of malaria infection with lipid changes is questionable and need further studies.