bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypersensitivity reaction with metformin: a case report
Authors: Vashisht Tushar , M. Naidu C. Dinesh , Mandal Chhanda
Published: November 2019

Metformin is a biguanide derivative widely used for treatment of diabetic patients. The most common toxic effects of metformin are gastrointestinal (anorexia, nausea, vomiting, abdominal discomfort and diarrhoea). As with other drugs, allergic reactions can occur with metformin also, but these are very rare. A case of hypersensitivity reaction with metformin was reported in adverse drug monitoring centre. A 59-year-old female, newly diagnosed case of diabetes mellitus II, started on metformin tablet 500 mg twice daily, developed purpuric skin lesions on her arms, legs and back few days after starting the drug. metformin was stopped and patient was put on glimepiride tablet. The lesions slowly started subsiding after stopping metformin.
Prevalence of dual endocrinopathy: hypothyroidism and gestational diabetes mellitus in patients of preeclampsia
Authors: Gupta Natasha , Sharma Sudhaa , Jamwal Sunita
Published: November 2019

Background: Hypertension associated with proteinuria greater than 0.3g/L in a 24-hour urine collection or 1+ by qualitative urine examination, after 20 weeks of gestation is preeclampsia. The present study was conducted to evaluate prevalence of dual endocrinopathy (hypothyroidism and gestational diabetes mellitus) in patients of preeclampsia.Methods: The observational study was conducted within a period of one year from November 2015 to October 2016 in the Department of Obstetrics and Gynaecology SMGS Hospital, GMC, Jammu. A total of 400 patients of preeclampsia were included in the study and underwent serum TSH and oral glucose tolerance test.Results: In this study 32.5% of the preeclampsia patients (130 out of 400) had hypothyroidism, 15.25% patients (61 out of 400 preeclampsia) had gestational diabetes mellitus, 9.75 % patients of preeclampsia had dual endocrinopathy  (both hypothyroidism and gestational diabetes mellitus).Conclusions: The current study concluded that dual endocrinopathy (both hypothyroidism and gestational diabetes mellitus) has substantially higher prevalence (9.75%) in the patients of preeclampsia.
A comparative study of thyroid stimulating hormone among lean and obese women with polycystic ovarian syndrome
Authors: C. Sangeetha M. , Patil Suman Shivanagouda , Arunkumar Nalini
Published: November 2019

Background: The polycystic ovarian syndrome (PCOS) is an abnormality of young women of reproductive age. Between 20-50% of women with PCOS are normal weight or thin, and the pathophysiology of the disorder in these women may be related to a hypothalamic-pituitary defect that results in increased release of LH. PCOS and Thyroid disorders share certain common characteristics, risk factors, and pathophysiological abnormalities. In this study we have compared the serum TSH levels in obese and non-obese PCOS women to detect if there is a significant difference in the occurrence of hypothyroidism based on the BMI.Methods: Non-pregnant women attending the gynecological OPD diagnosed with PCOS as per Rotterdam criteria were included. Serum TSH was done in all women diagnosed as PCOS and based on their BMI women were either included in obese or non-obese group using Asian cut-off for BMI and the values compared.Results: In the present study 152 women were included. Women with low BMI and normal BMI were grouped as lean PCOS or non-obese PCOS and the overweight and obese women together were grouped as obese PCOS. The total number in the lean group was 28 and 124 in the obese group. Raised serum TSH levels were observed in 23.02%(35) women out of which 17.14%(6) belonged to the non-obese group and the remaining 82.85%(29) to the obese group. Among the 152 women thyroid enlargement was seen in 1.3%(2). Both women had raised serum TSH levels and both belonged to the obese group.Conclusions: The results of our study seem to indicate that thyroid dysfunction in PCOS women developed irrespective of presence or absence of obesity.
Comparison of placental grading at different periods of gestation in PIH patients and their outcome
Authors: S. Sneha , S. Sreelatha , Ramaiah Renuka
Published: November 2019

Background: The current study follows grannum grading of placenta. It is well known that there is accelerated placental maturation in PIH patients and the ultrasonic appearance of grade 3 placenta before 37 weeks may signify placental dysfunction and is associated with development of low birth weight babies, IUGR meconium stained liquor, low APGAR score. Hence this study was conducted to emphasize on placental grading at different periods of gestation to predict and prevent increased obstetric and fetal compromise and to compare the outcomes.Methods: Obstetric scans were performed in all PIH patients attending antenatal OPD and inpatients at ESIC and PGIMSR medical college, Bangalore to know the placental grading and biophysical profile. These women were followed till their delivery for obstetric and fetal outcomes.Results: Grade 3 placenta is seen in 17 patients in group 1(50%) and 39 patients (59%) in group 2. For statistical analysis grade 1 and 2 were combined and compared with  grade 3. P-value 0.198 which was not statistically significant. There was no statistically significant difference in age and gravidity between two groups. The medical disorders were more in group 2 i.e., between 37 - 40 weeks. The complications of PIH were also more in group 2. There were more number of LSCS (n=19 versus 14) in 34-36 weeks group which was not statistically significant. Fetal outcomes like IUGR and IUD were more in group 2 which was not statistically significant. The mean birth weight in group 1 was 2 kg as compared to 2.7 kg in group 2. All associated medical disorders were more in group 2.Conclusions: In hypertensive women there is accelerated placental maturation leading to maternal and fetal complications. Hence women with accelerated placental maturity in ultrasound should be closely monitored and appropriately managed. However, we recommend larger randomized studies are necessary.
A prospective study on the role of Hysterolaparoscopy in the evaluation of infertility
Authors: B. Pandeeswari , Valecha Shalini Mahana
Published: November 2019

Background: Infertility affects about 10-15% of couples of reproductive age groups. The current evidence indicates a 9% prevalence of infertility with 56% of couples seeking medical care. Hysterolaparoscopy provides a comprehensive investigative procedure in which various factors causing female infertility can be assessed at one sitting.Methods: A total 100 infertile women between 20-40 years of age including primary and secondary infertility were evaluated. Patients would be investigated thoroughly for infertility and in preparation for anaesthesia. Tests include follicular study, Ultrasound pelvis. Hysterolaparoscopy was performed in the pre ovulatory period between days 6-10 of the cycle for infertility evaluation.Results: In the present study out of 100 cases for infertility evaluated, primary infertility were 57(57%) and secondary infertility were 43(43%). In our study out of 100 patients, Hysterolaparoscopy showed tuberculosis in 24 (24%) patients, remaining were endometriosis, polycystic ovarian syndrome, congestion, intra-pelvic adhesions, hydro-salpinx.Conclusions: It is concluded that while treating the causes of female infertility combined simultaneous diagnostic laparoscopy and hysteroscopy should be performed in all infertile patients as” seeing is believing” and if any pathologies found to be operable the gynaecologist can perform operative hystero-laparoscopy at that time, hence anticipating the pathologies after pre-operative work up is very important.
Knowledge attitude and practice of contraception in Barabanki district of Uttar Pradesh: how far are we from meeting the unmet needs of contraception
Authors: Thakur Neha , Khan Nahid Zia , Rai Narendra
Published: November 2019

Background: Barabanki one of the most populous districts of Uttar Pradesh with population growth rate being much higher than the national population growth rate. The objective of this study was to gain the knowledge about awareness and contraceptive practices in married women residing in Barabanki. To identify socio-demographic factors associated with unmet needs for contraceptionand also to ascertain the participation of husband in family planning.Methods: A cross sectional study was conducted in outpatient department of Obstetrics Gynecology and Department of Pediatrics in Medical college hospital in Barabanki. 144 females were enrolled in the study during the study period of one year. They were interviewed on the basis of a pre-structured proforma. Data obtained was then analyzed.Results: A total 144 women in the age group 18-45 years participated in the study of which 53% had knowledge of contraception. More than two thirds were not using any form of contraception. The most common method of contraception was barrier method followed by Depot medroxy progesterone acetate. Copper T was least used mode of contraception. The most common source of knowledge regarding contraception was from electronic media followed by friends and family. The most common reason behind the absence of contraception was lack of knowledge of contraception and husband disapproval.Conclusions: Poor knowledge of contraception led to decreased usage of contraceptive measures. Husband participation is virtually absent in family planning leading to high fertility. In order to make our family planning programs successful we must incorporate media for wider coverage to increase awareness and husbands for better implementation.
A clinical study on peripartum cardiomyopathy at tertiary care hospital
Authors: Garag Seeta S. , D. Vinay Raju
Published: November 2019

Background: Cardiac diseases complicate 1-4% of pregnancies in women without pre-existing cardiac abnormalities. Cardiac disease in the pregnant woman can present a challenge to the obstetrician, cardiologist and neonatologist. Peripartum cardiomyopathy (PPCM) is an idiopathic disorder defined as heart failure occurring in women during the last month of pregnancy and up to 5 months postpartum. Aim is to study the burden of the disease, maternal outcome in PPCM.Methods: The present study was conducted among the antenatal women admitted in the department of Obstetrics and Gynecology at KIMS, Hubli with a previously diagnosed cardiac disease or diagnosed after admission during index pregnancy from December 2016 to May 2018. The mothers were followed up till discharge. Maternal outcome was noted as discharged or died.Results: A total of 11 cases of PPCM noted in our study out of which one case was developed before delivery, and 10 cases developed postnatally. Out of ten cases which were developed postnatally, 5 patients died giving around 50% of mortality rate.Conclusions: PPCM affects previously normal healthy women in the last month of pregnancy and up to 5 months after delivery. Careful assessment of risk factors contributing PPCM could help in their prevention. And these patients should be stratified in developing PPCM in future pregnancies through proper tools available.
Categorization of patients with abnormal uterine bleeding according to PALM-COEIN FIGO classification
Authors: Tater Arihant , Jain Prakash , Sharma Kamal Nayan
Published: November 2019

Background: Abnormal uterine bleeding is a common problem of the women in the reproductive age group and leads to the frequent visits of women in hospitals to health care providers. In an effort to create a universally accepted system of nomenclature to describe uterine bleeding abnormalities in reproductive-aged women, an alternative classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN developed.Methods: It is a retrospective study on 200 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patient grouped under these categories after detailed history, examination, investigations and histopathological reports.Results: Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=60, 30%). It was followed by leiomyoma (n=48, 24%) and endometrial causes (n=38, 19%) and were the top three etiologies for AUB respectively. Adenomyosis (n=26, 13%), not classified (n=12, 6%), iatrogenic (n=8, 4%), polyp (n=4, 2%) and malignancy and coagulopathy each (n=2, 1%) contributing least to the PALM-COEIN classification as an etiology for AUB.Conclusions: PALM-COEIN classification is a universally accepted and consistent method of knowing exact etiology following investigations, so the proper treatment can be done for AUB.
Ferric carboxymaltose: choice of treatment in postpartum anaemia in multispeciality zonal hospital of armed forces medical services
Authors: Borse Dhananjay S. , Mitra Binay , Maji Debkalyan
Published: November 2019

Background: World Health Organization has defined postpartum anemia (PPA) as hemoglobin (Hb) of < 10 gm% during the postpartum period. The objective of the present study was to compare the safety and efficacy of ferric carboxymaltose (FCM) in the treatment of post-partum anaemia (PPA).Methods: A total of 214 patients were identified in a zonal hospital of Armed Forces Medical Services, between Jan 2019 and August 2019 who found to have PPA. Patients having hemoglobin (Hb) <10 g/dl were assigned to receive Intravenous FCM, as per the calculated dose. Changes in hemoglobin (Hb) and serum ferritin levels at 2 and 6 weeks after treatment were recorded and analyzed. Adverse effects to FCM administration were also recorded.Results: Significant rises in Hb and serum ferritin levels were observed. The mean increase in Hb after 2 weeks was 3.1±0.50 g/dl and 4.0±70 g/dl at 6 weeks. The mean increase in serum ferritin levels after 2 weeks was 210.40±38.50 and 270.25±14.60 ng/ml after 6 weeks. Adverse drug reactions were significantly less (p<0.001).Conclusions: Ferric carboxymaltose increases Hb level and restores iron stores faster without any severe adverse drug reactions. Patient tolerance was good after FCM injection.
A comparative study between ferrous carboxy maltose and iron sucrose in the management of post-partum anaemia in tertiary care hospital
Authors: Garag Seeta Sunil , Kumar Sanjana
Published: November 2019

Background: Anaemia is a global public health problem contributing tremendously to maternal morbidity and mortality. It is the most common indirect cause of maternal mortality. Variety of injectable iron preparations are now available which can be effective tools for combating post-partum anaemia. This study aims to compare FCM (Ferrous carboxy maltose) and iron sucrose in the treatment of iron deficiency anaemia in post-partum women at KIMS, Hubli, Karnataka, India.Methods: This study was conducted at KIMS, Hubli in the year 2018-19 wherein 100 post-partum women with hb levels ranging from 5-10g% were selected for the study and randomly allocated into 2 groups- FCM group and iron sucrose group. They were administered 1g of FCM and 1g of iron sucrose respectively after clinical evaluation and baseline measurement of hb. They were followed up after 2 weeks for repeat hb% and review of signs and symptoms. FCM and iron sucrose were compared in terms of their efficacy.Results: The mean increase in hb% was found to be 3.2 g% in the FCM group and 2 g% in the iron sucrose group. FCM was also found to be more efficacious in providing relief of common signs and symptoms like easy fatigability and pallor compared to iron sucrose.Conclusions: Ferrous carboxy maltose was found to be more efficacious compared to iron sucrose.
Prediction of efficacy of gonadotropin releasing hormone agonist trigger for final oocyte maturation through post-trigger 12-hour luteinizing hormone, follicle stimulating hormone and progesterone levels in COS: a prospective study
Authors: Agarwal Sonal , Krishna Deepika , Pranesh Gautham , Rao Kamini A.
Published: November 2019

Background: Circulating levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and progesterone (P4) in serum after administration of gonadotropin releasing hormone agonist (GnRHa) trigger for final oocyte maturation are found to be predictive of oocyte maturity. This prospective study was conducted at a tertiary care centre to evaluate relationship between serum LH, FSH and P4 levels at 12-h post-trigger and oocyte maturity rate and to predict which hormone has maximum sensitivity and specificity for appropriate oocyte maturation.Methods: Women at risk of ovarian hyper-stimulation syndrome who underwent either autologous or donor IVF cycle treated with flexible GnRH antagonist protocol were taken as participants of the study. GnRHa as trigger for final oocyte maturation was given. After 12 hours of agonist trigger, blood sample was drawn to assess LH, FSH and P4 levels in serum. Continuous variables were expressed as mean±SD. Independent sample t test was used for continuous variables which were normally distributed and Mann-Whitney U test for data not normally distributed. Main outcome measures were number of oocytes retrieved, oocyte maturity rate, fertilization rate, cleavage rate and grade of embryos.Results: There was a statistically significant reduction in number of retrieved oocytes, maturity rate, fertilization rate and grade 1 embryos with a concentration of serum LH and P4 less than the cut off value (p < 0.05).Conclusions: Serum LH and P4 level less than the cut off value at 12-hour post-trigger with GnRHa is associated with a dramatically less oocyte maturity rate and fertilization rate.
First trimester serum vitamin D, hs-CRP and second trimester uterine artery diastolic notching in predicting gestational hypertension and preeclampsia
Authors: Arora Renu , Salmani Sueba , Bharti Rekha , Kabi B. C. , Dabral Anjali
Published: November 2019

Background: Gestational hypertension and preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of this study was to study prediction of gestational hypertension/preeclampsia by using first trimester serum vitamin D and hs-CRP and second trimester uterine artery diastolic notching.Methods: It was an observational study conducted in the departments of obstetrics and gynaecology, clinical biochemistry and radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. All pregnant women with 11 to 14 weeks gestational age attending antenatal clinic between October 2012 and June 2013 were enrolled in the study. A detailed history including history of the duration of sun exposure was taken and a general physical examination including obstetrical examination was done at every visit. Serum sample were taken for hs-CRP and vitamin-D levels at 11-14 weeks. Uterine artery colour doppler study was done between 22-24 weeks for uterine artery diastolic notching. The main outcome measures were development of gestational hypertension/ preeclampsia/ eclampsia.Results: The mean vitamin D levels were significantly lower and mean hs-CRP levels were significantly higher in the hypertensive group as compared to the normotensive group, p=0.001 and p=0.004, respectively. Significant number women who developed hypertension had unilateral (46.2%) or bilateral (20.4%) uterine artery diastolic notching, p=0.005 and p=0.000, respectively. Crude’s odds ratio of uterine artery diastolic notching for prediction of hypertension in pregnancy was high, 9.894, 95% CI, 3.273-29.907 as compared to vitamin D (<13.5 ng/ml) and hs-CRP (>9.15 mg/L), 2.859, 95% CI, 1.418-5.763 and 7.16, 95% CI, 3.33-15.397.Conclusions: Uterine artery diastolic notching in the early second trimester is found to be the best predictor of PE followed by first trimester hs-CRP and vitamin D.
A study on peripartum hysterectomy in a tertiary referral government hospital
Authors: M. Chaithra , K. Tejeswini K. , C. Savitha
Published: November 2019

Background: Emergency peripartum hysterectomy (EPH) is a major surgical venture invariably performed in the setting of life-threatening haemorrhage during or immediately after abdominal and vaginal deliveries. Aim of the study was to study the frequency and indications for peripartum hysterectomy and to assess the maternal outcome of peripartum hysterectomy.Methods: Cross sectional study was done in the department of obstetrics and gynaecology, Vanivilas hospital, Bangalore from September 2018 to august 2019. This study consists of 24 cases of emergency peripartum hysterectomy within 24 hours of delivery, operated at Vanivilas hospital.Results: The frequency of peripartum hysterectomy was 1.102/1000 deliveries and following caesarean section and vaginal deliveries are 3.544/1000 deliveries and 0.248/1000 deliveries respectively. Among 24 cases who had peripartum hysterectomy, 16 cases were delivered by caesarean section and 4 cases delivered by vaginal route while another 4 cases delivered by laparotomy for rupture uterus. 22 cases (91.67%) survived with major number of cases having morbidities and there were 2 (8.33%) maternal death.Conclusions: The most common mode of delivery before peripartum hysterectomy was Caesarean section. The most common indication was atonic postpartum haemorrhage. Better protocols for induction and augmentation of labour will decrease the necessity of peripartum hysterectomies.
The role of trans obturator tape as a surgical procedure for female stress urinary incontinence and its impact on quality of life in Jammu region
Authors: Puri Sapna , Kohli Manisha
Published: November 2019

Background: Stress incontinence is one of the most common but debilitating health issue among women. It has a detrimental effect on overall health and quality of life of women. Trans obturator tape (TOT) has emerged as a promising treatment modality. The aim of present study was to assess the usefulness of TOT in terms of change in quality of life of stress incontinence patients.Methods: The study was performed at Department of Obstetrics and Gynecology, Acharya Shri Chandler of Medical Sciences (ASCOMS), Jammu. A total of 50 symptomatic women were enrolled in the study and underwent TOT procedure using outside-in technique. The quality of life of women was assessed at enrolment and 12 months after the procedure using King’s Health Questionnaire (KHQ). Change in QOL was assessed using paired ‘t’-test.Results: After 12 months follow-up, a total of 27 (54%) patients were entirely symptom free. As compared to pre-treatment QOL assessment on KHQ for general health/incontinence impact, quality of life and symptom scores a % decline of 73.2%, 79.8% and 78.4% was observed. For all the three parts, the change in scores was significant statistically. No other complications and side effects were reported.Conclusions: TOT is a useful procedure which provided symptomatic relief as well as QOL enhancement.
Prevalence and associated risk factors of abnormal pap smear in pregnant women
Authors: Mohindroo Neha , Sharma Anoop , Minhas Santosh , Pathania Kushla
Published: November 2019

Background: The Papanicolaou test is a method of cervical screening used to detect pre-cancerous and cancerous processes. The incidence of cervical cancer in India is alarmingly high and is the leading cause of cancer in women in India accounting for 147 deaths per lakh women. Cervical cytological abnormalities are found in up to 5% of all pregnancies. In Indian settings, published data on abnormal Pap smear in pregnancy is lacking. The present study was designed to know the prevalence of abnormal Pap smear in pregnant women and its associated risk factors.Methods: This prospective study included 450 pregnant and 450 non-pregnant women who fulfilled the inclusion criteria. After a detailed history, clinical examination and investigations, Pap smear was collected as per conventional method and reported using 2014 Bethesda system.Results: 53.6% pregnant and 44.6% non-pregnant subjects had abnormal Pap smear. Out of the abnormal smears in pregnant women, 31.18% had inflammatory cytology, 15.37% had bacterial vaginosis, 4.01% had Trichomonal and 3.34% Monilial pathology. No epithelial cell abnormality was seen. Rural residence, lower class, age at first intercourse less than 21 years and having more than one sexual partner were important risk factors observed in our study and were statistically significant.Conclusions: Bacterial vaginosis, the most common infection detected on Pap smear is strongly associated with previos preterm labour and delivery. This opportunity for screening of cervical cancer and counselling should not be missed in the antenatal period.
A comparative study of early postoperative feeding versus conventional feeding for patients undergoing caesarean section
Authors: S. Neeraja , Reddy Naritha , Fathima Naima
Published: November 2019

Background: Early alimentation after caesarean delivery probably has limited clinical significance in terms of improved energy and protein intake. Decreasing the post-operative ileus is possible with early feeding. Objective of this study was to study efficacy of early postoperative feeding versus conventional feeding for patients undergoing caesarean section.Methods: Present study was hospital based comparative study carried out among 200 women who fulfilled the selection criteria. The cases were divided into 2 groups of 100 each by suitable random sampling technique. Group A included 100 cases who were given early feeding within 6 hours of caesarean delivery. Group B included 100 control who were given the feeding after 24 hours of caesarean delivery.Results: The mean duration of postoperative hospital stay in Group A and Group B was 4.59±0.65 and 4.81±0.81 days respectively (p <0.05). The mean time to return of bowel sounds in Group A and Group B was 2.79±1.36 and 3.55±1.49 hours respectively (p <0.01). 2(2%) cases in group A had postoperative ileus symptoms, whereas 3 (3%) cases in Group B had the same. Statistically significant difference (p <0.05) was seen in terms of vomiting 1% versus 17%, nausea 5% versus 16%, abdominal distention 2% versus 7%, diarrhea 4% versus 90% in the early feeding versus conventional feeding groups.Conclusions: It can be concluded from present study that fast return to the normal diet is possible with early feeding among women undergoing cesarean section compared to the conventional feeding among women undergoing cesarean section.
Total laparoscopic hysterectomy: a retrospective study of 5 years
Authors: Moni Suma S. , Hoblidar Suchith , Desai Rathnamala M. , K. S. Sunil Kumar
Published: November 2019

Background: Hysterectomy is one of the most common gynecological surgeries performed around the world. This study was done to review the data of all patients who underwent TLH. With this study a uniform method of performing TLH by a single surgeon was assessed.Methods: A 5 years retrospective study was performed at Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital Dharwad, Karnataka India. Demographic data, pre-operative findings, indication for surgery, intra-operative and post-operative complications, duration of surgery were recorded and analyzed.Results: A total of 118 women were included in the study. Mean age of the patients wasMost common indication for the surgery was leiomyoma. Mean operating time was 162.18 minutes. Mean weight of the post-operative specimen was 208.45 grams. Intra-operative urinary bladder injury was seen in 1 patient. Conversion to laparotomy was needed in 2 patients.Conclusions: With improving experience TLH can be performed safely without complications. As number of surgeries done increases duration of TLH reduces. TLH can be effectively used to avoid laparotomy.
Placenta accreta not previa: a rare case report of placenta accreta in an unscarred uterus
Authors: Malik Renuka , Singh Swati , Chawla Jaya , Bhardwaj Meenakshi
Published: November 2019

Placenta accreta spectrum disorders are usually associated with direct surgical scar such as caesarean delivery, surgical termination of pregnancy, Dilatation and curettage, Myomectomy, Endometrial resection and Asherman’s syndrome. It can also be associated with non-surgical scar and uterine anomalies. Rarely it can be encountered in unscarred uterus. Mrs X, 35-year female, unbooked patient, G7P2L2A4 with nine months of amenorrhoea reported in emergency of RML Hospital on 30/07/2019 with history of labour pains since 2 days. Patient gave history of four dilatation and curettage for incomplete abortion. On examination patient was found to be severely anaemic (Hb -6 gm). 2 Packed RBC were transfused preoperatively. There was no progress in labour beyond 6 cm for 4 hours. Patient was thus taken for LSCS for NPOL, with blood on flow. Intraoperatively, after delivery of the baby placenta which was fundo-posterior did not separate. In view of parity and morbidly adherent placenta (clinical grade III), subtotal hysterectomy was done. Patient was transfused 4 PRBC, 4 FFP and 2 platelets. Uterus with placenta in situ was sent for histopathology. Patient was in ICU for 2 days and recovered well. Post-operative period was uneventful. Placenta accreta is defined as abnormal trophoblast invasion of whole or a part of placenta into myometrium of uterine wall. Caesarean delivery is associated with increased risk of placenta accrete and the risk increases with each caesarean section, from 0.3% in woman with one previous caesarean delivery to 6.47% for woman with five or more caesarean deliveries. Placenta accreta spectrum disorders occur in 3% of woman diagnosed with placenta previa and no prior caesarean. In the developing world, the obstetrician should be prepared to encounter un diagnosed placenta accrete even in absence of previous LSCS. Curretage following MTP is also a risk factor, so vigourous currettage should be avoided to prevent endometrial damage.
Prevalence of tuberculosis in newly diagnosed HIV patients and its relationship with cluster of differentiation 4 count in a tertiary care hospital
Authors: B. Archana , U. Vivek K.
Published: November 2019

Background: Tuberculosis (TB) is the commonest opportunistic infection among Human Immunodeficiency Virus (HIV) positive patients in India and HIV/TB co-infection poses a major public health challenge in developing countries. It is estimated that 60-70% of HIV positive patients will develop tuberculosis in their lifetime. The aim of the present study is to record the clinical, radiological profile of pulmonary and Extrapulmonary Tuberculosis (EPTB) in HIV positive patients.Methods: This was a prospective study conducted in the department of Pulmonary medicine, Kempegowda institute of medical sciences. All newly diagnosed HIV patients during the study period were included and screened for tuberculosis irrespective of whether they had signs and symptoms.Results: Among 44(15.94%) patients among 276 HIV positive patients were diagnosed to have tuberculosis. Males (72.72%) were affected more than females (27.27%). Most common affected age group was 31-40 years with a mean age of 38.08 years. Unprotected heterosexual contact was the most common mode of HIV transmission. Fever, weight loss and cough were the commonest symptoms at presentation. Pulmonary TB was diagnosed in 10(22.7%) patients, EPTB in 30(68.3%) and disseminated TB in 4(9%) patients. All the pulmonary TB patients had CD4 count below 250, EPTB below 150 and disseminated TB patients below 50.6(13.63%) patients had pleural effusion, 5(11.36%) had abdominal TB, 5(11.36%) had tubercular meningitis, 4(9%) had intra thoracic lymphadenopathy and one (2.27%) patient had pericardial effusion. Low CD4 count (<150) had statically significant association with HIV/TB co-infection.Conclusions: The prevalence of HIV-TB co-infection was high. Moreover, HIV positive patients need early diagnosis and treatment of active TB. The study has shown clear correlation between clinical data and the laboratory parameter of immunodeficiency (CD4 count) and the temporal development of TB.
The impact of intravenous thrombolysis in acute ischemic stroke in National Medical College, Kolkata: initial experience
Authors: Ghosh Saikat , Mahata Manoj Kr. , Das Sarbajit , Ghosh K. C. , Bhattacharya R. , Mondal G. P. , Deb Sumit
Published: November 2019

Background: Acute ischemic stroke is a potentially treatable condition, if left untreated, lead to mortality and morbidity. This study was conducted to study clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (r-TPA-alteplase) and to measure the outcome of thrombolysis.Methods: Retrospective observational study of 54 patients who underwent thrombolysis for acute ischemic stroke at National Medical College, Kolkata over a period of one year.Results: There was statistically significant improvement in NIHSS (p value-0.000) after intravenous thrombolysis.Conclusions: IV thrombolysis is feasible for AIS in governmental hospital in India.
Prevalence and risk factors for drug resistance in patients with lower respiratory infections in Healthcare Associated Infection: a single centre study from Eastern India
Authors: Rao C. Mohan , Subhankar Saswat , Pradhan Sujit , Dash Debee Prasad
Published: November 2019

Background: Healthcare Associated Infections (HCAI) are associated with longer hospitalisations and increased morbidity and mortality. Lower respiratory infections including Pneumonia is an entity among healthcare associated infections mostly witnessed in nursing home residents, patients on long term care and patients receiving home or hospital based intravenous therapy and undergoing dialysis. Aim of the study to assess the prevalence and risk factors of resistance among the patients developing lower respiratory infections as a consequence of Healthcare Associated Infection.Methods: The study was conducted as a prospective cohort model. All the eligible patients were subjected to detailed history taking, clinical examination, laboratory and radiological investigations. All the categorical parameters were compared using Fisher’s exact test. Continuous parameters were compared using independent t-test. All the statistical analysis was carried out using the software Stata 15.1.Results: Majority of the patients were older than 60 yrs (73%). Death was significantly seen in persons under 60 years and associated pulmonary consolidation equal to or more than three zones (p<0.05). Klebsiella spp (20.95%), and Acinetobacter (6.1%) were most commonly isolated. Multi-drug and extensive drug resistance were encountered among these organisms. Male gender, immune-compromised patients, bilateral pulmonary involvement and hospitalisation for at least 48 hours in preceding 90 days were associated with isolation of MDR organism.Conclusions: Lower respiratory infection is an important component of healthcare associated infections. It needs targeted antibiotic therapy covering MDR organisms prevalent in the local population. Data from different institutions to corroborate findings regarding antibiotic resistance pattern of the microbes is recommended.
Modulatory effect of Kolin PlusTM, a polyherbal formulation on muscle growth development in choline deficient diet model of broilers: a microarray approach
Authors: D'Souza Prashanth , Marimuthu Saravanakumar , Kaninathan Arigesavan , Selvam Ramasamy
Published: November 2019

Background: The present study was conducted to elucidate the genes and its associated pathways delineating the growth-promoting potential of polyherbal formulation (PHF), Kolin PlusTM using microarray in Cobb 430 broiler chickens.

Methods: Microarray was performed for four groups, namely, normal diet (ND) as G1, choline chloride deficient (CCD) diet as G2, choline chloride (CCL, 400 g/ton) as G3 and PHF (400 g/ton) as G4. Breast muscle samples were collected, and the growth-related gene expression profile was measured using the Agilent microarray platform.  

Results: Totally 2900 differentially expressed genes (DEGs) in muscle tissue sample was revealed using hierarchical clustering based on the similarity of their expression profiles, which further allows the user to pick out groups of similar genes. Among them, 1000, 364 and 481 genes were significantly upregulated and 244, 485 and 326 genes were significantly downregulated between ND and CCD, CCL and CCD, PHF and CCD respectively. Furthermore, some of the focused genes (CSRP3, SOX10, BCO1, CALB1, LMOD2, KLF15, CTHRC1, PHGDH, UTS2R, and ANKRD2) were significantly (p<0.05) modulated by PHF (400 g/ton) supplementation in birds fed with CCD diet. These genes play an essential role in protein translation, energy metabolism, and muscle growth promotion.
Conclusions:It may be concluded that supplementation of PHF at 400 g/ton of feed could positively influence the certain focused genes associated with muscle growth promotion, which favours the productive phenotypic response in broiler chickens fed with CCD diet. 
 
Immunohistochemical Determination of ATAD2 Protein Overexpression for Predicting Prognostic Value in Patients with Different Types of Cancer: A Meta-Analysis
Authors: S Jiang , J Liu , X Chen , X Zheng , J Ruan , A Ye , S Zhang , L Zhang , Z Kuang , R Liu
Published: November 2019

Background: Increasing number of studies has reported that Atpase family AAA domain-containing 2 (ATAD2) is nuclear coactivator, which is associated with tumor cell proliferation and invasion. Previous studies have demonstrated conflicting results on the relationship between high ATAD2 expression and clinicopathological characteristics of the tumors or patients’ survival outcomes. Considering the discordant results of published studies, we performed a metaanalysis to evaluate the ATAD2 expression in predicting prognosis, and to assess the relationship between high ATAD2 expression and clinicopathological parameters.Methods: We systematically searched electronic database of PubMed, Web of Science and Embase, and selected all immunohistochemical studies of hepatocellular cancer specimens for ATAD2, to analyze the relationship between high ATAD2 expression and prognosis of hepatocellular cancer patients. Pooled data of eligible studies together from individual studies and analyzed data using STATA software to perform this meta-analysis.Results: A total of 5 studies with 719 liver cancer patients were included. ATAD2 protein overexpression wassignificantly correlated with poorer overall survival (HR 3.53, 95% CI: 1.87-6.63, P = 0.000). In addition, high ATAD2 expression was also negatively related with tumor stage [RR, relative risk: 1.46 (95% CI: 1.30-1.64); P < 0.001], as well as tumor size [RR: 1.23(95% CI: 1.06-1.43); P < 0.001], and tumor recurrence [RR: 1.34 (95% CI: 1.05-1.72); P < 0.001].Conclusions: These data suggested that immunohistochemical determination of ATAD2 Protein might be aprognostic biomarker for the patients of hepatocellular cancer.
Introduction
Authors: Al-Hourani Mohammed Abdel Karim
Published: November 2019

I am thankful for the opportunity to produce this special issue on refugees in Jordan, and grateful to Professor Sybille Artz, Editor of the International Journal of Child, Youth and Family Studies, who motivated and encouraged me. The issue includes four articles that focus in general on the problems and challenges that are encountered by Syrian youth and children who reside in Jordan either inside or outside the refugee camps there. Focusing on children and youth, both male and female, is important to the literature on Syrian refugees in Jordan because this age group has been neglected and overlooked by scholars since Syrian refugees first fled to Jordan in 2011. Furthermore, the challenges and problems of children are both culturally critical and morally sensitive, and that is why this special issue has extra importance. In Jordan’s conservative social and cultural environment, certain research topics relevant to the refugee camps are regarded as unlawful and prohibited: sexual harassment, underage marriage, child employment and exploitation, youth unemployment and deprivation, and other violations against children and youth.
IDENTITY CRISIS AND ASSIMILATION PROBLEMS AMONG SYRIAN REFUGEE WOMEN RESIDING OUTSIDE REFUGEE CAMPS IN JORDAN
Authors: Al-Shar Sahar , Al-Tarawneh Muhammad
Published: November 2019

This article describes and analyzes the main problematic issues of social and cultural assimilation encountered by Syrian refugee women in Jordan who are not living in refugee camps, and the reasons for the identity crisis that these women experience. The data that provide this information were collected by means of semi-structured interviews from a sample of 50 of these women. The results show that most of the Syrian refugee women living outside the camps suffered from hardships that interfered with their social and cultural assimilation. There were few formal social relationships between refugee women and others in their milieu, and the refugees felt that there were distinct cultural differences in dialect, customs, and traditions between them and their Jordanian peers. The study shows that most of the participants were living in a state of social isolation resulting from identity crisis. It was difficult for them to develop a sense of belonging to the society of the country of asylum while being distracted both by day-to-day concerns and by their desire to return to their homeland. These factors limited their ability to develop good relations with the host community as a prelude to integration, assimilation, and social symmetry.
Molecular analysis of three novel G6PD variants: G6PD Pedoplis-Ckaro, G6PD Piotrkow and G6PD Krakow.
Authors: Maciag Monika , Plochocka Danuta , Jablonska-Skwiecinska Ewa , Mendek-Czajkowska Ewa , Golaszewska Ewa , Strojny Wojciech , Balwierz Walentyna , Zdebska Ewa , Burzynska Beata
Published: November 2019

We present three novel mutations in the G6PD gene and discuss the changes they cause in the 3-dimensional structure of the enzyme: 573C-->G substitution that predicts Phe to Leu at position 191 in the C-terminus of helix alphae, 851T-->C mutation which results in the substitution 284Val--> -->Ala in the beta+alpha domain close to the C-terminal part of helix alphaj, and 1175T-->C substitution that predicts Ile to Thr change at position 392.
Bacterial DNA repair genes and their eukaryotic homologues: 1. Mutations in genes involved in base excision repair (BER) and DNA-end processors and their implication in mutagenesis and human disease.
Authors: Krwawicz Joanna , Arczewska Katarzyna D , Speina Elzbieta , Maciejewska Agnieszka , Grzesiuk Elzbieta
Published: November 2019

Base excision repair (BER) pathway executed by a complex network of proteins is the major system responsible for the removal of damaged DNA bases and repair of DNA single strand breaks (SSBs) generated by environmental agents, such as certain cancer therapies, or arising spontaneously during cellular metabolism. Both modified DNA bases and SSBs with ends other than 3'-OH and 5'-P are repaired either by replacement of a single or of more nucleotides in the processes called short-patch BER (SP-BER) or long-patch BER (LP-BER), respectively. In contrast to Escherichia coli cells, in human ones, the two BER sub-pathways are operated by different sets of proteins. In this review the selection between SP- and LP-BER and mutations in BER and end-processors genes and their contribution to bacterial mutagenesis and human diseases are considered.
Bacterial DNA repair genes and their eukaryotic homologues: 3. AlkB dioxygenase and Ada methyltransferase in the direct repair of alkylated DNA.
Authors: Nieminuszczy Jadwiga , Grzesiuk Elzbieta
Published: November 2019

Environmental and endogenous alkylating agents generate cytotoxic and mutagenic lesions in DNA. Exposure of prokaryotic cells to sublethal doses of DNA alkylating agents induces so called adaptive response (Ada response) involving the expression of a set of genes which allows the cells to tolerate the toxic and mutagenic action of such agents. The Ada response includes the expression of four genes: ada, alkA, alkB, and aidB. The product of ada gene, Ada protein, is an activator of transcription of all four genes. DNA bases damaged by alkylation are removed by distinct strategies. The most toxic lesion 3meA is removed by specific DNA glycosylase initiating base excising repair. The toxic and mutagenic O6meG is repaired directly by methyltransferases. 1meA and 3meC are corrected by AlkB DNA dioxygenase. The mechanisms of action of E. coli AlkB dioxygenase and its human homologs ABH2 and ABH3 are described in more details.
Bacterial DNA repair genes and their eukaryotic homologues: 4. The role of nucleotide excision DNA repair (NER) system in mammalian cells.
Authors: Maddukuri Leena , Dudzińska Dominika , Tudek Barbara
Published: November 2019

The eukaryotic cell encounters more than one million various kinds of DNA lesions per day. The nucleotide excision repair (NER) pathway is one of the most important repair mechanisms that removes a wide spectrum of different DNA lesions. NER operates through two sub pathways: global genome repair (GGR) and transcription-coupled repair (TCR). GGR repairs the DNA damage throughout the entire genome and is initiated by the HR23B/XPC complex, while the CSB protein-governed TCR process removes DNA lesions from the actively transcribed strand. The sequence of events and the role of particular NER proteins are currently being extensively discussed. NER proteins also participate in other cellular processes like replication, transcription, chromatin maintenance and protein turnover. Defects in NER underlay severe genetic disorders: xeroderma pigmentosum (XP), Cockayne syndrome (CS) and trichothiodystrophy (TTD).
Bacterial DNA repair genes and their eukaryotic homologues: 5. The role of recombination in DNA repair and genome stability.
Authors: Nowosielska Anetta
Published: November 2019

Recombinational repair is a well conserved DNA repair mechanism present in all living organisms. Repair by homologous recombination is generally accurate as it uses undamaged homologous DNA molecule as a repair template. In Escherichia coli homologous recombination repairs both the double-strand breaks and single-strand gaps in DNA. DNA double-strand breaks (DSB) can be induced upon exposure to exogenous sources such as ionizing radiation or endogenous DNA-damaging agents including reactive oxygen species (ROS) as well as during natural biological processes like conjugation. However, the bulk of double strand breaks are formed during replication fork collapse encountering an unrepaired single strand gap in DNA. Under such circumstances DNA replication on the damaged template can be resumed only if supported by homologous recombination. This functional cooperation of homologous recombination with replication machinery enables successful completion of genome duplication and faithful transmission of genetic material to a daughter cell. In eukaryotes, homologous recombination is also involved in essential biological processes such as preservation of genome integrity, DNA damage checkpoint activation, DNA damage repair, DNA replication, mating type switching, transposition, immune system development and meiosis. When unregulated, recombination can lead to genome instability and carcinogenesis.
Bactericidal effect of photodynamic therapy against methicillin-resistant Staphylococcus aureus strain with the use of various porphyrin photosensitizers.
Authors: Grinholc Mariusz , Szramka Bozena , Olender Katarzyna , Graczyk Alfreda
Published: November 2019

Photodynamic therapy (PDT) is based on photosensitizers activated by light of appropriate wavelength. Their activation leads to generation of singlet oxygen and free radicals responsible for the cytotoxic effect. The aim of this project was to compare the bactericidal effect of PDT using different porphyrin photosensitizers against a methicillin-resistant Staphylococcus aureus strain. Exogenous sensitizers (protoporphyrin IX and newly synthesized derivative, protoporphyrin diarginate) induced a 3 log10-unit reduction in bacterial viable counts. With the use of endogenous, ALA-induced porphyrins, a 1.6 log10-unit reduction was obtained. The sensitizers tested executed their antibacterial activity with no essential change in the antibiotic resistance pattern of the studied strain.