bluuebunny/crossref_metadata_2025 huggingface dataset:
A retrospective study on ectopic pregnancy aspiration by transvaginal ultrasound at Institute of Kidney Diseases And Research Centre
Authors: Mishra Vineet V. , Rane Priyanka , Aggarwal Rohina S. , Shah Kunur N.
Published: May 2023

Background: Majority of the reports suggest that the frequency of ectopic pregnancies have grown in the last 30 years, especially in patients conceived through artificial reproductive techniques (ART). To prevent severe morbidity and mortality its prompt diagnosis and appropriate management is important. In a select patient population, most of the unruptured, live ectopic pregnancies can be successfully managed without surgical intervention using trans-vaginal ultrasound guided aspiration and instillation of local injection KCl or administration of systemic Inj. Methotrexate.
Methods: This study is a hospital based retrospective cohort study from January 2014 to December 2022 on patients who presented to Institute of Kidney Diseases and Research Centre (IKDRC) with unruptured ectopic pregnancy confirmed with ultrasound and β HCG. All the patients were analyzed according to history, clinical presentation, investigations, treatment and complications.
Results: β-HCG day 1 or 2 post procedure dropped in all cases but in variable levels ranging from 1.3% to 85.88%, while the drop during days 7-10, was more significant and reassuring; ranged from 48.69% to 98.95%.
Conclusions: By aspiration of ectopic gestational sac transvaginally under ultrasonographic guidance it is able to preserve the integrity of uterus and fallopian tube and thus the future fertility. The study will educate other healthcare professionals.
Comparison of diagnostic performance of simple international ovarian tumor analysis rules versus subjective pattern recognition for triage of adnexal masses
Authors: Singh Priya , Tomer Shaili , Amina Nishat , Anand Rama , Yadav Reena , Shukla Shailaja
Published: May 2023

Background: Accurate and early diagnosis of adnexal masses is essential for optimal clinical decision-making. The aim of the study was to compare the diagnostic performance of simple international ovarian tumor analysis (IOTA) rules vs subjective pattern recognition, to discriminate between benign and malignant adnexal mass, and to establish the diagnostic utility of IOTA rules as a standardized examination tool in early diagnosis of ovarian malignancy.
Methods: A prospective cohort study was conducted at a tertiary care hospital between November 2017 and March 2019 on 100 women with adnexal masses. All adnexal masses detected on ultrasound were classified according to IOTA rules by the trainee, followed by subjective pattern recognition by experts. These observations were further correlated with histopathology/intraoperative findings/ follow-up examination. Diagnostic efficacy was assessed by comparing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.
Results: Among the 100 patients, 81 had benign, and 19 had malignant masses on final diagnosis. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of malignancy using IOTA rules by trainee were 100%, 95.59%, 81.82%, 100%, and 95.65%, and by subjective evaluation by experts were 100%, 97.5%%, 90.5%, 100%, and 98% respectively. No statistically significant difference was found between the diagnostic accuracy of the two methods.
Conclusions: Simple IOTA rules are as accurate as subjective evaluation by experts in the characterization of adnexal masses. Their inherent simplicity and reproducibility make them ideal for use by less experienced sonographers.
Assessment of maternal factors and fetomaternal outcome in pregnant women conceived by artificial reproductive techniques
Authors: Jatav Deepika , Chandwaskar Nootan , Arya Madhuri
Published: May 2023

Background: Infertility is a major issue and a source of social and psychological suffering for many couples. Introduction of assisted reproductive technology (ART) leads to great relief for couples nowadays.
Methods: This present observational cross-sectional study was conducted at OBGY Department at Sri Aurobindo Medical College and Post Graduate Institute, Indore and who satisfy the inclusion criteria was studied from 1st April 2021 to 30th September 2022 (18 months). After approval from Institutional ethical committee. Each patient fulfilling the inclusion criteria was included in the study. Informed written consent was taken.
Results: The mean age of women in this study was 37.6 years and the most common age group was between 30-50 years. Infertility was mostly unexplained (40%), followed by female factor (33.33%), male factor (16.67%), and combined (10%). 63.33% were singletons, 36.67% twins. Preterm labor (43.33%) was most common. Preeclampsia/eclampsia (33.33%), gestational hypertension, renal failure, gestational diabetes, cardiomyopathy, hepatic failure, HELLP syndrome, and DIC were other complications. 60% were caesarean-sectioned and 40% vaginal delivery. 90.24% of neonates had 5-minute Apgar scores above 7 and 9.76% below 7. 4 stillbirths (9.76%) and 75.68% of live births required NICU admission. 5 neonatal deaths (12.2%) and 21.95% perinatal mortality.
Conclusions: There are numerous maternal and perinatal complications linked to ART. Couples should therefore be counselled about these risks while offering them ART as a mode of conception.
Assessment of maternal and fetal outcome in eclampsia patients getting admitted in Bundelkhand Medical College, Sagar, India on basis of general condition of patient at time of admission and induction delivery interval
Authors: Kelkar Deepti , Naagar Jagrati Kiran , Jain Sheela
Published: May 2023

Background: Eclampsia is the convulsive and most severe manifestation of the hypertensive disorders of pregnancy. Eclampsia is defined by new-onset tonic-clonic, focal, or multifocal seizures in the absence of other causative conditions.
Methods: It is a prospective observational study conducted in BMC Sagar, Madhya Pradesh, India of duration one year, according to inclusion and exclusion criteria with 72 eclampsia patients.
Results: Most patients had vaginal deliveries 62.5%. There were 4.2% maternal deaths. 65.4% patients’ babies were shifted to mother’s side. Lesser no. of SNCU referrals were seen in cases of LSCS as compared to vaginal deliveries, in cases where patients had GCS more than 8 at time of admission, where admission delivery interval was less than 12 hrs.
Conclusions: The results of the current study indicated that better the general condition of patient at time of admission, lesser the induction/admission delivery interval-better is the fetal maternal outcome. Eclampsia could have been prevented in patients by regular antenatal visits and early detection in pre-eclampsia/gestational hypertension stage.
A cross sectional study on the frequency of thyroid disorders in pregnancy and the asssociated obstetric complications
Authors: K. Sreelakshmy
Published: May 2023

Background: Thyroid disorders have a yet unclear impact on obstetric complications. The studies have been varied and mostly contradictory. The aim of the study was to examine the pattern of thyroid disorders and its obstetric complications.
Methods: This cross-sectional study enrolled 334 pregnant women of less than 12 weeks of gestation.  After routine clinical and ultrasound evaluation of all cases, all baseline investigations and TSH was done. In all cases with low TSH free T3 and free T4 was done. All patients were followed up till delivery and the obstetric events were recorded. The data collected were analysed using chi-square test.
Results: Of the 334 enrolled the data on pregnancy related events were available for 276 patients. Subclinical hypothyroidism was detected in 10.1% of the population while 3.6% were having overt (clinical) hypothyroidism. Anaemia was more in subclinical hypothyroidism (39.3%) and overt hypothyroidism (40%). Pre-eclampsia was seen 17.85% with subclinical hypothyroidism and 30% with overt hypothyroidism. Eclampsia was seen in 3.7% of subclinical hypothyroidism and 10% of clinical hypothyroidism. Gestational diabetes mellitus (GDM) was more in patients with subclinical hypothyroidism (25%) and overt hypothyroidism (20%). Oligohydramnios and IUGR were higher in the subclinical hypothyroidism (21.42%, 10.7%) and overt hypothyroidism (20%, 10%).  There was no difference between the euthyroid, subclinical hypothyroidism and overt hypothyroidism groups with respect to any of the other variables.
Conclusions: There was a high frequency of thyroid disorders among pregnant women in our study and this had adverse obstetric consequences.
Study on epidemiology of endometriosis in North East India
Authors: Udupa Kalpana S. , Phukan Pranay , Saikia Nabajyoti , Dutta Aparna
Published: May 2023

Background: Endometriosis is the presence of endometrial glands and/or stroma outside the uterus, predominantly in   reproductive age. The prevalence is around 10% in women of reproductive age and is caused by combination of multiple genetic and environmental factors. Characterization of endometriosis can be learnt from epidemiological factors of the patients which influence on disease development and thus helpful in clinical diagnosis. Histological pictures after surgery may vary considerably and sometimes over diagnosis of the disease is not uncommon. The purpose of the study was to study the epidemiology of endometriosis in North East population of India and correlation of clinical and histopathological diagnosis.
Methods: It was a hospital based observational descriptive study carried out in Department of Obstetrics and Gynecology, AMCH, Dibrugarh, Assam, India.  Detailed history and clinical presentations were elicited and relevant investigations were done. Operative findings and biopsy reports were correlated. All the findings were tabulated and statistically analyzed.
Results: Women in age group 30-39 years (48.31%) with mean BMI of 24.44±4.06 kg/m2, nulliparous (31.46%) or para 1(33.71%) formed the majority of study population. Majority had early age at menarche (11.45±1.24), irregular cycles, shorter cycle length, longer duration of flow. Majority (79.78%) had dysmenorrhea followed by dyspareunia (59.55%). Only 62.92% had biopsy proven endometriosis.
Conclusions: Epidemiological factors and clinical presentations guide in diagnosing endometriosis and should be given importance. Clinical diagnosis of endometriosis may not always correlate with histopathologic diagnosis and many other pathologies mimic endometriosis.
Induction of labour in pregnancies with fetal demise: a randomised control trial
Authors: Parmar Sanjay Prabhasbhai , Shah Maitri Chetan , Kumari Shipra , Solanki Vishnu Harkhabhai
Published: May 2023

Background: The present study aims at comparing efficacy and safety of two different regimens of induction of labour (IOL) in pregnancies with fetal demise.

Settings and Design: A randomised controlled trial was conducted on 100 eligible pregnant women diagnosed with intrauterine fetal demise who were admitted in the labour ward of a tertiary care hospital.

Methods: All participants were randomly divided into two groups in group A and group B. In Group A, IOL was done with transcervical foley’s catheter and vaginal misoprostol while in group B, mifepristone with vaginal misoprostol were used for IOL. During intrapartum period the mode of delivery, induction-delivery interval, total dose of induction agent used and amount of total blood loss were noted. Any side effect if present was also noted.

Results: Comparing both the groups, Induction delivery interval was less in group A as compared to group B.

Conclusions: Use of mifepristone with misoprostol as well as Foley’s with misoprostol were found to be equally safe and effective methods.
Study of fetomaternal outcome in pre-eclampsia at tertiary care centres, South Gujarat
Authors: Chauhan Jigisha U. , Agarwal Shraddha S. , Jain Mahak P. , Patel Sejal M. , Contractor Katha T. , Vaidya Jahanavi A.
Published: May 2023

Background: Hypertensive disorders are among the most common medical disorder during pregnancy and continue to be a serious challenge in obstetric practice. It affects about 7-15% of all gestations. In India it accounts for the third most important cause of maternal mortality. Aim if this study was to study the prevalence of pre-eclampsia and feto-maternal outcome in cases of pre-eclampsia.
Methods: This was a descriptive observational study conducted over a period from February 2019 to July 2021. This study enrolled 106 cases of pre-eclampsia, cases were selected by inclusion and exclusion criteria, data were entered and analysed by using SPSS version 20.
Results: A total of 106 patients were analysed. It was observed that it was more common in age group of 26 to 30 years 51%, 56% were unbooked patients. Maximum number of patients were primigravida 60%, 96% patients were from lower socioeconomic class, 37% patients had normal vaginal delivery, 63% had caesarean delivery. The most common maternal complication was eclampsia (12%), HELLP Syndrome 12%, abruptio occurred in 8% of patients. Maternal mortality occurred in 4 cases. Out of 106 babies 37 (34.93%) babies had normal outcome while 29% (27.35%) had low birth weight, 16 (15.09%) babies were IUGR, 15 (14.5%) babies were IUFD, 7 (6.6%) babies had RDS and 2 (1.8%) babies were stillbirth 40 (44.94%) babies were admitted in NICU.
Conclusions: This study concludes that foetal and maternal outcome were markedly affected by pre-eclampsia and also the grave complications were more common in pre-eclampsia. So proper antenatal care, early diagnosis of pre-eclampsia and timely intervention will decrease maternal perinatal morbidity and mortality.
A prospective observational study of post-partum intrauterine contraceptive device acceptance in a tertiary care centre
Authors: Bavdekar Nitin , Lewis Preeti F. , Sanjay Gupta Shusmita
Published: May 2023

Background: Provision of PPIUCD is being rapidly scaled up in India with facilities in at least 19 states offering the method in 2013. According to National Family Health Survey (NFHS)-3, the prevalence of modern method of contraceptive use is 48.5% and all methods 56% in India. PPIUCD placement remains a viable option for patients who wish to use a long-acting reversible contraceptive (LARC) method and to have it placed at the time of their delivery.  Hence, we planned this study with an aim to evaluate acceptability PPIUCD at tertiary care centre.
Methods: It was an observational and prospective study of acceptance of PPIUCD as a method of contraception in patients who delivered within the study period in our institute Grant Medical Hospital and College, Mumbai. Data analysis was done with statistical software SPSS V 25.0.
Results: A total of 2014 patients were enrolled in the study. The mean age was noted to be 25.87 years. Frequency of ANC visits among the patients was 4 to 6 (39.87%). Commonest obstetric history finding was previous live birth history in 59.38% cases. Pregnancy outcome was vaginal delivery noted in 63.01% of the females. 879 (43.65%) cases accepted PPIUCD. For those who did not accept PPIUCD, commonest cause was tubal ligation in 34.19%, followed by fear of pain in 18.94%, partner’s refusal in 10.31%.
Conclusions: The acceptance rate in study for PPIUCD was 43.65% which was higher than most of the published evidence. The common reasons for not accepting PPIUCD were tubal ligation.
Immunohistochemical expression of p16INK4a in premalignant lesions and malignant tumours of cervix
Authors: Sandhu Parminder J. S. , Nibhoria Sarita , Sandhu Vaneet K. , Kaur Harpreet
Published: May 2023

Background: Cervical carcinoma is the third most common cancer in women worldwide and firth most common cause of cancer related deaths. Human Papilloma virus, the most common cause of cervical cancer, causes functional inactivation of pRb, resulting in overexpression of p16INK4a. The overexpression of p16INK4a correlates well with the degree of cervical dysplasia and neoplasia. The present study is done to determine the IHC expression of p16INK4a so that it may be used as a biomarker for HPV and may play a role in the prevention, diagnosis and prognosis of cervical neoplasm.
Methods: The present study was conducted on 60 formalin-fixed, paraffin-embedded specimens of cervical neoplasms, which comprised 47 cases of squamous cell carcinoma followed by 8 cases of adenocarcinoma, 3 cases of HSIL and 2 cases of LSIL. These were then subjected to IHC by p16INK4a. Cytoplasmic and nuclear positivity for p16INK4a was noted.
Results: Overall 95% cases were positive for p16INK4a expression, 100% cases of adenocarcinoma, 98% cases of squamous cell carcinoma, 100% cases of HSIL and 0% cases of LSIL were positive for p16 expression.
Conclusions: The present study showed statistical correlation of immunoreactivity of p16INK4a with histological type was clinically significant (p value <0.0001). In our study, p16INK4a immunohistochemical expression increased with increasing degree of dysplasia and with presence of cervical carcinoma.
Effect of adolescent pregnancy on maternal and foetal health
Authors: Lewis Preeti F. , Nakhare Vedangee R. , Bavdekar Nitin
Published: May 2023

Background: Adolescence is a time when structural, functional, and psychosocial developments occur. Pregnancy during teenage can adversely affect the health of both the mother and the foetus as the adolescent female concerned is yet to attain her full growth potential. Adolescent pregnancy is a global phenomenon with serious health, social and economic consequences.
Methods: It was a single centric, prospective, observational study. 211 Patients who attended the inpatient or outpatient department of obstetrics and gynaecology in an urban tertiary care hospital and followed up till outcome.
Results: As per the study conducted, almost 83% of teenage mothers conceive by 19 years of age. Owing to the increasing awareness regarding maternal and foetal wellbeing, majority of the teenage mothers were booked. Teenage mothers and their babies are prone to intrapartum and postpartum complications as well as stillbirths. The most common comorbidity associated in teenage mothers was pregnancy induced hypertension (PIH) spectrum disorders followed by anaemia. The rate of neonatal intensive care unit (NICU) admission for babies of teenage mothers was 10%.
Conclusions: Adolescent mothers and their babies are at a risk of complications than other mothers in the twenties. The need of the hour are comprehensive measures and convergence among various departments to address all the needs of adolescents. Robust measures and policies to end teenage marriages and consequent pregnancies are exactly what the developing nations need at present.
Comparison of ferric carboxymaltose and iron sucrose for treatment of iron deficiency anemia in pregnancy at tertiary care centre, Western India
Authors: Papaniya Twinkle D. , Parmar Mehul T. , Solanki Harsha M.
Published: May 2023

Background: Iron deficiency anemia is the most common haematological health problem among pregnant women but can be prevented by effective measure. The study aimed to evaluate the efficacy and safety of intravenous ferric carboxymaltose (FCM) in comparison with intravenous Iron sucrose (IS) for treatment of iron deficiency anemia in pregnancy.
Methods: A prospective interventional comparative study was conducted from (June 2021-June 2022) at a tertiary care hospital. Pregnant women diagnosed with moderate to severe iron deficiency anaemia were screened for the study. One hundred patients were randomized to receive either intravenous FCM or IS. Treatment effectiveness was assessed by repeat Haemoglobin (Hb) and RBC indices measurement after 4 weeks of completion of therapy. Safety was assessed by analysis of adverse drug reactions during infusion and 2 hours after infusion.
Results: Mean rise in Hb at 4 weeks was significantly higher in FCM group (1.67±0.47 Vs 1.07±0.25; p<0.0001) as compared to IS group.  There was also rise in other biochemical parameters like MCV and MCHC in both groups. Numbers of visits were significantly less in FCM group. No serious adverse events were noted in either group.
Conclusions: Intravenous ferric carboxymaltose is more effective and safer as compared to intravenous iron sucrose in the management of anemia during pregnancy. It has advantage to administer large dose in single sitting which reduce overall cost of therapy and hence will lead to better compliance in community setting.
Study of clinical profile and outcome in pregnancy related acute kidney injury
Authors: Brahmbhatt Jagruti , Devada Kirti , Patel Manishkumar
Published: May 2023

Background: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden decrease in glomerular filtration rate leading to decreased excretion of nitrogenous waste like urea, creatinine and other uremic toxin. Even minor changes in serum creatinine are associated with increased in-patient mortality. To study various etiological factors responsible for AKI to do better management of condition for prevention of adverse effects on maternal and fatal outcome. To study outcome of disease in form of recovery, morbidity and mortality. To record maternal and foetal outcome.
Methods: A prospective, observational study of 50 patients conducted at department of obstetrics and gynaecology, Medical College Baroda and Sir Sayajirao General Hospital from the time period of 1 year.
Results: There was no significant association of initial serum creatinine with maternal outcome. However, there was significant association of last serum creatinine and Percentage Improvement in serum creatinine with maternal outcome as last serum creatinine was significantly lowest in completely recovered patients as compared to dead and discharged on request patients and percentage Improvement in serum creatinine was significantly high in completely recovered patients as compared to dead and discharged on request patients. There was no significant association of initial and last serum creatinine with fetal outcome; however, percentage improvement in serum creatinine was significantly high in alive fetuses as compared to aborted, dead and undelivered fetuses.
Conclusions: Pregnancy-related AKI is a common medical problem and understanding its association with various etiopathologies has significant impacts on maternal and fetal outcome.
Assessment of outcome of trial of labour after caesarean in a tertiary hospital based setting: prospective observational study
Authors: Bhardwaj Mahak , Gainder Shalini , Chopra Seema , Bagga Rashmi
Published: May 2023

Background: Aim of this study was to determine the success rate of vaginal birth after caesarean (VBAC) in Indian women, identify the factors that predict its success, and assess the maternal and neonatal outcomes following a trial of labour after caesarean (TOLAC).
Methods: A prospective observational study involving women with one  previous lower segment caesarean section (LSCS) who were admitted for TOLAC between January 2019 and June 2020 at Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. There were 124 women with previous LSCS who opted for TOLAC.
Results: During the study period, 124 women with previous LSCS who opted for TOLAC were included, of whom 68 (54.8%) had successful VBAC and 56 (45.2%) had failed TOLAC. The induction of labour (IOL) rate in the study was 69.4%, and 30.6% of women had spontaneous onset of labor. VBAC rates were significantly higher in women who went into labour spontaneously (84.2% vs. 15.8%). Maternal complication rates were comparable, whereas the neonatal complication rate was significantly higher in neonates born by CS (51.7% vs. 30.8%), with a greater incidence of low birthweight (LBW) and transient tachypnea in the newborn (TTNB).
Conclusions: TOLAC can be considered a safe option for women with a previous caesarean when combined with vigilant and stringent labour monitoring, despite the use of IOL agents.
Monoamniotic twins with complications and their outcome: case series
Authors: Mital Tuhina , Rachwani Kirti
Published: May 2023

Monoamniotic twins are identical twins sharing the same amniotic sac and placenta, with two separate umbilical cords. Although uncommon, monoamniotic twins are associated with high antenatal and perinatal morbidity and mortality. We present here a series of three cases of monoamniotic twin gestations with fetal complications who delivered in our hospital over a period of one month. Our first case Mrs. ABC with 33 weeks of gestation with Monoamniotic twins presented with twin anemia polycythemia sequence, second case, Mrs XYZ presented as primigravida with 35 weeks of gestational age with monoamniotic twins with severe preeclampsia presented with Cord entanglement who went into postpartum hemorrhage and was conservatively managed for the same. Our third case, Mrs. DEF G2P1L1 with previous scar 1.5 years back with 23 weeks of gestation with monoamniotic twins presented with Twin reversal arterial perfusion sequence and underwent medical termination of pregnancy.
Ovarian collision tumour: a rare case of serous cystadenoma with granulosa cell tumor of ovary
Authors: Vernekar Veena M. , Gollar Prashanth F. , Sana Syeda , Sampath Kumar Sreelatha
Published: May 2023

A collision tumor is the coexistence of two distinct tumours without any histological intermixing in the same organ or tissue. Each component of collision tumors occurs coincidently and biologic behaviour depends on their own tumor characteristics. A 48 year aged P2L2 women with pain abdomen since 15 days, on abdominal examination-a cystic mass occupying left iliac fossa present, bimanual examination a cystic mass measuring 13x10x8 cm in size, felt separately from the uterus. Sonography of abdomen and pelvis revealed a large cyst in the right adnexa 11.5x10.5x9.5 cm extending upto umbilical region. The serum tumor markers were within the normal range. Patient complained of severe pain abdomen on next day. Emergency laparotomy was done. Left ovarian cyst measuring 13x12x7 cm in size with one loop of torsion seen. Left salphingo-ophorectomy done and specimen sent for frozen section. It reported as serous cystadenoma of left ovary. Then proceeded to total abdominal hysterectomy with right salphingo-oophorectomy. Histopathology reported Serous cystadenoma with focal Granulosa cell tumour- left ovary. Patient was followed up with serum inhibin and CECT abdomen. The demographic factors, presentations and diagnosis of collision tutors are as similar as with single ovarian tumours. It is important for gynaecologist, radiologist and pathologist to be aware of occurrence of collision tumours. Histopathogical diagnosis of such neoplasms becomes very important, to provide appropriate treatment based on the individual biological characteristics of each component of collision tumours.
Successful detection of an incidental sigmoid injury during laparoscopic surgery by air saline test in a patient of endometrial carcinoma
Authors: Sharma Pooja , Mishra Jyoti
Published: May 2023

Laparoscopy has many advantages over open surgery including less post-operative pain, earlier return of normal bowel function, shorter hospital stay, and earlier recovery. Bowel injury is a serious complication of gynecological laparoscopy. The most common site of bowel injury is the small bowel, followed by the large bowel and stomach. This is in agreement with a recent systematic review which has shown that the incidence of bowel injury in gynecologic laparoscopy is 1 in 769.3. Air saline test performed to check bowel integrity by inserting the rectal probe and filling the cavity with normal saline. After performing total laparoscopic hysterectomy with bilateral salphingoopherectomy with retroperitoneal lymphnode dissection done initially after pushing air from rectal probe into the bowel, no bubble was noted but after pushing sigmoid into the pool of saline, escape of air was seen. After suction, a 2×2 cm incidental sigmoidal injury was detected. Bowel injury is a serious complication in laparoscopic surgeries and routine intraoperative checking of bowel integrity by air saline test with the help of rectal probe is a useful modality of intraoperative bowel repair.
A rare case of broad ligament fibroid in Mayer-Rokitansky-Küster-Hauser syndrome
Authors: Choudhary Arpit , Takkar Navneet , Kaur Pandher Dilpreet , Satodiya Mohit
Published: May 2023

Mayer-Rokitansky Kuster Hauser (MRKH) syndrome with lieomyoma is a rare disorder. Women with this syndrome have normal 46 XX karyotype, normal secondary sex characteristics and primary amenorrhea. There is a scarcity of cases in the literature where fibroid develops in women suffering from MRKH syndrome. Here, we present a case of an ectopic broad ligament fibroid found in a 41-year-old woman with MRKH syndrome type II. A 41-year-old married nulliparous female diagnosed with MRKH syndrome 20 years back, presented with an abdominal mass. Trans-abdominal ultrasound suggested a large mass on right side arising from paracolic area with heterogeneous echo texture. However, the ovarian vs leiomyoma origin of mass was of diagnostic dilemma. CEMRI confirmed the same findings and ruled out ovarian origin of the mass along with the presence of rudimentary uterus. Following this, the patient was taken for laparotomy followed by total abdominal hysterectomy with bilateral salpingoopherectomy, the fibroid was found to be arising from broad ligament and was removed along with the hypoplastic uterus and bilateral Fallopian tubes and ovaries. The case we presented exhibits the development of leiomyomas in patients with MRKH syndrome, although rare, is always a possibility and should be kept in mind as a differential diagnosis while evaluating an abdominopelvic mass. MRI is an accurate modality both for delineating the mass, confirming its origin as well as diagnosing MRKH syndrome.
A case report on dealing with complications of hypertension during child birth
Authors: Kaparwan Arti , Godiyal Pooja
Published: May 2023

Hypertensive disorder in pregnancy is a major source of morbidity and mortality worldwide. This is a disease unique to pregnancy typically characterized by blood pressure ≥140/90 mm of Hg after 20 weeks of pregnancy and associated with proteinuria 300 mg/24 hours or 1+ dipstick. If left untreated the disorder often leads to serious maternal and perinatal complications. Here there is a case report of women with undiagnosed hypertension during pregnancy which complicates life of both mother and fetus by complicating labour and birth with precipitate labour and postpartum haemorrhage. This is a preventable complication by educating women about importance of routine antenatal visits.
Schizencephaly: a rare case with early diagnosis, management and review of literature
Authors: Agarwal Megha , Pandher Dilpreet K. , Takkar Navneet , Satodiya Mohit , Thakur Bhawna
Published: May 2023

Schizencephaly or split brain is an uncommon congenital disorder of cerebral cortical development, belonging to the group of cell migration defects. It is characterized by the presence of a cleft in the brain extending from the surface of the piamater to the cerebral ventricles. A 21-year-old primigravida at 19+2 weeks of gestation was referred to our Outpatient department with a level-2 ultrasound done at 18+2 weeks suggestive of schizencephaly. First trimester genetic screening was not done. Quadruple testing was normal. After genetic consultation and poor prognostication by neonatologist, decision for medical termination of pregnancy was taken. Patient underwent medical termination with mifepristone -misoprostol regimen. A female abortus weighing 200 gm was delivered. Gross examination showed only facial malformation in the form of cleft lip and hypoplastic nose. Infantogram did not reveal any skeletal deformity. On fetal autopsy, findings were consistent with the diagnosis of schizencephaly (type 1). Schizencephaly is a rare disorder in prenatal medicine with grave prognosis. Majority of cases are either diagnosed at late gestation or present in the first decade of life. Hence with periodic surveillance during antenatal care and help of ultrasonography, such rare and serious congenital malformations can be diagnosed and managed at an early stage.
Large mucinous cystadenoma in pregnancy: a rare case report
Authors: Arya Varsha , Mukherjee Shubhra
Published: May 2023

Presence of ovarian tumors in pregnancy is uncommon. In most cases, they are benign, torsion is the most common complication. Management can be conservative or surgical depending on the size, clinical presentation, gestational age, available resources etc. advances in imaging techniques have made the decision making easier. We present a case of primigravida aged 24 years, with 18 weeks’ pregnancy with pain in abdomen. She had a large mass arising from the pelvis. Full work up was done. Imaging was suggestive of mucinous cystadenoma with bilateral hydronephrosis due to mass effect. Laparotomy was done and a 20 kg tumor was removed, histopathology confirmed a huge cystadenoma. Patient was discharged in a stable condition. The management of ovarian tumors in pregnancy can be challenging. Although the safety of antepartum surgical intervention is accepted, abdominal surgery will carry some risk to the pregnant woman and the unborn fetus. Surgery becomes necessary in the presence of rupture, torsion or malignancy.
A case of large leiomyoma arising from rudimentary horn in Mayer Rokitansky-Küster-Hauser syndrome, managed by minimally invasive surgery
Authors: Katkam Rusheetha R. , Dalmia Rachana D.
Published: May 2023

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital disorder marked by aplasia or hypoplasia of the uterus and vagina as a result of arrest in the development of the müllerian ducts. Prevalence being 1 in 4000–5000 live births of females. Leiomyoma is the most common uterine tumor, their occurrence from rudimentary uterus in females with MRKH syndrome is very rare and only a few cases have been documented in the literature. Here we report a 38-year-old female, known case of MRKH syndrome presenting with USG suggestive of 7.9x7.4x6.0 leiomyoma in proximity to the hypoplastic uterus, undergoing a laparoscopic removal of fibroid with right ovarian cystectomy (incidental finding). Therefore, it is important to consider such unusual diagnosis of fibroids originating from primitive horns while treating these patients for gynecological symptoms as well as infertility, and consider them managing endoscopically.
Success story of acute abdomen in pregnancy-torsion ovary
Authors: Saidhandapani Kalyani , Sadhana Karthikeyan
Published: May 2023

Torsion ovary is one of the acute emergencies in pregnancy with prevalence of 2.7-3% with high maternal and fetal mortality rates. Delay in diagnosis leads to hemorrhage, infarction and necrosis resulting in loss of ovary or fetal loss. Although 26% adnexal torsion can occur in apparently healthy adnexa, exact etiology remains unknown, predisposing factors include larger cyst size, free mobility and long pedicle. Acute onset of pelvic pain followed by nausea and vomiting is the most common presenting symptom. High levels of clinical suspicion along with ultrasound and doppler aids in diagnosis. We present a case of 18 weeks multipara with acute abdomen diagnosed as ovarian torsion, emergency laparotomy was done and salphingo-oophorectomy was proceeded without disturbing gravid uterus. Pregnancy continued and an alive term baby delivered by normal vaginal delivery. Once torsion ovary is suspected, surgical management remains the treatment of choice.
Exploring the effectiveness of various screening criteria used in gestational diabetes mellitus
Authors: S. Keerthana  , Usha Devi Gopalan
Published: May 2023

Hyperglycemia during pregnancy leads to fatal maternal and perinatal outcomes. Gestational diabetes mellitus (GDM) is diagnosed by 75 grams oral glucose tolerance test at 24-28 weeks of gestational age as insulin resistance increases during the second trimester. Increased prevalence of diabetes mellitus, sedentary lifestyle, Family history of DM predisposes women, particularly the Indian women to develop GDM. Existence of multiple criteria like IADPSG (International association of diabetes and pregnancy study groups), WHO (World health organisation), ADA (The American diabetes association criteria, DIPSI (Diabetes in pregnancy study groups criteria) creates serious confusion in screening of GDM. Therefore, there is a need to find a effective single screening criteria.
Effect of previous episode of symptomatic dengue infection on recent dengue infection in children
Authors: Mosleh Taskina , Poudel Apekshya , Mutanabbi Mahbub , Helal M. Al
Published: May 2023

Background: Approximately 390 million people worldwide are affected by dengue fever each year, >70% of them are from Asia. It is thought that antibody enhancement during the subsequent infections with dengue virus can cause more severe form of disease called dengue haemorrhagic fever (DHF). This study aims to observe the effect of prior dengue infection on recent infection.
Methods: This retrospective record based descriptive-analytical study was conducted from July 2021 to December 2021 in paediatrics department of Bangabandhu Sheikh Mujib Medical University, Dhaka. Medical records of all admitted confirmed cases of dengue fever during the study period were reviewed retrospectively to find out past symptomatic dengue infection ,which further verified by parents over phone. Finally 98 patients were analyzed after exclusion.
Results: Among 98 studied patients, 45 (45%) experienced DHF and 15 (15.3%) diagnosed with DSS. There was no significant (p>0.05) difference of age and sex between patients of DF, DHF and DSS. Majority of the patients 79 (80.6%) did not have a past history of documented symptomatic dengue infection. Here, 9 (23.6%) out of 38 DF patient, 8 (17.7%) out of 45 DHF patient and only 2 (13.3%) out of 15 patient with DSS had past symptomatic dengue infection. Maximum patients (92, 93.8%) were treated with isotonic fluid, 39 patients got colloid (39, 36.79%). This study found no significant (p>0.05) difference between DF, DHF and DSS with or without past symptomatic dengue infection.
Conclusions: In our study we noticed that there was no increase in dengue morbidity with documented previous symptomatic dengue infection.
Extra cardiac birth defects in children with congenital heart anomalies
Authors: Jan Muzafar , Sohil Parvaiz Rafieq , Khan Younus Ramzan , Bashir Amber
Published: May 2023

Background: Congenital heart disease (CHD) may be present with a syndrome containing known anomalies with specific physical findings or can be present with manifestations of a systemic defect that affects the heart and other systems. Aim of the study was to determine the prevalence and spectrum of extra-cardiac defects associated with CHD.
Methods: This prospective and observational study was conducted in the age group of 1 day to 12 years with CHD chosen by purposive sampling technique. Informed consent was obtained from parents or guardians. The CHD was diagnosed on the basis of detailed clinical examination, chest X-ray and Electrocardiography and confirmed by 2D echocardiography. The extra-cardiac defects were diagnosed based on standard definitions and various investigations like CBC, LFT, KFT, USG abdomen and skull, CT, MRI, G-Band karyotype, fluorescence in situ hybridization (FISH) studies for micro-deletions, audiometry, ophthalmologic evaluation and thyroid hormone profile.
Results: A total of 61,254 patients were examined during the study and 640 children were identified with CHD. So, the prevalence was 10.14 per 1000 live births. Out 640 children enrolled in the study 352 (55%) were males and 288 (45%) were females with a male female ratio of 1.2:1 and 520 (81.3%) had acyanotic CHD (ACHD) and 120 (18.3%) had cyanotic CHD (CCHD). The majority of the children with CHD belonged to the second birth order 360 (56.2%). The extra-cardiac anomalies were present in 128 (20%) cases. Out of them 77 (12%) cases had extra-cardiac anomalies associated with acyanotic CHD and 51 (8%) cases had extracardiac anomalies associated with cyanotic CHD. Out of 128 cases with extra-cardiac defects 64 (50%) cases were syndromic, 51 (39.8) cases had multiple congenital defects and 13 (10.2%) had laterality defects.
Conclusions: The CHD is often associated with various extra-cardiac abnormalities.
Clinicoetiological profile of pyrexia of unknown origin in children 1-12 years of age in a tertiary care centre
Authors: Surong Nafisha , Joseph Dibin
Published: May 2023

Background: A primary concern of the paediatricians in evaluating a child with PUO is the limited use of investigations that are case-specific especially in developing countries such as India where availability and affordability are the limiting factors. Hence, this study was conducted to evaluate the various etiological factors and the clinical profile of children presenting with PUO in this region.
Methods: A hospital based cross sectional study was conducted among 200 children presenting with fever i.e., temperature >100.9⁰F/38.3 ⁰C of more than one week duration, with no clear diagnosis after initial investigations
Results: A total of 193 children were included in the study with a mean age of 6.2±1.8 years. Most (62.5%) of the participants had infectious etiology, followed by collagen vascular disorders (10 %) and malignancies (9.5%). Among the participants, 10% remain undiagnosed. Among infectious causes, the most common was respiratory tract infections (17.5%), followed by scrub typhus (13.5%) and urinary tract infections (10%).
Conclusions: Our study was conducted to outline the clinic-etiological profile of pediatric patients with PUO in our region. After proper investigations, a diagnosis could be reached in most patients. The commonest aetiology was infectious, followed by collagen vascular disorders and malignancies. Further studies with a larger sample size are suggested.
Clinical profile of accidental ingestion of poisonous substances in children during COVID era
Authors: Deopa Bindu , Bhatt Ruchi , Rawal Arjun
Published: May 2023

Background: Poisoning and drug overdose is a common medical emergency for children. Majority of childhood poisonings are unintentional. To see the change in epidemiology and spectrum of poisoning in children during COVID period this study was conducted because COVID-19 has changed the mental, socioeconomical, education status of people which also effected mental health of children.
Methods: Prospective cross-sectional observation study was done in 95 children aged 0-15 years over a period of two and half years at tertiary care centre of Uttarakhand.
Results: Most common age group was affected was 1-5 years (44.21%). Most common poisonous substance intake was pesticides and insecticides 18.9% followed by medications 17.89%. Most of the children (44.21%) were asymptomatic at time of presentation and required only observation care.
Conclusions: During COVID time medicine became more common after pesticides in developing country. This spectrum is close to studies done in developed countries. Family education, interaction with children, close vigilance and proper storage of poisonous substance is important to avoid such incidences.
Diagnostic accuracy of procalcitonin as a marker of neonatal sepsis
Authors: Sodha Safiya , Jain Hemant , Goyal Dileep , Jain Shubham
Published: May 2023

Background: Sepsis is defined as “life-threatening organ dysfunction, caused by a dysregulated host response to infection”. Neonatal sepsis is the most common cause of morbidity and mortality in the neonatal period. Early diagnosis of neonatal sepsis is difficult. Therefore, this study was conducted with the objective to assess the diagnostic accuracy of procalcitonin as marker of neonatal sepsis and its comparison with C-reactive protein.
Methods: The present study was a hospital-based descriptive comparative study. A total of 59 neonates were enrolled. All suspected neonates for the sepsis admitted to NICU were enrolled in study on the basis of inclusion and exclusion criteria. A detailed clinical examination was done. Blood sample was collected for procalcitonin, C-reactive protein and blood culture. Statistical analysis was performed.
Results: In our study diagnostic accuracy of procalcitonin in diagnosis of neonatal sepsis was sensitivity (88.46%), specificity (87.88%), positive predictive value (85.19%), negative predictive value (90.63%) and diagnostic accuracy (88.14%). Diagnostic value of C-reactive protein in diagnosis of neonatal sepsis was sensitivity (88.46%), specificity (69.70%), positive predictive value (69.70%), negative predictive value (88.46%) and diagnostic accuracy (77.97%). Diagnostic accuracy of procalcitonin is maximum followed by C-reactive protein.
Conclusions: In our study all patient with gram negative organism were procalcitonin positive whereas 50% Staphylococcus aureus were procalcitonin positive and in candida positive cases out of 6 cases, 5 (83.3%) were procalcitonin positive.
A case series of invasive pneumococcal disease in children
Authors: B. Baburaj , Cherian Carol Sara , Abraham Jacob , Jacob Aneeta Mary
Published: May 2023

Invasive pneumococcal disease (IPD) has a high clinical burden, particularly among children in developing countries.  We presented 4 cases of IPD in children who were admitted to Pushpagiri institute of medical science and research centre, Kerala between 2021 and 2022. While our first 3 patients had milder course of disease, our fourth patient who presented with severe pneumonia with pleural effusion had poor outcome. The fact that three out of four of our patients have not received pneumococcal vaccination marks the necessity of this vaccine to prevent IPD in children.
Roger’s syndrome presenting with stroke
Authors: Kataria Bhavya , Patra Bijoy , Chumber Shishir , Vani Kavita
Published: May 2023

Rogers syndrome (Thiamine responsive megaloblastic anaemia-TRMA) occurs due to defect in the SLC19A2 gene. SLC19A2 and SLC19A3 genes encode THTR1 and 2 respectively, which are thiamine transporter proteins. The SLC19A2 gene is expressed in the inner ear cells, β-islet cells, and hematopoietic stem cells; consequently, the typical clinical trial of TRMA is diabetes, TRMA, and sensorineural hearing loss. This syndrome, eponymously called Roger’s syndrome is rare. Mode of inheritance of TRMA is autosomal recessive. Clinical presentation as recurrent stroke is extremely rare. We present a case of a five-year-old boy who had recurrent large artery territory cerebral infarcts, with no other identifiable underlying cause of stroke. During current admission, no underlying etiology could be identified for cerebral infarct. On workup, a preliminary diagnosis of TRMA was made and thiamine supplementation was instituted. Gene analysis confirmed the diagnosis. The child was a product of non-consanguineous marriage. There was history of early childhood demise of two older siblings within five years of age due to diabetic ketoacidosis (DKA). TRMA is a rare autosomal recessive syndrome that manifests as a typical triad with diabetes, hearing loss and megaloblastic anaemia. The treatment is with high dose thiamine supplementation that can alleviate symptoms of diabetes and megaloblastic anaemia. Onset and progression of hearing loss may be delayed with treatment. Some cases may present with recurrent stroke as in the proband.
Schimke immunoosseous dysplasia: a multisystem disorder
Authors: Karuna  , V. Sumitra , K. Shilpa
Published: May 2023

Schimke immunoosseous dysplasia is an autosomal recessive disorder characterized by spondyloepiphyseal dysplasia, lymphopenia with defective cellular immunity, and renal insufficiency. It is caused by a biallelic mutation in SMARCAL 1 gene. In this study, we described clinical and genetic diagnosis of a 5 years old girl who presented to our centre with short stature and repeated infections in the past. She had one episode of stroke in the past due to infarction and she was diagnosed with hypertension 1 year back. Last admission in the hospital, she had new stroke episode and found to have steroid resistant nephrotic syndrome.