Convulsions in early post-partum period, a diagnostic dilemma

Neurocysticercosis is the most common helminthic (tapeworm) infection of the brain worldwide. It presents as hydrocephalus and acute onset seizures. A 28-year-old para 3 live 3 [P3L3], post-partum [day 7], resident of Arvi, presented in casualty during emergency hours with headache and fever since 7 days. She presented with h/o convulsions 2 episodes, one on day 5 and one on day 7 of her full term vaginal home delivery. She presented to the Emergency Department on day 7 with generalised tonic-clonic seizures preceded by nausea and headache. All her blood investigations were within normal limits except an extremely surprising finding on CT scan. 40% of patients having postpartum convulsions do not experience preeclampsia, clinical awareness is essential for early treatment and care

Successful maternal and fetal outcome of Guillain-Barre syndrome complicating pregnancy: a case report

Guillain-Barré syndrome rarely complicates pregnancy, incidence being 2/100000 population. We report a case of 23-year-old 2nd gravida who developed a progressive ascending paralysis during the second trimester of pregnancy. The worsening of the respiratory insufficiency required transfer to an intensive care unit but did not require artificial ventilation. Cerebrospinal fluid examination revealed albumin-cytological dissociation and repeated electrophysiological studies showed typical features of demyelinating neuropathy with conduction blocks. Biological investigations, especially CMV and campylobacter jejuni serologies, were all negative. Intravenous immunoglobulin infusions resulted in rapid improvement in the patient. This case raises the question of the relationship between the Guillain-Barré syndrome and pregnancy. The occurrence of the disease, as well as the rapid recovery in antenatal period could be consecutive to a partial failure of the maternal immunological tolerance toward the fetus

Role of micronised progesterone in maintenance therapy following arrested preterm labor: a randomised controlled trial

Background: The aims and objectives of this study were to determine whether maintenance tocolytic therapy with micronised progesterone (400 mg) in patients with arrested preterm labor, prolongs the latency period of gestation and to see the effect of prolonged latency period on fetal outcome in terms of birth weight and NICU admissions and maternal outcome in terms of prolongation to term gestation.Methods: Pregnant women who were arrested with acute tocolysis as evidenced by a 12 hour contraction free period were randomized into study and control groups. The study group received 400 mg of vaginal micronized progesterone daily, while the control group did not receive any drug. The patients were followed up till 37 completed weeks. Prolongation of pregnancy upto term and birth wt. and NICU admissions were noted.Results: 1) In the present study the mean period of gestation at delivery was significantly high in study group 37.51 ± 2.70 weeks as compared to that in control group 35.15 ± 2.72 weeks. This was statistically significant at 95% confidence interval by using student’s t statistics. 2) In the present study, 42.00% babies in study group had birth weight more than 2.5 kg which was significantly higher than that in control group, in which 24.00% had birth weight more than 2.5 kg.Conclusions: We conclude that, maintenance tocolytic therapy with micronised progesterone (400 mg) up-to 37 weeks of gestation in patients with arrested preterm labor significantly prolongs the latency period and results in better perinatal outcome.

Correlation of diagnostic efficacy of unhealthy cervix by cytology, colposcopy and histopathology in women of rural areas

Background: The objective was to assess the sensitivity and specificity of pap smear and colposcopy and to study the socio demographic parameters of women with unhealthy cervix. Methods: This was a prospective observational study conducted from August 2011 – August 2013 in the Department of Obstetrics and Gynaecology. Pap smear was performed by the conventional method and colposcopy was done for all 200 sexually active women who came with complaints of discharge per vagina, inter menstrual or post coital bleeding. Colposcopy results were analysed. Final correlation of pap smear and colposcopy were based on histopathology.Results: There were 200 samples that were suitable for statistical analysis. The sensitivity of colposcopy was 79.37%, specificity 81.02%, positive predictive value 65.79%, negative predictive value 89.52% respectively and accuracy was 80.5%. Pap smear had a sensitivity of 25.4%, specificity of 99.27%, positive predictive value of 94.12%, negative predictive value of 74.32%, and accuracy of 76.0% respectively.Conclusions: Pap smear had a poorer sensitivity compared to Colposcopy but a better specificity than colposcopy. Hence it may be better to utilise both tests as they complement each other in screening of premalignant lesions of cervix

Association of iron deficiency states and febrile seizures in children-a case control study

Background: Iron deficiency being a potentially modifiable and treatable cause of febrile seizures.  Objectives of Study was to identify Iron Deficient States or Anemia in children with febrile seizures as evidenced by low hemoglobin, altered RBC indices and altered Iron profile, and to determine the association of Iron deficiency states or anemia with febrile seizures.Methods: This was a Case control study done between July 2013 to June 2014, on 50 indoor cases of febrile seizures in the age group of 6-60 months and 50 age and sex matched controls (fever without seizure) in department of Paediatrics, Hindu Hriday Samrat Balasaheb Thackrey Medical College (HBTMC) and Dr R.N. Cooper Hospital, Mumbai. Detailed clinical history and examination findings were noted.  Cases and control were investigated with complete blood count, RBC indices, peripheral smear, S. Ferritin, S. Iron and TIBC. SPSS software package was used for statistical analysis. P<0.05 was considered as significant.Results: 74% of cases and 66% of controls had low hemoglobin. MCV was low in 54% of cases and 34% of controls. RDW was raised in 46% of cases and 26% of controls. Iron deficiency anemia was prevalent among both cases and controls. Latent iron deficiency state suggested by low S. Iron and high TIBC in cases and control group was not significant in our study. However statistically significant lower Median S. Ferritin was noted in the febrile seizure group versus the controls (Cases-153.5, Control-173.0, p=0.0195) suggesting significant prevalence of prelatent iron deficiency state among cases.Conclusions: Prelatent iron deficient state in children are more prone for febrile seizures

A thoracophagus conjoined twins with myelomeningocele: an unusual case

Conjoined twins represent one of the rarest forms of twin gestation. Conjoined twinning is rare, occurring in about 1% of monochorionic twins with an estimated incidence ranging from 1:30,000 to 1:2,00,000 live births and 1 in 650 to 900 twin deliveries. A 21 year old gravida 2, with an abortion, a resident of Ginjakheda, Deoli Wardha came to our hospital, AVBRH Sawangi and presented with history of amenorrhoea of six months. She had her first ultrasonography done which demonstrated thoracophagus conjoined twins. Patient was admitted in view of management of conjoined twins. She was posted for elective caesarean section on 5/11/11. A conjoined twin of combined weight around 2 kgs was extracted out. Both the foetuses were female with multiple congenital anomalies. In conclusion, conjoined twins are associated with a high perinatal mortality; therefore making an early diagnosis by means of ultrasonography, gives parents a chance to elect pregnancy termination

Biological Consequences of Tightly Bent DNA: The Other Life of a Macromolecular Celebrity

The mechanical properties of DNA play a critical role in many biological functions. For example, DNA packing in viruses involves confining the viral genome in a volume (the viral capsid) with dimensions that are comparable to the DNA persistence length. Similarly, eukaryotic DNA is packed in DNA-protein complexes (nucleosomes) in which DNA is tightly bent around protein spools. DNA is also tightly bent by many proteins that regulate transcription, resulting in a variation in gene expression that is amenable to quantitative analysis. In these cases, DNA loops are formed with lengths that are comparable to or smaller than the DNA persistence length. The aim of this review is to describe the physical forces associated with tightly bent DNA in all of these settings and to explore the biological consequences of such bending, as increasingly accessible by single-molecule techniques.Comment: 24 pages, 9 figure

Prediction of Air-Side Particulate Fouling of HVAC&R Heat Exchangers

Air-to-refrigerant heat exchangers used in heating, ventilation, air-conditioning, and refrigeration systems routinely experience air-side fouling due to the presence of particulates in outdoor and indoor environments. The influence on the performance of the heat exchanger, in terms of heat transfer efficiency and pressure drop imposed, depends on the extent of air-side fouling. Fouling of a heat exchanger is determined by a variety of parameters such as the dimensions of the heat exchanger, physical properties of the airborne particulates, and airflow conditions over the heat exchange surfaces. A comprehensive model is developed to deterministically calculate the extent of fouling of a heat exchanger as a function of these parameters by accounting for each of the possible deposition mechanisms. The study enhances modeling approaches previously employed in the literature by accounting for time-dependent accumulation of particles as well as the effects of the streamwise distribution of accumulated dust on subsequent fouling; the calculations for the deposition due to several of the mechanisms are also refined to improve prediction accuracy. Particulate matter deposits already present on the surface are found to accelerate the process of fouling by decreasing available area for airflow; an existing deposit layer effectively decreases the distance that a particle must travel to collide with a surface and increases the surface area available for deposition. The modified model predictions are compared against extant experimental deposition fraction data; an improved agreement is observed compared to previous models in the literature