Feasibility and accuracy of fetal echocardiography at routine 11 to 13 weeks 6 days ultrasound performed on unselected obstetric population in a tertiary maternity centre with high patient turnover

Background: Congenital heart defects (CHD) remain the most prevalent congenital malformations, with an estimated prevalence of 6-8 per 1000 live births. Routinely, fetal echo is performed around 18-22 weeks among high risk cases. A dedicated early fetal echo (EFEC) performed by experts between 11-16 weeks is emerging as an excellent screening tool among high risk cases. However, feasibility of obtaining such cardiac views during routine Nuchal Translucency scan by trained obstetricians, is yet to be known as there is limited time available with high patient turn over. Present study aimed to know the feasibility and accuracy of EFEC in unselected obstetric population in a tertiary maternity centre with high patient turnover.Methods: This was an observational cohort study from March 2015 to April 2017 at a tertiary maternity referral hospital. Singleton pregnant women undergoing routine 11-13+6 weeks scanning (NT scan) were recruited in the study including both high and low risk pregnancies. Possibility of obtaining 4 basic cardiac views within this limited time was assessed.Results: A total of 180 early fetal ECHO’s were performed during the course of this study. The 4-chamber view (79.44%) of the heart was the easiest parameter to visualize. RVOT (28.88%) was the most difficult view to be obtained. Complete visualization of all the cardiac views was possible in only 34 women (18.88%). The visualization rates of the cardiac views improved as the gestational age increased. TVS was essential to obtain cardiac views in 5 cases out of 138 (3.6%) in 12-13+6 scans. Whereas, TVS was essential to visualize cardiac views in 34 cases out of 42 (80.95%) between 11 weeks to 11 weeks 6 days. A total of 7 cardiac anomalies were detected during this study. There were 3 major and 4 minor cardiac malformations. Out of the 3 major anomalies, 2 were AVSDs which were diagnosed by EFEC. Minor defects were undetected.Conclusions: It is feasible to get the basic cardiac views in the limited time available to perform NT scan among unselected obstetric population in a tertiary maternity centre with a high turnover. Gestational age of 12 weeks and above seems to increase the accuracy. TVS is a useful adjunct throughout 11-14 weeks scan

Obstetric and neonatal outcome among women presenting with reduced fetal movements in third trimester

Background: Reduced maternal perception of fetal movements allows early identification, timely evaluation and intervention for fetuses at risk of adverse outcome. The primary objective of this study was to assess the pregnancy characteristics and outcomes of pregnant women presenting to hospital with reduced fetal movements (RFM).Methods: Prospective observational study, recruiting all women with singleton pregnancy at or beyond 28 weeks of gestation presenting with a subjective perception of RFM from April 2015 to December 2016. Maternal characteristics, antenatal risk factors, management pathways and perinatal outcome studied.Results: 47% belonged to high risk pregnancy. Among high risk women, although only 39% showed poor BPP at the first presentation, 58% were delivered irrespective of their gestational age, out of which 32.75% had poor neonatal outcome. Among low risk who had >2 episodes of RFM, 50% had poor neonatal outcome. 7% among high risk pregnancies and 18% among low risk, presented with RFM within 48 hours following steroid prophylaxis.24% of high risk women showed liquor volume abnormalities as compared to low risk (6.3%).Conclusions: Significant proportion of those with RFM belonged to high risk pregnancy. Among high risk group, there were high rates of stillbirth and poor BPP at the time of admission when compared to low risk group. Due to early approach to the hospital and timely intervention, significant women with abnormal BPP had good perinatal outcome. All those fetuses who were delivered on first episode of RFM in low risk group did not show evidence of compromise at birth, probably indicating unnecessary delivery. More than 2 episodes of RFM even among low risk group seems significant as good number of fetuses were compromised at birth. Steroids prophylaxis for the fetal lung maturity causes transient changes in BPP, hence unnecessary delivery should be avoided especially those among low risk pregnancy

Prevelance, risk factors and adverse perinatal outcomes of bacterial vaginosis in pregnancy

Background: Bacterial Vaginosis (BV) is the most common lower genital tract syndrome in women of age group 16 to 25years.BV is a disorder of the vaginal microbial ecosystem characterized by a shift in the vaginal flora, from the normally predominant Lactobacillus species to one dominated by a mixed flora. The prevalence of BV can be around 15-30% and upto 50% in pregnancy. This study aims to study the prevalence of BV and their adverse outcomes on pregnancy.Methods: It is a Cross Sectional Study at Department of Obstetrics and Gynecology, at a tertiary care hospital, for a period of one and half year from November 2016-April 2018.Pregnant women attending antenatal clinic were enrolled after obtaining an informed consent and vaginal swab examination done. The sample size was 200.Results: The prevalence of BV in pregnant females was 18%. The major risk factors for BV in pregnancy were young age, low socioeconomic status and recent sexual activity. All patients who took treatment for BV had good outcome. Amsel criteria had low sensitivity but very high specificity(95%).Individually vaginal PH had a very high sensitivity(91.6%) when compared to the gold standard Gram stain.Conclusions: Routine screening is recommended for all pregnant women with risk factors and with symptoms. Early diagnosis and treatment in pregnant women who are asymptomatic and with no risk factors can prevent adverse outcome

PHARMACOEPIDEMIOLOGICAL EVALUATION OF HIV PHARMACOTHERAPY AT DISTRICT ART CENTER IN SOUTH TELANGANA

Objective: Objective of the study was to assess the drug utilization pattern of antiretroviral drugs, and medication adherence behavior among human immunodeficiency virus (HIV) patients attending a local ART center, Suryapet, South Telangana. Methods: This was a prospective observational study approved by institutional ethics committee. Demographic, clinical, laboratory, and the treatment details were collected on daily basis for new cases and the data add on was collected for old cases. Medication adherence behavior was assessed through Morisky Medication Adherence Scale-8. Results: During the study period, a total of 505 HIV patients were enrolled. Among them, majority patients were women (61%), in the age group of 31–45 (49.7%). Illiterates (52.6%). Major mode of transmission identified was intimate contact (74%), and majority patients were in Stage I (49%). TLE regimen was prescribed in 69.9% patients and for children the prescribed regimen was ABC, 3TC, EFV (5.1%). About 43% patients were found with medium adherence. Conclusion: This study concludes that the most prescribed regimens were combination of TLE, and majority of the patients were found with medium adherence

Incarcerated foreign body in the vagina of a postmenopausal lady

Vaginal foreign bodies retained for long duration are uncommon in present day scenario. When a female presents with recurrent foul smelling vaginal discharge, foreign body should be suspected. Here is a report of foreign body in the vagina of a postmenopausal lady

WOMEN SAFETY DEVICE

Women safety has always been an issue even in these modern times with so much advancement in technology. Women are not safe anywhere and are most vulnerable when travelling alone into lonely roads and deserted places. Existing hand held safety devices for women have many disadvantages as they require a software application to be connected with and also should be connected with Bluetooth . So to overcome these disadvantages we propose a solution which will try to overcome the disadvantages of the existing systems and also aim at providing true proof safety to women. The proposed work aims at designing an IoT based safety device that relies on providing security to women by connecting GPS and GSM to locate place and alert message is send to registered numbers when a women is not safe. When there is unsafe situation women can press push button of the device which sends alert message with location automatically to the registered number

The effect of antenatal corticosteroids on maternal glycemic control, in a tertiary care centre in North Kerala - India

Background: Antenatal glucocorticoid therapy (ACT) can be life-saving in preterm babies and risk of PTL is increasing in. The prevalence of GDM also increasing. Virtually, all women will experience deterioration in their glycaemic control following ACT. The NICE guideline recommends additional insulin and the national Indian guidelines recommend a 20% increase. Objective of this study was to evaluate the changes in maternal serum glucose following corticosteroids in antenatal women.Methods: Prospective controlled trial of 206 patients, divided into 2 groups. Group 1:105 patients with no GDM and Group 2: 101 patients with GDM. Ethical committee approved. FBS and PPBS measured for following 5 days of D1. BMI and starting dose of insulin and dose of insulin hike were recorded. FBS >90 mg/dL and PPBS >120 mg/dL were taken as abnormal. Data were analyzed using SPSSV22.Results: There were a total of 206 of which 105 were in group 1(51%) and 101(49%) were in Group 2. FBS >90 mg/dL in over 65% of all women on D2 10 new cases on D3 and PPBS >120 mg/dL in over 66% of all women on D2 and 13 new cases on D3. Insulin was started in a total of 66 patients of 105 (62.9%) in Group 1 and 33 out of 40 (82.5%) in GDM on MNT. Of the 66 patients who started on insulin in Group 1, 17 (16.2%) patients had to continue insulin and out of 33. In MNT subgroup 10 (25%) had to continue. BMI was high in the patients, who was given and continued insulin.Conclusions: The findings support the concept of increasing the dose of insulin even before the hyperglycemia documented. In the Group 1 66 of 105 patients were started on insulin due to hyperglycemia and 17 had to continue insulin 25.7%), and 33 of 40 patients in GDM on MNT were started on insulin and 10 (30.33%) had to continue. We suggest testing all patients for hyperglycemia and to start  insulin especially in the those with high BMI (>25 as per the Asian Indian)

Association of spirochetal infection with Morgellons disease

Morgellons disease (MD) is an emerging multisystem illness characterized by skin lesions with unusual filaments embedded in or projecting from epithelial tissue. Filament formation results from abnormal keratin and collagen expression by epithelial-based keratinocytes and fibroblasts. Recent research comparing MD to bovine digital dermatitis, an animal infectious disease with similar skin features, provided clues that spirochetal infection could play an important role in the human disease as it does in the animal illness. Based on histological staining, immunofluorescent staining, electron microscopic imaging and polymerase chain reaction, we report the detection of Borrelia spirochetes in dermatological tissue of four randomly-selected MD patients. The association of MD with spirochetal infection provides evidence that this infection may be a significant factor in the illness and refutes claims that MD lesions are self-inflicted and that people suffering from this disorder are delusional. Molecular characterization of the Borrelia spirochetes found in MD patients is warranted

A proposed role for efflux transporters in the pathogenesis of hydrocephalus

Hydrocephalus is a common brain disorder that is treated only with surgery. The basis for surgical treatment rests on the circulation theory. However, clinical and experimental data to substantiate circulation theory have remained inconclusive. In brain tissue and in the ventricles, we see that osmotic gradients drive water diffusion in water-permeable tissue. As the osmolarity of ventricular CSF increases within the cerebral ventricles, water movement into the ventricles increases and causes hydrocephalus. Macromolecular clearance from the ventricles is a mechanism to establish the normal CSF osmolarity, and therefore ventricular volume. Efflux transporters, (p-glycoprotein), are located along the blood brain barrier and play an important role in the clearance of macromolecules (endobiotics and xenobiotics) from the brain to the blood. There is clinical and experimental data to show that macromolecules are cleared out of the brain in normal and hydrocephalic brains. This article summarizes the existing evidence to support the role of efflux transporters in the pathogenesis of hydrocephalus. The location of p-gp along the pathways of macromolecular clearance and the broad substrate specificity of this abundant transporter to a variety of different macromolecules are reviewed. Involvement of p-gp in the transport of amyloid beta in Alzheimer disease and its relation to normal pressure hydrocephalus is reviewed. Finally, individual variability of p-gp expression might explain the variability in the development of hydrocephalus following intraventricular hemorrhage