Malignant Melanoma of the Stomach

Malignant melanoma with metastasis to the stomach is rare and seldom diagnosed before death. The most common gastrointestinal (GI) metastatic site is the small intestine, followed by the colon, rectum and stomach. We present the case of a 55-year-old woman with a history of melanoma who presented with melena and syncope, and was found to have metastatic gastric melanoma

A comparative study of single versus repeat instillation of intravaginal prostaglandin E2 gel for induction of labour

Background: The aim of induction was to achieve successful vaginal delivery where continuation of pregnancy is not desirable. Unfavourable cervix is one of the main causes of failed induction. Introduction of intravaginal prostaglandins E2 has revolutionised the method of cervical ripening. More than one dose of prostaglandin E2 (PGE2) gel may be necessary to facilitate cervical ripening and increase the chances of vaginal delivery.Methods: This retrospective study was done to find the efficacy of repeat instillation of intravaginal PGE2 gel and to compare the maternal and fetal outcome between the single instillation group and repeat instillation group. The women who went into labour or achieved cervical ripening with a single instillation of PGE2 gel forms Group A. Those who required repeat instillation of PGE2 gel forms Group B. Both groups were compared for specific parameters.Results: Primigravidas required repeat instillation. Postdated pregnancy was the most common indication for induction of labour. 45.2% of primis required only single dose and 54.8% required repeat dose. About two third (77.8%) of multipara required only one dose and a third of multipara needed repeat dose. In Group A 90.7% had vaginal delivery, 9.3% had Caesarean section. Group B 95.7% had vaginal delivery and 4.3% had Caesarean section.Conclusions: Prostaglandins PGE2 (0.5 mg) gel is recommended to be used intravaginally. We applied 2 doses of intravaginal PGE2, 24 hours apart and no complications like uterine hyperstimulation was seen. There is no increased fetal risk with repeat instillation of intravaginal PGE2 gel

A study of gestational diabetes mellitus and fetal outcome in a tertiary care center

Background: Modern desk-bound lifestyle and unhealthy dietary changes have brought a rise in the prevalence of obesity and gestational diabetes mellitus (GDM). It is associated with severe hazards to the mother and the baby. It is mandatory that early diagnosis ensues and timely and congruous management is undertaken.Methods: In this observational study, 1250 women were included. A standardized questionnaire was formed and their details were noted. Tests for glucose levels, complete blood picture, urine examination were performed. An oral glucose tolerance test was performed on all the patients. Neonatal outcomes in terms of birth weight and the presence of complications were noted.Results: A total 201 (16.1%) of all women were having gestational diabetes mellitus (GDM). Most mothers were in the 25-30 age group. The majority of the women had a BMI between 26-30. 21.9% of babies were having weight >3.5 kgs. 11.4% of babies were <2.5 kgs. Out of 201 neonates, 90 babies were having complications. Major complications in neonates were macrosomia and respiratory distress. Therefore, early diagnosis, glycemic control, and timely and congruous management are advantageous to both mother and baby.Conclusions: GDM complicating the pregnancy results in a higher prevalence of complications in the mother and the neonate. Therefore, appropriate control of the sugar level in mothers is necessary and it decreases the morbidity and mortality rates in the babies as well as the mothers.

Study of effects of oligohydramnios on perinatal outcome

Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome

A study of feto-maternal outcome in case of premature rupture of membrane at a tertiary care center

Background: Premature rupture of membranes is the rupture of the fetal membranes in the absence of uterine contraction or before the onset of labor. When this occurs before 37 weeks of gestation, it is termed as preterm premature rupture of membranes. Management depends upon gestational age and the presence of complicating factors. An accurate assessment of gestational age and knowledge of the maternal, fetal and neonatal risks are essential to appropriate evaluation, counselling, and care of patients with PROM. The purpose of the study is timely diagnosis and appropriate management of the cases of PROM and PPROM to improve maternal and neonatal outcomes. Methods: A Prospective study was performed at the department of obstetrics and gynecology, at a tertiary care center from August 2020 to December 2021. A clinical data sheet was made for recording all information about the pregnant women after taking their consent. And their maternal and neonatal outcomes were recorded. Results: a total of 150 cases of PROM and PPROM were taken during our study out of which 53.33% belong to the younger age group, 43.33% were primi gravida, 66.66% belonged to the lower socioeconomic class, 25.33% had a previous history of abortion followed by dilatation and evacuation, rate of cesarean delivery was 34.66% and rate of NICU admission of neonates was 15.78% and 57.87% babies had low birth weight and rate of stillbirth was 1.97%. whereas 34.66% of cases had various complications related to PROM. Conclusions: Individualized management of PROM cases depending on the gestational age and risk of complications and antibiotic coverage is the best way to achieve a good fetomaternal outcome

Association of common genetic variants with lipid traits in the Indian population.

Genome-wide association studies (GWAS) have been instrumental in identifying novel genetic variants associated with altered plasma lipid levels. However, these quantitative trait loci have not been tested in the Indian population, where there is a poorly understood and growing burden of cardiometabolic disorders. We present the association of six single nucleotide polymorphisms in 1671 sib pairs (3342 subjects) with four lipid traits: total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C). We also investigated the interaction effects of gender, location, fat intake and physical activity. Each copy of the risk allele of rs964184 at APOA1 was associated with 1.06 mmol/l increase in triglycerides (SE = 0.049; p = 0.006), rs3764261 at CETP with 1.02 mmol/l increase in both total cholesterol (SE = 0.042; p = 0.017) and HDL-C (SE = 0.041; p = 0.008), rs646776 at CELSR2-PSRC1-SORT1 with 0.96 mmol/l decrease in cholesterol (SE = 0.043; p = 0.0003) and 0.15 mmol/l decrease in LDL-C levels (SE = 0.043; p = 0.0003) and rs2954029 at TRIB1 with 1.02 mmol/l increase in HDL-C (SE = 0.039; p = 0.047). A combined risk score of APOA1 and CETP loci predicted an increase of 1.25 mmol/l in HDL-C level (SE = 0.312; p = 0.0007). Urban location and sex had strong interaction effects on the genetic association of most of the studied loci with lipid traits. To conclude, we validated four genetic variants (identified by GWAS in western populations) associated with lipid traits in the Indian population. The interaction effects found here may explain the sex-specific differences in lipid levels and their heritability. Urbanization appears to influence the nature of the association with GWAS lipid loci in this population. However, these findings will require replication in other Indian populations

Socio-economic patterning of cardiometabolic risk factors in rural and peri-urban India: Andhra Pradesh children and parents study (APCAPS).

AIM: To assess the prevalence of cardiometabolic risk factors by socio-economic position (SEP) in rural and peri-urban Indian population. SUBJECTS AND METHODS: Cross-sectional survey of 3,948 adults (1,154 households) from Telangana (2010-2012) was conducted to collect questionnaire-based data, physical measurements and fasting blood samples. We compared the prevalence of risk factors and their clustering by SEP adjusting for age using the Mantel Hansel test. RESULTS: Men and women with no education had higher prevalence of increased waist circumference (men: 8 vs. 6.4 %, P < 0.001; women: 20.9 vs. 12.0 %, P = 0.01), waist-hip ratio (men: 46.5 vs. 25.8 %, P = 0.003; women: 58.8 vs. 29.2 %, P = 0.04) and regular alcohol intake (61.7 vs. 32.5 %, P < 0.001; women: 25.7 vs. 3.8 %, P < 0.001) than educated participants. Unskilled participants had higher prevalence of regular alcohol intake (men: 57.7 vs. 38.7 %, P = 0.001; women: 28.3 vs. 7.3 %, P < 0.001). In contrast, participants with a higher standard of living index had higher prevalence of diabetes (top third vs. bottom third: men 5.2 vs. 3.5 %, P = 0.004; women 5.5 vs. 2.4 %, P = 0.003), hyperinsulinemia (men 29.5 vs. 16.3 %, P = 0.002; women 31.1 vs. 14.3 %, P < 0.001), obesity (men 23.3 vs. 10.6 %, P < 0.001; women 25.9 vs. 12.8 %, P < 0.001), and raised LDL (men 16.8 vs. 11.4 %, P = 0.001; women 21.3 vs. 14.0 %, P < 0.001). CONCLUSIONS: Cardiometabolic risk factors are common in rural India but do not show a consistent association with SEP except for higher prevalence of smoking and regular alcohol intake in lower SEP group. Strategies to address the growing burden of cardiometabolic diseases in urbanizing rural India should be assessed for their potential impact on social inequalities in health

Effect of supplemental nutrition in pregnancy on offspring’s risk of cardiovascular disease in young adulthood:long-term follow-up of a cluster trial from India

BACKGROUND: Undernutrition during intrauterine life and early childhood is hypothesised to increase the risk of cardiovascular disease (Developmental Origins of Health and Disease Hypothesis), but experimental evidence from humans is limited. This hypothesis has major implications for control of the cardiovascular disease epidemic in South Asia (home to a quarter of world's population), where a quarter of newborns have low birth weight. We investigated whether, in an area with prevalent undernutrition, supplemental nutrition offered to pregnant women and their offspring below the age of 6 years was associated with a lower risk of cardiovascular disease in the offspring when they were young adults. METHODS AND FINDINGS: The Hyderabad Nutrition Trial was a community-based nonrandomised controlled intervention trial conducted in 29 villages near Hyderabad, India (1987-1990). Protein-calorie food supplement was offered daily to pregnant and lactating women (2.09 MJ energy and 20-25 g protein) and their offspring (1.25 MJ energy and 8-10 g protein) until the age of six years in the 15 intervention villages, but not in the 14 control villages. A total of 1,826 participants (949 from the intervention villages and 877 from the control villages, representing 70% of the cohort) at a mean age of 21.6 years (62% males) were examined between 2009 and 2012. The mean body mass index (BMI) of the participants was 20 kg/m2 and the mean systolic blood pressure was 115 mm Hg. The age, sex, socioeconomic position, and urbanisation-adjusted effects of intervention (beta coefficients and 95% confidence intervals) on outcomes were as follows: carotid intima-media thickness, 0.01 mm (-0.01 to 0.03), p = 0.36; arterial stiffness (augmentation index), -1.1% (-2.5 to 0.3), p = 0.097; systolic blood pressure, 0.5 mm Hg (-0.6 to 1.6), p = 0.36; BMI, -0.13 kg/m2 (-0.75 to 0.09), p = 0.093; low-density lipoprotein (LDL) cholesterol, 0.06 mmol/L (-0.07 to 0.2), p = 0.37; and fasting insulin (log), -0.06 mU/L (-0.19 to 0.07), p = 0.43. The limitations of this study include nonrandomised allocation of intervention and lack of data on compliance, and potential for selection bias due to incomplete follow-up. CONCLUSIONS: Our results showed that in an area with prevalent undernutrition, protein-calorie food supplements offered to pregnant women and their offspring below the age of 6 years were not associated with lower levels of cardiovascular risk factors among offspring when they were young adults. Our findings, coupled with evidence from other intervention studies to date, suggest that policy makers should attach limited value to cardiovascular health benefits of maternal and child protein-calorie food supplementation programmes

Cohort profile: Andhra Pradesh Children and Parents Study (APCAPS).

The Andhra Pradesh Children and Parents Study (APCAPS) was originally established to study the long-term effects of early-life undernutrition on risk of cardiovascular disease. Its aims were subsequently expanded to include trans-generational influences of other environmental and genetic factors on chronic diseases in rural India. It builds on the Hyderabad Nutrition Trial (HNT) conducted in 1987-90 to compare the effects on birthweight of a protein-calorie supplement for pregnant women and children. The index children of HNT and their mothers were retraced and examined in 2003-05, and the children re-examined as young adults aged 18-21 years in 2009-10. The cohort was expanded to include both parents and siblings of the index children in a recently completed follow-up conducted in 2010-12 (N=∼6225 out of 10,213 participants). Recruitment of the remaining residents of these 29 villages (N=∼55,000) in Ranga Reddy district of Andhra Pradesh is now under way. Extensive data on socio-demographic, lifestyle, medical, anthropometric, physiological, vascular and body composition measures, DNA, stored plasma, and assays of lipids and inflammatory markers on APCAPS participants are available. Details of how to access these data are available from the corresponding author