Disc prolapse in pregnancy

Surgery is required only in about 1 in 10 cases of slipped disc. It may be considered if there is evidence of severe nerve compression, symptoms not improved using other treatments, having difficulty in standing or walking, have severe symptoms such as progressive muscle, weakness or altered bladder function. A microdiscectomy is typically performed for a herniated lumbar disc and is actually more effective for treating leg pain (also known as radiculopathy) than lower back pain. Impingement on the nerve root (compression) can cause substantial leg pain. While it may take weeks or months for the nerve root to fully heal and any numbness or weakness to get better, patients normally feel relief from leg pain almost immediately after a microdiscectomy spine surgery. Backache during pregnancy must not be overlooked as only minor ailment due to mechanical stress. Patient should be investigated on lines of spinal pathology

Role of anti-oxidants to reduce free radical induced injury in preeclampsia

Background: The aim of study is to study role of antioxidants to reduce free radical induced oxidative stress in preeclampsia.Methods: A prospective study conducted with 326 patients in UISEMH, Kanpur at Department of Obstetrics and Gynaecology from January 2011 - January, 2012 with 326 patients. There were divided into 2 groups - control and study group on the basis of measurement of activity of superoxide dismutase at 20 weeks, control group constituted patients with normal SOD level (Normal values >0.702 U/mg of protein). Study group constituted 180 patients with decreased SOD level at 20 weeks, they were further divided into 2 groups - study group A and study group B, according to intervention given in form of Vit. C 1000 mg OD from 20 weeks till delivery. SOD was re-measured in control and study group at 32 weeks. Result was studied in terms of value of SOD at 32 weeks and incidence of PIH and IUGR, mode of delivery, complications in forms of mild and severe PET, Abruptio placentae, antepartum eclampsia and IUGR.Results: The study showed that mean level of SOD at 20 weeks in study group was much less as compared to control group, also SOD value in group A at 32 weeks is much less as compared to group B in which intervention was given t value ~ 46.877, p value <0.0001; 95% CI - 0.285223 - 0.310391, which is statistically highly significant. Hence, in our study there was statistically significant improvement in SOD enzyme levels after giving intervention in study group.Conclusions: Since, preeclampsia is multifactorial disorder in which oxidative stress plays very important role in pathophysiology amongst various other factors. The antioxidant supplementation to such patients who already have reduced anti-oxidant status definitely has role in decreasing incidence of PIH and its severity

To study the role of epidural analgesia in anaemic parturients

Background: To study the safety of epidural analgesia, effect on cardiotocographic parameters, fetal outcome and obstetric outcome of epidural analgesia in anaemic parturients and maternal satisfaction as well as pain relief among antenatal cases admitted in Upper India Sugar Exchange, GSVM Medical College, Kanpur, UP, India.Methods: This prospective study was conducted in anaemic parturients with cephalic presentation, singleton pregnancy having 36-42 weeks of gestation. Subjects of present study were divided into 2 groups. Control group included anaemic parturients not undergoing epidural analgesia. Study group included anaemic parturients who will be undergoing epidural analgesia. All these patients were followed up to delivery. When cervix was 3cm dilated, NST was taken 15minutes before analgesia and every 30 minutes after analgesia. Top up dose (0.0625% bupivacaine) was injected through catheter on parturients demand. For effect on CTG parameters, NST was taken 15minutes before analgesia and every 30 minutes after analgesia. Following every top up dose 10 minute monitoring for uterine contractions and effect for adequate analgesia was noted. Side effects and complaints noted at 5, 15, 30, 45, 60, 90, 120, 150 and 180 min interval. Fetal condition was also monitored and evidence of fetal distress, on clinical and/or cardiotocographic monitoring, was recorded. Patients walking duration was recorded in relation to study time from epidural insertion to delivery time. Labour was managed and mode of delivery and time of delivery was noted. Assessment of neonatal outcome was done with the help of Apgar scoring at 1 and 5minute after delivery and NICU admissions.Results: Maximum numbers of patients are lying between age groups of 18-23 and 24-29 years and are of gestational age group 37-40 weeks in both study and control group. The duration of 1st stage of labour in maximum number of primigravida patients is 5-8 hours and in multigravida it was 2-4 hours in both epidural and control group. The visual analogue scale is according to pain perceived during the course of labour and delivery by the epidural and control group. The degree of pain relief is statistically highly significant between epidural and control groups. Occurrences of maternal tachycardia are 5 times more in cases in whom epidural analgesia was not given.Conclusions: There is no statistically significant difference in the duration of 2nd stage of labour in both the groups of primigravida as well as there is no effect on the duration of second stage of labour in multigravida parturients in both the groups. Pain relief was more in the epidural group and was more satisfied after their delivery. There was no difference in effect on fetal outcome in epidural and control groups. There was no significant effect on cardiotocographic parameters except for the fact that for about 30 minutes post epidural top-up, there was fetal bradycardia which easily subsided with conservative management with left lateral position and oxygen. Maternal tachycardia was less in epidural group. This was highly significant because anaemic parturients are more prone to develop signs of cardiac failure during labour due to increase in stroke volume due to increase in heart rate due to pain

To study the role of epidural analgesia in anaemic parturients

Background: To study the safety of epidural analgesia, effect on cardiotocographic parameters, fetal outcome and obstetric outcome of epidural analgesia in anaemic parturients and maternal satisfaction as well as pain relief among antenatal cases admitted in Upper India Sugar Exchange, GSVM Medical College, Kanpur, UP, India.Methods: This prospective study was conducted in anaemic parturients with cephalic presentation, singleton pregnancy having 36-42 weeks of gestation. Subjects of present study were divided into 2 groups. Control group included anaemic parturients not undergoing epidural analgesia. Study group included anaemic parturients who will be undergoing epidural analgesia. All these patients were followed up to delivery. When cervix was 3cm dilated, NST was taken 15minutes before analgesia and every 30 minutes after analgesia. Top up dose (0.0625% bupivacaine) was injected through catheter on parturients demand. For effect on CTG parameters, NST was taken 15minutes before analgesia and every 30 minutes after analgesia. Following every top up dose 10 minute monitoring for uterine contractions and effect for adequate analgesia was noted. Side effects and complaints noted at 5, 15, 30, 45, 60, 90, 120, 150 and 180 min interval. Fetal condition was also monitored and evidence of fetal distress, on clinical and/or cardiotocographic monitoring, was recorded. Patients walking duration was recorded in relation to study time from epidural insertion to delivery time. Labour was managed and mode of delivery and time of delivery was noted. Assessment of neonatal outcome was done with the help of Apgar scoring at 1 and 5minute after delivery and NICU admissions.Results: Maximum numbers of patients are lying between age groups of 18-23 and 24-29 years and are of gestational age group 37-40 weeks in both study and control group. The duration of 1st stage of labour in maximum number of primigravida patients is 5-8 hours and in multigravida it was 2-4 hours in both epidural and control group. The visual analogue scale is according to pain perceived during the course of labour and delivery by the epidural and control group. The degree of pain relief is statistically highly significant between epidural and control groups. Occurrences of maternal tachycardia are 5 times more in cases in whom epidural analgesia was not given.Conclusions: There is no statistically significant difference in the duration of 2nd stage of labour in both the groups of primigravida as well as there is no effect on the duration of second stage of labour in multigravida parturients in both the groups. Pain relief was more in the epidural group and was more satisfied after their delivery. There was no difference in effect on fetal outcome in epidural and control groups. There was no significant effect on cardiotocographic parameters except for the fact that for about 30 minutes post epidural top-up, there was fetal bradycardia which easily subsided with conservative management with left lateral position and oxygen. Maternal tachycardia was less in epidural group. This was highly significant because anaemic parturients are more prone to develop signs of cardiac failure during labour due to increase in stroke volume due to increase in heart rate due to pain

Role of anti-oxidants to reduce free radical induced injury in preeclampsia

Background: The aim of study is to study role of antioxidants to reduce free radical induced oxidative stress in preeclampsia.Methods: A prospective study conducted with 326 patients in UISEMH, Kanpur at Department of Obstetrics and Gynaecology from January 2011 - January, 2012 with 326 patients. There were divided into 2 groups - control and study group on the basis of measurement of activity of superoxide dismutase at 20 weeks, control group constituted patients with normal SOD level (Normal values &gt;0.702 U/mg of protein). Study group constituted 180 patients with decreased SOD level at 20 weeks, they were further divided into 2 groups - study group A and study group B, according to intervention given in form of Vit. C 1000 mg OD from 20 weeks till delivery. SOD was re-measured in control and study group at 32 weeks. Result was studied in terms of value of SOD at 32 weeks and incidence of PIH and IUGR, mode of delivery, complications in forms of mild and severe PET, Abruptio placentae, antepartum eclampsia and IUGR.Results: The study showed that mean level of SOD at 20 weeks in study group was much less as compared to control group, also SOD value in group A at 32 weeks is much less as compared to group B in which intervention was given t value ~ 46.877, p value &lt;0.0001; 95% CI - 0.285223 - 0.310391, which is statistically highly significant. Hence, in our study there was statistically significant improvement in SOD enzyme levels after giving intervention in study group.Conclusions: Since, preeclampsia is multifactorial disorder in which oxidative stress plays very important role in pathophysiology amongst various other factors. The antioxidant supplementation to such patients who already have reduced anti-oxidant status definitely has role in decreasing incidence of PIH and its severity

Aspirin and clopidogrel resistance in Indian patients with ischemic stroke and its associations with gene polymorphisms: A pilot study

Introduction: Antiplatelet resistance is one of the urgent issues in current stroke care. One-third to one-half of the patients who experience a recurrent stroke is already on antiplatelet medications. We studied resistance to aspirin and clopidogrel in Indian stroke patients and its association with gene polymorphisms. Methods: Platelet function testing by light transmission aggregometry was performed on 65 patients with ischemic stroke who were stable on dual antiplatelet therapy (clopidogrel 75 mg OD and aspirin 75 mg OD) along with 65 age-matched controls. Aspirin resistance was considered as mean platelet aggregation ≥70% with 10 μM adenosine diphosphate (ADP) and ≥20% with 0.75 mM arachidonic acid. Clopidogrel resistance was defined as <10% decrease from the baseline in platelet aggregation in response to ADP 10 μM and semi-response as <30% decrease from the baseline. Polymorphisms CYP2C19 * 2 and GPIIb/IIIa (PLA1/A2) were genotyped by polymerase chain reaction-restriction fragment length polymorphism. Results: We found 64.6% (42/65) patients with inadequate response to clopidogrel (15.4% [10/65] resistant and 49.2% [32/65] semi-responders) and 4.6% (3/65) patients with inadequate response to aspirin (3.1% [2/65] resistant and 1.5% [1/65] semi-responder). The frequency of CYP2C19*2 mutant genotype was significantly higher in clopidogrel nonresponders compared to responders (P = 0.014). Clopidogrel nonresponsiveness was much higher in small vessel stroke. Conclusion: Unlike aspirin, a high proportion of nonresponders to clopidogrel was identified. In an interim analysis on 65 Indian patients, a significant association was found between CYP2C19*2 and clopidogrel nonresponsiveness

Impact of pneumococcal conjugate vaccine on the carriage density of Streptococcus pneumoniae and Staphylococcus aureus in children living with HIV: a nested case–control study

Nasopharyngeal colonization density of Streptococcus pneumoniae (pneumococcus) is associated with disease severity and transmission. Little is known about the density of pneumococcal carriage in children with HIV (CLH). Pneumococcal vaccines may impact the density of pneumococcus and competing microbes within the nasopharynx. We examined the impact of one dose of PCV13 on carriage density of pneumococcus and Staphylococcus aureus, in CLH, HIV-uninfected children (HUC), and their unvaccinated parents. We conducted a pilot-nested case–control study, within a larger prospective cohort study, on the impact of PCV13, in families in West Bengal India. Quantitative real-time PCR was run on 147 nasopharyngeal swabs from 27 CLH and 23 HUC, and their parents, before and after PCV13 immunization. CLH had higher median pneumococcal carriage density, compared to HUC: 6.28 × 108 copies/mL vs. 2.11 × 105 copies/mL (p = .005). Following one dose of PCV13, pneumococcal densities dropped in both groups, with an increase in S. aureus carriage to 80% from 48% in CLH, and to 60% in HUC from 25%. While limited in sample size, this pilot study shows that CLH carried higher densities of pneumococcus. PCV13 was associated with a decrease in pneumococcal density and a temporal increase in S. aureus carriage regardless of HIV status

Role of Pre-A Motif in Nitric Oxide Scavenging by Truncated Hemoglobin, HbN, of Mycobacterium tuberculosis*S⃞

Mycobacterium tuberculosis truncated hemoglobin, HbN, is endowed with a potent nitric-oxide dioxygenase activity and has been found to relieve nitrosative stress and enhance in vivo survival of a heterologous host, Salmonella enterica Typhimurium, within the macrophages. These findings implicate involvement of HbN in the defense of M. tuberculosis against nitrosative stress. The protein carries a tunnel system composed of a short and a long tunnel branch that has been proposed to facilitate diatomic ligand migration to the heme and an unusual Pre-A motif at the N terminus, which does not contribute significantly to the structural integrity of the protein, as it protrudes out of the compact globin fold. Strikingly, deletion of Pre-A region from the M. tuberculosis HbN drastically reduces its ability to scavenge nitric oxide (NO), whereas its insertion at the N terminus of Pre-A lacking HbN of Mycobacterium smegmatis improved its nitric-oxide dioxygenase activity. Titration of the oxygenated adduct of HbN and its mutants with NO indicated that the stoichiometric oxidation of protein is severalfold slower when the Pre-A region is deleted in HbN. Molecular dynamics simulations show that the excision of Pre-A motif results in distinct changes in the protein dynamics, which cause the gate of the tunnel long branch to be trapped into a closed conformation, thus impeding migration of diatomic ligands toward the heme active site. The present study, thus, unequivocally demonstrates vital function of Pre-A region in NO scavenging and unravels its unique role by which HbN might attain its efficient NO-detoxification ability