Neuroimaging in eclamptic patients and its clinical implications

Background: Aim of the study is to assess the utility of neuroimaging (CT/MRI) in eclamptic patients and correlating their clinical implications and to study the role of Injection Mannitol in case of Eclampsia who did not respond to injection magnesium sulphate alone. Methods: This prospective study was conducted in Pannadhay Mahila Chikitsalya Udaipur, RNT Medical College Udaipur, Rajasthan. 50 eclamptic patients fulfilling the inclusion and exclusion criteria were subjected to neuroimaging CT/MRI from August 2021 to August 2022. Injection Mannitol was added in eclamptic patients who did not respond to injection magnesium sulphate alone. Results: In this study neuroimaging were normal in 42% cases while 58% cases had pathological changes; PRES, haemorrhage, infarction, ischemia etc. Out of these PRES was seen in 48% cases. Mannitol was given in 14% patients and only one patient did not respond to mannitol. Conclusions: This study revealed that PRES was the main neurological component among patients. Neuroimaging helps in better management of eclampsia. Mannitol holds utility in managing the patients unresponsive to injection magnesium sulphate.

Modified biophysical profile in high-risk pregnancy and its correlation with perinatal outcome

Background: Aim of the present study was to evaluate the perinatal outcome in high-risk pregnancy with modified biophysical profile (MBPP). Methods: The study is observational study,65 high risk pregnant women fulfilling the inclusion criteria participated in the study. The study subjects were subjected to MBPP. Then perinatal outcomes were assessed in view of mode of delivery, maternal and neonatal morbidity and mortality. Results: Out of 65 cases, 78.5% had normal NST, 80% had normal AFI.3 neonates got admitted in NICU. 13 women underwent LSCS, 9 had instrumental delivery and rest delivered vaginally normal. Conclusions: The study showed that HRPs with MBPP abnormal or any of MBPP parameter abnormal have higher chances of perinatal morbidity and mortality

Correlation of non-stress test with fetal outcome in term of Apgar score- a prospective observation study

Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. The objectives of antepartum fetal surveillance are to prevent fetal death and avoidance of unnecessary intervention. This study using NST as a tool for routine antepartum fetal surveillance was trying to catch up those fetuses who might be at risk in womb and provide prompt intervention in otherwise considered normal pregnancies without any obvious high risk factor thus giving the best outcome in mothers.Methods: The objective of this study was to evaluate the correlation of the non-stress test with fetal outcome in pregnancies from 37-42 weeks of gestation.  This was a prospective observational study at Pannadhaya Rajkiya Mahila Chikitsalya Udaipur (Rajasthan) from February 2022 to July 2022. This study included 100 normal pregnant mothers from 37 weeks to 42 weeks who were subjected to NST.Results: The parameters of poor fetal outcome like Apgar score <7 at 5 minutes had increased incidences in the non reactive group.Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. So This study suggested that the NST was found to be a good predictor of the healthy foetus even in normal pregnancies between 37-42 weeks of gestation and the probability of an adverse outcome such as poor Apgar score increases with a non reactive strip

A rare case of genital myiasis in genital prolapse

Genital myiasis is an infestation by fly larvae in genital organs, where they feed and develop as parasites. They can cause severe infection, inflammatory reaction and can be linked to psychiatric disturbances. Commonly cutaneous, ophthalmic, auricular and nasopharyngeal myiasis are seen, with genital myiasis being a rare condition. We reported a case of an 82-year-old postmenopausal female who presented with the complaint of intense pain in genital region. After clinical evaluation she was clinically diagnosed as a case of genital myiasis of prolapsed uterus. Myiasis of the genital organ is a rare clinical entity. Good personal hygiene and proper sanitary conditions are very crucial for prevention of myiasis

A rare case of giant condyloma acuminata during pregnancy

Genital warts (Condyloma acuminata) are a benign lesion caused by human papillomavirus (HPV) type-6 or type-11 and are usually transmitted sexually. During pregnancy, condyloma has a tendency to proliferate and may have recurrence. We have a case of G2P1L1 38 weeks previously normal vaginal delivered patient in our hospital with extensive genital warts. Patient was successfully managed by surgical excision and after that in follow up after 2 months for podophyllin resin application on remaining lesions. HPV infection presentation can range from asymptomatic to cervical cancer. Small genital wart lesion may become extensive and cumbersome during pregnancy and again regress after delivery in due course of time. HPV vaccination, sex education and early treatment of condyloma lesions should prevent and, in any case, improve the prognosis of this disease

Ultrasound assessment of foetal head-perineum distance prior to induction of labour as a predictor of successful vaginal delivery: a prospective study from a tertiary care hospital of Rajasthan

Background: Induction of labor (IOL) is one of the most frequent obstetric procedures require for various obstetrics indications in 13-20% of term. Traditionally success of induction has been determined by Bishop score, but this score is observer based and significant inter observer disagreements have been noted. Ultrasound can help obstetricians in counselling patients before induction of labour and explain the probability of successful induction. So in this study we did ultrasound assessment of foetal head-perineum distance prior to induction of labour as a predictor of successful vaginal delivery. Methods: All eligible women who are planned for induction of labour will undergo ultrasound assessment of foetal head–perineum distance prior to induction of labour. Transvaginal ultrasound will also be performed using ultrasound probe to measure cervical length. After the scans, prevaginal examination will be performed to assess the various components of modified Bishop score (min 0, max 10). If cervix is found unfavourable, induction of labour will be done. If patient did not go into active labour, then induction will be considered unsuccessful) or else oxytocin drip in cases where cervix is found favourable. The patients will be followed up till delivery. Results: Out of 125 patients enrolled for the study, 101 women delivered successfully vaginally and 24 had to undergo caesarean delivery. Of these 24 cases of caesarean delivery, 11 cases were excluded as the operative procedure was performed for indication not related to unsuccessful induction such as occurrence of foetal distress in labour, thick meconium-stained liquor with unfavourable cervix. The final analysis was performed from 114 subjects (101 vaginal births and 13 caesarean births). Conclusions: Transperineal fetal head–perineum distance is less painful as less time consuming and less acceptable by patients compare to Transvaginal measurement of cervical length and painful digital examination for bishop score

Isolation, identification and bioactive potential of bacterial endophytes from Coleus

Coleus (Lamiaceae) is a large and widespread genus comprising of species with diverse ethnobotanical uses. In the present study, bacterial endophytes were isolated from Coleus forskohlii and Coleus aromaticus. Endophytes are the microorganisms which reside within the plants without showing any harmful effect on its host. Diverse types of endophytes live symbiotically within almost all plants and in turn help the plant in a number of ways such as imparting resistance against biotic and abiotic stresses, producing compounds involved in attraction of pollinators, inducing the plant defense mechanisms, etc. The bacterial endophytes isolated in this study, were characterized by microscopic examination (using gram staining) and molecularly identified by sequencing the 16S rRNA. Extracts were prepared from endophytic biomass using solvents of different polarities (methanol, ethyl acetate and butanol) and were screened for their bioactive potential (in vitro cytotoxicity anti-microbial, and anti-oxidant activity). Scale-up of endophytes showing promising results is under process, which will help in isolation of pure compounds

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Yoga offers cardiovascular protection in early postmenopausal women

Context: Postmenopause, an estrogen deficient state comes with increased incidence of cardiovascular diseases (CVDs). Yoga has been described as having a beneficial effect on heart rate variability (HRV), a marker for cardiac autonomic activity which can assess cardiovascular risk, in various populations. Aim: the aim of the study was to study the effect of 3-month long Yoga practice on HRV in early postmenopausal women. Settings and Design: A prospective longitudinal study of 67 women within 5 years of menopause between 45 and 60 years of age attending menopause clinic of Department of Gynaecology, Sucheta Kriplani Hospital fulfilling inclusion and exclusion criteria and consenting were enrolled for the study. Subjects and Methods: HRV of 37 cases (Yoga group) and 30 controls (non-Yoga group) was recorded pre and 3-month postintervention. Statistical Analysis Used: GraphPad Prism Version 5 software was used. Values are a mean and standard error of mean. Statistical significance was set up at P < 0.05. Results: In HRV, frequency domain analysis showed a significant fall in low frequency (LF) in normalized units (nu) and LF: high frequency (HF) ratio and significant rise in HF in nu in the Yoga group (depicting parasympathetic dominance) against a significant rise in LF (nu) and LF: HF ratio and significant fall in HF (nu) in non-Yoga group (indicating sympathetic dominance). Time domain analysis showed a significant decrease in Standard Deviation of NN intervals in Non-Yoga group against nonsignificant changes in Yoga group indicating deterioration in parasympathetic activity in non-Yoga group. Conclusions: Three-month long Yoga practice improved HRV in early postmenopausal women significantly and has the potential to attenuate the CVD risk in postmenopausal women