Fetal akinesia deformation sequence: a case report and review of literature

Fetal Akinesia Deformation Sequence (FADS) is a condition characterised by decreased fetal movement (fetal akinesia), multiple joint contractures (arthrogryposis), facial anomalies, intrauterine growth restriction, pulmonary hypoplasia and other developmental abnormalities. These disorders are clinically and genetically heterogenous and its etiology remains unclear. This syndrome is rare and the primary diagnosis is made when lack of mobility is noted in routine ultrasound scanning. The increasing use of ultrasound has enabled earlier detection of these cases. A 20 year old primi in her routine ultrasound at 14weeks of gestation showed features fetal akinesia deformation sequence with increased nuchal translucency and hydrops. Early diagnosis, prenatal evaluation and better understanding of the ultrasound findings will be helpful for genetic counselling and clinical management.

A case of new-onset vitiligo in a patient on tofacitinib and brief review of paradoxical presentations with other novel targeted therapies

With recent advancements in the understanding of vitiligo pathogenesis, Janus kinase (JAK) inhibitors have emerged as a promising new treatment modality, but their effects remain incompletely elucidated. Tofacitinib, an oral JAK 1/3 inhibitor approved for the treatment of rheumatoid arthritis, has previously been shown to induce significant re-pigmentation in vitiligo. However, as with other novel targeted therapies, cutaneous adverse effects have been observed. We report a 36-year-old woman with a history of rheumatoid arthritis, refractory to multiple pharmacotherapies, who was initiated on tofacitinib and subsequently developed progressive depigmented patches consistent with new-onset vitiligo. Although definitive causation cannot be established in this case without additional studies, it is important to note that many targeted therapies have the potential to induce paradoxical effects, that is, the occurrence or exacerbation of pathologic conditions that have been shown to respond to these medications. Paradoxical findings with other targeted therapies include the occurrence of melanoma during treatment with BRAF inhibitors, keratoacanthomas with PD-1 inhibitors, vitiligo and psoriasis with TNF-alpha inhibitors, and hidradenitis suppurativa with various biologic agents. Although JAK inhibitors hold therapeutic promise in the treatment of inflammatory skin disorders, further research is warranted to more fully comprehend their effects

Use of cervical length, measured by transvaginal sonography at 22 to 26 weeks, as a predictor of preterm labour in twin pregnancy

Background: Preterm labour and delivery contributes significantly to perinatal morbidity and mortality in twin gestation. Measurement of cervical length during antenatal period and subsequent follow up may identify women at risk for preterm labour.  The purpose of this study was to determine if measurement of cervical length at 22 to 26 weeks can be used as a predictor of preterm labour in twin pregnancy.Methods: This prospective observational study was carried out in 50 women with twin gestation in a tertiary care teaching hospital. Cervical length was measured using transvaginal sonography and repeated every four weeks till delivery. Cervical length of ≤30 mm was taken as short cervix and delivery before 37 weeks was taken as preterm delivery.Results: Total of 18 out of 50 women (36%) delivered between 32 to 34 weeks, 14 out of 50 (28%) delivered between 34 to 37 weeks, 7 out of 50 (14%) delivered at less than 32 weeks. Therefore, total preterm deliveries at less than 37 weeks were 78%. Total 11 out of 50 (22%) delivered at term i.e. at more than 37weeks. In women, who had short cervical length (≤ 30 mm) at the time of presentation, 14 out of 37 (38 %) delivered between 30 to 34 weeks, 12 out of 37 (32 %) women delivered between 34 to 37 weeks, 5 out of 37 (14%) delivered at ≤ 30 weeks. Rest 6 out of 37 (16 %) delivered after 37 weeks.Conclusions: Short cervical length of ≤30 mm on transvaginal sonography at 22-26 weeks of gestation in twin pregnancy may be used as a screening tool in prediction of preterm labour in asymptomatic twin pregnancy

A retrospective comparative study to evaluate the efficacy and safety of mifepristone with misoprostol over misoprostol alone in induction in labor

Background: The aim is to compare the improvement in pre-induction Bishop’s score, proportion of patients going in labor and induction–delivery interval after using the Misoprostol versus Mifepristone and Misoprostol as cervical ripening and labor inducing agent.Methods: It is retrospective comparative study conducted on 110 women. Women were randomized in group A and in group B of 55 patients in each group. Group A received tab Mifepristone 200 mg orally on day 1 followed by Misoprostol 25 ug after 48 hours and continued 6 hourly till maximum four tablets and group B patients received tablet Misoprostol 25ug and continued 25ug 6hrly maximum 4 doses. Women observed for improvement in Bishop‟s score, induction-delivery interval and requirement of subsequent doses of Misoprostol.Results: Present study concluded that tablet Mifepristone is an efficient cervical ripening and inducing agent of labor as pre-induction Bishop’s score was improved. 36.4%patients went into labor only with tablet Mifepristone. The mean induction-delivery interval was,19±12.2hrs in Group 1 as compare to 13.1±13.0 hrs in Group 2. Mean Bishop’s score observed in Group 1 were 2.5±1.78 and 1.67±1.25 in Group 2. It was observed that there was significant improvement in the Bishop’s score after giving Mifepristone to the patients; mean Bishop’s 24hrs after mifepristone were 4.03±1.80. Repeated dose of Misoprostol required in Group 1 was observed to be higher than group 2 as shown in table 8. Mean misoprostol doses required in group 1 was 2.56±1.15 as compared to 1.71±1.58 in group 2.Conclusions: Mifepristone with Misoprostol reduce the induction delivery interval and more potent in combination for induction of labour as compared to Misoprostol alone

An investigation of solid waste management practices : the case of the Chatsworth township in metropolitan Durban - KwaZulu-Natal.

Thesis (M.A.)-University of KwaZulu-Natal, 2004.Solid waste management is a global phenomenon that presents one of the most immediate and serious challenges in developing urban areas. Chatsworth is a formal residential township and is a product of the apartheid system, where solid waste removal was not seen as a priority. The inefficient waste management system has resulted in environmental degradation with solid waste increasingly being disposed off in streets, open spaces and streams etc. Waste heaps are becoming the breeding places of insects and pests and potential health hazards. Moreover, the aesthetics of this formal residential area is lost due to bad odour, unsightly dumpsites and deterioration of the environment. With most residential areas in South Africa having formal waste removal services, the continued existence of illegal dumps is still a serious problem . In the light of the above, the aim of this study was to investigate the solid waste management practice in Chatsworth and its negative impact on the human and natural environments. The social dimensions, perceptions, attitudes and solid waste practices of households were investigated to examine the relationship between socio-economic status and current waste practices. A survey assessment was conducted by means of a questionnaire designed to get community opinions and understanding of the type of service they received from the municipality. One hundred questionnaires were administered to householders in the study area. The study was complemented with semi-structured interviews with specific people of interest. The Statistical Package for Social Scientists was used for data entry and analysis. The findings of this study indicated that the waste collection system is inefficient and the attitudes, perceptions and socio-economic characteristics are significant factors contributing to effective waste management practices. Appropriate policy backed by legislation and enforceable regulations must underpin the strategic alternatives selected to deal with waste management in the eThekwini Municipality. The planning of integrated waste management should be seen as part of the solution of waste management and waste management should be appreciated as a public service that provides employment. resource recovery, and safe disposal of hazardous waste, reduced pollution and community development projects

Clinical profile, maternal and fetal outcome in pregnant women with COVID-19 infection: a retrospective observational study in a tertiary care hospital of Himachal Pradesh

Background: The aim of this study was to evaluate the clinical characteristics and outcomes of pregnant women confirmed with COVID-19 infections and their neonates to provide more reference to contribute in managing this noval viral disease.Methods: We conducted a retrospective study over a period of six months; 20 March, 2020 to 8 October, 2020 at SLBSGMC Nerchowk (Himachal Pradesh). Total number of pregnant women who delivered in our hospital during the defined study period was recorded and analysed.Results: The total number of women were delivered over the study period was 13, out of which caesarean sections (CS) were 7 and NVDs were 6 in number. All of them were diagnosed mild COVID-19, and none one of the patients developed severe COVID-19 or died. Their all newborns were recorded healthy except one was COVID positive and one neonate had birth asphyxia.Conclusions: Apparently no difference was observed in relation to onset of disease, symptoms, cure rates or severity in pregnant women when compared to non-pregnant women and healthy men of similar age groups. Pregnancy does not seem to deteriorate the course and prognosis of the disease. Maternal and fetal outcomes are apparently favourable in these patients. Lastly COVID-19 is not an indication of cesarean section. More multicentre studies are the need of the hour to formulate the authentic management guidelines for this novel disease

Clonal Diversity of Group A Streptococci Causing Human Infections in Southern India.

GAS, commonly known as Group A Streptococcus (GAS), is a bacterial pathogen that infects the throat and skin and is able to cause a wide range of diseases in humans [1]. This ranges from pharyngitis (strep throat) and impetigo to more serious and fatal diseases such as acute post streptococcal glomerulonephritis, rheumatic heart disease and invasive diseases. Acute rheumatic fever (RF) is an autoimmune sequela of GAS infection which occurs in approximately 0.3- 3% of GAS infected patients aged between 5 and 15 years of all streptococcal sore throats [2]. GAS is a major global pathogen with a variety of clinical manifestations. Over 7 million visit pediatricians each year in the United States alone for complaints of “sore throat” and almost a fourth of these visits are due to streptococcal pharyngitis [3]. Acute rheumatic fever and rheumatic heart disease, which are well recognized non-suppurative sequelae of infection by this organism, have devastating public health implications worldwide. An apparent resurgence of acute rheumatic fever in the mid 1980s in the US [4, 5] with ongoing new cases [6] and estimated 10,000 cases of invasive streptococcal disease reported annually in the US [7] confirm that an improved standard of living and use of antibiotic have not adequately reduced the impact of GAS infections. Thus, there is need for a safe, efficacious and cost effective vaccine against GAS infection. The clonal diversity of GAS causing human infections in Southern India (or) population genetic structure of GAS disease in South India. These facets of this study have been poorly reported from India. This is the first study in India utilizing the technique multi locus sequence typing (MLST) for GAS which increased the information on diversity of GAS infections. From our study we have found out GAS isolates in relation to emm typing, shows high heterogeneity. Our MLST studies indicated that, there are new sequence types found which were not reported in any part of the world. It also depicted the high heterogeneity found within individual emm types in respect to sequence types. There was no association found between sequence types and to their site of isolation. The sequence types found based on their allelic profile of GAS isolates clearly explained there is no association between their STs and their site of isolation. eBURST population snap shot identified the clonal complexes present in the GAS isolates from the community and the hospital isolates and indicated that two third of the GAS population are clonal in nature with young clonal complexes

Admission test as a screening test for fetal distress in labour

Background: This study was undertaken with the purpose of evaluating the efficacy of labour admission test as a screening test to identify the compromised fetus or fetus at risk and to correlate with perinatal outcome.Methods: This was a retrospective cohort study of 300 patients in 1st stage of labour admitted to labour room at tertiary care hospital over a period of one and a half years. Patients with Singleton pregnancy, Cephalic presentation & Gestational age beyond 34 weeks were included in this study. A BPL electronic foetal heart monitor was used to perform the admission test. With the patient in left lateral position a 20 minute continuous electronic recording (paper speed of 3 cm per minute) of foetal heart rate and uterine activity was obtained, on a cardiotocograph.Results: Statistical significance was calculated between different categories for different parameters too. A p value of of<0.05 was considered to be statistically significant. Fetal distress was seen 64.71% in Category III group 33.33% with Category II group and 4.74 % in Category I trace. admission test has 97.75% specificity and 95.5% negative predictive value.Conclusions: Admission test makes screening convenient. Since it is non-invasive, patients also cooperate. Admission test helps to plan subsequent management of labour. It is a good predictor of foetal well-being at the time of admission and for the next few hours

Canonical steering ellipsoids of pure symmetric multiqubit states with two distinct spinors and volume monogamy of steering

Quantum steering ellipsoid formalism provides a faithful representation of all two-qubit states and helps in obtaining correlation properties of the state through the steering ellipsoid. The steering ellipsoids corresponding to the two-qubit subsystems of permutation symmetric $N$-qubit states is analysed here. The steering ellipsoids of two-qubit states that have undergone local operations on both the qubits so as to bring the state to its canonical form are the so-called canonical steering ellipsoids. We construct and analyze the geometric features of the canonical steering ellipsoids corresponding to pure permutation symmetric $N$-qubit states with two distinct spinors. Depending on the degeneracy of the two spinors in the pure symmetric $N$-qubit state, there arise several families which cannot be converted into one another through Stochastic Local Operations and Classical Communications (SLOCC). The canonical steering ellipsoids of the two-qubit states drawn from the pure symmetric $N$-qubit states with two distinct spinors allow for a geometric visualization of the SLOCC-inequivalent class of states. We show that the states belonging to the W-class correspond to oblate spheroid centered at $(0,0,1/(N-1))$ with fixed semiaxes lengths $1/\sqrt{N-1}$ and $1/(N-1)$. The states belonging to all other SLOCC inequivalent families correspond to ellipsoids centered at the origin of the Bloch sphere. We also explore volume monogamy relations of states belonging to these families, mainly the W-class of states.Comment: 13 pages, 13 figures; Revised version; Comments welcom

Comparison of progress of labour and maternofetal outcome among induced versus spontaneous labour in nulliparous women using modified WHO partograph

Background: Induced or spontaneous labour has implication on the eventual mode of delivery and neonatal outcome. The aim of study is to compare the progress and outcome of induced versus spontaneous labour among nulliparous women using the modified WHO partograph.Methods: Comparative study involving nulliparous women in active phase of labour with the cervix at least 4cm dilated. Those whose labours were induced were compared with those on spontaneous labour; both labouring women were monitored using modified WHO partograph. Outcome measures include the mean duration of labour, the eventual mode of delivery and the Maternofetal outcome. Data were managed using SPSS software. Chi-square t-test and student t-test were used in data analysis. Level of significance was placed at P<0.05.Results: 115 women were compared in each group. There was no difference in mean age group, gestational age at delivery, cervical dilatation on admission, and the level of head of fifth palpable on admission. More women had spontaneous vaginal delivery among those in spontaneous labour (72.1% versus 64.7%) P=0.0001. There were less caesarean section among those in spontaneous labour. The mean Apgar scores were significantly better among induced labour babies (P=0.0001).Conclusions: Induced labour may increase the chances of caesarean section, it does not adversely affect the neonatal outcome. Therefore, it is advised induced labour can be a safe procedure among nulliparous women if labour is partographically monitored