Feto-maternal outcome in patients with HELLP and partial HELLP syndrome: a prospective 10 year study in Shri Guru Ram Rai Institute of Medical and Health Sciences, Uttarakhand, India

Background: The acronym HELLP was coined by Loise Weinstein in 1982 to describe a syndrome consisting of hemolysis (H) elevated liver enzyme (EL) and low platelets (LP). The purpose of the study was to detect and evaluate the feto maternal outcome of HELLP and partial HELLP syndrome among preeclamptic patients.Methods: Study analyzed fetal and maternal outcome in 110 patients with HELLP syndrome and 89 patients with partial HELLP Syndrome and compared with 1100 patients of preeclampsia only.Results: 1210 patients were included in this study. Out of these patients HELLP syndrome, partial help syndrome and preeclampsia were 10% and 7.3% and 82.7%. The systolic BP, gestational age at admission and at delivery, hematological and biochemical parameters, vaginal delivery and type of anesthesia were significantly different in HELLP syndrome and partial HELLP syndrome than in pre eclampsia group. There was significant difference in perinatal outcome like birth weight, IUD, neonatal death and NICU-admissions. Eclampsia was significantly increased in HELLP syndrome and partial HELLP syndrome.Conclusions: HELLP and partial HELLP syndrome must be diagnosed as soon as possible. Partial HELLP and HELLP syndrome are equally dangerous. HELLP Syndrome is severe then preeclampsia in terms of maternal and perinatal outcome

Bowel injury: a rare but dreaded complication of unsafe abortion

Unsafe abortions represent a preventable yet major cause of maternal mortality and morbidity in India. Intestinal perforation is a rare dreaded complication of unsafe abortion. It is commonly seen in countries in which abortions are performed by people without proper training and proper instruments. Bowel perforation occurs when the posterior vaginal wall or the uterine wall is perforated. The ileum and the sigmoid colon are the most commonly injured portion of the bowel. Here, we report a case of ileal perforation following induced unsafe abortion which was managed successfully

Total vaginal hysterectomy: outcome analysis of 108 cases at a tertiary centre

Background: The aim of this study is to evaluate, analyze the indications of surgery, patients profile with respect to age group, parity, and comorbidities, intraoperative techniques, intra and post-operative complications and post-operative recovery.Methods: A hospital based cross sectional descriptive study of 108 cases was conducted in the department of Obstetrics and Gynecology in a tertiary hospital over a period of one year. All patients admitted with benign gynecological conditions of the uterus were included in study. The patients with uterine prolapse, uterine size >16wks and more than one previous sections were excluded from the study.Results: Among all the indications of TVH, abnormal uterine bleeding was the most common. Mean age group was 44.89 years and the mean parity was 2. Majority of the patients had no intra and post-operative complications. Postoperative recovery was good with shorter hospital stay.Conclusions: TVH should be promoted as the route of choice for all benign gynaecological conditions. It is safe to do TVH in patients who are at poor general anaesthesia risk. In a state like Uttarakhand where medical facilities are hard to avail due to difficult geographic terrain, TVH has a special role .In lack of endoscopic facility, trained medical and paramedical staff and lack of postoperative monitoring instead of; there is a need to promote TVH. To top it all, TVH is the most cost effective route of hysterectomy. It is truly the natural orifice scarless surgery

Bakri postpartum balloon: an obstetrician’s armamentarium in managing post-partum haemorrhage

Background: Post-partum haemorrhage (PPH), an obstetric emergency that can complicate vaginal or cesarean deliveries and associated with serious complications. Guidelines for the management of PPH involve a stepwise escalation of pharmacological and eventual surgical approaches. In women who do not respond to uterotonics or medical treatment, a variety of procedures, such as arterial embolization, surgical ligation of the uterine arteries or obstetric hysterectomy, may be used. The Bakri balloon is an intrauterine device indicated to reduce or control PPH temporarily when conservative treatment is warranted. Here, we are presenting case series of primary atonic PPH and which were managed by Bakri Balloon Tamponade (BBT).Methods: This case series included five women with PPH managed by Bakri balloon as a conservative therapeutic option.Results: All five women were in age group between 23 years to 34 years. The causes of PPH were uterine atony, retained placenta and central placenta previa. The Bakri balloon was successful in controlling hemorrhage in all women (five of five) who did not respond to medical uterotonic treatment.Conclusions: Bakri balloon is a simple, easy to use and effective method for conservative management of acute PPH. This device reduces bleeding, shortens the hospital stay and avoids the need for more aggressive procedures

Comprehensive Review on Analytical Profile of Antidepressant Drug

Venlafaxine is an antidepressant belonging to a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Venlafaxine affects chemicals in the brain that may be unbalanced in people with depression. It is used to treat major depressive disorder, anxiety and panic disorder. The present review assesses the various approaches for analysis of Venlafaxine in bulk drug as well as various formulations. A concise review represents the compilation and discussion of about more than 35 analytical methods which includes HPLC, HPTLC, UPLC, LC-MS and UV-Spectrophotometry methods implemented for investigation of Venlafaxine in biological matrices, bulk samples and in different dosage formulations. This detailed review will be of great help to the researcher who is working on Venlafaxine. Keywords: Venlafaxine; Analytical Profile; HPLC; HPTLC; Bioanalytical; Stability indicatin

Feto-maternal outcome in patients with HELLP and partial HELLP syndrome: a prospective 10 year study in Shri Guru Ram Rai Institute of Medical and Health Sciences, Uttarakhand, India

Background: The acronym HELLP was coined by Loise Weinstein in 1982 to describe a syndrome consisting of hemolysis (H) elevated liver enzyme (EL) and low platelets (LP). The purpose of the study was to detect and evaluate the feto maternal outcome of HELLP and partial HELLP syndrome among preeclamptic patients.Methods: Study analyzed fetal and maternal outcome in 110 patients with HELLP syndrome and 89 patients with partial HELLP Syndrome and compared with 1100 patients of preeclampsia only.Results: 1210 patients were included in this study. Out of these patients HELLP syndrome, partial help syndrome and preeclampsia were 10% and 7.3% and 82.7%. The systolic BP, gestational age at admission and at delivery, hematological and biochemical parameters, vaginal delivery and type of anesthesia were significantly different in HELLP syndrome and partial HELLP syndrome than in pre eclampsia group. There was significant difference in perinatal outcome like birth weight, IUD, neonatal death and NICU-admissions. Eclampsia was significantly increased in HELLP syndrome and partial HELLP syndrome.Conclusions: HELLP and partial HELLP syndrome must be diagnosed as soon as possible. Partial HELLP and HELLP syndrome are equally dangerous. HELLP Syndrome is severe then preeclampsia in terms of maternal and perinatal outcome

Bowel injury: a rare but dreaded complication of unsafe abortion

Unsafe abortions represent a preventable yet major cause of maternal mortality and morbidity in India. Intestinal perforation is a rare dreaded complication of unsafe abortion. It is commonly seen in countries in which abortions are performed by people without proper training and proper instruments. Bowel perforation occurs when the posterior vaginal wall or the uterine wall is perforated. The ileum and the sigmoid colon are the most commonly injured portion of the bowel. Here, we report a case of ileal perforation following induced unsafe abortion which was managed successfully

Total vaginal hysterectomy (TVH): outcome analysis of 108 cases at a tertiary centre

Background: The aim of this study is to evaluate, analyze the indications of surgery, patients profile with respect to age group, parity, and comorbidities, intraoperative techniques, intra and post-operative complications and post-operative recovery.Methods: A hospital based cross sectional descriptive study of 108 cases was conducted in the department of Obstetrics and Gynecology in a tertiary hospital over a period of one year. All patients admitted with benign gynecological conditions of the uterus were included in study. The patients with uterine prolapse, uterine size >16wks and more than one previous sections were excluded from the study.Results: Among all the indications of TVH, abnormal uterine bleeding was the most common. Mean age group was 44.89 years and the mean parity was 2. Majority of the patients had no intra and post-operative complications. Postoperative recovery was good with shorter hospital stay.Conclusions: TVH should be promoted as the route of choice for all benign gynaecological conditions. It is safe to do TVH in patients who are at poor general anaesthesia risk. In a state like Uttarakhand where medical facilities are hard to avail due to difficult geographic terrain, TVH has a special role .In lack of endoscopic facility, trained medical and paramedical staff and lack of postoperative monitoring instead of; there is a need to promote TVH. To top it all, TVH is the most cost effective route of hysterectomy. It is truly the natural orifice scarless surgery

The Supplementation of FloraMax-B11 Did Not Affect the Bile Acid Neosynthesis and the Enterohepatic Circulation in Broiler Chickens

Most probiotics possess bile salt hydrolase enzymes and may increase bile acid excretion and negatively affect fat digestion and absorption. Therefore, the study objective was to determine the time course effects of a commercial probiotic (P) FloraMax-B11 (FM) supplementation on bile acid neosynthesis and enterohepatic circulation in broiler chickens. Fertile Ross 708 eggs were incubated under standard commercial conditions. At hatch, chicks (n = 550) were randomly assigned to 5 treatment groups (n = 5 replicates per treatment group) with 22 birds per pen. The 5 treatment groups consisted of: control group (C, normal water from hatch to 35 days of age without supplements); P3, water supplemented with FM for the first 3 days post-hatch followed by normal water until day 35; P10, water supplemented with FM for the first 10 days post-hatch followed by normal water until day 35; P35, water supplemented with FM from hatch to day 35; and AGP, water supplemented with antibiotic growth promoter (AGP) from hatch until day 35. Ileum, liver, and plasma were collected at hatch, days 3, 10, 21, and 35 post-hatch. The relative mRNA expression of genes involved in bile acid synthesis (CYP7A1, CYP8B1, FXR, FGFR4, and FGF19) and transport (ASBT, I-BABP, OSTα, OSTβ, and BSEP) as well as ileal deoxycholic acid and plasma cholic acid were determined. There was no FM and AGP interaction for any of the response criteria. No FM or AGP effects were observed (p > 0.05) for any genes, except FGF19, which expression was increased (p < 0.0001) in AGP compared to P35. No FM or AGP effects were observed (p > 0.05) for levels of deoxycholic and cholic acids. However, all the genes, deoxycholic acid, and plasma cholic acid were affected by age (p < 0.0001). In general, the data indicate that FM did not negatively impact bile acid metabolism and enterohepatic circulation, which appeared to be age dependent. However, more research should be conducted to confirm these results and investigate the effects of FM on bile acid metabolism, fat digestion, and intestinal microbiota in broiler chickens

Image6_Temporal dynamics of the chicken mycobiome.pdf

The microbiome is an integral part of chicken health and can affect immunity, nutrient utilization, and performance. The role of bacterial microbiota members in host health is relatively well established, but less attention has been paid to fungal members of the gastrointestinal tract (GIT) community. However, human studies indicate that fungi play a critical role in health. Here, we described fungal communities, or mycobiomes, in both the lumen and mucosa of the chicken ileum and cecum from hatch through 14 days of age. We also assessed the effects of delayed access to feed immediately post-hatch (PH) on mycobiome composition, as PH feed delay is commonly associated with poor health performance. Chicken mycobiomes in each of the populations were distinct and changed over time. All mycobiomes were dominated by Gibberella, but Aspergillus, Cladosporium, Sarocladium, Meyerozyma, and Penicillium were also abundant. Relative abundances of some taxa differed significantly over time. In the cecal and ileal lumens, Penicillium was present in extremely low quantities or absent during days one and two and then increased over time. Meyerozyma and Wickerhamomyces also increased over time in luminal sites. In contrast, several highly abundant unclassified fungi decreased after days one and two, highlighting the need for improved understanding of fungal gut biology. Mycobiomes from chicks fed during the first 2 days PH versus those not fed during the first 2 days did not significantly differ, except during days one and two. Similarities observed among mycobiomes of fed and unfed chicks at later timepoints suggest that delays in PH feeding do not have long lasting effects on mycobiome composition. Together, these results provide a foundation for future mycobiome studies, and suggest that negative health and production impacts of delayed feeding are not likely related to the development of fungal populations in the GIT.</p