Electrocardiographic profile of patients with hypertensive disorders in pregnancy

Background: Preeclampsia in pregnancy is a frequently encountered entity. Recent evidence suggests that preeclampsia can be considered as a screening test for future cardiovascular problems and abnormalities in pregnancy may help in counselling patients regarding future risk of cardiovascular problems. Electrocardiography (ECG) is a simple tool for detecting cardiovascular problems. While physiological changes in the ECG in pregnancy have been documented, the pattern of ECG in hypertensive disorders of pregnancy is not adequately studied in India. This formed the basis of the study.Methods: 140 patients who have been diagnosed as gestational hypertension and pre-eclampsia during the pregnancy were studied in the antenatal period. An ECG (non-portable, standard, 12 lead) available in the hospital was done, and the ECG was reported by the physician on-call.Results: The average age distribution of the patients was 28.26 years. Majority of the patients in the study were primigravidae. 35% of the patients were more than 37 weeks of gestation. 20 patients showed electrocardiographic abnormalities. The most common abnormality was sinus tachycardia and left axis deviation.Conclusions: ECG abnormalities are seen in 14.2% of preeclamptic women. ECG abnormalities in preeclamptic women studied had no relation to the maternal age, gestational age; parity and use of antihypertensives

Placenta percreta: a successful conservative outcome

Placental adherent syndromes have been known to us since antiquity. These are very much common in the present era due to rising incidence of surgical evacuation of pregnancy, caesarean sections and hysterotomy. Thought to be due to abnormal trophoblastic invasion at the endo-myometrial junction along with vasculature leading to varying degrees of invasion and adherence, lastly including the pelvic organs. Morbidity and mortality associated with these have been an obstetrician’s nightmare and thus a good learning curve. Hence, knowing appropriate case selection and management in terms of early diagnosis, mode of delivery, dealing with obstetric emergencies and appropriate counseling has become the need of the hour. The focus being, conservative management and best perinatal outcome with least maternal morbidity

Perinatal outcome of term pregnancies with borderline amniotic fluid index: a prospective case control study

Background: It has been since antiquity that the importance of amniotic fluid and fetal growth with perinatal outcome is being documented. But the lacunae lies in studying the relationship between borderline amniotic fluid and perinatal outcome. The following study was undertaken to provide recent data that would help predict perinatal outcome in borderline AFI pregnancies.Methods: About 144 patients were considered in the study OPD/IPD patients in obstetrics and gynecology department in Bhabha Atomic Research Centre and Hospital, with about 72 cases with borderline amniotic fluid index (5-8 cm) and controls with amniotic fluid index ≥9-25 cm. Patients were selected and subjected to history taking, examination, ultrasound test with doppler studies and perinatal outcome documented over a period of one year.Results: The incidence of borderline AFI in my study was 16%. 58% were primigravidas. Meconium stained liquor was found in 18% cases compared to 7% controls. Low birth weight was found in 12.5% cases and 2.7% in controls. On applying statistical test analysis chi square test, it was found that borderline amniotic fluid index in relation to presence of meconium stained amniotic fluid and low birth weight, p value was found to be statistically significant (<0.05).Conclusions: Borderline amniotic fluid and perinatal outcome had significant relationship in terms of meconium stained liquor and birth weight while rest had no significance. Thus, borderline amniotic fluid patients require vigilant fetal surveillance

Analysis of caesarean section rate using WHO’s Robson’s 10-group classification system: a hospital based retrospective study

Background: Maternal morbidity and mortality has been an utmost priority worldwide as it is an indicator of healthcare system. In order to bring it down, it has become the need of the hour to decrease the number of caesarean sections as it is one of the most common cause of morbidity among women. Every institution should have an audit to determine the rate of caesarean section and corresponding indications in order to implement new protocols or modify existing ones to improve caesarean section rates.Methods: All women who underwent caesarean section between time period Jan 2015- Dec 2019 were included. All vaginal deliveries were excluded. Delivery and operative registers, logbooks and online entries were used for data collection in the obstetric and gynecologic department. A retrospective data collection was done, tabulated and entered in excel sheet.Results: Robson’s group 1, group 2, group 5 were the main contributors to overall caesarean section rate. The major indications for caesarean section were found to be as previous caesarean section (33%), non-progress of labor (22%) followed by meconium stained liquor, cephalopelvic disproportion both around 10%.Conclusions: Robson’s group 1, group 2, group 5 were the main contributors to the overall caesarean section rate. The major indications for caesarean section were found as previous caesarean section and non-progress of labor. Further studies are needed for comparison and to make amendments to protocols

Hemolytic activity and biofilm-formation among clinical isolates of group B streptococcus causing acute urinary tract infection and asymptomatic bacteriuria

Streptococcus agalactiae, also known as group B Streptococcus, is an aetiological agent of urinary tract infection (UTI) in adults, including cystitis, pyelonephritis and asymptomatic bacteriuria (ABU). Whereas ABU-causing S. agalactiae (ABSA) have been shown to grow and achieve higher culture denstity in human urine compared to uropathogenic S. agalactiae (UPSA) other phenotypic distinctions between S. agalactiae isolated from different forms of UTI are not known. Here, we define the hemolytic activities and biofilm-formation of a collection of clinical isolates of UPSA, ABSA and recurrent S. agalactiae bacteriuria (rSAB) strains to explore these phenotypes in the context of clinical history of isolates. A total of 61 UPSA, 184 ABSA, and 47 rSAB isolates were analyzed for relative hemolytic activity by spot assay on blood agar, which was validated using a erythrocyte lysis suspension assay. Biofilm formation was determined by microtiter plate assay with Lysogeny and Todd-Hewitt broths supplemented with 1% glucose to induce biofilm formation. We also used multiplex PCR to analyze isolates for the presence of genes encoding adhesive pili, which contribute to biofilm formation. Comparing the hemolytic activities of 292 isolates showed, surprisingly, that ABSA strains were significantly more likely to be highly hemolytic compared to other strains. In contrast, there were no differences between the relative abilities of strains from the different clinical history groups to form biofilms. Taken together, these findings demonstrate a propensity of S. agalactiae causing ABU to be highly hemolytic but no link between clinical history of UTI strains and ability to form biofilm

Variable resistance to zinc intoxication among Streptococcus agalactiae reveals a novel IS1381 insertion element within the zinc efflux transporter gene czcD

Streptococcus agalactiae, also known as group B Streptococcus, is an important human and animal pathogen. Zinc (Zn) is an essential trace element for normal bacterial physiology but intoxicates bacteria at high concentrations. Molecular systems for Zn detoxification exist in S. agalactiae, however the degree to which Zn detoxification may vary among different S. agalactiae isolates is not clear. We measured resistance to Zn intoxication in a diverse collection of clinical isolates of S. agalactiae by comparing the growth of the bacteria in defined conditions of Zn stress. We found significant differences in the ability of different S. agalactiae isolates to resist Zn intoxication; some strains such as S. agalactiae 18RS21 were able to survive and grow at 3.8-fold higher levels of Zn stress compared to other reference strains such as BM110 (6.4mM vs 1.68mM Zn as inhibitory, respectively). We performed in silico analysis of the available genomes of the S. agalactiae isolates used in this study to examine the sequence of czcD, which encodes an efflux protein for Zn that supports resistance in S. agalactiae. Interestingly, this revealed the presence of a mobile insertion sequence (IS) element, termed IS1381, in the 5′ region of czcD in S. agalactiae strain 834, which was hyper-resistant to Zn intoxication. Interrogating a wider collection of S. agalactiae genomes revealed identical placement of IS1381 in czcD in other isolates from the clonal-complex-19 (CC19) 19 lineage. Collectively, these results show a resistance spectrum among S. agalactiae isolates enables survival in varying degrees of Zn stress, and this phenotypic variability has implications for understanding bacterial survival in metal stress

Alterations in cell arrangements of group B streptococcus due to virulence factor expression can bias estimates of bacterial populations based on colony count measures

Group B streptococcus (GBS) is a chain-forming commensal bacterium and opportunistic pathogen that resides in the gastrointestinal and genitourinary tract of healthy adults. GBS can cause various infections and related complications in pregnant and nonpregnant women, adults, and newborns. Investigations of the mechanisms by which GBS causes disease pathogenesis often utilize colony count assays to estimate bacterial population size in experimental models. In other streptococci, such as group A streptococcus and pneumococcus, variation in the chain length of the bacteria that can occur naturally or due to mutation can affect facets of pathogenesis, such as adherence to or colonization of a host. No studies have reported a relationship between GBS chain length and pathogenicity. Here, we used GBS strain 874391 and several derivative strains displaying longer chain-forming phenotypes (874391pgapC, 874391ΔcovR, 874391Δstp1) to assess the impact of chain length on bacterial population estimates based on the colony-forming unit (c.f.u.) assay. Disruption of GBS chains via bead beating or sonication in conjunction with fluorescence microscopy was used to compare chaining phenotypes pre-and post-disruption to detect long-and short-chain forms, respectively. We used a murine model of GBS colonization of the female reproductive tract to assess whether chaining may affect bacterial colonization dynamics in the host during chronic infection in vivo. Overall, we found that GBS exhibiting long-chain form can significantly affect population size estimates based on the colony count assay. Additionally, we found that the length of chaining of GBS can affect virulence in the reproductive tract colonization model. Collectively, these findings have implications for studies of GBS that utilize colony count assays to measure GBS populations and establish that chain length can affect infection dynamics and disease pathogenesis for this important opportunistic pathogen

Modeling patient access to therapeutic oxytocin in Zanzibar, Tanzania

Abstract Background Our objective is to estimate the effects of therapeutic oxytocin supply chain factors and social determinants of health on patient access to oxytocin in low-income settings using system dynamics modeling. Postpartum hemorrhage (PPH), a major cause of maternal mortality disproportionately affects women in low and middle income countries (LMICs). The World Health Organization recommends therapeutic oxytocin as the frontline uterotonic for PPH management and prevention. However, lack of access to quality therapeutic oxytocin in Tanzania, and throughout Sub-Saharan Africa, continues to result in a high number of preventable maternal deaths. Methods We used publicly available data from Zanzibar and Sub-Saharan Africa, literature review, oxytocin degradation kinetics and previously developed systems dynamics models to understand the barriers in patient access to quality therapeutic oxytocin. Results The model makes four basic predictions. First, there is a major gap between therapeutic oxytocin procurement and availability. Second, it predicts that at current population increase rates, oxytocin supply will have to be doubled in the next 30 years. Third, supply and storage temperature until 30 °C has minimal effect on oxytocin quality and finally distance of 5 km or less to birthing facility has a small effect on overall access to oxytocin. Conclusions The model provides a systems level approach to therapeutic oxytocin access, incorporating supply and procurement, socio-economic factors, as well as storage conditions to understand how women’s access to oxytocin over time can be sustained for better health outcomes

An opportunistic pathogen under stress: How Group B Streptococcus responds to cytotoxic reactive species and conditions of metal ion imbalance to survive

Group B Streptococcus (GBS; also known as Streptococcus agalactiae) is an opportunistic bacterial pathogen that causes sepsis, meningitis, pneumonia, and skin and soft tissue infections in neonates and healthy or immunocompromised adults. GBS is well-adapted to survive in humans due to a plethora of virulence mechanisms that afford responses to support bacterial survival in dynamic host environments. These mechanisms and responses include counteraction of cell death from exposure to excess metal ions that can cause mismetallation and cytotoxicity, and strategies to combat molecules such as reactive oxygen and nitrogen species that are generated as part of innate host defence. Cytotoxicity from reactive molecules can stem from damage to proteins, DNA, and membrane lipids, potentially leading to bacterial cell death inside phagocytic cells or within extracellular spaces within the host. Deciphering the ways in which GBS responds to the stress of cytotoxic reactive molecules within the host will benefit the development of novel therapeutic and preventative strategies to manage the burden of GBS disease. This review summarizes knowledge of GBS carriage in humans and the mechanisms used by the bacteria to circumvent killing by these important elements of host immune defence: oxidative stress, nitrosative stress, and stress from metal ion intoxication/mismetallation

Pancreatic Cancer Heralded by Worsening Glycemic Control: A Report of Two Cases

Pancreatic ductal adenocarcinoma is the third leading cause of cancer-related death in the United States. Since it is usually diagnosed at an advanced stage, its prognosis remains poor. The initial presentation varies according to the tumor location. The most common presenting signs are weight loss, jaundice, and pain. Several epidemiological, clinical, and experimental studies over the past 2 decades have shown that long-standing diabetes is a modest risk factor for pancreatic cancer. However, new-onset diabetes has also been observed to be an early manifestation of pancreatic cancer. We report 2 cases where worsening glycemic control led to the diagnosis of pancreatic cancer