Self limiting fetal bradycardia associated with maternal evidence of dengue and chikungunya virus co-infection: a case report

Dengue and chikungunya infections are commonly encountered by the clinicians in a tropical country like India. We report this case to emphasize the rare manifestations of self-limiting intrapartum bradycardia in fetuses of chikungunya and dengue infected mothers. A primigravida at 32 weeks of gestation presented with history of fever for one day. The blood investigations were positive for both dengue and chikungunya virus infection. On the third day of fever, NST showed a low baseline fetal heart rate of 95 to 100 beats per minute but good beat to beat variability and three accelerations in 10 minutes. This pattern persisted for 48 hours. Although, the finding initially appeared alarming, the change in baseline heart rate of fetus was transient and self-limiting and recovered completely. Hence, a judicious approach and close fetal surveillance can avoid hasty decisions regarding an early termination of pregnancy

Sustainable traditional dyeing of wool by Bhotia tribe in Himalayan region: A case study

Bhotia tribe is one of the community residing in the high Himalayan region of Uttarakhand state that shares the border with Tibet. The tribe is divided into five sub-groups viz., the Jadhs ,  Marchas, Tolchas ,  Shaukas and Rung. The present study was conducted in the five villages namely Lata and Chinka from Chamoli, Darkot and Baluwakot from Pithoragarh and Dunda from Uttarkashi of Uttarakhand for exploring the information from different sub-groups of Bhotia tribe about plants used by them for extracting dyes and used for traditional textile coloration in past and during present time. The rich flora of Himalayan region in Uttarakhand has been abode to varieties of plant species. The wild plant species were used by the Bhotia tribals for dyeing their woolen products. These plant dyes were obtained from jangli palak (Rumex nepalensis), bagmaru (Eupatorium), kilmora (Berberis asiatica), akhrot (Juglans regia), dholu (Rheum aystrale), tea leaves, tantri (Rheum moorcroftianum), kaphal (Myrica esculenta), darim (Punica grantum), burans (Rhodendron araborium) and harda (Terminlia chebula). Today only Shauka and Jadh tribals are using natural dyes for dyeing woolen yarn. Reasons for the reduction in usage of natural dyes among Bhotia tribals were the extinction of plant species, change in land use, natural disasters, government restriction on plucking certain plant species, the availability of synthetic dyes and colored yarns at low cost in the market. The identification of factors that led to the non-practice of sustainable dying practice among tribals for woolen craft will help in planning and conducting interventions through public, private and government organizations

Awareness of cervical cancer and its screening methods in Indian women

Background: In spite of effective screening methods, cervical cancer continues to be a major public health problem in India. Therefore, the present study was carried out to assess the knowledge of cervical cancer and its screening among women, it also focuses on the reasons for not undergoing regular screening and the effect of counseling for the same.Method: 400 women were randomly enrolled from the women attending/visiting/working at a tertiary hospital. They were asked questions related to cervical cancer. All answers were obtained verbally and recorded in the questionnaire by the same investigator.Results: Out of 400 women, only 103 were aware of cervical cancer as well as its screening, and only 10 of them were undergoing regular screening. Among those who were aware of cervical cancer, majority (95.14%) were health care workers and most of them got this knowledge form their textbooks. After counseling, all except 6 women were willing for regular screening. The reason for refusal for the same was either they believed they were not at risk or they found pelvic examination uncomfortable.Conclusions: The study found that women had poor knowledge about cervical cancer and its screening. Awareness was higher among the women who had received higher education or were healthcare workers. However, cervical cancer screening rate was low even in these women. Government and health care professionals need to actively promote awareness of the risk factors of cervical cancer and encourage women to undergo regular Pap smear as a cervical cancer screening method

Estimation of maternal serum vitamin D levels and its correlation with gestational diabetes mellitus

Background: Several studies in the past two decades have proved beyond doubt that there is a high prevalence of hypovitaminosis D worldwide including India which has almost taken the shape of a pandemic. The study aims to determine the prevalence of hypovitaminosis D in the pregnant population of Delhi and its correlation with gestational diabetes mellitus.Methods: This prospective cross sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Dr R.M.L Hospital, New Delhi over a period of 1 year and 4 months. Four hundred term patients were enrolled randomly from amongst the patients admitted in labor room or antenatal ward at PGIMER, Dr. Ram Manohar Lohia Hospital who fulfilled the inclusion and exclusion criteria. 3-4ml of fasting blood samples were collected of all the enrolled women and were analysed for total serum calcium levels and serum vitamin D levels. History of presence of gestational diabetes mellitus was noted along with any treatment history. The 25(OH)D levels for each subject was recorded and correlation of vitamin D levels with gestational diabetes mellitus was analysed. Statistical analysis was done using ANOVA/ Kruska Wallis test and Chi-Square test/ Fisher’s exact test. A p value of <0.05 was considered statistically significant.Results: The overall prevalence of vitamin D deficiency in the present study was 86.25%. The overall mean serum vitamin D level was 14.06±9.43 ng/ml. Thirty five out of 37 GDM patients had hypovitaminosis D i.e. 94.59%. The prevalence of hypovitaminosis D among non-GDM population was 85.40%. The association between GDM and Vitamin D deficiency was statistically non- significant in the present study with p value=0.186.Conclusions: There is a very high prevalence of hypovitaminosis D in pregnant females attending present institute i.e. 86.25%. Although 94.59 % of Gestational Diabetes Mellitus patients had vitamin D deficiency, there is no statistically significant association between Gestational diabetes mellitus and serum vitamin D levels

Gestational weight gain and its effect on fetomaternal outcome

Background: In normal pregnancy, variable amount of weight gain is a constant phenomenon. The study aims to find an association between gestational weight gain and fetomaternal outcome. GWG (using institute of medicines guidelines meant for US population) and pregnancy outcomes among Asian Indians across different BMI categories (according to WHO Asia Pacific BMI cut points) were studied.Methods: 300 women were split into the three groups based on their gestational weight gain. Namely, below recommended GWG, recommended GWG and above recommended GWG group. Comparison of various fetomaternal outcomes was done between these groups.Results: In women, who had higher than recommended GWG, 30.5% developed GDM, 23.2% had gestational hypertensive disorder, 36.6% developed hypothyroidism, 12.2% had pre-term birth and 15.9% had low birth weight. In recommended GWG category, these were 5.4%, 4.5%, 30.6%, 7.2% and 17.1% respectively; and in below recommended category, these were 14%, 1.9%, 22.4%,12.1% and 24.3% respectively.Conclusions: GWG generally follows the BMI pattern at the time of entering into pregnancy, higher the BMI more the GWG. More GWG was associated with GDM, Gestational hypertensive disorders and poor APGAR at birth. Below recommended GWG was associated with higher occurrence of GDM. No statistical correlation, between GWG and mode of delivery, NICU stay, preterm birth and birth weight was observed. Larger study is required to establish the applicability of IOM Guidelines for GWG on Indian women

Primary ovarian carcinoid: a case report

Primary ovarian carcinoid tumor is a rare entity, usually seen in perimenopausal or menopausal age group, it’s rarely malignant. A case study of a 53yr old female who presented with a large primary ovarian carcinoid is being reported here

Granular cell tumour of clitoris: a case report

Granular cell tumour (GCT) is tumours showing neuroectodermal differentiation. It occurs mostly in the dermis and subcutaneous tissue and occurrence in the muscle layer is rare. The most common site is the head and neck region. It has been known to occur in the vulva, with clitoris being a very rare site. Granular cell tumours are slow growing tumours, which are mostly asymptomatic. We report a case of lump in the clitoris in a 42-year-old woman which was managed with surgical excision. Histopathology confirmed the diagnosis of granular cell tumour. Very few cases of granular cell tumour of clitoris have been reported in literature till date. Although mostly benign, the differential diagnosis of granular cell tumour should be borne in mind by the clinicians in cases of clitoral lump

Endometrial evaluation with methylene blue staining in patients with normal hysteroscopy

Background: Normally, endometrium comprises of non-absorptive epithelium and does not take up stain. Conventional staining with methylene blue is explained on the basis of existence of apoptotic cells in endometrium.Methods: Of 50 patients of unexplained infertility, AUB, recurrent pregnancy loss were randomly selected and included in the study. Those with abnormal ultrasound and history of tuberculosis were excluded. Conventional hysteroscopy was performed using normal saline as distending medium and in those with grossly normal endometrium were subjected to staining with 5% methylene blue instilled trans cervically. After 5 min, irrespective of the size and pattern, focal dark blue stained areas were considered abnormal and randomly biopsied. Incidence of endometritis in both groups was compared after histopathological examination.Results: Of total 50 patients, histopathological report of only one patient with dark blue staining had evidence of endometritis. Rest had no evidence, of which 73.5% had light blue or unstained areas and 26.5% showed dark blue staining. No statistically significant difference was found between histopathological reports and light or dark blue staining (p=0.28). When percentage stained area was considered more than 50% only to be positive, sensitivity was 100%, specificity 94%, PPV 25% and NPV 100%. False positives were 75% and no false negatives were observed. Although p values improved but still statistically insignificant.Conclusions: Present study failed to establish any significant correlation between staining pattern and detection rate of endometritis. With no Indian studies published on chromohysteroscopy so far, role of methylene blue in detection of subtle endometrial changes in modern gynaecology in Indian subpopulation is yet to be established

Comparison of diagnostic accuracy of hysteroscopy and ultrasonography in relation to histopathology in cases of postmenopausal bleeding

Background: To evaluate the role of hysteroscopy and ultrasound in relation to histological findings in patients of postmenopausal bleeding and to find out the sensitivity, specificity, positive predictive, negative predictive values and accuracy of ultrasound and hysteroscopy.Methods: A retrospective analysis of the 30 women who underwent hysteroscopic evaluation out of total 103 patients of postmenopausal bleeding over the period of one year (August 2017 and July 2018) was done. Records were taken out to collect the relevant information. USG and hysteroscopic findings were correlated with histopathology for the comparative analysis.Results: Indications of hysteroscopy cases were suspected polyp (5), fractional curettage (F/C) technically not feasible (7), inconclusive USG reports (5), recurrent bleeding with normal fractional curettage report (4), no tissue on F/C (1), removal of intra-uterine contraceptive device (1). Causes of postmenopausal uterine bleeding were found to be atrophic endometrium including one case of senile cystic atrophy (33.3%), secretory endometrium and endometrial polyps (23.3% each) and endometrial malignancy (20.0%) cases. Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy values of USG in various endometrial conditions was found to be 57.1%, 85.2%, 55.1%, 86.2% and 78.5% respectively and for hysteroscopy was 87.1%, 97.5%, 90.0%, 96.7% and 95.3% respectively.Conclusions: Hysteroscopy is a minimally invasive, safe and effective modality with least complications and morbidity rate and an ideal method for establishing the pathology as well as offering therapeutic intervention simultaneously

Profile of congenital defects in foetuses: incidence and risk factors: a prospective observational study

Background: Perinatal outcome is one of the major indicators of evaluating health care system of a country. Congenital defects form important components of this parameter. The aim of the study was to determine the risk factors associated with congenital malformations in foetuses.Methods: All antenatal mothers whose foetuses were detected to have congenital defects on ultrasonography irrespective of period of gestation were enrolled for the study.Results: Eighty-six pregnant women with prenatally diagnosed fetal anomalies were enrolled for the study, out of which, 87.2% (N=75) belonged to 20-30 years age group. Majority of the subjects were educated till secondary school. Compared to primigravidae, the incidence of malformations was significantly higher in the multigravida group (69.8% vs 30.2% respectively). Thirty-eight (44.2%) mothers with malformed foetuses missed folic acid intake during early pregnancy. Only 40% mothers had prior history of abortions. Smoking was seen in 9% of subjects with malformations. Seven (8.3%) mothers had previous history of malformations and 5 (5.8%) reported a family history of malformations. Consanguineous marriage was observed in 4.7% of couples. Oligohydramnios or anhydramnios was associated with 11.6% foetuses, while polyhydramnios was seen in 53.5%. CNS malformations were seen in 57% of foetus, followed by genitourinary system malformations (9.2%).Conclusions: Tertiary level hospitals need to be upgraded with a dedicated multidisciplinary team of foetal medicine to cater to medical, clinical, surgical, preventive and therapeutic needs of malformed foetuses