Clinicohistopathological correlation of hysterectomy in rural India: an observational study

Background: Hysterectomy - abdominal or vaginal or laparoscopic assisted, hysterectomy is the most commonly performed elective major gynaecological surgery. Rate of hysterectomy has varied between 6.1 and 8.6/1000 women of all ages. The abdominal removal of the uterus is called ‘total abdominal hysterectomy’ while the removal of the uterus by the vaginal route is termed as ‘vaginal hysterectomy’. The supracervical removal of the uterus is termed as ‘subtotal hysterectomy’. As compared to a higher frequency of hysterectomy (10-20%) in other countries, a lower rate (4-6%) has been reported in India.Methods: The study was conducted in the department of obstetrics and gynaecology National Institute of Medical Sciences (NIMS), Jaipur in 2013-2014. 100 patients were undergoing hysterectomy. The patients were diagnosed on the basis of history, clinical examination and ultrasonography report.Results: In our study, maximum number of clinical diagnosis made, were of DUB (with PID and Prolapse) which was 35%. This was followed by leiomyoma i.e. 29%, clinically 29 cases were diagnosed of which 24 were histopathologically proven. Adenomyosis (10%), clinically 10 cases were identified but there were 15 cases histopathologically, this can be due to different clinical presentation. Clinically diagnosed cases of carcinoma endometrium and cervical erosions were 1% and 2% respectively. Overall sensitivity for clinical diagnosis in our study was 52%. The most common histopathological finding was leiomyoma (24%), followed by adenomyosis (15%) and chronic cervicitis (15%). Other pathologies include combined adenomyosis and leiomyoma (6%), benign ovarian cyst in four cases. Normal histopathological report was obtained in 32 cases. Maximum correlation (100%) was found with cancer cervix, cancer ovary and cancer endometrium.Conclusions: Hysterectomy still remains the widely used modality in developing as well as developed countries. Every hysterectomy specimen should be subjected to histopathological examination to ensure diagnosis and thus management in particular of malignant diseases

Pregnancy outcome after antepartum diagnosis of oligohydramnios at or beyond thirty seven completed weeks in rural India

Background: Amniotic fluid volume abnormalities may reflect a problem with fluid production or its circulation, such as underlying fetal or placental pathology. These volume extremes may be associated with increased risks for adverse pregnancy outcome. Some studies show that amniotic fluid index is a poor predictor of adverse outcome and some authors have not confirmed the association of adverse perinatal outcome with oligo-hydramnios. Thus this study is conducted to find out the value of oligohydramnios in perinatal outcome and maternal outcome in pregnancies beyond 37 completed weeks.Methods: This study was done at department of Obstetrics and Gynaecology, NIMS hospital, Jaipur, Rajasthan, India, from January 2013 to January 2015 for a period of 24 months. Our analysis included a total of 200 antenatal women; both booked and unbooked were included in this study. In this study 100 women with AFI <5 cm were allotted into the study group and another 100 women with normal AFI were included into the control group. Labour was either spontaneous or induced in both study and control group . During labour intermittent auscultation of fetal heart rate was done to detect any signs of fetal distress. Artificial rupture of membranes was done in active phase of labour to notice the grade of liquor and progress of labour was monitored on a partogram. Mode of delivery and intrapartum complications were noted. At birth neonate was assessed using 5 minute APGAR score , birth weight was recorded and neonate who were admitted into NICU were followed until discharge.Results: Oligohydramnios i.e., AFI <5 cm measured by ultrasonography in term pregnancies is associated with adverse perinatal outcome. The risks of meconium staining of liquor, intrapartum fetal distress,operative delivery and perinatal mortality are significantly higher in patients with AFI <5 cm , compared to those with normal AFI.Conclusions: Determination of AFI can be used as an adjunct to other fetal surveillance methods. It helps to identify those infants at risk of poor perinatal outcome. Determination of AFI is a valuable screening test for predicting fetal distress in labour requiring cesarean section

Prospective study to evaluate management of ectopic pregnancy in a tertiary care centre

Background: To study the pattern of management of ectopic pregnancy in a referral Centre in North India.Methods: This prospective study was conducted over a period of one year in the department of obstetrics and gynecology, in a tertiary care Centre in North India. Total number of cases who reported to hospital with ectopic pregnancy during the study period were 110. All the cases were analyzed and managed either with conservative, medical or surgical treatment depending on the condition of cases at the time of presentation to the hospital. Frequencies of different variables were compared by chi square test using Graphpad Prism 9, p value less than 0.05 was considered statistically significant.Results: The incidence of ectopic pregnancies reported in present study was 18.62 per 1,000 deliveries. Total of 110 cases with ectopic pregnancy reported to hospital during the study period. Mean age of the cases was 28.72 years. Out of 110 cases, laparotomy was performed in 100 cases and medical management in 10 cases. Medical management failed in one case and necessitated surgery in that case. There was no maternal mortality during the study period.Conclusion: Most of the cases presented late to the hospital due to lack of awareness, topographically tough terrain in Himachal with limited transport facilities which delayed management of ectopic pregnancy and precludes conservative management either in the form of medical management or conservative surgery. Screening of high-risk cases, early diagnosis, early referral and early intervention reduces the maternal mortality and morbidity. So awareness at the primary health care level is the necessity of the hour

A programmed labour protocol for optimizing labour and delivery

Background: Objectives: 1) To evaluate the effect of programmed labor on duration of labor 2) To assess efficiency of analgesics in reducing severity of labor pains and 3) To find out any maternal and fetal/neonatal complications.Methods: 100 primigravida pregnant women meeting inclusion criteria admitted in labor room 50 were randomly enrolled in study group and 50 in control group.Results: Significant reduction in duration of active phase of labor and 43 (86%) cases had pain relief. Out of them 20 (40%) cases experienced excellent pain relief while in controls, only 22% had pain relief.Conclusions: Labour analgesia ensures pain relief, avoid maternal hyperventilation controls alteration of placental circulation thereby safe guarding the fetus against hypoxia. Thus programmed labor is easy, simple and effective method for painless deliver

Comparison of low dose Dhaka regimen of magnesium sulphate with standard pritchard regimen in eclampsia

Background: The purpose of this study was to determine the effects of altitude on severe preeclampsia and eclampsia and subsequent perinatal outcome.Methods: This prospective study was carried out during 1st March 2011 to 29th February 2012 in Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla situated at a height of 2200m from sea level. All the subjects with severe preeclampsia or eclampsia were included in the study and their perinatal outcome was noted.Results: There were a total of 5897 deliveries. There were 423 cases of PIH making an incidence of severe preeclampsia and eclampsia 15.4% and 7.3% among PIH, respectively. Majority of cases (60.4%) belonged to age group 18-25 year with mean systolic blood pressure in eclampsia was 184.3±18.6 mm of Hg and in severe preeclampsia was 171.5±13.9 mm of Hg. Mean diastolic blood pressure was 125.8±12.6 mm of Hg in eclampsia and 118.6±4.3 mm of Hg in severe preeclampsia. Various other complications in eclampsia and severe preeclampsia cases included IUGR (35.1%) cases, abruptio placentae (15.9%), HELLP syndrome (9.6%) cases, spontaneous preterm labour (21.3%) and intrauterine death (6.4%). Live births were 85.1%; fresh still births were 8.5%. Mean birth weight was 2192.5±572grams. Respiratory distress syndrome was seen in 21.3% neonates, Hyperbilirubinemia was seen in 26.2% neonates intracranial bleeding was seen in 7.5% neonates. Perinatal mortality was 27.7% which constitute14.9% still birth neonatal deaths.Conclusions: Efficacy of MgSO4 in prevention and treatment of eclamptic convulsions is time tested and supported with a variety of studies. Since its narrow therapeutic and toxicity is major concern, the use of low dose MgSO4 protocols is a viable alternative to standard dose therapy. However, because of small study design further studies on the larger scale are required to support routine clinical use of low dose protocols

SILICO MODELING AND DOCKING OF Cch1 PROTEIN OF CANDIDA GLABRATA WITH FDA-APPROVED DRUGS: A DRUG REPURPOSING APPROACH

Objective: Candida-associated mortality rate is increased worldwide in past few years due to increased resistance to available antifungal agents,where Candida glabrata has emerged as one of the most upcoming pathogens. To combat the Candida infection, new drug molecule is required. Hence,we have studied the antifungal potential of some FDA-approved drug by in silico tools against Cch1, membrane Ca+2 channel protein of C. glabrata.Methods: The 3D structure of Cch1 was predicted by Swiss modeling tool. Secondary structure was predicted by Sopma software. The docking ofFDA-approved drugs with C. glabrata Cch1 was done by iGemdock and Hex software separately.Results: We have tested total nine drugs against Cch1. Amlodipin besylate exhibited best binding energy (–372.16 kcal/mol and –185 kcal/mol foriGemdock and Hex, respectively) followed by Artesunate (–266.97 kcal/mol and –164.6 kcal/mol), Etazolate –244.35 kcal/mol and –163.9 kcal/mol).Conclusion: Amlodipin besylate has the best antifungal properties and could be used as drug after further in vitro and in vivo studies. It can be directlycome in practice since its toxicological testing has already been done.Keywords: Candida glabrata, CCH1, Calcium channel, Docking, Drug repurposing

What is better: cryocautery or electrocautery for cervical erosion?

Background: Present study was conducted with a background in mind to compare the efficacy of electrocautery and cryocautery for the management of cervical erosion. Aim of this study was to compare the efficacy of electrocautery and cryocautery for the treatment of cervical erosion and to check cost effectiveness.Methods: A comparative study was conducted at Maharishi Markandeshwar medical college and hospital, Kumarhatti (Solan) between July’13 to June’14 among 100 patients of reproductive age group with cervical erosion. They were grouped into 2 groups A (Electrocautery) & B (Cryocautery) and data obtained was analysed by paired t-test.Results: Though in short- term follow-up at 4-6 weeks after cautery, apparently electrocautery was superior to cryocautery in terms of erosion healing rate 92% vs. 76% as P value (0.4557) is not statistically significant, but in long-term follow-up at 12-14 weeks there was no significant difference in erosion healing but electrocautery was cost effective.Conclusions: Both types of cautery were equally good for treatment of cervical erosion in long-term follow-up. But electrocautery occupies less space and there is no chance of gas leakage in electrocautery, so electrocautery is more cost effective.

Optimization studies and characterization of advanced geopolymer coatings for the fabrication of mild steel substrate by spin coating technique

59-67Advance inorganic fly ash – metakaolin- phosphatic geopolymer has been developed via greener approach and deposited on mild steel substrate using spin-coating method, to improve the substrate-matrix interaction. The present research investigates the effect of incorporation of metakaolin and phosphate to geopolymer matrix to assess the performance of coating and optimization of spin coating parameters are performed as well to achieve maximum adhesion strength. XRD, FTIR, and SEM studies coupled with energy dispersive spectroscopy (EDX) have been carried out for determination of mineralogical phases, bonding interactions, substrate–matrix interface, and microstructural and chemical analysis.Results indicated that spin coating method produced well-ordered thin geopolymeric coating (thickness 13-20 micrometres), therefore spin coating deposition is the simplest way to obtain thin coatings of visibly thick materials. Maximum adhesion strength of material with substrate is 2.5M.Pa. which is obtained at optimized water to precursor ratio 0.5 at 500rpm spinning speed. It is concluded that new inorganic phases (originated from mutual contribution of phosphate, metakaolin and fly ash) like sodium iron aluminium phosphate, aluminium phosphate and sodium iron phosphate were responsible for good adhesion of material to the substrate and then related properties. The developed and optimized method can be used to produce homogeneous coating of heterogeneous geopolymer material on low carbon steel to indorse its advanced applications

The Influence of HLA on HIV-Associated Neurocognitive Impairment in Anhui, China

HLA-DR*04 was identified as a predictor of HIV-Associated neurocognitive disorder (HAND), low CD4 T-cell responses to HIV, and low plasma HIV RNA levels in a U.S. cohort. We hypothesized that low CD4 T-cell activation leads to poor immune control of HIV in the CNS, predisposing to HAND, but also provided fewer target (activated CD4 T-cells) for HIV replication. To assess the consistency of these HLA Class II associations in a new cohort and extend analysis to HLA Class I, HLA types, neurocognitive, and virologic status were examined in a cohort of former plasma donors in China.178 HIV infected individuals in Anhui China, were HLA typed and underwent neurocognitive evaluations (using locally standardized norms), neuromedical, treatment and virologic assessments at baseline and at 12 months.HLA DR*04 was associated with a higher rate of baseline neurocognitive impairment (p = 0.04), neurocognitive decline (p = 0.04), and lower levels of HIV RNA in plasma (p = 0.05). HLA Class I alleles (B*27,57,58,A*03,33) that specify a CD8 T-cell response to conserved HIV sequences were neuroprotective, associated with less impairment at baseline (p = 0.037), at month 012 (p = 0.013) and less neurocognitive decline (p = 0.023) in the interval. Consistent with the theory that effective CD8 T-cell responses require CD4 T-cell support, the HLA DR*04 allele reduced the neuroprotective effect of the Class I alleles. The presence of HLA-DR*04 and the Alzheimer associated allele ApoE4 in the same individual had a synergistic negative effect on cognition (p = 0.003).Despite major background differences between U.S. and Anhui China cohorts, HLA DR*04 predicted neurocognitive impairment and lower plasma HIV RNA levels in both populations. HLA Class I alleles associated with CD8 T-cell control of HIV were associated with protection from HAND, but protection was reduced in the presence of HLA-DR*04

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions