Endometrial stromal sarcoma: a rare tumour

Endometrial stromal sarcomas (ESS) are rare endometrial tumours arising from stroma of endometrium i.e. connective tissue of endometrium rather than glands. Usually a pre-operative diagnosis is difficult. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is main line of treatment. Adjuvant hormone therapy in the form of progesterones, GnRH analogues, aromatase inhibitors are effective for prevention of recurrences as these tumours are invariably positive for oestrogen & progesterone receptors. Surgical excision, radiotherapy, hormone therapy are recommended for recurrences. We report a 52 yrs widow with undifferentiated endometrial stromal sarcoma weighing 3.75 kg with a short history of 3 months diagnosed only after histopathology

Diverse presentation of connective tissue disorders in pregnancy

Connective tissue disorders (CTD) include a variety of chronic multisystem disorders including autoimmune conditions. Many of these conditions affect women of childbearing age and therefore pregnancy poses an important challenge for the caregivers. The precise knowledge of therapeutic safety and the effect of disease on pregnancy and vice versa are important to achieve best outcome. Hence, it is imperative to have a vast knowledge of disease with proper preconception counselling. We report series of cases of connective tissue disorders in pregnancy: tuberous sclerosis (TS), systemic lupus erythmatosis (SLE) and neurofibromatosis (NF) type 1. The first case with tuberous sclerosis was associated with obstetric complications. In both cases of SLE, we observed preterm delivery and IUGR. However, the course of SLE remained the same in both the cases. The case with NF 1 taught us that a normal obstetric outcome could be expected in pregnant women

Seroprevalence of human immunodeficiency virus among reproductive age group females presenting with genital ulcer: study from a tertiary care centre in India

Background: The co-existence genital ulcers either in the recipient or donor could potentially increase the risk of transmission of human immunodeficiency virus (HIV). Hence the meticulous clinical and serologic evaluation of females presenting with genital ulceration is important to curb the future spread of HIV.Methods: A total 80 female patients within the age group 15-45 years presenting with genital ulceration were enrolled in the study done at tertiary care centre in Amritsar for a period of one year. Various investigations such as Tzanck smear, VDRL, gram staining, genital mucosal biopsy, HSV serology and HIV testing - ELISA and Tri dot were done on study participants.Results: Out of 80 females, 8 patients with genital ulceration tested positive for HIV. Most common cause of genital ulceration in HIV positive female patients was herpes progenitalis (50%). Only 25% of HIV seropositive females were married rest were widowed or unmarried. History of condom use was absent in 62.5% of HIV positive females.Conclusions: Pre-existing genital ulcers due to sexually transmitted diseases (STD) or due to non-STDs, inconsistent condom use, urbanization and pre/extra marital affairs are risk factors for the acquisition of HIV

Comparative study between vaginal isosorbide mononitrate and misoprostol for induction of cervical ripening prior to surgical evacuation of first trimester embryonic demise

Background: Objective: To compare the efficacy & safety of Nitric Oxide (NO) donor, isosorbide mononitrate (ISN) to that of misoprostol, applied vaginally as tablets for cervical ripening prior to suction evacuation of first trimester embryonic demise.Methods: This is a prospective, randomized, double blind controlled trial conducted at tertiary level teaching hospital. 50 women with first trimester embryonic demise with closed cervix requiring suction evacuation were divided randomly into two groups of 25 women each. In group A, tab. isosorbide mononitrate 80 mg and in group B, tab. misoprostol 400 µg was applied vaginally. Both the drugs were repeated every three hourly up to a maximum of four doses or until reaching cervical dilation of 8 mm. Cervical dilatation was assessed at baseline & every three hours after each dose. A set of questionnaire was used for the appearance of side effects. Once 8 mm cervical dilatation achieved, suction evacuation was done. Total volume of blood lost at suction evacuation was measured.Results: Frequency of doses, induction to ripening interval & intra operative blood loss was significantly higher with isosorbide mononitrate as compared to misoprostol. Headache & palpitation were main side effects of isosorbide mononitrate. The percentages of successful & failed inductions were comparable in both the groups.Conclusions: Misoprostol is better cervical dilator prior to suction evacuation in first trimester embryonic demise with minimal side effects which are acceptable to the patient

Comparative evaluation of low dose-vaginal misoprostol and intra-cervical dinoprostone for cervical ripening and induction of labour in term pregnancy

Background: Induction of labour is one of the most common obstetric interventions worldwide. The study was conducted to compare the efficacy and safety of 25µg (low dose) vaginal Misoprostol with intracervical Dinoprostone for cervical ripening and induction of labour in term pregnancy.Methods: The study was conducted on 200 eligible term gravidas admitted for the purpose of labour induction. Subjects were randomly allotted to two groups. Group A (100 patients) received 25µg vaginal Misoprostol 6 hourly, while Group B (100 patients) received intracervical Dinoprostone 6 hourly for a maximum of 3 doses each, for cervical ripening and induction of labour. The main outcomes analysed were the induction-to-vaginal delivery interval, number of vaginal deliveries within 24 hours, dose of prostaglandin required, need for oxytocin augmentation and incidence of operative or caesarean delivery and rates of hyper stimulation, maternal complications and neonatal outcome.Results: Misoprostol use was associated with shorter induction-to-vaginal delivery interval (1165.60+306.28 minutes v/s 1369.80+286.96 minutes, p= <0.001), a greater proportion of patients delivering vaginally within 24 hours (67% v/s 46%, p=0.001) and lesser need for oxytocin augmentation to achieve vaginal delivery (25.3% v/s 54.7%, p<0.001).The mean change in Bishop’s score was greater with Misoprostol, although the difference was not statistically significant. The rates of operative and caesarean deliveries, and indications for caesarean were similar in both groups. The rates of uterine hyper stimulation, maternal and neonatal outcomes were similar.Conclusions: Vaginal Misoprostol is more efficacious than intracervical Dinoprostone for induction of labour in term gravidas

Severe maternal outcome: a rev

Maternal mortality ratio (MMR) is considered an indicator of obstetric care available in a society and reduction in MMR has been one of the important millennium development goals defined by World Health Organization (WHO) but it has always been recognized that maternal mortality is just the tip of iceberg. WHO has now defined maternal near-miss cases thus broadening the focus on life threatening conditions encountered by pregnant women. A study was started at our obstetric unit based on near-miss maternal mortality concept in March 2015 and is currently underway. We analyzed the initial data of the first few months and recognized four of such special cases which find mention in this review. We decided to review the literature with special reference to these cases as every such case is a lesson in itself for the health care provider, highlighting the acts of omission or interventions that may make the difference between a high risk pregnancy terminating without complication or ending as a near-miss or mortality. We reviewed the literature about various causes of maternal mortality and morbidity. In addition to the sincere efforts done by the doctors from different specialities, a good blood bank facility, ICU care as well as government provided transport facility played important roles in these cases. A long term analysis of this data can certainly guide the policy makers about the areas that need more stress and financial support

ORIGINAL ARTICLE: Status of Methicillin Resistant Staphylococcus aureus Infections and Evaluation of PVL Producing Strains in Belgaum, South India

Background: Panton Valentine Leukocidin (PVL) toxin, responsible for increased virulence and more severe infections can be found in both Methicillin-sensitive and Methicillin-resistant strains of Staphylococcus aureus (MSSA and MRSA). Aims & Objectives: To generate baseline data on the extent of MRSA infections and to estimate the frequency of PVL-positive S.aureus in Belgaum, South India. Material & Methods: 70 clinical isolates of S.aureus were obtained from various laboratories in Belgaum city. Theseisolates were identified, phenotypically characterized as MRSA/MSSA by disc diffusion method using oxacillin discs (1 µg) and genetically by multiplex PCR for mecA and fem B genes. PCR was subsequently carried out on all isolates to detect LukS-PV and LukF-PV genes, the markers for potential producers of PVL toxin. Results: 27 out of 70 isolates (38.6%) were confirmed as MRSA by PCR formecA. The prevalence of PVL gene was 85.1% and 48.8% in MRSA and MSSA respectively. The overall prevalence of PVL positive S.aureuswas 62.85%. Conclusion: Our study showed high percentage of PVL positive MRSA and MSSA, higher than the most reports worldwide. In the backdrop of bacterial strains gaining multiple drug resistance, our study warrants further epidemiological studies in hospitals and community levels in the region

FIGURES 14–16 in Chromosomes and their meiotic behavior in twelve species of the subfamily Harpactorinae (Hemiptera: Heteroptera: Reduviidae) from north India

FIGURES 14–16. Henricohahnia typica; 14. diffuse stage; 15. metaphase I; 16. metaphase II. FIGURES 17–19. Irantha armipes; 17. diffuse stage; 18. metaphase I; 19. metaphase II. FIGURES 20–22. Sphedanolestes himalayensis; 20. diffuse stage; 21. metaphase I; 22. metaphase II. FIGURES 23–25. Velinus annulatus; 23. diffuse stage; 24. metaphase I; 25. metaphase II. FIGURES 26–28. Villanovanus dichrous; 26. diffuse stage; 27. metaphase I; 28. metaphase II. Arrows represent Y chromosomes, arrowhead represents X chromosomes. Bar= 0.01mm.Published as part of &lt;i&gt;Kaur, Rajdeep &amp; Kaur, Harbhajan, 2013, Chromosomes and their meiotic behavior in twelve species of the subfamily Harpactorinae (Hemiptera: Heteroptera: Reduviidae) from north India, pp. 358-366 in Zootaxa 3694 (4)&lt;/i&gt; on page 361, DOI: 10.11646/zootaxa.3694.4.4, &lt;a href="http://zenodo.org/record/10098944"&gt;http://zenodo.org/record/10098944&lt;/a&gt

FIGURES 1–3 in Chromosomes and their meiotic behavior in twelve species of the subfamily Harpactorinae (Hemiptera: Heteroptera: Reduviidae) from north India

FIGURES 1–3. Rhynocoris kumarii; 1. diffuse stage; 2. metaphase I; 3.metaphase II. FIGURES 4–6. Rhynocoris costalis; 4. diffuse stage; 5. metaphase I; 6. metaphase II. FIGURES 7–9. Rhynocoris sp.1; 7. diffuse stage; 8. metaphase I; 9. metaphase II. FIGURES 10–13. Sycanus croceovittatus; 10. diffuse stage; 11. diplotene; 12. metaphase I; 13. metaphase II. Arrows represent Y chromosome, arrowhead represents X chromosomes. Bar= 0.01mm.Published as part of &lt;i&gt;Kaur, Rajdeep &amp; Kaur, Harbhajan, 2013, Chromosomes and their meiotic behavior in twelve species of the subfamily Harpactorinae (Hemiptera: Heteroptera: Reduviidae) from north India, pp. 358-366 in Zootaxa 3694 (4)&lt;/i&gt; on page 360, DOI: 10.11646/zootaxa.3694.4.4, &lt;a href="http://zenodo.org/record/10098944"&gt;http://zenodo.org/record/10098944&lt;/a&gt

Chromosomes and their meiotic behavior in twelve species of the subfamily Harpactorinae (Hemiptera: Heteroptera: Reduviidae) from north India

Kaur, Rajdeep, Kaur, Harbhajan (2013): Chromosomes and their meiotic behavior in twelve species of the subfamily Harpactorinae (Hemiptera: Heteroptera: Reduviidae) from north India. Zootaxa 3694 (4): 358-366, DOI: 10.11646/zootaxa.3694.4.