A study to evaluate pregnancy with maternal heart disease: a prospective observational study at a tertiary care centre in India

Background: Prevalence of heart disease in pregnancy vary from 0.3-3.5%. Normal pregnancy is associated with physiological cardiovascular changes. These changes may unmask underlying cardiac disease in normal women and increase morbidity and mortality in women with heart disease. Heart disease in pregnancy is an important cause of maternal mortality in India. The aim of this study was to evaluate the maternal and neonatal outcome of pregnancy with heart disease.Methods: A prospective observational study was conducted at Sassoon General Hospital, Pune, India. 75 patients who fulfilled the inclusion criteria were studied. Maternal and neonatal outcome were analyzed.Results: Maternal heart disease was classified into congenital (36%) and acquired (64%). In acquired variety, rheumatic heart disease was most commonly seen. In congenital, ASD was most common. We divided the cases into two groups based on their NYHA status, low risk group had 74.67% patients and high risk group had 25.33% patients. The most common antenatal complication was PROM (41.3%). There was statistically significant association between ICU admission and high-risk group. The most common neonatal complications were IUGR and prematurity. Maternal mortality rate in the study group was 6.6%.Conclusions: The perinatal outcome of heart disease in pregnancy is more dependent on the severity of symptoms rather than the duration and type of heart disease. Multidisciplinary evaluation is necessary. Suboptimal optimization of the heart condition in the antenatal period and delayed referral were the major risk factor for maternal mortality.

Supracrestal Non-Surgical Therapy in Periodontal Diseases

  Periodontal diseases are the complex disease with a dynamic relationship between biofilm and the host immunoinflammatory response. The goal of periodontal therapy is to preserve the natural dentition and increase their longevity by creation of a favorable environment around the teeth. The mainstay to achieve this is by the non-surgical periodontal therapy, followed by surgical and other recent treatment modalities. However, there seems no sure indication to choose amongst them that are clinically significant and offer long term predictability. We report here two cases that had supracrestal defects and were treated with less invasive instrumentation and repeated full mouth scaling and root planing. This avoided a surgical intervention and was more cost-effective in treating moderate to severe young chronic periodontitis patients. The decision for the type of treatment needs to be critically assessed with a better understanding of the outcome, morphology of the defects, and type of teeth involved.

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

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

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

Sphingosine 1 Phosphate (S1P) Receptor 1 Is Decreased in Human Lung Microvascular Endothelial Cells of Smokers and Mediates S1P Effect on Autophagy

Destruction of alveoli by apoptosis induced by cigarette smoke (CS) is a major driver of emphysema pathogenesis. However, when compared to cells isolated from non-smokers, primary human lung microvascular endothelial cells (HLMVECs) isolated from chronic smokers are more resilient when exposed to apoptosis-inducing ceramide. Whether this adaptation restores homeostasis is unknown. To better understand the phenotype of HLMVEC in smokers, we interrogated a major pro-survival pathway supported by sphingosine-1-phosphate (S1P) signaling via S1P receptor 1 (S1P1). Primary HLMVECs from lungs of non-smoker or smoker donors were isolated and studied in culture for up to five passages. S1P1 mRNA and protein abundance were significantly decreased in HLMVECs from smokers compared to non-smokers. S1P1 was also decreased in situ in lungs of mice chronically exposed to CS. Levels of S1P1 expression tended to correlate with those of autophagy markers, and increasing S1P (via S1P lyase knockdown with siRNA) stimulated baseline macroautophagy with lysosomal degradation. In turn, loss of S1P1 (siRNA) inhibited these effects of S1P on HLMVECs autophagy. These findings suggest that the anti-apoptotic phenotype of HLMVECs from smokers may be maladaptive, since it is associated with decreased S1P1 expression that may impair their autophagic response to S1P

A Comparison of Impact of Chronic Periodontal Diseases and Nonsurgical Periodontal Therapy on Oral Health-Related Quality of Life

Objectives. To evaluate the impact of chronic periodontal diseases (PDs) and compare phases of nonsurgical periodontal therapy (NSPT) on oral health-related quality of life (OHRQoL) in patients attending a tertiary care center of eastern Nepal. Materials and Methods. Matched for socioeconomic status, participants were recruited in two groups: moderate-to-severe chronic periodontitis ( = 24, 43 ± 46 years) and chronic gingivitis ( = 25, 30 ± 96 years). The treatment modalities were scaling and root surface debridement (RSD) and supragingival scaling, respectively. The impact of periodontal disease treatment status was assessed by a self-reported questionnaire of Nepali Oral Health Impact Profile (OHIP-14) at baseline and 9-12 weeks after NSPT. Results. The median (IQR) OHIP-14 total scores for PDs reduced from 7 (3-11) to 3 (1-7.5) after NSPT. Both groups showed a significant improvement on OHRQoL ( value < 0.001). The periodontitis group showed an increased median (IQR) reduction of 52% (35.22-86.15) compared with the gingivitis group with 27% (0.00-50.00). The impact on orofacial pain, orofacial appearance, and psychosocial dimensions was observed, which improved after NSPT in both groups. Conclusion. PDs are directly associated with OHRQoL and treatment of the disease may enhance quality of life from a patient's perspective. Scaling and RSD provided better influence on OHRQoL than supragingival scaling

The Histopathological Spectrum of Pyogenic Granuloma: A Case Series

Background. Pyogenic granuloma is a reactive tumor-like lesion commonly affecting the oral cavity. These lesions usually appear as localized solitary nodule with a sessile or pedunculated base and colour varying from red, purplish, or pink, depending on the vascularity of the lesion. Pyogenic granuloma shows predilection for gingiva and is usually slow growing, but at times it shows rapid growth. The natural course of this lesion can be categorized into three distinct phases, namely, (i) cellular phase, (ii) capillary phase/vascular phase, and (iii) involutionary phase. Histopathologically, pyogenic granuloma is classified into lobular capillary hemangioma (LCH) and non-lobular capillary hemangioma (non-LCH). Case Presentation. In this series, four cases (varied age groups and both genders) of pyogenic granuloma showing varying histopathological presentation in relation to its clinical course have been described. The lesion in its early phase reveals diffuse endothelial cells, with few budding into capillaries. Among the capillary phase, the LCH type shows numerous blood vessels organized into lobular aggregates whereas the non-LCH type does not show any such organization and resembles granulation tissue. The involutionary phase shows healing of the lesion and is characterized by extensive fibrosis in the connective tissue. Conclusion. In conclusion, knowledge of the various histopathological presentation of this lesion is necessary for proper identification

Effect of adjuvant yoga therapy for asthma control: A randomized controlled trial

Background: Asthma is a chronic respiratory disease with symptoms of attacks of wheezing, shortness of breath, &amp; tightness in the chest. Even with pre-existing treatment exacerbations go uncontrolled. Objective: This study compared asthma control in yoga intervention versus non-yoga intervention group using Asthma Control Test. Methods: In this randomized controlled trial, participants were allocated into two groups in 1:1 ratio - yoga intervention versus non-yoga intervention. Only outcome assessor was blinded. Sample size of 200 was calculated. Individuals between 18 and 60 years of age, diagnosed with mild to moderate asthma with no exacerbation in past one month were screened and enrolled. Per-protocol analysis was done to assess the outcomes of Asthma Control Test and expenditure.(CTRI/2020/02/023534) Results: A total of 192 participants enrolled, 165 completed this study who were considered for final analysis. A significant difference (p < 0.001) was found between yoga and non-yoga exercise group at 13 weeks. Expenses were more in non-yoga exercise group. Conclusion: Our findings confirm that yoga exercise with routine medical care reduces exacerbations and improves asthma control