Evaluation of outcome of pregnancy complicated by intrahepatic cholestasis of pregnancy

Background: Obstetric cholestasis (OC), also known as intrahepatic cholestasis of pregnancy (ICP), is a hepatic disease unique to pregnancy which presents with intense generalized pruritus without any skin rash. The aim is to study the outcome of pregnancy both maternal and fetal complicated by OC.Methods: This retrospective case control study was conducted at the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna. The medical records of all women with OC who delivered between Jan 2015 and Jan 2016 were reviewed.Results: The incidence of OC was 8.2%. The most common symptom was generalized pruritus which appeared after 28 weeks in 73.3% cases. The cesarean section rate was 93.3%. A higher incidence of meconium staining in amniotic fluid at delivery (17.1% vs 1.1%, p<0.005) and preterm premature rupture of membranes (8.9% vs 1.1%, p<0.01) was noted without an increase in preterm delivery rate (24.4% vs 15.6%). There was no statistically significant difference in the following parameter - pathological cardiotocography, 1-5 minuteApgar score <7, intrauterine growth restriction, neonatal intensive care admission or perinatal mortality. There was no case of postpartum hemorrhage.Conclusions: The incidence of OC is high in the Indian population. Perinatal outcome is good in actively managed women, although at the cost of a high intervention rate

Comparison of modified biophysical profile and vibroacoustic stimulation for intrapartum fetal assessment and prediction of perinatal outcome

Background: Present study was undertaken to evaluate the effectiveness and safety of intrapartum modified biophysical profile along with vibroacoustic stimulation test in the assessment of fetal well-being compared with modified biophysical profile for women with a singleton pregnancy.Methods: This prospective study was carried out on a group of pregnant women of gestational age more than 35 weeks attending the labour room of obstetrics and gynecological department of Patna medical college and hospital, from October 2013 to October 2015. A total 220 pregnant women were selected and randomly divided into two groups, 110 women were given modified biophysical profile and 110 were underwent modified biophysical profile with VAST.Results: Among 110 women, who underwent modified biophysical profile, 80(72.7%) showed reactive response and 30(27.3%) showed non-reactive response. A total 110 women, in whom modified biophysical profile was combined with VAST, 100(91%) showed reactive response and 10 (9%) showed non-reactive response. Statistical comparison for predicting perinatal mortality was done. Modified biophysical profile with VAST had a high sensitivity (100% vs. 80%), specificity (92.5% vs. 75.2%), negative predictive value (100% vs. 98.7%) and positive predictive value (20% vs. 13.3%) as compared to modified biophysical profile. Test accuracy for predicting perinatal mortality was more than mBPP (92.7% vs.75.4%).Conclusions: Addition of VAST in place of NST in modified biophysical profile has high specificity &amp; positive predictive value, shortens the testing time

A rare case of perineal endometriosis with anal sphincter involvement

Perineal endometriosis is a rare entity which can be explained by direct implantation of endometriotic cells over the fresh episiotomy wound and subsequent development of scar endometriosis. Perineal scar endometriosis incidence is reported to be 0.3% to 1%. 28 years old, P1L1, presented with pain and swelling near episiotomy site which is associated with menstruation. Examination during menstruation revealed swelling was tender, erythematous and slightly increased in size. Clinical diagnosis of scar endometriosis was made after clinical examination. Mass excised and sent for histopathological examination. Although diagnosis essentially remains clinical, preoperative evaluation with perineal ultrasound and MRI was performed. Wide local excision remains treatment of choice and follow up for recurrence is recommended. Histopathological examination is obligatory to exclude rare possibility of malignant changes

A case of atypical leiomyoma mimicking as endometrial cancer

Atypical leiomyoma or leiomyoma with bizarre nucleus is diagnosed on histopathological examination characterized by severe cytological atypia in the form of nuclear enlargement, multi nucleation, hyperchromasia, coarse chromatin and prominent nuclei. These tumours do not have typical features of necrosis or mitotic figures to characterize them as leiomyosarcoma. There are 2% risk of these tumours to convert to leiomyosarcoma. 50-year P3L3A1 postmenopausal for past 6 years presented to gynaecology outpatient department (GOPD) with complains of pain in lower abdomen for past 1 year. Patient was examined and investigated. On clinical examination there was no apparent finding. On radiological examination a well-defined hypoechoic lesion of 6.4×5.7 cm2 was found arising from uterus. Contrast enhanced computed tomography (CECT) abdomen showed heterogenous mass involving endometrium and myometrium likely neoplastic. Total abdominal hysterectomy with bilateral salpingoophrectomy was done. Histopathological examination (HPE) report revealed features of atypical leiomyoma. Patient is under follow up in GOPD

A Ten-year Retrospective Study of Nasal Bone Fractures at a Tertiary Care Hospital of Nepal

 Introduction: Nasal bone fracture occurs due to its vulnerable position and reduced biomechanical resistance to traumas. If not timely treated, it can result in permanent functional and esthetic damage. Methods: A retrospective and cross-sectional study conducted on 91 patients above 17 years of age with nasal bone fractures in the Department of Otorhinolaryngology and Head and Neck surgery of a tertiary care hospital in Kavre. Results: Road traffic accident was the most common cause of fracture (45.1%) followed by fall (36.3%), violence (13.2%), sports-related accidents (4.4%) and occupational accidents (1.1%). Class I fracture was seen in 70 (76.9%), Class II in 17 (18.7%), and Class III in 4 (4.4%). A closed reduction procedure was performed in 74 (81.30%) of the cases, closed reduction with septoplasty was done in 10 (11%), closed reduction with augmentation rhinoplasty was performed for 3 (3.3%), closed reduction with inferior turbinoplasty was required in 3 (3.3%) whereas closed reduction with debridement was done in 1(1.1%). Conclusion: Nasal bone fracture is a complex clinical issue which needs to be addressed early. Violence prevention programs along with drinking and driving campaigns need to be more strengthened to decrease the alarmingly high frequency of nasal bone fracture in the current scenario

Evaluation of outcome of pregnancy complicated by intrahepatic cholestasis of pregnancy

Background: Obstetric cholestasis (OC), also known as intrahepatic cholestasis of pregnancy (ICP), is a hepatic disease unique to pregnancy which presents with intense generalized pruritus without any skin rash. The aim is to study the outcome of pregnancy both maternal and fetal complicated by OC.Methods: This retrospective case control study was conducted at the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna. The medical records of all women with OC who delivered between Jan 2015 and Jan 2016 were reviewed.Results: The incidence of OC was 8.2%. The most common symptom was generalized pruritus which appeared after 28 weeks in 73.3% cases. The cesarean section rate was 93.3%. A higher incidence of meconium staining in amniotic fluid at delivery (17.1% vs 1.1%, p&lt;0.005) and preterm premature rupture of membranes (8.9% vs 1.1%, p&lt;0.01) was noted without an increase in preterm delivery rate (24.4% vs 15.6%). There was no statistically significant difference in the following parameter - pathological cardiotocography, 1-5 minuteApgar score &lt;7, intrauterine growth restriction, neonatal intensive care admission or perinatal mortality. There was no case of postpartum hemorrhage.Conclusions: The incidence of OC is high in the Indian population. Perinatal outcome is good in actively managed women, although at the cost of a high intervention rate

Comparison of modified biophysical profile and vibroacoustic stimulation for intrapartum fetal assessment and prediction of perinatal outcome

Background: Present study was undertaken to evaluate the effectiveness and safety of intrapartum modified biophysical profile along with vibroacoustic stimulation test in the assessment of fetal well-being compared with modified biophysical profile for women with a singleton pregnancy.Methods: This prospective study was carried out on a group of pregnant women of gestational age more than 35 weeks attending the labour room of obstetrics and gynecological department of Patna medical college and hospital, from October 2013 to October 2015. A total 220 pregnant women were selected and randomly divided into two groups, 110 women were given modified biophysical profile and 110 were underwent modified biophysical profile with VAST.Results: Among 110 women, who underwent modified biophysical profile, 80(72.7%) showed reactive response and 30(27.3%) showed non-reactive response. A total 110 women, in whom modified biophysical profile was combined with VAST, 100(91%) showed reactive response and 10 (9%) showed non-reactive response. Statistical comparison for predicting perinatal mortality was done. Modified biophysical profile with VAST had a high sensitivity (100% vs. 80%), specificity (92.5% vs. 75.2%), negative predictive value (100% vs. 98.7%) and positive predictive value (20% vs. 13.3%) as compared to modified biophysical profile. Test accuracy for predicting perinatal mortality was more than mBPP (92.7% vs.75.4%).Conclusions: Addition of VAST in place of NST in modified biophysical profile has high specificity &amp; positive predictive value, shortens the testing time

AUTOMATIC IDENTIFICATION OF SILENCE, UNVOICED AND VOICED CHUNKS IN SPEECH

The objective of this work is to automatically segment the speech signal into silence, voiced and unvoiced regions which are very beneficial in increasing the accuracy and performance of recognition systems. Proposed algorithm is based on three important characteristics of speech signal namely Zero Crossing Rate, Short Time Energy and Fundamental Frequency. The performance of the proposed algorithm is evaluated using the data collected from four different speakers and an overall accuracy of 96.61 % is achieved

Development of energy efficient routing protocol using Hop PEGASIS in Wireless Sensor Networks

Abstract: In a Wireless sensor network (WSN), communication of the gathered data in the network from the nodes to the base station is a prominent activity and this communication of data consumes the maximum amount of energy. When there is a constant flow of information from the nodes to the base station in a wireless sensor network, the energy of the nodes gets drained due to limited battery resources of a sensor node. This directly affects the lifetime of the entire network. So our aim is to devise a routing protocol which will minimize the energy consumption and hence result in achieving extended lifetime of the entire sensor network. In this paper, we propose the Hop PEGASIS approach. The proposed Hop PEGASIS approach is more efficient than the LEACH, PEGASIS and Hierarchical PEGASIS protocols. Therefore, we focus on the concept of energy conservation which is a important factor and a major challenge in the design of Wireless sensor networks. We have used MATLAB environment for simulation