First trimester uric acid level: a reliable marker for gestational diabetes mellitus

Background: The prevalence of diabetes mellitus (DM) is increasing worldwide and more in developing countries like India. The diabetic epidemic experienced in India can be due to strong genetic factors coupled with increasing urbanization, sedentary lifestyle, changes in the dietary patterns and increasing obesity. Indians are at an 11-fold increased risk of developing gestational glucose intolerance and hence universal screening is essential. Uric acid is a known marker of oxidative stress. Hyperuricemia in early pregnancy may be an indicator of the existing metabolic disturbance which can hinder the maternal physiological adaptations generally seen in pregnancy thus making the pregnant women more vulnerable to the development of gestational diabetes mellitus. The objective of this study was to investigate the association between elevated uric acid levels in the first trimester of pregnancy with gestational diabetes.Methods: This prospective observational study was conducted in Chinmaya mission hospital, Bangalore from June 2016 to March 2017 (10 months). Three hundred and twelve (312) pregnant women of gestational age less than 12 weeks who attended the OBG outpatient department within this time of period for regular antenatal check-up were enrolled in the study. Along with the other antenatal investigations serum uric acid levels were estimated before 12 weeks and also between 24-28 weeks. At 24-28 weeks screening for GDM was done by OGCT using 75 gms of glucose (IADPISG criteria). Other parameters like age, parity, BMI, family history of diabetes was noted and compared.Results: In our study, among the 312 pregnant women, 88 (28%) developed GDM. Of these 74 Women (84%) with GDM had uric acid levels above 3.5 mg/dl and 14 women (15.9%) with GDM had uric acid levels below 3.5 mg/dl. Women with higher BMI showed high uric acid levels.Conclusions: Elevated serum uric acid in the first trimester has a significant correlation with development of GDM. In present study; the cut-off level of maternal serum uric acid of 3.5 mg/dl in the first trimester appears to have a good sensitivity and specificity in identifying those patients who are most likely to develop GDM later in pregnancy

A rare case of urocolpos

Urocolpos (uro-urine, Colpos-vagina) is distension of the vagina due to the accumulation of urine; it is a rare occurrence.it can be seen from young pre-pubertal girls to post-menopausal women. Labia minora adhesions can be partial or complete.in pre-pubertal girls the fusion caused due to hypoestrogenic state may be asymptomatic and present only as urinary retention. It can be mistaken for haematocoplos, which should be ruled out. We present a case report of a young female patient who presented with complete labial fusion with urocolpos with urinary incontinence. She was surgically treated and is being followed up with no recurrence

CPK: The new tool in the diagnosis of ectopic pregnancy

Background: Ectopic pregnancy is still a diagnostic dilemma presenting with various complaints. The classic triad of amenorrhea, abdominal pain, vaginal bleeding and /or syncope is not always seen. Misdiagnosis can lead to delay in treatment, blood loss is found to be the major cause of death. Early and accurate diagnosis is critical in bringing down the maternal mortality and morbidity. Prompt and effective treatment of an ectopic pregnancy can help preserve the chances of future healthy pregnancies. Aim of present study was to investigate whether creatinine phosphokinase (cpk) can be used as an effective diagnostic tool in the early diagnosis of ectopic pregnancy which can help in decreasing the maternal mortality and morbidityMethods: This observational comparative three group clinical study was conducted at Chinmaya Mission Hospital, Bangalore, between May 2016 to January 2017.120 women in their early trimester were studied of which 40 were diagnosed cases of ectopic pregnancies, 40 women presented with intrauterine abortive pregnancies and 40 women had normal healthy pregnancies. Serum CPK, serum B-HCG, vaginal scans were done in all, along with routine investigations.Results: The mean CPK values in normal, abortive and ectopic pregnancies were 36.92±6.44, 43.95±11.96 and 91.55±30.43 respectively. It was found to be significantly higher in ectopic Pregnancies. Also, the mean CPK in ruptured and unruptured ectopic pregnancy were 97.26±25.97 and 63.82±34.92 respectively.Conclusions: Present study shows that maternal CPK levels are significantly higher in women with ectopic pregnancies. CPK can serve as the reliable biochemical marker to diagnose ectopic pregnancy particularly ruptured. CPK can be used to increase the diagnostic efficacy in ectopic pregnancy, which followed by rapid and appropriate treatment can reduce the mortality, morbidity and preserve future fertility

Partographic analysis of labour by modified who partograph in primigravidae: a prospective observational study

Background: The objective of this study was to assess the role of partogram in the analysis of outcome of spontaneous labour in primigravidae at term with singleton pregnancy with vertex presentation.Methods: This prospective observational study was carried out in Chinmaya Mission Hospital, Bangalore over a period of 2 years, from February 2013 to March 2015. A partographic analysis of labour was done in 300 primigravidae using modified WHO partogram. The study population was divided into 3 groups, group I- cervical dilatation and descent curve falling to the left of alert line. Group II- cervical dilatation and descent curve falling to the right of alert line. Group III cervical dilatation and descent curve falling to the right of action line. Partographic analysis was done and maternal and neonatal outcomes were studied in these groups.Results: In this study, 300 primigravidae in labour were analysed. Of these 282(94%) women belonged to group I, 18(6%) belonged to group II. There were no cases in group III. Mean durations of active phases of labour were 4.75 hrs and 7.74 hrs in group I and II. In group I, 275(98%) women delivered vaginally, 7(2%) underwent LSCS and 96 (34%) had instrumental deliveries. In group II, 14(78%) women delivered vaginally, 4(23%) had instrumental delivery and 4(22%) underwent LSCS.Conclusions: The WHO modified partogram is highly effective in reducing both maternal and neonatal morbidity. It aids in assessing the progress of labour and to identify when intervention is necessary

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

Study of cord blood nucleated RBC’s as a marker for fetal asphyxia

Background: Perinatal asphyxia is a serious problem globally and is a common cause of neonatal mortality and long term morbidity. Various Parameters are being used as predictors for birth asphyxia but the correlation between clinical presentation and the biochemical results has been unsatisfactory. NRBC count of the cord blood is reported in literature as a possible marker of perinatal asphyxia. In-utero hypoxic episode may induce a haemopoetic response of exaggerated erythropoiesis leading to the presence of nucleated RBC's in fetal circulation. The aim of this study was to investigate whether NRBC count of the cord blood can be a useful parameter to determine perinatal asphyxia.Methods: This prospective case control study was conducted in Chinmaya Mission hospital, Bangalore, India between July 2015 to June 2016.we have studied the NRBC counts from the cord blood of 50 neonates with perinatal asphyxia and 50 healthy neonates, thus comparing the results.Results: The mean NRBC /100 WBC for cases with birth asphyxia was 11.6 and that of the control group was 5.6. NRBC count was found to be significantly higher in neonates with low Apgar scores. There was correlation between the Apgar scores at 1st and at 5 minutes, the degree of Hypoxic Ischemic Encephalopathy and the NRBC counts.Conclusions: Therefore NRBC counts of the cord blood can be used as an effective tool to confirm perinatal asphyxia. It is a simple, quick, accurate and clinically effective test to diagnose and initiate treatment to prevent long term sequel of perinatal asphyxia

Changing Trends of Vulvovaginal Candidiasis

Introduction: Vulvovaginal candidiasis is one of the most common infections seen in women. Materials and Methods: A total of 300 symptomatic women were studied. High vaginal swabs collected from each patient were processed by Gram stain, culture on Sabourauds dextrose agar and CHROM agar plates. Isolates were identified and speciated using conventional methods and by the color of the colonies on the CHROM agar. Antifungal susceptibility was performed by disc diffusion method for fluconazole (25 μg) and voriconazole (1 μg) discs as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Vulvovaginal candidiasis was found in 53 (17.7%) of cases. Gram stain was positive in 22 (41.41%) of culture positives. Speciation of isolates by conventional and CHROM agar methods showed similar results. C. albicans 35 (66.0%) was the most common species isolated followed by C. tropicalis 14 (26.4%), C. krusei 2 (3.8%), C. parapsilosis and C. glabrata in 1 (1.9%) case each. Sensitivity to fluconazole was found in 91.4% of C. albicans, 57.1% of C. tropicalis and 50.0% of C. krusei. Sensitivity to voriconazole was seen in 91.4% of C. albicans, 85.7% of C. tropicalis and 50.0% of C. krusei. C. parapsilosis and C. glabrata were found sensitive only to voriconazole. Conclusion: CHROM agar has the advantage of being rapid, simple and cost effective method as compared to conventional methods in speciation of Candida. Routine susceptibility testing of Candida isolates help in selecting the most appropriate antifungal agent for vulvovaginal candidiasis

Partographic analysis of labour by modified who partograph in primigravidae: a prospective observational study

Background: The objective of this study was to assess the role of partogram in the analysis of outcome of spontaneous labour in primigravidae at term with singleton pregnancy with vertex presentation.Methods: This prospective observational study was carried out in Chinmaya Mission Hospital, Bangalore over a period of 2 years, from February 2013 to March 2015. A partographic analysis of labour was done in 300 primigravidae using modified WHO partogram. The study population was divided into 3 groups, group I- cervical dilatation and descent curve falling to the left of alert line. Group II- cervical dilatation and descent curve falling to the right of alert line. Group III cervical dilatation and descent curve falling to the right of action line. Partographic analysis was done and maternal and neonatal outcomes were studied in these groups.Results: In this study, 300 primigravidae in labour were analysed. Of these 282(94%) women belonged to group I, 18(6%) belonged to group II. There were no cases in group III. Mean durations of active phases of labour were 4.75 hrs and 7.74 hrs in group I and II. In group I, 275(98%) women delivered vaginally, 7(2%) underwent LSCS and 96 (34%) had instrumental deliveries. In group II, 14(78%) women delivered vaginally, 4(23%) had instrumental delivery and 4(22%) underwent LSCS.Conclusions: The WHO modified partogram is highly effective in reducing both maternal and neonatal morbidity. It aids in assessing the progress of labour and to identify when intervention is necessary