Silent uterine rupture in second trimester: a differential diagnosis to remember

Spontaneous silent uterine rupture is a life-threatening emergency situation requiring immediate laparotomy. High index of suspicion is key to prevent maternal mortality as at times the presentation can be nonspecific. Authors herein present a case of spontaneous silent uterine rupture during second trimester of pregnancy wherein the diagnosis was initially missed. To the best of authors knowledge, only a few cases with spontaneous fundal second trimester uterine rupture have been recorded so far

Pancytopenia and transient synovitis of hip joint in a SARS CoV-2 positive pregnant female: a case report

Pregnant women are at an increased risk for severe COVID-19 illness. Apart from the typical clinical manifestations, atypical presenting features of COVID-19 are also being found. We report the case of a 20 years old COVID positive antenatal patient with pancytopenia. The patient presented with scar tenderness and was taken up for emergency caesarean section at a platelet count of 5860 per microlitre. She was managed with intraoperative and postoperative transfusion of blood products. She developed chronic persistent hip pain and was diagnosed to have transient synovitis of the hip joint, which was managed conservatively. COVID-19 is a new disease with evolving clinical presentation. Pancytopenia and synovitis of hip are a rare manifestation of COVID-19 and has never been reported in a pregnant woman with COVID-19

Minimally invasive management of pyoperitoneum attributed by spontaneous perforated pyosalpinx and pyometra

Pyoperitoneum, apart from bowel perforation, can occur due to gynecologic causes like ruptured pyometra or ruptured tubo-ovarian abscess. Earlier, the management of pyoperitoneum included broad-spectrum antibiotics and emergency laparotomy with or without a hysterectomy and bilateral saphingo-oophorectomy. A higher rate of surgical complications like bowel or bladder injury was noted with surgery, and future fertility was also compromised in these patients. Later on, treatment strategies improved to laparoscopic drainage of pus with antibiotics without extensive surgery. However, such cases can be managed with an even more minimally invasive approach by image-guided pigtail drainage. In this report, we describe two cases of pyoperitoneum that were managed successfully with pigtail insertion and continuous drainage of pus along with antibiotics obviating the need for anaesthesia and surgery. It seems to be a promising approach for pyoperitoneum in a hemodynamically stable patient, not showing any features of severe sepsis

Association of ABO blood group and Rh factor in cleft lip and palate patients

Background: One of the most common congenital malformations, with widespread racial and regional variation is an orofacial cleft. The occurrence is attributed to an array of environmental and genetic factors. Blood grouping and Rh factor are genetically determined. Any possible association of clefts with them helps in planning interventional services. Methods: A case control observational study was conducted on 111 samples who were cases presenting with oral clefts in Super speciality hospitals and other 111 samples who came to hospital for their treatment other than for cleft lip or cleft palate, were controls in the study. Cases were evaluated for various phenotypes of clefts. Blood samples of each case and control was collected to elaborate on blood group genotype and Rh typing. SPSS 22.0 version was employed for statistical analysis. Results: The most common blood group noted in cases as well in controls respectively was type ‘B’ in 31.5% and 43.2%, while blood group ‘AB’ was noted the lowest in both cases (14.5%) and controls (7.3%).Rh positive was noted 94.6% in both cases and control population. Clefts were observed more in male population than female counterparts.Cases of cleft lip and palate (CLP) was noted the highest, in 61 (55%) of cases, followed by defects in lip, palate and lastly in soft palate. Conclusions: Though not associated to the biological characteristics of cleft lip and palate in the current study, the functional importance of ABO blood group distribution may be the subject of future research. Identification of any associative traits for clefts assesses individuals with risk so as to help eliminate the chance of occurrence and early identification for better prognosis

Massive retroperitoneal tubercular abscess mimicking a leaking abdominal aortic aneurysm: a case report

In spite of being a common diagnosis in the patients of Asian origin, atypical presentations of tuberculosis may pose diagnostic challenges. We report a huge prevertebral abscess in a 30-year-old female, mimicking a leaking aortic aneurysm. The patient was managed successfully by emergency decompression and stabilization. The issues related to poor patient compliance to chemotherapy and management of atypical presentations of spinal tuberculosis are discussed here

Development and validation of a photographic food atlas for portion size assessment in the southern plains of Nepal.

OBJECTIVE: To develop and validate a photographic food atlas of common foods for dietary assessment in southern Nepal. DESIGN: We created a life-sized photographic atlas of forty locally prepared foods. Between March and June 2014, data collectors weighed portion sizes that respondents consumed during one mealtime and then a different data collector revisited the household the next day to record respondents' estimations of their previous day's intakes using the atlas. Validity was assessed by percentage error, Cohen's weighted kappa (κ w) and Bland-Altman limits of agreement. SETTING: Dhanusha and Mahottari districts in southern Nepal. SUBJECTS: A random sample of ninety-five adults in forty-eight rural households with a pregnant woman. RESULTS: Overall, respondents underestimated their intakes (mean error =-4·5 %). Rice and dal (spiced lentil soup) intakes were underestimated (-14·1 % and -34·5 %, respectively), but vegetable curry intake was overestimated (+20·8 %). Rice and vegetable curry portion size images were significantly reliably selected (Cohen's κ w (se): rice=0·391 (0·105); vegetable curry=0·430 (0·139)), whereas dal images were not. Energy intake over one mealtime was under-reported by an average of 569 kJ (136 kcal; 4·5 % error) using recall compared with the weighing method. CONCLUSIONS: The photographic atlas is a useful tool for field estimation of dietary intake. Average errors were low, and there was 'modest' agreement between weighed and recalled portion size image selection of rice and vegetable curry food items. Error in energy estimation was low but with wide limits of agreement, suggesting that there is scope for future work to reduce error further