Risk factors for meconium stained amniotic fluid and its implications

Background: Meconium staining of amniotic fluid (MSAF) has for long been considered to be a predictor of adverse fetal outcome and meconium aspiration syndrome (MAS), a major cause of perinatal morbidity and mortality. The aim of the study was to identify the risk factors, perinatal outcome in deliveries complicated by meconium stained amniotic fluid.Methods: This study is a prospective case control study of 100 patients done in a tertiary care hospital over a period of six months. Fifty patients with meconium stained amniotic fluid detected at any time during the course of labour or prior to it were enrolled in the study group. The inclusion criteria for the study were, a singleton pregnancy, cephalic presentation, term gestation and absence of major congenital anomalies. For the control group, the next woman giving birth following the index patient who satisfied the same set of inclusion criteria and had clear amniotic fluid was selected. Data was collected on a standardized pretested proforma.Results: Gestational age and parity showed no statistical significance between the study and control groups. Among antepartum and intrapartum risk factors, preeclampsia (32% in the study group vs 6% in the control group) p=0.0034, fetal growth restriction (12% vs 2%) p=0.05, fetal distress (36% vs 6%) p=0.0002 and labour dystocia (20% vs none in the control group) p=0.0009 were found to be statically significant. Caesarean section was considerably higher in patients with meconium stained amniotic fluid (66% vs 28%), p=0.0004. 3 (66%) patients had thin meconium and 17 patients (34%) had thick meconium stained amniotic fluid. Eighteen percent of the babies with meconium stained amniotic fluid had an Apgar of less than 7 at 5 minutes. Thirteen (26%) of the babies with meconium stained amniotic fluid developed MAS.Conclusions: Meconium stained amniotic fluid is associated with a higher incidence of operative deliveries resulting in an increased maternal morbidity. It is also associated with an increased neonatal morbidity due to birth asphyxia and respiratory depression at birth and a significant risk of neonatal mortality due to meconium aspiration syndrome

Common tumor at a rare site

Extrauterine leiomyomas are rare and are a great diagnostic challenge. Leiomyoma and fibroma are the most common mesenchymal tumours of the vagina. 51-year-old multiparous lady presented with vulvovaginal swelling. On examination, a lobulated firm vulvovaginal mass measuring 6×7 cm, occupying the right posterolateral part of labia majora extending into the lateral vaginal wall was seen. Histopathology was suggestive of Leiomyoma. Leiomyoma should be considered as one of the differential diagnosis of solid vaginal mass

Jaundice during pregnancy: maternal and fetal outcome

Background: Jaundice affects a small percentage of pregnant women, yet it takes a major toll on health of both mother and fetus especially in developing countries like India. Jaundice in pregnancy carries a grave prognosis for both the fetus and the mother, and is responsible for 10% of maternal deaths. The aim of the study was to find out the effect of jaundice during pregnancy on maternal and fetal outcome.Methods: 51 pregnant women with jaundice during pregnancy attending the Institute of obstetrics and gynaecology, Egmore, Chennai between 2011-2012.Results: 51 patients had jaundice during pregnancy. The incidence of jaundice was 0.29%.74% of patients was between 20-29 years of age. Maximum numbers of cases were Primigravida. The most common cause of jaundice was Viral Hepatitis. Maternal mortality was 7.8%.The common maternal complications were atonic postpartum haemorrhage 9.8%, hepatic encephalopathy 7.87%, disseminated intravascular coagulation 5.88% and hepatorenal failure 4%. Perinatal mortality was 35.5%.Conclusions: Jaundice in pregnancy has adverse fetomaternal outcome. Improvement in health awareness, education and regular antenatal checkups, early referrals result in early diagnosis and treatment of jaundice during pregnancy thus reducing maternal and fetal mortality and morbidity

Awareness, attitude and practice of contraception among antenatal women in a tertiary care hospital- a cross sectional study

Background: Reproductive health services that empower women will greatly reduce the social and economic disruption in society. The aim of the study was to assess the level of awareness about different types of contraceptive choices and also to find out the current practice of contraceptive methods by antenatal women attending the antenatal outpatient department in a tertiary care hospital.Methods: This was a cross-sectional study conducted over a period of 6 months at SRM medical college hospital. 200 antenatal women attending outpatient department of obstetrics and gynecology were randomly selected and were interviewed with predesigned questionnaire. The data collected were analysed using percentage.Results: Majority of the women in the study were between 20 to 25 years. 97% were aware of contraception, 81% were aware of the needs of birth spacing and only 64% were aware of the benefits of birth spacing methods. About 74% of them were aware of more than one method of contraception. Condom (93%) was the most heard about method. Only 23% of these women gave a history of usage of contraception. Majority of these women had used condoms (16%). Sterilisation (44%) was considered the safest option among the contraceptive choices followed. Social circle (49%) and health care providers (42%) played a major role as source of knowledge. Majority of the antenatal women did not use contraception because of desire of child (41%) and fear of side effects (21%).Conclusions: The high contraceptive awareness and educational level did not reflect on the contraceptive usage level in this study. Hence proper counselling and education is required to motivate the women for contraceptive usage and eradication of myths involving the risks of using contraception

A retrospective study of ectopic pregnancies in a tertiary care hospital

Background: Ectopic pregnancy is a common life threatening emergency in first trimester of pregnancy and it leads to serious maternal morbidity and also can cause mortality. The aim was to study the incidence, clinical presentation, risk factors and the management of patients with ectopic pregnancies admitted in our hospital over three year period.Methods: The present study involves a retrospective analysis of ectopic pregnancies admitted in SRM Medical college hospital for three years from 2012 to 2015.Results: The incidence of ectopic pregnancy in the present study is 1.77%. About 79% of the women were in the age group of 21-30 years. About 79% of patients in present study belonged to low socioeconomic status. In the study ectopic pregnancies were more common among multigravida (78%). 73% of patients had identifiable risk factors of which tubal surgeries were more common (31.15%). Ultrasound was diagnostic of ectopic pregnancy in 85% of patients. 97.26% were tubal ectopic pregnancies and 2.74% were ovarian ectopic pregnancies. Among tubal pregnancies majority of cases were ampullary pregnancies (62%). All patients in the study underwent surgical management.Conclusions: Ectopic pregnancy is still a major challenge in gynaecological practice. Early diagnosis and early referral is the key to successful management. It is better to over diagnose an ectopic pregnancy especially in a rural setup. Most cases present late, making tubal conservation treatment inapplicable. The impact on future fertility can be improved by focusing on primary prevention and early diagnosis before rupture so that conservation treatment can be done

Incisional Hernia Involving the Neobladder: Technical Considerations to Avoid Complications

The management of incisional hernia following radical cystectomy (RC) and neobladder diversion poses a special challenge. Mesh erosion into the neobladder is a potential complication of hernia repair in this setting. We describe our experience and steps to avoid this complication. Three patients developed incisional hernias following RC involving the neobladder. The incisional hernias were repaired by the same surgeon. A systematic dissection and repair of the hernias with an onlay dual-layer mesh (made of polyglactin and polypropylene) was carried out. The critical steps were placing the polyglactin side of the mesh deeper and positioning of an omental flap anterior to the neobladder. The omental flap adds a protective layer that prevents adhesions between the neobladder and abdominal wall, and prevents erosion of the mesh into the fragile neobladder wall. All of these patients had received two cycles of neoadjuvant chemotherapy prior to RC. The time duration from RC to the repair of hernia was 7, 42, and 54 months. No intraoperative injury to the neobladder or other complication was noted during hernia repair. The patients were followed after hernia repair for 20, 22, and 42 months with no recurrence, mesh erosion, or other complications. Careful understanding and attention to details of the technique can minimize the risk of complications, especially incisional hernia recurrence, injury to the neobladder, and erosion of mesh into the neobladder wall

Pretreatment quality assurance of volumetric modulated arc therapy on patient CT scan using indirect 3D dosimetry system

Purpose: Aim of this study is to clinically implement the COMPASS 3D dosimetry system for pretreatment quality assurance of volumetric modulated arc therapy (VMAT-RapidArc) treatment plans. Methods: For this study, 10 head and neck (H&amp;N) and 10 pelvis VMAT plans dose response from Linac was measured using COMPASS system along with MatriXXEvolution and 3D dose was reconstructed in the patient computed tomography (CT) scan. Dose volume histograms and 3D gamma were used to evaluate the difference between the measured and calculated values. In order to validate the COMPASS system, dose response for open fields were acquired for both homogeneous and inhomogeneous phantoms. Results: The average dose difference between Eclipse treatment planning system (TPS) calculated and COMPASS measured (homogenous medium) in normalization region, inner region, penumbra region and buildup region was less than ±2%. In inhomogeneous phantom, there was a maximum difference of -3.17% in lung, whereas the difference other densities was within ±2%. The systematic increase in the average 3D gamma between the TPS calculated and COMPASS measured for VMAT plans with known dose errors and multi-leaf collimator (MLC) offset errors shows that COMPASS system was sensitive enough to find clinical significant errors. The 3D dose parameters (D95, D1, and average dose) of all H&amp;N and pelvis patients were well within the clinically acceptable tolerance level of ±5%. The average 3D gammas for planning target volumes (PTV) and organ at risks (OAR) of the patients were less than 0.6. Conclusion: The results from this study show that COMPASS along with MatriXXEvolution can be effectively used for pretreatment verification of VMAT plans in the patient anatomy.</p

Pretreatment quality assurance of volumetric modulated arc therapy on patient CT scan using indirect 3D dosimetry system

Purpose: Aim of this study is to clinically implement the COMPASS 3D dosimetry system for pretreatment quality assurance of volumetric modulated arc therapy (VMAT-RapidArc) treatment plans. Methods: For this study, 10 head and neck (H&amp;N) and 10 pelvis VMAT plans dose response from Linac was measured using COMPASS system along with MatriXXEvolution and 3D dose was reconstructed in the patient computed tomography (CT) scan. Dose volume histograms and 3D gamma were used to evaluate the difference between the measured and calculated values. In order to validate the COMPASS system, dose response for open fields were acquired for both homogeneous and inhomogeneous phantoms. Results: The average dose difference between Eclipse treatment planning system (TPS) calculated and COMPASS measured (homogenous medium) in normalization region, inner region, penumbra region and buildup region was less than ±2%. In inhomogeneous phantom, there was a maximum difference of -3.17% in lung, whereas the difference other densities was within ±2%. The systematic increase in the average 3D gamma between the TPS calculated and COMPASS measured for VMAT plans with known dose errors and multi-leaf collimator (MLC) offset errors shows that COMPASS system was sensitive enough to find clinical significant errors. The 3D dose parameters (D95, D1, and average dose) of all H&amp;N and pelvis patients were well within the clinically acceptable tolerance level of ±5%. The average 3D gammas for planning target volumes (PTV) and organ at risks (OAR) of the patients were less than 0.6. Conclusion: The results from this study show that COMPASS along with MatriXXEvolution can be effectively used for pretreatment verification of VMAT plans in the patient anatomy

Vitamin D resistant genes – promising therapeutic targets of chronic diseases

Vitamin D is an essential vitamin indispensable for calcium and phosphate metabolism, and its deficiency has been implicated in several extra-skeletal pathologies, including cancer and chronic kidney disease. Synthesized endogenously in the layers of the skin by the action of UV-B radiation, the vitamin maintains the integrity of the bones, teeth, and muscles and is involved in cell proliferation, differentiation, and immunity. The deficiency of Vit-D is increasing at an alarming rate, with nearly 32% of children and adults being either deficient or having insufficient levels. This has been attributed to Vit-D resistant genes that cause a reduction in circulatory Vit-D levels through a set of signaling pathways. CYP24A1, SMRT, and SNAIL are three genes responsible for Vit-D resistance as their activity either lowers the circulatory levels of Vit-D or reduces its availability in target tissues. The hydroxylase CYP24A1 inactivates analogs and pro-hormonal and/or hormonal forms of calcitriol. Elevation of the expression of CYP24A1 is the major cause of exacerbation of several diseases. CYP24A1 is rate-limiting, and its induction has been correlated with increased prognosis of diseases, while loss of function mutations cause hypersensitivity to Vit-D. The silencing mediator of retinoic acid and thyroid hormone receptor (SMRT) and its corepressor are involved in the transcriptional repression of VDR-target genes. SNAIL1 (SNAIL), SNAIL2 (Slug), and SNAIL3 (Smuc) are involved in transcriptional repression and binding to histone deacetylases and methyltransferases in addition to recruiting polycomb repressive complexes to the target gene promoters. An inverse relation- ship between the levels of calcitriol and the epithelial-to-mesenchymal transition is reported. Studies have demonstrated a strong association between Vit-D deficiency and chronic diseases, including cardio-vascular diseases, diabetes, cancers, autoimmune diseases, infectious diseases, etc. Vit-D resistant genes associated with the aforementioned chronic diseases could serve as potential therapeutic targets. This review focuses on the basic structures and mechanisms of the repression of Vit-D regulated genes and highlights the role of Vit-D resistant genes in chronic diseases

Plasma chemokines CXCL10 and CXCL9 as potential diagnostic markers of drug-sensitive and drug-resistant tuberculosis

Tuberculosis (TB) diagnosis still remains to be a challenge with the currently used immune based diagnostic methods particularly Interferon Gamma Release Assay due to the sensitivity issues and their inability in differentiating stages of TB infection. Immune markers are valuable sources for understanding disease biology and are easily accessible. Chemokines, the stimulant, and the shaper of host immune responses are the vital hub for disease mediated dysregulation and their varied levels in TB disease are considered as an important marker to define the disease status. Hence, we wanted to examine the levels of chemokines among the individuals with drug-resistant, drug-sensitive, and latent TB compared to healthy individuals. Our results demonstrated that the differential levels of chemokines between the study groups and revealed that CXCL10 and CXCL9 as potential markers of drug-resistant and drug-sensitive TB with better stage discriminating abilities