Study of the causes of non-acceptance of VBAC in patients with previous one LSCS in a tertiary institution

Background: Many women who are eligible candidates for a VBAC (Vaginal Birth after Caesarean) in the current pregnancy opt for a repeat LSCS (Lower Segment Caesarean Section) as a mode of delivery. We decided to evaluate the proportion of patients who opt out of a VBAC and to study the causality of this trend.Methods: All patients who presented to the Dept. of OBG in our institution and were eligible to have a VBAC were included in the study till the sample size of 100 cases was met. Consultant opinion was sought prior to deciding the mode of delivery.Results: Incidence of patients of previous one LSCS who were not willing for VBAC was 4%, out of total number of deliveries and 30.7%, out of all cases of patients with previous one LSCS. The reason for not opting for a VBAC in the current pregnancy in the majority of the eligible patients was the desire for a concurrent sterilization procedure. Others cited apprehension of a scar rupture or fear of labor pain or both as their primary reason for opting out of a VBAC.Conclusions: The high incidence of ERC (Elective Repeat Caesarean) as compared to TOLAC (Trial of Labour after Caesarean) has long-term clinical and financial implications. Counseling given to the pregnant woman with an emphasis on the advantages of VBAC in order that she opts for a VBAC with confidence and enthusiasm is the only way forward

Impact of maternal pre-pregnancy body mass index on neonatal outcomes: a hospital based study in a tertiary care hospital in Goa

Background: Maternal under-nutrition as well as obesity, both are known to have adverse effects on the perinatal outcomes. In developing countries like India wherein the burden of both under-nutrition and obesity is rising, there is a need to spread awareness regarding the need to achieve adequate weight prior to pregnancy. Thus, this study was undertaken to observe effect of maternal pre-pregnancy BMI on neonatal outcomes in Goa Medical College (GMC) during the time period from December 2018- December 2019.Methods: A hospital based retrospective observational study was conducted wherein the neonatal outcomes of 3940 women delivering in Goa Medical College during the time period of 1 year were studied. All the study participants were divided into five groups depending upon their BMI calculated at the first antenatal visit in the first trimester.Results: Most of the women in our study were in the normal BMI category (49.8%), however a large number were overweight (37.3%), 3.2% were obese and 0.1% were morbidly obese and 9.6%were underweight. The neonates born to underweight mothers were mostly low birth weight (66.6%) while macrosomia was more common in those born to obese (3.1%) and morbidly obese (25%) women. Neonatal complications like birth asphyxia, respiratory distress syndrome and hypoglycaemia were found in significantly higher proportion in both underweight as well as obese groups. These complications were responsible for a higher NICU admission rate and a higher neonatal mortality observed in both underweight as well obese group of mothers.Conclusions: Thus in view of the poor neonatal outcomes observed in both extremes of maternal BMI, it is the need of the hour to establish better nutrition programs and educate our women regarding the necessity to achieve adequate pre-pregnancy BMI to improve the pregnancy outcomes

Preparation and Evaluation of Silymarin β-cyclodextrin Molecular Inclusion Complexes

Silymarin is a hepatoprotective agent, having poor water solubility and oral absorption of about 23 – 47%, leading to low bioavailability of the drug. The aim of the present study is to improve the solubility and dissolution rate and in turn the hepatoprotective activity of the drug, by formulating its inclusion complex with beta (β)-cyclodextrin, using different methods. The phase solubility analysis indicates the formation of 1:1 molar inclusion complex of the drug with beta cyclodextrin. Apparent stability constant for Silymarin (Kc) was 722 K-1 with β-cyclodextrin complex. The inclusion complexes were prepared by four different methods, namely, physical mixing, kneading, co-precipitation, and solvent evaporation. The prepared complexes were characterized using differential scanning colorimetry, scanning electron microscopy, and x-ray diffractometry. The inclusion complex prepared by the co-precipitation methods exhibits an overall best result, with respect to the formulation of sustained release formulations

Incidence and risk factors for post caesarean delivery surgical site infection in a tertiary care hospital

Background: Post-operative surgical site infection (SSI) is the most commonly reported nosocomial infection which constitutes a major public health care problem worldwide. SSI are the one of the most common complication after caesarean section (C-sec) and results in maternal morbidity and mortality, increased length of the hospital stays and economic burden. The aim of the study is to determine the incidence and risk factors of SSI in women undergoing C-sec.Methods: The prospective observational study carried out in department of Obstetrics and Gynaecology in Goa medical college, Bambolim Goa from 1st November 2017 to 30th May 2019. Collection of data was carried using predesigned and pretested proforma. SSI was examined for association of different risk factors and its distribution.Results: During this study period, 2106 patients underwent C-sec, out of which 103 patients developed post-operative SSI with the incidence rate being 4.89%. The incidence rate was found higher in emergency cases (6.55%) as compared to that of elective (1.21%) and median time to SSI was the 6th post- operative day. Majority of SSI, i.e., 102 out of 103 (99.08%) were superficial SSI, 1 (0.98%) were deep SSI and no organ/space SSI. The highest rate of SSI was found in 21-34 years of age group (84.47%). The common risk factors associated are anaemia, diabetes, hypertension and obesity.Conclusions: SSI results from multiple risk factors which include modifiable and non- modifiable factors and thorough analysis of these factors can help prevent SSI. The medical staff should focus on some of the modifiable risk factors can be eliminated by strict antisepsis, timely prophylactic antibiotic and maintaining normothermia as well as optimal glucose level

Torsion of lobular capillary hemangioma of greater omentum: A rare cause of acute abdomen

Metastatic tumors of the omentum are common. In contrast, the primary tumors of the omentum are very rare. Primary benign tumors of the omentum include lipomas, myxomas, and desmoid tumors. Primary malignant tumors include leiomyosarcoma, liposarcoma, etc. We report here a case of a 32-year-old female who presented to our emergency department with pain in lower abdomen of 1-day duration. The patient underwent laparotomy and was found to have an irregular mass with bosselated surface arising from the omentum that had caused torsion of the omentum. Histopathology confirmed it to be a lobular capillary hemangioma (LCH) of greater omentum. The postoperative course was uneventful, and she has followed up for last 6 months without any recurrence. There is not yet a single reported case of LCH of omentum

Ichthyosis vulgaris and pycnodysostosis: An unusual occurrence

Pycnodysostosis is a rare autosomal recessive disorder whose generesponsible for this phenotype (CTSK), mapped to human chromosome1q21, code for the enzyme cathepsin K, a lysosomal cysteineprotease; with an estimated incidence of 1.7 per 1 million births. This clinical entity includes micromelic dwarfism, increased radiological bone density, dysplasia of the skull, acro-osteolysis, straightening of the mandibular angle and in some cases, dysplasia of the acromial end of the clavicle. Oral and maxillo-facial manifestations of this disease are very clear. Herein we reported a case of pycnodysostosis, showing short stature with widening of the sutures, unfused anterior and posterior fontanelles, crowding of teeth with dental caries and typical radiological features associated with ichthyosis vulgaris and palmoplantar keratoderma

Synthesis of thiazole linked indolyl-3-glyoxylamide derivatives as tubulin polymerization inhibitors

A series of thiazole linked indolyl-3-glyoxylamide derivatives were synthesized and evaluated for their in vitro cytotoxic activity against DU145 (prostate), PC-3 (prostate), A549 (lung) and HCT-15 (colon) cancer cell lines by employing the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Among all the synthesized compounds, compound 13d displayed cytotoxicity of IC 50 = 93 nM towards DU145 cancer cell line. The most active compound 13d was also tested on RWPE-1 cells and was found to be safe compared to the DU145 cells. The target compounds were also evaluated for their inhibition activity of tubulin polymerization. Further, the treatment of compound 13d on DU145 cells led to the inhibition of cell migration ability. The detailed studies such as acridine orange/ethidium Bromide (AO/EB), DAPI, annexin V-FITC/propidium iodide staining assay suggested that the compound 13d induced apoptosis in DU145 cells. The influence of the cytotoxic compound 13d on the cell cycle distribution was assessed on the DU145 cell line, exhibiting a cell cycle arrest at the G2/M phase. Moreover, the treatment with compound 13d caused collapse of mitochondrial membrane potential and elevated intracellular ROS levels in DU145 cells. The results from molecular modelling studies revealed that these compounds bind at the colchicine binding site of the tubulin. Thus, this new molecular scaffold could be a new lead for the development of anticancer agents that target tubulin

Aldehyde-Promoted One-Pot Regiospecific Synthesis of Acrylamides Using an in Situ Generated Molybdenum Tetracarbonyl Amine [Mo(CO)₄(amine)₂] Complex

A novel complex system generated in situ from Mo­(CO)₆ and an amine is described for the regiospecific aminocarbonylation of various terminal alkynes. The Mo­(CO)₆–amine system played a dual role as complexing agent and as CO donor, thus making this process palladium-free