Youssef’s syndrome following caesarean section: a rare case with review of literature

Youssef’s syndrome is a rare condition characterized by vesicouterine fistula with cyclic haematuria, amenorrhoea and incontinence of urine. A vesicouterine fistula is an abnormal connection between the uterus and bladder that most commonly occur due to inadvertent injury to the bladder during lower segment caesarean section. Vesicouterine fistula leads to psychological and has the negative impact on quality of life. A high suspicion should be kept in mind if the patient presents with urinary incontinence even many years after caesarean section. However, conservative management may be appropriate in some cases, but the definitive mode of management is surgery. Hereby authors present a 22-year-old para 2 live 2 (previous 2 caesarean section) with vesicouterine fistula with the complaint of urinary incontinence, cyclical haematuria (menouria) and amenorrhoea a year after caesarean section done due to obstructed labour.

Colour Stability of Two Different Denture Base Resins and the Efficacy of Two Denture Cleansing Agents after Tea and Coffee Staining: An In-vitro Study

Introduction: In dentistry, colour is one of the most important dimensions of aesthetics. Due to the diverse food habits in India, stains accumulate on dentures. Various denture cleansing agents such as Fittydent and Clinsodent are widely used, emphasising the importance of patient oral hygiene. Aim: To evaluate the colour stability of heat-cure activated acrylic denture base resins {Dental Products of India (DPI) and Trevalon} after staining with tea and coffee, subsequently treated with Clinsodent, Fittydent, and distilled water (control group) as cleansing agents. Materials and Methods: This in-vitro study was conducted at Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, in the Department of Prosthodontics, Crown and Bridge, and Implantology in collaboration with Indorama, Nagpur, Maharashtra, India, over a period of approximately 90 days (August-October 2017). Total 120 samples were prepared in-vitro study using custom-made brass metal discs measuring 10 mm by 2 mm. Trevalon and DPI heat-cure acrylic denture base resins were used for sample preparation. Baseline colour stability values were established after immersing the samples in distilled water at 37°C for 24 hours. The samples were then stained for eight hours, followed by immersion in different cleansing agents and distilled water for 12 hours. This process was repeated every 24 hours for 60 days, with the staining and cleansing agents replenished daily. Colour measurements were taken at baseline, 15th, 30th, 45th, and 60th days. Statistical analysis involved t-tests and one-way Analysis of Variance (ANOVA). Results: The DPI denture base resin exhibited a highly significant ΔE (change in energy) at 45 days (p=0.0001), while Trevalon showed significance at 60 days (p=0.0079). The difference in means was statistically significant using t-tests for independent samples, and the variance-measure analysis indicated statistical significance in the means of ΔE. The comparison of the three cleansing agents at 60 days was statistically obtained using one-way ANOVA. Conclusion: Dental Products of India (DPI) showed more colour variation than Trevalon. Tea showed a higher staining than coffee. Staining intensity increased over time, peaking at 45 days and stabilising thereafter. Clinsodent is better than Fittydent in removing stains

Echocardiographic parameters in clinical responders to surgical pericardiectomy – A single center experience with chronic constrictive pericarditis

Background: Chronic constrictive pericarditis (CCP) is the end result of chronic inflammation of the pericardium. Developing countries continue to face a significant burden of CCP secondary to tuberculous pericarditis. Surgical pericardiectomy offers potential cure. However, there is paucity of echocardiography data in post-pericardiectomy patients vis-a-vis their clinical status. We studied the changes in multiple echocardiographic parameters in these patients before and after pericardiectomy. Methods: Twenty-three patients (14 men, 9 women) who underwent pericardiectomy for CCP in the last 5 years (from January 2009 to December 2014) were subjected to detailed clinical and echocardiographic evaluation during the study period (between June 2013 and December 2014). Patients with residual symptoms of NYHA class II and below were considered as ‘responders’. The data thus obtained were compared to the pre-operative parameters. Results: After pericardiectomy, the incidence of vena caval congestion decreased from 100% to 15% (p < 0.001). There was significant reduction in the mean left atrial size from 39.33 ± 10.52 mm to 34.45 ± 10.08 mm (p < 0.001) and also the ratio of left atrium to aortic annulus from 1.93 to 1.69 (p < 0.001) among ‘responders’ to pericardiectomy. Septal bounce was observed to persist in 5 (25%) patients after pericardiectomy. There was significant respiratory variation of 39.23 ± 15.11% in the mitral E velocity before pericardiectomy. After pericardiectomy, this variation reduced to 14.43 ± 7.76% (p < 0.001). There was also significant reduction in the respiratory variation in tricuspid E velocities from 31.33 ± 18.81% to 17.35 ± 16.26% (p < 0.001). After pericardiectomy, the mean ratio of mitral annular velocities, medial e′: lateral e′, reduced from 1.08 to 0.87 (p < 0.03). The phenomenon of ‘annulus reversus’ was found to persist in 6 ‘responders’, thereby reflecting a 50% reduction in its incidence after pericardiectomy (p < 0.001). The ratio of mitral E to medial e′ (E/e′) increased from 4.21 ± 1.35 before pericardiectomy to 6.91 ± 2.62 after pericardiectomy (p = 0.001). Conclusion: Among clinical responders to surgical pericardiectomy, echocardiographic assessment revealed a significant reduction in vena caval congestion, LA size, ratio of LA to aortic annulus, septal bounce, respiratory variation in mitral and tricuspid E velocities, mitral annular medial e′ and the phenomenon of annulus reversus. Also, there was a significant rise in minimum tricuspid and mitral E velocities and the E/e′ ratio