Maternal and neonatal outcome in COVID-19 pregnancy: an ongoing review of first wave in a tertiary care center in North India

Background: This study analyzed the clinical outcomes in the obstetric patients with COVID-19 and their neonates in first wave of COVID-19 pandemic in North India, 2020.Methods: This prospective study was conducted between 10 May 2020 to 31 December 2020 on 83 obstetric patients with COVID-19 and their 52 neonates.Results: 36.14% obstetric patients presented with COVID-19 like symptoms with most common symptom as fever in 60% and cough in 53.33%. 4.81% patients were admitted in HDU and 1/83 (1.20%) patient who required ICU had mortality due post-operative complications. 20.48% had pre-existing medical diseases. Amongst (78) antenatal patients, 21.79% had pregnancy related hypertensive disorders, 12.82% had deranged liver function tests without hypertension and 8.97% had gestational diabetes mellitus. More probability of pre-term labour pains 2.4 (95% CI, 1.37-4.18) and IUFD 2.18 (1.13-4.20) were observed in symptomatic patients as compared to asymptomatic patients. Neonates born to COVID-19 symptomatic mothers had 1.81 (95% CI, 0.73-4.49) times the risk of being symptomatic, 1.37 (95% CI, 0.54-3.41) times the risk of getting admitted to NICU and 1.57 (95% CI, 0.48-5.09) times the risk of getting infected by SARS-CoV-2 and increased morbidity in neonates. 8% neonates had perinatal and 1.5% had horizontal transmission of SARS-CoV-2.Conclusions: First wave of COVID-19 pandemic did not cause significant adverse outcome in pregnant patients and mother-newborn dyads in our tertiary care centre when active and intensive management of mothers and newborns were done but still there is possibility of severe morbidity and mortality due to COVID-19.

Comparison of diagnostic accuracy of hysteroscopy and ultrasonography in relation to histopathology in cases of postmenopausal bleeding

Background: To evaluate the role of hysteroscopy and ultrasound in relation to histological findings in patients of postmenopausal bleeding and to find out the sensitivity, specificity, positive predictive, negative predictive values and accuracy of ultrasound and hysteroscopy.Methods: A retrospective analysis of the 30 women who underwent hysteroscopic evaluation out of total 103 patients of postmenopausal bleeding over the period of one year (August 2017 and July 2018) was done. Records were taken out to collect the relevant information. USG and hysteroscopic findings were correlated with histopathology for the comparative analysis.Results: Indications of hysteroscopy cases were suspected polyp (5), fractional curettage (F/C) technically not feasible (7), inconclusive USG reports (5), recurrent bleeding with normal fractional curettage report (4), no tissue on F/C (1), removal of intra-uterine contraceptive device (1). Causes of postmenopausal uterine bleeding were found to be atrophic endometrium including one case of senile cystic atrophy (33.3%), secretory endometrium and endometrial polyps (23.3% each) and endometrial malignancy (20.0%) cases. Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy values of USG in various endometrial conditions was found to be 57.1%, 85.2%, 55.1%, 86.2% and 78.5% respectively and for hysteroscopy was 87.1%, 97.5%, 90.0%, 96.7% and 95.3% respectively.Conclusions: Hysteroscopy is a minimally invasive, safe and effective modality with least complications and morbidity rate and an ideal method for establishing the pathology as well as offering therapeutic intervention simultaneously

Schizencephaly: a rare case with early diagnosis, management and review of literature

Schizencephaly or split brain is an uncommon congenital disorder of cerebral cortical development, belonging to the group of cell migration defects. It is characterized by the presence of a cleft in the brain extending from the surface of the piamater to the cerebral ventricles. A 21-year-old primigravida at 19+2 weeks of gestation was referred to our Outpatient department with a level-2 ultrasound done at 18+2 weeks suggestive of schizencephaly. First trimester genetic screening was not done. Quadruple testing was normal. After genetic consultation and poor prognostication by neonatologist, decision for medical termination of pregnancy was taken. Patient underwent medical termination with mifepristone -misoprostol regimen. A female abortus weighing 200 gm was delivered. Gross examination showed only facial malformation in the form of cleft lip and hypoplastic nose. Infantogram did not reveal any skeletal deformity. On fetal autopsy, findings were consistent with the diagnosis of schizencephaly (type 1). Schizencephaly is a rare disorder in prenatal medicine with grave prognosis. Majority of cases are either diagnosed at late gestation or present in the first decade of life. Hence with periodic surveillance during antenatal care and help of ultrasonography, such rare and serious congenital malformations can be diagnosed and managed at an early stage

Presentation and intervention in missing Copper T Thread in reference to timing of insertion

Background: To analyse the impact of time of insertion of Copper T to presentation and intervention for management of missing Cu-T thread.Methods: After approval of the study by research and institutional Ethics Committee, present study was carried out partly prospectively on patients presenting with missing Cu T thread. Retrospective data was also collected from minor OT or admission records for those admitted for removal of IUCD and duly completed telephonically. Proportion of women with missing Cu T thread were calculated in percentages. Correlation between different groups couldn’t be calculated because of major difference in number of subjects in groups. Data was analysed with regard to relation to timing of insertion, presentation, complications, number and kind of interventions for its removal.Results: Among 57 women, 30 had post LSCS CuT insertion, 6 had post NVD, 20 had interval CuT insertion, 1 had post abortal insertion. Misplaced CuT was detected in 8 women on USG, 4 (50%) had post LSCS, 3 (37.5%) post NVD and 1 (12.5%) had interval CuT insertion. OPD removal could be attempted successfully in 30 women; 11 (36.67%) post LSCS, 2 (33.33%) post NVD, 16 (80%) interval and 1 (100%) post abortion insertion. OT removal was needed in 23 women; 17 (56.67%) post LSCS, 2 (33.33%) post NVD, 4 (20%) interval CuT insertion. Spontaneous expulsion diagnosed in 4, 2 post LSCS and 2 post NVD CuT insertion.Conclusions: There is definite impact of timing of Cu T insertion on incidence of misplacement and expulsion and more data and studies are needed for developing a common information performa to develop SOPs for follow up of such patients

Efficacy and safety of intravenous paracetamol versus intravenous tramadol for labour analgesia

Background: An effective labour analgesia improves maternal and perinatal outcome and improves the course of labour. Methods: This was a prospective, randomised study done to compare effectiveness and safety of intravenous infusion of paracetamol with tramadol when used for labour analgesia. Group A (25 parturients) received paracetamol 1000 mg and group B (25 parturients) received tramadol 1mg/Kg at 4 to 6 cm cervical dilatation. Visual analogue score for pain was assessed at the baseline, 1 hour and 3 hours of drug administration and was compared between the two groups along with various maternal and fetal outcomes. Results: The difference in mean Visual Analogue Score (VAS) just before the drug administration was not statistically significant. However, at 1 hour of drug administration, mean VAS was significantly lower in the Group A (4.60) in comparison to Group B (5.82). The mean VAS at 3 hours was slightly lower in group A (6.35) in comparison to group B (6.65), though statistically there was no significant difference. Nausea, vomiting and sedation were found to be more in the tramadol group as compared to paracetamol group. The mean 1 and 5 minute apgar scores were found to be comparable in both the groups. Conclusions: So, it can be concluded from our study that intravenous paracetamol may be preferred over intravenous tramadol as it is associated with better analgesic efficacy and less maternal side effects. Although both the drugs were found to have good neonatal outcome

An atypical adenomatoid odontogenic tumour in the mandible: a report of a paediatric case

An adenomatoid odontogenic tumour (AOT) is a rare odontogenic tumour that is often misdiagnosed as an odontogenic cyst. To acquire additional information about AOT, all reports regarding AOT that had been cited in ‘Pub Med’ since 1990 onwards were reviewed. AOT accounts for about 1–9% of all odontogenic tumours. It is predominantly found in young and female patients, is located more often in the maxilla, and in most cases is associated with an unerupted permanent tooth. The differential diagnosis between AOT and other odontogenic tumours such as ameloblastoma should be well made to avoid extensive ablative surgery. However, AOT frequently resembles other odontogenic lesions such as dentigerous cysts or ameloblastoma. Immunohistochemically, AOT is characterized by positive reactions with certain cytokeratins. For illustration a rare case of an AOT in the mandible is presented that had atypical findings such as buccolingual cortical perforation and resorption with displacement of adjoining teeth.Keywords: adenomatoid odontogenic tumor, dentigerous cyst, odontogenic tumor, paediatric cas

A rare case of ruptured caesarean scar pregnancy

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. The incidence is approximately 1:2000 pregnancies and has potentially life-threatening complications. Ours is a rare case of scar ectopic pregnancy who had taken medical termination of pregnancy (MTP) kit while being unaware of her pregnancy location and presented with uterine rupture and hemoperitoneum. A 24-year-old female, P2L2A1, with previous two caesarean section (CS), presented with the complaint of bleeding per vaginum with acute pain abdomen and history of MTP kit intake at 7 weeks’ period of gestation (POG). She received symptomatic treatment at local hospital without any diagnosis being made but brought an ultrasound showing anterior myometrium defect with scar site hematoma and free fluid. She presented with moderate pallor, tachycardia and suprapubic tenderness. She was subsequently taken up for laparotomy in view of probable ruptured CSP. Intra-operatively, actively bleeding scar ectopic was seen with hemoperitoneum. The contents were scooped out and repair done with bilateral tubal ligation. She was resuscitated with adequate blood products. Embryo implantation in the region of a previous CS scar is rare and a delay in either diagnosis or treatment can have catastrophic complications like haemorrhage, rupture and significant maternal morbidity as seen in our case. Therefore, we should have a high index of suspicion of scar pregnancy especially in cases of previous CS so that timely intervention can be done preventing maternal morbidity. Unwarranted use of misoprostol can be deleterious when site of implantation is unknown, particularly in CSP

Dual targeting of the epigenome via FACT complex and histone deacetylase is a potent treatment strategy for DIPG

Diffuse intrinsic pontine glioma (DIPG) is an aggressive and incurable childhood brain tumor for which new treatments are needed. CBL0137 is an anti-cancer compound developed from quinacrine that targets facilitates chromatin transcription (FACT), a chromatin remodeling complex involved in transcription, replication, and DNA repair. We show that CBL0137 displays profound cytotoxic activity against a panel of patient-derived DIPG cultures by restoring tumor suppressor TP53 and Rb activity. Moreover, in an orthotopic model of DIPG, treatment with CBL0137 significantly extends animal survival. The FACT subunit SPT16 is found to directly interact with H3.3K27M, and treatment with CBL0137 restores both histone H3 acetylation and trimethylation. Combined treatment of CBL0137 with the histone deacetylase inhibitor panobinostat leads to inhibition of the Rb/E2F1 pathway and induction of apoptosis. The combination of CBL0137 and panobinostat significantly prolongs the survival of mice bearing DIPG orthografts, suggesting a potential treatment strategy for DIPG