Fetomaternal outcome in pregnancy with HELLP syndrome

Background: HELLP Syndrome is a serious complication of pregnancy induced hypertensive disorders. It is defined as a triad of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Objectives of this study was to find out incidence of HELLP syndrome in pre-eclampsia, eclampsia and its overall incidence. To analyse the clinical profile of HELLP syndrome. To study maternal and perinatal outcome including morbidity and mortality.Methods: A retrospective study was conducted from July 2017 to September 2019 at a tertiary care center with inclusion criteria of abnormal peripheral blood smear, elevated liver enzymes (LDH, aspartate aminotransferase), and low platelet count.Results: HELLP syndrome was more common in younger age group (45%) and in primigravida (52.5%). Most of the patients presented at >36 weeks of gestation (40%) and most of the patients delivered by caesarean section (67.5%). Maternal complications were acute renal failure (27.5%), DIC (22.5%), maternal mortality (7.5%). Neonatal complications associated were intrauterine death (27.5%), prematurity (25%) and intrauterine growth retardation (15%).Conclusions: Thus, HELLP syndrome requires an early diagnosis and early initiation of treatment at tertiary care center with all the medical facilities available

Mullerian ductal anomalies and its outcome

Background: The aim is to study various investigative modalities to diagnose Mullerian anomalies and to evaluate the reproductive outcome that occurs as a result of malformation of genital tract.Methods: A prospective study of reproductive anomalies and its outcome was performed by using data from women with congenital anomalies attended in OPD either with complains or for operative treatment or incidental diagnosis during caesarean section, manual removal of placenta, during laparoscopy or laparotomy at tertiary care center. Total 70 women with different types of congenital anomalies were included in study. Out of them gynecological cases (27) were diagnosed on basis of clinical examination and other diagnostic aids while Mullerian anomalies in obstetric cases (43) were observed and their outcomes were studied.Results: Most common utero-vaginal anomaly seen in present study was septate uterus with 18 (25.7%) cases, followed by bicornuate uterus with 13 (18.6%) cases. Most common presenting symptom is primary amenorrhea 21 (30%) followed by cyclical abdominal pain 11 (15.7). HSG, USG are the primary tools to detect genital tract anomalies. Surgical correction was required in 47.1% patients.Conclusions: Present study shows prevalence of congenital malformation of female reproductive tract is 0.17% at our tertiary care center. Utero-vaginal anomalies are a morphologically diverse group of developmental disorders. Establishing an accurate diagnosis is essential for planning treatment and management strategies. The surgical approach for correction of utero-vaginal anomalies is specific to the type of malformation and may vary in a specific group

Study of various treatment modalities of caesarean scar pregnancy

Background: Caesarean scar pregnancy (CSP) can be defined as the implantation of the gestational sac within the scar of a previous caesarean surgery. Incidence of CSP is 1 in 1800 pregnancies.Methods: It is a retrospective study based on clinical diagnosis and management of CSP of women who presented to the obstetrics and gynaecology department SVP hospital from January 2008 to August 2021. Total number of cases of CSP were 28. Incidence, gestational age, ultrasound findings, serum β-human chorionic gonadotropin (β-hCG) levels, flow profiles of color Doppler, and different methods of treatment were recorded. Diagnosis was confirmed by ultrasound.Results: In this study, all 28 cases of CSP considered were offered definitive management. In present study 5 cases (17.88%) showed torrential haemorrhage during dilatation and evacuation (D and E) which was treated by various methods like 1 (3.57%) Foley’s tamponade, 1 (3.57%) uterine artery embolization (UAE) and 3 (10.71%) hysterectomy. Hysterotomy was performed in 13 cases (46.42%) and (7.69%) of heterotrophic CSP (HCSP). One case (3.84%) of CSP presented at 26 weeks of gestation with haemorrhagic shock, underwent obstetric hysterectomy.Conclusions: There is a rise in the incidence of CSP because of increase in the global rate of caesarean sections and early transvaginal USG in pregnancy. Transvaginal sonography is the best diagnostic tool. Medical management can be offered when diagnosis is made at gestational age of 7 weeks of gestational age. Surgical management has an advantage of shorter follow up.

Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders

The adverse effects of prenatal alcohol exposure constitute a continuum of disabilities (fetal alcohol spectrum disorders [FASD]). In 1996, the Institute of Medicine established diagnostic categories delineating the spectrum but not specifying clinical criteria by which diagnoses could be assigned. In 2005, the authors published practical guidelines operationalizing the Institute of Medicine categories, allowing for standardization of FASD diagnoses in clinical settings. The purpose of the current report is to present updated diagnostic guidelines based on a thorough review of the literature and the authors’ combined expertise based on the evaluation of >10 000 children for potential FASD in clinical settings and in epidemiologic studies in conjunction with National Institute on Alcohol Abuse and Alcoholism–funded studies, the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, and the Collaboration on FASD Prevalence. The guidelines were formulated through conference calls and meetings held at National Institute on Alcohol Abuse and Alcoholism offices in Rockville, MD. Specific areas addressed include the following: precise definition of documented prenatal alcohol exposure; neurobehavioral criteria for diagnosis of fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder; revised diagnostic criteria for alcohol-related birth defects; an updated comprehensive research dysmorphology scoring system; and a new lip/philtrum guide for the white population, incorporating a 45-degree view. The guidelines reflect consensus among a large and experienced cadre of FASD investigators in the fields of dysmorphology, epidemiology, neurology, psychology, developmental/behavioral pediatrics, and educational diagnostics. Their improved clarity and specificity will guide clinicians in accurate diagnosis of infants and children prenatally exposed to alcohol

Evolution of pathogenicity and sexual reproduction in eight Candida genomes

Candida species are the most common cause of opportunistic fungal infection worldwide. Here we report the genome sequences of six Candida species and compare these and related pathogens and non-pathogens. There are significant expansions of cell wall, secreted and transporter gene families in pathogenic species, suggesting adaptations associated with virulence. Large genomic tracts are homozygous in three diploid species, possibly resulting from recent recombination events. Surprisingly, key components of the mating and meiosis pathways are missing from several species. These include major differences at the mating-type loci (MTL); Lodderomyces elongisporus lacks MTL, and components of the a1/2 cell identity determinant were lost in other species, raising questions about how mating and cell types are controlled. Analysis of the CUG leucine-to-serine genetic-code change reveals that 99% of ancestral CUG codons were erased and new ones arose elsewhere. Lastly, we revise the Candida albicans gene catalogue, identifying many new genes.publishe

Evaluation of right ventricular performance in patients with postoperative congenital heart disease using Doppler tissue imaging and cardiopulmonary bypass indices: A prospective cohort study

Abstract Background and Aims Postoperative cardiac outcomes after intracardiac repair (ICR) are determined by numerous factors whereas right ventricle (RV) dysfunction is considered essential for them, as only few studies attempted to evaluate it postsurgically. RV's function is supposed to be the strong prognostic factor for patients diagnosed with congenital heart defects; therefore, assessing it is the main objective of the study. Methods This is a prospective single‐centered cohort study performed on 50 pediatric patients with congenital heart disease (CHD) who underwent ICR between January 2019 and January 2022. All patients underwent echocardiographic assessment of RV function via tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) at 1, 24, and 48 h. After surgery, where pre‐ and postoperative RV pressure, cardiopulmonary bypass (CPB), and aortic cross‐clamp (ACC) time were assessed. Similarly ventilation intensive care unit (ICU) and hospital stay times and mediastinal drainage were also monitored. Results The mean ± standard deviation for pre‐ and postoperative RV pressure was 49.1 ± 16.12 and 42.7 ± 2.9 mmHg, respectively, whereas that for pre‐ and postoperative pulmonary artery pressure was 30.4 ± 2.6 and 24.2 ± 12.9 mmHg, with p value of <0.002 and <0.001, respectively. The mean ± standard deviation of CPB and ACC times was 120.92 ± 74.17 and 78.44 ± 50.5 min accordingly, while those for mean ± standard deviation of ventilation time, mediastinum chest drainage, ICU and hospital stays were 30.36 ± 54.04, 43.78 ± 46.7 min, 5.9 ± 4.01 h, were 30.36 ± 54.0, 43.78 ± 46.7 min, 5.9 ± 4.01 and 10.3 ± 4.83 h, respectively. Conclusions RV dysfunction plays the important role in longer recovery and intraoperative time, while its effect is mostly transient. The use of TAPSE and FAC methods is valuable in the evaluation of postoperative outcomes, and the former proved to be more effective