Optimisation of anticoagulation in patients with atrial fibrillation

Atrial fibrillation is a common cardiac arrhythmia associated with debilitating complications, one of which is stroke. Anticoagulants (warfarin and the non-vitamin K antagonist oral anticoagulants) are recommended for stroke prophylaxis, their utilisation however requires stroke risk reduction to be balanced against hemorrhage risk. Current review of the literature suggests that despite the presence of risk stratification tools such as the CHADS2 and the newer CHA2DS2-VASc, clinicians often find it challenging to anticipate the risk-benefit ratio of anticoagulation. This results in both the underuse and overuse of anticoagulation in patients as well as uncertainty over whether to use anticoagulation in paroxysmal AF. This review looks at optimising anticoagulation by improving the assessment of bleeding risk and by improving the assessment of stroke risk. The percutaneous occlusion of the left atrial appendage is an emerging alternative to oral anticoagulation therapy.peer-reviewe

The role of folic acid in promoting reproductive health and pregnancy outcomes

Throughout the past several years, there has been growing interest in folic acid as a crucial micronutrient that has several beneficial health outcomes. Given folic acid's crucial role in DNA synthesis and methylation, it is involved in several processes, especially during development. Although folic acid has been studied previously with several disease processes such as neural tube defects, different types of cancer and even Alzheimer's disease, specific attention has not been given to folic acid and reproductive health and other pregnancy outcomes such as implantation, embryogenesis and live birth. This thesis will examine the specific effects that folic acid could have in maintaining the reproductive health in women and men as well. The conclusion was reached that folic acid plays a critical role in several phases of reproductive health including maintenance of reproductive hormone levels in woman, protection against anovulation and spontaneous abortions as well improving sperm quality in males. Taken together, folic acid could be an inexpensive, convenient supplement for maintaining reproductive health as well as for couples who are attempting to begin and maintain a healthy pregnancy

Fortition in Marked on Marked Contexts

This paper presents a harmonic grammar analysis of the alternation of the velar voiceless fricative /x/ and the corresponding stop /k/ in the environment of high vowels /i/ and /u/ in Sylheti. This process occurs in several different environments: tautosyllabically [CVC], heterosyllabically [CV.C,] and the geminate [VC.CV]. I argue that the fricative undergoes fortition to a stop only when sonority requirements (*M1) become apparent in marked contexts (such as in the geminate condition (*M2), or in conjunction with *fricative and *dorsal) leading to fortition in special environments where constraints “gang up”, i.e., when the cumulative weight of markedness constraints outweigh the weight of the faithfulness constraints

Pregnancy complicated by cardiac disease: fetomaternal outcome

Background: Heart disease complicating pregnancy is an important indirect cause of maternal morbidity and mortality. The study aimed to know the prevalence of heart disease in pregnancy, type of lesions, maternal outcome (obstetric and cardiac) and fetal outcome.Methods: A retrospective study of 508 women with pregnancy complicated by cardiac disease who delivered at gestation age >28 weeks was carried out at Lok Nayak Hospital associated with Maulana Azad Medical College, New Delhi over a period of 2 years.Results: Among 508 patients, only 330 were booked cases and 92 were unbooked. 24 patients came to emergency first time with congestive heart failure. Rheumatic heart disease was the predominant lesion seen in 77.5% cases. Cardiac disease was diagnosed during index pregnancy in 43.5% cases. 12 cases underwent surgical intervention during pregnancy as they were refractory to medical management. Cesarean section was performed in 109 (21.4%) cases mainly for obstetric indication. Overall cardiac complication rate was 38.38%. Maternal mortality was seen in 6 cases. Small for gestation age was seen in 26.4% cases and preterm labor in 19.9 % cases.Conclusions: Patients in NYHA I /II have better fetomaternal outcome than in NYHA III/IV. Vaginal delivery is a safe option and caesarean section should be reserved mainly for obstetric indication. Multidisciplinary team approach can significantly improve maternal and fetal outcome

A comparison of intravaginal misoprostol with sublingual misoprostol for second trimester medical termination of pregnancy

Background: Second trimester abortions generally account for less number of patients as compared to first trimester abortions as patients generally come earlier as soon as pregnancy is recognized but now days due to advent of USG many cases of fetal anomaly are detected earlier accounting for increasing number of cases of second trimester.Methods: Present study was conducted among patients with pregnancy between 13-20 weeks of period of gestation (to be randomly assigned) after getting approval from institutional ethics committee and informed consent from the patient. Participants were randomly allocated to receive 400 µg of misoprostol either sublingually or intravaginally every six hours for a maximum of 5 doses. The blood pressure, pulse rate & temperature and side effects monitored every 3 hrs. If women in either group failed to abort after 48 hours of initiation of treatment termed as failure. In cases of failure they were given additional doses of sublingual misoprostol till abortion occurred. Primary outcome variable compared was success rate at 48 hours. Secondary outcome variables compared were bleeding patterns, completeness of abortion, induction abortion interval and any side effects.Results: It has been found that vaginal misoprostol 400 micro gm achieved a success rate to 100% in 48 hours, while the success rate was 93.33% with the sublingual route. (P = 0.4915, NS).Conclusions: Thus from our limited study population, we conclude that there is no significant difference in efficacy and complications between the two routes, although a larger cohort is required to get more dependable result.

The association of thyroid disorders with abnormal uterine bleeding

Background: Dysfunctional uterine bleeding is an abnormal bleeding from the uterus in absence of organic disease of genital tract and demonstrable extragenital cause. Thyroid dysfunction is marked by large number of menstrual aberrations. This study is aimed at detecting thyroid dysfunction in patients with provisional diagnosis of AUB and refers positive cases to physician for further evaluation.Methods: 100 cases of clinically diagnosed AUB were taken from Gynaecology OPD and inpatients of MGM hospital, Kalamboli. All patients from 19 to 45 age groups presenting as menorrhagia, acyclical metropathia, polymenorrhagia, metrorhhagia, oligomenorrhoea, polymenorrhoea and hypomenorrhoea were tested for their thyroid function by T3, T4, TSH estimations in their serum. Patients who had clinical signs and symptoms of thyroid disease, were on hormonal treatment, IUCD users, or had bleeding disorders were excluded from the study.Results: 30% of patients who were studied had thyroid dysfunction, of which 18% of patients had subclinical hypothyroidism, 9% of patients had hypothyroidism and only 3% of patients had hyperthyroidism. The commonest bleeding abnormalities in subclinical hypothyroid patients were polymenorrhaggia and menorrhaggia. Most of the hyperthyroid cases were oligomenorrhoeic.Conclusions: Both subclinical hypothyroid and profoundly hypothyroid cases together were the commonest thyroid dysfunction and menorrhagia was their commonest menstrual abnormality. So this study concludes that, biochemical evaluation of thyroid functioning should be made mandatory in all provisionally diagnosed cases of DUB to detect thyroid dysfunction.

A rare case of pregnancy with Sturge-Weber syndrome

Sturge-Weber syndrome is a rare sporadic neurocutaneous syndrome characterized by facial angiomas, ocular abnormalities (glaucoma and choroidal hemangioma), and leptomeningeal angioma. We report a case of Sturge Weber syndrome type I, associated with seizures, with gestational diabetes. She had successful labour outcome. Very few such cases have been reported in literature. The effect of pregnancy on neurological symptoms of Sturge Weber syndrome is not known.

Ependymoma in pregnancy: one suspicion can save a life

Ependymomas arise from ependymal cells that line the ventricles of the brain and the spinal canal. Ependymomas are relatively rare tumors accounting for 2-3% of all primary brain tumors in adults. We present this case of ependymoma to highlight the fact that aggressive management might be keystone in saving mothers life and even after surgical intervention, it is possible that the tumour recurs and may prove fatal. Maternal outcome in primary brain tumours in pregnancy largely depend on histologic grade of primary tumour and gestational age at which they present

Production of Amylase by Bacillus polymyxa NCIM No. 2539 from Agroindustrial Wastes

Background and Objective: In the present study, Bacillus polymyxa NCIM No. 2539 was selected to utilize agro-industrial byproduct (orange peel) for amylase production under submergedfermentation conditions.Material and Methods: Different agro-industrial byproducts like cane molasses, wheat bran, rice bran and orange peel were screened for maximum amylase production. Amylase activitiy of Bacillus polymyxa was studied using starch-agar plate method. MINITAB software Version 17 and central composite design were applied to evaluate effect of supplementation of substrate with different sulphur containing amino acids (cysteine, methionine and cystine) and vitamin thiamine on enzyme activity. Further optimization of the parameters viz. amount of substrate, concentration of amino acid and vitamin for maximum amylase production was studied by central composite rotatable design.Results and Conclusion: Among 4 different agro-industrial substrates applied, orange peel showed maximum enzyme production (activity: 492.31 IU g-1 sample). Supplementation of the production media with cysteine showed maximum amylaseproduction (515.38 IU g-1 sample) among all three amino acids and control. Supplementation with thiamine also showed more amylase production (469.23 IU g-1 sample) as compared to control (415.38 IU g-1). Cysteine and thiamine proved to increaseamylase production significantly. Maximum amylase production was obtained at 7.7 g orange peel, 37.29 mg cysteine and 34.23 mg per 10 ml thiamine.Conflict of interest: The authors declare no conflict of interest

Diagnostic usefulness of transtracheal aspiration in lower respiratory tract infections

Background: The incidence of pulmonary infections is on a constant rise. The present study was undertaken in order to identify those patients in whom transtracheal aspiration is most likely to provide information not obtainable from evaluation of expectorated sputum and delineates the clinical conditions under which transtracheal aspiration is indicated.Methods: A total of 50 patients of lower respiratory tract infections were studied. Both sputum and trans-tracheal aspirate samples were compared by Gram’s stain and culture methods.Results: Gram’s staining of the sputum was non-helpful in most cases as it showed mixed organisms while trans-tracheal aspiration showed only single type of colony. Culture showed less growth in sputum samples as compared to trans-tracheal aspirates.Conclusions: Trans-tracheal aspirate appears to be a very good method for isolating infective agents in lower respiratory tract infections. Besides by passing the contaminants of the oropharynx, it pinpoints the organism in most cases