Analysis of transfusion of blood and blood products and their utilization pattern at department of obstetrics of tertiary care hospital

Background: In developing countries, nutritional anaemia and obstetric complications are leading causes of transfusion of blood and blood products. The study was aimed to analyse utilization pattern and to identify the indications of transfusion of blood and blood products in obstetrics and to study outcome and management of pregnancy in patients who required blood and/or blood products.Methods: This retrospective study was carried out at department of obstetrics of tertiary care teaching hospital from September 2018 to November 2018 and data was collected from all patients who had received transfusion of blood and/or blood products for any obstetric cause.Results: A total of 164(6.8%) patients received blood and blood products transfusion. Department of obstetrics utilized maximum units of blood and FFP whereas PRC utilization was second highest. There were 62(37.8%) of patients who had not taken any antenatal care, whereas 64(39.0%) patients had less than 4 antenatal visits. Three most common indications for transfusion of blood and blood products were 63.4% in nutritional anaemia, 17.1% in obstetric haemorrhage and 11.6% in first trimester complications.Conclusions: Three most common indications for transfusion were nutritional anaemia, obstetric haemorrhage and first trimester complications. Majority of patients had inadequate or no antenatal care. Early and regular antenatal care, early diagnosis and management of high-risk pregnancies and obstetric complications, institutional delivery can reduce the rate of transfusion of blood and blood products

Study of feto-maternal outcome in patients of jaundice in third trimester of pregnancy

Background: Jaundice in pregnancy is an important medical disorder, more commonly seen in developing countries than developed ones. It comprises of a formidable list of complications that may adversely affect the pregnant woman and her fetus. Objective of current study was to study causes and feto-maternal outcome in pregnancies with jaundice in 3rd trimester.Methods: This was a retrospective study of 49 patients admitted in department of Obstetrics & Gynaecology at a tertiary care hospital with jaundice in 3rd trimester of pregnancy during the period from September 2008 to September 2010.Results: Out of 9972 deliveries, 49 patients were admitted with jaundice in 3rd trimester of pregnancy. Out of them 91.1% patients delivered. Vaginal delivery occurred in 82.2% and Cesarean section done in 17.7%. Preterm delivery occurred in 68.8%, low birth weight (LBW) was found in 82.2%, perinatal mortality occurred in 34.6% and maternal mortality occurred in 16.3% of patients.Conclusions: Jaundice in 3rd trimester of pregnancy leads to preterm delivery, fetal distress, intra uterine fetal death (IUFD) and high perinatal & maternal morbidity and mortality. Early diagnosis & aggressive management at tertiary care center help in reducing maternal & perinatal morbiditiy and mortality

Self-medication of abortion pills and its complications: an observational study

Background: Medical termination of pregnancy has been legalized in India since 1971. Medical abortion pill is well effective in early weeks of pregnancy. It is safe only when it is used under medical supervision. This study was carried out to analyse the complications following self-medication of abortion pills and to suggest measures to prevent such practice.Methods: This was a retrospective observational study conducted at our hospital from March 2017 to July 2017.Results: In present study 30 (75%) patients were in age group of 20-30 years. Illiterate patients were 22 (55%). Half of the patients, 20 (50%) were having three or more than three children. Majority of women 30 (75%) had consumed the abortion pills 1-10 days before coming to the hospital and 14 (35%) of patients had come with complain of excessive bleeding per vagina. Incomplete abortion was present in 32 (80%) of patients. Instrumental evacuation was required in 28 (87.5%) patients. Laparotomy for ruptured ectopic and rupture uterus was performed in 1 (2.5%) of each patient. 6 (15%) patients were severely anaemic. Transfusion of blood was required in 9 (22.5%) of patients.Conclusions: Medical abortion is effective and safe when carried out under medical supervision. Unsupervised use of medical abortion pills was associated with many complications like incomplete abortion, rupture ectopic and ruptured uterus. So, over the counter sale of medical abortion pill should be restricted

Study of feto-maternal outcome in patients with intra uterine fetal death

Background: Intra Uterine Fetal Death (IUFD) is an important issue in modern obstetrics. This study has been undertaken to find out the incidence of IUFD, socio-demographic factors, probable etiological factors, mode of delivery, its outcome and complications if any.Methods: This retrospective observational study was carried out at a tertiary care hospital. Data was collected from case papers of patients who have delivered beyond 20 weeks and/or baby weighing more than 500 grams and having IUFD prior to onset of labor or during labor with singleton pregnancy.Results: Incidence of IUFD was 17.2 per 1000 births. Majority of the patients 93 (48.1%) were in age group of 26-30 years, 115 (59.5%) came as an emergency and 94 (48.7%) were primi gravida. Majority 89 (46.1%) patients had not taken any antenatal visit. IUFD occurred due to unexplained etiology, pre-eclampsia-eclampsia, anemia, uncontrolled diabetes, jaundice, antepartum haemorrhage and congenital malformation in 77 (39.9%), 51 (26.4%), 10 (5.1%), 7 (3.6%), 4 (2%), 29 (15%) and 2 (1%) respectively. Vaginal delivery occurred in 151 (78.2%). Majority of dead babies 111 (57.5%) were male, 71 (36.7%) were weighing 1kg or less and 92 (47.6%) were macerated. Emotional upset, DIC, PPH and ARF occurred in 193 (100%), 21 (10.8%), 15 (7.7%) and 1 (0.5%) respectively.Conclusions: Majority of patients were unregistered and had not taken antenatal care or had inadequate antenatal care. Pre-eclampsia-eclampsia, APH, anemia and diabetes were the leading cause of IUFD along with unknown causes. A significant proportion of IUFD can be prevented by health education regarding adequate antenatal care, warning signs and institutional deliveries

Health profile of adolescent girls visiting obstetrics and gynecology department of tertiary care hospital

Background: Gynecological problems of adolescents occupy a special space in the spectrum of gynecological disorders of all ages. In this study, an attempt has been made to review the health profile of adolescent girls visiting department of Obstetrics and Gynecology of a tertiary care hospital.Methods: This observational study was conducted at a tertiary care teaching hospital during June 2014 to May 2016. Data was collected after due permission.Results: Adolescent girls having gynecological problems were 2.3%. Mean age of menarche was 12.5 years. Anemia was present in 89(62.7%). About 72(50.7%) adolescent girls were having abnormal body mass index (BMI). Majority of girls 136(95.8%) had menstrual problems. Leucorrhoea, Pelvic Inflammatory Disease (PID), ovarian mass, urinary problems, breast problems, injury to genital tract and sexual assault were present in 42(29.6%), 24(16.9%), 20(14.1%), 13(9.2%), 12(8.5%), 4(2.8%) and 1(0.7%) respectively.Conclusions: A very small proportion of adolescent girls came to the hospital for health-related issues. Anemia was present in more than half of adolescent girls and almost half of adolescent girls were having abnormal BMI. Majority of adolescent girls had menstrual problems. Health education regarding normal physiology, various gynecological problems, importance of nutrition and exercise for adolescents is necessary

Analysis of ectopic pregnancy at a tertiary care hospital: one year study

Background: Ectopic gestation is the leading cause of maternal mortality and morbidity in first trimester and is a major cause of reduced child bearing potential. The aims of our study were to understand the clinical profile, risk factors, sites and management modalities of ectopic pregnancy at tertiary care hospital.Methods: This is a retrospective study carried out for one year at the department of Obstetrics and Gynaecology of our institute. Data of the women admitted for management of ectopic pregnancy during January to December, 2010 was collected and analysed.Results: The proportion of ectopic pregnancy was 0.7 % at our institute. Majority of women 45(83.2%) were between the age group of 21-30 years. Pelvic inflammatory disease (PID) contributed to ectopic pregnancy in 16(29.6%) women. The most common symptom was lower abdominal pain, in 50(92.6%) women. Marked pallor was present in 25(46.3%) women and 38(70.4%) women had cervical motion tenderness. Out of all women, 10(18.5%), 18(33.3%) and 26(48.1%) women were managed successfully with methotrexate, laparoscopy and laparotomy respectively. The success rate was 83.3%, 90% and 100% with methotrexate, laparoscopy and laparotomy respectively. Blood and blood products were given to 25(46.3%) women. Conclusion: Ectopic pregnancy is a growing problem of reproductive age group. Women should be encouraged regarding early reporting of missed periods and made aware of complications of ectopic pregnancy and necessity of seeking urgent medical help as early as possible so that early diagnosis and prompt conservative surgical or medical management of ectopic pregnancy can be done

Targeting the SIN3A-PF1 interaction inhibits epithelial to mesenchymal transition and maintenance of a stem cell phenotype in triple negative breast cancer

Triple negative breast cancer (TNBC) is characterized by a poorly differentiated phenotype and limited treatment options. Aberrant epigenetics in this subtype represent a potential therapeutic opportunity, but a better understanding of the mechanisms contributing to the TNBC pathogenesis is required. The SIN3 molecular scaffold performs a critical role in multiple cellular processes, including epigenetic regulation, and has been identified as a potential therapeutic target. Using a competitive peptide corresponding to the SIN3 interaction domain of MAD (Tat-SID), we investigated the functional consequences of selectively blocking the paired amphipathic α-helix (PAH2) domain of SIN3. Here, we report the identification of the SID-containing adaptor PF1 as a factor required for maintenance of the TNBC stem cell phenotype and epithelial-to-mesenchymal transition (EMT). Tat-SID peptide blocked the interaction between SIN3A and PF1, leading to epigenetic modulation and transcriptional downregulation of TNBC stem cell and EMT markers. Importantly, Tat-SID treatment also led to a reduction in primary tumor growth and disseminated metastatic diseasein vivo. In support of these findings, knockdown ofPF1expression phenocopied treatment with Tat-SID bothin vitroandin vivo. These results demonstrate a critical role for a complex containing SIN3A and PF1 in TNBC and provide a rational for its therapeutic targeting

Performance Characteristics of qPCR Assays Targeting Human- and Ruminant-Associated Bacteroidetes for Microbial Source Tracking across Sixteen Countries on Six Continents

Numerous quantitative PCR assays for microbial fecal source tracking (MST) have been developed and evaluated in recent years. Widespread application has been hindered by a lack of knowledge regarding the geographical stability and hence applicability of such methods beyond the regional level. This study assessed the performance of five previously reported quantitative PCR assays targeting human-, cattle-, or ruminant-associated Bacteroidetes populations on 280 human and animal fecal samples from 16 countries across six continents. The tested cattle-associated markers were shown to be ruminant-associated. The quantitative distributions of marker concentrations in target and nontarget samples proved to be essential for the assessment of assay performance and were used to establish a new metric for quantitative source-specificity. In general, this study demonstrates that stable target populations required for marker-based MST occur around the globe. Ruminant-associated marker concentrations were strongly correlated with total intestinal Bacteroidetes populations and with each other, indicating that the detected ruminant-associated populations seem to be part of the intestinal core microbiome of ruminants worldwide. Consequently tested ruminant-targeted assays appear to be suitable quantitative MST tools beyond the regional level while the targeted human-associated populations seem to be less prevalent and stable, suggesting potential for improvements in human-targeted methods

National Outbreak of Salmonella Serotype Saintpaul Infections: Importance of Texas Restaurant Investigations in Implicating Jalapeño Peppers

BACKGROUND: In May 2008, PulseNet detected a multistate outbreak of Salmonella enterica serotype Saintpaul infections. Initial investigations identified an epidemiologic association between illness and consumption of raw tomatoes, yet cases continued. In mid-June, we investigated two clusters of outbreak strain infections in Texas among patrons of Restaurant A and two establishments of Restaurant Chain B to determine the outbreak's source. METHODOLOGY/PRINCIPAL FINDINGS: We conducted independent case-control studies of Restaurant A and B patrons. Patients were matched to well controls by meal date. We conducted restaurant environmental investigations and traced the origin of implicated products. Forty-seven case-patients and 40 controls were enrolled in the Restaurant A study. Thirty case-patients and 31 controls were enrolled in the Restaurant Chain B study. In both studies, illness was independently associated with only one menu item, fresh salsa (Restaurant A: matched odds ratio [mOR], 37; 95% confidence interval [CI], 7.2-386; Restaurant B: mOR, 13; 95% CI 1.3-infinity). The only ingredient in common between the two salsas was raw jalapeño peppers. Cultures of jalapeño peppers collected from an importer that supplied Restaurant Chain B and serrano peppers and irrigation water from a Mexican farm that supplied that importer with jalapeño and serrano peppers grew the outbreak strain. CONCLUSIONS/SIGNIFICANCE: Jalapeño peppers, contaminated before arrival at the restaurants and served in uncooked fresh salsas, were the source of these infections. Our investigations, critical in understanding the broader multistate outbreak, exemplify an effective approach to investigating large foodborne outbreaks. Additional measures are needed to reduce produce contamination

Reporting trends, practices, and resource utilization in neuroendocrine tumors of the prostate gland: a survey among thirty-nine genitourinary pathologists

Background: Neuroendocrine differentiation in the prostate gland ranges from clinically insignificant neuroendocrine differentiation detected with markers in an otherwise conventional prostatic adenocarcinoma to a lethal high-grade small/large cell neuroendocrine carcinoma. The concept of neuroendocrine differentiation in prostatic adenocarcinoma has gained considerable importance due to its prognostic and therapeutic ramifications and pathologists play a pivotal role in its recognition. However, its awareness, reporting, and resource utilization practice patterns among pathologists are largely unknown. Methods: Representative examples of different spectrums of neuroendocrine differentiation along with a detailed questionnaire were shared among 39 urologic pathologists using the survey monkey software. Participants were specifically questioned about the use and awareness of the 2016 WHO classification of neuroendocrine tumors of the prostate, understanding of the clinical significance of each entity, and use of different immunohistochemical (IHC) markers. De-identified respondent data were analyzed. Results: A vast majority (90%) of the participants utilize IHC markers to confirm the diagnosis of small cell neuroendocrine carcinoma. A majority (87%) of the respondents were in agreement regarding the utilization of type of IHC markers for small cell neuroendocrine carcinoma for which 85% of the pathologists agreed that determination of the site of origin of a high-grade neuroendocrine carcinoma is not critical, as these are treated similarly. In the setting of mixed carcinomas, 62% of respondents indicated that they provide quantification and grading of the acinar component. There were varied responses regarding the prognostic implication of focal neuroendocrine cells in an otherwise conventional acinar adenocarcinoma and for Paneth cell-like differentiation. The classification of large cell neuroendocrine carcinoma was highly varied, with only 38% agreement in the illustrated case. Finally, despite the recommendation not to perform neuroendocrine markers in the absence of morphologic evidence of neuroendocrine differentiation, 62% would routinely utilize IHC in the work-up of a Gleason score 5 + 5 = 10 acinar adenocarcinoma and its differentiation from high-grade neuroendocrine carcinoma. Conclusion: There is a disparity in the practice utilization patterns among the urologic pathologists with regard to diagnosing high-grade neuroendocrine carcinoma and in understanding the clinical significance of focal neuroendocrine cells in an otherwise conventional acinar adenocarcinoma and Paneth cell-like neuroendocrine differentiation. There seems to have a trend towards overutilization of IHC to determine neuroendocrine differentiation in the absence of neuroendocrine features on morphology. The survey results suggest a need for further refinement and development of standardized guidelines for the classification and reporting of neuroendocrine differentiation in the prostate gland