Risk factors and outcome analysis of post-partum haemorrhage in a tertiary care centre

Background: Maternal haemorrhage is the major cause of maternal mortality and morbidity all over the world and more so in developing countries. PPH is the commonest cause of maternal mortality in India. Identification of risk factors, early diagnosis and timely intervention can help in reducing maternal mortality and morbidity significantly. The aim of this study is to analyse the risk factors and causes and study the maternal and perinatal outcomes of PPH in North Karnataka.Methods: It is a retrospective study of 228 patients admitted with the diagnosis of PPH, at KIMS, Hubli during 2016.Results: Average age of the patients was 27 years. Commonest risk factor was PIH, followed by APH and prolonged labour. The commonest cause of PPH was atonicity followed by retained placenta. Majority of the patients recovered successfully with medical management. While 29 patients required Para cervical clamp. Sixteen patients underwent hysterectomy. Commonest complication was anaemia. Total maternal deaths were four; all of them were due to DIC, mostly due to late referrals.Conclusions: Maternal mortality and morbidity due to PPH can be reduced by encouraging regular anti natal visits, timely referral of high-risk patients, training of the health personals and timely intervention. Well stocked blood banks play an important role in management of PPH

Oral Proliferative Verrucous Leukoplakia-A Case Report

Oral Proliferative verrucous leukoplakia (OPVL), an aggressive and rare form of leukoplakia, is a long term progressive condition which in the initial stages starts as a harmless benign lesion. Eventually it may progress over a period of time to become multifocal, exophytic and malignant. This stumper of a disease, ambiguous in etiology, diagnosis and management poses a challenge to the clinician and the pathologist. This lesion is refractory to treatment and more often than not, recurs. In this article, we describe a case that possibly may have represented an OPVL

Florid Cemento-Osseous Dysplasia - A dilemma to intervene or not?!

Florid cemento - osseous dysplasia (FCOD) is a benign, non-neoplastic lesion characterized by multiple sclerosing masses within the jaw bones. We present an uncommon case of FCOD in a 37-year-old Indian woman incidentally discovered on a radiograph. She presented with bilaterally symmetrical lesions of variable radiodensities in the posterior mandible. In this asymptomatic case, the diagnosis of FCOD was made radiologically as biopsy is contraindicated. No treatment was imparted as the lesions were asymptomatic and the patient continues to be reviewed annually. The rationale of the present work is to describe this uncommon entity with only eleven reported cases noted in the literature amongst Indians. The case is unusual in its combination of the disease itself (FCOD) and the race (Indian). The confirmative role of radiography without histopathological evaluation and the need for no intervention is emphasized.   &nbsp

Clinical Utility of Anti-Mullerian Hormone in Pediatrics

CONTEXT: Anti-Mullerian hormone (AMH) was originally described in the context of sexual differentiation in the male fetus but has gained prominence now as a marker of ovarian reserve and fertility in females. In this mini-review, we offer an updated synopsis on AMH and its clinical utility in pediatric patients. DESIGN AND RESULTS: A systematic search was undertaken for studies related to the physiology of AMH, normative data, and clinical role in pediatrics. In males, AMH, secreted by Sertoli cells, is found at high levels prenatally and throughout childhood and declines with progression through puberty to overlap with levels in females. Thus, serum AMH has clinical utility as a marker of testicular tissue in males with differences in sexual development and cryptorchidism and in the evaluation of persistent Mullerian duct syndrome. In females, serum AMH has been used as a predictive marker of ovarian reserve and fertility, but prepubertal and adolescent AMH assessments need to be interpreted cautiously. AMH is also a marker of tumor burden, progression, and recurrence in germ cell tumors of the ovary. CONCLUSIONS: AMH has widespread clinical diagnostic utility in pediatrics but interpretation is often challenging and should be undertaken in the context of not only age and sex but also developmental and pubertal stage of the child. Nonstandardized assays necessitate the need for assay-specific normative data. The recognition of the role of AMH beyond gonadal development and maturation may usher in novel diagnostic and therapeutic applications that would further expand its utility in pediatric care

Enhancement of seed germination in stored seeds using different pre-sowing treatments in Bauhinia purpurea L.

Bauhinia purpurea L. is one of the important avenue tree species used in garden, road side plantations and other places. Fresh seed produce good germination upto 75 to 100 per cent. Seeds of this species stored for five months produced less germination (38.00 %) and it could be due to seed dormancy. Hence, the present study was carried out to evaluate different seed treatments to enhance seed germination in stored seeds of B. purpurea. Treatment like soaking seeds in hot water for 2 min to 5 min followed by overnight soaking in normal water resultedin highest germination of about 59.00 per cent over control (40.00%). Significant variation for germination parameters such as mean daily germination, germination rate index and germination value as well as early seedling vigour was recorded among different pre-sowing treatments in stored seeds

Bone mineral density in patients with inherited bone marrow failure syndromes.

BackgroundPatients with inherited bone marrow failure syndromes (IBMFS) may have several risk factors for low bone mineral density (BMD). We aimed to evaluate the prevalence of low BMD in IBMFS and determine the associated risk factors.MethodsPatients with IBMFS with at least one dual-energy X-ray absorptiometry (DXA) scan were evaluated. Diagnosis of each IBMFS, Fanconi anemia (FA), dyskeratosis congenita, Diamond-Blackfan anemia, and Shwachman-Diamond syndrome was confirmed by syndrome-specific tests. Data were gathered on age, height, and clinical history. DXA scans were completed at the lumbar spine, femoral neck, and forearm. BMD was adjusted for height (HAZ) in children (age ≤20 years). Low BMD was defined as a BMD Z-score and HAZ ≤-2 in adults and children, respectively, in addition to patients currently on bisphosphonate therapy.ResultsNine of thirty-five adults (26%) and eleven of forty children (27%) had low BMD. Adults with FA had significantly lower BMD Z-scores than those with other diagnoses; however, HAZ did not vary significantly in children by diagnosis. Risk factors included hypogonadism, iron overload, and glucocorticoid use.ConclusionsAdults and children with IBMFS have high prevalence of low BMD. Prompt recognition of risk factors and management are essential to optimize bone health

Medullary thyroid cancer in a 9-week-old infant with familial MEN 2B: Implications for timing of prophylactic thyroidectomy

BACKGROUND: Patients with Multiple Endocrine Neoplasia type 2 (MEN 2) are at high risk of developing aggressive medullary thyroid carcinoma (MTC) in childhood, with the highest risk in those with MEN type 2B (of whom >95% have an M918T RET proto-oncogene mutation). Metastatic MTC has been reported as young as 3 months of age. Current guidelines recommend prophylactic thyroidectomy within the first year of life for MEN 2B. PATIENT FINDINGS: We report a 9-week-old infant with MTC due to familial MEN 2B. A full-term male infant, born to a mother with known MEN 2B and metastatic MTC, had an M918T RET proto-oncogene mutation confirmed at 4 weeks of age. He underwent prophylactic total thyroidectomy at 9 weeks of age. Pathology showed a focal calcitonin-positive nodule (2.5 mm), consistent with microscopic MTC. SUMMARY: This case highlights the importance of early prophylactic thyroidectomy in MEN 2B. Although current guidelines recommend surgery up to a year of life, MTC may occur in the first few weeks of life, raising the question of how early we should intervene. In this report, we discuss the risks, benefits and barriers to performing earlier thyroidectomy, soon after the first month of life, and make suggestions to facilitate timely intervention. Prenatal anticipatory surgical scheduling could be considered in familial MEN 2B. Multidisciplinary collaboration between adult and pediatric specialists is key to the optimal management of the infant at risk

Clinical practice guidelines for the care of girls and women with Turner syndrome:Proceedings from the 2023 Aarhus International Turner Syndrome Meeting

Turner syndrome (TS) affects 50 per 100 000 females. TS affects multiple organs through all stages of life, necessitating multidisciplinary care. This guideline extends previous ones and includes important new advances, within diagnostics and genetics, estrogen treatment, fertility, co-morbidities, and neurocognition and neuropsychology. Exploratory meetings were held in 2021 in Europe and United States culminating with a consensus meeting in Aarhus, Denmark in June 2023. Prior to this, eight groups addressed important areas in TS care: (1) diagnosis and genetics, (2) growth, (3) puberty and estrogen treatment, (4) cardiovascular health, (5) transition, (6) fertility assessment, monitoring, and counselling, (7) health surveillance for comorbidities throughout the lifespan, and (8) neurocognition and its implications for mental health and well-being. Each group produced proposals for the present guidelines, which were meticulously discussed by the entire group. Four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with systematic review of the literature. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with members from the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology, the European Reference Network on Rare Endocrine Conditions, the Society for Endocrinology, and the European Society of Cardiology, Japanese Society for Pediatric Endocrinology, Australia and New Zealand Society for Pediatric Endocrinology and Diabetes, Latin American Society for Pediatric Endocrinology, Arab Society for Pediatric Endocrinology and Diabetes, and the Asia Pacific Pediatric Endocrine Society. Advocacy groups appointed representatives for pre-meeting discussions and the consensus meeting.</p

Albuminuria According to Status of Autoimmunity and Insulin Sensitivity Among Youth With Type 1 and Type 2 Diabetes

OBJECTIVETo evaluate whether etiologic diabetes type is associated with the degree of albuminuria in children with diabetes.RESEARCH DESIGN AND METHODSSEARCH is an observational, longitudinal study of children with diabetes. Youth with newly diagnosed diabetes were classified according to diabetes autoantibody (DAA) status and presence of insulin resistance. We defined insulin resistance as an insulin sensitivity score <25th percentile for the United States general youth population. DAA status was based on positivity for the 65-kD isoform of glutamate decarboxylase and insulinoma-associated protein 2 antigens. The four etiologic diabetes type groups were as follows: DAA+/insulin-sensitive (IS) (n = 1,351); DAA+/insulin-resistant (IR) (n = 438); DAA−/IR (n = 379); and DAA−/IS (n = 233). Urinary albumin:creatinine ratio (UACR) was measured from a random urine specimen. Multivariable regression analyses assessed the independent relationship between the four diabetes type groups and magnitude of UACR.RESULTSAdjusted UACR means across the four groups were as follows: DAA+/IS = 154 μg/mg; DAA+/IR = 137 μg/mg; DAA−/IR = 257 μg/mg; and DAA−/IS = 131 μg/mg (P < 0.005). Only DAA−/IR was significantly different. We performed post hoc multivariable regression analysis restricted to the two IR groups to explore the contribution of DAA status and insulin sensitivity (continuous) to the difference in UACR between the IR groups. Only insulin sensitivity was significantly associated with UACR (β = −0.54; P < 0.0001).CONCLUSIONSIn youth with diabetes, the DAA−/IR group had a greater UACR than all other groups, possibly because of the greater magnitude of insulin resistance. Further exploration of the relationships between severity of insulin resistance, autoimmunity, and albuminuria in youth with diabetes is warranted