Comparison of placental grading at different periods of gestation in PIH patients and their outcome

Background: The current study follows grannum grading of placenta. It is well known that there is accelerated placental maturation in PIH patients and the ultrasonic appearance of grade 3 placenta before 37 weeks may signify placental dysfunction and is associated with development of low birth weight babies, IUGR meconium stained liquor, low APGAR score. Hence this study was conducted to emphasize on placental grading at different periods of gestation to predict and prevent increased obstetric and fetal compromise and to compare the outcomes.Methods: Obstetric scans were performed in all PIH patients attending antenatal OPD and inpatients at ESIC and PGIMSR medical college, Bangalore to know the placental grading and biophysical profile. These women were followed till their delivery for obstetric and fetal outcomes.Results: Grade 3 placenta is seen in 17 patients in group 1(50%) and 39 patients (59%) in group 2. For statistical analysis grade 1 and 2 were combined and compared with  grade 3. P-value 0.198 which was not statistically significant. There was no statistically significant difference in age and gravidity between two groups. The medical disorders were more in group 2 i.e., between 37 - 40 weeks. The complications of PIH were also more in group 2. There were more number of LSCS (n=19 versus 14) in 34-36 weeks group which was not statistically significant. Fetal outcomes like IUGR and IUD were more in group 2 which was not statistically significant. The mean birth weight in group 1 was 2 kg as compared to 2.7 kg in group 2. All associated medical disorders were more in group 2.Conclusions: In hypertensive women there is accelerated placental maturation leading to maternal and fetal complications. Hence women with accelerated placental maturity in ultrasound should be closely monitored and appropriately managed. However, we recommend larger randomized studies are necessary

Multiple sclerosis in pregnancy- a case report

Multiple sclerosis is primarily a disease of women in their reproductive years. Relapse rate decreases during pregnancy and rises after delivery. Pregnancy and puerperium have opposite effects on the course of the disease. The case presented is that of a second gravida who was a known case of multiple sclerosis. She was managed conservatively during pregnancy and puerperium

Correlation of HbA1c levels in third trimester with maternal and perinatal outcome in patients with gestational diabetes mellitus

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders complicating pregnancy. GDM occurs in 2-22% of pregnancies depending on the diagnostic criteria and the epidemiologic characteristics of the population. Elevation of HBA1c have strong correlation with risks of adverse maternal and neonatal outcomes. Aims and objective were to determine the HbA1c levels and to evaluate the maternal and neonatal outcomes in women with HbA1c <5.8% and >5.8% Methods: A retrospective study at ESIC-PGIMSR from June 2021 to December 2021.All mothers diagnosed with GDM using IADPSG criteria were included. HbA1c measured during the 2nd or 3rd trimester. Cut offs of HbA1c in 3rd trimester was taken as 5.8 according to Versantvoort et al. Maternal and neonatal outcome were assessed among two groups i.e., HbA1c <5.8% the control group and HbA1c >5.8% the case group. Demographic, maternal, and infant data were entered and statistical analysis done using SPSS software. Results: Total GDM mothers diagnosed were 152 out of 1454 pregnancies. Incidence is 10.4%. the 38.8% were of 25-30 years age group and 46% were multiparous.48.6% neonates were male and 50.6% were females. Among women with HbA1c >5.8%- Preeclampsia seen in 11 cases (21%), polyhydromnios in 5 cases (11.6%), hypothyroidism in 6 cases (12%) UTI in 1 case (2.3%) and candidiasis in 2 cases (4.6%) while among women with HBA1c <5.8% preeclampsia seen in 20 cases (18.3%), polyhydromnios in 2 cases (1.8%), hypothyroidism in 14 cases (13%) UTI in 2 cases (1.8%) and candidiasis in 4 cases (3.6%). Among women with HbA1c >5.8%-respiratory distress syndrome in 6 babies (13%), hyperbilirubinemia in 9 babies (18.6%), hypoglycemia 2 (4.6%) and hypocalemia in 2 babies (4.6%), 14 babies had normal course (32.5%) while among women with HbA1c 5.8% Among women with HbA1c >5.8%-respiratory distress syndrome in 13 babies (12%), hyperbilirubinemia in 20 babies (18.3%) and hypoglycemia 3 (2.7%). Conclusions: Optimal control of HbA1c along with lifestyle modification and glycemic control helps to reduce maternal and neonatal complications

The study of maternal and fetal outcome in pregnant women with thyroid disorders

Background: Thyroid disorders are among the common endocrine disorders in pregnant women after diabetes mellitus. Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction. It is well established that not only overt, but subclinical thyroid dysfunction also has adverse effect on mother and the fetus, like miscarriages, preterm delivery, preeclampsia, eclampsia, polihydromnios, placental abruption, post-partum haemorrhage, low birth weight, neonatal hypothyroidism. Decreased availability of thyroid hormones may also impair neurological and intellectual development of foetus. With this background, we are conducting a study to know the effect of thyroid disorders on pregnancy and its maternal and the fetal outcome.Methods: The present study was conducted in ESI Hospital Rajaji Nagar, Bangalore. It is a prospective study which involved 100 patients diagnosed to have thyroid disorder during their antenatal checkup in the first trimister. It also includes known cases of thyroid disorder. TSH level was estimated. If it is deranged, then FT3 and FT4 levels estimated. Patients were managed accordingly and followed till delivery. Their obstetric and perinatal outcomes were noted.Results: In our study out of 100 cases, 96 cases are subclinical hypohyroid and 4 cases are subclinical hyperthyroid. Subclinical hypothyroidism in pregnancy are associated with abortions (2.1%), Anaemia (4.20%), PIH (14.7%), GDM (4.2%), Preterm labour (3.1%), oligohydromnios (16.67%), Lscs (22.9%), PPH (6.3%), LBW (21.9%), Hyperbilirubinemia (9.4%), NICU admission (14.6%), Which are co-relatine with other studies and hyperthyroid cases in our study were not sufficient for outcome analysis.Conclusions: Thyroid disorders in pregnancy have adverse effects on maternal and fetal outcome emphasizing the importance of routine antenatal thyroid screening

A comparative study of different route of administration of misoprostol in the management of third stage of labour

Background: Post partum haemorrhage is the most common cause of maternal morbidity and mortality.  Misoprostol is a prostaglandin analogue, used for management of post partum haemorrhage. It can be used by various routes with minimal side effects. This study is done to compare the different routes of administration of Misoprostol for the third stage management and their side effects. Objectives of present study were to estimate the amount of blood loss, to assess the maternal side effects of drug, to know the haemoglobin deficit, to know the duration of third stage of labour.Methods: This was a prospective hospital base study of 150 women delivery at obstetrics and gynaecology department at ESICMC Model Hospital, Rajajinagar. They were randomized into 3 groups of 50 patients each. They received 400 µg of misoprostol either orally or rectally or sublingually immediately after delivery of the fetus. The primary outcomes analysed were amount of blood loss duration of third stage of labour haemoglobin deficit and their side effectsResults: The amount of blood loss and haemoglobin deficit was least in sublingual group which was statistically significant. Need of additional oxytocics was less in sublingual and oral group, though it was not statistically significant.Conclusions: In the present study, sublingual Misoprostol was found to be more effective in reducing blood loss during third stage of labour

An unusual case of posterior vaginal wall cyst

Vaginal cysts are rare and are mostly detected as an incidental finding during a gynecological examination. The commonest type of simple vaginal cyst is the Mullerian cyst arising from paramesonephric duct remnants. These are typically lined by columnar epithelium and contain serous or mucinous fluid. A 41 year old multiparous woman presented with mass per vagina since 6 months. On examination, posterior vaginal wall cyst of 8 x 4 x 3 cm was detected. Surgical excision of the cyst was done under spinal anaesthesia by sharp and blunt dissection. The cyst was filled with mucoid material and histopathological examination confirmed mullerian origin. This is a rare presentation of mullerian cysts developing posteriorly

Role of BRCA1 in Breast Cancer Metastasis

The role of BRCA1 in breast cancer metastasis is a less explored area that might have importance in increased aggressiveness of BRCA1 defective triple negative cancers. The possible influence of BRCA1 on apico basal polarity and ezrin, radixin and meosin (ERM) proteins are discussed in this review as a reason for cell metastasis. This might help in developing antimetastatic drugs that could help for better prognosis in BRCA1 defective breast cancers

A rare case of primary parasitic leiomyoma

We report a rare case of a parasitic fibroid in a 42 year old woman who presented with mass per abdomen and backache. Ultrasound showed a mass suggestive of posterior wall fibroid. Laparotomy revealed a parasitic fibroid densely adherent to the omentum and extending retroperitoneally. Histopathological findings were consistent with leiomyoma

Protein targets in Mycobacterium tuberculosis and their inhibitors for therapeutic implications: A narrative review

Advancement in the area of anti-tubercular drug development has been full-fledged, yet, a very less number of drug molecules have reached phase II clinical trials, and therefore "End-TB" is still a global challenge. Inhibitors to specific metabolic pathways of Mycobacterium tuberculosis (Mtb) gain importance in strategizing anti-tuberculosis drug discovery. The lead compounds that target DNA replication, protein synthesis, cell wall biosynthesis, bacterial virulence and energy metabolism are emerging as potential chemotherapeutic options against Mtb growth and survival within the host. In recent times, the in silico approaches have become most promising tools in the identification of suitable inhibitors for specific protein targets of Mtb. An update in the fundamental understanding of these inhibitors and the mechanism of interaction may bring hope to future perspectives in novel drug development and delivery approaches. This review provides a collective impression of the small molecules with potential antimycobacterial activities and their target pathways in Mtb such as cell wall biosynthesis, DNA replication, transcription and translation, efflux pumps, antivirulence pathways and general metabolism. The mechanism of interaction of specific inhibitor with their respective protein targets has been discussed. The comprehensive knowledge of such an impactful area of research would essentially reflect in the discovery of novel drug molecules and effective delivery approaches. This narrative review encompasses the knowledge of emerging targets and promising chemical inhibitors that could potentially translate in to the anti-TB-drug discovery