From the Editors

We are proud to publish the 14th issue of the Jefferson Medicine Forum. The editorial staff would like to acknowledge the support of Dr. Diemer in producing this year’s forum. We appreciate your guidance and support in bringing this issue to print. Over the years, the Medicine Forum has provided a unique opportunity for our housestaff and medical students to not only share scholarly activities, but also to pursue their interests outside of the medical field. This year, we are proud to announce the addition of medical application reviews as well as an opinion piece on the use of opiates in primary care – a controversial topic that often leads to heated debates. We have also been fortunate enough to include interesting travel experiences, unique case reports, and exciting review articles, along with some breathtaking photography and original cartoon

A Case Series of Lyme Carditis with Complete Heart Block

Case 1 A 25-year-old Caucasian male with a history of a benign functional heart murmur presented to the emergency department for evaluation of 10 days of dyspnea with minimal exertion, such as walking a few blocks or climbing a flight of steps. Dyspnea was accompanied by moderate, dull, left-sided chest pain, which had been progressively worsening over the previous 3-5 days. The symptoms initially occurred only with exertion, but progressed to last 30-45 minutes after discontinuation of activity. He also noticed palpitations during these episodes, but did not try any remedies for his symptoms. Of note, two weeks prior to presentation, the patient had been camping in Shenandoah National Park, Virginia for four days. During that trip, he sustained over 30 mosquito bites, but never noticed any tick bites or rashes. He also traveled to Brazil five months ago, during which time he took malaria prophylaxis

Importance of parenteral iron sucrose therapy in correction of iron deficiency anemia during pregnancy

Background: Iron deficiency anemia (IDA) is described as decrease in the hemoglobin and/or the amount of red blood cells in the blood due to iron insufficiency in the body. The aim of the study was to measure the efficacy and tolerability of iron sucrose   in iron deficiency anemia in pregnant women.Methods: This was the prospective study of 50 pregnant women with iron deficiency anemia (Hb- 5 g/dl to 8 g/dl) between 20-34 weeks of gestation, who were given intravenous iron sucrose as per their requirements and follow up measurement of Hb was done.Results: Mean rise in Hb was seen by 2.2 g/dl. Minor side effects were seen in 6 out of 50 participants.        Conclusions: Parenteral iron sucrose therapy can be used effectively and safely in pregnant women with iron deficiency anemi

Simple Mechanisms for Representing, Indexing and Manipulating Concepts

Deep networks typically learn concepts via classifiers, which involves setting up a model and training it via gradient descent to fit the concept-labeled data. We will argue instead that learning a concept could be done by looking at its moment statistics matrix to generate a concrete representation or signature of that concept. These signatures can be used to discover structure across the set of concepts and could recursively produce higher-level concepts by learning this structure from those signatures. When the concepts are `intersected', signatures of the concepts can be used to find a common theme across a number of related `intersected' concepts. This process could be used to keep a dictionary of concepts so that inputs could correctly identify and be routed to the set of concepts involved in the (latent) generation of the input.Comment: 19 page

12-(4-Methoxy­phen­yl)-10-phenyl-3,4,5,6,8,10-hexa­azatricyclo­[7.3.0.02,6]dodeca-1(9),2,4,7,11-penta­ene

In the title compound, C19H14N6O, the fused 12-membered tetra­zolo/pyrimidine/pyrrole ring system is almost planar (r.m.s. deviation = 0.013 Å). The 4-methoxy­phenyl and phenyl substituents on the pyrrole ring are both twisted with respect to the fused-ring system [dihedral angles = 25.39 (18) and 36.42 (18)°, respectively]. Intra­molecular C—H⋯N inter­actions occur. In the crystal, mol­ecules pack into layers in the ac plane and these are connected along the b axis via C—H⋯π and π–π [centroid–centroid separation = 3.608 (3) Å] inter­actions

Fetomaternal outcome in pregnancy with oligohydramnios

Background: Oligohydramnios has been correlated with increased risk of FGR, meconium aspiration, birth asphyxia, low APGAR scores and congenital anomalies. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality. The aim and objectives of the study was to study the effect of oligohydramnios on fetal outcome in form of FGR, fetal distress, altered APGAR scores, NICU admission and early neonatal morbidity and mortality and to study maternal morbidity in the form of operative delivery and induced labour.Methods: 100 patients in third trimester of pregnancy with oligohydramnios confirmed by ultrasound measurement of AFI were selected randomly after satisfying inclusion and exclusion criteria.Results: Incidence of oligohydramnios and operative intervention for the same was seen more in primipara (52%). Most common causes of oligohydramnios were idiopathic (52%) followed by PIH (25%). Operative morbidity was highest in PIH (60%). Most common indication of caesarean section was fetal distress due to cord compression or FGR. 7% patients had fetoplacental insufficiency on Doppler study.Conclusions: Oligohydramnios demands intensive fetal surveillance and proper antepartum and intrapartum care. Due to high rates of intrapartum complications, perinatal morbidity and mortality, rates of caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so that unnecessary operative morbidity is prevented without jeopardizing the fetal well-being

A study of role of doppler in gestational hypertension and perinatal outcome

Background: Hypertensive disorder of pregnancy is one of the most common complications that affect the human pregnancy. Hence it is important to identify women at risk of developing gestational hypertension or preeclampsia, its early diagnosis and subsequent consequences due to uteroplacental insufficiency with help of Doppler ultrasound, to improve perinatal outcome. The objective of this study was to study the application of Doppler ultrasound with analysis of blood flow velocity waveform in gestational hypertension and to examine and study the perinatal outcome in pregnancy with altered Doppler indices.Methods: A prospective study was carried out in 50 antenatal patients diagnosed to have gestational hypertension during a period of 12 months to evaluate the role of color Doppler imaging in gestational hypertension in patients more than 28 weeks of gestation, the initial scan was performed immediately after the diagnosis. This study analyzed the blood flow in umbilical artery, maternal uterine artery and fetal middle cerebral artery using Doppler ultrasound.Results: In this study approximately 76% of cases were found in 20-30 years group. 58% showed abnormal umbilical artery Doppler while 42% women had normal umbilical artery Doppler. In this study 23 cases had cerebro-placental index 1. Cases with cerebro-placental index <1 had various complications like preterm delivery, low birth weight, increased chances of still birth, intra uterine death (IUD), increased NICU admission. In this study 31 cases had abnormal uterine artery Doppler which accounts for 62% of total cases, while 38% had normal uterine artery Doppler.Conclusions: Doppler ultrasound can reliably predict any adverse fetal outcome in hypertensive pregnancies and can be a useful tool for decision making in appropriate timing of intervention for delivery

Neonatal outcome in deliveries complicated by meconium-stained amniotic fluid

Background: Meconium staining amniotic fluid is associated with lots of adverse outcome and has long been considered to be a bad predictor of fetal outcome. This prospective observational study was undertaken to find out immediate fetal outcome in meconium-stained liquor.Methods: The design of the study was prospective. This study was conducted from July 2021 to December 2021.The study included women with meconium-stained amniotic fluid in labor with gestational age >37 completed weeks.Results: Total 100 cases were enrolled. Majority of the patients (74%) were in the age group of 21-30 years with the mean age being 24.6±2.4 years. Fetal distress occurred in 30% of babies, more in association with thick meconium (15%). Caesarean deliveries were 70%. Apgar scores between 0-3 was seen in 17% babies and 1% at fifth minute, between 4-6 in 21% babies and between 7-10 in 62% babies at first minute of birth. Admission in neonatal ward was 32% with perinatal mortality of 6%.Conclusions: Meconium-stained amniotic fluid was associated with higher rate of caesarean delivery, increased need for neonatal resuscitation, increased rate of birth asphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome, hospital admission and mortality. It is more commonly associated with pregnancy induced hypertension (PIH), post-datism, oligohydramnios and gestational diabetes mellitus.

Cardiac diseases in pregnancy and its feto-maternal outcome

Background: Cardiac disease complicates 1-3% of all pregnancies. Of this Rheumatic heart disease constitute 74% and congenital heart disease 26%.Methods: A retrospective study of all patients with cardiac diseases delivered was conducted. A tabulated representation of the data was done. The various cardiac diseases were categorized according the severity, NYHA classification, type of pathology, the maternal and perinatal outcome was assessed, and the maternal mortality and perinatal mortality was recorded.Results: 84% patients belonged to age group 20-29 years. 8% were teen aged and 4% patients were elderly. 64% patients were either P0+0 or P0+1. 8% patients were P0+3 and 2% patient were P3+0. 74% patients had RHD. 26% had grade I, 40% had grade II, 20% patients had grade III and 14% had grade IV heart disease. The associated complications were anemia 46%, Respiratory tract infection 12%, pregnancy induced hypertension 2% and recurrent rheumatic fever 2%. 48% had normal vaginal delivery, 20% had forceps delivery and 32% had caesarean delivery. One mother died of heart failure. All patients of grade I (100%) had term delivery. 23.07% of grade I, 30% of grade II, 60% of grade III and 100% babies of grade IV mothers were of low birth weight (˂2.5 kg). Babies weighing ˂1.5 kg were seen in 5% grade II, 10% grade III and 42.85% mothers with grade IV disease. 2 of grade IV and each of grade I, II and III died.Conclusions: Feto-maternal outcome can be improved with close supervision of obstetrician and cardiologist throughout the pregnancy by antenatal care, early diagnosis and management