Feto-maternal outcome in cases of antepartum hemorrhageat a tertiary care hospital-a retrospective study

Background: Antepartum haemorrhage (APH) is described as bleeding from or into the genital tract which occurs after 24 weeks of pregnancy and before prior to birth of infant. As per RCOG Guidelines in India, viable period is 28 weeks. APH is one of the leading causes of maternal mortality mostly in perinatal period worldwide and almost 3-5% of all the pregnancies are complicated because of it. Objectives of the study were to analyse incidence, risk factors of APH and to study the outcomes, the mode of delivery, perinatal mortality and also maternal mortality in APH.Methods: A retrospective study conducted on patients who were admitted to TMMC and RC with complaints of bleeding per vagina after 28 weeks of pregnancy over a period of 1 year (December 2019-2020).Results: A total of 100 patients with APH out of 1440 deliveries were noted which calculated the incidence to 6.9%. Out of all APH cases, the patients having placenta praevia made 65% of the total cases, abruptio placenta were 34% and undetermined cause was up to 1%. Out of majority of patients of APH, almost 62% were emergency cases. The incidence calculated for un-booked cases was far more. 15 patients having placenta praevia underwent curettage after having a spontaneous abortion. Among all patients of placenta previa, 9 patients had history of 1 previous c-section with incidence of 13% while 5 cases had history of 2 previous section with incidence of 7.6%. Placenta previa type 1 has an incidence of 12%, type 2-20%, type 3-38.4% and type 4-29.2%. The 76.9% patients of placenta praevia underwent caesarean section and 23% of patients underwent spontaneously delivery. APH can lead to a variable degree of maternal and perinatal mortality. Maternal mortality in study was 5% due to placenta previa and 7% due to abruption.Conclusions: The incidence of APH could be reduced by taking some preventive measures like early registration, regular antenatal care, promptly detecting high risk cases, and early referral to higher centre. The incidence of maternal and fetal mortality due to abruption still remains high.

Vesico-vaginal fistula as a complication of total laparoscopic hysterectomy: a case report and literature review

Complications are possible in all type of surgeries including hysterectomy irrespective of the route of surgery, experience of the operating surgeon or the associated risk factors present. If the surgeon is careful from the beginning of the surgery and follows all the preventive measures complications like urinary tract injuries and vesico-vaginal fistula formation following hysterectomy can be avoided. Here we are presenting a case of vesico-vaginal fistula formed following total laparoscopic hysterectomy (TLH) and reviewed literature regarding incidence, preventive measures for this complication

A randomized comparative study between low-dose magnesium sulphate and standard dose regimen for management of eclampsia

Background: Eclampsia is a hypertensive disorder related to pregnancy, in which there is occurrence of one or more generalized convulsions and or coma, in the absence of other neurologic conditions. It is a common obstetric emergency. It contributes significantly to maternal and perinatal morbidity and mortality. Dr. J. A. Pritchard in 1955, introduced magnesium sulphate for control of convulsions in eclampsia and is used worldwide. Considering the low body mass index of Indian women, a low dose magnesium sulphate regime has been introduced by some authors. The Objective was to compare the efficacy of low dose magnesium sulphate regimen with standard Pritchard’s regimen for eclampsia.Methods: A prospective randomized study of fifty eclampsia cases, treated with magnesium sulphate (25 each with low dose regime and Pritchard regime) was carried out from October 2010 to January 2012 at MAMC & LNH, New Delhi, India. Results were analysed using Statistical Package of Social Sciences (SPSS) software 17.0.Results: In the present study, convulsions were controlled in 96% of eclampsia cases with low dose magnesium sulphate regimen. One case i.e. 4% had single episode of recurrence of convulsion, which was controlled by giving additional drugs and shifted to standard dose regimen. There was no maternal mortality.Conclusions: The maternal and perinatal morbidity and mortality in the present study were comparable to those of standard Pritchard’s regimen. The study did not find a single case of magnesium related toxicity with low dose magnesium sulphate regimen. Low dose magnesium sulphate regimen was found to be safe and effective in eclampsia

Giant lipoleiomyoma-an intimidating entity: case report and literature review

Lipomatous uterine neoplasms are extremely uncommon lesions with a reported incidence of 0.01% to 0.2%. These lesions frequently pose a diagnostic challenge not only for the clinician but also for radiologists and pathologists alike. Diagnosis requires a multidisciplinary as well as multimodality approach. A 42-year-old peri-menopausal lady presented with abdominal distension, pain and irregular menstrual bleeding. On radiology, an intra-abdodominal hetergenous mass was seen suggestive of neoplastic etiology, possibly intraperitoneal liposarcoma. Microscopy revealed numerous adipocyte clusters intersecting the smooth muscle bundles, diagnostic of lipoleiomyoma. The present case is unusual as the patient had both intramural and broad ligament lipoleiomyoma. Through the present case we revisit clinical and morphological findings of lipoleiomyomas along with review of cases published in literature till date

A prospective study of demographic profile, risk factors and pregnancy outcome in Hepatitis B and Hepatitis C virus positive pregnant women in a tertiary care centre

Background: Viral hepatitis is the most common liver disease in pregnancy and is also the most common cause of jaundice in pregnancy in tropical countries. Risk factors for transmission are intravenous drug abuse, surgical and dental procedures done without adequate sterilization of instruments, sexual route etc. Early diagnosis and management can prevent maternal and fetal complications. This study was done to evaluate the frequency, risk factors and pregnancy outcome in hepatitis B virus (HBV) and hepatitis C virus (HCV) positive antenatal women.Methods: This case control study was conducted in Teerthankar Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India from January 2017 to June 2018 on total 2511 pregnant women. The serum samples were checked for presence of hepatitis B surface antigen (HBsAg) and presence of IgG antibodies to HCV. Analysis of sociodemographic profile, risk factors and pregnancy outcome were done in all HBV and HCV positive women.Results: Out of 2511 pregnant women, 292 were tested positive for hepatitis. Maximum number of women were in the age group of 21-30 years. Most of the seropositive women were multipara. Frequency of positivity was maximum for HCV (67.1%). The risk factors for transmission in study population were intravenous drug abuse, blood transfusion, history of surgery and tattooing.Conclusions: Hepatitis infection rate is increasing. Universal screening for HBV and HCV can be recommended in pregnant women in developing countries. Education and awareness of public and health care workers can reduce the risk of transmission.

Should ACE2 be given a chance in COVID-19 therapeutics: a semi-systematic review of strategies enhancing ACE2

The severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) has resulted in almost 28 million cases of COVID-19 (Corona virus disease-2019) and more than 900000 deaths worldwide since December 2019. In the absence of effective antiviral therapy and vaccine, treatment of COVID-19 is largely symptomatic. By making use of its spike (S) protein, the virus binds to its primary human cell receptor, angiotensin converting enzyme 2 (ACE2) which is present in the pulmonary epithelial cells as well as other organs. SARS-CoV-2 may cause a downregulation of ACE2. ACE2 plays a protective role in the pulmonary system through its Mas-receptor and alamandine-MrgD-TGR7 pathways. Loss of this protective effect could be a major component of COVID-19 pathogenesis. An attractive strategy in SARS-CoV-2 therapeutics would be to augment ACE2 either directly by supplementation or indirectly through drugs which increase its levels or stimulate its downstream players. In this semi-systematic review, we have analysed the pathophysiological interplay between ACE and ACE2 in the cardiopulmonary system, the modulation of these two proteins by SARS-CoV-2, and potential therapeutic avenues targeting ACE-Ang II and ACE2-Ang (1-7) axes, that can be utilized against COVID-19 disease progression

High spin polarization and the origin of unique ferromagnetic ground state in CuFeSb

CuFeSb is isostructural to the ferro-pnictide and chalcogenide superconductors and it is one of the few materials in the family that are known to stabilize in a ferromagnetic ground state. Majority of the members of this family are either superconductors or antiferromagnets. Therefore, CuFeSb may be used as an ideal source of spin polarized current in spin-transport devices involving pnictide and the chalcogenide superconductors. However, for that the Fermi surface of CuFeSb needs to be sufficiently spin polarized. In this paper we report direct measurement of transport spin polarization in CuFeSb by spin-resolved Andreev reflection spectroscopy. From a number of measurements using multiple superconducting tips we found that the intrinsic transport spin polarization in CuFeSb is high ($\sim$ 47\%). In order to understand the unique ground state of CuFeSb and the origin of large spin polarization at the Fermi level, we have evaluated the spin-polarized band structure of CuFeSb through first principles calculations. Apart from supporting the observed 47\% transport spin polarization, such calculations also indicate that the Sb-Fe-Sb angles and the height of Sb from the Fe plane is strikingly different for CuFeSb than the equivalent parameters in other members of the same family thereby explaining the origin of the unique ground state of CuFeSb.Comment: 6 pages, 4 figure

Oxidation of Cyclohexane Over Nanoclusters of Cu (II) Supported on Nanocrystalline Tungsten Oxide with H2O2 as Oxidant

A facile hydrothermal synthesis method is developed for the preparation of Cu (II) nanoclusters (with average particle size 6 nm) supported on nanocrystalline tungsten (VI) oxide. Detailed characterization of the material was carried out by XRD, SEM, TEM, ICP-AES and TGA. The catalyst was highly active for selective oxidation of cyclohexane to adipic acid with H2O2. The reusability of the catalyst was tested by conducting same experiments with the spent catalyst and it was found that the catalyst did not show any significant activity loss even after 5 reuses. A cyclohexane conversion of 62.5 % with 27 % adipic acid selectivity was achieved over this catalyst at room temperatur

Studies on Aloe Juice Supplemented Kinnow Nectar

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COVID-19 vaccine hesitancy and attitude toward booster doses among US healthcare workers

Vaccine reluctance among healthcare workers (HCW) can have widespread negative ramifications, including modeling behavior for the general population and challenges with maintaining a healthy workforce so we can respond to a resurgence of the pandemic. We previously reported that only one-third of HCW were willing to take the vaccine as soon as it became available prior to its Emergency Use Authorization (EUA). Here, we re-examine the attitude toward COVID-19 vaccines among HCW several months after the vaccines have been made widely available. In this study, only 7.9% (n = 107) of respondents were hesitant to take the first or second dose of the vaccine. Younger age (18-40 years) and lower level of education attainment (GED or less) were associated with higher vaccine hesitancy, whereas self-identified Asian racial identity was associated with greater acceptance of COVID-19 vaccination. Among the vaccine-hesitant group, more respondents noted mistrust of regulatory authorities (45.3%), government (48.6%), and pharmaceutical companies (50%) than mistrust of doctors (25.4%). Nearly two-thirds of respondents were concerned that vaccination may be ineffective against new strains and booster doses may be required; however, vaccine-hesitant respondents\u27 acceptance of a hypothetical booster dose was only 14.3%. Overall, vaccine hesitancy was observed to have demographic predictors similar to those previously reported; the hesitancy of some US HCW to receive booster doses may reflect a general hesitancy to receive other forms of vaccination