An approach to diagnosis and management of acute fatty liver of pregnancy

Acute fatty liver of pregnancy is a rare life threatening cause of jaundice in the third trimester of pregnancy and early postpartum period and is associated with a poor outcome. The maternal and fetal outcome can be improved by a high index of suspicion, early diagnosis and prompt delivery. We report a case of a 30 year old parous lady with 36 weeks twin pregnancy with Acute Fatty Liver of Pregnancy [AFLP] and coagulation failure, she responded to prompt induction of labour and appropriate management of the coagulopathy and related complications. We provide a review of literature on jaundice in pregnancy and the clinical approach to management

PREVALENCE OF DIABETIC RETINOPATHY IN TYPE 2 DIABETES MELLITUS: AN OBSERVATIONAL STUDY IN SOUTHERN INDIA

  Objectives: In India, 69.1 million are diabetics as of 2015 compared to 18 million in 1995. Pan India prevalence study in diabetics carried out at 194 centers by All India Ophthalmological Society reported the prevalence of diabetic retinopathy (DR) among diabetics as 21.8%. DR is of two types, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). The severity of NPDR depends on microaneurysms, hemorrhages, cotton wool spots, and beading of veins and can progress to PDR. Inherit characteristic of PDR is neovascularization. The aim of this observational prevalence study is to study the prevalence of diabetic retinopathy in Type 2 diabetic patients attending diabetic clinic and to study the distribution of diabetic retinopathy with respect to age, sex, and duration of disease in a tertiary care hospital in southern India.Methods: This is a retrospective observational study. Age above 20 years and patients diagnosed with Type 2 diabetes mellitus (DM) and examined by the ophthalmologist were included and others excluded. Data documented were analyzed using statistical software SPSS version 16.Results: About 52.07% of patients with Type 2 DM for more than 10 years had diabetic retinopathy and 13.07 % of patients with Type 2 DM for more than 5 years have diabetic retinopathy.Conclusion: India being the diabetic capital of the world and DR being the most common cause for visual impairment and blindness and it becomes empirical to assess the factors for its rising prevalence, which will significantly contribute in reducing the progression of DR

Down Syndrome: Let's Work Together to End the Stereotypes

Each year, we observe the 21st day of March as our World Down Syndrome Day. The goal is to raise public awareness of Down syndrome (DS) and encourage all member states, relevant organizations of the UN system, all member states, other international organizations, non-governmental organizations, and the private sector to join this effort. The epidemiology of DS is complex. The incidence of DS is estimated to be somewhere between 1 in 1,000 and 1 in 1,200 live births worldwide, but there may well be some temporal, racial/ethnic, and geographical variability in the prevalence of DS. Most infants with DS have an extra copy of chromosome 21, which occurs due to the failure of chromosome 21 to separate during gametogenesis. However, a minority with the same phenotype may have a Robertsonian translocation, an isochromosome, or a ring chromosome. Increasing information suggests that many of the most frequently seen phenotypic features may be rooted in sequential variability in only one band, the 21q22. The characteristic facial appearance, cardiac anomalies such as the endocardial cushion defect, neurodevelopmental delay, and many dermatoglyphic changes could result from a small region including the genes for superoxide dismutase in the region 21q22.1, the amyloid precursor protein mapping in 21q11.2-21.05, and six probes for single-copy sequences: D21S46 in 21q11.2-21.05, D21S47 and SF57 in 21q22.1-22.3, and D21S39, D21S42, and D21S43 in 21q22.3. Speaking from this medical perspective, we need to understand the pathophysiology of DS to meet their healthcare needs. If we could do so, we could make a small change in this world

A study on pre-XDR & XDR tuberculosis & their prevalent genotypes in clinical isolates of Mycobacterium tuberculosis in north India

Background & objectives: Pre-extensively drug resistant (pre-XDR) and extensively drug resistant tuberculosis (XDR-TB) have been areas of growing concern, and are posing threat to global efforts of TB control. The present study was planned to study the presence of pre-XDR and XDR Mycobacterium tuberculosis and their genotypes in clinical isolates obtained from previously treated cases of pulmonary TB. Methods: A total of 219 isolates obtained from previously treated cases of pulmonary TB were subjected to first-line (streptomycin, isoniazid, rifampicin and ethambutol) and second-line (ofloxacin, kanamycin, capreomycin and amikacin) drug susceptibility testing on solid Lowenstein-Jensen medium by proportion method. Genotyping was done for pre-XDR and XDR-TB isolates using 12 loci Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeats (MIRU-VNTR). Results: Multi-drug resistance was observed in 39.7 per cent (87/219) isolates. pre-XDR and XDR M. tuberculosis isolates amongst 87 multi-drug resistant (MDR) TB isolates were 43 (49.4%) and 10 (11.4%), respectively. Two most dominant genotypes among pre-XDR and XDR M. tuberculosis isolates were Beijing and Delhi/CAS types. Interpretation & conclusions: Resistance to second-line anti-tubercular drugs should be routinely assessed in areas endemic for TB. Similar genotype patterns were seen in pre-XDR and XDR-TB isolates. Beijing and Delhi/CAS were predominant genotypes

Bone outcomes following sleeve gastrectomy in adolescents and young adults with obesity versus non-surgical controls

BACKGROUND: Sleeve gastrectomy is the most commonly performed weight loss surgery in adolescents with moderate-to-severe obesity. While studies in adults have reported on the deleterious effects of gastric bypass surgery on bone structure and strength estimates, data are lacking for the impact of sleeve gastrectomy on these measures in adolescents. OBJECTIVE: To evaluate the impact of sleeve gastrectomy on bone outcomes in adolescents and young adults over 12 months using dual energy X-ray absorptiometry (DXA) and high resolution peripheral quantitative computed tomography (HRpQCT). PARTICIPANTS AND METHODS: We enrolled 44 youth 14-22 years old with moderate to severe obesity; 22 underwent sleeve gastrectomy and 22 were followed without surgery (16 females and 6 males in each group). At baseline and 12 months, DXA was used to assess areal bone mineral density (aBMD), HRpQCT of the distal radius and tibia was performed to assess bone geometry, microarchitecture and volumetric BMD (vBMD), and finite element analysis to assess strength estimates (stiffness and failure load). These analyses were adjusted for age, sex, race and the bone measure at baseline. Fasting blood samples were assessed for calcium, phosphorus, and 25(OH) vitamin D (25OHD) levels. RESULTS: Over 12-months, the surgical group lost 27.2% of body weight compared to 0.1% in the non-surgical (control) group. Groups did not differ for changes in 25OHD levels (p = 0.186). Compared to controls, the surgical group had reductions in femoral neck and total hip aBMD Z-scores (p \u3c /= 0.0006). At the distal tibia, compared to controls, the surgical group had reductions in cortical area and thickness and trabecular number, and increases in trabecular area and separation (p \u3c /= 0.026). At the distal radius, the surgical group had greater reductions in trabecular vBMD, than controls (p = 0.010). The surgical group had an increase in cortical vBMD at both sites (p \u3c /= 0.040), possibly from a decrease in cortical porosity (p \u3c /= 0.024). Most, but not all, differences were attenuated after adjusting for 12-month change in BMI. Groups did not differ for changes in strength estimates over time, except that increases in tibial stiffness were lower in the surgical group (p = 0.044) after adjusting for 12-month change in BMI. CONCLUSIONS: Over 12 months, weight loss associated with sleeve gastrectomy in adolescents had negative effects on areal BMD and certain HRpQCT parameters. However, bone strength estimates remained stable, possibly because of a simultaneous decrease in cortical porosity and increase in cortical volumetric BMD. Additional research is necessary to determine the relative contribution(s) of weight loss and the metabolic effects of surgery on bone outcomes, and whether the observed effects on bone stabilize or progress over time