Comparative study of maternal and fetal outcome between low and normal amniotic fluid index at term

Background: Amniotic fluid index (AFI) is kind of an estimate of the amount of amniotic fluid. It is an index for the fetal well-being. The aim was to study fetal and maternal out come in cases of low AFI and normal AFI.Methods: This was a case control prospective comparative study performed on 200 randomly selected low risk pregnant patients at term (37-40 weeks of gestation) admitted in Obstetrics and Gynaecology Department. 100 patients with AFI <5 cm (cases) and 100 patients with AFI 8-20 cm (control).Results: Increased number of LSCS in cases that is 35 while only 10 in control and almost equal incidences of MSL and FD in both the groups, while in cases 17 women were planned for elective LSCS for various indications in expectation of better fetal outcome.  There was significant low APGAR score in babies of cases, but clinically we refute this. In present study almost double the no. of babies in cases was IUGR or FGR. Significant association between low AFI and congenital anomalies in babies. Most of the anomalies were of urinary tract system.Conclusions: An AFI ≤5 cm detected at term that was at or after 37 completed weeks of gestation in a low risk pregnancy was an indicator of poor perinatal outcome. Oligohydramnios was being detected more frequently now-a-days due to ready availability of ultrasonography these days

Effect of EndoActivator and Er,Cr:YSGG laser activation of Qmix, as final endodontic irrigant, on sealer penetration: a confocal microscopic study

Through chemomechanical debridement of the root canal is a primary requisite for successful endodontic therapy. Thus the aim of this study was to evaluate the effects of using QmiX alone, QmiX with EndoActivator and QmiX with Er,Cr:YSGG laser for final irrigation on sealer penetration into the dentinal tubules. 75 extracted human mandibular premolar teeth were treated with sodium hypochlorite (NaOCl) irrigation. The samples were divided into 5 groups according to the final irrigation solution used: (1) 17% EDTA and 2.5% NaOCl, (2) QmiX (3) QmiX with Er,Cr:YSGG laser and (4) QmiX with EndoActivator (5) 2.5%NaOCl. All teeth were obturated using cold lateral condensation technique with gutta percha and AH 26 sealer (Dentsply; DeTrey,Konstanz, Germany) labeled with Rhodamine B dye. The teeth were sectioned at distances of 2 and 5 from root apex. Total percentage and maximum depth of sealer penetration were measured using confocal laser scanning microscopy. Results of one way Anova analysis showed that there was a significant difference in the percentage and depth of sealer penetration among all groups at 3 and 5 mm level sections (P < .05). Within the groups maximum sealer penetration was recorded for Er,Cr:YSGG laser activated group. Greater depth of sealer penetration was recorded at 5mm as compared to 3mm in all the groups. Activation of QMix using EndoActivator and Er,Cr:YSGG laser enhanced the sealer penetration at apical and middle third. Thus Er,Cr:YSGG laser and EndoActivator may act as an appropriate adjunct during chemomechanical preparation of the root canal

An observational study to assess feto-maternal outcome in severely ill COVID-19 positive pregnant females admitted at dedicated COVID care center of southern Rajasthan

Background: COVID-19 infection is caused by corona virus SARS-COV2. the aim of the study is to assess feto-maternal outcome in severely ill covid positive pregnant females.Methods: An observational study was conducted at dedicated covid care center, RNT medical college Udaipur from Jan 2021 to May 2021 among pregnant females. In this study out of 236 total covid positive pregnant patients, 54 patients which could not maintain oxygen saturation, according to NIH criteria were included in our study.Results: Out of 54 pregnant women, 24 women delivered with 2 twin pregnancies. Out of this 67% underwent cesarean section and 33% were delivered by vaginal route. Postpartum hemorrhage seen in 29% of patients. Maternal death reported in 39% of patients. Out of 54 patients 38 patients were admitted in ICU. Invasive ventilation received by 26% of patients while oxygen received by non-invasive ventilation (15%), Bains (18%) rest by NRBM and venturi mask (41%). Remdesivir were given in 26 (48%) patients.Conclusions: Our study suggests there may be increased risk of adverse pregnancy outcome for mother and fetus. COVID-19 in pregnancy was associated with risks of pre-eclampsia, stillbirth, preterm birth, PPH. Similar to general population comorbidities do play a role in the outcome of disease in pregnancy. Further studies are needed for effective strategies to prevent adverse outcomes in pregnant females with COVID-19.

A rare case of genital myiasis in genital prolapse

Genital myiasis is an infestation by fly larvae in genital organs, where they feed and develop as parasites. They can cause severe infection, inflammatory reaction and can be linked to psychiatric disturbances. Commonly cutaneous, ophthalmic, auricular and nasopharyngeal myiasis are seen, with genital myiasis being a rare condition. We reported a case of an 82-year-old postmenopausal female who presented with the complaint of intense pain in genital region. After clinical evaluation she was clinically diagnosed as a case of genital myiasis of prolapsed uterus. Myiasis of the genital organ is a rare clinical entity. Good personal hygiene and proper sanitary conditions are very crucial for prevention of myiasis

Correlation of non-stress test with fetal outcome in term of Apgar score- a prospective observation study

Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. The objectives of antepartum fetal surveillance are to prevent fetal death and avoidance of unnecessary intervention. This study using NST as a tool for routine antepartum fetal surveillance was trying to catch up those fetuses who might be at risk in womb and provide prompt intervention in otherwise considered normal pregnancies without any obvious high risk factor thus giving the best outcome in mothers.Methods: The objective of this study was to evaluate the correlation of the non-stress test with fetal outcome in pregnancies from 37-42 weeks of gestation.  This was a prospective observational study at Pannadhaya Rajkiya Mahila Chikitsalya Udaipur (Rajasthan) from February 2022 to July 2022. This study included 100 normal pregnant mothers from 37 weeks to 42 weeks who were subjected to NST.Results: The parameters of poor fetal outcome like Apgar score <7 at 5 minutes had increased incidences in the non reactive group.Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. So This study suggested that the NST was found to be a good predictor of the healthy foetus even in normal pregnancies between 37-42 weeks of gestation and the probability of an adverse outcome such as poor Apgar score increases with a non reactive strip

A rare case of giant condyloma acuminata during pregnancy

Genital warts (Condyloma acuminata) are a benign lesion caused by human papillomavirus (HPV) type-6 or type-11 and are usually transmitted sexually. During pregnancy, condyloma has a tendency to proliferate and may have recurrence. We have a case of G2P1L1 38 weeks previously normal vaginal delivered patient in our hospital with extensive genital warts. Patient was successfully managed by surgical excision and after that in follow up after 2 months for podophyllin resin application on remaining lesions. HPV infection presentation can range from asymptomatic to cervical cancer. Small genital wart lesion may become extensive and cumbersome during pregnancy and again regress after delivery in due course of time. HPV vaccination, sex education and early treatment of condyloma lesions should prevent and, in any case, improve the prognosis of this disease

Ultrasound assessment of foetal head-perineum distance prior to induction of labour as a predictor of successful vaginal delivery: a prospective study from a tertiary care hospital of Rajasthan

Background: Induction of labor (IOL) is one of the most frequent obstetric procedures require for various obstetrics indications in 13-20% of term. Traditionally success of induction has been determined by Bishop score, but this score is observer based and significant inter observer disagreements have been noted. Ultrasound can help obstetricians in counselling patients before induction of labour and explain the probability of successful induction. So in this study we did ultrasound assessment of foetal head-perineum distance prior to induction of labour as a predictor of successful vaginal delivery. Methods: All eligible women who are planned for induction of labour will undergo ultrasound assessment of foetal head–perineum distance prior to induction of labour. Transvaginal ultrasound will also be performed using ultrasound probe to measure cervical length. After the scans, prevaginal examination will be performed to assess the various components of modified Bishop score (min 0, max 10). If cervix is found unfavourable, induction of labour will be done. If patient did not go into active labour, then induction will be considered unsuccessful) or else oxytocin drip in cases where cervix is found favourable. The patients will be followed up till delivery. Results: Out of 125 patients enrolled for the study, 101 women delivered successfully vaginally and 24 had to undergo caesarean delivery. Of these 24 cases of caesarean delivery, 11 cases were excluded as the operative procedure was performed for indication not related to unsuccessful induction such as occurrence of foetal distress in labour, thick meconium-stained liquor with unfavourable cervix. The final analysis was performed from 114 subjects (101 vaginal births and 13 caesarean births). Conclusions: Transperineal fetal head–perineum distance is less painful as less time consuming and less acceptable by patients compare to Transvaginal measurement of cervical length and painful digital examination for bishop score

Establishing the promising role of novel combination of triple therapeutics delivery using polymeric nanoparticles for Triple negative breast cancer therapy

Introduction: Triple-negative breast cancer (TNBC) is a lethal tumor with an advanced degree of metastasis and poor survivability as compared to other subtypes of breast cancer. TNBC which consists of 15 % of all types of breast cancer is categorized by the absence of expression of estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor-2 (HER2). This is the main reason for the failure of current hormonal receptor-based therapies against TNBCs, thus leading to poor patient outcomes. Therefore, there is a necessity to develop novel therapies targeting this devastating disease. Methods: In this study, we have targeted TNBC by simultaneous activation of apoptosis through DNA damage via cytotoxic agent such as paclitaxel (PAC), inhibition of PARP activity via PARP inhibitor, olaparib (OLA) and inhibiting the activity of FOXM1 proto-oncogenic transcription factor by using RNA interference technology (FOXM1-siRNA) in nanoformulations. Experiments conducted in this investigation include cellular uptake, cytotoxicity and apoptosis study using MDA-MB-231 cells. Results: The present study validates that co-delivery of two drugs (PAC and OLA) along with FOXM1-siRNA by cationic NPs, enhances the therapeutic outcome leading to greater cytotoxicity in TNBC cells. Conclusion: The current investigation focuses on designing a multifunctional drug delivery platform for concurrent delivery of either PAC or PARP inhibitor (olaparib) and FOXM1 siRNA in chitosan-coated poly(D, L-lactide-co-glycolide) (PLGA) nanoparticles (NPs) with the ability to emerge as a front runner therapeutic for TNBC therapy

Immature Platelet Fraction as a Predictive Marker of Severity in Hypertensive Disease of Pregnancy: a Prospective Cross-Sectional Study

Objective: This study aimed to evaluate the role of immature platelet fractions (IPFs) and the degree of thrombocytopenia and their association with the severity of hypertensive disease of pregnancy. Material and Methods: One-hundred-and-ten primigravida females between 20-30 years of age, with a singleton live pregnancy, who attended the ANC clinic at Mahila Chikitsalaya, at over 20 weeks of gestation, with hypertensive disease of pregnancy, from November 2019 to August 2021, were enrolled in the study. Blood samples were obtained from all subjects  at a regular ANC visits and at the time of admission in hypertensive disease of pregnancy and  samples were analyzed within 4 hours of collection using an automated hematology system. IPFs were quantified using an optical fluorescence method. The levels of thrombocytopenia and immature platelet fractions were statistically analyzed against the severity of the disease. Results: The mean IPF was highest in females with eclampsia (18.12±3.59%), followed by severe preeclampsia (14.81±2.91%), mild preeclampsia (10.55±3.26%) and was smallest in females with gestational hypertension (10.08± 0.91%). This increase in IPF with increasing severity of hypertensive disorder of pregnancy was found to be statistically significant (p-value<0.001). The mean platelet count was lowest in females with eclampsia (1.60±0.41 lac/mm3, followed by severe pre-eclampsia (1.65±0.36 lac/mm3), mild pre-eclampsia (1.90±0.47 lac/mm3) and highest in females with gestational hypertension (2.57±0.25 lac/mm3) (p-value<0.001) Conclusion: Higher IPFs had a negative correlation with lower platelet counts and was significantly correlated s with disease severity. Changes in IPF in HDP may occur before development of thrombocytopenia, thus providing an opportunity to plan preemptive management strategies to reduce fetomaternal morbidity and mortality

Diversity and scale: Genetic architecture of 2068 traits in the VA Million Veteran Program

One of the justifiable criticisms of human genetic studies is the underrepresentation of participants from diverse populations. Lack of inclusion must be addressed at-scale to identify causal disease factors and understand the genetic causes of health disparities. We present genome-wide associations for 2068 traits from 635,969 participants in the Department of Veterans Affairs Million Veteran Program, a longitudinal study of diverse United States Veterans. Systematic analysis revealed 13,672 genomic risk loci; 1608 were only significant after including non-European populations. Fine-mapping identified causal variants at 6318 signals across 613 traits. One-third (n = 2069) were identified in participants from non-European populations. This reveals a broadly similar genetic architecture across populations, highlights genetic insights gained from underrepresented groups, and presents an extensive atlas of genetic associations