Effects of Waterborne Benzo[A]Pyrene Embryonic Exposure on Development, Behavior, Reproduction, and Mitochondrial Bioenergetics in Zebrafish

Benzo[a]pyrene (BaP) is a polycyclic aromatic hydrocarbon (PAH) that is a known carcinogen leading to adverse effects in the development of both humans and animals. BaP is also continuously present in the environment leading to regular exposure via inhalation or ingestion. Because organisms’ early life stages can be more susceptible to contaminant exposure, our focus was on BaP’s adverse impacts on survival, length, weight, behavior, bioenergetic state, and fecundity following developmental exposures. To study BaP’s impacts, zebrafish (Danio rerio) were used as a model organism. BaP is a ligand for the aryl hydrocarbon receptor (AHR in humans; Ahr in fish). This receptor mediates some of BaP’s adverse effects (i.e., metabolic activation of reactive oxygen species). To understand the role of Ahr in behavior and bioenergetics, wild-type (5D) and a presumptive Ahr2-/- line were used. Embryos were exposed to waterborne BaP exposure at confirmed concentrations of 0, 4.02, or 53.9 µg/L from 6 – 120 hours post fertilization (hpf). Fish were then raised in clean water until 4 months postfertilization (mpf). Subsequently, survival, hatch, size, and behavioral effects (locomotion and anxiety-like behaviors) were recorded at various life stages: larval photomotor response at 120 hpf (larval); and open field test at 1 mpf (juvenile); 3 mpf (adolescent); and 4 mpf (adult). In addition, at 4 mpf, fecundity was assessed by breeding the F0 adults who were developmentally exposed to BaP to produce the F1 generation. The Seahorse XFe96 Flux Analyzer was used to assess the relative mitochondrial bioenergetic state at 4 mpf in the F0 fish. Furthermore, F1 survival and hatch was recorded, and behavior was assessed using a larval photomotor response assay at 120 hpf. In the wildtype (5D) F0 generation, while there were no significant differences in survival between control and 53.9 µg/L BaP through adulthood, larvae from the 4.02 µg/L BaP treatment group did not survive past 2 weeks post fertilization (wpf). The 53.9 µg/L BaP exposed males weighed significantly more than controls at 3 mpf and length was significantly increased at 4 mpf. With respect to behavior, BaP exposed larvae displayed increased activity in the dark phase compared to controls. No behavioral differences were observed in the open field assessment at 1 mpf. However, at 3 mpf, BaP exposed fish had a significant decrease in total distance traveled and a significant increase in freezing duration. At 4 mpf, adult females, regardless of treatment, spent significantly more time in the periphery than males indicating anxiety-related behavior, but there were no significant treatment effects. There were no significant differences in the bioenergetic state between treatments. No differences were observed in F0 fecundity or F1 survival and hatch. In the F1 generation, larvae whose parents were exposed to BaP were significantly less active in the dark phase compared to the F1 controls, which is the opposite effect of what was observed in the F0 larvae. The Ahr2-/- fish when genotyped represented a mix of Ahrgenotypes so no conclusions were drawn from null animals. Overall, our wild-type results suggest that BaP-related behavioral impacts are present and can cause multigenerational effects and is potentially harmful in terms of cognition and development

DEVELOPMENT AND VALIDATION OF REVERSE-PHASE HIGH-PERFORMANCE LIQUID CHROMATOGRAPHY METHOD FOR SIMULTANEOUS ESTIMATION OF OLANZAPINE AND ARIPIPRAZOLE IN SYNTHETIC MIXTURES

Objective: A simple, rapid, accurate, precise, specific, and sensitive reverse-phase high-performance liquid chromatography (RP-HPLC) method has been developed and validated for simultaneous estimation of olanzapine (OLZ) and aripiprazole (APR) in synthetic mixtures. Methods: The stationary phase used for chromatographic separation was Phenomenex C18 column (250 mm × 4.6 mm i.d, particle size 5 μm) and mobile phase used for separation was methanol: Phosphate buffer (pH 3) taken in ratio of 75:25 %v/v. The flow rate was used 1.0 ml/min at room temperature and drugs detected at 240 nm with injection volume 20 μL. Results: The retention time for OLZ and APR was found to be 4.231 and 6.523 min, respectively. The linearity was performed using a concentration range of 0.5–3.0 for both drugs. The correlation coefficient was found to be 0.999 for OLZ and APR. The % purity of both the drug was found to be 98–102%. The proposed RP-HPLC method has been validated, according to International council on harmonization Q2 (B) guidelines. Conclusion: There was no interference of any diluents and excipients in the determination of drugs from synthetic mixture. Hence, the developed method can be used for routine quality control analysis

Effect of gestational weight gain on pregnancy outcome of Indian mothers

Background: Gestational weight gain (GWG) and pre-pregnancy body mass index (BMI) play important roles in determining the pregnancy outcome. The weight gain recommendations by the IOM are based on Western WHO BMI cut-offs, making it difficult to generalize their findings to Asian Indians. We aimed to compare GWG among healthy pregnant women across different BMI with the IOM guidelines-2009. We also aimed to evaluate associated feto-maternal outcomes with GWG among the pregnant women enrolled in the study.Methods: A retrospective cohort study conducted at department of obstetrics and gynecology, from April 2019 to November 2019. Postnatal mothers whose weight was registered at first trimester of pregnancy and at term and delivered in SSG hospital were included. According to IOM Women were divided into: Group 1 less than recommended weight gain and Group 2 recommended weight gain.Results: Significant difference was seen in the baby weight between the two groups (p value 0.05), and no association was seen between GWG and preterm deliveries (p >0.05).Conclusions: Majority of patients in the both groups had term delivery. Women gaining less than recommended weight gain during pregnancy had new born with significantly lower birth weight. There was no association of mode of deliveries and GWG

DIFFERENT ASPECTS INVOLVED IN PROCESS VALIDATION

ABSTRACT Validation refers to establishing documented evidence that a process or system, when operated within established parameters, can perform effectively and reproducibly to produce a medicinal product meeting its pre-determined specifications and quality attributes. Validation of the individualsteps of the processes is called the process validation. Process validation involves the collection and evaluation of data, from the process design stage throughout production, that establish scientific evidence that a process is capable of consistently delivering a quality drug substance. It is internationally recognized that validation is necessary in analyticallaboratories. The use of validated methods is important for an analyticallaboratory to show its qualification and competency.This new approach to process validation encompasses equipmentand utility qualification and is fully science and risk-based. Itprovides the pharmaceutical industry with the opportunity tore-think the whole concept of validation and ensure that theseactivities add real value to our businesses and to patients.It involves prospective validation, retrospective validation and concurrent validation.A life-cycle approach should be applied linking product and process development, validation of the commercial manufacturing process and maintenance of the process in a state of control during routine commercial production. KEYWORDS:Validation, prospective validation, concurrent validation, retrospective  validation, quality by desig

HYSTEROSALPINGOGRAPHY: TECHNIQUE AND APPLICATIONS (VIEW)

Hysterosalpingography (HSG) is the radiographic evaluation of the uterine cavity and fallopian tubes after the administration of a radio-opaque medium through the cervical canal. The first HSG was performed in 1910 and was considered to be the first special radio¬logic procedure. A properly performed HSG can de¬tect the contour of the uterine cavity and the width of the cervical canal. Further contrast medium injection will outline the cornua isthmic and ampullary portions of the tubes, and will show the degree of spillage. If a properly performed HSG shows no uterine cavity abnormality, it is very unlikely that other modalities would do so. Although this procedure is considered diagnostic, there may also be a possible therapeutic benefit from the flushing effect. Indications and Contraindications HSG is used predominantly in the evaluation of in-fertility. Despite the arrival of newer imaging modalities, HSG still remains the best procedure to image the fallopi¬an tubes. Although evaluating feminine infertility, with or without the presence of repeated miscarriages, is the main indication for this method, it can also be used in other cas-es, such as pain in the pelvis tract, congenital or anatomic abnormalities, anomalies of the menstrual cycle, and ab-normal menses. Also, it is sometimes used as a preoper-ative control for women who are about to have uterine or tubal surgery. Soares and coworkers showed that HSG had a sensitivity of 58% and a positive-predictive value of 28.6% for polypoid lesions, and a sensitivity of 0% for endometrial hyperplasia. The same study showed HSG to have a sensitivity of 44.4% for uterine malformations, and a sensitivity of 75% for the detection of intrauterine adhesions. The main contraindication of the examination is possible pregnancy. This contraindication can be avoid¬ed by performing the examination before the ovulation phase, between the 7th to 10th day of the menstrual cycle. Because of the scattering risk, the examination should be avoided when there is active intrapelvic inflammation. Another contraindication is vaginal or uterine bleeding because of the risk of unrestrained bleeding, which could lead to transfusion or surgical recovery procedures. Fi¬nally, the examination should not be performed in cases of severe cardiac or renal deficiency, or in cases of recent uterine or tubal surgery. Technique Patient Preparation The procedure is performed in the first half of the menstrual cycle following cessation of bleeding. The endometrium is thin during this proliferative phase, which facilitates better image interpretation and should also ensure that there is no pregnancy. The patient is asked to refrain from unprotected sexual intercourse from the date of her period until after the investigation to be certain there is no risk of pregnancy. Examination in the second half of the cycle is avoided because the thickened secretory-phase endometrium increases the risk of venous intravasation and may cause a false-pos¬itive diagnosis of cornual occlusion. Antibiotics might be required 1 day before and for a few days after the examination if previous inflamma¬tions are present in the patient’s clinical history. Antibiotics are required after the examination when the maneuvers are fairly sanguineous or if the fallopian tubes present a certain degree of dilation. The suggest¬ed antibiotic regimen is metronidazole 1 g rectally at the time of the procedure, plus doxycycline 100 mg twice daily for 7 days.Steroid (prednisolone) premed¬ication is prescribed in asthmatics when intravenous contrast is used; there-fore, it is reasonable to do the same for HSG because intravasation is also possible from this procedure. Catheterization Technique For the catheterization technique, the patient is placed on the fluoroscopic machine in a gynecologic examination position. After cleaning the external gen¬ital area with antiseptic solution, the vagina is dilated by a gynecologic dilator. The cervix is localized and cleansed with iodine solution. Afterward, the uterine cervix is straightened by one (at the 12 o’clock posi¬tion) or two (at the 9 and 3 o’clock positions) surgi¬cal forceps exercising a degree of pulling. Next, the outside uterine cervix ostium is catheterized. The catheterization can be performed in two ways. In the authors’ country, a salpinographer with a bell-shaped end (diameter depends on the case) is pushed through the vagina and fits in the external uterine cervix osti¬um. In the second technique, the salpingographer has a plastic cup-shaped end that is fitted to the external uterine cervix ostium, creating a void phenomenon. In both techniques, there is a syringe with iodinated hydrosoluble contrast medium at the other end of the salpingographer. The vagina dilator is taken off after catheterization of the external uteri cervix ostium and before administration of the contrast medium. Contrast Media In the past, oil-soluble contrast media were mainly used. Today, we use all available iodinated hydrosol¬uble contrast media. According to international liter¬ature, the use of oil-soluble contrast media increases the pregnancy rate and contributes to a decrease in conception time after the salpingography is performed. However, Spring and coworkers found that there is no evidence that the choice of the contrast material affects the rate of term pregnancy. Moreover, they reported that oil-soluble contrast media may promote granulo¬matous inflammation in the presence of obstructed or inflamed fallopian tubes. Radiological Views One conventional radiograph of the pelvis (on a 24¬30 cm radiologic film) is necessary before the contrast medium is administrated into the uterine cavity so that possible intrapyelic masses or calcifications will not complicate interpretation of the images. A metallic marker is placed over one side of the pelvis to indicate the right or left side of the patient. Next, the examina¬tion is performed under fluoroscopic control so that ra¬diographs can be taken during the filling of the uterine cavity (usually 2-3 cm of contrast medium is sufficient) and again during the filling of the fallopian tubes. Final¬ly, after the removal of the salpingographer, we radio¬graphically check the presence of contrast medium in the peritoneal cavity. The total amount of injected con¬trast medium should not exceed 10 mL. Additional spot radiographs are obtained to document any abnormality that is seen. Before the first radiograph, we also fluoro- scopically check the reflux of the contrast medium. Complications The two most common complications of HSG are pain and infection. These and other complications and side effects are summarized below. • Uterine contractions and discomfort due to the introduction of contrast medium into the uterine cavi¬ty: The most common type of pain referenced is subab¬dominal colic caused by dilation of the uterine cavity. A more diffuse pain, caused by irritation of the peri¬toneum due to the contrast medium, has also been re¬ported. Pain can be minimized by slowly injecting the contrast medium and using isosmolar contrast agents. • Postprocedural infection: Spreading and gener-alization of intrapyelic inflammation may happen in cases of chronic inflammation and hydrosalpinges, or after severe uterine injury caused by the examination maneuver. • Vasovagal reaction: A possible reaction to ma-nipulation of the cervix or inflation of a conclusion balloon in the cervical canal. • Traumatic elevation of endometrium by the in¬serted cannula: A complication which does not cause significant consequences. • Uterine perforation and tubal rupture: These complications are very rare. • Venous or lymphatic intravasation of contrast me-dia: With a water-based contrast medium there is no ad-verse effect on the patient, but it can make interpretation of the image difficult. It occurs more commonly in the presence of fibroids or tubal obstruction. Extravasation of the contrast medium could occur if the contrast me¬dium is administered too quickly, if the endometrium is injured during the catheterization, or if the examination is performed during menstruation. Extravasation is also possible when common or special inflammations of the endometrium are present due to the intercourse rate be-tween the uterine vein and the ovarian veins. • Allergic reaction to contrast media: Such a reac¬tion is very uncommon with the use of the low-osmolar nonionic contrast agents currently available. • Radiation exposure to the ovaries: Exposure is minimal and can be reduced if the proper technique is utilized. Normal Findings On face radiographs, the uterine cavity has a nor¬mal trigonal shape and the apex of the triangle corre¬sponds to the isthmus, which is nearly 3.7 cm wide. The apex is pointed downwards and connected to the internal ostium of the cervix uteri, which is 2.5 cm in total length. The base of triangular uterine cavity is the fundus, which can be concave, flattened, or slightly convex. On both sides of its base, in the area of the lateral horns, the two fallopian tubes are drowned. The fallopian tubes are separated into three segments: isth¬mus (attached to the uterus, not imaged in several cas¬es), ampullary (in the middle, the longest and widest segment), and bell-shaped (to the distal end). There are two ostiums: the internal or uterine, and the external or abdominal. From the abdominal ostium, the con¬trast medium disperses and diffuses into the peritone¬al cavity. Remaining contrast medium in the furrows of the peritoneum can be observed up to 3 hours after administration. Very often, the contrast medium in the rectouterine pouch of the peritoneum (Douglas’ space) can demonstrate the profile of the coordinate ovary. Congenital Uterus Anomalies Congenital uterus anomalies are caused by incom¬plete junction of the paramesonephric ducts (Muller ducts), or Extravasations of the contrast medium. The true incidence and prevalence of mullerian duct anomalies are difficult to assess. Examination of different patient populations, nonstandardized clas¬sification systems, and differences in diagnostic data acquisition has resulted in widely disparate estimates, with a reported prevalence that ranges from 0.16 to 10%. As a result of selection bias, a prevalence of 8 to 10% has been reported in women being evaluated with HSG because of recurrent pregnancy loss. The overall data suggest that the prevalence both in women with normal fertility and in women with infertility is approximately 1%, and the prevalence in women with repeated pregnancy loss is approximately 3%. While the majority of women with mullerian duct anomalies have little problem conceiving, they have higher associated rates of spontaneous abortion, pre¬mature delivery, and abnormal fetal position and dys¬tocia at delivery. Most studies report an approximate frequency of 25% for associated reproductive prob¬lems, compared with 10% in the general population. Primary infertility in these women usually has an ex¬tra uterine cause and is not generally attributable to mullerian duct anomalies alone. Additionally, cervical incompetence has been reported to be associated with these anomalies. According to the American Society of Reproduc¬tive Medicine, there are seven different classes of mul¬lerian duct anomalies: Class I: Segmental agenesis or variable degrees of uterovaginal hypoplasia. The anomaly can be detected, because of the amenorrhea, before HSG is performed. Class II: Unicornuate uteri that represent partial or complete unilateral hypoplasia. In rare cases of degen-eration of the mesonephric duct, the uterine cavity ap¬pears monocular when imaged, placed right or left of the middle line. The unicornuate uterus contacts only the coordinate fallopian tube. Class III: Didelphys uterus. This is a rare abnor¬mality that results from complete nonfusion of the mullerian ducts, and includes the duplication of the uterine cavity, cervix neck, and vagina. Rarely, this uterus has a single vagina. Class IV: Bicornuate uterus that demonstrates incomplete fusion of the superior segments of the uterovaginal canal. The uterine cavity is divided in two; each half has a narrow-length shape and stands apart from the other. Class V: Septate uteri that represent partial or com¬plete nonresorption of the uterovaginal septum. Class VI: Arcuate uterus resulting from nearly complete resorption of the septum. Along with the pre¬vious anomaly, these are the most common congenital anomalies (50%) in cases detecting female infertility. Class VII: Anomalies that comprise sequelae of in utero diethyloestradiol exposure. Another congenital anomaly, caused by inadequate hormonic stimulation as a fetus, is small uterine cavi¬ty size with normal vaginal length. This is a common finding in cases of female infertility. Abnormal Findings Fibromyomas While fibromas are diagnosed by suprapubic ultra-sound, submucosa fibromyomas are imaged as smooth filling defects in the uterine cavity. Differential diagno¬sis must be made from endometrial polyps or possible pregnancy. Small intramural fibromyomas do not distort the endometrial cavity and are not visualized on HSG. Subserous fibromyomas can provoke smooth filling de-fects or smooth repression of the fallopian tubes only if they are located in the lateral walls of the uterus. Endometrial Polyps Endometrial polyps are focal overgrowths of the endometrium. They usually manifest as well-defined filling defects and are best seen during the early filling stage. Small polyps may be obscured when contrast material completely fills the uterine cavity and may be indistinguishable from a small submucosal myoma. Sonohysterography has become the preferred method of imaging endometrial polyps. Internal Endometriosis (Adenomyosis) Adenomyosis is caused by the presence of ectopic islets of active endometrium in the muscularis wall of the uterus. It is usually imaged as a pointed projection of 2 to 3 mm length, perpendicular to the uterine wall after contrast medium administration. Rarely, this is imaged as a sack-shaped projection filled by contrast medium, 4 mm to 1 cm in length. Differential diag¬nosis should include the hyperplasia of the endome¬trium and the entrance of the contrast medium in the myometrium or in the nutrient arteriole of submucosa fibromyomas. Uterine Cancer Uterine cancer manifests as an irregular filling de¬fect, but is rarely diagnosed by the HSG method. Intrauterine Adhesions Intrauterine adhesions are most commonly caused by endometrial trauma of curettage. They are also seen in patients with chronic endometriosis due to tubercu¬losis. Genital tuberculosis primary affects the fallopian tubes, and 50% of patients with tubal disease also have a uterine abnormality. Intrauterine adhesions manifest as irregular filling defects, most commonly as linear filling defects arising from one of the uterine walls. Hydrosalpinx HSG is the best method for visualizing and eval¬uating the fallopian tubes. Hydrosalpinx is a common finding that results from a previous inflammation of the fallopian tubes (salpingitis). This is usually the se¬quelae of distal tubal occlusion, leading to dilation of the proximal segment. The radiologic image shows a dilated lumen in one or more spots, and the contrast medium will not make its way to the peritoneal cavity Tuberculated Salpingitis This entity usually causes distant fallopian tube end obliteration. In extensive infections, multiple con¬strictions along the course of fallopian tube can form, resulting in areas of dilation and stenosis. Abnormal uterine and vaginal profiles are observed in cases of widespread infection. Salpingitis Isthmica Nodosa Salpingitis isthmica nodosa is a disease of un¬known etiology, characterized by multiple small out- pouchings or diverticula affecting one or both fallopian tubes. It is presumably caused by pelvic inflammatory disease or endometriosis and is associated with ectopic pregnancy and infertility. Nondrawing of the Fallopian Tubes This is the most common finding during the exam-ination and is usually caused by poor technique, spasm, or obliteration of the fallopian tube. Poor technique in¬cludes imperfect straightening of the external cervical ostium or an inadequate amount of contrast medium in the uterine cavity. The cornual portion of the fallopian tube is encased by the smooth muscle of the uterus and, if there is a spasm of the muscle during HSG, one or both tubes may not fill. Using radiography, tubal spasm cannot be distinguished from tubal occlusion. This could be avoided by progressive administration of the contrast medium or, when the spasm occurs, administration of a spasmolytic agent to relieve spasm, helping differentiate cornual spasm from true occlusion. Obliteration is usu¬ally caused by previous inflammation or uterine surgery and manifests as nonopacification or abrupt cutoff of the fallopian tube with no free intraperitoneal spillage. External Adhesions External adhesions occur secondary to previous inflammation or surgery, similar to the causes of tubal occlusion. Peritubal adhesions prevent contrast materi¬al from flowing freely around the bowel loops as seen in normal cases, and most commonly manifest as loc- ulation of the contrast material around the ampullary portion of the tube. Conclusion. HSG remains the front-line imaging modality in the investigation of infertility. It is an ac¬curate means of accessing the uterine cavity and tubal patency, but has a low sensitivity for the diagnosis of pelvic adhe¬sions, which is why it cannot replace laparoscopy. It requires knowledge of the female anatomy as well as skillful technique in order to avoid pitfalls and misin¬terpretations.Кафедра акушерства та гінекологі

MSCT coronary angiography in non-invasive assessment of coronary artery bypass grafts patency

Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India and worldwide and last decade has seen a steep rise in incidence of CAD in India and its treatment as bypass surgery. Direct visualization of the grafts and native coronary arteries by invasive catheterization is now being replaced by non-invasive CT coronary angiography with higher slice machines and newer technology as it has good temporal resolution, high scanning speed as well as low radiation dose. We share our experience of graft imaging on 128 slice CT machine.Methods: This is a retrospective, single-center, observational study. We included 500 symptomatic patients who have undergone CT study between the year 2014 to 2018 post bypass surgery.Results: Arterial grafts have a better patency rate than venous grafts. (88% vs. 64.1%). Amongst the individual arterial grafts RIMA had the best patency rate (100%) followed by LIMA (90.8%), RA (68.7%). LAD was the most commonly involved artery (91%).Conclusions: Significant absolute concordance between CT and catheter angiographic findings have been documented for all arterial and venous grafts patency in the literature. The MSCT with retrospective gating permits an accurate and non-invasive evaluation of patent and diseased arterial and vein grafts and could replace conventional angiography for the follow-up of symptomatic, stable patients. Moreover, an optimal diagnostic accuracy was also documented in the appraisal of native vessels distal to the graft anastomoses

Knowledge, attitude and practice among consumers about adverse drug reaction reporting

Background: Background: Adverse Drug Reaction (ADR) reporting by consumers is quite low in India. Assessing knowledge and attitude of consumers regarding ADR reporting and observing practice of ADR reporting among them can help explore probable causes for underreporting of ADRs by consumers.Methods: This was a cross-sectional study conducted in a tertiary care teaching hospital using investigator-administered questionnaire and interviewing indoor patients of Surgery, Medicine, Obstetrics & Gynaecology and Dermatology departments. The questionnaire was prepared to assess knowledge, attitude and practice of consumers about ADR reporting. Data was analysed using mean, standard deviation and percentages.Result: A total of 820 consumers of medicines were included. It was found that 32.2% consumers were not aware that a drug can produce adverse effects. After being explained about adverse drug reactions, 94.6% consumers felt that adverse drug reactions should be reported. However, 98.8% consumers were not aware of Pharmacovigilance Programme of India. After consulting about consumer reporting programme, majority of respondents (96.1%) felt that the direct consumer reporting programme helps reporting of ADRs. Moreover, 93.7% of consumers were willing to use it to report ADRs in future. Consumers preferred the Telephonic method with a Toll free number for ADR reporting followed by informing a health care professional.Conclusion: Poor knowledge and awareness about ADR reporting is the major factor for low to nearly absent ADR reporting by consumers in India

Comparison of the safety and efficacy of intracervical Foleys catheter versus PGE2 gel for induction of labour at term

Background: Before the induction of labour cervical ripening is needed for the success of induction to reduce the complication and diminish the rate of cesarean section and duration of labour. Various mechanical methods like Foleys catheter are effective but not much popular because of infection and pharmacological preparations which have more side effects, are used for cervical ripening. Therefore study has been conducted to compare the efficacy and safety of intra cervical Foleys catheter versus PGE2 gel for induction of labour at term. The aims and objectives of this study was to success of induction of labour depends on the cervical status at the time of induction.Methods: A prospective comparative study was conducted in the department of obstetrics and gynecology, L.G. hospital (AMCMET Medical college), Ahmedabad, during period of July 2019 to December 2019. 100 patients at term with a Bishop’s score with various indications for induction were randomly allocated to receive (50 patients) intra cervical Foleys catheter or PGE2 gel (50 patients). Post induction Bishop’s score was noted after 6 hours, 12 hours, 24 hours. Statistical methods used were Student t test and Chi square test to statistically compare the two groups. Differences with a p value of <0.005 was considered statistically significant with confidence limit of 95%.Results: The groups were comparable with respect to maternal age, gestational age, parity, indication of induction and initial bishops score. Both groups showed significant change in the Bishops score, 5.10±1.55 and 5.14±1.60 for Foleys catheter and PGE2 gel, respectively, p<0.001. Fetal outcome was noted in NICU admission and fetal death. No significant difference between two groups.Conclusions: This study shows that both Foleys catheter and PGE2 gel were equally effective in pre induction cervical ripening

An analytical study of 50 women presenting with an adnexal mass

Background: The aim of this study was to detect and determine the origin of adnexal mass and to narrow down the diagnosis. Also, to determine the reliability of the bimanual pelvic examination in diagnosing adnexal mass and to determine clinical, radiological and histopathological co-relation of adnexal mass. Adnexal mass lesions are fairly common among women (with a prevalence of 0.17% to 5.9% in asymptomatic women and 7.1% to 12% in symptomatic women) of all age group but very common among reproductive age. Differential diagnosis of adnexal mass is difficult and complex. Recognition of the severity of the problem, appropriate and timely evaluation and treatment with good outcome is the goal.Methods: Prospective, observational study of 50 patients with suspected various adnexal masses were conducted for a period of 1.5yr i.e. from November 2014 to May 2016. All patients underwent pelvic and ultrasonography examination. All patients later underwent surgery. Results were correlated later.Results: The patient ages ranged from 19 to 58 with a mean age of 31.5. Most common site of origin of adnexal masses is the Ovary (Rt. 38% and Lt. 34%) Most common adnexal masses on histopathological diagnosis are mucinous cyst adenoma (20%), Benign and mature cystic teratoma (16% and 6%) and serous cyst adenoma (10%). About 92% patients with adnexal mass presents with abdominal pain as a chief complaint.Conclusions: Although bimanual palpation of the adnexal masses may not allow a very specific diagnosis, clinically useful information can usually be obtained and hence it is particularly useful as a first step in assessment of adnexal masses and as an adjunct to morphological assessment of ovarian lesions. Ultrasonography is an important noninvasive investigation and is helpful in diagnosing most of these cases, but the histopathological examination of specimen obtained from laparotomy of adnexal mass is the gold standard for confirming the diagnosis

Double outlet of right ventricle: imaging spectrum on multi-slice computed tomography

Background: Multi-slice computed tomography (MSCT) is the main stay of pre-operative assessment of many complex congenital heart diseases (CHD) in current clinical practice, one of them is double outlet of right ventricle (DORV). DORV is one of the conotruncal anomalies that encompasses a wide spectrum of anatomic malformations in which both the aorta and pulmonary arterial trunk arise entirely or predominantly from the morphologically right ventricle (RV). Purpose of this article is to understand spectrum of DORV and associated types of ventricular septal defect (VSD) on MSCT imaging with special emphasis of usefulness of 3-D volume rendered (VR) images in pre surgical evaluation.Methods: A total of 500 paediatric patients (<18 years old), who had undergone MSCT were studied during the period 2014 to 2019 at the tertiary cardiac care centre.Results: 500 patients having primary/suspicious diagnosis of DORV on echocardiography during the said period were enrolled in the study. All the patients who underwent MSCT scan, were studied in detail for: DORV spectrum, associated types of VSD and its relationship to the semilunar valves. Out of 500 total subjects, subaortic VSD was the most common type of VSD observed (53%), followed by subpulmonic VSD (22%), non-committed VSD (18%) and doubly committed VSD (7%). Associations of pulmonary stenosis, subaortic stenosis and aortic co-arctation with various types of VSDs were addressed. Associated other anomalies were also analysed.Conclusions: Advances in MSCT technology has revolutionized pre-surgical diagnosis, management approach and post-operative follow-up of DORV patients. Excellent image qualities along with 3D volume rendered images help surgeon understand complex morphology of DORV variants and associated types of VSD. Significant reduction in intra and post-operative mortality in DORV patients in current era is result of MSCT technology