Successful pregnancy outcome in grade IV lupus nephritis and secondary antiphospholipid antibody syndrome with recurrent pregnancy failures - challenging achievement of motherhood

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that occurs predominantly in women of childbearing age. The risk of complications and adverse fetal outcomes in pregnant women with lupus is high viz., increased risks of preterm birth, hypertensive diseases of pregnancy and lupus flares both during pregnancy and in the postpartum period. An additional association with Antiphospholipid antibody (APLA) syndrome is expected to multiply the pregnancy complications. Though improved understanding of the disease nature and greater number of therapeutic options in the treatment of SLE, made the medical community regard these patients with less trepidation, the risk of significant morbidity to both the mother and the fetus still exist. We report an interesting case of grade IV Lupus nephritis (LN) with secondary APLA syndrome and h/o recurrent pregnancy failures for twenty times but had a successful pregnancy and delivery in the 21st attempt though pregnancy was absolutely contraindicated in view of her medical illness. Many complications were encountered during her pregnancy which could be successfully tackled and a live male baby was delivered by Caesarean section

Wunderlich--Herlyn--Werner syndrome

A 25 year old married and nulliparous woman with regular menstrual cycles presented with dyspareunia, infertility, increasing dysmenorrhea and recent onset vulval swelling in the gynaec outpatient department at Bhaskar medical college & Bhaskar General Hospital, Moinabad, Telangana. Gynaecological examination, ultrasound, MRI & laparoscopy helped in the diagnosis of right hematometrocolpos with noncommunicating right hemivagina,uterus didelphys with absent right kidney and right ureter commonly named as Wunderlich--Herlyn--Werner syndrome or Obstructed Hemivagina with Ipsilateral Renal Agenesis(OHVIRA) syndrome. Left half of uterus, cervix , vagina along with left kidney and ureter were normal. Vaginal septal resection was done draining out the hematometrocolpos and patient’s symptoms were relieved. It also improved the chances for fertility. Wunderlich -Herlyn--Werner syndrome or Obstructed Hemivagina and ipsilateral renal agenesis (OHVIRA syndrome) is a rare mullerian anomaly.

A study of prevalence of Vitamin D deficiency among pregnant women and its impact on feto maternal outcome

Background: The aim of our study was to determine the prevalence of vitamin D among pregnant women and its impact on feto maternal outcome.Methods: An observational study was conducted among 80 pregnant women at PESIMSR, Kuppam over a period of one month from first September 2014 to 30th September 2014. Our primary outcome was to study prevalence of Vitamin D deficiency in pregnant women and secondary outcome to study maternal and fetal outcome in pregnant women with Vitamin D deficiency. The subjects participating in the study were requested to complete a questionnaire that covered socio-demographic data, religion, obstetric history, lifestyle, dietary habits and psychosocial factors. Reliable serum 25-hydroxyvitamin D (25(OH) D) level was measured using an enzyme immunoassay method in the extra nine ml blood sample. Data on date of delivery, baby sex, birth weight, length and gestational age (based on ultrasound or on the timing of the last menstrual period) were collected prospectively.Results: In the study period of the 80 women recruited, 3.8% were Christians, 78.8% were Hindus and 17.4% were Muslims. All women recruited for the study were >32 wks gestation. It was found that 53.8% had insufficient serum 25 (OH) D concentrations and 13.8% were deficient for vitamin D. The lowest 25(OH) D concentrations (insufficient levels) were found in those with only one-two hours of sun exposure (65.1%), and 54.5% had deficient levels. Highest concentrations (11.5%) were found in those with two-four hours of sun exposure. There were no significant associations between 25(OH) D concentrations and maternal outcome. The analysis showed a significant association between a deficient vitamin D status (45.5%) and low birth weight (<2.5Kg) compared to 15.4% who had normal vitamin D levels. An insufficient vitamin D status was also related to a lower birth weight, but the association was not statistically significant. Among babies born to study subjects 84.6% had a normal birth weight of 2.5-3.5 kg with normal maternal vitamin D levels, when compared to 36.4% with deficient maternal vitamin D levels. We did not find any significant association between Vitamin D levels and neonatal complications.Conclusions: In our pilot study we found that prevalence of vitamin D deficiency was very high. Our sample size was too small to comment on impact of vitamin D deficiency on fetomaternal outcome. Hence we stopped our study and considered universal supplementation to all pregnant women

STUDY OF SIGNIFICANCE OF PHASE MASK IMAGE IN ACUTE STROKE PATIENTS

Background: Phase images contains information regarding local susceptibility changes between the tissues, which can help measure the iron and other content which changes the local field. Typically, this information is ignored before looking at console. Susceptibility weighted imaging (SWI) is a magnetic resonance (MR) technique detects an early hemorrhagic transformation within the infarct to provide insight into cerebral hemodynamics following the stroke. Objective: Significance of “phase mask imaging in differentiation of hemorrhage and calcifications†in acute stroke patients. Methods: An observational non-interventional study carried out on 100 patients with stroke and headache symptoms. MRI Brain Stroke Profile with FLAIR, DWI, ADC, SWAN, and Phase mask sequences, done on 3T GE MRI scanner. Results: All patients underwent MRI study with SWI sequence. Of 183 cases, 33%(n=60) patients had microbleeds, 5%(n=10) patients had granulomas, 32%(n=58) patients had arterial thrombus with infarct, 11%(n=20) patients had falx calcifications, 11%(n=20) patients had intraparenchymal haemorrhage, and 8%(n=15) patients had infarcts with haemorrhagic transformation. The sensitivity of phase imaging in the detection of calcification was 90%. Conclusion: Phase mask imaging plays an important role to detect intracranial calcifications and chronic microbleeds. Phase mask imaging acts as a supplement tool in acute stroke patients, which guides further management

Analysis of spontaneously reported cutaneous adverse drug reactions in a tertiary care teaching hospital in South India

Background: Skin is the most common organ involved in adverse reactions due to drugs. With newer drugs released into market every year, there is changing pattern of the reported cutaneous adverse drug reactions (ADRs). In order to ensure safer use of medicines in patients, there is need for continuous monitoring of ADRs. This is a retrospective study to analyse spontaneously reported cutaneous ADRs.Methods: All the cutaneous ADRs reported between January 2017 and September 2018 were analysed for clinical patterns, suspected medications, causality, severity and preventability.Results: Of the 1035 reports received during the study period, 232 (22.41%) included cutaneous reactions. 113 (48.7%) were male and 119 (51.29%) were female. Maculopapular rash 70 (30.17%), pruritus 31 (13.36%), palmar plantar erythrodysesthesia 30 (12.93%), acne 19 (8.19%), urticaria 16 (6.89%) and fixed drug eruptions (FDE) 13 (5.6%) were the common clinical patterns. Antimicrobial agents followed by anticancer drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), hormones and related drugs, and antiepileptic drugs were the common suspected group of drugs. Causality assessment as done by WHO-UMC scale showed that 3 (1.29%) were certainly related, 174 (75%) were probably related and 55 (23.7%) were possibly related to the suspected medication.Conclusions: Cutaneous ADRs are most frequently reported ADRs in the present study. With newer drugs released into market, there is a need for continuous monitoring of use of drugs to promote safer use of medicines in patients

CLINICAL PROFILE, PRESCRIPTION PATTERNS, AND ADVERSE DRUG REACTIONS IN PATIENTS WITH VITILIGO: A PROSPECTIVE STUDY

Objectives: The objectives of the study were to assess clinical profile (age of onset, age of presentation, gender, site of involvement, severity (stage), type of vitiligo, triggering factors, and associated diseases), prescription patterns (monotherapy, combination therapy, oral, topical, and therapeutic categories of drugs prescribed) and to monitor and report adverse drug reactions (based on World Health Organization [WHO] causality assessment scale) in vitiligo patients. Methods: A hospital-based prospective observational study was carried out by evaluating and assessing the clinical profile and prescription patterns of 85 patients who attended dermatology venereology and leprosy (DVL) outpatient department at Sri Padmavathi Medical College for Women, SVIMS, Tirupati, over a period of 6 months from June 2019 to December 2019. Results: In our study, forty four (51.77%) patients were female, vitiligo vulgaris is the most common morphological type observed in twenty seven (31.76%) patients. 31–50 years was the predominant age group. The mean age of onset and presentation was 38.35 (standard deviation of 18.37) and 43.27 (standard deviation of 17.96) years, respectively. Forty-one (48.23%) patients were having Stage 1 vitiligo. Fifty (58.85%) patients were having vitiligo at more than 1 site. Twelve (14.11%) patients were having a positive family history of vitiligo. Thirty-seven (43.53%) patients had triggering factors. Associated diseases were found in thirty (35%) patients. Combination therapy was given to sixty one (71.77%) patients. Topical medications were given to fifty two (61.18%) patients. During the study, we did not have a single patient complaining of any adverse drug reaction. Conclusion: Longer the time after appearance of vitiligo, lesser the number of patients attending follow-up. If vitiligo is diagnosed at the earliest stage, more are the chances for complete repigmentation. Patients with a poor economic background are less bothered about their skin condition and are not using medications properly

Molecular marker-based characterization in candidate plus trees of Pongamia pinnata, a potential biodiesel legume

Molecular marker studies provide valid guidelines for collection, characterization and selective cultivation of elite Pongamia germplasm that can be exploited further for its improvement through breeding and marker assisted selection for improved characters and oil yield towards biodiesel production

Pigeonpea

Pigeonpea is one of the major grain legumes grown in the tropics and subtropics of the world that forms a significant component of the diet due to its high protein content. Most of the differences in potential and realized yields in pigeonpea have been attributed to several biotic and abiotic constraints; besides the low productivity potential of marginal lands, where this crop is commonly grown. Of the various constraints limiting pigeonpea production, insect pests cause substantial damages. Conventional breeding efforts in pigeonpea crop improvement have been successful in producing improved seed quality and reduction of crop maturity duration. Nevertheless, genetic improvement of pigeonpea has been restricted due to the nonavailability of better genetic resources and strong sexual barriers between the cultivated and wild species. The recent developments in plant genetic engineering have provided immense potential in overcoming some of these constraints, thereby, offering opportunities for its successful integration with conventional crop improvement strategies. This chapter describes the pigeonpea crop, various constraints to its productivity, recent developments in its breeding, and emerging transgenic innovations that could play a significant role in the improvement of pigeonpea crop. We also highlight the current status of pigeonpea transgenics and related biosafety and IPR issues for the successful application of this technology in the near future