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The placenta being a foetal organ, undergoes the same stress and strain to which the foetus is exposed. Common yet life threatening complications of Pregnancy like Gestational Diabetes, Hypertension, Anaemia and Intra uterine growth retardation result in both macroscopic as well as microscopic changes in the placenta. Hence study of the placenta will give a valuable insight in cases of adverse foetal outcome. The present study was conducted on a total of two hundred and ninety two freshly delivered placentae with umbilical cord obtained from the labour rooms and operation theatres of the Department of Obstetrics & Gynaecology and received at the Department Of Anatomy, PMCH, Patna, Bihar. Exclusion criteria was multiple pregnancy. Inclusion criteria's were normal uncomplicated primigravida and multigravida and pathological factors complicating pregnancy like Anaemia, Gestational Diabetes mellitus, Pregnancy induced Hypertension and prematurity. The 292 placentae were divided into four categories according to the risk factors and clinical diagnosis of pregnant women namely normal patients (147), patients with Pregnancy induced hypertension (15), Gestational Diabetes mellitus (30), anaemia (65) and preterm (35). The circular type of placenta is the common shape of placenta. The diameter of the placenta is increased in anaemia, gestational diabetes and decreased in prematurity. The weight of the placenta is increased in gestational diabetes mellitus, anaemia and decreased in prematurity. The number of maternal cotyledons is decreased in prematurity and increased in gestational diabetes mellitus. The eccentric type of cord attachment is the most common type in complicated pregnancies. The diagnosis of such risk factors in pregnancies during antenatal period and early intervention will improve the perinatal outcome.

Background: Exposure to inhaled allergens in patients with allergic rhinitis results in IgE mediated hypersensitivity of nasal mucosa. The mainstay of management is allergen identification and avoidance, pharmacotherapy with antihistamines, corticosteroids and nasal douching and immunotherapy. Patients refractory to medical management can be offered surgical interventions aimed at providing symptom relief. The objective of this review is to evaluate the effectiveness of surgical intervention on functional and symptomatic outcomes in patients with allergic rhinitis that have failed medical management. Methods: Prospective and retrospective studies that assess the effectiveness of intranasal surgery to include inferior turbinate surgery, posterior nerve resection, vidian neurectomy, septoplasty and endoscopic sinus surgery (ESS) in patients that have failed medical treatment for proven allergic rhinitis. Medline, Web of Science and Embase will be searched for studies published in English from 1990. Two authors will independently screen the search results and assess the full text of potentially relevant studies. Studies that meet the inclusion criteria will be critically appraised and the data will be extracted and synthesised by two authors. Ethics and Dissemination: Ethical approval was not required for this study as secondary data will be collected. The results will be disseminated through peer-reviewed medical journal. Systematic Review Registration: This protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020223773). Highlights: Allergic rhinitis (AR) is a chronic immune-mediated inflammatory nasal condition with hallmark symptoms of sneezing, nasal obstruction, mucus discharge and anosmia in adverse cases. A plethora of interventions are at the hands of otolaryngologists in order to relieve symptoms of AR, however literature is yet to determine which method is best for patient outcome and quality of life. The primary objective of this study is to convey a systematic qualitative analysis of all the surgical interventions used in AR management.

Background: Knowledge of the normal and variant arterial anatomy of the upper extremity is of signicant clinical importance for the vascular radiologist and surgeons for accurate diagnostic interpretation as well as in the conduct of interventional and surgical procedures on the upper extremity. The anatomical knowledge of the anomalous branching pattern of the brachial artery is important during percutaneous arterial catheterization, so as to prevent any complications arising from accidental damage to the anomalous vessel and knowledge of the variations are important for plastic surgeons using aps for reconstructive surgeries. Methods: The present study was undertaken on 50 upper limbs of both sexes from embalmed adult human cadaver in department of Anatomy, Patna Medical College, Patna, Bihar. Results: In the present study, normal brachial artery was found in 42 specimens accounting for 84%. Variations were found in 8 specimens (16%); of these ve specimens presented with trifurcation of brachial artery into radial, ulnar and radial recurrent arteries (10%); one specimen presented with double profunda brachii artery (2%); one specimen showed high origin of radial artery (2%) and one specimen presented with high division of brachial artery in the proximal third of arm (2%). Conclusions: Accurate anatomical knowledge about the brachial artery and its branching pattern with their variations are important for physicians, cardiologists, vascular surgeons and interventional radiologists. Study of these variations and its awareness helps in avoiding the iatrogenic injuries of the blood vessels, in the management of accidental/traumatic injuries to arteries in upper limb and during diagnostic procedures (like arteriograms).

Background The Global Influenza Hospital Surveillance Network (GIHSN) aims to determine the burden of severe influenza disease and Influenza Vaccine Effectiveness (IVE). This is a prospective, active surveillance and hospital-based epidemiological study to collect epidemiological data in the GIHSN. In the 2016–2017 influenza season, 15 sites in 14 countries participated in the GIHSN, although the analyses could not be performed in 2 sites. A common core protocol was used in order to make results comparable. Here we present the results of the GIHSN 2016–2017 influenza season. Methods A RT-PCR test was performed to all patients that accomplished the requirements detailed on a common core protocol. Patients admitted were included in the study after signing the informed consent, if they were residents, not institutionalised, not discharged in the previous 30 days from other hospitalisation with symptoms onset within the 7 days prior to admission. Patients 5 years old or more must also complied the Influenza-Like Illness definition. A test negative-design was implemented to perform IVE analysis. IVE was estimated using a logistic regression model, with the formula IVE = (1-aOR) × 100, where aOR is the adjusted Odds Ratio comparing cases and controls. Results Among 21,967 screened patients, 10,140 (46.16%) were included, as they accomplished the inclusion criteria, and tested, and therefore 11,827 (53.84%) patients were excluded. Around 60% of all patients included with laboratory results were recruited at 3 sites. The predominant strain was A(H3N2), detected in 63.6% of the cases (1840 patients), followed by B/Victoria, in 21.3% of the cases (618 patients). There were 2895 influenza positive patients (28.6% of the included patients). A(H1N1)pdm09 strain was mainly found in Mexico. IVE could only be performed in 6 sites separately. Overall IVE was 27.24 (95% CI 15.62–37.27. Vaccination seemed to confer better protection against influenza B and in people 2–4 years, or 85 years old or older. The aOR for hospitalized and testing positive for influenza was 3.02 (95% CI 1.59–5.76) comparing pregnant with non-pregnant women. Conclusions Vaccination prevented around 1 in 4 hospitalisations with influenza. Sparse numbers didn’t allow estimating IVE in all sites separately. Pregnancy was found a risk factor for influenza, having 3 times more risk of being admitted with influenza for pregnant women. Electronic supplementary material The online version of this article (10.1186/s12889-019-6713-5) contains supplementary material, which is available to authorized users.

Background: Chronic suppurative otitis media (CSOM) is a significant cause of hearing loss in remote Aboriginal communities of Australia. Myringoplasty aims to prevent otorrhoea and improve hearing loss associated with CSOM by closing tympanic membrane perforations. This study aims to review myringoplasty outcomes for Indigenous Australians in the West Kimberley region. Methods: Retrospective chart review of clinical, operative, and audiometric data at Broome and Derby hospitals from 2004 to 2014 found 419 myringoplasty operations were performed on 327 patients. The primary outcome “success” was defined as closure of the perforation with an air-bone gap of less than 25 dB at 6 months or greater post-surgery. Results: Of the 419 ears undergoing myringoplasty, only 90 (21.5%) had complete follow-up. Simple closure was seen in 39% of ears with complete follow-up, with higher rates seen in female patients, small to medium perforations, and ears with normal pre-operative hearing. Closure of the tympanic membrane with normal hearing was seen in 29% of ears with complete follow-up, with higher success rates seen in those with dry ears pre-operatively. Conclusions: Follow-up and outcomes for myringoplasty remain poor for Indigenous people in the West Kimberley region. Standardised prospective data recording and integration will minimise data attrition. Patient attrition will remain a challenge requiring ongoing investment and education. Improvements in ear and hearing outcome are more likely to arise from health care system improvements over patient selection and operative technique.