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The present study was a prospective observational study done to evaluate elective induction of labour (e-IOL)* in overdate pregnancies (40 1/7 to 40 6/7 weeks) versus expectant management (EM)* up to 41 weeks. The primary objective was to compare rates of Caesarean section among the two groups. Study design: Women at 40 weeks of gestation satisfying the inclusion and exclusion criteria were recruited for the study. Total sample size was 112. The e-IOL group 1, included 56 participants who were induced at 40 1/7 to 40 6/7 weeks of gestation and EM group 2 had 56 participants, who were given expectant management till 41 weeks of gestation. Group 2 was further divided as group 2a who went into spontaneous labour while on expectant management and group 2b as those who were induced while on expectant management for maternal / fetal reasons or ≥ 41 0/7 weeks of gestation.Expectant management till 41 weeks of gestation beyond the due date increased the likelihood of spontaneous labour without adversely affecting the perinatal outcome. 73.2% of participants went into spontaneous labour in the EM group and 78% of them delivered vaginally. Caesarean section rates were lesser with EM (37.5%) as compared to e-IOL (58.9%) in our study (p=0.002).Caesarean section rates were lesser among women with post date pregnancies when expectant management was followed as compared to elective induction of labour. No difference in perinatal outcomes was noted amongst the two groups. Participants who went into spontaneous labour when on expectant management were more likely to deliver vaginally.

Reproductive tract infections (RTIs) such as vaginal candidiasis and bacterial vaginosis (BV) are common among sexually active women and can be both symptomatic or asymptomatic. The microbiota of the reproductive tract triggers immune response at the cervicovaginal interface resulting in secretion of cytokines during the course of these RTIs. The objective of this study was to evaluate the cytokine profile in cervicovaginal lavage of women having asymptomatic vaginal infections. Measurement of vaginal cytokines was done for various interleukins including IL-1β, IL-6, IL-8, IL-10, IL-12/IL23p40, IL-17A, tumour necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) by ProcartaPlex™ Multiplex Immunoassay. Women having vaginal

Benign ovarian cysts comprise a majority of all ovarian masses presenting in women. Apart from functional cysts, dermoid cysts and benign cystadenomas are responsible for significant morbidity. Recurrent ovarian dermoid cysts are uncommon and attributed to incomplete surgical excision. Multiple benign cystadenomas, along with other large benign ovarian tumors arising from single ovary, are an extremely rare occurrence. We present a case with recurrent bilateral ovarian dermoids, co-occurring with multiple large benign cystadenomas from one ovary. This case was managed by laparoscopic surgery with successful enucleations and cystectomies. There are no such cases reported in the literature to the best of our knowledge. We also describe the various challenges in such surgery and implications of various surgical techniques.

Background: The global pandemic of the novel coronavirus disease 2019 (COVID-19) has created a public health emergency straining the entire human race. The population of antenatal and postnatal women is subjected to additional anxiety and psychological stress due to issues related to the pandemic like the public health measures, such as quarantine, and anxiety about the health of the fetus. Aim: To study the prevalence of depression and anxiety in antenatal and postnatal women during the COVID-19 pandemic. Materials and methods: We have screened 300 women in a COVID-19 care center for psychological depression and anxiety. The Edinburgh postpartum depression scale (EPDS) and also a self-reported questionnaire with COVID-specific anxiety questionnaire with eight items related to the COVID-9 pandemic were answered in graded response scale from 1 to 5. The clinical records identifying high-risk factors along with EPDS score and anxiety response were analyzed. EPDS greater than 13 was suggestive of probable depression. Anxiety questions were analyzed according to the percentage of questions that have been marked as ’much’ and ’very much' responses. Results: Among 300 women, the prevalence of depression was 43.3%. The anxiety question marked by 39% of women was about worries of the health of fetus graded as “very much” followed by that regarding the worries about delivery marked by 25.3% of women as very much. Conclusion: The increased psychological distress among pregnant women irrespective of COVID-19 status is significant. The preventive mental health strategies should be integrated with antenatal and postnatal care of women during the pandemic. © Jaypee Brothers Medical Publishers. 2021.

Background Survival of preterm infants has improved drastically. In addition to significant contribution to neonatal mortality, impact of prematurity among survivors may continue through life impairing long-term physical life through neuro-disability and increased risk of cerebral palsy. Maternal administration of magnesium sulfate prior to impending preterm birth is an effective strategy to reduce neuromorbidity. Aim To investigate the effectiveness of antenatal magnesium sulfate for neuroprotection in preterm infants between 26 and 34 weeks in preventing early neonatal morbidity and mortality. Secondary objective was to assess any adverse events with the use of magnesium sulfate on the mother and neonate. Method This was a prospective observational comparative study for 2 years at our tertiary care hospital of 100 pregnant women who gave preterm births. Fifty infants each were born to mothers who were either not given MgSO4 (Group 1) or given 4gm intravenous loading dose MgSO4 (Group 2), preferably 4 h prior to preterm birth. Results Among all the preterm in our study, 81% delivered between 30 and 34 weeks. There was no significant difference in terms of maternal mortality or serious morbidity including postpartum hemorrhage, caesarian section rates or length of hospital stay among women receiving MgSO4 versus no MgSO4. Mild maternal side effects secondary to magnesium sulfate were experienced in 8% cases. There were no significant differences between both groups for low 5 min APGAR, need for NICU admission, neonatal convulsions, hyperbilirubinemia, necrotizing enterocolitis, periventricular leukomalacia and septicemia. There was a trend toward reduced risk in the magnesium sulfate group for need for mechanical ventilation and ongoing respiratory support, intraventricular hemorrhage, neonatal hypotension, hypothermia, length of NICU stay. IVH was less frequent and less severe in babies exposed to antenatal MgSO4 (8%) as compared to non-MgSO4 group (16%). Neonatal morbidities were more when antenatal MgSO4 was given less than 4 h from delivery. Conclusion MgSO4 is a safe drug to use in antenatal women at risk for impending preterm. Antenatal magnesium sulfate given to women in established preterm labor conferred significant neuroprotective advantage to the neonate. MgSO4 also has protective effect on the need of invasive ventilatory support in preterm infants. Given the breadth of evidence in its favor, it is time for us to start using MgSO4 in clinical practice for neuroprotective intent in all our extreme preterm births.

PURPOSE OF THE STUDY: Chromosomal aneuploidies are major causes of perinatal death and childhood handicap. Awareness about screening and prenatal diagnosis for these disorders among obstetricians and primary care physicians is increasing. Since invasive tests like amniocentesis or chorionic villus sampling (CVS) are associated with a risk of miscarriage these tests should be carried out judiciously in pregnancies considered to be at high risk for aneuploidies and other genetic disorders. The purpose of our study was to examine the patterns, trends and outcomes of the various screening procedures and invasive tests results. METHODOLOGY: Retrospective observational study done over a period of 3 years and one month including 433 pregnant women with high risk for genetic disorders undergoing invasive prenatal testing like chorionic villus sampling, amniocentesis or cordocentesis. Data were collected from our department records regarding the maternal age, indication for invasive testing, past obstetric history, family history of genetic syndromes, ultrasound findings in the current sonographic examination and the results of the tests done. Any immediate or late complications of the procedure if any were telephonically addressed. RESULTS: A total of 436 procedures on 433 patients (418 singleton,12 single fetus of twin, 3 both fetuses of twins) were done out of which 281 were amniocentesis(64.4%), 153 were chorionic villus sampling (35.1%) and 2 were cordocentesis(

BACKGROUND/PURPOSE OF THE STUDY: Foetal urinary tract dilation (UTD) abnormalities affect 1–5% of all pregnancies. However, exact incidence is difficult to estimate because of different terminologies used to define the condition and different grading systems to define its severity antenatally as well as postnatally worldwide. In order to overcome this problem, the new UTD classification system has been introduced in the year 2014 so as to have universal approach for diagnosis and management of UTD globally. Indian data about clinical utility of the UTD classification system and its role in prenatal prediction of severity of renal disease are lacking. The present study aims to investigate clinical utility of new UTD classification system in foetal UTD abnormalities and to evaluate the role of UTD classification system in antenatal prediction/prognostication of severity of UTD abnormalities. METHODS: We conducted a single-centre retrospective study between April 2014 and January 2017, which included 70 infants with antenatally diagnosed UTD delivered in our hospital and managed in our paediatric unit postnatally. Pre- and postnatal ultrasound findings were noted, and UTD-A and UTD-P classification were applied retrospectively in all cases as per criteria defined in the new UTD classification. Postnatal outcome in all cases was evaluated in terms of need for immediate postnatal urosurgical intervention, presence of persistent UTD pathology and severity of renal impairment in relation to their pre- and postnatal UTD A and P risk categories. RESULTS: None from UTD A1 risk group in the last prenatal scan showed significant postnatal UTD abnormality. In contrast to this, UTD A2–3 risk group in the last prenatal scan had persistent postnatal UTD pathology in 70% cases. All infants with abnormal postnatal UTD diagnosis were identified prenatally as UTD A2–3 (high risk). Nine infants (12.8%, n = 70) who needed urosurgical intervention postnatally were categorised as UTD A2–3 prenatally and UTD P3 postnatally. CONCLUSION: We found increased frequency of complications and urosurgical interventions in all infants with antenatal UTD A2–3 grades in the last prenatal scan in comparison with those with UTD A1 grades who showed complete resolution (100%) postnatally. Antenatal UTD classification may be useful in antenatal prediction and prognostication of postnatal severity, especially in high-risk cases (i.e. UTD A2–3).

To study the genome wide alterations in sperm DNA methylation in male partners of idiopathic recurrent pregnancy loss cases and note regions as potential diagnostic markers DESIGN: Case-Control study and methylome analysis of human sperm SUBJECTS: Control group consists of apparently healthy fertile men having fathered a child within the last 2 years (n = 39); and Case group consists of male partners of idiopathic recurrent pregnancy loss cases having two or more consecutive 1None MAIN OUTCOME MEASURES: Sperm DNA samples of controls and cases were selected for Whole Genome Bisulfite Sequencing analysis based on the previously set thresholds of global methylation levels and methylation levels of imprinted genes (KvDMR and ZAC). Whole Genome Bisulfite Sequencing of selected sperm genomic DNA was performed to identify differentially methylated CpG sites of idiopathic recurrent pregnancy loss cases compared to fertile controls. Pathway analysis of all the differentially methylated genes was done by DAVID functional annotation tool and Kyoto Encyclopedia of Genes and Genomes tool. Differentially methylated CpGs within genes relevant to embryo and placenta development were selected to further validate their methylation levels in study population by pyrosequencing.A total of 9497 differentially methylated CpGs with highest enrichment in intronic regions were obtained. 5352 differentially methylated regions and 2087 differentially methylated genes were noted. Signaling pathways involved in development were enriched upon pathway analysis. Select CpGs within genes PPARG, KCNQ1, SETD2 and MAP3K4 showed distinct hypomethylated sub-populations within idiopathic recurrent pregnancy loss study population.Our study highlights the altered methylation landscape of idiopathic recurrent pregnancy loss sperm and their possible implications in pathways of embryo and placental development. The CpG sites that are hypomethylated specifically in sperm of idiopathic recurrent pregnancy loss sub-population can be further assessed as predictive biomarkers.

Background: Non-immune hydrops (NIH) associated with bronchopulmonary sequestration (BPS) is quite rare with a 95% risk of intrauterine fetal death, without a fetal intervention. Case Presentation: We describe a case of an antenatally diagnosed extralobar BPS with severe NIH, who underwent fetal thoracentesis, but had worsening of NIH requiring an emergency cesarean section. Postnatally, the baby required skillful intensive care management and timely surgical management in the form of a sequestrectomy. Conclusion: We report the smallest neonate with antenatally diagnosed NIH complicating BPS treated successfully by early neonatal surgery.

STUDY QUESTION What is the sperm DNA methylation status of imprinted genes in male partners from couples experiencing recurrent pregnancy loss (RPL)? SUMMARY ANSWER Aberrations in sperm DNA methylation status of several imprinted genes, such as insulin like growth factor-2-H19 differentially methylated region (IGF2-H19 DMR), intergenic differentially methylated region (IG-DMR), mesoderm specific transcript (MEST), zinc finger protein which regulates apoptosis and cell cycle arrest (ZAC), DMR in intron 10 of KCNQ1 gene (KvDMR), paternally expressed gene 3 (PEG3) and paternally expressed gene 10 (PEG10), as well as decreased sperm global 5-methylcytosine (5mC) levels, are associated with RPL. WHAT IS KNOWN ALREADY RPL is defined as loss of two or more pregnancies, affecting 1–2% of couples of reproductive age. Although there are several maternal and paternal aetiological factors contributing to RPL, nearly 50% of the cases remain idiopathic. Thus, there is a need to identify putative paternal factors that could be contributing towards pregnancy loss in cases of idiopathic RPL. STUDY DESIGN, SIZE, DURATION In this case–control study, 112 couples undergoing RPL with no identifiable cause were recruited from September 2015 to May 2018. The control group comprised of 106 healthy proven fertile couples with no history of infertility or miscarriage. PARTICIPANTS/MATERIALS, SETTING, METHODS In this study, we investigated the paternal genetic and epigenetic factors that could be associated with RPL. We studied DNA methylation, by pyrosequencing, of selected imprinted genes implicated in embryo development, such as IGF2-H19 DMR, IG-DMR, MEST, ZAC, KvDMR, PEG3, PEG10 and small nuclear ribonucleoprotein polypeptide N (SNRPN) in sperm of men whose partners present RPL. Global DNA methylation in sperm was evaluated by studying 5mC content and long interspersed nuclear element 1 (LINE1) promoter methylation. We also studied polymorphisms by pyrosequencing in the IGF2-H19 DMR as well in the IGF2 promoter in both groups. MAIN RESULTS AND THE ROLE OF CHANCE In the RPL group, we found a significant decrease in the global sperm 5mC levels and significant decrease in DNA methylation at three CpG sites in LINE1 promoter. For IGF2-H19 DMR and IG-DMR, a significant decrease in sperm DNA methylation at specific CpG sites was observed in RPL group. For maternally imprinted genes like MEST, ZAC, KvDMR, PEG3 and PEG10 hypermethylation was noted. Polymorphism studies for IGF2-H19 DMR and IGF2 revealed significant differences in the genotypic frequencies in males. LIMITATIONS, REASONS FOR CAUTION In this study, we analysed the methylation levels of selected candidate imprinted genes implicated in embryo development. Detection of methylation changes occurring at the genome-wide level may reveal further candidate genes having a better distinction between the control and study groups. WIDER IMPLICATIONS OF THE FINDINGS Our study demonstrates that certain polymorphisms and aberrant sperm methylation status in imprinted genes are associated with RPL and could contribute to the aetiology of RPL. This study suggests that investigation of paternal genetic and epigenetic factors could be useful in identification of possible causes of idiopathic RPL. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Department of Science and Technology-Science and Engineering Research Board (EMR/2014/000145) and National Institute for Research in Reproductive Health intramural funds (RA/872/01-2020). All authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

The study was undertaken for comparing the colposcopy directed punch versus loop excision biopsy technique in order to get the most precised sample for study as well as comparing the complications associated with them. The prospective clinical study was conducted on 50 women of age group 20–80 years. Women who were found to have a Reid colposcopic index of high grade disease, low grade disease or invasive disease recognized as the patients needed biopsy. They were randomly divided into either the punch biopsy forceps group (PB group) or the round loop electrode group (LE group). The quality of tissue of the LE group was found significantly better than the tissue quality of PB group based on the size, site and tissue damaged measures. Both the groups were found to have the same cytology report as well as colposcopic diagnosis and histology reports. Mild degree of bleeding has been reported as a frequent complication in LEEP and punch biopsy. The VAS pain score associated in each procedure was found to be 2.4 and 2.8, respectively, in both groups with no significant difference. The present study has concluded that the quality of tissue from the LEEP biopsy electrode was better than the punch biopsy forceps with no difference in the pain score, and it could be suggested that use of the round loop electrode in CDB provides good quality tissue to evaluate the histology.

Prenatal Diagnosis (PND) forms an important part of primary preventive management for families having a child affected with primary immunodeficiency. Although individually sparse, collectively this group of genetic disorders represents a significant burden of disease. This paper discusses the prenatal services available for affected families at various centers across the country and the challenges and ethical considerations associated with genetic counseling. Mutation detection in the index case and analysis of chorionic villous sampling or amniocentesis remain the preferred procedures for PND and phenotypic analysis of cordocentesis sample is reserved for families with well-characterized index case seeking PND in the latter part of the second trimester of pregnancy. A total of 112 families were provided PND services in the last decade and the presence of an affected fetus was confirmed in 32 families. Post-test genetic counseling enabled the affected families to make an informed decision about the current pregnancy.

The aim of this prospective randomized controlled study was to compare the rate of wound healing of 1–5% second degree burns treated with wheat grass extract versus silver sulfadiazine cream in consecutive patients aged 1–60 years with scald, flame, contact, friction, or electric flash burns attending the Burns Out Patient Clinic and Casualty Department of Choithram Hospital and Research Centre, Indore, India, from November 2012 to November 2014. Sixty patients were randomized to receive either wheat grass extract or silver sulfadiazine. The primary outcome was completeness of wound healing at 2 weeks and secondary outcomes pain relief within 24 h, compliance of patient with allocated treatment, and incidence of wound infection. After the allocated treatment had been applied, the burns were dressed in the silver sulfadiazine group but kept open in the wheat grass group. Burn healing was assessed on alternate days until complete epithelization had been achieved. In the wheat grass extract group, complete healing had occurred in 3/30 study subjects by day 4, 1/30 by day 5, 3/30 by day 6, 10/30 by day 8, 8/30 by day 10, 1/30 by day 15, 1/30 by day 19, 2/30 by day 17, and one patient underwent SSG on day 4. In contrast, in the SSD group, 9/30 study subjects (30%) had achieved complete healing by day 12, 4/30 by day 13, 5/30 by day 14, 9/30 by day 15, and 1/30 by day 16. Thus, wound healing was achieved significantly faster (P = 0.0001), pain scores were significantly lower at the end of the first 24 h (P = 0.0001), and there was better compliance (P = 0.0001) in the wheat grass than in the silver sulfadiazine group. The wheat grass extract used in this study is cost-effective and achieves faster wound healing and pain relief than silver sulfadiazine in subjects with 1–5% burns. Further research on this promising approach to burns management is warranted.

To evaluate the combination of plasma activated endothelial microparticles (CD62e), serum Copeptin (CPP) and placental growth factor (PlGF) levels at 18-23 weeks of gestation for prediction of preeclampsia (PE) in primigravid women.This was a nested case-control study from a prospective cohort of 1115 primigravid women attending antenatal care clinic. Plasma levels of CD62e and serum Copeptin, PlGF levels were measured by flow cytometry and ELISA, respectively. Data were presented as median (Interquartile range) and biomarker levels were compared between patients and controls using Mann-Whitney Test. Using binary logistic regression, predictive potential of a combination of biomarkers for PE prediction was determined.Women who developed PE 41 (3.97%) showed significantly increased levels of plasma CD62e [799.33 (546.86-1249.29) versus 384.08 (245.03-576.00), p 0.0001], serum Copeptin [303.42 (226.01-484.18) versus 207.24 (169.73-276.46), p 0.0001] and reduced level of PlGF [238.38 (161.36-312.62) versus 947.21 (466.7-1428.56), p 0.0001] compared to controls at 18-23 weeks of gestation. None of the marker showed statistically significant alteration in levels in fetal growth restriction (FGR) group 68 (6.58%) compared to controls. Using binary logistic regression analysis, AUC, Sensitivity, specificity, PLR, NLR, PPV, and NPV of combination of CD62e, Copeptin and PlGF for prediction of PE at 18-23 weeks of gestation was 0.969, 92.3%, 90.3%, 9.73, 0.08, 79.17%, and 96.94%, respectively.At 18-23 weeks, Combination of CD62e microparticles, copeptin, and PlGF levels can effectively identify women at risk of developing PE later in gestation.

Preeclampsia is a pregnancy related condition identified by hypertension and either proteinuria or end-organ dysfunction after 20(th) week of gestation and complicates 2-8% pregnancies worldwide. Enigmatic pathophysiology and multi-system involvement hinder accurate identification and clinical management of patients. Inadequate trophoblast invasion and subsequent inflammatory response have been implicated in the onset of PE. In absence of effective treatment of preeclampsia except delivery, recent research has been focused on identification of specific and sensitive biomarkers for early prediction of PE. Several angiogenic, anti-angiogenic, inflammatory, biophysical (mean arterial pressure and uterine artery Doppler) biomarkers, alone and in combination, have been proposed for prediction but limited predictive values have hindered their use in clinical settings. Current review summarizes some of relatively new biomarkers such as corin, copeptin, microparticles and miRNA, the prognostic efficiency of which are either analyzed in associated disorders or recently discovered.

Background: Mastalgia and fibrocystic breast disease is common in women. Ormeloxifene (SEVISTA) is a weak oestrogen receptor (ER) agonist, a strong ER antagonist (SERA) and therefore a selective ER modulator (SERM) used in the treatment of the disease. Aim of study was to see the efficacy of ormeloxifene in women with pain in breast associated with or without fibrocystic breast disease. Methods: This was a randomized control trial of oral ormeloxifene 30 mg alternate day for 3 month in patients of 20 – 50 years old with breast pain and fibrocystic (without cancer). The pain was accessed by visual analogue scale and nodularity grade on a 5 – point. Results: Total 203 patients were completed the study. The mean age was 32.8 ± 8.35 years. The mean pain level was continuously decrease over 5 visit (5.8 to 0.86) and there was significant improvement was observed in the nodularity grades i.e. at beginning of treatment 1 and 2 nodularity were seen in 62 (30.5%) patients where as grades 3, 4 and 5 were seen in 141(69.5%) and at the end of six month it was 188 (92.6%) patients had grades 1 and 2 and only 15 (7.4%) had grade 3, 4 and 5 nodularity. Conclusion: SEVISTA (Ormeloxifene) showed significant efficacy for the treatment of mastalgia and fibrocystic breast disease.

Introduction Preeclampsia (PE) remains to be an enigmatic puzzle for clinicians and researchers perplexing them for decades. As delivery remains only choice of treatment, early prediction of PE will offer timely therapeutic invention and hence extensive research efforts have been put in identification of biomarkers which will facilitate early prediction of PE. Methods Serum levels of CPP, PlGF and plasma total annexin V MPs were assessed in women who subsequently developed PE (n = 33), IUGR (n = 81) and normal pregnancy outcome (n = 112) at 10–14 weeks of gestation. Comparison of biomarker levels between patients and control group was done using Mann Whitney test. Receiver operating curve (ROC) analysis and binary logistic regression analysis were used to evaluate predictive utility of combination of CPP, PlGF and total annexin V MPs for prediction of PE. Results Women who subsequently developed PE showed significantly elevated levels of total annexin V MPs [2766.04 (2086.88–3794) versus 1090.74 (631.91–2197.16)] and CPP [440.98 (365.12–488.92) versus 217.8 (171.13–308.98)] compared to controls. Serum PlGF levels were significantly reduced in women with PE 17.68 (12.66–22.32) compared to controls 105.22 (35.02–255.1). Using logistic regression analysis, the combination of CPP, PlGF and total annexin V MPs gave high predictive value with AUC of 0.970, 93.1% sensitivity, 90.7% specificity, 77.50% Positive predictive value, 98.10% Negative predictive value, 11.69 Positive likelihood ratio and 0.07 Negative likelihood ratio for PE prediction at 10–14 weeks. Conclusion The combination of serum markers and plasma microparticles can be used for 10–14 weeks prediction and discrimination of PE from other pregnancy complications.

Cholecystitis with cholelithiasis is a very common disease in clinical practice. Now a days it is treated by laparoscopic cholecystectomy very safely with minimal trauma, discomfort and short hospital stay. Rarely, it is complicated by post-operative chyle leakage in peritoneum. We present a case of spontaneous chylous ascitis after laparoscopic cholecystectomy. Probably idiopathic or caused by trauma of pneumoperitoneum, abnormal peritoneal reaction to various chemicals released during operative procedure and diathermy used during laparoscopic cholecystectomy. We discuss its review, clinical presentation, diagnosis, treatment and management of this case. Chyle leake is rare post-operative complication can be managed by simple conservative treatment.

Intrathoracic disease involving lungs and pleura encounteredfrequently and remains a challenging clinical problem.The definitive diagnosis of lung or pleural disease some timesremain unclear despite thoracocentesis, closed pleural biopsy,transthoracic needle aspiration or bronchoscopy. Recentadvances in endoscopic technique, video equipment anddevelopment of better instrumentation have contributed to theresurgence of thoracoscopy as a diagnostic and thoracoscopicmodality.

Background: The synchronised depolarization and repolarisation of the atria and ventricles is achieved by specialised cardiac cells that generate an electrical impulse and propagate it along the conducting system in the myocardial tissue, leading to rhythmic activity of the atria and ventricles. Abnormalities of these rhythms lead to foetal arrhythmia.Methods: A retrospective observational study was conducted in a tertiary care hospital over period of one year to study the course and perinatal outcome of women with foetal arrhythmias.Results: The confinement in the study period was N=4302, of which 207(4.81%) women had foetal congenital malformations. Among them 21(0.48%) women had foetal cardiovascular abnormalities and 6(0.14%) women had foetal arrhythmias. There were two cases of maternal primary Sjogrens syndrome: one with foetal 2nddegree atrioventricular (AV) heart block with 2:1 AV conduction and another with foetal 3rd degree or complete heart block. Others were a case of Atrial premature contractions with compensatory pause, a case of Supraventricular tachycardia, one case of sinus tachycardia with non-immune hydrops and a case of foetal bradyarrhythmia with regular ectopic beats in a case of complex congenital heart disease. The course of these pregnancies, treatment options and perinatal outcome was studied.Conclusions: Foetal echocardiography and Doppler are effective tools for detection and monitoring of foetal arrhythmias. Early and correct diagnoses of arrhythmias help in management of foetal arrhythmias and multidisciplinary team-based approach gives optimum treatment results.

Background: Pre-eclampsia is a vascular related disorder of pregnancy, Despite the increasing research efforts in the field, the etiology and pathogenesis of this disorder remain elusive, resulting in failure to develop specific screening, preventive and treatment strategies. Peripheral vasodilatation and angiogenesis are critical components of physiological adaptation in normal pregnancy. Women who have later developed preeclampsia had significant structural capillary density rarefaction early in the pregnancy before the onset of preeclampsia.Methods: Case control, comparative study was carried out at our institute. 30 pregnant participants were recruited in each group after satisfying the inclusion criteria. Data was collected by using dermatoscope (200X magnification). Statistical analysis was done by non-parametric test- Mann-Whitney test as blood pressure was not normally distributed among participants. Spearman’s correlation coefficient was used to make correlation between skin capillary densities and blood pressures.Results: On applying Mann-Whitney test, mean rank for systolic and diastolic blood pressure at 20 weeks for both groups were not significant statistically, mean rank for systolic and diastolic blood pressure between 28-36 weeks of gestation for both groups were significant statistically. After testing, skin capillary density came significantly less in hypertensive group as compare to normotensive pregnant participant of same gestational ages. Spearman’s correlation coefficient came negative for systolic and positive for diastolic blood pressure at 28-36 weeks of gestation.Conclusions: Authors conclude that estimating the skin capillary density provides a potentially useful clinical marker in the prediction of preeclampsia and dermatoscope is an especially attractive clinical tool.

Fetal gallstones are a rare ultrasonography finding. Authors came across a similar case of fetal gallstones detected in routine third trimester scan. Patient had Rh negative blood group which might be the cause of fetal gallstone in this case however in most cases, the cause is undefined. Case was confirmed to have gallstones in postnatal scan which eventually resolved spontaneously within 1 month. The presence of gallstones in the fetus does not alter the fetal prognosis or obstetrical management since complete resolution is seen in most of the cases in late third trimester or neonatal period which may be due to either spontaneous passage of gallstones during early neonatal period or dilution of cholesterol crystals with postnatal hydration.

Lenz-Majewski syndrome (LMS) is an extremely rare syndrome characterized by osteosclerosis, intellectual disability, characteristic facies and distinct craniofacial, dental, cutaneous and distal - limb anomalies. Recently, mutations in PTDSS1 gene have been identified as causative in six unrelated individuals. We report the seventh mutation proven case of LMS and provide a concise review of all known patients till date.

Congenital megalourethra is a rare urogenital malformation characterised by pathological elongation and dilatation of penile urethra. It is a form of functional obstructive uropathy which is associated with significant urological and sexual dysfunction secondary to hypoplasia or absence of corpora cavernosa and spongiosa. We report a case of megalourethra in one of the dichorionic diamniotic twin diagnosed prenatally in a young primigravida. Initial ultrasound report suggested two different diagnoses i.e. omphalocoele and gastroschisis. Later, diagnosis of congenital megalourethra was made on detailed ultrasound examination by our fetal medicine consultant. Postnatal gross and ultrasonographic examination confirmed the prenatal diagnosis. In the present case report, we have emphasized proper perineal anatomical ultrasound examination which revealed a megalourethra. Although this anomaly is not lethal in isolation, but it has worse prognosis in presence of other associated structural anomalies. This anomaly also raises the controversy regarding disclosure of sex of foetus in countries like India where sex disclosure is prohibited by law. As this condition typically affects male foetuses and significantly affects sexual function, it may be necessary to reveal fetal sex for appropriate counselling and prognostication to prospective parents. Ethical dilemma arises for practising clinicians while dealing with isolated forms of megalourethra whether to offer termination of pregnancy on the grounds of having significant impact on sexual life due to erectile dysfunction. Anorectal malformation is often associated with megalourethra, although suspected in the present case, can be difficult to identify antenatally prior to 20 weeks (the time limit up to which legal termination can be performed in India). These issues have been highlighted in the present report.

A very efficient and simple method is presented for the regioselective mononitration of coumarins, using chromium nitrate in acetic anhydride, in high yields at room temperature.

A case of caesarean scar ectopic pregnancy managed diagnosed early on transvaginal ultrasound and managed successfully by sequential approach of methotrexate and hysteroscopic removal preserving the woman’s fertility is discussed below. Ectopic pregnancy i.e. implantation of the blastocyst outside the endometrium of the uterine cavity occurs in 1.9% of reported pregnancies.

Introduction: Nodal metastases in cervical cancer have prognostic implications. Imaging is used as an adjunct to clinical staging for evaluation of nodal metastases. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has an advantage of superior resolution of its CT component and detecting nodal disease based on increased glycolytic activity rather than node size. But there are limited studies describing its limitations in early stage cervical cancers. Objective: We have done meta-analysis with an objective to evaluate the efficacy of FDG PET/CT and its current clinical role in early stage and operable cervical cancer. Materials and Methods: Studies in which FDG PET/CT was performed before surgery in patients with early stage cervical cancers were included for analysis. PET findings were confirmed with histopathological diagnosis rather than clinical follow-up. FDG PET/CT showed lower sensitivity and clinically unacceptable negative predictive value in detecting nodal metastases in early stage cervical cancer and therefore, can not replace surgicopathological staging. False negative results in presence of microscopic disease and sub-centimeter diseased nodes are still the area of concern for metabolic imaging. However, these studies are single institutional and performed in a small group of patients. There is enough available evidence of clinical utility of FDG PET/CT in locally advanced cervical cancer. But these results can not be extrapolated for early stage disease. Conclusion: The current data suggest that FDG PET/CT is suboptimal in nodal staging in early stage cervical cancer.

Microwave irradiation accelerates the bromination of 1, 4-quinones and coumarins with (i) bromine adsorbed on neutral alumina in “dry media” and (ii) with iodine monobromide in acetic acid as compared to the reactions run at room temperature. Bromination takes place selectively at active quinonoid position in 1,4-quinones and at α, β-double bond in coumarins.

1,4-Quinones and its derivatives have been alkylated by dimethyl sulfoxide in the presence of anhydrous copper(II) sulfate at the active quinonoid position selectively, in a facile single step reaction with good yields.

1,4-Quinones and its derivatives have been alkylated by dimethyl sulfoxide in the presence of anhydrous copper(II) sulfate at the active quinonoid position selectively, in a facile single step reaction with good yields.

Microwave irradiation accelerates the bromination of 1, 4-quinones and coumarins with (i) bromine adsorbed on neutral alumina in “dry media” and (ii) with iodine monobromide in acetic acid as compared to the reactions run at room temperature. Bromination takes place selectively at active quinonoid position in 1,4-quinones and at α, β-double bond in coumarins.

1,4-Naphthoquinones and its derivatives have been hydroxymethylated and alkoxylated in the quinone ring using,respectively, formalin or an alcohol, in the presence of K2CO3 or HgO by heating or microwave irradiation.

Female infertility can be categorised into those who fail to ovulate (anovulatory infertility) because of some defect at hypothalamic-pituitary-ovarian axis and those who are ovulatory (ovulatory infertility), but are infertile because of some lesion present in genital tract. The role of vaginal hormonal cytology, endometrial biopsy and endocrinological evaluation in the detection of ovulation and various ovulatory dysfunction was studied in 42 infertile female patients. On the basis of cytological findings, of the 42 patients, 14 were found to be ovulatory, 26 anovulatory (which include 5 cases of atrophic changes) and 2 inconsistent due to inflammatory changes. Endometrial biopsy showed evidence of ovulation in 15, anovulation in 27 cases. Hormonal evaluation indicated some sort of endocrinological disorders in 15 patients, which may underlie anovulatory infertility in these patients, while results were within normal range in the rest 27 patients. Results of vaginal cytology and endometrial biopsy showed correlation in respect to ovulation in 93.33% of the cases.

Background: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This is a comparative study of 121 patients, presented in outpatient and emergency department at the hospital, randomized double blind trial was done and divide into two groups (percutaneous needle aspiration and pigtail catheter drainage.) about which surgeon did not knew about the division it was marked by evaluator. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, reduction in abscess cavity size and total/near total resolution of abscess cavity. Results: The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.