Serum uric acid level in normal pregnant and preeclamptic ladies: a comparative study

Preeclampsia is a serious pregnancy complication characterized by hypertension, proteinuria with or without pathological edema. According to some studies, serum uric acid lacks sensitivity and specificity as a diagnostic tool whereas another group of the researchers indicated uricemia as a predictor of preeclampsia in pregnant ladies. The present study was designed to assess whether serum uric acid can be used as a biochemical indicator or not in preeclamptic patients. Pre-eclamptic patients admitted in Nepal Medical College Teaching Hospital from June 2012 to June 2013 were included in this study. Age matched normal healthy pregnant ladies served as control. The record of their blood pressure and serum uric acid level was evaluated. Results showed significantly high blood pressure [SBP 149.42±12.35 vs 109.00±7.93 mm Hg; DBP 96.85±8.32 vs 72.5±7.10 mm Hg], and serum uric acid level [6.27±1.37 vs 4.27±0.61 mg/dl] in pre-eclamptic patients compared to their healthy counterparts. Uric acid is a terminal metabolite of the degradation of nucleotides, which increases their blood levels in patients with preeclampsia increasing its synthesis by damage and death of trophoblastic cells and proliferation. Uricemia in preeclampsia likely results from reduced uric acid clearance from diminished glomerular filtration, increased tubular reabsorption and decreased secretion. Results of the present study indicated association of elevated serum uric acid level with preeclampsia which could be used as a biochemical indicator of preeclampsia in pregnant women.

Dermoid Cyst and its bizarre presentation

Dermoid cysts or mature cystic teratoma are the most common type of ovarian germ cell tumor usually occurring in the reproductive age group. They are commonly unilateral and 10-12 % can be bilateral. They are commonly multicystic and contain sebaceous fluid as well as tissue of three germ cell layers e.g. ectoderm (skin, hair, brain) mesoderm (muscle, fat ,teeth ,bone, and cartilage) and endoderm (mucious and ciliated epithelium).These teratomas usually arise from the gonads but has been found anywhere in the body. Their site, size and clinical presentations are extremely variable causing confusion with medical and surgical diseases, acute emergency due to rupture and torsion , bowel and bladder injuries, and pregnancy etc. The malignant teratoma occurs at 3-4% only among ovarian carcinoma. The malignant transformation in benign cysts is a rare occurrence with 1-2% cases and squamous cell carcinoma being the commonest. This review is undertaken to study the different presentations produced by these tumors.

Massive ascites in severe pre-eclampsia: a rare complication

We report a rare case of massive maternal ascites complicating severe pre- eclampsia toxaemia (PET) seen in April 2013. This complication developed in association with the rise of blood pressure of 160/110 mmHg or more, worsening of proteinuria and hyperuricaemia. The onset of massive ascites caused respiratory compromise to the patient, thus necessitating immediate termination of pregnancy.

Transthoracic echocardiography may be useful for preoperative cardiac evaluation of gynaecological patients undergoing routine surgery

Echocardiography has been an integral noninvasive tool for [preoperative] cardiac evaluation that provides with echocardiographic details which may also be useful to perioperative clinicians to tailor their anesthetic deliberation while dealing with preoperative patients. The objective of this study is preoperative evaluation of routine gynecological patients echocardiographically after being referred from respective internists or anesthesiologists. This was a prospective, nonrandomized study of elective 68 cases who underwent echocardiographic evaluation preoperatively from 15th July 2009 to 14th July 2012. The mean age of the patients was 52.1 +/- 10.3 years with the age range of 30-79 years. Valvular heart disease was the most common echocardiographic finding (129.4%) followed by left ventricular diastolic dysfunction, LVDD (48.5%) and left ventricular hypertrophy (22.1%). Systolic dysfunction was detected in 2.9% of patients and pulmonary arterial hypertension in 2.9% patients. Amongst patients referred after preoperative anaesthetic evaluation, patients had different cardiac lesions echocardiographically. Preoperative echocardiographic evaluation may provide important cardiac informations and values which might be employed by perioperative physicians to tailor their treatment.

Sonographic assessment of placental migration in second trimester low lying placenta

To assess the migration of low lying placenta diagnosed in the second trimester ultrasonogram (USG). All the women attending antenatal OPD clinic had undergone routine obstetric USG in the second trimester (14 weeks onwards). Those cases who had low lying placenta lower edge of placenta within 3.0 cms from the cervical internal os were included in the study. These cases were subjected to be followed up at 4 weekly interval to repeated serial ultrasonogram by Transabdominal and/or Transvaginal USG well through 3rd trimester of pregnancy or delivery which ever was earlier. Of the total 1229 second trimester USG, 312 (25.3%) women had low lying placenta in the second trimester. Follow up of this 312 cases indicated that in 288 (92.4%) cases it had migrated to upper segment by 3rd trimester. The migration of placenta was 92.4% and 68.0 % where the distance between the leading edge of placenta and cervical internal os was more than 2.0 cm or less than 2 cm respectively. Migration was not observed in women where the distance was less than 1.5 cm. Placental migration was 94.5% in anteriorly situated placenta and 90.2% in posteriorly situated placenta. The rate of placental migration was 95.1%, 77.7%, 55.5% in women who had previous normal delivery, previous caesarean delivery and prior history of dilatation and curettage (D & C) or manual removal of placenta (MRP), respectively. The prevalence of low lying placenta in 2nd trimester is 25.3%, which reduces to 7.3% at term. The rate of placental migration was over 90.0%. Factor like initial distance between the lower edge of the placental and cervical internal os. placental position and previous birth by caesarean section influence the placental migration.

Asymptomatic bacteriurea among pregnant women visiting Nepal Medical College Teaching Hospital, Kathmandu, Nepal

Urinary tract infection is the commonest bacterial infection in pregnancy. The overall incidence is 5.0-10.0% of all pregnancy. During pregnancy bacterial growth is favoured by increased urinary content of glucose, aminoacids and other nutrients. Other factors responsible for infection are basically related to hormonal effect and mechanical factors. Prolonged stasis of urine in urinary bladder favours growth of micro organism, relaxation of vesico-ureteric junction leads to reflux of urine from bladder to ureter and later up to renal pelvis and later can affect the renal parenchyma affecting the function of kidneys. In addition, some maternal defense mechanism are less effective during pregnancy. Bacteriuria either asymptomatic (5.0%) or symptomatic is common in pregnancy, if left untreated, asymptomatic bacteriuria will lead to acute pyelonephritis in 20.0-30.0%. This may result in abortion, premature delivery, low birth baby and even still birth. About 12.0% of antenatal admission are sepsis due to pyelonephritis. Keeping in mind that UTI in pregnancy leads to increase in maternal morbidity as well as neonatal morbidity and mortality. In this prospective study all asymptomatic consecutive antenatal women were included 200 from each trimester with total of 600 in number to see the incidence in different trimester, most prevalent organisms and it's sensitivity. They were followed up till delivery to see the incidence of asymptomatic bacteriurea in different trimester and its outcome in terms of type of delivery, baby weight, apgar score given at the time of birth and hospital admission for morbidity.

First case of congenital toxoplasmosis from Nepal

Reportedly, nearly half of the Nepalese are Toxoplasma seropositive. However, neither the prevalence of congenital toxoplasmosis (CT) nor the confirmed case to CT is reported from Nepal yet. In this case report, we report the first case of CT in a 53 days old full term male baby (weight: 2,600 grams) delivered by caesarean section. The baby had hepatosplenomegaly and optic nerve coloboma with large scar in the right eye. The TORCH panel test showed significantly high Toxoplasma IgM antibody level (5.77 OD Ratio) compared with IgM antibody level against other agents. The baby was diagnosed as a case of CT and treatment was started accordingly. The baby, however, did not improve with the treatment and died after six days. The immediate cause of death was cardiorespiratory failure with antecedent cause of liver failure, renal insufficiency with thrombocytopenia.

Still-birth--a tragic journey: a critical analysis

Despite improvement in antenatal and intrapartum care, late intrauterine fetal death at and after 28 weeks of gestation remains a persistent and challenging problem to the obstetricians. We undertook the retrospective review of the medical records of 89 women with singleton pregnancy who gave birth to still-born infants at or more than 28 weeks gestation during the period from April 1998 to April 2007 at Nepal Medical College Teaching Hospital to know the prevalence rate and devise preventive measures for still-born infants which accounts more than 50.0% of perinatal death in Nepal. Major malformations were present in 5 (5.6%) of 89 infants including three infants with neural tube abnormalities. Pre-eclampsia preceded the stillbirth and might have been an indirect cause of stillbirth in 16 (19.0%) of 84 women whose infants had normal formations. The cause of still birth in 68 non-pre-eclamptic women was unclear in 31 (45.6%) home breech delivery with head stuck in 11 (16.0%), abruptio placentae in 5 (7.3%), intrauterine fetal growth restriction in 10 (14.7%), infection in 6 (8.8%) and cord accidents in 5 (7.3%). The causes of still births were many and varied, with large population having no obvious cause, although autopsy was not done in any case in this study. Proper monitoring of women with preeclampsia and early diagnosis and prompt delivery for women with abruption placenta might be helpful in reducing the number of stillbirths. Great advocacy with community education on importance of community focused antenatal care and increasing institutional delivery with availability of emergency obstetric care is necessary to decrease the number of stillbirths and perinatal mortality in developing countries like Nepal.

Lung hypoplasia and patellar agenesis in Ehlers-Danlos syndrome

A 22-year-old male patient was admitted with severe cough associated with purulent expectoration, left-sided chest pain and breathlessness. There was a history of recurrent respiratory ailments since childhood. The patient appeared younger than his chronological age. His face and ears were both dysmorphic. Clinically, the patient was diagnosed with Ehlers-Danlos syndrome (EDS). Computed tomography of the thoracic region revealed hypoplasia of the left lung and hyperplasia of the right lung. Both the patellae were absent. However, ultrasonography of his abdomen, echocardiography and other routine blood and urine examination showed no gross abnormalities. Although other respiratory tract abnormalities with EDS are not uncommon, unilateral lung hypoplasia and patellar agenesis in EDS make this case unique.

Low-coherence enhanced backscattering and its applications

The phenomenon of enhanced backscattering (EBS) of light, also known as coherent backscattering, has been the object of intensive investigation in non-biological media over the last two decades. However, there have been only a few attempts to explore EBS for tissue characterization and diagnosis. We have recently made progress in the EBS measurements in tissue by taking advantage of low spatial coherence illumination, which has led us to the development of low-coherence enhanced backscattering (LEBS) as a technique to characterize living tissue. In this paper, we review the current state of research on LEBS. In particular, we show that LEBS spectroscopy enables detection of early microarchitectural changes in tissue associated with carcinogenesis prior to the development of histologically-detectable alterations as well as any other known markers of neoplasia. Thus, LEBS may offer insights into initial events in carcinogenesis.

Prevalence of anti HCV, HBsAg and HIV antibodies in high risk recipients of blood and blood products

Along with hepatitis B virus (HBV) and human immunodeficiency virus (HIV), Hepatitis C virus (HCV) is emerging as a major transfusion hazard. 22 cases of haemophilia (A 19, B 3) and 20 cases of thalassaemia (2 16, E(2) 4) constituted the study group. Patients tested for anti HCV (using third generation ELISA), HBsAg and antibodies to HIV I and II. Prevalence of anti HCV was 54.5% in haemophilics and 5% in thalassaemics. HBsAg was detected in 9.09% haemophilics and 5% thalassaemics. No anti HIV was detected in this cohort. Anti HCV seropositivity in haemophilics has increased compare to previous studies.

Eclampsia An Obstetric Disaster

Eclampsia has been graded as fatal and dreadful disease even before Christ and is the important cause ofmaternal and perinatal mortality in developed and developing countries. Severe morbidity associated witheclampsia include placental abruptio, cerebral haemorrhage, cortical blindness, renal failure, disseminatedintravascular coagulopathy, pulmonary oedema, psychosis and growth retardation and preterm or both.Present management of eclampsia aims to stop the convulsions, its recurrences, control of blood pressureand correct fluid and electrolyte balance and delivery of the baby. There have been great controversiesabout the best anticonvulsants to use. The randomised trials comparing magnesium sulphate with diazepamor phenytoin showed greater efficacy of magnesium sulphate in the control and prevention of recurrence offits. Perinatal mortality is also better with magnesium sulphate. Intramuscular injection is painful andlocal abscess formation at the site of injection is possible. Control of dose is better with intravenous routetherefore preferred. Magnesium sulphate should be continued for 24 hours after the delivery or after thelast fit. Antihypertensive drug therapy is now a routine practice in the management of pre-eclampsia andeclampsia. Methyl dopa, Lobetelol, Nefedipine are well tried in pregnancy and safe in pregnancy. However,hydralazine intravenous is good for quick and smooth control of blood pressure. Termination of pregnancyhas been an important part of the management of eclampsia. Studies have shown that maternal outcomesseems better with caesarean delivery compared to vaginal delivery. The caesarean section rate is high at26.3-80.4% in different studies. Recently maternal mortality and morbidity has been greatly improvedeven in developing countries by better control of fits by magnesium sulphate and caring them in intensivecare unit.Key Words: Eclampsia, Anticonvulsants, Antihypertensives, Delivery.

Crystal structure of pimolin, C26H20O8

C26H20O8, triclinic, P̅1̅ (No. 2), a = 9.002(2) Å, b = 9.140(2) Å, c = 14.501(3) Å, α = 104.90(3)°, β = 95.34(3)°, ϒ = 113.83(3)°, V = 1028.2Å3, Z = 2, Rgt(F) = 0.074, wRref(F2) = 0.250, T = 293 K.

EMERGENCY CONTRACEPTION - AN UPDATE

Abstract

Haematometra Following Evacuation of Retained Product of Conception

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EMERGENCY CONTRACEPTION- AN UPDATE

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