Abstract 3088: The efficient utilization of paracrine support from established cell lines for breast/ovarian cancer model generation

Ex vivo cancer cell models provide the starting material for in-depth mechanistic studies of cancer. However, the clinical/histopathologic, biomarker, and genetic heterogeneity of breast cancer has not been well represented in the current breast cancer cell model collection. While published breast cancer model generation protocols have been helpful, their high failure rates indicate the urgent need to improve model derivation efficiency. Here, the Broad Cancer Cell Line Factory (CCLF) project presents a novel model derivation technology to generate breast and ovarian cancer organoids with a high success rate by leveraging the paracrine support from historical cancer cell lines.

We observed that most established breast cancer cell lines can grow in a simple basal media with 10% fetal bovine serum; We hypothesized that historical cell lines may secrete vital growth factors that support breast cancer cells' survival and growth. To test this, we randomly selected a pool of 20 breast cancer cell lines, collected its conditioned media (CM20) and incorporated the CM20 as a supplement into our empirical rich media matrix (HYBRID, 16 mixed media conditions) with a Matrigel culturing system. Three-dimensional (3D) structures formed at Day 14-21 in the CM20 supplementary conditions compared to conditions without CM20 and only organoids with the CM20 supplement could be propagated to passage 5 and beyond. We performed pan-cancer targeted sequencing to evaluate tumor content of these organoids at passage 5 with paired tumor tissues. In our first 10 attempts, 95% of organoid cultures were genomically verified as high purity tumor models, indicating the CM20 is essential to enrich breast cancer cell growth in an in vitro culturing setting.

We applied the CM20 to ovarian cancers and observed a similar success rate suggesting a tissue-specific supporting manner. We tested conditioned media collected from other historical cancer cell lines but the breast/ovarian cancer organoid growth effect was not recapitulated. Importantly, when testing the individual breast cancer cell lines from the pool of 20, we discovered one cell line to be supporting the effect. More biochemistry work is needed to dissect the possible factors secreted by the line and molecular mechanisms of cancer cell survivors but preliminary data suggests the secretion factors are most likely proteins.

We generated 27 breast/ovarian cancer cell models using this technology and RNAseq data shows the breast cancer organoids still express their expected molecular subtype markers. 22 breast/ovarian cancer organoids have been propagated long-term with 17(out of 22) deposited to ATCC. Overall, this method provides an efficient model generation rate for female cancers. We anticipate that this method will not only allow us to quickly increase breast cancer cell model diversity but shed light on a new direction for breast cancer dependencies

Citation Format: Rebecca Deasy, Xin Jin, Pierre Michel Jean Beltran, Adel Atari, Madison Liistro, Cheryl Thompson, Stefanie Avril, Julie Boerner, Payal Pradhan, Samuel Klempner, Keith Ligon, William Sellers, Steven Carr, Todd Golub, Yuen-Yi (Moony) Tseng. The efficient utilization of paracrine support from established cell lines for breast/ovarian cancer model generation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3088.

Problems and Prospects of IT in Healthcare in Russia: Modern Realities

The article deals with the problems and prospects of applying information technologies in healthcare in Russia. The general model of information technologies, problems and ways of dealing with the restrictions from Western IT companies are highlighted. In view of the digitalization of the healthcare system in our country, the article discusses the need to ensure the continuity and independence from external influence of information technology systems in its full cycle: from client terminals, communication systems, to data storage and processing servers. The most important factor that allows us to speak with confidence about the development of specialized IT solutions in the healthcare system of the Russian Federation is an effective state policy in ensuring the digitalization of the economy: national projects, government programs, changes in legislation, roadmaps for achieving key indicators.

Prevalence of methicillin-resistant Staphylococcus aureus in a tertiary hospital in Nepal

SETTING:

Patan Hospital, Lalitpur, Nepal.

OBJECTIVES:

To describe 1) the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and its antibiotic sensitivity pattern; 2) the demographic and clinical characteristics associated with MRSA infections; and 3) the treatment outcomes of in-patients with MRSA infection among patients with S. aureus infection between January 2018 and December 2020.

DESIGN:

This was a cross-sectional study using electronic and paper-based hospital records of patients with S. aureus infection.

RESULTS:

Of the 1,804 patients with S. aureus infection, 1,027 patients (57%, 95% CI 55–59) had MRSA. The MRSA were susceptible to vancomycin (100%), linezolid (96%), doxycycline (96%), chloramphenicol (86%) and cotrimoxazole (70%), and resistant to erythromycin (68%), clindamycin (56%), gentamycin (58%), ciprofloxacin (92%) and ofloxacin (91%). The prevalence of MRSA was higher in 2019, among out-patients, and in respiratory samples, and lower in blood samples. Of the 142 in-patients with MRSA, 93% had a successful clinical outcome (cured/improved).

CONCLUSION:

More than 50% of patients with S. aureus infection had MRSA that were resistant to commonly available antibiotics. This calls for strengthening surveil-lance and good infection control practices in this hospital.

Perception of Students on Online Assessment: A Descriptive Study among Medical Undergraduates at Basic Sciences

Background Assessment drives learning. Student assessment cannot be neglected in the long ongoing online learning during COVID-19 pandemic to motivate and assess students' learning. Hence Patan Academy of Health Sciences (PAHS) conducted online assessment to medical undergraduates amidst limitations. Objective To measure the perception of online assessment of students which will provide applicable insights for the further improvement. Method This is a single center, cross-sectional and descriptive study. A Google form containing a semi-structured questionnaire was sent to MBBS students of Basic Science at PAHS who attended online classes and online examination. The responses from close ended questions expressed in percentage and Chi-square test was used to find the association. Open ended questions were analyzed using Braun and Clarke's thematic analysis. Result Of 118 students that responded, 75% passed the online examination. A majority of students (73%) stated that online exam motivated them in learning process and it could be a good alternative during pandemic time. However the most of students (56%) were unsatisfied with the modality of online assessment and reasons that they mentioned were technical problems (89%), inadequate online proctoring (77%), insufficient examination time (58%), lack of orientation to exam, lack of computer skills. Technical problem was worse in rural areas. Conclusion Even though online assessment motivated students' learning during online classes, a large number of students were unsatisfied with assessment modality.

TRAF6-IRF5 kinetics, TRIF, and biophysical factors drive synergistic innate responses to particle-mediated MPLA-CpG co-presentation

Innate immune responses to pathogens are driven by co-presentation of multiple pathogen-associated molecular patterns (PAMPs). Combinations of PAMPs can trigger synergistic immune responses, but the underlying molecular mechanisms of synergy are poorly understood. Here, we used synthetic particulate carriers co-loaded with monophosphoryl lipid A (MPLA) and CpG as pathogen-like particles (PLPs) to dissect the signaling pathways responsible for dual adjuvant immune responses. PLP-based co-delivery of MPLA and CpG to GM-CSF-driven mouse bone marrow-derived antigen-presenting cells (BM-APCs) elicited synergistic interferon-β (IFN-β) and interleukin-12p70 (IL-12p70) responses, which were strongly influenced by the biophysical properties of PLPs. Mechanistically, we found that MyD88 and interferon regulatory factor 5 (IRF5) were necessary for IFN-β and IL-12p70 production, while TRIF signaling was required for the synergistic response. Both the kinetics and magnitude of downstream TRAF6 and IRF5 signaling drove the synergy. These results identify the key mechanisms of synergistic Toll-like receptor 4 (TLR4)-TLR9 co-signaling in mouse BM-APCs and underscore the critical role of signaling kinetics and biophysical properties on the integrated response to combination adjuvants.

Comparison of gustatory function between mucosal and squamous disease: a randomised controlled study

OBJECTIVE

The aim of this study was to evaluate and compare the gustatory function between patients with chronic mucosal and squamous diseases before and after the surgery.

METHOD

A total of 33 patients with mucosal diseases and 34 patients with squamous diseases were evaluated for gustatory function both in the pre-operative and post-operative periods. The taste scores were compared between the two groups.

RESULTS

The gustatory scores in the mucosal disease group were significantly better than the scores in the squamous disease group (p < 0.05). There was no significant correlation detected between the age of the patients or duration of the disease with the taste scores in any of the study groups.

CONCLUSION

The improvement in gustatory score was better in the chronic mucosal disease group than the squamous disease group. There was no significant correlation found between the age of the patients or duration of disease and the taste score in any of the study groups.

Basal cell carcinoma arising over lesion of discoid lupus erythematosus: a rare occurrence

Although the association of discoid lupus erythematosus (DLE) with squamous cell carcinoma has been described in the literature, coexistence with a basal cell carcinoma is very rare. The indolent and non-pruritic nature of the lesion cause it often to be diagnosed at the late stage of the disease. Long-standing photosensitivity and chronic inflammation later lead to scarring and hypopigmentation, which are considered as the risk factors for the malignant changes over DLE. Incisional biopsy is often performed from the erythematosus lesion which does not respond to medical treatment. Here we have reported a rare case of basal cell carcinoma of the skin developing in the background of long-standing DLE, which was successfully managed with cold knife local excision.

Developing tool and Measuring Integration Characteristics of Basic Science Curriculum to Improve Curriculum Integration

Background Integrated curriculum enhances students' learning and the retention of knowledge. At Patan Academy of Health Sciences, integrated organ system based curriculum is used with Problem Based Learning as the principle teaching learning method to foster students' learning. In addition, other approaches of integration were under taken such as integrated assessment; logical arrangement teaching learning methods (lectures and practicals); joint effort of faculty in curriculum planning and delivery; conducive environment to foster hidden curriculum. This study describes the perception of faculty and students on integration characteristics of Basic Science curriculum. Objective To measure the integration characteristics of Basic Science Curriculum. Method Tool was developed to measure integration characteristics of Basic Science Curriculum and ensure whether such planned integration has been achieved. Mixed method was used to measure the perception of the integration characteristics i) quantitatively by questionnaire survey to faculty and students ii) qualitatively by in-depth interview of students. Result Both faculty and students perceived that all the blocks in Basic Science was well integrated in the quantitative questionnaire survey. But, in the in-depth interview, students perceived integration of curriculum in organ system blocks were better integrated compared to Principle of Human Biology blocks where fundamentals of basic science disciplines were delivered. Students reflected that Problem Based Learning not only integrated Basic Science disciplines but also with clinical sciences and the social context. But, students perceived that Community Health Sciences curriculum was not so well integrated with Basic Science subjects. Conclusion Overall, this study showed that planned integration in Basic Science curriculum was successfully executed during curriculum implementation.

Relationship between Amniotic Fluid Index and Perinatal Outcome

Aims:  This study was done to evaluate the predictive value of low amniotic fluid index (AFI) of < 5 cm for adverse perinatal outcome in term of caesarean section for fetal distress, birth weight, meconium stained liquor and APGAR scores. Methods: This was a prospective study of 200 antenatal women booked at Nepal Medical College Teaching Hospital during the year 2013-2014 with gestational age between 34 and 41 weeks. Patients history and clinical examination were recorded and AFI was measured and the perinatal outcome was compared between two groups i.e AFI <5 cm and >5 cm. Results: The caesarean section (C/S) rate for fetal distress and low birth weight babies (<2.5 kg) was higher in patients with low AFI (p=0.048, 0.001 respectively). There was no significant difference in meconium staining, APGAR score at 5 minutes between the two groups (p=0.881, 0.884 respectively). Conclusions: Caesarean section for fetal distress and low birth weight babies was significantly associated with low amniotic fluid index. There was no significant difference in meconium staining liquor, APGAR score at 5 minutes between the two groups.  

Spinal Anaesthesia Failure among Women Undergoing Caesarean Section in Kirtipur Hospital

Aims: This study was done to find out the spinal anaesthesia failure rate necessitating the conversion to general anaesthesia and use of intraoperative supplemental analgesia. Methods: This was a retrospective study undertaken in Kirtipur hospital in 660 patients. Spinal anaesthesia (0.5% heavy bupivacaine 2.2 ml) was given to women who had undergone elective or emergency caesarean section from January 2009 to December 2013. Results: In this study spinal anaesthesia failure rate was 1.66% (n=11/660). Among them complete failed spinal anaesthesia rate was 0.75% (n=5/660) requiring conversion to general anaesthesia. Intraoperative supplemental analgesic and sedation like pethidine, ketamine or midazolam was required in 0.90% (n=6/660). Conclusions: The failure rate of spinal anaesthesia given for caesarean section was low (1.66%) and it was within the acceptable range.

Aerobic Bacteria in the Diaphragmatic Portion of Stethoscope of Medical Professionals of Tertiary Care Hospital

INTRODUCTION

Hospital environment is a reservoir of wide varieties of microorganisms which are frequently reported colonizing in medical equipment. Stethoscopes are essential tools and of universal use in the medical profession, which might be a source of spreading nosocomial infections. This research project was conducted with an aim to assess the presence of aerobic bacteria in the stethoscope of the medical doctors working at Patan Hospital and students of Patan Academy of Health Sciences.

METHODS

It is a cross sectional study based on structured questionnaire and sample assessment from the stethoscope of doctors and students of Patan Hospital and Patan Academy of Health Sciences. The stethescopes used by the doctors of five major departments of Patan Hospital and students of clinical years were included in this study.

RESULTS

Total of 99 stethoscope owned by different level of professionals (positions) and different departments were examined for bacterial contamination. Out of them, 36 were found to be considerably contaminated. Single strain of bacteria was grown from a single stethoscope. Among them 34 were Gram positive and remaining were Gram negative. Out of 34 gram postive bacteria, 29 were identified as Staphylococcus aureus, six were identified as Coagulase Negative Staphylococcus and remaining were Gram positive bacilli.

CONCLUSIONS

There is presence of aerobic bacteria in diaphragmatic portion of stethoscope of medical professional of which the gram positives were the commonest.

Profile of Caesarean Section in Kirtipur Hospital

Aims: This study was done to find out the incidence and outcome of caesarean sections done at Kirtipur Hospital. Methods: This was a retrospective study conducted from 1st January 2009 to 31st December 2013. Case files of 660 patients who underwent caesarean section for various indications were analyzed for incidence, indication of caesarean section, booking status, parity, and maternal and fetal outcomes. Results: Out of 1295 deliveries, 50.9% (n=660) had caesarean section. Most of the caesarean section was done for fetal distress (40.2%; n=265) and on account of previous history of caesarean section (13.5%; n=89). Majority of caesarean section (44.4%, n=293) was done in age group of 25-29 years. Among them, 65.9% (n=435) were nulliparous. There were 35.3% (n=563) booked cases. Emergency caesarean sections were performed in 62.4% (n=412) cases. Maternal morbidity was less (7.2%, n=48). Conclusions: The study showed high rate of caesarean section. The most common indication was fetal distress. Post-operative complications and fetal outcome were within acceptable range. DOI: http://dx.doi.org/10.3126/njog.v9i2.11763  

Role of Angiogenic Factors in Preeclampsia

Preeclampsia, the syndrome of hypertension, proteinuria, edema and hyperuricemia occurring during the last trimester of pregnancy remains one of the great mysteries. Recently gene expression profiling of placental tissue from healthy and preeclamptic women used to see which genes were up or down regulated in preeclamptic patients. Alterations in circulating angiogenic proteins correlated with disease severity, earlier onset of preeclampsia and birth of small for gestational age (SGA) fetus. These findings lend support to the hypothesis that circulating angiogenic proteins may have an important biological role in preeclampsia. DOI: http://dx.doi.org/10.3126/njog.v9i1.11194 NJOG 2014 Jan-Jun; 2(1):71-73

Prevalence of intestinal parasitic infections among public school children in a rural village of Kathmandu Valley

Intestinal parasitic infections (IPI) are one of the most prevalent infections in humans residing in developing countries and its burden is high among school aged children. This cross-sectional study was conducted to determine the prevalence of intestinal parasitic infection and types of intestinal parasites in rural public school children of Nepal. It included students from Nursery to Class X of a rural public school located in the northeast part of the Kathmandu Valley, Nepal. Among the 194 participating children, prevalence of intestinal parasitic infection was found as 23.7%; (28.2% for boys; 20.2% for girls). Amongst the infected children, single and mixed parasitic infection was detected in 43 (93.5%) and 3 (6.5%) children respectively. Among protozoan parasites, Giardia lamblia was the most common (58.6%) whereas Hymenolepis nana was the most common (21.7%) among the helminths. Statistically different prevalence of intestinal parasitic infection was observed among children aged above 10 years and children aged below 6 years as well as 6 to 10 years. Gender-wise, there was no statistical difference in prevalence of intestinal parasitic infection. This study suggests the need of health education program in schools along with regular screening of intestinal parasites and treatment for effective management of the intestinal parasites among school children in Nepal.

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

Abstract

EMERGENCY CONTRACEPTION- AN UPDATE

ABSTRACT