Feto-Maternal Outcome of Jaundice in Pregnancy in a Tertiary Care Hospital.

Acute viral hepatitis is the most common cause of jaundice in pregnancy. Amongst hepatitis E bears a deadly combination with pregnancy, leading to loss of very young lives. There is almost no data available in this aspect documenting prevalence, profile and effect of jaundice on outcome of pregnancy in Bangladesh. This observational study was done to determine and analyze the frequency, cause and outcome of jaundice in pregnancy among the admitted patients in the feto-maternal medicine wing of Bangabandhu Sheikh Mujib Medical University, for a 2 years period from August 2009 to July 2011. Management was done in collaboration with the hepatologists, hematologists and intensive care unit specialist. Outcome was noted in terms of the mode of delivery, maternal complications, need of blood transfusion and fresh frozen plasma and maternal end result. Fetal outcome was assessed by birth weight, Apgar score, neonatal admission, and perinatal mortality. Prevalence of jaundice was found 2.5% among all high risk and 1.3% among all obstetric admissions. Hepatitis E was the commonest cause and responsible for 80.4% cases of jaundice and next was cholestatic jaundice. Almost half of the patients (43.4%) faced complications like post partum haemorrhage (15.3%), hepatic encephalopathy (10.8%), ante partum hemorrhage (6.5%). Preterm delivery was noted in 71.1% cases. Out of 46 patients with jaundice four (4) mothers died due to hepatic encephalopathy in hepatitis E group. Regarding perinatal outcome 55.8% were of low birth weight, 35.3% had low Apgar score and perinatal mortality was 6.4%.

Dynamical behavior of solitons of the (2+1)-dimensional Konopelchenko Dubrovsky system.

Utilizing nonlinear evolution equations (NEEs) is common practice to establish the fundamental assumptions underlying natural phenomena. This paper examines the weakly dispersed non-linear waves in mathematical physics represented by the Konopelchenko-Dubrovsky (KD) equations. The [Formula: see text]-expansion method is used to analyze the model under consideration. Using symbolic computations, the [Formula: see text]-expansion method is used to produce solitary waves and soliton solutions to the [Formula: see text]-dimensional KD model in terms of trigonometric, hyperbolic, and rational functions. Mathematica simulations are displayed using two, three, and density plots to demonstrate the obtained solitary wave solutions' behavior. These proposed solutions have not been documented in the existing literature.

Pregnancy in sick sinus syndrome with pacemaker - two cases.

Sick sinus syndrome is a generalized abnormality of cardiac impulse formation that may be caused by extrinsic causes or by intrinsic disease of the sinus node making it unable to perform pace making function. It can be manifested for the first time in pregnancy. First case was diagnosed as sick sinus syndrome at 8 weeks of gestation having Mobitz type I heart block (Wenckebach block), and needed temporary pacemaker during caesarean section. Second case was diagnosed at 24 weeks of gestation having complete heart block and needed permanent pacemaker at 38 weeks of gestation due to exaggeration of the symptoms. Both the cases were dealt successfully by caesarean section under general anesthesia in close collaboration with cardiologists and anesthesiologists.

The tocolytic role of nifedipine in preventing preterm labour pain.

This study was undertaken to evaluate the efficacy of oral nifedipine to reduce labour pain in patient with preterm labour, to complete the doses of steroids in lung maturity and in utero transfer to the Neonatal Intensive Care Unit (NICU) and to evaluate the maternal adverse effects and neonatal outcome. Diagnosed cases of preterm labour (between 24 to 34 weeks gestation) were randomly selected. Among them 50 patients were given oral nifedipine (n=50) and 50 patients were observed with no treatment (n=50). There were no statistically significant differences in age, race, parity, preterm delivery risk factor between the groups. At first the labour pain were observed through Continuous CTG in first hour, then intermittent CTG. The patient in the Nifedipine group can prolong the pregnancy time 36.0±3.2 wks than 30.6±3.1 wks in the control group (p<0.05) with reduced neonatal complications and admission to NICU. Oral nifedipine in patients with preterm labour pain as Tocolytic therapy has significantly prolonged pregnancy with lesser neonatal problems and fewer maternal adverse effects.

Effect of maternal anemia on fetal outcome.

We assess the effect of maternal iron deficiency anemia (MIDA) on cord blood iron status, placental weight and fetal outcome [birth weight, APGAR (appearance, pulse, Grimace, activity, and respiration) scores and birth asphyxia]. We conducted a cross sectional analytic study on fifty hospitalized pregnant women and their neonates over a year in a teaching hospital in the capital city of Bangladesh. Serum and cord hemoglobin concentration [Hb] with ferritin values were determined immediately after delivery, placental weight, gestational age, birth weight, APGAR scores and birth asphyxia were recorded. It was observed that 36 percent of the pregnant women were anemic. Maternal [Hb] and serum ferritin showed a highly significant positive correlation (r=0.92; p<0.001) indicating that iron deficiency was the most dominant factor in the causation of anemia amongst them. The maternal [Hb] showed a significant correlation with placental weight (r=0.40; p<0.001), birth weight (r=0.35; p<0.001), APGAR score (r=0.52; p<0.001), gestational age (r=0.61; p<0.001) and birth asphyxia. Maternal serum ferritin also correlated positively with cord ferritin (r=0.94; p<0.001), placental weight (r=0.26; p<0.001) and birth weight (r=0.27; p<0.001). Iron deficiency anemia (IDA) during pregnancy had significant adverse affect on the foetal outcome.

Panhypopituitarism in an Adult Male and Hypogonadism as a First Clue.

Hypopituitarism is a rare entity with reported incidence, 4 per 100,000 and about 50% of such patients present with three to five pituitary hormone deficits. A slow onset of symptoms is typical. But, diversified presentations from absence of symptoms to vague clinical features to lethal effects leading to mortality are not uncommon in such disorder. In adults, in such cases symptoms of hypogonadism may be the first noticeable illness for reporting to physicians, but it is often under evaluated or even ignored. Here, we present a case of 40-year-old adult male with panhypopituitarism, who presented with loss of generalized body hair and loss of libido for about last five years but the problem was not evaluated adequately. Later, he developed lethargy, generalized weakness, weight loss and then the underneath cause detected was panhypopituitarism due to pituitary macro adenoma. So, suspicion and hormonal evaluation for hypogonadism would help in early detection and management of progressive hypopituitarism in symptomatic adult patients. Cases of panhypopituitarism need lifelong hormone replacement and follow-up and if pituitary adenoma is present, surgical removal by trans-sphenoidal approach is preferable.

Comparison of Placental Growth Factor Levels in Maternal Serum at Early Pregnancy between Normotensive Pregnant Women and Patients with Hypertensive Disorders in Pregnancy.

Hypertensive disorder of pregnancy is a major public health problem worldwide. Pre-eclampsia and its complications are frequent causes for maternal and perinatal mortality and morbidity, particularly in developing countries. In preeclampsia some angiogenic factors like PlGF (Placental growth factor), VEGF (Vascular endothelial growth factor) etc. are assumed to be low in maternal serum. This prospective cohort study was carried out including 134 pregnant women with early gestation (15-20wks) attending the Feto-Maternal Medicine OPD of Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, Bangladesh from January 2015 to April 2015. Maternal serum was taken for measurement of PlGF by ELISA technique and values were converted to Multiples of Median (MoM) for their specific gestational age. The subjects were regularly followed up till delivery by measuring blood pressure and testing urine for protein by heat coagulation method. Hypertension was diagnosed if blood pressure found to be more than or equal 140/90mm of Hg and preeclampsia was labeled when proteinuria associated with it. Patients' information was kept in a prepared data sheet. The mean age of the patients was 25.7±5.57 years, mean BMI was 22.42±3.23. The incidence of Hypertensive disorder was 6.72% among them Pregnancy Induced Hypertension (PIH) was 2.98% and Preeclampsia (PE) was 3.9%. The mean age of hypertensive patients was 30.6±5.16 years and BMI was 26.92±1.54. The mean value of PlGF in normotensive women was 1.17±0.67 MoM, PIH patients were 0.66±0.41 MoM and PE patients were 0.65±0.30MoM. The comparison of mean values between Normotensive with PIH (p value 0.023) and Normotensive with PE (p value 0.014) both were found significant. From the current study and also from previous studies we can summarize that the level of PlGF become reduced significantly in pregnant women who will later on develop Hypertensive disorders.

Molecular detection of Babesia microti in dogs and cat blood samples collected from Punjab (Pakistan).

Babesia microti (B. microti) is an intra erythrocytic protozoan that mainly infects red blood cells and causes babesiosis. Its frequent hosts are rodents, ticks and humans. Dog's blood samples (N = 150) were collected from three different districts in Punjab including Multan (N = 49), Islamabad/Rawalpindi (N = 49) and Lahore (N = 52) while 159 cat's blood samples were collected from Lahore (N = 159). Data on the epidemiological characters of all animals (including age, gender, breed, body temperature, deworming, vaccination, mucus membrane status, hydration status, presence of hematuria and tick infestation) was collected through questionnaire. Polymerase chain reaction (PCR) amplified a 238 base pair amplicon specific for 18S rRNA gene of B. microti in two (1.3%) dog and 21 (13.2%) cat blood samples. Amplified PCR products were confirmed by DNA sequencing and the four partial 18S rRNA gene sequences were submitted to the EMBL/GenBank. Among epidemiological factors, high body temperature (P < 0.05) and pale mucous membrane (P < 0.05) were the parameters associated with the presence of B. microti in infected dogs. Females were found to be more infected (P = 0.05) than males and incidence of B. microti infection was higher in cat samples collected during winter months (P = 0.0001) than in summer. In conclusion, we are reporting the prevalence of B. microti in blood samples of cats and dogs from Pakistan for the first time and recommending that this Protozoan parasite should be considered for screening in cats and dogs with compatible clinical signs.

Assessment of Postnatal Depression by Edinburgh Postnatal Depression Scale in a Tertiary Care Hospital of Bangladesh.

The objective of the study was to estimate the prevalence of post partum depression and its associated risk factors among the mothers in their immediate post natal period. This cross sectional study was carried out in the Department of Obstetrics & Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and a tertiary care centre in Dhaka, Bangladesh from July 2015 to December 2015. Total 145 post natal mothers were screened for postnatal depression from day 5-7 following caesarean section by the validated Bangla version of Edinburgh Postnatal Depression Scale. To find out the risk factors for depression baseline data included age, parity, socioeconomic conditions, educational level, and occupation, history of depression, social support, and marital support, gestational age at the time of delivery, weight and sex of the baby. Postpartum depression was noted among 12.4% cases. Maternal age, history of depression, lack of social support was found to be significantly associated with maternal depression. This small study reflected the facts that many of the postnatal mothers of our circumstances suffer from postpartum depression and needs medical attention. Screening of postpartum depression can be considered as a routine part of postpartum care.

Brain regional serotonin synthesis following adaptation to repeated restraint.

A single 2 h episode of restraint stress decreased food intake and growth rate of rats. These deficits were not observed after five restraint periods of 2 h a day, suggesting that adaptation occurred. An acute challenge with 2 h restraint increased 5-hydroxytryptamine (5-HT) synthesis rate in the cortex, hypothalamus, midbrain and hindbrain of previously unrestrained rats, but not those adapted to 5 days of 2 h daily restraint. Hippocampal and striatal 5-HT synthesis was not increased significantly by 2 h restraint in previously unrestrained rats but was increased and decreased, respectively, in rats exposed to five 2 h daily restraints, when they were restrained on the sixth day. The findings suggest an important role of 5-HT particularly in the hippocampus, in adaptation to stress.

Anopheles culicifacies Giles: a release-recapture experiment with cohorts of known age with implications for malaria epidemiology and genetical control in Pakistan.

A mark-release-recapture experiment with the progeny of wild collected Anopheles culicifacies was performed during the monsoon season of 1978 at the village of Khano-Harni, a malarious area situated in Lahore District, Punjab Province, Pakistan. The recapture rates of males and females released at breeding and resting sites were statistically comparable and totalled 8.0% for females and 5.9% for males collected resting in houses and cattle sheds. Mating occurred mostly on the night following the evening of release when the females were about two days old. Insemination rates for females released at resting and breeding sites were statistically comparable. The initial gonotrophic cycle required four days; subsequent cycles occurred at two-day intervals with re-feeding on the same night as oviposition. Constant daily survivorship estimated from the decline in recaptures per day was 0.568 for females and 0.676 for males. Female survivorship estimated by vertical age grading methods ranged from 0.472 to 0.820. Horizontal life tables were calculated from the decline in recaptures and from vertical age-grading techniques and indicated that female or male life expectancy at emergence was less than 2.5 days. Population size was calculated using the Lincoln Index, Jackson's positive and negative methods and Itô's modification of Jackson's positive method and averaged from 1045.5 to 1049.6 females and from 449.1 to 1323.7 males. The relationship of these results to malaria transmission and genetical control is discussed.

Inhibition of restraint-induced anorexia by injected tryptophan.

Tryptophan injected at doses of 50mg/kg did not alter 24 h cumulative food intake and growth rate in rats. A single episode of 2 h restraint stress decreased food intake and growth rate of saline and tryptophan injected rats. The decreases of both food intake and growth rate were smaller in tryptophan injected (food intake 23.9% p<0.05; growth rate 2.9% p<0.05) than saline injected (food intake 78.5% p<0.01; growth rate 6.1% p<0.01) rats suggesting that tryptophan administration inhibits restraint-induced anorexia. Following an acute challenge with 2h restraint increases of 5-hydroxytryptamine (5-HT; serotonin) and 5-hydroxyindoleacetic acid (5-HIAA) but not tryptophan were greater in tryptophan injected than saline injected rats. The findings imply that tryptophan-induced increases of brain 5-HT and 5-HIAA have little effect on functional serotoninergic activity under basal conditions but a facilitatory effect on functional response occurs in conditions of increased serotoninergic neuronal activity such as during stress.

Enhancement of hepatic tryptophan pyrrolase activity and decreases of open field locomotion following single and repeated administration of high doses of caffeine in rats.

In view of a possible role of kynurenine in caffeine-induced anxiety syndrome, the effects of single and repeated administration of caffeine on hepatic tryptophan (T)-pyrrolase activity are investigated. Single administration of caffeine at doses of 80 mg/kg decreased open field locomotion and increased hepatic T-pyrrolase activity. Locomotor stimulating effects of 80 mg/kg caffeine, monitored in the home cages of rats, were attenuated following daily administration of caffeine for 5 days. Open field locomotor activity of rats and its caffeine-induced decrement were also attenuated following 5 daily administrations of caffeine on the 6th day. Basal levels of hepatic T-pyrrolase activity increased after 5 daily administrations of caffeine on the 6th day. Acute administration of caffeine did not further elevate hepatic T-pyrrolase activity in 5 day caffeine injected rats. Drug adjuvants decreasing hepatic T-pyrrolase activity may prove valuable for extending the clinical utility of caffeine.

Intracranial lipomas with teratomatous elements.

We report two cases of patients with intracranial tumors that share features with lipomas and teratomas. Although rare reports of lipomas with "hypertrophic nerves" and "teratoid tumors" have been recorded, these two cases are unusual because they contain mature neuroectoderm (choroid plexus, peripheral nerve) and mesoderm (skeletal muscle). The findings are discussed and modern classification schemes are presented. We believe that the cases are examples of a transition between lipoma and teratoma.

Benign fibrous tumor of the tunica vaginalis testis. Report of a case with light, electron microscopic, and immunocytochemical study, and review of the literature.

Benign fibrous tumor of the tunica vaginalis testis is an uncommon lesion of unknown pathogenesis and histogenesis, frequently described as fibrous pseudotumor. We describe a case of a fibrous tumor of the tunica vaginalis testis studied with light, immunocytochemical, and electron microscopy in a 64-year-old man who also developed a metachronous renal cell carcinoma. To our knowledge, this is the first such case to be presented. We describe the cell of origin of this rare entity and its similarity to fibrous tumors of pleura and extrapleural sites, with a review of the English-language literature and emphasize that not all intrascrotal tumors are malignant.

Low-grade B-cell lymphoma of mucosa-associated lymphoid tissue arising in the kidney.

We describe a malignant lymphoma arising in the kidney that exhibited clinical and histologic features of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). Clinically, the neoplasm involved the kidney and one perirenal lymph node (stage IIE) and did not recur or disseminate following nephrectomy, lymphadenectomy, and local radiation therapy. Histologically, the neoplasm recapitulated the features of low-grade B-cell lymphomas of MALT at other sites. The neoplastic cells resembled centrocyte-like cells, some of which formed lymphoepithelial lesions with renal tubules, and reactive lymphoid follicles were scattered within the neoplasm. The neoplastic cells expressed monotypic cytoplasmic Ig kappa. Low-grade B-cell MALT lymphomas arising in the kidney are rare. Their occurrence further demonstrates the diversity of anatomical sites that may be involved by MALT lymphomas. In addition, this neoplasm also had histologic and cytologic features resembling those of monocytoid B-cell lymphoma, supporting the hypothesis that low-grade B-cell lymphomas of MALT and monocytoid B-cell lymphomas are closely related and may be two morphological manifestations of the same neoplasm.

The neurochemical profile of long term oral administration of moclobemide.

Moclobemide, a benzamide derivative, predominantly inhibits the A form of monoamine oxidase (MAO) and its MAO binding is reversible. Acute administration of moclobemide has been shown to induce an increase in brain levels of monoamines and a concomitant decrease in their respective metabolite. In the present study, the drug was administered to rats orally in drinking water at doses of 0.5-1.0 mg/day/rat of an average weight of 250 g for three weeks. This was equivalent to the recommended human dose of 150-300 mg/day. The drug administration did not alter food intake, growth rate and activity of rats. Brain levels of 5-hydroxytryptamine (5-HT) and dopamine (DA) increased. However, increases in 5-hydroxyindoleacetic acid (5-HIAA), dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) as reported in acute studies were not observed following chronic drug administration in the present study in addition, an increase in brain levels of tryptophan also occurred. Neurochemical profile of long-term moclobemide administration is explainable in terms of an inhibition of MAO activity, increased availability of 5-HT precursor tryptophan and decreased egress of monoamine metabolites.

Neurochemical and behavioural effects of long term intake of tea.

Tea consumption in many cases is the main source of caffeine intake in humans. In the present study neurochemical and behavioural effects of long-term tea intake are monitored in rats. Long-term tea administration did not alter plasma tryptophan (TRP) but significantly attenuated brain TRP and 5-hydroxytryptamine (5-HT, serotonin) levels. Brain 5-hydroxyindole acetic acid (5-HIAA) was comparable in both tea-treated and control rats. An increase in home cage activity was observed after one week in rats taking tea as sole source of liquid, whereas no change on the activity was observed in an open field. Caffeinism has been associated with depression. The decreases of brain monoamine metabolism observed in present study are discussed as lowering of mood observed in tea or coffee consumers.