Cervical cytological abnormalities and human papilloma virus infection in women infected with HIV in Southern India.

AIM: The aim of this study was to examine the association between CD4 count, human papilloma virus (HPV) infection, and the risk of cervical intraepithelial neoplasia among HIV-infected women. METHODS: A cross-sectional study was conducted among 104 HIV-infected women attending an antiretroviral therapy clinic. They underwent Pap smear and cervical HPV DNA testing. RESULTS: The overall prevalence of HPV infection was 57.7%. HPV 16 was the commonest genotype found (38.5%); HPV 16 and 18 put together contributed to 73.3% of HPV infection; 27.5% of HIV-infected women had squamous cell abnormalities. Cervical intraepithelial neoplasia was less likely among women with CD4 count > 500/mm3 (12%) and in those without opportunistic infections (17.8%). The prevalence of high-risk HPV infection was higher in women with high-grade squamous intraepithelial lesions or greater lesions (85.7%) as compared to women with normal cytology (52.1%). CONCLUSION: The high prevalence of HPV infection and cervical intraepithelial neoplasia in HIV-infected women warrants the need for regular Pap smear screening in these women and routine HPV vaccination for adolescents to reduce the burden of cervical cancer in India.

Recombinant activated factor VII in the management of acute fatty liver of pregnancy: A case report.

A 20-year-old woman, primigravida at 36(+4) weeks' gestation presented with malaise, vomiting for 1 week, yellowish discoloration of the eyes for 3 days and loss of fetal movements. A clinical diagnosis of acute fatty liver with intrauterine fetal demise was made. Labor was induced with prostaglandin E2 gel and delivered vaginally. The post-partum period was complicated by atonic post-partum hemorrhage, an episode of seizure, recurrent hypoglycemic attack, hypokalemia and continuing coagulopathy. Supportive management in the intensive care unit using blood and blood products and injection recombinant activated factor VIIa to arrest the bleeding resulted in a successful outcome.

IV Ferric Carboxymaltose Vs Oral Iron in the Treatment of Post-partum Iron Deficiency Anaemia.

INTRODUCTION: Iron deficiency is the most common cause of Post-partum anaemia, reported as 50-60% in India. It is primarily due to inadequate iron intake and due to peripartum blood loss. It has been associated with significant post-partum complications. Therefore, Post-partum iron deficiency warrants greater attention and higher quality care. Oral iron treatment has been considered the standard of care. However, parenteral iron treatment is expected to be advantageous in cases where oral iron therapy is not possible. As a result, there is increased interest in parenteral iron therapy. Recently, a new parenteral iron preparation, Ferric Carboxy Maltose (FCM), was developed to facilitate effective treatment of Iron Deficiency Anaemia (IDA). This study was carried out in women with Post-partum IDA who were expected to benefit from the short treatment period permitted by the larger doses given parenterally. AIM: To evaluate the efficacy, safety and tolerability of intra venous FCM compared to oral iron in treating Post-partum IDA patients. MATERIALS AND METHODS: This was a hospital based prospective comparative study. Women with Haemoglobin (Hb) between 7-10 g/dl and peripheral smear showing microcytic hypochromic anaemia on the first Post-partum day were included in the study. These women were randomised to receive either IV FCM (single dose 1000 mg) or oral ferrous ascorbate (100 mg twice daily for 6 weeks). Statistical analysis was done by student's paired and unpaired t-test and by chi- square test and fischer-exact t-test. RESULTS: Ninety patients (45 in each group) were followed at one week and six weeks from the start of treatment and their Hb were estimated. Significant rise in Hb was observed in subjects treated with FCM compared to oral iron. FCM treated subjects were more likely to achieve an Hb rise greater than or equal to 3.0 g/dL. FCM was better tolerated with complete adherence to treatment as compared to oral ferrous ascorbate. CONCLUSION: FCM showed robust evidence of efficacy, tolerability and safety in comparison to oral iron. Collectively, these data support the clinical utility of FCM in treating Post-partum IDA patients.

Is elective induction safe? A prospective analysis.

OBJECTIVES: To identify whether electively induced labor places the mother or her fetus at an increased risk as compared to her spontaneous labor cohort. To quantify the risk of cesarean section in the induced group. METHODS: A prospective analysis comparing 200 electively induced parturients with 200 matched controls who labored spontaneously, in 1 year from April 2007 to April 2008. The parturients were between 37 and 41 weeks of gestation and had no complications necessitating induction. RESULTS: Induction per se was not associated with a statistically significant increase in cesarean section rates. Only when associated with nulliparity, low bishop score, and birth weight >3.5 kg, the risk of cesarean increases. CONCLUSION: Elective induction does not appear to pose an increased risk to the mother or her fetus in a carefully selected patient population. However, when associated with risk factors the cesarean rate increases. Hence informed consent should be taken before induction.