Sirenomelia- A rare congenital anomaly: Case report.

Sirenomelia is an extremely uncommon congenital deformity in which neonate has fused lower limbs associated with various visceral malformations including urogenital and gastrointestinal tract, pulmonary hypoplasia, and potter's facies. The prevalence is 0.8 to 1 per 100,000 newborns. About 300 cases were recorded till date. We describe a case of 31-year G4P1L1A2 with previous lower segment caesarean section with gestational age of 22 weeks 5 days with anomaly scan suggestive of single live intrauterine pregnancy of 21 weeks 5 days with bilateral renal agenesis with placenta previa and no demonstrable amniotic fluid pocket seen. Her pregnancy was uneventful without any medical disorder, drug history, and no congenital anomaly in the family. Termination of pregnancy done by emergency hysterotomy and delivered anomalous foetus with fused lower limb with absent toes, low set ears, absent left ear ostium, imperforate anus, and absent external genitalia. Sirenomelia is fatal congenital anomaly with unclear etiology. Early antenatal diagnosis and termination of pregnancy is the treatment.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Antenatal Women With Pre-eclampsia: A Case-Control Study.

Background Pre-eclampsia (PE) is a disorder characterized by hypertension that may occur in a pregnant woman who was normotensive earlier. One of the major factors responsible consists of the inflammatory system being activated with cytokines and chemokines. The normal range of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) varies from 1 to 3 and 90 to 210, respectively. Therefore, this study was conducted to compare PE patients with normotensive pregnant women in relation to their NLR as well as PLR. Methodology From January 1, 2021, to December 31, 2022, a case-control study was conducted in the department of obstetrics and gynecology at a tertiary care center. Based on the inclusion and exclusion criteria, a total of 140 antenatal women were included and divided into a case group consisting of 70 women with PE and a control group involving 70 normotensive pregnant women. A blood sample for complete blood count testing was collected to determine NLR and PLR. Results The mean NLR in the case group and control group was 3.52 ± 1.05 and 3.22 ± 0.88, respectively, with statistically significant results. Additionally, the PLR in the case group was 98.08 ± 18.27, and in the control group, it was 85.25 ± 12.36, having a significant difference between both the groups along with a significant difference in the case group among the severe and non-severe PE. Conclusion In antenatal women, NLR and PLR increase with PE along with an increase in NLR and PLR. Additionally, with the availability of a complete blood count, detecting PE ability markers such as the NLR and PLR will be a significant advantage for managing PE to prevent adverse outcomes.

The Acceptance of Postpartum Intrauterine Contraceptive Devices Among Women Who Receive Focused Family Planning Counseling in the Antenatal Period Compared to Those Who Receive Routine Counseling: A Randomized Controlled Trial.

Background and objective Unplanned pregnancies are very common in the postpartum period, and they often lead to negative outcomes such as abortion, low-birth-weight neonates, early delivery, postpartum bleeding, and fetal mortality. In the first 12 months after delivery, closely spaced and unintentional pregnancies can be prevented with postpartum contraception. The postpartum intrauterine contraceptive device (PPIUCD) is a method of family planning that may be used during the first few weeks after giving birth, and it is highly successful, reliable, affordable, non-hormonal, immediately reversible, long-acting, and does not interfere with lactation. Urban and educated women are largely aware of IUCD and its benefits, but the proportion of these women who use them is still small. In light of this, this study aimed to assess if providing focused antenatal counseling led to a greater postpartum IUCD acceptance rate when compared to routine counseling. Method We conducted a randomized controlled trial in the Department of Obstetrics and Gynaecology of a tertiary care center from January 2021 to December 2022. Based on the inclusion and exclusion criteria, 220 women were enrolled and were classified into two groups. Group A comprised 110 women (the focused counseling group) who received focused postpartum family planning (PPFP) counseling, and Group B consisted of the control group involving 110 women who received routine counseling. Results In both groups, the women who inserted IUCD were mostly gravida 2. Additionally, willingness to use IUCD was shown by 68% of women in the focused counseling group and 58% of women in the routine counseling group, and PPIUCD was accepted by 22% of women in the focused counseling group and 9% of women in the routine counseling group. Post-placental insertion was carried out in 18 (75%) cases in the focused counseling group and seven (70%) cases in the routine counseling group. Extended postpartum insertion (insertion within one year of delivery) was carried out in six (25%) cases in the focused counseling group and three (30%) cases in the routine counseling group. The most common reasons for the refusal were a preference for tubal ligation (TL) and a fear of side effects. When the patients were enquired about their contraceptive use over the past year on telephone conversations after one year of delivery, it was observed that 21.81% inserted PPIUCD, 30% used injectable depot-medroxyprogesterone acetate (DMPA), 13.63% had undergone TL, 11.81% used barrier contraception, while 22.72% did not use any contraception in the focussed counseling group. In the routine counseling group, 16.36% of women inserted PPIUCD, 20% used injectable DMPA, 12.72% underwent TL, 18.18% used barrier contraception, and 32.72% did not use any contraception. Conclusion Although PPIUCD is a long-acting reversible contraceptive that is safe and reliable, only a few women choose it as a method of birth control. This may be due to ignorance, misconceptions, and worries/fears about potential difficulties/adverse effects associated with IUCD insertion. The IUCD stigma mostly results from misconceptions about the fear of complications. Hence, we recommend that proper IUCD counseling be provided during antenatal care visits to dispel misunderstandings and concerns regarding potential complications associated with PPIUCD insertion.

Fertility Sparing Surgery in Young Woman With Granulosa Cell Tumor Followed by a Successful Pregnancy.

An uncommon form of cancer known as a granulosa cell tumor (GCT) arises from ovarian sex cord cells that produce estrogen. The goal of conservative surgery in cancer is to retain organ functions while avoiding severe excision wherever possible. In oncologic gynecological surgery, fertility-sparing surgery (FSS) is a technique that tries to preserve the uterus and ovarian tissue. A 26-year-old woman with nulligravida presented with the main complaints of pain in the right iliac fossa for 10 to 15 days and fullness in the abdomen for one month, along with a change in appetite and noticeable weight loss. The Magnetic Resonance Imaging (MRI) revealed a large, well-defined, multiloculated, solid cystic mass with altered signal intensity. On exploratory laparotomy, an intraoperatively left ovarian cystic mass was seen. The ovarian mass was histopathologically diagnosed as a sex cord tumor of the ovary, with characteristics compatible with adult GCT. Disregarding the follow-up advice on discharge four months later, the patient conceived spontaneously and gave birth to a male child via emergency lower segment cesarean section. In GCTs that have not spread beyond the ovary or in people who have had relapses of the disease, FSS created the groundwork for conception and appeared safe. In the lack of any compelling supporting evidence, the line of care of terminal surgery should always be thoroughly discussed with the patient and advised for women after their families are complete.

Kalman filter based short term prediction model for COVID-19 spread.

Corona Virus Disease 2019 (COVID19) has emerged as a global medical emergency in the contemporary time. The spread scenario of this pandemic has shown many variations. Keeping all this in mind, this article is written after various studies and analysis on the latest data on COVID19 spread, which also includes the demographic and environmental factors. After gathering data from various resources, all data is integrated and passed into different Machine Learning Models in order to check its appropriateness. Ensemble Learning Technique, Random Forest, gives a good evaluation score on the tested data. Through this technique, various important factors are recognized and their contribution to the spread is analyzed. Also, linear relationships between various features are plotted through the heat map of Pearson Correlation matrix. Finally, Kalman Filter is used to estimate future spread of SARS-Cov-2, which shows good results on the tested data. The inferences from the Random Forest feature importance and Pearson Correlation gives many similarities and few dissimilarities, and these techniques successfully identify the different contributing factors. The Kalman Filter gives a satisfying result for short term estimation, but not so good performance for long term forecasting. Overall, the analysis, plots, inferences and forecast are satisfying and can help a lot in fighting the spread of the virus.