A Case Report on Acute Fatty Liver of Pregnancy: A Difficult Differential Diagnosis of Liver Disorder.

Acute fatty liver of pregnancy is a rare but potentially dangerous pregnancy condition with significant maternal and fetal fatality rates. The disorder is driven by a complex pathophysiology and clinically manifests as a rapid worsening in health conditions, increasing the rate of mortality and necessitating expert diagnosis and management. The condition progresses from spontaneous resolution to post-operative complications, resulting in negative consequences. We offer a case report of a young primigravida patient diagnosed with acute fatty liver of pregnancy at term. The report describes the clinical course and its effect. The perinatal result, however, could not be improved due to the late diagnosis. Over the last 40 years, death rates have been dramatically lowered because of competence and a multidisciplinary approach, increasing maternal-fetal outcomes. In this scenario, time management is crucial to success.

Patient Perception of Bladder Condition after Treatment with Solifenacin and Tolterodine in Overactive Bladder Patients.

BACKGROUND: Solefinacin and Tolterodine are new generation antimuscarinics claimed to have bladder specific action and less adverse effect like dry mouth. The objective of the study was to compare the improvement in urinary symptoms among patients using solefinacin and tolterodine with overactive bladder symptoms. METHODS: A hospital based cross-sectional comparative study was done for one year duration. All patients with overactive bladder symptoms were included and in every alternate patient's solefinacin and tolterodine were given after taking note of baseline OAB symptoms, PPBC score and UPS score. Participants were followed up after one month and noted improvement in endpoint OAB symptoms. Comparison of baseline to end-point symptoms changes among each group of participants were analyzed for statistical significance. RESULTS: Among 101 participants included in the study, 49 participants were in solefinacin group and 52 participants were in tolterodine group. The end-point comparison of urgency symptoms were improved by 20.1±6.76 (mean ± SD) units in solefinacin group and by 17.0 ± 9.18 units in tolterodine group. Urgency perception score improved to 2.1±0.66 for patients under solefinacin and 2±0.73 for tolterodine. Patient perception of bladder condition (PPBC) showed improvement in solefinacin group by 3.2±1.26 units and in tolteradine by 2.8±1.54 units (p = 0.165). Comparing the patient's perception of treatment outcome, massive improvement was reported by 81.6% of those receiving Solefinacinand 65.4% receiving tolterodine, though not statistically significant ( p = 0.131). CONCLUSIONS: Solefinacin and Tolterodine showed improvement in urinary symptoms, UPS and PPBC. Both showed comparable efficacy without significant superiority over one another.

Obstetric Cholestasis among Pregnant Women Visiting a Tertiary Care Centre.

Introduction: Obstetric cholestasis is one of the most frequent hepatic disorders specific to pregnancy. It occurs commonly during the latter half of pregnancy. The data regarding this issue is rare in our settings. The aim of this study was to find out the prevalence of obstetric cholestasis among pregnant women visiting a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among pregnant women, who attended a tertiary care centre from 24 July 2022 to 24 January 2023. Ethical approval was taken from the Institutional Review Committee of the same institute. Convenience sampling method was used. The point estimate was calculated at a 99% Confidence Interval. Results: The prevalence of obstetric cholestasis was 80 (1.38%) (1-1.80, 99% Confidence Interval). A total of 40 (50%) were in the age group 21-30 years, with a mean age of 28.06±6.39 years. A total of 48 (60%) were multigravida and 73 (91.30%) had singleton pregnancies. Pruritus of the whole body was complained of by 56 (70%) patients. Previous history of obstetric cholestasis was present in 21 (26.30%). Conclusions: The prevalence of obstetric cholestasis among pregnant women is lower than other studies done in similar settings. Keywords: Nepal; obstetric cholestasis; pregnancy.

Induction of Labour among Pregnant Women in the Department of Obstetrics and Gynaecology in a Tertiary Care Centre.

Introduction: Induction of labour is the artificial initiation of uterine contraction by various means such as medical, surgical or mechanical with the aim of achieving vaginal delivery. Misoprostol, a prostaglandin E1 analogue is used popularly for the induction of labour in resource-limited health centres. The aim of the study was to find out the prevalence of induction of labour among pregnant women in the Department of Obstetrics and Gynaecology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among pregnant women in a tertiary care centre from 3 February 2022 to 31 July 2022. Ethical approval was taken from the Institutional Review Committee. The women with a singleton pregnancy, reactive non-stress test, and adequate pelvis were included. Women with malpresentation, previous cesarean section, placenta previa, and cephalopelvic disproportion were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 1355 pregnant women, the prevalence of induction of labour was found to be 135 (9.96%) (8.37-11.55, 95% Confidence Interval). Conclusions: The prevalence of induction of labour among pregnant women was found to be similar to other studies done in similar settings. Keywords: induction of labour; misoprostol; pregnancy.

Scar Endometriosis: A Rare Cause of Abdominal Pain.

Scar endometriosis or incisional endometriosis is the presence of endometrial tissues with glands in the previous incision or scar. Its overall estimated incidence after post-cesarean and post-hysterectomy is 0.03-0.4% and 1.08-2%, respectively. The patient presents with non-specific symptoms such as cyclical abdominal pain at the site of a previous surgical incision and scar and an abdominal lump with a cyclical increment in size, which is tender. The diagnosis is made only after the surgical excision with confirmation by histopathological analysis. We present the case of a 31-year-old female complaining of cyclical abdominal pain and a lump on the right side of a Pfannenstiel incision for five months. She had undergone two Lower Segment Caesarean Sections (LSCSs); the last surgery was eight months prior. Surgical excision was planned with the corresponding clinical features and radiological data. After the surgical excision, the sample was sent for histopathological examination, and scar endometriosis was diagnosed.

Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome Rare Obstructive Uterovaginal Anomaly: A Case Report.

Obstructed Hemivagina and Ipsilateral Renal Anomaly syndrome is a rare obstructive uterovaginal anomaly involving both mesonephric and paramesonephric ducts. It usually presents after menarche with non-specific symptoms like pelvic pain, dysmenorrhea, or paravaginal mass and examination findings of paravaginal or pelvic mass. Because of non-specific symptoms and signs, the diagnosis is usually overlooked, which leads to complications like endometriosis, tubo-ovarian abscess compromising patient’s fertility, and quality of life. Therefore, in presence of these nonspecific clinical features along with imaging findings of uterine didelphys and unilateral renal agenesis, this syndrome should be considered in the diagnosis. We present a case of a 17-year-old lady with Obstructed Hemivagina and Ipsilateral Renal Anomaly syndrome, diagnosed by finding of paravaginal mass on examination and uterine didelphys with ipsilateral renal agenesis in USG and managed successfully by resection of vaginal septum. Keywords: ipsilateral renal anomaly;paravaginal mass;uterovaginal anomaly.

Adverse Maternal and Fetal Outcome in Patients with Eclampsia.

BACKGROUND: Eclampsia is a multisystem disorder that may lead to deterioration of maternal condition, hypoxia and acidosis of fetus. Objective was to evaluate the risk factors associated with adverse maternal and fetal outcome in patients with eclampsia. METHODS: All patients with eclampsia were enrolled after informed consent from February 2013 to February 2014. Questions as per per-forma were asked to the patients and attendants about antenatal visits, parity, number of episodes of seizures, duration from onset of seizure to magnesium sulfate, then the patients were followed as per the hospital protocol, the mode of delivery, outcome of baby, post partum maternal condition and mortality were then noted. RESULTS: Fifty-two patients with eclampsia were admitted in the study period. Thirty-one patients required mechanical ventilator support. Twenty-five (48.07%) patients were delivered by emergency cesarean section and 30(57.6%) babies were low birth weight and there were 11(21.1%) stillbirths. There was one maternal mortality and 45(86.5%) patients were discharged with improvement but 6(11.5%) patients had neurological impairment. Mortality was significantly related with number of seizure episodes and time interval between seizure onset and administration of magnesium sulphate. CONCLUSIONS: Early detection of hypertension and management with magnesium sulphate for eclampsia can help to minimize the maternal and fetal adverse outcomes.

Access to enantiomerically enriched cis-2,3-disubstituted azetidines via diastereoselective hydrozirconation.

An asymmetric variant of the hydrozirconation reaction has been established starting from Boc-protected chiral allylic amines. The resulting diastereoselectively formed N-functionalized organozirconiums can be considered as promising chirons. In this case, they have been transformed into enantiomerically enriched cis-2,3-disubstituted azetidines through a iodination/cyclization sequence.

Intermolecular electrophilic O-amination of alcohols.

We report the first examples of an intermolecular electrophilic O-amination of aliphatic alcohols. Thus, the new reagents, fluorenone oxime tosylate, 5a, or mesylate, 5b, permit O-amination of diverse alcohols in the presence of NaH under mild conditions. By following the formation of the resulting oxime ethers, 6, the reaction was shown to be sensitive to steric effects in the alcohol. Furthermore, the presence of an aromatic ring or of a double bond in the alcohol molecule (benzyl, allyl) was found to increase the reaction rate.

Photophysical processes involved within the anisole-thioindoxyl dyad system.

The photophysical properties and the nature of the photoinduced electron transfer (PET) reactions within a synthesized anisole (A)-thioindoxyl (T) dyad system (24MBTO) have been studied by electrochemical, steady-state, and time-resolved spectroscopic techniques. Computations on the dyad were performed both in gas phase as well as solvent environment by TD-DFT method with B3LYP density function. The geometry optimization calculation of 24MBTO was done by 6-311G(d,p) basis function set implemented in the Gaussian package. The theoretical values of singlet vertical excitation energies were found to correlate well with the experimentally observed ones. The electrochemical measurements indicate the possibility of occurrence of PET reactions within 24MBTO between the linked redox centers A and T. Both steady-state and time-resolved spectroscopic measurements on the novel synthesized 24MBTO dyad demonstrate the formations of the two types of isomeric species: Z- and E- forms, resulted from the charge separation reactions. From the detailed studies it reveals that the present thioaurone may behave as a versatile photoswitchable system. It has been hinted that the loss process (charge recombination) within 24MBTO could possibly be prevented by incorporating it within the hydrophobic cavity of beta-cyclodextrin (betaCD).