Ureterovaginal fistula after insertion of a McDonald suture: Case report and review of published reports.

Complications associated with cerclage that are commonly described in the existing published reports include injuries to the cervix or bladder, premature rupture of membranes, chorioamnionitis and bleeding. We report an unusual complication of a ureterovaginal fistula formation after the insertion of a McDonald suture.

Proteomic analysis of human placental syncytiotrophoblast microvesicles in preeclampsia.

BACKGROUND: Placental syncytiotrophoblast microvesicles (STBM) are shed into the maternal circulation during normal pregnancy. STBM circulate in significantly increased amounts in preeclampsia (PE) and are considered to be among contributors to the exaggerated proinflammatory, procoagulant state of PE. However, protein composition of STBM in normal pregnancy and PE remains unknown. We therefore sought to determine the protein components of STBM and whether STBM protein expressions differ in preeclamptic and normal pregnancies. Patients with PE (n = 3) and normal pregnant controls (n = 6) were recruited. STBM were prepared from placental explant culture supernatant. STBM proteins were analyzed by a combination of 1D Gel-LC-MS/MS. Protein expressions levels were quantified using spectral counts and validated by immunohistochemistry. RESULTS: Over 400 proteins were identified in the STBM samples. Among these, 25 proteins were found to be differentially expressed in preeclampsia compared to healthy pregnant controls, including integrins, annexins and histones. CONCLUSION: STBM proteins include those that are implicated in immune response, coagulation, oxidative stress, apoptosis as well as lipid metabolism pathways. Differential protein expressions of STBM suggest their pathophysiological relevance in PE.

The Prevalence of Gestational Diabetes Mellitus Among Asian Females is Lower Using the New 2013 World Health Organization Diagnostic Criteria.

OBJECTIVE: To determine the impact of the new 2013 World Health Organization (WHO) criteria for gestational diabetes mellitus (GDM) diagnosis on GDM prevalence and pregnancy outcomes in Asian ethnic groups compared to the 1999 WHO criteria. METHODS: A retrospective cohort study included 855 pregnant females of Chinese, Malay, and Asian Indian ethnicity at high risk of GDM who underwent 75-g oral glucose tolerance tests (OGTTs) between July 2008 and June 2010 in a tertiary center in Singapore. GDM prevalence, reclassification, and pregnancy outcomes were determined using the 2013 and 1999 diagnostic cutoffs for fasting and 2-hour postglucose (PG) values. RESULTS: The prevalence of GDM was reduced from 28.8% to 21.1% when the 2013 criteria were used. Overall, 10.2% subjects were reclassified from GDM to normal using the 2013 criteria, and 2.6% were reclassified from normal to GDM, giving a net reclassification rate of 12.8%. Reclassification from GDM to normal was greatest among Chinese, followed by Asian Indians, but the prevalence rate was unchanged among Malays. Babies of mothers who were reclassified from normal to GDM were more likely to have birth weight >95th centile and shoulder dystocia. CONCLUSION: The prevalence of GDM was reduced when the 2013 criteria were used, with the greatest reduction seen among Chinese, followed by Asian Indians. Lowering the fasting cutoff as per the new criteria identified a select group of patients who might benefit from GDM treatment. However, raising the 2-hour PG cutoff would miss a significant number of patients who might potentially benefit from GDM treatment.

Effect of availability of fetal ECG monitoring on operative deliveries.

OBJECTIVE: The objective of our study was to test the hypothesis that the availability and selective use of STAN in conjunction with cardiotocography for intrapartum monitoring, lowers the incidence of operative deliveries for fetal distress. DESIGN: Observational study. SETTING: Delivery suite of the National University Hospital, Singapore. METHODS: The data regarding intrapartum cesarean sections and instrumental vaginal deliveries for presumed fetal distress and the condition of the neonate at birth (Apgar scores at one and five minutes and admission to neonatal intensive care unit (NICU) were collected over two consecutive three-year periods. In the first triennium, only external cardiotocography was used for intrapartum fetal surveillance and in the second triennium STAN monitoring was available for use in the delivery suite. RESULTS: With the availability and selective use of STAN monitoring, there was a significant decrease in the number of instrumental deliveries for fetal distress (from 66 out of 520 (0.9%) to 36 out of 474 (0.5%), p<0.025), the number of admissions to the NICU (from 418 (5.6%) to 311 (4.6%), p<0.01) and the number of neonates with Apgar score of seven or less at five minutes (from 192 (2.6%), p<0.001 to 113 (1.7%), p<0.001). There was no significant difference in the incidence of emergency cesarean sections for fetal distress during the two time periods. CONCLUSION: Intrapartum monitoring of term fetuses with cardiotocography combined with selective use of ST analysis leads to a significant reduction in the number of operative deliveries for suspected fetal distress with no adverse effect on neonatal outcome.

Erratum to: Respiratory consequences of N95-type Mask usage in pregnant healthcare workers-a controlled clinical study.

[This corrects the article DOI: 10.1186/s13756-015-0086-z.].

Respiratory consequences of N95-type Mask usage in pregnant healthcare workers-a controlled clinical study.

BACKGROUND: Outbreaks of emerging infectious diseases have led to guidelines recommending the routine use of N95 respirators for healthcare workers, many of whom are women of childbearing age. The respiratory effects of prolonged respirator use on pregnant women are unclear although there has been no definite evidence of harm from past use. METHODS: We conducted a two-phase controlled clinical study on healthy pregnant women between 27 to 32 weeks gestation. In phase I, energy expenditure corresponding to the workload of routine nursing tasks was determined. In phase II, pulmonary function of 20 subjects was measured whilst at rest and exercising to the predetermined workload while breathing ambient air first, then breathing through N95-mask materials. RESULTS: Exercising at 3 MET while breathing through N95-mask materials reduced mean tidal volume (TV) by 23.0 % (95 % CI -33.5 % to -10.5 %, p < 0.001) and lowered minute ventilation (VE) by 25.8 % (95 % CI -34.2 % to -15.8 %, p < 0.001), with no significant change in breathing frequency compared to breathing ambient air. Volumes of oxygen consumption (VO2) and carbon dioxide expired (VCO2) were also significantly reduced; VO2 by 13.8 % (95 % CI -24.2 % to -3 %, p = 0.013) and VCO2 by 17.7 %, (95 % CI -28.1 % to -8.6 %, p = 0.001). Although no changes in the inspired oxygen and carbon dioxide concentrations were demonstrated, breathing through N95-mask materials during low intensity work (3 MET) reduced expired oxygen concentration by 3.2 % (95 % CI: -4.1 % to -2.2 %, p < 0.001), and increased expired carbon dioxide by 8.9 % (95 % CI: 6.9 % to 13.1 %; p <0.001) suggesting an increase in metabolism. There were however no changes in the maternal and fetal heart rates, finger-tip capillary lactate levels and oxygen saturation and rating of perceived exertion at the work intensity investigated. CONCLUSIONS: Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use. The benefits of using N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage. TRIAL REGISTRATION: The study was registered at clinicaltrials.gov, identifier NCT00265926.

Quality theory paper writing for medical examinations.

UNLABELLED: Aim & Objectives: Developing a tactful paper writing skill, through delivery and depiction of the necessary expressions required for in standard or superior essay writing. Understanding relevance and tact of theoretical expression in exam paper writing Learning Indices of standard or quality theory/essay answer (SAQ/LAQ). Applying knowledge and skill gained through these theory writing exercises and assignments to achieve high or better scores in examinations. METHODS AND MATERIALS: The study subjects were divided into two groups- Group A (17 students) and Group B students (10students). The students were selected from II M.B.B.S 4(th) term. Students of Group A were sensitized on how to write a theory paper and went through 4 phases namely pre-sensitization test, sensitization (imparting them with skills of good theory paper writing through home assignments and deliberations/ guidance), post-sensitization test and Evaluation. Students of Group A (17 students) undertook theory tests (twice, i.e. before and after sensitization) and Students of Group B (10 students) who were not sensitized and took the theory test with post sensitized Group A students (random 10 students). Both groups were given general pathology as the test syllabus, taught to both groups in didactic lectures during the last 6 months. The results of pre and Post-sensitization tests from both groups were analyzed. Intra group comparisons (pre sensitized Group A with Post sensitized Group A) and inter group comparisons (Non-sensitized group B with Sensitized Group A) were made. RESULTS: Significant results were found between results of pre and Post-sensitization tests in Group A (intra group analysis) and inter group (Group A and B) Post-sensitization tests, as there was remarkable improvement in student theory paper writing skills post sensitizing the students of Group A. CONCLUSION: Medical students should be mandatorily guided and exposed to the nuances and tact of writing the theory paper for their examinations, as it definitely gives them better understanding of presentations ultimately improving their score in the theory exams.

Lipid parameters - significance in patients with endogenous depression.

BACKGROUND: People are aware of the consequences of high serum lipid levels, specifically, total cholesterol. Awareness about harmful effects of very low levels of serum lipids is still lacking. Very low levels of serum lipids lead to psychological consequences. OBJECTIVES: The objective of this study was to show whether there was a significant relationship between serum lipid levels and depression. MATERIAL AND METHODS: Total 70 subjects were included in this study. 40 subjects suffering from depression as assessed with the help of clinical findings and Beck Depression Inventory (BDI) scores were included in the study group, while control group comprised of 30 normal subjects. Lipid profile was done on blood samples obtained after overnight fasting. BDI scores were also obtained in control group using BDI. Co-relation between BDI score and lipid levels was obtained in both the groups. RESULTS: Serum lipid levels were significantly low in study group as compared to control group. There was a significant negative co-relationship between serum lipid levels with depression. Subjects of study group having lower lipid levels specifically Total Cholestrol (TC) (r = -0.78), Low-Density Lipoprotein (LDL) (r = -0.69), TG (r = -0.41) and Very Low-Density Lipoprotein (VLDL)(r = - 0.418), showed higher BDI scores (p<0.05). CONCLUSION: We can conclude that there is a significant relationship between low TC and depression. Similarly, low levels of serum LDL, TG and VLDL also showed significant relationship with depression. Lipid levels below a certain limit are not good as it may cause depression. Patients with low lipid levels should be screened for depression so that if necessary, corrective measures can be taken at the earliest.

Establishment of Normative data for Monaural Recordings of Auditory Brainstem Response and its Application in Screening Patients with Hearing Loss: A Cohort Study.

OBJECTIVES: To establish normative data required for recording Auditory Brainstem Response (ABR) using monaural stimulations in children with normal hearing. METHODS: This study was conducted on 40 apparently healthy children. Database was collected after assessing with otological questionnaire, otoscopic examination and audiometric evaluation. Brainstem Evoked Response Audiometry (BERA) was used as a tool for establishment of normative data. ABR recordings by monaural presentation were obtained by following the standard test protocol given by Hall. RESULTS: ABR parameters like Absolute latencies, amplitudes, amplitude ratios, Inter- peak latencies and thresholds were assessed for their normative values which are required to establish a baseline data. The Interaural latency difference was less than 0.2 ms (milliseconds) and was found to be normal limit. Mean values of absolute latencies for left ear were1.66 ms 3.68 ms and 5.64 ms respectively and for right ear these were 1.66 ms, 3.65 ms and 5.59 ms respectively. Mean values for amplitude of wave I and V for left ear were 0.32 uV and 0.41 uV respectively. For right values were 0.31 uV and 0.36 uV respectively. Mean values of amplitude ratio (V/I) for left and right ears were 1.81 and 1.74 respectively. Mean values of interpeak latencies of wave I-III, III-V, I-V were 2.02 ms, 2.02 ms and 3.92 ms respectively for left ear and for right ear values were 2.04 ms, 1.98 ms and 4.03 ms respectively. Mean values for left and right ear hearing threshold was 25.25 dBnHL. CONCLUSION: ABR parameters shows variation in values depending upon age, myelination process, maturation of auditory pathway, environmental factors, laboratory setup etc. Hence it is concluded that each laboratory should have its own normative data which can be used as a baseline data for screening of patients with hearing loss.