Anjali Gupta

Expression of CD34 as a novel marker for glioneuronal lesions associated with chronic intractable epilepsy.

The spectrum of glioneuronal lesions underlying intractable epilepsies includes malformative pathologies like focal cortical dysplasia (FCD); and neoplastic lesions like gangliogliomas (GG) and dysembryoplastic neuroepithelial tumours (DNT). These may occur either singly or as dual lesions, having simultaneous presence of both elements. Currently, the relationship between the malformative and neoplastic glioneuronal lesions is poorly understood. Recently, CD34, a stem cell marker transiently expressed during early neurulation, has been identified in these tumours. This study was undertaken to (i) evaluate the role of CD34 as a diagnostic marker for glioneuronal lesions of epilepsy, namely, GG, DNT and FCD, and (ii) attempt to define the relationship among these lesions, using CD34 as a marker.

Six hourly vaginal misoprostol versus intracervical dinoprostone for cervical ripening and labor induction

Aim:  Prospective clinical trials were conducted to assess the safety and efficacy of 6‐hourly vaginal misoprostol versus intracervical dinoprostone for induction of labor.

Acute pancreatitis: a rare cause of acute abdomen in pregnancy

Pancreatitis in pregnancy is rare and occurs in approximately 1 in 1,000 to 1 in 10,000 births. Acute pancreatitis rarely complicates pregnancy, can occur during any trimester but over half (52%) occur during the third trimester and rarely during post-partum period. A case of idiopathic pancreatitis in pregnancy has been reported. Pancreatitis often presents as an acute abdomen and can have lethal effect on the mother and the fetus.

Observations on aetiology and management of genital fistulas

MethodsWe evaluated the aetiological factors and outcome of the management of genital fistulas. A review of patients who presented with genital fistulas between January 1998 and June 2002 was performed.ResultsThere were 34 cases of various genital fistulas, including 29 urinary and 5 intestinal fistulas. Among them 14 (41.2%) were attributed to obstetrical causes, 11 (32.3%) to gynaecological surgery, and 9 (26.3%) to other factors like vaginal procedure, coitus, trauma, etc. We had an operation success rate of 85.7% (30 out of 35 repairs). The success rate was 85.71% (24 out of 28) after primary and 83.3% (5 out of 6) after secondary repair (p=1.00). Vaginal repair was done in 28 cases whereas abdominal repair was carried out in 7 cases. The failure rate was 7.14% (2 out of 28) using the vaginal route and 42.8% (3 out of 7) using the abdominal route (p=0.05). The average duration of disease was 11.8±4.9 months vs. 30±10.3 months (p=0.5), the mean size of the fistulas was 1.5±1.0×1.3±0.9 cm vs. 2.4±1.9×2.2±1.8 cm (p=0.02) in successful and failed cases respectively.Conclusion The vaginal repair of fistulas is associated with a higher success rate. Fistulas due to other etiological factors specifically associated with genital malformation, like vaginal procedures and coitus, have the worst prognosis. Larger or longer duration fistulas are associated with poorer prognosis.

Hemophagocytic syndrome secondary to cytomegalovirus infection in an infant

Virus associated hemophagocytic syndrome is a non-neoplastic, generalized histiocytic proliferation with prominent hemophagocytosis associated with a systemic viral infection. We report a case of cytomegalovirus (CMV) associated hemophagocytic syndrome in a 2 month old male child presenting with rashes, fever, hepatosplenomegaly, cervical lymphadenopathy and pancytopenia. Fine needle aspiration cytology and biopsy from cervical lymph nodes revealed prominent hemophagocytosis. Serology for CMV IgM was positive in both the mother and the child, suggesting recent infection. Possibly there was intrauterine transmission of the infection.

Adenolipoma of the thyroid gland

Thyrolipoma or adenolipoma of the thyroid gland is defined as a thyroid adenoma containing mature fat tissue. It is a rare encapsulated lesion. A case of a 35-year-old female presenting with swelling in the neck that was diagnosed as adenolipoma is described because of its extreme rarity.

Immediate Postpartum Intrauterine Contraceptive Device Insertions in Caesarean and Vaginal Deliveries: A Comparative Study of Follow-Up Outcomes.

Background. Immediate postpartum intrauterine contraceptive device (IPPIUCD) is a lucrative postpartum family planning method which provides effective reversible contraception to women in the delivery setting. Our aim was to study the clinical outcomes of IPPIUCD insertions and compare them as a factor of route of insertion (vaginal versus caesarean). Methods. This is a retrospective analytical study done in a tertiary care teaching institute. A Cohort of 593 vaginal and caesarean deliveries with IPPIUCD insertions, over a two-year period, was studied and compared for follow-up results. Outcome measures were safety (perforation, irregular bleeding, unusual vaginal discharge, and infection), efficacy (pregnancy, expulsions, and discontinuations), and incidence of undescended IUCD strings. Descriptives were calculated for various outcomes and chi square tests were used for comparison in between categorical variables. Results. Overall complication rates were low. No case of perforation or pregnancy was reported. Spontaneous expulsions were present in 5.3% cases and were significantly higher in vaginal insertions (p = 0.042). The incidence of undescended strings was high (38%), with highly significant difference between both groups (p = 0.000). Conclusion. IPPIUCD is a strong weapon in the family planning armoury and should be encouraged in both vaginal and caesarean deliveries. Early follow-up should be encouraged to detect expulsions and tackle common problems.

The need for developing comprehensive epilepsy surgery units in India

This journal took shape as a result of a natural need required for an academic and research platform for the work done by the neurosurgical community of India. India currently has about 2000 neurosurgeons. Apart from the academic curriculum from the major institutes, there are a number of smaller hospitals which cater to diploma courses in neurosurgery. It is expected that by 2020, the neurosurgical community would cross about 7000, bringing it to an equivalent platform as many other medical specialties.

Spontaneous asymptomatic uterine scar dehiscence at 20 weeks of gestation as a result of endomyometritis

Spontaneous uterine rupture during second trimester is a rarity in obstetrics. Rupture of the pregnant uterus is considered spontaneous if the rupture occurs without contractile activity of the myometrium. An unusual case of asymptomatic spontaneous uterine scar dehiscence in second trimester with previous three lower uterine segment caesarean sections following endomyometritis is presented here.

Early induction versus expectant management in prelabour rupture of membranes

Prelabour rupture of membranes (PROM) is one of the most common clinical problem where a low risk pregnancy can turn into high risk pregnancy at term. Prelabour rupture of membranes is defined by the American college of Obstetrics and gynaecology as “Spontaneous rupture of membranes prior to the onset of regular uterine contractions.” PROM occurs in 6-18% of all pregnancies of which 80% occurs at term.