Jessie Lionel

Pandemic (H1N1) 2009 virus infection during pregnancy in South India

To assess the clinical profile of pregnant/puerperal women from a semi‐urban Indian population who were infected with pandemic (H1N1) 2009 virus (P[H1N1]2009v) and to evaluate their outcome.

Domestic violence as a risk factor for maternal depression and neonatal outcomes: A hospital-based cohort study

Objectives: This study attempted to follow up a cohort of women who presented to a tertiary hospital to investigate the effect of domestic violence on maternal and neonatal outcomes. Materials and Methods: Women, between 26-34 weeks of gestation, attending the obstetrics outpatient department, were recruited and followed up until delivery. They were assessed at recruitment and after delivery using the Edinburgh Postnatal Depression Scale, the Abuse Assessment Screen, and a pro forma to assess socio-demographic and clinical characteristics. Bivariate and multivariate statistics were employed to assess statistical significance. Results: One hundred and fifty women were recruited, 132 delivered in the hospital and were followed up. Domestic violence was associated with antenatal and postnatal depression, spouses insistence of a boy baby, medical complications during pregnancy, preterm delivery, and lower birth-weight. Conclusion: Domestic violence has a significant impact on maternal and neonatal outcomes. Screening for domestic violence and interventions should be part of all antenatal programs. India should also employ public health approaches to change its patriarchal culture.

HIV and obstetric complications and fetal outcomes in Vellore, India.

Antenatal prevalence is more than 1% in parts of India, yet little is known about the complications and fetal outcomes in this region. We reviewed the records of 23,386 women who delivered at the Christian Medical College Hospital in Vellore, India from 2000 through 2002. HIV-infected women were more likely than HIV-uninfected women to have pregnancy-induced hypertension, anaemia, breech presentations, stillborn babies and fetal deaths. HIV-infected women who did not receive mother-to-child transmission prophylaxis or had breech fetal presentation were more likely to have fetal deaths (P = 0.001). HIV prophylaxis and optimal prenatal care should be a priority for HIV-infected pregnant women in resource-limited countries.

HIV-1 Seroprevalence and Awareness of Mother-to-Child Transmission Issues Among Women Seeking Antenatal Care in Tamil Nadu, India

Background: Despite increasing availability of HIV-1 testing, education, and methods to prevent transmission, Indian women and their children remain at risk of acquiring HIV. We assessed the seroprevalence and awareness about HIV among pregnant women presenting to a private tertiary care hospital in South India. Methods: Seroprevalence was determined via enzyme-linked immunosorbent assay (ELISA) testing, and questionnaires were analyzed using chi-square statistics and odds ratios to look for factors associated with HIV positivity. Results: A total of 7956 women who presented for antenatal care were interviewed. Fifty-one women of the 7235 women who underwent HIV testing (0.7%) were found to be HIV positive. Awareness of mother-to-child transmission (MTCT) of HIV (64%), HIV transmission through breast milk (42%), and prevention of MTCT (13%) was low. Conclusions: There is a need to educate South Indian women about HIV to give them information and the means to protect themselves and their unborn children from acquiring HIV.

Comprehensive Maturity Onset Diabetes of the Young (MODY) Gene Screening in Pregnant Women with Diabetes in India.

Pregnant women with diabetes may have underlying beta cell dysfunction due to mutations/rare variants in genes associated with Maturity Onset Diabetes of the Young (MODY). MODY gene screening would reveal those women genetically predisposed and previously unrecognized with a monogenic form of diabetes for further clinical management, family screening and genetic counselling. However, there are minimal data available on MODY gene variants in pregnant women with diabetes from India. In this study, utilizing the Next generation sequencing (NGS) based protocol fifty subjects were screened for variants in a panel of thirteen MODY genes. Of these subjects 18% (9/50) were positive for definite or likely pathogenic or uncertain MODY variants. The majority of these variants was identified in subjects with autosomal dominant family history, of whom five were in women with pre-GDM and four with overt-GDM. The identified variants included one patient with HNF1A Ser3Cys, two PDX1 Glu224Lys, His94Gln, two NEUROD1 Glu59Gln, Phe318Ser, one INS Gly44Arg, one GCK, one ABCC8 Arg620Cys and one BLK Val418Met variants. In addition, three of the seven offspring screened were positive for the identified variant. These identified variants were further confirmed by Sanger sequencing. In conclusion, these findings in pregnant women with diabetes, imply that a proportion of GDM patients with autosomal dominant family history may have MODY. Further NGS based comprehensive studies with larger samples are required to confirm these finding

Different subsets of Langerhans cells in human uterine tubes and uterus

Langerhans cells (LC) are antigen‐presenting cells present in tissues with high antigenic exposure. Their role in the upper female reproductive tract is not fully understood. This study aims to determine the distribution and morphology of LC in the normal and post‐partum human uterine tubes and uterus by staining with the specific LC markers, CD1a and zinc iodide‐osmium (ZIO), and to determine their association with helper and cytotoxic T cells.

Morphological Study of Dendritic Cells in Human Cervix by Zinc Iodide Osmium Method

BACKGROUND Dendritic cells (DCs) are a heterogeneous population of antigen presenting cells that have been identified in several tissues including the female reproductive organs. The aim of the present study is to demonstrate the morphological differences of dendritic cells in normal human exocervix using the Zinc Iodide Osmium (ZIO) procedure. MATERIALS AND METHODS Normal cervical tissues obtained from nine patients who underwent abdominal hysterectomies for various ailments were processed for histochemical study. Six microns thick serial sections were taken and viewed under a light microscope. The diameters of the cells were measured under a magnification of 40x using the Cellsens image analysing software and analysed using SPSS version 16. RESULTS AND CONCLUSION In the normal human exocervix, a greater density of ZIO-positive DCs was noted in the epithelium and subepithelium and their distribution was not uniform. In some areas of epithelium, the ZIO-positive cells in the basal layer showed a typical dendritic morphology, while the cells in the intermediate and superficial layers were nondendritic polygonal cells. Intraepithelial capillaries were noted, which were surrounded by ZIO-positive nondendritic polygonal cells. There was significant difference in the mean diameters of typical DCs (8.61±1.86 μm) and nondendritic polygonal cells (10.97±1.93 μm). In the subepithelium the DCs had typical morphology and their distribution varied. ZIO positive DCs were noted in the epithelium and cervical glands of endocervix also. In conclusion, the human cervix has different subsets of ZIO positive DCs with varied distribution. Their functional role has yet to be defined.

Prevalence of Chlamydia trachomatis in a tertiary center in South India

Objective: To determine the prevalence for Chlamydia trachomatis and the need for introduction of screening test for chlamydia infection in patients attending a gynaecology outpatient clinic. Materials and Methods: Ninety-nine patients had endocervical swabs taken during pelvic examination, after an informed consent and tested using the Clearview ® chlamydia test kit. Results: Overall prevalence of infection was 10%. Conclusion: There is a high prevalence of C. trachomatis which warrants introduction of screening.

Endometrial resection/vaporization: a patient-friendly first-option treatment for menorrhagia in rural areas.

SUMMARY Hysterectomy, a major surgical procedure, is often an unacceptable procedure for many patients from rural areas who attend small rural hospitals. Near total endometrial resection/vaporization is a more acceptable procedure which can control menorrhagia. This procedure can be carried out with standard urology instruments.