Raju Agarwal

Why do obstetric patients go to the ICU? A 3-year-study

BACKGROUND Pregnant women are at risk to develop complications due to illness related to pregnancy or due to aggravation of pre-existing disease. These patients also require critical care and ICU admissions in some cases. To determine the current spectrum of diseases in an obstetric population resulting in admission to the intensive care unit (ICU) at a tertiary care hospital. METHODS A retrospective case series study and analysis of data from obstetric patients admitted for critical care management. RESULTS 0.26% of the total obstetric patients admitted to the hospital required ICU admissions. 46% of patients were admitted to ICU for ventilator support. Pre-eclampsia and obstetrical hemorrhage were the common diagnosis for these patients. CONCLUSION Critically ill obstetric patients require a team approach of the obstetrician, anesthesiologist and intensive care specialist for the optimal care of these patients.

Takayasu arteritis in pregnancy

In 1908, Mikito Takayasu, a Japanese ophthalmologist, reported the case of a 21-year-old woman with retinal arteriovenous anastomoses, syncope, and absent upper extremity pulses.1 Takayasu arteritis (TA), also known as occlusive thromboaortopathy, is a primary systemic vasculitis of unknown etiology, predominantly affecting women2 during their reproductive years (female to male ratio is 4:1). It has variable geographical distribution with the greatest prevalence in Asians, especially Japan, and the Orient. Optimal management for pregnant patients with this disease has not yet been established. Due to the manifold cardiovascular complications that can occur in the course of the disease, management of pregnancies in TA patients is a challenge for the obstetrician, the rheumatologist and the cardiologist.

Role and efficacy of vaginal dinoprostone gel (PGE2) plus vaginal misoprostol (PGE1) in second trimester termination of pregnancy

Second trimester termination contributes approximately 10% to 20% of all induced abortions cases and about 65% to 70% of all fatal complications are related to induced abortions. Various agents are used to ripen the cervix and stimulate uterine contractions and induce abortion after 12 weeks, but available data regarding their safety and effectiveness are limited. Various agents include hypertonic saline, or hyperosmolar urea, injected intra-amniotically; ethacridine lactate administered intraor extra-amniotically; prostaglandin analogues administered parenterally or intraor extra-amniotically; and oxytocin injected intravenously or intramuscularly. These methods and routes of administration, however, are invasive and likely to be less safe, and the time to complete abortion is longer when compared to the use of methods such as misoprostol alone, combined dinoprostone and misoprostol combined mifepristone and misoprostol. Second trimester abortion also includes surgical procedure, but it can result in complications like uterine perforation, cervical incompetence, uterine ABSTRACT

Generation and characterization of human iPSC line from CD34+ cells isolated from umbilical cord blood belonging to Indian origin

We describe here the reprogramming of CD34+ cells isolated from umbilical cord blood obtained after full term delivery of a healthy female child of Indian origin. The cells were nucleofected by episomal vectors expressing Oct4, Sox2, L-Myc, Klf4, Lin28 and p53DD (negative mutation in p53). Colonies were identified by alkaline phosphatase staining and characterized for expression of pluripotency markers at protein level by immunofluorescence, flow cytometry and at transcript level by PCR. Genomic stability of the cell line was checked by G-banded karyotype. The ability to differentiate to endoderm, mesoderm and ectoderm in vitro was confirmed by immunofluorescence staining.

Accuracy of MR Imaging in endometrial cancer: our experience

Background: MRI is a useful modality for preoperative imaging in endometrial cancer. We report our experience in Indian population managed at a tertiary care center regarding accuracy of preoperative MRI in prediction of deep myometrial invasion and cervical stromal invasion. Methods: 30 patients with endometrioid adenocarcinoma endometrium on endometrial biopsy underwent preoperative MRI in the week preceding surgery. MRI impression of depth of myometrial invasion, cervical stroma involvement and positive nodes were compared with final histopathology findings to calculate the accuracy of MRI. Results: The accuracy of MRI for estimation of tumour size was 72% and for detection of myometrial invasion was 76%. The accuracy for detection of cervical, adnexal and nodal involvement was 96%, 100% and 96% respectively. Conclusions: MRI is an accurate modality for preoperative assessment in endometrial cancer and can significantly assist in surgical planning.