Rajyashri Sharma

Hepatitis B virus infection in pregnant women and its transmission to infants

HBsAg was screened by Reverse Passive Haemagglutination Test (RPHA) and was confirmed by ELISA test in 157 pregnant females and their newborns. Anti-HBc and IgM anti-HBc was done in these cases by enzyme immuno-assay. The overall prevalence of HBsAg in mothers was 16 out of 157 (10 per cent) and in cord blood of newborns 5 per cent. The transplacental transmission was found in eight of 16 (50 per cent) HBsAg positive mothers. Anti-HBc was present in 12 out of 16 (75 per cent) HBsAg positive mothers and, of these, seven (58 per cent) neonates acquired HBsAg infection. IgM anti-HBc was present in seven out of eight (88 per cent) HBsAg positive neonates, suggesting active in utero infection. Fourteen out of 16 (88 per cent) neonates born to HBsAg positive mothers were alive and healthy, one was stillborn and one had a congenital anomaly.

Application of a multiplex PCR to cervical cells collected by a paper smear for the simultaneous detection of all mucosal human papillomaviruses (HPVs) and typing of high-risk HPV types 16 and 18.

A simple paper smear (PS) method for dry collection and storage of cervical specimens was employed to develop an easy multiplex (MPX) PCR for simultaneous detection of generic human papillomaviruses (HPVs) as well as typing of the high-risk HPV-16 and -18, the two clinically most important HPV genotypes, which are responsible for more than 80 % of cervical cancers. Multiplexing was performed with a small amount of DNA eluted by boiling from a single PS punch in a single tube and using a mixture of four pairs of primers specific for the HPV L1 consensus sequence, HPV-16, HPV-18 and the β-globin gene. Sixty HPV-positive biopsies and corresponding PS specimens from cervical cancer patients as well as cervical smears from 100 healthy women with or without abnormal cytology were collected both as PSs and in PBS. Detection of HPV DNA from cervical biopsies collected in PBS and corresponding cervical scrapes on a PS or in PBS by conventional and MPX-PCR showed a concordance of 100 % and adequacy of 93 %. A similar comparative study in cervical scrapes from normal women also revealed 100 % concordance. The technique was validated in a multicentric study at four different national laboratories. PSs collected by different centres showed variable adequacy (73-82 %) but the use of multiple PS discs for DNA extraction significantly increased the adequacy. Integration of PSs with MPX-PCR for the detection and typing of HPVs is a highly convenient, efficient, simple and cost-effective method for large-scale clinico-epidemiological studies and is also suitable for HPV vaccine monitoring programmes in resource-poor settings.

Maternal outcomes after 12 hours and 24 hours of magnesium sulfate therapy for eclampsia

To assess the effectiveness of a reduced duration (12 hours) of magnesium sulfate (MgSO4) administration for eclampsia.

Apoptotic Index and Mib-1 Antibody Expression in Premalignant and Malignant Lesions of Uterine Cervix

Introduction: Cervical cancers are the second most frequent type of female cancer, responsible for about 5% of cancer deaths in females worldwide. Recently, parameters of cell proliferation and cell death have emerged as important diagnostic and prognostic tools. Aims: The aim was to evaluate the role of Apoptotic Index and Ki-67 as proliferation marker in premalignant and malignant lesions of uterine cervix. Materials and Methods: The study included 179 patients of cervical dysplasias and malignancy. Evaluation of Apoptotic Index (using light microscopy) was performed on hematoxylin and eosin-stained sections. Ki-67 (MIB-1 antibody) expression was both graded as well as Labelling Index was calculated. Statistical evaluation was carried out using the Student t test (p<0.05). Results: There was increase in mean Apoptotic Index with increasing grade of dysplasia and difference in mean values between CIN-I and CIN-II; CIN-I and CIN-III were found to be statistically significant. Also Apoptotic Index increased from well differentiated Squamous Cell Carcinoma (SCC) to poorly differentiated SCC. There was increase in mean Labelling Index with increasing grade of dysplasia and when the p value amongst these groups was statistically significant. Labelling Index was maximum in Poorly Differentiated SCC and minimum in Moderatly Differentiated SCC and p value amongst these groups was found to be statistically significant. Conclusion: Both Apoptotic Index and Ki-67 expression could be used as a biomarkers in the evaluation of the proliferative activity and progressive potential of dysplastic and neoplastic changes.

An unusual mode of delivery

We are living in the third world, where only 25 % of the women receives hospital care and sometimes those who require, are not able to reach hospital in time due to lack of transport facilities, resulting in complications. We want to share a rare case of obstetrical trauma in which delivery of the baby occurred through ano-rectal canal causing severe fourth degree perineal injury and fetal demise. A 25-year old, primigravida was admitted to JN Medical College and hospital emergency with complaints of labor pains since 18 h after getting trial by untrained birth attendant at home. On admission, though she was dehydrated the vitals were stable, and mild pallor was present. Lower segment was over stretched, FHS was absent. On local examination, head was seen coming out through the introitus and the face, shoulder and hand were coming out through the anal opening (Fig. 1). An IUD baby delivered out spontaneously through the anal opening leaving the fourchette intact. On examination a large fourth degree tear was seen involving rectum, anal canal, and anal sphincter complex. The walls were ragged but not bleeding. A decision of transvaginal repair and not performing colostomy was taken. Post-operatively, injectable antibiotics were given for 72 h, followed by oral antibiotics for 7 days and clear fluids were started after 24 h. Local treatment by infrared diathermy and cold treatment by ice packs were given to reduce edema. Though the ano-sphincter complex and rectum healed well, but the vaginal mucosa and skin gave way due to massive edema. At the end of 4 weeks, the vaginal mucosa and skin had healed well. She was passing flatus and feces normally. She was discharged in good condition. Severe perineal lacerations are reported to occur in 6 % of women during vaginal delivery [1]. The need for simultaneous diversion of feces is an area that is under research. There is a marked difference in expert opinion. Only 30 % Coloproctologists recommend diversion for third or fourth degree tears, but not the Obstetricians in a recent practice survey [2]. Colostomies may impair healing by reducing collagen metabolism and altering mucosal defense in the de-functionalized rectum [3]. They may also increase infectious morbidity by attenuating mucosal integrity and promoting microbe translocation [4]. And 20–25 % of patients experience additional morbidity at colostomy closure [5]. The repair of fourth degree lacerations without diversion promotes uneventful healing. These are low-energy injuries with minimal tissue loss and