Syed Habeebullah

Urological injuries during hysterectomies: A 6‐year review

Aim:  Urological injuries that occur during hysterectomy are a rare but important cause of morbidity. An understanding of the risk factors can help us to reduce their incidence and studying their management and outcome could help us to evolve optimal management strategies. The aim of the present study was to examine the incidence of urological injuries that occur during hysterectomy and to determine the risk factors, management and outcome of such injuries.

Spectral Analysis of Heart Rate Variability for Early Prediction of Pregnancy-Induced Hypertension

The early prediction of pregnancy-induced hypertension (PIH), a common morbid disorder of pregnancy is unsatisfactory. Therefore, in the present study we have investigated the role of spectral analysis of heart rate variability (HRV) in the early prediction of PIH. Spectral analysis of HRV was performed in three groups of subjects (Group I: normal pregnant women; Group II: pregnant women with risk factors, but did not develop PIH; Group III: pregnant women with risk factors and developed PIH). It was observed that the LF-HF ratio, the most sensitive indicator of sympathovagal balance, was significantly high (p < 0.01) since early pregnancy in group III compared to other groups, which was significantly correlated with heart rate and blood pressure. It was suggested that the predictive knowledge of sympathovagal imbalance should be utilized in designing the prevention and management of PIH.

Immunohistochemical distinction between mesothelial and adenocarcinoma cells in serous effusions: A combination panel-based approach with a brief review of the literature

BACKGROUND The prognostic and therapeutic significance of differentiating adenocarcinoma (AC) from reactive mesothelium (RM) in effusions cannot be overemphasized. To avoid diagnostic errors, ancillary techniques like immunohistochemistry are employed. However, results vary and no universal standard has been accepted so far. OBJECTIVE To study the combined diagnostic efficacy of epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), E-cadherin (EC), calretinin (CAL), desmin (DES) and vimentin (VIM) in distinguishing RM from AC cells in serous effusions. STUDY DESIGN Unequivocally diagnosed cases of 39 adenocarcinomatous and 38 RM populations were studied using sections from 49 formalin-fixed, paraffin-embedded cell blocks. MATERIALS AND METHODS The immunomarkers were applied on cell block sections using the avidin-biotin peroxidase technique. The distribution/intensity of immunostaining in mesothelial and AC cells were graded semiquantitatively. STATISTICAL ANALYSIS USED Fischers exact test was used to calculate the efficacy of individual markers and their combinations. RESULTS EMA was the best single marker for AC, with 100% sensitivity and 97.37% specificity. For the mesothelial cells, CAL exhibited 100% sensitivity and 92.31% specificity. DES was more specific than CAL but had a poor sensitivity of 55.26%. EC, CEA and VIM had unsatisfactory predictive values precluding their use as individual diagnostic markers. Among the combinations, two panels--EMA+ AND (CAL- OR DES-) for ACs and CAL+ AND (EMA- OR CEA-) for RM had 100% specificities and sensitivities. CONCLUSIONS Most panel studies on fluid cytology are based on the arbitrary use of individual markers with the best statistical values, leading to a less than accurate diagnostic assessment. We believe that statistical parameters calculated in combination provide for a more practical and objective evaluation as well as allowing for meaningful comparative studies.

Assessment of cardiovascular autonomic function in patients with polycystic ovary syndrome

The study was conducted to assess the sympathovagal balance in patients with polycystic ovary syndrome (PCOS) using short‐term heart rate variability (HRV) analysis and conventional autonomic function tests (CAFT).

Increased inflammatory response and imbalance in blood and urinary oxidant–antioxidant status in South Indian women with gestational hypertension and preeclampsia

OBJECTIVE The objective of this study is to assess the association of blood and urinary oxidative stress parameters and inflammatory markers in women with gestational hypertension and preeclampsia. DESIGN AND METHODS Malondialdehyde, protein bound sialic acid and C-reactive protein were estimated in serum and urine of pregnant women diagnosed with preeclampsia (n=30) and gestational hypertension (n=30) and the results were compared with 30 normal pregnant women. RESULTS Whole blood glutathione level was reduced, and malondialdehyde and C-reactive protein levels were significantly higher and correlated with each other in preeclampsia (p<0.05). Urinary malondialdehyde significantly correlated with urinary protein bound sialic acid in preeclampsia (r=0.412; p=0.02). Receiver operating curve analysis of serum protein bound sialic acid and serum malondialdehyde showed reasonable cutoff values for the differential diagnosis of preeclampsia. CONCLUSIONS Oxidative stress and inflammatory response are greater in women with preeclampsia in comparison to pregnant women with gestational hypertension and there is an association between oxidative stress and inflammatory response.

Maternal mortality due to hypertensive disorders of pregnancy in a tertiary care center in Southern India

ception (Table 2). When compared with data from some Muslim countries concerning awareness of emergency contraception, for example Kuwait (6.1%) and Iran (8%), our study result was higher [3,4]. Among the women who were aware of emergency contraception, only 29.2% gave the correct answer about utilization time: within 72 hours following unprotected sexual intercourse. When asked about when emergency contraception should be used, 46% gave the correct answer: when the condom tears and after unprotected sexual intercourse. However, no responses were provided when asked whether it could be used after rape. Our study showed that 80 (35.6%) women had used some form of emergency contraception, while 145 (64.4%) had not. Although emergency contraception is not recommended as a routine family planning method, it is a useful method after unprotected sexual intercourse to reduce the chance of unwanted pregnancy. Emergency contraception is particularly useful when barrier methods fail. However, women must be provided with sufficient information about emergency contraception and must be willing to use it for it to be effective [5]. Health providers were the most commonly cited source of information about emergency contraception (29.3%). A smaller proportion stated that they had received information from their family (4.5%). Healthcare providers have been slow to incorporate emergency contraception into routine consulting in Turkey. Family planning services and primary healthcare units provide free information on contraceptive methods for individuals or couples, and these units provide contraceptives free of charge or in return for minimal payment. In the present study, 70.2% of the women reported that they wanted to receive more information about emergency contraception, suggesting that they felt their knowledge was insufficient. The study has some limitations. It was carried out in one area of Turkey and may not be generalizable. The sample size was small and the participantswere all marriedwomen. In Turkey it is difficult to ask unmarried women about sexual matters. The study reveals a lack of knowledge among married women about the effective use of emergency contraception. We suggest that women should be routinely informed about emergency contraception during family planning counseling and other visits that offer potential educational opportunities from health professionals.

Vagal Withdrawal and Sympathetic Overactivity Contribute to the Genesis of Early-Onset Pregnancy-Induced Hypertension

Objective. In this study, we have assessed sympathovagal imbalance (SVI) by spectral analysis of heart rate variability (HRV) that contributes to the genesis of early-onset PIH. Methods. Body mass index (BMI), basal heart rate (BHR), blood pressure (BP) and HRV indices such as LFnu, HFnu, LF-HF ratio, mean RR, SDNN and RMSSD were assessed in normal pregnant women (Control group) and pregnant women having risk factors for PIH (Study group) at all the trimesters pregnancy. Retrospectively, those who did not develop PIH (Study group I) were separated from those who developed PIH (Study group II). Study group II was subdivided into early-onset and late-onset PIH. Sympathovagal balance (LF-HF ratio) was correlated with BMI, BHR and BP. Results. LF-HF ratio was significantly high in study group II compared to study group I and control group, and in early-onset PIH group compared to the late-onset category at all the trimesters of pregnancy, which was significantly correlated with BHR and BP. Alteration in HFnu in early-onset category was more prominent than the alteration in LFnu. Conclusion. Though the SVI in PIH is contributed by both sympathetic overactivity and vagal withdrawal, especially in early-onset type, SVI is mainly due to vagal inhibition.

Pruritus Gravidarum : A Clinical and Laboratory Study

Five hundred pregnant women attending obstetrics OPD were screened for the presence of pruritus. The patients with other dermatological causes of pruritus (other than specific dermatosis of pregnancy) were excluded from the study. The selected patients were further subjected to routine laboratory investigations including liver function tests and HBs Ag detection. The prevalence of pruritus in pregnancy was found to be 4.6% (23 cases). Ten patients were found to have specific dermatoses of pregnancy, including four cases of pruritus gravidarum and four of pruritic urticarial papules and papules of pregnancy. The prevalence of pruritus gravidarum was 0.8% of pregnancies. All the patients with pruritus gravidarum were primigravidae and had no clinical overlap with other specific dermatoses of pregnancy, jaundice, or intrahepatic cholestasis. One case of perinatal death was recorded among the pruritus gravidarum cases. This study has been helpful in determining the prevalence and severity of pruritus gravidarum in South India.

Oxidative stress in preeclamptic mother – newborn dyads and its correlation with early neonatal outcome – a case control study

Abstract Background: Preeclamptic mothers are likely to have increased oxidative stress during pregnancy which can adversely affect the outcome in their neonates. Objectives: To measure the oxidative stress in preeclamptic mother- newborn dyads and correlate it with the immediate neonatal outcome. Methods: This case control study conducted in a tertiary care teaching hospital, South India included 71 preeclamptic mothers – newborn dyads (cases) and 72 normal mothers – newborn dyads (controls). Biochemical parameters including total antioxidant status (TAS), protein carbonyls and malondialdehyde levels (MDA) were measured in both maternal and cord blood. Association between these oxidative stress parameters and early neonatal outcome was studied. Results: All oxidative stress markers were higher in the preeclampsia group compared to the controls. Cord blood protein carbonyl levels had significant correlation with maternal levels. Prematurity, low-birth weight, respiratory distress syndrome (RDS), early onset sepsis (EOS) and intra-uterine growth restriction (IUGR) were more among cases. Early neonatal outcomes like death, IUGR, EOS, and RDS had significant correlation with protein carbonyl levels among the cases. Conclusions: Oxidative stress is increased in preeclamptic mother – newborn dyads. Increased protein carbonyl levels in preeclampsia correlate with adverse early neonatal outcome.

Spectrum of vaginal discharge in a tertiary care setting

Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies.