Cama and Albless Hospital

Vein of Galen malformation (VOGM) is a rare congenital arteriovenous malformation affecting the pediatric population, characterized by a fistula between the diencephalon and a dilated vein of Galen. The present study reports the case of a 6-month-old male infant referred for developmental delays and abnormal head circumference. A clinical examination revealed macrocephaly, dilated scalp veins and neurological abnormalities. Neuroimaging confirmed a large VOGM with associated hydrocephalus. A multidisciplinary team devised a treatment plan involving endovascular embolization and ventriculoperitoneal shunt placement. The post-operative recovery exhibited an improvement in neurodevelopmental milestones and a reduced head circumference. Generally, the management of VOGM requires a comprehensive approach, including early diagnosis, precise imaging and timely intervention. The case described herein highlights the importance of interventional radiology in planning a management plan and the novel kissing microcatheter endovascular embolization technique.

Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.

This case presents the work-up and management of a spina bifida patient with recurrent prolapse. Four international experts also provide their evaluation of and approach to this complex case. According to the literature, little is known regarding the approach to the management of this specific patient population.

Introdução: ACSF, 4 anos, sexo feminino, com quadro de mudança comportamental associada à cefaleia de forte intensidade e vômitos. Ao exame neurológico estava vigil, consciente, com força motora preservada e simétrica, reflexos profundos normais, coordenação motora sem alterações e pares cranianos com funções preservadas. Foi solicitada ressonância magnética de crânio que evidenciava volumoso processo expansivo heterogêneo captante de contraste na região frontotemporo-parietal esquerda com desvio da linha média.

Adsorption behavior of remazol reactive dyes from textile effluent was investigated using Rhizopus arrhizus as a biosorbent in up-flow fixed-bed micro column. The characteristics of mass transfer zone (MTZ), where adsorption in column occurs, were affected by bed depth and flow rate. The height of mass transfer zone (HMTZ), the rate of mass transfer zone (RMTZ), the effluent volume (Veff) and the column capacity at exhaustion (qcolumn) were estimated for the removal of dyes by the biosorbent. Thomas and Yoon–Nelson models were applied to the experimental data to predict the “S” shaped breakthrough curves and to determine the biosorption capacity of the column. Both the models were found suitable for describing the whole dynamic behavior of the column with respect to flow rate and bed depth. Hutchins BDST model showed that the variation of the service time with the bed depth was highly linear, thus, indicating its validity when applied to the continuous microcolumn studies. The empty bed residence time model (EBRT) indicated that the biosorbent exhaustion rate decreased with increasing EBRT. The results of this study indicated the applicability of fixed-bed micro column for removing remazol reactive dyes from the textile effluent. © 2017 American Institute of Chemical Engineers Environ Prog, 2017

Aim: To study the outcome and complications of neoadjuvent chemotherapy in locally advanced Carcinoma of Cervix in Indian patients. To study the outcome and complications of Radiotherapy in locally advanced Carcinoma of Cervix in Indian patients. Materials and Methods: It is a Prospective analytical study of 95 ( n =95) patients registered in the Out-patient section (OPD) of Department of Radiation Therapy and Oncology and indoor patients in gynaec oncology ward in tertiary care institute with histopathologically proven carcinoma of cervix were included in the study. Study duration was from August 2012 to August 2014. Patients with Histologically confirmed cases of carcinoma of cervix with FIGO stage IIB to IVA who were suitable for chemoradiotherapy were included in the study. The baseline characteristics Age, Parity, Weight, Height, Body Surface Area, Socioeconomic Status, FIGO Staging, Histological Variety of Carcinoma Cervix, pre and post treatment ECOG score were noted. The median follow up period was 18 months. All patients were given 3 cycles of Neoadjuvent chemotherapy with each cycle 3 weeks apart, consisting of the drugs dose calculated according to body surface area, Injection Paclitaxel was given as intravenous infusion in a dose of 175 mg /m 2 on day 1 of chemotherapy cycle whereas Injection Cisplatin was given in a dose of 60 mg /m 2 intravenous infusion in two divided doses on day 1 and day 2 of neoadjuvent chemotherapy cycle. NACT was followed by concurrent chemoradiotherapy which included conventional fractionated radiotherapy (CFR) with weekly injection cisplatin 35mg/m 2 , EBRT of total dose 50Gy (Gray) in 25 fractions, 200cGy (centigray) per fraction daily for 5 days a week and brachytherapy i.e. Intracavitary Radiation Therapy (ICRT) was given. Results: RECIST 1.0 criterion was used for assessment of the response to treatment. Out of 95 patients, 72 patients (75.78%) had complete response. Partial response was seen in 13 patients (13.68%). Stable disease was seen in 7 patients (7.3)%. 3 patients (3.15%) had progressive disease. Subjective response was evaluated after asking the patient about status of their presenting symptoms one month after completion of whole treatment. Out of 90 patients who had vaginal discharge, 80 patients (88.89%) got relief after complete treatment. Out of 65 patients who had vaginal bleeding, 59 patients (90.76%) were free of this symptom at the completion of treatment. Out of 36 patients who suffered with pelvic discomfort at the start of therapy, 16 patients (44.44%) got symptomatic improvement. During the course of treatment, 56 patients (58.94%) developed Nausea and Vomiting, 30 patients (31.57%) had diarrhoea, 10 patients (10.52%) had cystitis, 7 patients (7.36%) had proctitis, 9 patients (9.47%) developed peripheral neuropathy, 15 patients (15.78%) suffered fever and rash. Renal complications occurred in 7 patients (7.36%). Hematological side effects including anemia neutropenia and thrombocytopenia were noted in 25 patients (26.31%) Median follow-up period for patients was 18 months. Overall survival rate at 1 year after treatment was 74.73% whereas Disease free survival rate at 1 year after treatment was 69.47%. Conclusions: We conclude that, the study has demonstrated a good response rate to NACT followed by CRT in patients with locally advanced carcinoma of cervix with regard to tumour response, overall and disease free survival. The combination of paclitaxel with cisplatin for use in neoadjuvnant chemotherapy showed acceptable adverse effects.

Multiple pregnancy is simultaneous development of more than one fetus in uterus. Multifetal gestations also are associated with significantly higher maternal morbidity and associated health care costs. Women with multiple gestations are nearly 6 times more likely to be hospitalized with complications, including preeclampsia, preterm labor, preterm premature rupture of membranes, placental abruption, pyelonephritis, and postpartum hemorrhage. Aim and objectives: To find out incidence of multifetal pregnancies, and frequency of preterm births and low birth weight. To find out correlation of parity and the incidence of different modes of delivery in multifetal pregnancy. To study the complication multifetal pregnancy and the neonatal outcome. Materials and methods: Patients with multifetal gestation were studied over a period of 2 years in a tertiary health care centre. Observations: These were recorded as per the proforma.It is determined that, prematurity was the most common complication among the multiple pregnancies, in both twins (49.606 %) and triplets. Followed by 6.13 % of the twins with intrauterine fetal death, 3.906 % twins having polyhydroamnios, 1.562 % having congenital anomaly like hydrocephalous, and other neural tube defects, 1.986% twins had IUGR. Among the maternal risks in multiple pregnancy, the majority of patients developed preterm labour (48.461 %) and 14.615 % developed PIH, 11.538 % patients had PROM, Polyhydroamnios was present in 3.846% patients, 1.538% patients had abruption, 1.538 % patients had PPH, 3.706 % of patients were hypothyroid, amongst others included one case of Heart disease, Autoimmune hepatitis, HEV positive, HBsAg positive and tubercular pleural effusion each. The outcome of all the 128 cases of twins and 2 cases of triplets were studied in detail. Of which 70 patients presented in labour and 50 patients were admitted in hospital as high risk pregnancies Conclusion: Our study highlighted the importance of antenatal care playing a major role in the final outcome of multiple pregnancy. Also the age at which the patient conceived, for this multiple gestation and the parity for the present multiple gestations reflected the socioeconomic status and awareness among the patients.

Umbilical venous pH is claimed to mirror fetal acid-base status. Importantly, it is easier to perform. The aim of this study is to : 1. Evaluate the umbilical venous blood gas (UVBG) profile of normal newborns and to compare UVBG in the following situations: presence or absence of asphyxia presence or absence of meconium-stained amniotic fluid presence or absence of respiratory distress: and in newborns that did and did not survive and 2. To study the peripheral venous blood gas (PVBG) profile of newborns that develop cardio-respiratory insufficiency (CRI). Venous blood gas (VBG) was performed in 961 newborns consecutively admitted to the neonatal nursery over one year and in 100 controls. PVBG was also performed in 370 admissions to the nursery that developed signs of CRI. Demographic, clinical and outcome data were collected. Mean UVBG parameters (pH, pCO2, HCO3, base deficit, pO2 and SO2%) were compared between different groups of newborns using t test. This study had ethical approval. Of the 3349 live births over one year, 961 (28.7%) needed intensive care. Of these, 123 (12.8%) died. All the mean cord gas parameters differed significantly between who died and who survived. Metabolic acidosis and hypoxemia were conspicuous on PVBG among babies with CRI. Except for PO2 all the mean parameters of UVBG differed significantly with asphyxia and meconium-stained amniotic fluid. When similar comparison was made among newborns that did or that did not develop respiratory distress, the difference was significant for all the parameters except SO2%. UVBG gives useful information about common neonatal morbidities and appears to be a useful tool for neonatal assessment. PVBG gives objective information about babies with CRI that may need special interventions.

Background: Globally the incidence of unwed mothers is rising. While the incidence is higher in western countries, developing countries like India are soon catching up. Methods: Ours is a retrospective study from January 2009 to December 2013 analyzing 51 cases of unwed mothers for - changing incidence of unwed mothers in India, to look for predisposing social & family pressures which may have led to the pregnancy, to study neonatal outcomes in such mothers & to analyze the role of social worker intervention in the management of such pregnancies. Results: Our study showed a 50% rise in the incidence of unwed mothers in our institute over the years with a majority (49%) of them being teenaged girls. 68% unwed mothers were uneducated or had only primary education & 58.9% unwed mothers had some predisposing factor which might have contributed to the pregnancy. 52% unwed mothers (who delivered) opted for institutional admission till term and 35.4% of these underwent a caesarean section at term (higher than institute LSCS rates). 21.5% unwed mother united with father with social worker intervention. Conclusions: Social and demographic parameters play a significant role in the incidence of unwed mothers. Several of these parameters are subject to external regulation & can reduce incidence of unwed mothers. Also the role of a social worker is priceless in management of these patients.