Fernandez Hospital

Women with high Body Mass Index (BMI) are at increased risk of maternal and perinatal complications. These complications range from diabetes, hypertensive disorders, preterm births, increased rates of cesarean births, anesthesia related challenges, macrosomic fetuses, fetal anomalies, stillbirths, postpartum hemorrhage and surgical site infections. In this study, maternal and perinatal outcomes of women with BMI > 50kg/m2 from a single center are presented. The primary objective was to determine the risk of maternal and fetal complications in super obese pregnant women. The secondary objective was to study the incidence of super obesity in the study population. This was a retrospective cohort study conducted over eleven years (January 2013-December 2023) at Fernandez Hospital, a tertiary perinatal care center with approximately 8000 births per annum. Data were sourced from electronic medical records. The study group included women with singleton pregnancies with BMI ≥ 50kg/m2, birthed at the center and the control group included all other women. The overall incidence of super obesity (BMI ≥ 50kg/m2) was 1 in 1000 births. On comparing women with various BMI ranges, there was a significant increase in maternal complications such as chronic hypertension, pregnancy induced hypertension, pregestational diabetes mellitus, gestational diabetes mellitus and hypothyroidism (p < 0.001) as the BMI increased. Super obese women experienced high rates of cesarean section (54%, p = 0.009), fetal growth abnormalities like small for gestational age (12%, p = 0.017), large for gestational age (17%, p < 0.001) and stillbirths (1%, p = 0.001). Adverse maternal and perinatal outcomes are directly proportional to maternal obesity. This emphasizes that these women should be managed at a dedicated clinic for comprehensive multidisciplinary care.

Parents of children with cancer often face complex decisions about clinical trial participation and treatment options. This cross-sectional survey of 100 parents of pediatric oncology patients explored their perspectives on accessing clinical trials, focusing on influencing factors and perceived barriers. While most parents expressed interest in clinical trial participation, common obstacles included inadequate information, geographic constraints and financial challenges. Many parents emphasized the need for improved communication with healthcare providers to better understand trial risks and benefits. These findings suggest that addressing informational and logistical barriers can enhance access to clinical trials and support informed decision-making among parents of pediatric oncology patients.

Urological malignancies during pregnancy are exceedingly rare, with bladder cancer posing significant diagnostic and management challenges. This study describes a 28-year-old pregnant woman diagnosed with non-invasive papillary urothelial carcinoma, presenting with painless hematuria at 22 weeks of gestation. The diagnostic process included ultrasound and MRI, both of which confirmed a solitary polypoidal lesion. Surgical management was performed through transurethral resection of bladder tumor (TURBT) under spinal anesthesia at 24 weeks gestation. Challenges included differentiating hematuria from common pregnancy-related conditions and ensuring fetal safety during diagnostic imaging and surgery. The patient delivered a healthy baby at 37 weeks and remains recurrence-free one-year post-surgery. This study underscores the importance of multidisciplinary care and highlights the need for further research into urological cancers in pregnancy to improve outcomes for both mother and fetus.

IntroductionCongenital hypothyroidism (CH) is one of the most common, easily treatable, causes of long-term neurodevelopmental complications in children. The prevalence of CH in India is much higher compared to other countries. Although developed countries have well-established neonatal screening programs, a uniform nationwide screening program at birth is still not established in India. Cord blood thyroid-stimulating hormone (TSH) screening is crucial in diagnosing congenital hypothyroidism even with advancements in expanded newborn screening programs. The aim of this study was to determine the prevalence of elevated cord blood TSH levels and factors associated with it among newborns and to analyze the false positive rates of elevated cord blood TSH levels among the study population and factors associated with it.MethodsThis retrospective cross-sectional study was conducted among 51,251 live newborn babies born at Fernandez Hospital, Hyderabad, India, over a period of five years from January 2019 to December 2023. The data of all the mothers and newborns was retrieved from medical records and details of maternal age, parity, co-morbidities, mode of delivery, gestational age of the newborn at delivery, gender, number of babies, APGAR score, and birth weight were obtained. As per hospital policy, 5 ml of cord blood sample of all newborn babies was collected from the umbilical cord at the time of birth. Samples were analysed for cord TSH batchwise by the enzyme-linked immunosorbent assay (ELISA) method. As per the manufacturer, the normal biological reference intervals are <20 uIU/mL. All the cord TSH values > 20 uIU/ mL were considered abnormal and advised a repeat serum TSH test within 14 days of life. Cord TSH values that were higher than the biological reference range after retesting were considered positive for CH. All the initial and repeat results were retrieved from the neonatal digital database.ResultsOut of 51,251 live newborn babies, 71 (0.14%) were confirmed with a diagnosis of congenital hypothyroidism. The prevalence of CH in our study population was 1.4 per 1000 live births. Anaemia was found to be a statistically significant predictor of true positive cases (p<0.05). In our study, while evaluating risk factors for elevated cord TSH levels, we found that the babies born by vaginal delivery had higher cord TSH levels than babies born by lower segment caesarean section (LSCS) (p<0.001). The other variables considered in the study which include maternal age, BMI, parity of mother, gender of the baby, birth weight, gestation age and APGAR score were not statistically significant for CH.ConclusionThe prevalence of congenital hypothyroidism was 1.4 in 1000 in our study. Mode of delivery and maternal anaemia had an impact on elevated cord TSH levels. These factors should be considered while interpreting cord TSH values. Cord TSH testing is an effective screening tool for CH. It helps in the early detection of thyroid dysfunction in newborns, enabling timely intervention and treatment to prevent developmental delays and other complications. This study presents evidence supporting the inclusion of cord blood TSH as a predictive factor in CH screening programs.

SummaryBackgroundDespite higher risk of poorer outcomes and potential sub-optimal vaccine effectiveness, people living with HIV (PLWH) are underrepresented in SARS-CoV-2 vaccine trials. We evaluated the safety and immunogenicity of the Ad5-nCoV vaccine (CanSino Biologics Inc./The Beijing Institute of Biotechnology) in PLWH.MethodsIn this single arm, open-label Phase 2b trial, PLWH were enrolled in Argentina. Participants received two doses of Ad5-nCoV vaccine (intramuscular, dosage 5×1010viral particles) at days 0 and 56. The primary outcomes were safety as serious adverse events [SAE], solicited and unsolicited local and systemic adverse events, impact on HIV viral load and CD4 counts and immunogenicity measured by S-RBD IgG and pseudo-virus neutralizing antibodies (nAbs) up to 52 weeks (ClinicalTrials.gov:NCT05005156).FindingsBetween June 2021-January 2022, 140 PLWH received at least one dose of Ad5-nCoV vaccine. At baseline, the majority were on antiretroviral therapy (99.3%), virologically suppressed (93.6%), with a median (IQR) CD4-cell count:736 (531-946) cells/ul. At baseline, 38 (27%) participants were seropositive for S-RBD antibodies, and 40 (28%) for nAbs. There were no SAEs related to the vaccine. Solicited AE within 7 days after first and second dose occurred in 93 (69%) and 75 (60%) participants, mostly grade 1, included pain, drowsiness and headache. The incidence of unsolicited AE within 28 days of vaccination was 10.7%. There were no significant changes in plasma viral load, CD4, CD4/CD8 ratio and no new AIDS-defining illnesses were reported. There were significant increases in the geometric mean titers (GMT) of S-RBD and nAbs between baseline to week 52. Seroconversion rates 28 days after the first and second doses (day 84) were 80% and 94% for S-RBD, and 35% and 78% for nAbs.InterpretationTwo doses of the Ad5-nCoV vaccine were safe and induced an adequate immune response in virologically suppressed PLWH, maintaining high antibody titers at least during the first year post-vaccination.FundingCanSino Biologics Inc, Tianjin, China

Abstract Objectives This article determines the incidence, management, and outcomes of twins discordant for major structural anomalies. Materials and Methods A retrospective observational study was conducted from 2011 to 2021. Pregnant women discordant for major malformations as confirmed postnatally were included in the study. Demographic and clinical details were collected from medical records. Determining the incidence and profile of twins discordant for major structural anomalies and their management and outcomes were considered as primary objectives that were detailed in dichorionic (DC) and monochorionic (MC) twin pregnancies. Results A total of 83 subjects were included, with an incidence of 1.76% in DC pregnancies and 1.4% in MC pregnancies. Major structural anomalies among DC twins were musculoskeletal (26%), followed by circulatory system anomalies (20.2%), while among MC twins, the majority were found to be central nervous system anomalies (35.7%). Gastrointestinal system anomalies were found the least, with 5.8% in DC anomalous twins, and none were observed in MC anomalous twins. Live birth rate among anomalous twins was found to be 79.71 and 64.29%, and in normal cotwins, it was 92.75 and 85.71% in DC and MC twins, respectively. Surviving anomalous twins underwent postnatal surgery or intervention in 25/69 (36.2%) DC twins, out of which 20 infants were alive and healthy. In the MC anomalous twin group, 3/14 (21.42%) underwent surgical correction; all were alive and well. Postnatally, babies were followed up until 2 years of life. The survival rate for anomalous twins was 47.82% in DC and 35.7% in MC twins. Normal cotwins had overall favorable outcomes, with a survival rate of 89.8 and 85.7% in DC and MC twins, respectively. Conclusion In DC twins discordant for major anomalies, expectant management is a safe option.

Abstract Objective Nasal Intermittent Positive Pressure Ventilation (NIPPV) is an effective therapy for infants in respiratory distress. We here report the safety of a novel, low-cost, non-electric bubble NIPPV device in comparison with bubble NCPAP.Study Design: At Paramitha Children’s Hospital (Hyderabad, India), preterm (n = 60) neonates with moderate respiratory distress were pragmatically allocated to bubble NCPAP (5–8 cm H2O) or bubble NIPPV (Phigh 8–12 cm H2O/Plow 5–8 cm H2O) based on staff and equipment availability. Primary outcomes to assess safety included clinically relevant pneumothorax, nasal septal necrosis, or abdominal distention.Results One patient in each arm developed minor nasal septal injury (grade 3 on NCPAP, grade 2 on NIPPV); no patients in either arm developed a clinically significant pneumothorax or abdominal distention.Conclusion The similar rates of nasal septal injury, pneumothorax and abdominal distention suggest that bubble NIPPV has a similar safety profile as bubble NCPAP for preterm infants in respiratory distress.

Dengue fever is one of the most important mosquito borne neglected tropical disease of major public health concern. The disease may be asymptomatic or may give rise to undifferentiated fever, dengue fever, dengue haemorrhagic fever, or dengue shock syndrome. This review outlines the current knowledge of the dengue virus, mosquito vector, transmission, immune pathogenesis, clinical manifestations, diagnosis, and the treatment and management and prevention and control of these infections and recent advances in vaccine development.