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2019 | January-June | Volume 3 | Issue 1

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Reena Sood, Parvinder Arora, Harleen K Cheema, Madhu Nagpal

Outcome of Abnormal Placental Attachments in Pregnancies with a Review of Literature

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:7] [Pages No:1 - 7]

Keywords: Antepartum hemorrhage, Placenta accreta, Placenta previa

   DOI: 10.5005/jp-journals-10055-0057  |  Open Access |  How to cite  | 


Objective: The study evaluated the clinical course of a low-lying placenta, the outcome of a placenta previa with or without morbidly adherent placenta, and the association with previously reported risk factors. Materials and methods: A prospective descriptive study was conducted from December 2016 to May 2018 at a tertiary care hospital and medical institute on 66 cases of a sonographically diagnosed abnormal placental attachment at 20 or more than 20 weeks of gestation. We analyzed the potential risk factors and the respective outcomes of pregnancies with an abnormal placental attachment. Results: Of the 66 patients in the study, most of the patients (60.6%) were above the age of 30 years; the mean maternal age in the present study was 29.03 years. In this study, the rate of placental migration was 85% in patients without any history of a prior uterine surgery compared to 19.6% in patients with a history of a prior uterine surgery. The major outcome in our study was operative delivery (in 45 patients). A live birth was observed in 64 cases and 2 cases presented with an Intrauterine fetal demise. Of the 64 live born babies in the study, 14 (21.2%) were small for the gestational age and 50 (75.8%) were appropriate for the gestational age. Conclusion: Our study concluded that the most consistent risk factor of an abnormal placental attachment in pregnancy is scarred uterus. Abnormal placental attachment was associated with a higher operative delivery, hysterectomy, and blood transfusions.



Swati Sharma, Kamalpreet Kaur, Reena Sood, Madhu Nagpal

Emerging Trends in Peripartum Hysterectomy: A Retrospective Study in a Tertiary Care Center over 2 Years

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:8 - 12]

Keywords: Intrapartum, Peripartum hysterectomy, Placenta accreta

   DOI: 10.5005/jp-journals-10055-0059  |  Open Access |  How to cite  | 


Introduction: Peripartum hysterectomy (PH) is a lifesaving procedure performed at the time of delivery or in the immediate postpartum period in case of intractable obstetrical hemorrhage unresponsive to other measures. The indication for such procedure is severe uterine hemorrhage that may be due to abnormal placentation, i.e., placenta accreta, uterine atony, uterine rupture, leiomyomas, coagulopathy, or laceration of a uterine vessel not manageable by mere conservative measures. Materials and methods: This retrospective and analytical study was carried out at the Department of Obstetrics and Gynecology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar (SGRDIMSR, Amritsar), for a period of 2 years from January 2017 to December 2018. All the patients who underwent PH were reviewed. All concerned factors related to emergency and critical care were analyzed. Results: Out of under study cases, nine PH were conducted, seven being emergency and two elective for placenta accreta. The incidence being 3.53%, main indications were placenta accrete, n = 4 (44.4%); atonic PPH, n = 3 (33.3%); rupture uterus, n = 2 (22.2%). Out of these, n = 8 (88.8%) were referred cases and n = 1 (22.2%) were elderly gravida, almost all patients went to intensive care unit (ICU), average ICU stay being 10 days. Massive blood transfusion was done in n = 3 (33.3%) patients. Morbidity encountered were sepsis, anemia, bladder injuries and hypertension which were analyzed in this study. There was one mortality of G5P3L3A1 in emergency with placenta covering os in shock with severe anemia where emergency hysterectomy was performed for placenta accreta. Conclusion: Proper antenatal intrapartum care, early referral, and judicious decision making regarding cesarean section are the potential methods which can be implemented to prevent this catastrophic event. The anticipation of such complication by classifying those patients in the risk group, notifying a multidisciplinary team, and treatment, will greatly improve the final outcome.



Arunima Guru, Meenu Bhola, Gagandeep Singh

Comparative Evaluation of the Effect of Propolis and Chlorhexidine Mouthwashes on Streptococcus mutans Counts in Saliva: An In Vivo Study

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:13 - 17]

Keywords: Chlorhexidine, Propolis, Streptococcus mutans

   DOI: 10.5005/jp-journals-10055-0062  |  Open Access |  How to cite  | 


Background: The role of Streptococcus mutans as the causative agent of dental caries is well demonstrated and documented. Besides chlorhexidine being the widely used synthetic medicament, a natural antibiotic substance called propolis (bee glue) has attracted the attention of researchers due to its multiple pharmacological properties. This natural product is produced by honey bee and showed antibacterial activity against a range of commonly encountered Gram-positive microorganisms including Streptococcus mutans, preventing dental caries. Aims and objectives: This study aimed to compare the efficacy of 5% propolis and 0.2% chlorhexidine mouthwashes in reducing Streptococcus mutans colony counts in saliva. Materials and methods: Prerinse and 0.2% chlorhexidine mouthwash postrinse unstimulated salivary samples were collected from sixty subjects. The samples were then transferred to laboratory, using a transport medium, where they were cultured on trypticase soy yeast 20% sucrose bacitracin agar (TYS20B), a selective media for the growth of Streptococcus mutans. After one week, prerinse and 5% propolis mouthwash postrinse salivary samples were collected from the same subjects and were cultured in a similar manner. Each sample was serially diluted upto 1:104 dilutions with the help of automated pipettes. Streptococcus mutans colonies were identified by various tests and counted by the use of a digital colony counter. Results: The reduction of Streptococcus mutans by both the mouthwashes was found to be statistically significant and compared. 0.2% chlorhexidine showed better results in reducing Streptococcus mutans colonies than 5% propolis, which individually showed a good efficacy against the culprit microorganism. Conclusion: Chlorhexidine has statistically better anticariogenic efficacy in comparison to propolis against Streptococcus mutans in saliva. On the other hand, propolis itself showed a significant anticariogenic activity against the growth of Streptococcus mutans. It may be considered as an alternative natural mouthwash to enhance oral health with minimum side effects.



Manpreet Kaur, Gopal S Charan, Tamil Selvi

Parents’ Satisfaction Concerning Their Children's Care at Tertiary Hospital

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:18 - 22]

Keywords: Children, Factors, Parents, Satisfaction

   DOI: 10.5005/jp-journals-10055-0066  |  Open Access |  How to cite  | 


Introduction: Hospitalization of children is painful for both children and their parents. Patient's satisfaction is defined as patient's attitude toward and decision about the degree of fulfilling their proclivity and assumptions by healthcare providers. Materials and methods: An exploratory study on factors affecting parental satisfaction regarding care of children admitted to the Pediatric Department of SGRD Hospital, Amritsar, Punjab, India. Convenience sampling technique was employed to obtain a sample of 100 parents residing at pediatric department through interview schedule. The data were analyzed using SPSS software version 17. Descriptive statistics was used to determine mean and percentages. In inferential statistics, Chi-square test was used for association. Results: The study results showed that 69.0% parents were satisfied and 31.0% were more satisfied. The domain-wise findings show that parents’ satisfaction regarding admission criteria is 67.0%, hospital environment 86.0%, patient care 77.0%, and communication/information 53.0%. Conclusion: This study suggests that parents were satisfied and very satisfied with the treatment and care provided to their children during hospitalization at SGRD Hospital. However, some components need to be considered to increase and maintain the high satisfaction level, i.e., friendly communication/information with parents.



Guljit Kaur, Bhakti Kohli, Reena Sood

Correlation of Hyperhomocysteinemia with the Severity of Pregnancy-induced Hypertension—A Case–Control Study

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:4] [Pages No:23 - 26]

Keywords: Folic acid, Homocysteine, Preeclampsia, Pregnancy-induced hypertension, HELLP syndrome

   DOI: 10.5005/jp-journals-10055-0068  |  Open Access |  How to cite  | 


Background: Hypertension is the most common medical problem encountered during pregnancy and is a major cause of maternal morbidity and mortality. Serum homocysteine-mediated vascular changes are similar to those associated with preeclampsia and, hence, hypothesized to be associated with this condition. The present study is being undertaken to study the association of serum homocysteine with pregnancy-induced hypertension (PIH) and folic acid supplementation. Materials and methods: This is a prospective study conducted in a tertiary care teaching hospital in Punjab. The study was carried out for a period of 2 years. This study included 60 pregnant women, out of which 30 subjects were having hypertensive disorders of pregnancy and 30 were normotensive subjects. Fasting serum homocysteine levels were obtained, compared, and analyzed. The test was based on an immunoassay technique. The normal range of serum homocysteine was taken as 5–15 µmol/L. Results: In this study, serum homocysteine levels were found to be higher in hypertensive subjects as compared to that in normotensive subjects. The levels of serum homocysteine were higher in severe forms of PIH in comparison to nonsevere forms. Also, the level of serum homocysteine was associated with folic acid supplementation. Conclusion: In summary, the present study has shown an increased level of serum homocysteine in both mild and severe preeclampsia compared with normal pregnancy and a statistically significant association of total homocysteine concentrations with the severity of the disease.



Manpreet Kaur, Jasbir Kaur

Health Issues of Women in Old Age: A Literature Review

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:6] [Pages No:27 - 32]

Keywords: Elderly women, Feminization of aging, Health disparities

   DOI: 10.5005/jp-journals-10055-0065  |  Open Access |  How to cite  | 


India, the largest democracy of the world and second most populous country, is now also emerging as the sixth largest economy in the world. There are around 104 million elderly persons (8.6%) (Census, 2011) and the number is expected to increase to 296.6 million constituting 20% of the total population by 2050. The sex ratio of the elderly was 938 women to 1,000 men in 1971 which has increased to 1,033 in 2011 and further projected to increase to 1,060 by 2026. These changing trends have led to feminization of aging. Further inherent discrimination and neglect experienced by aging women, frequently exaggerated by widowhood and complete dependence on others. On the social front, old women experience isolation/destitution, financial, and emotional insecurity. This further aggravates the health problems among old women. Elderly women in India face different types of health-related issues due to various socioeconomic factors. Studies report that chronic morbidity, poor vision, cataract, blood pressure, back pain/slipped disc, malnutrition, depression, impaired physical performance, and elder abuse were significantly higher amongst women as compared to elderly men. The literature also reveals that women experience difficulty in coping with these health problems due to widowhood, economic dependency, lack of proper food and clothing, fear of the future, lack of caring, and progressive decline in health made coping with health problems difficult. The socioeconomic and health needs of the women are enormous but, unfortunately, the existing, national policies, and programmatic capacities are inadequate and lack gender sensitivity.



Dinesh Kumar, Saniya Kapila

Morvan's Syndrome—A Case Report of a Rare Clinical Scenario

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:2] [Pages No:33 - 34]

Keywords: Agrypnia excitata, Antivoltage-gated potassium channel antibodies, Morvan's syndrome

   DOI: 10.5005/jp-journals-10055-0056  |  Open Access |  How to cite  | 


Background: Neuromyotonia is a disorder of peripheral nerve hyperexcitability, causing spontaneous muscular activity. It is an extremely rare disease. Infrequency with which it is encountered and nonspecific, vague symptoms in young people make it a formidable diagnostic challenge. Case description: We present a case of a 34-year-old male with complaints of twitching in muscles and pain in the thigh and calf region. These complaints occurred on and off since the last 6 months. He has a positive family history of similar symptoms. The patient was positive for serum voltage gated potassium channels (VGKC) antibodies. Electromyography (EMG) studies showed evidence of neuromyotonia. A diagnosis of Morvan's syndrome (neuromyotonia) was made on the basis of symptoms and EMG findings. The treatment of the patient was started on intravenous steroids, antiepileptics, and SSRI. Conclusion: Diagnosis of neuromyotonia is a challenge. Awareness among people is important to mitigate the symptoms and provide timely management.



Jotdeep S Bamrah, Kulwant S Ded, Gopal S Bhargava

An Unusual Presentation of Epidermoid Cyst: A Case Report

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:2] [Pages No:35 - 36]

Keywords: Dermoid cyst, Epidermoid cyst, Penile cyst

   DOI: 10.5005/jp-journals-10055-0060  |  Open Access |  How to cite  | 


Penile cysts are uncommon. A case of a 5-year-old boy with an epidermoid cyst of the penis is reported. He was found to have an asymptomatic soft mass at the dorsum of his penis. Preoperative differential diagnosis of the epidermoid cyst and the dermoid cyst was considered. Excision of the mass was performed, and the diagnosis of epidermoid cyst in the penis was made that was confirmed on histopathological examination. In such cases, clinicians should manage patients either by observation or excision of the cyst.



Ayesha J Khan, Gopal S Bhargawa, Manu Kohli, Kulwant S Ded

Gastrointestinal Hemorrhage due to Metastatic Choriocarcinoma

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:2] [Pages No:37 - 38]

Keywords: Gastrointestinal hemorrhage, Germ-cell tumors, Metastatic choriocarcinoma

   DOI: 10.5005/jp-journals-10055-0061  |  Open Access |  How to cite  | 


Testicular germ-cell tumors represent approximately 1% of all cancers in man and are the most common malignancy between 15- and 35-year olds. Choriocarcinoma represents less then 1% of testicular tumors. Metastatic choriocarcinoma is a rare nonseminomatous germ-cell tumor with a characteristic hemorrhagic tendency due to its trophoblastic origin. The main characteristic of these tumors is that they metastasize to retroperitoneal lymph nodes, less frequently, to lungs, liver, and brain in 80% of the cases. Metastasis to gastrointestinal tract is extremely rare, around 5%. We report a case of 39-year-old man with no significant medical or surgical history was admitted with complaints of melaena and was diagnosed by the presence of metastatic lesions in the jejunum and ileum during laparotomy and left high-end orchidectomy was done. The patient could not survive because of grave prognosis. This is probably due to choriocarcinoma on histological findings. In conclusion, the case of gastrointestinal hemorrhage, a pan endoscopic examination, and histologic evaluation should be carried out to identify metastatic lesions and provide potential endoscopic therapy.



Shivkaran K Gill, Karaninder S Wilku, Neeti R Singh

Patent Urachus with Stone in Adult Male: A Rare Case Report

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:2] [Pages No:39 - 40]

Keywords: Adult male, Patent urachus, Urachul calculus

   DOI: 10.5005/jp-journals-10055-0063  |  Open Access |  How to cite  | 


The urachus is a fibrous remnant of the allantois, a canal that drains the urinary bladder of the fetus that joins and runs within the umbilical cord. The fibrous remnant lies in the space of Retzius, between the transverse fascia anteriorly and the peritoneum posteriorly. Failure of the inside of the urachus to be filled in leaves the urachus open, and four distinct types of urachal anomalies arise. In order of frequency, they are a patent urachus (50%), a urachal cyst (30%), an umbilical urachal sinus (15%), and a vesicourachal diverticulum. We are reporting here a case of a patent urachus containing calculus in a 45-year-old male patient, which is an extremely rare finding. The patient underwent exploratory laparotomy. Post-operative recovery of the patient was uneventful. This case was unusual in that the urachus contained a calculus, the patient was a young man who had never before shown any signs or symptoms of the condition or lower urinary track obstruction before this attack, and the calculus was near the vesical end of patent urachus.



Gaurav Agnihotri, Piyush Jindal

An Overview of the Biomedical Waste Generation on Per Bed Basis in Some Hospitals of Punjab State of India

[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:4] [Pages No:41 - 44]

Keywords: Bed occupancy, Biomedical waste generated, Biomedical waste practices

   DOI: 10.5005/jp-journals-10055-0064  |  Open Access |  How to cite  | 


Introduction: The biomedical waste management is an important issue and it also a challenging one. The present study was designed to assess the quantum of biomedical waste generated for some hospitals in Punjab. The study also intends to seek possible explanations for the different values obtained for different institutes. Materials and methods: Ten hospitals with a bed capacity of 200 or more were selected for the study. The biomedical waste generated from these institutions for the months of September, October, and November 2018 was scrutinized. The biomedical waste generated per bed (assuming 100% bed occupancy and actual bed occupancy) was determined. The results were sent to the administrative officers of these institutes and possible explanations sought for the similarity/difference amongst institutes. Results: From the results, it is evident that hospitals with larger bed strength are not necessarily generating more biomedical waste per bed. Rather, a careful observational analysis reveals that private institutes in general are generating more biomedical waste per bed occupied vis-a-vis the government institutes. This could in part be attributable to more disposables being used in these institutions and good practices of biomedical waste management followed in these institutes. The extent of biomedical waste generated by an institute also depends upon the number and type of patients admitted in departments. It is also influenced by the bed strength allocated to different departments. Still, the institutes with lesser biomedical waste generation should ensure that biomedical waste practices are strictly being followed and the record keeping is referable and meticulous. Conclusion: The quantity of biomedical waste is increasing in its amount and type due to advances in scientific knowledge and this has an impact on human lives. So, it is imperative that efforts are continuously made in the right direction so that biomedical waste disposal goals are achieved to highest possible pinnacle.


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