Feto-maternal outcomes in near miss events in obstetrics

Background: Maternal near miss is defined by world health organization as a woman, who being close to death survives a complication occurring during pregnancy, delivery or upto 42 days after her end of pregnancy.It is a retrospective diagnosis. Evaluation of near miss maternal morbidity and mortality is a surveillance method to assess the quality of obstetric care and determinants of poor maternal outcome. It is an indicator of quality of obstetrical care. Aims and objectives for current study was to evaluate the cause of near miss maternal morbidity in our hospital which occurred either in admitted patients or were referred from elsewhere and to study the maternal and fetal outcomes in all near miss cases.Methods: A retrospective review of obstetrical records as well as prospective analysis was done at Christian medical college and hospital, a tertiary care teaching institute in North India and referral centre. The study was done for a period of one year from November 2018 to October 2019 retrospectively and for 6 months from November 2019 to April 2020 prospectively. The maternal near miss cases were taken as per WHO criteria.Results: The age ranged from 19 years to 49 years with maximum belonging to age group of 20-24 years. Maximum number of cases was primigravida and was in third trimester. The primary obstetric complication evaluated were hypertensive disorders followed by hematological diseases, viral hepatitis, haemorrhage, and obstructed labour or ruptured uterus.Conclusions: All the causes of MNM observed in this study are preventable causes, which can be identified timely and treated early to prevent maternal mortality, thereby, improving obstetrical and neonatal outcome.

A Pilot Study of Rare Renal Amyloidosis Based on FFPE Proteomics

Renal amyloidosis typically manifests albuminuria, nephrotic-range proteinuria, and ultimately progresses to end-stage renal failure if diagnosed late. Different types of renal amyloidosis have completely different treatments and outcomes. Therefore, amyloidosis typing is essential for disease prognosis, genetic counseling and treatment. Thirty-six distinct proteins currently known to cause amyloidosis that have been described as amyloidogenic precursors, immunohistochemistry (IHC) or immunofluorescence (IF), can be challenging for amyloidosis typing especially in rare or hereditary amyloidosis in clinical practice. We made a pilot study that optimized the proteomics pre-processing procedures for trace renal amyloidosis formalin-fixed paraffin-embedded (FFPE) tissue samples, combined with statistical and bioinformatics analysis to screen out the amyloidosis-related proteins to accurately type or subtype renal amyloidosis in order to achieve individual treatment. A sensitive, specific and reliable FFPE-based proteomics analysis for trace sample manipulation was developed for amyloidosis typing. Our results not only underlined the great promise of traditional proteomics and bioinformatics analysis using FFPE tissues for amyloidosis typing, but also proved that retrospective diagnosis and analysis of previous cases laid a solid foundation for personalized treatment.

The Influence of Depression on Biased Diagnosis of Premenstrual Syndrome and Premenstrual Dysphoric Disorder by the PSST Inventory

The diagnosis of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) poses a challenge for clinicians due to the overdiagnosis of retrospective methods and overlapping symptoms with depression. The present study utilized an Item Response Theory analysis to examine the predictive utility of the Premenstrual Symptom Screening Tool (PSST) in women with and without depression. Two hundred and fifteen women aged 20–35 completed the PSST, a daily symptom calendar, SCID-I, and CES-D for two consecutive menstrual cycles. PSST items: fatigue, depressed mood, feeling overwhelmed, anxiety/tension, and decreased interest in everyday activities were the best predictors of PMS. Unlike the daily symptom ratings, the PSST over-diagnosed PMS/PMDD in the depressed group but not in the group of women without PMS/PMDD. While diagnosing premenstrual disorders, clinicians should be aware that a retrospective diagnosis with PSST can be more sensitive to mood disorders and cycle phases than a prospective diagnosis with a daily symptoms calendar.

Retrospective diagnosis of SARS-CoV-2 infection in patients with Long COVID by measuring specific T cell mediated IL-2 release.

National Institute for Health and Care Excellence (NICE) guidelines define Long COVID as signs and symptoms that develop during or after an infection consistent with COVID-19, that continue for more than 12 weeks and are not explained by an alternative diagnosis. Long COVID is as yet poorly understood and difficult to diagnose. The diagnostic complexity of Long COVID is compounded in many patients who were infected with SARS-CoV-2 but not tested at acute presentation and are antibody negative. Given the diagnostic conundrum of Long COVID, we set out to design a SARS-CoV-2 specific T cell assay, to follow up a cohort of undifferentiated mostly non-hospitalised patients with Long COVID for up to 13 months. Here, we show that IL-2 release from SARS-CoV-2-specific memory T cells shows >75% sensitivity and >88% specificity in identifying individuals with confirmed SARS-CoV-2 infection >6 months after a positive PCR test.

Retrospective diagnosis of lymphatic tuberculosis in frozen samples using two genetic amplification methods, Xpert® MTB/RIF ULTRA and Abbott RealTime MTB Assay

Objectives. The main objective of the present study is to assess the sensitivity and specificity of a retrospective diagnostic of lymphatic tuberculosis (LTB), testing frozen samples using gene amplification PCR methods. The secondary objective was to compare the results of two different commercial tuberculosis gene amplification methods for this purpose. Material and methods. We retrospectively studied 38 frozen samples, previously processed for mycobacterial culture between January 2014 and August 2019. The results of the previous cultures were: 21 samples positive for Mycobacterium tuberculosis complex (MTB) (5 being smear positive), 7 samples culture positive for Mycobacterium avium-intracellulare complex and 10 samples which were mycobacterial culture negative and discarded for LTB diagnosis, used as controls. The samples were processed using two gene amplification methods: Xpert® MTB/RIF Ultra (Cepheid) and Abbott RealTime MTB Assay (Abbott). Results. Compared to initial culture results the sensitivity and specificity of Xpert® MTB/RIF Ultra were 57.1% and 100% and 52.3 % and 92.5%, respectively for the Abbott RealTime MTB assay. The differences were not statiscally significant. In addition, there were no differences according to the period of freezing. Conclusions. Gene amplification of frozen samples confirmed the diagnosis of lymphatic TB in almost 60% of cases, allowing retrospective diagnosis in initially non suspected cases. Both gene amplification techniques tested were equally useful.

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL)

A 44-year-old Caucasian man presented with seizures and cognitive impairment. He had marked retinal drusen, and MR brain scan showed features of cerebral small vessel disease; he was diagnosed with a leukoencephalopathy of uncertain cause. He died at the age of 46 years and postmortem brain examination showed widespread small vessel changes described as a vasculopathy of unknown cause. Seven years postmortem, whole-genome sequencing identified a homozygous nonsense HTRA1 mutation (p.Arg302Ter), giving a retrospective diagnosis of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy.

3D MODELING OF EXPERIMENTAL WOUND CANAL CAUSED BY STABCUTTING TOOL WITH ONE-SIDED SHARPENING OF THE BLADE

The aim – to carry out 3D modelling of the wound canal formed by a stab-cuttingtool with one-sided sharpening of the blade, using photogrammetry method for furtherinvestigation of its morphological peculiarities and obtaining linear dimensions withhigh accuracy in the space of the graphic editor "3ds Max".Material and methods. Fifteen experimental wound canals were reconstructedby means of an alginate imprinting mass with a rubber-like effect "Hydrogum 5"(Zhermack, Italy), which hardens quickly, remains elastic after polymerization, allowsto obtain imprints with an extremely smooth surface andmost accurately preserves andreproduces the properties of the immersed in it blade of the knife under study. Astabcutting tool - a knife with one-sided sharpening of the blade, blade length - 9.6 cm,width in the place of the greatest blade thickening - 2.6 cm, butt thickness - 0.24 cmwas used to mark experimental damage. Given dimensions of the stab- cutting toolwere obtained by means of sliding caliper with an error of ± 0.03-0.15 cm. The formedwound canal was divided into fragments with a step of about 3.5 cm. Each fragmentof the wound canal was contrasted with dye (1% alcohol solution of diamond green).These fragments of the wound canal were opened parallel to its length and placed on arotating table, which was located in a light cube to provide sufficient illumination andphotography was performed. A SONY RX 10 II digital camera was used for taking aphotograph. The index number and a fragment of a scale ruler 1.0 cm long were placedon the object for further calibration of the scale and control of the dimensions of theobject under study in computer programs. The photos obtained in JPEG format wereloaded to the computer program "Agisoft Photoscan", where 3D textured models of thewound canal fragment were created. The obtained model and texture were exportedin OBJ format. Then the obtained 3D models were moved to the graphic space of theprogram "3ds max" to calibrate the scale of the model and in the graphic editor thereconstruction of the wound canal was carried by means of 3D models of its fragments.Results. Measurements of the linear dimentions of damages were carried out at firstby a classical method (by means of a ruler). In addition to, that the depth of the woundcanal, which consists of three fragments, was obtained according to the method ofmeasuring the depth of the wound canal in the body of the corpse by putting togetherits seperate parts in accordance with immersion and permeability of the blade in thevictim's body (skin, subcutaneous muscle tissue, cavity wall and in it itself, the internalorgan and other anatomical formations). Similarly, the width of the wound canal andthe distance between the corners from the side of the butt, which illustrate the thicknessof the blade of the cutting edge and the length of its separate fragments, which in itsturn reproduce the parameters of the blade of an acute traumatic object, were fixed at different levels of immersion.The next stage of our work was to study and obtain the linear dimensions of 3Dmodels’damage by means of a graphic editor "3ds max". In this case, the mentionedcomputer program allowed to obtain the dimensions, described by us,already by anorder with higher accuracy (up to 0.001 cm).The results, obtained by us in the experiment, allow to assert about the high accuracyof measurements, carried out using a computer program for 3D modeling "3ds Max".When combining the obtained linear dimensions of the damage with increased accuracyand the possibility to conduct retrospective diagnosis of the most specific part of thewound canal, formed by the blade belly, the level of accuracy and visualization of thecarried out forensic medical examination is significantly increased.Conclusions. The results, obtained by photogrammetry and 3D modeling of the woundcanal, make it possible to assert the increased accuracy of investigations of individualmorphological characteristics of the lesions and allow to conduct retrospectiveidentification of fragments of the wound canal with the instrument of injury. In additionto that, forensic medical experts receive a modern objective tool for the selection andidentification of the used stab- cutting tool among those provided for examination byjudicial investigation organs. The introduction of the modern methods of 3D modelinginto forensic medical and medical-criminal practice allows to improve the accuracyand visualization of the carrying out examinations and brings them to a new higherlevel.

Retrospective Diagnosis of Ankylosing Spondylitis after Spinal Fractures: A Review of 3 Cases and Clinical Implication

Ankylosing spondylitis (AS) is an underdiagnosed inflammatory condition in the initial stages of disease that can cause vertebral fractures in young adults after trivial trauma. Hence, low-energy spinal fractures in young patients must be carefully evaluated to exclude AS as the treatment protocol (fixation levels, period of immobilization) may change drastically if AS is diagnosed. Here, we present cases of 3 patients who presented at emergency after low-velocity spinal trauma and diagnosed as AS during workup for fracture management. This cases series indicates underdiagnosis of AS in general population as well as importance of strong suspicion of AS in low-energy spinal fractures in the younger age-group.