Continuous quality improvement and assisted reproductive technology multiple gestations: some progress, some answers, more questions

The past decade has seen a fall in the number of embryos transferred accompanied by a reduction in the rate of higher order multiple pregnancies occurring from U.S. assisted reproductive technology (ART) cycles, which is temporally related to voluntary adherence to embryo transfer guidelines. The twin rate has remained relatively constant. The ability to continue the reduction in multiple pregnancies while maintaining advocacy positions for both patient couples and offspring will best occur with attention to scientific, sociologic, economic, and provider issues.     

Fat patterning of Santhal children: a tribal population of West Bengal, India

A cross sectional study was undertaken to examine the body composition including fat patterning among 1012 Santal children, aged 5-12 years, in Puruliya district of West Bengal, India. The anthropometric variable measured included height, weight and skinfold thickness of triceps and subscapular. The body mass index (BMI) was also calculated. The measurements were used to estimate body fat percent (%BF) and fat-free mass (FFM) from skinfolds. Fat mass and FFM were each divided by height squared to produce the fat mass index (FMI) and fat-free mass index (FFMI). Maximum gaining of %BF and FFM was found at ages 11-12 years in both sexes. Difference of-FFM between 5 and 12 years of age was found to be highest in girls (18.7 kg) than in boys (14.92 kg). Body fat percentage of girls was significantly (p < 0.05) higher (except in 8 and 9 years old) than that of boys. FMI and FFMI of girls showed different pattern than that of boys. FFM and %BF showed significant (p < 0.01) relationship with all anthropometric variables. Results suggests a clear evidence of sexual dimorphism in fat patterning; girls showing a greater subcutaneous adiposity in comparison with boys. FMI and FFMI, both indices indicate an age-and sex-related variation among Santal children. The data of the present study could be serving as reference data in other studies of Santal children.     

Pemphigus in North India

BACKGROUND: Pemphigus is an autoimmune mucocutaneous blistering disease caused by antibodies against desmogleins Dsg-1 and Dsg-3. The epidemiology of the disease varies in different countries. In India, pemphigus is relatively common, with considerable interstate variation. OBJECTIVE: The objective of this study was to review the demography, clinical features, and treatment aspects of pemphigus in North India. METHODS: The case records of pemphigus patients registered from 1988 to 2004 were retrospectively analyzed. The age, sex, residential particulars, site of onset of disease, duration between involvement of skin and mucosa, subtype and course of the disease, and treatments offered were analyzed. RESULTS: Of the 328 patients, 302 (92%) were pemphigus vulgaris and the remaining 26 (8%) were pemphigus foliaceous patients. The mean age at onset was 39.27 years for males and 38.57 years for females. The majority of patients were from the states of Punjab and Haryana. The majority of patients were treated with dexamethasone-cyclophosphamide pulse (DCP) therapy, and the number of DCPs required for inducing remission correlated roughly with the severity of the disease. The mortality rate was 4% in the total sample. CONCLUSION: North Indian patients of pemphigus have a relatively younger age at onset. The majority of patients were from the states of Punjab and Haryana. The response to DCP therapy was good, and with DCP, the additional dose of oral steroids that was required to control the activity of the disease was less than 30 mg/d, which is much less than the dosage used in the standard conventional regimens.     

Technical error during deployment leads to vena cava filter migration and massive pulmonary embolism

The Günther Tulip vena cava filter is a safe, effective, well-established device for pulmonary embolism prophylaxis. We report a patient in whom there was migration of the filter to the right atrium, 2 weeks after insertion, caused by a technical error during deployment. An attempt to retrieve the filter percutaneously failed, necessitating removal at open-heart surgery. The potential causes of migration are described and the lessons learned from this unusual case are outlined.     

Epiphyseal osteochondromas with autosomal dominant inheritance and multiple parosteal bone proliferations

The familial cases of dysplasia epiphysealis hemimelica (DEH), or Trevor’s disease, are thought to represent dominant carpotarsal osteochondromatosis (DCO). Only three families affected by DCO have been reported so far in the literature. We report a fourth family: a 10-year-old girl, her father, and his cousin. Unlike the other reported cases of DCO this family had no carpal or upper limb epiphyseal osteochondromas and many of the other reported associations. The only consistent associated finding in our cases was the presence of multiple parosteal osteochondromatous proliferations. The findings of our cases are, therefore, unique in many ways. These cases may represent a variant of dominant carpotarsal osteochondromatosis or may represent a new entity.     

Distribution and risk factors of postoperative endophthalmitis in people with diabetes

Purpose:To evaluate (i) the distribution of postoperative endophthalmitis (POE) in patients who underwent cataract surgery, (ii) risk factors in diabetic versus nondiabetic patients, and (iii) distribution of POE in those who had undergone rapid reduction of preoperative blood sugar levels versus those with normal blood sugar levels.Methods:Medical records were reviewed from January 1995 to July 2021. In total, 391 eyes of 391 patients who developed POE after cataract surgery were studied. Patients with POE were divided into Group A, patients with diabetes (n = 128), and Group B, patients without diabetes (n = 263), and the associations of various clinical factors in the two groups were studied. Patients with diabetes with raised random blood sugars (RBS) preoperatively were subjected to a rapid reduction of blood sugar (RBS <200 mg%) to be considered eligible for surgery. Microbiological profile of patients was examined.Results:The cumulative incidence of POE over 26 years was 0.09%. Those who underwent a rapid reduction in preoperative blood sugar levels had higher rates of POE (53.1%) compared with (46.9%) those with blood sugar levels under control (P = 0.486). Men with diabetes had 1.634 times higher odds of POE (P = 0.048), and those with diabetes and hypertension had 3.961 times greater odds of having POE (P < 0.001) when adjusted for age, alcohol, smoking, and socioeconomic strata and presence of posterior capsule rupture. Positive culture results were observed in 45/128 (35%) patients with diabetes and 71/263 (27%) patients without diabetes. Staphylococcus epidermidis was the most commonly identified organism and was detected in 10/45 (22%) in those with diabetes and 21/71 (29%) in those without diabetes of all the culture-positive cases.Conclusion:In patients with POE, the odds are greater for men with diabetes, those with a history of hypertension, as well as those who undergo a rapid reduction of preoperative blood sugar.