Risk factors for maternal mortality in Delhi slums: a community-based case-control study

BACKGROUND: In order to develop, implement and evaluate policy for reducing maternal mortality, it is essential to study the risk factors associated with maternal deaths. AIMS: The study aims to determine the epidemiological risk factors and its related causes associated with maternal deaths in Delhi slums. MATERIALS AND METHODS: A community-based case-control study was designed, wherein snowball-sampling method was used to identify the maternal deaths (cases) in the community and circular systematic random sampling procedure was used to select the controls from the same area where a maternal death was found. STATISTICAL ANALYSIS: Data on 70 cases and 384 controls that had live births as the outcome of the pregnancy were analyzed. Logistic regression was applied to identify the risk factors. RESULTS: In the study population, most of the deliveries were conducted at home by untrained 'dais.' Cases were mostly illiterate, young, having high parity and no antenatal care taken during pregnancy (P CONCLUSIONS: The study findings suggest that women should be educated about the importance of antenatal registration and regular checkups. Untrained 'dais' should be trained to recognize the obstetric complications at an early stage and refer high-risk cases for adequate management. These preventive measures could help in reducing maternal mortality at the community level.     

Absent left common carotid artery in a right aortic arch: Separate origins of left internal and external carotid arteries from brachiocephalic artery

We present a case of cyanotic congenital heart disease with left common carotid artery agenesis in the setting of the right aortic arch highlighting the potential implications in management.     

A two-vessel aortic arch: Rare configuration with bilateral brachiocephalic arteries

We present a case of type B aortic dissection with a rare aortic arch branching variation whereby two separate brachiocephalic trunks arise from the arch. This case also highlights the potential implications of this variant in the management of thoracic aortic dissections and aneurysms.     

Three-dimensional speckle-tracking echocardiography for evaluating myocardial motion in patients with cardiorenal syndrome

Because of better awareness and understanding of its pathophysiology, the cardiorenal syndrome (CRS) is more often diagnosed and better managed. The echocardiographic evaluation of CRS now benefits from three-dimensional speckle tracking echocardiography (3D-STE), which allows multidimensional and real-time evaluation of regional myocardial and overall cardiac function, and helps assessing the degree of myocardial damage. This article describes the application of 3D-STE in evaluating the myocardial motion in patients with CRS.     

Induction of renin activity by gonadotropic hormones in cultured Leydig tumor cells

The hormonal regulation of renin activity in cloned and cultured Leydig tumor cells (designated MA-10) was examined. The treatment of Leydig cell cultures with bovine LH (bLH), hCG, or with (Bu)2cAMP elicited a dose- and time-dependent induction of renin activity and a concomitant increase in steroid biosynthesis. The optimum concentration of hCG was 25 ng/ml, which caused an average 25-fold increase in renin activity compared to the control value. bLH action was optimum at 75-100 ng/ml and induced an approximately 35-fold increase in renin activity. The maximum inducible level of renin activity was attained after 8-9 h of hormone treatments. The addition of progesterone (the major steroid product of the MA-10 cells) did not induce a significant increase in renin activity. Treatment of MA-10 cells with epidermal growth factor also failed to produce any increase in renin activity. The optimum concentration of (Bu)2cAMP was 800 microM for the induction of renin activity and caused an approximately 40-fold increase compared to the control value. Renin activity induced by bLH, hCG, or (Bu)2cAMP was completely inhibited by mouse anti-renin antibody, indicating the specific nature of renin. Upon withdrawal of (Bu)2cAMP from the culture medium, renin activity gradually declined to the control level, and with retreatment of these cultures with (Bu)2cAMP, a newly induced state of enzyme activity was resumed. Indirectly, the role of new protein and RNA synthesis was examined during hormonal regulation of renin induction using protein and RNA synthesis inhibitors such as cycloheximide, puromycin, actinomycin D, or rifampicin. Both protein and RNA synthesis inhibitors blocked the induction of renin activity in the presence of all three inducing agents, bLH, hCG, or (Bu)2cAMP. The results provide evidence that the induction of renin activity is modulated by bLH, hCG, or (Bu)2cAMP and represent the de novo synthesis of enzyme molecules.