No abstract

Methods used to commit suicide are widely available and are difficult to restrict. Therefore, suicide prevention strategy based on risk factors could be more effective rather than limiting the access to methods.

Background: Antenatal fetal surveillance is a field of increasing importance in modern obstetrics. It is based on fetal heart rate monitoring using nonstress test and contraction stress test, ultrasound biometry and amniotic fluid assessment, Doppler blood flow studies of fetal and uteroplacental circulation, and an evaluation of biophysical fetal parameters. The combination of these methods leads to improvements in fetal morbidity and mortality. Aim: The present study aimed to assess the sensitivity, specificity, and positive and negative predictive values of umbilical artery (UA) systolic/diastolic (S/D) ratio, and amniotic fluid index (AFI) in term pregnancies for the prediction of perinatal outcome and their relation with perinatal outcome. Methods: This study was conducted at a tertiary care hospital on 100 pregnant women where all the term singleton pregnancies (37–42 weeks) admitted in maternity were subjected to color Doppler for UA S/D ratio assessment and AFI estimation. Further, management of patients was done according to color Doppler findings and their relation with perinatal outcome. Results: Out of 100 pregnant women, 68% had AFI >8 (normal), while 32% of women had AFI <8 (abnormal), with the mean AFI being 9.39 ± 2.55 cm, whereas70% had S/D ratio <3 (normal) and 30% of women had S/D ratio >3 (abnormal), with the mean S/D ratio of 2.61 ± 0.450. UA S/D ratio had better performance values (i.e., sensitivity, specificity, and positive and negative predictive value) than AFI in predicting adverse perinatal outcomes. Conclusion: AFI and UA S/D ratio are important for predicting low appearance, pulse, grimace, activity, and respiration score, meconium, respiratory complications, and perinatal mortality in high as well as low-risk pregnancy cases. However, UA S/D ratio is a better predictor of perinatal outcome in high-risk pregnancies.

Micronutrient and vitamin deficiencies in young adults in the United States are relatively rare and often pose a diagnostic challenge. Here, we present the case of a young female who developed acute encephalopathy and muscular weakness two days following an endoscopic procedure performed to investigate the patient’s four-month history of intractable nausea, vomiting, dysphagia, and weight loss. She was diagnosed with severe Wernicke encephalopathy due to thiamine deficiency as well as myotonic dystrophy type 1 (DM1). The patient’s family history revealed an undiagnosed muscular disorder that required her father to ambulate with a wheelchair in the fourth decade of his life. DM1 with 11 trinucleotide repeats of cytosine-thymine-guanine in allele 1 and more than 150 in allele 2 of the myotonic dystrophy protein kinase ( DMPK ) gene were found on genetic testing. The patient’s progressive dysphagia was likely a chronic manifestation of myotonic dystrophy that became more apparent following general anesthesia. DM1 is a multisystem genetic disorder of both skeletal and smooth muscles caused by deviation in the DMPK gene. Due to the involvement of esophageal smooth muscle, dysphagia may also be present. The long-standing dysphagia in our patient resulted in significant vitamin deficiency presenting as Wernicke encephalopathy. This case highlights the need for detailed, accurate family history and heightened suspicion for malnutrition in young adults who have eating disorders, dysphagia, and unexplained neurological changes.