Background:Despite endorsement of the line probe assay (LPA) for the diagnosis of drug-resistant pulmonary tuberculosis patients, there is limited data available on the performance of LPAs in India, especially from high burden states like Maharashtra, for the early diagnosis and detection of drug resistance, in order to initiate timely and appropriate treatment.Objective:To evaluate the utility of the line probe assay (LPA) for the early diagnosis of drug-resistant pulmonary tuberculosis as compared to the ‘Gold standard’ 1% proportion method (PM).Materials and Methods:A total of 687 patients suspected of pulmonary tuberculosis were screened. One hundred samples (95 sputum and 5 BAL), positive for Acid Fast Bacilli (AFB) by Ziehl Neelson (ZN) smears, were included in the study. Digested and decontaminated specimens were subjected directly to the LPA (Genotype MTBDR@ plus assay) and were processed in parallel using the conventional culture on the Lowenstein-Jensen (LJ) medium followed by drug susceptibility testing (DST) using the PM.Results:All the 100 samples gave interpretable results on LPA with a turnaround time of 24-48 hours as opposed to six to eight weeks taken by the 1% proportion method. Sensitivity for the detection of rifampicin, isoniazid, and multidrug resistance (MDR) was 98.1, 92.1, and 95%, respectively, with a specificity of 97.8% for rifampicin and 98.33% for MDR detection. It also had the additional advantage of allowing a study of mutation patterns.Conclusions:High performance characteristics and a short turnaround time makes LPA an excellent diagnostic tool, for an early and accurate diagnosis, in a high MDR- TB-prevalent region, as reflected from our data.

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BACKGROUND Gestational Diabetes Mellitus (GDM) refers to any degree of glucose intolerance with onset or first recognition during pregnancy. Maternal diabetes constitutes an unfavourable environment for embryonic and foetoplacental development. The histomorphological changes in the placenta are associated with increased perinatal morbidity, increased risk of diabetes in the offspring and the mother in the ensuing years of life. Present study aims to study the morphological changes in the placenta along with maternal and foetal outcomes in pregnancies complicated by GDM. MATERIALS AND METHODS A descriptive observational case-controlled study was conducted from January 2013 to November 2016 in King George Hospital, Visakhapatnam. Hundred and sixty four women diagnosed with GDM and hundred women with normal gestation were enrolled in the study. Foetal surveillance was done by Doppler ultrasound and kick count technique during the gestation. Foetal and maternal outcome was evaluated and compared to the outcome of normal gestation. Placental specimens from term gestations (38-42 weeks) diagnosed with GDM and normal full-term gestations were studied to assess the morphological parameters. Statistical analysis was done using descriptive statistical measures. RESULTS In the present study, 62.19% of the GDM cases terminated as normal gestations. Recurrent UTI was the most common complication (14.02%) during the antenatal period. 17.68% of the foetuses from GDM mothers presented with macrosomia, however, there were no cases of congenital anomalies or shoulder dystocia. Placental tissue from the GDM cases was larger, heavier and more cotyledonous as compared to placenta from normal subjects. The umbilical cord showed eccentric and central attachment in all the controls and most of the cases and 5.48% of the cases showed marginal attachment of the umbilical cord. CONCLUSION The study describes the various maternal, foetal and placental outcomes in pregnancies complicated by GDM. Recurrent UTI was the most common maternal complication during antenatal period while macrosomia was the most common foetal outcome. The morphological changes in the placenta were studied to understand the placental presentation in GDM patients. Thus, the study brings to light the possible pathophysiological areas of clinical research for disease modifying interventions.

BACKGROUND HELLP syndrome is an acronym for Haemolysis (H), Elevated Liver Enzymes (EL) and Low Platelet (LP). This is a rare complication of preeclampsia (10-15%). HELLP syndrome may develop even without hypertension. This syndrome is manifested by nausea, vomiting, epigastric or right upper quadrant pain along with haematological changes. Parenchymal necrosis of liver causes elevation in hepatic enzymes (AST and ALT >70 IU/L, LDH >600 IU/L) and bilirubin (>1.2 mg/dL). There may be subcapsular haematoma formation (which is diagnosed by CT scanning) and abnormal peripheral blood smear. Eventually, liver may rupture to cause sudden hypotension due to haemoperitoneum. Periportal haemorrhagic necrosis of the liver occurs due to thrombosis of the arterioles. The necrosis is seen at the periphery of the lobule. There may be subcapsular haemorrhage. Hepatic insufficiency seldom occurs because of the capacity and regenerative ability of liver cells. Liver function tests are especially abnormal in women with HELLP syndrome. A sincere effort has been put to study the HELLP syndrome incidence and its clinical prognosis and to understand its outcome.

Ectopic pregnancy is still a major challenge & its incidence is on the rise due to changes in lifestyle & advances in medical practice. The objective was to study incidence, clinical presentation, risk factors & management of cases that presented in our hospital over a four -year period. A Prospective study of 100 cases presenting as ectopic pregnancy from 15-1-2010 to 15-1-2014.During this period total of 3176 deliveries & 1347 gynaecological surgeries were recorded. 100 patients had ectopic gestations accounting for 3.1% of all deliveries & 7.4% of gynaecological surgeries. Peak age group was 20-29y in 59cases(59%). Gestational age at presentation was 6-8weeks for most of the cases (62%). 59 cases (59%) were multiparous & 41(41%) were nulliparous. All had symptoms suggestive of ectopic pregnancy (amenorrhea, abdominal pain, giddiness, bleeding pervaginum). Diagnosis was confirmed by urine pregnancy test & USG. Common risk factors present were previous surgery ie LSCS-30(30%), Tubectomy-19(19%); Abortions-32(32%); Infertility-36(36%); PID-16(16%).Out of 100cases, 93 (93%) were ruptured & 7(7%) unruptured. Unruptured cases were treated medically using Methotrexate. Laparotomy was done for ruptured cases. Commonest site of Ectopic was ampulla (60%). Salpingectomy was done for most cases (73%).Although case-fatality has decreased, ruptured Ectopic gestation continues to be a common life-threatening emergency making tubal conservation inapplicable. This is of concern in a society with high premium on child-bearing.