Sweta Singh

Bio: Sweta Singh is an academic researcher from All India Institute of Medical Sciences. The author has contributed to research in topics: Leiomyoma & Endometriosis. The author has an hindex of 7, co-authored 37 publications receiving 330 citations. Previous affiliations of Sweta Singh include Academy of Medical Sciences, United Kingdom & AIIMS, New Delhi.

Recent advances in the diagnosis of leishmaniasis.

Abstract: Leishmaniasis is a parasitic disease caused by a haemoflagellate Leishmania. There are more than 21 species causing human infection. The infection is transmitted to humans through the bites of female sandflies belonging to 30 species. The disease manifests mainly in 3 forms: the visceral, the cutaneous and the mucocutaneous leishmaniasis. The diagnosis of visceral form is conventionally made by the demonstration of amastigotes of the parasite in the aspirated fluid from the bone marrow, the spleen, and rarely from the lymph nodes, or the liver. The parasite demonstration and isolation rates are rather poor from cutaneous and mucocutaneous lesions due to low parasite load and high rate of culture contamination. Recently several recombinant proteins have been developed to accomplish accurate diagnosis. Recombinant kinesin protein of 39 kDa called rK 39 is the most promising of these molecules. The antigen used in various test formats has been proved highly sensitive and specific for visceral leishmaniasis. It is useful in the diagnosis of HIV-Leishmania co-infection and as a prognostic marker. Molecular techniques targeting various genes of the parasite have also been reported, the PCR being the most common molecular technique successfully used for diagnosis and for differentiation of species.

Diagnosis and management of cervical ectopic pregnancy.

Abstract: Cervical ectopic pregnancy (CP) is a rare condition with an incidence of less than 0.1% of all ectopic pregnancies. It is associated with a high morbidity and mortality potential. Timely intervention is required to preserve fertility and avoid the need for a hysterectomy. A case of CP is reported and the challenges in the diagnosis and management are discussed.

Leptospirosis in pregnancy

Abstract: Leptospirosis is a direct zoonotic disease caused by spirochetes belonging to the genus Leptospira. Many animals act as carriers or vectors. Human infection results from accidental contact with carrier animals or environment contaminated with animal urine containing the organism. Epidemics of leptospirosis result from poor sanitation in urban areas and are aggravated following natural calamities. The majority of leptospiral infections are either subclinical or result in very mild illness and patients recover without complications. In a few cases it may manifest as multiorgan failure where the mortality can go up to 40%. Infection in pregnant women may be grave leading to severe fetal and maternal morbidity and mortality. The presentation may mimic other viral, bacterial, and parasitic infections, acute fatty liver, pregnancy-induced hypertension, and HELLP syndrome. Owing to the unusual presentation, leptospirosis in pregnancy is often misdiagnosed and under-reported. Preventive public education regarding hygiene, personal practices, source reduction, environmental sanitation, early diagnosis, and treatment of the condition are needed to avoid perinatal and maternal mortality.

Eclampsia In Eastern India: Incidence, Demographic Profile And Response To Three Different Anticonvulsant Regimes Of Magnesium Sulphate

Abstract: IntroductionEclampsia continues to be a major cause of maternal and perinatal morbidity and mortality in the developing world. We evaluated the incidence and outcome of women diagnosed with eclampsia in a tertiary referral centre in eastern India.MethodsThe prospective randomized study was carried out in the department of Obstetrics & Gynecology, MKCG Medical College and Hospital, Berhampur, Orissa, India, a tertiary level Government referral centre for whole of Southern Orissa, over a 2 year period. The incidence, demographics of women with eclampsia and response to three different regimens of magnesium sulphate was studied.Results160 women presented with convulsions against a background of preeclampsia of which 2 were diagnosed with cerebral malaria and hence excluded. Out of 4925 live births during the study period, there were 158 women with eclampsia, giving an incidence of 3.2 %. Majority were unbooked 154 (97.4%) and from rural areas 133 (84.2%). Antepartum eclampsia occurred in 21(13.3%) patients; antepartum / intrapartum eclampsia in 108(68.3%) while postpartum eclampsia occurred in 29 patients (18.4%). Primigravidas accounted for 105/129 cases with antepartum & intrapartum eclampsia while primiparas accounted for 25/29 cases with postpartum eclampsia. The all cause maternal mortality in the study period was 67, of which a total of 7 women died due to eclampsia, giving a case fatality rate of 4.4 % and maternal mortality ratio of 10.44%. Majority of the patients 75/158(47.45%) received magnesium sulphate at 4-8 hours after of onset of convulsions. 60 women received magnesium sulphate by Pritchard regimen (Group-A), while 49 each received magnesium sulphate by Zuspan regimen (Group-B) and Sibai regimen (Group-C) . There was no recurrence of convulsions in any patient after start of magnesium sulphate in both Groups A and C, whereas there was recurrence of convulsion in 1 patient in Group-B. There were a total of 50 still births and 5 neonatal deaths out of total of 167 deliveries in the 158 women with eclampsia. The maternal mortality and morbidity did not differ significantly between the three groups; neither did the perinatal mortality and morbidity.ConclusionEclampsia continues to be a major cause of both maternal and perinatal morbidity and mortality. Magnesium sulphate was equally effective in controlling seizures in the three groups.

Management of Young Patients with Temporomandibular Joint Ankylosis—a Surgical and Anesthetic Challenge

Abstract: Temporomandibular joint ankylosis is a unique disease where fracture of the mandibular condyle or any other cause leading to ankylosis of the joint can lead to multiple problems if not detected and treated early. If affected in early years of life, it may cause facial dysmorphism, restricted mouth opening, and difficulty in eating, speech, and sleep. Early surgery and physiotherapy can restore the joint function to a great extent. Anesthetizing a pediatric patient with this disorder is a definite challenge which needs expertise in difficult airway management.

Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

Abstract: Objective To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia. Design Systematic review and meta-analysis of cohort studies. Data sources PubMed and Embase databases, 2000-15. Eligibility criteria for selecting studies Cohort studies with ≥1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤16 weeks’ gestation. Data extraction Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. Results There were 25 356 688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. Conclusions There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at “high risk” of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy.

An assessment of maxillofacial fractures: a 5-year study of 237 patients an assessment of maxillofacial fractures: a 5-year study of 237 patients an assessment of maxillofacial fractures: a 5-year study of 237 patients

Abstract: PURPOSE This descriptive analytical study assesses the cause, type, incidence, demographic, and treatment data of maxillofacial fractures managed at our medical center during a 5-year period and compares them with the existing body of literature on the subject. PATIENTS AND METHODS A 5-year retrospective clinical and epidemiologic study evaluated 237 patients treated for maxillofacial fractures from 1996 to 2001 at one medical center. There were 211 male patients (89%) and 26 (11%) female patients. The patients ranged in age from 3 to 73 years, with 59.0% (140 patients) in the 20- to 29-year age group. A number of parameters, including age, gender, cause of injury, site of injury, type of injury, treatment modalities, and complications, were evaluated. All maxillofacial injuries were assessed and treated by a single oral and maxillofacial surgeon. Other concomitant bodily injuries were treated by appropriate consultant specialists. RESULTS There were 173 (72.9%) mandibular, 33 (13.9%) maxillary, 32 (13.5%) zygomatic, 57 (24.0%) zygomatico-orbital, 5 (2.1%) cranial, 5 (2.1%) nasal, and 4 (1.6%) frontal injuries. Car accidents caused 73 (30.8%), motorcycle accidents caused 55 (23.2%), altercations 23 (9.7%), sports 15 (6.3%), and warfare caused 23 (9.7%) of the maxillofacial injuries. Regarding distribution of mandibular fractures, 32% were seen in the condylar region, 29.3% in the symphyseal-parasymphyseal region, 20% in the angle region, 12.5% in the body, 3.1% in the ramus, 1.9% in the dentoalveolar, and 1.2% in the coronoid region. The distribution of maxillary fractures was Le Fort II in 18 (54.6%), Le Fort I in 8 (24.2%), Le Fort III in 4 (12.1%), and alveolar in 3 (9.1%). Of the 173 mandibular fractures, 56.9% were treated by closed reduction, 39.8% by open reduction, and 3.5% by observation only. Of 33 maxillary fractures, 54.6% were treated using closed reduction, 40.9% using open reduction, and 4.5% with observation only. Approximately 52.1% of the patients were treated under general anesthesia, and 47.9% were treated under local anesthesia and sedation. Postsurgical complications were recorded in 5% of patients. These complications included infection, asymmetry, and malocclusion. Overall mortality in this series was 0.84% (2 patients); mortality was caused by pulmonary infection. CONCLUSION The findings of this study, compared with similar studies reported in the literature, support the view that the causes and incidence of maxillofacial injuries vary from 1 country to another.

New developments in diagnosis of leishmaniasis.

Abstract: In this review recent advances made in the field of human leishmaniasis have been discussed with special emphasis on the parasite, and various serological and molecular methods of diagnosing the infection. The article also reviews various modes of parasite transmission including vector borne, blood transfusion, needle sharing, sexual and person-to-person. Microbiological methods including the bone marrow, spleen, liver, lymph node aspirations and various staining methods used to demonstrate the amastigotes of the parasites and various in vitro promastigote culture methods are discussed in detail with their comparative sensitivity rates.

Diagnosis of leishmaniasis

Abstract: Leishmaniasis is a clinically heterogeneous syndrome caused by intracellular protozoan parasites of the genus Leishmania. The clinical spectrum of leishmaniasis encompasses subclinical ( not apparent), localized (skin lesion), and disseminated (cutaneous, mucocutaneous, and visceral) infection. This spectrum of manifestations depends on the immune status of the host, on the parasite, and on immunoinflammatory responses. Visceral leishmaniasis causes high morbidity and mortality in the developing world. Reliable laboratory methods become mandatory for accurate diagnosis, especially in immunocompromised patients such as those infected with HIV. In this article, we review the current state of the diagnostic tools for leishmaniasis, especially the serological test.

Leishmaniose tegumentar americana: histórico, epidemiologia e perspectivas de controle

Abstract: A Leishmaniose Tegumentar Americana (LTA) e uma doenca causada por protozoarios do genero Leishmania, transmitida ao homem pela picada de mosquitos flebotomineos (Ordem Diptera; Familia Psychodidae; Sub-Familia Phlebotominae). No Brasil existem atualmente 6 especies de Leishmania responsaveis pela doenca humana, e mais de 200 especies de flebotomineos implicados em sua transmissao. Trata-se de uma doenca que acompanha o homem desde tempos remotos e que tem apresentado, nos ultimos 20 anos, um aumento do numero de casos e ampliacao de sua ocorrencia geografica, sendo encontrada atualmente em todos os Estados brasileiros, sob diferentes perfis epidemiologicos. Estima-se que, entre 1985 e 2003, ocorreram 523.975 casos autoctones, a sua maior parte nas regioes Nordeste e Norte do Brasil. Neste estudo, sao discutidos aspectos relacionados ao tratamento e ao controle dessa doenca, assim como tambem as dificuldades para a implementacao dessas medidas. Sao apontadas alternativas que passam pela estruturacao dos servicos de saude, com respeito ao diagnostico, no desenvolvimento de drogas de aplicacao topica ou por via oral, no desenvolvimento de vacinas, no controle diferenciado de vetores e no aprofundamento de estudos relacionados a biologia celular do parasita.