This review is a summary of the modern-day approach and recent trend in the determination of uric acid in the saliva of humans and its use in diagnosis by clinicians. Uric acid, which is the end product obtained from the breakdown of purine nucleotides, is an important biomarker associated with various conditions. Uric acid is found in various body fluids, such as serum, plasma, and urine. It can be used as an important tool for various diseases, such as gout and hyperuricemia, or conditions that are associated with increased oxidative stress. Recently, there has been an emergence of studies that have utilized uric acid concentrations measured in the saliva and studied its association with various diseases. Salivary uric acid can prove to be a noninvasive method to provide a diagnosis of serious illness. A raised uric acid level in the saliva can be associated with cancer, human immunodeficiency virus (HIV) infection, gout, and hypertension. A reduced level of salivary uric acid on the other hand can be a marker for Alzheimer’s disease, progression of multiple sclerosis, and impairment of cognition. Online search databases, including Google Scholar, Scopus, PubMed, and Web of Science, were searched, and articles that were published before September 2021 based on salivary uric acid analysis were analyzed for this review. Uric acid is an essential biomarker that has antioxidant properties. Assessment of salivary uric acid levels was found to be essential in conditions such as cancer, metabolic syndrome, neurological conditions, psychiatric conditions, human immunodeficiency virus, and gout and in monitoring treatment of hyperuricemia. Although having importance in diagnosis and therapeutic monitoring, salivary uric acid analysis has not gained enough popularity due to limitations such as saliva collection and sample processing issues. With proper education and standardization, salivary uric acid analysis can be used as a cost-effective and noninvasive tool for getting a clue about antioxidant biomarker concentration in saliva and hence various diseases associated with oxidative stress.

Ectopic pregnancy has emerged as an alarming problem for obstetricians worldwide. Live twin ectopic conception is rare to occur, and spontaneously conceived twin ectopic pregnancy is even more infrequent. A 32-years-old gravida 3, para 1, live 1, abortion 2, presented with a confirmation of pregnancy on a urinary pregnancy test kit along with pain in the right iliac fossa. Blood investigations revealed raised serum beta-human chorionic gonadotropin hormone. Transvaginal ultrasonography revealed twin ectopic conception in the right fallopian tube with both the embryos showing cardiac activity and no evidence of intrauterine gestational sac. The patient was managed with methotrexate-mediated ultrasound-guided fetal reduction and is doing well on follow-up presently. Hence, our case report highlights the importance of prompt diagnosis and management of twin ectopic pregnancies with the help of newly evolving interventional radiology procedures.

Background: Premature rupture of membrane is linked to significant maternal prenatal mortalities and morbidity. The maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes in patients with PLROM at tertiary care hospital in central rural India.Methods: This prospective study was conducted in Department of obstetrics & Gynecology, in a tertiary care institute located in central India, over a period of 18 months. 210 patients were diagnosed with PLROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books.Results: The rate of maternal morbidity was 26%, commonest cause was clinical chorioamnionitis (11.9%) followed by febrile illness seen in 10.5%. No maternal mortality was seen in the study. Perinatal morbidity was seen in 30% of cases. Clinical early onset neonatal infection was the commonest cause for perinatal morbidity noticed in 23.8% of cases (50 out of 210). Perinatal mortality observed was 1.43% (3 out of 210). Birth asphyxia being the commonest cases of mortality.Conclusions: Major maternal morbidity is chorioamnionitis (11.9%). Major perinatal morbidity observed is early onset neonatal infection (24%).

Incidence of Dengue has been on the up rise ever since the second wave of the pandemic of COVID19 has ended introducing an old enemy on the frontline to the health care professionals.A 28 year old Gravida 2 Parity 0 Living 0 Abortion 1 with twin pregnancy presented with fever along with chills and retro orbital pain along with body ache since two days in the emergency department  with the gestational age of 36 weeks.She tested positive for Dengue NS1 antigen.Patient was having thrombocytopenia and was managed with intravenous fluids,platelet and blood transfusion and was taken for caesarian section and she delivered twins with normal birth weight.During the post operative period the patient went into dengue shock syndrome and which was managed with fluids and inotropic support and patient ultimately recovered and was discharged on day seventeen of admission .This case report emphasises on the importance of prompt detection and management of dengue in a case of high risk pregnancy such as twin pregnancy.After extensive review of literature we found that this is the first case report to report the association of twin pregnancy with dengue shock syndrome making it an important topic of discussion.

We present a case of term pregnancy which presented with chief complaint of Breathlessness, chest pain as well as a one day history of vomiting. She tested positive for COVID19 through reverse transcriptase polymerase chain reaction of nasopharyngeal swab and the symptoms were attributed to Pneumonia caused due to COVID19.However,the arterial blood gas showed metabolic acidosis with high anion gap. This was a non lactate acidosis with no hypoxemia. Most reasonably the state of pregnancy with increased energy demands along with increased metabolic maternal demand due to infection coupled with maternal starvation had resulted in this Ketoacidosis . In view of non progression of labor caesarian section was carried out and a healthy neonate was delivered. There was an initial improvement in maternal ketoacidosis post partum however optimal management of COVID19 pneumonia required oxygen support and use of corticosteroids. Thus we highlight how an unusual metabolic demands of pregnancy might mimic COVID 19.

Background: Laryngeal Mask Airways are increasingly being used now a day as an option to endotracheal intubation, as it is less invasive and causes less discomfort in the postoperative period. The aim of this study was to evaluate the clinical use of the laryngeal mask airway SupremeTM in patients undergoing elective gynaecological surgeries under general anaesthesia and compare it with endotracheal intubation.Methods: 60 ASA I and II females, having BMI <30kg.m-2 in the range of 20-50 years of age, scheduled for elective gynaecological surgeries were randomly allocated to one of the two groups according to the device used (LMAS or ETT). Time required for insertion, number of attempts, hemodynamic response to insertion/removal and incidence of immediate and late postoperative complications such as coughing, laryngospasm, sore throat, dysphagia etc. were assessed.Results: Number of attempts for successful insertion was similar but time required for LMA Supreme™ insertion was significantly less (25.40±12.90 versus 33.27±14.82 sec) similarly, time required for nasogastric tube insertion was significantly more in ETT group (30.28±16.22 versus 21.93±12.64 sec). No episode of failed ventilation or hypoxia was recorded. The changes in hemodynamic parameters were significantly higher after endotracheal intubation and during extubation. Incidence of postoperative complications was significantly higher after endotracheal intubation (p<0.05).Conclusions: The LMA Supreme™ is a suitable alternative to endotracheal intubation during general anaesthesia for elective gynaecological surgeries with the added advantage of less hemodynamic response during airway management and lower incidence of postoperative complications.

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Premature rupture of membranes (PROM) affects approximately 10% of pregnant women. PROM, when unattended or mismanaged may lead to severe maternal and neonatal complications. The present study aims to study the subsequent course of pregnancy and evaluate the maternal, and neonatal morbidity and mortality in PROM patients admitted in our hospital. To study the outcome of PROM and assess the maternal and perinatal morbidity and mortality. It was a prospective observational study. All the patients of PROM admitted in hospital and considered based on inclusion and exclusion criteria were included in the study. They were induced with either oxytocin or misoprostol depending on their Bishops score. In the group of patients, where PROM delivery interval >18 hours were found to have more maternal complications like puerperal sepsis, chorioamnionitis, wound gape, paralytic ileus, and more neonatal complications like jaundice, sepsis. In our study, maternal morbidity was directly related to the PROM delivery interval. Thus, women diagnosed with PROM should be hospitalised early or referred early to tertiary hospital and actively managed and followed up till delivery. Timely referral and timely intervention can further improve perinatal outcome.