Pyoderma gangrenosum (PG) is a rare ulcerative cutaneous disorder with tendency to recur in the injured area. Though most of the time is associated with chronic systemic conditions, it can occur in isolation and can be a diagnostic dilemma. The aetiology is poorly understood. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. Lesions can develop after surgery, after trauma or de novo. We are reporting a 32-year-old pregnant lady with two previous instances of pyoderma gangrenosum in the previous pregnancy, who in postoperative period following caesarean section developed the same condition for the third time. She responded well to local wound care, oral Prednisolone, and Dapsone and made a good recovery. Pregnancy being an immunologically altered status can play a role in development of pyoderma gangrenosum and one should always rule out its possibility when there is a delayed wound healing.

Majority of fetal abnormalities can be detected, and majority adverse pregnancy outcomes can be predicted at 11-14-week antenatal visit, although this study shows high screen positivity and low specificity in a tertiary referral unit.

Background. Progressive proteinuria indicates worsening of the condition in hypertensive disorders of pregnancy and hence its quantification guides clinician in decision making and treatment planning. Objective. To evaluate the efficacy of spot dipstick analysis and urinary protein-creatinine ratio (UPCR) in hypertensive disease of pregnancy for predicting 24-hour proteinuria. Subjects and Methods. A total of 102 patients qualifying inclusion criteria were evaluated with preadmission urine dipstick test and UPCR performed on spot voided sample. After admission, the entire 24-hour urine sample was collected and analysed for daily protein excretion. Dipstick estimation and UPCR were compared to the 24-hour results. Results. Seventy-eight patients (76.5%) had significant proteinuria of more than 300 mg/24 h. Dipstick method showed 59% sensitivity and 67% specificity for prediction of significant proteinuria. Area under curve for UPCR was 0.89 (95% CI: 0.83 to 0.95, P < 0.001) showing 82% sensitivity and 12.5% false positive rate for cutoff value of 0.45. Higher cutoff values (1.46 and 1.83) predicted heavy proteinuria (2 g and 3 g/24 h, resp.). Conclusion. This study suggests that random urinary protein : creatine ratio is a reliable investigation compared to dipstick method to assess proteinuria in hypertensive pregnant women. However, clinical laboratories should standardize the reference values for their setup.

Objective: To find the prevalence of subclinical hypothyroidism in the first trimester of pregnancy and to compare the maternal and perinatal outcome in them with euthyroid mothers.Methods: The present study was a prospective observational case-control study done in a tertiary hospital over the period of one and half years. Pregnant women in the first trimester of pregnancy were tested for Thyroid Stimulating Hormone (TSH) levels and those who had TSH>2.5mIU/l, free T3 and free T4 estimation was carried out on the same sample. A total of 171 women could be followed up till delivery and their first-trimester thyroid profile was available for analysis. They were grouped into two groups, Group 1: all women with TSH level>2.5 mIU/l, considered to be hypothyroid (n=79), Group 2: women with euthyroid status with TSH levels 0.1 to 2.5 mIU/l (n=95). All the neonates delivered in the first group had cord blood TSH estimation.Results: In the study period, there were 2632 deliveries. The number of pregnant women with first trimester TSH levels>2.5 mIU/l were 79, giving the prevalence rate of 3 % for subclinical hypothyroidism during pregnancy. The obstetric complications observed were gestational hypertension 3.8%, gestational diabetes 6.3%, placenta praevia1.3% and preterm delivery 7.6%. The perinatal complications included Intrauterine growth restriction (IUGR) 1.3%, Low Birth Weight (LBW) 3.8%, perinatal asphyxia 2.5% and neonatal hypothyroidism 1.3%. Only preterm delivery appeared to be significantly associated with subclinical hypothyroidism.Conclusion: The observed complication rates were much similar, in fact, lesser with gestational diabetes, pregnancy hypertension, IUGR, LBW compared to global and Indian prevalence rates. This indicates that the cut-off for diagnosing subclinical hypothyroidism should be derived from TSH assays from the local geographic population and should guide the treating physician to establish appropriate TSH ranges where definite therapeutic intervention is required to improve the maternal and foetal outcome.

Introduction There is a definite need to find a highly sensitive and specific, noninvasive, and cost-effective marker for prediction of preterm labor. We hypothesize

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We report an unusual case of genitourinary malignancy in an otherwise asymptomatic elderly male, which was discovered via workup of a supraclavicular neck mass. We present his clinical workup as well as the pathological workup and how it influenced our decision-making. A review of the literature is also discussed and demonstrates how uncommon it is for seminomas to present in this manner.