bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical study of various risk factors associated with intrauterine fetal death
Authors: K. Ashok Kumar , Kanakeri Ravindra , Anjanappa Bharathi
Published: November 2017

Background: The death of a fetus is one of the unhappy events in the field of obstetrics. It is really distressing when it occurs without warning in a pregnancy that has previously entirely normal. It is thus vital to identify specific probable causes of fetal death to determine the risk of recurrence, prevention or corrective action.Methods: A prospective observational study was conducted in ESIC MC and PGIMSR, Rajajinagar, Bangalore, Karnataka, India. All cases of intrauterine fetal death confirmed either with ultrasound or on clinical examination by absence of fetal heart rate and fetal movements were studied. The age, parity, literacy, socio-economic status was recorded. Detailed history, clinical examination, associated conditions. Mode of delivery and details of the fetus and their placentas were noted. They were followed for 3 days for complications.Results: Mean maternal age was 26.03yrs, 98.5% of the women were booked cases, 82% belonged to lower middle class.16.39% of the women had hypertensive disorder of pregnancy, 4.91% had gestational diabetes, 9.8% had abruption placentae, 9.8% had oligohydramnios and 1.63% had polyhydramnios 4.9% were Rh isoimmunisation, 1.9% had twin pregnancy, 3.27% had PROM, 6.6% had cord accidents, 21% had anomalous fetus, 3.27% foetuses had non immune hydrops, 19.67% of IUDs were unexplained.Conclusions: Unexplained causes, PIH and abruptio placentae were major causes of IUFD. Significant proportion of IUFD due to PIH and abruption placenta is preventable by regular antenatal care and timely intervention. Despite advances in diagnostic and therapeutic modalities large number of fetal deaths remain unexplained. Poverty, illiteracy, unawareness and inaccessibility may be some of the reasons for unexplained IUFD.
Practice patterns in the management of preterm labor in India: a multi-centric, retrospective study
Authors: Jaju P. B. , Sood Abha , Chavan Vaishali , Devgarha Geetanjali , Jain Seema , Kundapur Vinodraj , Hegde Rashmi
Published: November 2017

Background: Preterm labor (PTL) is considered as one of the leading cause of perinatal morbidity and mortality. Preterm labor refers to the onset of uterine contractions of sufficient strength and frequency to effect progressive dilatation and effacement of cervix between 22 and 37 weeks of gestation.Methods: In this study, 285 patients of PTL admitted/treated (during the period of 1st January 2014 to 31st December 2016) across 5 centres in India were enrolled. Adult women with PTL, receiving oral or intravenous regime of tocolytic drugs were screened based on eligibility criteria.Results: We evaluated the practice patterns in the management of PTL in India. The pharmacological management (n=193) was preferred over nonpharmacological management (n=92) in the present study. Amongst the pharmacological agents, isoxsuprine (60.10%) was more frequently used followed by nifedipine (23.83%). Prolongation of delivery for at least 48 hours was observed in 57.76% patients receiving isoxsuprine compared to 34.78% patients receiving nifedipine. The mean latency period (36.77±28.09 vs. 1.44±1.33 days), birthweight (2.25±1.34 vs. 1.07±0.34 kg) and Apgar score at 5 mins (7.56±2.36 vs. 4.87±2.10) was higher for isoxsuprine compared to nifedipine group patients, with mean gestational age of <32 weeks (extreme to very PTL cases; p<0.0001). Similar results were observed in latency period and Apgar score between isoxsuprine and nifedipine groups in late PTL cases (>32 weeks).Conclusions: Pharmacological treatment was preferred for the management of PTL in India. Among pharmacological agents, isoxsuprine was preferred over other tocolytics. Significant improvement in mean latency period, prolongation of delivery beyond 48 hours and perinatal outcomes were noted amongst patients on isoxsuprine versus other pharmacological agents.
Combined use of CA 125 and Inhibin as tumor marker for detection of ovarian cancer in comparison to CA 125 or Inhibin alone
Authors: Dubbewar Avinash P. , Pathak B. , Biswas Manas , Malhotra Gunjan
Published: November 2017

Background: Ovarian cancers are diagnosed at an advanced stage. Early diagnosis is the key to reduce death from ovarian cancer. The present study is an effort to assess the suitability of combined test using CA 125 and Inhibin for early diagnosis of ovarian cancer as compared to CA125 or Inhibin alone.Methods: Fifty women with clinical suspicion of ovarian malignancy attending Gynae OPD were enrolled. All of these women were subjected to estimation of CA 125 and Inhibin levels prior to surgical intervention. A value of 35 IU/ml was taken as positive for CA 125. For Inhibin, 10.5 pg/ml was taken as cut off for premenopausal patients, whereas, any detectable assays were taken as positive for postmenopausal patients. The results were analyzed after establishing final histopathology of the disease.Results: Out of 50 patients recruited, 30 (60%) were found to have carcinoma ovary and 20 (40%) were found to have benign diseases. Out of 30 cases of carcinoma ovary, CA125 was raised in 81% of cases and Inhibin was raised in 78% of cases. For detection of carcinoma ovary, CA 125 was found to have a sensitivity of 90% and specificity of 60% with a positive predictive value of 77% and negative predictive value of 80% which were statistically significant. Sensitivity and specificity of serum Inhibin for the same was 86.6% and 20% respectively. The positive and negative predictive value were 61.9% and 50%, which were not statistically significant. Sensitivity and specificity of combined CA125 and Inhibin were 100% and 30% respectively. The positive and negative predictive value were 68.1% and 100% respectively, which were statistically significant.Conclusions: Combined use of CA125 and Inhibin has got better sensitivity and specificity in detection of ovarian cancer in comparison to CA 125 or Inhibin used alone.
Socio demographic profile of GDM using 75 gm OGCT
Authors: P. Muthuprabha
Published: November 2017

Background: The aim of this study was to study the prevalence of GDM in a tertiary care centre based on 75 gm OGCT and to analyse the socio demographic and clinical profile of GDM using 75 gm OGCT in a tertiary care centre.Methods: This study was conducted in the antenatal OPD of Tirunelveli Medical College Hospital from October 2014 to July 2015, a period of 10 months on 300 antenatal women. The mothers were screened using 75gm 2-hour OGCT once during each trimester and the results analysed.Results: The prevalence of GDM in this study was 3.4%. Out of this 47-50% of women with GDM were of the age group 26-30 years. 6% of the women had BMI of >25 kg/m2. The incidence of GDM was found to be high in multigravidas and 70% belonged to class V socioeconomic status. Using the 75 gm OGTT 20%, 40% and 40% were diagnosed during the I, II and III trimesters respectively. 90% of the women delivered at term and total caesarean section rate was 30.6%. Mean birth weight of the babies was 2.9 kg. 70% of the diagnosed GDM women were treated using Medical Nutrition Therapy (MNT).Conclusions: 75gm OGCT recommended by WHO can be used to detect significant number of cases of GDM.
Efficacy of 25 mcg sublingual versus vaginal misoprostol for induction of labor
Authors: Dewangan Sonal , Dewangan Mithlesh , Sabzposh Noor Afshan , Bano Imam , Ali Syed Manazir
Published: November 2017

Background: Currently, to decrease the incidence of contractility disturbances and neonatal complications, 25 mcg of vaginal misoprostol is recommended for induction of labor. American College of Obstetrics and Gynecology suggested 25 mcg every 4-6 hourly by vaginal route. But till date, there is no consensus either for route or dosage. The present study was to compare the efficacy and suitability of low dose (25 μg) sublingual misoprostol for induction of labor in term pregnancy as compared with the same dose given vaginally.Methods: This was a hospital based unblinded randomized prospective study conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh from February 2015 to November 2016.The study involved pregnant women attending O.P.D. or admitted in the labor room. Patients were randomly allocated into two groups: Group 1 received 25 mcg of misoprostol sublingually and Group 2 received 25 mcg of misoprostol 4 hourly vaginally to a maximum of 5 doses. Maternal and neonatal outcomes were analysed.Results: There is no difference between groups for indications for induction of labor, mean induction to the onset of contraction interval and mean interval from the initiation of induction to the delivery. No significant difference in indication for caesarean section and number of doses. No significant differences in neonatal outcomes.Conclusions: 25µg misoprostol administered by sublingual route is equally efficacious as by vaginal route for induction of labor at term.
A study on maternal and perinatal outcome in premature rupture of membranes at term
Authors: Surayapalem Sailaja , Cooly Vijayalakshmi , Salicheemala Bhuvaneswari
Published: November 2017

Background: Premature rupture of membranes is defined as rupture of foetal membranes before the onset of labour. Management of cases of PROM still remains as one of the most difficult and controversial problems in obstetrics. PROM can cause maternal complications like chorioamnionitis, increased operative procedures, puerperal sepsis and neonatal morbidity and mortality. The present study is undertaken to study the labour outcome, maternal morbidity and perinatal morbidity and mortality in term PROM.Methods: 200 Cases of spontaneous rupture of membranes with gestational age >37 weeks with confirmed PROM by a speculum examination were selected. A detailed history was taken, and gestational age confirmed, general, systemic and obstetric examinations were done. Parameters of maternal and foetal well being were recorded. All study groups received prophylactic antibiotics. Single pelvic examination done, and maternal vitals recorded fourth hourly. All the data was analyzed and statistical significance was calculated using Chi-square test.Results: PROM was common in age group of 20-24 years (35%) with mean age of 22.6 years and SD of 2.8 years, and common in primigravida. Majority of women were admitted within six hours of PROM (41.5%) and Mean duration of induction to delivery interval was 12.9 hours. The mean duration between PROM to delivery was 20.2 hours which was statistically significant. Cesarean sections were more among primigravidas. Failure to progress was the common indication. Maternal morbidity was significant (17.5%). No maternal mortality in the study. Perinatal mortality was 1.5%. Birth asphyxia was the commonest cause. Perinatal morbidity was seen in 26%. Escherichia coli was common organism found in cervical swab culture.Conclusions: In present study, majority was primigravidas and the most common age group was 20-24 years belonging to low socioeconomic status. Maternal morbidity and neonatal morbidity was associated with increased duration of PROM to delivery and infection of the female genital tract with pathogens. Hence an appropriate and accurate diagnosis of PROM is essential for favorable outcome in pregnancy.
Clinical presentation of autoimmune disorders in pregnancy
Authors: Singhal Neha , Gupta Alka S. , Prasad Madhva
Published: November 2017

Background: Autoimmune disorders have a significant impact over the health of an individual. This heterogenous group of disorders affects pregnancy in a multitude of ways. Pregnancies with autoimmune disorders are usually cared for by a multidisciplinary team of doctors.Methods: Pregnancies with autoimmune disorders were studied over a one-year period in one unit of a medical college teaching hospital set up. Obstetric and neonatal outcomes were studied.Results: Ten patients were studied. Average age was 29.9 years. Majority presented in early second trimester. Eight patients were ANA positive. Two patients had antiphospholipid antibody syndrome, for whom low molecular weight heparin was helpful. Hypothyroidism was seen in two patients. Bad obstetric history was seen in most patients. Successful neonatal outcome was seen in six patients. One patient had Evans syndrome. There were no maternal mortalities. There was one perinatal mortality.Conclusions: Autoimmune disorders in pregnancy when managed in a tertiary care centre with multidisciplinary approach can result in good obstetric and neonatal outcomes.
A comparative study of exteriorization and intraperitoneal closure of uterus in caesarean delivery
Authors: K. R. Bharathi , G. Mahendra , S. Vindhyshree , Sherawath Sonia
Published: November 2017

Background: Caesarean delivery is the most common intraperitoneal surgical procedure in obstetrics. Many surgical techniques for caesarean delivery have been described, and the debate about the ideal caesarean technique to minimize morbidity is going on still. The aim of this study was to assess the intraoperative and postoperative advantages and disadvantages following exteriorization of uterus at caesarean section with intraperitoneal repair of uterus.Methods: It is a randomized controlled trial conducted at Adichunchanagiri Institute of Medical Sciences, B G Nagar, Mandya. Minimum of 100 cases, 50 each were randomly allocated into case and control groups. All patients who were undergoing emergency and elective caesarean delivery under spinal anaesthesia were randomly allocated into exteriorization and intraperitoneal group. In exteriorization group, uterus is exteriorized after delivery of foetus and placenta for repair, whereas in intraperitoneal group in situ repair was done. A pfannenstiel incision was taken for all the cases. Placenta was removed either by controlled traction after spontaneous separation or manually. Uterus was exteriorized after delivery of placenta and may be repaired by single or double layer. Visceral and parietal peritoneum are not closed.Results: There is significant difference in the operating time in the exteriorization group and in the in-situ group. But no significant difference between 2 groups regarding nausea, vomiting intra operatively, in return of bowel function, number of analgesic doses, incidence of cystitis, endometritis and wound infection. Period of hospitalization were also same in both groups.Conclusion: Exteriorization of uterus at caesarean delivery has the advantages less perioperative haemoglobin reduction, good exposure, good access to incision angle, especially during difficult extraction. Easy identification of uterine anomaly, adnexal mass if present and exposure of posterior aspect of lower segment.
Fetal and maternal outcome following expectant management of severe pre-eclampsia remote from term
Authors: A. V. Deepak , R. P. Reena , Anirudhan Deepa
Published: November 2017

Background: Expectant management of severe preeclampsia, remote from term is often a difficult decision. Maternal and foetal complications may occur while trying to achieve a more favourable perinatal outcome. We wanted to find out the foetal and maternal outcomes of expectant management in these women.Methods: A prospective cohort study was conducted at Government Medical College, Thrissur, India between May 2013 and April 2015. Women with severe preeclampsia remote from term, who were admitted, managed expectantly and delivered in our hospital during the study period, were recruited. The study subjects were grouped into: Group A (between 28 weeks and 31 weeks 6 days) and Group B (between 32 weeks and 33 weeks 6 days). A structured proforma was used to collect demographic and clinical details. The maternal and foetal outcomes were noted.Results: There were 4786 deliveries during the study period. Among them 76 (1.58% of total deliveries) women with severe preeclampsia between 28 weeks and 33-week 6 days gestation on expectant management were included in the study. The mean duration of expectant management was 7.92 days in group A (27 women) and 6.67 days in group B (49 women). Most women required termination of pregnancy for foetal distress (36.8%). HELLP syndrome and imminent eclampsia were the maternal complications that occurred. Perinatal loss was significantly more in Group A when compared to Group B.Conclusions: Expectant management of women with severe preeclampsia remote from term, especially between 32weeks and 33weeks 6 days, with antenatal corticosteroids and close monitoring, seems a reasonable option in developing countries.
Knowledge, awareness and breast-feeding practices of postnatal mothers in a rural teaching hospital: a cross sectional survey
Authors: Ambike Deepali , Ambike Abhijit , Raje Swati , Chincholikar Sanjana
Published: November 2017

Background: Breastfeeding has several benefits for both the infants and mothers. Despite the evidence of the protective, immunological and psychological beneficial factors seen in breast milk, a decline in breastfeeding rates has been documented in India. The objective of the present study was to examine the knowledge, attitude and practices in breastfeeding in the postnatal mothers of a rural hospital.Methods: A cross-sectional descriptive study was carried out among randomly selected postnatal mothers in the postnatal ward of a rural teaching hospital. Data was collected by face to face interviews using a pre-validated structured questionnaire.Results: Significant difference was found in prevalence of knowledge about advantages of colostrum with respect to education, with less number of people being aware in lower class of education. (χ2=6.6) Statistically significant difference was also found in the prevalence of knowledge about advantages of breast feeding with respect to education trend (χ2=10.48). No significant association was seen with the knowledge provider (doctor/ relatives) regarding breast feeding practices. Significant difference was found in no. of women with knowledge about breast feeding with respect to parity. Less number of primigravida mothers were aware about advantages of breast feeding compared to multigravida women. (χ2=4.1). As against this, more number of primigravida mothers initiated breast feeding within 2 hours compared to multigravida women and difference was statistically significant (χ2=3.95).Conclusions: Our Findings show that prenatal and antenatal education of mothers on initiation of breastfeeding and colostrum along with proper method and techniques of breastfeeding will eliminate the problems and ignorance regarding same. We also recommend involvement of the nursing and social workers in the postnatal ward to encourage and counsel the mothers for proper breastfeeding practices.
How successful is color flow mapping and pulsed Doppler studies in predicting histologically confirmed benign and malignant adnexal masses in perimenopausal women
Authors: Gangopadhyay Souptik , Chakraborty Partha Sarathi , Singh Archana
Published: November 2017

Background: Adnexal masses in perimenopausal women presents a specific diagnostic challenge because benign masses outnumbers malignant masses. Majority of adnexal masses are benign but 25% are malignant. The objective of this study was to see the effectiveness of transvaginal colour Doppler in predicting malignancy in adnexal masses in perimenopausal women.Methods: Clinically detected adnexal masses were subjected to transabdominal ultrasound scan (for basic characterization of mass into solid, cystic, mixed) then transvaginal scan and neovascularization, resistivity index (RI) was measured. Subsequently all patients underwent laparotomy. Histopathological reports obtained, and correlation done between USG and histopathology.Results: Among cystic masses neovascularization was present in 4 cases, among them benign and malignant masses were equal in number. Among mixed masses neovascularization was present in 17 cases 9 were malignant 8 benign, among solid masses all cases where neovascularization was detected were malignant. Neovascularization was absent in 12 cystic masses and 11 mixed masses, and all were benign. Kappa value calculated for tumour status and neovascularization is 0.610 which is substantially agreement with neovascularization as predictor of malignancy. Sensitivity, specificity, positive predictive value and negative predictive value of neovascularization for cystic masses are 100, 85, 50, 100(%) respectively. Sensitivity, specificity, positive predictive value and negative predictive value of neovascularization for mixed masses are 100, 57.89, 52.94, 100(%) respectively. Sensitivity and positive predictive value of neovascularization for solid masses is 100(%). Sensitivity specificity positive predictive value and negative predictive value of RI for cystic masses: 100, 92.8, 66.6, 100 (%) respectively. Sensitivity specificity positive predictive value and negative predictive value of RI for mixed masses: 77.7, 89.4, 77.7, 89.4(%). Sensitivity positive predictive value of RI for solid masses 100%.ROC curve analysis shows cut off value for differentiating between benign and malignant masses is 0.4. Less than 0.4 has more chance of malignancy.Conclusions: Transvaginal Doppler ultrasound must be done preoperatively for adnexal mass characterization.
Study of role of Magnesium sulfate in prevention of eclampsia
Authors: Gadappa Srinivas N. , Dixit Pratibha
Published: November 2017

Background: Hypertensive disorders of pregnancy have a clinical spectrum ranging from non-severe to severe preeclampsia and then potentially to eclampsia. Magnesium sulfate is drug of choice for women with eclampsia and now adapted for prophylaxis of seizures in women with preeclampsia.Methods: It is randomized clinical trial, including 876 patients with preeclampsia fulfilling inclusion criteria. Patients with severe preeclampsia received anticonvulsant prophylaxis with magnesium sulfate. Patients with non-severe preeclampsia were randomized in two groups study group and control group. Patients in study group had received anticonvulsant prophylaxis with magnesium sulfate. The data obtained was analyzed with respect to maternal and perinatal outcome, severity of disease progression and adverse reactions of magnesium sulphate in each group.Results: In this study statistically, significant difference was seen with respect to severity of disease progression and incidence of eclampsia among study and control group.Conclusions: Administration of Magnesium sulfate in patients with non-severe preeclampsia does not affect the progress of labour or perinatal outcome, on contrary it improves maternal outcome by reducing incidence of eclampsia and progression of disease, without significant side effect of drug.
A comparative study of the effects of programmed labour protocol and expectant management of labour
Authors: Alam Anjuman , Goswami Swapnil
Published: November 2017

Background: Childbirth is one of the most wonderful and anticipated moments in a woman’s life. But the excruciating pain associated with labour makes it a really undesirable one. Objective of present study was to compare the effects of programmed labour protocol and expectant management of labour.Methods: A clinical study was conducted on 120 low risk primigravida, 60 of them were managed with programmed labour protocol (group A) and the rest 60 (group B) were managed expectantly. Primary parameters were pain relief and changes in the mean duration of labour. Secondary parameters were changes in the amount of blood loss and APGAR score of delivered babies.Results: Among group A, 25% had good pain relief, 60% had moderate pain relief, 15% had mild pain relief and 0% had no relief of pain. The mean duration of labour from active phase through third stage in group A was 234.27±50.38 minutes and 304.58±41.72 minutes in group B. The average blood loss during labour was 89.33±19.06 ml in group A and 142.15±32.27 ml in group B. In group A, 4 babies had APGAR score less than 7 at 1 minute, but had score more than 7 after 5 minutes following resuscitation. In group B, 9 babies had APGAR less than 7 at 1 minute. Of these, 6 babies had score more than 7 after 5 minutes following resuscitation. 3 babies had score less than 7 even after 5 minutes and were shifted to neonatal ICU.Conclusions: Programmed labour protocol is an effective method to reduce the deleterious effects of labour on both mother and foetus.
Are preeclampsia and small for gestational age baby could be predicted by placental location?
Authors: Singh Alpana , Vats Garima , Sharma Taruna , Shriya Rashmi
Published: November 2017

Objective: Preeclampsia is one of the major cause of maternal and perinatal mortality and morbidity. The pathophysiology is complex and involves multiple organs. The purpose of this study was to find out whether the placental laterality as a predictor of preeclampsia and small for gestational age baby.Methods: This was prospective observational study conducted from February 2015 to December 2015, in a tertiary care hospital of Delhi. 347 antenatal patients attending obstetrics OPD without high risk factors were enrolled. After enrolment 50 patients were lost to follow up and 27 not delivered in our hospital. Ultrasonography for placental localization was done at 18-24 weeks of pregnancy. Patients were followed till delivery for pregnancy outcomes such as preeclampsia, small for gestation age (SGA) baby and mode of delivery. Placenta locations were divided into lateral (either right or left) and central (anterior, posterior or fundal).Results: Out of 347, a total of 270 patients were analysed, 39 (14.4%) had lateral placenta and among them 17 (43.5%) developed preeclampsia and 24 (61.5%) had small for gestational age baby (p<0.001). 231 (85.5%) had central placenta and among them 49 (21.2%) developed preeclampsia and 63 (27.2%) had small for gestational age baby (p <0.001).Conclusions: Laterally located placenta had significant association with preeclampsia and small for gestational age babies.
A prospective randomized trial of trans cervical Foley’s with extra amniotic saline infusion versus intra cervical prostaglandin E2 gel for induction of labour setting
Authors: Kumar Sunil , D. Rita , Desai R. M. , K. R. Mohan Kumar , . Dhanalaxmi
Published: November 2017

Background: This study evaluated the effectiveness of Extra-amniotic saline infusion (EASI) in comparison with that of intracervical Prostaglandin E2 (PGE2) gel for cervical ripening and induction of labour.Methods: The study conducted in SDM College of Medical College Dharwad, Department of OBG, from December 2012 to November 2013. Consecutive patients with unfavorable cervices requiring pre-induction cervical ripening and induction of labour for various indications were asked to participate in this study. 50 patients (Group A) underwent extra amniotic saline infusion and 50 patients (Group B) underwent PGE2 gel application. Post induction augmentation if required was administered. Labour profile outcomes were compared between the groups.Results: Results were comparable in terms of maternal age, indication for induction in majority of cases, pre-induction Bishop Score, mode of delivery, complications and side effects, neonatal complications, and Apgar Score. The mean post induction Bishop Score was higher in EASI group by an average of 9. The mean duration of augmentation was more in PGE2 group by an average of 2 hrs. The induction delivery interval (IDI) was prolonged by an average of 3.5 hours in PGE2 group.Conclusions: For pre-induction cervical ripening the extra amniotic saline infusion is valid alternative for the PGE2 gel. Both the modes of induction were equally safe and effective in terms of mode of delivery and Apgar Score. EASI, however, had rapid cervical ripening and shorter induction delivery interval.
Diagnosis of placenta accreta with postpartum hemorrhage in the case of pregnancy termination
Authors: Goksever Celik Hale , Turan Gokce , Ozdemir Ismail
Published: November 2017

The placenta normally attaches to the uterine wall, however there is a condition that occurs where the placenta attaches itself too deeply into the uterine wall. This condition is known as placenta accreta, increta or percreta depending on the deepness of the placenta attachment. This study aimed to present the patient who induced with prostoglandin E2 (misoprostol) for 22 weeks intrauterine mort fetus and then hysterectomized because of atony and placenta accreta
Pelvic pain due to intrauterine retention of fetal bone after second trimester medical termination of pregnancy: a rare case report
Authors: Salvi Meena Bhati , Chauhan Madhubala
Published: November 2017

Intrauterine retention of fetal bone is a rare complication of second trimester termination of pregnancy. These patients may present with abnormal uterine bleeding, dysmenorrhea and secondary infertility. In this case pelvic pain was the only symptom. A 32-year-old woman with history of second trimester medical termination of pregnancy was examined. Pelvic ultrasound revealed retained products of conception. After surgical evacuation, intrauterine retained fetal bone was identified to be the cause of pelvic pain. In patients with history of second trimester abortion, cause of pelvic pain should be properly evaluated.
Rectal prolapse in pregnancy: a case report
Authors: Sunil Isha , Kohli Manisha
Published: November 2017

Rectal prolapse is complete or partial protrusion of rectal tissue through the anus to the exterior of the body. It generally occurs after 60 years of age and is more common in women than men. Here we present a case report of 30 years old G3P1L1A1 with 37 weeks gestation age with complaint of mass protruding per rectum and diagnosed as rectal prolapse which is uncommon during childbearing years. Its management during pregnancy is mostly conservative and definite treatment is deferred until delivery. Rectal prolapse is not a contraindication for vaginal delivery and low outlet forceps deliveries have been mentioned in literature. However, most obstetricians prefer caesarean section to prevent a difficult vaginal delivery and perineal trauma to the patient that could further aggravate rectal prolapse
Roberts uterus: a rare congenital anomaly
Authors: Sardeshpande Nagendra , Chipalkatti Pratima , Doctor Jainesh
Published: November 2017

A 23-year-old girl presented with severe cyclical lower abdominal pain during menstruation since menarche, which had increased since the last 4 years. Transabdominal ultrasound showed adnexal mass with no internal vascularity; MRI reported it as bicornuate uterus with one non-communicating right uterine horn with haematometra. On hysteroscopy there was evidence of septate uterus communicating only to the left ostia. Ultrasonography-guided hysteroscopic resection of septa with drainage of haematometra was done. Patient is presently asymptomatic.
Factors associated with exclusive breastfeeding in Kenya: a systematic review
Authors: Mututho Leah N. , Kiboi Willy K. , Mucheru Patrick K.
Published: November 2017

World Health Organization (WHO) recommends that infants should be exclusively breastfed (EBF) for the first six months of life. Breast milk is considered an ideal food for the healthy growth and development of the infant. Exclusive breastfeeding is also important in ensuring the health of the mother. Lack of exclusive breastfeeding in the first six months of a child’s life is considered a risk for infant and childhood morbidity and mortality. In Kenya, sub-optimal breastfeeding practices are still prevalent which has contributed to high rates of under nutrition. Different studies done in Kenya have reported varying factors as potential determinants of exclusive breastfeeding. These factors have been reported under different contexts and settings. This paper explores these factors, which can help in policy making and informing other relevant interventions promoting exclusive breastfeeding. Literature was searched through Freefullpdf, Google scholar and PubMed (Medline) using the following key terms; exclusive breastfeeding in Kenya, determinants of exclusive breastfeeding and factors influencing exclusive breastfeeding. Only peer reviewed articles, and research theses were included. Additionally, only literature reporting on exclusive breastfeeding practices and its associated factors was included. A total of 20 papers were included in the review. The following factors were found to be associated with exclusive breastfeeding; socioeconomic, demographic, maternal, socio-cultural, social and psychosocial support factors. Strategies targeting socioeconomic, demographic, maternal, socio-cultural, social and psychosocial support factors for improving exclusive breastfeeding should be up scaled. Behavior change communication on appropriate exclusive breastfeeding practices is also highly recommended.
Essential drug use patterns in primary health care in Tamil Nadu
Authors: C. Sashidharan , S. Gopalakrishnan
Published: November 2017

Tamil Nadu is one among the few States in India to implement the concept of essential drugs in the health care delivery system. Essential drugs are those that satisfy the health care needs of the majority of the population, meant to treat commonly prevalent diseases, they should therefore be safe, effective and should be available at low cost at all times, in adequate amounts and in the appropriate dosage forms. Essential drugs are critically required for the management of 90-95% of commonly occurring disease conditions in our country. The Tamil Nadu medical services corporation (TNMSC) was established in 1994 by the Tamil Nadu State Government in order to scientifically procure, store and distribute quality drugs based on the Essential drugs concept to all levels of health care delivery system in the State at low cost. This article is meant to identify the benefits of using essential drugs in the health care delivery system in Tamil Nadu.
A study on awareness of organic food products in Trichy district
Authors: B. Rock , K. Puhalenthi , S. Vishnupriya , R. Pavithra , A. S. Supriya , K. Gayathri
Published: November 2017

Background: The high growth of population and life expectancies during the recent years increased demand for food supplies in India. To meet this, the green revolution became the corner stone of agricultural achievement. Overexploitation of natural and non-renewable resources has impaired ecological balance and has put the health of the consumers in jeopardy. Therefore it is inevitable to resort to organic food products. The aim of the study was to assess the awareness of organic food products among the consumers in Trichy district, Tamil Nadu.Methods: A cross sectional questionnaire based study was conducted among rural, semi-urban, urban residents (100 each, total of 300) in august 2016. Results: Out of 300 respondents, 76%, 73%, 62% of the respondents have heard known about, and purchase organic food products respectively. The main source of organic foods was from specific shops and kitchen gardens and the most preferred factor while purchasing food items is the credibility. Though 62% of consumers purchase organic food, they mainly prefer vegetable and fruits and 38% of the respondents consume organic food regularly. The reason for not consuming organic foods in our residents is the non-availability. Conclusions: Awareness of organic food products among study population is about 76% with the greater awareness level among urban population. The main reasons for consuming organic food being credibility & availability. Increasing the awareness level of organic products, encouraging people to create their own organic garden can increase consumption of organic foods.
Analysis of neonatal deaths in Maharashtra: policy implications
Authors: Saunik S. , Jaiswal C. , Nair R. , Radkar A. , Patil A. , Irani S. , Phadke M.
Published: November 2017

Background: As per statistics on infant mortality, the State of Maharashtra has done well in bringing down IMR from 33 to 21 per 1000 live births. However a lot needs to be achieved still. Various child health programs like home based new born care and others have improved child survival. But the analysis of cases will throw light on actionable points for policy change. Methods: Keeping in mind mortality statistics of the State, an analysis was done on causes of neonatal deaths and social determinants. A retrospective study was done on causes of death from birth to 28 days during 2015-2016 in the State of Maharashtra. 6 deaths per block were reviewed by a committee that included a pediatrician. Verbal autopsy was done and all factors like social, cultural, behavioral as well as factors that resulted in delay in deciding to take the baby to health facility, delay in transport and delay at health facility were studied in details. Results: Latur circle had the highest deaths i.e. 70%, Nashik and Gadchiroli had 62 and 63% respectively. Males were more than females (55.7%). ^0.6% of deaths occurred in babies weighing less than 2500 gms. Delay in deciding to take the baby to the health facility and getting treatment was important (41.4% cases). In 40.8% cases delay in receiving treatment at health facility was observed. Major causes were infections, prematurity and asphyxia. Conclusions: Various causes of neonatal deaths are studied. Delay in deciding to take the baby to the health facility was one of the major factors. Majority of deaths were due to infection prematurity and asphyxia.
Non dermatophytic molds causing onychomycosis: a rising trend in North India
Authors: Kaur Ravinder , Panda Pragyan Swagatika , Khan Shahnawaz
Published: November 2017

Background: Onychomycosis is rarely life threatening but can affect patient’s quality of life by its associated morbidity and cosmetic disfigurement that makes it an important public health problem. So the current study was undertaken to look for causes of onychomycosis including the non-dermatophytic molds that are normally considered as contaminants. Methods: A total of 100 nail samples from clinically suspected cases of onychomycosis, were processed by direct microscopy of the KOH mount followed by two sets of culture on Sabourauds’ Dextrose Agar and incubated at 25ºC and 37ºC and were examined once a week for a period of 4-6 weeks, to look for the fungal causative agent. Results: Infection was more common among males and amongst age group 21-30 years (31%). The finger nails (57%) were more commonly involved than toe nails (43%). Onychomycosis was mostly caused by molds (55%), followed by dermatophytes (15.8%) and yeasts (9.3%). Aspergillus niger and A. flavus (13% each) were the most common molds, T. verrucossum (4.6%) was the most common dermatophyte, while Candida albicans (6.5%) was the most common yeast isolated. Conclusions: There is a rising trend of non dermatophytic molds causing onychomycoses, Thus microbiologists should look for all the possible causes of superficial fungal infection.
Influence of socio demographic factors on noncompliance among patients treated under RNTCP in a rural tuberculosis unit in Karimnagar district
Authors: Sairam Amarvadhi , Guthi Visweswara Rao , Prasad Sarma M. M. V
Published: November 2017

Background: Tuberculosis (TB) remains the number one killer infectious disease affecting adults in developing countries. The 1990 World Health Organization (WHO) report on the global burden of disease ranked TB as the seventh most morbidity-causing disease in the world, and expected it to continue in the same position up to 2020. The objective of this study is to evaluate the socio-demographic factors leading to non-compliance. Methods: The present study is case control study conducted to evaluate socio-demographic characteristics factors for non-compliance among patients treated under RNTCP in a rural tuberculosis unit in Karimnagar District. Among the 394 defaulters, 77 were not available at the address given to the TU during visits for sampling, 15 were not willing to participate and 2 patients were unable to communicate. 300 TB cases who have completed the treatment were taken as controls. Results: Age wise distribution of sample respondents is shown in above table. Most of the respondents 241 (40.2%) belonged to the age group of 31-40 years followed by 136 (22.7%) between age 41-50 years. 398 (66.3%) of them were male and 202 (33.7%) were female among the studied population. majority of the studied sample belonged to rural area 539 (89.8%) as compared to urban area 61 (10.2%). Conclusions: Increasing age with respondents above 40 years were likely to be non-compliant, living in a rural area, having migrated and belonging to low socio-economic status were also significant factors. Living in a nuclear family was also significant due to the lack of familial support. Patients who were tobacco users and consumers of alcohol were likely to be non-compliant. Families with multiple members suffering from TB were likely to have non-compliant patients.
A prospective study of clinical profile, epidemiology and etiological diagnosis of corneal ulcer in North-West Rajasthan
Authors: Joshi Rashmi Kewaliya , Goyal Rekha Kumari , Kochar Anju
Published: November 2017

Background: To determine clinical profile, epidemiological and etiological diagnosis of corneal ulcer in North-West Rajasthan. Methods: One hundred thirty three patients who were treated for corneal ulcer were enrolled in this study from February 2015 to May 2017. The historical aspect including symptoms, duration of ulcer and relevant local and systemic predisposing factor and detailed ocular examination were noted. Corneal scrapings were taken up in almost all cases except few cases and sent for microbiological assessment. Results: 66.9% were males and 33.08% females. Most common age group was between 30-60 years and majority of patients were from rural areas. Most common pathogen was found Aspergillus fumigatus. Conclusions: Corneal ulcer was seen predominantly in males of 30-60 years of age of rural background. Aspergillus fumigatus being most common etiological organism.
A community based cross sectional study on prevalence of iodine deficiency disorders among 6-12 years children of a district of North Karnataka
Authors: Sonavane Rekha S. , Mayappanavar Ramesh H. , K. R. Ananthachari , Roy Subarna , Prasad U. Venkateswara , Byakod Mahesh , Mudaraddi Roshan , K. Shilpa
Published: November 2017

Background: Iodine deficiency is the major preventable cause of irreversible mental retardation in the world with nearly 2 billion people with iodine deficiency disorders (IDD).In India district level surveys conducted in 2006 in 324 districts have revealed that IDD is a major public health problem in 263 districts that is total goitre prevalence rate of more than 10% in the population. Methods: The survey was conducted from November 2016 to January 2017, after obtaining permission from Institutional Ethical Committee, using population proportionate to size (PPS) sampling method among of 6-12 years children. In the selected villages, primary schools were visited and a sample of 90 children was selected and was examined after consent from school authority. Prevalence of goitre was assessed and graded by standard palpation method. In few selected children urine and house hold salts are examined. Results: The prevalence of goitre among the 6 to 12 years children was found to be 22.78%. There was not much difference in prevalence of goitre in females compared to males in all the age groups and prevalence of goitre was observed to increase with age, which was found to be statistically significant (p=0.00001). Conclusions: Prevalence of iodine deficiency is significantly high and higher prevalence was found with increasing age.
Alcohol consumption among college students in Minahasa, Indonesia: a cross-sectional study towards the formulation of intervention strategies
Authors: Supit Alva , Mamuaja Prycilia , Pissu Aditya
Published: November 2017

Background: College students are within the high-risk group to experience the full spectrum of alcohol-related psychopathologies, ranging from initial contact with alcohol to the severe problematic drinking. The prevalence, degree of severity, reasons of drinking, among other variables, however, have been inconsistent across studies. Therefore, it is crucial to replicate such studies in different socio-cultural settings to synthesize a broader understanding about alcohol-consuming behavior and formulating intervention strategies. This research aims to describe the pattern of alcohol drinking behavior among college students in Minahasa, Indonesia, and to analyze its correlation with academic performance. Methods: We conducted a questionnaire-based cross-sectional study to investigate the alcohol-consumption pattern and examined its association with the students' academic performance obtained from the campus database. A total-sampling technique was applied to draw the samples. Chi-square and Kendall's tau analyses were employed accordingly to measure the relationship significance. Results: From 417 samples (338 samples were females), 70.98% of them reported never had consumed alcohol of any amount. Male sex and local ethnicity are positively associated with consuming behavior. We found an association between alcohol consumption status with cumulative GPA but not with current GPA. Although alcohol consumers considered GPA as less important, the self-insight about their academic performance is intact. The consumed beverages were mostly beers, followed by traditional liquor and winepalms. Most of them consumed alcohol to "warm-up the body"—a common practice in this area, followed by social reasons. Only small number of them identified themselves as being addicted. Majority of the consumers realized the importance to reduce or quit consuming alcohol. The implications of these findings are then discussed. Conclusions: This study showed that most of the students have never consumed alcohol. However, among the consumers, male sex and local ethnicity are more prone to become alcohol users. The academic performance is also affected, and since most of the consumers consider to reduce their drinking behavior, professional interventions are necessary to facilitate recovery attempts.
A study of risk factors of hepatitis B infection among rural adult population of Patna, Bihar
Authors: Lohani Pallavi , Kumar Alok , Singh Rashmi , Kumar Sinha Ranjeet , Mukherjee Madhumita
Published: November 2017

Background: Chronic infection with heptitis B virus (HBV) leading to cirrhosis, cancer, premature death and consequent economic burden is a global problem. Prevention is a public health challenge especially in unvaccinated and disadvantaged populations with unknown risk factors. Majority of Bihar’s population is rural, whose risk factors have not been studied earlier. The objective was to study the risk factors of HBV infection in the rural adult population of Bihar with aim of identifying target group for prevention. Methods: Analytic case-control study in which health camps were organized in villages of Phulwarisharif block of Patna district to screen adults and identify cases and controls. Results: H/o jaundice 6 months or more (p=0.00, OR=3.58); contact with HBV (p=0.00, OR=4.17), family H/o HBV (p=0.00 OR=5.41); blood transfusion (p=0.00, OR=6), H/o hospitalization (p=0.001, OR=2.36), surgery (p=0.003, OR=2.17) and migration (p=0.018, OR=1.95) were significant risk factors. Lack of knowledge about HBV was significant (p<0.030). About 40% and 20% of both cases and controls were aware of parenteral and sexual transmission respectively; 4% cases vs. 13% controls knew about preventive vaccination. Logistic regression revealed that H/o jaundice, family H/o hepatitis B, blood transfusion, hospitalization and migration were independent risk factors for HBV transmission (OR=4.69, 6.55, 3.89. 2.49 and 2.76 respectively) Conclusions: Screening and awareness programs for rural adults necessary to identify and follow up those with H/o jaundice, HBV+ contacts and migrant population. Infection control and biomedical waste management need strengthening.