bluuebunny/crossref_metadata_2025 huggingface dataset:
Cupping: a reasonable choice for attenuating morphine withdrawal symptoms in Wistar rats
Authors: Khosravi Parinaz , Roostayi Mohammad M. , Manshadi Farideh Dehghan , Khademi-Kalantari Khosro , Hassanzadeh Kambiz , Baghban Alireza Akbarzadeh
Published: November 2017

Background: Nowadays, the sedative drugs are the main treatments to attenuate the opioid withdrawal symptoms. However, physical therapies are found a safe alternative treatment without any serious adverse effects. This study aimed to evaluate the effects of cupping treatment on the morphine withdrawal symptoms in rats.Methods: Eighty rats were divided into two main groups; treated with morphine or saline, and each group was also divided to cupping and sham cupping subgroups (with single or daily treatment). Injection of morphine and saline were done in the morphine and saline groups twice a day for nine days. On the ninth day, the naloxone was administered and the withdrawal symptoms including jumping, rearing, body grooming, abdominal writing, and wet-dog shaking were recorded for 60 minutes. Cupping or sham cupping was applied on the GV14 once before or daily after withdrawal induction in each group.Results: The results revealed that a single cupping before the withdrawal induction significantly attenuated the withdrawal symptoms in the morphine group (p<0.01).But, the daily cupping failed to decrease the withdrawal symptoms in this group. The results also indicated that the daily cupping in the saline group increased the naloxone-induced withdrawal symptoms significantly (p<0.01).Conclusions: Single session cupping before the withdrawal induction could decreased the withdrawal symptoms. This finding might be related to the modulation of GABAergic system.
Preference for utilization of drug information sources among postgraduate medical residents
Authors: Gandhi Kedar , Jadhav Pradeep R.
Published: November 2017

Background: Drug use information is vital for ensuring rationale and safe drug therapy. Physician across the globe use different sources of drug information during their routine practice. Postgraduate residents are in their interim-phase of education, research and clinical exposure. They are exposed to vast array of authentic and non-authentic drug information due to technology advancements and interaction with peers and medical representatives. There exists paucity in literature on their preference and drug information pattern. Therefore, this study was conducted to find out their preference for drug information sources.Methods: The present study was prospective, observational, questionnaire-based survey. The study was conducted between March 2017 and April 2017. The study included postgraduate medical residents pursing speciality courses at a tertiary care teaching hospital in Navi-Mumbai. Data was compiled and analysed in Microsoft excel.Results: Majority postgraduate residents preferred Non-electronics source for drug information. Text books (84%) were commonly preferred followed by medical journals in Non-electronic sources while internet-websites (76%) followed by e-journals and e-books were preferred in electronic sources. Majority preferred non-electronic sources for drug pharmacology and adverse reactions while electronic was preferred for indication, interaction, cost and therapy guidelines. For information on new drugs, majority preferred journals (71%) and websites (64%). Lack of time, source knowledge and high cost were perceived limiting factors for drug information.Conclusions: Postgraduate residents have varied preferences for drug information resources. Internet websites poses a challenge for authentic drug information. Interventions in the form of continuous medical education are required to improve their information-seeking behaviours.
Knowledge, attitude and practice of adverse drug reactions reporting among nurses in a tertiary care centre
Authors: Survase Priyanka S. , Date Amit P. , Borkar Archana S. , Badwaik Rupesh T. , Siddiqui Riaz A. , Shende Tanaji R. , Dashputra Amruta V.
Published: November 2017

Background: Adverse drug reactions are one of the major medicine related problem related to pharmacotherapy which may lead to increased morbidity and mortality causing increased hospital stay and financial burden on the society. Spontaneous voluntary reporting of adverse drug reaction can play a vital role in generating safety signals in which nurses can play important role, hence this study was undertaken to evaluate the knowledge attitude and practice of ADR reporting along with factors affecting reporting among nurses.Methods: The present study was a cross sectional questionnaire based study, which included nurses of a tertiary care hospital in central India. We tried to find out the possible ways to perk up spontaneous reporting of ADR and factors responsible for scarce reporting of ADRs.Results: After analyzing the data, we observed few of responders were aware of the ADR reporting system and the most encouraging finding was that majority of the responders were of the view that this reporting system is necessary. However, response to practice related questions was below average. Main factors which discouraged ADR reporting by nurses was thinking that reporting would lead to extra work and non availability of forms.Conclusions: The deficiencies in ADR reporting require awareness so as to perquisite spontaneous reporting and improve safety of patients. Training to nurses will lead to improvement in reporting of ADR.
Zolpidem dependence with frontal lobe syndrome: a case report
Authors: Majumder Udayan , Das Rajesh , Singh Rajkumar Lenin
Published: November 2017

Zolpidem is a non-benzodiazepine sedative hypnotic that binds to the benzodiazepine binding site on the gammaaminobutyric acid type A (GABA-A) receptors. It is the most commonly prescribed sleep medication which has been shown to be effective for treating insomnia on a short-term basis with fewer side effects than traditional benzodiazepines, which are feared for their abuse and dependence potential. Many studies have reported efficacy and safety of zolpidem in treatment of insomnia keeping in mind about its low abuse, and dependence capability. We present a case of zolpidem dependence in a 36-year-old male to emphasize that zolpidem also should be judiciously prescribed under supervision so that it does not develop tolerance, abuse and dependence.
Correlation between the anti-Müllerian hormone and endovaginal ultrasound in the predictivity of polycystic ovary syndrome at Chracerh
Authors: C. C. Noa Ndoua , G. Ayissi Ngah , V. Mve Koh , E. Belinga , J. D. Kemfang , J. M. Kasia
Published: November 2017

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome posing diagnostic problems in current practice, because of the cumbersomeness associated with the application of the criteria that define it; giving rise to over or under diagnosis of it. Anti-Müllerian hormone (AMH) is an effective alternative in this case, being a stable, reproducible and non-operator dependent marker to diagnose PCOS due to the link that binds it to the multiple pre-antral follicles in the ovaries of PCOS patients. The aim of this study was to determine the threshold value of AMH required to define PCOS in our African population, by revealing the correlation with antral follicles count (AFC) on endovaginal ultrasound.Methods: We carried out a comparative cross-sectional study, with retrospective data collection in 23 infertile patients diagnosed with PCOS according to the Rotterdam 2003 criteria, and 23 non-PCOS infertile controls having performed the AMH test using the Immunotech technique at CHRACERH. Endovaginal ultrasound (U/S) was performed using a 7.5 mega Hertz (MHz) transvaginal transducer by different qualified operators (radiologists, gynecologists). The comparison of the two independent groups (PCOS and non-PCOS) was performed by the Student t-test; correlations between AMH, age, AFC and ovarian volume obtained by the Pearson test; and the diagnostic power of AMH test in PCOS was evaluated by receiver operating characteristic curves (ROC).Results: AMH was approximately twice as high in PCOS compared to controls (6.09 versus 3.80, P <0.001) and was inversely correlated with age (r = -0.301; P ˂0.05); significantly correlated antral follicle count (R = 0.85, P <0.0001) and ovarian volume (r = 0.625, P <0.0001). ROC analysis revealed that the AMH test was very informative for the diagnosis of PCOS with an area under the curve (AUC) at 0.90 (0.81-0.99; 95% CI); and the threshold value given by the farthest point of the diagonal representing the nil contribution test was 4.40 ng/L, and predicted PCOS with a sensitivity of 96% and a specificity of 70%.Conclusions: AMH is a predictive marker for PCOS. It is highly correlated with AFC and ovarian volume and appears to decrease with age. It offers good diagnostic performance in PCOS, with a threshold value of 4.40 ng/L for a sensitivity of 96% and specificity of 70%.
The use of HPV-DNA testing combined with Pap smear in detection of pre-invasive disease of the cervix
Authors: Nwesar Fayrouz A. , Salam T. Tawfik Abdel , M. Marwa Hanafi , Younis Layla K. , Abou-Zeid Ziad S. , Elkaffash Dalal M. N.
Published: November 2017

Background: Cancer cervix constitutes a major health problem worldwide. It is one of the most common female malignancy in both incidence and mortality. Cancer cervix has many risk factors, the most important one is persistent infection with one of HPV high risk types. Its morbidity and mortality can be reduced by frequent screening and early diagnosis. So that, several studies have been conducted in recent years in order to find better tests for screening for pre-invasive disease of the cervix and so early intervention and better prognosis. This study aimed to compare the sensitivity of Pap test and HPV DNA test as screening tests for pre-invasive disease of the cervix.Methods: 100 females from those attending Alexandria University gynaecologic clinic for causes rather than cancer cervix were subjected to Pap smear and cervical swab for HPV-DNA testing at the same setting. Cases of HSIL or positive HPV were subjected to VIA test, colposcopy and cervical punch biopsy was taken if aceto-whitening of the cervix or any other abnormality was found. Cases with ASCUS or LSIL were re-smeared after 3-6 months, if persistent or progressive pathology, colposcopy and punch biopsy from acetowhite areas were taken.Results: 21 cases (21%) were HPV positive and 66 cases (66%) were positive for intraepithelial lesions (37% ASCUS, 18% LSIL and 11% HSIL) with re-smearing there were 3 persistent ASCUS cases (8.1%) and 5 LSIL cases (27.78%). Colposcopy done, and biopsies were taken from 10 HSIL cases (90.1%), 5 LSIL (27.8%), 3 ASCUS (8.1%) and 10 HPV positive cases (62.5%). With significant relationship between colposcopic findings and HPV-DNA positivity and abnormal cytology. Biopsies were 18; 14 were CIN I and 4 were CIN II.Conclusions: HPV-DNA positivity has positive association with HSIL. Pap smear is an easy cheap method for screening. HPV-DNA test is less sensitive than cytology as a method for screening.
Study of maternal and perinatal outcome of referred patients in tertiary health centre
Authors: Jyotsana . , Kapadia Lalit D. , Vohra Hafsa
Published: November 2017

Background: Referral services for identification and referral of high risk pregnancies are an integral part of maternal and child health services. The aim of this study was to review the pattern of obstetric cases referred to tertiary care center, to identify their clinical course, mode of delivery, maternal and perinatal outcomes.Methods: It is a prospective observational study carried out from January 2017 to July 2017. Study population was all Obstetrics patients referred to Department of Obstetrics and Gynecology of B.J Medical College, Ahmedabad, Gujarat, India a tertiary care center during the study period.Results: The total number of referred cases in above study period was 100. Mode of transport used by the referred patients was by 108 ambulances (75%) and private vehicles (25%). Most common diagnosis at the time of referral was hypertensive disorders of pregnancy (31%). Out of the total referred cases, 57% had vaginal delivery, 42% had caesarean section. Hypertensive disorders of pregnancy constitute the leading cause of maternal deaths amongst the referred cases.Conclusions: The present study has shown that inadequate antenatal and intra-natal care at the periphery level is responsible for increased maternal and perinatal morbidity and mortality. Even today, hypertensive disorders of pregnancy are the leading cause of maternal mortality. Health education to the community will definitely reduce maternal and perinatal morbidity and mortality.
Comparative study to evaluate the prevalence of deranged lipid profile and oral glucose tolerance test in polycystic ovarian syndrome patients with normal females: a prospective observational study
Authors: Phutela Isha Rani , Pandit Basharat Hussain , Ashraf Asia , Wani Sadia Ali , Din Mehraj Ud
Published: November 2017

Background: PCOS is a complex endocrine disorder characterized by menstrual dysfunction, anovulation, infertility and hyper androgenic symptoms with dyslipidaemia, cardiovascular diseases, and impaired glucose tolerance and type II diabetes mellitus. Multiple risk factors are involved in the pathogenesis of PCOS.Methods: A comparative evaluation of deranged lipid profile and OGTT in PCOS patients with normal females was done in patients with age group of 15 to 30 years. The Rotterdam criteria for PCOS was used for selection of the participants prospectively and a detailed history regarding period of amenorrhea, menstrual cycles, obstetric history, any past history of medical disorder were taken followed by general physical, systemic and obstetric examination. All the patients underwent Ultrasound examination, OGTT and lipid profile, prolactin, 17-OH progesterone and testosterone level.Results: A significant association of PCOS with deranged lipid profile and blood glucose tolerance and obesity was observed. Patients with PCOS had higher prevalence of oligomenorrhoea, infertility, hirsutism and acne. Furthermore, a statistically significant trend was seen where signs and symptoms like infertility, hirsutism and acne, deranged OGTT and dyslipidaemia were more frequently associated with increased BMI, sedentary life style intake of high calorie diets.Conclusions: An association between obesity, sedentary lifestyle, and dietary factors with PCOS was observed which can be modified to improve the health condition of the women with PCOS.
Effectiveness of Laparoscopic Ovarian Drilling (LOD) on restoration of menstrual cycles, ovulation and pregnancy in clomiphene citrate resistant women with PCOS
Authors: Chundawat Rama Singh , Gupta Arun
Published: November 2017

Background: Anovulatory infertility is present in 75% of patients with polycystic ovarian syndrome (PCOS), in addition to oligomenorrhoea and signs and symptoms of hyperandrogenism. This study was performed to evaluate the role of laparoscopic ovarian drilling (LOD) on ovulation, restoring menstrual cycles and pregnancy in clomiphene resistant women with PCOS.Methods: This prospective cohort study included 50 women who were diagnosed with PCOS and anovulatory infertility. These patients had already tried Clomiphene citrate for conception and did not ovulate, underwent LOD between 1st September 2009 until February 2011 in the Department of Gynecology and Obstetrics, at the Panna Dhay Mahila Chikitasalya, Udaipur. The major outcome measures include spontaneous ovulation, menstrual regularity after LOD and pregnancy rates.Results: Among 50 patients 33 (66%) started to menstruate regularly and 60% ovulated spontaneously, of them 24 (48%) conceived.Conclusions: Women with PCOS respond favourably to LOD.
Histopathological pattern of ovarian neoplasms in Sub-Himalayan belt of rural India: a four-year study from a tertiary care teaching hospital
Authors: Sharma Manupriya , Soni Anjali , Kaul Rashmi
Published: November 2017

Background: Ovarian tumors are one of the ubiquitous and common forms of neoplasms in women. The aim of the study was to understand the pattern of benign and malignant ovarian neoplasms and their distribution in different age groups in rural population of India.Methods: A retrospective study conducted in the Department of Pathology in close collaboration with Department of Obstetrics and Gynecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda (HP), India. All the patients irrespective of age group who were operated for ovarian neoplasms (benign or malignant) were included in this retrospective analysis over duration of four years (2013 to 2016). “WHO classification system” was used, for classification of all these ovarian tumors. The incidence of these tumors with respect to age group was also studied.Results: During the study period (2013-2016), there were a total of 242 surgeries for ovarian neoplasms. Of these, majority of the tumours were benign 184 (76%), but an alarming number of women had malignant ovarian tumours 51 (21%), remaining 7 (3%) cases were borderline. Age wise distribution was 7% (16/242) in less than 20 years age, 19% (46/242) in 20-30 years age, 29% (69/242) in 30-40 years age group, 24% (59/242) in 40-50 years and remaining 21% (52/242) in more than 50 years age group. Pre-dominantly benign tumors were surface epithelial tumors (serous/ mucinous cystadenoma), germ cell tumors (mature cystic teratoma) and endometrioma. Major malignant tumors were surface epithelial tumors (serous/mucinous cystadeno-carcinoma), and germ cell tumors (dysgerminoma, immature teratoma).Conclusions: In this sub-Himalayan belt of rural India, the incidence of benign ovarian tumors was 76%. Borderline ovarian tumors were seen in 3% cases and the remaining 21% cases were malignant ones. Even though benign tumors were the commonest for each age group, however as the age of women increased the proportion of malignant tumors in them increased. Surface epithelial tumors are the most common class of tumors in both benign and malignant tumors. Serous cystadenoma is the most common ovarian tumor overall as well as most common benign tumor whereas serous cystadeno-carcinoma is most common malignancy. Stromal ovarian tumor (one case) is a rarity. Only one woman had bilateral ovarian tumor.
Fever in pregnancy and its maternal and fetal outcomes
Authors: More Vibha S.
Published: November 2017

Background: Contemporary obstetrics has witnessed improved maternal and fetal outcomes, owing to several advances. Any source of maternal hyperthermia that results in significant core temperature increase (>38.9°C), could potentially affect the fetus.  Hence a study was planned to know the effect of fever on maternal and fetal outcome.Methods: This was a retrospective cohort analysis of case-records, of patients admitted in the Department of Obstetrics and Gynecology at tertiary care centre, Mumbai, between May 2007 and October 2009. The main parameters of assessment included incidence of fever in pregnancy, causes of fever, effect of episode(s) of fever on maternal and fetal outcomes, effect of specific infection on maternal and fetal outcomes, impact of fever on antepartum, intrapartum and postpartum phasesResults: The incidence of fever was 10.5%. the common cause of fever was malaria (15%), urinary tract infection (14%), viral (14%), respiratory tract infection (18%), and typhoid (7%). Seventy eight percent had fever in third trimester. The most common antenatal complication observed was preterm (13%), premature rupture of membrane (12%), oligohydramnios (8%), intrauterine growth retardation (26%). The rate of LSCS was 13% in study group and the most common indication was fetal distress and meconium stained amniotic fluid.Conclusions: In the present study on fever during pregnancy and its maternal and fetal outcomes, fever was associated with a definite impact on maternal and fetal outcomes. Preterm and IUGR were the most common fetal complications. Duration of fever was linearly associated with poor outcomes. Different causes of fever also had different impact on maternal and fetal outcome. Preterm IUGR, MSAF were more common with malaria and tuberculosis. Abortion was more commonly seen in first trimester fever, whereas preterm, PROM in the third trimester fever. Hence it is suggested that fever during pregnancy needs to be promptly investigated and treated to have a better outcome.
Vaginal birth after caesarean section: why and how?
Authors: Bangal Vidyadhar B. , Gavhane Satyajit , Yadav Vishesha , Aher Kunal , Bhavsar Dhruval
Published: November 2017

Background: With the significant rise in the incidence of primary caesarean section(CS) for various indications, an increasing proportion of the pregnant women coming for antenatal care, report with a history of a previous CS. This necessitates definite need to bring down the caesarean section rate, either by judicious selection of cases for primary caesarean section or by attempting vaginal delivery, following previous caesarean section (VBAC).Methods: A prospective observational study was conducted to find out the success of VBAC and the common predictive factors leading to successful VBAC. A total of 136 pregnant women with full term pregnancy, having history of previous one lower segment caesarean section and without any other medical and obstetrical complication were enrolled in the study.Results: Majority of the women (95.59%) had spontaneous onset of labor. The success of VBAC was 75 percent. The commonest maternal complications were fever (7.35%), scar dehiscence (3.68%), PPH (1.47%) and wound infection (2.21%).There was significantly higher number of women who had history of previous successful VBAC, had vaginal delivery (91.67%; p=0.038).It was observed that the rate of vaginal delivery was significantly high in women with Bishop’s score between 10 to 13 (94.64%) compared to 6 to 9 (61.25%) (p<0.001).The baby weight determined by ultrasound scan was significantly associated with mode of delivery (p=0.049).Conclusions: Vaginal Birth After Caesarean section is relatively safe, provided it is conducted in carefully selected cases, under constant supervision. Spontaneous onset of labour, good Bishops score and average baby weight were good predictors of successful VBAC.
Cervical length measurement by transvaginal sonography in predicting preterm labour in low risk women
Authors: P. Sandeep Sethumadhavan , Agarwal Raju , M. Anilkumar Jayamol , Ramchandran Pillai Anup
Published: November 2017

Background: Preterm birth is the leading cause of perinatal morbidity and mortality. Transvaginal sonographic measurement of the cervix is a reliable alternative method for the assessment of cervical length as it allows better quality and more accurate visualization of the uterine cervix. Several studies have reported that cervical assessment on transvaginal sonography may be useful in the prediction of preterm delivery. The objective of this study was to assess cervical length at 20 to 24 weeks of gestation in low risk women and correlate with the gestational age at delivery.Methods: A prospective cohort study conducted in a tertiary care Military Hospital in Pune, India. 354 asymptomatic low risk antenatal women with gestational age of 20 to 24 weeks were studied. Cervical assessment with transvaginal sonography for the measurement of cervical length was performed using a 10 MHz transvaginal probe.Results: 7 percent women delivered preterm. The incidence of short cervix in low risk women was only 0.56%. 100% women with short cervix delivered preterm and, only 6.9% patients who had cervical length more than 25 mm delivered preterm. Cervical length 25 mm has got sensitivity and NPV of 100% and a specificity of 93.46%. However, the PPV was only 8%.Conclusions: The study reported significant inverse relation between short cervix and the occurrence of preterm delivery. Our findings suggest that cervical length can be used as a screening method for preterm labour in low risk women. However strong evidences from large randomized control trials would be required to assess its cost-effectiveness.
Association of maternal serum vitamin D level with preeclampsia or eclampsia and its relationship with neonatal outcome and neonatal serum calcium level
Authors: Sahu Mahija , Tripathy Sonali , Bhuyan Pallavi
Published: November 2017

Background: Vitamin D deficiency has been associated with various poor maternal and fetal outcome and is proposed to be important in the pathogenesis of preeclampsia. The aim of the study was to evaluate the serum vitamin-D levels in normal pregnant females and pre-eclampsia or eclampsia individuals in the third trimester admitted for termination or in labour and to assess the neonatal outcome and neonatal serum calcium levels of babies born to mother in both the groups.Methods: This study was a prospective comparative study carried out on the pregnant women in the third trimester admitted for termination or in labour. 100 pregnant females with either pre-eclampsia or eclampsia were compared with equal number of normotensive pregnant females for serum vitamin D. They were followed up until delivery and subsequently neonatal serum calcium level was estimated.Results: Most pregnant females had vitamin D deficiency pointing towards universal prevalence. Only 10% had suboptimal to optimal vitamin D level while 90% had vitamin deficiency. The hypertensive group had lower mean serum vitamin D level (9.06±5.20 ng/ml) as compared to normotensive group (13.67±7.24 ng/ml). Neonatal outcome was poorer in the hypertensive group. Neonates born to hypertensive mothers had lower mean calcium level (8.30±1.46mg/dl) when compared to those born to normotensive mothers (8.82±0.918mg/dl).Conclusion: The study findings revealed that there lies a consistent association of maternal serum vitamin D deficiency with the hypertensive disorders of pregnancy and neonatal morbidity.
Awareness of cervical cancer risk factors and screening methods among women attending a tertiary hospital in Lucknow, India
Authors: Nigar Asma
Published: November 2017

Background: Cervical cancer is the second most common cancers among women worldwide after breast cancer. It is the only cancer in which early diagnosis of precancerous lesions can be done by a very simple and sensitive test that is, paps test. Knowledge of the women about cervical cancer risk factors and awareness about its screening are the key factors that may decrease the mortality and morbidity caused by cancer cervix. Most of the cases of cervical cancer in India are diagnosed very late, because of lack of awareness about risk factors and screening methods, resulting in fatal outcome. So, this study was done to assess the knowledge of risk factors for cervical cancer, and paps smear test for its screening.Methods: This cross-sectional study was conducted among 200 women aged 18-55 years, attending Gynaecology Out-Patient Department (OPD) in a tertiary care hospital in Lucknow. Information about their knowledge of cervical cancer, awareness of its prevention and their socio demographic characters were collected by a questionnaire.Results: Majority (47%) of the females were in 26-35 years of age. (81.5%) were from rural background. 88% women were not aware of cervical cancer and its risk factors. 6.5% women were aware of the paps test. 8% were aware of probability of early diagnosis. Majority (98.5%) were not aware of vaccination as prevention for cervical cancer.Conclusions: Present study population shows very poor knowledge about cervical cancer risk factors and is unaware of the concept of prevention. Hence extensive health education to the public is needed regarding cervical cancer and its prevention.
Successful outcome of a triplet pregnancy following laparoscopic myomectomy for infertility: a unique case report
Authors: Hymavathi Kaliki , Tadisetti Surekha , Devi Gottipati Malini , T. C. Bhavana
Published: November 2017

Infertility is a burning problem affecting 10-15% of the couples globally. The female factors contribute to about 40- 45% among which uterine factor is up to 10%. Presence of uterine myomas also significantly contribute to infertility. A conservative surgical approach like myomectomy is indicated for women in reproductive age both for psychological reasons as well as to preserve their reproductive potential. In recent years laparoscopic myomectomy (LM) has become the procedure of choice. Pregnancy outcome after myomectomy is a more significant concern especially with regard to the obstetric calamity of sudden uterine rupture due to the presence of an operative scar. The intensity of such complication will be considerably high when a triplet pregnancy occurs with a LM scar in the upper uterine segment with history of uterine cavity being opened during the myomectomy surgery. Managing such a case will be a difficult task to the attending clinician posing many unexpected clinical dilemmas. We are reporting a unique case of triplet pregnancy occurred following a LM resulting in successful maternal and fetal outcome. During the course of this pregnancy apart from considerable maternal distress due to uterine over distension many clinical problems like cervical insufficiency, pre eclampsia, polyhydraminos, intrauterine growth restriction (IUGR) and last but not the least severe postpartum haemorrhage (PPH) have been encountered and could be managed efficiently. An elective Caesarean section was performed at 33+4 weeks gestation delivering live triplets. Mother and all the three babies discharged from the hospital in good condition.
Aggressive angiomyxoma of vagina: a rare entity
Authors: Bhatia Ruby , Mohi Manjit K. , Gupta Anju , Singh Shalini
Published: November 2017

Aggressive angiomyxoma a soft tissue tumor arising in the pelvis and perineal regions of women in reproductive age group is a rare entity. It is slow growing locally aggressive myxoid mesenchymal tumor, with a marked tendency to local recurrence. Preoperative clinical diagnosis is usually difficult due to absence of diagnostic features as well as rarity of the disease. We describe a case of aggressive angiomyxoma of vagina in a 47-year-old para 4 woman with multiple fibromyoma (upto 22-week size of pregnant uterus) with 10*10 cms posterior vaginal cyst. Total abdominal hystrectomy with surgical excision of vaginal wall cyst done. A retrospective diagnosis-Aggressive Angiomyxoma of the vagina was made after histological confirmation. Surgical excision with wide margins and long term follow up remains treatment of choice.
Risk factors for dog bites in Moiben Sub-county, Uasin Gishu county, Kenya
Authors: Tuwei Philip Kipchoge , Kariuki Stephen Mwaura
Published: November 2017

Background: Rabies virus still causes human and animal deaths around the world. Human rabies is transmitted by an infected canine. If rabies-infected person is not treated within 48 hours, the virus could move to the central nervous system and cause irreversible cell damage that could be fatal. The aim of this study was to establish risk factors for dog bites in Moiben Sub-county, and whether there is a significant association between dog bite frequency and those risk factors.Methods: A total of 339 respondents were selected from a total of 1152 households using multistage sampling, simple random sampling and systematic sampling methods. The head of the household responded to interviewer-administered questionnaires. Data was analyzed using SPSS version 22 of 2013. Associations were tested using chi square test and any associations reported at critical p-value of 0.05 and 95% confidence interval. Results: This Study found more children <15 years bitten by dogs (351/643, 54.6%, X²=26.3, p<0.01) than any other age bracket. There were significantly more males bitten compared with female victims (334/643, 51.9%, X²=10.3, p=0.03). Strangers were bitten in larger numbers than family members (512/643, 79.6%, X²= 7.11, p=0.03). The unconfined dogs bit people than the partially confined dogs (487/643, 75.7%, X²=12.9, p=0.01). Most people were bitten during the wet season than in dry season (437/643, 67%, X²=18.8, p=0.01). Conclusions: The risk factors with significant association in dog bites in Moiben Sub-coounty were age and sex of the residents, dog confinement and seasons of the year. We recommend that the County government of Uasin Gishu controls the movement of dogs by enforcing the existing confinement policy and movement permits made mandatory for anyone intending to move a dog from one place to another. Free educational vaccination campaigns should be provided in order to attain 75% dog vaccination coverage.
Prevalence of tooth wear and its associated risk factors among industrial workers in Daman, India: a cross-sectional study
Authors: Ahuja Nikhil , Ahuja Nirmal
Published: November 2017

Background: Tooth wear is an ever increasing problem. Therefore, the aim of the present study was to assess the prevalence of tooth wear and its associated risk factors among industrial workers in Daman, India. Methods: This cross sectional study was conducted among 613 industrial workers selected using simple random sampling. The clinical assessment of tooth wear was done using tooth wear index (TWI) developed by Smith & Knight. A specifically designed questionnaire was used to seek information on risk factors of tooth wear. Data were analyzed using Pearson’s chi-square test, ANOVA and a multiple logistic regression model. Results: The overall prevalence of tooth wear was found to be greater in mandible (86.8%) as compared to maxilla (61.7%). In both maxilla and mandible, the most frequently affected teeth were incisors (55.8% and 83.7%) followed by canines (52.2% and 81.2%), pre molars (38.5% and 42.1%) and molars (37.8% and 38.8%). Among the risk factors, consumption of hard or acidic foods (p=0.01, OR=1.73) and use of hard toothbrush bristles (p=0.04, OR=0.04) in maxilla and clenching or grinding of teeth (p=0.01, OR=3.96) in mandible were significantly associated with tooth wear. However, work environment involving dust or acid gas was the only risk factor associated with tooth wear in both maxilla (p=0.004, OR=0.53) and mandible (p<0.001, OR=0.35). Conclusions: There is a high prevalence of tooth wear among industrial workers. Thus, efforts should be made by dentists to increase awareness about tooth wear and plan a three-level prevention program based on analysis of risk assessment.
Prevalence of overweight and obesity risk factors among adolescents in Tirupati schools and junior colleges
Authors: Gorantla Anand Krishna , Bineni Chandrasekhar
Published: November 2017

Background: Obesity increases the risk of several chronic conditions including type 2 diabetes, cardiovascular diseases, gallbladder disease, osteoarthritis, back pain and some cancers. The present study was conducted to study the prevalence of obesity and overweight in adolescent population. Methods: A total of 1258 students (males-644; females-614) with an age group 10-19 years were selected from the higher secondary schools and junior colleges in the urban area of Tirupati. Results: The prevalence of overweight/obesity is found to be significantly higher in adolescents of private institutions than those from government institutions. Higher prevalence of overweight/obesity is found in school going adolescents 13.8% compared to college adolescents 6.7%. The variables like type of institution, residence, family history of obesity showed a significant positive association with overweight/obesity. Conclusions: The present study recommended that the private institutions should encourage healthy life style practices among students to prevent the risk of overweight/obesity from emergence.
Knowledge, attitude and practice regarding snakes and snake bite among rural adult of Belagavi, Karnataka
Authors: Pathak Ishan , Metgud Chandra
Published: November 2017

Background: India is home to over 270 species of snakes, including 60 venomous. Belagavi, set in foothills of Western Ghats, is home to four major venomous snakes viz. Russell’ s viper, spectacled cobra, common krait and saw scaled viper. Surveys suggest that around half of the snake bite related deaths take place in India and are largely avoidable and treatable. The objective of the study was to assess the knowledge, attitude and practice regarding Snakes and Snake bite among adult in a rural area of Belagavi, Karnataka.Methods: This community based cross-sectional study was conducted among 400 adults who were permanent residents of Kinaye village located in the field practice area of JN Medical College, Belagavi. A predesigned and pretested questionnaire was used to assess their knowledge, attitude and practice after taking written informed consent. Results: Most of the study participants when shown different photographs could differentiate between venomous and non-venomous snakes and their bite marks. 100% of the study participants knew that medical treatment was available for snakebite and would rush to a health facility in an event of snakebite. Most common venomous Snake to be identified was Spectacled Cobra (72%) while Common Krait was the least identified (24%). About 75% of study subjects correctly differentiated between the pictures of venomous and non-venomous Snake bite marks. Nearly 90.5% believed that Snakes bite for self-defence. Conclusions: In the present study majority of the participants had basic knowledge about Snake identification and snakebite. Most correctly identified venomous and non-venomous Snakes was Spectacled Cobra and Green Vine Snake respectively, while most incorrectly identified venomous Snake was common Krait. All the participants knew that there is medical treatment available for snakebite and most of them were in favour of not killing Snakes.
Birth preparedness: studying its effectiveness in improving maternal health in urban slums of Jamnagar, Gujarat
Authors: Patel Neha A. , Mehta J. P. , Unadkat Sumit V. , Yadav Sudha B.
Published: November 2017

Background: Maternal health and healthy outcome of a pregnancy are the core focus of all the programmes related to maternal and child health. Most of the causes of maternal morbidity and mortality are preventable. So we need to introduce new strategies according to the need of beneficiaries to reduce the underlying causes which ultimately lead to morbidities or complications during pregnancy. Birth preparedness is a kind of strategy which can help the mothers to plan out their pregnancy to combat the complications arising during pregnancy, childbirth or puerperium. The aims and objectives were to study the birth preparedness amongst the women, to study effect of various socio demographic determinants on birth preparedness and to find out relation between maternal morbidity and mortality with birth preparedness. Methods: Cross sectional study was conducted in Jamnagar. 450 women were selected by 30 cluster sampling. Data analysis was done with Microsoft office Excel and SPSS 20, Chi square test was applied. Results: 11.33% women were fully prepared, 67.33% were partially prepared while 96 women were not prepared at all. Education, place of delivery, parity and knowledge of danger signs has statistically significant association with birth preparedness in cases of both maternal mortalities, women were not at all prepared. Conclusions: Birth preparedness practices need to be improved. Education, parity, place of delivery, knowledge about danger signs are associated with birth preparedness practices. Birth preparedness can help in decreasing maternal morbidities and mortalities.
Cross-sectional study on the prevalence of risk factors for non-communicable disease in a rural area of Kancheepuram, Tamil Nadu
Authors: M. Vijayakarthikeyan , J. Krishnakumar , R. Umadevi
Published: November 2017

Background: Currently, non-communicable diseases (NCDs) are in the limelight replacing communicable diseases, which were the leading cause of death in most countries. Non communicable disease is the leading cause of death globally. Non communicable diseases (NCDs) kill 38 million people each year. This study aims to estimate the prevalence rate of NCD risk factors among adult population and to determine the association between behavioural and metabolic risk factors. Methods: This is a cross sectional descriptive study carried out in the rural field practice area attached to a Medical college in Kancheepuram district. The study group were 370 adults (20-60 years). The data was collected using a structured questionnaire with the help of WHO steps approach containing socio-demographic particulars, details regarding NCD risk factors and physical measurements. Data was analysed using SPSS 15 software. Prevalence of NCD risk factors was calculated using percentages and strength of association was tested between behavioural and metabolic risk factors. Results: Prevalence of risk factors for non-communicable disease are tobacco use (17.8%), alcohol use (17.3%), physical inactivity (50.2%), unhealthy diet (62%), overweight (38.1%), obesity (11.4%), hypertension (15.7%), diabetes (21.9%) respectively. There was strong statistical significant association between obesity (odds ratio-3.057, p=0.020 at 95% confidence interval (0.915-10.211)), hypertension (odds ratio-23.062, p=0.001 at 95% confidence interval (3.147-168.989)), diabetes (odds ratio-6.837, p=0.001 at 95% confidence interval (2.085-22.417)) and alcohol use and also between obesity (odds ratio-2.637, p=0.004 at 95% confidence interval (0.787-8.83)), hypertension (odds ratio-2.773, p=0.019 at 95% confidence interval (1.145-6.714)) and tobacco use. Conclusions: The prevalence of non-communicable diseases risk factors is high in this study. It is necessary to minimize the burden of growing non-communicable disease epidemic in the society, by curbing the rates of the risky behaviours at a very early stage by lifestyle modification.
Study of nutritional status of adolescent girls in a rural area of a district of Maharashtra
Authors: Nair Abhilasha , Doibale Mohan K. , Kuril Bina M. , Domple Vijay K.
Published: November 2017

Background: Adolescence is the transition period between childhood and adulthood where rapid physical, mental, emotional and social development takes place. Adolescent girls are at greatest risk for nutrient deficiency and it badly affects their overall development. With this background this study was conducted to study some aspects of the socio-demographic profile and to assess the nutritional status of adolescent girls by anthropometry in a rural area of a district. Methods: It was a community based cross sectional study conducted during January 2015 to June 2015 in 10 villages of a district. 583 adolescent girls were interviewed using pre designed, pretested questionnaire and anthropometric examination was done. Results were analyzed with the help of Microsoft Excel 2007 and SPSS version 16.0 statistical software. Results: Mean age of the study population was 13.95±2.48 years. Majority (63.12%) were Hindu and belonged to nuclear family (54.72%). 45.63% were educated up to high school level. Most of the girls belonged to socio economic class IV (45.46%). The prevalence of underweight and stunting in this study was 36.54% and 48.37% respectively. Statistically significant association was found between underweight and marital status of adolescent girls (p=0.029). The association of age group, religion and educational status with stunting was statistically significant (p<0.05). Mean BMI of the total 583 study subjects was 17.66±2.42 kg/m2. The prevalence of thinness was 18.87% in this study, significantly associated with religion, type of family and socioeconomic status (<0.05). Conclusions: Since the prevalence of under nutrition was high among adolescent girls in our study, appropriate health education and nutrition intervention should be directed towards them to improve their nutritional status.
A comparative study on prevalence of anaemia among urban and rural adolescent high school girls of Davangere, Karnataka
Authors: Shedole Dayalaxmi T. , S. Vidya G. , H. A. Suryakantha , Vijayakumar B.
Published: November 2017

Background: Adolescence is the formative period of life when the maximum amount of physical, psychological, and behavioural changes take place. During this stage the requirement of nutrition and micronutrients is relatively high. Therefore, adolescents, especially girls, particularly those between the ages of 12–15 years, are vulnerable to iron deficiency mainly because requirements are at a peak. This study was planned to highlight the problem of anaemia in adolescent females. The objectives were to study the prevalence and severity of anaemia among urban and rural adolescent high school girls and to compare the prevalence and severity of anaemia among urban and rural adolescent high school girls.Methods: A school based cross sectional study was done for a period of one year (December 1, 2014 to November 30, 2015) among 650 adolescent high school girls of Davangere city and field practice area of JJM Medical College, Davangere, Karnataka. Colour scale for haemoglobin was used for Hb estimation. Results: The overall prevalence of anaemia was 84.46%; prevalence was more in rural area (96.88%) than urban area (72.42%). The prevalence of mild, moderate and severe anaemia is 53.69%, 17.54% and 13.23%. Overall the severity of anaemia was highest among rural adolescent high school girls compared to that of urban adolescent high school girls. Conclusions: The prevalence of anemia was higher among rural girls compared to urban girls considering it to be a major health problem among the adolescents in rural areas.
Professional stress levels among healthcare workers of Nelamangala: a cross sectional study
Authors: Sagar Spoorthy , K. S. Ravish , T. S. Ranganath , Ahmed Mohammed Tanveer , D. Shanmugapriya
Published: November 2017

Background: Occupational stress can impair one’s health and reduce the efficiency and productivity of work. Delivering health services in rural areas is a tedious job for healthcare workers due to various factors. Inadequate staffing of workers leading to overloaded work and many other factors make them less motivated and experience work stress. Methods: A cross sectional study done in Nelamangla, rural field practice area of BMCRI. A multi stage random sampling technique was applied for the study. 5 PHCs were randomly chosen. Healthcare workers (such as LHV, ANM, Health Assistants, ASHA workers and AWWs) were recruited by probability proportion to sample size. 140 study participants were interviewed using pre tested semi structured questionnaire to collect socio demographic details and work related details; validated professional life stress scale was used to assess stress levels. Descriptive statistics and chi square test were used. Results: 37.1% (52) had mild stress, 52.1% (73) were moderately stressed, 10.7% (15) were severely stressed and none of them were very severely stressed that needed immediate intervention. Working hours, job satisfaction, clarity about work, amount of work exceeding stipulated time, loss of interest at work, not being rewarded and valued for their work are few of the factors that are found to be associated with stress levels. Conclusions: Work related factors have been the main stressors and higher stress levels might impede the performance of the workers and hence addressing this is necessary.