bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of pregnancy outcome in elderly gravida
Authors: Dixit Pratibha V. , Mehendale Madhuri A.
Published: November 2017

Background: Elderly gravida which is defined as age of mother as 35 years or more at the time of delivery has become increasingly common in last two to three decades. This accelerating demographic shift is of major clinical and public health concern, because advanced maternal age has consistently been associated with adverse pregnancy outcomes.Methods: An observational prospective study consisting of 120 pregnant women. All participants were divided into Study group and Control group.Results: Women of advanced maternal age have higher frequency of antenatal complications leading to early pregnancy termination and operative interference. There is significant increase in the incidence of adverse perinatal outcome due to preterm deliveries and NICU admission and neonatal death.Conclusions: With improved health services and better prospects of women who are >35 years of becoming pregnant, these pregnancies are fraught with complications. Women should realistically appraise the risks of pregnancy in later life. Hence these women should be counselled, and their complications managed with utmost care.
Value of PI of uterine artery at 23-24 weeks in the prediction of adverse pregnancy outcome
Authors: Dhar Anshu , Kaul Indu
Published: November 2017

Background: Increased resistance in uteroplacental circulation is associated with pregnancy complications. The aim of this study was to determine the role of uterine artery PI at 23-24 weeks gestation in predicting adverse pregnancy outcomes.Methods: 200 singleton pregnancies were prospectively examined with color Doppler to determine the PI of uterine artery at 23-24 weeks and study its correlation with subsequent development of adverse maternal and fetal outcomes defined as any or the combination of preeclampsia, intrauterine growth restriction (IUGR), intrauterine death (IUD), preterm delivery and placental abruption.Results: There were 13 cases (6.5%) with abnormal uterine artery Doppler results and 8 (61.5%) of them developed preeclampsia, out of these 8, 1 had IUGR as well and 3 had iatrogenic preterm delivery due to severe preeclampsia. 2 (15.4%) out of 13 had only IUGR. The pregnancies with adverse outcomes had significantly higher mean PI than those with normal outcomes (1.2±0.3 versus 0.857±0.179; p <0.001). The sensitivity, specificity, PPV and NPV of PI ≥95th percentile in the prediction of adverse pregnancy outcome was 35.71%, 98.26%, 76.92% and 90.37% respectively. The birth weight in higher mean PI group was significantly lower than in pregnancies with PI <95th percentile (2.33±0.49 kg versus 2.86±0.48 kg; p <001). No cases of spontaneous preterm labor, IUD or abruption were present in higher mean PI group.Conclusions: Increased uterine artery PI at 23-24 weeks of pregnancy is associated with an increased risk of adverse pregnancy outcomes.
A retrospective analytical study of the epidemiology and causes of preterm birth
Authors: Jamal Shehla , Srivastava Ruchi
Published: November 2017

Background: Preterm birth is the leading cause of perinatal morbidity and mortality. The incidence of preterm birth in India is 7-9%, and the rates are constantly rising. The main cited reasons for this trend are increasing indicated preterm births and rising rates of artificially conceived pregnancies. Major causes for indicated preterm births are hypertensive disorders of pregnancy, foetal growth restriction, antepartum haemorrhage and PPROM. Risk factors for spontaneous preterm birth include obstetrical complications like multifetal gestation, malpresentations and infections, poor antenatal care, having history of previous preterm delivery, and history of bleeding in the index pregnancy.Methods: This is a retrospective analytical study, done in the department of Obstetrics and Gynecology over a period of two years (January 2015-December 2016). All singleton preterm live births were included in the study. The records of all the included patients were studied from the medical records department of the hospital, after obtaining permission for the same. The results were analysed and obtained by percentage method.Results: A total of 2564 pregnancies were analysed in present study. The number of preterm deliveries was 436 in two years. Out of 2564, the number of live births was 2365, making an incidence of 18.4%. Maximum preterm deliveries were observed in the teenage group (27%) and elderly gravidas (23.9%), both the groups falling into high risk categories for preterm birth. Multiparity was an independent risk factor observed in our study and was found to be associated with 47.5% cases. Level of antenatal care received was also directly related to the number of preterm deliveries. As high as 58.4% of the females landed into preterm birth, who never sought antenatal care, the commonest risk factor for preterm birth was PPROM (26.6%) followed by hypertensive disorders of pregnancy (18.6%). We observed a labor induction rate of 23.4% and Caesarean delivery was performed in 146 (33.5%) cases, thus indicating a high induction and caesarean rates in such pregnancies.Conclusions: Preterm birth continues to challenge obstetricians despite much efforts being executed at all levels. Many of the risk factors are identifiable and can be addressed with a specialised antenatal care program. Screening of genitourinary infections and initiation of treatment can cut down the rates. Early referral and NICU equipped institutional delivery should be promoted to prevent neonatal morbidity and mortality.
Use of mobile phone for improvement in maternal health: a randomized control trial
Authors: Bangal Vidyadhar B. , K. Borawake Sai , P. Gavhane Satyajit , H. Aher Kunal
Published: November 2017

Background: The rapid escalation of cellular network coverage and expansion of mobile phone usage has opened up a new way of deploying health services. The mobile app with message facilities help in imparting health education regarding nutrition, iron and folic acid prophylaxis, tetanus toxoid immunization, danger symptoms and signs during pregnancy etc. Present study aimed to improve maternal health and pregnancy outcome by optimum utilization of antenatal, natal and postnatal care services, with the use of mobile phone as a medium of communication between health care provider and community in rural area.Methods: The prospective randomized control study, with two hundred pregnant women each, coming for antenatal visit and having personal mobile phone facility, were randomly allocated to control and intervention group. Control group women received routine antenatal care and advice as per hospital protocol. In addition to routine care and advice, intervention group received mobile phone calls, as reminders about next visit and text messages (SMS) on important aspects of antenatal care at regular intervals. The primary outcome indicators of the study were percentage of pregnant women coming for at least four antenatal visits, percentage of institutional delivery and postnatal check-ups.Results: Women in the intervention group had significantly higher number of antenatal visits, consumption of iron tablets, tetanus toxoid immunization, institutional deliveries and postnatal check-ups as compared to the control group.Conclusions: In the present study, the mobile phone intervention, significantly increased the percentage of women receiving the recommended four antenatal visits and showed a trend towards more women receiving preventive health services. Study gathered good evidence that m-Health tools present an opportunity to influence behaviour change and ensure that women access prevention services, including antenatal, natal and postnatal care. Mobile technology, specifically SMS can be successfully used to extend health information services to pregnant women.
Cytological screening for cervical cancer in women of reproductive age group
Authors: Mittal Swati , Kamath Anagha J.
Published: November 2017

Background: Cervical cancer is a malignant neoplasm arising from cells of cervix uteri. It is the second most common cancer among women worldwide, affecting about 16 per 1,00,000 women each year.Methods: A cross sectional study of 400 women of reproductive age group (21-49 years) attending Lady Goschen Hospital and KMC Hospital, Attavar, Mangalore was conducted, and women were screened for the presence of cervical cancer by Pap smear. The results were analyzed with respect to age distribution, age at marriage, parity, symptoms and per-speculum findings. Pregnant women and women with active infection of the genital tract were excluded from the study population.Results: The age range was 21 to 49 years. Mean age was 38.14 years. Of the 400 women, 398 were married and majority of these, 237 (59.5%), got married between 21-25 years. Menstrual irregularity was the most common presenting symptom, 150/400 (37.5%). Abnormal per speculum findings were seen in 102/400 (25.5%). 17 of 400 Pap smears were abnormal, of which 1 (0.25%) was AG-FN, 2 ASCUS (0.5%), 3 (0.75%) ASC-H, 1 (0.25%) LSIL, 7 (1.75%) HSIL and 3 (0.75%) SCC. Mean age for cancer cervix patients was 42.33 years.Conclusions: Pap smear screening, which appears to be the most feasible and affordable mode for control of carcinoma cervix in developing countries like India, should be carried out in all women of reproductive age group.
Study of duration of gestation in 500 patients with spontaneous
Authors: Pandya Munjal J. , Kotdawala Parul J. , M. Pandya Janki
Published: November 2017

Background: There have been variations in the length of gestation depending upon the ethnicity of the patient.Methods: We studied 500 patients with spontaneous onset of labor for their duration of pregnancy from First day of Last Menstrual Period (FLMP).Results: The average gestational age was 275 days, 5 days earlier than the Expected date of delivery (EDD). 70% of pregnancies ended before EDD, 4.8% on the day of EDD and 25.2% ended after EDD. 35.80% patients completed 39 weeks, 24% completed 40 weeks, 23.20% completed 38 weeks, 11% completed 37 weeks and only 6% completed 41 weeks. Average gestational age was 39.31 weeks for male baby and 39.36 weeks for female baby. Sex ratio derived was 915.7 females per 1000 males. Average birth weight was 2.705 kg.Conclusions: The implication of this study is that the length of human gestation does vary according to geographic location. This may be due to genetic influences, weather conditions, food habits or some unknown factor. The clinical significance is the decision to consider a term pregnancy and a post-term pregnancy. A majority of the parturient women went in to spontaneous labour at 39 completed weeks, 5 days earlier than ‘Expected date of delivery’ calculated by Naegele’s formula. This possibility should be kept in mind when maturity assessments are made with a view to intervene in the labour process to minimize perinatal complications.
Prevalence and associated risk factors of asymptomatic bacteriuria among antenatal women attending a health care center: one year study
Authors: Cooly Vijayalakshmi , Bandaru Sailaja , Salicheemala Bhuvaneswari , Surayapalem Sailaja
Published: November 2017

Background: Asymptomatic bacteriuria is defined as presence of persistent and actively multiplying bacteria in urine in significant numbers, ≥105/ml but without clinical symptoms. Detection of ASB is important during pregnancy as it leads to 25% of symptomatic urinary tract infection in pregnant mothers, pyelonephritis, hypertension in pregnancy, postpartum UTI, anemia, preterm labour, low birth weight and perinatal death of the foetus. The objective of the present study is to identify the prevalence of ASB among pregnant women, epidemiological pattern, risk factors associated with it, type of pathogens and their antimicrobial susceptibility.Methods: A prospective cross-sectional study was conducted on 500 asymptomatic antenatal women who fulfilled the inclusion criteria attending the department of Obstetrics and Gynecology. Mid stream urine specimen was collected from all the cases and subjected to microscopic analysis and culture and sensitivity.Results: Our study showed the prevalence of ASB as 7.6% among antenatal women.78.8% of sterile cases and 13.6% as contaminants. 21-25 years was the common age group of ASB cases in our study. ASB was common among multiparous women, during 3rd trimester.  Statistically significant association was observed with low socio-economic status, increases sexual activity and among illiterate cases. Escherichia coli (42.11%) was the most common isolate in the study. Other isolates were Klebsiella, Staphylococcus aureus, CONS, Citrobacter and Enterococcus sp. Imipenem, Meropenem exhibited 100% sensitivity for gram negative isolates and clindamycin for gram positive isolates.Conclusions: All the cases of ASB diagnosed should be treated based upon the culture and sensitivity report to prevent unnecessary prescription of antibiotics which can economically burden the patient as well pave a way in development of resistant strains. Hence, further initiatives should be undertaken to include urine culture sensitivity as a part of national screening programme to prevent maternal and foetal complications.
A study of vaginismus in patients presenting with infertility
Authors: Bhatt Jalpa K. , Patel Vipul S. , Patel Alpesh R.
Published: November 2017

Background: Vaginismus is an uncommonly reported entity, most of the patients present to the gynaecologist with complaint of inability to conceive. Female sexual dysfunctions are a common entity but difficult to diagnose and treat, Vaginismus is one of the categories of female sexual dysfunction.Methods: Total 25 patients out of 900 patients attending the outdoor of Shivanjali Women’s Hospital for infertility from the year 2008 to 2016 were found to be having vaginismus. With couple’s consent females were treated for vaginismus. This is a retrospective study of 25 patients identified having vaginismus.Results: Maximum 11 patients were in age group of 20 to 25 years. Forty percent 10 patients improved with counselling and education, lubricant gel and analgesic gel. Total 84% (21) patients conceived with different modes of treatment.Conclusions: Vaginismus is uncommonly reported. With proper history and counselling of the couple vaginismus can be revealed, managed and conception can be achieved.
A comparative study of two different techniques of subcutaneous tissue closure in abdominal surgery
Authors: Dwivedi Jyotsna S. , Gupta Alka S. , Pardeshi Sachin H.
Published: November 2017

Background: Surgical access to abdomen is required for many operative procedures. The subcutaneous tissue of the anterior abdominal wall can either be sutured or left unsutured with drain in situ. The purpose of this study was to compare the two methods of closure of the subcutaneous tissue and determine the benefit of one over the other.Methods: The study was conducted in a tertiary care centre with sample size of 30 each in study and control group. Patients fulfilling the inclusion criteria were selected and depending on the randomisation the closure of subcutaneous tissue was done either by polyglactin 910, 2-0 or left unsutured with indigenously designed syringe suction drain kept in situ. The patients were followed up till the day of suture removal and further in case of any complications.Results: Total duration taken for the procedure was significantly increased in the study group. There was a significant level of discomfort among the participants due to drain. The rate of surgical site infection, hospital readmission morbidity was significantly higher in the study group.Conclusions: The type of drain studied was indigenously designed where the closed system was not maintained during charging the drain, hence further studies need to be conducted which will compare this with the other closed suction drains to determine the difference in the risk of wound complications.
One-year retrospective study on clinical, investigational and operative correlation in a tertiary care hospital
Authors: Pati Basant Kumar
Published: November 2017

Background: Ectopic pregnancy is a life-threatening emergency which is one of the important cause of maternal mortality. Ectopic pregnancy must be suspected in any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding. Our aim was to review all cases of ectopic pregnancy and determine the incidence, high risk factors, types of clinical presentation and mode of management.Methods: This was a retrospective cohort study, conducted at a tertiary care hospital. Medical records of all women with an ectopic pregnancy between 2016 and 2017 were seen. Demographic data, risk factors, clinical features, and mode of management were noted.Results: 90 patients, diagnosed with ectopic pregnancy during last one year was included in the present study, with an incidence of 1.2%. Majority of women were aged 20-30 years (50%). 74.4% cases were ruptured ectopic. The most common risk factors were previous ectopic (50%) and pelvic inflammatory disease (17.7%). Lower abdominal pain was seen in 80 (40.3%) patients. Majority of patients (91.1%) had tubal ectopic pregnancies. Most common mode of treatment was salpingectomy.Conclusions: Risk factors for ectopic pregnancy must be enquired and early diagnosis and management to be done to avoid maternal morbidity and mortality.
Management of adnexal masses: save the ovaries
Authors: Champawat Chitra , Wani Reena Jatin
Published: November 2017

Background: Adnexal mass is a common presenting complaint in gynaecology. Total 1318 cases were operated over two and a half years (January 2015-June 2017), out of which 195 (14.7%), were for adnexal mass.Methods: To review cases of adnexal masses who underwent surgery over the period of two and a half year in a tertiary care hospital with respect to presentation, aetiology, type of surgeries and fertility preservation.Results: There were totally 195 patients, mostly of age group 26-45 years affected by adnexal mass. Most common presentation was pain abdomen (70 cases i.e. 79.5%). Ectopic pregnancy (115 cases i.e. 58.9%) was the most common diagnosis, followed by ovarian cyst (71 cases i.e. 36.4%). Most cases were treated by open surgery. Laparoscopic management was done for 33 cases (17.9%). Except in unavoidable situations active effort were made to conserve ovaries. Oophorectomy was done in 22 cases (11.2%) and in 173 cases (i.e. 88.8%) fertility preservation was done. Malignancy was seen in 4 (2%), which were managed by open surgery.Conclusions: Ectopic pregnancy was the most common aetiology of adnexal mass, and laparoscopy and its known benefits to patients is the best approach if available. For cases with suspected malignancy, open surgery will remain a safer option.
Laparoscopy: the tool for infertility
Authors: Shah Neelima P. , D. Shah Prashant
Published: November 2017

Background: Most of the healthy couples conceive within a year after marriage. The infertility patients have become important part of clinical practice. Diagnostic and therapeutic Laparoscopy plays major role in the management of these cases. We investigated hale 50 infertile women with laparoscopy. This study was undertaken to ascertain the diagnostic and therapeutic role of Laparoscopy in female infertility.Methods: We evaluated 50 couples having infertility. The cases of primary and secondary infertility were evaluated. The laparoscopy was done under general anaesthesia. The pelvic organs were examined, and tubal patency was tested with chromo-perturbation by using Methylene blue dye. The findings were noted. The therapeutic intervention was done in the cases where it was necessary.Results: Total 50 cases of infertility were studied. Thirty were of primary infertility and 20 were of secondary infertility. The patients with primary infertility were younger with mean age of 20 years. The duration of infertility ranged from 1.5 to 8 years. We detected total 21 (42%) patients with ovarian pathology, 5 (10%) with tubal, four (8%) with peritoneal factor 3 (6%) with endometriosis. One patient had uterine fibroid and 16 (32%) cases had normal laparoscopic findings.Conclusion: This study supported the diagnostic and therapeutic value of laparoscopy in managing infertile women. It helped in detection of pelvic pathology. It also helped to plan further management in the form of IUI or IVF.
Maternal and perinatal outcome in hypothyroidism in pregnancy: a prospective observational study
Authors: Sharma Deepika , Dixit Pratibha V. , Gavit Yogita
Published: November 2017

Background: This study was conducted to analyse the antenatal complications, perinatal outcome and to be advocate routine screening for thyroid disorders in pregnancy. This study was prospective and observational study with 50 cases which was newly diagnosed when suspected as pregnancy with thyroid disorders. The commonest thyroid disorder found in pregnancy is hypothyroidism and it adversely affects the maternal and fetal health in the form of infertility, early pregnancy loss, PIH, anaemia, IUGR, PROM, preterm labor, neonatal and maternal morbidity and mortality. If thyroid disorders are appropriately detected and treated either before or in early pregnancy, the adverse maternal and fetal outcome can be prevented.Methods: The present study was conducted in a tertiary care centre Mumbai from June 2015 to October 2016. All pregnant females who are newly diagnosed as hypothyroid, attending the ANC clinic were enrolled in the study.Results: In the present study, most common obstetric complication observed was preeclampsia and most common fetal complication was preterm delivery.Conclusions: In view of the high prevalence of thyroid dysfunctions in Indian pregnant woman and its association with different adverse pregnancy related complications we recommend routine screening for thyroid dysfunctions in pregnancy.
Maternal mortality in a tertiary care centre in North India: a retrospective study
Authors: Sethi Prachi Sarin , Sharma Sujata , Chawla Indu
Published: November 2017

Background: The World Health Organization (WHO) estimates that, of 536,000 maternal deaths occurring globally each year, 136,000 take places in India. Maternal death has serious implications to the family, the society and the nation. It deprives the surviving infant of mother's care. This study was done to assess maternal mortality in a tertiary care centre in north India where large numbers of patients are referred from the peripheral centers and the rural parts. This study was done to assess the causes of maternal mortality and suggest remedial measures to reduce the same. Objective of present study was to assess the causes of maternal death over a period of one year at G.M.C Amritsar, India.Methods: A retrospective hospital based study of 22 maternal deaths over a period of 1 year from June 2012 to June 2013. The information regarding demographic profile and reproductive parameters were collected and results were analyzed.Results: Over the study period, there were 22 deaths and 7272 live births (Majority were referral from other districts all over Punjab). Most common direct cause of maternal mortality was haemorrhage and anemia was the most common indirect cause. Most maternal deaths were seen in patients from rural areas, unbooked, illiterate patients and patients from low socioeconomic status.Conclusions: Proper health education should be given to the women; early registration of antenatal cases should be done which allows for rapid diagnosis and treatment of high risk cases. Also constructing a well equipped health care facility with trained staff and prompt transport facilities for early referral can bring down the maternal mortality rate in our country.
Determination of frequency of specified structural congenital anomalies and the pattern of determinants affecting congenital malformations in prenatally diagnosed fetal anomaly cases before 20 weeks
Authors: Sood Nishi , Thakur Manish
Published: November 2017

Background: Congenital anomalies accounts for 8-15% of perinatal deaths and 13-16% of neonatal deaths in India. The aim of this study was to determine frequency of specified structural congenital anomalies and the pattern of determinants affecting congenital malformations in prenatally diagnosed fetal anomaly cases before 20 weeksMethods: The present study was conducted at Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla. During the study period, all pregnant women with prenatally diagnosed fetal anomaly before 20 weeks, reporting to the Department of OBG, were enrolled for this non-interventional prospective observational study. The observations were analysed on a statistical basis in structured data collection form.Results: Congenital malformations were significantly more common in the age groups of 20-30 years, of low socioeconomic status, vegetarians and who were non-compliant regarding folic acid intake. The majority of women bearing malformed foetuses came from areas at altitude of 500-2000 meters. 33.33% of foetuses had amniotic fluid abnormalities. 83.33% of the foetuses had a single malformation. Central nervous system was the most common system involved (61.90%) out of which neural tube defects (76.91%) were commonest. 11.9% malformations were of the gastrointestinal tract out of which majority (60%) were omphalocele. 4.76% of the total malformations were of the musculoskeletal system. 4.76% malformations involved the genito-urinary tract and 2.38% of the total malformations were of the cardiovascular system and craniofascial anomalies.Conclusions: Early detection of major malformation during pregnancy helps in reducing the high morbidity and mortality of neonates due to congenital malformations because of termination of pregnancy. The commonest system found to be affected was central nervous system followed by gastro-intestinal system. Food fortification with folates and vitamin B12 is the need of the hour.
Study of maternal outcome in emergency peripartum hysterectomy at a tertiary hospital
Authors: K. Varalakshmi , Rastogi Radha , Choudhary Neha
Published: November 2017

Background: Emergency peripartum hysterectomy is an indispensable part of the obstetricians' armamentarium. In no other gynecological or obstetrical surgery, is the surgeon in as much a dilemma as when deciding to resort to an emergency hysterectomy. On one hand, it is the last resort to save a woman's life and on the other hand, her reproductive capability is sacrificed. Many times, it is a very difficult decision and requires good clinical judgment. Objective of present study was to study the cases of emergency peripartum hysterectomy performed in tertiary care center to estimate the incidence, indications, and maternal outcome following the procedure.Methods: All cases of peripartum emergency hysterectomy that were performed in our hospital from January 2015 to June 2016 were reviewed and evaluated in terms of the incidence, indications, and the associated complications.Results: During the study period there were 28 emergency peripartum hysterectomies out of 28215 deliveries giving an incidence of 0.10%. rupture uterus was the Commonest indication contributing to 13 cases. Septicemia was the common post operative complication associated. There were 4 maternal deaths in our study.Conclusions: Emergency peripartum hysterectomy though a rare operation, still remains a life‑saving procedure with which every obstetrician must be conversant. regular antenatal care, identification of high‑risk cases, and prompt referral can reduce the incidence of this operation. Peripartum hysterectomy will always remain an essential life saving surgery for the mother at cost of their uterus and when performed in indicated cases at right time will help in bringing down maternal mortality.
Work place based assessment of medical interns on surgical asepsis following training in Obstetrics and Gynecology
Authors: Bangal Vidyadhar B.
Published: November 2017

Background: Internship programme for medical interns is meant to develop basic skills and to have experience in management of common illnesses and emergencies. Medical interns are often posted to the clinical disciplines, without adequate instructions on surgical asepsis and bio-safety measure. Training need was identified for interns in the subject of surgical asepsis.Methods: Hands on training programme was organized for interns that included common procedures performed by them in wards, operation theatre and labour room complex on day to day basis. A pre and post test was performed to assess the gain in knowledge by interns. Subsequently, interns were supervised by residents, nurses and faculty members in labour room, operation theatre and wards. The observations were documented, and immediate feedback was given to interns. Feedback from interns was obtained at the end of the rotation in Obstetrics and Gynecology.Results: There was significant gain in knowledge by interns following training programme. Interns adopted good aseptic precautions during their posting. Compliance to aseptic precautions was significantly more in female interns as compared to male. A demand got generated from other batches of interns in conducting similar training programme for them. Nurses, faculty members and co-ordinator of internship programme gave positive feedback about the changes observed in the batch of interns who underwent training as compared to previous batches.Conclusions: Adoption of techniques of surgical asepsis by interns was improved following training programme held at the beginning of rotation posting in Obstetrics and Gynecology. It is recommended to include the topic in internship orientation programme.
A bizarre highly vascular tumor with alarming presentation: a diagnostic dilemma
Authors: Buckshee Kamal , Harsh Rastogi , Deepshikha Arora , B. Tanya Rohatgi
Published: November 2017

An exceedingly rare, highly vascular tumor with atypical and alarming presentation posed diagnostic and management challenges. A 29 years old lady, complained of abdominal and pelvic pain, nausea, vomiting and repeated spells of fainting attacks following the jumping episode (2-3 times). Emergency admission and investigations at United States of America (USA) revealed a large, complex, highly vascular, irregular mass displaying finger like projections, filling the lower abdomen, pelvis and large amount of intra peritoneal bleed. A provisional diagnosis of arteriovenous malformation (AVM), arteriovenous fistula (AVF), and rupture/leak was made. Uterine artery angiography (UAA), preoperative embolization and possibility of hysterectomy as a life saving measure were suggested, to which the couple declined and got discharged. To save uterus and fertility they presented to us for second opinion and further management. Angiography, magnetic resonance imaging (MRI) and preoperative uterine artery embolization were done followed by exploratory laparotomy which revealed hemoperitoneum and a large weird looking vascular tumor (a veil of sea weeds/dark purple nodules of various sizes resembling cotyledons of placenta). Intra-operative tissue analysis (frozen section) suggested benign pathology. Mass was removed completely and fertility sparing surgery was undertaken. Histopathological diagnosis was cotyledonoid dissecting leiomyoma (CDL). No recurrence/metastasis has been observed on follow up of 5 years.
A rare case of severe hypertriglyceridemia induced pancreatitis in pregnancy
Authors: Kashyap Poonam , Prasad Sudha , Bhushan Singh Chandra
Published: November 2017

Acute pancreatitis is caused by various causes such as Gall stone disease, alcoholism, drug abuse but rarely caused by severe hypertriglyceridemia. It typically presents as acute or recurrent pancreatitis. The hypertriglyceridemia can be gestation induced or familial. The family history of the pregnant women needs to be taken in detail. The serum triglyceride levels in the range of 1000 to 2000 mg/dl in patients with type I, III, IV and V hyperlipoproteinemia (Friedrickson's classification) is the identifiable risk factor. The clinical course of hypertriglyceridemia induced pancreatitis is similar to other causes. We hereby report a case of 21-year-old lady G3P1L0A1 with 37 weeks of pregnancy without any family history of hypertriglyceridemia and but with history of recurrent episodes of acute pancreatitis.
A rare case report: pregnancy with pancytopenia
Authors: Rajput Yogesh , N. Wankhede Uma
Published: November 2017

Pancytopenia is reduction in all the three major cellular elements of blood, hence it is the simultaneous presence of anaemia, leukopenia and thrombocytopenia. Here we present a case of a 28-year-old female, G4P3L1D2 with previous LSCS with 30 weeks gestation with pancytopenia managed with steroids and transfusions.
Management of twin pregnancy with a hydatidiform mole and surviving healthy co-existent fetus
Authors: Goksever Celik Hale , Meriç Demirezen Gözde , Erdem Baki , Atış Aydın Alev , Ülker Volkan
Published: November 2017

Twin pregnancies with complete mole and a coexisting live fetus are rare obstetric conditions seen in 1 case of 22000 to 100000 pregnancies. In our case, a twin molar pregnancy was diagnosed in the first trimester by ultrasound. In a 27-year-old patient with the first pregnancy, a 12-week live fetus with a normal placenta and a twin molar pregnancy appearance were observed on a routine ultrasonographic examination of the uterine cavity. Twin molar pregnancies are reported to be terminated by live birth in the literature, but termination of pregnancy is an important option to prevent maternal morbidity since molar pregnancy may lead to complications ranging from theca lutein cysts to gestational trophoblastic neoplasia.
An ageing world of the 21st century: a literature review
Authors: Naja Sarah , Din Makhlouf Mohamed Mohei El , Chehab Mohamad Abdul Halim
Published: November 2017

Aging is the process of growing older at cellular, organ, or whole body level throughout the life span. Furthermore, the term “demographic transition” refers to a shift in fertility and mortality rates leading to changes in population growth rates, and age distribution. Thus, as people globally live longer, increasing levels of chronic illness as well as diminished wellbeing are nominated to become major global health challenges. Subsequently, the global population of elderly is projected to further increase and reach 1.4 billion by 2030 and 2.1 billion by 2050. Moreover, ageing has important implications on social security, the economy, the organization and delivery of health care, caregiver availability and constraints, society, and policies. Thus, it is pertinent to establish comprehensive elderly-friendly health care with further focus on preventive action to maintain a healthy ageing process.
Design matters in home visiting improvement
Authors: Babyar Julie Christine
Published: November 2017

Maternal and child health home visiting services play a critical role in healthcare within the United States. Programs are widely varied and services offered depend on local and regional adopted designs. Observational and experimental research provides mixed conclusive results. Some literature reports statistically significant positive outcomes for home visitation services while other research fails to duplicate or provide secondary matched findings. Future research design opportunities include national, inclusive, cross collaborative home visiting research that seeks to minimize limitations. Future home visiting programs should utilize research opportunities in public and private program redesign, continuous quality improvement as well as in accreditation for optimal effect on target populations. Only with strong, supportive research can maternal and child home visiting services be tailored, replicated and consistent across the United States.
Health and associated social problems of elderly population in an urban setting: a study from Kolkata, India
Authors: Bhattacharyya Kallol Kumar
Published: November 2017

Background: World population is aging, in its truest sense of the term. Therefore socio-economic condition of the elderly population is changing constantly, which is adversely affected by various health problems during their way of life course. This study aimed to describe the relation between different comorbidities and social problems of the elderly people. Methods: A community-based cross-sectional study was carried out by house to house visit in an urban setting in greater Kolkata area, the field practice area of a family physician. A total of 208 elderly patients (60 years old and above) were interviewed using a pre-tested schedule. Study findings were recorded in terms of proportions and percentages and its correlation to social problems was searched. Results: Male older adults were more than their female counterparts, though widows were more in numbers than widowers. Most of them were having multiple morbidities (87.98%). Visual impairment was the commonest problem detected in the studied elderly population with prevalence of 75.96% (158/208). Prevalence of hypertension was 68.75% (143/208). Other significant morbidities seen are auditory, musculoskeletal, urinary, cardiac etc. Conclusions: The result of the study showed that health problem has a significant relation with increasing age in human beings. Awareness generation should be done among the elderly people for regular health check-ups to ensure prevention and early detection of many chronic diseases. So the strategies are required to bring about the quality of life in health, which should be an equal responsibility for individual, family, society and the government.
Scenario of malaria in Andaman and Nicobar Islands
Authors: Singh Shiv Shankar , Rao Shivani , Thatkar Pandurang V. , S. Ajay Raj
Published: November 2017

Background: Malaria is an important vector borne disease persisting to be a major public health problem in India. The objective of this study is to find the present scenario of malaria in Andaman and Nicobar Islands.Methods: Retrospective data mining of records from the year January 2010 to December 2016 from 35 primary and community health centres existing across Andaman and Nicobar Islands.Results: A total of 517303 samples were examined from 2010 to 2016 out of which this 8397 samples were found microscopically positive of which P. vivax cases were 5631 (67.06%) and P. falciparum cases were 2766 ( 32.94%).Conclusions: There is gradual decrease in number of positive malarial cases as well as decrease in API.
Prevalence and determinants of obesity among male secondary schools students in Al Bukhiriyah, Qassim region, Saudi Arabia
Authors: Khan Asif , AlRshidi Bader Abdullah , AlRshidi Ibrahim Abdullah , Elmosaad Yousif M. , Jaber Mahmoud
Published: November 2017

Background: Obesity is a condition associated with the presence of excess fat in the body. It is determined by genetic and environmental factors that are difficult to control when dieting. Methods: The study population consisted of 254 students randomly drawn from five secondary schools which are present in Bukhiriyah and the students were selected using systemic random sampling method. Results: Overweight (21.26%) and obesity (17.72%) was more prevalent in students who used vehicles as mode of transport. Overweight (19.29%) and obesity (15.75%) was more prevalent in students who consumed carbonated drinks. Conclusions: The conclusion of our study was that overweight and obesity were associated with various factors like physical inactivity, soft drink intake, fast food intake and less sleep.
The effect of Kenya’s free maternal health care policy on the utilization of skilled delivery services and maternal and neonatal mortality rates in public health facilities
Authors: Gitobu Cosmas Mugambi , Gichangi Peter Bundi , Mwanda Walter O.
Published: November 2017

Background: Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting skilled delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of the free maternal health care policy’s effect on skilled delivery service utilization and maternal and neonatal mortality rates in Kenyan public health facilities. Methods: Interrupted time series analysis of skilled delivery services utilization, maternal and neonatal mortality rates two years before and after the policy intervention was carried out in 77 Kenyan public health facilities. Results: A statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the rates of maternal mortality and neonatal mortality. Conclusions: The findings suggest that cost is a deterrent to skilled delivery service utilization in Kenya and thus free delivery services are an important strategy in the effort to promote the utilization of skilled delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related deaths when addressing maternal and neonatal mortality rates.
Overweight and obesity: a rising problem in India
Authors: Meharda Bharat , Sharma Sanjeev Kumar , Singhal Govind , Kumar L. Dilip
Published: November 2017

Background: Obesity is one of today’s most neglected public health problems. Childhood obesity is one of the most serious public health problems. Obesity causes cluster of non-communicable diseases and creating an enormous socioeconomic and public health burden. Methods: School based cross-sectional study was done in Udaipur city of Rajasthan. Simple random sampling method was used to obtain 1000 study subjects. Questionnaire included their general information, factor contributing to overweight and obesity. Results: 500 (50.00%) subjects were from the government schools and 500 (50.00%) from private schools. Among study participants 336 (33.60%), 332 (33.20%) and 332 (33.20%) were from 8th, 9th and 10th class respectively. 8.20% Overweight and 2.40% obesity found among school children. Overweight and obesity was found high in private schools 14.00% as compared to government schools 7.20%. The prevalence of overweight and obesity is slightly more in girls 12.60% than boys 8.60%. Conclusions: Prevalence of overweight and obesity is more than 10% in school children of Udaipur city, The prevalence of overweight and obesity was high among girls, among school children’s whose mother were working.
Association of maternal and child health related variables with decline in infant mortality rate in Punjab, India
Authors: Kaur Harjot , Singh Tarundeep , Lakshmi PVM
Published: November 2017

Background: Infant mortality rate (IMR) is a sensitive indicator for monitoring child health and survival. Punjab state in North India is performing better than most of the other states in various health indicators. Punjab’s IMR has shown a rapid decline from 38/1000 live births in 2008 (Sample registration system (SRS) 2008) to 24/1000 live births in 2014 (SRS 2014). This study was planned to assess which of the maternal and child health services is associated with rapid decline in infant mortality rate. Methods: Association between various components of prenatal care, intranatal care and postnatal care, and child healthcare and socio demographic variables (taken from secondary data of District Level Household Surveys) and Infant Mortality Rate (taken from SRS) of Punjab was studied. Spearman correlation coefficient was calculated to measure the association between the variables. Results: Total fertility rate (TFR), women who had institutional deliveries, safe deliveries and mean children ever born are statistically significantly associated with decline in infant mortality rate. Conclusions: In Punjab, maternal and child health indicators are directly or indirectly associated with decline in infant mortality rate. Findings of the study demonstrate that the recent rapid decline in IMR of Punjab is strongly associated with increase in institutional deliveries and decline in TFR and the mean number of children ever born.
Prevalance of stress and its risk factors among medical students
Authors: B. Rock , R. Ronald , T. Elamparithi , S. Zakeena , M. Susin , R. Sundri , J. Vivek , K. Naveen
Published: November 2017

Background: Studying medicine is stressful. Stress may cause serious health problems and affects their professional life. Hence establishing a database on the extent of the problem will help in the planning of measures to reduce stress. The aim of the study was to determine the prevalence and risk factors of stress among the medical students. Methods: Cross-sectional study was done using 40 item medical student stressor questionnaire (MSSQ) to evaluate the level of stress and the stressors and hence finding the factors associated with it. Data were analysed using EPI INFO. Results: Of the medical students who were administered questionnaire, 250 (83%) participated in the study. About 17.2% are from Tamil medium. 37.2% were first child in the family. 64.4% and 57.6% have responded that 6-8hrs sleep needed and the actual sleeping hours respectively. About 74%, 75.2%, 62.8% and 56.4% have less focus, less energy and motivation, negative mood and poor academic performance due to decreased sleep. Academic and group related activities contribute to about 29.2%, 20.8% of the total stress respectively. Conclusions: The prevalence of stress among medical students is moderate to high. The second and final year students are having high stress levels. Academic and group related activities were the major stressors among medical students. Year of study and being the first doctor in the family were the best predictors of a medical student’s stress level.
Perception and practices pertaining to prevention and control of dengue fever among rural population in Mysore district
Authors: Shabadi Nayanabai , G. S. Vidya
Published: November 2017

Background: Dengue is the most prevalent arboviral disease in human beings, with 3.6 billion people living in areas with risk of disease transmission. Many dengue prevalence studies have been conducted in urban areas but it is important to remember the often-forgotten rural population who are also affected. The objective of the study was to assess the perceptions and practices related to dengue among residents of rural community.Methods: A community based cross sectional study was conducted for a period of two months, at Suttur village of Mysore district. Total of 200 individuals were interviewed by doing house to house survey to obtain details of socio-demographic characteristics, perceptions regarding dengue and practices of preventive measures for mosquito breeding and man mosquito contact were obtained using a pre tested questionnaire. Results: In the present study 42 (21%) members had ever heard of the disease called dengue and 18 (42.85%) of them knew that dengue fever spreads by mosquito bite and 12 (28.57%) people said it spreads by drinking dirty water, none of them knew which species of mosquitoes spread dengue fever. Many of them perceive that mosquito spreading Dengue breads in dirty water and garbage. Majority of the people used bed nets, mosquito coil and fans as methods of personal protection and 97% they followed weekly cleaning of water containers to eliminate mosquito breeding. Conclusions: the study shows, the knowledge regarding cause, modes of spread of dengue and vector characteristics were poor but the practices towards mosquito control and eliminating the breeding places of mosquito were adequate.