Comparison of diagnostic accuracy of two one step procedures for screening of gestational diabetes mellitus

Background: Single test procedures for screening GDM in Indian women will help in its management.This study was aimed to compare the accuracy measures of the random glucose test and the Diabetes In Pregnancy Study group India (DIPSI) recommended glucose challenge test as screening tests for Gestational Diabetes Mellitus (GDM) between 24 and 28 weeks of pregnancy and to study the prevalence of GDM and associated risk factors.Methods: In this prospective cohort study, all pregnant women without pre-existing diabetes underwent a random glucose test first followed by DIPSI recommended method (2 hours after a 75 g oral glucose load, without regard to the time of the last meal). All the pregnant women were subjected to 2-h 75-g oral glucose tolerance test for diagnosis of GDM within one week. Receiver Operating Characteristic (ROC) analysis was used to evaluate the discriminatory power of the two screening tests.  Results: The OGTT was performed in 576 women. The area under the ROC curve was larger for the DIPSI test [0.97 (95% CI 0.95-0.98)] than for the random glucose test [0.76 (95% CI 0.72-0.79)]. There was a significant difference in the areas under the curve of the two tests of 0.21 (0.14 to 0.28) (P <0.0001) in favour of the DIPSI recommended method. GDM was present in 8.9% women confirmed by 75 g 2 hour OGTT using the WHO criteria. Age ≥30 years, BMI ≥25 and family history of diabetes were found to be risk factors for GDM.Conclusions: In screening for GDM, the DIPSI procedure test was more useful than the random glucose test

Identification of factors determining the initiation of breastfeeding in postnatal women in a tertiary care centre: an observational study

Background: The WHO recommends that mothers worldwide to initiate breastfeeding within an hour of delivery to achieve optimal growth, development and health but the breastfeeding rates remain far below the recommended standards. The aim of this study was to find the prevalence of delay in initiation of breast feeding, to identify various factors which determine the initiation of breastfeeding and to correlate their association with delayed onset of breast feeding.Methods: Hundred and thirty six postnatal women, who delivered in Santosh Medical College and Hospital, Ghaziabad, were recruited in the study. They were interviewed after their informed consent using a pretested structured questionnaire. Socio-demographic and obstetric factors were compared between subjects who initiated breast feeding in less than and more than 1 hours. Frequencies were calculated for different variables. Data was statistically analyzed and p value of <0.05 was taken significant.Results: The prevalence of delay in initiation of breast feeding in our study was found to be 74.2% (n=101).The mean time of initiation of breast feeding was 18.43 hours. Significant association (p <0.05) was found in various sociodemographic, obstetrical and social factors.Conclusions: Identifying mothers at risk of delayed breastfeeding initiation should be the target for breastfeeding promotion during prenatal, antenatal as well as postnatal period. Public health officials and health care providers should consider interventions to promote and support early initiation of breast feeding

Role of cytology, colposcopy and colposcopic directed biopsy in the evaluation of unhealthy cervix

Background: The objective was to find out the magnitude of precancerous lesions and evaluate the performance of colposcopy in estimating the presence and grade of cervical disease vs conventional Pap smear testing of women with unhealthy cervix.Methods: This was a prospective observational study. All the women were subjected to Pap smear and colposcopy, whereas histopathology was done in patients having abnormal findings on colposcopy. Biopsies were taken from the abnormal areas.Results: Out of 110 women who completed the study 60 (54.5%) had changes in their cervical epithelium on colposcopy. These 60 women with unhealthy cervix underwent cervical biopsy, and 20 (33.3%) had histologically proven chronic cervicitis, 6 (10%) had chronic cervicitis with condylomatous change followed by 17 (28.3%) with CIN 1 lesion, 8 (13.3%) with CIN 2, 4 (6.7%) with CIN 3 lesion and only one (1.7%) had histologically proven malignancy. Cytology alone identified the population at risk with a high sensitivity [70.00% (95% CI: 50.60 % to 85.24 %)] but low specificity [60.00% (95% CI: 40.61 % to 77.32 %)] rate. Colposcopy showed a high sensitivity rate [93.33 % (95% CI: 77.19 % to 98.99 %)] but a limited specificity [70.00% (95% CI: 50.60% to 85.24%)].Conclusions: It is very important to diagnose the CIN lesions with accuracy once a woman comes to a tertiary care hospital with symptoms or is referred for a suspicious looking cervix. All these women must be screened by colposcopy and directed biopsy must be taken if indicated in the same sitting

Prevalence of subclinical hypothyroidism in North-Indian pregnant women

Background: It is now well established that not only overt but subclinical thyroid dysfunction can also have adverse effects on fetal and maternal outcomes. In recent years several studies show a much larger prevalence of SCH and marked variation between different ethnic groups. The aim of this study was to find out the prevalence of subclinical hypothyroidism during first trimester in a teaching hospital in North India.Methods: A prospective observational study was conducted in all the consecutive first trimester pregnant women attending Santosh Medical College, Hospital, Ghaziabad from June 2014 to April 2015 after institutional ethics approval and consent from the study subjects. Morning samples of serum were tested for TSH. If serum TSH value was more than 2.5mIU/L then Free T4 and TPO Antibody level were estimated.Results: Serum TSH level was normal in 66.2 % women, 32.5 % women had subclinical hypothyroidism and 1.3 % women had overt hypothyroidism using a first trimester normal reference range of 0.1 to 2.5 mU/l suggested by American Thyroid Association or by the American Endocrine Society.Using 5 mIU/L as upper limit of TSH suggested by some Indian studies serum TSH level was normal in 90.6 % women, 8.1 % women had subclinical hypothyroidism and 1.3 % women had overt hypothyroidism.Conclusion: The prevalence of SCH is very high in our study population. We feel that the use of thyroid function reference values based on studies using different populations and different backgrounds can introduce bias in the evaluation of a local population

Utility of fasting plasma glucose test as screening tool for gestational diabetes mellitus based on International Association of the Diabetes and Pregnancy Study Group criteria

Background: The International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria have recently been endorsed by various bodies for screening and diagnosing Gestational Diabetes (GDM). The present study was done to diagnose gestational diabetes (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria in a North Indian Population and to evaluate the performance of fasting plasma glucose (FPG) in screening and diagnosis of GDM.Methods: We conducted a prospective observational study on 417 pregnant women. The women were screened for GDM between 24 weeks and 28 weeks of gestation by 75-g oral glucose tolerance test (OGTT) and GDM diagnosed by the IADPSG criteria.Results: The prevalence of GDM was 17.7% [95% Confidence interval (CI) 21.4 -14.1%] using the IADPSG criteria. Amongst the women diagnosed to have GDM, 64.9% had abnormal fasting plasma glucose (FPG). FPG cut-off value of 92 mg/dL identified 11.5% pregnant women with GDM. FPG cut-off value of 80 mg/dL ruled out GDM in 54.7% women. If 80 mg/dL were made the cut point to decide who should have the 75-g OGTT, then 56.8% (45.3 % with values 5.1 mmol/L) of pregnant women could avoid the 75-g OGTT with the probability that 1.9% of patients with GDM may be missed.Conclusions: FPG at 24-28 weeks’ gestation could be used as a screening test to identify GDM patients. Women with an FPG between ≥ 80 mg/dL and ≤ 92 mg/dL would require a 75-g OGTT to diagnose GDM

Comparative evaluation of colposcopy, cytology and histopathology for diagnosis of cervical lesions

Background: Cervical cancer is the fourth most frequent cancer globally in women with an estimated 570,000 new cases and 311,000 deaths in 2018 representing 6.6% of all female cancers. To correlate the cytology, colposcopy and histopathology of cervical lesions in patients attending gynaecology OPD in a tertiary care centre, Ghaziabad.Methods: 208 women were enrolled from Gynaecology OPD of Santosh Medical College and Hospital, Ghaziabad, irrespective of their chief complaints. Women aged 19-80 years were included in the study group. Those with pregnancy and already diagnosed or treated with CIN, Cervical cancer or Cervical HPV infection were excluded from the study. PAP-smear was taken for all the patients followed by colposcopy without waiting for PAP-smear report. Cervical biopsy was taken from patients with abnormal colposcopic findings (90 patients).Results: Majority of women were in age group 30-39 years. 37.5% had unhealthy, 21.6% had hypertrophied cervix and only 9.1% had normal cervix. It was found that PAP -smear has a sensitivity of 33.33%, specificity of 92.59%, accuracy of 68.89%, positive predictive value of 75% and negative predictive value of 67.57%. Test parameters calculated for colposcopy revealed that it has sensitivity of 73.33%, specificity of 92%, PPV of 64.7%, NPV of 94.52% and accuracy of 88.89%.Conclusions: The results from the current study conclude that it is better to use cytology and colposcopy together as part of routine screening for cervical cancer rather than pap smear alone in order to detect maximum number of lesions

Questionnaire-based assessment on knowledge, attitude and practice of fixed-dose combination in medical undergraduates of a tertiary care teaching hospital, Kanpur

Background: Aim was to assess knowledge, attitude and practice of second-year medical undergraduates towards FDC. Methods: A cross-sectional questionnaire-based study was conducted among second-year medical undergraduates of GSVM, medical college, Kanpur in the form of a pre-test, and after sensitizing the students about FDC, the same questionnaire was given as a post-test. Results: A total of 251 students, 157 students participated in the pre-test and 140 participated in the post-test. The percentage of male students in pre and post-test were more (58% and 61.4%) compared to female students (42% and 38.6%). After conducting a post-test survey, there is a significant improvement in knowledge and attitude toward FDC. Conclusions: The inclusion of FDC in the undergraduate curriculum is a good initiative by NMC but there is a need to conduct more CME, symposiums, and workshops in medical colleges to update the knowledge regarding FDC among medical undergraduates.

Utility of fasting plasma glucose test as screening tool for gestational diabetes mellitus based on International Association of the Diabetes and Pregnancy Study Group criteria

Background: The International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria have recently been endorsed by various bodies for screening and diagnosing Gestational Diabetes (GDM). The present study was done to diagnose gestational diabetes (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria in a North Indian Population and to evaluate the performance of fasting plasma glucose (FPG) in screening and diagnosis of GDM.Methods: We conducted a prospective observational study on 417 pregnant women. The women were screened for GDM between 24 weeks and 28 weeks of gestation by 75-g oral glucose tolerance test (OGTT) and GDM diagnosed by the IADPSG criteria.Results: The prevalence of GDM was 17.7% [95% Confidence interval (CI) 21.4 -14.1%] using the IADPSG criteria. Amongst the women diagnosed to have GDM, 64.9% had abnormal fasting plasma glucose (FPG). FPG cut-off value of 92 mg/dL identified 11.5% pregnant women with GDM. FPG cut-off value of 80 mg/dL ruled out GDM in 54.7% women. If 80 mg/dL were made the cut point to decide who should have the 75-g OGTT, then 56.8% (45.3 % with values &lt;4.4 mmol/L plus 11.5 % with value &gt;5.1 mmol/L) of pregnant women could avoid the 75-g OGTT with the probability that 1.9% of patients with GDM may be missed.Conclusions: FPG at 24-28 weeks’ gestation could be used as a screening test to identify GDM patients. Women with an FPG between ≥ 80 mg/dL and ≤ 92 mg/dL would require a 75-g OGTT to diagnose GDM

Retracted: Knowledge, attitude, and practice of contraception among women attending a tertiary care hospital

The article "Knowledge, attitude, and practice of contraception among women attending a tertiary care hospital" is retracted by the Editor-in-Chief, due to violation of the policies and practices of International Journal of Reproduction, Contraception, Obstetrics and Gynecology. The article is retracted due to dispute in authorship