Reproductive outcome of a patient with congenital adrenal hyperplasia: case report

Congenital Adrenal Hyperplasia are a group of inherited autosomal recessive enzymatic defects of adrenal steroid biosynthesis. Low pregnancy rate has been reported in women with CAH. Several factors have been suggested to contribute to this subfertility such as androgen excess, adrenal progesterone hyper secretion, consequences of genital reconstructive surgery, secondary PCOS and psychosexual factors. In contrast to this subfertility, pregnancies are normal and uneventful. During pregnancy, maternal & fetal problems are confined to these deficiencies. Adequate glucocorticoid therapy and improvement of surgical and psychological management could contribute to optimize fertility in CAH. The interposition of the placenta on the HPA axis & other endocrine changes during pregnancy impact considerably on the clinical evaluation of CAH. A 21 years old Primigravida presented to us at 13 weeks of gestation with history of CAH on treatment and vaginoplasty done in the childhood. Endocrinologist opinion was taken, and steroids continued. Advised to meet genetist and follow up for prenatal testing. But patient denied. Antenatal period was uneventful. Patient underwent Emergency LSCS in view of CPD in labour at 36+6 weeks of gestation. Pre-op stress dose of steroid given. A girl baby of birth weight 2.13 kg was born with good Apgar scores. Perioperative period uneventful. Preconception health, including hormonal, psychosexual and anatomical barriers to fertility should be addressed early in women with CAH. This review provides fertility outcome and pregnancy issues of a woman with CAH

A prospective, randomized, cross sectional study of manual versus vacuum extraction of mobile head in caesarean section

Background: Considering the high rate of caesarean section, and the difficulty during delivery of the floating foetal head even by the most experienced obstetrician, the use of vacuum has been described. The present study was undertaken with the hypothesis that, vacuum assisted foetal head delivery during caesarean section is safe and effective without increasing maternal and neonatal complications. The outcomes enumerated by the limited literature available need to be evaluated before it is used routinely.Methods: A prospective, randomized, comparative, cross sectional Hospital based study was conducted at St. Philomena’s Hospital, Bangalore. Every woman randomized for the study received either conventional method or ventouse extraction of fetal head at cesarean section. 200 women were enrolled into the study with 100 in each arm. The primary outcome measures were percentage of successful extractions and I-D interval. The secondary outcome measures were, uterine incision extension, estimated blood loss, Apgar scores, neonatal hyperbilirubinemia and neonatal scalp or head injury.Results: Successful extraction was done in 89 % and 98 % cases in manual and vacuum extraction cases. (p =0.0184). U-D interval in the manual extraction group was 66.59±4.64 seconds and in the Vacuum extraction group it was 56.06±3.46 seconds (P<0.001). The mean pre-delivery hemoglobin levels in group I was 11.6±0.73 compared to 11.36±0.49 gm% in group II. The mean post-delivery hemoglobin levels in group I was 10.29±0.79 compared to 10.21±0.53 gm% in group II (p <0.001). The uterine incision extensions were significantly higher in manual extraction group, 18 of the 100 women (18 %), whereas only 2 of the 100 women in vacuum group had uterine extensions (p=0.0002).Conclusions: Authors conclude that the routine use of ventouse is safe and effective for mobile fetal head extraction at cesarean section

Peri conceptional association of the triad of hyperhomocsteinemia, hypothyroidism and impaired carbohydrate metabolism with recurrent pregnancy loss

Background: Recurrent pregnancy loss is a cause of great concern to the affected couple as well as the treating physician. We evaluated the periconceptional association of the triad of hyperhomocystienemia, hypothyroidism, and impaired carbohydrate metabolism with RPL and to identify the potential risk factors for RPL which are probably nutritional.Methods: Seven hundred ninety-six consecutive pregnancies with two or more abortions referring to our Infertility clinic were selected to be studied in a descriptive, prospective observational study in 2012-2014. All the pregnant women were subjected to routine blood tests/ examination/ imaging as per hospital protocols. All underwent TSH, FT4, GTT 75 gm (fasting and 2 h postprandial) as per routine antenatal workup. Additionally, fasting plasma homocysteine, antinuclear antibody, anti phospholipid antibody, anti- thyroid peroxidase antibody tests were performed for patients with RPL. All the patients were studied for the triad of hypothyroidism, hyperhomocysteinemia and impaired carbohydrate metabolism.Results: The incidence of RPL was found to be 5.65 %. Majority of women (51.1%) were in the age group 30-34 years. Majority of the women (55.6%) had 2 previous abortions. Majority of women (57.7%) had conceived normally. Majority of women (46.7%) had BMI<25. PCOS was reported in 28.9% women. HHcy, hypothyroidism and impaired carbohydrate metabolism was found in 78%, 73% and 73% women, respectively. The presence of two factors was reported in 60 to 65% women. 56% women reported the presence of the triad. About 7% of the patients underwent repeat abortion in second trimester of which 66.6% had the association of triad.Conclusions: Investigating these three factors in patients with RPL would help in early recognition, monitoring, and aggressive surveillance, which will help prevent obstetric complications. Simple nutritional correction may allow for better maternal and fetal programming and appropriate risk modulation

A Review on Detection of Traumatic brain Injury using Visual-Contextual model in MRI Images

Recently, there are various computational methods to analyze the traumatic brain injury (TBI) from magnetic resonance imaging (MRI).The detection of brain injury is very difficult task in the medical science. There are various soft techniques for the detection of the patch of brain injury on the basis of MRI image contents. This paper gives brief analysis about the different methods to determine the normal and abnormal tissues of the brain

COST ANALYSIS OF COMMONLY USED DRUGS UNDER PRICE CONTROL IN INDIA: ASSESSING THE EFFECT OF DRUG PRICE CONTROL ORDER ON BRAND PRICE VARIATION

Objective: Rising cost of medical therapy is a major concern for patients, and there is high variability in the prices of numerous branded medicines available in India. Drug Price Control Order (DPCO) 2013 was implemented by the government of India with the aim of bringing down the cost of essential medicines. This cost analysis study was carried out to assess the brand price variation in major classes of common drugs under price control; thus assessing the impact of DPCO and analyse issues related to it.Methods: Latest price list of available brands for cardiovascular drugs, antibacterial, analgesics, drugs for diabetes, asthma, arthritis, convulsions covered under the DPCO, was procured from a leading commercial drug directory. Unit prices of drug formulations available as different brands were compared. Maximum-minimum prices and average prices were found. Price variations between brands were calculated and expressed as percentage variations. Assessment of existing pricing policy and quality norms was done.Results: Significant inter-brand price variations were found for the majority of formulations. These variations ranged from more than 100 % from average to more than 500 % between maximum and minimum brand prices for drugs like amlodipine, atorvastatin, diclofenac, amoxicillin-clavulanic acid, clopidogrel. Out of 60 formulations observed, 40 showed price variations in excess of 50 % from average price and 23 showed variations greater than 200 % between the costliest and cheapest brands.Conclusion: Despite the implementation of price control, brand price variations still exist widely for commonly used drugs. Re-assessment of pricing policy and implementation of quality norms is needed.Keywords: Pharmacoeconomics, Price control, Brands, Price variation, Essential medicine

A comparative study of antihyperglycemic effect of Gymnema sylvestre and metformin in streptozotocin induced diabetic rats

Background: Diabetes mellitus (DM) is a metabolic disorder that has the phenotype of hyperglycemia. According to World Health Organization (WHO) there were 65.1 million diabetics in India in 2013, International Diabetes Federation estimates this to increase to 190 million by 2035. Although a number of drugs are available for treatment of DM, their cost and safety profile are major concern. Medicinal plants are used by clinicians for treatment of diabetes. Gymnema sylvestre (GS) extract has been reported to increase insulin levels in diabetic rats. This study was designed to compare the antihyperglycemic effect of Gymnema sylvestre with metformin.Methods: Diabetes was induced in Sprague-Dawley rats using streptozotocin 45mg/kg. Methanolic extract of Gymnema sylvestre 120mg/kg p.o. prepared using Soxhlet apparatus.Results: GS extract reduced blood glucose levels but not statistically significant. GS extract increased HDL and triglycerides, reduced both serum ALT and AST but no statistical significance seen. Metformin significantly increased serum urea, which was not seen in GS extract group. GS extract showed regenerative changes in pancreas, liver and kidney.Conclusions: The study investigation demonstrates that methanolic extract of GS possesses antihyperglycemic and hypolipidaemic activity and so it can be considered as a promising natural remedy in a prediabetic state and in mild hyperlipidaemia to prevent its progression. Increase in β cell regeneration activity could be a probable mechanism of action. However, further long term clinical studies are recommended to define its possible role in diabetes mellitus and hyperlipidaemia. Role of GS as a potential hepatoprotective agent also needs further evaluation

Secure Mobile Based E-Voting System

The E-Voting means the voting process in election by using electronic device. In this proposed system described how the android mobile phones are efficient and can be used for voting. The android platform is used to develop an application. Our system support simultaneous voting due to the distributed nature of the database. During election electronic device is used for voting process. A voter may only need to register only once for a particular election and that does all, voter need to cast his /her vote without actually have to present at the voting cell. The registration process must be done at Booth application for once then voter is been given a facility to vote from his/her Android mobile phone irrespective of his/her location. This proposed system suppose to propose a new e-voting system, which ensures voter confidentiality and voting accuracy, thus providing an important framework that based on unique identification ADHAAR ID (U-ID) number. An online solution is very useful as the information about the voters and the election committee is also made available to the people in this system