Comparative study of safety and efficacy of intravenous iron sucrose and ferric carboxymaltose in the treatment of postpartum iron deficiency anaemia

Background: Anaemia is the most commonly encountered and reversible medical problem during pregnancy and postpartum period. It adversely affects the health of both mother and foetus. Oral iron therapy has many disadvantages-poor compliance and gastrointestinal side effects lead the list. Intravenous iron is an effective alternative in correcting anaemia and restoring iron stores. The objective of this study was to evaluate the safety and efficacy of intravenous iron sucrose and ferric carboxymaltose in treatment of post partum anaemia and compare the rise in Hb% and serum ferritin stores after treatment with IV iron sucrose and ferric carboxymaltose.Methods: This was a prospective analytical study conducted on 100 postpartum patients in a medical college and research centre in South India. Patients for study were selected from the postnatal ward, having haemoglobin concentration of <10gm/dl and iron deficiency anaemia as the aetiology. All the selected patients were randomly categorized into two groups to receive intravenous iron sucrose and ferric carboxymaltose. The tolerability and side effects of both the injections were noted. Hb% and serum ferritin were repeated 2 weeks and 6 weeks after treatment and results analyzed. Results: The increment in Hb% in IV iron sucrose group after 2 and 6 weeks was 9.69±0.49 gm/dl and 11.28±0.53 gm/dl respectively. Ferric carboxymaltose showed 9.8±0.43 gm/dl and 12.22±0.43 gm/dl rise in Hb% at the same time interval. Serum ferritin showed a significant increase in IV ferric carboxymaltose group as compared to IV iron sucrose at 2 and 6 weeks (p=0.049; p=0.023).Conclusions: Ferric carboxymaltose has a greater safety profile (p) and offers faster elevation of haemoglobin and iron stores with lesser hospital stay as compared to iron sucrose

Outsourcing Strategy in Avionics Manufacturing in Indian DPSUs

The Avionics manufacturer DPSUs is a high end technology oriented which involve in complex integration among their supplier vendors. The global competition of DPSUs not only related the manufacturing facility technology but also their supply chain. This research paper point out the outsourcing as a strategic tool for economic growth of DPSUs. In this paper researcher discuss the present challenges in supply chain for avionics manufacturer DPSUs and GOI policy for outsourcing. Researcher develop a strategic outsourcing model for avionics manufacturer DPSUs which application enhances their performance

Iniencephaly: a rare birth defect

Iniencephaly is form of neural tube defect which includes occipital bone defect at foramen magnum along with fixed retroflexion of fetal head and absence of fetal neck. Incidence of iniencephaly is 0.1-10 in 10,000 pregnancies. There is a known female predilection for this condition. Iniencephaly has a poor prognosis. It can be diagnosed antenatally by raised maternal serum alpha-fetoprotein and typical ultrasound features. Termination should be advised to patients who present before 20 weeks. Herein we are describing a case of iniencephaly who presented at 27 weeks of gestation with a brief review of literature

Comparison of metformin and N-acetylcysteine on metabolic parameters in women with polycystic ovarian syndrome

Background: Polycystic ovary syndrome (PCOS) is a common disease that affects up to 10% of women of reproductive age, in which hyperandrogenism (HA), enlarged cystic ovaries, and chronic anovulation often co-exist with obesity, dyslipidemia and insulin resistance (IR). There is a need for an alternative to metformin with minimal side effects to improve insulin sensitivity and correct dyslipidemia in PCOS patients.Methods: It was a prospective, Randomized controlled clinical trial. 116 PCOS patients, 58 each in two groups received either Metformin 500 mg TDS or N-acetylcysteine (NAC) 600 mg TDS for 3 months. Clinical and biochemical parameters contributing to metabolic syndrome (MS) and insulin resistance (fasting blood sugar (FBS), fasting insulin (FI), FBS:FI, HOMA-IR and QUICKI) were assessed at the start and end of the study. Results were compared between the two groups.Results: Both treatment modalities resulted in a significant reduction in number of cases with IR (p=0.001) and MS. Fasting hyperinsulinemia improved in 15 % (p=0.12) and 30% (p=0.001) of patients while 12% (p=0.23) and 18% (p=0.049) improvement was seen in FBS:FI in MET and NAC group respectively. Similarly, improvement in HOMA-IR was 12% (p=0.30) and 32% (p=0.001) in MET and NAC group which is significant with NAC. QUICKI and impaired glucose tolerance showed significant improvement in both the groups with a p-value of 0.04 and 0.006, 0.035 and 0.046 respectively. Significant reduction was seen in triglycerides (p=0.048) in NAC group.Conclusions: NAC is equally efficacious as metformin in improving parameters of insulin resistance and metabolic syndrome with minimal occasional side effects ensuring better compliance for a long-term therapy

Study of histopathological pattern of endometrium in abnormal uterine bleeding and its management

Background: Abnormal uterine bleeding is one of the most common and challenging problems presenting as an enigma to the gynecologist regardless of the age of the women.  Histopathological evaluation of endometrium plays a significant and pivotal role in the diagnosis and management of endometrial causes of Abnormal Uterine Bleeding. The main aim was to study the frequency of different histopathological patterns of endometrium in patients with abnormal uterine bleeding across different age groups, know the endometrial causes of abnormal uterine bleeding and its managements.Methods: This study was conducted on 300 patients from March 2014 to February 2015 in the department of Obstetrics and Gynaecology in a reputed teaching hospital and research centre in South India. Demographic indices were collected and recorded. Endometrial samples were sent for histopathological examinations and different endometrial patterns were noted.Results: Abnormal Uterine Bleeding (AUB) presented mostly in the 41-50 years age spectrum (48.6%) and most of the patients were multipara. The main presenting complaint among our patients was menorrhagia (42%) followed by polymenorrhagia (15%), menometrorrhagia (10.6%) ,continuous vaginal bleeding (9.6%), Polymenorrhea (9.3%), postmenopausal bleeding (8.6%) and metrorrhagia (4.6%).The commonest histopathological  pattern in abnormal uterine bleeding was  normal physiological phases of menstrual cycle - proliferative and secretary endometrium (37% and 30%  respectively). Endometrial hyperplasia was the most common endometrial pathology observed (22.6%).Conclusions: Endometrial evaluation in abnormal uterine bleeding in different age groups helps in the management, especially in the perimenopausal and postmenopausal age groups to rule out premalignant conditions and malignancy

Müllerian duct cyst misdiagnosed as ovarian cyst: a rare case report

The Müllerian duct cyst is a remnant of the caudal ends of the fused embryologic paramesonephric ducts (or Müllerian ducts). Preoperative distinction of ovarian cyst from a Müllerian duct cyst is important and is based on visualization of the ipsilateral ovary separate from the mass. Müllerian duct cysts may also be mistaken as paratubal, paraovarian or peritoneal inclusion cysts and hydrosalpinx. Thus, preoperative diagnosis of Müllerian cyst of the uterus can be very challenging. However, with increased awareness, preoperative diagnosis of this condition should be possible by sonography. Laparoscopy is useful as a minimally invasive treatment to diagnose as well as resect the cyst at the same time. We present a rare case of Müllerian duct cyst misdiagnosed as ovarian cyst pre-operatively and managed laparoscopically. A 32 year old multiparous female presented with the complaint of lump and dull aching pain in lower abdomen since three months. A cystic mobile mass measuring 6X7 cm with smooth surface which corresponded to 16 weeks gravid uterus size was palpated arising from pelvis. Her pelvic ultrasonography revealed a 7X7 cm unilocular thin walled simple cyst in right ovary suggestive of serous cystadenoma. Her CA-125 was 5.3 IU/ml. She was taken up for laparoscopic ovarian cystectomy. Intra-operatively, a 7X7 cm cyst was seen arising from right lateral wall of uterus. Histopathology showed the cyst wall features consistent with a Müllerian duct cyst

Are preeclampsia and small for gestational age baby could be predicted by placental location?

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

A knowledge, attitude and practice study on awareness and acceptance of contraception in postpartum women in a tertiary care hospital

Background: India was the first country in the world to launch National Family Planning Programme in 1951. This was first step taken to stabilize population, but still lag behind in limiting family size and practicing contraceptive use. 55 million unintended pregnancies occur every year in developing countries due to no contraception use. 25 million pregnancies occur due to inconsistent or incorrect use of contraception method and contraception failure. The reason for promotion of family planning services to increase inter-pregnancy interval, birth spacing or to delay conception after birth by this method we can achieve optimum maternal and child outcome. This study was conducted to assess knowledge, awareness and acceptance about contraceptive methods during postpartum period.Methods: A prospective observational questionnaire based study in which 500 postpartum women belongs to 15 to 45 years age group was interviewed with informed verbal consent. This was KAP study regarding socio-demographic profile, awareness and acceptance of contraceptive method in postpartum period or during inter-pregnancy and factors affecting its use.Results: Statistical analysis of univariate and bivariate data done by using chi-square test and percentage (%). Out of 500 postpartum women, 46% women reported that they did not use any contraceptive method before. There was a significant association between contraceptive use with religion and education status (p=0.000, p=0.042 respectively). 62% obtained information from health professional (doctor/nurse), 23.8% obtained information from husband 44.4% of postpartum women implied that they would use contraceptive. Barrier method is the most preferred method (40.1%) of contraception.Conclusions: To improve maternal and child outcome, health professionals should be more focused to encourage effective and high quality contraceptive counseling during antenatal, intrapartum and postpartum period

Hygiene practices and awareness regarding Milk borne diseases (MBD) among dairy workers in unorganized urban settings of Bhubaneswar, Odisha, India

Background: Dairy work is thought to be predominantly a rural occupation. However, due to preferences we see a lot of urban residents consume fresh milk and hence, few people even in the urban areas take up cattle rearing as a cost effective profession. In the midst of much talked re-emerging diseases, caused by close habitation of animals and man, it would be very relevant to see living conditions of these populations and their hygiene practices in a space compromised scenario. In urban settings, they stay in close proximity and due to socioeconomic conditions, dairy workers in do not have appropriate amenities to tend on the cattle,clean or even scope for proper waste disposal. This in nutshell, leads to a disease enabling environment and the study aims at reviewing these living conditions. Besides, an assessment of health conditions of the dairy workers, their awareness regarding the milk borne diseases(MBD) was done. The findings helped generate recommendations for improvement of the profession and ultimately the quality of the milk. Objectives:1) Assess the hygiene practices during the stages of milk collection, storage and transport of milk among the sampled dairy workers from urban unorganized settings of Bhubaneswar. 2) Assess awareness of these workers regarding milk borne diseases. Methodology: This cross?sectional survey was part of a larger study and was conducted in unorganized sector of dairy workers in Bhubaneswar. 60 dairy households were surveyed and from each household, 2 members actively involved in dairy work were selected.The study tool was a semi structured, mixed questionnaire. The questionnaire had 3 sections; A was regarding household information(General sociodemographic details and Housing conditions for 60 HHs); B was to elicit the hygiene status of dairy workers(n=120) during each step of their work, their milk handling details during milk collection, storage and transportation; C had questions to assess the awareness of dairy worker regarding MBD. Results: Hygiene practices were very dismal at all points like milking,storage and transportation. Only 5.0% dairy households practised cleaning udder twice- prior to and after milking. Only 35% households kept the milk storage containers covered. 44.2% workers agreed that “MBD” is a community health problem. On general examination, pallor and icterus was found among workers. This strongly brings out that this group not only have the potential to be infected by zoonotic diseases, but can also transmit it to through the milk they are selling. A felt need is assessed for these workers in terms of creating standards of hygiene practices of cattle and milk handling and also impart them training on improving their occupational practices