Practice of contraception in this modern world: still a myth?

Background: Objective: To assess the attitude, knowledge and practice of contraception among MTP seekers women attending Family Planning OPD.Methods: 150 women attending family planning clinic and requesting for Medical Termination of Pregnancy (MTP), were interrogated on a pre- structured questionnaire and their knowledge, attitude and practice about contraception were assessed.Results: Of the women 80% women had some or the other knowledge of contraception but still 92 (61.3%) were not using any contraception 92 (61.3%), 54 (36%) were using barrier method and only 4 (2.6%) were used OCP’s. The request for MTP was mainly on grounds of unplanned pregnancy and completed family in 57.3% cases followed by previous child small 42 (28%). Of the women, only 38 (25.3%) had heard about emergency contraceptives and only few had used them off and on. The various methods of contraception accepted by the women post abortion were IUDs by 91 (61.3%) and female sterilization by 55 (36.6%). Statistical analysis was done using SPSS software 15.Conclusions: Practice of contraception is still a myth. There is a great need to strengthen the awareness among people by various programmes and the target group should be both males and females

Safety of patwardhan technique in deeply engaged head

Background: Deeply engaged head in second stage caesarean section is not new, every obstetrician must have faced it and its associated problems many times in their career. Caesarean sections done at full cervical dilatation with impacted foetal heads are technically difficult as the lower segment is thinned out and oedematous and hence associated with an increased incidence of maternal and foetal morbidities. The objective of this study was to compare patwardhan technique with Push and pull technique of delivering deeply impacted head and to assess the safety of patwardhan technique by correlating them with maternal and fetal outcome.Methods: It is a retrospective study including all caesarean sections done in second stage at Tertiary care centre, New Delhi, India in the years from 2011 to 2013. Patients were divided into two groups: group -1 where baby delivered by Patwardhan technique and group 2 where baby delivered by push or pull technique. Both groups were compared in terms of maternal outcomes as uterine incision extensions, PPH, blood transfusions and neonatal outcomes in terms of their weight, APGAR and NICU stay.Results: There were total 135 patients who underwent caesarean section for obstructed labour during 2011-2013.  Out of 135, 71 babies were delivered by push and pull method and 64 babies got delivered by Patwardhan technique. There was significant less uterine incision extensions in patwardhan group as compared to push and pull technique (3.1%, 23.9%: p=0.01). The traumatic PPH and blood transfusion was also significantly high in push and pull method as compared to patwardhan technique (1.5%, 22.5%: p=0.01). Baby outcome was almost similar in both the groups.Conclusions: The patwardhan technique needs expertise but is safe and has minimal complications if anticipated and done skill fully. It is easy to learn and needs to be more widely publicized and utilized

Comparison of centchroman and PPIUCD in terms of efficacy, safety and continuation rate in immediate postpartum period

Background: Study was done to assess the efficacy, safety and continuation rate of Centchroman and IUCD administered in immediate postpartum period (within 48 hours).Methods: An interventional study was conducted in Obstetrics and Gynecology department of Safdarjung Hospital, New Delhi, at a tertiary care hospital after approval from ethical committee. 280 women were enrolled in the study and divided into 2 groups centchroman group and PPIUCD group, 140 in each group after excluding the exclusion criteria and satisfying inclusion criteria. These women were followed up at 6 week, 3 month and 6 months to study efficacy, safety and continuation rate.Results: Centchroman as contraception is safe with fewer side effects, better satisfaction rate and better continuation rate in comparison to PPIUCD.Conclusions: Centchroman is a newer contraceptive which is recently added in basket of family planning in our country to give wider choices to women. It is an indigenous product developed by central drug research institute (CDRI), Lucknow available free of cost in government hospitals. Centchroman needs more popularity and education for its widespread use

Investigation of drug ionic liquid salts for topical delivery systems

Pharmaceutical companies and FDA (Federal Drug Administration) rules rely heavily on crystalline active pharmaceutical ingredients delivered as tablets and powders in the form of neutral compounds, salts and solvates of neutral compounds and salts. About half of all drugs sold in the market are in the form of salts which are held together by ionic bonds along with some other forces. Recently, Ionic liquids (ILs) an interesting class of chemical compounds have offered potential opportunity for exploration as novel drug ionic liquid salts, particularly in the field of transdermal/topical drug delivery. Due to the multifunctional nature of these salts they could allow generation of new pathway to manipulate the transport and deposition behaviour of the drug molecule. It is this modular approach of IL that forms the basis of the research presented here, in which pharmaceutically acceptable compounds are combined with selected drugs with known problems. IL salts were generated by combining at least one drug molecule with FDA approved compounds and were assessed for physicochemical properties, skin deposition and permeation studies. Skin deposition data suggested that these systems exhibit high skin retention, which was found to correlate with the molecular weight. On the other hand, permeation data displayed an inverse relationship between flux values and molecular weight of the permeant. Similar work was extended with ILs with mixed anions containing two drugs. The benzalkonium-sulfacetamide ILs were investigated for synergism and the biological studies data display no synergistic effect. It was also illustrated that in-situ IL based ibuprofen hydrogels systems could be manipulated via IL approach for topical application. These findings suggest the potential applicability of IL based formulations for topical delivery of drugs

Need of premarital care

Background: Marriage is considered a remarkable event in an individual’s life. It provides people with a sense of belonging, support, security and responsibility. We put so much of efforts to find a good match for our younger and loved ones but we forget to match the most important wealth of our life “Health”. This study aimed to know the knowledge, attitude and practice of the population through a structured questionnaire.Methods: A cross-sectional study was conducted using a self-administered questionnaire which was distributed to 110 males and 110 females attending Medicine and Gynae OPD at Safdarjung hospital, New Delhi. Participants were questioned according to the self administered questionnaire and their answers were evaluated.Results: Only 11% of males new of premarital counseling and none of the females were aware of premarital care. Contraception knowledge was also poor among females as 7% females new only I-Pill as the method of contraception. After knowing the importance of premarital counseling and screening 92% males and 52 % females agreed for premarital counseling and screening.Conclusions: Marriage provides people with a sense of belonging, support, security and responsibility. Premarital care nurtures it and fill its “Neev” with the goodness of health. Therefore, it is recommended that premarital care is important before every marriage for the happy and healthy family ahead

Association of low serum vitamin D level among pulmonary tuberculosis patients

Background: Recent studies suggest that the incidence and severity of tuberculosis is associated with low levels of Vitamin D, this is especially important in developing countries like India which carries a major portion of global Tuberculosis burden. Therefore, this study aimed to determine the prevalence of Vitamin D deficiency in newly diagnosed tuberculosis patients in our institute. Aims and objective is to study the deficiency of Vitamin D In newly diagnosed sputum positive pulmonary TB and to compare the level of Vitamin d with that of age matched healthy control population.Methods: This was a descriptive cross-sectional case control study to asses Vitamin D deficiency among 140 cases which included 2 categories of patients (a) Group 1: 70 sputum AFB positive newly diagnosed pulmonary TB patients, (b) Group 2: 70 apparently healthy people who came to the hospital with regular checkup.Results: Mean age of study groups and control in years were, Control: 40.3857±10.231, Cases: 36.885±11.076. Mean BMI was significantly higher in controls when compared with new TB cases (19.27±2.455 vs 15.215±1.774) kg/m2 p <0.05).There was significant decrease in mean Vitamin D3 value when new cases TB patients were compared with controls (18.212±9.3027 vs 36.1267±8.410 p <0.05).Conclusions: Patients with tuberculosis are significantly Vitamin D deficient as compared to normal people. This deficiency is more marked in females and those with low BMI. The present finding favours the role of Vitamin D in the prevention and treatment of tuberculosis in developing countries like India

Bishop score and transvaginal ultrasound for preinduction cervical assessment: a randomized clinical trial

Background: The objective was to compare transvaginal ultrasound with the Bishop score for preinduction cervical assessment and for choice of induction agent. Methods: 150 women were randomized to have preinduction cervical assessment for choice of induction agent based on either Bishop score or transvaginal ultrasound. The primary outcome measure was the percentage of women who were administered prostaglandin as a preinduction agent. The criteria for considering the cervix as unripe and thus for using prostaglandin were either a Bishop score <6 or cervical wedging of <30% of the total cervical length. Secondary outcome measures included interval to active phase, interval to delivery and rate of Caesarean section and fetal outcome. Results: While 85% of women received prostaglandin in the Bishop score group, only 53% of them did in the transvaginal ultrasound group (p =0.001). The interval to active phase, interval to delivery, rate of Caesarean section for failed induction and fetal outcomes were similar in both groups.Conclusions: With the suggested cut-off values of a Bishop score <6 and wedging <30%, the use of transvaginal ultrasound instead of Bishop score for preinduction cervical assessment to choose induction agent significantly reduces the need for intracervical prostaglandin treatment without adversely affecting the success of induction

Study on correlation between six minute walk test and BODE index in chronic obstructive pulmonary disease patients

Background: Chronic obstructive pulmonary disease is preventable and treatable disease with progressive persistent airflow limitation and enhanced chronic inflammatory response in the airways. Indian council of medical research conducted a study and found that total burden of COPD in India has more than doubled to about 14.84 million in 2011 from about 6.45 million in 1971Methods: It was an open label cross sectional study. It was conducted on patients attending the outpatient department of respiratory medicine, new medical college and hospital, Kota, over a period of one year. 100 COPD patients attending the respiratory outpatient department of GMC, Kota and fulfilling the inclusion criteria’s were included in the study. A diagnosis and severity of COPD was established by clinical symptoms and spirometric data as per GOLD guideline (ratio of FEV1 and forced vital capacity &lt;0.7).Results: We found a significant negative correlation (Pearson correlation coefficient r = -0.664, p&lt; 0.001) between 6 MWD and BODE index in study population.Conclusions: Thus, we concluded that the functional exercise capacity of COPD patients measured by 6MWT deteriorates linearly with severity of the disease assessed by the GOLD staging criteria. Hence we can use 6 MWT for assessing the severity of COPD in place of spirometry where the facility of spirometry is not feasible

Effect of Beam tunnels on Resonant Frequency of Cylindrical Reentrant Cavity

Analytical formulations for the resonant frequency of a reentrant cavity for klystron are available in the literature only for such cavities having a single beam-tunnel. An improved analytical formulation has been proposed in this paper for the calculation of cavity gap-capacitance of reentrant cavities having single and multiple beam-tunnels and its effects on the resonant frequency are studied. The results obtained through analysis have been validated against those obtained from the 3D electromagnetic field simulations and measurements. The proposed analytical formulation provides good estimation of resonant frequency of cavity with single and multiple beam-tunnels

Enlarged uterus through a natural orifice: worth an effort? A randomized controlled trial

Background: The objective was to compare the efficacy, safety and patient satisfaction of the Non-Descent Vaginal Hysterectomy (NDVH) with Total Abdominal Hysterectomy (TAH) in benign enlarged uterus.Methods: This was a prospective Randomized comparative study. A total of 60 subjects were randomly divided into VH and TAH groups (Group A, group B), by sealed opaque envelope, each comprising 30 subjects. Subjects having uterus of more than 12 weeks size requiring hysterectomy for benign pathology and non-prolapsed uterus were included in the study.  Corporal bisection, morcellation, myomectomy, coring and combination of these were used as debulking procedures.  Results: We could do all the VH successfully with no conversion to laparotomy and 100% success rate. The mean uterine size was 420.00 g ± 117.24 in group A and 454.33 g ± 52.50 in group B, mean operative time taken was more in group B as compared to group A, though not statistically significant (97 ± 4.46 min, 100 ± 7.27 min; P = 0.621).The mean blood loss, haemoglobin decrease and the Blood Transfusion was significantly lesser in VH group as compare to TAH group (251.13 ± 57.98 ml, 327.33 ± 58.54 ml; P = 0.000). There was no visceral injury in either group, though postoperative fever and wound infection were more in the TAH group than VH group.Conclusions: VH is safe and should be offered as the first surgical choice in women with uterine enlargement due to benign reasons and non-prolapsed uterus where feasible, and should be included in training program for residents and postgraduates trainees. It is definitely a surgical challenge worth the effort