A randomized controlled trial to study the efficacy of intravaginal hormonal ring for control of heavy menstrual bleeding as compared to combined oral contraceptive pills

Background: Heavy menstrual bleeding (HMB) is one of the commonest presenting complaints in reproductive age group. Although combined oral contraceptives (COCs) are commonly used in such patients, combined hormones by intravaginal route has been found acceptable and effective. Aim of the study is to compare the efficacy and side effects of combined intravaginal hormonal ring (IHR) with COCs in control of HMB in these patients.Methods: Hundred women with HMB fulfilling inclusion criteria were randomized into two equal groups and treated with either IHR or COCs for three cycles. Each cycle consisted of three weeks of IHR/COC use followed by 1-week ring-free/non-hormonal pills period. Outcome measures were change in PBAC score (pictorial blood loss assessment chart), hemoglobin rise, side effects and overall patient satisfaction.Results: The percentage reduction in PBAC score, the duration of menses and increase in hemoglobin levels were statistically significant at the end of study in each group. The PBAC score reduction was 87.37% vs 61.52%, menses duration was 4.24±0.74 versus 5.16±1.67, and hemoglobin increase was 3.16 (95% CI:0.142-1.412) and 1.24 (95% CI:1.048-1.640) in the IHR versus COC group. However, the intergroup reduction of mean PBAC score was not statistically significant. Significantly more ring users were satisfied and elected to continue with treatment.Conclusions: Both the IHR and COCs are effective treatments for HMB in reproductive age group. IHR may be an attractive option for HMB due to better compliance and lesser systemic side-effects

Determinant factors affecting the trends of permanent sterilization: a decadal analysis in a tertiary care institute

Background: Permanent sterilization is a preferred method of contraception worldwide. In spite of popularization of temporary methods, it is used by 2/3rd of married women using any contraception. It has a low incidence of complications and failure rate and is cost-effective. Various socio-demographic factors play a role in acceptability of this method. It has an important role in controlling the total fertility rate.Methods: A retrospective record based analysis was done in armed forces personnel undergoing permanent sterilization operation over 11 years between 2005-2015 in a tertiary care institute. Analysis of trends in method choices of surgery, and comparison of the variables determining these choices was done. Year wise total fertility rates was calculated and the trend over 11 years was analyzed.Results: Permanent sterilization operations were performed in 2121 couples over the 11 years period. Of total operations, 1823 (85.95% with 95% confidence interval = 84.42, 87.38) were done in females and 298 (14.05% with 95% confidence interval = 12.62, 15.58) in males. Female sterilization acceptance ranged between 71.6% to 91.6% and male sterilization between 8.4%-28.4% with an increasing trend towards male sterilization acceptance over the years. Total fertility rate declined from 2.3 to 2.09 in 11 years.Conclusions: Increase in literacy rate of both the partners can positively impact the male involvement in permanent sterilization and control of TFR. This would help to stabilize India’s population growth. Also, a decline in son preference can be beneficial for decline in fertility rate.

Pregnancy outcomes after spontaneous conception with previous spontaneous abortion preceding present pregnancy

Background: The objective of the present study was to study pregnancy outcomes in patients with Spontaneous conception with history of previous spontaneous abortion preceding present pregnancy.Methods: A prospective study included patients with spontaneous conception with history of previous spontaneous abortion preceding present pregnancy admitted in the department of obstetrics and gynecology, command hospital, Pune between October 2018 and April 2020. The patients were booked (minimum 3 visits in antenatal outdoor clinic) or admitted for the first time as an emergency. The detailed history about previous abortions was taken and routine as well as investigations for possible etiologies of previous abortions were done. Cases with history of mid-trimester abortion were investigated for cervical incompetence. All the patients were observed for complications during present pregnancy like threatened abortion, preeclampsia, preterm labour, intrauterine death and final outcome.Results: A total of 110 patients with history of previous spontaneous abortion were admitted, all patients were booked. Majority (51.8 %) of patients belong to the age group 25-30 years. All patients were with history of previous one abortion followed by pregnancy with spontaneous conception. The final outcomes were term live birth (86.4%), abortion (8.2%), preterm delivery (5.4%), and no still birth. Caesarian section was done in 32.7% patients for various indications.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss in cases of previous spontaneous abortions. These complications and fetal loss can be reduced by booking the patients and giving due antenatal care

Evaluation of the incidence and outcome of gestational diabetes mellitus using the current international consensus guidelines for diagnosing hyperglycaemia in pregnancy

Background: GDM is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. It may be appropriate to screen pregnant women belonging to high-risk populations during the first trimester of pregnancy in order to detect previously undiagnosed Diabetes Mellitus. Formal systematic testing for Gestational Diabetes is usually done between 24 to 28 weeks of gestation. Even though there are many diagnostic criteria and guidelines for management of GDM, there still exists lack of consensus regarding diagnosis and management of patients with GDM. After HAPO study, IADPSG has formulated a new consensus guideline for diagnosing hyperglycaemia in pregnancy which has formed the back bone for this particular study.Methods: This prospective observational study was carried out for a period of one year from July 2014 to Jun 2015 at AFMC, Pune in Dept. of Obstetrics & Gynaecology. To determine if gestational diabetes is present in pregnant women, a standard OGTT was performed with 75 g glucose. The incidence of GDM in antenatal population visiting AFMC, Pune was calculated. Maternal and neonatal outcome was observed and was compared with those of euglycaemic antenatal population.Results: The incidence of GDM in the antenatal population visiting AFMC, Pune was found to be 12.4%. Family history of Diabetes among first degree relatives is the commonest risk factor associated with GDM. It was found that, with adequate glycaemic control, most of the maternal as well as neonatal complications associated with GDM can be reduced to a level comparable with euglycaemic antenatal population.Conclusions: The new international consensus guideline in diagnosing GDM has shown an incidence of GDM comparable with other criteria for diagnosing GDM. Ensuring an adequate glycaemic control throughout the antenatal period alleviates most of the maternal and neonatal complications associated with GDM

SARS-CoV-2 B.1.617.2 Delta variant replication and immune evasion

Abstract: The B.1.617.2 (Delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in the state of Maharashtra in late 2020 and spread throughout India, outcompeting pre-existing lineages including B.1.617.1 (Kappa) and B.1.1.7 (Alpha)1. In vitro, B.1.617.2 is sixfold less sensitive to serum neutralizing antibodies from recovered individuals, and eightfold less sensitive to vaccine-elicited antibodies, compared with wild-type Wuhan-1 bearing D614G. Serum neutralizing titres against B.1.617.2 were lower in ChAdOx1 vaccinees than in BNT162b2 vaccinees. B.1.617.2 spike pseudotyped viruses exhibited compromised sensitivity to monoclonal antibodies to the receptor-binding domain and the amino-terminal domain. B.1.617.2 demonstrated higher replication efficiency than B.1.1.7 in both airway organoid and human airway epithelial systems, associated with B.1.617.2 spike being in a predominantly cleaved state compared with B.1.1.7 spike. The B.1.617.2 spike protein was able to mediate highly efficient syncytium formation that was less sensitive to inhibition by neutralizing antibody, compared with that of wild-type spike. We also observed that B.1.617.2 had higher replication and spike-mediated entry than B.1.617.1, potentially explaining the B.1.617.2 dominance. In an analysis of more than 130 SARS-CoV-2-infected health care workers across three centres in India during a period of mixed lineage circulation, we observed reduced ChAdOx1 vaccine effectiveness against B.1.617.2 relative to non-B.1.617.2, with the caveat of possible residual confounding. Compromised vaccine efficacy against the highly fit and immune-evasive B.1.617.2 Delta variant warrants continued infection control measures in the post-vaccination era

India Hypertension Control Initiative—Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics

Abstract The India Hypertension Control Initiative (IHCI) is a multi‐partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow‐up visit between July 2019 and September 2019. Among patients returning for follow‐up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow‐up (p < .001). The absolute improvement in BP control was more than two times greater in primary care (48.1 percentage point increase) than secondary care facilities (22.9 percentage point increase). Most IHCI patients received prescriptions according to state‐specific treatment protocols. This study demonstrates that a scalable public health hypertension control program can yield substantial BP control improvements, especially in primary care settings. However, high loss to follow‐up limits population health impact; future efforts should focus on improving systems to increase the likelihood that patients will return to the clinic for routine hypertension care