Thyroid function in women with polycystic ovary syndrome

Background: This study aimed to assess the serum thyroid stimulating hormone (TSH) levels in women with polycystic ovary syndrome (PCOS), and its variation with obesity, insulin resistance and LH:FSH ratio.Methods: This was a facility based cross sectional study conducted for a period of 18 months on a total of 165 females with PCOS diagnosed based on Rotterdam 2003 criteria. A thorough history and clinical and anthropometric examination was conducted for all females. USG abdomen and serum TSH levels and fT4 were also done and the findings were recorded on questionnaire.Results: Subclinical hypothyroidism was documented in 17% females with PCOS. No statistically significant difference in mean values of LH:FSH ratio, insulin resistance, and obesity parameters were noted among euthyroid and subclinical hypothyroid females with PCOS (p>0.05). TSH levels in present study showed a statsitcally significant positive correlation with BMI.Conclusions: The proportions of thyroid disorders are higher in females with PCOS and they both may present with various similar clinical features. BMI in females with PCOS has significant positive correlation with TSH levels. However, it is not clear whether thyroid dysfunction has significant effect on insulin resistance

An unusual case of delivery with central rupture of perineum and intact introitus

Most women experience some degree of tear during childbirth and in some these can be extensive. Obstetrics injuries contribute 0.5-15% of vaginal deliveries. Here authors present a case of 23-year-old primigravida who presented at Safdarjung hospital New Delhi, Delhi, India with complaint of pain in perineum and excessive bleeding per vaginum. On examination, introitus was intact and there was central rupture of perineum which involved anal sphincter proximally and rectal mucosa distally. Patient was shifted to operation theatre for exploration and repair. She received 2 units of blood transfusion, antibiotics and laxatives. Patient was discharged on post-operative day 5 in satisfactory condition. Thus, authors emphasise the need of institutional delivery and prevention of perineal injuries which would further obviate the need for surgical repair and associated morbidity. In present era of easy communication and transport we still receive cases of unsupervised deliveries which gives us a strong motive to spread awareness for antenatal visits and care among this population

Analysis of causes and clinical pattern of infertility in couples coming to a tertiary care centre in Bihar, India

Background: Infertility is one of the major health problems and a socially destabilizing condition for couples often causing marital disharmony. Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Worldwide, its prevalence is approximately 8-12%.There are numerous factors such as anatomical, physiological and genetic factors that cause infertility. Many environmental and acquired factors also lead to inability to conceive. Objective of the present study was to determine the causes and clinical pattern of infertility in infertile couples.Methods: It was a hospital based observational study carried out on 750 women in reproductive age group attending out-patient clinic of Reproductive Biology Department of Indira Gandhi Institute of Medical Sciences (IGIMS) at Patna during April 2013 to March 2017. All the cases of primary and secondary infertility diagnosed after full examinations and laboratory tests were included and cases lacking of full examinations and laboratory tests were excluded. All the data of infertile couples were recorded in a semi-structured Case Information Performa.Results: Out of 750 women 454 women had all the data and they participated in the study Nearly 68% women had primary infertility and rest had secondary infertility. Male factor was responsible in 37.39%, female factor in 20.48%, unexplained in 22.46% while a combination of both factor was seen in 8.37% cases in our study .135 women had irregular menstrual cycles in which 64(47%) had oligomenohhrea. 79% women had normal ultrasonography and nearly 11% of women had evidence of PCOD. 24% women had hypothyroidism (TSH more than 4.5 IU/L) and 59(13%) were found to have high level of prolactin i.e. >25 ng/ml. Nearly 8% of women had high level of FSH i.e. more than 10 IU/L which is an indicator of ovarian resistance. In nearly 16% women one fallopian tube was found blocked and 8% had both tubes blocked in hysterosalpingography. Husband semen analysis was done to assess male factor. Nearly 14% of their male partners suffered from azoospermia and 23% had at least one abnormal parameter in semen analysis.Conclusions: Etiological pattern of infertility varies in different parts of World. Male and female factors both are responsible for infertility. So, both the partners should be counselled and investigated properly

Influencing Factors of Behavior Intention and Actual Use of Technology: An Application of UTAUT Model on Science Undergraduates

This study was conducted by empirically testing a model to predict the factors affecting science undergraduates’ behaviour intentions towards the actual use of technology (digital leaning). This study explored the behavioural intention of use of digital learning from the perspective of students by applying the extended UTAUT model. A cross-sectional study was conducted on science undergraduates. The data was derived from an online survey with 425 respondents and analyzed using a structural equation model. PLS-SEM was used for model and hypothesis testing. The result revealed that performance expectancy, effort expectancy, and social influence are positively associated with behaviour intention and actual use of technology. Facilitating conditions were negatively associated with BIUT (behavior intention and actual use of technology). Our findings correspond with the UTAUT model and provide a practical reference for educational institutions on designing digital learning for further studies

First trimester serum vitamin D, hs-CRP and second trimester uterine artery diastolic notching in predicting gestational hypertension and preeclampsia

Background: Gestational hypertension and preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of this study was to study prediction of gestational hypertension/preeclampsia by using first trimester serum vitamin D and hs-CRP and second trimester uterine artery diastolic notching.Methods: It was an observational study conducted in the departments of obstetrics and gynaecology, clinical biochemistry and radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. All pregnant women with 11 to 14 weeks gestational age attending antenatal clinic between October 2012 and June 2013 were enrolled in the study. A detailed history including history of the duration of sun exposure was taken and a general physical examination including obstetrical examination was done at every visit. Serum sample were taken for hs-CRP and vitamin-D levels at 11-14 weeks. Uterine artery colour doppler study was done between 22-24 weeks for uterine artery diastolic notching. The main outcome measures were development of gestational hypertension/ preeclampsia/ eclampsia.Results: The mean vitamin D levels were significantly lower and mean hs-CRP levels were significantly higher in the hypertensive group as compared to the normotensive group, p=0.001 and p=0.004, respectively. Significant number women who developed hypertension had unilateral (46.2%) or bilateral (20.4%) uterine artery diastolic notching, p=0.005 and p=0.000, respectively. Crude’s odds ratio of uterine artery diastolic notching for prediction of hypertension in pregnancy was high, 9.894, 95% CI, 3.273-29.907 as compared to vitamin D (9.15 mg/L), 2.859, 95% CI, 1.418-5.763 and 7.16, 95% CI, 3.33-15.397.Conclusions: Uterine artery diastolic notching in the early second trimester is found to be the best predictor of PE followed by first trimester hs-CRP and vitamin D

Role of levonorgestrel releasing intra-uterine system in the treatment of menorrhagia due to dysfunctional uterine bleeding and fibroid uterus

Background: This study was carried out to assess the clinical effectiveness of levonorgestrel releasing intrauterine device (LNG-IUS) in the treatment of menorrhagia due to either Dysfunctional Uterine Bleeding (DUB) or fibroid in Indian patients, and to assess patient satisfaction with this treatment modality.  Methods: Sixty women with menorrhagia, 30 due to fibroid and 30 due to DUB, meeting inclusion criteria, received LNG-IUS and were prospectively followed up for 9 months with periodic clinical assessments and transvaginal ultrasounds. Patient satisfaction was assessed on a five-point scale.Results: One patient in DUB group was lost to follow-up. In DUB patients, the treatment failure rate was only 3.4% (1 out of 29 patients). The median PBAC score reduced by 95% at 9 months. Fibroid patients also had an equally impressive 97.7% reduction of PBAC score at 9 months, although the failure rate was higher (23.3%; 7 out of 30). Majority of patients were either ‘very satisfied’ or ‘satisfied’ with the treatment, although this percentage was more in DUB (82.8%) than in the fibroid group (66.7%). Haemoglobin and serum ferritin levels significantly increased in both groups. No major side effect was noted.Conclusions: LNG-IUS is an excellent treatment modality for patients of DUB, with good patient satisfaction. It is also a useful treatment option in non-submucosal small fibroids for the symptoms of menorrhagia, can reduce uterine volume and can help avoid hysterectomy, but there is no effect on fibroid volume. Majority of patients are satisfied, although satisfaction rates are less than in DUB patients

Upright kneeling position during second stage of labor: a pilot study

Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients’ satisfaction.Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction.Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position.Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions

Book of Abstracts & Success Stories National Conference on Marine Debris COMAD 2018

Marine debris has become a global problem with considerable threats to the habitat and to the functions of marine ecosystem. One of the first reports of large areas of plastics in the ocean has been by National Oceanic and Atmospheric Administration (NOAA) in 1988 about the Great Pacific Garbage patch or the Pacific trash vortex, where the density of litter is estimated as four numbers per cubic meter. Globally, this shocking information led to initiation of new research programs on marine litter and in India, the ICAR-CMFRI started an in house research program on this theme in 2007.Understanding the significance of this ecological problem which is purely a direct impact of anthropogenic activity, the Marine Biological Association of India decided to organise a National Conference on Marine Debris (COMAD 2018 ) with an aim to bring together researchers, planners, NGOs, entrepreneurs and local governing bodies working on this theme. Thus, this conference was planned with three main componentsunderstand the research outputs, get first- hand information on the various activities carried out by the public to reduce or recycle non degradable waste generated at various levels and also to have an exhibition of eco-friendly activities and products which would help to reduce marine debris in the long run. The response to all the three themes has been very encouraging. We have received about 50 research articles on themes ranging from micro-plastics to ghost nets and the same number of success stories which are actually details of the diverse activities carried out in different maritime states of the country to solve the issue of solid waste generated in the country. The section on success stories includes attempts by eco-clubs, individuals, schools, colleges, local governing bodies, district administrations, Institutions and NGOs. Activities by some Panchayats like banning plastics in public functions and mechanisms to collect sold waste from households are really commendable. Similarly, the efforts put in by various groups to remove marine debris from the coastal waters is something which should be appreciated. The message from these success stories is that, this problem of increasing marine debris can be resolved. We have got success stories from almost all states and these leaders of clean campaign will be presenting their work in the conference. It is well known that visuals such as photographs and videos are powerful tools of communication. In COMAD 2018, we have provided an opportunity for all across the nation to contribute to this theme through photographs and videos. Am very happy that we have received more than 300 photographs and nearly 25 videos. The MBAI will place these on the web site. It is really shocking to see the quantity of litter in the fishing ground and in the coastal ecosystem

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe