Knowledge, attitude and practices about contraception among married reproductive women

Background: Total unmet need for contraception at national level has been 20.5% (DLHS 3, 2007-08).  According to NFHS 4 (2015-16), total unmet need for family planning for Bangalore Urban is 13.3%. This study has been done to assess the knowledge, attitude and practices about contraception among married women in the reproductive age group.Methods: Cross sectional study conducted from 1st March 2017 to 15th April 2017 in Bowring and Lady Curzon Hospital, Bangalore.  Married women in age group of 15 to 45 years, antenatal women were included.  Unmarried women, Hysterectomised women were excluded.Results: 72% of the clients had awareness of contraception.  Most common method known is Female sterilization followed by IUCD.  Awareness of emergency contraception was found only in 5.33%.  48% of the clients did not follow any method of contraception.  Most commonly used method is female sterilization.Conclusions: The study shows that we need to use multiple resources to educate people by intensifying IEC activities.  Women should be made aware about their right of protecting their own health and more emphasize should be given on postpartum family planning.

Clinical course of ectopic pregnancy:a tertiary centre experience

Background: Ectopic pregnancy (EP) is one of the causes of maternal mortality and morbidity in the first trimester. EP is still a major challenge and its incidence is on the rise due to changes in lifestyle and advances in medical practice. The early diagnosis and treatment of this condition over the past two decades has allowed a definitive medical management of unruptured ectopic pregnancies even before there were clinical symptoms in these high-risk women.Methods: It was a retrospective study of 100 cases of EP conducted in the Department of Obstetrics and Gynecology, Bowring and Lady Curzon Hospital, attached to Bangalore medical college, Bengaluru for a period of 3 years. The aim of the study was to study the incidence, risk factors, clinical profile and management of EP cases.Results: Incidence of EP was 1.3% of all deliveries and 5.6% of gynecological surgeries. Peak age group was between 25-30 years (37%). Most of them were multiparous (83%), 58% of the patients had identifiable risk factors. 95% had amenorrhea, followed by pain abdomen in 81%, bleeding PV in 43%. 17% presented with shock. 91% patients presented with ruptured ectopic, 9% were unruptured. Unruptured cases were treated medically using Methotrexate. Laparotomy was done for ruptured cases. Commonest site of Ectopic was ampulla (81%). Salpingectomy was done for most cases (86%). No maternal mortality observed.Conclusions: All high-risk women should be screened at the earliest with serum β-hCG and TVS. The impact on future fertility can be improved by focusing on primary prevention and early diagnosis before rupture

Acute pain abdomen in adolescents: a gynecologist’s dilemma

Background: Ovarian torsion is 5th most common emergency in gynecology. Benign functional ovarian cysts and benign teratomas are most common among ovarian torsion. Aims and objectives were to study the outcome and HPE of all adolescent girls presenting with acute pain abdomen at BGS GIMS, Bangalore. Methods: A study was conducted at BGS GIMS from 2020 to 2022 of all children and adolescents presenting with acute pain abdomen. Study included data consisting of age, complaints, investigations, intervention and HPE was collected and analysed. Results: There were 21 cases between 12- and 21-years age group who presented with acute pain abdomen in the study period. Majority of them were of 16-19 years age group. Out of 21 cases, 100% of them presented with acute pain abdomen. Operative procedures included 15 (71%) exploratory laparotomy and 6 (29%) operative laparoscopies. Ovarian torsion was seen in 11 cases of which 2 cases had bilateral ovarian torsion and 9 cases had unilateral torsion. Ovarian cystectomy was done in 7 patients, unilateral oophorectomy in 3 patients and unilateral salpingo-oophorectomy in 6 patients. Histopathology reports showed 5 cases of serous cystadenoma, 1 case of teratoma and others were mostly simple cyst or corpus luteal cysts. Conclusions: Acute pain abdomen in adoloscents should be diagnosed early to prevent from risk of ovarian torsions. Operative procedures should aim at fertility preservation.

A study on the clinical, biochemical and hormonal profile of polycystic ovary syndrome patients attending tertiary care hospital

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorder of reproductive age affecting 5% to 10% of women worldwide. It is a heterogenous, multifactorial, complex genetic disorder. PCOS receives a considerable attention because of its high prevalence and metabolic, reproductive and cardiovascular consequences.Methods: A cross sectional observation study of 100 PCOS patients was carried out between January 2014 to July 2015 in Gynaecology out-patient and Infertility OPD, Justice K. S. Hegde charitable hospital, Mangalore. The clinical, biochemical and hormonal profile of these patients were analysed and correlation was done between clinical features and biochemical and hormonal profile.Results: The prevalence of PCOS was 6.3% in the Gynaecology out-patient visits and 37.14% among infertile women. Menstrual irregularity was the most common complaint accounting for 31% followed by infertility (23%). Elevated leutinizing hormone and elevated LH: FSH was significant in irregular menstrual group. The prevalence of metabolic syndrome in our study was 21.3%. Spearmans correlation between various clinical and laboratory parameters showed menstrual cycle and body mass index(BMI) had a fair positive correlation and was significant. WHR (waist hip ratio) showed 21 times risk for metabolic syndrome.Conclusions: The study showed that most of our polycystic ovary syndrome subjects were hirsute, with central obesity and overweight or obese. Oligomenorrhea was the most common presentation. Among the various risk factors studied, WHR (waist hip ratio) showed 21 times risk for metabolic syndrome. Obese women with PCOS had more severe ovulatory dysfunction and need more attention for their appropriate management

Spontaneous heterotopic pregnancy with tubal rupture

Heterotopic pregnancy is the coexistence of intrauterine pregnancy (IUP) and extrauterine gestation. It is a rare and dangerous life-threatening condition that is difficult to diagnose and easily missed. The incidence in the general population is estimated to be 1 in 30,000. We report a case of a 24-year-old multigravida who was seen in the emergency department with a diagnosis of a ruptured ectopic pregnancy. A careful ultrasound assessment led to the diagnosis of a heterotopic pregnancy despite lack of any notable risk factors. Immediate surgical intervention with supportive measures resulted in a successful outcome. An obstetrician should keep in mind the occurrence of a heterotopic pregnancy while dealing with pregnant females. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality

A combined computational-experimental approach to define the structural origin of antibody recognition of sialyl-Tn, a tumor-associated carbohydrate antigen.

Anti-carbohydrate monoclonal antibodies (mAbs) hold great promise as cancer therapeutics and diagnostics. However, their specificity can be mixed, and detailed characterization is problematic, because antibody-glycan complexes are challenging to crystallize. Here, we developed a generalizable approach employing high-throughput techniques for characterizing the structure and specificity of such mAbs, and applied it to the mAb TKH2 developed against the tumor-associated carbohydrate antigen sialyl-Tn (STn). The mAb specificity was defined by apparent KD values determined by quantitative glycan microarray screening. Key residues in the antibody combining site were identified by site-directed mutagenesis, and the glycan-antigen contact surface was defined using saturation transfer difference NMR (STD-NMR). These features were then employed as metrics for selecting the optimal 3D-model of the antibody-glycan complex, out of thousands plausible options generated by automated docking and molecular dynamics simulation. STn-specificity was further validated by computationally screening of the selected antibody 3D-model against the human sialyl-Tn-glycome. This computational-experimental approach would allow rational design of potent antibodies targeting carbohydrates

Eliminating Monitor Overuse (EMO) Type III Effectiveness-Deimplementation Cluster-Randomized Trial: Statistical Analysis Plan

Background: Deimplementing overused health interventions is essential to maximizing quality and value while minimizing harm, waste, and inefficiencies. Three national guidelines discourage continuous pulse oximetry (SpO2) monitoring in children who are not receiving supplemental oxygen, but the guideline-discordant practice remains prevalent, making it a prime target for deimplementation. This paper details the statistical analysis plan for the Eliminating Monitor Overuse (EMO) SpO2 trial, which compares the effect of two competing deimplementation strategies (unlearning only vs. unlearning plus substitution) on the sustainment of deimplementation of SpO2 monitoring in children with bronchiolitis who are in room air. Methods: The EMO Trial is a hybrid type 3 effectiveness-deimplementation trial with a longitudinal cluster-randomized design, conducted in Pediatric Research in Inpatient Settings Network hospitals. The primary outcome is deimplementation sustainment, analyzed as a longitudinal difference-in-differences comparison between study arms. This analysis will use generalized hierarchical mixed-effects models for longitudinal clustering outcomes. Secondary outcomes include the length of hospital stay and oxygen supplementation duration, modeled using linear mixed-effects regressions. Using the well-established counterfactual approach, we will also perform a mediation analysis of hospital-level mechanistic measures on the association between the deimplementation strategy and the sustainment outcome. Discussion: We anticipate that the EMO Trial will advance the science of deimplementation by providing new insights into the processes, mechanisms, and likelihood of sustained practice change using rigorously designed deimplementation strategies. This pre-specified statistical analysis plan will mitigate reporting bias and support data-driven approaches

Knowledge, attitude and practices about contraception among married reproductive women

Background: Total unmet need for contraception at national level has been 20.5% (DLHS 3, 2007-08).  According to NFHS 4 (2015-16), total unmet need for family planning for Bangalore Urban is 13.3%. This study has been done to assess the knowledge, attitude and practices about contraception among married women in the reproductive age group.Methods: Cross sectional study conducted from 1st March 2017 to 15th April 2017 in Bowring and Lady Curzon Hospital, Bangalore.  Married women in age group of 15 to 45 years, antenatal women were included.  Unmarried women, Hysterectomised women were excluded.Results: 72% of the clients had awareness of contraception.  Most common method known is Female sterilization followed by IUCD.  Awareness of emergency contraception was found only in 5.33%.  48% of the clients did not follow any method of contraception.  Most commonly used method is female sterilization.Conclusions: The study shows that we need to use multiple resources to educate people by intensifying IEC activities.  Women should be made aware about their right of protecting their own health and more emphasize should be given on postpartum family planning.

A faster parathyroidectomy: Techniques to shorten non-surgical operating room time

OBJECTIVE: To assess the capacity of different techniques to reduce non-operative times during parathyroid surgery. The impact of monitored anesthesia care (MAC) instead of general anesthesia, and the pre-operative placement of a second peripheral intravenous catheter (PIV) were analyzed. METHODS: A retrospective case series at an academic medical center was performed to study patients undergoing parathyroidectomy by a single surgeon between November 2013 and October 2016. Three operating room (OR) time measurements were compared: pre-incision time, post-closure time, and total OR time. RESULTS: Surgeries performed under MAC (n = 21) had statistically shorter pre-incision (33.2 min vs. 39.7 min, p \u3c .001), post-closure (10.1 min vs. 16.2 min, p = .002), and total operative times (113.0 min vs. 151.5 min, p \u3c .001) compared to those in which general anesthesia (n = 169) was used. Of the 169 patients who underwent general anesthesia, 25 had a second PIV placed preoperatively and 144 had only a single PIV. All 3 time periods were statistically shorter in patients who had a second PIV versus those who had only a single PIV (pre-incision 32.2 min vs. 41.0 min, p \u3c .001; post-closure 12.2 min vs. 16.9 min, p \u3c .001; total 117.9 min vs. 157.4 min, p \u3c .001). CONCLUSIONS: In patients undergoing parathyroid surgery in which ioPTH levels will be used, the placement of a second PIV in the pre-operative holding area and performance of surgery under MAC can significantly shorten non-operative and total OR time