A study comparing non-gestational diabetes mellitus and gestational diabetes mellitus in antenatal patients in a tertiary care center

Background: Gestational diabetes mellitus is defined as any glucose intolerance with the onset or first recognition during pregnancy. Objectives of this study were to diagnose cases of GDM by screening with DIPSI criteria at less than 28 weeks. And observation and comparison of maternal and perinatal outcome in women diagnosed of GDM in less than 20 weeks and at 24-28 weeks.Methods: This was the prospective analytical study conducted in the department of obstetrics and gynecology for one year in Muzaffarnagar medical college and Hospital. After history taking, clinical and obstetrics examination 1503 antenatal patients of less than 28 weeks were enrolled underwent screening with DIPSI criteria. Out of which 80 patients with abnormal OGTT of gestational age less than 20 weeks and 69 patients with abnormal OGTT of gestational age 24 -28 weeks.Results: In early diagnosed GDM group alive and healthy babies were slightly lower as compared with late diagnosed GDM group.Conclusions: The diagnosis of GDM gives us an opportunity in identifying individuals who will be benefitted by early therapeutic intervention with diet, exercise, and normalizing the weight to delay or prevent the onset of the disease

Fast computation of Hankel Transform using orthonormal exponential approximation of complex kernel function

The computation of electromagnetic (EM)fields,for 1-D layered earth model,requires evaluation of Hankel Transform (HT)of the EM kernel function.The digital filtering is the most widely used technique to evaluate HT integrals.However,it has some obvious shortcomings. We present an alternative scheme,based on an orthonormal exponential approximation of the kernel function, for evaluating HT integrals. This approximation of the kernel function was chosen because the analytical solution of HT of an exponential function is readily available in literature.This expansion reduces the integral to a simple algebraic sum.The implementation of such a scheme requires that the weights and the exponents of the exponential function be estimated. The exponents were estimated through a guided search algorithm while the weights were obtained using Marquardt matrix inversion method. The algorithm was tested on analytical HT pairs available in literature. The results are compared with those obtained using the digital filtering technique with Anderson filters.The field curves for four types (A-,K-,H-and Q-type)of 3-layer earth models are generated using the present scheme and compared with the corresponding curves obtained using the Anderson scheme. It is concluded that the present scheme is more accurate than the Anderson scheme

Maternal and perinatal morbidity and mortality in severe pre-eclampsia and eclampsia in a tertiary care hospital: a prospective study

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality worldwide. In India, they account for the third most important cause of maternal mortality. The objective of this study was to evaluate maternal and perinatal outcome and complications in cases with severe pre-eclampsia and eclampsia and measures to prevent them.Methods: A prospective study was carried out on 100 patients with severe pre-eclampsia and eclampsia in tertiary care referral hospital over a period of one year i.e. from November 2017 to October 2018. Only those cases with initial blood pressure reading of ≥160/110mmHg or presenting with eclampsia were in included in the study. Detailed history and examination was carried out. Investigations and management were carried out as per standardized department protocol and maternal and fetal outcomes were analyzed.Results: 48% of women were between 21-25 years age, 82% were from rural area, and 86% cases were unbooked, 68% cases were primigravida. Liver Function Tests were deranged in 18% of the patients and 19% had abnormal Renal Function Tests. Labetalol was the most commonly used antihypertensive. Lower segment cesarean section was the mode of delivery in 59% of the cases. Most common maternal complication was Eclampsia. There were 5 maternal deaths i.e. maternal death rate was 5%. 54.3% of live births needed NICU admission and out of these 50% were preterm deliveries.Conclusions: Accessible healthcare and health education and awareness regarding antenatal checkup for all women will lead to early detection of severe pre-eclampsia. Hence, early treatment and management of patient’s complications will certainly improve the maternal and perinatal outcome

Evaluation of bile acid and deranged liver function test in obstetrics cholestasis in pregnancy in fetal and perinatal outcome

Background: Pregnancy-related intrahepatic cholestasis is most prevalent hepatic disorder intense pruritus that affects the entire body including palm and sole. It is typically detected during second or third trimester. Pruritus frequently exacerbates at night, marked on the palms and soles of the feet and hands. Aim of this study was to evaluate bile acid and deranged liver function test in obstetrics cholestasis in pregnancy and to determine maternal fetal and outcomes. Methods: This prospective case series study was conducted in the Department of Obstetrics and Gynaecology, Muzaffarnagar Medical College. The present study was conducted in 50 women, who were selected from outpatient department of antenatal care from tertiary care, taken written permission before study. The medical records of all women with obstetrics cholestasis who delivered between December 2021and August 2022. Results: Subjects with IHCP  has mean age of 30.11±5.03 year, found SGOT 40% in 100-200  and SGPT 44 % I (0-100) range  and total bilirubin levels   is 33 %  in IHCP patients. In study found that LSCS due to 24% in fetal distress, 36% in MSL, 16% in IUGR, 14% preterm. Participants have 22% birth weight <2.5kg and 39 (78%) are under >2.5kg  babies  in IHCP patients and 24 % were underwent fetal distress and  24 % preterm delivery and 6 % got IUD . and no stillborn and 12% meconium. Conclusions: It causes maternal pruritus with impaired LFT and raised serum bile acids. Maternal morbidity is increased in terms of increased LSCS rates and discomfort due to pruritus

Comparison of metformin and insulin in the treatment of gestational diabetes: a retrospective study

Background: As various data are available on treatment of gestational diabetes mellitus (GDM), our aim is to compare the effect of treatment of metformin, insulin and diet control in GDM on maternal and neonatal outcomes.Methods: A retrospective study was conducted and it includes 50 women of GDM treated with Metformin, 50 women with insulin and 50 with only diet control without any drug.Results: The outcome was not much different in all groups studied. Maternal outcomes were similar in all three groups. The difference was: post prandial glucose values after 2 hour of oral glucose were slightly high in the insulin group than in the metformin group (p <0.003). Neonatal outcome was also not different in all groups. But the incidence of neonatal hypoglycemia was higher in the insulin group (p = 0.03).Conclusions: The study suggests that metformin is effective for GDM and maternal or neonatal outcomes were similar as compared with insulin

Role of LNG-IUS in abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB), is defined as a change in any or a combination of frequency, duration, or amount of bleeding, is a common gynecological complaint that affects 10‑30% of reproductive‑aged women and constitute about one‑third of all outpatient gynecological visits. Mirena is a hormonal intrauterine device classified as a long-acting reversible contraceptive method. Women with heavy menstrual blood loss, the LNG‑IUS can normalize blood flow. This high level of levonorgestrel in the endometrium induces dramatic effects leading to the unique mode of contraceptive and therapeutic action of the LNG‑IUS. Initially developed to decrease the risk of expulsion of the intrauterine contraceptive device by reducing myometrial contractility. Methods: This study was a prospective interventional study conducted in the department of Obstetrics and Gynaecology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, over a period of 6 months. MIRENA insertion was done in outpatient department. The effectiveness of device was assessed by reduction in amount of bleeding in case of abnormal uterine bleeding and in the form of subjective symptomatic improvement along with improvement in quality of life. Record of menstrual pattern. Pictorial Blood loss Assessment Chart was used to assess the amount of blood loss in each cycle. The women were called for follow-up after 1 month, then 3 months, and then 6 months and asked regarding the relief they have obtained from the antecedent menstrual complaints. Hemoglobin (Hb) estimation was done on the subsequent visits. Results: The mean subjective percentage reduction of blood loss reduced from 13.64% at the first visit to 72.16% at 6th month and the mean Hb level in our study before treatment was 6.8 which increased to 9.8 at the end of 6 month. Conclusions: The levonorgestrel-releasing intrauterine system-mirena, provides an incredible nonsurgical alternative in treatment of menorrhagia which is reversible and spares fertility

Blood transfusion practices in obstetrics and gynecology: study of indications as a measure to prevent maternal morbidity and mortality

Background: This is a study of rational use of blood transfusion in a tertiary care center. So, this study was done to find out the indications of blood transfusion in department of obstetrics and gynaecology and measures to minimize the requirement of blood transfusion to reduce maternal mortality and morbidity.Methods: This is a retrospective study in department of obstetrics and gynaecologyin Muzaffarnagar Medical College, Muzaffarnagar, U.P. in collaboration with the department of pathology including blood bank for the duration of 1 year i.e. 1st January, 2017 to 31st December, 2017.  Total transfusions in 1 year were 706 of which 406 were in obstetrics and 300 were in gynecology.Results: In our study maximum 16.20% blood transfusions were given during cesarean section in third trimester in unbooked cases who came with severe anemia in labour. Others were APH (12%) and abortions (13.05%). This shows that anemia is still a major cause of maternal mortality and morbidity in India. In Gynecological cases blood transfusion was more in third parity and above indicating that perimenopausal women were also more susceptible for anemia due to disease of perimenopausal age group like AUB and fibroid.Conclusions: Maximum number of transfusions specially PRBC in obstetrics were of moderate to severe anemia, mainly to the patients who were term or in labor and of high-risk pregnancies, who were unbooked with no antenatal care. In Gynecology cases, blood transfusion was of perimenopausal or menopausal group with moderate anemia. This comes to the conclusion that all preventive measures should be taken in females from womb to tomb to correct anemia and this will indirectly help to prevent maternal and perinatal morbidity and mortality

Effect of phyto additives and Saccharomyces cerevisiae on rumen ferementation and microbial profile in buffaloes

To study the effect of plants containing plant secondary metabolites (PSM) and Saccharomyces cerevisiae on rumen ferementation and microbial profile, four fistulated adult buffaloes were fed in 4×4 Latin square design. The four groups were, control, without additive; T1, mixture of harad seed pulp and garlic bulb (2% of DMI); T2, S. cerevisiae (350g feremented feed containing S. cerevisiae 106 /g); T3, mixture of harad seed pulp, garlic bulb and S. cerevisiae. All the animals were fed on a basal diet consisting of wheat straw and concentrate mixture in 50:50 ratio. Daily DM intake was similar in all the four groups. Feeding of any of the dietary treatments did not affect rumen fluid pH, concentration of ammonia N and lactic acid. The total volatile fatty acids and its fractions except butyrate were also not influenced by supplementation of any of the additives. The activities of ruminal enzymes viz. carboxymethylcellulase, xylanase, avicelase and acetyl esterase were similar in all the four groups. The rumen microbial density of total bacteria, Ruminococcus flavefaciences, R. albus, methanogens and fungi were not changed whereas Fibrobacter succinogenes and protozoa populations were significantly reduced in T1 but were at par of control by inclusion of yeast in the diet. It is concluded that mixture of harad and garlic alone or in combination with yeast culture did not influence rumen fermentation however microbial profile (F. succinogenes and protozoa) was improved by feeding yeast as additive. The additives tested seem to have potential to alter rumen microbial ecology and can further be explored for its efficacy in improving the performance of the animals

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Maternal and perinatal morbidity and mortality in COVID-19 positive obstetrics patients in tertiary care centre

Background: COVID-19 disease had been declared as a public health crisis by WHO by the end of 2019. The effect of SARS-CoV-2 infection on pregnancy including symptoms, disease severity, risk of vertical transmission and perinatal and neonatal outcome have been the subject of research. Preliminary studies showed a fluctuating course of the disease ranging from asymptomatic or mild symptoms to even maternal death. However, recent evidences suggest that effect of COVID-19 infection during pregnancy may not lead to adverse maternal and neonatal outcome.Methods: In this cross sectional prospective observational study, we analysed 60 pregnant women infected with SARS- CoV-2 and their neonatal outcome, who tested positive for COVID-19 at district hospital, and were referred to Muzaffarnagar Medical College, were enrolled in this study.Results: The majority 96.7% (58) of these women were asymptomatic with cough being the most common symptom which was present in 3.3% (2) of the women. 24(75%) women developed pneumonitis radiologically, but they were asymptomatic, so intensive care was not required. Along with 76.08% (35) perinatal/neonatal outcomes were observed normal.Conclusions: In this study we observed that most of the women with COVID-19 were asymptomatic or with mild symptoms. Even though they were asymptomatic, most of the patients showed pneumonitis changes radiologically but still they didn’t require any intensive care, had good recovery postpartum and were discharged under satisfactory condition. The neonatal outcome was highly favourable