Study of perinatal outcomes in normal and borderline oligamnios

Background: Oligamnios is a common cause of perinatal mortality and morbidity, but the outcome of borderline oligamnios, defined as Amniotic Fluid Index (AFI) between 5 and 8, is less clear. This study aims to find out the effect of borderline oligamnios on perinatal outcomes in pregnancies beyond 37 weeks.Methods: An observational prospective study of 131 antenatal mothers with AFI between 5 and 8, after 37 weeks of gestation was conducted in Sree Gokulam Medical College and Research Foundation from October 2017 to September 2019. These observations were compared with that of 131 antenatal mothers with normal AFI beyond 37 weeks of gestation. The observations according to fetal heart rate abnormalities, meconium staining of amniotic fluid, mode of delivery, low birth weight babies, APGAR score, the need of neonatal intensive care unit (NICU) admissions due to neonatal complications were statistically analysed.Results: Both groups were comparable with respect to age, parity and gestational age. In those with borderline oligamnios, fetal heart rate abnormality was seen in 21% (28), meconium stained amniotic fluid in 18% (23), 70% (91) delivered vaginally and 30% (40) underwent caesarean section, 31% (41) babies weighed below 2.5 kg and 21% (27) neonates needed NICU admissions. In those with normal AFI, none showed fetal heart rate abnormality, 2% (3) showed meconium staining, 93% (122) delivered vaginally and 7% (9) underwent caesarean section, 11% (14) babies weighed below 2.5 kg and 3% (4) neonates needed NICU admissions.Conclusions: Borderline oligamnios is associated with poor perinatal outcome. AFI can be used as an adjunct to other fetal surveillance methods. It helps to identify those infants at risk of poor perinatal outcome

Medication abortion in missed abortion up to 13 weeks amenorrhoea: a prospective study

Background: Missed abortion is a type of abortion in which the dead fetus is retained within the uterus. The objective of the study was to find out whether the use of medication abortion is safe and effective in termination of missed abortion up to 13 weeks of pregnancy.Methods: This study was conducted in a tertiary care center as a prospective study, for a period of 24 months from April 2013 to March 2014. Sample size consisted of 150 cases of missed abortion up to 13 weeks of pregnancy which was confirmed by ultrasound. These patients were given medication abortion and was followed up for complications viz., pain, excessive bleeding, need for surgical evacuation, rupture uterus, infection and coagulopathy.Results: In the present study, 16 % required surgical evacuation. The common complications were pain (8%), nausea and vomiting (4.7%), low grade fever (3.3%), excessive bleeding (6%). There were no cases of rupture uterus or coagulopathy, or infections.Conclusions: Medication abortion is a safe and effective method for the termination of missed abortion up to 13 weeks of pregnancy with fewer complications thus reducing the need for surgical methods

Retrospective analysis of elective hysterectomy cases in a tertiary care centre

Background: Often hysterectomy remains the only option available in many gynaecological conditions, though it is resented by most women. This study aims to analyse the cases of hysterectomy performed in a tertiary care centre in India, with a view to modify and improve health care provided to women.Methods: A retrospective analysis of 500 cases of elective hysterectomy in Sree Gokulam Medical College and Research Foundation from January 2016 to December 2017 was done from hospital records. The observations according to age, indications of hysterectomy, route of hysterectomy and preservation of ovaries were statistically analysed.Results: 35.2% (176 cases) were between 45 and 50 years. Mean age was 48±2 years. 90.4% (452 cases) were done in women above 40 years of age. The commonest indication for hysterectomy was symptomatic fibroid uterus 59.4% (297 cases). 81.8% (409 cases) women underwent abdominal hysterectomy while 18.2 % (91 cases) women underwent vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy. 84.6% (77 of 91 cases) of vaginal hysterectomy was done for prolapse uterus. Preservation of one or both ovaries was done in 47.2% (236 cases).Conclusions: Hysterectomy is usually done after the age of 40 years with the mean age being 48±2 years. Symptomatic fibroid uterus was the most common indication. The rates of vaginal hysterectomy were lower for indications other than prolapse uterus. Ovaries were preserved in several cases

ORIGINAL ARTICLE: Identification of Practical Pharmacology Skills Useful for Good Clinical Practice

Background: Awareness about animal ethics is increasing everywhere. This increased awareness coupled with strict regulations discouraging the use of animals for routine experiments have tied the hands of many pharmacologists. They are now forced to develop alternative experiments without using animals. At present, there is acute need to come out with more innovative and useful practical exercises for pharmacology practical sessions. In this background, the present study was undertaken to develop the much-needed alternative experiments. Aims and Objective: To identify new pharmacological practical skills useful for good clinical practice. Material and Methods: A pre-tested questionnaire was administered to 110 doctors of different categories like house surgeons, postgraduate students, assistant professors and professors who are working in a tertiary care hospital. They were asked to give their suggestions regarding new pharmacology practical skills useful for good clinical practice. Statistical analysis: Responses of the participants to the questions asked were tabulated and analyzed. Suggestions given by them were listed out and studied. Results: Use of emergency drugs, dosage calculation, drugs used in pregnancy, case discussions and prescription writing exercises received a lot of support from the participants. Research methodology, cost calculation, animal experiments and interpretation of data of animal experiments did not receive support from the participants. Suggestions given by the participants regarding useful pharmacological skills belonged to the areas like therapeutics, safe use of drugs, recent advances, analysis of information given by the medical representatives and analyzing articles in journals for knowing the efficacy of drugs. Conclusion: Exercises relevant to the clinical practice, as identified in this study, can be introduced as practical pharmacology exercises. Steps are to be taken to highlight the importance of research methodology and pharmaco-economics to the undergraduates

A descriptive study of the prevalence of hypothyroidism among antenatal women and foetal outcome in treated hypothyroid women

Background:The objective of the study was to find out the prevalence of hypothyroidism among pregnant women and to study the foetal outcome in antenatal mothers in whom treatment was initiated early in pregnancy.Methods:This was a descriptive study conducted in the department of OBG Sree Gokulam Medical College, Venjaramoodu, Trivandrum from April 2013 to Oct 2014. 500 antenatal women coming for routine antenatal check up in the first trimester to antenatal OP were screened for hypothyroidism.TSH(thyroid stimulating hormone) was done in the first trimester and the prevalence of hypothyroidism was estimated. Patients were diagnosed as having subclinical or overt hypothyroidism based on the FT3 (free T3) and FT4 (free T4) results. Patients detected with hypothyroidism –both subclinical and overt were started on appropriate dose of L-thyroxin depending on her gestational age, body weight and level of TSH. Every 6weeks TSH levels were estimated and the dose of the drug adjusted. All these patients were followed up for their foetal outcome such as intrauterine demise, hyperbilirubinemia, prematurity, stillbirths and neonatal hypothyroidism.Results: In the present study, the prevalence of hypothyroidism was 5.6% of which 4% were having subclinical and 1.6% was having overt hypothyroidism. No significant difference in foetal complications, perinatal mortality and morbidity was noted between hypothyroid and euthyroid women.Conclusions:TSH testing should be included in routine antenatal investigations for early detection of subclinical and overt hypothyroidism among antenatal women and early treatment should be initiated so as to prevent complications.1.       Akhter SN, Tarannum R, Kabir MS. Pregnancy in overt and subclinical hypothyroidism and its fetomaternal outcome. Med Today. 2014;25(2). 2.       Sahu MT, Das V, Mittal S, Aggarwal A, Sahu M. overt and subclinical hypothyroid dysfunction among Indian pregnant women and its effect on maternal and foetal outcome. Arch Gynecol Obstet. 2010;281(2):215-20.3.       Ajmani SN, Aggarwal D, Bhatia P, Sharma M, Sarabhai V, Paul M. Prevalence of overt and subclinical thyroid dysfunction among pregnant women and its effect on maternal and foetal outcome. J Obstet Gynecol India. 2014;64(2):105-10.4.       Nirmala CV. Maternal outcome of hypothyroidism in pregnancy- a south Indian perspective. Am J Clin Med Res. 2014;2(2):47-50.5.       Goel P, Radotra A, Devi K, Malhotra S, Aggarwal A, Huria A. Maternal and perinatal outcome in pregnancy with hypothyroidism. Indian J Med Sci. 2005;59 (3):116-7.6.       Cleary-Goldman J, Malone FD, Lambert-Messerlain G, Sullivan L, Canick J, Porter TF, et al. Maternal thyroid hypo function and pregnancy outcome. Obstet Gynecol. 2008;112(1):85-92.7.       Casey BM, Dashe JS, Wells CE, McIntre DD, Byrd W, Leveno KJ, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005;105(2):239-45.8.       Allan WC, Haddow JE, Palomaki GE, Williams J R, Mitchell ML, Hermos RJ, et al. Maternal thyroid deficiency and pregnancy complications implications for population screening. J Med Screen. 2000;7(3):127-30.9.       Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid Off J Am Thyroid Association. 2011;21(10):1081-125.10.    Cite this article as: Prasad DR, Nair NV, Deepika K.A descriptive study of the prevalence of hypothyroidism among antenatal women and foetal outcome in treated hypothyroid women.Int J Reprod Contracept Obstet Gynecol 2016;5:1892-6. Basnet P, Aggarwal N, Suri V, Dutta P, Mukhopadhyay K. Comparison of Maternal and perinatal outcome in pregnant women with hypothyroidism diagnosed before conception with hypothyroidism diagnosed during pregnancy Univers Coll Med Sci. 2014;2(2)

A comparative study to assess the efficacy of dinoprostone and misoprostol in labour induction

Background: Induction of labour is the non-spontaneous initiation of uterine contractions, prior to their spontaneous onset leading to progressive effacement and dilation of cervix and delivery of the baby. The objective of this study to compare efficacy of induction of labour with dinoprostone and misoprostol with respect to induction delivery interval, oxytocin augmentation, type of delivery and cost effectiveness.Methods: 200 Patients admitted to labour ward of Sree Gokulam Medical College and Research Foundation, Vejaramoodu, Kerala, India with an indication of induction of labour and unfavorable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone between December 2012 and May 2014.Results: Average induction to delivery interval among misoprostol group was 21.6+4.2 hours and that of dinoprostone was 29.1+4.2 hours. Dinoprostone group had significant longer duration than misoprostol group in induction delivery interval.64% of misoprostol group had spontaneous onset of labour whereas only 31% of dinoprostone group had spontaneous labour onset. Mean bishop’s score change over 6 and 12 hours was significantly greater in the misoprostol group. There was no significant difference in the mode of delivery or rate of caesarean section in both the groups.Conclusions: Misoprostol is an effective and economical drug for induction of labour, which is easy to preserve and administer. It shortness the induction delivery interval with less need for oxytocin compared to dinoprostone

Comparative study to assess the safety of misoprostol and dinoprostone for cervical ripening and induction of labour

Background: To compare safety of induction of labour with dinoprostone and misoprostol with respect to maternal complications like fever, diarrhoea, vomiting, hyperstimulation, tachysystole; and Neonatal outcomes like APGAR score of baby, meconium aspiration, birth asphyxia, hyperbilirubinemia and NICU admission.Methods: 200 Patients admitted to labour ward of Sree Gokulam Medical College and Research Foundation with an indication of induction of labour and unfavourable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone between December 2012 and May 2014.Results: There was no significant difference in maternal or neonatal complications between the two groups. Apgar at 1 minute was significantly higher for Misoprostol group while at 5 minutes Apgar was comparable between the two groups.Conclusions: Misoprostol is as safe as dinoprostone for the induction of labour

GENETIC INVOLVEMENT OF INTERLEUKIN 4 FOR ASTHMA AND IDENTIFICATION OF POTENTIAL PHYTOCHEMICAL SCAFFOLD THROUGH MOLECULAR DOCKING STUDIES

Objective: Interleukin 4, an important cytokine, has the major role in the immunomodulatory responses associated with asthma. The present study focused on the involvement of single nucleotide polymorphism variation (SNP) of interleukin 4 (IL4) in the development of disease, asthma and designing small molecules for the inhibition of IL4 through in silico strategy.Methods: Identification of disease causing SNP will be a wise approach towards the phenotype specific treatment. A human origin deleterious no synonymous SNP of IL4 were found out in the chromosome region 5q31-q33 (rs199929962) (T/C). Proteins of the corresponding nucleotide variation were identified and were subjected to characterization studies for selecting the most appropriate one for further mutational analysis and molecular docking studies.Results: Influence of microbes on SNP variation of IL4 gene leading to asthma was found to be insignificant by metagenomic studies. Gene responsive drugs were identified through environmental factor analysis. The drug candidates including corticosteroids were subjected to protein interaction studies by in silico means. The pharmacophoric feature derived from drug receptor interaction was utilized for virtual screening on a dataset of anti-inflammatory phytomolecules. The scaffolds of ellagic acid and quercetin were identified as potential nonsteroidal entities which can shield the asthmatic activities.Conclusion: Developing small molecules using these scaffolds taking interleukin 4 as a target will be an adequate solution for steroid resistant asthma

Equation of state and high-pressure phase transitions in Mg2GeO4 olivine

Germanates are often used as structural analogs of planetary silicates. We have explored the high-pressure phase relations in Mg2GeO4 using diamond anvil cell experiments combined with synchrotron x-ray diffraction and computations based on density functional theory. Upon room temperature compression, forsterite remains stable up to 30 GPa. At higher pressures, a phase transition to a CmC21 structure was observed, which remained stable to the peak pressure of 105 GPa. Using a 3rd order Birch Murnaghan fit to the experimental data, we obtained V0 = 305.1 (3) A3, K0 = 124.6 (14) GPa and K' = 3.86 (fixed) for forsterite and V0 = 263.5 (15) A3, K0 = 175 (7) GPa and K' = 4.2 (fixed) for the CmC21 phase. In three separate runs, the forsterite sample was compressed to 26 GPa, 54 GPa and 105 GPa respectively and then laser-heated to ~2500 K. On laser heating, a mixture of perovskite MgGeO3 + MgO was found to be stable at the lower pressure conditions, whereas post-perovskite + MgO was observed at the highest pressure