Role of diagnostic laparoscopy in chronic pelvic pain

Background: Laparoscopy in chronic pelvic pain can reveal findings that cannot be detected clinically, so it can be treated and diagnosed at same sitting. This study was undertaken to evaluate role of diagnostic laparoscopy in chronic pelvic pain.Methods: It was a prospective study conducted at department of Obstetrics and Gynecology, ESI PGIMSR, Basaidarapur, New Delhi. The study was carried out from 2012- 2014. Total 110 cases were enrolled. 55 cases who had been suffering from chronic pelvic pain for ≥6 months were taken as study group (A). 55 cases without any symptoms that underwent laparoscopic sterilization were taken as control group (B). Results were statistically analyzed using Karl Pearson's correlation coefficient.Results: Chronic pelvic pain whereas on laparoscopy normal finding were seen only in 25.45% cases. This difference was found to be statistically significance (P value 0.04). Normal findings were seen in 60% cases of chronic pelvic pain on USG as compared to 25.14% cases on laparoscopy was statistically significant .( p value <0.05.)Conclusions: Laparoscopy is a gold standard tool in evaluation of women with chronic pelvic pain, because diagnosis and often treatment can be accomplished in one sitting, without subjecting them to exploratory laparotomy

Option Pricing: A Theoretical as well as Practical View

This particular study has been undertaken to form a basis of comparison in the 2 main pricing techniques for options, the Black Scholes model and the Binomial Lattice model. The Black Scholes has been the fundamental model for option pricing but has certain limitations. These limitations of the model have been provided for in the Binomial Tree model. Due to this, the Binomial Tree model is used for valuing American options taking real time market data for a stock option that trades on NASDAQ under the Chicago Board Options Exchange which is then compared to the actual price of the option for that given data. This is done with a view to develop a program that has the ability to calculate the price of an option using real time data as close to the actual market price of the option. Before comparing the pricing models for options and getting started with the computer programming part of it, it is important to understand options in theory. The research starts with defining options and talking about their various types and features and goes further ahead to examining the pricing models. Volatility is discussed in greater detail and its effect on option prices are observed by varying it in the binomial tree program. The program gives results that fortunately do not differ from the actual option prices too much. So the objective is achieved. Like any other model, this one too has limitations which are also looked into in this dissertation. The literature, methodology, testing and analysis are all done from the point of view of Computational Finance combined

Binomial Tree Model for Option Pricing: A Theoretical as well as Practical View

This particular study has been undertaken to implement the Binomial Option Pricing technique using computational software. This has been done with a view to price European as well as American options. Even though most of the option prices are given and available to the users, having a model to price them can prove as a useful tool for analysis and subsequent hedging. The Binomial Tree model has been chosen for valuing American options taking real time market data for stock options that trade on NASDAQ under the Chicago Board Options Exchange. Implied volatility has been used to compute option prices from the program to match their actual market value. This is done with a view to develop a program that has the ability to calculate the price of an option using real time data as close to the actual market price of the option.Volatility is discussed in greater detail and its effect on option prices are observed by varying it in the binomial tree program

A clinical study of postdated pregnancy

Background: Objective of the study was to find out the incidence of maternal complications, perinatal mortality and morbidity in postdated pregnancies. Design of the study was prospective observational study.Methods: Patients who have completed 40 weeks of gestational age, patients who were sure of the date of last menstrual period (LMP) along with 1st trimester obstetrics scan were included. Patients not sure of LMP were excluded.Results: There is high fetal and maternal risk associated with postdated pregnancy. Total 100 cases were selected from antenatal clinic and Labour Room and were divided into two groups. Study group and control group, 50 cases in each. Induction rate is more in postdated pregnancies. Incidence of operative deliveries is 54% in study group. Postpartum haemorrhage and septicaemia are the most common maternal complication in the study group. Perinatal mortality is higher and more NICU admissions were required.Conclusions: Considering this, policy of early intervention should be undertaken in postdated pregnancy to avoid maternal and perinatal complications

Conventional stimulation protocol failed to produce mature oocytes : rescue ivm resulted in six pregnancies after invitro fertilization and embryo transfer

When conventional stimulation protocol in IVF cycle fails to produce mature oocytes, many a times, the cycle is cancelled and the patient is disappointed.  Now that in-vitro maturation of oocyte is possible in view of commercial availability of media, perhaps it may be mandatory to retrieve immature oocytes and mature them in-vitro, freeze them if necessary and fertilize, develop embryos for transfer in order to help couples to achieve pregnancy.  Thus maturation in-vitro of GVs has become an important adjuvant for treating PCOS and in particular poor responders to gonadotrophin stimulation.  Our study is interesting because in spite of conventional stimulation protocol, we failed to recover any mature oocytes in eleven women when the average follicles size being 17mm at the time of hCG.  However, maturing these oocytes in-vitro, as a rescue measure, resulted in 50% of these women becoming pregnant after embryo transfer

Meaningful teaching of mathematics

It is always a good idea to use more than one method to draw/represent concepts so that the teacher can be reasonably sure that the learner has understood and is comfortable with the concept

Ultrasonographic evaluation of first trimester bleeding per vaginum

Background: First trimester is a very crucial period of pregnancy having high risks of pregnancy losses. The objective of this study was to assess the accuracy of ultrasound in diagnosis of cause of first trimester bleeding per vaginum.Methods: 200 women who attended the out-patient department with the complaint of bleeding per vagina in the first trimester pregnancy were taken for the study. Clinical assessment by pelvic examination was done and a provisional diagnosis was made. All necessary routine investigations were done followed by ultrasonographic scan of each patient. All the data was recorded in a proforma.Results: Among these 200 cases, threatened abortion in 72 cases. It was the commonest cause for bleeding. There were 20 cases of ectopic pregnancy out of which 16 were correctly diagnosed. There were 16 cases of missed abortion. There were 8 cases of hydatidi form mole. There were 40 cases of incomplete abortion, 16 cases of inevitable abortion, 8 cases of an embryonic gestation and 20 cases of complete abortion. By this study it is concluded that the accuracy of USG in diagnosing the cause of first trimester bleeding per vaginum is 96%.Conclusions: Use of USG in diagnosis of cause of bleeding in first trimester can lead to accurate and early diagnosis and save the patients from unneeded interventions based on history and clinical examination

A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

BACKGROUND: Palliative care (PC) has been shown to be beneficial in end stage liver disease (ESLD), yet the hospitalization data for PC utilization is unknown. AIM: To identify the trend of PC utilization for the special population of alcohol-associated ESLD patients, factors affecting its use and ascertain its impact on healthcare utilization. METHODS: We analyzed around 78 million discharges from the 2007-2014 national inpatient sample and 2010-2014 national readmission database including adult patients admitted for decompensated alcohol-associated cirrhosis. We identified patients with PC consultation as a secondary diagnosis. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS: Out of the total 1421849 hospitalizations for decompensated liver cirrhosis, 62782 (4.4%) hospitalizations had a PC consult, which increased from 0.8% (1258) of all alcohol-associated ESLD hospitalizations in 2007 to 6.6% in 2014 ( CONCLUSION: Inpatient PC is sparingly used for patients with decompensated alcohol related liver disease, however it has increased over the past decade. PC consultation is associated with lower 30-d readmission rates on multivariate analysis, and lower hospitalization cost and length of stay in patients with ACLF score ≥ 2

The systematic development of a mobile phone–delivered brief intervention for hazardous drinking in India

Background: The treatment gap for alcohol use disorders (AUD) in India is the highest among all mental health and substance use disorders. Despite evidence of the cost effectiveness of brief interventions (BIs) for hazardous drinking, implementation in low- and middle-income countries (LMICs) is rare due to several human resource–related barriers. This paper describes the processes and outputs of a study aimed at systematically developing a mobile phone–delivered BI to overcome such barriers. Methods: This is a mixed methods study with four steps: (1) Review of existing relevant evidence base by extracting data from studies cited in two recent, relevant and high-quality systematic reviews; (2) In-depth interviews (IDIs) with 11 national experts in addictions research and practice, and 22 hazardous drinkers; (3) Delphi survey (2 rounds) to identify components for the intervention package through consensus building; and (4) Content and intervention development workshops with a range of stakeholders to develop the intervention package. Results: The research team sourced 72 journal articles from two selected systematic reviews. Key content areas extracted from the studies included facts and statistics about health related to drinking behavior, self-reflection, goal-setting messages, motivational messages, and skills to manage risky situations. The IDIs with experts and hazardous drinkers endorsed most of these content areas as well. The Delphi survey achieved consensus on 19 content areas, which included targeted recommendations, personalized feedback and information, goal management, and coping skills. The content and intervention development workshops resulted in an intervention package delivered over 8 weeks, with the following seven themes guiding the content of the weekly messages: safe drinking/health education, alcohol reduction, drinking and risk management, drinking alternatives, situational content, urge management, and maintenance and relapse prevention. Conclusion: The research team designed this study to consider contextual factors while developing the intervention, which is important to ensure acceptability and feasibility of the intervention. Interestingly, the contextually informed intervention components had several commonalities with BIs developed and tested in high-income countries.</p

Coping Strategies and Help-Seeking Behaviors among Survivors of Intimate Partner Violence: A Qualitative Study of Spouses of Men with Heavy Drinking in India

Background. Despite the high prevalence of intimate partner violence (IPV) against women in India (33%), there are persistently low rates of disclosure and help-seeking amongst survivors. The aim of this study was to explore both coping strategies employed by survivors and the perceived barriers and facilitators to seeking support from informal and formal resource networks. Methods. We conducted semistructured, in-depth qualitative interviews with thirty-five women survivors of IPV in Goa, India, in secure, private locations, utilizing flipcharts and vignettes to elicit deeper insights into efficacies of support resources. The data were transcribed, translated, and analyzed utilizing qualitative content analysis. Results. The most common coping mechanisms cited by survivors involved passive resistance, such as self-distraction, keeping quiet during violent outbursts, and leaving the home temporarily. Generally, survivors sought support from informal support networks (the natal family, in-laws, neighbors/community members, and close friends) before approaching formal support structures (medical/legal professionals, professors, police, and nongovernment organizations). In fact, informal structures were often facilitators of formal help-seeking. Survivors sought help at various stages of their marital relationship. Primary deterrents to help-seeking included the normalization of IPV by survivors and providers alike, resulting in the stigmatization of disclosing experiences of IPV and ostracism of survivors and close relatives; another barrier was a general lack of awareness of existing support resources. Conclusion. Our findings reveal that there are numerous barriers to help-seeking and shortcomings of support resources. Survivors’ evaluations of support resources reveal that robust, community-level, and meso-level structural changes are required to promote help-seeking behaviors, including the destigmatization of IPV amongst providers and broader society and raising awareness of available support resources