To study the correlation of mid-cycle luteinizing hormone surge, endometrial thickness and blood flow with histopathological finding of premenstrual endometrial biopsy in patient undergoing evaluation for infertility

Background: A prospective study of infertility evaluation: a comparison between premenstrual endometrial biopsy and mid-cycle non-invasive methods. A multicentre study in PGIMSR, GMCH, St stephens hospital, New Delhi, India.Methods: women attending infertility clinics of age between 20-35 years, with regular menstrual cycles ranging from 21-35 days. Were included, a total of 120 women were enrolled. The study was performed with trans vaginal probe (6.5 MHz), at mid cycle on day 12-14, endometrial thickness was measured, with pattern and Doppler study to evaluate PI (Pulsatility index) and RI (Resistive index) of endometrial myometrial junction, with measurement of LH (Luteinising hormone) level at the same time. Assuming a minimum incidence of 6% with alpha = 0.05; power = 80% & dropout rate = 10% sample size is proposed to include 120 cases. Endometium sampling was done in premenstrual phase.Results: The high level of LH correlated well with good secretory endometrium and patients with endometrial thickness ≥7 mm and a trilaminar pattern correlated well with secretory endometrium( in phase) and with ET <7 mm had out of phase or non-secretory endometrium. Among blood flow indices low (Pulsatility index) PI is seen to correlate with secretory endometrium. High blood flow impedance was detected in out of phase & non-secretory endometrium.Conclusions: To conclude mid-cycle non-invasive methods are comparable to premenstrual endometrial biopsy for identification of patient with luteal phase defect

Outcome of treatment of vulvodynia by local application of anaesthetic agent

Background: Vulvodynia is a chronic gynecological disorder. It has a widespread effect on quality of life due to physical disabilities, psychological distress and sexual dysfunction. The objective of the study was to assess the effectiveness of application of 5% Xylocaine ointment for treatment of Vulvodynia.Methods: This prospective study was conducted in the department of Obstetrics and Gynecology in Government Medical College and Hospital Chandigarh, from November 2004 to October 2010. Study included 520 female patients (age range, 20–65 years; mean, 32.50 years) with the diagnosis of Vulvodynia. Vulvodynia was measured by using Friedrich criteria. Daily and intercourse related pain was measured using a 10-mm visual analogue scale. Comparison was done between ability to have intercourse and pain ratings before and after the treatment.Results: After a mean of 8 weeks’ treatment, the daily pain rating was 10.37 points lower as compared to pretreatment phase. The intercourse-related pain score was 39.11 points lower after treatment. After six months of follow-up, eighty-eight percent (458/520) of women reported ability to have intercourse after treatment compared with 34% 177/520) at the initial visit. Visual analogue score of 520 patients were significantly reduced from 8.6 to 2.5 after post treatment.Conclusions: Topical 5% Xylocaine ointment was associated with an improvement in symptoms in the majority of women with Vulvodynia

Treatment of Organic Recalcitrant Contaminants in Wastewater

Research has shown that a myriad of contaminants enter the environment through industrial and domestic sources on a daily basis. The biodegradable compounds often get degraded or mineralized by various physical, chemical or biological processes, whereas the recalcitrant organic contaminants either are transformed or get dispersed and persist in the receiving environments, and to an extent much greater than was earlier estimated. Many chemical compounds that were not previously included as pollutants can now be detected at much higher concentrations globally. The effect of most of these emerging contaminants on human and environment health is still unknown. Therefore, there is an urgent need to study the fate of these persistent compounds so as to better understand and manage their ecological and health effects

Determinants of Spiritual Tourism Consumption: A Hierarchical Approach

This paper aims to analyse the relationship between factors influencing the travel intentions of the spiritual tourist. The research design comprises three segments, i.e., identifying factors from the literature, conducting interviews with the academic experts and managers, and analysing the responses recorded. The Interpretive Structural Modelling (ISM) technique is used to determine the interlinkage between the factors and develop a hierarchical relationship. This paper identified twelve factors that influence the travel intention of spiritual tourists. The results indicate that the pro-tourism attitude of the management of religious monuments, presence of relaxation and recreational activities, historical and cultural heritage of a destination, infrastructure development, and accessibility of place significantly drive tourist motivation to undertake spiritual tourism. Also, destination cost, reference group influence, marketing of the destination, destination image, and stress and spirituality level of tourist influence intention to undertake spiritual tourism, but get influenced by tourist motivation drivers. The study’s value lies in clarifying the relationship between factors influencing the travel intentions of spiritual tourists, an area where limited research has been done

Ethnic conflict and state security in South Asia: India's Punjab crisis

Arms Control & Domestic and International Security (ACDIS

Misoprostol for induction of labour: a comparative study of various routes of administration

Background: Oxytocin has been used for labor induction since very long, but with high rates of failed induction. The objective of this study is to compare the safety and efficacy of various routes of misoprostol for induction of labor at term. Design: Prospective randomized study was done at the department of obstetrics and Gynecology at the PGIMSR ESI Basaidarapur, New Delhi between August 2009 and July 2011.Methods: 150 pregnant women were randomized into three groups each to receive 50 mcg of Misoprostol via oral, sublingual and vaginal routes respectively. Doses were repeated 6 hourly for a maximum of 3 doses till the patient entered active stage of labor (clinically adequate contractions of 3/10 min of >40 s duration, and cervical dilatation of with 4 cm). Statistical analysis was done using chi-square test and ANOVA (one-way analysis of variance).Results: Mean number of dosage required for successful induction were significantly less in the vaginal group than oral and sublingual groups (in oral groups A were 2.1±0.42, sublingual 1.4±0.34, vaginal 1.1±0.29). The induction to delivery interval was significantly less in vaginal group than oral and sublingual groups (Group A oral 21.06±9.22 h, group B sublingual 16.81±8.08 h, group C vaginal 12.9±5.16 h 0.016 significant). Rate of caesarean was least in the vaginal group 12% vs 20% in oral and 26% in sublingual. All the three groups showed satisfactory neonatal outcomes.Conclusions: This study shows that vaginal route of administration of misoprostol is preferable to oral route and sublingual route for induction of labor when used in equivalent dosage of 50 mcg 6 hourly, however all three routes are well tolerated with favorable neonatal outcomes

A rare case of cervical dysgenesis presented with endometriosis and ectopic kidney

Cervical dysgenesis is a rare cause of obstructive amenorrhoea. We are presenting a case of a 15-year-old girl presented with primary amenorrhoea diagnosed with cervical dysgenesis with left ectopic kidney and endometriosis. The patient underwent laparoscopy followed by exploratory laparotomy with total abdominal hysterectomy with left salpingectomy followed by neovaginal creation and right ureteric D-J stenting and vaginal mould insertion. Cervical agenesis treatment should aim at the re-establishment of patency of the outflow tract. A fistulous tract with stent placement has been done in some cases but eventually, hysterectomy is required in view of recurrent and severe pelvic infection is a common problem. Ovarian function can be preserved if a hysterectomy is performed timely

Minimal Intubating Dose of Succinylcholine: A Comparative Study of 0.4, 0.5 and 0.6 mg/kg Dose

Muscle relaxants are integral part of modern balanced anesthesia and succinylcholine, a depolarizing drug, is in use despite its adverse effects. The excellent intubating condition, fastest onset and shortest duration of action make it an excellent choice for anesthesiologists. The conventional dose of 1.5-2 mg/kg is commonly used for obtaining relaxation for intubation. This study was conducted with much smaller dose of succinylcholine as 0.4, 0.5 and 0.6 mg/kg to evaluate the acceptable intubating dose at 60 seconds, which was unlikely to have any untoward/side effects