Prevalence, clinical presentation and complications of diabetes mellitus in obstetric patients attending a medical college hospital

Background: Diabetes mellitus (DM) may be present in the patient before the conception or it may appear during pregnancy. Obstetric management shall ensure prevention of diabetic embryopathy and early detection and management of diabetic complications in pregnancy.Methods: A descriptive observational study was undertaken on participants from a Medical College Hospital. The pre-existing medical disorders, blood sugar, routine antenatal investigations, type of delivery, ultrasound findings, complications of delivery, foetal outcome etc. were recorded. The participants were advised diet, exercise and pharmacotherapy. The intranatal and postnatal events were recorded. The results were compared with related literature.Results: The study had total 89 participants. Five participants (5.6%) had abnormal blood sugar values. Out of these, 2 participants were having pregestational DM and 3 were having gestational DM. Although all the participants who had abnormal blood sugar levels required caesarean section, two could not be operated. One participant with gestational DM who did not follow management advice delivered a macerated still born baby after shoulder dystocia. Another participant having gestational DM, who complied strictly as per dietary advice and exercise, could be managed well without insulin and delivered a healthy baby. The requirement of insulin increased in pregnancy in patients with pregestational diabetes.Conclusions: It is essential to ensure compliance on all three pillars of management of diabetes viz. diet, exercise and insulin during pregnancy. Hence health education for diabetes with special emphasis on obstetric care in pregnancy with diabetes should be promoted.

Study of the sexual and reproductive health of young women with visual impairment

Background: Census figures in 2011 have depicted that half of the visually impaired in India are women and a third of these females are in reproductive age group. This study was undertaken to identify the gynaecological health problems of the visually impaired young women and impart them necessary health education.Methods: All young visually impaired women attending composite regional centre for persons with disabilities, Bhopal during one day were offered consultation by gynecologist. Their needs and clinical findings were recorded.Results: There were 15 young women in the age range of 19 to 27 years participating in the study. This was their first ever visit to gynecologist. More than half of them reported that menstrual hygiene was taught to them by their mother, a third by peers, and one participant each reported that sister, aunt, and teacher helped them learn it. The cramping pain and warmth of discharge per vaginum helped them identify the onset of menses. Primary dysmenorrhea was the commonest complaint for which they relied on rest and over the counter available medicine.Conclusions: This study highlights the need of the inclusion of the visually impaired girls in adolescent reproductive and sexual health education with appropriate teaching learning material. Access to a gynecologist for the visually impaired shall be ensured through camps on regular basis and referral on individual need basis

Study of gynecological health of women with disabilities

Background: In routine gynaecological practice, women with disabilities are rarely seen. The available literature regarding gynaecological and obstetric issues of women with disabilities is scanty. Hence this study was designed on women with disabilities participating.Methods: History and examination findings regarding gynaecological problems of 30 participants were collected.Results: Results show that two third of the participants had normal menses while others had dysmenorrhea, oligomenorrhea, premenstrual syndrome, menorrhagia, infective vaginitis and urinary tract infection. 11 participants were married, out of which 2 had infertility. None of the participants had clinical findings suggestive of breast or cervical cancer. These findings are compared with available studies of similar type.Conclusions: This study concludes recommending the need of special camps for women with disabilities with Gynaecologist on the panel

Nutritional status of pregnant women reporting at Rural Health Training Centre

Background: United Nations had passed MDGs followed by SDGs, half of which are based on women’s health. Despite best efforts, malnutrition remains a major problem that affects our country. This is a significant risk factor for maternal and foetal mortality. This study was conducted to identify current status of maternal wellbeing in villages under an RHTC to get baseline for further interventional studies in the villages.Methods: A descriptive study was done on the rural pregnant patients attending RHTC of LNMC and JKH situated at outskirts of Bhopal was done. All pregnant women attending RHTC from January 2016 to June 2017 were studied for nutrition indicators. Their weight and height were recorded and haemoglobin was measured by Sahli’s Haemoglobinometer and the data was compared. WMA Declaration of Helsinki was followed during this study.Results: Two hundred participants in this study were between age ranges 17 to 35 years with gravidity level of the participants ranging 1 to 5. Their Body Mass Index (BMI) ranging 14 to 30. One fourth participants were having BMI of 18.5 or less and four fifth had anaemia.Conclusions: Majority of pregnant women reporting for prenatal checkup at RHTC are malnourished and anaemic. It is recommended to study government scheme at micro level if it is serving as cash incentive for frequent and multiple pregnancy to potentially catapult the desired effect to worsen the situation of maternal health on one side and population control on the other. Health education for the rural public is recommended

Determinants of Per Capita Food Expenditure to Assess Food Security Status of Nepal

Food security is the global issue as the Sustainable Development Goal (SDG) has explicitly considered zero hunger in the Goal 2. Nonetheless, in the recent years, the number of hunger population is in constant rise. Therefore, the paper attempts to estimate the determinants of the per capita food expenditure from the household expenditure. The data of National Living Standard Survey 2010/11 by the Central Bureau of Statistics Nepal has been used for the study. The multiple regression analysis has been performed. The per capita food expenditure has been used as the dependent variable. The model was found significant and the R-squared value was found 0.77. All the explanatory variables – except gender and education level (completed grade 5-7), were found significant. The number of households, area related variables urban rural and few development regions were found negatively associated with the per capita food expenditure

Study of Thyroid Function in Adolescent Girls with Intellectual Disabilities

Introduction: Thyroxine is an important hormone that ensures proper growth and development throughout life. It has an important role in the development of the reproductive system. Methods: The objective of this study was to evaluate the thyroid status of adolescent girls with disabilities. A survey was undertaken at a residential institution on all adolescent girls with disabilities in 10-19 years age group. There were 21 girls with intellectual disabilities. Their sexual development was noted. Thyroid profile was advised in all subjects. Results: There were 2 girls who had not developed any secondary sexual characters but they showed normal thyroid profile. The thyroid profile was deranged in 1 girl who had Down’s syndrome and another girl had subclinical hypothyroidism. Conclusion: The study concludes that thyroid profile should be done at regular intervals in adolescent girls with intellectual disabilities, especially Down’s syndrome

Prevalence of helicobacter pylori infection in patients with peptic ulcer disease at Kathmandu Model Hospital

Introduction: Endoscopic rapid urease test is a simple and most widely used test to detect the presence of urease in the gastric mucosa. Many studies have reported prevalence of H. pylori infection in relation to age, gender and site of ulcer. Therefore, this study was designed to determine the prevalence and significance of H. pylori in peptic ulcer disease. Methods: A retrospective review was carried out for patients with peptic ulcer disease who had undergone upper GI endoscopy in Department of Internal Medicine at Kathmandu Model Hos­pital. The records from January 2013 to December 2017 were analyzed. Any patient with previously diagnosed peptic ulcer, history of active bleeding, cancer and incomplete records were excluded. Peptic ulcer associated with H. pylori was diagnosed on the basis of endoscopic rapid urease test. Results: Among the 418 diagnosed case of peptic ulcer disease by upper GI endoscopy from Jan 2013 to Dec 2017, 213 tested positive for H. pylori by rapid urease test. Among the positive cases, over a half were males patients. Majority (23.9%) of the patients were in the age group of 35-44 years. Prevalence of H. pylori in duodenal ulcer was 51.6% followed by combined gastro-duodenal ulcer (26.8%) and gastric ulcer (21.6%). H. pylori was significantly associated with duodenal ulcer (

Inadequate venous drainage-transesophageal echocardiography as rescue

Malposition of venous cannula can cause inadequate venous drainage during cardiopulmonary bypass. It would be good clinical practice to use TEE to check the position of inferior venous cannula to avoid this problem at the earliest

Expert eValuation of Efficacy and Rationality of Vildagliptin “EVER-Vilda”: An Indian Perspective

Vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor is effective in reducing HbA1c levels in patients with type 2 diabetes (T2DM) when administered as monotherapy, dual or triple combination therapy. In India, Vildagliptin is commonly prescribed in T2DM patients because it reduces mean amplitude of glycemic excursion (MAGE), has lower risk of hypoglycemia and is weight neutral. Early combination therapy with vildagliptin and metformin is effective and well-tolerated in patients with T2DM, regardless of age or ethnicity. In view of already existing data on vildagliptin and the latest emerging clinical evidence, a group of endocrinologists, diabetologists and cardiologists convened for an expert group meeting to discuss the role and various combinations of vildagliptin in T2DM management. This practical document aims to guide Physicians and Specialists regarding the different available strengths and formulations of vildagliptin for the initiation and intensification of T2DM therapy