Assessment of symphysio-fundal height (SFH) and its implication during antenatal period

Background: The aim of antenatal care is to ensure that every pregnancy is given the maximum chance to culminate in the delivery of a healthy baby without impairing the health of the mother. Symphysio fundal height (SFH) is an essential part of examination of pregnant women. In this study we discuss various formulas and USG for determining gestational age and applying them on our population.Methods: This is a prospective observational study done at the Department of Obstetrics and Gynecology, Dhiraj General Hospital from January 2012 to January 2013. Total of 1056 eligible women were enrolled for the study.Results: According to our study, gestational age calculated by Mac Donald's formula and USG based on Tokyo & Osaka charts were more near to gestational age calculated by LMP. The gestational age calculated by USG based on European charts coincided with gestational age calculated by LMP up to 32 weeks, but after 32 weeks it did not correlate with LMP.Conclusion: In our population most of deliveries occur at home and primary centers, where facility for USG is not available. Hence application of Mac Donald's formula for calculating gestational age from SFH is a better option for detection of abnormal growth.

Antepartum hemorrhage and its fetomaternal outcome: a retrospective study

Background: Antepartum hemorrhage (APH) is defined as any bleeding from or into the genital tract after the period of viability and before the delivery of the baby. Aim of the research was to study the fetomaternal outcome in patients with APH.Methods: The present study was a retrospective observational study undertaken in Obstetrics and Gynaecology department of Dhiraj General Hospital, during a period of 1.5 years from November 2018 to May 2020 in 84 cases of antepartum hemorrhage. Only patients with APH >28 weeks gestational age and willing to participate in study were included. Open STAT statistical software has been used to analyse the data in this study.Results: The incidence of antepartum hemorrhage was 2.86%. Maximum patients of APH lie between the age group of 26-34 years. In abruptio placenta (AP) 65% and in placenta previa (PP) 77.2% of the patients were multiparous. APH presents mostly between 34-36 weeks. Around 90% patients of APH required blood transfusion. APH overall shows increased rate of cesarean sections upto 62%. Around 9.5% patients went into shock, 4.7% had disseminated intravascular coagulation (DIC), 3.5% postpartum hemorrhage (PPH) and 8.3% had wound gap and peurperial pyrexia. 23.8% babies had asphyxia of which 60% were contributed to PP and 40% were in AP group. Respiratory distress syndrome was in 7.1% babies of which both groups equally contributed. Septicemia was seen in 13% and jaundice in 29.8%.Conclusions: Higher rates of neonatal intensive care unit (NICU) admission and stay were seen with these complications. This study showed 20.2% perinatal deaths as outcome of APH and 14.2% still births.

ADENOKARCINOM JAJOVODA – PRIKAZ BOLESNICE

Mrs. UB aged 35 years came to us with complaints of oligomenorrhoea, lower abdominal pain, haematuria, retention of urine with CT scan report of December 2008 which was suggestive of left sided ovarian tumor. We investigated her with ultrasonography and CA-125 level and primary diagnosis of left sided ovarian tumor was made. On laparotomy it turned out to be primary fallopian tube carcinoma. Abdominal total hysterectomy with bilateral salpingo-oophorectomy with omental and node biopsy was done. On histopathological examination it turned out, as primary serous adenocarcinoma of fallopian tube grade G2PT1(C)PN0. To patient were given two cycles of chemotherapy. Primary fallopian tube carcinomas are quite rare. In routine practice when we come across a case, it is usually diagnosed as an adnexal mass, more commonly as an ovarian tumor. The usual investigations cannot discriminate between the ovarian and the tubal mass. The fallopian tube cancer comes as a surprise on laparotomy. We have to be ready to deal with this condition even when it suddenly crops up.Gospođa UB, životne dobi 35 godina, javila sa smetnjama oligomenoreje, bolima donjeg trbuha, hematurijom i retencijom mokraće. Posjedovala je CT nalaz iz prosinca 2008. godine koji je upućivao na lijevostrani ovarijski tumor. Istražili smo je ultrazvukom i razinom Ca 125 u krvi te je bila postavljena dijagnoza lijevostranog ovarijskog tumora. Učinjena je laparotomija te je nađen primarni karcinom lijevog jajovoda. Ućinjena je totalna abdominalna histerektomija s obostranom salpingo-ooforektomijom s biopsijom omentuma i limfnih čvorova. Histopatološki je utvrđen primarni adenokarcinom jajovoda, stupnja G2PT(1C)PN0. Bolesnici su aplicirana dva ciklusa kemoterapije. Primarni rak jajovoda je zaista rijedak. U rutinskoj praksi se dijagnosticira kao adneksalna tvorba, obično kao ovarijski tumor. Uobičajene pretrage ne mogu razlikovati ovarijsku od tubarne tvorbe. Rak tube Fallopii je iznenađenje prigodom laparotomije. Moramo biti spremni suočiti se s tim stanjem makar ono naglo iskrsne

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

ADENOKARCINOM JAJOVODA – PRIKAZ BOLESNICE

Mrs. UB aged 35 years came to us with complaints of oligomenorrhoea, lower abdominal pain, haematuria, retention of urine with CT scan report of December 2008 which was suggestive of left sided ovarian tumor. We investigated her with ultrasonography and CA-125 level and primary diagnosis of left sided ovarian tumor was made. On laparotomy it turned out to be primary fallopian tube carcinoma. Abdominal total hysterectomy with bilateral salpingo-oophorectomy with omental and node biopsy was done. On histopathological examination it turned out, as primary serous adenocarcinoma of fallopian tube grade G2PT1(C)PN0. To patient were given two cycles of chemotherapy. Primary fallopian tube carcinomas are quite rare. In routine practice when we come across a case, it is usually diagnosed as an adnexal mass, more commonly as an ovarian tumor. The usual investigations cannot discriminate between the ovarian and the tubal mass. The fallopian tube cancer comes as a surprise on laparotomy. We have to be ready to deal with this condition even when it suddenly crops up.Gospođa UB, životne dobi 35 godina, javila sa smetnjama oligomenoreje, bolima donjeg trbuha, hematurijom i retencijom mokraće. Posjedovala je CT nalaz iz prosinca 2008. godine koji je upućivao na lijevostrani ovarijski tumor. Istražili smo je ultrazvukom i razinom Ca 125 u krvi te je bila postavljena dijagnoza lijevostranog ovarijskog tumora. Učinjena je laparotomija te je nađen primarni karcinom lijevog jajovoda. Ućinjena je totalna abdominalna histerektomija s obostranom salpingo-ooforektomijom s biopsijom omentuma i limfnih čvorova. Histopatološki je utvrđen primarni adenokarcinom jajovoda, stupnja G2PT(1C)PN0. Bolesnici su aplicirana dva ciklusa kemoterapije. Primarni rak jajovoda je zaista rijedak. U rutinskoj praksi se dijagnosticira kao adneksalna tvorba, obično kao ovarijski tumor. Uobičajene pretrage ne mogu razlikovati ovarijsku od tubarne tvorbe. Rak tube Fallopii je iznenađenje prigodom laparotomije. Moramo biti spremni suočiti se s tim stanjem makar ono naglo iskrsne

Persistent Health Issues, Adverse Events, and Effectiveness of Vaccines during the Second Wave of COVID-19: A Cohort Study from a Tertiary Hospital in North India

Background There is paucity of real-world data on COVID-19 vaccine effectiveness from cohort designs. Variable vaccine performance has been observed in test-negative case-control designs. There is also scarce real-world data of health issues in individuals receiving vaccines after prior COVID-19, and of adverse events of significant concern (AESCs) in the vaccinated. Methods: A cohort study was conducted from July 2021 to December 2021 in a tertiary hospital of North India. The primary outcome was vaccine effectiveness against COVID-19 during the second wave in India. Secondary outcomes were AESCs, and persistent health issues in those receiving COVID-19 vaccines. Regression analyses were performed to determine risk factors of COVID-19 outcomes and persistent health issues. Results: Of the 2760 health care workers included, 2544 had received COVID-19 vaccines, with COVISHIELD (rChAdOx1-nCoV-19 vaccine) received by 2476 (97.3%) and COVAXIN (inactivated SARS-CoV-2 vaccine) by 64 (2.5%). A total of 2691 HCWs were included in the vaccine effectiveness analysis, and 973 COVID-19 events were reported during the period of analysis. Maximum effectiveness of two doses of vaccine in preventing COVID-19 occurrence was 17% across three different strategies of analysis adopted for robustness of data. One-dose recipients were at 1.27-times increased risk of COVID-19. Prior SARS-CoV-2 infection was a strong independent protective factor against COVID-19 (aOR 0.66). Full vaccination reduced moderate&ndash;severe COVID-19 by 57%. Those with lung disease were at 2.54-times increased risk of moderate&ndash;severe COVID-19, independent of vaccination status. AESCs were observed in 33/2544 (1.3%) vaccinees, including one case each of myocarditis and severe hypersensitivity. Individuals with hypothyroidism were at 5-times higher risk and those receiving a vaccine after recovery from COVID-19 were at 3-times higher risk of persistent health issues. Conclusions: COVID-19 vaccination reduced COVID-19 severity but offered marginal protection against occurrence. The possible relationship of asthma and hypothyroidism with COVID-19 outcomes necessitates focused research. With independent protection of SARS-CoV-2 infection, and high-risk of persistent health issues in individuals receiving vaccine after recovery from SARS-CoV-2 infection, the recommendation of vaccinating those with prior SARS-CoV-2 infection needs reconsideration