Analysis of maternal mortality: a retrospective study at tertiary care centre

Background: Mother is the pillar of the family and maternal deaths during pregnancy and delivery are great loss to baby, family, society and country too. Epidemiological data pertaining to maternal mortality is valuable in each set-up to design interventional programs to reduce the ratio favourably. This study was design to evaluate the mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, types of delay, and to suggest recommendations for improvement. Aim of the study was to analyse the causes of maternal death at tertiary care centre. Objective of the study was to analyse causes of maternal death and type of delay, and to suggest measures to reduce it.Methods: A retrospective study done at a tertiary level care centre from January 2011 to June15. Demographic data and other data were collected from maternal death review forms and case records. Data studied and analysed.Results: Most maternal deaths were due to obstetric causes like eclampsia (16.66%), preeclampsia (11.53%), anaemia (14.10%)and haemorrhage (10.25%). Associated co-morbid medical conditions hepatitis (6.41%) and heart disease (5.12%) were in the top list. Majority women were from rural area (69.23%), belonged to below poverty line (76.92%), had less than three visits (64.09%), received care at periphery below the level of specialist sub-district hospital. 94.87%were referred, and travelled more than 4 hours to reach hospital (88.44%). In majority cases Type 1 delay was most common (85.89%) comparatively to Type 2 and 3 delay.Conclusions: High risk cases should be identified. Early referral, easy transport, continued skill based training, monitoring of health services can reduce maternal mortality. Special training should be conducted for ASHA workers and ANM who generally works at grass root level in our country. Continued medical training is required for medical officers who are working at PHC and sub district hospital for early recognition of high risk women and their referral in time to higher centers to avoid maternal near miss or death

Clinical profile and obstetric outcome in pregnancies complicated by heart disease: a five year Indian rural experience

Background: Cardiac diseases are a major cause of morbidity and mortality in pregnant women in the developing world. This study illustrates the problem in rural India focusing on patterns of diseases, clinical features, and pregnancy outcome in these women.Methods: A retrospective analysis of five year data, from 2006 to 2010 for all patients admitted with cardiac disease in pregnancy.Results: Past history of heart disease was present in 70%. Rheumatic heart disease was predominant type in 83% and the chief complaint at admission was breathlessness in 44%.   Mitral stenosis was the commonest lesion in 55% and mitral regurgitation with or without stenosis in 48%. Preeclampsia was seen in 20% and preterm labor in 10%. Spontaneous vaginal delivery was seen in 41% and cesarean in 20.6%.Conclusions: Heart disease in pregnancy is a high risk condition has a major impact on pregnancy. Associated obstetric complications along with lack of knowledge and ignorance regarding the pathology lead to unpleasant obstetric outcomes

Analysis of risk factors, maternal and fetal outcome of spontaneous preterm premature rupture of membranes: a cross sectional study

Background: Preterm premature rupture of membranes (PPROM) is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality. Objective of present study was to determine incidence, risk factors, maternal, fetal outcome of PPROM occurring in patients attending a tertiary hospital in North Eastern India.Methods: This descriptive cross- sectional study was carried out in the department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal, India. Out of 15,969 deliveries between July 2010 to December 2011, 358 pregnant patients with spontaneous preterm premature rupture of membranes from 28-0 to 36-6weeks gestation were reviewed. After excluding patients with uterine anomalies, intrauterine deaths and congenital anomalies 293 patients were included and evaluated in this study.Results: The incidence of PPROM was 2.2%. Out of 293 patients 86% were singleton pregnancies, 12.9% were twins and 1.02% were triplets. 48.4% had previous history of termination of pregnancy, 28.6% history of previous PPROM and 16.3% had urinary tract infection. The mean gestational age at the onset of membrane rupture was 34.1+2.4 weeks and the latency from the membrane rupture to delivery interval ranged from 0-72 days with a mean of 48.4 hours. There were 7stillbirths (2.38%) and 4 neonatal deaths (1.02%) resulting in perinatal deaths of 3.29% and perinatal mortality rate of 0.329 per 1000 births due to PPROM. Maternal morbidity was minimal with postpartum haemorrhage in 11 patients (4.1%), abruptio placentae in 7 patients (2.3%) and sepsis in 43patients (14.6%). 66 patients (22.5%) underwent caesarean section for which malpresentations were the major cause.Conclusions: Despite remarkable advances in perinatal care, preterm premature rupture of membranes continues to cause perinatal morbidity and mortality. Strategies should be developed for its prevention. Management protocol should be improved in regard to vaginal swab culture and use of specific antibiotics

Beyond behaviour as individual choice: a call to expand understandings around social science in health research

The focus of behavioural sciences in shaping behaviour of individuals and populations is well documented. Research and practice insights from behavioural sciences improve our understanding of how people make choices that in turn determine their health, and in turn the health of the population. However, we argue that an isolated focus on behaviour - which is one link in a chain from macro to the micro interventions - is not in sync with the public health approach which per force includes a multi-level interest. The exclusive focus on behaviour manipulation then becomes a temporary solution at best and facilitator of reproduction of harmful structures at worst. Several researchers and policymakers have begun integrating insights from behavioural economics and related disciplines that explain individual choice, for example, by the establishment of Behavioural Insight Teams, or nudge units to inform the design and implementation of public health programs. In order to comprehensively improve public health, we discuss the limitations of an exclusive focus on behaviour change for public health advancement and call for an explicit integration of broader structural and population-level contexts, processes and factors that shape the lives of individuals and groups, health systems and differential health outcomes

Traditional method or online teaching; which method students prefer: an observational study

Background: An unexpected global pandemic broke out in initial months of 2020 i.e., COVID-19 which drastically brought a difference in the progress of education in various institutions, especially the medical field where we study about life was also made online. This study aims to conduct a comparative analysis of students ‘opinion regarding which is the better, traditional teaching or online live teaching.Methods: Survey was conducted among two group of students, 2019 (both online and offline teaching) and 2020 (online teaching with offline practical) batches of Andhra Medical College, Visakhapatnam. A questionnaire was circulated to students regarding the class experience, interest of attending the class, learning effect and clarity of the lecture. Results: Students expressed their views that overall teaching experience and learning effect of offline methodology is superior to online approach, so the traditional offline style or the blend of online and offline modes are apt for teaching.Conclusions: The study is focused on the way in which the teaching and learning approach is delivered which is favoured by the medical practitioners, the qualitative data suggesting required modifications for further improvement in the delivering method to produce qualified medical practitioners to meet the current and imminent situations. This study suggests that a intermingled learning approach is an effective method for anatomy learning, and this approach mainly inculcates self-directed study through online learning

Immunobiology of a synthetic luteinizing hormone receptor peptide 21-41

Immunization of adult male rabbits with a synthetic luteinizing hormone-receptor peptide (LH-RP; representing amino-acids 21-41 of the extracellular domain of the rat LH receptor) resulted in production of high-titer antibodies capable of interacting with particulate and cell-based LH receptors. The antibody produced was able to inhibit binding of 125I-labeled human chorionic gonadotropin (hCG) to a particulate sheep luteal LH receptor preparation by 40%-50%. Maximal inhibitory activity was correlated with high antibody titer. Immunocytometry revealed that the antibody could directly bind to cells having LH receptors, such as rat granulosa and Leydig cells. The antibodies recognized a 77-kilodalton membrane protein in Western blots of mouse testicular extracts. Interaction of endogenous Leydig cell LH receptor with the LH-RP antibody resulted in both hormone agonist and antagonistic activities. The hormone-mimicking activity (increase in serum testosterone over control) was confined only to the early phase of immunization when the antibody titer was low. Blockade of LH receptor during the later part of immunization resulted in a significant reduction in serum testosterone over controls and inhibition of spermatogenesis. DNA flow cytometry showed that a specific and significant inhibition of meiosis (transformation of primary spermatocytes to round and elongated spermatids P < .01) and spermiogenesis (transformation of round spermatids to elongated spermatids P < .0001) occurred following blockade of LH function

Evaluating rice germplasm for iron and zinc concentration in brown rice and seed dimensions

The lack of micronutrients such as Fe and Zn in staple food crops is a widespread nutrition and health problem in developing countries. Biofortification is one of the sustainable approaches, for improving the Fe and Zn content and their bioavailability in rice grain. Screening germplasm for Fe and Zn content is the initial step of biofortification. We analyzed brown rice of 126 accessions of rice genotypes for Fe and Zn concentration. Iron concentration ranged from 6.2 ppm to 71.6 ppm and zinc from 26.2 ppm to 67.3 ppm. Zn concentration and grain elongation (-0.25) was significantly correlated. The wild accessions had the highest Fe and Zn. Thus, wild species are a good source for biofortification of popular rice cultivars using conventional, acceptable, non transgenic methods. Â

Primary Ovarian Insufficiency: Current Understanding and Diagnostic Approaches

Primary ovarian insufficiency (POI) is a medical condition where ovarian function stops prematurely, typically before the age of 40. This condition leads to infertility and produces symptoms similar to those experienced during menopause. Although the origins of POIs are diverse, genetic elements substantially influence their emergence. This assessment delves into the genetic facets of POI, covering genetic triggers, detection, and genetic consultation. We scrutinize the genes linked to POI and their function in ovarian activity, as well as the genetic deviations and mutations that foster POI onset. We also examine the challenges and limitations of genetic testing and counseling for POI and suggest ways to address these challenges. This review offers a thorough examination of the existing understanding of the genetic factors linked to Primary Ovarian Insufficiency (POI) emphasizing the critical need for further investigation in this field

Endocrine Autoimmunity in Association with Female Infertility

Infertility is the inability to conceive after a year of regular unprotected sexual intercourse, affecting 10-15% of couples. Advanced age, obesity, and certain medications can hinder fertility. Endocrine autoimmunity is increasingly recognized as a significant contributor to female infertility, often complicating various gynecological conditions. Autoimmune issues involving the hypothalamus, pituitary gland, thyroid, adrenal glands, and ovaries can impact fertility. A multidisciplinary approach is essential for diagnosing infertility, with a crucial focus on identifying potential endocrine disorders. Here we discuss how to identify endocrine autoimmune patients with ovulatory dysfunction. Women must be advised about limiting factors to be avoided, to protect their fertility. A comprehensive understanding of the underlying mechanisms, coupled with appropriate diagnostic and therapeutic approaches, is crucial for effectively managing this complex condition and helping women achieve their reproductive goals