Precocious puberty: a clinical review

Precocious puberty is defined as pubertal development occurring more than 2.5 standard deviations earlier than the average age. It may comprise of central or gonadotropin-dependent precocious puberty and peripheral or gonadotropin-independent precocious puberty. Variants of precocious puberty include premature thelarche, premature pubarche and isolated premature menarche which principally implies onset of menstruation without any other signs of sexual development. Precocious puberty may have long-term consequences including short stature later on in adulthood owing to premature epiphyseal fusion as also psychosocial problems. Evaluation includes a detailed history, physical examination, biochemical tests and imaging directed towards detecting the cause. Gonadotropin Releasing Hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the cause. Isolated variants are usually normal but should be closely monitored. Multi-speciality consultation with involvement of pediatricians and enocrinologists may improve treatment outcomes in these children, who otherwise pose significant challenges to the gynaecologist

Effect of perineal massage in the second stage of labour, on the incidence of episiotomy and perineal tears

Background: This study aimed to investigate whether perineal massage during second stage of labour could decrease perineal trauma in the form of episiotomy and perineal tears.Methods: One hundred and fifty term antenatal women in labour were randomly assigned to two groups, one of which received perineal massage and the other received routine care during the second stage. Frequency of episiotomies, perineal tears, intact perineums, degrees of perineal tears, duration of second stage of labour and perineal pain after 24 hours was compared.Results: Perineal massage was efficient in reducing incidence of episiotomy, duration of second stage of labour and perineal pain assessed 24 hours after delivery. The frequency of perineal tears and intact perineums did not differ significantly. Perineal massage was protective against severe form of third degree perineal tears.Conclusions: Authors suggest that perineal massage can be routinely practiced by health professionals to improve quality of life in women post vaginal delivery

A case of post-caesarean vesico-uterine fistula: A rare entity becoming common?

Vesicouterine fistula (VUF) is rare, with an incidence estimated at 1-4% of all genitourinary fistulas. We report a case of VUF which was referred to our institute on the 6th postoperative day following an emergency repeat lower section caesarean section (LSCS) at 39 weeks, with complaints of hematuria and watery discharge per vaginum for further management. Patient had stable vitals with slight abdominal distension and tenderness and watery discharge per vaginum having an ammoniacal odour. USG examination showed Foley’s bulb inside uterine cavity. CT abdomen confirmed the findings and showed presence of contrast inside uterine cavity. Patient was re-operated on 9th postoperative day in concurrence with urologists. Cystoscopy showed a 2 cm size fistulous opening. Intra-operative findings revealed a fistulous track between posterior wall of bladder and uterine incision. Appropriate reparative surgery was done. Obstetricians need to be aware of this condition particularly while operating on previous caesarean sections

Spontaneous utero-rectal fistula formation following reconstructive genital tract surgery: An interesting case report

A genital fistula is an abnormal communication between uterus with either urinary tract or gastrointestinal tract. Although genitourinaryfistula is a common entity, rectovaginal or even uterorectal fistula is relatively uncommon. The etiology of fistula is usually due toan obstetric cause in a developing country, whereas, it is gynecological in the developing country. Whether etiology is obstetricalor gynecological, this develops following days of the procedure. Here, we present the case of a 17-year-old girl, who underwentvaginoplasty for cervical atresia and develop uterorectal fistula one and a half year following the first surgery. She was finallymanaged with hysterectomy

Prompt emission polarimetry of Gamma Ray Bursts with ASTROSAT CZT-Imager

X-ray and Gamma-ray polarization measurements of the prompt emission of Gamma-ray bursts (GRBs) are believed to be extremely important for testing various models of GRBs. So far, the available measurements of hard X-ray polarization of GRB prompt emission have not significantly constrained the GRB models, particularly because of the difficulty of measuring polarization in these bands. The CZT Imager (CZTI) onboard {\em AstroSat} is primarily an X-ray spectroscopic instrument that also works as a wide angle GRB monitor due to the transparency of its support structure above 100 keV. It also has experimentally verified polarization measurement capability in the 100 $-$ 300 keV energy range and thus provides a unique opportunity to attempt spectro-polarimetric studies of GRBs. Here we present the polarization data for the brightest 11 GRBs detected by CZTI during its first year of operation. Among these, 5 GRBs show polarization signatures with $\gtrapprox$3$\sigma$, and 1 GRB shows $\>$2$\sigma$ detection significance. We place upper limits for the remaining 5 GRBs. We provide details of the various tests performed to validate our polarization measurements. While it is difficult yet to discriminate between various emission models with the current sample alone, the large number of polarization measurements CZTI expects to gather in its minimum lifetime of five years should help to significantly improve our understanding of the prompt emission.Comment: Accepted for Publication in ApJ ; a figure has been update

Public Health Policy and Infectious Disease Control: Lessons from Recent Outbreaks

This research explores the complex dynamics of public health policy and its crucial role in managing pandemics, considering the unprecedented challenges presented by recent outbreaks of infectious diseases. Examining the worldwide consequences of the COVID-19 pandemic and the Ebola outbreak, we analyze the insights gained from these emergencies, highlighting the necessity for flexible policy development, cooperative endeavors, and the incorporation of community-led strategies. This study adds to the current discussion on pandemic preparedness and the development of robust public health systems. This research paper examines the significant influence of the COVID-19 pandemic and the Ebola outbreak on worldwide public health. It specifically analyzes the efficacy of public health policies and the involvement of mathematical models in managing infectious diseases. Understanding the development of public health responses requires considering the historical context of infectious disease outbreaks such as the Spanish Flu, H1N1, SARS, and MERS. This study conducts a comparative analysis of the responses to the COVID-19 pandemic and the Ebola outbreak, taking into account their distinct challenges and contextual factors. The emergence of the COVID-19 pandemic, resulting from the SARS-CoV-2 virus, has presented a multifaceted global health crisis that requires swift and flexible public health measures. Conversely, the Ebola epidemic in the Democratic Republic of Congo revealed difficulties that are unique to areas affected by conflict and emphasized the significance of involving the community in efforts to control the disease. The paper explores the global ramifications of these outbreaks, encompassing not only health consequences but also economic, societal, and international relations implications. The interdependence of global health is examined by analyzing the responses to COVID-19 and Ebola, highlighting the crucial requirement for collaborative endeavors, exchange of information, and fair allocation of resources. The research utilizes a case study methodology, specifically examining the COVID-19 pandemic and the Ebola outbreak as illustrative instances. Data collection encompasses the evaluation of implemented public health policies, the utilization of mathematical models for analysis, and the contemplation of ethical ramifications in the study of global health emergencies. The paper concludes by providing policy recommendations derived from the insights gained from these outbreaks. It highlights the importance of flexible and data-driven policymaking, international collaboration, and the incorporation of community-led strategies

Transportation Behavior Among Older Vietnamese Immigrants in the Dallas-Fort Worth Metroplex: Well-Being, Geospatial Mobility, and Potential Indicators for Ride Providers’ Geospatial Burden

Nearly 4.6 million immigrants aged 65 and older live in the United States. This population is expected to more than triple in size by 2050. A lack of culturally appropriate transportation solutions for older immigrants creates disparities in access to services for older immigrant populations, increasing their risk of social isolation and reduced physical and mental health. A growing number of older immigrants live in low-density urban environments, which are characterized by high automobile dependency and limited public transportation. In these environments, older immigrants are likely to depend on others to provide private transportation. Negative aspects of this reliance on others are that the private transportation providers may be at risk for caregiver burden and stress, and older immigrants may lack transportation to social or health opportunities if their ride providers are unavailable. This survey research examines the mobility; activity spaces; transportation patterns, resources, and needs; transportation-related support networks; and health and well-being among older Vietnamese adults in the Dallas-Fort Worth metroplex. It also investigates the provision of rides from private transportation providers and the impact of providing rides to an older Vietnamese adult in an urban area. It uses geographic information systems (GIS) to construct regular activity spaces for the older adults and their ride providers, and ride-provision activity spaces for the ride providers. Using the ride providers\u27 activity spaces, it proposes three indicators of geospatial burden for providing rides. Findings indicate that the older adults and their ride providers rely on automobiles for transportation. Most of the older adults receive rides for transportation and their ride providers are also Vietnamese and primarily speak Vietnamese. The GIS analyses suggest that constructing activity spaces with self-reports of regular and ride-provision routine activities and locations may be an appropriate assessment tool to provide valuable insights into the burden of providing rides. The best performing burden indicator was the percentage of the ride-provision activity space that was not within the boundaries of the ride providers’ regular activity spac

Ertapenem susceptibility of extended spectrum beta-lactamase-producing organisms

<p>Abstract</p> <p>Background</p> <p>Infections caused by multiply drug resistant organisms such as extended spectrum <it>beta</it>-lactamase (ESBL)-producing <it>Escherichia coli </it>and <it>Klebsiella pneumoniae </it>are increasing. Carbapenems (imipenem and meropenem) are the antibiotics commonly used to treat these agents. There is limited clinical data regarding the efficacy of the newest carbapenem, ertapenem, against these organisms. Ertapenem susceptibility of ESBL-producing <it>E. coli </it>and <it>K. pneumoniae </it>clinical isolates were evaluated and compared to imipenem to determine if imipenem susceptibility could be used as a surrogate for ertapenem susceptibility.</p> <p>Methods</p> <p>100 ESBL isolates (n = 34 <it>E. coli </it>and n = 66 <it>K. pneumoniae</it>) collected from 2005–2006 clinical specimens at WRAMC were identified and tested for susceptibility by Vitek Legacy [bioMerieux, Durham, NC]. Ertapenem susceptibility was performed via epsilometer test (E-test) [AB Biodisk, Solna, Sweden].</p> <p>Results</p> <p>100% of ESBL isolates tested were susceptible to ertapenem. 100% of the same isolates were also susceptible to imipenem.</p> <p>Conclusion</p> <p>These results, based on 100% susceptibility, suggest that ertapenem may be an alternative to other carbapenems for the treatment of infections caused by ESBL-producing <it>E. coli </it>and <it>K. pneumoniae</it>. Clinical outcomes studies are needed to determine if ertapenem is effective for the treatment of infection caused by these organisms. However, due to lack of resistant isolates, we are unable to conclude whether imipenem susceptibility accurately predicts ertapenem susceptibility.</p

A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India

Background: Childhood malnutrition has been a longstanding crisis in Mumbai, India. Despite national IYCF (Infant Young Child Feeding) guidelines to promote best practices for infant/toddler feeding, nearly one-third of children under age five are stunted or underweight. To improve child nutrition, interventions should address the cultural, social, and environmental influences on infant feeding practices. This study is an in-depth qualitative assessment of family barriers and facilitators to implementing recommended nutrition practices in two Mumbai slum communities, within the context of an existing nutrition education-based intervention by a local non-governmental non-profit organization. Methods: The population was purposively sampled to represent a variety of household demographics. Data were collected through 33 in-depth semi-structured interviews with caregivers (mothers and paternal grandmothers) of children age 0\u20132 years. Transcripts were translated and transcribed, and analyzed using qualitative analysis procedures and software. Results: A complex set of barriers and facilitators influence mothers\u2019/caregivers\u2019 infant-toddler feeding practices. Most infants were fed complementary foods and non-nutritious processed snacks, counter to IYCF recommendations. Key barriers included: lack of nutrition knowledge and experience, receiving conflicting messages from different sources, limited social support, and poor self-efficacy for maternal decision-making. Key facilitators included: professional nutrition guidance, personal self-efficacy and empowerment, and family support. Interventions to improve child nutrition should address mothers\u2019/caregivers\u2019 key barriers and facilitators to recommended infant-toddler feeding practices. Conclusions: Nutrition interventions should prioritize standard messaging across healthcare providers, engage all family members, target prevention of early introduction of sugary and non-nutritious processed foods, and strengthen maternal self-efficacy for following IYCF recommended guidelines