Uterine necrosis following B Lynch suture: a rare complication

The B-Lynch uterine suture brace is a relatively new technique used for treatment of postpartum haemorrhage. These uterine compression sutures have achieved hemostasis while preserving fertility in many women and thus their efficacy and safety have been time tested. Very few complications have been reported following B Lynch suture. These include Asherman’s syndrome, hematometra, pyometra, localized areas of uterine necrosis and full-thickness defects in the lower uterine segment or uterine fundus and erosion of uterine wall. Herewith, reporting a case of 23-year-old woman who underwent cesarean section for breech presentation. She had atonic PPH for which uterine artery ligation was done along with B-lynch suture. She developed uterine necrosis for which hysterectomy was done. Microsections showed that endometrial cavity was filled with gangrenous slough extending to variable extent in myometrium and cervix

Effect of melatonin addition in ovulation induction protocols with clomiphene citrate in management of infertility

Background: About 10-12% of couples are unable to conceive by natural means despite concerted efforts and these figures have risen in past few decades. In recent years, effect of oxidative stress on the fertility has been widely recognised. Oxidative stress has been known to affect both male and female fertility reducing sperm count and motility in men, and affecting ovum reserve and quality in women. Melatonin is the secretion of the pineal gland responsible for circadian sleep rhythm has also shown to be good antioxidant. Aim and objective of current study was to study effect of melatonin addition to clomiphene citrate for induction of ovulation with a view to improve conception rates.Methods: This was a retrospective analysis of 52 women with infertility who were given clomiphene citrate with melatonin. Ovulation, conception rates and pregnancy outcomes were noted.Results: We observed 77.8%ovulation rates, and a significantly better conception and live birth rates.Conclusions: Melatonin, as an anti-oxidant may improve, conception and live birth rates when added to clomiphene citrate induction protocols

A rare case of mixed germ cell tumor in a teenage girl: a case report

Germ cell tumors represent only 20% to 25% of all benign and malignant ovarian neoplasms. Mixed germ cell tumors are a rare variety of non–dysgerminomatous germ cell tumors. They contain two or more elements; the most frequent combination being a dysgerminoma and an EST (Endodermal Sinus Tumor). We present a case of malignant mixed germ cell tumor comprising of yolk sac tumor, embryonal carcinoma and choriocarcinoma. A 13-year-old girl presented with a huge 25 x 18 cm mass in abdomen with raised values of CA-125, hCG, AFP (alpha-feto protein) and LDH (lactate dehydrogenase). She underwent laparotomy followed by unilateral salpingoopherectomy and infracolic omentectomy. Histopathology report revealed malignant mixed germ cell tumor comprising predominantly of EST with elements of embryonal carcinoma and non-gestational choriocarcinoma. Following surgery, she was started on adjuvant chemotherapy (Bleomycin, Etoposide and Cisplatin regimen). Mixed germ cell tumor (YST/EST, non-gestational choriocarcinoma and embryonal carcinoma) is a very rare tumor. Careful initial surgery with adequate staging biopsies followed by combination chemotherapy can greatly improve the prognosis of these patient

Obesity in Adolescents: Prevalence and Association with Sociodemographic and Lifestyle Factors

Introduction: Overweight and obesity has become a worldwide epidemic and is a growing public health concern. The increase in prevalence and severity of obesity among children and adolescents has been attributed largely to behavioral factors such as changing eating habits and sedentary lifestyles. Objective: To determine prevalence of obesity and abdominal obesity among adolescents and its association with sociodemographic factors and lifestyle. Methods: Present cross-sectional study was conducted in the urban field practice area under the Community Medicine Department of LLRM Medical College, Meerut, among 872 adolescents. All localities in the field area were covered and house to house survey was done. Questions were asked about eating patterns, physical activity and sedentary lifestyle. Data was collected and analyzed using appropriate statistical tests. Results: The prevalence of overweight and obesity was 17.43, 6.88%, respectively. Obesity was significantly higher among females, those who indulged in unhealthy eating habits were physically inactive, watched television for a longer duration and ate junk while watching television. Conclusion: In the present study, we found that high junk food consumption and a sedentary lifestyle were found to be significantly associated with childhood overweight/obesity. As a result, timely interventions should be taken to improve awareness about healthy lifestyle behavior to prevent obesity and its complications among adolescents

Maternal and neonatal outcome in pregnancy with previous lower segment caesarean section undergoing trial of scar

Background: Women with previous LSCS often have to make a decision about mode of delivery of their second baby. As the rate of caesarean section is continuously increasing, vaginal birth after caesarean section (VBAC) is a good strategy to decrease caesarean rate. The present study was planned to assess the fetomaternal outcome in pregnancies with previous lower segment caesarean section undergoing trial of scar and to identify the factors, which can influence the outcome of trial of scar.Methods: This was a prospective observational study on 100 patients at a tertiary care institute. Pregnant women with previous LSCS were selected randomly for the study on the basis of the inclusion and exclusion criteria. Each labor monitored closely using a partogram. Decision for repeat emergency caesarean was taken by consultant. All women included in the study were followed through delivery and till discharge.Results: Out of 100 pregnant women 49 % cases had successful VBAC, 50% had emergency caesarean and one patient had laparotomy for rupture uterus. In women, who also had a prior vaginal delivery, 72% delivered vaginally, as compared to 40% of the women who did not undergo prior vaginal delivery (p value=0.003). Women who were in spontaneous labor, 59.21% delivered vaginally, whereas women who were induced, 16.6% delivered vaginally. The rate of perinatal complication was more in the patients who required an emergency CS after a failed trial. Conclusions: Our findings may encourage obstetricians to encourage VBAC in the properly screened ANC patients and decrease the rate of recommending caesarean section

Mechanism and kinetics of chlorpyrifos co-metabolism by using environment restoring microbes isolated from rhizosphere of horticultural crops under subtropics

The indiscriminate use of organophosphate insecticide chlorpyrifos in agricultural crops causes significant soil and water pollution and poses a serious threat to the global community. In this study, a microbial consortium ERM C-1 containing bacterial strains Pseudomonas putida T7, Pseudomonas aeruginosa M2, Klebsiella pneumoniae M6, and a fungal strain Aspergillus terreus TF1 was developed for the effective degradation of chlorpyrifos. Results revealed that microbial strains were not only utilizing chlorpyrifos (500 mg L–1) but also coupled with plant growth-promoting characteristics and laccase production. PGP traits, that is, IAA (35.53, 45.53, 25.19, and 25.53 μg mL–1), HCN (19.85, 17.85, 12.18, and 9.85 μg mL–1), and ammonium (14.73, 16.73, 8.05, and 10.87 μg mL–1) production, and potassium (49.53, 66.72, 46.14, and 52.72 μg mL–1), phosphate (52.37, 63.89, 33.33, and 71.89 μg mL–1), and zinc (29.75, 49.75, 49.12, and 57.75 μg mL–1) solubilization tests were positive for microbial strains T7, M2, M6, and TF1, respectively. The laccase activity by ERM C-1 was estimated as 37.53, 57.16, and 87.57 enzyme U mL–1 after 5, 10, and 15 days of incubation, respectively. Chlorpyrifos degradation was associated with ERM C-1 and laccase activity, and the degree of enzyme activity was higher in the consortium than in individual strains. The biodegradation study with developed consortium ERM C-1 showed a decreased chlorpyrifos concentration from the 7th day of incubation (65.77% degradation) followed by complete disappearance (100% degradation) after the 30th day of incubation in the MS medium. First-order degradation kinetics with a linear model revealed a high k –day value and low t1/2 value in ERM C-1. The results of HPLC and GC-MS analysis proved that consortium ERM C-1 was capable of completely removing chlorpyrifos by co-metabolism mechanism

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.Peer reviewe

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Percolating Risk Factors for Cardiovascular Diseases in Rural North India

Background: World has seen a tremendous epidemiological transition in disease patterns from communicable to non-communicable diseases (NCDs). Currently cardiovascular diseases are a major cause of disability and premature deaths globally. Objective: (1) To know prevalence of various risk factors of cardiovascular diseases in the rural area of Meerut. (2) To find out the association of sociodemographic factors with hypertension. Settings and design: A cross-sectional study was conducted in Machchra village. Methods: The study was conducted among 315 study participants over time period of one year in which all the adults aged >30 years above residing in the ward of study area were included. Sampling technique used was systematic random sampling. Results: The prevalence of hypertension, diabetes and hypercholesterolemia was found to be 30.2%, 22.2% and 15.2% respectively. The prevalence of pre-obese and obese were 14.3% and 7.0% respectively. The maximum prevalence of hypertension was seen in the age group of 70 years (66.7%), in females (30.6%), SES as class IV (36.5%), secondary school completed population (42.9%) and among homemakers (40.9%). The prevalence of hypertension was found to be statistically significant in relation to age, educational status and occupation. Conclusion: In our study the prevalence of hypertension was found to be 30.2% (in males 29.6% while in females 30.6%)