Uterine Perforation With Subtotal Small Bowel Prolapse – A Rare Complication of Dilatation and Curettage

Uterine perforation is the well known complication of induced abortion. We report a rare case of uterine perforation with subtotal prolapse of small bowel following first trimester abortion by an unqualified physician. Early surgical exploration with resection and anastomosis of bowel performed. Patient discharged uneventfully after postoperative recovery

An Investigation towards Effectiveness in Image Enhancement Process in MPSoC

Image enhancement has a primitive role in the vision-based applications. It involves the processing of the input image by boosting its visualization for various applications. The primary objective is to filter the unwanted noises, clutters, sharpening or blur. The characteristics such as resolution and contrast are constructively altered to obtain an outcome of an enhanced image in the bio-medical field. The paper highlights the different techniques proposed for the digital enhancement of images. After surveying these methods that utilize Multiprocessor System-on-Chip (MPSoC), it is concluded that these methodologies have little accuracy and hence none of them are efficiently capable of enhancing the digital biomedical images

Antenatal exposure to household air pollution and its association with increased risk of retinopathy

Background: Household air pollution (HAP) has been implicated in endothelial dysfunction and systemic inflammation which are the underlying mechanisms for retinopathy of prematurity (ROP). Objective: The study aims to estimate the incidence of ROP and its risk factors, specifically exploring antenatal exposure to HAP due to the use of traditional stoves/chullah as a risk factor for ROP. Methods: This cross-sectional observational study was conducted at a neonatal intensive care unit (NICU) of tertiary care hospital in Nagpur, India. Screening for ROP was done in 196 hospitalized preterm neonates discharged from NICU for a period of23 months in between December 2012 and October 2014. Mothers were considered as exposed to HAP if there was predominant use of chullah or open fire using wood, charcoal, crop waste, etc., for household cooking activities during her pregnancy and if cooking was done in the same room as the living room. Results: The incidence of any ROP in preterm neonates of mothers who were exposed to high polluting fuels (HPFs) antenatally was 51% as compared to 30% among those exposed to low polluting fuels. Those pregnant women who cooked outdoors or in a separate room had significantly lesser chances of developing ROP. Multivariateanalysis showed that environmental factors such as smoking in the household and usage of HPFs while cooking in the living room of the house (odds ratio 10.15; 95% confidence interval [1.3, 79.43]) increased the risk of developing ROP, after adjusting for other risk factors. In our study population, exposure to smoking and HAP were associated with higher risks of developing ROP, independent of covariates. Conclusion: Effective interventions to a committed and determined intersectoral coordination toward the promotion of public health are the need of the hour

Association between school dropouts, early marriages, childbearing, and mental health in early adulthood of women: Evidence from a cohort study in Bihar, India

School dropouts, early marriages, and low age at childbearing are issues still prevalent in Indian states like Bihar, which may be responsible for poor mental health among young adults. The present study examined the effect of life-course events such as school dropouts, early marriages, and early childbearing on mental health status at later ages (23–28 years). Using data from the Understanding the Lives of Adolescents and Young Adults consisting of a 2360 adolescent (ages 15 – 19) girl cohort interviewed in 2007 and re-interviewed at ages 23 – 28 in 2016 from the state of Bihar, India, we applied ordinal logistic regression models in analyzing factors associated with mental health status. Women who never attended school, or dropped out from school, and who got married before age 19 showed a poorer mental health status in their young adulthood (22 – 28 years) compared to their respective counterparts who attended a school and who got married at age 19 or older. As compared to women who had a child before age 19, those who did not have any child, or who had children after 20 years of age were more likely to have poor mental health. Working women, high self-efficacy of women, and women who have decision-making power showed better mental health outcomes as compared to their respective counterparts. To enhance psychological well-being of young women, the study recommends continue education and delaying marriage as the programmatic keys with attention to improving young women’s autonomy and gender role attitudes and reducing societal pressure for bearing first child soon after marriage

Economic evaluation of zinc and copper use in treating acute diarrhea in children: A randomized controlled trial

BACKGROUND: The therapeutic effects of zinc and copper in reducing diarrheal morbidity have important cost implications. This health services research study evaluated the cost of treating a child with acute diarrhea in the hospital, the impact of micronutrient supplementation on the mean predicted costs and its cost-effectiveness as compared to using only standard oral rehydration solution (ORS), from the patient's and government's (providers) perspective. METHODS: Children aged 6 months to 59 months with acute diarrhea were randomly assigned to receive either the intervention or control. The intervention was a daily dose of 40 mg of zinc sulfate and 5 mg of copper sulfate powder dissolved in a liter of standard ORS (n = 102). The control was 50 mg of standard ORS powder dissolved in a liter of standard ORS (n = 98). The cost measures were the total mean cost of treating acute diarrhea, which included the direct medical, the direct non-medical and the indirect costs. The effectiveness measures were the probability of diarrhea lasting ≤ 4 days, the disability adjusted life years (DALYs) and mortality. RESULTS: The mean total cost of treating a child with acute diarrhea was US $14 of which the government incurred an expenditure of 66%. The factors that increased the total were the number of stools before admission (p = 0.01), fever (p = 0.01), increasing grade of dehydration (p = 0.00), use of antibiotics (p = 0.00), use of intra-venous fluids (p = 0.00), hours taken to rehydrate a child (p = 0.00), the amount of oral rehydration fluid used (p = 0.00), presence of any complications (p = 0.00) and the hospital stay (p = 0.00). The supplemented group had a 8% lower cost of treating acute diarrhea, their cost per unit health (diarrhea lasting ≤ 4 days) was 24% less and the incremental cost-effectiveness ratio indicated cost savings (in Rupees) with the intervention [-452; 95%CI (-11306, 3410)]. However these differences failed to reach conventional levels of significance. CONCLUSION: An emphasis on the costs and economic benefits of an alternative therapy is an important aspect of health services research. The cost savings and the attractive cost-effectiveness indicates the need to further assess the role of micronutrients such as zinc and copper in the treatment of acute diarrhea in a larger and more varied population

Pattern distribution of abnormal hemoglobin variants by cation exchange High Performance Liquid Chromatography: a study of 9,116 subjects

Background: The present study was conducted to identify pattern distribution of abnormal haemoglobin variants by using HPLC method in a tertiary care hospital, Surat, Gujrat, India.Methods: A cross sectional study of one-year duration was conducted including 9,116 patients screened for the presence of abnormal haemoglobin variants. Blood samples were initially tested for solubility test and run on automated haemoglobin analyzer for complete haemogram. All the suspected and family study cases were processed for HPLC (Bio-Rad Variant II) for conclusive diagnosis. Patients with a history of recent blood transfusion of less than 3 months duration were excluded from the study.Results: A total of 9,116 cases (1390 males, 7726 females) were included in the present study. The age group of patients ranged from 1 month to 95 years. Solubility test and complete haemogram were performed in all the cases. Out of the 9,116 cases, 8409(92.24%)cases had normal HPLC pattern. 492(5.40%)cases were diagnosed as sickle cell trait, 176(1.93%) cases as sickle cell disease, 29(0.32%) cases as β thalassaemia trait, 1(0.01%) case as β thalassaemia major, 2(0.02%)cases as Hb E heterozygous and 03 (0.07%) cases as Hb D Punjab heterozygous. One case of double heterozygous for Hb E-β thalassaemia was also found.Conclusions: HPLC is a rapid, accurate and useful method for diagnosing haemoglobinopathies. It serves as an reliable tool in diagnosing the presence of abnormal haemoglobin variants in suspected cases on routine haematology in developing countries like India, where the resources for detection of haemoglobinopathies are limited. Early diagnosis may help in proper management of patients

Frequency of metabolic syndrome in psychiatric patients, is this the time to develop a standardized protocol to reduce the morbidity from an acute care psychiatry unit.

OBJECTIVE: To determine the frequency of Metabolic Syndrome among psychiatric patients and to look for the correlation between the two medical conditions. METHODS: The cross-sectional study was conducted from February to April 2013 at the acute care psychiatry in-patient unit at Kingston General Hospital, Ontario, Canada, and comprised adult patients of both genders diagnosed under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. For Metabolic Syndrome, definitions outlined by the International Diabetes Federation were used. The patients were divided into two groups on the basis of presence or absence of the Syndrome and were compared for clinical and demographic characteristics. SPSS 22 was used for statistical analysis. RESULTS: Of the 50 patients in the study, 24(48%) were found to have Metabolic Syndrome. Besides, 40 (80%) patients were taking atypical antipsychotics regardless of the diagnosis; 20(83%) among those with the Syndrome, and 20(77%) among those without it. CONCLUSIONS: Patients at high risk of developing metabolic syndrome need to be identified early so that an individualised care plan can be formulated. Identifying the variables to make a management plan is vital

Evaluation of intersystem agreement between standard pelvic organ prolapse quantification system and simplified pelvic organ prolapse scoring system

Background: Pelvic organ prolapse (POP) is one of the most common gynaecological problem encountered worldwide. The POPQ has become the most commonly used prolapse staging system since its introduction (1996). In spite of having merits to it, POP-Q has not acquired a widespread acceptance. International Urogynaecological Association (IUGA) Standardization of Terminology Committee has devised a simplified version S-POP classification system based on the ordinal stages of the POPQ. The objectives of present study are to determine the intersystem agreement between the standard POPQ and S-POP classification system of pelvic organ prolapse and to propose a user-friendly classification system.Methods: This prospective observational blinded study was conducted in the department of Obstetrics and Gynaecology, NSCB Medical College and Hospital, Jabalpur (M.P.) from March 2015-August 2016. 125 women underwent two separate pelvic examinations POPQ and S-POP, by two groups of gynaecologists at each site. Results were compared and analysed using appropriate statistics.Results: Out of 125 women 54 (43.2%) were in age group 41-50 years. 79 (63.2%) were post-menopausal. 102 (81.4%) were more than third parity. 107 (85.6%) had home delivery. 119 (95.2%) had symptom of something coming out of vagina. The weighted Kappa statistics for the intersystem agreement of S-POP system with POPQ system for overall stage was 0.82, 0.61 for both anterior and posterior vaginal wall, 0.9 for cervix and 0.87 for posterior fornix/cuff.Conclusions: There is significant agreement between the POPQ and S-POP classification systems of POP

Association of umbilical cord blood lead with neonatal behavior at varying levels of exposure

BACKGROUND: In the light of the ongoing debate about lowering the cut-off for acceptable blood lead level to <5 μg/dL from the currently recommended level of <10 μg/dL, we considered whether prenatal exposure to varying levels of lead is associated with similar or disparate effects on neonatal behavior. METHODS: Using Brazelton's Neonatal Behavioral Assessment Scale (NBAS), an epidemiological approach and robust statistical techniques like multivariate linear regression, logistic regression, Poisson regression and structural equations modeling analyses we estimated the simultaneous indirect effects of umbilical cord blood lead (CBL) levels and other neonatal covariates on the NBAS clusters. RESULTS: We observed that when analyzed in all study subjects, the CBL levels independently and strongly influenced autonomic stability and abnormal reflexes clusters. However, when the analysis was restricted to neonates with CBL <10 μg/dL, CBL levels strongly influenced the range of state, motor and autonomic stability clusters. Abnormal walking reflex was consistently associated with an increased CBL level irrespective of the cut-off for CBL, however, only at the lower cut-offs were the predominantly behavioral effects of CBL discernible. CONCLUSION: Our results further endorse the need to be cognizant of the detrimental effects of blood lead on neonates even at a low-dose prenatal exposure