Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers

Impact of counselling on selecting a hormonal contraceptive method

Background: Unmet need for family planning is an important indicator for assessing the demand for family planning services. As per NFHS-4, the contraceptive prevalence rate in women age 15-49 years was 53.5 % and the unmet need for family planning among married women was 12.9%. Counselling provides the Health care professionals (HCPs) an opportunity to understand the individual need of a contraceptive seeker.Methods: This was a cross-sectional, observational study conducted at GMERS hospital, Valsad during June 2017 to October 2017. Sexually active women of 18 to 40 years who consulted HCPs for contraception and who interested in starting hormonal contraceptive method or expressed interest in switching (changing) to hormonal methods were included in the study. Total 213 women were enrolled in the study.  Questionnaires with information on the women’s pre- and post-counseling contraceptive choice, her perceptions, and the reasons behind her post-counseling decision were filled both by the HCP and the participating women. The completed questionnaires were collected and analyzed.Results: During pre-counseling, most common hormonal contraceptive method selected by women was combined hormonal contraceptive pills followed by DMPA, LNG-IUS and POPs. In present study, structured contraception counseling helped most women (97.2 %) to choose a contraceptive method. There were statistically significant differences in choice of contraceptive methods during pre and post-counseling except COCs. Among hormonal contraceptive methods, maximum difference was observed for choice of the COCs after counseling as compared to pre-counseling. Counseling helped more than 90% of the women who were indecisive to choose any contraceptive method. More than three fourth of them opted for hormonal methods with a maximum selection of COCs. The most common reasons for selecting COCs was ease of use for COC, breast feeding for POP and the most common reasons for not choosing other available contraceptive methods was discussion with partner.Conclusions: The combined hormonal contraceptive pills were reported to be the most commonly used contraceptive method. There were statistically significant differences in choice of contraceptive methods during pre and post-counseling with maximum difference in COCs. Counseling helped most of the women who were indecisive to choose any contraceptive method

SILVER STAINED NUCLEOLAR ORGANIZER REGION COUNT (AGNOR COUNT) – VERY USEFUL TOOL IN BREAST LESIONS

Introduction: Accurate histopathological typing, grading and staging of a tumour is of proven value in clinical management as well as prognostic outcome of cancer patients. But many times histopathological assessment correlates poorly with clinical outcome. These limitations have motivated development of new technique so as to improve accuracy and reproducibility of prognostication. Method: One of the newer techniques is “Silver stained nucleolar organizer regions (AgNORs)’which is cheap, simple used to assess its role in histopathological diagnosis and prognosis of disease of breast lesion cases. Results: There is high AgNOR count in malignant breast tumours as compared to benign lesions. Characteristic morphological changes are observed in benign and malignant lesions. Morphological variation can also be used as diagnostic as well as prognostic parameter. Conclusion: The newly invented simple technique of AgNOR staining and its proven predictability may become a trustworthy milestone

Supplemental Vitamins and Minerals for CVD Prevention and Treatment

The authors identified individual randomized controlled trials from previous meta-analyses and additional searches, and then performed meta-analyses on cardiovascular disease outcomes and all-cause mortality. The authors assessed publications from 2012, both before and including the U.S. Preventive Service Task Force review. Their systematic reviews and meta-analyses showed generally moderate- or low-quality evidence for preventive benefits (folic acid for total cardiovascular disease, folic acid and B-vitamins for stroke), no effect (multivitamins, vitamins C, D, β-carotene, calcium, and selenium), or increased risk (antioxidant mixtures and niacin [with a statin] for all-cause mortality). Conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated; therefore, any benefits seen must be balanced against possible risks

Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND): a multicentre, parallel, randomised controlled trial in the UK

BACKGROUND: Motor neuron disease is a progressive, fatal neurodegenerative disease for which there is no cure. Acceptance and Commitment Therapy (ACT) is a psychological therapy incorporating acceptance, mindfulness, and behaviour change techniques. We aimed to evaluate the effectiveness of ACT plus usual care, compared with usual care alone, for improving quality of life in people with motor neuron disease. METHODS: We conducted a parallel, multicentre, two-arm randomised controlled trial in 16 UK motor neuron disease care centres or clinics. Eligible participants were aged 18 years or older with a diagnosis of definite or laboratory-supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis; progressive muscular atrophy; or primary lateral sclerosis; which met the World Federation of Neurology's El Escorial diagnostic criteria. Participants were randomly assigned (1:1) to receive up to eight sessions of ACT adapted for people with motor neuron disease plus usual care or usual care alone by a web-based system, stratified by site. Participants were followed up at 6 months and 9 months post-randomisation. Outcome assessors and trial statisticians were masked to treatment allocation. The primary outcome was quality of life using the McGill Quality of Life Questionnaire-Revised (MQOL-R) at 6 months post-randomisation. Primary analyses were multi-level modelling and modified intention to treat among participants with available data. This trial was pre-registered with the ISRCTN Registry (ISRCTN12655391). FINDINGS: Between Sept 18, 2019, and Aug 31, 2022, 435 people with motor neuron disease were approached for the study, of whom 206 (47%) were assessed for eligibility, and 191 were recruited. 97 (51%) participants were randomly assigned to ACT plus usual care and 94 (49%) were assigned to usual care alone. 80 (42%) of 191 participants were female and 111 (58%) were male, and the mean age was 63·1 years (SD 11·0). 155 (81%) participants had primary outcome data at 6 months post-randomisation. After controlling for baseline scores, age, sex, and therapist clustering, ACT plus usual care was superior to usual care alone for quality of life at 6 months (adjusted mean difference on the MQOL-R of 0·66 [95% CI 0·22–1·10]; d=0·46 [0·16–0·77]; p=0·0031). Moderate effect sizes were clinically meaningful. 75 adverse events were reported, 38 of which were serious, but no adverse events were deemed to be associated with the intervention. INTERPRETATION: ACT plus usual care is clinically effective for maintaining or improving quality of life in people with motor neuron disease. As further evidence emerges confirming these findings, health-care providers should consider how access to ACT, adapted for the specific needs of people with motor neuron disease, could be provided within motor neuron disease clinical services. FUNDING: National Institute for Health and Care Research Health Technology Assessment and Motor Neurone Disease Association

Congestive heart failure model representing aortic banding induced hypertrophy: A study to analyse extent of pressure overload and alteration in myocardial structure and function

Congestive Heart failure (CHF) is a severe pathology representing a major public health problem in industrialized nations which is increasing in prevalence and incidence. The aortic banding rat model provides steady progression of cardiac dysfunction under chronic pressure overload. Present study evaluated two abdominal aortic constriction techniques including constriction of aorta above renal arteries and between renal arteries. The extent of constriction was varied with 22 G and 24 G needles and the duration for evaluation of CHF was also varied by terminating the banded animals after 6 and 8 weeks of banding. Various hemodynamic, ECG and tissue parameters were evaluated after banding to see the progression of CHF. The findings revealed that the constriction of the aorta above both renal arteries with 24 G needle is a better technique amongst other tested banding techniques as the rate of progression of CHF was found to be maximum with it. On the basis of above study, it was concluded that, aortic banding above both renal arteries with 24 G needle is a better technique for induction of pressure overload and for further observation in transition of the cardiac compensatory to decompensatory phase, the duration of the model needs to be prolonged

Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers

Consumption of a dietary portfolio of cholesterol lowering foods improves blood lipids without affecting concentrations of fat soluble compounds

Abstract Background Consumption of a cholesterol lowering dietary portfolio including plant sterols (PS), viscous fibre, soy proteins and nuts for 6 months improves blood lipid profile. Plant sterols reduce blood cholesterol by inhibiting intestinal cholesterol absorption and concerns have been raised whether PS consumption reduces fat soluble vitamin absorption. Objective The objective was to determine effects of consumption of a cholesterol lowering dietary portfolio on circulating concentrations of PS and fat soluble vitamins. Methods Using a parallel design study, 351 hyperlipidemic participants from 4 centres across Canada were randomized to 1 of 3 groups. Participants followed dietary advice with control or portfolio diet. Participants on routine and intensive portfolio involved 2 and 7 clinic visits, respectively, over 6 months. Results No changes in plasma concentrations of α and γ tocopherol, lutein, lycopene and retinol, but decreased β-carotene concentrations were observed with intensive (week 12:p = 0.045; week 24:p = 0.039) and routine (week 12:p = 0.031; week 24:p = 0.078) portfolio groups compared to control. However, cholesterol adjusted β-carotene and fat soluble compound concentrations were not different compared to control. Plasma PS concentrations were increased with intensive (campesterol:p = 0.012; β-sitosterol:p = 0.035) and routine (campesterol: p = 0.034; β-sitosterol: p = 0.080) portfolio groups compared to control. Plasma cholesterol-adjusted campesterol and β-sitosterol concentrations were negatively correlated (p < 0.001) with total and LDL-C levels. Conclusion Results demonstrate that consuming a portfolio diet reduces serum total and LDL-C levels while increasing PS values, without altering fat soluble compounds concentrations. The extent of increments of PS with the current study are not deleterious and also maintaining optimum levels of fat soluble vitamins are of paramount necessity to maintain overall metabolism and health. Results indicate portfolio diet as one of the best options for CVD risk reduction. Trial registration clinicaltrials.gov Identifier: NCT0043842

Consumption of a dietary portfolio of cholesterol lowering foods improves blood lipids without affecting concentrations of fat soluble compounds

Background: Consumption of a cholesterol lowering dietary portfolio including plant sterols (PS), viscous fibre, soy proteins and nuts for 6 months improves blood lipid profile. Plant sterols reduce blood cholesterol by inhibiting intestinal cholesterol absorption and concerns have been raised whether PS consumption reduces fat soluble vitamin absorption. Objective The objective was to determine effects of consumption of a cholesterol lowering dietary portfolio on circulating concentrations of PS and fat soluble vitamins. Methods Using a parallel design study, 351 hyperlipidemic participants from 4 centres across Canada were randomized to 1 of 3 groups. Participants followed dietary advice with control or portfolio diet. Participants on routine and intensive portfolio involved 2 and 7 clinic visits, respectively, over 6 months. Results No changes in plasma concentrations of α and γ tocopherol, lutein, lycopene and retinol, but decreased β-carotene concentrations were observed with intensive (week 12:p = 0.045; week 24:p = 0.039) and routine (week 12:p = 0.031; week 24:p = 0.078) portfolio groups compared to control. However, cholesterol adjusted β-carotene and fat soluble compound concentrations were not different compared to control. Plasma PS concentrations were increased with intensive (campesterol:p = 0.012; β-sitosterol:p = 0.035) and routine (campesterol: p = 0.034; β-sitosterol: p = 0.080) portfolio groups compared to control. Plasma cholesterol-adjusted campesterol and β-sitosterol concentrations were negatively correlated (p < 0.001) with total and LDL-C levels. Conclusion Results demonstrate that consuming a portfolio diet reduces serum total and LDL-C levels while increasing PS values, without altering fat soluble compounds concentrations. The extent of increments of PS with the current study are not deleterious and also maintaining optimum levels of fat soluble vitamins are of paramount necessity to maintain overall metabolism and health. Results indicate portfolio diet as one of the best options for CVD risk reduction. Trial registration clinicaltrials.gov Identifier: NCT00438425Medicine, Faculty ofPathology and Laboratory Medicine, Department ofNon UBCReviewedFacult