Analytical study of an iron deficiency anemia during pregnancy at tertiary care center

Background: Anemia is a serious global public health problem affecting both developing and developed countries in reproductive age group. India contributes to about 80% of the maternal deaths due to anemia in south Asia. The objective was to analyse maternal and fetal outcome in anemic pregnant patients as compared to non anemic pregnant patients. Methods: This analytical study of 100 patients (50 anemic and 50 control groups) was conducted in department of obstetrics and gynecology, at tertiary care hospital, Surat from September 2022 to June 2023. Results: 56% were booked against 86% in the control group.44% were unbooked against 14% in the control group.66% in cases and 76% in controls were in majority age group of 21-29 years. 68% of the anemic women were multigravida as 50% in the control group.66% of the cases and 34% of the controls belongs to low socioeconomic class. Out of 50 cases of anemia 28% mild, 32% moderate and 40% severe degree. 32% anemic patients were managed with oral iron, 20% with parenteral iron therapy and 48% with blood transfusion. In cases, preeclampsia in 14 patients, preterm in 13 patients, PPH in 4 patients, while in control group 5 patients had preeclampsia, 6 patients had preterm labour and 2 patients had PPH. 1% maternal mortality in cases and zero in control groups. Conclusions: Antenatal management with correcting prenatal anemic status with dietary advises, prophylactic iron therapy, planned pregnancy with ensuring maternal iron sufficiency during gestation is most effective method.

Study of cervical pap smears in a tertiary care hospital of south Gujarat, India

Background: In India cervical cancer is the leading cause of morbidity and mortality. Cancer of cervix is preventable, and can be diagnosed at the pre-malignant/pre-invasive stage with adequate and repetitive cytological screening by Papanicolaou (Pap) smears.  Methods: The prospective study includes total 1425 patients who were presented with various gynecological problems. Samples were taken and prepared smear were stained with PAP stain. Reporting was carried out by two independent cytopathologist as per Bethesda system.Results: Total 1425 patients were screened; there were 1034 (72.56%) abnormal Pap smears, with 354 (24.84%) normal cases and 37 (2.59%) unsatisfactory or inadequate samples. Total 27 (1.89%) cases showed epithelial cell abnormalities. ASCUS was the most commonly found (40.74%) epithelial cell abnormality out of 27 cases.Conclusions: Incidence of invasive cervical malignancy can be prevented if Pap screening program is effectively implemented in target population

Retrograde study of patients with adenomyosis at tertiary health centre, a spectrum from clinical presentation to its final diagnosis and treatment

Background: Adenomyosis is a disease where ectopic endometrial glands affect the muscular wall of the uterus. It is considered a specific entity in the PALM-COEIN FIGO (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified- International Federation of Gynaecology and Obstetrics). Aims and objectives were to diagnose adenomyosis accurately with help of data of clinical findings and imaging modalities. Methods: It was a retrospective study done at tertiary hospital, Junagadh from June 2022 to November 2022. The HPE reports and case records of all the hysterectomy specimen were reviewed. Data regarding age, parity, symptoms, obstetric history, examinations, co-morbidities, investigation findings and treatment modalities were noted. They were tabulated and analysed. Results: Out of the 50 patients, 30 patients (60%) were in the age group of 41-50 years. The prevalence of adenomyosis in our study was only 6% in post-menopausal women when compared to the age group 41-50 years (60%). Multiparous women had 92% incidence of adenomyosis. 62% had menstrual disturbances. Dysmenorrhea and dyspareunia were the next common symptoms. Fibroid was the commonest associated pathology 44%. 32% had endometrial hyperplasia, whereas 68% had no pathology. Imaging picked up only 36% of cases contrary to 28% of clinical diagnosis and was raised to 64% with gross examination of specimen and 100% with HPE. Conclusions: Better modality to diagnose adenomyosis is clinical presentation. USG failed to diagnose all the cases. Gold standard modality is histopathological examination

Death due to sickle cell anaemia, an autopsy diagnosis: a study at a tertiary care hospital

Background: Sickle cell disease (SCD) is the generic term for the group of inherited haemoglobinopathies caused by the occurrence of Haemoglobin S (HbS) in the homozygous or heterozygous form in combination of Hbs with another abnormal haemoglobin such as HbSC or beta-thalassaemias (HbS-thal). Sickle cell syndromes are remarkable for their clinical heterogeneity, including their presentations as sudden and unexpected deaths due to a sickle cell crisis. Less numbers of deaths are reported due to this cause because of ignorance of autopsy surgeon in considering this disease as a cause of death despite of its high prevalence. While doing autopsy in cases of deaths with no apparent cause and physical over activity medical officer must keep in mind the possibility of death due to vaso-occlusive crisis in sickle cell disease.  Methods: The study covers a period of one year (January 2013 - December 2013) and it is a study of cases of autopsy carried out in a tertiary care hospital of South Gujarat.Results: A total of 607 cases examined, out of which sickled red blood cells were detected in 17 cases. The respective records were reviewed. Out of 17 cases, 13 cases were male and 4 cases were females. The youngest person was 15 years female and oldest was 70 years male.  Conclusion: Sickle cell crisis is one of the causes of sudden unexplained deaths. The present study highlights the role of autopsy in such cases. Community awareness and marriage counseling programs are also helpful in preventing sickle cell disease.

A study of role of doppler in gestational hypertension and perinatal outcome

Background: Hypertensive disorder of pregnancy is one of the most common complications that affect the human pregnancy. Hence it is important to identify women at risk of developing gestational hypertension or preeclampsia, its early diagnosis and subsequent consequences due to uteroplacental insufficiency with help of Doppler ultrasound, to improve perinatal outcome. The objective of this study was to study the application of Doppler ultrasound with analysis of blood flow velocity waveform in gestational hypertension and to examine and study the perinatal outcome in pregnancy with altered Doppler indices.Methods: A prospective study was carried out in 50 antenatal patients diagnosed to have gestational hypertension during a period of 12 months to evaluate the role of color Doppler imaging in gestational hypertension in patients more than 28 weeks of gestation, the initial scan was performed immediately after the diagnosis. This study analyzed the blood flow in umbilical artery, maternal uterine artery and fetal middle cerebral artery using Doppler ultrasound.Results: In this study approximately 76% of cases were found in 20-30 years group. 58% showed abnormal umbilical artery Doppler while 42% women had normal umbilical artery Doppler. In this study 23 cases had cerebro-placental index 1. Cases with cerebro-placental index <1 had various complications like preterm delivery, low birth weight, increased chances of still birth, intra uterine death (IUD), increased NICU admission. In this study 31 cases had abnormal uterine artery Doppler which accounts for 62% of total cases, while 38% had normal uterine artery Doppler.Conclusions: Doppler ultrasound can reliably predict any adverse fetal outcome in hypertensive pregnancies and can be a useful tool for decision making in appropriate timing of intervention for delivery

A study of fetomaternal outcome in elderly primigravida

Background: Elderly primigravida is defined as all women going through their first pregnancy over the age of ≥35 years. They are considered to be categorized as high-risk pregnancy. Advanced contraception methods and artificial reproductive technology have played key role in delaying the pregnancy. Methods: A retrospective study of fetomaternal outcome in elderly primigravida was conducted at department of obstetrics and gynecology, GMERS medical college, Junagadh from 1st September 2021 to 1st August 2022. All the patient data was obtained from their case records and indoor files and were followed up till delivery for fetal outcome. Results: There were 54 elderly primigravida patients in our study with an incidence of 1.05% based on the inclusion criteria with 96.3% between the age 35-40 years. Most common reason for delayed child bearing was pursuing higher education and work preferences. Gestational hypertension was most common maternal complication (48%), associated with preeclampsia in 28%. Among fetal complications 46% had low birth weight, 38.5% had IUGR. 54% patients had delivered by LSCS. Conclusions: Although elderly primigravida is considered a high-risk pregnancy with increased maternal and fetal complications, proper antenatal care, early recognition of maternal risk factors with timely intervention pregnancy outcome can be improved

Changes in WBC and platelet count in patients with malaria: a hospital based comparative study

Introduction: Malaria is one of the most common infectious diseases of tropics. It presents with varied clinicopathological manifestations. Most of the complication in malaria occurs due to various hematological abnormalities. Present study was aimed to find out abnormalities in WBC and platelet counts in patients with malaria. Methods: A total 135 patients either hospitalized or treated on an outpatient basis were included in the study after positive identification for malarial parasites on Giemsa stained PSMP smears. WBC and platelet count was carried out on 3 part hematology analyzer (Sysmax KX 21). WBC count less than 4000/cumm was considered as leucopenia and platelet count less than 150000/cumm was considered as thrombocytopenia. Results: The present study includes 135 patients with malaria from which 72.59% of subjects were male and 27.41% of subjects were female. P. falciparum was present in 68.89% of cases, P. vivax in 28.15% of cases. Majority of patients had normal leucocyte count (97.03%). Neutrophilia with lymphopenia was observed in both species of malaria in our study. Thrombocytopenia was observed in89.62% of cases in malaria. Thrombocytopenia in P. falciparum was found in 92.48% of cases and in P. vivax it was 81.57% of cases. Conclusion: Present study did not show any significant change in WBC count. Present study showed neutrophilia with relative lymphopenia in both group of malaria. Incidence of thrombocytopenia was observed in both species of malaria without any statistical significance.

Medical Futility: The Ethical Dilemma

This presentation will navigate the framework of medical futility, and try to understand what it means to provide care to a growing elderly population in the face of limited resources and futile medical treatment. This will be done by illustrating how medical futility is utilized in healthcare settings, problems with the current framework, and the ethical implications of adopting medical futility as a way of determining how much care a patient receives because what constitutes “futile” is subjective

An Investigation of the Big Five and Narrow Personality Traits in Relation to Life Satisfaction

The present study focuses on the relationship between personality and Life Satisfaction. I analyzed the Big Five traits, six Narrow personality traits, and levels of Life Satisfaction in a sample of 5,932 individuals. A review of existing literature on other variables that contribute to Life Satisfaction was also conducted and used to measure against personality traits. The narrow traits added variance above and beyond the Big Five personality traits. All the Big Five traits and Optimism, Assertiveness, Intrinsic Motivation, and Tough-Mindedness were significantly and positively correlated with Life Satisfaction. Image Management was significantly and negatively correlated with Life Satisfaction. Results were discussed in terms of the relation of personality traits to Life Satisfaction and the amount narrow personality traits related to Life Satisfaction after controlling for the Big Five. Explanations were offered as to how these traits might have value in relation to Life Satisfaction

An Evaluation of How Strategic Financial Management Enhances Performances of Small & Medium Enterprises in the Nairobi County

A Research Project Report Submitted to the Chandaria School of Business in Partial Fulfilment of the Requirement for the Degree of Masters in Business Administration (MBA)The purpose of this study was to evaluate how strategic financial management can improve the performances of Small and Medium Enterprises (SMEs) in Nairobi. The study sought to answer the following questions: What are the components for the formulation of Strategic Financial Management for SMEs? What are the potential alternatives for implementation of Strategic Financial for SMEs? And lastly, What are the challenges against Strategic Financial Management for SMEs. This study tends to be important for the Kenyan economy as a whole, for various investors, business managers, and the general public. The research had also taken into consideration concepts, methodologies as well as theories on the foundation which had been built by various other researchers in the past, which has been elaborated in the literature review, which sets the core of the study from different perspectives.The research used descriptive and explanatory research design to evaluate the performance of the variables in order to justify the research findings. The data that was examined for the purpose of the study contained both secondary and primary data which was obtained by central bank of Kenya, the Kenya Chamber of Commerce and Industry and data was also obtained through filled questionnaires from the selected sample of operating SMEs. The population of the study were from the SMEs which were situated in industrial area, according to the data obtained there were ten thousand SMEs located in industrial area. The study used purposive and random sampling technique to select a sample of fifty one SMEs, upon which the data was gathered. The study used descriptive statistics and inferential statistics such as correlation to answer the research questions. Statistical Package for the Social Sciences was the tool used to analyse the data collected through descriptive and inferential statistics. Furthermore the analysed data was presented using tables. The findings of the study indicated that there was significant relationship between the components for the formulation of strategic financial management and the performance of SMEs. There were four major components which were dealt with in order to bring out the concept of Strategic Financial Management in SMEs, from the results that were obtained an average of 80% of the SMEs have the respective four components in access in their organization. However, there was still a gap of 20% downpour which also needs to be incorporated, never the less the milestones have been put in place for the Small and Medium Enterprises. Secondly, the results obtained also determined that there was significant relationship between implementation of Strategic Financial management and the performance of SMEs. There were eight major factors which were tackled under the implementation procedures so as to get the most appropriate success for the running of the SMEs. The results showed that an average of 85% of the SMEs positively inhabited the implementation factors and techniques in the organization, creating a ladder of improvement and development for the Small and Medium Enterprises. However, there was no significant relationship that was drawn towards some factors for implementation that now needs to be taken into consideration in further researches.Thirdly, SMEs are the growing business opportunities in the country, due to their respective constrains which put a halt in their progress, similarly, there are challenges against Strategic Financial management, that needed to be taken into consideration for SMEs while implementing Strategic Management. There were five major elements that were taken into consideration under the challenges against Strategic Financial management for SMEs. The results which were obtained from the research showed that with an average of 80% of the SMEs taken into consideration, that there was no significant relationship between challenges against strategic financial management and the performance of SMEs. Concluding that more precision needs to be put under for these factors to gauge some level of accuracy. From the results, the researcher concluded that, there needs to be a strict precision of rules that need to be incorporated to enhance that the components of strategic financial management are taken into consideration in the SMEs. Furthermore when it is about the implementation process, then appropriate implementation techniques need to be elaborated and imbibed in the organization, to achieve respective growth, additionally, there will be the need of the local government to put in an initiative especially for SMEs so that the organizations are able to successfully operate in the competitive environment. Therefore, lastly once the components and the implementation of strategic financial management is done with effectiveness and efficiency, then the room for challenges is no longer likely to be in existence. The overall conclusion drawn from the study is that finance is the key to any successful business and in the similar way incorporation of Strategic Financial Management in SMEs, will definitely improve the performance of the SMEs. Major recommendations for improvement were: to encourage more government intervention to support the growing market of SMEs in Nairobi, through which they will be able to boost up the performances of SMEs, Secondly, wide and broad research coverage is recommended for a more precise and elaborate research outcome, as the population of SMEs is very high in Nairobi and it wasn’t possible in this study to be able to carry out wide-spread analysis