Knowledge of obesity and its effects on cardiometabolic and reproductive health in women

Background: Obesity is following a raising trend in India. Being a major risk factor for various diseases, awareness should be raised among people regarding this issue. The objective of the study was to assess knowledge of obesity and its ill effects on cardio metabolic and reproductive health in women.Methods: This was a prospective survey study done on women visiting gynecology OPD at Rajarajeswari Medical College and Hospital. 300 Subjects were randomly picked and were administered a questionnaire on the health risks of obesity, that is,  its effect on cardio metabolic status, reproductive outcome in terms of infertility and spontaneous abortions and obesity related cancers such as endometrial and breast cancers.  Height and weight measurements of the study subjects were measured.Results: Subjects' age ranged from 19 to 47 years (mean SD: 28.72 ± 6.52). subjects who were aware that obesity increases the risk of various diseases were: diabetes  (85.3% ) ,  blood pressure (88.7%), raised cholesterol levels in the blood(90.7%), infertility (84%), irregular periods (62%), abortions (44%),arthritis (86.7% ),  breast cancer (36%) , endometrial cancer (36.7% ).Conclusions: Women in our study have good knowledge about obesity and its effect on general health and cardio metabolic diseases, fair knowledge about reproductive outcomes. They are less aware of the association of obesity and sex hormone sensitive cancers like endometrial and breast cancers.  Public education is needed to increase awareness of obesity and malignancy

Emergency cervical cerclage and pregnancy outcomes

Background: To evaluate the effectiveness and safety of emergency cervical cerclage in women who presented with advanced cervical changes such as cervical dilatation and bulging foetal membranes.Methods: This is a retrospective study on all women treated with cervical cerclage presented in the late second trimester with advanced cervical dilatation (2 to 4cms) for whom emergency cervical cerclage by McDonald technique.Results: Out of the 24 patients for whom emergency cervical cerclage was performed, three patients had spontaneous abortion after cervical cerclage, two had PROM and eight of these patients had term delivery. Twenty-one fetus were live born after the period of viability. Nine of these babies were admitted to NICU and 50 percent of the neonates required only regular perinatal care.Conclusions: Post emergency cervical cerclage, the outcome in terms of prolongation of pregnancy, live births and neonatal survival is better

Comparison of Doppler findings and neonatal outcome in fetal growth restriction

Background: Fetal growth restriction (FGR) affects up to 5-10% of pregnancies. It is associated with increased perinatal mortality and morbidity. Doppler studies identify at risk fetuses and help in timing interventions and prognosticate outcomes. The ability of Doppler studies to predict neonatal outcome is studied here.Methods: Prospective study of seventy-two women with singleton pregnancies with gestational age above 28 week and detected to have FGR was done. The patients were subjected to Doppler analysis. Abnormal Doppler indices were compared with neonatal outcomes such as NICU admission, ventilator or CPAP support, sepsis, phototherapy and perinatal mortality.Results: Elevated umbilical artery PI, reduced middle cerebral artery PI and low CP ratio were found in 14, 18 and 36 fetuses. The sensitivity and specificity in predicting neonatal outcome was 25% & 75%, 58.1% and 62% and 17.9% and 75% for umbilical artery PI, MCA PI and CP ratio respectively. None of the Doppler indices showed significant p value. On testing, gestational age at delivery and length of NICU stay, gestational age was a significant determining factor with ‘p’ value of 0.003.Conclusions: Antenatal Doppler analysis of UA and MCA can predict neonatal outcome in FGR fetuses. Though the ‘p’ value was not significant in this study, the sensitivity, specificity, positive predictive value and negative predictive value are comparable to other studies. Gestational age at delivery significantly influences neonatal outcome

Prospective study of primary amenorrhoea and its management in a rural tertiary centre

Background: Amenorrhoea (absence of menstruation) is a symptom of varied causes. It results from dysfunction of hypothalamic-pituitary ovarian axis, uterus and vagina. It is a major concern for pubertal girls and their family members. It has a major impact on the physical, mental, psychological and social life of the girl and her family. The objective of the present study was to evaluate the aetiology and management of primary amenorrhoea in young adolescent girls.Methods: It was a prospective study conducted for a period of 2 years from August 2016 to July 2018 at Rajarajeswari medical college and hospital. Patients presenting with history of amenorrhoea that is, absence of menses by the age of 13 years with no visible development of secondary sexual characteristics or by 15 years of age with the presence of normal secondary sexual characteristics were included in our study. Cases of secondary amenorrhoea were excluded. Detailed history, examination, investigations and management was documented and analysed.Results: A total of 25 patients of primary amenorrhea were studied during the study period. In our study outflow tract anomalies were the commonest cause of amenorrhoea accounting for 84%, of which imperforate hymen (32%) and Mayer Rokitansky Küster Hauser syndrome (MRKH) 36% were the two most common Mullerian anomaly causing primary amenorrhoea. Gonadal dysgenesis accounted for 12% of the cases. Amenorrhoea was the commonest complaint patients presented with accounting to 76%, followed by cyclical pain abdomen accounting for 16% of cases.Conclusions: Primary amenorrhoea is multifactorial and is of major concern among adolescent girls. Early diagnosis and intervention has an impact on the physical and psychological wellbeing of the girl

The outcome of laparoscopic management of adnexal pathology complicating pregnancies

Background: Adnexal pathology found during pregnancy is relatively common and the reported incidences are population and investigation dependent. The most frequent types of adnexal masses are corpus luteum cysts, endometriomas, benign cystadenomas and mature cystic teratomas. The objective was to study the feasibility of laparoscopic management of adnexal pathology in pregnancy, maternal complications and fatal outcome. We have reported 25 cases of adnexal pathology complicating pregnancy, managed successfully laparoscopically with no maternal and fetal complications.Methods: The study is based on the outcome of laparoscopic management of adnexal pathology in 25 pregnant women over period of eight years. Laparoscopy was done using three port technique, 10 mm umbilical or supra umbilical port for optics and two lateral ports for instrumentation. Cystectomy was the most common procedure.Results: There was no intra or post-operative complication observed in the study. Successful obstetric outcome in all the patients with no complications was observed.Conclusions: Laparoscopy is preferred for exploration and treatment of adnexal masses especially between 14 to 25 weeks of gestation

Knowledge of obesity and its effects on cardiometabolic and reproductive health in women

Background: Obesity is following a raising trend in India. Being a major risk factor for various diseases, awareness should be raised among people regarding this issue. The objective of the study was to assess knowledge of obesity and its ill effects on cardio metabolic and reproductive health in women. Methods: This was a prospective survey study done on women visiting gynecology OPD at Rajarajeswari Medical College and Hospital. 300 Subjects were randomly picked and were administered a questionnaire on the health risks of obesity, that is, its effect on cardio metabolic status, reproductive outcome in terms of infertility and spontaneous abortions and obesity related cancers such as endometrial and breast cancers. Height and weight measurements of the study subjects were measured. Results: Subjects age ranged from 19 to 47 years (mean SD: 28.72 +/- 6.52). subjects who were aware that obesity increases the risk of various diseases were: diabetes (85.3% ) , blood pressure (88.7%), raised cholesterol levels in the blood(90.7%), infertility (84%), irregular periods (62%), abortions (44%),arthritis (86.7% ), breast cancer (36%) , endometrial cancer (36.7% ). Conclusions: Women in our study have good knowledge about obesity and its effect on general health and cardio metabolic diseases, fair knowledge about reproductive outcomes. They are less aware of the association of obesity and sex hormone sensitive cancers like endometrial and breast cancers. Public education is needed to increase awareness of obesity and malignancy. [Int J Reprod Contracept Obstet Gynecol 2016; 5(1.000): 143-147

Comparison of the boronic acid disk potentiation test and cefepime-clavulanic acid method for the detection of ESBL among AmpC-producing Enterobacteriaceae

Purpose: Extended spectrum β-lactamase (ESBL) and AmpC β-lactamase are important mechanisms of betalactam resistance among Enterobacteriaceae . The ESBL confirmation test described by Clinical Laboratory Standards Institute (CLSI) is in routine use. This method fails to detect ESBL in the presence of AmpC. Therefore, we compared two different ESBL detection methods against the CLSI confirmatory test. Materials and Methods: A total 200 consecutive clinical isolates of Enterobacteriaceae from various clinical samples were tested for ESBL production using (i) CLSI described phenotypic confirmatory test (PCT), (ii) boronic acid disk potentiation test and (iii) cefepime-CA disk potentiation method. AmpC confirmation was done by a modified three-dimensional test. Results: Among total 200 Enterobacteriaceae isolates, 82 were only ESBL producers, 12 were only AmpC producers, 55 were combined ESBL and AmpC producers, 14 were inducible AmpC producers and 37 isolates did not harboured any enzymes. The CLSI described PCT detected ESBL-producing organisms correctly but failed to detect 36.3% of ESBLs among combined enzyme producers. The boronic acid disk potentiation test reliably detected all ESBL, AmpC, and combined enzyme producers correctly. The cefepime-CA method detected all ESBLs correctly but another method of AmpC detection has to be adopted. Conclusion: The use of boronic acid in disk diffusion testing along with the CLSI described PCT enhances ESBL detection in the presence of AmpC betalactamases