An observational study of effect of Mullerian anomalies on pregnancy

Background: Mullerian anomalies occur in approximately 3-4% of fertile and infertile women, 5–10% of women with recurrent early pregnancy loss, and up to 25% of women with late first or second-trimester pregnancy loss or preterm delivery. However, due to low prevalence rate and asymptomatic course of the anomalies, Mullerian anomalies remain underdiagnosed and often overlooked as a possible cause of recurrent pregnancy failures, preterm deliveries, IUGR and low birth weight.Methods: Total of 30 cases of Mullerian anomalies with pregnancy, prior diagnosed or incidental during LSCS, were studied for complications during pregnancy, history of gynecological complaints and rate of diagnosis with routine imaging technique.Results: Septate uterus was the most common anomaly seen in this study (36.6%).56.6% were diagnosed incidentally during LSCS despite the fact 26.6% of cases had history of 2 or more abortions and 30% had some or other gynecological complaints previously. 10% of pregnancies ended in abortions, 20% had preterm delivery, 36.6% had malpresentations and there was case of rupture uterus (03.3%).Conclusions: Mullerian anomalies are often asymptomatic or have subtle gynecological symptoms which are often missed by both patient and gynecologists. It is observed that due to the asymptomatic course of Mullerian anomalies, invasive nature of HSG and lack of 1.5 Tesla MRI at many institutes leads to low rate of diagnosis of Mullerian anomalies. Pregnancy with Mullerian anomalies often have preterm delivery, IUGR and malpresentation, so, require proper counselling and close monitoring during antenatal period

Detection of Wormhole Attack using Hop-count and Time delay Analysis

Abstract- MANET, due to the nature of wireless transmission, has more security issues compared to wired environments. In this paper we specifically considering Tunneling attack which does not require exploiting any nodes in the network and can interfere with the route establishment process. Instead of detecting suspicious routes as in previous methods, we implement a new method which detects the attacker nodes and works without modification of protocol, using a hop-count and time delay analysis from the viewpoint of users without any special environment assumptions. The proposed work is simulated using OPNET and results showing the advantages of proposed work. Index Terms- Ad hoc network, hop-count analysis, network security, Tunneling attack

Husband's Alcohol Use, Intimate Partner Violence, and Family Maltreatment of Low-Income Postpartum Women in Mumbai, India.

Husbands' alcohol use has been associated with family-level stress and intimate partner violence (IPV) against women in India. Joint family systems are common in India and IPV often co-occurs with non-violent family maltreatment of wives (e.g., nutritional deprivation, deprivation of sleep, blocking access to health care). Alcohol use increases for some parents following the birth of a child. This study examined 1,038 postpartum women's reports of their husbands' alcohol use and their own experiences of IPV (by husband) and non-violent maltreatment from husbands and/or in-laws. We analyzed cross-sectional, quantitative data collected in 2008, from women (ages 15-35) seeking immunizations for their infants <6 months at three large urban health centers in Mumbai, India. Crude and adjusted logistic regression models estimated associations between the independent variable (husbands' past month use of alcohol) and two dependent variables (postpartum IPV and maltreatment). Overall, 15% of husbands used alcohol, ranging from daily drinkers (10%) to those who drank one to two times per week (54%). Prevalence of postpartum IPV and family maltreatment was 18% and 42%, respectively. Prevalence of IPV among women married to alcohol users was 27%. Most abused women's husbands always (27%) or sometimes (37%) drank during violent episodes. Risk for IPV increased with a man's increasing frequency of consumption. Women who lived with a husband who drank alcohol, relative to non-drinkers, were more likely to report postpartum IPV, aOR = 2.0, 95% confidence interval (CI) = [1.3, 3.1]. Husbands' drinking was marginally associated with increased risk for family maltreatment, aOR = 1.4, 95% CI = [1.0, 2.1]. Our findings suggest that men's alcohol use is an important risk factor for postpartum IPV and maltreatment. Targeted services for Indian women contending with these issues are implicated. Postpartum care offers an ideal opportunity to screen for IPV, household maltreatment, and other health risks, such as husband's use of alcohol. There is need to scale up proven successful interventions for reducing men's alcohol use and design strategies that provide at-risk women protection from alcohol-related IPV

CHARM, a gender equity and family planning intervention for men and couples in rural India: protocol for the cluster randomized controlled trial evaluation.

BackgroundGlobally, 41% of all pregnancies are unintended, increasing risk for unsafe abortion, miscarriage and maternal and child morbidities and mortality. One in four pregnancies in India (3.3 million pregnancies, annually) are unintended; 2/3 of these occur in the context of no modern contraceptive use. In addition, no contraceptive use until desired number and sex composition of children is achieved remains a norm in India. Research shows that globally and in India, the youngest and most newly married wives are least likely to use contraception and most likely to report husband's exclusive family planning decision-making control, suggesting that male engagement and family planning support is important for this group. Thus, the Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention was developed in recognition of the need for more male engagement family planning models that include gender equity counseling and focus on spacing contraception use in rural India.Methods/designFor this study, a multi-session intervention delivered to men but inclusive of their wives was developed and evaluated as a two-armed cluster randomized controlled design study conducted across 50 mapped clusters in rural Maharashtra, India. Eligible rural young husbands and their wives (N = 1081) participated in a three session gender-equity focused family planning program delivered to the men (Sessions 1 and 2) and their wives (Session 3) by village health providers in rural India. Survey assessments were conducted at baseline and 9&18 month follow-ups with eligible men and their wives, and pregnancy tests were obtained from wives at baseline and 18-month follow-up. Additional in-depth understanding of how intervention impact occurred was assessed via in-depth interviews at 18 month follow-up with VHPs and a subsample of couples (n = 50, 2 couples per intervention cluster). Process evaluation was conducted to collect feedback from husbands, wives, and VHPs on program quality and to ascertain whether program elements were implemented according to curriculum protocols. Fidelity to intervention protocol was assessed via review of clinical records.DiscussionAll study procedures were completed in February 2015. Findings from this work offer important contributions to the growing field of male engagement in family planning, globally.Trial registrationClinicalTrial.gov, NCT01593943

Climate Change Impacts and Adaptation in a Hill Farming System of the Himalayan Region: Climatic Trends, Farmers’ Perceptions and Practices

Farming communities in the hills and mountains of the Himalayan region are some of the most vulnerable to the changing climate, owing to their specific biophysical and socioeconomic conditions. Understanding the observed parameters of the changing climate and the farmers’ perceptions of it, together with their coping approaches, is an important asset to making farming communities resilient. Therefore, this study aimed to explore the observed change in climatic variables; understand farmers’ perceptions of the changing climate; and document their adaptation approaches in farming systems in the mid-hills of the central Himalayas. Data on the observed change in climatic variables were obtained from the nearby meteorological stations and gridded regional products, and farmers’ perceptions and their adaptation practices were collected from household surveys and from the interviews of key informants. The analysis of temperature data revealed that there has been a clear warming trend. Winter temperatures are increasing faster than summer and annual temperatures, indicating a narrowing temperature range. Results on precipitation did not show a clear trend but exhibited large inter-annual variability. The standardized precipitation index (SPI) showed an increased frequency of droughts in recent years. Farmers’ perceptions of the changing climate are coherent with the observed changes in climatic parameters. These changes may have a substantial impact on agriculture and the livelihood of the people in the study area. The farmers are adapting to climate change by altering their farming systems and practices. Location-specific adaptation approaches used by farmers are valuable assets for community resilience

Climate Change Impacts and Adaptation in a Hill Farming System of the Himalayan Region: Climatic Trends, Farmers’ Perceptions and Practices

Farming communities in the hills and mountains of the Himalayan region are some of the most vulnerable to the changing climate, owing to their specific biophysical and socioeconomic conditions. Understanding the observed parameters of the changing climate and the farmers’ perceptions of it, together with their coping approaches, is an important asset to making farming communities resilient. Therefore, this study aimed to explore the observed change in climatic variables; understand farmers’ perceptions of the changing climate; and document their adaptation approaches in farming systems in the mid-hills of the central Himalayas. Data on the observed change in climatic variables were obtained from the nearby meteorological stations and gridded regional products, and farmers’ perceptions and their adaptation practices were collected from household surveys and from the interviews of key informants. The analysis of temperature data revealed that there has been a clear warming trend. Winter temperatures are increasing faster than summer and annual temperatures, indicating a narrowing temperature range. Results on precipitation did not show a clear trend but exhibited large inter-annual variability. The standardized precipitation index (SPI) showed an increased frequency of droughts in recent years. Farmers’ perceptions of the changing climate are coherent with the observed changes in climatic parameters. These changes may have a substantial impact on agriculture and the livelihood of the people in the study area. The farmers are adapting to climate change by altering their farming systems and practices. Location-specific adaptation approaches used by farmers are valuable assets for community resilience

Maternal morbidity associated with violence and maltreatment from husbands and in-laws: findings from Indian slum communities.

BackgroundIntimate partner violence (IPV) victimization is linked to a broad range of negative maternal health outcomes. However, it is unclear whether IPV is directly related to poor maternal outcomes or whether IPV is a marker for other forms of chronic, mundane maltreatment of women that stem from the culture of gender inequity that also gives rise to IPV. To determine the prevalence of non-violent forms of gender-based household maltreatment by husbands and in-laws (GBHM), and violence from in-laws (ILV) and husbands (IPV) against women during the peripregnancy period (during and in the year prior to pregnancy); to assess relative associations of GBHM, ILV and IPV with maternal health.MethodsCross-sectional data were collected from women <6 months postpartum (n = 1,039, ages 15-35 years) seeking child immunization in Mumbai, India. Associations of IPV, ILV and GBHM during the peripregnancy period with maternal health (prenatal care in first trimester, no weight gain, pain during intercourse, high blood pressure, vaginal bleeding, premature rupture of membranes, premature birth) were evaluated.ResultsOne in three women (34.0 %) reported IPV, 4.8 % reported ILV, and 48.5 % reported GBHM during the peripregnancy period. After adjusting for other forms of abuse, IPV related to pain during intercourse (AOR = 1.79); ILV related to not receiving first trimester antenatal care (AOR = 0.49), and GBHM remained associated with premature rupture of membranes (AOR = 2.28), pain during intercourse (AOR = 1.60), and vaginal bleeding (AOR = 1.80).ConclusionAfter adjusting for ILV and IPV, peripregnancy GBHM remained significantly associated with multiple forms of maternal morbidity, suggesting that GBHM is a prevalent and reliable indicator of maternal health risk

A retrospective analysis of drug resistance in M. tuberculosis and role of CBNAAT, LPA and culture in diagnosis

Background: Nucleic acid detection has potentially revolutionized diagnosis of tuberculosis and has established as a screening test of choice. However, conclusions on its role in diagnosing extrapulmonary infection and discordance between drug susceptibility reported through culture, Xpert MTB/ RIF, line probe assay require further review. Objectives were to compare positivity rate of Xpert MTB/RIF ULTRA across various sample types; compare drug susceptibility percentage of Mycobacterium tuberculosis (M. tb) across three platforms i.e., culture, Xpert MTB/RIF and LPAMethods: A retrospective analysis of results of samples was undertaken for a period of one year for Xpert MTB/RIF ultra and three years for LPA and susceptibility through MGIT.Results: Xpert MTB/ RIF Ultra showed overall positivity of 26%, with 10% rifampicin resistance; genitourinary sample positivity was 4%. First line LPA recorded 26% Rif resistance and very few Rifampicin indeterminates. Second line LPA revealed 5.4% aminoglycoside resistance and 26% fluoroquinolone resistance. Through MGIT Rif resistance was 18.2%, multidrug resistance 17.5%, isoniazid monoresistance 6.6%, FQ resistance 18.6%, MDR with FQ resistance 18.6%, amikacin resistance 4% and streptomycin resistance 18%.Conclusions: Xpert MTB/ RIF should be used as a test of choice for detection; Rifampicin resistance should be confirmed with LPA. However, for GUN, pleural fluid and GIT tissue samples; an additional culture should be attempted on the primary sample to improve detection rates. Drug resistance detected through LPA should be phenotyped especially for fluoroquinolones. Moxifloxacin and amikacin could be empirical antibiotics of choice over ofloxacin and Kanamycin due to lower resistance percentage recorded for them