Correlation of serum Nesfatin 1 level with metabolic and clinical parameters in Indian women with and without polycystic ovarian syndrome

Background: Objective of the study was to compare serum Nesfatin 1 levels in Indian women with and without polycystic ovarian syndrome (PCOS) and to evaluate the association of serum Nesfatin 1 with metabolic and clinical parameters. Methods: 40 PCOS and 40 age and body mass index (BMI) matched non PCOS controls were enrolled. Comparison of hormonal (serum Nesfatin 1, anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone, and estadiol) metabolic (blood pressure, fasting and post prandial blood glucose and insulin, HOMA-IR) and clinical (acne, acanthosis nigricans and hirsutism) parameters was done between two groups. Student’s t test, Mann Whitney test, Pearson’s correlation test was used. P value of <0.05 was considered statistically significant. Results: There was a significant difference in levels of serum Nesfatin 1 in PCOS subjects and controls (8.6 ng/ml versus 0.75 ng/ml, p<0.01). Positive correlation was present between serum nesfatin 1 level and post prandial plasma glucose (r=0.009; p<0.009). A positive correlation was also present between serum Nesfatin 1 levels and AMH (r=0.512; p<0.01). No correlation was found between serum Nesfatin 1 and other endocrine, cardiovascular and metabolic parameters. Serum LH levels, LH/FSH ratio, post prandial plasma glucose and post prandial insulin were significantly higher (p<0.05) in PCOS subjects compared to controls. Conclusions: Nesfatin 1 levels were ten times higher in PCOS subjects compared to controls irrespective of age and BMI. A positive correlation was observed between serum Nesfatin 1 and post prandial plasma glucose levels which indicates Nesfatin 1 may be a reliable marker of PCOS suggesting energy homeostasis imbalance in these women

Over‐the‐Counter Sale of Emergency Contraception: A Survey of Pharmacists in Delhi

AbstractIntroductionPharmacists play a key role while dispensing over‐the‐counter emergency contraception (EC) to the client.AimsThe study aims to evaluate the knowledge and over‐the‐counter services provided by the pharmacists in Delhi.MethodsA prestructured questionnaire‐based survey was conducted in Delhi, the capital city of India.ResultsOnly 60 out of 85 pharmacies approached agreed to participate in the study. Number of packs sold in a month per pharmacy varied from 2 to 500 packs/month. Sixty‐two percent of the pharmacists claimed that majority of the clients repeated use during the same month. Only 18% of the clients were referred by doctors while 82% directly approached the pharmacists. Nearly one third of the clients were adolescents. Sixty‐seven percent of the pharmacists had adequate knowledge about EC. Only 3.3% asked about the last menstrual period or the time elapsed since the last unprotected intercourse. No pharmacist inquired whether there were one or multiple unprotected acts of intercourse, if any regular contraceptive method was being used, or explored the reason for EC intake. There were 91.7% who explained the dosage schedule to clients. Only half of them explained that the client may experience side effects. None of the pharmacists advised their clients for a sexually transmitted disease screening, and 35% counseled the clients regarding regular contraception.ConclusionImproving the quality of services provided by the pharmacists can clear misconceptions of the clients and promote subsequent regular contraception along with precautions to avoid sexually transmitted diseases. Mishra A and Saxena P. Over‐the‐counter sale of emergency contraception: A survey of pharmacists in Delhi. Sex Med 2013;1:16–20

Prediction of metabolic syndrome by visceral adiposity index, lipid accumulation product and model of adiposity index amongst infertile women with and without polycystic ovary syndrome

Background: This study was conducted to compare visceral adiposity index (VAI), lipid accumulation product (LAP) and model of adiposity index (MAOD) for prediction of metabolic syndrome (MS) amongst infertile women with and without PCOS. Methods: It was a case control, retrospective study performed in gynecology outpatient department of a tertiary care center. Total 143 infertile women with PCOS and 367 infertile women without PCOS were recruited in the study. Waist circumference (WC), BMI, waist hip ratio (WHR), insulin resistance, VAI, LAP, MOAD were assessed in both groups. Results: Significantly higher values of WC, WHR, systolic BP, insulin postprandial and all 3 adiposity indices were found among infertile women with PCOS as compared to women without PCOS. In hormonal profile, testosterone, AMH, FSH, prolactin, estradiol was found to be significantly higher in PCOS group. For predicting MS in PCOS women, VAI had the highest AUC 0.878 with a cut off value of 3.1, highest sensitivity of 88.9%, specificity of 90.7%, positive and negative predictive value of 76.2% and 96% respectively followed by LAP and MOAD. Conclusions: To conclude, all three adiposity indexes VAI, LAP and MOAD were significantly raised in PCOS women. VAI followed by LAP were the best indicators to predict metabolic syndrome in women with PCOS

Chronic abruption in early second trimester mimicking partial mole - A rare case report

Placental abruption is known as one of the most serious complications in pregnancy with detrimental effect on both the mother and the fetus. The clinical presentation and the ultrasound findings of this condition vary to a large extent as can be depicted from our case report. We report a rare case of a 30-year-old, G3P2L2 at 4 months of gestation, who presented with the complaints of dark altered bleeding along with pain lower abdomen for 1 day. Ultrasound findings were a dead fetus of 19 weeks 2 days with diffusely enlarged placenta with multiple cystic areas suggestive of intrauterine demise with partial mole. This case report is important as chronic placental abruption in the second trimester is rare, and a high index of suspicion is imperative to differentiate it from other conditions such as partial mole

Efficacy of 2-hour post glucose insulin levels in predicting insulin resistance in polycystic ovarian syndrome with infertility

Background : Insulin resistance (IR) is central to the pathogenesis of polycystic ovarian syndrome (PCOS), but tests for determining IR are elaborate, tedious and expensive. Aims : To evaluate if "2-hour post-glucose insulin level" is an effective indicator of IR and can aid in diagnosing IR in infertile PCOS women. Settings and Design : Observational study at infertility clinic of a tertiary care center. Materials and Methods : 50 infertile women with PCOS and 20 females with tubal/male factor infertility were evaluated for the presence of IR, as defined by the fasting/2-hour post-glucose insulin levels cutoffs of >25/>41 μU/mL, respectively. The clinical, metabolic and endocrinologic profile was determined in both the groups. Statistical Analysis : Statistical analysis was performed using SPSS (Chicago, IL, USA). Results : Body mass index, post load glucose, insulin, glucose/insulin ratio, area under curve (AUC) of glucose and insulin and insulinogenic index were significantly lower in the controls as compared to the PCOS group. "2-hour post-glucose insulin levels" were elevated in 88% of PCOS individuals but were normal in all females not suffering from PCOS. These levels significantly correlated with AUC of glucose and insulin, and insulinogenic index and inversely correlated with 2-hour glucose to insulin ratio (r=0.827, 0.749 and −0.732, respectively). Conclusions : "2-hour post-glucose insulin levels" appears to be a good indicator of IR. It can be a useful tool, especially in low resource setting where a single sample can confirm the diagnosis, thus reducing cost and repeat visits

Effect of metformin therapy on 2-h post-glucose insulin levels in patients of polycystic ovarian syndrome

Aims : To evaluate if 2-h post glucose insulin level is an effective tool to monitor insulin resistance in response to metformin therapy, in infertile women with polycystic ovarian syndrome (PCOS). Settings and Design : This prospective observational study was carried out in a tertiary care infertility clinic. Materials and Methods : 40 women with PCOS were categorized as having insulin resistance if fasting or 2-h post glucose insulin levels were >25 or >41μU/ml respectively. Post glucose insulin was compared before and after six months of metformin therapy along with other clinical, hormonal and metabolic parameters by using McNemar and the Student′s t-test. Results : Fasting insulin was elevated in 4 (10%) and post-load insulin in 34 (85%) patients; after metformin therapy respective values were 2 (5%) and 16 (40%). Metformin therapy reduced post glucose insulin levels (P<0.001), improved the regularity of periods (P<0.001) and resulted in reduction of LH levels (P<0.001), total testosterone (P<0.001) and mean Body mass index (BMI) (P=0.047). Metformin therapy did not alter waist-hip ratio and fasting insulin levels. Conclusion : 2-h post glucose insulin level is an effective tool to monitor insulin resistance in PCOS patients and improves significantly after metformin therapy, similar to improvements observed in clinical, hormonal and metabolic parameters

Surrogacy: Ethical and Legal Issues

Surrogacy refers to a contract in which a woman carries a pregnancy "for"another couple. Number of infertile couples from all over the World approach India where commercial surrogacy is legal. Although this arrangement appears to be beneficial for all parties concerned,there are certain delicate issues which need to be addressed through carefully framed laws in order to protect the rights of the surrogate mother and the intended parents

Evaluation of pharmacists' services for dispensing emergency contraceptive pills in Delhi, India: A mystery shopper study

Background: Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented. Objective: To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. Material and Methods: This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. Results: None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. Conclusion: There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter