Iodine status and its determinants in subpopulation of pregnant women in rural Central India

Background: There is an increased demand for iodine and thyroid hormones, in pregnancy starting from the early weeks of pregnancy suggesting that there may be a need for additional supplements of iodine in high risk population to prevent iodine deficiency and its associated disorders. Hence this study was undertaken to determine the iodine status and its determinants in a subpopulation of pregnant women from a rural area of Central India.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, use of iodized salt, iodine rich food and goitrogens as part of diet and other determinants. Spot urine samples were obtained, and assessment of urine iodine concentration was done by using Sandell-Kolthoff reaction.Results: Among 250 pregnant women of first trimester, iodine deficiency (ID) was present in 11.8 %, of which 59.25% had mild deficiency, 33.33% moderate deficiency and 7.4% severe deficiency. More women with iodine deficiency were of higher age, had less formal education and belonged to lower middle and lower economic class. Higher number of women with iodine deficiency had family history of thyroid disorders compared to iodine sufficient (18.51% versus 5.58%), more iodine deficient commonly had goitrogens (cabbage, cauliflower, radish, sweet potato, soya etc) as part of their meals (77.77% versus 68.60%), lesser women with ID ate iodine rich food (fish, milk yoghurt, bread) (18.51% versus 68.60%) and fewer of them used iodized salt during food preparation (25.92% versus 69.95%) compared to iodine sufficient, with a significant difference.Conclusions: Iodine deficiency is prevalent in pregnant women in this geographic region of central India. Age, low socioeconomic status, lack of education, family history, low intake of iodized salt and iodine rich food and more consumption of goitrogenic food as part of diet are risk factors. Appropriate health education, promoting use of iodized salt, quality assurance of universal salt iodization by household survey and screening in high risk group is suggested

Placental abruption: a persisting killer

Background: Placental abruption, common disorder in obstetric practice, enigma too, is uniquely fraught with dangers to mother baby. Objectives of study were to study trends of placental abruption, risk factors, management strategies to learn more for reduction in morbidity-mortality of mother-baby, even with low resources, also get insight for future research.  Methods: Records of cases of placental abruption managed over 27 years (between 1985 to 2011) were divided into three yearly blocks, A to I and analysed. Details  including operative procedures like dilatation-curettage, Caesarean Section (CS) or Ante-Partum Haemorrhage (APH) in past, disorders like chronic hypertension, threatened abortion, pregnancy specific hypertension, diabetes, anaemia in index pregnancy, management done maternal-neonatal outcome were analysed using stata 6 software.Results: There were 66,459 births during analysis period with 667 cases of placental abruption, 1% births, increasing trends from, 0.73% between 1985-1987 to, 1.11% in 2009-2011. In these 667 cases of placental abruption, 211 (32.5%) perinatal deaths occurred. Ratio of perinatal deaths due to placental abruption to overall perinatal deaths increased from 2.12% (8 cases) between 1985-1987 (Block A) to 5.12% (37 cases) between 2009-2011 (Block I). Case fatality in cases of placental abruption has been fluctuating between 3 to 5% till 2004, contributing to around 12-15%, maternal mortality, with no fatality in last 7 years.Conclusions: Cases of placental abruption have been increasing with no obvious reason. In recent past maternal deaths could be prevented but perinatal deaths, have been persisting actually more in last decade

Determinants of Thyroid Autoimmunity in Pregnant Women of Rural Central India- A Cross Sectional Study

: Background: Thyroid autoimmunity (TAI) is the most common autoimmune disorder in women of reproductive age. TAI in pregnancy is seen to rise markedly all over the world & can remain undiagnosed as it may present without thyroid dysfunction. It is seen to be associated with a number of feto-maternal disorders and may affect pregnancy outcome. The occurrence of TAI in pregnancy, in the present rural community is not known, hence this study was carried out to determine the occurrence of thyroid autoimmunity in pregnant women from rural area.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables. Family history and other determinants. Serum TSH, Free T4, and antithyroglobulin antibody levels were in the first trimester. Thyroid status was labelled as euthyroid, overt hypothyroid, subclinical hypothyroid, overt hyperthyroid and subclinical hypothyroid and correlation was done with antibody positivity and various determinants.Results: Among 250 pregnant women of first trimester, antithyroglobulin antibody was positive in 32 (12.8%) of which 22 (68.75%) had thyroid dysfunction in the form of hypo or hyperthyroidism, and 10 (31.25 %) were euthyroid. Of 218 with negative antibody, 24 (11%) had thyroid dysfunction and 194 (88.99%) were euthyroid with a significant difference. Though TAI was present in all age groups, the numbers increased with increasing age. Among study subjects, 9.95 % from rural compared to 28.20 % from urban residential area had TAI indicating higher occurrence in urban population. TAI was observed in all socioeconomic classes but more so in middle, lower middle and lower economic class. Positive family history was noted in 18.75 % women with positive antibody compared to 3.71 % negative women (p value 10.62, chi square 0.002). More number of pregnant women with negative antibody had an average BMI compared to positive (77.06% vs 31.25%), more positive PW were overweight compared to negative ( 37.5% vs 18.34%) and also obese ( 15.62% vs 0.91%) (Chi square – 26.67, p value – 0.00002). As BMI increased proportion of PW with positive antibody increased with a significant difference Conclusions: Thyroid autoimmunity was seen in 12.8% pregnant women of the rural area of present study site. A substantial number of women with TAI had thyroid dysfunction and some were found to be euthyroid too. Older age, socioeconomic status, urban residence, high BMI and positive family history were risk factors for thyroid autoimmunity. Screening for thyroid antibodies in high risk pregnant women and those with thyroid dysfunction is suggested

Impact of Round-the-Clock, Rapid Oral Fluid HIV Testing of Women in Labor in Rural India

Nitika Pant Pai and colleagues report the results of offering a round-the-clock rapid HIV testing program in a rural labor ward setting in India

Amalgamation of teaching / training of public health with clinical medicine and concepts beyond

Background: For health of populations, teaching / training of public health with clinical medicine is essential. Also health providers, educators need to remain sensitive, while training public health, clinical medicine about things beyond. We have collected information about teaching training of public health with clinical medicine and concepts beyond. Methods: Information was collected by simple review with help of different search engines. Results: There is void of guidance on practice-based teaching for personal health with public health. Socio-environmental determinants of health strongly interact with demands of everybody's life. For all medical conditions indicated, treatments are prescribed, but many unanswered questions remain. Answers are searched in gadgets, forgetting that, in medicine there is much room for judgments which help in re-adaptation to demands of life. Also many barriers exist in achieving practice-based teaching with public health for social justice. Conclusion: Public health teachers need to provide linkage of public health issues of disease to symptoms, signs, prevention, cure. Clinical teachers need to link the same to public health issues of disease. Public health education needs to be a shared enterprise with clinical teaching in health professionals' schools, who have mission of teaching, service, research for populations. In addition to caring for those who seek services, gaps between academia, practice, public health need bridges so that personal health as well as public health are ensured for healthy communities. Amalgamated teaching training of clinical medicine, public health, concept of social justice, accountability, and vision beyond for health wellness, needs to be mission of medical schools

Health hazards among health care personnel

While providing health services, (preventive, curative, rehabilitative), health care personnel (HCP) face hazards. Developments in medical science provide some safety, still modern technology has made health care very complex with many hazards. Biological (viruses, bacteria, and parasites) and chemical (disinfectants, drugs, and diagnostics) therapeutic modalities in health delivery are leading to many disorders in HCP. Needle prick injuries, radiation exposure, violence, psychiatric disorders, stalking by patients, and suicides are common. HCP are at high risk for musculoskeletal disorders, due to patient handling, compounded by increasing number of obese patients. With increase in workload because of human immunodeficiency virus, hardships have increased. Despite potential for exposure to hazards, many HCP lack awareness about prevention. Also the system is not conducive, policies of prevention not clear, inaccessibile, or there is attitude problem. Hence, HCP continue to suffer, more in developing countries. Health managers need to ensure that health care is geared toward assessment of hazards suffered by HCP, there reasons, and do everything possible for prevention

Essentialities of knowledge of whys and whats of acute abdomen during pregnancy

Acute abdomen accounts for 5-10% of emergency department visits. It designates symptoms, signs of intraperitoneal disease with sudden onset, can persist for hours to days, and is associated with wide variety of clinical features which may not be, specific to underlying disease. Pregnant state complicates the issue because of anatomic, physiologic changes during pregnancy. Its causes are many, obstetric, gynecological, many others which encompass a wide spectrum of surgical and medical conditions from aortic dissection to psychogenic pain, almost anything in between, a trivial to life-threatening condition, which requires immediate therapy. Diagnosis is challenging, requires careful history, thorough evaluation of symptoms, examination, and judicious use of investigations to specify disease and management which many times could be surgery only. Individualized approach is the best with basics known

Fertility Preservation in Gynecological Cancers

For cancers of reproductive system in women, fertility preservation is complex. Fertility is also affected by therapies, however prevention is possible. Radiotherapy affects gonads, uterus, and subsequent pregnancy outcomes in all ages. However, degree and damage depend on dose, irradiation field, and age at the time of exposure. Ovarian transposition is considered if ovarian involvement is unlikely. Gonadotoxic effects of chemotherapy are related to agent's type, cumulative doses, age, and ovarian reserve. Some agents are highly toxic. Rendering follicular development quiescent by suppression of gonadotropins does reduce the ovarian damage. Simple or radical trachelectomy can be used in early cervical cancer. Fertility saving surgery is possible only in early stage low grade epithelial cancers of the ovary, however, in germ cell tumors even in advanced stages it may be possible to preserve fertility. There are no standard recommendations for endometrial cancer. Embryo, oocyte, and ovarian tissue cryopreservation are possible. The human embryo is very resistant to damage. In view of these possibilities, it is advocated that attention to long term health and quality of life in gonadotoxic therapy must be incorporated into plans as early as possible

Rationale use of blood and its components in obstetric-gynecological practice

Appropriate and rational use of blood/components is essential for ensuring availability for the needy as well as preventing risks of transfusion-transmitted diseases and saving resources. Rational use means providing the right blood or products, in the right quantity, to the right patient and at the right time, bridging demand, and supply gap. The safety, adequacy, and effectiveness can only be achieved if unnecessary transfusions can be prevented. Further, risk can be reduced, but cannot be eliminated completely. Alternative to banked blood, autologous blood donation, normovolemic hemodilution, and intraoperative cell salvage should be considered as possible options. Recombinant factor VIIa is a new adjunct for treatment of massive hemorrhage and should be considered, if available

Iodine status and its determinants in subpopulation of pregnant women in rural Central India

Background: There is an increased demand for iodine and thyroid hormones, in pregnancy starting from the early weeks of pregnancy suggesting that there may be a need for additional supplements of iodine in high risk population to prevent iodine deficiency and its associated disorders. Hence this study was undertaken to determine the iodine status and its determinants in a subpopulation of pregnant women from a rural area of Central India.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, use of iodized salt, iodine rich food and goitrogens as part of diet and other determinants. Spot urine samples were obtained, and assessment of urine iodine concentration was done by using Sandell-Kolthoff reaction.Results: Among 250 pregnant women of first trimester, iodine deficiency (ID) was present in 11.8 %, of which 59.25% had mild deficiency, 33.33% moderate deficiency and 7.4% severe deficiency. More women with iodine deficiency were of higher age, had less formal education and belonged to lower middle and lower economic class. Higher number of women with iodine deficiency had family history of thyroid disorders compared to iodine sufficient (18.51% versus 5.58%), more iodine deficient commonly had goitrogens (cabbage, cauliflower, radish, sweet potato, soya etc) as part of their meals (77.77% versus 68.60%), lesser women with ID ate iodine rich food (fish, milk yoghurt, bread) (18.51% versus 68.60%) and fewer of them used iodized salt during food preparation (25.92% versus 69.95%) compared to iodine sufficient, with a significant difference.Conclusions: Iodine deficiency is prevalent in pregnant women in this geographic region of central India. Age, low socioeconomic status, lack of education, family history, low intake of iodized salt and iodine rich food and more consumption of goitrogenic food as part of diet are risk factors. Appropriate health education, promoting use of iodized salt, quality assurance of universal salt iodization by household survey and screening in high risk group is suggested