Men as partners in maternal health: an analysis of male awareness and attitude

Background: Men remain an authority in all the aspects of reproductive health from policy making to its implementation at grass root level. Present study was conducted to determine the awareness and participation of men in maternal health care and to assess their attitude towards their partners. Methods: We conducted a study in which 232 husbands accompanying their wives for delivery in teaching hospital of a metropolitan city were interviewed using a questionnaire. The questions were framed to assess their attitude, knowledge and participation in pregnancy care and maternal health Results: 61% of participants had accompanied their wives to the antenatal clinics at one or the other time. However despite of coming to hospital 60.1% were not aware of the components of antenatal care like number of tetanus immunizations or requirements of increased diet during pregnancy. 44% of the men did not approve of their wives working outside home. 30% of the men admitted to have physically abused their partner on single or multiple occasions. 31% of the pregnancies were unplanned. 75.7% of the men thought that ideal family size comprises of two children. Only 36.2% of the men knew that male sterilization was safer than female sterilization.Conclusion: Men in India have been marginalized in the dispense of antenatal and reproductive health care with policies emphasizing on the services and infrastructure more than involving men as responsible partners. Changes in men's and women's knowledge, attitudes and behavior are necessary conditions required in achieving the millennium development goals

An approach to diagnosis and management of acute fatty liver of pregnancy

Acute fatty liver of pregnancy is a rare life threatening cause of jaundice in the third trimester of pregnancy and early postpartum period and is associated with a poor outcome. The maternal and fetal outcome can be improved by a high index of suspicion, early diagnosis and prompt delivery. We report a case of a 30 year old parous lady with 36 weeks twin pregnancy with Acute Fatty Liver of Pregnancy [AFLP] and coagulation failure, she responded to prompt induction of labour and appropriate management of the coagulopathy and related complications. We provide a review of literature on jaundice in pregnancy and the clinical approach to management

Double blinded study on comparison of phosphorylated insulin like growth factor binding protein 1 test and fetal fibronectin test for prediction of preterm delivery

Background: Recently new markers like fetal fibronectin (FFN) and phosphorylated Insulin like growth factor binding protein 1 (phIGFBP-1) have been found useful in diagnosis of pre-term labor. Fetal fibronectin (FFN) and phosphorylated Insulin like growth factor binding protein 1 (phIGFBP-1) were compared to predict the risk of pre- term delivery.Methods: Cervicovaginal samples of 50 symptomatic and 50 asymptomatic pregnant women were tested. Statistical analysis was done using chi square test, fisher’s exact test for qualitative data and for quantitative data unpaired student t test and Mann Whitney test were used.Results: For Symptomatic group phosphorylated Insulin like growth factor binding protein 1 (phIGFBP-1) and fetal fibronectin (FFN) had 100% sensitivity and 100% NPV for predicting delivery within 48 hours, 7days and 14 days. Specificity and PPV of FFN was higher than phIGFBP-1 to predict delivery (Specificity: within 48 hours 63.2% vs 52.6% within 7 days 72.7% vs 60.6%, within 14 days 75% vs 62.5%, ≤37 weeks 76% vs 56%; PPV: within 48 hours 46.2% vs 40%, within 7 days 65.4% vs 56.7%, within 14 days was 69.2% vs 60% and ≤37 weeks 76.9% vs 63%).Conclusions: Rapid bed side dip stick tests for detecting FFN and ph IGFBP-1 in cervicovaginal secretions are useful clinical adjuncts in ruling out delivery within 14 days of test in symptomatic patients, thus avoiding unnecessary hospital stay and medical interventions. However, FFN has slightly higher NPV in predicting risk of pre term delivery

Predictive and prognostic significance of placental growth factor in pregnant women at high-risk for development of preeclampsia

Background: The study aimed to assess the predictive and prognostic role of placental growth factor (PlGF) in high-risk antenatal women for development of preeclampsia (PE). Methods: In this observational cohort study, antenatal women with gestation age from 20 to 32 weeks with high risk for development of PE were included. Serum PlGF was estimated by sandwich ELISA technique. A p-value of less than .05 was considered significant. Results: A total of 286 high-risk women were analysed for development of PE and obstetric outcomes. Of these 97/286 (34%) developed PE and 62/286 (21.7%) had abnormal PlGF value ( 100 pg/ml). Among the women with abnormal PIGF, 48 (77.4%) developed PE and out of 224 women with normal PIGF level, 49 (21.9%) developed PE resulting in a significant (p<0.001) odds ratio of 12.2 (95% CI: 6.0-25.9). For prediction of PE, a sensitivity and specificity of more than 75% at a cut-off value of <204.5 pg/ml was observed by ROC curve analysis. For prediction of preterm delivery (<34 weeks), a sensitivity and specificity of 65% was observed at a cut-off value of PlGF 191.7 pg/ml. Obstetric complications like eclampsia, preterm births (<34 weeks), neonate with low 5-minute APGAR score, low birth weight, fetal growth restriction, still-births and neonatal intensive care unit admissions all were significantly higher in abnormal PlGF group compared with normal PlGF group (p<0.05). Conclusions: Serum PlGF levels can provide valuable information for the prediction of PE and preterm births and abnormal PlGF values showed a significant association with adverse obstetrical outcomes

Role of pelvic and para-aortic lymphadenectomy in epithelial ovarian cancers

Background: Lymphadenectomy in epithelial ovarian cancers has remained a controversial subject. Lack of robust evidence on survival benefits and surgical morbidity associated questions its role in the era of adjuvant chemotherapy. The present study assessed pelvic and para-aortic lymph node removal in epithelial ovarian cancer in Indian women and tried to find clinicopathological correlation of nodal involvement and postoperative implications of lymphadenectomy.Methods: Thirty patients with diagnosis of epithelial ovarian cancer posted for primary debulking surgery were recruited and underwent staging laparotomy along with pelvic and para-aortic lymphadenectomy. Nodal involvement was confirmed on histopathology and various parameters which could predict nodal metastasis were assessed. Patients were followed up for 12 months post-surgery.Results: Nodal yield was ten for pelvic and four for paraaortic nodes. Pelvic node involvement was seen in 26.6% (8/30) of the patients and para-aortic in 15% (3/20) of the patients. Serous histology, higher grade, stage 3 and above, positive peritoneal cytology, omental involvement showed a higher lymph node involvement though not statistically significant. Para-aortic lymphadenectomy was associated with increased operating time, blood loss and longer hospital stay.Conclusions: Lymphadenectomy increases morbidity and decision should be based on predictors of nodal involvement

Feasibility of laparoscopy in management of ectopic pregnancy: experience from a tertiary care hospital

Background: Ectopic pregnancy is an important cause of maternal morbidity and mortality. For surgical management, laparoscopy is preferred option. In developing world for ruptured ectopic pregnancy laparotomy is done at most of places. In this study we have assessed feasibility of laparoscopic management in both ruptured and unruptured ectopic pregnancy.Methods: A prospective study, conducted over period of 1 year from July 2014 to July 2015 in Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi. In 110 patients of ectopic pregnancy parameters studied were age and parity, symptoms, risk factors, diagnostic methods, site of ectopic, management and its outcome. Primary objective was to evaluate management outcome of ectopic pregnancy and to assess feasibility of laparoscopy in ectopic pregnancy. Ruptured ectopic pregnancy with massive hemoperitoneum were analyzed separately. Secondary objective was to study demographic characters and risk factors of ectopic pregnancy.Results: Surgical management was required in 93.6% patients, out of which 86.4% were managed laparoscopically. Unruptured ectopic pregnancy was managed successfully by laparoscopy in 96.6% (29/30) patients. Ectopic was ruptured in 73 (66.3%) cases, laparoscopy was attempted in 91.7% (67/73). In 10.4% (7/67) patients laparoscopy had to be converted to laparotomy and it was successful in 89.5%. Out of 16 patients with massive hemoperitoneum, 12(75%) were managed laparoscopically. There was no mortality.Conclusions: In most of cases laparoscopy is safe and successful. Laparoscopy is feasible in ruptured ectopic cases including selected cases with massive hemoperitoneum thus avoiding unnecessary laparotomy and associated morbidity. Timely diagnosis and management prevents mortality

Alkaline phosphatase variation during carfilzomib treatment is associated with best response in multiple myeloma patients

The ubiquitin–proteasome pathway regulates bone formation through osteoblast differentiation. We analyzed variation alkaline phosphatase (ALP) during carfilzomib treatment. Data from 38 patients enrolled in the PX‐171‐003 and 29 patients in PX‐171‐004 studies, for patients with relapsed/refractory myeloma, were analyzed. All patients received 20 mg/m 2 of carfilzomib on Days 1, 2, 8, 9, 15, and 16 of a 28‐day cycle. Sixty‐seven patients from ALP data were evaluable. In PX‐171‐003, the ORR (>PR) was 18% and the clinical benefit response (CBR; >MR) was 26%, while in PX‐171‐004, the ORR was 35.5% overall and 57% in bortezomib‐naive patients. ALP increment from baseline was statistically different in patients who achieved ≥VGPR compared with all others on Days 1 ( P  = 0.0049) and 8 ( P  = 0.006) of Cycle 2. In patients achieving a VGPR or better, ALP increased more than 15 units per liter at Cycle 2 Day 1 over baseline. An ALP increase over the same period of time was seen in 26%, 13% and 11% of patients achieving PR, MR, and SD, respectively. This retrospective analysis of patients with relapsed or refractory myeloma treated with single‐agent carfilzomib indicates that early elevation in ALP is associated with subsequent myeloma response.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86807/1/j.1600-0609.2011.01602.x.pd

A Phase 2 Study of Bortezomib in Relapsed, Refractory Myeloma

BACKGROUND Bortezomib, a boronic acid dipeptide, is a novel proteasome inhibitor that has been shown in preclinical and phase 1 studies to have antimyeloma activity. METHODS In this multicenter, open-label, nonrandomized, phase 2 trial, we enrolled 202 patients with relapsed myeloma that was refractory to the therapy they had received most recently. Patients received 1.3 mg of bortezomib per square meter of body-surface area twice weekly for 2 weeks, followed by 1 week without treatment, for up to eight cycles (24 weeks). In patients with a suboptimal response, oral dexamethasone (20 mg daily, on the day of and the day after bortezomib administration) was added to the regimen. The response was evaluated according to the criteria ofthe European Group for Blood and Marrow Transplantation and confirmed by an independent review committee. RESULTS Of 193 patients who could be evaluated, 92 percent had been treated with three or more ofthe major classes of agents for myeloma, and in 91 percent, the myeloma was refractory to the therapy received most recently. The rate of response to bortezomib was 35 percent, and those with a response included 7 patients in whom myeloma protein became undetectable and 12 in whom myeloma protein was detectable only by immuno-fixation. The median overall survival was 16 months, with a median duration of response of 12 months. Grade 3 adverse events included thrombocytopenia (in 28 percent of patients), fatigue (in 12 percent), peripheral neuropathy (in 12 percent), and neutropenia (in 11 percent). Grade 4 events occurred in 14 percent of patients. CONCLUSIONS Bortezomib, a member of a new class of anticancer drugs, is active in patients with relapsed multiple myeloma that is refractory to conventional chemotherapy

Daratumumab monotherapy in patients with treatment-refractory multiple myeloma (SIRIUS): an open-label, randomised, phase 2 trial

BACKGROUND: New treatment options are needed for patients with multiple myeloma that is refractory to proteasome inhibitors and immunomodulatory drugs. We assessed daratumumab, a novel CD38-targeted monoclonal antibody, in patients with refractory multiple myeloma. METHODS: In this open-label, multicentre, phase 2 trial done in Canada, Spain, and the USA, patients (age ≥18 years) with multiple myeloma who were previously treated with at least three lines of therapy (including proteasome inhibitors and immunomodulatory drugs), or were refractory to both proteasome inhibitors and immunomodulatory drugs, were randomly allocated in a 1:1 ratio to receive intravenous daratumumab 8 mg/kg or 16 mg/kg in part 1 stage 1 of the study, to decide the dose for further assessment in part 2. Patients received 8 mg/kg every 4 weeks, or 16 mg/kg per week for 8 weeks (cycles 1 and 2), then every 2 weeks for 16 weeks (cycles 3-6), and then every 4 weeks thereafter (cycle 7 and higher). The allocation schedule was computer-generated and randomisation, with permuted blocks, was done centrally with an interactive web response system. In part 1 stage 2 and part 2, patients received 16 mg/kg dosed as in part 1 stage 1. The primary endpoint was overall response rate (partial response [PR] + very good PR + complete response [CR] + stringent CR). All patients who received at least one dose of daratumumab were included in the analysis. The trial is registered with ClinicalTrials.gov, number NCT01985126. FINDINGS: The study is ongoing. In part 1 stage 1 of the study, 18 patients were randomly allocated to the 8 mg/kg group and 16 to the 16 mg/kg group. Findings are reported for the 106 patients who received daratumumab 16 mg/kg in parts 1 and 2. Patients received a median of five previous lines of therapy (range 2-14). 85 (80%) patients had previously received autologous stem cell transplantation, 101 (95%) were refractory to the most recent proteasome inhibitors and immunomodulatory drugs used, and 103 (97%) were refractory to the last line of therapy. Overall responses were noted in 31 patients (29.2%, 95% CI 20.8-38.9)-three (2.8%, 0.6-8.0) had a stringent CR, ten (9.4%, 4.6-16.7) had a very good PR, and 18 (17.0%, 10.4-25.5) had a PR. The median time to first response was 1.0 month (range 0.9-5.6). Median duration of response was 7.4 months (95% CI 5.5-not estimable) and progression-free survival was 3.7 months (95% CI 2.8-4.6). The 12-month overall survival was 64.8% (95% CI 51.2-75.5) and, at a subsequent cutoff, median overall survival was 17.5 months (95% CI 13.7-not estimable). Daratumumab was well tolerated; fatigue (42 [40%] patients) and anaemia (35 [33%]) of any grade were the most common adverse events. No drug-related adverse events led to treatment discontinuation. INTERPRETATION: Daratumumab monotherapy showed encouraging efficacy in heavily pretreated and refractory patients with multiple myeloma, with a favourable safety profile in this population of patients. FUNDING: Janssen Research & Development

A Meta-analysis of Multiple Myeloma Risk Regions in African and European Ancestry Populations Identifies Putatively Functional Loci

Genome-wide association studies (GWAS) in European populations have identified genetic risk variants associated with multiple myeloma (MM)