A study on fetal outcome in patients with oligohydramnios

Background: There is an association between oligohydramnios and intrauterine growth restriction as well as increased perinatal mortality. Amniotic fluid provides a protected environment for the growing fetus, moderating the fetus against mechanical and biological injury. The objective of the present study was to study the fetal outcome in patients with oligohydramnios between 20 to 42 weeks of pregnancy.Methods: Prospective study of 87 pregnancies with oligohydramnios was carried in Department of Obstetrics and Gynaecology, NSCB Medical College, Jabalpur from 1st March 2016 to 31stMarch 2017. All women enrolled for the study were subjected to history taking, clinical examination and amniotic fluid index estimation.Results: Rate of caesarean section was higher in patients with oligohydramnios and higher number of neonates were admitted to the NICU amongst the patients of oligohydramnios.Conclusions: Oligohydramnios has a significant correlation with adverse perinatal outcome

Evaluation of vitamin D3 in patients of polycystic ovary syndrome and their correlation

Background: Polycystic ovary syndrome (PCOS) is enigma faced by young females since the onset of urbanization. As on day, PCOS is the most common endocrine disorder in the women of reproductive age affecting 4-10%. This study done to measure serum vitamin D3 levels of PCOS patients and to identify its association with factors associated with various symptoms and signs in PCOS.Methods: Institutional based prospective observational study conducted on 70 patients of PCOS, both suspected and already diagnosed, attending gynecology OPD of Department of obstetrics and gynecology of NSCB Medical College Jabalpur from 1 March 2015 to 31 August 2016. Diagnosis of PCOS was made by Rotterdam 2003 criteria. A detailed assessment was done and preformed proforma was filled. Serum Vitamin D3 levels were estimated by standard lab technique ‘Liquid Chromatography Tandem Mass Spectrometry’ and categorized into vitamin D3 sufficient >30ng/dl, insufficient 20-29ng/dl and deficient <20ng/dl. Categorical data was coded numerically before the analysis. For comparison of frequency distribution chi square test or fisher’s exact test were applied as appropriate.Results: Prevalence of Vitamin D3 deficiency in patients of PCOS was found to be 84.3%.Conclusions: The present study concludes that there is correlation between vitamin D3 and PCOS, screening and correction of vitamin D3 deficiency may prevent PCOS and its manifestations. Hence, it is speculated that improvement of vitamin D3 levels at a younger age can contribute to prevention of PCOS

Evaluation of acceptability, safety and expulsion rate of PPIUCD

Background: The modern intrauterine contraceptive device (IUCD) is highly effective, safe, private, long acting, coitus independent, rapidly reversible, cost effective and can be used by women who are breastfeeding. This study was conducted to evaluate factors associated with acceptability, safety and expulsion rates of PPIUCD among clients in the Department of Obstetrics and Gynecology, N. S. C. B Medical College, Jabalpur.Methods: A questionnaire based prospective study was conducted between March 2016 -17 on all the clients who were counseled for PPIUCD and who fulfilled the WHO Medical Eligibility criteria. Proforma included follow up at 6 weeks post-delivery.Results: In our study 961 women accepted PPIUCD (53.3%). Majority of the cases belonged to low socioeconomic group with low literacy rates. Most acceptors counseled in antenatal period (53.1%). Majority (67.3%) of insertions were post placental and instrumental (89%). At the time of insertion most clients experienced mild pain (49.7%) & anxiety (42.5%). Amongst clients who followed up (51.1%), the most common complaint was pain (16.7%) and most common reason for removal was heavy bleeding. Continuation rate was 77.7%, spontaneous expulsion in 9.75% while voluntarily removal was done in 12.6%. At follow up 91.3% clients were satisfied with PPIUCD.Conclusions: Antenatal counseling has a very important role. Demographic factors influencing acceptance are education, socioeconomic status and family structure. PPIUCD is demonstrably safe and effective method of contraception with low expulsion rate. Awareness about the safety and efficacy of PPIUCD should be emphasized during antenatal visits

Endometriosis in broad ligament: a rare case

Endometriosis is a relatively common entity among females presenting with abdominal pain and infertility. The endometriosis of broad ligament is a very rare yet interesting condition. In majority of the reported cases, endometriosis of broad ligament had recurrence after surgical excision. We are reporting one such case in a young nulliparous woman from Jabalpur Madhya Pradesh

Feasibility and acceptability of a remote stepped care mental health programme for adolescents during the COVID-19 pandemic in India

Remote mental health services were rapidly deployed during the COVID-19 pandemic, yet there is relatively little contemporaneous evidence on their feasibility and acceptability. This study assessed the feasibility and acceptability of a stepped care mental health programme delivered remotely by lay counsellors to adolescents in New Delhi, India, during a period of ‘lockdown’. The programme consisted of a brief problem-solving intervention (“Step 1”) followed by a tailored behavioural module (“Step 2”) for non-responders. We enrolled 34 participants (M age = 16.4 years) with a self-identified need for psychological support. Feasibility and acceptability were assessed through quantitative process indicators and qualitative interviews (n = 17 adolescents; n = 5 counsellors). Thirty-one (91%) adolescents started Step 1 and 16 (52%) completed the planned Step 1 protocol. Twelve (75%) of the Step 1 completers were non-responsive. Eight (67%) non-responsive cases started Step 2, all of whom met response criteria when reassessed at 12 weeks post-enrolment. Adolescents favoured voice-only sessions over video-calls due to privacy concerns and difficulties accessing suitable devices. Counsellors noted challenges of completing remote sessions within the allotted time while recognising the importance of supervision for developing competence in new ways of working. Both adolescents and counsellors discussed the importance of working collaboratively and flexibly to fit around individual preferences and circumstances. Disentangling pandemic-specific barriers from more routine challenges to remote delivery should be a focus of future research

Commercial Immunoglobulin Products Contain Neutralizing Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2 Spike Protein

BACKGROUND: Patients with antibody deficiency respond poorly to COVID-19 vaccination and are at risk of severe or prolonged infection. They are given long-term immunoglobulin replacement therapy (IRT) prepared from healthy donor plasma to confer passive immunity against infection. Following widespread COVID-19 vaccination alongside natural exposure, we hypothesised that immunoglobulin preparations will now contain neutralising SARS-CoV-2 spike antibodies which confer protection against COVID-19 disease and may help to treat chronic infection. METHODS: We evaluated anti-SARS-CoV-2 spike antibody in a cohort of patients before and after immunoglobulin infusion. Neutralising capacity of patient samples and immunoglobulin products was assessed using in vitro pseudo-virus and live-virus neutralisation assays, the latter investigating multiple batches against current circulating omicron variants. We describe the clinical course of nine patients started on IRT during treatment of COVID-19. RESULTS: In 35 individuals with antibody deficiency established on IRT, median anti-spike antibody titre increased from 2123 to 10600 U/ml post-infusion, with corresponding increase in pseudo-virus neutralisation titres to levels comparable to healthy donors. Testing immunoglobulin products directly in the live-virus assay confirmed neutralisation, including of BQ1.1 and XBB variants, but with variation between immunoglobulin products and batches.Initiation of IRT alongside Remdesivir in patients with antibody deficiency and prolonged COVID-19 infection (median 189 days, maximum over 900 days with an ancestral viral strain) resulted in clearance of SARS-CoV-2 virus at a median of 20 days. CONCLUSIONS: Immunoglobulin preparations now contain neutralising anti-SARS-CoV-2 antibodies which are transmitted to patients and help to treat COVID-19 in individuals with failure of humoral immunity

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

An <em>in vitro</em> evaluation of <em>Tribulus terrestris</em> L. fruit extract for exploring therapeutic potential against certain gut ailments

430-436The enteric pathogens and oxidative stress are known to generate intestinal inflammation, chronic gut ailments and oncogenesis. Modulation of the gut microbial peak populations through herbal agents, offers a promising therapeutic modality. Tribulus terrestris Linn. (Tt), a widely documented medicinal herb in Ayurveda, was investigated for antioxidant, anti-inflammatory and antimicrobial activities in vitro. Fruit extract of Tt and quercetin, evaluated for free radical scavenging by DPPH method, revealed IC50 values as 98.83 and 24.77 µg/mL, respectively. Anti-inflammatory attributes of Tt fruit extract and indomethacin, a known anti-inflammatory drug, rendered IC50 values as 10.8 and 12.9 µg/mL against protein denaturation. MTT assay on HCT-15 cells revealed a decrease in viability from 78 to 22% against 30 and 70 µg/mL of Tt fruit extract, respectively. Zone of inhibition against E. coli increased from 0.19 to 9.82 cm2 at 200 and 1000 µg/mL of Tt, respectively. The fruit extract of Tt enhanced the growth of probiotic Lactobacillus rhamnosus (L.rh) by 19, 44 and 50 % over the control at 100, 150 and 200 µg/mL, respectively. This study indicated the potential of Tribulus terrestris fruit extract against inflammatory, oxidative and microbe generated pathogenic ailments in the digestive system

Barrier Strengthening And Anti-Inflammatory Effect Of Cucurbit Fruits On Intestinal Epithelial Cells In-Vitro

Background: Acute and chronic infections and inflammations in the gut are highly prevalent in tropical and subtropical countries. Therapeutic measures like Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) often manifest toxic effects. Objective: Some herbal agents (cucurbit fruits) were investigated in-vitro for gut-barrier reinforcement and anti-inflammatory action. Methods: Zonula Occludens (ZO-1), mucin (MUC-2), cyclooxygenases (COX-1 and COX-2) expressions were estimated through ELISA kits. Nitric oxide (NO) was estimated through Griess reaction and adhesion of Lactobacillus rhamnosus (Lrh) to epithelial cells was evaluated microscopically. Results: TNF-α (10 ng/mL) induced inflammatory reaction in epithelial cells (HT-29 and Caco-2) by decreasing ZO-1 proteins. Cells pretreated with cucurbits, when challenged by TNF-α, countered the reduction of ZO-1 proteins, but pretreatment with indomethacin (NSAID) decreased the expression of ZO-1 further. Addition of Lrh to HT-29 cultures, enhanced mucin (MUC-2) production. Cucurbits alone did not enhance MUC-2 production in HT-29 cells but the addition of cucurbits to the combination of Lrh + HT-29 cells significantly increased MUC-2 production and adhesion of Lrh to epithelial cells. TNF-α and LPS treatment to Caco-2 cells increased COX-2 and NO production, but pretreatment with either cucurbits or indomethacin rendered their decrease. Pretreatment with indomethacin decreased COX-1 production in Caco-2 cells but pretreatment with cucurbits yielded enhanced COX-1 expression. Conclusion: This study revealed the potential of cucurbits as non-toxic anti-inflammatory and barrier strengthening agents against gut ailments

Radioprotective potential of Lagenaria siceraria extract against radiation induced gastrointestinal injury

The cucurbits (prebiotics) were investigated as novel agents for radio-modification against gastro-intestinal injury. The cell-cycle fractions and DNA damage were monitored in HCT-15 cells. A cucurbit extract was added to culture medium 2 h before irradiation (6 Gy) and was substituted by fresh medium 4 h post-irradiation. The whole extract of the fruits of Lagenaria siceraria (Ls), Luffa cylindrica (Lc) or Cucurbita pepo (Cp) extract enhanced G2 fractions (42 %, 34 % and 37 % respectively) as compared to control (20 %) and irradiated control (31 %). With cucurbits, the comet tail length remained shorter (Ls - 28 µm; Lc - 34.2 µm; Cp -36.75 µm) than irradiated control (41.75 µm). For in vivo studies, Ls extract (2mg/kg body wt.) was administered orally to mice 2 h before and 4 and 24 h after whole body irradiation (10 Gy). Ls treatment restored the GSH contents to 48.8 µmol/gm as compared to control (27.6 µmol/gm) and irradiated control (19.6 µmol/gm). Irradiation reduced the villi height from 379 to 350 µm and width from 54 to 27 µm. Ls administration countered the radiation effects (length - 366 and width - 30 µm respectively) and improved the villi morphology and tight junction integrity. This study reveals the therapeutic potential of cucurbits against radiation induced gastro-intestinal injury.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author