Benefits and limitations of evidence-based dentistry in the Indian context

The American Dental Association defines the evidence-based dentistry (EBD) as “an approach to oral health care that requires the integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences” [1]. Nowadays, evidence-based care is regarded as the gold stan- dard in health care delivery. Published reports of research pro- jects constitute the basis of EBD. They are analyzed systemati- cally in meta-analysis

Is it safe to use intravenous iron sucrose during pregnancy? A randomized controlled trial

Background: To compare the efficacy and safety of intravenous iron sucrose to oral iron in the treatment of iron deficiency anemia in pregnancy.Methods: In this randomized trial 200 pregnant women with hemoglobin between 7g/dl and 9g/dl and serum ferritin <15 ng/ml received either iron sucrose or oral iron sulphate. The iron sucrose dose was calculated from the following formula: weight (kg) x (110 g/l – actual hemoglobin (g/l) x 0.24 + 500mg. Treatment efficacy was assessed by clinical and laboratory response on 2nd week, 4th week of therapy, after that 4th weekly till delivery.Statistical analysis was done with paired and independent samples “t” test applied. Hemoglobin measurements were analyzed by repeated- measures of analysis of variance with Huynh and Feldt corrections. Serum ferritin measurement across the time within each group was analyzed by two sample test with equal variance .Adverse drug reactions, fetal weight, blood transfusions were also recorded.Results: The significant rise in hemoglobin from 8.0 ± 0.79gm/dl to10.80± 0.61gm/dl in intravenous group as compared to oral iron group from 8.19 ± 0.60gm/dl to 9.86± 0.61 gm/dl was seen at 4th week of treatment (P = 0.000).After 2 week of treatment rise in serum ferritin values were higher in intravenous group from 6.25± 1.05 ng/ml; to 155.33± 57.4 ng/ml and in oral group from5.71± 1.71ng/ml to20.8 ±9.5 ng/ml ( p=.000 ).No serious adverse drug reactions were observed in intravenousgroup. Conclusion: Iron sucrose is safe to use during pregnancy. It raises hemoglobin and restores iron stores faster than oral iron

Clinical significance of ovarian stromal blood flow in assessment of ovarian response in stimulated cycle for in vitro fertilization

Background: Several ultrasound parameters have been examined to predict the ovarian response to gonadotropins. The only parameter that has been conclusively proven to predict ovarian response is the antral follicle count. It has been suggested that ovarian blood flow may play a crucial role in the development of ovarian follicles. The present study was planned to prospectively analyse the effect of ovarian stromal blood flow on ovarian responsiveness in terms of number of oocytes retrieved in stimulated cycle for IVF.Methods: Fifty subjects between 22 to 37 years of age with male factor, tubal factor or unexplained infertility underwent controlled ovarian stimulation by the standard “Long protocol”. Ovarian stromal blood flow was recorded on baseline transvaginal sonography on day 2 or 3 of cycle and was correlated with number of oocytes retrieved in IVF cycle.Results: The ovarian stromal blood flow was found to be negatively correlated with age. The number of follicles formed in a subject after stimulation with gonadotropins was negatively correlated with ovarian stromal resistance index and pulsatility index.Conclusions: Ovarian blood flow predicts ovarian responsiveness and hence provides a non-invasive and cost effective prognostic factor of IVF outcome

Spectrum of acute kidney injury in obstetrics

Background: Acute kidney injury (AKI) associated with pregnancy is a serious medical complication which can lead to significant maternal as well as perinatal morbidity and mortality.Methods: Forty antenatal/postnatal /postabortal patients who fulfilled the Acute kidney injury network criteria were enrolled and followed up till 3 months of acute insult/ postpartum.Results: Majority of the patients, 23/40(57.5%) with AKI presented in postpartum period, 14/40(35%) developed AKI in antenatal period and 3/40(7.5%) were postabortal. AKI was attributable mostly to sepsis in 11/40(27.5%) followed by hypertension and its complications which included eclampsia in 5/40(12.5%) and HELLP syndrome in 3/40(7.5%). 5/40(12.5%) patients had postpartum haemorrhage and abruptio placentae was found in 2/40(5%). Renal replacement therapy (RRT) was the treatment in majority of them 28(70%). 25/40(62.5%) had complete recovery of their renal functions whereas maternal mortality was seen in 10/40(25%) patients. Prolonged anuria was found to be highly significant in our study and served as poor prognostic factor towards maternal outcome (p=0.034). Out of 37 patients, 21(56.7%) had live births and 16 patients (43.2%) had still births.Conclusions: Timely initiation of RRT in patients with AKI associated with pregnancy has a good maternal outcome in the form of complete recovery of renal functions

Hypergonadotropic hypogonadism: looking beyond ovarian senescence

Gonadotropin resistant ovary syndrome (GROS) is a rare cause of primary infertility where ovarian reserve is present but they fail to respond to gonadotropin stimulation. This condition can be easily confused with premature ovarian insufficiency (POI) if thorough workup is not done as in both the cases serum FSH is high, but ovarian reserve is normal in GROS and low or absent in POI. So, we are presenting this case of GROS. A 28-year-old lady presented with oligomenorrhoea since menarche and primary infertility. On workup her serum FSH and LH levels were markedly elevated, serum estradiol was normal. Markers of ovarian reserve, ante Mullerian hormones (AMH) and antral follicle count (AFC), were normal. Her autoantibody assay was also normal. She did not respond to stimulation with high doses of gonadotropins (uHMG). Hypergonadotropic hypogonadism is not always POI. We should not miss diagnosis of GROS where it is possible to have own biological child by in vitro maturation of immature oocytes, whereas in POI donor oocyte is the only fertility option

Stakeholders’ opinion regarding disabled friendliness of obstetrics and gynaecology services in hospitals of North India

Background: Hospitals are part of our society. Barriers faced by people with disability (PWD) in hospitals reflect obstacles in society also. Women with disability (WWD) are at particular disadvantage. Our objective was to explore the domain related to the problems that WWD face in accessing obstetrics and gynecology (OBG) services in government institutes/hospitals of Chandigarh.Methods: This mixed quantitative and qualitative research was done during 2013-2017. Stakeholders included WWD, their families, self-help groups, community-based organisations, NGOs, doctors, nurses, public health experts, research scholars and government bodies involved in disability services. Five major government institutes/hospitals of Chandigarh were purposively selected for the study. In-depth interviews were conducted among different groups to gain an insight into their views regarding the degree to which the reproductive health services were disabled-friendly.Results: Most (80-90%) of the stakeholders emphasized the need of making OBG services disabled-friendly. The majority of doctors and nurses said that no special training was given to them to deal with WWD. They opined that SRH needs of WWD were different from other women. Lack of access was the main barrier to OBG care in hospitals reported by 46% of WWD. Most of the hospitals lacked any special provisions for PWD.Conclusions: There is a lack of concern and apathy for WWD in the society. Hospitals lack a disabled-friendly attitude, design and facilities. Access to OBG services for WWD was barrier ridden

Impact of Lifestyle Intervention for Management of the Modern Life Scourge of Polycystic Ovarian Syndrome among Girls – A Case Series

Polycystic ovarian syndrome (PCOS) is a complex endocrine, metabolic and reproductive disorder. It affects various body organs. Oligomenorrhea, hirsutism, insulin resistance, obesity and polycystic ovaries are its hallmark features. Usual medicines for PCOS focus on blood glucose and hormonal regulation. Diet, exercise and lifestyle changes for losing weight provide relief from symptoms. We describe here eight PCOS cases enrolled in an RCT. The study aimed to ascertain the impact of the lifestyle intervention for management of polycystic ovarian syndrome among girls. Anthropometric assessments and biochemical parameters, including reproductive hormones and insulin resistance, were performed at baseline and after 6 months of intervention, change in their health profile was noted. After intervention, menstrual regularity was achieved in all cases. The average weight loss was 4.07 kg (range 2.5–14 kg). The average BMI reduced from 26.6 to 25.0 and waist circumference from 94.1 to 86.6. At the end of the intervention, five cases had normal ovarian size, LH:FSH was normal in three cases. Out of six with insulin resistance, only one tested positive after intervention. One of the subjects said “I am very satisfied with the treatment. Almost all of my problems have been resolved – periods are regular, lab reports are normal, mood has improved, weight has reduced; other people ask me how I have lost weight.” Simple changes in lifestyle can easily provide relief in PCOS cases without any medical intervention

Clinical profile and outcome of patients with placenta previa: a study at a tertiary care referral institute in Northern India

Background: The aim of this study was to determine clinical profile, evaluate our antenatal and intraoperative management and see the maternal and perinatal outcome in patients with placenta previa.Methods: A prospective study was carried out in 130 women with placenta previa in the Department of Gynecology, PGIMER, Chandigarh, India between Jan 2015–April 2016. The profile of these patients was recorded in a predesigned proforma and maternal and perinatal outcome analyzed in detail.Results: One third (46/130) of the patients with placenta previa had a history of previous caesarian section, 27% had previous uterine curettage and 82% were multiparous.18% were asymptomatic placenta previa whereas 82% had one or more bleeding episodes. Expectant management was given to 67% patients after first bleeding episode. Majority (92/130) of patients required emergency cesarean section. Due to invasive placentation, 25 patients required cesarean hysterectomy. Ninety percent patients required delivery at ≤37 weeks and neonatal outcome improved with increasing gestation as expected.Conclusions: Reduction in cesarean rate is the major key factor for decreasing the incidence of placenta previa as, as well as placenta accreta and other associated complications as there were no patients diagnosed to have placenta accreta when placenta previa was present without any previous cesarean scar. In cases of invasive placenta, performing a classical CS, not trying to remove the placenta and proceeding directly to hysterectomy resulted in reduced blood loss. Neonatal outcome as well as maternal outcome is best when cesarean is done between 36-37 weeks

Pregnancy in a patient with paroxysmal nocturnal hemoglobinuria

The occurrence of Paroxysmal Nocturnal Hemoglobinuria (PNH) during pregnancy is very rare. It can cause significant fetomaternal morbidity and mortality due to associated complement mediated hemolysis and/or thrombosis. We report a case of PNH in a pregnant lady who presented to our antenatal clinic at 10th weeks of gestation. Her pregnancy was managed with multiple blood transfusions and steroid administration.  During 3rd weeks postpartum period she developed sepsis with acute renal failure and posterior reversible encephalopathy syndrome requiring prolonged hospitalization. She was subsequently discharged from hospital in satisfactory condition