Meta-analysis on maternal deaths and assessing significant factors for heterogeneity between states of India during 2016

Objective of the study was to provide a more precise estimate of maternal mortality (MM), maternal mortality ratio (MMR) and to identify significant factors contributing for heterogeneity between the states in India. “Metaprop” procedure in STATA software, which are specific to binomial data was applied on state wise MM data published by sample registration system (SRS) during 2014-16. An overall MM estimate and potential sources of heterogeneity could be identified using meta-regression. Corrected estimates of MMR by states were compared. SRS published the MM data by 17 Major states. Overall reported MM was 8.8 per 100, 000 women. Estimate obtained by random effect model was 8.3 (95% CI: 5.9-11.1) per 100,000 women. Heterogeneity between states was very high (I2-statistics =91.9%), and egger regression revealed no reporting bias (p=0.672). Meta-regression analysis indicated that the percent women attending full antenatal care (ANC) visits found to be highly significant (p<0.001) for MM with inverse relationship implying that the states with a higher percentage of women with full ANC visits are likely to have lesser MM. While the estimate of MMR by SRS was 130 per 100,000 live births, corrected MMR was 123 (95% CI: 87-164) accounting for 26% reduction from previous estimate 167 obtained in 2013. This paper provided a precious estimate of both MM and MMR adjusted for sampling weight. Further, the importance of either full ANC visits or four ANC visits could be demonstrated for reduction in MMR on achieving the Millennium development goal (MDG) in the country.

Role of transdermal testosterone gel pre-treatment on IVF outcome: a prospective randomized controlled trial with active control

Background: Dealing with poor ovarian responders is the newest challenge for the present-day reproductive physicians. Androgens are said to increase pregnancy outcomes due to enhanced oocyte retrieval in poor responders. The aim of the study was to measure the effect of transdermal testosterone gel in women with unexplained poor ovarian response.Methods: It was a prospective randomized controlled trial with active control conducted at ART centre, department of obstetrics and gynaecology, AIIMS, New Delhi from August 2017-August 2018. Seventy women with previously failed IVF/ICSI who had ≤5 oocyte retrieval in previous cycle having normal ovarian reserve with normal or low testosterone levels were randomized. Study arm (N=35) received testosterone gel pre-treatment whereas the control arm (N=35) received standard treatment. GnRH antagonist stimulation protocol was followed. The number of oocytes retrieved and pregnancy outcomes were studied.Results: Of the 70 women in the study, the number of oocytes retrieved was significantly higher (6.5±5.8 vs 3.1±2.1; p=0.002), cycle cancellation rate was lower (8.6% vs 22.9%; p=0.094), implantation rate (8.2% vs 2.6%; p=0.228), clinical pregnancy, ongoing pregnancy, live birth rates (14.7% vs 2.9%; p=0.092) and take home baby rates (17.6% vs 2.9%; p=0.049) were higher in testosterone group compared to controls. One woman in testosterone group developed mild OHSS.Conclusions: The study shows that transdermal testosterone gel is found to improve oocyte retrieval significantly in unexpected poor responders, although there was not a significant improvement in pregnancy outcomes. Hence further studies are of utmost importance to establish the effectiveness of the gel

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&lt;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 &lt;204.5 pg/ml was observed by ROC curve analysis. For prediction of preterm delivery (&lt;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 (&lt;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&lt;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

Assessment of the customized birth weight formula in a low risk Indian population

Background: Birth weight is probably the single most important factor that affects neonatal mortality, infant and childhood morbidity in both developed and developing countries. Objective of the study was to formulate a model for prediction of fetal weight at term based on individualized fetal growth parameters.Methods: 131 participant low risk gravidas were enrolled into the study. The participants underwent an ultrasound 7 days prior to delivery. All fetal variables of growth of a random 100 participants were incorporated in an equation derived using multiple regressions to predict birth weight at term. The new equation was then prospectively applied to another 31 pregnant women for validation. The diagnostic performance of the new regression formula was then compared to the Hadlock formula.Results: The customised birth weight formula predicted a higher accuracy with MPE±SD of 0.790±9. compared to the Hadlock formula with MPE±SD - 4.42±8.73. The new formula also explained a greater variance in birth weight of 56% compared to the Hadlock formula of 49%.Conclusions: The new model based on individualized fetal growth parameters recognizes the capacity to modulate an accurate final birth weight, thus emphasizing the need for customized population specific birth weight formulas

Impact of different grades of anaemia severity during pregnancy on maternal and neonatal outcomes: a prospective study

Background: Anaemia in pregnancy is a universal health problem that may cause a number of obstetrical and neonatal complications. This prospective observational study aims to evaluate and compare maternal and neonatal outcomes in different grades of anaemia severity.Methods: A total of 400 pregnant women with anaemia in third trimester were classified into three groups according to haemoglobin (Hb) levels-group I with Hb:10-10.9 g/dl, group II with Hb:7-9.9g/dl and group III with Hb<7 g/dl. Maternal and neonatal outcomes of women with different severity of anaemia were analyzed and compared. Two groups means were compared by Student’s t-independent test and more than two groups means by one way analysis of variance test followed by post-hoc pairwise comparison using Bonferroni test.Results: The prevalence of anaemia in the study population was 35.2%. Mild, moderate and severe anaemia were found in 58% (n=232), 29.0% (n=116) and 13% (n=52) women respectively. A statistically significant difference in maternal outcomes such as Preterm labor (p=0.001), Prelabor premature rupture of membranes (p=0.044), Intrauterine growth restriction (p=0.002) and postpartum hemorrhage (p=0.001) was observed amongst the three groups. Cardiac failure occurred in 26.9% (n=14) and mortality in 13.4% (n=7) women with severe anaemia. Amongst the neonatal morbidities, the rate of low birth weight, preterm birth, respiratory distress syndrome, septicaemia, pneumonitis and jaundice revealed an increasing trend with rising severity of anaemia which was statistically significant.Conclusions: Targeted interventions addressing early detection and appropriate treatment in early pregnancy can prevent and avoid dismal maternal and neonatal consequences

Can endometrial volume assessment predict the endometrial receptivity on the day of hCG trigger in patients of fresh IVF cycles: a prospective observational study

Background: Objective of present study was to evaluate the role of three dimensional (3D) endometrial volume measurement on the day of hCG trigger in predicting the endometrial receptivity. The present study is a prospective observational study conducted at assisted reproductive centre of a tertiary care hospital.Methods: Endometrial volume was evaluated by three-dimensional ultrasound in 90 patients undergoing first cycle of IVF on hCG trigger day and was correlated with endometrial receptivity.Results: Out of 90 patients studied 12 patients achieved pregnancy. A significant difference was found in mean endometrial volume on hCG trigger day among pregnant (5.33±2.14 cm3) women compared to non-pregnant women (4.17±1.72cm3). Using Receiver operating characteristics (ROC) analysis the cutoff value for endometrial volume on hCG trigger day was 3.50 cm3 corresponding to sensitivity 75% and specificity 37.2%. Conclusions: The endometrial volume on hCG trigger day was significantly higher in pregnant women as compared to non-pregnant

Epifil: a dynamic model of infection and disease in lymphatic filariasis

The lack of a quantitative framework that describes the dynamic relationships between infection and morbidity has constrained efforts aimed at the community-level control of lymphatic filariasis. In this paper, we describe the development and validation of EPIFIL, a dynamic model of filariasis infection intensity and chronic disease. Infection dynamics are modeled using the well established immigration-death formulation, incorporating the acquisition of immunity to infective larvae over time. The dynamics of disease (lymphodema and hydrocele) are modeled as a catalytic function of a variety of factors, including worm load and the impact of immunopathological responses. The model was parameterized using age-stratified data collected from a Bancroftian filariasis endemic area in Pondicherry in southern India. The fitted parameters suggest that a relatively simple model including only acquired immunity to infection and irreversible progression to disease can satisfactorily explain the observed infection and disease patterns. Disease progression is assumed to be a consequence of worm induced damage and to occur at a high rate for hydrocele and a low rate for lymphodema. This suggests that immunopathology involvement may not be a necessary component of observed age-disease profiles. These findings support a central role for worm burden in the initiation and progression of chronic filarial disease

Chikungunya Outbreak, South India, 2006

We investigated chikungunya outbreaks in South India and observed a high attack rate, particularly among adults and women. Transmission was facilitated by Aedes aegypti mosquitoes in peridomestic water containers, as indicated by a high Breteau index. We recommended vector control measures and health education to promote safe water storage practices

A joinpoint regression model to determine COVID-19 virulence due to vaccination programme in India: a longitudinal analysis from 2020 to 2022

Abstract Background In late 2019, coronavirus disease, an acute respiratory illness caused by the novel coronavirus (SARS-CoV-2), was designated COVID-19 and declared a pandemic. The interim guidance for prevention is through voluntary quarantine, mandatory quarantine, personal protective measures and maintaining social distance in public places. However, considering the severity and rapid spread of the disease to various countries, vaccine development was the last option to cope with the dire consequences. As of 14 Feb 2023, approximately 756 million people were infected with COVID-19 and 6.84 million deaths. As of 30 Jan 2023, around 1317 crores of vaccine doses were administered worldwide. In India, as of 15 Feb 2023, there were approximately 44.15 million infected persons due to COVID-19 and 5,30,756 deaths (1.2%). Considering the high case fatality rate and population size, the Government of India (GOI) implemented the COVID vaccination programme on 16 Jan 2021. As of 15 Feb 2023, approximately 220.63 crores of vaccine doses were administered. Methods We applied joinpoint regression analysis to determine the virulence of COVID-19 cases concerning their daily percentage change (DPC) and average DPC (ADPC) during India’s prevaccination and vaccination phases. We considered the database of daily reporting of COVID-19 cases covering 1018 days (19 Mar 2020 to 31 Dec 2022) that included both prevaccination and vaccination phases. Results Three joinpoint regression analyses adequately fit the data and identified four segments during the prevaccination and vaccination phases. Although the DPC value was 6.4% (95% confidence interval [CI]: 4.7 to 8.3) in the initial period of 50 days, the ADPC value significantly declined to 1.6% (95% CI 1.3 to 1.8) at the end of the prevaccination phase. During the vaccination phase, the model identified two significant segment periods that coincided with the waves of SARS-CoV-2 and Omicron Delta variants. The corresponding DPC values were 4.6% (95% CI 4.2 to 4.9) and 21.6% (95% CI 15.1 to 28.4), respectively. Despite these waves, COVID vaccination significantly reduced the ADPC value (− 1.6%; 95% CI − 1.7 to − 1.5). Conclusions We demonstrated the lockdown and vaccination phases significantly reduced ADPC. Furthermore, we quantified the severity of SARS-CoV-2, the Delta and the Omicron variant. The study findings are significant from an epidemiological perspective and can help health professionals to implement appropriate control measures

Antifilarial lead molecules isolated from Trachyspermum ammi

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