Assessing the pros and cons of vaginal birth after caesarean relative to elective repeat caesarean section

Background: Recent years have witnessed a rise in rate of primary caesarean section (CS). No. of women reporting with a previous CS scar is also increasing. Judicious trial of labor in such patients can prevent repeat caesarean section. Aim of this study was to assessing the safety and success rate of vaginal birth after caesarean (VBAC) in selected cases of patients who have undergone previous lower segment CS (LSCS) is the main aim of this study.Methods: In this prospective observational study carried out in a tertiary care teaching hospital over a period of 1 year. 375 pregnant women with a history of one previous LSCS for non-recurrent indications were enrolled. The statistical technique of t-test was administered for relative comparison with respect to maternal and neonatal complications across the two groups, i.e. repeat LSCS and vaginal delivery.Results: Out of 375 patients 187 patients (49.9%) underwent elective LSCS for recurrent indication and for non-recurrent indication associated with some complicating factor. Trial of labor in 188 (50.10%) was given out of which 59.3% had spontaneous vaginal delivery,7.20% had instrumental delivery and 33.50% landed into emergency CS. Commonest cause of Em. LSCS being Fetal distress. As regards maternal complications, no statistically significant difference was found between the Repeat LSCS and Vaginal delivery groups (t = 0.779, p > 0.05). On similar lines, there was no statistically significant difference across both groups as regards neonatal complications (t = 0.632, p > 0.05).Conclusions: Taking into account the increased trend of primary CS, trial of VBAC in selected cases is very important. It can be concluded that VBAC has chances of success in cases with previous one LSCS but it must be carefully investigated and monitored

Outcome of post caesarian pregnancy in a tertiary care hospital in Udaipur, Rajasthan

Background: The prevalence of caesarean section has increased due to a variety of factors such as patient choice and relative safety of the procedure. However in many cases the risk involved in LSCS is still present.Methods: The present study was designed to evaluate the outcome in cases where VBAC or TOLAC were used for the second pregnancy in a previous LSCS case. The study employed a sample of 60 subjects who were equally divided in two groups who were subjected to elective cesarian and TOLAC.Results: The results showed that TOLAC did have a better outcome as compared to repeat cesarian in context of maternal and foetal factors.Conclusions: The practice of TOLAC must be tried as an alternative and can be a viable option for uncomplicated post cesarian deliveries.

YOGA PRACTICE AND BIOCHEMICAL AND PHYSIOLOGICAL ALTERATIONS IN NORMAL SUBJECTS

ABSTRACTObjective: To assess the effect of 45 minute yogic kriya (Surya Namaskar and Kapalbhati) for 30 days on various physiological and biochemicalparameters.Methods: About 20 Nursing College students of the Santosh Medical University, Ghaziabad, between the age group 17 and 21 years volunteered toparticipate in the study. They were divided into two Groups A and B. Group A students including 10 students in each group were subjected to 30 daysyoge kriya for 45 minutes for 6 days in a week. Statistical analysis: A student's t-test was used for comparing the means of pre- and post-yoga resultsof various parameters.Results: No significant difference was found in systolic blood pressure, pulse, body mass index, hemoglobin except for fasting blood sugar and diastolicblood pressure (p<0.001) among the yoga subject while comparing with baseline values and control.Keywords: Yoga, Biochemical alterations, Physiological alterations, Surya Namaskar and Kapal Bhati

Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome

Study Question What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? Summary Answer International evidence-based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. What Is Known Already Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. Study Design, Size, Duration International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. Participants/Materials, Setting, Methods Governance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis, and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels. Main Results and the Role of Chance The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: i) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; ii) reducing unnecessary testing; iii) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and iv) emphasizing evidence based medical therapy and cheaper and safer fertility management. Limitations, Reasons for Caution Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided. Wider Implications of the Findings The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program. Study Funding/Competing Interest(S) The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine. Guideline development group members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline in the Register of disclosures of interest. Of named authors, Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Laven declared grants from Ferring, Euroscreen and personal fees from Ferring, Euroscreen, Danone and Titus Healthcare. Prof. Norman has declared a minor shareholder interest in an IVF unit. The remaining authors have no conflicts of interest to declare. The guideline was peer reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREEII criteria and underwent methodological review. This guideline was approved by all members of the guideline development groups and was submitted for final approval by the NHMRC

Electric Vehicles Mission Leap Towards a Greener Future

28-31The EV Mission is critical for India to reduce fossil fuel consumption and mitigate emissions by facilitating the production of Electric Vehicles (EVs) economically

Analyzing the changes in thyroid hormones and the serum lipid profile in non-pregnant, pregnant and preeclamptic women: Kavita Tanwar 1* Preeti Malhotra 2 Hemendra Yadav3 and Suman Jain4* 1, 2Assistant Professor, Department of Obstetrics and Gynaecology, 4Associate professor, Department of Biochemistry, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, India. 3Intensivist, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India.

Objective- The objective of the study was to investigate lipids and thyroid profile status among women with (100 pregnant women) or without pregnancy (100 normal ) and with preeclampsia (100 pre-eclamptic women). Methodology-The Department of Obstetrics and Gynecology at the Pacific Institute of Medical Sciences in Udaipur treated 300 patients (obstetric cases) for the current case control comparative study. The Total lipid and thyroid profile were examined for in a fasting blood sample. Results- The study showed increased level of T3, T4 in Pre- eclampsia than normal pregnant but non-significant. Lipid profile (TC, TG, LDL & VLDL), TSH were significantly higher in pre-eclampsia than in normal pregnant and non- pregnant women. In conclusion, Thyroid disorder is one of the predisposing causes for pre-eclampsia. Hence thyroid hormonal assay can be considered as a screening test for early diagnosis and treatment of pre-eclampsia to prevent further complications of it

Screening for Latent and Active Tuberculosis in Paediatric Contacts of Tuberculosis Patients: A Cross-sectional Study

Introduction: Globally, World Health Organisation (WHO) estimate suggests that, one million cases of Tuberculosis (TB) occur among children (approximate 10% of the total 9.6 million TB cases). As per Revised National Tuberculosis Control Programme (RNTCP), high importance and priority is given to the household contacts and paediatric age group (especially <6 years). Since, transmission can happen at any time from index case to the contact (before diagnosis or during treatment), all contacts of TB patients should be screened. Aim: To focus on the screening of paediatric contacts of TB positive patients by Mantoux test and to find out active and latent TB. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India. The duration of the study was 16 months, from February 2020 to June 2021. Participants, who were proven cases, either sputum positive or clinically diagnosed and were less than 18 years of age were included. Contacts in whom Isoniazid Preventive Therapy (IPT) had been started were excluded. The candidates who tested Mantoux positive and had symptoms of TB were further screened by following test chest X-ray, Ultrasonography (USG) abdomen, Microscopy for Acid Fast Bacilli (AFB), Cartridge Based Nucliec Acid Amplification Test (CBNAAT), Cerebrospinal Fluid (CSF) analysis and contrast Magnetic Resonance Imaging (MRI). The data collected was analysed statistically with Statistical Package for Social Sciences (SPSS) version 26.0 and the level of significance was determined p-value 0.05 as significant and p-value <0.001 as highly significant. Results: A total of 82 contacts were included. Out of these, 60 children had no organ system involvement, whilst 11 had lymphadenopathy, five had respiratory involvement and six had abdominal involvement. Out of 82 contacts, 23 children tested Mantoux positive and 59 tested negative. Out of 23 Mantoux positive contacts 16 (19.51%) had latent TB and only 1 (2.44%) had active TB. Conclusion: A significant number of children in contact with TB positive patients were found to have latent TB, and it is possible that, there can be activation from latent to active TB later on in these children