Patterns of antenatal care services utilization in rural Amroha, Uttar Pradesh: a community based cross sectional study

Background: Antenatal care (ANC) services are considered to be the crucial element in the primary health care delivery system of a country. World Health Organization (WHO) estimates suggested that almost all of the maternal deaths (99%) and child deaths (98%) occurred in developing countries. These maternal deaths could have been prevented if the pregnant women or adolescent girls had been able to access quality antenatal care. The objectives of the present study were conducted in rural parts of district Amroha, Uttar Pradesh for assessing the patterns of utilization of the ANC services and to ascertain the factors influencing utilization of ANC services.Methods: The present study was a cross sectional in nature. Recently delivered women were selected as study subject. A multi-stage stratified sampling design with random approaches had been used. Total 360 subjects included in the study.Results: Respondents age, education, occupation, socio economic status, family type and family size were the factors that influenced the utilization of the ANC services. With 100% ANC registration, sub centre was the most preferred place for registration. 76.9% of woman received more than 3 ANC visits. 315 (87.5%) and (71.9%) respondents received 2 doses to TT vaccine and more than 100 IFA tablets respectively.Conclusions: Utilization of ANC services are on rise in rural parts of Amroha, Uttar Pradesh. Still significant proportions of women are doesn’t return to health facility after the ANC registration. Intensification of efforts is needed to cater this left out group through improving community awareness and motivation.

Ureteroscopy and stone treatment in the elderly (≥70 years): prospective outcomes over 5- years with a review of literature

ABSTRACT Objective: To assess outcomes of ureteroscopy for treatment of stone disease in the elderly. Ureteroscopy (URS) is an increasingly popular treatment modality for urolithiasis and its applications are ever expanding with the development of newer technologies. Its feasibility and outcomes within the elderly population to our knowledge remain under-reported. Materials and Methods: We examined the patient demographics and surgical outcomes from our prospective database for patients ≥70 years who underwent URS for urolithiasis, in a 5-year period between March 2012 and December 2016. Results: A total of 110 consecutive patients underwent 121 procedures (1.1 procedure/patient) with a mean age of 77.2 years (range: 70-91 years). Stone location was in the kidney/ pelviureteric junction (PUJ) in 29%, ureter in 37% and in multiple locations in 34%. The initial and final stone free rate (SFR) was 88% and 97% respectively. While 73% were done as true day case procedures, 89% patients were discharged within 24 hours. Eleven patients (9%) underwent complications of which 10 were Clavien I/II including acute urinary retention, urinary tract infection, stent symptoms and pneumonia. One patient underwent Clavien IV complication where they needed intensive care unit admission for urosepsis but fully recovered and were discharged home subsequently. Conclusion: Ureteroscopy is a safe and effective method of managing urolithiasis in elderly patients. Although most patients are discharged within 24-hours, consideration needs to be made for patients where social circumstances can impact their discharge planning.

Uterocutaneous Fistula –A Rare Clinical Entity

Uterocutaneous fistula is a rare complication that may follow caesarean section. Herein is described a rare case of uterocutaneous fistula. The 35-year-old P3 L3 female patient presented to general surgery OPD with complaints of bleeding from sinus near the caesarean section scar site for last 2 years. She underwent three caesarean sections in the past. Laparotomy was performed. Conservative surgical treatment was successful. At 6-month follow-up, hysteroscopy revealed a normal uterine cavity. We conclude that conservative surgical treatment can be an efficient procedure.

A Rare Case Report of Spigelian Hernia

Introduction spigelian hernias (SH) represent 0.12–2.4% of all abdominal wall hernias. Its diagnosis is elusive and requires a high level of conjecture given the disease rarity, vague-associated abdominal complaints and frequent lack of consistent physical findings. Presentation of case A 40-year-old woman presented with a history of chronic pain in the right lower side of the abdomen. The patient was treated for several diseases with no relief of symptoms. Abdominal ultrasound showed an SH in the lower right abdomen and surgery was scheduled for treatment. Discussion an SH is generally an inter-parietal hernia, meaning that the pre-peritoneal fat and the hernia sac penetrate the transversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. In most of the patients the lack of clinical signs demands the importance of radiological investigation especially high grade which is. That's the importance of the high grade of suspicion of the disease during the physical exam. The surgical repair is necessary due to the high risk of incarceration-related complications, which can occur in up to 21% of cases. Conclusion diagnostics and history of abdominal pain is important in diagnosing SH as it cause of lower abdominal pain to prompt indicate surgical repair and provide the patient's symptom relief. Also the type of repair is dependent on the surgeon's choice and also the means available in each centre.

Shock wave lithotripsy outcomes for lower pole and non-lower pole stones from a university teaching hospital: parallel group comparison during the same time period

Shock wave lithotripsy [SWL] is a treatment option for all locations of renal and ureteric stones. We compared the results of SWL for lower pole renal stones with all other non-lower pole renal and ureteric stones during the same time period. All SWL procedures were carried out as day case procedures by a mobile lithotripter from January 2012 to August 2013. The follow-up imaging was a combination of KUB X-ray or USS. Following SWL treatment, the stone free rate [SFR] was defined as

Maternal mortality in a tertiary care hospital: a 10-year review

Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement. This was a 10 year retrospective study. Epidemiological data was collected from the hospital register and maternal mortality ratio, epidemiological factors and causes affecting maternal mortality were assessed. A total of 120 maternal deaths occurred. Most maternal deaths occurred in the age group of 20-24 years, multiparous women [56.66%], women from rural areas [69.16%], illiterate women [65%], unbooked patients [83.33%], and patients of low socioeconomic status [83.33%]. Direct causes accounted for 72.5% of maternal deaths where as 27.5% of maternal deaths were due to indirect causes. There is a wide scope for improvement as a large proportion of the observed deaths are preventable

Flexible ureteroscopy and Holmium:YAG laser lithotripsy for stone disease in patients with bleeding diathesis: a systematic review of the literature

INTRODUCTION AND OBJECTIVES: The management of urolithiasis in patients on anticoagulants presents a challenge to the endourologist. Due to multiple comorbidities, it may be impossible to safely discontinue the anticoagulant treatment. Other modalities such as shock wave lithotripsy and PCNL are contraindicated in these patients, so ureteroscopic treatment may be the only option. We conducted a systematic review of the literature to look at the safety and efficacy of ureteroscopic management in these patients. METHODS: Systematic review and quantitative meta-analysis was performed using studies identified by a systematic electronic literature search from January 1990 to August 2011. All articles reporting on treatment for stones in patients with a bleeding diathesis using ureteroscopy and a Holmium:YAG laser were included. Two reviewers independently extracted the data from each study. The data was included into a meta-analysis and discussed. RESULTS: Three studies were identified reporting on 70 patients (73 procedures). All patients had stone fragmentation using Holmium laser. The mean stone size was 13.2mm with a range of 5-35mm. The quality of the included studies was modest. Stone free status was achieved in sixty-four patients (87.7%). There were no major complications and only 11% of the patients developed minor complications with only 4% rate of minor bleeding. CONCLUSIONS: Retrograde stone treatment using ureteroscopy and holmium laser lithotripsy can be safely performed in patients with bleeding diathesis with a low complication rate.

Antidiabetic activity of alcoholic extract of cinnamomum zeylanicum leaves in alloxon induced diabetic rats.

The present study was carried out to investigate theantidiabetic potential of ethanolie extract of Cinnomomum zeylamicum leaves. Oral administration of ethanolic extract in the doses of 100,150 & 200 mg/kg body weight to white Wistar albino rats significantly reduced their blood sugar level in allxon induced diabetic rats under acute and sub acute studies.

Secondary immune defects in non-Hodgkin's lymphoma.

Changes in the humoral, cellular and phagocytic components of the immune system were investigated in 44 biopsy proven, untreated patients of non-Hodgkin's lymphoma (NHL). There was significant decrease in the total lymphocyte number, their subsets (T and B) and the T helper (T mu) population. Impaired leukocyte migration inhibition response and DNA synthesis following stimulation by phytohaemagglutinin were noted. Significant reduction of serum IgA was found in patients of both diffuse and nodular NHL. Phagocytic activity and nitroblue tetrazolium (NBT) reduction were unaltered, but chemotaxis was significantly reduced and bactericidal activity showed variable results.

Periampullary carcinoma with special reference to their mucin characteristics--a pathologic study of 53 cases.

Histological features and mucin characteristics of 53 cases of periampullary carcinoma, a rare group of epithelial tumors is presented. The cases comprised of 17 resected specimens and 36 endoscopic biopsies. Jaundice was the commonest symptom. The mean tumor size was 2 cms diameter (1-6 cms). Forty cases were characterised as well differentiated adenocarcinoma, 5 as moderately differentiated adenocarcinoma, 5 as mucin secreting adenocarcinoma, 3 as papillary adenocarcinoma and 1 as undifferentiated carcinoma. Desmoplasia and insignificant mitosis were amongst the commonly encountered histological features. Forty four cases (83%) stained positive for mucin (PAS-AB) with a majority of them (66%) predominantly showing acidic mucin. The likely prognostic implication of this feature is discussed.

Solitary ulcer syndrome of the rectum--a histopathologic characterisation of 33 biopsies.

Histological analysis of 33 rectal biopsies from 26 patients of solitary ulcer syndrome (SUS) of rectum was undertaken. Fibrous obliteration and smooth muscle extension into the lamina propria were the characteristic and most constant findings. The limitation of the biopsy procedure in procuring deeper tissue made the detection of colitis cystica profunda rare in our study. A combination of fibrosis of the lamina propria, superficial mucosal ulceration, muscularis mucosae hypertrophy and submucosal fibrosis, along with the clinical suspicion should clinch the diagnosis of SUS.