A study to assess knowledge and attitude of infertile Kashmiri couples

Background: Infertility is defined as the inability to conceive naturally after one year of regular unprotected sexual intercourse. The chance to conceive depends on multiple factors like the length of sexual intercourse, frequency of coitus and age of couples. This could be due to male as well as female factors and deficiencies.Methods: This is a cross sectional observational study conducted on infertility patients. A fertility questionnaire was designed for both the partners with questions covering knowledge and attitude towards infertility.Results: A total 100 couples were selected in which prevalence of primary and secondary infertility was 72% and 28% respectively. The mean duration of infertility was 3 years. On scoring their level of knowledge, 52% had inadequate knowledge, 44% had moderate knowledge and 4% had adequate knowledge. There was no statistically significant difference in the knowledge in relation to their educational qualification and type of infertility among participants.Conclusions: Infertility is common problem affecting 10-15% of the population. The knowledge about infertility and its risk factors is generally limited among the participants, in spite of their educational status.

Study of Microalbuminuria in Non-Diabetic and Non-Hypertensive Patients with Acute Myocardial Infarction

Introduction: Microalbuminuria has relationship on thedevelopment of coronary heart disease and it may identify asa new risk factor of this disease. The MA happens more oftenin diabetic patients with AMI but it has been reported evenin non –diabetic patients with AMI. The aim of the presentstudy was to assess the prevalence of microalbuminuria innon diabetic and non hypertensive patients suffering fromAMI. To evaluate the relationship between MA and AMI innon- diabetic and non hypertensive patients admitted in ICCUcardiology department at Rajshree Medical Research InstituteBareilly (UP).Matereial and methods: The study was carried out in thedepartment of Biochemistry and ICCU in RMRI, Bareilly(UP) to establish the correlation between MA with 50non diabetic, non hypertensive patients of AMI and in50 healthy age matched controls. MA was determined byimmunoturbidimetric method and plasma glucose weremeasured by enzymatic method.Result: There was a significant increase in the level of MA inpatients with AMI who were non diabetic, non hypertensive ascompare to those in the healthy control.Conclusion: MA may have an association with AMI inabsence of traditional risk factors like diabetes and HTN. SoMA can be used as an adjunct biochemical parameter in nondiabetic, non hypertensive AMI patients.

A root cause analysis of increasing caesarean section rates in a tertiary care private hospital in North India

Background: Increase in the incidence of caesarean section is a matter of concern worldwide. Robson’s criteria which is universally accepted now as a way for calculating caesarean rates takes into account only the obstetrical consideration, however, it is noteworthy that many socioeconomic and cultural factors also have a role to play. This study takes into account both Robson’s criteria and common socio-cultural factors which lead to increased caesarean rates with an attempt to suggest ways to curtail this trend.Methods: The study was a hospital based cross-sectional study at a private tertiary care hospital in New Delhi. 1200 consecutive live births after 34 weeks of gestation were analysed over a period of one year.Results: LSCS was the most common mode of delivery 733 (61.1%). 329 (27.4%) had induced labour of which 260 (76.2%) had LSCS. 333 women had elective LSCS. Rates of CDMR were 185 (25.2%) which is very significant. As per Robson’s criteria maximum number of women (318) were in group 2, of which 226 (71.1%) underwent caesarean section.Conclusions: High caesarean rates can be attributed to a multitude of factors. Robson’s criteria are an effective way for analysis of obstetric indications. Other added factors include comorbidities, CDMR, fear of litigations, etc which were analysed.

Cases of management of paediatric tubo-ovarian torsion

Ovarian torsion is the fifth most common cause of gynaecologic surgical emergency. It warrants early diagnosis as timely surgical management will avoid the further adnexal injury. In paediatric population, this is especially dangerous as the condition can go undiagnosed because of its rarity and nonspecific presentation. This leads to delay in surgical exploration and loss of ovarian function. In these cases, the ovary and often the ipsilateral fallopian tube twist with the vascular pedicle, resulting in vascular compromise. Unrelieved torsion leads to haemorrhagic infarction. We encountered 3 cases of ovarian torsion in paediatric age group during a period of 12 months. All cases presented with acute pain abdomen for 3-7 days period with loss of appetite and unable to pass motion with varied disappearance of pain. On ultrasound all the cases were diagnosed with ovarian cyst with torsion and underwent laparoscopic cystectomy. This case series is written just to show the results of de-torsion and conserving the fallopian tube and ovary after vascular damage. This type of conservative management may give chance to ovary to return to viability. This was seen in all 3 cases dealt by us on repeat scan on follow up. Even on de-torsion if ovary does not regain its colour immediately it should be conserved, and cystectomy should be performed rather than oophorectomy. Conservative surgery, in the form of ovarian de-torsion can be tried in cases of ischemia but if ovarian necrosis has occurred, then salpingo-oophorectomy is performed as the last resort.

Feto-maternal haemorrhage: a review after and a case report

Feto-maternal haemorrhage is the transmission of fetal blood cells to the maternal blood stream. It is quite common in small volumes- occurring in most pregnancies. Large volumes of feto-maternal haemorrhage can have serious consequences. Some risk factors are identified, but they are not always present. Decreased perception of fetal movements is most important clinical sign, together with a pathological NST. Prompt diagnosis and immediate obstetric care is fundamental, as serious risk to the fetus might result from this condition. Author described the case report of 35 years old G3P1L1A1 with 37 weeks 5 days pregnancy, who came in outpatient department with reduced perception of fetal movements during the previous 10 hours. There was no history of abdominal trauma. Cardiotocograph showed nonreactive NST with minimal beat to beat variability for more than 40minutes. An emergency caesarean section was performed and a female limp baby delivered with heart rate <60/minutes, pale, no respiration and no reflexes. Baby resuscitated with bag and tube ventilated. APGAR score was 3/5/6 at 0, 1, and 5 minutes. Fetal haemoglobin at the first hour of life was 3.0gm/dl. Kleihauer-Betke test revealed 265.7ml of fetal erythrocytes in the maternal blood stream. Despite being rare, it is important to detect a massive feto-maternal haemorrhage. Fetal anemia could be suspected, but the diagnosis was only made after delivery. This case reveals the importance of keeping a high suspicion in obstetric practice, as feto-maternal haemorrhage is a rare but potentially catastrophic event for a fetus.