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Background & objectives: Government of India (GoI) released operational guidelines for maternal near miss-review (MNM-R) in 2014 for use by programme managers of public health system to assist them for conducting MNM-R. The objective of the present study was to review the incidence and factors influencing MNM events in two tertiary hospitals of Maharashtra, India, as per the operational guidelines of the GoI released in 2014 and identify delays based on three-delay model to prevent such events in future. Methods: This prospective observational study was conducted in two tertiary hospitals of Maharashtra, from July 2018 to November 2020. All women during pregnancy, childbirth or postpartum upto 42 days meeting the eligibility criteria of MNM as per the 2014 GoI guidelines were included as cases (n=228), interviewed and discussed during the monthly MNM meetings at these hospitals. Results: The incidence of MNM was 11/1000 live births; the ratio of MNM to maternal deaths was 1.2:1. Leading causes of MNM were haemorrhage (36.4%) and hypertensive disorders of pregnancy (30.3%). Haemorrhage was maximum (70.6%) in abortion and ectopic pregnancies. Majority of the women (80.2%) were anaemic, of whom 32.4 per cent had severe anaemia. Eighty six per cent of women included in the study had MNM events at the time of admission and 81 per cent were referred from lower facilities. Level one and two delays were reported by 52.6 and 32.5 per cent of women, respectively. Level three delay at referral centres and at tertiary hospitals was reported by 69.7 and 48.2 per cent of women, respectively. Interpretation & conclusions: The findings of this study suggest that MNM-R should be undertaken at all tertiary hospitals in India as per GoI guidelines to identify gaps based on three-delay model. These hospitals should implement interventions as per the identified gaps with emphasis on strengthening the infrastructure, facilities and manpower at the first-referral units.
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Emesis is a common experience in first trimester of pregnancy affecting 70 to 80% of all pregnant women. Altered immunological endocrinological and psychological states are responsible for initiation of symptoms. Mild to moderate emesis gravidarum have a significant adverse effect on quality of women's life. Even though onset is physiological its morbidity has to be reduced to minimize disease burden, enhance maternal health and to prevent hyper emesis gravidarum. Anti-emetic and anti-histamines are used in conventional Allopathic practice. Ayurvedic principle is early intervention and prevention of hyperemesis gravidarum with lifestyle modifications and adopting Pathya ahara. This is a case report of emesis gravidarum managed with pharmaco nutrient product –Malarinji modaka
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Perimenopause refers to the period around menopause. In Ayurveda it is considered as Rajakshaya, the transition period of body from predominance of Pitta dosha to Vatadosha which is characterized by aggravation of Vata, alteration of Pitta and Kaphadosha. It is included as a Swabhavikavyadhi in Ayurveda. Management of Dhatukshaya, Rasayana, Balya and Rasa- Raktha Prasadana treatments are seen beneficial in this condition. Guduci is one among Rasayana drugs mentioned in Ayurveda. The drug Guducisatva taken for the study is from the classic Yogaratnakara and has Dhatukrith and Vayastapana property. The objective of the study was to evaluate the effect of 1g Guduci Satva along with Ksheera (25ml boiled and lukewarm) in perimenopausal symptoms. Females in the age group 40-50 years with perimenopausal symptoms were selected for the study from the OPD of Prasutitantra-striroga, GAVC Hospital, Tripunithura as per the inclusion criteria. Study tools are clinical case proforma and Greene Climacteric scale score above 30. Drug was given orally in the dose of 1g twice along with 25ml Ksheera one hour before food. Duration of administration was 30 days and assessment was taken on 0th day, 31st day and 60th day. Results were analysed statistically by Wilcoxon's signed rank test and Friedman’s test. The study result is highly significant after treatment with P value <0.001 during treatment and during follow up and is found effective in reducing the symptoms in perimenopause.
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Background & objectives: Polycystic Ovary Syndrome (PCOS) is becoming an area of global and national health concern. It requires a life cycle approach from adolescence to menopause. To comprehensively address the wide spectrum of this disorder, a multidisciplinary model of care was established for women with PCOS in a government setting in India with an objective to screen and manage multifaceted manifestations of PCOS and to diagnose and treat associated comorbidities such as metabolic syndrome, dermatologic manifestations and psychological issues. Methods: A model of integrated multidisciplinary PCOS clinic was implemented for services and research at ICMR-National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai Maharashtra, India. This is a one-stop holistic centre for managing menstrual, cosmetic, infertility, obesity, metabolic and psychological concerns of women affected with PCOS. Two hundred and twenty six women diagnosed with PCOS using the Rotterdam criteria were screened for metabolic comorbidities with anthropometry, ultrasonography, hormonal and biochemical tests and for psychological problems. Analysis was performed using SPSS version 19.0. Results: Mean body mass index (BMI) was 26.1 kg/m2, higher for Asians. Hirsutism was observed in 53.6 per cent of women. Metabolic syndrome was seen among 35.3 per cent and non-alcoholic fatty liver in 18.3 per cent. Psychological issues such as anxiety and depression were identified in majority of the women 31.4 per cent of women could achieve pregnancy at the end of one year of multidisciplinary management. Interpretation & conclusions: The results of the present study suggest that an integrated multidisciplinary approach led to the early identification and treatment of comorbidities of PCOS, especially metabolic syndrome. There is hence an urgent need to implement multidisciplinary PCOS clinics in government health facilities.
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This study was aimed to screen the activity of the methanolic extract of Mikania cordata leaves (MLME) againstpathogenic bacteria and Ehrlich ascites carcinoma (EAC)-induced cancer in mice. Antibacterial activity was testedagainst some Gram-positive (Bacillus subtilis IFO 3026 and Sarcina lutea IFO 3232) and Gram-negative (Klebsiellapneumoniae ATTC 10031, Proteus vulgaris MTTC 321, Pseudomonas denitrificans KACC 32026, and Xanthomonascampestris IAM 1671) bacteria by disk diffusion and liquid microdilution assay. The anticancer activity wasassessed by EAC cell death, apoptosis, hematological parameters determination, and 3-(4, 5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide test. The MLME exhibited prominent antibacterial activity against the test strains.The minimum inhibitory concentrations were ranged from 1.25 to 20 mg/ml for the bacterial strains that were foundampicillin resistant. The MLME exhibited remarkable anticancer activity on EAC in a dose-dependent manner. Oralintake of MLME at the dosage of 400 mg/kg body weight (b.w) exhibited the highest EAC cell death with remarkableapoptotic features including chromatin condensation, nuclear fragmentation, and accumulation of apoptotic bodies.The MLME-treated EAC-bearing mice showed dose-dependently restored altered hematological parameters towardthe normal level. The IC50 value was 6.6 ± 1.91 µg/ml. These findings suggest that the M. cordata leaves have strongantibacterial and anticancer properties.
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Objective: In this study our main aims to know the clinicalprofile of pediatric enteric fever and the sensitivity pattern ofthe disease to drugs in this region.Methodology: This prospective observational study conductedin a tertiary care hospital at Dhaka from March to December2016 among suspected case of Enteric fever as per casedefinition. Among 212 suspected enteric fever 117 childrenwere diagnosed as enteric fever by blood culture and/or Widaltest.Results: During the study, Male: female were 1.3: 1. Maximum(70%) children were in age group 5 years or more. Most of thechildren were from urban slum area (53.6%) of Dhaka city.Cases were admitted throughout the year. Commonpresentation were fever (100%), anorexia (100%), painabdomen (74.4%) and loose motions (46.1%). The commonsigns were hepatomegaly (41.9%), hepatosplenomegaly(5.1%) coated tongue (64.9%), pallor (74.4%). Thecomplications rate was 35.9% and commonest being UTI andpneumonia. The overall positivity of Widal test was 89.7% andthe culture positivity was 32.5%. Among isolates, 94.7%wereSalmonella typhi and 5.3% Salmonella paratyphi A. Amongthem18.1% isolates were multi drug resistant.Conclusion: Enteric fever is most prevalent during summer &rainy session. WASA supplied water may play a role.Hepatomegaly is common. UTI and pneumonia are thecommonest complication. Multidrug resistant cases are not soas high as other countries. Cefixime, Ceftriaxone. Meropenamand Ofloxacine are the drugs of choice. Ciprofloxacin is stillcould be chosen for the treatment of enteric fever. Higher rateof resistant to Azithromycin is alarming.
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Objective: In this study our main goal is to evaluate clinicaloutcome of neonatal septicemia in Bangladesh.Methods: This cross-sectional study is conducted at Neonatalunit of the department of paediatrics, Sir Salimullah MedicalCollege and Mitford Hospital, Dhaka, From July 2005 to June2006. Among 90 clinically diagnosed septicemic neonates, 30were blood culture positive.Results: During the study, where low birth weight (60%),prematurity (53%), prolonged rupture of membrane wasdocumented in 17% of cases. 70% delivery occurred by normalvaginal route, among them 50% occurred at home and 20%occurred at hospital. 30% were delivered by LUCS. 13% caseshad H/O fever in last trimester. Lethargic and reluctant to feed,83% had respiratory distress. Jaundice was present in 60%cases, fever was present in 40% cases. Other presentationswere apnea, convulsion, abdominal distension, sclerema,vomiting, hypothermia and diarrhoea.Conclusion: From our result, we can conclude that, thepattern of organisms are changing and high incidence ofmultidrug resistance remains a major challenge to manageneonatal septicemia.
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Objectives@#To find out the factors influencing discharge process turnaround time (TAT) and to accurately predict the discharge process TAT. @*Methods@#The discharge process of cardiology department inpatients in a tertiary care hospital was mapped over a month. The likely factors influencing discharge TAT were tested for significance by ANOVA. Multiple linear regression (MLR) was used to predict the TAT. The sample was divided into testing and training sets for regression. A model was generated using the training set and compared with the testing set for accuracy. @*Results@#After a process map was plotted, the significant factors influencing the TAT were identified to be the treating doctor, and pending evaluations on the day of discharge. The MLR model was developed with Python libraries based on the two factors identified. The model predicted the discharge TAT with a 69% R2 value and 32.4 minutes (standard error) on the testing set and a 77.3% R2 value and 26.7 minutes (standard error) on the overall sample. @*Conclusions@#This study was an initiation to find out factors influencing discharge TAT and how those factors can be used to predict discharge in the hospital of interest. The study was validated and predicted the TAT with 77% accuracy after the significant factors that affect the discharge process were identified.
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Introduction: Rupture uterus is an uncommon and frequentlycalamitous circumstance. It is connected with a highoccurrence of fetal and maternal mortality and morbidity.Objective: Our primary objective of this investigation is toassess results of uterine rupture among women with earliercesarean section.Method: This cross-sectional study was done at JalalabadRagib Rabeya Medical College Hospital, Sylhet from January2016 February to 2019 February. All out 63 instances ofruptured uterus were recorded in this investigation and everyone of the instances of ruptured uterus who were eitherconceded with complain or who developed it in medical clinicwere incorporated into the examination.Results: During the examination most events of ruptureduterus was the gestational age 37-40 weeks, (66.67%) andamong 63 patients, most (65.08%) had no antenatal checkup.(34.92%) had unpredictable antenatal checkup. Likewise therupture was bound to lower segment in the abdominal uterus.Conclusion: Lack of antenatal care, misuse of oxytocin, andinappropriate counseling of patients with history of previouscaesarian section for hospital delivery are the main causes fora ruptured uterus in this study.
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Sickle cell disease and homozygous beta-thalassaemia are common haemoglobinopathies in Oman, with many implications for local healthcare services. The transfusions of such patients take place in many hospitals throughout the country. Indications for blood transfusions require local recommendations and guidelines to ensure standardised levels of care. This article summarises existing transfusion guidelines for this group of patients and provides recommendations for blood banks and transfusion services in Oman. This information is especially pertinent to medical professionals and policy-makers developing required services for the standardised transfusion support of these patients
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Background: Diabetes is a chronic disorder of carbohydrate, fat and protein metabolism characterized by increased fasting and post prandial blood sugar levels. The global prevalence of diabetes is estimated to increase, from 4% in 1995 to 5.4% by the year 2025. WHO has predicted that the major burden will occur in developing countries. Drugs used in treatment of diabetes mellitus type II include sulfonylureas, biguanides, meglitinides, thiazolidinediones, dipeptidyl peptidase IV inhibitors, and α-glucosidase inhibitors. Due to low compliance of allopathic medicines patients are in search of medicinal herbs to treat their hyperglycemic state. Garlic is one of those herbs whose hypoglycemic effects are remarkable and accepted by cardiologists. Methods: We compared hypoglycemic potential of herbal hypoglycemic herb Garlic with Metformin. It was single blind placebo control research conducted at Jinnah Hospital Lahore-Pakistan from January 2016 to June 2016. Seventy-five diabetic type-II patients were selected for research. Hospital research counsel-approved and explained consent was taken from all patients. They were divided in three groups, 25 patients in each group. Group-1 patients were advised to take 250 mg Metformin thrice daily for two months. Group-2 patients were advised to take 10 grams of garlic in three divided doses for two months. Group-3 was on placebo therapy. Their base line fasting blood glucose level was taken and kept in record. They were advised to visit the lipid research clinic of the hospital fortnightly. They were also advised to check their fasting plasma glucose level daily at the morning by using Glucometer. Results: After two months’ trial when results were compiled and statistically analyzed by applying paired ‘t’ test, it was observed that Metformin decreased blood sugar level 28.4 mg/dl in 24 diabetic patients, which is highly significant change biostatistically. Garlic reduced fasting blood sugar 25.5 mg/dl in 22 diabetic patients, which is biostatistically highly significant change with p-value <0.001. Conclusions: It was concluded from the study that garlic can decrease blood glucose level highly significantly, near to hypoglycemic effect of Metformin.
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Objectives: To investigate the burden of hepatitis B, hepatitis C and human immunodeficiency virus and to explore route of transmission in internally displaced persons of South Waziristan
Methodology: A cross sectional study was carried out in Gomal Medical Collage, Dera Ismail Khan; Mufti Mehmood Teaching Hospital Bannu and Basic Health Unit Zaferabad, Dera Ismail Khan. Total 300 internally displaced persons [IDPs] of South Waziristan who were undiagnosed and presented with non-specific symptoms were included in the study. The data was analyzed in SPSS version 16. Confidentiality of subjects was ensured
Results: In this study 300 IDPs were screened for HBsAg, anti-HCV and anti HIV antibodies. Out of which male were 190 and female were 110. More males were suffering from hepatitis B [10.3%] than hepatitis C [6.7%] or HIV [0.7%] as compared to females [3.3%], [5%] and [0.3%] respectively. A total of 5[1.7%] cases had history of previous surgery and 17[5.7%] had history of tooth extraction
Conclusion: The frequency of HBV was higher as compared to HCV and HIV infections. The frequency of all the three infections was comparatively more in males as compared to females. Most likely Most likely risk factors for acquistion of infection were unhygienic tooth extractions, unsafe blood transfusions and iatrogenic
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Objectives: To identify association between socio-demographic characteristics and pattern of health seeking behavior among hepatitis C patients in Karachi, Pakistan
Study design, settings and duration: A descriptive, cross-sectional study done at Aga Khan University Hospital and the Civil Hospital Karachi between March and May 2013
Patients and Methods: Hepatitis C patients who were coming for treatment at the above 2 sites underwent a filling of questionnaire by the researcher. The questionnaire collected basic demographic information and their health seeking behavior i.e. visit to traditional healer or spiritual healer or medical doctor. Sample size of 250 patients was calculated. Analysis was done by using Chi square test and Fisher's exact test. p-value of 0.05 was considered as statistically significant
Results: A total of 250 hepatitis patients were interviewed. The study showed that patient's occupation and educational level had significant association with their first visit either to a spiritual healer or traditional healer. More educated group consulted the medical doctor while those with none or low education initially went to see spiritual healers [p < 0.008] and second visit was made to traditional healers [p < 0.002]. Patients with larger number of children went less often to visit a medical doctor on their second visit [p = 0.007], and family members belonging to the medical field were more likely to make their first visit to doctors [p < 0.05]
Conclusion: Socio-demographic characteristics greatly influence the pattern of health seeking behavior among hepatitis C patients
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Adult , Adolescent , Aged , Female , Humans , Male , Middle Aged , Young Adult , Demography , Socioeconomic Factors , Patient Acceptance of Health Care , Surveys and Questionnaires , Cross-Sectional StudiesABSTRACT
Background & objectives: Preventing unintended pregnancies among people living with HIV (PLHIV) is one of the strategies of WHO for preventing parent-to-child transmission (PPTCT). Given the limitation of only condom use, the objective of this study was to improve use of dual contraceptive methods among HIV infected women. Methods: An experimental study among HIV positive women was conducted at two tertiary care level hospitals in Mumbai. Linking HIV with family planning services was the focus of intervention at one site and standard level of care was maintained at the control site. At each site, 150 HIV+ve women attending counselling and testing centres, who did not intend to get pregnant in the next one year and were eligible to use dual methods, were enrolled and followed up to one year. Results: At the end of one year, 60 per cent women in the intervention group reached Family Planning Centres compared to eight per cent in the control group. There was three times more acceptance and continuation of use of dual methods along with increase in consistent use of condoms and less number of unplanned pregnancies in the intervention group than the control group. Interpretation & conclusions: The study findings demonstrate that linking HIV and family planning services may facilitate the uptake of dual methods of contraception without reducing consistent condom use among HIV infected women. The PPTCT programmes need to focus on the component of Prong 2 of PPTCT which aims to prevent unintended pregnancies among HIV positive women.
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Magnetic resonance imaging using T2[asterisk] [MRI T2[asterisk]] is a highly sensitive and non-invasive technique for the detection of tissue iron load. Although the single breath-hold multi-echo T2[asterisk] technique has been available at the Sultan Qaboos University Hospital [SQUH], Muscat, Oman, since 2006, it could not be performed on younger patients due to their inability to hold their breath after expiration. This study was carried out between May 2007 and May 2015 and assessed 50 SQUH thalassaemic patients aged 7-17 years old. Seven of these patients underwent baseline and one-year follow-up MRI T2[asterisk] scans before receiving physiotherapy training. Subsequently, all patients were trained by a physiotherapist to hold their breath for approximately 15-20 seconds at the end of expiration before undergoing baseline and one-year follow-up MRI T2[asterisk] scans. Failure rates for the pre- and post-training groups were 6.0% and 42.8%, respectively. These results indicate that the training of thalassaemic patients in breathhold techniques is beneficial and increases rates of compliance for MRI T2[asterisk] scans
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Objectives: transfusions are a common medical intervention. Discussion of the benefits, risks and alternatives with the patient is mandated by many legislations prior to planned transfusions. At the Sultan Qaboos University Hospital [SQUH], Muscat, Oman, a written transfusion consent policy was introduced in March 2014. This was the first time such a policy was implemented in Oman. This study therefore aimed to assess adherence to this policy among different specialties within SQUH
Methods: the medical records of patients who underwent elective transfusions between June and August 2014 were reviewed to assess the presence of transfusion consent forms. If present, the consent forms were examined for completeness of patient, physician and witness information
Results: in total, the records of 446 transfused patients [299 adult and 147 paediatric patients] were assessed. Haematology patients accounted for 50% of adult patients and 71% of paediatric patients. Consent was obtained for 75% of adult and 91% of paediatric patients. The highest adherence rate was observed among adult and paediatric haematology specialists [95% and 97%, respectively]. Consent forms were correctly filled out with all details provided for 51% and 52% of adult and paediatric patients, respectively. Among inadequately completed forms, the most common error was a lack of witness details [20-25%]
Conclusion: in most cases, the pre-transfusion consent policy was successfully adhered to at SQUH. However, further work is required to ensure full compliance with the consent procedure within different specialties. Implementation of transfusion consent in other hospitals in the country is recommended
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Objective: to determine the frequency of Vitamin D deficiency in children presenting with rickets
Methods: descriptive case series was conducted at the department of Paediatrics Unit III, Dow University of Health Sciences and Civil Hospital Karachi in children 6 months to 5 years of age presenting with clinical rickets. Children taking vitamin D were excluded. The subjects fulfilling inclusion criteria were enrolled after informed consent. Blood samples were taken from each patient and were sent to the laboratory for vitamin D [25[OH] D] level. Serum level of vitamin D less than 20ng/ml was labeled as vitamin D [25[OH] D] deficiency rickets. The data was collected on pre-designed performa by the principal researcher. The data was analyzed using SPSS version 10
Results: the age of enrolled participants was 1.5 +/- 1 year. Of 159 enrolled participants, 91 [57.2%] were male and 68 [42.8%] were female. Frequency of sun exposure of 2-3 days a week was 97 [61.01%] and using vitamin D fortified foods were 34 [21.38%]. The frequency of vitamin D deficiency was 120 [75.47%] cases
Conclusion: in this study the frequency of vitamin D deficiency in children 6 months to five years with rickets was 75%
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Objective: To determine the frequency of congenital hypothyroidism among healthy newborns presenting to a public health facility in Karachi, Pakistan
Methods: This cross sectional study was carried out for six months duration at the Well Baby Clinic, Paediatric unit III, Civil hospital Karachi. Neonates of both sex delivered after 37 weeks of gestation, at Civil Hospital Karachi and visited the well baby clinic, after 48 hours of birth to <4 weeks of age for follow up were included in the study. A 3 cc venous blood sample taken for serum Thyroid Stimulating Harmone [TSH] level. Data analysis was done using SPSS statistics version 16
Results: A total of 215 healthy newborns were included, 112 were male and 103 female patients
Congenital hypothyroidism was considered according to the TSH value. The results showed that 35 patients had TSH >40 [microU/ml]
Conclusion: This study shows that in the screening for the congenital hypothyroidism, 16.3% had a TSH level of >40 [microU/ml]
This suggests that screening of hypothyroidism should be mandatory in all newborns especially in our region for early diagnosis and treatment of congenital hypothyroidism
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A simple and efficient protocol for recurrent somatic embryogenesis and plant regeneration is one of the prerequisites for genetic improvement of guava. An efficient reproducible regeneration somatic embryogenesis protocol was developed in four genotypes of Psidium guajava L. using immature zygotic embryo as starter explant. Somatic embryogenesis induction was obtained on MS basal medium supplemented with 2.0 mgL-1 2, 4-D, 400 mgL-1 L-glutamine, 6% sucrose and 500 mgL-1 Malt extract. Following SE induction different developmental stages of somatic embryos (Globular, heart-shaped, torpedo, cotyledonary) was directly obtained and further recurrent embryogenesis also obtained upon prolonged incubation in induction media. Addition of polyethylene glycol (50 mgL-1) significantly improved the embryos maturation in MS supplemented with and 3% sucrose. The regeneration in MS medium supplemented with BAP (0.5 mgL-1), NAA (0.2 mgL-1), casein hydrolysate (100 mgL-1) and 3% sucrose. High plant regeneration frequency and intensity of somatic embryos (58.5%) obtained. Plant maturation on MS medium supplemented with BAP 2.0 mgL-1 with 2% sucrose. The rooted plants was successfully acclimatize in the greenhouse with a survival rate of 85%. This somatic embryogenesis protocol developed would be helpful in establishment of genetically modified guava aimed at seedlessness, increased shelf life and wilt disease.