ABSTRACT
Background & objectives: Uterine leiomyomas (fibroids) are common cause of morbidity in women of reproductive age group. High intensity focused ultrasound with the imaging guidance of magnetic resonance imaging (MRI) known as magnetic resonance guided focused ultrasound sonication (MRgFUS) is now available. However, there are no available studies with this non invasive modality of treatment in Indian subjects. The objective of this study was to determine the safety and clinical efficacy of MRgFUS in the treatment of uterine fibroids. Methods: This prospective study included 32 consecutive women with clinically symptomatic uterine fibroids who were treated with MRgFUS from February 2011 to October 2011. Pre and post treatment symptom severity scores (SSS) were assessed at the time of enrolment and at one, three and six months follow up using a validated uterine fibroid symptom - quality of life questionnaire (UFS-QOL). Pre and post treatment fibroid volumes were compared immediately after treatment and at six months follow up using contrast enhanced MRI scan. Non perfused volume (NPV) ratios were calculated and correlated with fibroid volume reductions immediately after the treatment and at the end of six months follow up. Results: This procedure was well tolerated by the patients and procedure related adverse effects were non significant. Significant reductions in SSS were seen at one, three and six month intervals after the treatment (P<0.01). Significant reductions were noticed in fibroid volumes at six months follow up compared to pretreatment fibroid volumes (P<0.01). Significant positive correlations were observed between NPV ratios and reduction in fibroid volumes at six months follow-up (r=0.659, P<0.01). Interpretation & conclusions: MRgFUS is relatively a safe and effective non invasive treatment modality for treating uterine fibroids in selected patients. Its long term efficacy is yet to be tested and compared with other available minimally invasive treatment options.
ABSTRACT
Obesity is associated with increased cardiovascular morbidity and mortality. A direct effect of isolated obesity on cardiac function is not well established. The study was designed to determine the direct effect of various grades of isolated obesity on Echocardiographic indices of systolic and diastolic left ventricular function. Forty five overweight & obese and 30 normal weight, serving personnel without any other pathological condition were studied. Group I (n=23) consisted of subjects with normal weight and body mass index (BMI 18.5-22.9 kg/m2), Group II (n=28) of overweight subjects (BMI 23-24.9 kg/m2) and Group III (n=24) of obese subjects (BMI ≥25 kg/m2). Echocardiographic indices of systolic and diastolic function were obtained and dysfunction was assumed when at least two values differed by ≥2 SD from the normal weight group. Ejection fraction was increased (p=0.001) in group II and III however fractional shortening was increased significantly in group III (<0.001). Left ventricular dimensions (EDD & ESD) were increased (P<0.001, 0.002) but relative wall thickness was unchanged in group II & III. Systolic dysfunction was not observed in any of the obese patients. The deceleration time was increased (P<0.01) in overweight and obese subjects compared to normal group individuals. No difference was found between obesity subgroups. Subclinical diastolic dysfunction in the form of reduced E/A ratio and increased deceleration time was more prevalent among obese subjects. BMI correlated significantly with indices of left ventricular systolic and diastolic function. Subclinical left ventricular diastolic dysfunction was noted in all grades of obesity which correlates with BMI.
ABSTRACT
Abstract : Increasing female literacy and employment have resulted in a clear rise in the age at which women conceive. As fertility starts to decline with advancing age more and more number of women are facing the problem of infertility and are seeking medical attention to over come this problem. This resulted in more number of women seeking medical help to over come the problem of Infertility. This age related decline in ovarian reserve is not uniform in all women of reproductive age. A number of ovarian reserve tests were developed to overcome this problem. But to date there is no ideal marker for predicting ovarian reserve and pregnancy outcome in assisted reproductive technology program (ART). Recent studies indicate that anti mullein hormone is a promising marker for predicting ovarian reserve and pregnancy out come. The aim of this study was to assess the influence of age on Anti-Mullerian Hormone (AMH) in ART program outcomes. Ninety-three subjects in the age group of 25 to 42 years were recruited to the study. All these subjects underwent controlled ovarian stimulation (COS) and later intracytoplasmic sperm injection (ICSI). Subjects were divided into four groups. AMH levels in positive and negative pregnancy subjects in the above and below 35years age groups were compared. AMH levels were correlated with other ovarian reserve parameters and clinical pregnancy out come in both the age groups. Statistically significant differences were found in AMH levels between positive and negative pregnancy subjects in the age group of 35 and above, but not in the age group below 35 years. There were positive correlations between AMH and other ovarian reserve markers and clinical pregnancy outcome in this age group. AMH and the number of retrieved oocytes (r=0.784, P<0.01), Antral Follicle count (AFC) (r=0.749, P<0.01) and Mature Oocytes (MII) (r=0.407, P<0.01) followed by Grade-I Embryos (r=0.433, P<0.01). The current study revealed that AMH levels are better correlated with ovarian reserve and clinical pregnancy out come in subjects aged 35 years and above.
ABSTRACT
Prevalence, determinants, and prognostic value of left ventricular function in subjects with asymptomatic essential hypertension are still incompletely known. The goal of this study was to investigate the effects of asymptomatic untreated essential hypertension on left ventricular structure and function. The left ventricular functions were assessed among 127 hypertensive and 80 healthy subjects. American society of echocardiography (ASE) convention was applied to measure the stroke volume, percentage ejection fraction, percentage fractional fiber shortening, cardiac output and cardiac index. The stroke volume, cardiac output and cardiac index were normal but significantly high among hypertensive compared to normotensive subjects (P<0.05). The percentage ejection fraction and fractional fiber shortening were significantly reduced among hypertensives compared to normotensives (P<0.05). The significant impairment of percentage fractional fiber shortening is due to alteration in dimension of left ventricular wall thickness, left ventricular cavity and left ventricular geometry. This carries prognostic implication and requires further documentations, investigations and researches. Percentage ejection fraction and fractional fiber shortening is considered a hallmark of normal left ventricular function. The left ventricular contractile state was negatively correlated to left ventricular after load parameters. So the main objective of management of hypertensive subjects should be, to reduce the after load to improve the left ventricular contractile state.