Obstructive mullerian anamolies: a case series

AIM of the study was to review the heterogeneous clinical presentations and management options for some of the obstructive mullerian anomalies through a case series. Background: Müllerian duct anomalies (MDAs) are a miscellaneous group of entities that result from the non-development, defective vertical or lateral fusion, or resorption failure of the müllerian ducts due to genetic mutation. 5 cases of obstructive mullerian anomaly are reviewed. Cases of OHVIRA (obstructed Hemivagina with Renal Agenesis) syndrome, transverse vaginal septum, imperforate hymen and obstructed rudimentary horn of unicornuate uterus are included. Results: We found that cyclical abdominal pain was the most common presenting complaint. There is a high incidence of associated renal anomalies. Psychosocial counselling before treatment is necessary to address the functional and emotional aspects of the patient. Surgical management was done in all patients with good postoperative outcome. Conclusion: Obstructive mullerian anomalies need to be evaluated by a meticulous examination and imaging studies to reach the diagnosis with precision. The treatment has to be tailored to the specific anomaly.

Prevalence of metabolic syndrome in women with polycystic ovary syndrome attending a tertiary care hospital in West Delhi, India

Background: The aim of the present study was to evaluate the prevalence of metabolic syndrome in women with polycystic ovary syndrome (PCOS).Methods: All the women attending the gynae out-patient department of our hospital were screened for polycystic ovary syndrome as diagnosed by the Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group, 2004. Two hundred women with PCOS underwent screening for metabolic syndrome as defined by the national cholesterol education program adult treatment panel III (ATPIII) (2001) definition and the prevalence of metabolic syndrome was compared with two hundred age and BMI matched healthy control subjects. A multivariate logistic regression analysis was applied, and significant predictors identified for the prediction of metabolic syndrome.Results: The prevalence of metabolic syndrome among PCOS patients was 42 % in present study group as compared to 14 % in control group (p=0.01). The prevalence of metabolic syndrome was even higher in obese PCOS Vs non obese PCOS (52 % Vs 28.6 %). But even non-obese PCOS had higher prevalence of metabolic syndrome as compared to controls (28.6 % Vs 14 %).Conclusions: The study suggests a high prevalence of metabolic syndrome in patients with PCOS & thus it is important to screen all PCOS patients for manifestations of metabolic syndrome & its cardiovascular sequelae.

Anaemia in term pregnancy: influence on maternal and perinatal outcome and role of demographic factors

Background: The aim is to study maternal and perinatal outcome and various demographic factors in term pregnancy complicated with anaemia at DDU Hospital.Methods: Hospital based prospective observational analytical study. 200 pregnant women reporting to antenatal clinic or admitted to the Hospital in labour/not in labour after 36+6weeks of pregnancy were taken as study subjects. Study duration was one year between  July 2017 to June 2018.Results: The prevalence of mild, moderate and severe anaemia was 25%, 56% and 19% respectively. Education status, socioeconomic status, ANC visit, interpregnancy interval were significantly associated with anemia(p<0.05). Significant association was observed between occurrence of PPH and severity of anaemia(OR 12.77; CI 2.32 to 70.12). The incidence of LBW increased with severity of anaemia. (OR-6.25;CI 2.6 to 15). There was a statistically significant difference found in prevalence of IUGR babies. The risk of Apgar score <8 increased with severity of anaemia. Perinatal mortality was observed in 8% subjects with anaemia as compared to 3% in subjects without anaemia.Conclusions: Maternal anaemia is a major public health problem. Simple steps taken to correct anaemia in female contemplating pregnancy and pregnant women can definitely have far reaching influences on maternal and perinatal morbidity.

RP-HPLC and HPTLC Methods for Simultaneous Estimation of Metformin Hydrochloride and Vildagliptin from Bulk and Marketed Formulation: Development and Validation.

The reversed-phase high performance liquid chromatography (RP-HPLC) and high performance thin layer chromatography (HPTLC) methods for simultaneous estimation of Metfomin Hydrochloride (MET) and Vildagliptin (VLD) in bulk and their marketed combined dosage form were developed. For RP-HPLC, separation was carried out using HiQsil C18HS (4.6mmø×250mm) analytical column and detection was carried out using variable wavelength detector. The mobile phase was composed of phosphate buffer (pH adjusted to 6 using 3M KOH): methanol: acetonitrile in the ratio of 50:30:20 v/v/v. Flow rate was kept at 0.8ml/min. The drugs- MET and VLD were retained at 3.7 minutes and 4.8 minutes respectively. The HPTLC method was developed using Camag HPTLC system. Silica Gel 60GF254 precoated TLC plates were used as stationary phase. The mobile phase was ammonium acetate in methanol (1% w/v): Toluene; (10:0.5). The detection of spots was carried out densitometrically at 214 nm in absorbance mode. The Rf values for MET and VLD were found to be 0.44 and 0.55 respectively. Performance characteristics of both of these RP-HPLC and HPTLC methods for simultaneous estimation of MET and VLD in bulk and their marketed combined dosage form were statistically validated as per the recommendations of ICH guidelines of analytical method validation. The RP-HPLC method was found to be linear across concentration range of 10-60μg/mL for MET and VLD respectively. For RP-HPLC the LOD values for MET and VLD were 1.09μg/ml and 1.70μg/ml respectively and LOQ values for MET and VLD were 3.32μg/ml and 5.15μg/ml respectively. The HPTLC method was found to be linear with across the range 1000-5000ng/spot and 500-2000ng/spot for MET and VLD respectively. For HPTLC the LOD values for MET and VLD were 17.22ng/spot and 34.60ng/spot respectively and LOQ values for MET and VLD were 52.20ng/spot and 104.85ng/spot respectively. Both of these RP-HPLC and HPTLC methods were found to be simple, specific, linear, accurate, precise and robust, hence any of these methods can be conveniently adopted for routine analysis of the formulations containing MET and VLD, for their simultaneous estimation.

Local responses to the Maharashtra gutka and pan masala ban: A report from Mumbai.

Background: The Maharashtra government has banned the production, sale, distribution and storage of gutka, and pan masala in the Maharashtra State due to the increasing burden of cancer and reproductive health problems attributable to the use of these products. In view of this, it is important to understand the way producers', sellers' and users' are adapting to the ban. Objective: During the two months following the ban (July 19 th through Sept 30, 2012), a research team studying smokeless tobacco use and promotion in a low income community of Mumbai conducted rapid surveillance to assess the impact of the ban in the study community. Materials and Methods: Assessment involved documenting new points of sale, informal observations of tobacco use, and interviews with thirteen shop owners and eight gutka users'. Overall changes in accessibility, availability, patterns of use of tobacco products, perception of ban, social norms and surveillance activities were assessed. Results: Tobacco companies were marketing new products that resembled gutka, under similar brand logos. Surveillance, financial and social cost of selling gutka or using it in public have had an immediate effect on reducing local supply, demand and use and increasing stigma associated with its use. There was an increased recognition of ill-effects of gutka on cancer among sellers' but not overall. Conclusions : To reduce the overall consumption of tobacco in the community, it is critical to include programs that create awareness about effects of smokeless tobacco on health and sustain surveillance levels. This would maintain requirements of the ban, and sustain limits on accessibility, availability and use of these products in the community and other similar communities.

A cost-effectiveness analysis of three antimalarial treatments for acute, uncomplicated Plasmodium falciparum malaria in Mumbai, India.

BACKGROUND: Malaria is a major public health problem representing 2.3% of the overall global disease burden. The cost of treatment of malaria continues to rise as older drugs and insecticides become less effective and are replaced by more effective, but also more expensive products. METHODS: A post-hoc pharmacoeconomic analysis (direct and indirect costs only) of three antimalarials, chloroquine, mefloquine and co-artemether, was carried out to address the problem of switch to a more expensive first-line antimalarial in the face of growing chloroquine resistance. RESULTS: From the perspective of a large public hospital, it was seen that in an area of high grade chloroquine resistance, the total expenditure on patients who fail chloroquine would exceed the excess expenditure on mefloquine when the RII + RIII resistance exceeded 9%. CONCLUSIONS: Switch to a more expensive drug like mefloquine as a first-line option would be cost-effective when the moderate-severe chloroquine resistance exceeded 9%.

Relapse pattern of Plasmodium vivax in Mumbai: a study of 283 cases of vivax malaria.

OBJECTIVES: To analyze the relapse pattern of Plasmodium vivax in the city of Mumbai. METHODS: 283 cases of smear positive vivax malaria were treated with full dose (25 mg/kg) chloroquine and were asked to follow up for at least one year. None of the patients received primaquine. RESULTS: Of the 150 cases who followed up for at least one year, 19 relapsed, 17/19 relapsed within the first 6 months; indicating that the relapse pattern in the city is predominantly of the tropical or Chesson strain type. CONCLUSIONS: Vivax malaria patients should be monitored for at least six months. Those who do relapse should receive treatment with full dose chloroquine and 14 days of primaquine treatment.