ABSTRACT
Tobacco use is one of the major public health problems in India and also the single most important remediable public health problem. Tobacco cessation is the need of the hour. The dentists have a unique opportunity and professional obligation to be a positive influence in reducing the economic and social burden inflicted by tobacco use on dental and general health. However, dentists, in general, have not widely embraced tobacco cessation in practice. In this article, an evidence-based model (an adaptation of the World Health Organization “5As” tobacco cessation model) is presented for the dentist to help patients avoid tobacco initiation, to encourage and assist patients in tobacco cessation
ABSTRACT
Background: Postpartum hemorrhage is the most common preventable cause of maternal mortality in developing countries. The present study aimed to examine the impact of cervical traction technique in reducing the amount of postpartum blood loss and rate of PPH.Methods: This was a case-control, pilot study conducted in a tertiary hospital between June 2017 to June 2018. A total of 200 singletons, low-risk pregnant females, undergoing normal vaginal delivery, were enrolled in this study. Subjects showing a high risk for PPH were excluded. Patients were randomized as case group (n=100) and control group (n=100). The case group received sustained traction for 90 seconds to anterior and posterior lip of the cervix with active management of the third stage of labor, whereas the control group received routine active management of the third stage of labor. All subjects were followed up for 6 hours post-delivery. The amount of blood loss, hematocrit and hemoglobin post-delivery were compared between both groups.Results: The mean blood loss (ml), decrease in hemoglobin (g/L) and decrease in hematocrit post-delivery in cases were significantly low compared to controls (207±37.6 versus 340±49, P<0.01), (0.78±0.2 versus 1.4±0.3, P=0.03) and (1.7±0.2 versus 3.5±0.2, P<0.01). PPH occurred in 7 of 200 (3.5%) patients. The difference in the number of PPH was not significant (5/100; 5% versus 2/100; 2% P=0.2). There were no complications reported due to cervical traction.Conclusions: Cervical traction is a simple and safe maneuver to reduce the amount of postpartum blood loss. Larger RCT is recommended to investigate the reduction in PPH rate.
ABSTRACT
Background: The attitude of the fetal head during labour significantly influences the progress and outcome of delivery and is mainly diagnosed by vaginal examination during labour. The aim of the study was to quantify the extent of deflexion of the fetal head by measuring the fetal occiput spine angle (OSA) through transabdominal ultrasonography in the first stage of labour and to determine whether the fetal OSA can predict the mode of delivery.Methods: We conducted a prospective observational study on 145 nulliparous uncomplicated singleton pregnant women without occiput-posterior position of the fetus during active labour. The OSA was measured as the angle between the two tangential lines to the occipital bone and the vertebral body of the first cervical spine, during active labour and monitored until delivery. Intra- and interobserver reproducibility of the OSA measurement and the correlation between the OSA and mode of delivery were also evaluated.Results: For the study population, the mean value of the OSA measured in the active phase of the first stage was 124.2±11.5⁰. The OSA measurement showed excellent intraobserver agreement (r = 0.82; 95% confidence interval [95% CI] 0.70-0.80) and fair-to-good interobserver agreement (r = 0.62; 95% CI 0.51-0.71). The mean OSA was significantly less for the group of patients who required conversion to cesarean section due to labour arrest (n=32) as compared to those who had vaginal delivery (n=113) (116.25±9.2⁰ versus 126.53±11.1⁰, P<0.01). An OSA of ≥121° was associated with vaginal delivery in 80.5% (91/113) of women, whereas 87.5% (28/32) of the women who delivered by cesarean section had an OSA <121⁰.Conclusions: Measurement of the OSA, by sonography is feasible, reproducible and an objective tool to assess the degree of fetal head deflexion during labour and to predict the mode of delivery.
ABSTRACT
Background: Vitamin D deficiency is thought to be common among pregnant women and is associated with adverse maternal and perinatal outcome. Maternal and foetal outcome in pregnant women with standard obstetric care was compared with women with additional vitamin D supplementation.Methods: A randomized comparative study was conducted on 100 patients attending the antenatal clinic at JSS Medical College and Hospital, Mysuru, Karnataka, India who were randomly grouped into group A (50 patients) who received standard obstetric care (500 mg calcium+200 IU vitamin D) and group B (50 patients) who received in addition to standard obstetric care supplementation of Vitamin D 1000 IU/day starting from 14 weeks of gestation till delivery. Vitamin D levels were assessed in both the groups with onset of labour by chemiluminescence immunoassay and obstetric and neonatal outcomes in both groups were compared.Results: High incidence of vitamin D deficiency (96%) in standard care group compared to vitamin D supplemented group ( p= <0.0001) was noted. The study showed significant reduction in risk of Preeclampsia (P=0.004), GDM (P= 0.02) and primary caesarean delivery (0.008) in Vitamin D supplemented group. Significantly high birth weight in vitamin D supplemented group, an increase in 320 grams in birth weight was noted (P <0.0001).Conclusions: There is a high incidence of subnormal vitamin D levels in antenatal women and is associated with maternal and neonatal adverse effects. Measuring Vitamin D levels and appropriate supplementation of higher dose of vitamin D is an effective strategy in prevention of adverse maternal and neonatal outcomes.
ABSTRACT
Background: Infertility is defined by WHO as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. The prevalence of infertility is about 10%-15% of reproductive age couples. Female factor is responsible for 40-45% of etiology of infertility. Aim of the study was to evaluate the role of diagnostic hysterolaparoscopy in female infertility at a tertiary care centre.Methods: This is a retrospective hospital based study done at a tertiary care hospital attached to JSS Medical College, Mysuru between January 2017 and December 2018. Infertile women with primary or secondary infertility in the 18-40 years age group, with normal hormonal profile and no known male factor were included.Results: In our study, primary infertility was found in 77% of the 96 patients and secondary infertility was found in 23% of patients. In primary infertility, ovarian pathology was the most common finding while Endometriosis was the most common finding in secondary infertility group. 77 % patients were found to have bilaterally patent tubes while remaining had unilateral or bilateral blockage. On hysteroscopy, endometrial polyps were the commonest hysteroscopic finding in both groups.Conclusions: Combined hystero-laparoscopy is a safe, effective and reliable method in comprehensive evaluation of infertility. It helps in the diagnosis of pelvic pathology which may have been missed by routine examination and thereby helps in optimal management of female infertility.
ABSTRACT
Background: Hypertensive disorder affects 10-12% of pregnancies. Identifying women, who are at risk is conducive to prompt gestational management. PAPP-A is a protein complex produced by the developing trophoblasts. Low levels of PAPP-A at 10–14 weeks is a marker of impaired placentation and a smaller placental mass. Doppler imaging permits non-invasive evaluation of the uteroplacental circulation and is invaluable in the management of high-risk pregnancies. The uterine artery Doppler screening identifies patients at risk for developing preeclampsia. To study the association of PAPP-A and the uterine artery Doppler changes as predictor of pre-eclampsia in pregnant women at 11-14 weeks of gestation.Methods: This was a prospective study of 150 pregnant women presenting at 11-14 weeks of gestation for a prenatal check-up. After considering the inclusion and exclusion criteria, serum samples for PAPP-A were assayed. Ultrasound Doppler was used to obtain uterine artery flow velocity waveforms and mean pulsatility index and resistance index of uterine arteries were calculated. Cases were followed up till term and observed for development of pre-eclampsia.Results: 48.6% had low serum PAPP-A levels, in which 77% developed PE. The Mean PI and RI is 2.34±1.16 and 0.58±0.1 respectively. 30% women with abnormal PI values and 24% of women with abnormal RI values developed PE.Conclusions: The combination of maternal history with low serum PAPP-A levels and abnormal uterine artery Doppler at 11-14 weeks can be used as predictor of pre-eclampsia.
ABSTRACT
Background: The aim of this study was to find role of SHBG as an early predictor for gestational diabetes mellitus.Methods: A hospital based prospective/observational/diagnostic and explorative study. The necessary information was collected from the participants through the prepared set of questionnaires. Pregnant women between 11 to 14 weeks of gestation who visited JSS OPD for antenatal checkup satisfying inclusion and exclusion criteria giving informed and written consent for the study were examined clinically. 3ml of venous blood was drawn with aseptic precautions for the estimation of SHBG and adiponectin. OGTT with 75gms glucose first done at 11 to 14weeks and again at 24-28 weeks and 32-36 weeks were done to the same patient to find out whether the patient developed GDM or not. These mothers were followed periodically till delivery. The sensitivity and specificity of SHBG were assessed and compared in patients who developed GDM.Results: 100 cases were selected for the study. About 12 patients were diagnosed as gestational diabetes mellitus in present study by OGCT at 32 weeks to 36 weeks. In present study about 14 patients had low level of SHBG. Low level of SHBG is found to be statistically significant in predicting GDM in first trimester.Conclusions: The combination of SHBG can be used as predictor of GDM in first trimester.
ABSTRACT
Pain management is an all-time challenge in dentistry. Discontent to pain management is a concern among patients and professionals. Unrelieved pain affects physical and mental well-being contributing to delayed recovery, psychological distress and anxiety. Studies have revealed that chronic pain interferes with normal daily chores of the individual like exercise, sleep, social life and lifestyle. At one end of pain management spectrum are Non-steroidal anti-inflammatory drugs (NSAIDs) while at the other end are the opioids. These drugs are not without constituent side effects. The quest is for new analgesics with potent and long term analgesia with minimal or no side effects. An analgesic that is intermediate in this spectrum is the need of the hour. Opiorphin is an endogenous peptide isolated from human saliva. Opiorphin produces analgesia, by inhibiting enkephalin (ENK) metabolizing enzymes, thus increasing the half-life of circulating ENKs. Apart from being a potent analgesic it can also be a potential biomarker for various systemic and psychosocial disorders. This review focuses on the pharmacological effects of opiorphin and its potential role as a biomarker in various disease conditions.
ABSTRACT
Indian system of medicine has always focused on cure from the nature. Plant products from the Indian household have been used as medicine to cure myriad of ailments since ancestral times. Curcumin is a polyphenol, an active ingredient found in turmeric. In Southeast Asia, turmeric has been used as a coloring, flavoring and as a therapeutic agent. The use of turmeric to treat ailments dates back to the times of Charaka and Shushrutha. It has been widely used as an antiseptic for cuts, burns, and bruises, and as an antibacterial agent. Modern medicine has begun to understand its importance in recent times. Unfortunately its poor solubility, limited absorption and enhanced metabolism limits its bioavailability for its extended therapeutic use. Integration of nanotechnology in drug design and development has led the way to development of nanocurcumin with improved pharmacological properties. A precise understanding of effective dose, safety, and mechanism of action is required for the rational use of turmeric in the treatment of human diseases. This review focuses on the molecular actions of curcumin and its possibility to be used as a therapeutic agent in conditions affecting oral mucosa.
ABSTRACT
Background: Meningiomas are common CNS tumors arising from the meningothelial cells and usual sites are intracranial, followed by intra spinal. WHO 2007 has categorised meningiomas into 3 grades. This grading helps in predicting their behaviour and treatment. Aim and objectives: To study the frequency, clinical details, histological typing of meningiomas in comparison with squash cytology (intra operative diagnosis) and Histopathological examination post operatively. Materials and methods: The present study was a prospective study conducted from May 2015 to April 2017 in the Department of Pathology, Gandhi Hospital. We received 50 clinically as well as radiologically diagnosed cases of meningiomas, which were compared with squash cytology and Histopathological examination. Results: In our study, meningiomas constituted 15% of all CNS tumors received from the Neurosurgery Department in a period of 2 years. In the present study, the number of Meningiomas was 50. Females outnumbered males (36 out of 50). Common site was intracranial (45), followed by intra spinal-thoracic (5). The commonest sub type was meningothelial variant of meningioma (12), followed by transitional variant (11). Squash cytology matched with the Histopathological examination in 91.15% cases. Conclusion: Meningiomas are predominantly occur intra cranially with female preponderance, majority were of benign grade I neoplasms. Squash cytology plays a major role in their intra operative diagnosis.
ABSTRACT
Ovarian tumors are important because of increased morbidity and mortality associated with them. A total number of 157 specimens of ovarian neoplasms were studied in the department of pathology, Gandhi Medical College for a period of 2 years, i.e. June 2014 to May 2016. In our study, majority of the ovarian neoplasms were classified as benign tumors 101 (64.3%) followed by borderline neoplasms 44 (28.2%), and malignant tumors were 12 in number (7.6%). Out of these surface epithelial tumors were the commonest variety constituting 128 (81.5%), followed by germ cell tumors - 24 (15.28%). A relatively high no. of malignancies was observed in the study.
ABSTRACT
Background: Verruccous lesions of the penis are difficult to classify. Materials and methods: The present study included 60 verruccous lesions of the penis in a period of 5 years, at Kakatiya Medical College, Warangal. Ours was a prospective study of 5 years duration. Results: In our study the age group ranges from 30 years to 80 years. Majority of the lesions were observed between 60-69 years age group. Warty lesions constituted 40 (66.7%), Cauliflower like growths constituted 14 (23.3%), and diffusely infiltrating constituted 6 (10%). Histopathological examination findings showed out of 60, 24 biopsies diagnosed as condyloma accuminata, 9 as simple verruccous hyperplasia, and remaining 27 are diagnosed as carcinomas out of which verruccous carcinoma were 12 followed by condylomatous carcinoma and papillary carcinomas each 6, squamous cell carcinomas were 3 in number. Conclusion: Each and every grossly visible verruccous lesions of the penis should be adequately biopsied for the early diagnosis of carcinoma.
ABSTRACT
Background: Autopsy serves as a gold standard for the clinical diagnosis of cardiac arrest, which is important for quality assurance. Materials and methods: 44 medico legal cases of suspicious/ sudden deaths were examined by using various dissection techniques of the heart to identify the cause of death in a 2 year period. The main objective was to know the cause of death by correlating with the past history by the previous reports of the patients, the clinical diagnosis, photographic records, gross study of the heart and Histopathological examination and confirmation. The various methods used are inflow-outflow method; short axis method; window method; Valve plane method; Four chamber cut methods, etc. Different methods are used for different conditions of the heart, e.g., cardiomyopathy, valvular diseases, ischemic heart diseases etc. Results: In the present study males outnumbered the females constituting 26 and 18 respectively. At autopsy majority of the cardiac deaths were confirmed as ischemic heart disease by the short axis dissection method. One case of myocarditis identified with Inflow-Outflow method, one case of restrictive cardiomyopathy dissected with four chambered cut method. 1 case of replaced prosthetic valve dissected with valve-plane method. In three cases cause of death is not identified. Conclusion: Cardiac autopsy is backbone in diseases like Ischemic heart disease and cardiomyopathy etc. Its role in medico-legal case importance cannot be excluded.
ABSTRACT
Anemia has been a very important nutritional disorder in the world. India has reported high prevalence of anemia in pregnancy. Most of the articles have reported an adverse pregnancy outcome related to anemia. Of late, reports are emerging suggesting anemia could be indeed beneficial. Apart from that, there was no consistency in the timing of hemoglobin considered for analysis. Hence, we designed an observational study to look into these aspects. 1000 mothers admitted for delivery were recruited and their hemoglobin was measured. Hemoglobin in previous trimesters was noted from their antenatal record. We followed up these mothers till delivery and looked into the gestation and birth weight of the babies. Descriptive statistics was used for baseline characteristics. Comparison of means was done using Student's t-test. Qualitative variables were compared using Fisher's exact test. More than 50% of the mothers were anemic at some point of time during their pregnancy and 39% of the mothers were anemic throughout. Mean birth weight of babies born to anemic mothers was marginally lower compared to that of babies born to nonanemic mothers. This difference was statistically significant. There was 6.5% increase in the incidence of low birth weight babies and 11.5% increase in preterm deliveries in mothers who were anemic in their third trimester. The incidence of low birth weight babies was significantly more in mothers who were anemic in their third trimester. Preterm deliveries occurred more frequently in mothers who were anemic in their second and third trimesters. Higher hemoglobin did not show any effect on either birth weight or gestation in our study
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications, Hematologic , Birth Weight , Gestational Age , Pregnancy Trimesters , Hemoglobins/analysisABSTRACT
Insulin resistance is characterized by alterations in insulin signaling components thereby resulting in reduced glucose uptake. The mechanistic role of [3beta]-stigmast-5-en-3-ol in augmenting glucose uptake to overcome insulin resistance is deciphered in this study. 16 myotubes, rat skeletal muscle model have been used to check the effect of [3beta]-stig-mast-5-en-3-ol, a plant phytosterol isolated from the ethyl acetate extract of Adathoda vasica on glucose transport. The influence of [3beta]-stigmast-5-en-3-ol on various cellular targets of insulin signaling cascade has been evaluated using inhibitors on glucose uptake as well as gene and protein expression to unravel the mechanistic action in triggering glucose uptake. [3beta]-stigmast-5-en-3-ol promoted glucose uptake in a dose dependent manner under insulin resistant condition. As assessed by inhibitor studies using Genistein [IRTK inhibitor] and Wortmannin [PI3K inhibitor], gene expression and protein expression studies using specific primers and antibodies, an activation of IR-[3, IRS-1, PI3K, AKT/PKB, PKC by both the crude and [3beta] stigmast-5-en-3-ol were observed. This suggested that [3beta]-stigmast-5-en-3-ol induced glucose uptake functions through the PI3K dependent pathway in L6 myotubes. Both, the crude and [3beta]-stigmast-5-en-3-ol activates GLUT 4 transport [evident from increased mRNA levels and redistribution of GLUT4 from intracellular membrane to plasma membrane through translocation studies]. Confocal microscopy revealed a substantial increase in redistribution of FITC tagged GLUT4 throughout the cells. Our results emphasize the insulin-like effect of [3beta]-stigmast-5-en-3-ol in stimulating glucose transport in vitro and provide evidence in its beneficial role possessing antidiabetic property apart from its existing cholesterol lowering efficacy