ABSTRACT
IntroductionThe syndromic management has been the cornerstone of management of sexually transmitted infections (STIs) over the last few decades especially in developing countries. But due to its inability to treat asymptomatic cases leading to undesirable sequeale, it has received a lot of criticism recently. On the other hand, Evidence based management of patients of vaginal and cervical discharge has lead to effective and timely management of these patient but has increased the financial burden.Objective:The goal of the study is to compare syndromic vs. Evidence based approach in the management of vaginal and cervical discharge.Method:The present study was conducted in the outpatient department of dermatology, venereology & leprology of a tertiary care teaching hospital. 354 patients of clinical impression of vaginal and cervical discharge were included in the study. Detailed history and examination was recorded. Patients selected for syndromic management were managed as per NACO guidelines. For evidence based management special investigations were carried out and patients were managed accordingly.Result:Out of total 342 cases of VD, treated with syndromic and evidence based approach, p value is significant for 7,14 and 21 days follow-up which means evidence based approach is better than syndromic approach. Similar findings were observed in patients of cervical discharge.Also, among CVV patients managed on lines of syndromic approach only 10% showed improvement by end of one week.Conclusion:The control of STIs in resource-poor settings remains a major challenge.Focus is now shifting towards a diagnostic model of STI care, given the improving economic status of developing countries and availability of affordable point-ofcare testing. Also, various changes in the syndromic approach are needed immediately for it to still remain relevant.
ABSTRACT
Background: Our study is planned to note the outcome ofpregnancy of the women detected as HIV positive in thePPTCT program as well as to have an evaluation of thePPTCT program in our institute since the initiation of thisprogramme in 2005.Materials & Methods: The present study was carried out inthe department of Obstetrics and Gynaecology, Umaid Hospitalattached to Dr. S. N. Medical College, Jodhpur. The data overthis period were analyzed. As per the strategy and policyprescribed by NACO, tests (E/R/S) were performed on theserum samples. Those found HIV positive went for confidentialpost-test information and counselling regarding throughintimation about the vertical transmission and importance oftheir institutional deliveries.Results: Our study observed that out of the total deliveredbabies of seropositive women 95.31% were live births, 3.90%were IUD babies and one was still birth. Out of the totaldelivered babies 64 i.e. 52.45% had physiological jaundice,35 i.e. 28.68% had acute diarrheal disease, 2 i.e. 1.63% hadoral thrush, 20 i.e. 16.93% had URI, 2 i.e. 1.63% had ServerSepticaemia, 9 babies i.e. 7.37 % expired in neonatal periodand another 9 expired after one month.Conclusion: PPTCT programs are feasible in Governmenthospital were resources are limited. Rural pregnant women arereceptive to voluntary counselling and testing.
ABSTRACT
Background: Puerperium is of 6 weeks after delivery, when body reverts back to its original non pregnant state. This period holds its own set of medical issues with frequent occurrence of gynaecological complaints like hematoma, bleeding, painful discharge and many medical issues like pyrexia, mastalgia, coagulation disorders and depression. The management of all these problems is further complicated by consideration of lactation which prohibits use of many drugs. There are many studies available in international communities that analysed women in puerperium but the data from Indian subpopulation where most deliveries are conducted in government funded institutes is lacking. The current study was an observational single center study carried out at gynaecology department along with medicine and surgery department of a tertiary care hospital associated with a medical teaching institute for defining the epidemiological parameters of the puerperal maladies.Methods: 150 randomly selected pregnant subjects with otherwise uncomplicated pregnancies, both booked at our institute or referred at the time of delivery between January to July 2016 were included in the study. Both normal vaginal or assisted deliveries were considered irrespective of booking status. Patient not willing for consent, and patients reporting beyond 2 weeks of delivery were excluded. All patients were observed while in hospital and weekly thereafter till 6th week and detailed gynaecological, medical and psychiatric evaluation was carried out by a multidisciplinary team. Detailed evaluation of cause was carried out in all cases of pyrexia, pain or other objective symptoms and analysis of depression was done. All data were collected and analysed by spss 22.0 at the end of 6 weeks.Results: Of the 150 patients studied, 40% had caesarean delivery while 60% had normal vaginal delivery with or without episiotomy. The most common complications noted during puerperium were wound discharge (10.67%), perineal pain (10%), fever (15%) and Mastalgia & Mastitis (13%). Depression was diagnosed in 6% of the studied cases. Cause of fever was mastitis/breast abscess in 30%, Urinary tract infection in 24%, Malaria in 7% and puerperal sepsis in 12% cases, in rest of the cases the cause of fever could not be found. The puerperal complication rate was more in LSCS 22.95% as compared with vaginal deliveries 14.6%.Conclusions: Puerperium remains an important aspect of pregnancy where the nature of complications differs totally from those seen during antenatal period. Our study suggests that most important complications in puerperium are purulent discharge, perineal pain and pyrexia. Depression is a frequent occurrence in post-partum period and its early identification can benefit both maternal and child health. Fever in puerperium is fairly common Perineal infection, Breast infection, Urinary tract infection and Malaria being common causes. A vigilant multidisciplinary approach is required to optimally manage all these complications.
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This study was carried out from January 2006 to December 2008 in the rural district of Andhra Pradesh, India. It included counselling and spreading of awareness encouraging voluntary Human Immunovirus testing in antenatal cases and starting prophylactic treatment of seropositive cases with nevirapine for safe deliveries and for preventing the mother to child transmission with distinct improvement effectively.
ABSTRACT
With the Government of India’s initiative to ensure Universal Access to health through its fl agship program of National Rural Health Mission, the debate on the economic effi ciency and sustainability of a ‘stand-alone’ over ‘integrated’ programs has become extremely relevant. This study was conducted with the aim to establish opinion on the issue of sustainability of ‘stand-alone’ HIV program in India. Experts working on health policy development and implementation at various were interviewed on this issue and majority of experts interviewed were of the opinion that a ‘stand-alone’ HIV program is not sustainable in the long run because of ineffi cient use of resources. Integration of HIV program with the general health system is essential but it needs extensive planning. Areas like HIV testing centers, prevention of parent to child transmission and sexually transmitted infection diagnosis and treatment can be integrated with the general health system immediately.