A cross sectional study on the prevalence of reproductive tract infections amongst married women in the rural area of Surendranagar district.

Background: In the recent years, the issue of gynaecological problems of poor women in the developing countries has been receiving increasing attention. High levels of gynaecological morbidity, especially reproductive tract infections and sexually transmitted infections may turn out to be fatal if not treated properly. Objectives of current study were to find out the prevalence of reproductive tract infections amongst married women, to co-relate the disease with certain socio demographic variables and to assess the awareness about reproductive tract infections in the study population. Methods: Sample size - Various community based studies carried out in the different regions world showed the prevalence of reproductive tract infections 36-84%. The sample size of study as per statistical calculation (4pq/l2, where p =50, q=100-p and l= 10% of p) came out to be 400. Method of Sampling - Prior enlisting all villages of Surendranagar district, one village was selected randomly. After random selection the village found was Khodu. Results: 56.5% of women reported either one or more symptoms of reproductive tract infections; vaginal discharge (29.7%) was the commonest symptom. Basic awareness about disease was 64.0%; Maximum prevalence of reproductive tract infections (62.90%) was found in the age group of 25-34 years. Conclusions: There is a significant association between socio-economic class, educational status and women having symptoms of reproductive tract infections.

Diabetic foot resulting in amputation: our experience.

Background: The aim of our study was to early diagnosis of diabetic foot so that the complications can be prevented, to control the systemic infection and prevent the complications, to study the effectiveness of regular dressing in diabetic foot so as to prevent the local spread of infection and the ulcer and to conclude that early diagnosis, care and proper meticulous treatment of diabetic foot can prevent amputation. Methods: The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet, Informed Consent Form and approval from Ethical Committee. The present study was carried out in surgery department of C.U Shah medical college, Surendranagar; Gujarat state. The study was carried out from 1st August 2011 to 30th September 2013. A total of one hundred patients admitted in surgery ward with diabetes type 1 or 2 with ulcer on foot having grade 1 or 2 of Wagner’s classification without any other co morbid condition. These patients undergo daily dressing with various dressing solutions according to their ulcer characteristics. All the patients given diet/oral hypoglycaemic drug/insulin for control of diabetes. Antibiotics given according to the infective status of the patients. Patients were either completely treated, went under skin grafting or ended up with amputation were recorded. Results: Of 100 cases studied, youngest patient was 32 years and oldest was 80 years of age. Highest number of cases was found in the age group 61-70 years (30%). Of the 100 cases studied in this series 36 (36%) patient were having Wagner’s class 1 ulcer and 64 (64%) patient having class 2 ulcers. Of 100 cases, various surgical treatment given to the patients according to the ulcer. In that 65(65%) debridement, 20 (20%) Incision & drainage, 10 (10%) STG, 5 (5%) fasciotomy. Most of the patients were undergone basic surgical procedure which is debridement on the 7th day follow up, out of 100 cases 70 patients came for follow up. Out of 70, all patients having healing ulcer. Out of 70 patients, 15(21.43%) patients were underwent STG on 15th day and other 55 (71.57%) patients having healing ulcer advised daily dressing with follow up after 1 week. Out of 30 patients, 3 (10%) patients underwent amputation on 7th day of follow up. On the 15th day new 5 (16.67%) patients underwent amputations, so total number of amputation done till date was 8 (26.67%). On 21st day, new 7 (23.34%) patients were underwent amputations and total number of amputations till date were 15 (50%). On 30th day, new 15 (50%) patients underwent amputations. Conclusions: Foot ulceration in diabetic patients is a resource consuming, disabling morbidity that often is the first step towards lower extremity amputation. Prevention is the best treatment.

Health seeking attitude of women regarding reproductive tract infections in a rural area of Surendranagar district.

Background: In the recent years, the issue of gynaecological problems of poor women in the developing countries has been receiving increasing attention. High levels of gynaecological morbidity, especially reproductive tract infections and sexually transmitted infections may turn out to be fatal if not treated properly. The objective of this study was to assess the health seeking attitude of women regarding reproductive tract infections, to elicit the past history pertaining to it, to assess the personal hygiene measures relevant to it. Methods: Various community based studies carried out in the different regions world showed the prevalence of reproductive tract infections 36-84%. The sample size of study as per statistical calculation (4pq/l2, where p =50, q=100-p and l= 10% of p) came out to be 400. Prior enlisting all villages of Surendranagar district, one village was selected randomly. After random selection the village found was Khodu. Results: 75.3% of women narrated treatment was necessary; 44% told that preferably to be taken from doctor and 24.7% told treatment should not be taken because of social and personal reason. 56.5% of women having one or the other kind of symptom of reproductive tract infections. Women with poor menstrual and personal hygiene has got 2.5 times chances of reproductive tract infections (OR= 2.35, CI= 1.374-4.01, P value: 0.001). Thus the overall prevalence in our study is 56.5%. On statistical analysis it was found that women who used clothes were two times more symptomatic as compared to women who used sanitary pads, a significant association between women having symptoms of reproductive tract infections and their sexual history. The present study showed 61.94% of women had taken treatment which shows that the health seeking behavior had improved. Conclusions: Women who used sanitary pads during menstrual periods had lower prevalence. Women with complaints of dyspareunia, bleeding during and or after intercourse and history of forceful intercourse had maximum prevalence of reproductive tract infections. 19.8% of women gave past history of reproductive tract infections and out of that 15.16% of women had taken treatment for it. Regarding health seeking attitude of symptomatic women, 61.94% of women had taken treatment and majority of them had taken treatment from doctors. This implies that health intervention measures directed towards reducing morbidity from reproductive tract infections need not focus mainly on treatment of reproductive tract infections but rather on disease preventing strategies.

A comparative study of different anatomical position, clinical presentation and USG findings with operative findings in patients of appendicitis.

Background: The objective was to find out and compare accuracy of USG findings with that of per-operative findings of location & status of appendix, to compare , evaluate & study the signs and symptoms in different varieties of appendicitis, to compare & study pre, per & post op follow up of patients with such different location of appendix undergoing appendicectomy and to study the type of appendicitis responsible for inflammation/infection by histopathological examination of different locations of appendix. Methods: The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet and Informed Consent Form. The present study was carried out in surgery department of C.U. Shah medical college, Surendranagar; Gujarat state. The study was carried out from 1st October 2010 till 31st September 2012. A total of 100 cases were subjected to clinical assessment using signs, symptoms and laboratory criteria, histopathology and also the position of the appendix, which were recorded in the proforma. All patients were subjected to ultrasound examination by a qualified radiologist to exclude any other associated pathology and also to confirm the diagnosis. At surgery the Position of the appendix was first identified before disturbing the structures and the position of the appendix. After completion of the appendectomy the specimen was subjected to histopathological examination by the qualified pathologist only those cases, which were proved as, appendicitis by the histopathology were included in the study. Results: Out of 100 cases, a total of 62 cases presented with clinical features suggestive of retrocaecal appendicitis, out of which 51 had typical presentation & 11 had atypical presentation with overall sensitivity of 72.9%, followed by pelvic position which had a sensitivity of 15.29% in which 8 patients had typical presentation & 5 had atypical presentation. All modalities (clinical presentation + lab investigations + USG + intra operative + histopathology) patients were 47; with clinical presentation + lab investigations + USG + intra operative patients were 51; with clinical presentation + lab investigations + USG patients were 57; with clinical presentation + lab investigations patients were 69 and with only clinical presentation patients were 85. Conclusions: A total of five modalities that were used for the diagnosis of position of appendix & appendicitis, i.e. clinical features, lab Ix, ultrasound, intraoperative findings & histopathology, only 47% of cases all the modalities were positive. So the diagnosis of position of appendix & appendicitis is a combination of all the modalities and not just dependent on one basis.

Medical expulsive therapy for the management of ureteric calculi.

Ureteric stones in endemic areas if treated on OPD basis with helps of oral drugs saves hospitalization and economic burden to the patient and the hospital. A prospective study was carried out for 9 and half years in two medical colleges by offering two different regimes to patients on random basis and regular follow-up was done on OPD basis. The stone passage rate was highest in the lower ureter 1/3rd (80%) followed by middle 1/3rd (45%) and upper 1/3rd (40%). The patients who were offered regime 1 which included diuretics had less success rate then that with regime 2 which included drugs like nifedipine and steroids. Treatment of ureteric stones on OPD basis in endemic areas is a boon for the patients and for the health management system in terms of cost and health care system.

Single shot versus multiple shot antibiotic therapy in patients undergoing laparoscopic surgery: our experience.

The aim of our study was to see the effect of single dose regime versus multi dose regime of antibiotic in laparoscopic surgery; in terms of type of laparoscopic surgery done, type and dose of intravenous antibiotic given and the occurrence of post operative complications like wound gape, stitch abscess, local pain and discharge from the wound in both the groups. The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet and Informed Consent Form. The present study was carried out in surgery department of C.U Shah medical college, Surendranagar; Gujarat state. The study was carried out from 1st October 2010 till 31st August 2012. A total of one hundred and twenty patients undergoing emergency and elective laparoscopic surgery were included in our study. Case records of patients was recorded in the Performa containing demographic details, chief complaints, provisional diagnosis, details of operative procedures and drug details during the hospital stay. Follow up of the patients was done after one and three weeks and any change of regime of antibiotics was noted in respect to the symptoms or clinical findings like pain, fever, discharge, stitch abscess, wound gape. Out of 120 patients enrolled mean age was 38.88±14.19. Out of 120 patients in the study; 63 (52.5%) were Male and 57 (47.5%) were Female. Intravenous antibiotics were used in single dose or multiple dose in the patients undergoing laparoscopic procedures. Single dose of antibiotic was given to 65 patients and multiple dosage of antibiotics was given to 48 patients while 7 patients were converted from single to multiple dosage regime of antibiotics. Choice of a dosage of an appropriate antibiotic is of utmost importance in the treatment of the patients and the post operative outcomes. The adverse effects of the used antibiotics must also be kept into consideration while choosing the antibiotics and its dosage. Thus based on our study we conclude that single and multiple dosages of antibiotic regimes can be used for laparoscopic surgeries. However, single dose of antibiotics are more patient compliant, cost effective, less adverse effects and prevents emergence of antibiotic resistance.

Developmental and neurobehavioural toxicity study of arsenic on rats following gestational exposure.

To characterize developmental and behavioral alterations induced by arsenic exposure, Albino rats were exposed to arsenic (0, 1.5, 3.0 and 4.5 mg/kg/day/po) from gestation day 8 to till parturition and the offspring were observed over the first 3 postnatal weeks, until they were weaned on post-natal day (PND) 21. Once the pups were delivered (PND0), the treatment was discontinued. All pups were assessed for physical development, reflex development, strength and motor coordination from standard neurobehavioural developmental test batteries beginning on PND1. Gestational administration of arsenic at tested dose levels, showed no significant changes in the day of appearance of eye opening, startle reflex, negative geotaxis and spontaneous alteration performance in comparison to the control group. The number of live fetuses, mean fetal body weight and percentages of resorptions or malformations per litter were not affected by arsenic exposure. No treatment-related malformations or developmental variations were noted at any exposure level, suggesting that arsenic exposure at this dose level did not adversely affect behavioural endpoints of developmental toxicity.

Chromium exposure study in chemical based industry.

176 chromium-exposed and 30 control subjects were selected for this study. Blood samples (3 ml) were collected for the estimation of chromium. The data on chromium concentration indicated a significant higher level of chromium in the blood of the exposed workers as compared to the control. There was no significant correlation between the mean blood and environmental chromium level. This study suggests that exposure to chromium may have some effect on the health of workers, even though the dose response relationship could not be established between blood chromium and environmental chromium levels. This study suggests that exposure to chromium may have some effect on the health of workers, even though the dose response relationship could not be established between blood chromium and environmental chromium levels. Study also indicates that the environmental levels to Cr are well below the permissible levels at all the sites of the industry at the time of survey even though the blood Cr levels were observed high in 14.8% of workers and some of them were having Cr related morbidity. Therefore, preventive and engineering control measures are suggested to minimize the chromium exposure in the chromium based industry located in Gorwa industrial estate at Baroda, Gujarat. About three months period was taken to complete this study.

Male exposure mediated adverse reproductive outcomes in carbon disulphide exposed rayon workers.

The authors examined 100 carbon disulphide (CS2) exposed male workers who had been employed ten years prior to study were selected for the study. They were virtually obliged to participate in the study by the Medical Labor Inspector and all of them participated voluntary. The aim was to assess the effects of occupational exposure to carbon disulphide concentrations below the threshold limit value (31 mg/m3) on the reproductive functions with special emphasis on miscarriages. Specially, workers history records were build up on number of children, miscarriages and general weakness, mental fatigue etc. It was found that the incidences of number of miscarriages against number of living children correlated well with environmental concentration of CS2. Where the average CS2 levels were 1.695 ppm, the incidences of miscarriages was 5.71% (group 1). Where as in group 2 environmental concentrations were 12.28 ppm and the incidences of miscarriages were 18.91%. It was also found that in the spinning department the exposure exceeds many times the Threshold Limit Values (TL V).

Steroidogenic inhibition in testicular tissue of formaldehyde exposed rats.

Three groups of rats (n = 10) were subjected to intraperitoneal treatment of formaldehyde daily at doses of 5, 10 and 15 mg/kg body weight over a period of 30 days. Gradual diminution in body and testicular weight was observed in all treated groups. Leyding cell impairement was conspicuous in those given doses of 10 and 15 mg/kg. Inhibition of 3 beta-delta 5-hydroxy steroid dehydrogenase and accumulation of sudanophillic materials in testicular tissue of formaldehyde treated rats was recorded histochemically. Significant decline of serum testosterone was also observed in the same groups. Structural and functional impairement of Leydig cells after formaldehyde treatment caused steroidogenic inhibition.