Rising trends of caesarean section: a retrospective study

Background: The indications of Caesarean Section (CS) have been changing over time, along with a visible, much talked about rise in the rate. Without a doubt, C-sections can effectively prevent maternal and perinatal mortality when done for a medical indication. However, little is researched about the extent of maternal indications and the fetal outcomes of C-sections.Methods: Data of January to March 2012 and January to March 2017 was obtained by detailed study of the patient files from the Medical Records Department of the hospital. A predesigned proforma was used to record the relevant information. Data was analysed using standard statistical methods.Results: Cephalo pelvic disproportion (CPD) and fetal distress (FD) remained the major causes of CS in both the groups, being 50.4% in group2012 and 60.5% in group2017. Trends of CS due to maternal demand and tubal ligations are emerging. Though the rise in CS was not significant in the 5 year period having gone up from 45.41% to 48.81%, there was significant increase in deliveries without complications, having jumped up from 74.8% to 88.3%.Conclusions: As per the study, there was non-significant rise in the incidence of C-sections in the time period of study. Major contributory factors observed were CPD and FD, in which it is imperative to perform C-sections.

Ovarian Cyst Regression With Levothyroxine In Spontaneous Ovarian Hyper Stimulation Syndrome Associated With Hypothyroidism.

Spontaneous ovarian hyperstimulation syndrome (sOHSS) can occur following hypothyroidism. Ultrasonography facilitates diagnosis and monitoring of this syndrome. We describe complete regression of ovarian changes in two hypothyroid patients with sOHSS after treatment with levothyroxine.

Sub-chronic diclofenac sodium induced alterations of alkaline phosphatase activity in serum and skeletal muscle of mice.

The present study has been carried on changes in activity of alkaline phosphatase in serum and gastrocnemius muscle of mice after sub-chronic use of diclofenac. Mice in experimental group received diclofenac (10 mg/kg body wt /day) for 30 days while control group received normal saline. Alkaline phosphatase was assayed in muscle and serum and its activity was localized histochemically in muscle. Results showed that diclofenac induced changes in specific activity of alkaline phosphatase at different periods of treatment variably compared to control group. Specific activity of alkaline phosphatase decreased significantly in gastrocnemius initially (48.74%), increased thereafter (132.96%) and slight decrease (13.97%) was noticed after 30 days. In serum, the specific activity of alkaline phosphatase decreased slightly after 10 days (18.78%), increased in the middle of the treatment period (132.04%) as well as showed increase (109.09%) compared to control group after 30 days stage of investigation. These findings were also confirmed by electrophoretic studies in muscle.

Metabolic and physiologic characteristics of skeletal muscle determine its response to clenbuterol treatment.

beta-Adrenoceptor agonists are reported to induce skeletal muscle hypertrophy and hence serve as valuable adjunct to the treatment of wasting disorders. In the present study, we attempted to find out whether metabolic and physiologic characteristics of fibres are important in determining skeletal muscle response to clenbuterol (an adrenergic receptor agonist) therapy, as proposed in the treatment of wasting disorders. The treatment of mice with clenbuterol (2 mg/kg body wt for 30 days) resulted in skeletal muscle hypertrophy, more common amongst fast-twitch glycolytic fibres/muscle, with increase in body mass and a parallel rise in muscle mass to body mass ratio. Measurement of fibre diameters in soleus (rich in slow-twitch oxidative fibres), ALD or anterior latissimus dorsi (with a predominance of fast-twitch glycolytic fibres) and gastrocnemius (a mixed-type of muscle) from clenbuterol-treated mice for 30 days revealed noticeable increase in the per cent population of narrow slow-twitch fibre and a corresponding decline in white-type or fast-twitch glycolytic fibres in gastrocnemius and ALD. As revealed by counting of muscle cells in soleus, narrow red fibres declined with corresponding increase in white-type glycolytic fibres population. A significant decline in the succinic dehydrogenase activity was observed, thereby suggesting abnormality in oxidative activity of skeletal muscles in response to clenbuterol therapy.

Histological evidences of reparative and regenerative effects of beta-adrenoceptor agonists, clenbuterol and isoproterenol, in denervated rat skeletal muscle.

The aim of this study was to determine the contribution of beta-adrenoceptor activation in the reconstruction of the structural and functional organization of denervated skeletal muscle. beta-agonists, clenbuterol (1.2 mg/kg body weight) and isoproterenol (2 mg/kg body weight), administration (daily oral administration; maximum 7 days) to normal innervated rats as well as denervated animals caused muscle hypertrophy. An increase in mean fiber diameter confirmed this stimulated growth both in normal innervated and denervated rat gastrocnemius muscle. Examination of muscle nuclei from treated but normal innervated rat gastrocnemius exhibited features like large size, active nucleoplasm and an increase in their number per fiber cross section and per mm mean fiber length indicating towards an elevated biosynthetic activity in tissue in the presence of beta adrenoceptor agonists. Administration of drugs to normal innervated animals resulted in an emergence of central muscle nuclei. The hyperactive and enlarged muscle nuclei ultimately organized themselves into unusually elongated nuclear streaks. beta agonist treatment to denervated rats resulted in amelioration of atrophic state of tissue characterized by hypertrophy of muscle fibers thus lending to a restoration of structural organization of tissue. Bizarre shapes of nuclei in denervated muscle tend to recover to that characteristic to normal innervated muscle in presence of clenbuterol and isoproterenol hydrochloride. All observations were confirmed by administering butoxamine, a beta-adrenoceptor antagonist along with beta-agonists. The results suggests that both clenbuterol and isoproterenol hydrochloride are capable of mimicking normal innervation functions in skeletal muscle and thus play important role in the structural and functional reorganization of tissue. Amelioration of denervation atrophy in rat gastrocnemius in the presence of beta-agonists supports this.

Beta-adrenoceptor agonist treatment reverses denervation atrophy with augmentation of collagen proliferation in denervated mice gastrocnemius muscle.

Daily oral administration of isoproterenol hydrochloride (60 mg/kg body weight; for 30 days) a beta-receptor agonist to normal innervated and denervated adult male Swiss albino mice confirmed its ability to induce skeletal muscle hypertrophy and reverse denervation atrophy respectively. Measurement of total tissue proteins and dry muscle mass showed 15-17% increase with 6% rise of hypertrophy index in gastrocnemius muscle. Hydroxyproline assay employed to measure the total tissue collagen exhibited 45% increase in collagen in normal innervated gastrocnemius muscle in response to beta agonist treatment. beta-adrenoceptor agonist ameliorated denervation atrophy along with further increase in collagen content of denervated gastrocnemius muscle.

Isoproterenol ameliorates workstress-induced rat skeletal muscle degeneration.

Beta-Agonists though have been widely studied for their protein anabolic effects in skeletal muscles, but the lipid status under work stress and agonist treatment have not been understood well in the skeletal muscles and heart of rat. In the present study, adult male Wistar rats were subjected to work overload stress and beta agonist isoproterenol treatment (2 mg kg(-1) day(-1) intraperitoneally) to examine, whether it attenuates work stress-induced changes or not. Simultaneously, beta2 antagonist butoxamine (2 mg kg(-1) day(-1) intraperitoneally) was administered to another isoproterenol-treated group. Work stress led to myofibrillar degeneration as well as rapid utilization of lipid to meet increased energy demands and for muscle repair, which was reflected through histochemical localization of lipids and biochemical estimation of cholesterol and triglycerides. Significantly decreased cholesterol levels in skeletal muscles and heart muscles were noticed. As expected, isoproterenol reversed the conditions by raising cholesterol and triglyceride levels significantly in the skeletal muscles and also by ameliorating the degenerative changes in muscle fibres as induced by work overload. However, severe accumulation of lipids in heart infers towards deleterious effects of isoproterenol on heart and thus remains a limiting factor for its immediate clinical application. Further research is needed to separate desirable effects of beta agonists on skeletal muscles from any undesirable effects on the heart, so as to optimize their therapeutic potential.

Dietary intake and growth pattern of children 9-36 months of age in an urban slum in Delhi.

This investigation deals with the dietary intakes and growth in early childhood in poor communities. Five hundred and forty five children, 9-36 months of age, and their caretakers (mothers) were selected randomly and invited to participate in the study. The food and nutrient intake of children was assessed using a 10-item food frequency and amount questionnaire (FAQ). The anthropometric nutritional status was assessed by the indices height-for-age (H/A), weight-for-age (W/A), weight-for-height (Wt/Ht) and MUAC, according to Indian and NCHS standards. The results showed that the intake of cereals, pulses, roots, green leafy vegetables (GLVs), other vegetables, fruits, sugar, fats and oils among children was grossly inadequate. The nutrient intake for energy was 56% of the current RDA. Anthropometric analysis revealed that the children were grossly undernourished. Seventy five per cent children were underweight (<-2 SD), while 35% severely undernourished (<-3 SD). Approximately, 74% children were having short stature (chronic malnutrition) with 39% severely stunted. Nineteen per cent children were excessively thin (wasted). The data regarding the degree of malnutrition among children demonstrated that 9.6% girls in 9-36 months of age had severe malnutrition as compared to 6.5% males. The maximum prevalence of severe malnutrition was in the age 31-36 months (10%) followed by 9.6% in 13-18 months. The moderate degree of malnutrition was around 30 to 33% in age group 13-36 months. The evidence from the study provides a strong basis to suggest low food intake as the main cause of under/malnutrition and growth retardation (stunting) in early childhood in poor communities.

Clenbuterol induced changes in cholesterol and triglyceride levels of gastrocnemius, pectoralis and heart of rat under work induced stress.

Work induced stress led to decreased cholesterol and fluctuating triglyceride levels in gastrocnemius and pectoralis muscles in rats. But the drug (clenbuterol, 2 mg kg(-1) day(-1)) treatment increased cholesterol and triglyceride levels in both the muscles. However, heart showed decreased cholesterol and increased triglyceride level in the animals under work stress, but at the same time drug treatment led to a significant increase in levels of the two lipid fractions, inferring towards deleterious effect of the drug on heart.

Iron status of children aged 9-36 months in an urban slum Integrated Child Development Services project in Delhi.

OBJECTIVE: To assess the magnitude/severity and possible etiology of anemia and iron deficiency among children 9-36 months of age. METHODS: A population-based study on the prevalence, etiology of anemia and iron status in 545 children, 9-36 months of age, was conducted in an urban slum ICDS (Integrated Child Development Services) project in North-East Delhi. Hemoglobin and serum ferritin was estimated and information on socio-economic, demographic, parasitic infection/infestation and dietary intake was collected. RESULTS: Prevalence of anemia (using WHO cut-off values of Hb >11.0 g/dl) among children, 9-36 months of age, was 64%, of these 7.8% had severe anemia (Hb >7.0 g/dl). Using 10.0 g/dl as the Hb cut-off point 44% children less than 18 months of age in the present study population were anemic. On a sub-sample study, 88% children were estimated to be iron deficient, with serum ferritin concentration less than 12 microg/L. The peripheral smear red cell morphology showed 33.9% as microcytic-hypochromic and 37.1% as dimorphic. Dimorphic anemia was 55% in moderate anemia group. The energy and iron intakes were 56% and 45%, respectively of the Recommended Dietary Allowances (RDA). The parasitic infestation/infection was not related to the prevalence or severity of anemia. CONCLUSION: In Delhi, high prevalence of moderate to severe anemia and iron deficiency with vitamins folate and/or B12 among children under 3 years of age in an ICDS block in operation for 20 years is of concern. Dietary origin was the main cause of anemia in this age group.