Comparison of Clinical, Biochemical, and Sonological Parameters in Adolescents with and without Polycystic Ovarian Syndrome

Objectives?The Pediatric Endocrine Society consensus criteria was developed in 2015 to diagnose adolescent PCOS. There are no Indian studies that use these criteria for diagnosis and then compare the clinical characteristics with those of normal controls. The objective of this study was to compare the clinical and biochemical profile in adolescents with and without PCOS and to study the ovarian morphology in adolescents with and without PCOS. Materials and Methods?We conducted a prospective case–control study on 60 adolescents who attended the outpatient department/adolescent immunization clinic. Group A included 30 adolescent girls with PCOS diagnosed as per the consensus criteria and Group B included 30 adolescents without PCOS. All participants were clinically evaluated and called empty stomach in the follicular phase for metabolic (Serum TSH, prolactin, FSH, LH, and testosterone) and endocrinal workup (2-hour OGTT, lipid profile) followed by ultrasonic examination. Results?In group A, 40% were overweight and 36.7% were obese and in group B, 20% were overweight and 20% were obese. There were no significant differences noted in gonadotropin levels in two groups. Mean testosterone levels were higher in PCO adolescents. The mean ovarian volume and ovarian follicle number were significantly higher in adolescents with PCOS. We found that if ultrasound criteria were added to the diagnosis, there would be about 7% lesser PCOS diagnosis. Conclusion?PCOS alters the fat distribution and lipid distribution in the body. These are features that lead to long-term metabolic alterations and life-threatening diseases. All PCOS adolescents thus be screened for these abnormalities and advised lifestyle modifications to keep these parameters under control

Obstetric outcome in twin pregnancies complicated with single intrauterine fetal demise

Background: It has been reported that single intrauterine fetal death in twin pregnancy occurs in 3.7-6.8% all twin pregnancies. The objective of this study was to evaluate the maternal and fetal demographic features and feto-maternal outcomes in twin pregnancies complicated with single intrauterine fetal demise and evaluation of available management guidelines.Methods: This retrospective study was conducted at obstetrics and gynecology department of SGRRIM and HS, Dehradun, Uttarakhand between January 2015 and December 2019. There was a total of 182 twin deliveries at study hospital during this period and 35 of these cases were complicated with single intrauterine fetal demise. Maternal age, parity, chorionicity of twin gestation, gestational age at single intrauterine fetal demise, gestational age at delivery, mode of delivery, birth weight, Apgar Score at birth, neonatal intensive care unit stay of newborn,  maternal fibrinogen levels during pregnancy and delivery time and associated obstetric complications were analyzed in these cases of single intrauterine fetal demise with twin gestation. All monochorionic twin pregnancies were included in the study Group A and dichorionic twin in Group B.Results: The mean age of 32 patients included in study was 29.7±4.6 years. Twenty (62.5%) of these patients were dichorionic and 12 (37.5%) of these were monochorionic twin gestation. Single intrauterine fetal demise occurred in first trimester in 8 (25%) patients, during the second trimester 20 (62.5%) and 4 (12.5%) patients had third trimester single intrauterine fetal demise. Preterm deliveries occurred in 18 (56.3%) of patients and 8 (44.4%) of patients were of monochorionic and 10 (55.6%) of dichorionic twin patients. Among thirty-two patients, 11 (34.4%) patients had caesarean delivery and 21 (65.6%) patient had vaginal birth. No maternal or fetal mortality noted and none of the patients had maternal coagulation disorder.Conclusions: This study indicates that in cases of twin pregnancies with single fetal intrauterine demise with individualized management plan at higher centre and close maternal and fetal surveillance live fetus can be saved without any maternal risk.

Scenario of molar pregnancy in a tertiary care centre in Delhi, India

Background: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases with incidence varying with geographic region. Aim was to review all molar pregnancies admitted at our institution and to study the incidence, clinical presentation, management, complications and outcome of molar pregnancies.Methods: An observational study was done in department of obstetrics and gynaecology at Dr. BSA Medical College and Hospital among women with molar pregnancy over two years.Results: The incidence of molar pregnancy of the institute was 1.05/1000 deliveries. 21- 25 years age group and nulliparous women constituted 28.1% of patients. Amenorrhea (100.0%) was the commonest presenting complaints followed by abnormal vaginal bleeding (90.62%). Anemia (37%) was the commonest complication followed by acute hemorrhage (31%) and hyperthyroidism (18%). Suction evacuation was done in 96.8% of patients and 87.5% required blood transfusion. Only 6.2% (2/32) of patients had post evacuation chemotherapy. None of the cases developed choriocarcinoma. Limitation of the study was that the incidence of subsequent pregnancies after complete treatment of molar pregnancies was not studied.Conclusions: Early diagnosis of complete molar pregnancy can change the clinical presentation, diagnosis, and treatment of molar pregnancy. There is need for early recognition, timely referral, prompt and proper treatment of this condition. Adequate follow-up of the patients and need for contraception should be reinforced.

Swasth Saarthi Abhiyan for public transport drivers, filling fuel at Indraprastha gas limited stations in Delhi and National Capital Region

Background: A public transport driver (Saarthi) if sick thinks twice before taking a day off. The community health department (CHD) of a tertiary care hospital started a ‘Swasth Saarthi (healthy drivers) Abhiyaan’ (SSA) for the public transport drivers (PTDs) for one year. The objectives of the study were to conduct 220 health check-up camps at selected compressed natural gas (CNG) stations in Delhi and National Capital Region; to improve health awareness and early detection of diseases in drivers and getting treated at base hospital.Methods: A cross-sectional study carried out from 15th March 2017 to 14th March 2018 at 36 Indraprastha Gas Limited (IGL) stations for all public transport drivers coming to IGL stations. Health camps conducted were - general health camp at IGL stations, NCD camps at community health department and clinical camps at the base hospital.Results: A total of 408 camps were held in which 14,945 drivers came for health check-up. The PTDs with Eye problems 5981 (40%), over-weight 5315 (35.56%), tobacco/gutka chewing 4687 (31.36%), drinking 3734 (24.98%), smoking 3616 (24.20%), obesity 1655 (11%), hypertension 1433 (9.59%) and diabetes 1057 (7.07%). Health awareness was improved through health education. Surgeries for cataract 20/155 and sleep apnoea 4/122, and de-addiction drugs for 15 drivers of ‘addiction’ were started at base hospital.Conclusions: The health check-up camps under SSA revealed that a large number of public transport drivers are at risk of various health related disorders. Innovative programme like ours is good to reduce “Treatment Gap” and is a step towards achieving Universal “Health for All”.