The Medical Termination of Pregnancy (Amendment) Act, 2021: A step towards liberation

Reform of the abortion laws in favour of the well-being of pregnant women is one aspect of the removal of gender discrimination. The Medical Termination of Pregnancy Act (MTP Act) 1971, was a breakthrough legislation in this regard, as it reduced the number of unsafe illegal abortions. With advancements in ultrasonography and genetic technologies, many foetal malformations and genetic disorders were being diagnosed after 20 weeks of gestation. The fact that termination of pregnancy was not legally permitted beyond 20 weeks of gestation caused great distress to such women, and highlighted the need to increase the upper limit of termination of pregnancy. Concurrently, there has been greater awareness around the world on the rights of women to take decisions regarding their own bodies. The MTP Bill, 2020, has come as a breath of fresh air extending the term limit for legal abortions to 24 weeks for certain categories of women, and removing the limit for abortion in the presence of a significant foetal abnormality. The amendments were recently approved by Parliament and the President of India, and have become law as of March 25, 2021. This paper presents the amendments made and their implications for obstetric, ultrasonographic and foetal medical practice. It also presents a critique of the various Acts and suggests further amendments that would enhance the value of the Act.

Service quality dimensions regarding maternal and child health-care provided to the beneficiaries attending a Nagrik Hospital Rohtak Haryana

Background: Understanding service quality dimensions regarding maternal and child health (MCH) care are important for their utilization, and it could help in planning interventions for their betterment. It also encourages adherence to the services and contributes to enhancing the quality of MCH care services provided in health-care facility. Objective: The objective of the study was to determine the services quality dimensions related to MCH care provided to beneficiaries. Materials and Methods: A cross-sectional, descriptive study conducted in Nagrik Hospital among women of reproductive age group (15–49 years) who had come at least once previously to avail the MCH services. Systematic random sampling and exit interview technique were followed and data collected using pre-designed, pre-tested semi-structured schedule and permission from Institutional Ethics Committee Maulana Azad University Jodhpur taken. To determine services quality dimensions related to MCH care, factor analysis was used. This statistical approach was utilized to construct new factors affecting the quality of MCH care services availed by the beneficiaries. The analysis was done using software Statistical Package for the Social Sciences for Windows version 18.0. Results: Among 226 study participants, 125 beneficiaries utilized maternal health care services and 101 availed child health-care services. Health-care provider’s characteristics, expectations of beneficiaries toward healthcare services attributes were found statistically significant toward perceived satisfaction for utilization pattern of MCH care services. Conclusion: Services quality dimensions related to MCH care provided to beneficiaries concluded as health-care provider’s characteristics, expectations of beneficiaries toward health-care services and support and help by supporting staff such as Yashoda, Class IV employees, and sweepers from this study.

Clinical Importance Of Nontuberculous Mycobacteria In Chronic Pulmonary Lung Diseases

Introduction: The isolation of non – tuberculous mycobacteria (NTM) from clinical specimens is becoming common in mycobacteriology laboratories. Globally, the NTM’ s are perceived as a contaminant only. Concomitantly NTMs are observed to be another major causative agent of pulmonary and extrapulmonary diseases in immunocompetent patients. It calls for a different line of diagnosis. To complement the paradox on role of NTM, its isolation, identification and diagnosis, a study was carried out in symptomatic patients attending OPD of NITRD New Delhi. Materials & Methods: The study was conducted on the patients whose first sputum culture report was positive for NTM in the microbiology laboratory. At the time of enrollment, second sputum sample was collected along with patient’s clinical data and radiological finding. The results of 2 sputum culture along with clinical & radiological features were recorded and co–related. During the study, tracing of the patients was done mainly through 3 different methods (i) Patients were traced during the report collection in microbiology laboratory by clinical microbiologist, (ii) Through laboratory records registration number address and/or phone number iii)By the help of field worker of the DOTS Centre. Cultures were done in MGIT 960 automated bacterial culture system and identification was done through routine biochemical character. Conclusion : It is imperative on the part of microbiologist to carry out identification tests on all culture isolates before DST is done as 50 % of the laboratory isolates were positive for NTM in repeat samples. Any of the standard tests for M. Tb complexes turn out to be negative;microbiologist shall look for NTM’s. For this purpose a checklist to be developed to avoid delay in diagnosis of NTM related diseases.

Light regulation of nitrate reductase gene expression and enzyme activity in the leaves of mulberry

Nitrate reductase (NR) is considered to be an essential enzyme in plants, as it catalyses the conversion of nitrate to nitrite. In mulberry (Morus spp.), a plant of sericultural importance, the NR enzyme activity is found to be regulated by light. Three mulberry genotypes used in the present study showed that the NR enzyme activity increased in response to light. To identify whether light also regulates NR gene at the transcriptional level the expression of NR mRNA has been studied. The analysis of NR gene expression showed that light plays a significant role in regulating the NR gene with basal or no expression in response to light during the day while it is found to increase in the dark during the night showing maximum expression at pre-dawn hours.

Conventional cytology, visual tests and evaluation of P16INK4A as a biomarker in cervical intraepithelial neoplasia.

OBJECTIVES: (1) To detect cervical intraepithelial neoplasia (CIN) using Papanicolaou test (PAP test), visual tests (visual inspection after the application of acetic acid [VIA], visual inspection after the application of Lugol’s iodine [VILI]), colposcopy, and biopsy. (2) To study the biomarker p16INK4A expression by immunostaining. MATERIALS AND METHODS: Experimental study was conducted from November 2009 to April 2011. 1500 women were screened for cancer cervix using conventional PAP test, VIA, and VILI. Sensitivity, specificity, positive, and negative predictive values of these tests were calculated individually, sequentially, and in parallel. Women having positive results underwent colposcopy and biopsy if required. p16INK4Aexpression in biopsy samples was studied using immunohistochemistry. RESULTS: All test positive cases (n = 235) underwent colposcopy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PAP with atypical squamous cells of undetermined significance (ASCUS) as cut‑off was 40%, 99.25%, 35.25%, and 99.39%; VIA was 60%, 93.06%, 8.03%, and 99.56% and VILI was 80%, 86.06%, 5.4%, and 99.76%, respectively. When PAP, VIA, and VILI were used in parallel sensitivity, specificity, PPV, and NPV improved to 100%, 85.18%, 6.38%, and 100%, respectively. Colposcopic abnormalities were detected in 83 and biopsy proven CIN in 15. p16INK4A expression was seen in eight of 15 CIN cases. CONCLUSIONS: (1) PAP test and visual techniques are complementary. (2) p16INK4Aexpression was seen in majority of CIN 2 lesions suggesting a higher grade lesion.

Applications of ultrasonography in respiratory intensive care.

Emerging evidence suggests that ultrasonography of lung is a fast, inexpensive, widely available bed-side diagnostic tool which is useful for quick and early diagnosis of respiratory diseases. It is useful in the differential diagnosis of pulmonary infiltrates and has good accuracy in identifying consolidation and alveolar-interstitial syndrome. This technique can also be useful in the immediate evaluation of patients with dyspnoea or acute respiratory failure in the respiratory intensive care unit and helps in monitoring treatment response. Ultrasonography of lung has also been found to be useful in the diagnosis of pulmonary embolism, traumatic lung contusion and lung consolidation as well. There is a need for developing specific guidelines for establishing the standards of training and education regarding lung ultrasonography in India.

Occurrence of Non-Tuberculous Mycobacterium in clinical samples - a potential pathogen.

Background: Silent presence of non-tuberculous mycobacterium (NTM) has been observed since the last 100 years, but now the increasing incidence of NTM is of great concern for clinical microbiologists as well as clinicians. Although many advanced efforts are being made for identification and control of Mycobacterium tuberculosis, still the silently growing menace of non-tuberculous mycobacteria is receiving negligible attention. Objectives: This study was aimed to find NTMs in positive cultures and identify them up to species level. Material & Methods: During the study period, i.e. from January 2009 to June 2011, a total of 4104 positive cultures were subjected to species identification by different morphological and biochemical tests. All the tests for identification were performed as per standard procedure along with the standard strains of NTM provided by JALMA, Agra. Results: The identification of positive cultures showed 4044/15581 (25.95%) Mycobacterium tuberculosis complex and 60/15581(0.38%) NTM. The mycobacterium species identification results showed that out of total 60 NTM, 21 different species of NTM were found and they belonged to all the four groups of runyon. The most common species identified in this study was M.simiae (07) followed by M.avium(06), M.gordonae(05), M.kansasii(05), M.fortuitum(05), M.chelonae(05), M.pheli(05), M.terrae(04), M.szulgai(02), M.vaccae(02), M.flavescens(02), M. trivale(02), M.malmoense(01), M.scrofulaceum(01), M.intracellulare(01), M.xenopi(01), M.ulcerans(01), M.tusciae(01), M.triplex(01), M.septicum(01), M.mucogenicum(01). Conclusion: The isolation of NTMs from different clinical samples indicated that they may be the causative agents for pulmonary and extra-pulmonary non-tuberculous diseases. Elaborate and focused studies are needed to differentiate NTMs amongst commensal/colonizer, pathogen and laboratory contaminants.

Tuberculosis of the ilium: a case report.

A twenty year old man presented with pain in the upper part of right hip. CT scan showed multiple osteolytic areas in the right ilium, suggesting malignancy. CT guided needle biopsy was done and diagnosis of tuberculosis was made. The patient was cured with medical management only. Isolated tuberculosis of the ilium is an extremely rare condition. It is important to have a high clinical suspicion to diagnose early and manage the patient without surgical intervention.

Endobronchial tuberculosis presenting as tumorous mass.

We report a case of an 18-year-old boy presenting with features of right middle lobe collapse. On bronchoscopy, a tumorous type of endobronchial tuberculosis was found to be obstructing the lumen of the right middle lobe bronchus. On treatment with anti-tuberculous drugs the growth resolved significantly within three months. The patient, however, developed mild stenosis of the airway.

Trends of Extra-pulmonary Tuberculosis under Revised National Tuberculosis Control Programme: A study from south Delhi.

Background & Objectives: Extra-pulmonary tuberculosis (EPTB) cases have been treated with a daily short course chemotherapy (SCC) regimens in past. Following the success of Directly Observed Treatment-Short Course (DOTS) programme over recent years, a study was carried out to determine prevalence of EPTB, to draw comparison between annual case detection of pulmonary TB (PTB) and extra-pulmonary TB and to assess outcome of DOTS in EPTB in a patient population of Delhi. Methods: All consecutive EPTB cases of Delhi, diagnosed within LRS Institute of TB and Respiratory Diseases between January 1996 to March 2003 and subsequently given DOTS at the area DOTS Centres, constituted the study group. Results: Of overall 14185 cases, 2849 (20%) had EPTB. A significantly higher prevalence was observed in females (57%) and in young age (mean + standard deviation of 23.4 + 12.8 years). Commonest involved site was lymph node (54%). Whereas number of PTB and EPTB cases have increased over successive years, percentage of former declined significantly through 84 in 1996 to 78 in 2002 and that of latter rose significantly through 16 to 22 correspondingly. EPTB to PTB ratio changed significantly from 1:5 at start to about 1:3.5 at study-conclusion. Treatment completion was observed in 94% (1775/1885) of EPTB cases. Conclusions: Under Revised National TB Control Programme (RNTCP) employing a DOTS strategy, annual case detection has improved for both pulmonary and extra-pulmonary TB. Cure of infectious disease is likely to have resulted in a relative rise of the annual EPTB case detection. DOTS effected an acceptable treatment outcome in EPTB case management.

Emphysematous pyelonephritis: a consequence of adenocarcinoma of urinary bladder in a nondiabetic patient.

Emphysematous pyelonephritis (EP) is a life threatening condition of acute necrotising renal parenchymal infection that encompasses a much wider spectrum of complicated urinary tract infections such as renal abscesses, emphysematous pyelitis, pyelonephritis, acute renal papillary necrosis, and sepsis. We report an unusual case of adenocarcinoma bladder in a middle aged nondiabetic patient, presenting with EP. Emphysematous pyelonephritis was the initial symptom in this case with an underlying carcinoma of the bladder. The role of imaging is prime in management of such cases, if an early diagnosis is to be made and a potentially devastating outcome is to be avoided. The literature regarding EP has been reviewed and discussed. The goals of managing EP should be (1) early institution of parenteral antibiotics and a (2) a staged nephrectomy (preceded by a temporary percutaneous drainage particularly with antibiotic resistant septicemia) so as to maximize survival rather than proceeding directly to emergency nephrectomy.