Analysis of Survey on Violence Against Women and Early Marriage: Gyneaecologists' Perspective.

Violence against women and girls (VAWG) is one of the most widespread, persistent and devastating human rights violations in the world today and remains largely unreported due to the impunity, silence, stigma and shame surrounding it even in this era with huge social communication. The incidences of domestic violence, emotional violence, economical violence, sexual assault, rape, molestation, harassment at work place, exploitation, acid attack are increasing in our country and across the world. Violence against women commences before birth and continues throughout life in various forms. These range from infanticide, genital mutilation, child marriage, sexual abuse, domestic violence, sex selected abortions, domestic violence, cyber violence, dowry death, honour killing, acid attack, trafficking, physical abuse in situations of conflict and the neglect of the girl child, adolescent and ageing women. Data of violence against women available mainly from male and female partners of the community. But our study is conducted amongst gynaecologists regarding the data on violence against women they over all come across in their practice. Another problem addressed in the article was about age of marriage and early pregnancy through a survey conducted on similar grounds amongst practicing gynaecologists. Under-age marriage is a marker of multiple vulnerabilities. Early marriage is a worldwide problem associated with a range of health and social consequences including violence for teenage girls and women.

Usefulness and Utility of NACO Regime in the Management of Sexually Transmitted Infections: A Pilot Study.

INTRODUCTION: Treatment of sexually transmitted infections (STIs) has been made easy for field workers due to syndromic approach. The etiological agent responsible for different STI syndromes needs to be validated from time to time so as to guide the therapeutic regimen. AIMS AND OBJECTIVES: The aim of this study was to evaluate the etiological agent for STI syndromes and correlate the syndromic diagnosis with etiological diagnosis. MATERIALS AND METHODS: The study was conducted over 9 months in all patients attending the STI and Gynaecology Outpatient Department. Syndromic diagnosis was done by STI-trained medical officer of respective clinic. Sample was collected for etiological diagnosis and subjected to relevant investigations. Data were analyzed by applying statistical methods. RESULTS: Among 308 patients (male:female = 1:3.5), no syndromic diagnosis could be made in 11 cases (all females and had premalignant changes on Pap smear). In 68 patients (22.08%), no etiological diagnosis could be arrived at (mostly genital ulcer disease [GUD]-herpetic [H] and vaginal discharge). In cervical discharge syndrome, six patients (16.7%) showed gonococcus. In GUD-H syndrome, 37 patients (27.027%) were tested positive. In GUD-nonherpetic syndrome, three patients (33.33%) were syphilis, granuloma inguinale, and chancroid (1 each). In urethral discharge syndrome, etiology could not be found in 33 cases (45.45%). In vaginal discharge syndrome (n = 217), etiologies were overlapping as follows: trichomonas vaginalis (76.04%), bacterial vaginosis (40%), gonococcus (24%), and undiagnosed (6.5%). CONCLUSION: The present tool for validation of GUD-H can validate only 27% of cases. Overlap of etiologies is mostly common in vaginal discharge syndrome, wherein malignancies and premalignant conditions are overtreated with kits. Validation can be done only in two-third of cases with the available resources. However, syndromic approach provides the opportunity of treating STI without delay.

Effectiveness of Early Infant Diagnosis (EID) in Detecting the Serostatus of HIV-Exposed Infants and Children.

BACKGROUND/PURPOSE OF THE STUDY: Although interventions to prevent mother-to-child transmission of HIV infection are being increasingly implemented as a part of national guideline, the prevalence of pediatric HIV remains high. There is remarkable increase in survival if HIV-infected children have access to early infant diagnosis (EID) and treatment. METHODS: The study was conducted in the Department of Obstetrics and Gynecology Medical College, Kolkata from July 2011 to February 2014 after obtaining approval from the institutional ethics committee. All the infants of HIV-positive mothers who came for EID between 6 weeks to 18 months of age during the study period were included in the study. A total number of 151 infants were included in the study and divided into Group A and B according to the time of first testing. It was a prospective observational longitudinal study. Data were collected from the EID register of PPTCT unit Medical College Kolkata. EID was done as laid out in the pediatric ART (anti-retroviral therapy) guidelines of the National AIDS Control Organization. RESULTS: Effectiveness of EID is judged by the corroboration of results at 6 week, 6 and 18 months. Comparing the results in group A, we found that 10.26, 8.41, and 7.29 % were positive at 6 weeks, 6 and 18 months, respectively, and with p value of 0.5828 the differences were not statistically significant. In group B, we observed that 47.06 and 45.45 % were positive at 6 and 18 months, respectively. Analysis revealed a p value of 0.9072 indicating no significant statistical difference between the results of testing in different periods. This reflects a good correlation between the 6 weeks, 6 and 18 months value, thus establishing the integrity of the EID. CONCLUSION: Ultimate integrity of the PPTCT is judged by testing the child. EID is a novel procedure which aims at earlier diagnosis and initiation of treatment in the children.

Palonosetron Versus Ramosetron Prophylaxis for Control of Postoperative Nausea and Vomiting after Cesarean Delivery under Spinal Anesthesia.

PURPOSE: Postoperative nausea and vomiting (PONV) after spinal anesthesia for cesarean delivery are distressing to both patients and surgeons. This study was designed to evaluate the efficacy and safety of palonosetron and ramosetron (both newer and highly potent 5HT3 receptor antagonists) in nausea and vomiting in cesarean delivery after spinal anesthesia. METHODS: In this randomized, double-blind study, 109 women received either palonosetron (0.075 mg) or ramosetron (0.3 mg) intravenously immediately after clamping of the fetal umbilical cord. Nausea, vomiting, adverse events, and overall satisfaction were then observed for 48 h after administration of spinal anesthesia. RESULTS: A complete response (defined as no postoperative nausea and vomiting) during first 0-2 h postoperative after administration of spinal anesthesia was achieved in 85.5 % of patients with palonosetron and in 83.3 % of patients with ramosetron (p > 0.05). However, the corresponding incidence during 2 to 24 h was 70.9 and 53.7 %, respectively (p < 0.05), while it was 63.3 and 44.4 % at 24-48 h after anesthesia (p < 0.05). Along with a more complete response, the severity of nausea was also lesser with palonosetron during the corresponding study periods (2-24 and 24-48 h, respectively; p < 0.05). Patients who received palonosetron were also more satisfied than those who received ramosetron (p < 0.05). No difference in adverse events was observed in any of the groups. CONCLUSION: To conclude, prophylactic therapy with palonosetron is more effective than prophylactic therapy with ramosetron for the long-term prevention of PONV after cesarean section.

Diagnosis of bacterial vaginosis in cases of abnormal vaginal discharge: comparison of clinical and microbiological criteria.

INTRODUCTION: Bacterial vaginosis is a polymicrobial syndrome involving replacement of normal vaginal hydrogen peroxide producing lactobacilli by a variety of mycoplasmas and Gram-negative rods. Bacterial vaginosis has been conventionally diagnosed using Amsel criteria (a clinical method) or Nugent's score (a laboratory method with higher reproducibility). This study was undertaken to compare the diagnostic ability of the Amsel criteria with that of Nugent's score among patients presenting with abnormal vaginal discharge. METHODOLOGY: The study was conducted at the Medical College in Kolkata, India to determine the prevalence of patients with bacterial vaginosis and their demographic profile. Subjects attending the outpatient department presenting with abnormal vaginal discharge were evaluated for the presence of bacterial vaginosis by Amsel criteria and Nugent's score. RESULTS: Prevalence of bacterial vaginosis was 24% by Nugent's score. In comparison, Amsel criteria had sensitivity of 66.67%, specificity of 94.74%, positive predictive value of 80% and negative predictive value of 90%. There was no perfect inter-rater agreement between the Amsel criteria and Nugent's score (Kappa = 0.58). Presence of clue cells correlated best with a positive diagnosis by Nugent's score while the amine test (whiff test) had the lowest correlation. CONCLUSION: Although the Amsel criteria method is a convenient and inexpensive means of diagnosing bacterial vaginosis, it is not always reliable.  Alternative reliable and inexpensive diagnostic methods that unify clinical and microbiological parameters, thus increasing sensitivity while retaining specificity, are needed.

Evaluation of post partum depression in a tertiary hospital.

OBJECTIVE: To evaluate the association of different factors with postpartum depression. METHODS: A prospective study conducted in the Department of Obstetrics and Gynecology, Medical College, Kolkata. Six thousand patients, 4-7 days postpartum, were interrogated using Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic factors (age, parity, literacy, socioeconomic status, marital status and family structure), history of psychiatric disorder and abuse, mode of delivery and obstetric outcome were recorded. The results were analyzed statistically using Chi-square test. RESULTS: Incidence of PPD was 25%. Significant association of PPD was seen with poor socioeconomic group (P < 0.05), literacy (P < 0.001), nuclear family structure (P < 0.05), single mother (P < 0.001), past history of psychiatric illness (P < 0.001), history of abuse (P < 0.05), and poor obstetric outcome (P < 0.001). Age, parity and method of delivery showed no association. CONCLUSION: EPDS should be used routinely to screen for PPD among high risk cases.

Hysterectomy ..Which route?

OBJECTIVE: We designed this study to focus on women with mobile uteri benign no larger than 14 weeks, who would ordinarily be considered candidates for vaginal hysterectomy and compare the outcomes when abdominal routes were chosen. We also compared the intra and post operative complications, requirement for blood transfusion, length of hospital stay, between abdominal and vaginal route of hysterectomy. METHOD: In a simple randomized prospective comparative study 200 consecutive patients requiring hysterectomy for benign uterine conditions were analysed over a period of 2 years. (June 2006-May 2008). Group A (n = 100) underwent vaginal hysterectomy (non descent vaginal hysterectomy, NDVH) which was compared with group B (n = 100) who had abdominal hysterectomy. RESULTS: As far as duration of operation, duration of i.v. drip, mobilization in post operative ward, duration of hospital stay, P value was significant. Regarding blood loss P value was insignificant. CONCLUSION: The accessibility of the vaginal passage, disease confined to the uterus and the surgeons experience are the major determining factors for the choice of the route of hysterectomy.

Prevention of Parent to Child Transmission of HIV (PPTCT): An Effort of 4 Years in a Tertiary Centre.

OBJECTIVE: The aim of this study was to see the fetomaternal outcome of pregnancy in HIV positive mother. METHODS: This study was conducted in the department of OBGYN Medical College Kolkata from 1st January 2004 to 31st December 2007, a period of 4 years since the establishment of PPTCT centre in our institution. All the pregnant women attending the antenatal clinic for consultation and those coming directly to labour room for delivery (unbooked cases) were counseled for HIV testing, informed consent was obtained and blood samples collected for HIV testing. Babies of HIV positive women delivered were followed up to 18 months for testing. RESULTS: The no. of women detected positive were 28, 53, 69 and 98 (total 248) in the consecutive years. Therefore the seroprevalence of HIV was 0.41, 0.63, 0.67 and 0.76% in 2004, 2005, 2006 and 2007 respectively. Out of 248 women who were detected positive in the 3 years, only 103 (41.53%) delivered in our institution. 32 (12.90%) underwent MTP. But unfortunately 113 (i.e. 248 - (103 + 32) = 113) were lost to follow up during antenatal care. Out of the 95 live births, only 46 babies have been tested so far out of which only one is reactive, 45 are non reactive. CONCLUSION: The main obstacle we faced was in following up the mother and the baby. To achieve a high success rate, PPTCT programmes must have well-trained, supportive staff who take great care to ensure confidentiality. They must be backed up by effective HIV testing and counseling programmes and by good quality HIV/AIDS education, which is essential to eliminate myths and misunderstandings among pregnant women, and to counter stigma and discrimination in the wider community.