Bacterial vaginosis: a cause of infertility?

Bacterial vaginosis (BV) is a common disorder of the genital tract in women characterized by an alteration of the normal acidic lactobacilli-predominant vaginal ecosystem to a vaginal environment dominated by Gardnerella vaginalis, mycoplasma species and anaerobes, with an increase in pH. The present study evaluated whether BV is associated with reproductive complications in women. BV was screened with a Gram stain of vaginal smear and interpretation was done using the Nugent score. Wet mount and polymerase chain reaction were used to screen other infections. Among 510 enrolled women, 72 (14.1%) had BV. Statistical analysis between the BV negative and positive population revealed a significant association (P = 0.0001) with infertility. In pregnant women, the infection rate was low (P = 0.01). Multiple infections such as Candida, Chlamydia and human papilloma virus were observed in 4.2%, 15.3% and 8.3% of BV-infected women, respectively. Results suggest that BV infection is associated with infertility and its absence leads to pregnancy, emphasizing its screening and treatment.

Medical education in Maharashtra: the student perspective.

BACKGROUND: There is hardly any structured study reporting the perspective of medical students, with regard to the medical education system in Maharashtra, which is facing challenges. AIM: A perception study of students was conducted to explore the situation, challenges, and consequent solutions of medical education in Maharashtra. SETTINGS AND DESIGN: A descriptive perception study. MATERIALS AND METHODS: A structured questionnaire was e-mailed to 92 students, and interviews with seven key-informants comprising of faculty, administrators, and policy makers were conducted, to gather qualitative insights. RESULTS: Thirty-seven student replies were received and analyzed. The satisfaction level of student respondents for various factors was as follows: infrastructure 18/37 (48.6%), quality of teaching 14/37 (37.8%), patient population 22/37 (59.5%), and administration 8/37 (21.6%). Ninety-two percent (34/37) of the students stated that the fundamental problem was the inability of the system to attract good, quality teachers. The reasons stated were low salaries, low level of job satisfaction, high level of bureaucracy, and high work load. CONCLUSIONS: The medical education system in Maharashtra is viewed as being stagnant. The respondents emphasized an urgent need for educational reforms, which should include better compensation for teachers, sharing of facilities between government and private medical colleges, and improved efficiency of the Medical Council of India. In the long run a public-private mix with sharing of resources may be a plausible solution.

Use of vaginal pH in diagnosis of infections and its association with reproductive manifestations.

Increase in vaginal secretion pH is an indicator of bacterial vaginosis (BV), but is yet to be in use as a diagnostic tool by clinicians. Similarly, no reports are available on the effect of cervical chlamydia infection and different reproductive manifestations on vaginal secretion pH. This study evaluated the use of vaginal pH for screening of BV, the effect of Chlamydia trachomatis (C. trachomatis) infection, and different reproductive manifestations on vaginal pH of women attending the gynecology outpatient department of a general hospital. Vaginal pH was recorded while diagnosing infections in 358 women, among which 45 were with repeated spontaneous abortion, 79 with infertility, 185 had sign and symptoms of lower genital tract infection, and 49 had no history or symptom of any complications or infections. Normal vaginal pH, BV, and C. trachomatis infection were observed in 72.6, 21.5, and 10.1% of women, respectively. BV and C. trachomatis were observed in 78.6 and 4.1% of women, respectively, with high vaginal pH; 12.3% of women with normal vaginal pH had C. trachomatis infection. C. trachomatis infection or different reproductive manifestations do not lead to change in vaginal pH but high vaginal pH correlated with BV and should be used as a simple tool for its diagnosis.

Eisenmenger syndrome in pregnancy.

Maternal mortality in the presence of Eisenmenger syndrome is reported to be 30 to 50% & increases further with associated complications. A case of Eisenmenger syndrome in pregnancy where the patient progressively deteriorated postpartum & expired 3 weeks later is reported.

Indomethacin therapy in hydramnios.

AIM: The use of indomethacin in treatment of hydramnios was evaluated. SUBJECTS & METHODS: Twelve patients with symptomatic hydramnios were treated with indomethacin (2.2- 3.0 mg/kg body weight/day). RESULTS: The treatment was started at a gestational age of 31.17-/+7.94 weeks and continued for 3.74-/+2.3 weeks. Eleven patients responded to the therapy both subjectively and objectively and pregnancies were prolonged by 4.6-/+3.1 weeks (range 0.1-10 weeks). Five women had term deliveries. Six patients had a favourable perinatal outcome. Four patients who had a known congenital anomaly in the foetus, delivered stillborn babies or had an early neonatal death. One patient who did not follow up after commencing therapy delivered a full-term stillbirth. One patient delivered within 1 day of starting therapy. Indomethacin therapy caused no maternal complications. CONCLUSION: Indomethacin was effective in the management of hydramnios and preventing it's complications.

Balloon mitral valvotomy in pregnancy: maternal and fetal outcomes.

BACKGROUND: Rheumatic mitral valve stenosis contributes to significant morbidity in pregnancy. Surgical commissurotomy has been performed during pregnancy in patients with severe mitral stenosis for several decades, but the efficacy and safety of percutaneous balloon mitral valvotomy (BMV) in this subset has not been clearly defined. STUDY DESIGN: In 1996 and 1997, 40 pregnant women aged 24+/-5 years underwent BMV at 21+/-11 weeks of pregnancy. Special shielding was used during BMV to limit radiation to the fetus, except in those who were to undergo medical termination of pregnancy subsequently. A detailed echocardiographic evaluation was performed before and after BMV. After the BMV, the 29 patients in whom pregnancy was continued were assessed every 2 weeks for symptoms and fetal growth. RESULTS: The BMV procedure was successful in 39 patients with an increase in mitral valve area from 0.8+/-0.2 cm2 to 1.7+/-0.2 cm2 (p < 0.001) and marked symptomatic relief. Fluoroscopy time was 7.8+/-1.9 minutes. Eleven patients whose BMV was performed before 20 weeks of pregnancy, subsequently underwent medical termination of pregnancy uneventfully. Eighteen patients had a normal delivery, three underwent cesarean section for fetal distress, one had a preterm delivery, and there was one stillbirth. Four patients are continuing pregnancy and two are lost to followup. Fullterm delivery data were available in 23 babies, whose birth weights were 2.32+/-0.5 kg. None of these babies needed any special care and were healthy at discharge. CONCLUSIONS: During pregnancy, BMV by the Inoue technique is feasible, safe, and effective. There is marked symptomatic relief, along with excellent maternal and fetal outcomes.

Steroids and related products. LIV. The synthesis of 11-oxa steroids. VI. The synthesis of 11-oxatestosterone.

The synthesis of 11-oxatestosterone from 11-oxa-5 alpha-androstane-3,17-dione, which is available from hecogenin, is described. The product shows, in comparison with the natural hormone, diminished androgenic and anabolic activities.

Steroids and related products. LIII. The synthesis of 11-oxa steroids. V. The synthesis of 17-ethynyl-11-oxatestosterone.

The synthesis of 17-ethynyl-11-oxatestosterone, both from 11-oxa-5 alpha-pregnane-3,20-dione and, via a 3,17-dioxygenated 9-oxo 9,12-seco 11-nor 5 alpha-androstane-12-oic ester, from 3 beta-acetoxy-17-hydroxy-5 alpha-pregnan-12-one--two products available from hecogenin--is reported. The new hormone analogue shows significant progestational activity in the Clauberg test and relatively weak activity in a post-coital antifertility assay.

Steroids and related products. XLII. (1) The synthesis of 11-oxa steroids. IV. (2) The synthesis of 17,21-dihydroxy-11-oxa-4-pregene-3,20-dione, an 11-oxa analogue of the 17-hydroxylated glucocorticoids.

The synthesis, from 11-oxa-5alpha-pregnane-3,20-dione, available from hecogenin, of 17,21-dihydroxy-11-oxa-4-pregnene-3,20-dione, the first 11-oxa analogue of corticoid hormones, is described. The acetate of its 1-dehydro derivative, 17-hydroxy-21-acetoxy-1,4-pregnadiene-3,20-dione, analogous in structure to the acetates of prednisone and prednisolone, is an intermediate in the synthesis.

11-Oxa and 17alpha-hydroxymethyl analogues of steroid hormones and their derivatives.

PIP: The syntheses of 11-oxa and 17alpha-hydroxymethyl analogues of steroid hormones and their derivatives are reported and some of their biological activities are discussed. Generally, the replacement of the 11-methylene group by oxygen results in a diminution of the progestational, androgenic-anabolic, and estrogenic activities. This effect is least pronounced in the case of the progestational activity of 11-oxa-ethisterone and particularly strong in the case of the uterotropic activity of 11-oxa-estradiol. 17alpha-acetoxymethylprogesterone and 17alpha-hydroxymethylprogesterone were synthesized by 2 pathways, 1 of which can be advantageously applied also to the synthesis of 17alpha-acyloxymethyl and 17alpha-hydroxymethyl glucocorticoids. 17alpha-acetoxymethylprogesterone was inactive in the Clauberg test even at high doses.^ieng