Hysteropathological Correlation in Abnormal Uterine Bleeding in a Tertiary Care Hospital in South India.

Background: Abnormal uterine bleeding is a common problem mainly encountered in reproductive age group and post-menopausal women. Hysteroscopy is a safe, simple, well tolerated and reliable procedure for the diagnosis of AUB across all age groups. The aim of the study is to determine the association of hysteroscopy and histopathologic examination (HPE) findings in abnormal uterine bleeding. The secondary objective of the study are to enumerate the hysteroscopy findings in patients with AUB and to evaluate the pattern of AUB. Materials and Methods: Observational cross-sectional study among 60 women in reproductive and post-menopausal age group presenting with features/symptoms suggestive of abnormal uterine bleeding were studied. All patients reporting in the outpatient department (OPD) and who are eligible to participate were included in the study, after obtaining written informed consent. Detailed history, Clinical examination, Ultrasound pelvis and endometrial thickness assessment is done. Hysteroscopic findings were compared against histopathological findings. Results: The various patterns of bleeding documented in our study population were menorrhagia, metrorrhagia, menometrorrhagia, polymenorrhea, and post-menopausal bleeding. Out of these patterns, the commonest was menorrhagia at 50.0% and post-menopausal bleeding at 26.67%. In our study population, the various hysteroscopy findings were strawberry, tongue-shaped projections, pebble stones, polypoidal patterns, and cerebroid patterns. Out of these, the most common was a polypoidal pattern, strawberry pattern, and tongue-shaped projections with 45%, 31.67%, and 26.7%, respectively. The most common histopathology finding was secretory and proliferative constituting 35% and 26.67%, respectively. Carcinoma endometrium constitutes about 6.67% of the study population. The sensitivity, specificity, PPV, and NPV of strawberry appearance in hysteroscopy in comparison with secretory changes in histopathology were 52.38%, 79.49%, 57.89%, and 75.61%, respectively. The sensitivity, specificity, PPV, and NPV of tongue-shaped projections appearance in hysteroscopy in comparison with HPE findings was 60%, 76.36%, 18.75%, and 95.45%, respectively. The sensitivity, specificity, PPV, and NPV of polypoidal pattern in hysteroscopy in comparison with Endometrial hyperplasia in histopathology was 66.67%, 56.14%, 7.41%, and 96.97%, respectively. The sensitivity, specificity, PPV, and NPV of cerebroid appearance in hysteroscopy in comparison with carcinoma endometrium in histopathology were 75.0%, 100%, 100%, and 98.25%, respectively. This correlation of cerebroid pattern with carcinoma endometrium was highly significant. Among all correlations, the highly reliable was in Carcinoma endometrium followed by endometrial polyps. Conclusion: Hysteroscopy has high sensitivity and specificity in diagnosing intrauterine pathology especially endometrial cancer followed by endometrial polyps. Among the various patterns of abnormal uterine bleeding, menorrhagia was the most common. A combination of hysteroscopy and endometrial sampling was found to increase diagnostic accuracy in patients with abnormal uterine bleeding and will effectively guide us in planning the appropriate management for these patients.

The Cardioprotective and Anticancer Effects of SGLT2 Inhibitors: JACC: CardioOncology State-of-the-Art Review.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors, originally approved for type 2 diabetes mellitus, have demonstrated efficacy in reducing cardiovascular events, particularly heart failure, in patients with and without diabetes. An intriguing research area involves exploring the potential application of SGLT2 inhibitors in cardio-oncology, aiming to mitigate the cardiovascular adverse events associated with anticancer treatments. These inhibitors present a unique dual nature, offering both cardioprotective effects and anticancer properties, conferring a double benefit for cardio-oncology patients. In this review, the authors first examine the established cardioprotective effects of SGLT2 inhibitors in heart failure and subsequently explore the existing body of evidence, including both preclinical and clinical studies, that supports the use of SGLT2 inhibitors in the context of cardio-oncology. The authors further discuss the mechanisms through which SGLT2 inhibitors protect against cardiovascular toxicity secondary to cancer treatment. Finally, they explore the potential anticancer effects of SGLT2 inhibitors along with their proposed mechanisms.

Genotype Distribution and Antibiotic Susceptibility Pattern of Clinical Isolates of Group B Streptococcus in a Tertiary Care Hospital in Puducherry, South India.

Background: Streptococcus agalactiae apart from being a colonizer in the genital region is also associated with several other invasive infections in all age groups. With the varied distribution of serotypes across different regions of the world, universal vaccination is also unattainable. However, in India, the knowledge of group B Streptococcus (GBS) genotype distribution is deficient. Thus, this study was initiated to add data on this aspect. Methodology. A cross-sectional study was conducted using isolates of group B Streptococcus from all clinical specimens. Along with that, the clinical specimen type and the antibiotic resistance profile of the isolates were correlated with the genotypes recognized through a multiplex PCR assay. Results: Among the 86 isolates subjected to multiplex PCR for genotype identification, five genotypes were identified with genotype Ib as the predominant one (34.9%), followed by III (20.9%), II (16.3%), Ia (12.7%), and V (11.6%). Conclusion: The results demonstrated a correlation of types Ib and III with vaginal colonization and type II with urine specimens in the current study. This preliminary study exhibited the distribution of common genotypes and their antibiotic resistance profiles in various GBS isolates. However, multiple studies across the country with larger sample sizes are needed to validate these findings.

Fetal sex-specific epigenetic associations with prenatal maternal depressive symptoms.

Prenatal maternal mental health is a global health challenge with poorly defined biological mechanisms. We used maternal blood samples collected during the second trimester from a Singaporean longitudinal birth cohort study to examine the association between inter-individual genome-wide DNA methylation and prenatal maternal depressive symptoms. We found that (1) the maternal methylome was significantly associated with prenatal maternal depressive symptoms only in mothers with a female fetus; and (2) this sex-dependent association was observed in a comparable, UK-based birth cohort study. Qualitative analyses showed fetal sex-specific differences in genomic features of depression-related CpGs and genes mapped from these CpGs in mothers with female fetuses implicated in a depression-associated WNT/ß-catenin signaling pathway. These same genes also showed enriched expression in brain regions linked to major depressive disorder. We also found similar female-specific associations with fetal-facing placenta methylome. Our fetal sex-specific findings provide evidence for maternal-fetal interactions as a mechanism for intergenerational transmission.

The effect of older sibling, postnatal maternal stress, and household factors on language development in two- to four-year-old children.

Previous literature has shown that family structure affects language development. Here, factors relating to older siblings (their presence in the house, sex, and age gap), mothers (maternal stress), and household size and residential crowding were assessed to systematically examine the different roles of these factors. Data from mother-child dyads in a Singaporean birth cohort, (677-855 dyads; 52% males; 58% to 61% Chinese, 20% to 24% Malay, 17% to 19% Indian) collected when children were 24, 48, and 54 months old, were analyzed. There was a negative effect of having an older sibling, moderated by the siblings' age gap, but not by the older sibling's sex, nor household size or residential crowding. Maternal stress affected language outcomes in some analyses but not others. Implications for understanding the possible effects of family structure on language development are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Manual fetal stimulation during intrapartum fetal surveillance: a randomized controlled trial.

BACKGROUND: Manual fetal stimulation, either by mechanical manipulation or by stimulation of the fetal scalp, is known to evoke a fetal heart response in a normal fetus. OBJECTIVE: This study aimed to assess the clinical effectiveness of manual fetal stimulation in the assessment of fetal well-being during labor vs no stimulation among women with a singleton pregnancy and to investigate the maternal and neonatal outcomes in the 2 groups. STUDY DESIGN: This was a randomized controlled trial conducted in the department of obstetrics and gynecology at a tertiary care teaching hospital between 2014 and 2016. The inclusion criteria included women with a singleton pregnancy at ≥37 weeks of gestation with cephalic presentation in labor having one of the following abnormalities on fetal heart tracing: fetal heart rate of <110 bpm or >160 bpm, variable decelerations, late decelerations, and minimal or absent beat-to-beat variability. The exclusion criteria included women requiring immediate cesarean delivery, conditions that would preclude a vaginal delivery, and intrauterine fetal demise or a major fetal congenital abnormality. The women were followed up in labor and randomized to either the manual stimulation group or the no stimulation group when one of the cardiotocography abnormalities were present. In the manual stimulation group, the fetus was stimulated abdominally by holding the head in the palm of 1 hand when the cervical dilatation was <3 cm or vaginally by pinching the scalp of the fetus when the cervical dilatation was ≥3 cm. After delivery, a cord blood sample was collected and pH estimated. Mother and baby were followed up until discharge, and mode of delivery, cord blood pH at birth, Apgar scores at 1 minute and 5 minutes, neonatal intensive care unit admissions, and duration of stay were the outcomes studied. Data were entered and compiled as frequency and percentage for categorical variables. For continuous variables, data were calculated using mean and standard deviation. The chi-square test was used for assessing the association between the intervention and fetal and maternal outcomes. RESULTS: A total of 327 women were included in the trial, of whom 164 were in the manual fetal stimulation group (group 1) and 163 were in the "no stimulation" group (group 2). The cesarean delivery rates were 25.61% in group 1 and 30.67% in group 2 (P=.308). The mean cord blood pH levels at birth were 7.267±0.027 in group 1 and 7.265±0.024 in group 2 (P=.479), and the Apgar scores at 1 minute and 5 minutes (P=.169 and P=.423, respectively, between the 2 groups) were not found to be statistically different among the 2 groups. CONCLUSION: There was no considerable change in fetomaternal outcomes with manual fetal stimulation in women having nonreassuring cardiotocographic changes in labor.

COVID-19-Related Life Experiences, Outdoor Play, and Long-term Adiposity Changes Among Preschool- and School-Aged Children in Singapore 1 Year After Lockdown.

IMPORTANCE: Despite the potential for COVID-19 infection control-related events to have an effect on child well-being, comprehensive assessments of postlockdown changes and persistent outcomes are lacking. OBJECTIVE: To survey the extent of COVID-19 lockdown-related lifestyle changes, their differences by child age and family socioeconomic status, and the potential association with child adiposity 1 year after lockdown. DESIGN, SETTING, AND PARTICIPANTS: A self-administered, electronic survey was introduced to 2 ongoing child cohorts (the Singapore Preconception Study of Long-term Maternal and Child Outcomes [S-PRESTO] cohort of preschool children aged 1-4.5 years and the Growing Up in Singapore Towards Healthy Outcomes [GUSTO] cohort of primary school children aged 9-10.7 years) from July 8, 2020, to September 5, 2020, which was 1 to 3 months after the end of strict universal movement restrictions (duration of 73 days ending on June 19, 2020). All active participants from S-PRESTO and GUSTO, 2 population-based, longitudinal, parent-offspring cohorts in Singapore, were invited to participate and monitored through June 15, 2021. EXPOSURES: Exposures included family income before and after the COVID-19 lockdown, changes in child outdoor play or exercise, and COVID-19-related life events; all data were self-reported by parents and school-aged children 1 to 3 months after the lockdown. MAIN OUTCOMES AND MEASURES: Primary outcomes were self-reported COVID-19-related life events and changes in child online socialization, outdoor play or exercise, and intrafamily relationships. Study staff measured children's weight, height, and skinfold thickness before and up to 1 year after lockdown. Body mass indices (calculated as weight in kilograms divided by height in meters squared) and World Health Organization-standardized scores were computed. Differences before and after lockdown were compared using baseline-adjusted linear regression. RESULTS: A total of 604 parents (53% of active cohort participants) and 356 school-aged children completed the survey and were similar to source cohorts. This represents 373 of 761 eligible children in the GUSTO cohort (mean [SD] age, 9.9 [0.4] years; 197 girls [52.8%]) and 231 of 370 eligible children in the S-PRESTO cohort (mean [SD] age, 2.6 [0.8] years; 121 boys [52.6%]). The COVID-19-related life changes were prevalent and varied (eg, 414 of 600 children [69.0%] reported changes in social activities). More than one-third of primary school-aged children (122 of 356 [34.3%]) and one-quarter of preschool-aged children (56 of 229 [24.5%]) eliminated any outdoor play after the lockdown. Lower family income before the lockdown was associated with increased odds of elimination of outdoor play (adjusted odds ratio per 1000 Singapore dollars [$730 US dollars] decrease, 1.09; 95% CI, 1.01-1.19). Complete elimination of outdoor activity (vs continued outdoor activity) was associated with an increase in body mass index of 0.48 (95% CI, 0.03-0.94) and a body mass index z score of 0.18 units (95% CI, 0-0.37) in school-aged children approximately 1 year after lockdown. CONCLUSIONS AND RELEVANCE: Results of this cohort study suggest that 1 to 3 months after a brief, strict lockdown, a large proportion of parents and school-aged children reported elimination of outdoor play, which was more prevalent in lower-income families. Future research to better understand clinical implications and ways to mitigate lockdown outcomes is essential.

Improving the Food Environment in Washington State-Run Correctional Facilities: The Healthy Commissary Project.

Improvements to correctional facilities' food environment can provide healthier food and beverage options for incarcerated individuals, a population disproportionately affected by chronic disease. This article describes efforts to increase healthy options in the commissary program at Washington State correctional facilities from 2017 to 2019, and the role of a multidisciplinary collaboration between the state's Department of Corrections, Department of Health, and Statewide Family Council. Through the development, implementation, and promotion of nutrition standards, the nutritional quality of foods and beverages in the commissary program improved.

Development of a Conceptual Framework for Severe Self-Neglect (SN) by Modifying the CREST Model for Self-Neglect.

Self-neglect is an inability or refusal to meet one's own basic needs as accepted by societal norms and is the most common report received by state agencies charged with investigating abuse, neglect and exploitation of vulnerable adults. Self-neglect is often seen in addition to one or multiple conditions of frailty, mild to severe dementia, poor sleep and depression. While awareness of elder self-neglect as a public health condition and intervention has significantly risen in the past decade as evidenced by the increasing amount of literature available, research on self-neglect still lacks comprehensiveness and clarity since its inception to the medical literature in the late 1960s. With the burgeoning of the older adult population, commonness of self-neglect will most likely increase as the current incidence rate represents only the "tip of the iceberg" theory given that most cases are unreported. The COVID-19 pandemic has exacerbated the incidence of self-neglect in aged populations and the need for the use of intervention tools for aging adults and geriatric patients living alone, many of which may include in-home artificial intelligence systems. Despite this, little research has been conducted on aspects of self-neglect other than definition and identification. Substantial further study of this disorder's etiology, educating society on early detection, and conceivably preventing this syndrome altogether or at least halting progression and abating its severity is needed. The purpose of this research is to provide a definition of severe self-neglect, identify key concepts related to self-neglect, comprehensively describe this syndrome, present a conceptual framework and analyze the model for its usefulness, generalizability, parsimony, and testability.

Reflex anuria causing acute kidney injury following myomectomy: A case report.

Reflex anuria is a rare cause of acute renal failure, which may occur following ureteric manipulation or painful stimuli to adjacent organs during pelvic surgery. This condition, relatively unfamiliar to the general gynecologist, should be considered even when no obvious cause of anatomical obstruction is found. We present a case of reflex anuria in a 28-year-old woman for two large intramural fibroids. Evaluation did not reveal any organic obstruction of the urinary tract. Bilateral ureteric stenting and other supportive measures resulted in diuresis and improvement of renal function. Stents were removed after 10 days and patient was discharged on the 15th postoperative day with normal renal parameters. Intrarenal arteriolar spasm or ureteric spasm following pelvic manipulation can cause reflex anuria and should be considered in the differential diagnosis of acute renal failure in cases following pelvic surgery.

Change in attitudes and perceptions of undergraduate health profession students towards inter-professional education following an educational experience in post natal care.

BACKGROUND: Inter-professional Education (IPE) has been identified as an educational program aimed at increasing collaboration among health professionals, and improving health care outcomes. IPE programs have been incorporated in several countries and have shown positive results. The same may not be true for Asian cultures which are typically more hierarchical than others. The purpose of this study was to examine the impact of IPE on undergraduate health professional students' attitudes and perceptions in an Indian context. METHODS: Following an IPE experience undergraduate health professional students (n = 96) from three professions (Medicine, Nursing and Physiotherapy) completed a validated retro-pre questionnaire. Paired-sample t test was used to compare pre-test and post-test scores and ANOVA was used to compare the magnitude of change. Qualitative analysis was done for the open ended questions. RESULTS: The three professions showed a significant improvement in attitude (p < 0.001). The physiotherapists were more comfortable (p = 0.021) with questioning and being questioned and the nurses showed a significantly (p = 0.012) greater increase in extent of reliability as compared to the other two professionals. Participants identified the concepts of "team work", "knowledge of roles of other professionals" and "communication" as important to their learning and practice. CONCLUSIONS: The study identified a positive attitude among students and the given intervention resulted in a significant improvement in their comfort levels and reliability on other professionals. It would be reasonable to conclude therefore that acceptability for Inter professional education in the Indian context is high in spite of the cultural differences and hierarchical nuances.

Role of vitamin D-calcium supplementation on metabolic profile and oxidative stress in gestational diabetes mellitus: A randomized controlled trial.

AIM: To assess role of vitamin D-calcium supplementation on the metabolic profile and oxidative stress in women with Gestational Diabetes Mellitus (GDM) controlled on diet. METHODS: A randomized controlled trial was conducted at a tertiary care teaching hospital. Seventy women diagnosed as GDM at 24-28 weeks of gestation, controlled on a diabetic diet, were randomized to receive either vitamin D 1000 IU and calcium 1000 mg (group A, n = 34) or vitamin D 250 IU and calcium 500 mg (group B, n = 36) daily for 6 weeks. Levels of serum 25-hydroxy vitamin D, fasting plasma glucose (FPG), serum insulin, fasting lipid profile and total glutathione (GSH) were analyzed both prior to and after supplementation. Means, standard deviations and mean change were computed. Paired and independent t-tests were used to determine statistical significance between the two groups. RESULTS: Women in group A showed a significant reduction in FPG level (P-value = 0.007), fasting serum insulin level (P-value = 0.000), LDL (P-value = 0.000), total cholesterol levels (P-value = 0.000) and increase in HDL levels (P-value = 0.000). Group B had a significant fall only in FPG after 6 weeks supplementation. A significant change in total glutathione level (P-value = 0.000) was observed in both groups. CONCLUSION: Vitamin D and calcium supplementation at a dose of 1000 IU and 1000 mg, respectively, has a beneficial role in glucose metabolism, lipid metabolism and oxidative stress in GDM.

Qualitative Study on Participant Perceptions of a Supermarket Fruit and Vegetable Incentive Program.

BACKGROUND: Complete Eats Rx is a fruit and vegetable prescription program designed to incentivize fruit and vegetable consumption among Supplemental Nutrition Assistance Program (SNAP) participants via $10 incentives distributed either weekly or per encounter to purchase fruits and vegetables at a mid-price supermarket chain in Washington State. OBJECTIVE: To better understand SNAP participants' experience, and to determine perceived impacts and consequences of the program. DESIGN: Qualitative analysis of nine photovoice sessions. Participants chose the topics for discussion. Sessions were audiorecorded and transcribed. Thematic content analysis was performed to identify key emergent themes using Atlas.ti. SETTING: Spokane, Seattle, and Yakima, Washington. PARTICIPANTS: Twenty-six individuals who received a fruit and vegetable prescription within the past 6 months, 23 of whom attended all three photovoice sessions offered at their site. Participants were recruited from three participating health care or public health organizations in Spokane, Seattle, and Yakima, Washington. ANALYSIS: Transcriptions were coded using inductive methods. Coded statements were organized into major themes. Coding structures and analysis were strengthened by iterative interactions between researchers. RESULTS: Participants reported Complete Eats Rx was an important resource for families and improved food security, diet quality, and the ability to purchase healthy foods, including a greater variety of fruits and vegetables. Primary barriers to food security and fruit and vegetable consumption included limited geographic accessibility and the high cost of fruits and vegetables, exacerbated by other financial constraints such as rising housing costs. Participants reported supermarket checkout difficulty because of embarrassment, stigmatization, and inability to redeem incentives. The most frequently mentioned barrier to perceived program acceptability was having only one supermarket chain as the acceptor of the incentive. CONCLUSION: Partnering with supermarkets to accept fruit and vegetable incentives is a unique strategy to increase produce purchasing that can be adopted by other localities. Focus on geographic accessibility, appropriate price points, and positive shopping experiences via expansion to local grocers, improvements in staff interactions, and a transition to an electronic system may improve incentive redemption and usability.

A randomised double-blind trial of minimal bolus doses of oxytocin for elective caesarean section under spinal anaesthesia: Optimal or not?

BACKGROUND: Oxytocin administration regimens are arbitrary and highly subjective. Hence, it is essential to reinvestigate the appropriate dose for effective uterine contraction with minimal bleeding and adverse effects. AIM: To determine the optimal dose of bolus oxytocin for uterine contractions for elective caesarean section under spinal anaesthesia. METHODS: Ninety term mothers (37 to 41 weeks) undergoing caesarean section electively under spinal anaesthesia were considered for the trial and divided into three groups to receive oxytocin bolus of one, two or three units. The uterine tone was assessed at 2 min after oxytocin administration. Intraoperative blood loss, mean arterial pressure, heart rate and possible side effects were also compared. Paired t-test, Kruskal-Wallis test, Chi-square test and analysis of variance (ANOVA) test with Scheffe multiple comparisons were used as inferential statistics. RESULTS: Adequate uterine contraction was seen in 66% of participants who received one unit of oxytocin, and in 83.3% of participants who received two units of oxytocin. All those who received three units of oxytocin had an adequate uterine contraction. Blood loss was inversely related to the bolus dose of oxytocin. CONCLUSIONS: Lower bolus oxytocin doses of one and two units were inadequate for uterine contraction at elective caeserean section, while three units appeared to be effective in terms of adequate uterine contraction, reduced blood loss and stable haemodynamic system and absent side effects.

Maternal and perinatal outcomes of induction of labor in oligohydramnios at term-a retrospective cohort study.

Objective: To evaluate the maternal and perinatal outcomes of labor induction in women at term with oligohydramnios.Methods: A retrospective cohort of women with a singleton pregnancy, who had oligohydramnios at or beyond term (37-42 weeks) and underwent induction of labor for oligohydramnios were studied. Antenatally diagnosed fetal anomalies and intrauterine fetal demise were excluded. The women were categorized into two groups: 1) women with isolated oligohydramnios (n = 166) and 2) women with oligohydramnios associated with other maternal or fetal complications (n = 43). Maternal and perinatal outcomes were collected from the records of all deliveries, data compiled, and appropriate statistical tests were applied.Results: The study included 209 women with mean gestational age of 38.76 ± 1.00 weeks and mean induction-delivery interval of 17.45 ± 8.70 hours (16.98 hours in group 1 versus 19.23 hours in group 2). Most (75%) women delivered vaginally. Only one of the neonates had an Apgar score of less than 7 at 5 min. Average neonatal ICU length of stay was 5.52 days (5.27 days in group 1 versus 6.17 days in group 2). Among all the maternal and neonatal outcomes studied, only the mean birth weights among the two groups was found to be statistically significant (p = 0.0017).Conclusions: Women with isolated oligohydramnios and their neonates were not found to suffer any additional harm due to labor induction at term than women who had oligohydramnios associated with other complications.

Uncharacterized ORF HUR1 influences the efficiency of non-homologous end-joining repair in Saccharomyces cerevisiae.

Non-Homologous End Joining (NHEJ) is a highly conserved pathway that repairs Double-Strand Breaks (DSBs) within DNA. Here we show that the deletion of yeast uncharacterized ORF HUR1, Hydroxyurea Resistance1 affects the efficiency of NHEJ. Our findings are supported by Protein-Protein Interaction (PPI), genetic interaction and drug sensitivity analyses. To assess the activity of HUR1 in DSB repair, we deleted its non-overlapping region with PMR1, referred to as HUR1-A. We observed that similar to deletion of TPK1 and NEJ1, and unlike YKU70 (important for NHEJ of DNA with overhang and not blunt end), deletion of HUR1-A reduced the efficiency of NHEJ in both overhang and blunt end plasmid repair assays. Similarly, a chromosomal repair assay showed a reduction for repair efficiency when HUR1-A was deleted. In agreement with a functional connection for Hur1p with Tpk1p and NEJ1p, double mutant strains Δhur1-A/Δtpk1, and Δhur1-A/Δnej1 showed the same reduction in the efficiency of plasmid repair, compared to both single deletion strains. Also, using a Homologous Recombination (HR) specific plasmid-based DSB repair assay we observed that deletion of HUR1-A influenced the efficiency of HR repair, suggesting that HUR1 might also play additional roles in other DNA repair pathways.

Emergency Peripartum Hysterectomy: A 14-Year Experience at a Tertiary Care Centre in India.

INTRODUCTION: Emergency Peripartum Hysterectomy (EPH), although relatively infrequent in present day obstetrics, is a life-saving procedure in the event of a massive postpartum haemorrhage. AIM: To assess incidence, risk factors, indications and complications of peripartum hysterectomies at a tertiary care teaching hospital in India. MATERIALS AND METHODS: A retrospective study was conducted at 650-bedded tertiary care medical teaching hospital in Southern India. All emergency peripartum hysterectomies performed between February 2002 and December 2015 at a tertiary care teaching hospital, were included in the study. Demographic characteristics, risk factors, antepartum, intrapartum and post-partum events, need for blood transfusion, length of stay in intensive care unit and postoperative complications were noted. Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 22.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean±SD. RESULTS: Among 16,473 deliveries in the study period, 12 emergency peripartum hysterectomies were undertaken, the incidence being 0.073%. Women were aged 20 to 40 years (mean 30.25 years). Majority (83%) were multiparous women. Atonic postpartum haemorrhage was the most common (58%) indication for hysterectomy. About 67% of hysterectomies performed were subtotal hysterectomies. One half of them had a previous caesarean section. Two patients had bilateral internal iliac artery embolization for ongoing haemorrhage. All patients required intensive care and blood transfusion. Two patients did not survive even after hysterectomy. CONCLUSION: Atonic postpartum haemorrhage was the most common reason for performing an emergency peripartum hysterectomy. Women with previous caesarean section are at increased risk, both due to atonic and traumatic postpartum haemorrhage. Regular departmental audits are needed to formulate appropriate protocols to decrease mortality and near-miss events like EPH. Stringent protocols should be instituted for managing obstetric haemorrhage. Although EPH is life-saving, early intervention by a senior obstetrician well versed with conservative procedures may avoid morbidity associated with EPH.

Analysis of Item-Level Bias in the Bayley-III Language Subscales: The Validity and Utility of Standardized Language Assessment in a Multilingual Setting.

Purpose: The purpose of this study was to improve standardized language assessments among bilingual toddlers by investigating and removing the effects of bias due to unfamiliarity with cultural norms or a distributed language system. Method: The Expressive and Receptive Bayley-III language scales were adapted for use in a multilingual country (Singapore). Differential item functioning (DIF) was applied to data from 459 two-year-olds without atypical language development. This involved investigating if the probability of success on each item varied according to language exposure while holding latent language ability, gender, and socioeconomic status constant. Associations with language, behavioral, and emotional problems were also examined. Results: Five of 16 items showed DIF, 1 of which may be attributed to cultural bias and another to a distributed language system. The remaining 3 items favored toddlers with higher bilingual exposure. Removal of DIF items reduced associations between language scales and emotional and language problems, but improved the validity of the expressive scale from poor to good. Conclusions: Our findings indicate the importance of considering cultural and distributed language bias in standardized language assessments. We discuss possible mechanisms influencing performance on items favoring bilingual exposure, including the potential role of inhibitory processing.

A Comparison of Pregnancy Outcomes Using Two Diagnostic Criteria for Gestational Diabetes Mellitus-Carpenter Coustan Criteria and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) Criteria.

OBJECTIVE: To compare the maternal and perinatal outcomes in women with GDM diagnosed by Carpenter & Coustan (CC) criteria and by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. METHODOLOGY: A cross-sectional comparative study was conducted using data of women who were screened and diagnosed with GDM between April 2006-March 2007 using the CC criteria and April 2013-March 2014 using IADPSG criteria. Maternal and perinatal outcomes were noted. Means and proportions were calculated for continuous and categorical variables respectively. Data were analyzed using t-test for normally distributed data and Mann-Whitney U test for those that were not normally distributed. Pearson Chi-square test was used to find an association between the various outcomes between the two groups. RESULTS: Among 500 pregnant women screened, 36 were diagnosed GDM in the CC group. In the IADPSG group, 733 women were screened and 167 were diagnosed GDM. Prevalence of GDM was 7.2% in CC group and 22.78% in IADPSG group (p=0.000). There was a statistically significant difference in the number of women who developed hypertension and polyhydramnios among the two groups. Women who had an operative vaginal delivery (16.67% vs. 6.6%, p=0.085) and mean birth weight (3.10 ± 0.55 kg vs. 2.97 ± 0.48 kg, p=0.165) were higher in CC group than the IADPSG group. Among the perinatal outcomes, a statistically significant improvement was found in the number of neonates developing respiratory distress syndrome (p=0.000) and hyperbilirubinemia (p=0.000), when the IADPSG criteria were used. CONCLUSIONS: There is a statistically significant difference between the maternal and neonatal outcomes when the newer IADPSG criteria were used for diagnosis of GDM.

Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study.

INTRODUCTION: Ectopic Pregnancy (EP) is a life-threatening emergency commonly encountered by medical practitioners where diagnosis can often be missed. Any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding must raise the suspicion of an ectopic pregnancy to prevent mortality and morbidity. AIM: To review all cases of EP and determine the incidence of EP. To study the high risk factors and know the types of clinical presentation, methods of diagnosis, outcome and complications. MATERIALS AND METHODS: This was a retrospective cohort study, conducted at a tertiary care medical teaching hospital in Pondicherry, India. Medical records of all women with an EP between 2009 and 2015 were retrieved. Demographic data, parity, risk factors, clinical features, mode of management and need for blood transfusion was noted. Main outcome measures studied were the incidence of EP, risk factors, mortality and morbidity in these women. STATISTICAL ANALYSIS: Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 19.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean ± SD. RESULTS: Seventy-two EP were diagnosed during the six-year period with an incidence of 9.1/1000 pregnancies. Majority of women were aged 21-30years (51.39%), 27.8% women were nulliparous. The most common risk factors were previous abortion (36.1%) and pelvic surgery (37.50%). Fifteen cases (20.8%) were diagnosed in women who had tubectomy. The classic triad of lower abdominal pain, amenorrhoea and vaginal bleeding was seen in 29(40.3%) cases. Ultrasonography was required to arrive at a diagnosis in 28(38.9%) cases. Urine pregnancy test was positive in 100% of cases. Majority (94.4%) were tubal ectopic pregnancies. Medical management with methotrexate alone benefitted 10(13.89%) of patients while another four required surgery for failed medical management. More than half of the patients (59.7%) required blood transfusion and two (2.8%) had transfusion related acute lung injury. No deaths were noted. CONCLUSION: Common risk factors for EP must be identified. Use of transvaginal ultrasonography and human chorionic gonadotropin assay have revolutionised the management of EP and serve as valuable adjuncts to early diagnosis and management.