Real-world utilization pattern of dydrogesterone in 7287 Indian women with obstetric and gynecological conditions: data from multicentric, retrospective study.

Objective: Despite the literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients. Methods: This was a multi-center, retrospective, observational, cross-sectional, and descriptive study across 817 centers in India. Data of patients who received dydrogesterone in past and provided consent for future use of their medical record for research purpose was were retrieved and analyzed. Results: Data of 7287 subjects (aged 29.55±4.84 years) was analyzed. Threatened abortion was the most common indication for which the subjects received dydrogesterone (46.9%) followed by recurrent pregnancy loss. Polycystic ovary syndrome (PCOS), thyroid disorders and anemia were the most common comorbid conditions and prior pregnancy loss, advanced maternal age and obesity were the most common risk factors seen in subjects who received dydrogesterone. Total 27.5% of subjects received a loading dose of dydrogesterone, and majority (64%) received 40 mg as loading dose. 10 mg dose was used as maintenance or regular dose in 81.4% of the subjects. Twice daily (BID) was the most common dosing frequency (66.6%). The most common concomitant medications being taken by the subjects on dydrogesterone included folic acid (45.1%), iron supplements (30.3%) and calcium and vitamin D3 supplements (25.5%). Another progesterone preparation (oral, injection, vaginal, tubal) other than dydrogesterone was used concurrently in 7.8% of subjects. Conclusion: The study helped to identify the patient population that is benefitted by dydrogesterone and the preferred indications, risk factors, comorbid conditions and concomitant medication used in this patient population at real-life scenario.

Real-world utilization pattern of dydrogesterone in 7287 Indian women with obstetric and gynecological conditions: data from multicentric, retrospective study

Abstract Objective: Despite the literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients. Methods: This was a multi-center, retrospective, observational, cross-sectional, and descriptive study across 817 centers in India. Data of patients who received dydrogesterone in past and provided consent for future use of their medical record for research purpose was were retrieved and analyzed. Results: Data of 7287 subjects (aged 29.55±4.84 years) was analyzed. Threatened abortion was the most common indication for which the subjects received dydrogesterone (46.9%) followed by recurrent pregnancy loss. Polycystic ovary syndrome (PCOS), thyroid disorders and anemia were the most common comorbid conditions and prior pregnancy loss, advanced maternal age and obesity were the most common risk factors seen in subjects who received dydrogesterone. Total 27.5% of subjects received a loading dose of dydrogesterone, and majority (64%) received 40 mg as loading dose. 10 mg dose was used as maintenance or regular dose in 81.4% of the subjects. Twice daily (BID) was the most common dosing frequency (66.6%). The most common concomitant medications being taken by the subjects on dydrogesterone included folic acid (45.1%), iron supplements (30.3%) and calcium and vitamin D3 supplements (25.5%). Another progesterone preparation (oral, injection, vaginal, tubal) other than dydrogesterone was used concurrently in 7.8% of subjects. Conclusion: The study helped to identify the patient population that is benefitted by dydrogesterone and the preferred indications, risk factors, comorbid conditions and concomitant medication used in this patient population at real-life scenario.

Relative fat distribution in relation to menarcheal status among Bengalee Hindu girls of West Bengal, India.

BACKGROUND: Menarche seems be related to the relative distribution rather than the total amount of body fat. Previous studies showed that the ratio between lower-body vs. upper-body fat was associated with the timing of menarche. AIM: To compare the relative distribution of subcutaneous fat among Bengali Hindu pre- and post-menarcheal girls. MATERIALS AND METHODS: The participants were 234 Bengali Hindu girls aged 11-14 years: 111 pre-menarcheal and 123 post-menarcheal girls, randomly selected from a secondary school from a suburb of Kolkata, West Bengal, India. Triceps, abdominal, sub-scapular, and calf skinfolds were measured. For each skinfold site, ratio was calculated as follows: Log (one skinfold/sum of skinfolds). Principal components (PC) analysis was performed to derive components which express the maximum contrast among the log of ratios. T-test was employed to assess differences between individual scores of components between pre- and post-menarcheal girls. RESULTS: The three identified PC suggested extremities-trunk, lower trunk-upper trunk, and an upper extremity-lower extremity contrasts, respectively. Scores for second and third components showed significant differences between pre- and post-menarcheal groups of girls. CONCLUSION: The attainment of menarche by Bengali girls aged 11-14 years was associated with characteristically more relative subcutaneous fat distribution in the upper trunk and in the lower limbs, in contrast to lower trunk and upper limbs, respectively.

Mid-upper Arm Circumference Based Undernutrition among Bengalee Children of Chapra, West Bengal, India.

OBJECTIVE: To investigate age and sex variations in undernutrition using mid-upper arm circumference (MUAC) cut-off values among 2016 (930 boys and 1086 girls). 3-5 years old rural children of Bengalee ethnicity at 66 Integrated Child Development Services (ICDS) Centers of Nadia District, West Bengal, India. METHODS: In a cross sectional study in west Bengal of India, MUAC was measured using standard technique. A total of 2028 children (935 boys and 1093 girls) from 66 ICDS centers were enrolled in this study. The response rate was approximately 95%. FINDINGS: Mean MUAC among boys was higher than girls at all ages except 5 years. Significant sex differences were not observed over ages. The age-combined rates of overall (moderate and severe) undernutrition among boys (38.49%) was higher than among girls (32.22%).The age-combined rates of moderate undernutrition were 36.34% and 31.03% among boys and girls, respectively. The rates of severe undernutrition were 2.15% and 1.20% among boys and girls, respectively. There were sex differences in both moderate and severe undernutrition. In general, there was an increasing trend in the rates of overall undernutrition from 3 to 5 years in both sexes. CONCLUSION: These children were experiencing severe nutritional stress.

Undernutrition among adult Bengalees of Dearah, Hooghly District, West Bengal, India: relationship with educational status and food habit.

A cross-sectional study of 1203 adult (> 18 years of age) Bengalees of Dearah, Hooghly District, West Bengal, India, was undertaken to evaluate the prevalence of undernutrition and the relationship of educational level and food habit with undernutrition. Height and weight were measured and body mass index (BMI) computed following the standard equation. A BMI < 18.5 kg/m2 was classified as undernutrition or chronic energy deficiency (CED) as per World Health Organization (WHO) recommendations. The public health problem of low BMI in this population was classified according to the WHO criteria. Educational status was coded as: no formal education, 1-8 years of schooling and > 8 years of schooling. Food habit was recorded as vegetarian or non-vegetarian. The mean ages of males and females were (39.6 +/- 15.0 years) and (39.6 +/- 15.0 years), respectively. There were significant (p < 0.001) sex differences in mean height and weight; both sexes had a similar BMI. The overall (sex combined) prevalence of undernutrition was 27.7%. The frequency of undernutrition was significantly (p < 0.001) higher among females (31.7%) compared to males (23.6%). According to the WHO classification of low BMI, the prevalence of CED was high (20-39%) indicating a serious situation. There existed a significant (p < 0.001) relationship between the level of formal education and nutritional status. Overall, the frequencies of CED (43.5%) were much higher than overweight (7.0%) among subjects with no formal education. The frequencies of CED and overweight among subjects with 1-8 years of formal education were 25.7% and 9.7%, respectively. Similarly, significantly (p < 0.001) higher rates of CED were found among subjects with no formal education in both sexes (males = 39.5%; females = 45.6%) compared to the presence of overweight (males = 1.8%; females = 9.8%). Sex-combined frequency of undernutrition was significantly (p < 0.001) higher among vegetarians (48.3%) compared with non-vegetarians (25.5%). The respective frequencies of overweight were 1.7% and 12.8%. This significant (p < 0.001) trend existed in both sexes with 46.9% male and 49.3% female vegetarians having CED. The corresponding figures for overweight among vegetarians were 0.0% and 2.9%, respectively. The rates of CED were significantly (p < 0.001) lower among non-vegetarians (males = 21.5%; females = 29.6%). Non-vegetarians had significantly higher rates of overweight in both males (8.7%) and females (16.9%). Multiple regression analysis revealed that both educational status as well as food habit had significant effect on BMI in both sexes. In general, the educational status had a stronger impact (males: t = 6.356, females: t = 5.017) than food habit (males: t = 3.373; females: t = 2.763) on BMI. This significant impact remained even after controlling for the effect of age. In conclusion, this study demonstrated that adult Bengalees of Dearah were under serious nutritional stress indicating a public health problem. In addition, a strong inverse relationship existed between educational level and CED. Moreover, vegetarianism was significantly associated with CED. Urgent public health measures are required, particularly among females, to reduce the high prevalence of CED in this population. Similar studies should be conducted in other parts of West Bengal before any general conclusions can be inferred about the relationship between educational status, food habit and CED in the state.

Prevalence of undernutrition among pre-school children of Chapra, Nadia District, West Bengal, India, measured by composite index of anthropometric failure (CIAF).

Since independence, one of the greatest problems facing India is malnutrition among under five year old children. However, there exists scanty information of the prevalence of undernutrition among preschool children in India and West Bengal. The present cross-sectional study investigates the prevalence of undernutrition among children 3.0-5.9 years old in a rural area of West Bengal covered by the Integrated Child Development Services Scheme (ICDS) using Composite Index of Anthropometric Failure (CIAF). Randomly selected sixty six ICDS centres of the Chapra Block Nadia District, West Bengal, India, were chosen. A total of 2016 children, aged 3.0-5.9 years were studied. It was observed that boys were heavier and taller than girls at all ages. Significant age differences existed in mean height and weight in boys as well as in girls. Among the children, 48.20%, 10.60% and 48.30% were stunting, wasted and underweight, respectively. The CIAF showed a higher prevalence of undernutrition, with 60.40% of the studied children suffering from anthropometric failure, in comparison to the three other conventional indicators. We conclude that the nutritional status of the subjects is unsatisfactory. More studies dealing with CIAF should be undertaken among pre-school children from different parts of India. Such investigations will allow us not only to compare the rates of three conventional measures of undernutrition with CIAF, but also help to demonstrate the enhanced utility and effectiveness of the latter measure.

Prevalence of hypothyroidism and importance of cholesterol estimation in patients suffering from major depressive disorder.

The coexistence of hypothroidism and depression is already reported and both of these conditions are known to share some common clinical symptoms. Serum cholesterol level is known to be altered in either condition considered separately. But, no report is obtained regarding serum cholesterol level when both the conditions coexist. In this study, 78 patients (61 females and 17 males, age ranged 19 to 67 years) suffering from major depressive disorder were included. Serum T3, T4, TSH and cholesterol levels were estimated in all of them. Sixty-two patients were found to be euthyroid and 16 patients (11 females, 5 males) were found to be hypothyroid. Among female patients, 6 had subclinical hypothyroidism and 5 had overt hypothyroidism. Among male patients 3 had subclinical hypothyroidism and 2 had overt hypothyroidism. The overall prevalence of hypothyroidism in major depressive disorder was estimated as 20.5%. Mean serum cholesterol level in 62 euthyroid patients was found to be 150.9% +/- 16 mg% and that of 16 hypothyroid patients to be 190.7 +/- 12 mg% showing a significant difference (p < 0.01). Thus estimation of cholesterol in major depressive disorder patients may give an idea regarding their thyroid status and vice-versa.

Stunting, underweight and wasting among Integrated Child Development Services (ICDS) scheme children aged 3-5 years of Chapra, Nadia District, West Bengal, India.

This study investigated age and sex variations in height and weight, levels of stunting, underweight and wasting among 533 (254 boys; 279 girls) 3- to 5-year-old rural children of Bengalee ethnicity at 11 Integrated Child Development Services centres of Nadia District, West Bengal, India. Height-for-age, weight-for-age and weight-for-height < -2 z-scores were used to evaluate stunting, underweight and wasting, respectively, following the National Center for Health Statistics (NCHS) Guidelines. Results revealed that boys were significantly heavier than girls at age 3 years. Significant age differences existed in mean height and weight in both sexes. Mean z-scores of height-for-age, weight-for-age and weight-for-height were lower than those of NCHS for both sexes at all ages. The overall (age and sex combined) rates of stunting, underweight and wasting were 23.9%, 31.0% and 9.4%, respectively. The rate of underweight and wasting was higher among girls (underweight = 35.1%, wasting = 12.2%) compared with boys (underweight = 26.5%, wasting = 6.3%). In general, the frequency of stunting increased with increasing age in both sexes. Based on the World Health Organization classification of severity of malnutrition, the overall prevalence of underweight was very high (>or=30%). The prevalence rates of stunting (20-29%) and wasting (5-9%) were medium. In conclusion, the nutritional status of the subjects is unsatisfactory. There is scope for improvement in the form of enhanced supplementary nutrition.

Overweight and obesity among affluent Bengalee schoolgirls of Lake Town, Kolkata, India.

A cross-sectional study was undertaken to determine the prevalence of overweight and obesity among 431 Bengalee schoolgirls aged 6-9 years in Kolkata, India. Anthropometric measurements of height and weight were made on 431 girls. The body mass index (BMI) was computed following the standard equation. Overweight and obesity was defined following the internationally accepted BMI cut-off points. Results revealed that the overall rates of overweight and obesity were 17.63% and 5.10%, respectively. A steady increase in number of overweight individuals was observed from 6 to 9 years. The prevalence of overweight among affluent Bengalee children was higher than those reported from other Asian countries.

Comparison of nutritional status between tuberculosis patients and controls: a study from north 24 parganas district in west bengal, India.

The nutritional status of tuberculosis patients (TBP) and controls (CT) was compared among adult (> 20 years) Bengalees in Shyamnagar, Barrackpore, Naihati and Jagaddal of North 24 Parganas District, West Bengal, India. The subjects included 310 men (154 TBP and 156 CT) and 246 women (128 TBP and 118 CT). The mean ages of TBP men was 36.4 years (CT = 34.5) and that of TBP women was 26.4 years (CT = 25.6). Variables compared included weight, height, fat mass, fat mass index, mid-upper arm fat area, and skinfolds. Results revealed that TBP had significantly lower means for all variables (except for height in men) compared to CT in both sexes. In men, the highest percent differences between the two groups were observed for fat mass (FM: 60.1%), fat mass index (FMI: 59.2%) and suprailiac skinfold (SUPSF: 58.8%). In women, the highest percent differences between the two groups were observed for SUPSF (59.7), mid-upper arm fat area (MUAFA: 58.1), triceps skinfold (TSF: 51.4), biceps skinfold (BSF: 51.2), FM (51.2) and FMI (49.0). Regression analyses confirmed that tuberculosis status had significant impact (p < 0.0001) on all anthropometric and body composition characteristics compared (except for height in men) in both sexes. Among men, tuberculosis status explained the highest percent variation in percent body fat (PBF: 57.2%), FMI (56.0%) and FM (55.6%). In women, tuberculosis status explained the highest amount of variation in PBF (67.9), TSF (63.5%), BSF (62.8), FMI (61.0) and FM(60.7). Results of contingency chi-square tests revealed that there were significant differences in the frequency of undernutrition between TBP and CT in men (χ2 = 73.13361) and women (χ2 = 59.0000). The frequencies of undernutrition were significantly more common among TBP, in both men (56.5%) as well as women (51.6%). This study provided evidence that there was significant differential amount of loss in fat and muscle measures in tuberculosis patients.

Physical exercise, body mass index, subcutaneous adiposity and body composition among Bengalee boys aged 10-17 years of Kolkata, India.

A comparative study of 215 sedentary (no regular physical exercise undertaken) and 313 physically active (regular physical exercise undertaken) Bengalee boys aged 10-17 years was undertaken to investigate the differences in overall adiposity (body mass index), subcutaneous adiposity (skinfolds) and body composition (percent body fat, fat mass and fat mass index). Both groups had a similar age. The results revealed that boys who did not undertake regular physical exercise (NPE) had a significantly greater mean body mass index (BMI) compared with those who undertook regular physical exercise (PE); p < 0.001. The means for all the skinfolds as well as percent body fat (PBF), fat mass (FM) and fat mass index (FMI) were significantly higher among the NPE group. The percentile distributions of all these variables and indices were consistently higher among the NPE group. The results of ANOVA of physical exercise (PE = yes, NPE = no) and PBF, FM and FMI, with age as covariate, revealed that PE had a significant negative effect on all these measures of body composition even after controlling for the impact of age. The means in each case were greater among the NPE group. In conclusion, this study provided evidence that Bengalee boys, who undertook regular physical exercise, had significantly less adiposity compared with those who did not undertake regular physical exercise.

Regional adiposity, body composition and central body fat distribution of 10-16 years old Bengalee boys of Nimta, North 24 Parganas, West Bengal, India.

A cross-sectional study of 502 Bengalee boys aged 10-16 years of Nimta, North 24 Parganas, West Bengal, India, was undertaken to study regional adiposity, body composition and central body fat distribution. The subjects were classified into seven age groups: 10-10.9 years (n = 74), 11-11.9 (n = 53), 12-12.9 (n = 87), 13-13.9 (n = 116), 14-14.9 (n = 58), 15-15.9 (n = 57), 16-16.9 (n = 57). In general, there was a significant linear increasing trend from 10 to 16 years for all the anthropometric variables. There was a net increase of 30.5 cm and 22.8 kg in mean height and weight, respectively, between 10 and 16 years of age. Mean BMI increased by 3.7 kg/m2 during the same period. Among circumferences, the largest increase was in hip followed by chest while the smallest increase was in mid upper arm, between 10 and 16 years of age. Subscapular skinfold showed the largest increase followed by abdomen and suprailiac skinfolds, while the increase was least in forearm skinfold. Significant linear increasing trend was observed for all the body composition measures. The largest increase in percent of body fat (PBF) was observed between ages 10 and 11 years while mean fat mass (FM), fat free mass (FFM) and fat mass index (FMI) increased the most between 14 to 15 years. However, an overall decreasing trend was observed, in mean waist-to-hip ratio (WHR) from 10 to 16 years. Boys aged 10 years had the highest mean WHR while those aged 15 years had the lowest mean WHR. There was an increase in mean WHR among 16 years old boys.

Adiposity, central body fat distribution and blood pressure among young Bengalee adults of Kolkata, India: sexual dimorphism.

A cross-sectional study of 174 men and 153 women of Bengalee ethnicity was undertaken to compare levels of adiposity, central body fat distribution and blood pressure. The mean age of both the sexes were similar (men = 20.1 years; women = 20.0 years). Significantly more women (n = 42, 27.5%) were overweight (body mass index, BMI > or = 25.0 kg/m2) as compared with men (19, 10.9%). Men were significantly taller and heavier. They also had significantly greater mean waist (WC) and mid upper arm (MUAC) circumferences compared with women. On the other hand, women had significantly (p < 0.001) greater mean BMI, biceps (BSF), triceps (TSF) and subscapular (SSF) skinfolds. The mean values of systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure were significantly greater among men. These significant differences existed even after controlling for BMI. Regression analyses revealed that sex had significant effect on all these variables even after controlling for BMI. Correlation studies showed that WC was found to be much more strongly correlated than BMI with SBP, DBP and MAP, in both sexes. However, when the effect of WC (along with BMI) was also controlled for, there was no significant sex difference in blood pressure.