A meta-analysis of ferric carboxymaltose versus other intravenous iron preparations for the management of iron deficiency anemia during pregnancy.

Objective: We conducted a meta-analysis of randomized clinical trials evaluating the clinical effects of ferric carboxymaltose therapy compared to other intravenous iron in improving hemoglobin and serum ferritin in pregnant women. We also assessed the safety of ferric carboxymaltose vs. other intravenous iron. Data source: EMBASE, PubMed, and Web of Science were searched for trials related to ferric carboxymaltose in pregnant women, published between 2005 and 2021. We also reviewed articles from google scholar. The keywords "ferric carboxymaltose," "FCM," "intravenous," "randomized," "pregnancy," "quality of life," and "neonatal outcomes" were used to search the literature. The search was limited to pregnant women. Selection of studies: Studies related to ferric carboxymaltose in pregnancy were scanned. Observational studies, review articles, and case reports were excluded. Randomized studies in pregnant women involving ferric carboxymaltose and other intravenous iron formulations were shortlisted. Of 256 studies, nine randomized control trials were selected. Data collection: Two reviewers independently extracted data from nine selected trials. Data synthesis: The final effect size for increase in hemoglobin after treatment was significant for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 0.89g/dl [95% confidence interval 0.27,1.51]). The final effect size for the increase in ferritin after treatment was more for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 22.53µg/L [-7.26, 52.33]). No serious adverse events were reported with ferric carboxymaltose or other intravenous iron. Conclusion: Ferric carboxymaltose demonstrated better efficacy than other intravenous iron in increasing hemoglobin and ferritin levels in treating iron deficiency anemia in pregnant women.

A meta-analysis of ferric carboxymaltose versus other intravenous iron preparations for the management of iron deficiency anemia during pregnancy

Abstract Objective: We conducted a meta-analysis of randomized clinical trials evaluating the clinical effects of ferric carboxymaltose therapy compared to other intravenous iron in improving hemoglobin and serum ferritin in pregnant women. We also assessed the safety of ferric carboxymaltose vs. other intravenous iron. Data source: EMBASE, PubMed, and Web of Science were searched for trials related to ferric carboxymaltose in pregnant women, published between 2005 and 2021. We also reviewed articles from google scholar. The keywords "ferric carboxymaltose," "FCM," "intravenous," "randomized," "pregnancy," "quality of life," and "neonatal outcomes" were used to search the literature. The search was limited to pregnant women. Selection of studies: Studies related to ferric carboxymaltose in pregnancy were scanned. Observational studies, review articles, and case reports were excluded. Randomized studies in pregnant women involving ferric carboxymaltose and other intravenous iron formulations were shortlisted. Of 256 studies, nine randomized control trials were selected. Data collection: Two reviewers independently extracted data from nine selected trials Data synthesis: The final effect size for increase in hemoglobin after treatment was significant for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 0.89g/dl [95% confidence interval 0.27,1.51]). The final effect size for the increase in ferritin after treatment was more for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 22.53µg/L [-7.26, 52.33]). No serious adverse events were reported with ferric carboxymaltose or other intravenous iron. Conclusion: Ferric carboxymaltose demonstrated better efficacy than other intravenous iron in increasing hemoglobin and ferritin levels in treating iron deficiency anemia in pregnant women.

A Prospective Multi-centric Study of Acceptance, Insertion and Follow-Up of Postpartum Insertions of IUCD.

Purpose of the Study: The unmet need for contraception in the postpartum period is a major challenge in our country. Unintended pregnancies are highest in the first year after birth, and postpartum IUCD insertion is an effective way to counter this problem. This study was planned to build up data for acceptance and follow-up of postpartum IUCD insertions. Methods: The present study has included data of PPIUCD insertions and follow-up from seven institutions over a period of 6 months. The case recruitment lasted for 3 months, including only those who had PPIUCD insertions in this period, and they were followed up for a period of 6 months. The follow-up of patients was at 6 weeks and 6 months. All issues were addressed including side effects, expulsions, myths surrounding the device, etc., along with routine postnatal care. Results and Conclusion: There were 5227 deliveries and 1895 insertions. The acceptance rate was 36%, and a follow-up at 6 weeks and 6 months showed up an expulsion rate of approximately 4% and a removal rate of 5%. Overall, at the end of 6 months we have a continuation rate of 90%. This shows that a dedicated approach to postpartum contraception will definitely bring down incidence of unintended pregnancies.

VAW, Law and US!

AIMS AND OBJECTIVES: To evaluate presentation, trends and management of violence against women and children at a tertiary referral center in Mumbai and to suggest ways to optimize handling of sexual assault cases. DESIGN: Retrospective descriptive case study. SETTING: Department of Obstetrics and Gynaecology, HBTMC, and Dr. R. N. Cooper Hospital, Mumbai (tertiary teaching hospital). SAMPLE SIZE: A total of 1449 cases of alleged sexual assault from January 2015 to December 2019. METHODS: A retrospective descriptive study was conducted, of all the reported incidents of alleged sexual violence managed by department of OBGY from January 2015 to December 2019 at a tertiary teaching hospital in Mumbai. RESULTS: During the study duration 1449 cases of alleged sexual assault were seen in our facility. A steady rise in the number of incidents of sexual assault over the past 5 years was noted. In our study, we found one-third of the survivors were children below 15 years of age. Forensic samples were collected in 21% cases. Counseling by onsite NGO showed positive trend over the years. DISCUSSION: There is growing recognition that violence against women has a health impact, in addition to being a gross violation of women's human rights. There was a steady increase in the number of cases coming to us; increasing awareness of the law, collaboration with NGOs, and provision of services under one roof may be the reason for this. CONCLUSION: Violence against women is a public health problem of epidemic proportion. There is urgent need to integrate these issues into clinical training for health-care providers. All efforts need to be made to ensure the right of the survivors to healthcare is upheld and appropriate physical and mental health services are available without discrimination and are accessible, acceptable and of good quality.

Hysterectomy: treatment for secondary infertility.

Infertility is a distressing condition but extenuating circumstances sometimes make the choice of treatment seem paradoxical. Here is discussed a challenging case of a 30-year-old woman with no living child and secondary infertility who presented with a large abdominal mass and severe abdominal pain, sequelae of previous obstructed labour. There was complex management dilemma. She was young, had no living child, had undergone vesicovaginal fistula (VVF) repair and vaginoplasty yet was wanting fertility; however she was distressed with the abdominal pain and desired a complete cure. Both she and her spouse were counselled about the high possibility of failure if repeat attempt at vaginoplasty was made, and possible damage to the VVF repair. Finally, decision of exploratory laparotomy with total abdominal hysterectomy was taken after counselling the couple about adoption as an option for childbearing.

Money & Menopause: The Relationship Between Socioeconomic Class and Awareness about Menopause in Women in Mumbai, India.

PURPOSE: The primary aim of this study is to determine the awareness regarding menopause and its treatment options among women in Mumbai, India and correlate the same with the social class of the subject. In addition, this study also attempts to identify the attitude of Indian women toward menopause. METHODS: A cross-sectional study was conducted using a self-constructed semi structured questionnaire given to women between the ages of 35 and 55 years, currently residing in Mumbai. The 192 women interviewed were then divided into 6 groups as per Prasad's Socioeconomic Classification (based on per capita monthly income) with 53 % falling in class I and II and 47 % in class III, IV and V. Although the study was conducted primarily at a charitable hospital, no subject was found who fulfilled the Class VI criteria. RESULT: The study shows that two-thirds of class I, four-fifths of class II, less than half of class III, and one third of class IV and V are aware about treatment options for menopause which is a significant variation (χ (2) value = 20.127, df = 1, P < 0.0001). We also found that once counseled, more than half the subjects of classes I to V were willing to accept treatment, which thus is not a significant variation (P = 0.4659). Of the total subjects, more than half were relieved, one fourth frightened, and less than one fifth were uncertain about their feelings toward menopause. CONCLUSION: We thus conclude that there is a significant relationship between socioeconomic status and awareness about menopause treatment options while there is no relationship between socioeconomic status and acceptance of treatment for the same. A majority of the Indian women are relieved by the onset of menopause.

Malaria in South Asia: prevalence and control.

The "Malaria Evolution in South Asia" (MESA) program project is an International Center of Excellence for Malaria Research (ICEMR) sponsored by the US National Institutes of Health. This US-India collaborative program will study the origin of genetic diversity of malaria parasites and their selection on the Indian subcontinent. This knowledge should contribute to a better understanding of unexpected disease outbreaks and unpredictable disease presentations from Plasmodium falciparum and Plasmodium vivax infections. In this first of two reviews, we highlight malaria prevalence in India. In particular, we draw attention to variations in distribution of different human-parasites and different vectors, variation in drug resistance traits, and multiple forms of clinical presentations. Uneven malaria severity in India is often attributed to large discrepancies in health care accessibility as well as human migrations within the country and across neighboring borders. Poor access to health care goes hand in hand with poor reporting from some of the same areas, combining to possibly distort disease prevalence and death from malaria in some parts of India. Corrections are underway in the form of increased resources for disease control, greater engagement of village-level health workers for early diagnosis and treatment, and possibly new public-private partnerships activities accompanying traditional national malaria control programs in the most severely affected areas. A second accompanying review raises the possibility that, beyond uneven health care, evolutionary pressures may alter malaria parasites in ways that contribute to severe disease in India, particularly in the NE corridor of India bordering Myanmar Narayanasamy et al., 2012.