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Carrying out fieldwork in private infertility clinics poses its own specific set of challenges. Gaining access to these field sites not only obliges researchers to negotiate with gatekeepers but also to deal with structures of hierarchy and power. Based on my preliminary fieldwork in Lucknow city of Uttar Pradesh, I discuss the challenges of conducting fieldwork in infertility clinics and how methodological challenges push the researcher to question the academically established notions of the “field”, “fieldwork” and “research ethics”. The paper stresses the importance of discussing the challenges of doing fieldwork in private health setups and is an attempt to answer vital questions about the nature of fieldwork, how the fieldwork was conducted, and the need to include questions and dilemmas that anthropologists might face in the process of making decisions in the field.
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Background: Medical as well as surgical methods for abortion is performed worldwide since many years. Medical methods are safe till first trimester of pregnancy. The present study is intended to compare success rate and side effects of both method of abortion during first trimester. Aims and Objectives: The aim of the study was to study and compare the success rate in both the methods of termination of pregnancy in first trimester and to study side effects and complications as well as satisfaction among study participants undergoing termination of pregnancy during first trimester in both methods. Materials and Methods: A prospective comparative study was conducted at the Department of Obstetrics and Gynecology of one of the teaching medical institute of Ahmedabad among women seeking Medical termination of pregnancy with less than or equal to 9 weeks of gestation. Total 150 participants were selected using purposive sampling (75 in each group). Group A consist of patients having medical termination of pregnancy by medical method and Group B consist of cases that required termination of pregnancy by surgical method. Results: Mean age of the patients in Group A was 27.98 � 4.57 years and Group B was 27.58 � 4.22 years. Proportion of complete abortion in medical and surgical method was 88% and 96%, respectively. Surgical method had more effectiveness and success rate for complete abortion as compare to medical method. The mean duration of bleeding per vagina in both groups were more among Group A. Abdominal pain and gastrointestinal symptoms such as nausea, vomiting, diarrhea, and fever were also found to be more in Group A as compared to Group B. Those who had medical method were more satisfied than surgical method. Conclusion: Both methods are safe and effective as far as termination of first trimester pregnancy is concerned. Proper counseling with appropriate selection can bring safe and effective outcome in first trimester of termination of pregnancy
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Background: During pregnancy, hemodilution of plasma volume leads to reduction in platelets count by approximately 6–7% during 3rd trimester. Pregnant women with thrombocytopenia have higher risk of bleeding excessively during pregnancy, labor, and puerperium. The present study focuses on fetomaternal outcome among pregnant women having thrombocytopenia. Aims and Objectives: This study aims to study the incidence of thrombocytopenia in pregnancy, to identify various factors responsible for thrombocytopenia in pregnancy, and to evaluate fetomaternal outcome in patients with thrombocytopenia in pregnancy. Materials and Methods: A prospective study was conducted in the department of obstetrics and gynecology at tertiary care center of Ahmedabad. A total of 96 cases of thrombocytopenia in pregnancy were included in the study. Fetomaternal outcome was assessed among the study participants. Results: The incidence of thrombocytopenia in the present study was 0.77%. Obstetric causes (53.12%) accounted for most common cause of thrombocytopenia, followed by gestational thrombocytopenia (27.08%), dengue (10.41%), malaria (4.16%), and immune thrombocytopenia (4.16%). Postpartum hemorrhage (15.62%), eclampsia (14.58%), disseminated intravascular coagulation (11.45%), and abruption (8.33%) were the most common maternal complications. The most common neonatal complication was prematurity (67.7%) followed by intrauterine growth retardation (23.95%) and birth asphyxia (9.3%). Conclusion: Hypertensive disorders of pregnancy including severe preeclampsia, eclampsia, and HELLP syndrome are found to be the most common cause of thrombocytopenia followed by gestational thrombocytopenia and infectious causes. The present study widened the spectrum of the causes for thrombocytopenia in pregnant women. Gestational thrombocytopenia is associated with mild-to-moderate thrombocytopenia and hardly having any complications.
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Background: Head and Neck cancer (HNC) is a recognized major public health concern all over the world Objectives: To study age and gender predilection and clinical profile of Head & Neck Cancers Materials and Methods: This was a retrospective study including 21121 patients with Head & Neck Cancer presented to tertiary care centre, Ahmadabad. Patients' details of age, sex, site of carcinoma, stage at presentation and Outcome were recorded. The data was analyzed using MS office excel 2010 and Epi info software version 7.0. Result: Male to female ratio was 4.8:1. The most common site of presentation of tumour was in cheek mucosa (29.01 %). On comparison of different anatomical sites, majority of patients were presented in locally advanced stage. Significant association (p<0.05) was found between presentation of disease and literacy status. Overall 5 - year survival rate was 60.5% � 1.6% when disease was localized. Conclusion: Majority of patients diagnosed in locally advanced stage. Strategies for the early diagnosis and prevention of Head & Neck cancer must be undertaken by government to overcome this situation.
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A 65?year?old male post?CABG surgery presented with history of ventricular storm refractory to antiarrhythmics and requiring multiple DC shocks. He got posted for VATs bilateral cardiac denervation for sympathetic remodulation. Patient was induced with high dose opioids and Etomidate and intubated with 37Fr left double lumen tube. A multidisciplinary approach was planned to tackle peri?operative cardiac event along with the placement of invasive monitors. Events that might lead to sympathetic overactivation because of laryngoscopy, pain, capnothorax, and surgical handling were kept in mind and avoided with optimum depth of anesthesia, analgesia, and pharmacological sympatholysis. There was no major cardiac event intraoperatively as well as in postoperative period.
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Background:Labour progress in partograph plotting helps to early recognition and prevention of the complication of labour. This helpful in better maternal and perinatal outcome. Aim of the study is to evaluate the maternal and perinatal outcome in primigravida and multigravida by comparing their partograph in labour.Material And Methods:This prospective observational study was carried out in Smt. SCL General Hospital a teaching tertiary care hospital from May-2018 to November-2019. Total 250 cases out of which 125 cases of primigravida and 125 cases of multigravida admitted in labour room were randomly selected and monitored by using modified WHO partograph. All the cases reporting to labour room and fulfilled the inclusion criteria were included in thisstudy. Individual partograph was studied to know the various aspect of course of labour.Result:208 out of 250 cases were before alert line, 34 cases were between alert and action line and 8 cases were beyond action line. Rate of cervical dilatation in most primigravida was between 1.1-2cm/hour and in multigravida was >2.1cm/hour. In Zone A, in primigravida 90.7% had VD and 9.3% had LSCS whereas in multigravida 96.4% had VD and 3.6% had LSCS. In Zone B, in primigravida 47.8% had vaginal delivery and 52.2% had LSCS whereas in multigravida 54.4% had VD and 45.5% LSCS. In Zone C, in primigravida and multigravida there were no VD and 100% had LSCS. Protracted active phase (50%) was presents the most common abnormality of first stage of labour in both group inpresent study and in second stage, arrest of decent (82%) was more common. In both groups, NICU admission were more in Zone C (3.2%) as c ompared to Zone A (2%) and Zone B (1.6%).Conclusion:This study has shown that using the partograph can be highly effective in reducing complications from both mother and neonate. It is also helpful in monitoring of labour and early diagnosis of abnormal labour. It prevents maternal mortality and morbidity.
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Erythema ab igne is a characteristic reticular telangiectatic and pigmented dermatosis, resulting from repeated or prolonged exposure to heat or infrared radiation insufficient to cause burns. Occupational history has played a pivotal role in dermatological diagnosis, and its importance cannot be overstated. It could lead to the provisional or final diagnosis in many instances.Over the course of time, the site and cause of erythema ab igne has evolved. From commonly being found on knees shins and palms due to tapnas (a practice in Indian villages to sit in front of fire); the disease is now observed on other sites such as on thighs and trunk after the discovery of heating pads and laptops.In thisparticular case, a 26-year-old male presented with erythematous to light brown patches on his right arm. The site of presentation was quite unusual, thus making occupational history the key to diagnosis.
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Background:In current maternal mortality situation in India, it is pertinent to determine the relationship between booking status of mother and maternal and fetal outcomes. Material And Methods:In present study 1500 patients were studiedfrom July 2019 to June 2021 in department of Obstetrics and Gynaecology Smt. S.C.L general hospital, Ahmedabad. Amongst these 1000 were booked (>= 3 antenatal visits) and 500 were emergency (unbooke d) cases (<3 antenatal visits). Result:Majority of patients was between 21 to 30 year age group, lower socioeconomic class and from urban area. In booked patients incidence of Antepartum, Intrapartum, Postpartum complications, medical complications, blood transfusion requirement, rate of caesarean section, incidence of Preterm babies, low birth weight babies, NICU admission, perinatal mortality and maternal mortality was less. Conclusion:In booked cases fetomaternal outcome was good. Hence targeted, integrated, patient friendly, affordable, accessible health services need to be delivered in an equitable manner and through routine screening, monitoring and follow up complications, mortality and morbidity can be reduced.
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Background:Bleeding per vaginum in the first trimester is a common obstetric situation ranging from an insignificant episode to life threatening emergency. The major causes are abortion, ectopic, and molar pregnancy. Ultrasonography is playing an increasing role in the management of such patients. The aim of this study was to determine the role of first trimester bleeding on obstetrical ultrasound.Material And Methods:This was a retrospective observational study done at urban health care Hospital Ahemdabad, a tertiary care teaching hospital. All obstetric cases with a history of bleeding per vaginum in the first trimester of pregnancy between July2019 and December2019 were included. A complete general physical and pelvic examination was done to arrive at a clinical diagnosis. Patients were then subjected to ultrasound examination. Clinical diagnosis and ultrasound diagnosis were correlated.Result:150 of all 2000 obstetric cases had the first trimester bleeding (incidence of 7.5%). Commonest causes were abortion (78.66%), ectopic (6%), and molar pregnancy (2%). Of 150 cases, 106 cases were correctly identified by ultrasonography. 44 cases proved by sonography were misdiagnosed by clinical examination with a disparity of 52.38%. In this study, 56% pregnancies were clinically diagnosed as viable, but only 34% pregnancies were viable.Conclusion:When the first trimester of pregnancy is complicated by vaginalbleeding, the history and clinical findings are often misleading and if relied upon can only lead to a delay in diagnosis and management.This study reinforces that USG is important to establish a definitive diagnosis, differential diagnosis and subsequent management.
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Background:The aim of our study was to explore the demographics, surgical outcomes and performance of diagnostic imaging modalities namely Ultrasound and Magnetic Resonance Imaging for predicting abnormal placental invasion spectrum in females with history of past caesarian sections.Materials & Methods:We conducted a prospective study from February 2017 till December 2019 at a tertiary referral public hospital in western India. During this time-period we had 26 females satisfying our study criteria. They were subjected to imaging diagnostics to confirm abnormal placental invasiondisorder in their present pregnancy. The imaging findings were compared with the final findings at the time of delivery and pathological examinations of placental specimens.Results:More than two thirds of our study patients were young and belonged to the age group of twenties (mean age 29.5 +/-4.64). Half of them were 3rdgravidas and 77 % (> 3/4 th) of them were diagnosed in their second trimester of pregnancy. Majority of them had history of single past caesarian delivery and the commonest indication for performing it was placenta praevia. Both Ultrasound and MRI were found to be fairly accurate in diagnosing abnormal placental invasion with good sensitivities. Overall, in our series MRI scored an upperhand as a diagnostic imaging modality in posteriorly implanted placentas and cases with ambiguous USG findings.Conclusion:Both diagnostic imaging modalities USG and MRI can predict abnormal placental invasion spectrum with high sensitivity in the antenatal period. These imaging modalities can have a complimentary role, although MRI was found to be superior over USG in our case series with inconclusive findings.
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Cisplatin is a major antineoplastic drug for the treatment of solid tumors. Nephrotoxicity is dose- limiting side effect associated with clinical use of cisplatin. The present study was executed to determine whether bartogenic acid containing fraction of Barringtonia racemosa fruits (BREAF) possesses a nephroprotective effect against cisplatin-induced nephrotoxicity in rats. Furthermore, the study was also aimed to explore the mechanisms underlying this effect of BREAF. The BREAF was orally administered at the doses of (2, 5 and 10 mg/kg) for five consecutive days following single dose administration of cisplatin (5 mg/kg, i.p.). Treatment of animals with cisplatin resulted into the significant body weight changes, oxidative stress, elevated levels of serum biomarkers and histological alterations in the kidney architecture. The BREAF administration reduced relative body weight and organ weight changes in cisplatin-treated rats. The BREAF exhibited nephroprotective effect through the significant reduction of cisplatin-induced rise in the serum creatinine, and blood urea nitrogen levels as well as renal levels of malondialdehyde (MDA) the makers of lipid peroxidation. Additionally, the treatment with BREAF resulted into the increased renal levels of reduced glutathione (GSH), superoxide dismutase (SOD) and catalase activity. Histopathological examination established the nephroprotective effect of BREAF. In conclusion, the anti-oxidant, and anti-inflammatory effects of BREAF has important role underlying its nephroprotective effect.
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Nitrofurantoin is effective against many urinary tract pathogens. It acts as bacteriostatic and/or bactericidal by inhibiting DNA-RNA protein& cell wall synthesis. Nanostructured Lipid Carriers (NLCs) of NFT was prepared by Hot Homogenization Process. Glyceryl Monostearate and Miglyol 812 were heated at 80ºC temperature on hot plate. In the melted lipid, drug was added with continuous stirring at high speed homogenization. Formulation NLC12B has % Entrapment efficiency 89.1 ± 0.5, PDI 0.11 ± 0.01 and mean particle size 237 ± 7nm represents narrow particle size distribution. Spherical feature of NLCs with better uniformity without aggregation of Nitrofurantoin loaded NLC was confirmed by TEM. Moreover, efficient miscibility of drug in lipids was confirmed by the absence of intense and characteristic peak of NFT in XRPD. After 6 month storage at 2-8°C there was no significant changes in the PDI as well as mean particle size.
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Background: The incidence of diabetes mellitus (DM) is increasing substantially worldwide. CAD silently progresses over years in the diabetics. Diabetic individual appears to be less able to perceive some of the symptoms and signs of ischemia or may have asymptomatic ‘classic silent ischemia’. Thus, screening for early detection of asymptomatic CAD in type 2 diabetes may be helpful to prevent these catastrophic cardiac events and consequent deaths. Objectives of the study was to assess utility of TMT in Type 2 diabetic mellitus subjects to detect silent myocardial infarction.Methods: Hospital based observational analytical case control study was conducted in Department of Medicine in Dr BRAM Hospital Raipur during August 2016 to September 2018. Cases were 45 subjects of Type 2 Diabetes mellitus with normal ECG and controls were 45 subjects of Type 2 Diabetes Mellitus with abnormal resting ECG. Data analyzed using SPSS 17 version.Results: Majority i.e. 40% were found to be in fifth decade of their life. 71 (78.9%) male subjects and 19 (21.1%) female subjects. TMT was found positive in 8(17.8%) subjects with positive ECG changes whereas in 12(26.7%) subjects with no ECG changes. No significant difference was noted between distribution of any parameters except for hypertension which was found to be significantly higher in TMT positive subjects compared to TMT negative subjects.Conclusions: No significant difference was observed regarding TMT findings between T2DM subjects with and without ECG changes. Type 2 diabetes mellitus subjects with dyslipidemia, and hypertension are at higher risk of Positive TMT.
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Background: According to WHO, pneumonia is the third important cause of death worldwide despite various advances in medical science. Incidence of Community acquired pneumonia is about 20% to 30% in developing countries compared to 3% to 4 % in developed countries. Incidence of CAP is much higher in the very young and the elderly individuals. Objectives of the study was to compare CURB 65, PSI (Pneumonia severity index) and SIPF (shock index and hypoxemia) scores with respect to outcome prediction in community acquired pneumonia (CAP).Methods: The present hospital based descriptive observational study was conducted in the Dept of medicine, Pt. J.N.M. Medical College and Dr B. R. A. M. Hospital, Raipur, during 2016-2018 involving a total of 98 patients of community acquired pneumonia.Results: Majority of them i.e. 22 (22.4%) subjects belonged to age group 41-50 years. 34 (34.7%) subjects were found to have CURB65 score 1. 28(28.6%) subjects PSI score was noted to be class I. 89 (90.8%) subjects were discharged while, there was death of 9 (9.2%) subjects. The difference in the mean score was statistically significant (p<0.001). PSI score was found to have diagnostic sensitivity of 94.4% and specificity of 100% while CURB 65 score having 83.1% sensitivity and 100 % specificity. SIPF score had least AUC 0.88.Conclusions: Maximum diagnostic ability was noted with PSI score followed by CURB 65 and SIPF score.
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The traditional system of medicine is so ingrained in our culture that, about 75% of the Indian population depends on this indigenous system for relief. With such a huge section of an ever increasing population relying on herbal remedies, it is imperative that the plant products which have been in use for such a long time be scientifically supported for their efficacy. Diabetes a metabolic disorders is most frequent occurring disease in India. The present paper reports with the investigation of antidiabetic potential of Eugenia jambolana (Bark), Phyllanthus niruri (Whole plant), Momordica charantia Linn. (Seeds) and Nyctanthes arbor-tristis (Leaves).
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The present study describes a simple, reliable and reproducible liquid chromatography–tandem mass spectro-metry method (LC–MS/MS) for the simultaneous determination of allopurinol and its active metabolite, oxypurinol in human plasma for a pharmacokinetic/bioequivalence study. After protein precipitation (PPT) of 100 μL plasma sample with 1.0%formic acid in acetonitrile, the recovery of the analytes and allopurinol-d2 as an internal standard ranged from 85.36% to 91.20%. The analytes were separated on Hypersil Gold (150 mm×4.6 mm, 5 μm) column using 0.1% formic acid-acetonitrile (98:2, v/v) as the mobile phase. Quantification was done using electrospray ionization in the positive mode. The calibration concentration range was established from 60.0 to 6000 ng/mL for allopurinol and 80.0–8000 ng/mL for oxypurinol. Matrix effect in human plasma, expressed as IS-normalized matrix factors ranged from 1.003 to 1.030 for both the analytes. The developed method was found suitable for a clinical study with 300 mg allopurinol tablet formulation in healthy subjects.
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A highly sensitive and selective high performance liquid chromatography–tandem mass spectrometry method was developed and validated for the quantification of alverine (ALV) and its active metabolite, para hydroxy alverine (PHA), in human plasma. For sample preparation, solid phase extraction of analytes was performed on Phenomenex Strata-X cartridges using alverine-d5 as the internal standard. The analytes were separated on Symmetry Shield RP18 (150 mm×3.9 mm, 5 μm) column with a mobile phase consisting of acetonitrile and 10 mM ammonium formate (65:35, v/v). Detection and quantitation was done by electrospray ionization mass spectrometry in the positive mode using multiple reaction monitoring. The assay method was fully validated over the concentration range of 15.0–15,000 pg/mL for ALV and 30.0–15,000 pg/mL for PHA. The intra-day and inter-day accuracy and precision (%CV) ranged from 94.00%to 96.00%and 0.48%to 4.15%for both the analytes. The mean recovery obtained for ALV and PHA was 80.59% and 81.26%, respectively. Matrix effect, expressed as IS-normalized matrix factor ranged from 0.982 to 1.009 for both the analytes. The application of the method was demonstrated for the specific analysis of ALV and PHA for a bioequivalence study in 52 healthy subjects using 120 mg ALV capsules. The assay reproducibility was also verified by reanalysis of 175 incurred subject samples.
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Magnetic resonance imaging has been shown to be very useful in the diagnosis and monitoring of multiple diseases affecting the central nervous system. Gadolinium has been used extensively worldwide. It has been estimated that since its introduction more than two hundred million doses of GBCA have been administered globally. Gadolinium-based contrast agents (GBCAs) were long considered medicines with a high safety profile, the literature reports incidences of immediate adverse effects such as headache, dizziness, and altered sense of taste. Studies performed a few years after the introduction of GBCA showed that there were gadolinium deposits in the tissues but their clinical significance was not known. It wasnt until 2006 when the first reports were published that associated the gadolinium ion tissue deposits from GBCA with a systemic inflammatory entity of the connective tissue similar to scleroderma known as Nephrogenic Systemic Fibrosis (NSF), in patients with chronic renal failure. In 2013, the association between the use of GBCAs and the progressive increase in the signal intensity of the dentate nucleus and the globus pallidus in T1-weighted MRI images without contrast medium, was described for the first time. This review describes the most relevant aspects of the pathophysiology of these findings taking into account their differential diagnosis.
Las imágenes por resonancia magnética han mostrado ser de gran utilidad en el diagnóstico y seguimiento de múltiples enfermedades que afectan el sistema nervioso central. El gadolinio se ha utilizado ampliamente a nivel mundial. Se estima que desde su introducción se han administrado más de doscientos millones de dosis de MCBG en el mundo. Los medios de contraste basados en Gadolinio (MCBG) fueron considerados por mucho tiempo medicamentos con un alto perfil de seguridad, la literatura reporta incidencia de efectos adversos inmediatos como cefalea, mareo y alteración del sentido del gusto. Estudios realizados pocos años después de la introducción de los MCBG mostraron que había depósitos de gadolinio en los tejidos, pero no se conocía su significancia clínica Fue hasta 2006 cuando se publicaron los primeros reportes que asociaban el depósito tisular del ion gadolinio proveniente de los MCBG con una entidad inflamatoria sistémica del tejido conectivo similar a la escleroderma conocida como Fibrosis Sistémica Nefrogénica (FSN) en pacientes con falla renal crónica. En 2013 se describió por primera vez la asociación entre el uso de los MCBG y el aumento progresivo de la intensidad de señal del núcleo dentado y los globos pálidos en las imágenes de RM ponderadas en T1 sin medio de contraste. En esta revisión se describen los aspectos más relevantes de la fisiopatología de estos hallazgos considerando su diagnóstico diferencial.
الموضوعات
Humans , Nephrogenic Fibrosing Dermopathy/diagnostic imaging , Gadolinium/administration & dosage , Magnetic Resonance Spectroscopy , Contrast Media/administration & dosageالملخص
Introduction: The diaphragm is man's main respiratory muscle. The role of the abdominal muscles is seen in both quiet and forceful breathing. Abdominal muscle function could be affected in subjects with back pain. Few studies are done about the relation between expiratory muscle strength and pulmonary function. So the aim of this study was to evaluate the correlation of abdominal muscle strength with pulmonary function in patients with low back pain. Materials and methods: Sixty subjects with low back pain were included in the study. Subjects with history of acute or chronic respiratory disorders were excluded. Abdominal muscle strength was measured by curl up test and FEV1/FVC and peak expiratory flow rate (PEFR) was measured to assess pulmonary functional. Results: Using Spearman test for correlation between abdominal muscle strength and FEV1/FVC (r= - 0.27, p=0.03), and between abdominal muscle strength and PEFR (r=0.34, p=0.007) was seen. Conclusion: There was a weak correlation between abdominal muscle strength and pulmonary function in subjects of low back pain.
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An improved high performance liquid chromatography–tandem mass spectrometry (LC–MS/MS) method has been developed for sensitive and rapid determination of albendazole (ABZ) and its active metabolite, albendazole sulfoxide (ABZSO), in the positive ionization mode. The method utilized solid phase ex-traction (SPE) for sample preparation of the analytes and their deuterated internal standards (ISs) from 100 mL human plasma. The chromatography was carried out on Hypurity C18 column using acetonitrile-2.0 mM ammonium acetate, pH 5.0 (80:20, v/v) as the mobile phase. The assay exhibited a linear re-sponse over the concentration range of 0.200–50.0 ng/mL for ABZ and 3.00–600 ng/mL for ABZSO. The recoveries of the analytes and ISs ranged from 86.03%–89.66% and 89.85%–98.94%, respectively. Matrix effect, expressed as IS-normalized matrix factors, ranged from 0.985 to 1.042 for the both analytes. The method was successfully applied for two separate studies in healthy subjects using single dose of 400 mg conventional tablets and 400 mg chewable ABZ tablets, respectively.