Effect of Reproductive and Lifestyle Factors on Anti-Mullerian Hormone Levels in Women of Indian Origin.

Background: Infertility is a world-wide problem and one third females. Over the years, anti-mullerian hormone (AMH) has emerged as a major marker of ovarian reserve. There is also increasing interest in determining the factors which can impact AMH levels. Aims: To correlate the association of reproductive and lifestyle factors on AMH levels in women of Indian origin. Settings and Design: Multicentric cross sectional study. Materials and Methods: The study was conducted using data extracted from the patient records of seven private fertility practices located in North India. Women who were attending these clinics for fertility treatment were requested to fill the questionnaire related to reproductive and lifestyle factors. Statistical Analysis used: Our outcome variable was level of AMH measured in the past 3 months, and was assessed as normal or low. All analyses were conducted using STATA 17. Results: We found a direct association of low AMH with increasing age, short cycles, amenorrhea and women with family history of premature menopause. We found a direct correlation of high AMH and women with polycystic ovary syndrome and those whose partners had Oligoasthenoteratozoospermia (OATS) or azoospermia. There was no correlation with smoking, sleep, diet, body mass index, cell phone or laptop use in our study. Conclusion: Reproductive and lifestyle factors may affect ovarian reserve and but there was a dearth of human studies in this area. To the best of our knowledge this is the first human study on the effect of AMH on Laptop and Cell phone use. We urgently need more studies to confirm or refute our findings so that we can counsel our patients well.

Gas Chromatography Mass Spectrometry Profiling in Methanolic and Ethyl-acetate Root and Stem Extract of Corbichonia decumbens (Forssk.) Exell from Thar Desert of Rajasthan, India.

BACKGROUND: Corbichonia decumbens (Forssk.) Exell (Molluginaceae), recently has moved to Lophiocarpaceae as per angiospermic plant group (APG) III system, is an annual or short-lived, dwarf, glabrous subshrub, prefers to grow on rocky places and on sand-stones in dry, hot areas of Rajasthan. This is the potential plant with medicinal properties. Vegetative organs under study show antioxidant, anti-inflammatory, antiulcer, antimicrobial, and antinociception activity. OBJECTIVE: This study was carried out to identify the phytoconstituents present in the methanolic and ethyl-acetate extract of root and stem of C. decumbens by GC-MS analysis. MATERIALS AND METHODS: Powdered test samples were sequentially extracted with methanol and ethyl-acetate. The compounds obtained as a result of GC-MS screening were identified on the basis of their retention time, peak area and compared with that of literature available and by interpretation of mass spectra. RESULTS: GC-MS analysis of a methanolic extract of root detected mome-inositol (49.53%), guanosine (20.91%), and cis-vaccenic acid (9.25%). While ethyl-acetate extract of root analyzed pentadecanoic acid (17.91%), octadecanoic acid (15.01%) and cis-vaccenic acid (12.04%). Methanolic extract of stem detected mome-inositol (75.47%), pentadecanoic acid (6.04%), and 7-tetradecenal, (Z) (4.54%) while ethyl-acetate extract of stem revealed the presence of 1-heptacosanol (17.35%), hexadecanoic acid (17.17%), and octadecanal (12.64%). CONCLUSION: The results suggest that C. decumbens (Forssk.) Exell is a plant of potential medicinal value, yielding various bioactive compounds that confirm the application of this plant as a plant-based drug in pharmacy-industry. SUMMARY: Extraction is the most important step in the analysis of bioactive compounds present in botanical preparations. The strength of solvent plays a key role in this process, methanol as well as ethyl-acetate showed better response as far as extraction potency is concerned. Gas chromatography mass spectrometry analysis is highly reliable, and the interpretations of the results are of high-quality. This tool is in particular useful for confirming of the presence of bioactive-substances. The results suggest that Corbichonia decumbens (Forssk.) Exell can be used for drug formulations against some major disorders, i.e., cancer, ulcer, tuberculosis, arthritis, etc.Abbreviations Used: GC-MS: Gas Chromatography-Mass Spectrometry, kPa: Kilopascal, RT: Retention time, MF: Molecular formula, MW: Molecular weight.

Dengue in pregnancy: an under-reported illness, with special reference to other existing co-infections.

OBJECTIVE: To keep the level of awareness high as far as incidence of dengue among pregnant women is concerned. METHODS: A total of 300 blood samples of patients with fever in pregnancy were received in the Department of Microbiology to rule out dengue infection (January 2011 to December 2012). The samples were put up for presence of dengue IgM antibodies and NS1Ag by ELISA. The patients who turned out to be positive for dengue serology were retrospectively analysed with respect to patient's age, gestational age, clinical presentation, complications, platelet counts and maternal as well as foetal outcomes. RESULTS: Out of 300 females tested, 22 (7.3%) were found positive for dengue infection during the said time period. Out of them 9 were positive for IgM antibodies against dengue and 10 were found to be positive for NS1Ag, while 3 were positive for both IgM antibody and NS1Ag. Five patients presented with dengue in first trimester, 9 in second trimester and 8 in third trimester. Two patients had coinfections. Patient with coinfection of dengue with malaria had intrauterine death of fetus at 37 weeks while the second one having dengue with typhoid had a preterm vaginal delivery at 35 weeks. CONCLUSIONS: Establishing diagnosis of dengue infection in pregnancy is important for effective management by the obstetricians particularly the mode of delivery due to the potential risk of hemorrhage for both the mother and the newborn. Co-infections seen in endemic areas may be more common than usually reported.

Non-puerperal uterine inversion caused by malignant mixed mullerian sarcoma.

Non puerperal uterine inversions resulting from mixed mullerian uterine sarcoma are rare. We present a case of a postmenopausal woman with a large mixed mullerian tumour presenting as a huge abdominopelvic mass. It required a challenging surgical procedure to remove the tumour which is also described along with the review of literature.

Role of uterine artery velocimetry using color-flow Doppler and electromyography of uterus in prediction of preterm labor.

AIM: To evaluate the role of Doppler waveforms of uterine vessels and electromyography (EMG) of the uterus in predicting preterm labor. METHODS: One hundred ante-natal women at >or=24 weeks of gestation who fulfilled the selection criteria were included in the study. A single Doppler recording for bilateral uterine vessels was taken at >or=26 weeks gestation using the transvaginal route. Transabdominal EMG of the uterus was recorded serially at 4-week intervals from 24 weeks until delivery or until 37 weeks were completed. RESULTS: Women with a sensation of heaviness in the lower abdomen during pregnancy had a significant association with preterm delivery. Of the three Doppler indices, the systolic/diastolic ratio and the resistivity index of uterine vessels were found to have a sensitivity as high as 83-95% for the prediction of preterm labor. The electrical activity of uterine musculature, as recorded using EMG, showed that there was a statistically significant difference between the electrical activity recorded for the two groups at 31 weeks and later, while the duration of burst activity was significantly longer in the preterm group at 26 weeks and later. CONCLUSIONS: Patients with a dull aching sensation in the lower abdomen should not be neglected. Doppler of the uterine vessels and EMG of the uterus could prove to be a good predictor of preterm labor.

Preoperative blood volume deficit influences blood transfusion requirements in females and males undergoing coronary bypass graft surgery.

STUDY OBJECTIVE: To evaluate whether preoperative blood volume and postoperative blood loss influence blood transfusion in females and males undergoing coronary artery bypass graft (CABG) surgery. DESIGN: Prospective study. SETTING: Anesthesiology department of a teaching hospital. PATIENTS: 57 CABG patients (21 females and 36 males). MEASUREMENTS: Blood volume was determined using the radioactivity dilution method. Preoperatively, each patient received intravenous (IV) injection of 1 mL Albumin I(131) tracer having 25 microcuries of radioactivity. Five-milliliter blood samples were collected at different intervals. From these samples, hematocrit (Hct) value, preoperative total blood volume, red blood cell (RBC) volume, and plasma volume were determined. Postoperatively, some consenting patients received another 1 mL dose of the tracer, and the postoperative blood volumes were determined. If a patient received a blood transfusion, the units of packed red blood cells (PRBCs), platelets, or fresh frozen plasma (FFP) transfused were recorded. For each patient we recorded the gender, age, weight, height, body surface area (BSA), preoperative Hct, duration of surgery, and discharge Hct. RESULTS: Preoperatively, the mean total blood volume, RBC volume, and plasma volume, respectively, were 2095 mL/m(2), 631 mL/m(2), and 1,465 mL/m(2) in females; and 2,580 mL/m(2), 878 mL/m(2), and 1,702 mL/m(2) in males. The preoperative blood volumes were significantly lower (p < 0.01) in females than in males. There was no significant difference between males and females in the extent of blood loss during CABG. Intraoperatively, females received PRBC transfusion of 1.38 units, significantly more (p < 0.01) than the 0.39 units received by males. During the entire hospital stay, females received 4.33 units of PRBC, significantly more than (p < 0.02) the 1.33 units received by males. Significantly more (p < 0.01) females (12 of 21) received intraoperative PRBC transfusion than did males (6 of 36). Multiple logistic regression analysis of the data showed that PRBC transfusion was significantly correlated with the preoperative total blood volume and RBC volume. CONCLUSION: The greater need for blood transfusion in females than in males during CABG is primarily attributable to significantly lower preoperative total blood volume and RBC volume in females.