Trend analysis of caesarean sections using modified Robson's classification in a teaching institution in Uttarakhand.

Background: Globally, the rising caesarean section (CS) rate is of great concern as it is associated with increased maternal morbidity and mortality in subsequent pregnancies. It is essential to reanalyze the CS trend and curb the rising menace using a standardized uniform auditing system. This study aimed to analyze and evaluate the trend of CS using Modified Robson's Ten Group classification system (RTGCS) in a teaching institution in Uttarakhand. Methodology: This cross-sectional study from October 2022 to March 2023 included 260 women undergoing elective or emergency CS. Data on maternal demographics, obstetrics, labour, and fetal outcomes were recorded. Indications for CS were analyzed using modified RTGCS. Results: The overall CS rate for the study period at our hospital was 31.4%. The major contributors to CS were Group 2 (21.5%), Group 10 (21.5%), and Group 5 (20.7%), while Group 6 and Group 8 contributed 10% and 7.6%, respectively. Group 9 had the least share (1%) in the study population. The two main indications for which CS was performed were prior Lower Section Caesarean Section (LSCS) and fetal distress, contributing to 24.6% and 19.2%, respectively. CS for breech presentation was done in 16% of the total cases. Conclusion: Modified RTGCS is an easy and effective method for auditing CS, preventing unnecessary procedures, and improving maternal care. Its implementation is crucial in addressing the increasing prevalence of CS and ensuring better maternal and fetal outcomes.

INTRODUCTION.

The National Public Health Law Conference: People. Policy. Progress., held October 2023, brought together more than 400 stakeholders in public health to explore how law and policy can be leveraged to advance health equity, improve data sharing for community health, protect access to reproductive health and facilitate system change.

To Evaluate the Effect of Vitamin B Complex on Wound Healing - A Clinical and Microbiological Study.

Background: The purpose of this study is to explore the effect of vitamin B complex supplementation following periodontal flap surgery on clinical and microbiological parameters. Materials and Methods: A randomized controlled trial on 10 patients with periodontitis in split-mouth design was undertaken to find the effect of vitamin B complex supplementation with open flap debridement on periodontal wound healing. Multiplex polymerase chain reaction (PCR) for Tannerella forsythus and Porphyromonas gingivalis was done using subgingival plaque samples at 0 and 90th day. Results: The results showed a significant reduction (P < 0.01) of clinical (plaque index, gingival index, gingival bleeding index, probing pocket depth, and relative attachment level) and microbial profile in both treatment groups, whereas on intergroup analysis, more reduction in all clinical parameters were observed in the test group, but statistically, the results were insignificant.

Pulmonary Artery Hypertension in Transfusion-Dependent Thalassemia.

OBJECTIVE: Patients with transfusion-dependent thalassemia (TDT) are at risk of developing pulmonary artery hypertension (PAH) due to chronic hemolysis, iron overload, hypercoagulability and splenectomy. The objective of the study was to assess the prevalence and predictors of PAH in patients with TDT. METHODS: Patients aged 6-18 years with TDT were included. 2D-echocardiography was done to measure the pulmonary artery systolic pressure (PASP) and left ventricular ejection fraction (LVEF). T2* MRI was done to evaluate cardiac iron overload. N-terminal-pro brain natriuretic peptide (NT-pro BNP) level was also assessed. RESULTS: Out of 61 participants, PAH was noted in 19 (31.6%). Mean (SD) age of the patients with PAH and without PAH was 12.2 (3.8) and 9.6 (3.5) years, respectively (P = 0.016). Five of 19 patients with PAH (26.3%) had undergone splenectomy as against 5 of 41 patients without PAH (12.2%) (P = 0.17). Years since splenectomy was higher in the PAH group. Mean (SD) NT-Pro BNP levels were also higher in patients with PAH [63.80 (25.89) vs 41.97 (23.95), P = 0.01]. Significantly higher number of patients with PAH had cardiac T2* value of < 10 ms (P = 0.04). Age (OR 4.11; 95% CI 1.46-8.77), years since splenectomy (OR 3.24; 95% CI 1.30-7.86), NT-Pro BNP levels (OR 4.43; 95% CI 2.14-9.61) and cardiac T2* MRI (OR 2.46; 95% CI 2.18-6.90) values were predictors of PAH in patients with TDT. CONCLUSION: PAH was observed in 31.6% of patients, with older age and years since splenectomy being important risk factors. NT-Pro BNP can be used as screening test for detecting PAH.

A Study to Evaluate the Effect of Opportunistic Salpingectomy on Ovarian Reserve and Function.

Background: There are conflicting reports on status of ovarian function after hysterectomy and opportunistic salpingectomy in premenopausal women. The present study was undertaken to understand the effect of salpingectomy done at the time of hysterectomy on ovarian reserve and function as measured by serum AMH and FSH levels before and after the surgery. Methods: This was a prospective study conducted on 60 women who underwent hysterectomy at our tertiary care centre, Shri Guru Ram Rai Institute of medical and health sciences, Dehradun, from January 2020 to September 2021. Serum AMH and FSH levels were monitored preoperatively and 3 months postoperatively in patients undergoing hysterectomy with bilateral salpingectomy and hysterectomy without salpingectomy. Results: The mean age of the patients was 41.83 yrs in group 1 and 43.73 yrs in group 2 [p value = 0.078]. Most common indication of hysterectomy was AUB-L in both the groups (86% and 80%, respectively). Mean operative time was 115.50 min in group 1 and 114.40 min in group 2 [p value = 0.823]. Mean intra-operative blood loss was 214 ml in group 1 and 199.33 ml in group 2 [p value = 0.087]. Serum AMH and FSH were insignificantly decreased in both the groups post-operatively after 3 months, and the difference between both groups was also not statistically significant. Conclusion: Salpingectomy done at the time of hysterectomy for benign indications with preservation of ovaries did not have any short-term adverse effects on ovarian reserve and function.

Patient Perspectives on Contraceptive use in North India: A Case for Increased Contraceptive Counseling by Providers.

Background: Given the underutilization of contraception in India, this study was undertaken to gauge cisgender female clients' knowledge of, attitudes toward, and barriers to contraceptive usage in North India. Methodology: The present study was done at a tertiary care Institute in North India, where 209 structured interviews were conducted with cisgender female patients attending the outpatient department. One-way chi-square tests for independence, Kruskal-Wallis test, and Wilcoxon test were applied to quantitative data. Themes from qualitative questions were coded and analyzed. Results: Differences in awareness among contraceptives were found to be highly statistically significant (H (9) = 1022.3, p < 2.2 e-16). Friends or colleagues comprised the predominant information source for most contraceptive methods. Participants' contraceptive usage was low, with 27.27% stating no prior use and 47.47% indicating occasional use (X2 (3, N = 198) = 66.121, p < 2.89 e-14). Lack of perceived need, concern for side effects, fear and desire for children were top reasons for non-use of contraceptive methods. Majority of the participants (79.45%) expressed comfort speaking with their spouse about contraception, 47.18% with a medical provider, 32.82% with friends, 15.38% with family, 2.05% with a health educator, and 3.59% with no one. Participants indicated little prior contraceptive counseling experience. Conclusion: Our study shows differential levels of awareness, usage, and barriers on contraceptive methods among participants. Results also suggest the importance of spouses and friends in clients' contraceptive decision-making process and their limited counseling experience with health care providers.

Profile of Hemoglobin D (HbD) Disease in Eastern Uttar Pradesh: A Single-Center Experience.

Hemoglobin D (HbD) disease was identified in 31 samples from 15 families out of the 2560 samples (1.20%) analyzed for variant Hbs. There were five patients with HbSD disease, three with HbDß disease, and the remaining 23 were HbD trait. Patients with HbSD disease had a variable clinical presentation with a pair of siblings being transfusion dependent although the age of first blood transfusion was different in the two patients. The one with high HbF started transfusions much later. None of them had symptoms related to sickling. Patients with HbDß also had a variable presentation with only one of them being transfusion-dependent. All patients with HbSD and HbDß disease were started on hydroxyurea. Persons with HbD trait were asymptomatic with half of them having normal Hb. The remaining half had mild microcytic hypochromic anemia. All the families with HbD disease were natives of this region and not migrants from other states. Although HbD disease has not been reported from this region in previous studies, clinicians need to be aware of this entity as it can give rise to symptomatic disease in some cases if associated with beta-thalassemia or sickle cell trait.

Serum Vitamin D level and its association with red blood cell indices in patients with periodontitis.

Background: Research of late has brought to light a connect between Vitamin D and anemia. The level of 25hydroxyvitamin D (25(OH) D) is decreased in periodontitis subjects as against subjects without periodontitis and this reduced level could be related to more risk for anemia in periodontitis patients. Objective: This study aimed to evaluate the serum 25(OH) D levels and red blood cell indices in patients affected by generalized Stage III Grade B periodontitis and healthy controls and to assess the association between level of Vitamin D and red cell indices in periodontitis patients. Materials and Methods: The subjects were categorized into (i) case and (ii) control group of 30 each. Clinical parameters including oral hygiene index simplified, mean ratio of sites that bled on probing, gingival index, probing pocket depth, and the clinical attachment loss were assessed in both the groups. Subjects' blood samples (venous) were taken for the biochemical analysis. Results: In contradiction to healthy subjects, periodontitis subjects had significantly diminished 25(OH) D levels, hemoglobin (Hb), hematocrit, and mean corpuscular hemoglobin concentration (MCHC). 25(OH) D was moderately correlated with MCHC (r = 0.53) and it was statistically significant (P = 0.002). Conclusion: Periodontitis impacts Vitamin D status which further causes anemia. It suggests that effective management of periodontitis can help maintain sufficient Vitamin D status and may be vital in preventing anemia.

Association between Periodontitis and COVID-19 Based on Severity Scores of HRCT Chest Scans.

BACKGROUND: A relationship between periodontitis and COVID-19 may exist, as highlighted by several hypothetical models. However, the evidence is limited. Hence, the present study was conducted to determine whether an association exists between periodontitis and COVID-19. METHODS: A cross-sectional study was carried out with patients diagnosed with COVID-19 who were divided into three groups-mild, moderate, and severe COVID-19-based on the COVID-19 severity score of high-resolution computed tomography (HRCT) chest scans. Periodontal parameters-including the plaque index (PI), ratio of sites with gingival bleeding (BOP), pocket depth (PD), gingival recession (REC), clinical attachment loss (CAL), and mean numbers of mobile and missing teeth due to periodontitis-were recorded for all three groups. Statistical analyses were applied to the data. RESULTS: Of 294 patients with COVID-19, approximately 50.68% (n = 149) had periodontitis, and the highest percentage (87.5%) was reported in the severe COVID-19 group. Additionally, severe and advanced stages of periodontitis (stage III-IV) were found to be significantly more frequent in subjects with severe COVID-19 than in the other two groups. The HRCT severity score (CT-SS) was moderately correlated with increased levels of periodontal parameters. CONCLUSIONS: Results of logistic regression analyses showed that the probability of developing severe COVID-19 was 2.81 times higher in patients with periodontitis. An association exists between periodontitis and severe COVID-19.

Comparison of the effects of calcium channel blockers plus iron chelation therapy versus chelation therapy only on iron overload in children and young adults with transfusion-dependent thalassemia: A randomized double-blind placebo-controlled trial.

BACKGROUND: Myocardial iron deposition is a significant cause of morbidity and mortality in patients with transfusion-dependent thalassemia (TDT). Amlodipine, L-type calcium channel blocker with regular chelation therapy may reduce myocardial iron overload. Lack of randomized trials prompted this study to assess the effect of calcium channel blocker (amlodipine) in combination with iron chelation therapy on iron overload in patients with TDT. METHODS: Sixty-four eligible patients were randomized to receive either amlodipine and chelation (group A) or chelation alone (group B) in double-blind placebo-controlled trial. Myocardial iron concentration (MIC) using T2* magnetic resonance imaging (MRI), liver iron concentration (LIC), left ventricular ejection fraction (LVEF), and serum ferritin were measured at baseline and 12 months. RESULTS: In the amlodipine group, mean cardiac T2* value significantly increased from 18.11 ± 8.47 to 22.15 ± 7.61 (p = .002) at 12 months, whereas in control group, there was a nonsignificant increase (p = .62) in cardiac T2* value from 19.50 ± 8.84 to 20.03 ± 9.07. There was a significant decrease in MRI-derived MIC in the amlodipine group compared to control group (1.93 ± 1.61 to 1.29 ± 0.90, p = .01). Changes in the LVEF (p = .45), MRI-derived LIC (p = .09), and serum ferritin (p = .81) were not significant between the two groups. CONCLUSION: Amlodipine is safe and when combined with chelation therapy appears to be more effective in reducing cardiac iron overload than chelation only in children and young adults with TDT.

Alterations in Bone Turnover during Chemotherapy in Children with Acute Lymphoblastic Leukemia.

Background Disturbances of bone metabolism frequently occur in children with acute lymphoblastic leukemia (ALL), leading to increased risk of osteopenia and osteoporosis at diagnosis, during and after completion of chemotherapy. The present study was performed to evaluate alteration in bone mineral metabolism in children with ALL during chemotherapy. Method Fifty newly diagnosed patients with ALL in the age group of 2 to 14 years were included. Relapsed and refractory cases were excluded. Enrolled children were stratified into standard and high risk according to National Cancer Institute criteria. Quantitative analysis of bone resorptive marker carboxyl-terminal telopeptide of human type 1 collagen (ICTP) was assessed at baseline and 3 months after chemotherapy by the sandwich enzyme-linked immunosorbent assay technique. Results Of 50 patients enrolled, 21 were standard and 29 were high risk. The mean age was 7.75 ± 4.0 years and the male-to-female ratio was 3.5:1. ICTP levels were analyzed in 44 patients, of which 37 (84%) showed significantly increased levels. The mean ICTP level in patients at diagnosis and controls was 1.78 ± 1.39 and 0.96 ± 0.32 µg/L, respectively ( p = 0.001). The mean ICTP level at 3 months after chemotherapy increased to 3.55 ± 1.40 µg/L ( p = 0.000). It was significantly increased in males ( p = 0.000) and in B cell ALL group ( p = 0.000) in comparison to females and T cell group. Both standard and high risk groups were equally affected ( p = 0.000). On multivariate analysis, no single risk factor could be identified. Conclusion The marker of bone resorption (ICTP) in children with ALL was increased at diagnosis, which further increased during chemotherapy. The disease itself and the intensive chemotherapy both contributed to the increased levels.

Rifampicin-Resistant Disseminated Tuberculosis in an Immunocompetent Adolescent Male Presenting with Retropharyngeal Abscess and Spinal Involvement.

Retropharyngeal abscess is a rare manifestation in spinal tuberculosis. Early clinical diagnosis followed by microbiological confirmation and effective treatment is crucial to avoid irreversible damage to the spine. Here, we report a case of disseminated tuberculosis in an immunocompetent adolescent male who presented with retropharyngeal abscess, multifocal involvement of the spine, and skin tuberculids. Xpert MTB/RIF assay in this patient facilitated early lifesaving treatment by detecting rifampicin-resistant Mycobacterium tuberculosis (MTB) in the clinical specimen.

Analysis of the positions of anterior teeth in orthodontically treated and untreated population: A proof of uniqueness.

AIM: To compare the uniqueness of human dentition in both orthodontically treated and untreated populations and evaluate the reliability of bitemark analysis. MATERIALS AND METHODS: A total of 1464 maxillary and mandibular casts were fabricated from orthodontically treated and nontreated population. After careful examination of the study teeth, 326 nontreated maxillary cast (Group 1), 333 nontreated mandibular cast (Group 2), 336 orthodontically treated maxillary cast (Group 3), and 320 orthodontically treated mandibular casts (Group 4) were selected for the analysis. For uniformity, the sample size of 320 was selected from each group for comparison. RESULTS: The arch width was a major cause of variance. In Group 1, only 6.87% of similarity rate was seen, whereas in Group 3, the match rate increased to 55% showing similarity. In Group 2, only 1.87% similarity and Group 4 showed 42.7% match rate. CONCLUSION: The human dentition may be unique, but it loses its uniqueness once any dental treatment is carried out.

Anxiety among pregnant women during the COVID-19 pandemic in India - A multicentric study.

While higher anxiety during antenatal period cause several maternal and foetal health related complications, lower anxiety levels are found to be associated with lesser "precautionary behaviours" and consequently greater risk of infection, during the COVID-19 pandemic. In this study, we aimed to assess rates and determinants of generalized anxiety at the time of the pandemic as well as anxiety that was specific to the context of being pregnant during the COVID-19 pandemic. (COVID-19-antenatal anxiety) in Indian women. This hospital-based, cross-sectional study using face-to-face interviews was conducted at antenatal clinics of five medical college hospitals in India. The Generalized Anxiety Disorder-7 scale (GAD -7) and a customized scale to assess antenatal COVID-19 anxiety along with other tools that assessed social support and COVID-19-risk perception were administered to 620 pregnant women. We found that the percentage of women with moderate or severe anxiety based on GAD -7 was 11.1%. Multivariate analysis showed that higher COVID-19-risk perception, greater antenatal COVID-19 anxiety and lower perceived support significantly predicted moderate and severe generalized anxiety. Greater number of weeks of gestation, lower education, semiurban habitat and lower perceived social support were significant predictors of antenatal COVID-19 anxiety. We conclude that the rates of anxiety in pregnant women though not very high, still warrant attention and specific interventions.