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Kaur I, Kishore K, Suri V, Sahni N, Rana SV, Singh A. Determinants of polycystic ovary syndrome: A matched case-control study. J Hum Nutr Diet 2024; 37:583-592. [PMID: 38234173 DOI: 10.1111/jhn.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is a multifaceted endocrine disorder of women of reproductive age with a multifactorial aetiology. Despite much research, there is still inconclusive data on the impact of dietary, lifestyle and socio-economic factors on PCOS aetiology. Thus, the present study explored the association of PCOS with diet, eating behaviour, other lifestyle and socio-economic factors. METHODS A matched-pair case-control study was conducted on 150 women with PCOS and 150 healthy controls. Information on diet, eating behaviour and physical activity, and also anthropometric and socio-economic data were collected through standard questionnaires. The adjusted odds ratios (AmOR) were calculated and reported using conditional multivariable logistic regression. RESULTS The results showed low education level (AmOR = 8.44; 95% confidence interval [CI] = 1.63-43.68), high sugar consumption (AmOR = 11.61; 95% CI = 2.05-65.72) along with higher body mass index (BMI) and inactivity to be significantly associated with PCOS. Also, a significant protective effect was found for cognitive dietary restraint (AmOR = 0.79; 95% CI = 0.66-0.93), crude fibre (AmOR = 0.61; 95% CI = 0.45-0.82) and protein intake. CONCLUSIONS Low education status may contribute to higher receptiveness to choosing unhealthy diets and lifestyles, resulting in adiposity and an increased risk of PCOS.
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Affiliation(s)
- Ishwarpreet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kamal Kishore
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nancy Sahni
- Department of Dietetics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satya Vati Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Bansal A, Suri V, Sikka P, Attri SV, Varma N, Saini SS, Goyal A, Malhotra P. B12 Deficiency is the Commonest Cause of Anaemia During Pregnancy in Northern India: Study from a Tertiary Care Institute. Indian J Hematol Blood Transfus 2024; 40:78-82. [PMID: 38312179 PMCID: PMC10830963 DOI: 10.1007/s12288-023-01682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/27/2023] [Indexed: 02/06/2024] Open
Abstract
Iron deficiency anemia is considered the leading cause of anemia during pregnancy; however, there is a lack of comprehensive studies on the etiological factors of anemia in pregnant women. The objective of this study was to systematically investigate the causes of anemia in pregnancy. Five hundred women with hemoglobin levels < 11 g/dl between 6 and 40 weeks of pregnancy underwent a complete hemogram, iron studies, serum folate, serum B12, serum copper, and serum zinc level assessments using standard methods. The median age of the patients was 26 years (range 24-29 years). The majority of patients were in the third trimester (449/500, 89.8%). Among the patients, 325 (65%) had vitamin B12 deficiency, with 159 (31.8%) having isolated B12 deficiency and 142 (28.4%) having combined B12 and iron deficiency. Isolated iron deficiency anemia was present in 74 patients (14.8%). Additionally, 28 patients (5.6%) had beta-thalassemia minor, and anemia of chronic disease was found in 17.2% (86) of the patients. Vitamin B12 deficiency was the most common cause of anemia, followed by combined B12 and iron deficiency. Further studies in diverse populations are warranted as they have broader implications for nutrient supplementation during pregnancy. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01682-x.
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Affiliation(s)
- Ankita Bansal
- Department of Obstetrics and Gynaecology, Sankalp Hospital, Ambikapur, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | | | - Neelam Varma
- Department of Haematology, PGIMER, Chandigarh, India
| | | | - Akshaya Goyal
- Department of Ophthalmology, Sankalp Hospital, Ambikapur, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, PGIMER, Chandigarh, 160012 India
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Yadav B, Soni R, Biswal M, Suri V, Rohilla M. Clinical profile and outcomes of Scrub typhus in pregnant women presenting to a tertiary care hospital of North India. J OBSTET GYNAECOL 2023; 43:2141617. [PMID: 36428288 DOI: 10.1080/01443615.2022.2141617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging endemic zoonosis in the Asia Pacific region. It is a febrile condition ranging in severity from mild to severe, with fatality rates as high as 30%. The present study aims towards analysing the clinical profile and pregnancy outcomes in 27 cases of scrub typhus admitted to a tertiary care centre in North India. The medical records of 27 pregnant women who had scrub typhus were analysed. The IgM ELISA was used to look for IgM antibodies to Orientia tsutsugamushi in the patient's serum sample. An optical density of more than or equal to 0.468 was considered as positive. Majority of the pregnant females delivered healthy and live babies. However, poor foetal outcomes were observed in four (14.8%) cases with intrauterine deaths occurring in two (7.4%) cases and still birth in one (3.7%) case, while one (3.7%) patient had spontaneous abortion. Maternal mortality was reported in one patient (3.7%) due to a delay in diagnosis. In endemic settings, a strong index of suspicion for scrub typhus is necessary in pregnant females presenting with fever. The key to reducing morbidity in both the mother and foetus is early diagnosis and treatment.Impact StatementWhat is already known on this subject? Scrub typhus is a febrile condition ranging in severity from mild to severe, with 30% mortality in untreated patients.What do the results of this study add? Majority of the pregnant females delivered healthy and live babies. However, poor foetal outcomes were observed in four (14.8%) cases with intrauterine deaths occurring in two (7.4%) cases and still birth in one (3.7%) case, while one (3.7%) patient had spontaneous abortion. Maternal mortality was reported in one patient (3.7%) due to a delay in diagnosis.What are the implications of these findings for clinical practice and/or further research? In endemic settings, a strong index of suspicion for scrub typhus is necessary for pregnant females presenting with fever. The key to reducing morbidity in both the mother and foetus is early diagnosis and treatment.
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Affiliation(s)
- Bhavana Yadav
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Ranu Soni
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics & Gynecology, PGIMER, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics & Gynecology, PGIMER, Chandigarh, India
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Punj P, Arora A, Shah R, Patil AN, Sikka P, Jain V, Suri V, Saini SS. Prospective assessment of mental and physical health of maternal near-miss women: A low-middle-income country's experience. J Family Med Prim Care 2023; 12:3387-3392. [PMID: 38361862 PMCID: PMC10866246 DOI: 10.4103/jfmpc.jfmpc_1319_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 02/17/2024] Open
Abstract
Background Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around. Aim A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries. Materials and Methods The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist - Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery. Results The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P < 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P < 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P < 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P < 0.05). Conclusion There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events.
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Affiliation(s)
- Pankhuri Punj
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Aashima Arora
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Ruchita Shah
- Department of Psychiatry, PGIMER, Chandigarh, India
| | - Amol N. Patil
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
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Sharma R, Kumar A, Suri V, Kaur S, Singh AJ. An integrated qualitative and quantitative study on sexual and reproductive health problems faced by women with disabilities in Chandigarh, India. Int J Gynaecol Obstet 2023; 163:818-824. [PMID: 37345270 DOI: 10.1002/ijgo.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/14/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES To estimate the prevalence of sexual and reproductive health (SRH) problems among women with disabilities (WWD) in Chandigarh, India, and to ascertain the difficulties experienced by WWD in accessing hospital services. METHODS This cross-sectional study was conducted during 2014 to 2017 in Chandigarh, India. The study participants were women 15 years and older with at least 40% disability. A pretested questionnaire and in-depth interview were used to determine sociodemographic profile, medical history, sexual and reproductive morbidity, treatment-seeking behavior, and the type, extent, and course of the disability. Verbatim responses of the participants were noted. Data were manually coded and collated into possible themes. RESULTS Postpolio residual paralysis (80; 30.7%) was the main reported disability, followed by severe sight impairment (52; 19.9%). A majority (170; 65%) of participants were unmarried. Of them, 66 (39%) were not willing to get married. The prevalence of SRH problems was high (151; 57.9%) among WWD, and only 82 (54%) took treatment. Dysmenorrhea (47; 31.1%), irregular periods (36; 23.8%), and vaginal discharge (17; 11.3%) were the main problems reported. The WWD in this study were likely to hide their SRH problems from others out of shame or fear. CONCLUSION Among WWD, the prevalence of SRH problems is high and obtaining relief is difficult.
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Affiliation(s)
- Ruchi Sharma
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Vanita Suri
- Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | | | - Amar Jeet Singh
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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Sharma H, Parekh S, Pujari P, Shewale S, Desai S, Bhatla N, Joshi S, Pimple S, Kawade A, Balasubramani L, Thomas A, Suri V, Lalwani S, Uday R, Kamath V, Mandal R, Rajeswar A, Peedicayil A, Poli UR, Banerjee D, Sankaranarayanan R, Basu P, Muwonge R, Gairola S, Dogar V, Rao H, Shaligram U. Immunogenicity and safety of a new quadrivalent HPV vaccine in girls and boys aged 9-14 years versus an established quadrivalent HPV vaccine in women aged 15-26 years in India: a randomised, active-controlled, multicentre, phase 2/3 trial. Lancet Oncol 2023; 24:1321-1333. [PMID: 37949086 DOI: 10.1016/s1470-2045(23)00480-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND To meet global cervical cancer elimination efforts, a wider range of affordable and accessible vaccines against human papillomavirus (HPV) are needed. We aimed to evaluate the immunogenicity and safety of a quadrivalent HPV vaccine (targeting HPV types 6, 11, 16, and 18), developed and manufactured by the Serum Institute of India (SIIPL). Here we report outcomes in the 9-14 years cohort. METHODS This randomised, active-controlled, phase 2/3 trial was conducted at 12 tertiary care hospitals across India. Healthy participants aged 9-14 years or 15-26 years with no history of HPV vaccination were eligible for enrolment. Female participants were randomly assigned (1:1) with an interactive web response system, by use of a central computer-generated schedule and block randomisation (block sizes of 2, 4, 6, and 8), to receive the SIIPL quadrivalent HPV vaccine (Cervavac; SIIPL, Pune, India) or the comparator quadrivalent HPV vaccine (Gardasil; Merck Sharp & Dohme, Harleem, the Netherlands). Participants, investigators, laboratory technicians, and sponsors were masked to treatment allocation of female participants. Male participants were given the SIIPL quadrivalent HPV vaccine in an open-label manner. Study vaccines were administered intramuscularly with a two-dose schedule (at day 0 and 6 months) in the cohort aged 9-14 years, and with a three-dose schedule (at day 0, month 2, and month 6) in the cohort aged 15-26-years. Immunogenicity was assessed 30 days after the last dose by use of multiplexed ELISA. The primary outcome was the non-inferiority of immune response in terms of the geometric mean titre (GMT) of antibodies against HPV types 6, 11, 16, and 18 generated by the SIIPL quadrivalent HPV vaccine in girls and boys (aged 9-14 years) compared with the GMT generated by the comparator quadrivalent HPV vaccine in women aged 15-26 years at month 7 in the modified per-protocol population (ie, all participants who received all doses of study vaccines per assigned treatment group and had both day 0 and 1-month immunogenicity measurements after the last dose following protocol-defined window periods with no major protocol deviations). Non-inferiority was established if the lower bound of the 98·75% CI of the GMT ratio was 0·67 or higher. The co-primary outcome of occurrence of solicited adverse events (within 7 days of each dose) and unsolicited adverse events (up to 30 days after the last dose) was assessed in all participants who were enrolled and received at least one dose of study vaccine. The trial is registered with the Clinical Trials Registry - India (CTRI/2018/06/014601), and long-term follow-up is ongoing. FINDINGS Between Sept 20, 2018, and Feb 9, 2021, 2341 individuals were screened, of whom 2307 eligible individuals were enrolled and vaccinated: 1107 (738 girls and 369 boys) in the cohort aged 9-14 years and 1200 (819 women and 381 men) in the cohort aged 15-26 years. No race or ethnicity data were collected. 350 girls and 349 boys in the SIIPL quadrivalent HPV vaccine group and 338 women in the comparator vaccine group were included in the modified per-protocol population for the primary endpoint analysis. The median follow-up for the analyses was 221 days (IQR 215-231) for girls and 222 days (217-230) for boys in the SIIPL quadrivalent HPV vaccine group, 223 days (216-232) for girls in the comparator vaccine group, and 222 days (216-230) for women in the comparator vaccine group. GMT ratios were non-inferior in girls and boys receiving the SIIPL quadrivalent HPV vaccine compared with women receiving the comparator vaccine: GMT ratios for girls were 1·97 (98·75% CI 1·67-2·32) for HPV type 6, 1·63 (1·38-1·91) for HPV type 11, 1·90 (1·60-2·25) for HPV type 16, and 2·16 (1·79-2·61) for HPV type 18. For boys the GMT ratios were 1·86 (1·57-2·21) for HPV type 6, 1·46 (1·23-1·73) for HPV type 11, 1·62 (1·36-1·94) for HPV type 16, and 1·80 (1·48-2·18) for HPV type 18. The safety population comprised all 1107 participants (369 girls and 369 boys in the SIIPL quadrivalent HPV vaccine group, and 369 girls in the comparator group). Solicited adverse events occurred in 176 (48%) of 369 girls and 124 (34%) of 369 boys in the SIIPL vaccine group and 179 (49%) of 369 girls in the comparator vaccine group. No grade 3-4 solicited adverse events occurred within 7 days of each dose. Unsolicited adverse events occurred in 143 (39%) girls and 147 (40%) boys in the SIIPL vaccine group, and 143 (39%) girls in the comparator vaccine group. The most common grade 3 unsolicited adverse event was dengue fever, in one (<1%) girl in the SIIPL vaccine group and three (1%) girls in the comparator group. There were no grade 4 or 5 adverse events. Serious adverse events occurred in three (1%) girls and three (1%) boys in the SIIPL vaccine group, and five (1%) girls in the comparator vaccine group. No vaccine-related serious adverse events were reported. There were no treatment-related deaths. INTERPRETATION We observed a non-inferior immune response with the SIIPL quadrivalent HPV vaccine in girls and boys aged 9-14 years and an acceptable safety profile compared with the comparator vaccine. These findings support extrapolation of efficacy from the comparator vaccine to the SIIPL quadrivalent HPV vaccine in the younger population. The availability of the SIIPL quadrivalent HPV vaccine could help meet the global demand for HPV vaccines, and boost coverage for both girls and boys globally. FUNDING Biotechnology Industry Research Assistance Council, Department of Biotechnology (DBT), Government of India, and Serum Institute of India.
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Affiliation(s)
| | | | | | | | | | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sharmila Pimple
- Tata Memorial Hospital & Cancer Research Institute, Mumbai, India
| | | | | | | | - Vanita Suri
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sanjay Lalwani
- Bharati Vidyapeeth Medical College & Hospital, Pune, India
| | - Rajini Uday
- M S Ramaiah Medical College & Hospital, Bangalore, India
| | - Veena Kamath
- Kasturba Medical College and TMA Pai Hospital, Manipal, India
| | | | - A Rajeswar
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | | | - Usha Rani Poli
- MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad, India
| | | | | | - Partha Basu
- International Agency for Research on Cancer, World Health Organization, Early Detection, Prevention and Infections Branch, Lyon, France
| | - Richard Muwonge
- International Agency for Research on Cancer, World Health Organization, Early Detection, Prevention and Infections Branch, Lyon, France
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Rai R, Sehgal R, Singhal S, Suri V, Shivkumar P, Balasubramani L, Rajaram S, Shamsunder S, Bagga R, Vashist S, Meena J, Mishra A, Chawla L, Kumari S, Mani K, Bhatla N. Cervical Cancer Screening Coverage at Tertiary Care Institutes Across India. Asian Pac J Cancer Prev 2023; 24:4269-4275. [PMID: 38156863 PMCID: PMC10909083 DOI: 10.31557/apjcp.2023.24.12.4269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES The 70% screening coverage target proposed in the global cervical cancer elimination strategy is not achieved even at tertiary centres in India. A situational analysis was done to assess the currently existing facilities and barriers in tertiary care institutes. METHODS This cross sectional multicentric study was conducted from August to September 2021 in six tertiary care institutes across India. Women aged 30-49 years attending outpatient services (OPD) were invited for cervical screening. Women and health care professionals (HCPs) were administered structured questionnaires to assess knowledge, attitude and practices regarding cervical cancer screening services. RESULTS Out of 6709 eligible women who attended OPD, 1666 (24.8%; range:19-57%) received screening. Availability of screening kits was limited to 10-25 Pap/HPV tests per day. Visual inspection with acetic acid (VIA) and HPV testing were offered only at certain centres. Colposcopy and treatment facilities were optimal at all centres. Knowledge, attitude and practices were analysed for 1800 women: 45.7% had heard of cervical cancer, 78.0% did not know that it is preventable, 75.8% never heard about screening. Common symptoms correctly identified included postmenopausal bleeding (4.8%), postcoital bleeding (5.7%), intermenstrual bleeding (5.8%) and vaginal discharge (12.4%). Risk factors were identified by minority: poor menstrual hygiene (6.6%), oral contraceptive pill use (6.4%), multiparity (4.4%), and HPV infection (3.0%). Out of 21, mean total knowledge score (MTKS) was 2.07± 2.67. Out of 317 HCPs, 96.5% knew that cervical cancer is caused by HPV infection, is preceded by premalignant stage, and that it is preventable by screening and treatment (80.1%). Knowledge about screening modalities was present in 87.4% for cytology, 75.1% for VIA, 68.8% for HPV test. MTKS of HCPs was 20.88±6.61 out of 32. CONCLUSION Even at tertiary centres, limited availability of HPV tests, reluctance to implement VIA and lack of awareness among women remain the major barriers.
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Affiliation(s)
- Rakhi Rai
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Rohini Sehgal
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India.
| | | | - Latha Balasubramani
- Department of Gynaecology Oncology, VN Cancer Centre, GKNM Hospital, Coimbatore, India.
| | - Shalini Rajaram
- Department of Obstetrics and Gynaecology AIIMS, Rishikesh, India.
| | - Saritha Shamsunder
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India.
| | - Rashmi Bagga
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India.
| | - Shachi Vashist
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | - Archana Mishra
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India.
| | - Latika Chawla
- Department of Obstetrics and Gynaecology AIIMS, Rishikesh, India.
| | - Sarita Kumari
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
| | | | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, WHO CC AIIMS, New Delhi, India.
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Chahal S, Arora A, Jain K, Patil AN, Sikka P, Jain V, Suri V, Saini SS. Naturalistic Evaluation of ERAS Bundle Implementation Feasibility in Elective Cesarean Deliveries of Tertiary Care Hospital in a Low-Middle-Income Country. Hosp Top 2023:1-9. [PMID: 37941403 DOI: 10.1080/00185868.2023.2277948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The present study assessed whether applying enhanced recovery after surgery (ERAS) guidelines for cesarean delivery is feasible in the tertiary care setting with an add-on objective to identify barriers to successful implementation. The cross-sectional study included women undergoing elective CS and willing to participate. The study attempted to understand barriers to ERAS implementation through timely interviewing study participants. Sixty-two patients participated in the study. Antenatal and fetal complications were observed in 39(63%) and 32(51%) participants. The study observed that at least 80% of the proposed components could be applied to 71% of the study population. All 15 components could be applied to 7(11.2%) patients, and at least 50% could be applied to 58(94%) patients. The least applied component was minimizing starvation by taking clear liquids until 2 hrs before surgery in 26(42%) patients due to waiting hours outside the operation-theater (OT). When fitness-for-discharge was assessed against the percent components of ERAS implemented, the area under the curve (AUC) value was 0.75, with a specificity value of 95.65% and a positive predictive value of 94.12%. In the postoperative ERAS bundle, fitness-for-discharge on day-two was statistically associated with early and frequent breastfeeding (p = 0.000) and prevention of intra-op hypotension (p = 0.03). In conclusion, the primary barriers to implementing ERAS were resource limitations in the form of single functional OT and limited doctors.
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Affiliation(s)
- Sneha Chahal
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Aashima Arora
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Kajal Jain
- Department of Anaesthesiology, PGIMER, Chandigarh, India
| | - Amol N Patil
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
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Sharma B, Sikka P, Chopra S, Bansal R, Suri V, Aggarwal N, Saha SC, Vijayvergiya R, Bhukal I, Kumar P. Pregnancy in Eisenmenger syndrome: a case series from a tertiary care hospital of Northern India. Cardiol Young 2023; 33:2185-2189. [PMID: 36601954 DOI: 10.1017/s1047951122004152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Despite advances in medical care, we still come across pregnancy in Eisenmenger syndrome. Eisenmenger syndrome represents the severe end of the spectrum for disease in pulmonary artery hypertension associated with CHD. Due to very high maternal and perinatal morbidity and mortality, pregnancy is contraindicated among these women. Current guidelines also recommend that the women who become pregnant should opt for early termination of pregnancy. Here, we present a case series of 11 women of Eisenmenger syndrome and their pregnancy outcome. METHODS It was a retrospective analysis of 12 pregnancies among 11 women with Eisenmenger syndrome who were managed in a tertiary care referral centre of Northern India. RESULTS The mean age of these women was 28 ± 4 years (range 22 to 36 years). Almost 80% of them (9/11) were diagnosed with Eisenmenger syndrome during pregnancy. The commonest cardiac lesion was Ventricular Septal defect (54.5%) followed by Atrial Septal defect (27.3%) and Patent Ductus arteriosus (9.1%). Only three women opted for medical termination of pregnancy, rest eight continued the pregnancy or presented late. Pregnancy complications found include pre-eclampsia (50%), abruption (22%), and fetal growth retardation (62.5%). There were three maternal deaths (mortality rate 27%) in postpartum period. CONCLUSION This case series highlights the delay in diagnosis and treatment of CHD despite improvement in medical care. Women with Eisenmenger syndrome require effective contraception, preconceptional counselling, early termination of pregnancy, and multidisciplinary care.
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Affiliation(s)
- Bharti Sharma
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chopra
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Bansal
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Aggarwal
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhas C Saha
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ishwar Bhukal
- Department of Anesthesiology & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Department of Pediatrics (Neonatology Unit), Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Mathew JL, Wagner AL, Ratho RK, Patel PN, Suri V, Bharti B, Carlson BF, Dutta S, Singh MP, Boulton ML. Maternally transmitted anti-measles antibodies, and susceptibility to disease among infants in Chandigarh, India: A prospective birth cohort study. PLoS One 2023; 18:e0287110. [PMID: 37788252 PMCID: PMC10547151 DOI: 10.1371/journal.pone.0287110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/29/2023] [Indexed: 10/05/2023] Open
Abstract
Prior to the age of measles vaccination, infants are believed to be protected against measles by passively transferred maternal antibodies. However, the quantity and quality of such protection have not been well established in the Indian setting. We undertook this study to characterize the transfer and decline in maternal anti-measles antibodies among infants, and determine their susceptibility to measles. In this population-based, birth-cohort study, we enrolled pregnant women and their newborn infants, from a catchment area of 30 Anganwadis in Chandigarh, India. We collected maternal blood at delivery, and infant blood samples at birth, and 3, 6, and 9 months of age. Anti-measles IgG antibodies were measured using quantitative ELISA. We assessed antibody decline using log-linear models. In total, 428 mother-infant dyads were enrolled, and data from 413 dyads were analyzed. At birth, 91.5% (95% CI: 88.8, 94.2) of infants had protective antibody levels, which declined to 26.3% (95% CI: 21.0%, 31.9) at 3 months, 3.4% (95% CI: 0.9, 5.9) at 6 months, and 2.1% (95% CI: 0.1, 4.1) at 9 months. Younger mothers transferred lower levels of antibodies to their infants. We concluded that the majority of infants are susceptible to measles as early as three months of age, much earlier than their eligibility to receive measles vaccination.
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Affiliation(s)
- Joseph L. Mathew
- Department of Pediatrics, Advanced Pediatrics Center, PGIMER, Chandigarh, India
| | - Abram L. Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - Pooja N. Patel
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Vanita Suri
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Bhavneet Bharti
- Department of Pediatrics, Advanced Pediatrics Center, PGIMER, Chandigarh, India
| | - Bradley F. Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sourabh Dutta
- Department of Pediatrics, Advanced Pediatrics Center, PGIMER, Chandigarh, India
| | | | - Matthew L. Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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11
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Bhattacharjee U, Jandial A, Singh C, Lekshmon KS, Mishra K, Sandal R, Nampoothiri R, Naseem S, Suri V, Jain A, Lad DP, Prakash G, Khadwal A, Malhotra P. Pregnancy and long-term outcomes of female patients with chronic myeloid leukemia on tyrosine kinase inhibitors who experienced unplanned pregnancies. Leuk Res 2023; 133:107367. [PMID: 37566974 DOI: 10.1016/j.leukres.2023.107367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Despite the general recommendation to avoid Tyrosine Kinase Inhibitors (TKIs) for Chronic Myeloid Leukemia (CML) during pregnancy, unplanned pregnancies still occur, particularly among female patients residing in low- and middle-income countries (LMICs). We aimed to investigate the outcomes of pregnancy, foetal development, and disease progression among female CML patients in chronic phase (CML-CP) undergoing TKI therapy who encountered unplanned pregnancies in a tertiary care hospital in northern India. METHODS We conducted a retrospective analysis of all pregnancies in female CML-CP between January 2002 and December 2022 at our hospital. Patients were included if they had a confirmed diagnosis of CML-CP, were receiving TKI therapy during conception, and had available medical records. We analysed the data on pregnancy outcomes, foetal development, and disease progression through a review of medical records. RESULTS We identified 36 pregnancies in female CML-CP patients on TKI therapy during the study period, with 33 (91.7%) being unplanned. Sixteen pregnancies (48.5%) were conceived at less than major molecular remission (MMR) status. Twelve pregnancies (36.4%) were electively terminated, 4 (12.1%) had miscarriages, and, 17 (51.5%) pregnancies resulted in childbirth. Out of the 17 childbirths, 10 were full-term deliveries, and 7 were preterm deliveries. Twin pregnancies had a high incidence (18.2%). Among the 21 pregnancies that were not electively terminated, TKI was stopped at the first pregnancy detection in 14 pregnancies, while imatinib was continued throughout 7 pregnancies. Patients who discontinued TKI had a higher but statistically non-significant incidence of adverse pregnancy outcomes compared to those who continued imatinib throughout pregnancy (64.2% vs. 28.6%, p = 0.18). Additionally, the risk of long-term disease progression among patients who discontinued TKI during pregnancy and those who continued imatinib throughout pregnancy was 21.4% and 16.7% (p = 0.9), respectively. The risk of long-term disease progression was significantly increased in those persistently at less than MMR pre- and post-gestation (p = 0.0002). CONCLUSION Our findings suggest that continuing imatinib therapy during pregnancy, may be a reasonable option for CML patients residing in low- and middle-income countries to reduce the risk of disease progression and adverse pregnancy outcomes. Patients persistently at less than MMR levels pre- and post-gestation should be closely monitored for the risk of long-term disease progression. Further studies with larger sample sizes are needed to confirm these results.
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Affiliation(s)
- Urmimala Bhattacharjee
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jandial
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Charanpreet Singh
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K S Lekshmon
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kundan Mishra
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Sandal
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Nampoothiri
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Department of Haematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh P Lad
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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12
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Nadholta P, Kumar K, Saha PK, Suri V, Singh A, Anand A. Mind-body practice as a primer to maintain psychological health among pregnant women-YOGESTA-a randomized controlled trial. Front Public Health 2023; 11:1201371. [PMID: 37766749 PMCID: PMC10520697 DOI: 10.3389/fpubh.2023.1201371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/28/2023] [Indexed: 09/29/2023] Open
Abstract
Objective The objective of this study was to investigate the impact of Gestational Yoga-YOGESTA (Gestational Yoga), on the neuropsychology, quality of life, and personality of pregnant women. Design Open label, randomized controlled trial, used allocation concealment to allocate the treatment. Setting Department of Obstetrics and Gynecology and Neuroscience Research Lab, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Participants We recruited a total of 100 pregnant women visiting the Outpatient Department of Obstetrics and Gynecology. Participants were aged between 18 and 35 with uncomplicated pregnancies and they were randomly assigned to either the Yoga group (YG) or the usual care group (UCG). A total of 77 pregnant women completed both the pre- and post-survey, with 34 participants in the Yoga group and 43 in the Usual care group. Intervention Pregnant women in their second and third trimesters were provided with a 16-week online Prenatal Yoga intervention. The intervention began after enrollment in the 2nd trimester, specifically between the 16th and 20th week, and was conducted 5 days a week until delivery, with an average intervention period of 47.18 ± 2.031 (mean ± SEM) days. Chief outcome measures We measured Perceived stress, Depression, Anxiety, Stress, and quality of life by using standard questionnaires. Results A total of 77 participants were included in the analysis, with 34 assigned to the Yoga group and 43 assigned to the control group. Most of the measured parameters demonstrated significant changes. The Yoga group exhibited a noteworthy decrease in perceived stress, depression, anxiety, and psychological stress, as well as an improvement in the psychological and environmental domains of QOL-BREF. Conversely, the control group demonstrated a significant increase in perceived stress, depression, anxiety, and psychological stress, along with a reduction in the physical, psychological, and social domains of QOL-BREF at the follow-up stage. Although the two groups were similar at baseline, the Yoga group showed substantial enhancements in perceived stress, depression, anxiety, physiological stress, and overall quality of life when compared to the control group at follow-up. Conclusion The study's findings indicate that stress, anxiety, and depression are more likely to occur as gestational age progresses during pregnancy. Nevertheless, practicing Prenatal Yoga can effectively manage these changes and enhance the quality of life for expectant mothers.Clinical trial registration: Clinical Trials Registry-India, Identifier CTRI/2021/01/030827.
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Affiliation(s)
- Pooja Nadholta
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishan Kumar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pradip Kumar Saha
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Singh
- Division of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India
| | - Akshay Anand
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- CCRYN-Collaborative Centre for Mind Body Intervention, PGIMER, Chandigarh, India
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Ganie MA, Chowdhury S, Suri V, Joshi B, Bhattacharya PK, Agrawal S, Malhotra N, Sahay R, Jabbar PK, Rozati R, Wani IA, Shukla A, Arora T, Rashid H. Prevalence, Regional Variations, and Predictors of Overweight, Obesity, and Hypertension Among Healthy Reproductive-Age Indian Women: Nationwide Cross-Sectional Polycystic Ovary Syndrome Task Force Study. JMIR Public Health Surveill 2023; 9:e43199. [PMID: 37672315 PMCID: PMC10512112 DOI: 10.2196/43199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/05/2023] [Accepted: 05/16/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND A clear understanding of the anthropometric and sociodemographic risk factors related to BMI and hypertension categories is essential for more effective disease prevention, particularly in India. There is a paucity of nationally representative data on the dynamics of these risk factors, which have not been assessed among healthy reproductive-age Indian women. OBJECTIVE This cross-sectional polycystic ovary syndrome (PCOS) task force study aimed to assess the anthropometric and sociodemographic characteristics of healthy reproductive-age Indian women and explore the association of these characteristics with various noncommunicable diseases. METHODS We conducted a nationwide cross-sectional survey from 2018 to 2022 as part of the Indian Council of Medical Research-PCOS National Task Force study, with the primary aim of estimating the national prevalence of PCOS and regional phenotypic variations among women with PCOS. A multistage random sampling technique was adopted, and 7107 healthy women (aged 18-40 years) from 6 representative geographical zones of India were included in the study. The anthropometric indices and sociodemographic characteristics of these women were analyzed. Statistical analysis was performed to assess the association between exposure and outcome variables. RESULTS Of the 7107 study participants, 3585 (50.44%) were from rural areas and 3522 (49.56%) were from urban areas. The prevalence of obesity increased from 8.1% using World Health Organization criteria to 40% using the revised consensus guidelines for Asian Indian populations. Women from urban areas showed higher proportions of overweight (524/1908, 27.46%), obesity (775/1908, 40.62%), and prehypertension (1008/1908, 52.83%) categories. A rising trend of obesity was observed with an increase in age. Women aged 18 to 23 years were healthy (314/724, 43.4%) and overweight (140/724, 19.3%) compared with women aged 36 to 40 years with obesity (448/911, 49.2%) and overweight (216/911, 23.7%). The proportion of obesity was high among South Indian women, with 49.53% (531/1072) and 66.14% (709/1072), using both World Health Organization criteria and the revised Indian guidelines for BMI, respectively. BMI with waist circumference and waist-to-height ratio had a statistically significant linear relationship (r=0.417; P<.001 and r=0.422; P<.001, respectively). However, the magnitude, or strength, of the association was relatively weak (0.3<|r|<0.5). Statistical analysis showed that the strongest predictors of being overweight or obese were older age, level of education, wealth quintile, and area of residence. CONCLUSIONS Anthropometric and sociodemographic characteristics are useful predictors of overweight- and obesity-related syndromes, including prehypertension, among healthy Indian women. Increased attention to the health of Indian women from public health experts and policy makers is warranted. The findings of this study can be leveraged to offer valuable insights, informing health decision-making and targeted interventions that mitigate risk factors of overweight, obesity, and hypertension. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/23437.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Vanita Suri
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Meghalaya, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Chatisgarh, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - Roya Rozati
- Department of Obstetrics & Gynaecology, Maternal Health & Research Trust, Hyderabad, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Amlin Shukla
- Reproductive Biology and Maternal Health, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Taruna Arora
- Reproductive Biology and Maternal Health, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Haroon Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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14
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Ganie MA, Chowdhury S, Suri V, Joshi B, Bhattacharya PK, Agrawal S, Malhotra N, Sahay R, Jabbar PK, Nair A, Rozati R, Shukla A, Rashid R, Shah IA, Rashid H, Wani IA, Arora T, Kulkarni B. Normative range of various serum hormonal parameters among Indian women of reproductive age: ICMR-PCOS task force study outcome. Lancet Reg Health Southeast Asia 2023; 15:100226. [PMID: 37614351 PMCID: PMC10442974 DOI: 10.1016/j.lansea.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 08/25/2023]
Abstract
Background The hormonal profile varies considerably with age, gender, ethnicity, diet or physiological state of an individual. Limited population-specific studies have studied the variations in hormonal parameters among apparently healthy women. We aimed to analyse the biological reference interval for various hormonal parameters in the reproductive-aged healthy Indian women. Methods Out of 3877 participants that were clinically evaluated, 1441 subjects were subjected to laboratory investigations. All participants underwent a detailed clinical, biochemical and hormonal profiling. The hormone analysis was carried out at a single centre using a uniform methodology. Among the participants evaluated for biochemical and hormonal parameters, subjects that presented any abnormal profile or had incomplete investigations (n = 593) were excluded for further analysis. Findings The mean age (±SD) of the subjects retained in the final analysis (n = 848) was 29.9 (±6.3) years. In the present study, the biological reference interval (2.5th-97.5th centile) observed were: serum T4: μg/dL (5.23-12.31), TSH: μg/mL (0.52-4.16) and serum prolactin: ng/mL (5.13-37.35), LH: mIU/mL (2.75-20.68), FSH: mIU/mL 2.59-15.12), serum total testosterone: ng/mL (0.06-0.68), fasting insulin: mIU/mL (1.92-39.72), morning cortisol: μg/dL (4.71-19.64), DHEAS:μg/dL (50.61-342.6) and SHBG: nmol/L (21.37-117.54). Unlike T4, TSH, LH, and E2, the biological reference interval for prolactin, FSH, testosterone, C-peptide insulin and DHEAS varied when the subjects were stratified by age (p < 0.05). The comparative analysis showed marginal differences in the normative ranges for the hormones analysed among different populations. Interpretation Our first large composite data on hormonal measures will benefit future endeavours to define biological reference intervals in reproductive-aged Indian women. Funding The study was financially supported by the grant-in-aid from ICMR vide file No:5/7/13337/2015-RBMH.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
- Multidisciplinary Research Unit, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Subhankar Chowdhury
- Department of Endocrinology Metabolism, Institute of Postgraduate Medical Education Research, Kolkata, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of General Medicine, North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Raipur, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - Abilash Nair
- Department of Endocrinology, Government Medical College, Thiruvananthapuram, India
| | - Roya Rozati
- Department of Obstetrics and Gynaecology, Maternal Health, Research Trust, Hyderabad, India
| | - Amlin Shukla
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
| | - Rabiya Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Idrees A. Shah
- Multidisciplinary Research Unit, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Haroon Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Taruna Arora
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
| | - Bharati Kulkarni
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
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Malhotra N, Arora T, Suri V, Jena SK, Verma A, Gowri M, Kapoor N, Chalga MS, Kulkarni B, Kamath MS. Publisher Correction: Individualized lifestyle intervention in PCOS women (IPOS): a study protocol for a multicentric randomized controlled trial for evaluating the effectiveness of an individualized lifestyle intervention in PCOS women who wish to conceive. Trials 2023; 24:486. [PMID: 37525194 PMCID: PMC10388493 DOI: 10.1186/s13063-023-07535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Affiliation(s)
- Neena Malhotra
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Taruna Arora
- Division of Reproductive and Child Health and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saubhagya Kumar Jena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Asha Verma
- Department of Obstetrics and Gynaecology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
- Non-Communicable Disease Unit, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Manjeet Singh Chalga
- Division of Biomedical Informatics, Indian Council of Medical Research, New Delhi, India
| | - Bharati Kulkarni
- Division of Reproductive and Child Health and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
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Malhotra N, Arora TK, Suri V, Jena SK, Verma A, Gowri M, Kapoor N, Chalga MS, Kulkarni B, Kamath MS. Individualized lifestyle intervention in PCOS women (IPOS): a study protocol for a multicentric randomized controlled trial for evaluating the effectiveness of an individualized lifestyle intervention in PCOS women who wish to conceive. Trials 2023; 24:457. [PMID: 37464435 PMCID: PMC10353229 DOI: 10.1186/s13063-023-07466-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/18/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrine condition which affects women in the reproductive age group. South Asian women with PCOS have a higher risk of insulin resistance and metabolic disorder compared to women from other ethnic backgrounds. Lifestyle interventions such as dietary advice and physical exercise are recommended as a first-line management option for infertile women with PCOS. Most of the randomized controlled trials evaluating the role of lifestyle interventions in infertile PCOS women were characterized by methodological issues. The uptake of lifestyle modifications as a treatment strategy in the South Asian population is complicated by a difficult-to-change conventional high-carbohydrate diet and limited availability of space for physical activity in the region. METHODS The study is designed as an open-label, multicentre, randomized controlled trial in South Asian women with PCOS. Women attending the fertility clinic will be screened for eligibility, and women aged between 19 and 37 years who have been diagnosed with PCOS and wishing to conceive will be invited to participate in the trial. We will include women with body mass index (BMI) between ≥ 23 and ≤ 35 kg/m2 and duration of infertility ≤ 3 years. We plan to randomize women with PCOS into two groups: group A will receive the intervention which will consist of individualized advice on diet and physical exercise along with a telephonic reminder system and follow-up visits, and group B (control) will receive one-time advice on diet and physical exercise. Both groups will receive up to three cycles of ovulation induction with letrozole after 3 months of randomization during the 6-month treatment period. The primary outcome of the trial will be the live birth following conception during the intervention period. The secondary outcomes include clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, ectopic pregnancy rate, stillbirth, time to pregnancy, mean weight loss, differences in anthropometric parameters, improvement in menstrual regularity and quality of life score. DISCUSSION The IPOS trial results could help clarify and provide more robust evidence for advocating an individualized lifestyle intervention in PCOS women who wish to conceive. TRIAL REGISTRATION Clinical Trial Registry of India CTRI/2023/04/051620. Registered on 13 April 2023.
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Affiliation(s)
- Neena Malhotra
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Taruna Katyal Arora
- Division of Reproductive and Child Health and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saubhagya Kumar Jena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Asha Verma
- Department of Obstetrics and Gynaecology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
- Non-Communicable Disease Unit, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Manjeet Singh Chalga
- Division of Biomedical Informatics, Indian Council of Medical Research, New Delhi, India
| | - Bharati Kulkarni
- Division of Reproductive and Child Health and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
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Kaur I, Singh A, Suri V, Kishore K, Rana SV, Sahni N, Bhattacharya S. Assessment of quality of life in patients having Poly-Cystic Ovarian Syndrome: A cross-sectional facility-based study. J Educ Health Promot 2023; 12:190. [PMID: 37545991 PMCID: PMC10402774 DOI: 10.4103/jehp.jehp_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/12/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is a complex and heterogeneous disorder affecting various body organs. Menstrual irregularity, anovulation, and many cosmetic issues faced by PCOS patients endanger the essence of being a woman and may have a deleterious impact on their health-related quality of life (HRQOL). This study aimed to assess HRQOL in patients with PCOS and to identify the clinical and socio-demographic factors that might predict poor HRQOL. MATERIALS AND METHODS This cross-sectional study was carried out in the tertiary care hospital in India. A total of 275 women visiting the same setting and diagnosed with PCOS were included. The participants' quality of life was studied using a disease-specific HRQOL questionnaire. Information regarding clinical and socio-demographics was collected using the interviewer schedule. For evaluating the predictors of HRQOL in PCOS subjects, analysis of variance and independent t-test was applied. For subgroup analysis, the post hoc (Gabriel) test was applied. RESULTS The average total score of HRQOL of the study participants was 125.41 ± 29.1. The lowest weighted mean score was for menstrual problems. Among the socio-demographic variables, age and educational level influenced the HRQOL scores. Highly educated women reported the poorest HRQOL. The analysis of variance also indicated a significant variation in HRQOL scores among body mass index categories [F (4,270) = 5.09, P = <.001] and hirsutism status [F (2,272) = 14.222, P =<.001]. CONCLUSIONS Menstrual irregularity, hirsutism, increased body mass index, educational status, and age are critical in altering HRQOL in PCOS cases. Clinicians should inquire about the HRQOL of patients with severe clinical manifestations and appropriate support must be provided during patient care.
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Affiliation(s)
- Ishwarpreet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kamal Kishore
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satya Vati Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nancy Sahni
- Department of Dietetics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Deoghar, Jharkhand, India
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Kaur I, Singh A, Suri V, Kishore K, Rana SV, Sahni N, Bhattacharya S. Treatment seeking behavior among patients with polycystic ovarian syndrome (PCOS)-A cross-sectional study from Northern India. J Educ Health Promot 2023; 12:194. [PMID: 37546021 PMCID: PMC10402790 DOI: 10.4103/jehp.jehp_102_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/12/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) has now become a common problem among adolescent girls and young women in India. However, little is known about the treatment and satisfaction incurred from it. Our study aimed to assess the treatment-seeking behaviour among patients with PCOS. MATERIALS AND METHODS The cross-sectional study was carried out in gynecology OPD of PGIMER, Chandigarh. Women with PCOS, 275, visiting the gynecology OPD were included. The treatment-seeking behavior for PCOS was elucidated among cases using a questionnaire. This included parameters like healthcare consulted, preferred system of medicine, referral pattern, treatment efficacy, and expenses incurred. Univariate descriptive analysis was used to present the results. RESULTS The majority (68%) of the study participants were less than 25 years of age. The average weight was 66.78 (±13.0) Kg. Half of the participants were students. More than 70% belonged to the upper or upper-middle class. The study participants were diagnosed with PCOS at an average age of 21.4 (±4.7) years. The minimum age reported at diagnosis was 11 years, and the maximum age of diagnosis was 36 years. Most respondents preferred Allopathic treatment followed by homeopathy and Ayurveda. Few also opted for other treatment choices like diet therapy, yoga & meditation, weight loss supplements, and home remedies. Treatment efficacy ranged between 17.3%-34.2%. The majority of respondents reported the treatment to be moderately expensive. Most respondents (58.91%) were hardly influenced, while 16% were quite influenced by PCOS medicine or treatment advertisements. CONCLUSION PCOS patients opt for different treatment options but generally find the treatment less effective and expensive.
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Affiliation(s)
- Ishwarpreet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kamal Kishore
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satya Vati Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nancy Sahni
- Department of Dietetics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Deoghar, Jharkhand, India
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Joshi B, Sahoo S, Prasad GRV, Suri V, Mahajan V, Grover S, Brar R, Chopra S. Postpartum Collapse Subsequent to Catatonia in a Female with COVID-19 Infection: a Rare Entity Visited. J Obstet Gynaecol India 2023; 73:279-281. [PMID: 36685334 PMCID: PMC9838526 DOI: 10.1007/s13224-022-01737-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Postpartum collapse is a life-threatening condition caused by obstetrical and non-obstetrical events. In this case report, we discuss a case of postpartum collapse in COVID-19-positive woman who required intensive care and mechanical ventilation for two days. After confusing collision of many provisional diagnoses soldiering for three days, she was ultimately diagnosed with malignant catatonia. Targeted therapy with lorazepam challenge resulted in drastic improvement, and she was discharged with her baby in healthy condition.
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Affiliation(s)
- Bharti Joshi
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - G. R. V. Prasad
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Varun Mahajan
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Rinne Brar
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Seema Chopra
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
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Joshi B, Sahoo S, Prasad GRV, Suri V, Mahajan V, Grover S, Brar R, Chopra S. Correction to: Postpartum Collapse Subsequent to Catatonia in a Female with COVID-19 Infection: A Rare Entity Visited. J Obstet Gynaecol India 2023:1. [PMID: 37361926 PMCID: PMC10148693 DOI: 10.1007/s13224-023-01756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 06/28/2023] Open
Abstract
[This corrects the article DOI: 10.1007/s13224-022-01737-5.].
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Affiliation(s)
- Bharti Joshi
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - G. R. V. Prasad
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Varun Mahajan
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Rinnie Brar
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Seema Chopra
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
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Suri V, Bansal R, Aggarwal N, Sikka P, Chopra S, Saha SC, Gupta N, Rai B. Successful in vitro fertilization following conservative surgery for synchronous endometrioid tumor of ovary and uterus. J Ovarian Res 2023; 16:63. [PMID: 36991430 DOI: 10.1186/s13048-023-01137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/08/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Successful pregnancy outcome in women with synchronous ovarian and endometrial cancers is very rare. We report successful pregnancy outcome in a young woman managed conservatively for synchronous endometrial and ovarian cancer. CASE PRESENTATION Thirty years old nulliparous lady presented following exploratory laparotomy, left salpingo-oophorectomy and hysteroscopic polypectomy for left adnexal mass. Histology revealed endometrioid carcinoma of left ovary and moderately differentiated adenocarcinoma in the resected polyp. She underwent staging laparotomy along with hysteroscopy which confirmed above findings without any evidence of further tumor spread. She was treated conservatively with high dose oral progestin (megestrol acetate, 160 mg) and leuprolide acetate 3.75 mg monthly injections for three months along with four cycles of carboplatin and paclitaxel based chemotherapy followed by monthly injection of leuprolide for further three months. After failure of spontaneous conception, she underwent ovulation induction for six cycles along with intrauterine insemination which failed. She underwent in vitro fertilization with donor egg followed by elective cesarean section at 37 weeks of gestation. She delivered a healthy baby of weight 2.7 kg. Intraoperatively 5 × 6 cm right ovarian cyst was found which drained chocolate coloured fluid on puncture and cystectomy was carried out. Histological examination revealed endometrioid cyst of right ovary. Uterus was spared as she wanted to preserve her fertility. She is being followed periodically and is normal nine months following delivery. She is on injection Depot medroxy progesterone acetate once every three months.
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Affiliation(s)
- Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Bansal
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Neelam Aggarwal
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chopra
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Chandra Saha
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bhagat N, Singla R, Rohilla M, Arora A, Suri V. Usage of postpartum intrauterine contraceptive device (postpartum-IUD) after an increase in the institutional delivery rate in India: time to re-visit the effect of timing of counselling on its acceptance. EUR J CONTRACEP REPR 2023; 28:132-140. [PMID: 36971318 DOI: 10.1080/13625187.2023.2187249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE While increase in institutional deliveries brings an opportunity to counsel women for postpartum family planning (PPFP), its uptake remains low. Reasons for poor acceptance of postpartum intrauterine contraceptive device (postpartum-IUD), and its relation with the timing of counselling need to be investigated. METHODS Women attending the antenatal clinic, reporting in labour, and within 48 h of delivery respectively were invited to participate. Eligible women were asked about awareness and choice for PPFP. After counselling, acceptance for PPFP was compared with the baseline. Acceptance and continuation of postpartum-IUD were compared between women counselled in the antenatal, intrapartum, and postpartum periods. RESULTS Only 23% of 360 women were aware of postpartum-IUD. After counselling, acceptance for PPFP increased from 14% to 97% and for postpartum-IUD, from 0.5% to 33.9%. Acceptance of postpartum-IUD among women counselled in the antenatal, intrapartum and postpartum period was 45%, 35% and 21.7% respectively. Acceptance was higher among the antenatal-counselling group than the postpartum-counselling group (OR 0.45; CI 0.22-0.94; p = 0.03). CONCLUSION Counselling, irrespective of its timing, improves acceptance for PPFP. Acceptance and continuation of postpartum-IUD are higher following counselling in antenatal period. All eligible women should be counselled irrespective of 'when' they approach the facility.
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Gupta Y, Malik N, Goswami S, Arora M, Kundu A, Gupta S, Kapoor M, Suri V, Suri A, Chattopadhyay P, Sinha S, Chosdol K. 4P FAT1: A novel modulator of autophagy in human glioblastoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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24
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Ganie MA, Chowdhury S, Suri V, Joshi BN, Bhattacharya PK, Agarwal S, Malhotra N, Sahay R, Jabbar PK, Rozati R, Shukla A, Rashid H, Bashir R, Wani I, Nair A, Arora TK, Kulkarni B. Variation in normative values of major clinical biochemistry analytes in healthy reproductive-age women in India: A subset of data from a National Indian Council of Medical Research-Polycystic Ovary Syndrome task force study. Indian J Pharmacol 2023; 55:76-88. [PMID: 37313933 DOI: 10.4103/ijp.ijp_694_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES Clinical biochemistry reference intervals (RIs) play a crucial role in interpreting patient test results and making informed clinical decisions. Using data from an ongoing Indian Council of Medical Research-National task force study on healthy women, normative ranges for commonly analyzed biochemical analytes were established. MATERIALS AND METHODS A. total of 13,181 women of reproductive age (18-40 years) were recruited from different urban and rural regions of the country, of which 9898 women signed an informed consent were included. Among these, women having features of hyperandrogenism, menstrual cycle irregularities, and comorbidities were excluded. RIs of 22 analytes were computed in the remaining 938 women controls. To estimate the 95% range of the reference distribution, the limits of the 2.5th percentile and the 97.5th percentile were used in the study. RESULTS Mean ± standard deviation of age and body mass index of participants was 30.12 ± 6.32 years and 22.8 ± 3.36 kg/m2 respectively. Centiles (2.5th-97.5th) of liver function parameters, lipid parameters, glycaemic parameters, and renal parameters are presented. No significant difference in analytes was observed in relation to the area of residence, and age groups except in albumin (P = 0.03). The distribution of most of the parameters was consistent with the various RI studies conducted in India as well as other countries. CONCLUSION This is the first study generating biochemical RIs data among a large representative sample of healthy reproductive-age women recruited using a robust design across the country. The resource may serve as a reference range for common biochemical analytes for future in this age group.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, West Bengal, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Nitin Joshi
- Department of Operational Research, National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Sarita Agarwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Raipur, India
| | - Neena Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College and Aster Prime Hospital, Hyderabad, India
| | - P K Jabbar
- Department of Endocrinology, Professor and Head, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Roya Rozati
- Department of Obstetrics and Gynaecology, Maternal Health and Research Institute, Telangana, India
| | - Amlin Shukla
- Indian Council of Medical Research, New Delhi, India
| | - Haroon Rashid
- Department of Clinical Research, Sher-i Kashmir Institute Of Medical Sciences, Jammu and Kashmir, India
| | - Rohina Bashir
- Department of Clinical Research, Sher-i Kashmir Institute Of Medical Sciences, Jammu and Kashmir, India
| | - Imtiyaz Wani
- Department of Clinical Research, Sher-i Kashmir Institute Of Medical Sciences, Jammu and Kashmir, India
| | - Abhilash Nair
- Department of Endocrinology, Professor and Head, Government Medical College, Thiruvananthapuram, Kerala, India
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Thakur G, Singh A, Jain V, Sikka P, Arora A, Suri V. Acute kidney injury and it's outcome following maternal near miss event: A prospective observational study from a tertiary care hospital. Obstet Med 2023; 16:48-51. [PMID: 37139512 PMCID: PMC10150313 DOI: 10.1177/1753495x211069020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose Haemorrhage, preeclampsia and sepsis are the leading causes of renal dysfunction in women with a maternal nearmiss(MNM) complication. The study aimed to assess the prevalence, pattern and follow up of these women. Methods This was a hospital based prospective observational study, conducted over one year. All women with a MNM leading to acute kidney injury (AKI) were analysed for fetomaternal outcomes and renal function at 1 year of followup. Results The incidence of MNM was 43.04 per 1000 livebirths. 18.2% women developed AKI. 51.1% women developed AKI in the puerperal period. Most common cause of AKI was haemorrhage seen in 38.3% women. The majority of women had s.creatinine between 2.1 to 5 mg/dl and 44.68% required dialysis. 80.8% women recovered fully when the treatment was initiated within 24 h. One patient underwent renal transplant. Conclusion Early diagnosis and treatment of AKI results in full recovery.
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Affiliation(s)
- Geetika Thakur
- Department of Obsterics and
Gynaecology, PGIMER, Chandigarh, India
| | - Aruna Singh
- Department of Obsterics and
Gynaecology, PGIMER, Chandigarh, India
| | - Vanita Jain
- Department of Obsterics and
Gynaecology, PGIMER, Chandigarh, India
| | - Pooja Sikka
- Department of Obsterics and
Gynaecology, PGIMER, Chandigarh, India
| | - Aashima Arora
- Department of Obsterics and
Gynaecology, PGIMER, Chandigarh, India
| | - Vanita Suri
- Department of Obsterics and
Gynaecology, PGIMER, Chandigarh, India
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Singla R, Suri V, Veeramalla S, Shafiq N, Rohilla M, Kalra J. Ensuring Compliance with Surgical Antimicrobial Prophylaxis Policy in High-Volume Resource-Limited Settings: Integrated Measures from Inception to Audit. J Gynecol Surg 2023. [DOI: 10.1089/gyn.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Affiliation(s)
- Rimpi Singla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Snigdha Veeramalla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaswinder Kalra
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Thakur S, Rawat N, Sharma B, Sikka P, Dogra N, Aggarwal N, Suri V, Vijayvergiya R, Gawalkar AA. Challenges and outcomes of pregnancy in an uncorrected Tetralogy of Fallot with pulmonary atresia and major aorta-pulmonary collateral arteries (MAPCA): a case report. Egypt Heart J 2023; 75:9. [PMID: 36729200 PMCID: PMC9895401 DOI: 10.1186/s43044-023-00335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Tetralogy of Fallot is a severe type of congenital heart disease (CHD) and one of the leading indirect causes of mortality & morbidity among women with CHD. We came across a rare case of an uncorrected Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries in pregnancy. CASE PRESENTATION We are reporting the challenges in managing a pregnancy of 25-years-old G3 P0110, previous one stillbirth and who was diagnosed to have congenital heart disease during pregnancy following spontaneous abortion. CONCLUSIONS This case report highlights the role of multidisciplinary care in managing such a high risk case. It also emphasizes the role of cardiac examination of every woman before pregnancy so that definitive treatment or optimization can be done in time for a better outcome.
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Affiliation(s)
- Surekha Thakur
- grid.415131.30000 0004 1767 2903Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Neha Rawat
- grid.415131.30000 0004 1767 2903Department of Anesthesia, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Bharti Sharma
- Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Pooja Sikka
- grid.415131.30000 0004 1767 2903Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Neeti Dogra
- grid.415131.30000 0004 1767 2903Department of Anesthesia, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Neelam Aggarwal
- grid.415131.30000 0004 1767 2903Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vanita Suri
- grid.415131.30000 0004 1767 2903Department of Obstetrics and Gynaecology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Rajesh Vijayvergiya
- grid.415131.30000 0004 1767 2903Department of Cardiology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Atit A. Gawalkar
- grid.415131.30000 0004 1767 2903Department of Cardiology, PGIMER Chandigarh, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Muacevic A, Adler JR, Suri V, Kaur S, Singh A. Physical Access Related User-Friendliness of Sexual and Reproductive Health Services for Women With Disabilities in Various Hospitals in a City in North India: An Integrated Qualitative and Quantitative Study. Cureus 2023; 15:e34276. [PMID: 36855501 PMCID: PMC9968490 DOI: 10.7759/cureus.34276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Access to optimum health care services is vital for every woman. Women with disabilities (WWD), in particular, face multiple discrimination and social exclusion on this issue. The objective of the study was to evaluate the user-friendliness of sexual and reproductive health (SRH) services in terms of the physical access to health facilities in various hospitals in a city in north India. METHODS This cross-sectional evaluation study was conducted during 2013-2017 in five purposively selected major government hospitals in a city in north India. A disabled friendliness evaluation tool was used to analyze the barriers to physical access in terms of approach to SRH care facilities. Data analysis was done through Microsoft Excel (Microsoft, Redmond, WA, USA) and content analysis. Results: Overall, 270 respondents aged 15 years and above with at least 40% disability were interviewed for the study. Lack of access to SRH care in hospitals (infrastructure/equipment/communication/transport) was the main barrier (46.36%) reported by WWD. Most of the hospitals lacked any special provisions for people with disability (PWD). Proper ramps, stairs, toilets, etc. were not present in hospitals as denoted by their verbatim responses. CONCLUSIONS All the hospitals scored low on access to sexual and reproductive health services for WWD.
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Sharma B, Rohilla M, Suri V, Jain V, Prasad GRV, Kalra J, Pandey N. Obstetric Teleconsultation by Using Mobile Phone Technology in COVID Pandemic. Indian J Community Med 2023; 48:190-195. [PMID: 37082410 PMCID: PMC10112758 DOI: 10.4103/ijcm.ijcm_552_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/21/2022] [Indexed: 02/10/2023] Open
Abstract
Introduction Obstetrics teleconsultation is a new concept to enable health-care services in the COVID pandemic by limiting in-person visits. This study describes the methodology of mobile-based teleconsultation, preliminary findings, and the experience of the obstetricians. Material and Methods The data of pregnant women who got registered for teleconsultation in early phase of COVID pandemic lockdown were reviewed and analyzed. A qualitative analysis was performed to assess the experience of obstetricians (consultants, senior residents, and junior residents) via an online electronic survey. Results The majority of obstetrics teleconsultations were for routine antenatal care (75%) and fetal medicine consultation (12.3%). Out of 187 women, 29.9% were advised to continue antenatal care at local hospitals, whereas 33.6% were asked to follow up via teleconsultation. Most of the obstetricians (73.68%) felt that they were able to satisfy the pregnant women and rated the teleconsultation satisfactory. Conclusion Obstetrics telemedicine found to be beneficial for providing routine antenatal care services via reducing physical visits and overcrowding in outpatient departments, promoting antenatal care at local hospitals, and making specialized (maternal-fetal medicine) care accessible even during COVID-19 pandemic.
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Affiliation(s)
- Bharti Sharma
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - GRV Prasad
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasvinder Kalra
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navin Pandey
- Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kumar S, Bhatla N, Sharma KA, Agarwal R, Verma A, Perumal V, Shiv Kumar P, Garg BS, Goudar SS, Pujar YV, Kavi A, Suri V, Joshi B, Rathore A, Gupta MM, Kumar A, Puri M, Meena D, Nangia S, Arora R, Bachani S, Anand P, Seth S, Gupta R, Sehgal R, Rana A, Kumari A, P. S, Donimath K, Gowder G, Kedar L, Kar T, Mishra S, Joshi C, Kabade Y, Kamatar S, Nanda S, Mohapatra V, Vellanki J, Agarwal S, Borkar AW, Kumar A, Sultan S, Gangane N, Chaudhary P, Jayathilaka A, Raina N, Karna P. SCOPE: Surveillance of COVID-19 in pregnancy- results of a multicentric ambispective case-control study on clinical presentation and maternal outcomes in India between April to November 2020. PLoS One 2023; 18:e0272381. [PMID: 36877672 PMCID: PMC9987819 DOI: 10.1371/journal.pone.0272381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/18/2022] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVE To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group. DESIGN Multicentric case-control study. DATA SOURCES Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020. STUDY POPULATION All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls. DATA QUALITY Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy. STATISTICAL ANALYSIS Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression. RESULTS A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%). CONCLUSION Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.
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Affiliation(s)
- Sunesh Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | - K. Aparna Sharma
- All India Institute of Medical Sciences, New Delhi, India
- * E-mail: ,
| | - Ramesh Agarwal
- All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Verma
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Poonam Shiv Kumar
- Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - B. S. Garg
- Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | | | - Yeshita V. Pujar
- Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India
| | - Avinash Kavi
- Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India
| | - Vanita Suri
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bharti Joshi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Ajay Kumar
- Maulana Azad Medical College, New Delhi, India
| | - Manju Puri
- Lady Hardinge Medical Delhi, New Delhi, India
| | | | | | - Renu Arora
- Vardhaman Medical College and Safdarjung Hospital, New Delhi, India
| | - Sumitra Bachani
- Vardhaman Medical College and Safdarjung Hospital, New Delhi, India
| | - Pratima Anand
- Vardhaman Medical College and Safdarjung Hospital, New Delhi, India
| | - Shikha Seth
- Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Rakesh Gupta
- Government Institute of Medical Sciences, Noida, Uttar Pradesh, India
| | - Rohini Sehgal
- All India Institute of Medical Sciences, New Delhi, India
| | - Anubhuti Rana
- All India Institute of Medical Sciences, New Delhi, India
| | - Archana Kumari
- All India Institute of Medical Sciences, New Delhi, India
| | - Shainy P.
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Lakshmi Kedar
- Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India
| | - Tushar Kar
- S C B Medical College, Cuttack, Odisha, India
| | - Sujata Mishra
- Fakir Mohan Medical College, Balasore, Odisha, India
| | - Chinmayi Joshi
- Belagavi Institute of Medical Sciences, Belagavi, Karnataka, India
| | | | | | | | | | | | | | | | - Aruna Kumar
- Government Medical College, Bhopal, Madhya Pradesh, India
| | - Shabana Sultan
- Government Medical College, Bhopal, Madhya Pradesh, India
| | - Neha Gangane
- Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
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Verma S, Baig MZ, Rawat A, Kapoor R, Rawat A, Suri V, Suri V. 109. Seroprevalence of Protective Antibodies against Varicella, Hepatitis-A and Dengue among Indian Children, Adolescents and Adults. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Varicella, Hepatitis-A and Dengue cause significant disease burden in our country. Estimation of age-wise seroprevalence of antibodies against these diseases not only help us in understanding age-specific incidence rates and susceptibility, but also help policy makers in deciding need and timing of vaccination. None of these vaccines are part of current national immunization program in India, yet.
Methods
In this observational cross-sectional study, apparently healthy children (9-12 years), adolescents (15-18 years) and adults (25-30 years) attending OPD of a tertiary care hospital in Northern India over two-year period (July 17- June 19) were enrolled after taking informed written consent, and their 3-ml venous blood sample was collected. Ethical clearance was obtained from Institute Ethics committee, before enrolling subjects. Serum was tested for IgG antibodies using specific commercial ELISA kits. Those who received received Hepatitis-A or Varicella vaccination in past were excluded from enrollment.
Results
Out of total 240 subjects (M:F=117:123) enrolled, 75 were children, 75 adolescents and 90 adults in specified age groups. Mean age in these three groups were 11.04, 16.52 and 26.53 years respectively.
In our study, antibodies (IgG) against Varicella were >12 U/ml (seroprotective) in 36% (27/75), 74.6% (56/75), 64.5% (58/90) in children, adolescent and adults in specified age groups, respectively. Similarly, the antibodies (IgG) against Hepatitis-A were >10 U/ml (seroprotective) in above three groups were 68% (51/75), 85.3% (64/75), 95.5% (86/90). For dengue IgG antibodies also, seropositivity rates in above three groups were 37.3% (28/75), 62.7% (47/75), 53.3% (48/90).
Conclusion
Large proportion of children, adolescents and adults remain susceptible to Varicella and Hepatitis-A infection in India. Early childhood vaccination with Varicella and Hepatitis-A vaccines should be a part of National Immunization Programme in India, as a part of preventive strategy.
Our study also showed a large proportion of children, adolescents and adults remain seronegative for Dengue antibodies in various age groups. Therefore, if currently available dengue vaccine (Dengvaxia) has to be used in our population, it can only be used after individual screening.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Sanjay Verma
- PGIMER , Chandigarh, India, Chandigarh, Chandigarh , India
| | | | - Ankita Rawat
- PGIMER , CHANDIGARH, INDIA, Chandigarh, Chandigarh , India
| | - Rajesh Kapoor
- PGIMER , CHANDIGARH, INDIA, Chandigarh, Chandigarh , India
| | - Amit Rawat
- PGIMER , CHANDIGARH, INDIA, Chandigarh, Chandigarh , India
| | - Vikas Suri
- PGIMER , CHANDIGARH, INDIA, Chandigarh, Chandigarh , India
| | - Vanita Suri
- PGIMER , CHANDIGARH, INDIA, Chandigarh, Chandigarh , India
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Das L, Sahoo J, Dahiya N, Taneja S, Bhadada SK, Bhat MH, Singh P, Suri V, Laway BA, Dutta P. Long-term hepatic and cardiac health in patients diagnosed with Sheehan's syndrome. Pituitary 2022; 25:971-981. [PMID: 36243797 DOI: 10.1007/s11102-022-01282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Sheehan's syndrome (SS) is characterised by chronic pituitary insufficiency following a vascular insult to the pituitary in the peripartum period. There is a lack of substantial evidence on the long-term hepatic and cardiac consequences in these patients, following hormone replacement. METHODS Patients with a diagnosis of SS were recruited for the study. Detailed clinico-biochemical and radiological evaluation were performed in all patients (n = 60). Hepatic and cardiac complications were assessed using fibroscan and echocardiography (2D speckle-tracking) respectively, in a subset of patients (n = 29) as well as age-and BMI-matched controls (n = 26). Controlled attenuation parameter (for steatosis) and liver stiffness measurement (for fibrosis) were used to define non-alcoholic fatty liver disease (NAFLD). Diastolic cardiac function was evaluated using standard criteria and systolic function by ejection fraction and global longitudinal strain (GLS). RESULTS The mean age of the cohort was 42.7 ± 11.6 years. Multiple (≥ 2) hormone deficiencies were present in 68.8% of patients, with hypothyroidism (91.4%), hypocortisolism (88.3%), and growth hormone (GH) deficiency (85.7%) being the most common. At a mean follow-up of 9.8 ± 6.8 years, NAFLD was present in 63% of patients, with 51% having severe steatosis, which was predicted by the presence of GH deficiency and higher body mass index. Though the ejection fraction was similar, increased left ventricular GLS (18.8 vs. 7.7%) was present in a significantly higher number of patients versus controls. CONCLUSION NAFLD, especially severe hepatic steatosis, is highly prevalent in SS. Subclinical cardiac systolic dysfunction (impaired GLS) is also more common, but of mild intensity.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension Block, Chandigarh, 160012, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Sunil Taneja
- Department of Hepatology, PGIMER, Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension Block, Chandigarh, 160012, India
| | - Mohammad Hayat Bhat
- Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, India
| | | | - Vanita Suri
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Bashir Ahmad Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India.
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension Block, Chandigarh, 160012, India.
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Wagner AL, Mathew JL, Carlson BF, Kachoria AG, Bharti B, Suri V, Boulton ML. Measles Vaccination Immunogenicity and Association with Caste in Chandigarh, India. Am J Trop Med Hyg 2022; 107:1129-1131. [PMID: 36191873 PMCID: PMC9709014 DOI: 10.4269/ajtmh.22-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/29/2022] [Indexed: 11/07/2022] Open
Abstract
Measles affects those of lower socioeconomic status disproportionately. This study evaluated the impact of measles vaccination on antibody titers 3 months after vaccination across different socioeconomic groups, with a focus on caste. In total, 169 infants in Chandigarh, India, had serum samples collected immediately prior to vaccination at 9 months of age and 3 months later. Overall, 126 infants (76%) were seropositive (antibody titers > 12 mIU/mL), 26 (16%) were borderline (8-12 mIU/mL), and 14 (8%) were seronegative (< 8 mIU/mL). Seropositivity (versus borderline/seronegative infants) was 0.78 times as high among individuals from the historically marginalized scheduled castes/scheduled tribes compared with the others caste grouping (95% CI, 0.62-0.98). Antibody response was not tied to anthropometric measures but was attenuated among scheduled castes/scheduled tribes with higher incomes. This study provides observational evidence that social structures can be associated with individual immune responses.
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Affiliation(s)
- Abram L. Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Bradley F. Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Aparna G. Kachoria
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | | | - Vanita Suri
- Department of Obstetrics & Gynecology, PGIMER Chandigarh, India
| | - Matthew L. Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan
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Ray A, Samra T, Mahajan V, Singla K, Naik BN, Joshi B, Ashok V, Suri V, Singh M, Ghosh A, Puri GD. Characteristics and outcomes of parturients with COVID-19, admitted to a critical care unit: A single-center retrospective observational study. J Family Med Prim Care 2022; 11:6478-6486. [PMID: 36618233 PMCID: PMC9810863 DOI: 10.4103/jfmpc.jfmpc_551_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background Data on outcomes of coronavirus disease 2019 (COVID-19) in pregnancy are scarce, although they represent a unique physiological state affecting both the mother and child. We present collated data from a tertiary care center in North India, encompassing the outcome, clinical characteristics, and management of these patients. Materials and Methods Parturients ≥ 18 years old, with COVID-19 reverse transcriptase polymerase chain reaction positive for severe acute respiratory syndrome coronavirus 2, requiring intensive care unit (ICU) admission at a tertiary care hospital were included. Data were retrospectively collected from April 2020 to November 2021. Results In all, 26 parturients were admitted to ICU with COVID-19. Five patients were admitted during the first wave, and all were asymptomatic. Twenty-one patients presented during the second wave (March 2021 onward), among which four were asymptomatic and 17 symptomatic (all with severe pneumonia). Three patients presented in the second trimester, all with critical disease, out of which one did not survive. Two patients had twin gestation, and others were singleton pregnancies. Seven patients (27%) were primigravida, and five patients (19.2%) had more than third pregnancy. Twenty critically ill women (77%) delivered during the hospital stay. Six patients died during the second wave, and four deaths (66.7%) were because of COVID-19 acute respiratory distress syndrome (ARDS). Conclusions The number of admissions and mortality related to COVID-19 ARDS was higher in the second wave than in the first. We report the safe use of remdesivir and tocilizumab in our patients.
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Affiliation(s)
- Ananya Ray
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Mahajan
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Varun Mahajan, Assistant Professor, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail:
| | - Karan Singla
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - B Naveen Naik
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bharti Joshi
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vighnesh Ashok
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arnab Ghosh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gupta P, Kapatia G, Gupta N, Ballari N, Rai B, Suri V, Rajwanshi A. Mismatch Repair Deficiency in Adult Granulosa Cell Tumors: an Immunohistochemistry-based Preliminary Study. Appl Immunohistochem Mol Morphol 2022; 30:540-548. [PMID: 35960021 DOI: 10.1097/pai.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adult granulosa cell tumors (AGCTs) are rare ovarian malignant neoplasms; their etiopathogenetic mechanisms remain largely unelucidated. Lately, defects in mismatch repair (MMR) have been implicated in the pathogenesis of AGCTs. Demonstration of MMR deficiency in these tumors can help identify patients potentially eligible for immune checkpoint inhibition therapy. The present study was done to explore the role of MMR deficiency in the etiopathogenesis of AGCTs. METHODS This was a retrospective study conducted on histopathologically confirmed AGCT cases. MMR protein expression was evaluated by immunohistochemistry (IHC) on tissue microarrays using an antibody panel of MSH2, MSH6, MLH1, and PMS2. RESULTS Of a total of 40 ovarian AGCTs evaluated for MMR deficiency, none demonstrated loss of expression of any of the 4 MMR proteins. CONCLUSIONS The results of our preliminary study show that there is no association between MMR deficiency with AGCT. Nevertheless, larger multicenter studies are needed to confirm or refute this observation.
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Affiliation(s)
| | | | - Nalini Gupta
- Department of Cytology and Gynecological Pathology
| | | | | | - Vanita Suri
- Department of Gynecology and Obstetrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sikka P, Suri V, Chopra S, Aggarwal N, Saha SC, Bansal R, Vijayvergiya R, Bahl A. Hypertrophic Cardiomyopathy and Pregnancy: A Retrospective Analysis From a Tertiary Care Hospital. Tex Heart Inst J 2022; 49:e207427. [PMID: 36223225 PMCID: PMC9632386 DOI: 10.14503/thij-20-7427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Pregnancy in women with hypertrophic cardiomyopathy is not well described. In this retrospective study, we analyzed data on pregnant women with hypertrophic cardiomyopathy who were under follow-up care in the cardiology department of a tertiary care hospital. We reviewed data on all women registered in the hypertrophic cardiomyopathy cohort and those who attended the cardio-obstetric clinic and delivered between January 2010 and June 2019. From these 2 groups, we identified 7 pregnant women with hypertrophic cardiomyopathy who delivered during this period. These 7 women (mean [SD] age, 25 [3.3] years) had a total of 15 pregnancies (range per woman,1-4). This was a high-risk cohort, as 7 (46.7%) pregnancies were in the modified World Health Organization class III. The mean (SD) left ventricular wall thickness was 19.71 (2.56) mm in all pregnancies. Two of the 7 women with left ventricular outflow tract obstruction developed severe symptoms in the third trimester; these improved soon after delivery. Eight pregnancies without obstruction were well tolerated. Two pregnancies occurred after successful alcohol septal ablation. Both remained asymptomatic throughout pregnancy. All women tolerated labor well. Adverse maternal outcomes, including death, were not seen in any patient. All women who became symptomatic during pregnancy had relief of symptoms after delivery. Most women remained asymptomatic or had mild symptoms during pregnancy. Of the women with left ventricular outflow tract obstruction, 28.6% had severe symptoms that improved after delivery. Pregnancy was well tolerated after successful alcohol septal ablation.
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Affiliation(s)
- Pooja Sikka
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chopra
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Aggarwal
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhas Chandra Saha
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Bansal
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sharma B, Aggarwal N, Suri V, Siwatch S, Kakkar N, Venkataseshan S. Facility-based stillbirth surveillance review and response: an initiative towards reducing stillbirths in a tertiary care hospital of India. J Perinat Med 2022; 50:722-728. [PMID: 35234022 DOI: 10.1515/jpm-2021-0440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/07/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES India has the highest number of stillbirths in the world in 2019, with an estimated stillbirth rate of 13.9 per 1,000 births. Towards better identification and documentation, a stillbirth surveillance pilot was initiated with the World Health Organization Southeast Asia collaboration in Northern India in 2014. This study aimed to assess whether stillbirth surveillance is feasible and whether this approach provides sufficient information to develop strategies for prevention. METHODS This study followed the framework provided in "WHO Making Every Baby Count" in which mortality audit is conducted in six steps; (1) identifying cases; (2) collecting information; (3) analysis; (4) recommending solutions; (5) implementing solutions; and (6) evaluation. RESULTS A total of 5,284 births were examined between December 2018 and November 2019; 266 stillbirths were identified, giving a stillbirth rate of 50.6 per 1,000 births in a tertiary care referral hospital of northern India. Out of 266 stillbirths, 223 cases were reviewed and recommendations were formulated to strengthen obstetric triage, implementing fetal growth charts, strengthen the existing referral system and improve the communication skills of health care providers for better compliance with clinical practice guidelines. CONCLUSIONS Conducting stillbirth surveillance review and the response of cases in low-middle income countries setting is feasible. As countries progress towards ending preventable mortality, this has the potential to serve as a key process in improving evidence-based and context-specific planning and preventive strategies towards improving the quality of care.
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Affiliation(s)
- Bharti Sharma
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Aggarwal
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sujata Siwatch
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sundaram Venkataseshan
- Department of Pediatrics (Neonatology), Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Vijayvergiya R, Suri V, Sikka P, Kasinadhuni G, Gupta A, Kaur N, Siwatch S, Aggarwal N, Chopra S. Maternal and Fetal Outcomes Following Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Critical Mitral Stenosis: An Experience of a Tertiary Care Center from Northern India. Anatol J Cardiol 2022; 26:552-558. [PMID: 35791711 PMCID: PMC9361397 DOI: 10.5152/anatoljcardiol.2022.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Rheumatic mitral stenosis is the common valvular heart disease seen during pregnancy. Percutaneous transvenous mitral commissurotomy is an effective, safe, and recommended treatment for critical mitral stenosis during pregnancy. We hereby report the maternal and fetal outcomes of pregnant women subjected to percutaneous transvenous mitral commissurotomy at our institute. Methods: Seventy consecutive pregnant women with critical mitral stenosis, who underwent PTMC during the last 10 years, were retrospectively analyzed. All patients had a detailed clinical and obstetric evaluation and were optimally managed with drugs, before the intervention. A comprehensive pre- and post-percutaneous transvenous mitral commissurotomy transthoracic echocardiographic evaluation was performed. Detailed obstetric and fetal outcomes were noted at the time of delivery. Six weeks of post-partum follow-up was noted in all patients. Results: The mean gestational age at the time of percutaneous transvenous mitral commissurotomy was 29.5 ± 6.68 weeks. Percutaneous transvenous mitral commissurotomy was successful in 97% of patients. Post-percutaneous transvenous mitral commissurotomy New York Heart Association functional class, mitral valve area, trans-mitral pressure gradient, and left atrial pressure had a significant improvement (P < .001). The mean gestational age at the time of delivery was 36.92 ± 3.02 weeks. The mean birth weight of live newborn was 2.29 ± 0.55 kg. The fetal complications include growth restriction in 62.85%, preterm delivery in 34.37%, and low birth weight in 67.21%. A delayed percutaneous transvenous mitral commissurotomy at about 30 weeks of gestation did not affect the maternal and fetal outcomes. Conclusion: Percutaneous transvenous mitral commissurotomy is safe and efficacious in managing pregnant women with critical mitral stenosis. There was a significant improvement in clinical symptoms and echocardiographic parameters following percutaneous transvenous mitral commissurotomy.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
- Corresponding author:Rajesh Vijayvergiya✉
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankush Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Navjyot Kaur
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sujata Siwatch
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Neelam Aggarwal
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Seema Chopra
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Kakkar A, Jandial A, Suri V. Atrocious tetrad in paraquat poisoning. QJM 2022; 115:310-311. [PMID: 35294038 DOI: 10.1093/qjmed/hcac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Kakkar
- Department of Internal Medicine, 4th Floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - A Jandial
- Department of Clinical Haematology and Medical Oncology, 4th Floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - V Suri
- Department of Internal Medicine, 4th Floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research , Chandigarh, 160012, India
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Iyengar K, Gupta M, Pal S, Kaur K, Singla N, Verma M, Dhiman A, Singla R, Rohilla M, Suri V, Aggarwal N, Singh T, Goel P, Goel NK, Pant R, Gaur KL, Gehlot H, Bhati I, Verma M, Agarwal S, Acharya R, Singh K, Chauhan M, Rastogi R, Bedi R, Pancholi P, Nayak B, Modi B, Nakum K, Trivedi A, Aggarwal S, Patel S. Baseline Assessment of Evidence-Based Intrapartum Care Practices in Medical Schools in 3 States in India: A Mixed-Methods Study. Glob Health Sci Pract 2022; 10:e2100590. [PMID: 35487543 PMCID: PMC9053154 DOI: 10.9745/ghsp-d-21-00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Implementation research with pre- and post-comparison was planned to improve the quality of evidence-based intrapartum care services in Indian medical schools. We present the baseline study results to assess the status of adherence to intrapartum evidence-based practices (IP-EBP) in study schools in 3 states in India and the perception of the faculty. METHODS A concurrent mixed-methods approach was used to conduct the baseline assessment in 9 medical schools in Rajasthan, Gujarat, and Union Territory from October 2018 to June 2019. IP-EBP among pregnant women in uncomplicated first (n=135), second (n=120), and third stage (n=120) of labor were observed using a predesigned, pretested checklist quantitatively. We conducted in-depth interviews with 33 obstetrics and gynecology faculty to understand their perceptions of intrapartum practices. Quantitative data were analyzed using SPSS (version 22). COM-B (Capability, Opportunity, and Motivation Behavior) model was used to understand the behaviors, and thematic analysis was done for the qualitative data. FINDINGS Unindicated augmentation of labor was done in 64.4%, fundal pressure applied in 50.8%, episiotomy done in 58.3%, and delivery in lithotomy position was performed in 86.7% of women in labor. CONCLUSIONS Intrapartum practices that are not recommended were routinely practiced in the study medical schools due to a lack of staff awareness of evidence-based practices and incorrect beliefs about their impact.
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Affiliation(s)
| | - Madhu Gupta
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Swarnika Pal
- Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Kiranjit Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neena Singla
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madhur Verma
- All India Institute Medical Science, Bathinda, Punjab, India
| | - Anchal Dhiman
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rimpi Singla
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Minakshi Rohilla
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neelam Aggarwal
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tarundeep Singh
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Poonam Goel
- Government Medical College and Hospital, Chandigarh, India
| | - N K Goel
- Government Medical College and Hospital, Chandigarh, India
| | - Reena Pant
- Swai Maan Singh Medical College, Jaipur, Rajasthan, India
| | | | - Hanslata Gehlot
- Dr. Sampurnanand Medical College and Hospital, Jodhpur, Rajasthan, India
| | - Indra Bhati
- Dr. Sampurnanand Medical College and Hospital, Jodhpur, Rajasthan, India
| | - Manoj Verma
- Dr. Sampurnanand Medical College and Hospital, Jodhpur, Rajasthan, India
| | - Sudesh Agarwal
- Sardar Patel Medical College and PBM Hospital, Bikaner Rajasthan, India
| | - Rekha Acharya
- Sardar Patel Medical College and PBM Hospital, Bikaner Rajasthan, India
| | - Keerti Singh
- Rabindranath Tagore Medical College and Hospital, Udaipur, Rajasthan, India
| | - Madhubala Chauhan
- Rabindranath Tagore Medical College and Hospital, Udaipur, Rajasthan, India
| | - Radha Rastogi
- Rabindranath Tagore Medical College and Hospital, Udaipur, Rajasthan, India
| | - Renu Bedi
- Jawaharlal Nehru Medical College and Hospital, Ajmer Rajasthan, India
| | - Poornima Pancholi
- Jawaharlal Nehru Medical College and Hospital, Ajmer Rajasthan, India
| | - Bipin Nayak
- GMERS Medical College and Hospital, Gandhinagar, Gujarat, India
| | - Bhavesh Modi
- GMERS Medical College and Hospital, Gandhinagar, Gujarat, India
| | - Kanaklata Nakum
- Government Medical College and Hospital, Bhavnagar, Gujarat, India
| | - Atul Trivedi
- Government Medical College and Hospital, Bhavnagar, Gujarat, India
| | | | - Sangita Patel
- Government Medical College and Hospital, Baroda, Gujarat, India
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Pragnia P, Arora A, Patil AN, Sikka P, Jain V, Suri V. Developing locoregional evidence through comparison of WHO and national maternal near miss criteria: a cross sectional study experience from low resource setting. J OBSTET GYNAECOL 2022; 42:2535-2539. [PMID: 35321630 DOI: 10.1080/01443615.2022.2039906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Poloju Pragnia
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aashima Arora
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amol N Patil
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Ratho RK, Thakur V, Arya S, Singh MP, Suri V, Das A. Placenta as a site of HEV replication and inflammatory cytokines modulating the immunopathogenesis of HEV in pregnant women. J Med Virol 2022; 94:3457-3463. [PMID: 35257382 DOI: 10.1002/jmv.27699] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Viral hepatitis E is an under-estimated clinical entity with high mortality (20-30%) especially in the third trimester of pregnancy. As complications due to HEV in pregnancy is much more, it is hypothesized that HEV may cross the placenta and replicate in placental tissues even weeks after clearance from the blood, and cytokines may play a role in the immunopathogenesis of HEV in pregnancy. METHODS Twelve pregnant women with features of AVH/ALF and positive for either HEV-IgM/HEV-RNA and thirty pregnant women negative for HEV RNA/IgM/IgG were enrolled as study subjects and healthy controls respectively. Following delivery, 5 ml blood was collected from the mother for HEV-RNA. Replicative RNA and viral load in placental tissue were detected through Real-Time PCR. Placental tissues from the maternal/fetal sides were stained for HEV antigen using HEV-ORF2 antibody by immunohistochemistry and for histopathological changes by H&E. Plasma samples were tested for IL-1β and IL-18 cytokine levels using Duo-R&D ELISA kit, whereas PBMCs were used to study the inflammasomes and IL-1β and IL-18 cytokine genes expression. RESULTS Of the 10 HEV RNA-positive sera, 9 had HEV RNA either in the maternal/fetal side of the placenta with the mean viral load of 137.4 IU/ml. Of the 10 HEV RNA-positive pregnant women, stillbirth in two and fetal and maternal death in one case was reported. Immunohistochemistry revealed strong brownish cytoplasmic staining (HEV antigen) in cytotrophoblasts, and syncytiotrophoblast cells in positive samples. The maternal/fetal side of the infected placenta showed irregular intervillous fibrin deposition as well as tissue necrosis. The mean levels of IL-1β and IL-18 cytokine in serum of infected subjects were significantly higher than the healthy controls (17.31±4.462 vs 8.85±4.36 pg/ml; p<0.0001*** and 2275±536.9 vs 1085±531.7 pg/ml; p<0.0001***) respectively. CONCLUSION Detecting replicative HEV RNA and HEV antigen in placental tissues indicated the extra-hepatic replication of HEV. Further, placental tissue necrosis and a significant rise of cytokine levels in HEV-infected pregnant women might be contributing to the HEV pathogenesis in pregnancy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Radha Kanta Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, 160012, India
| | - Vikram Thakur
- Department of Virology, Postgraduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, 160012, India
| | - Shallu Arya
- Department of Virology, Postgraduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, 160012, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, 160012, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, 160012, India
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, PGIMER, Sector-12, Chandigarh, 160012, India
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Arora N, Gulati P, Suri V, Bhalla A, Singh H. Hemolytic anemia in expanded dengue syndrome. QJM 2022; 115:103-104. [PMID: 34850225 DOI: 10.1093/qjmed/hcab298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Arora
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - P Gulati
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - H Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Sharma R, Mukhopadhyay K, Rawat A, Suri V, Singh S. Immunoglobulin Profile and Lymphocyte Subsets in Preterm Neonates. Indian Pediatr 2022. [PMID: 34992185 PMCID: PMC8964378 DOI: 10.1007/s13312-022-2470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective Methods Results Conclusion Electronic Supplementary Material
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Sharma B, Kulshreshtha S, Aggarwal N, Suri V, Nehra R. Bereavement Care Practices Following Stillbirths: Health-Care Provider's Perspective. Indian J Community Med 2022; 47:30-33. [PMID: 35368488 PMCID: PMC8971884 DOI: 10.4103/ijcm.ijcm_676_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Addressing stillbirth is a difficult task and becomes more challenging with a huge burden and skewed doctorpatient ratio. There is a lack of data regarding the knowledge about the bereavement care practices following pregnancy loss and practices being followed by the health-care providers in the Indian context. The objective of this study is to describe the experience, views, and practices of health-care professionals while managing women with stillbirths. Design: Internet-based Monkey Survey. Methodology: An on-line self completion questionnaire was shared with various health care providers via emails and whats app groups. Results: A total of 281 responses of health-care providers were analyzed, and the majority of them were obstetricians. Almost 90% had managed women with stillbirth, but just a third (38.1%) had provided bereavement care. The majority of them felt the lack of a uniform and comprehensive training model for providing bereavement care to such women. Out of 281 participants, 258 (91.8%) believed that health-care providers should have a bereavement care training and support system, whereas only 23 (8.2%) rejected this idea. Conclusion: There is no defined protocol or standards for providing bereavement care to women following stillbirth. Most health-care professionals feel an urgent need for professional training to bridge the gap between the expectations of patients and the care provided.
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Affiliation(s)
- Bharti Sharma
- Department of Obstetrics Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shatakshi Kulshreshtha
- Department of Obstetrics Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Aggarwal
- Department of Obstetrics Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Singh L, Jain K, Jain A, Suri V, Sharma RR. Massive transfusion protocol: Need of the hour - A tertiary care centre experience. J Anaesthesiol Clin Pharmacol 2022; 38:423-427. [PMID: 36505206 PMCID: PMC9728422 DOI: 10.4103/joacp.joacp_476_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/04/2021] [Accepted: 04/14/2021] [Indexed: 11/07/2022] Open
Abstract
Background and Aims Massive transfusion (MT) in critically ill patients during major volume losses can lead to serious adverse outcomes. Studies have reported that rampant red cell infusion for maintaining perfusion support has had detrimental effects on patients' short- and long-term survival rates. Evidence-based studies quote the importance of maintaining blood product ratio during massive hemorrhage and ensuring good outcomes with the least morbidity and mortality. Material and Methods It is an observational study to compare the ratio of usage of blood products and their role in the outcome of MT cases. Results A total of 70 patients (29 females and 41 males) who received MT were included in the study. There was no fixed ratio of packed red blood cells (PRBC) to blood components for patients with massive hemorrhage. The average ratio of PRBC: fresh frozen plasma (FFP):platelet concentrate (PC) was 1:0.9:0.6. However, blood component therapy with PRBC: FFP ratio between 1 and 2 was associated with a significant rise in post-acute phase hemoglobin value (P value = 0.018). Conclusion Appropriate blood component therapy during the acute bleeding phase in massively transfused patients can further decrease the transfusion demand and transfusion-related complications. There is a need to adhere to the MT protocol for the clinical areas requiring MT in the developing world too.
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Affiliation(s)
| | - Kajal Jain
- Department of Anaesthesiology and Intensive Care, PGIMER, Chandigarh, India
| | - Ashish Jain
- Department of Transfusion Medicine, PGIMER, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Ratti Ram Sharma
- Department of Transfusion Medicine, PGIMER, Chandigarh, India,Address for correspondence: Prof. Ratti Ram Sharma, Department of Transfusion Medicine, PGIMER, Chandigarh, India. E-mail:
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Kaur J, Vatsa R, Suri V, Gainder S, Arora A, Choudhary N, Sharma S. Clinical pregnancy rate of women with unexplained infertility with or without cervical mucus aspiration before intrauterine insemination: A randomized controlled trial. Asian Pac J Reprod 2022. [DOI: 10.4103/2305-0500.361220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bagga R, Suri V, Thami M, Nehra R, Dhaliwal N, Biswal M, Singhal S, Soni A, Joshi L. A Simple Infection Prevention 'Bundle' Including Preoperative Bath With Hair-Wash to Reduce Surgical Site Infection (SSI) Following Elective Caesarean and Gynaecological Surgery in India. J Family Med Prim Care 2022; 11:1970-1979. [PMID: 35800527 PMCID: PMC9254765 DOI: 10.4103/jfmpc.jfmpc_1838_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Surgical site infections (SSIs) may be reduced by following SSI prevention measures. We assessed the SSI rate following caesarean section (CS) and gynaecologic surgery after implementing a simple SSI prevention bundle including preoperative bath and hair wash Methods: The study was carried out in two hospitals in North India (Post Graduate Institute of Medical Education and Research [PGIMER] and Civil Hospital CH) from August 2018 to July 2019. The SSI rate during intervention period (9 months) was compared with baseline rate (3 months). Womens’ knowledge about SSI was assessed preoperatively and after counselling, postoperatively Results: The baseline SSI rate after CS (n = 165) was 11.1% at PGIMER and 8.5% at CH. After gynae surgery (n = 172), it was 13% at PGIMER and 11.5% at CH. During intervention, (CS = 585, gynae surgery = 503), SSI rate was reduced significantly at PGIMER (CS: 11.1% to 3.7%, P = 0.048; gynae surgery: 13% to 7.1%, P = 0.027), but not at CH (CS: 8.5% to 8.2%, P = 0.903; gynae surgery: 11.5% to 11.4%, P = 0.984). Three measures were followed more often at PGIMER than at CH: before CS, bath with hair-wash: 99.3% vs 78.5%, P = 0.00, hair-clipper vs razor: 100% vs 5.1%, P = 0.00 and antibiotic prophylaxis ≤120 min: 100% vs 92.4%, P = 0.00; and before gynae surgery, bath with hair-wash: 93.2% vs 71%, P = 0.00, hair-clipper vs razor: 93.6% vs 1.9%, P = 0.00 and antibiotic prophylaxis ≤120 min: 100% vs 80.8%, P = 0.00. Postoperatively, womens’ knowledge about SSI prevention improved significantly at the two sites Conclusion: The reduction in SSI at PGIMER was attributed to better compliance to SSI prevention measures listed above. Counselling women about simple SSI prevention method like preoperative bath with scalp hair wash increased their knowledge about these significantly.
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Sivaranjani P, Arora A, Suri V. Unintended pregnancies during cancer therapy requiring pregnancy termination: Can these be avoided? Indian J Public Health 2022; 66:533. [PMID: 37039194 DOI: 10.4103/ijph.ijph_924_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Mathew JL, Patel PN, Wagner AL, Suri V, Bharti B, Carlson BF, Boulton ML. Analysis of reasons for loss to follow up in a prospective study in Chandigarh, India and impact from telecom changes. BMC Res Notes 2021; 14:419. [PMID: 34794507 PMCID: PMC8600768 DOI: 10.1186/s13104-021-05837-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Mobile phones are used in research studies, to enroll and follow-up participants, collect data, and implement mHealth initiatives. We conducted a longitudinal study in a birth cohort, where infants were required to make four scheduled visits by 12 months of age. Families of those failing to attend scheduled follow-up visits, were contacted telephonically to ascertain the reasons, which were categorized as: not interested to continue participating, migrated, phone disconnected due to telecom change, or other reason. Results A total of 413 mother-infant dyads were enrolled. The overall attrition was 56%, with majority occurring at the first follow-up visit. This temporally coincided with a telecom service provider announcing strong incentives to switch providers. Attrition monotonically decreased at subsequent visits. The reasons were: moved away (13%), no longer interested (8%), phone disconnected (7%), and multiple other reasons (28%), the majority of whom had unreachable phones. Those who remained in the study and those lost to follow-up were similar on most demographic variables. Among common reasons for attrition in cohort studies, we experienced a new dimension introduced by telecom changes. These findings underscore the need to consider unexpected reasons for attrition in longitudinal studies, and design more robust methods to follow-up participants.
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Affiliation(s)
- Joseph L Mathew
- Advanced Pediatrics Center, PGIMER, Chandigarh, 160 012, India.
| | - Pooja N Patel
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Vanita Suri
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, 160 012, India
| | - Bhavneet Bharti
- Advanced Pediatrics Center, PGIMER, Chandigarh, 160 012, India
| | | | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.,Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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