IMPORTANCEWomen with recent gestational diabetes (GDM) have increased risk of developing type 2 diabetes. OBJECTIVE To investigate whether a resource-appropriate and context-appropriate lifestyle intervention could prevent glycemic deterioration among women with recent GDM in South Asia. DESIGN, SETTING, AND PARTICIPANTS This randomized, participant-unblinded controlled trial investigated a 12-month lifestyle intervention vs usual care at 19 urban hospitals in India, Sri Lanka, and Bangladesh. Participants included women with recent diagnosis of GDM who did not have type 2 diabetes at an oral glucose tolerance test (OGTT) 3 to 18 months postpartum. They were enrolled
Aim: To study the clinical characteristics of adnexal masses in children and adolescents who were treated in our hospital from 2009-2013. Materials and methods:We performed a retrospective analysis of adnexal masses in girls less than 20 years of age. Medical records were reviewed for symptoms, tumour markers, origin /size of the masses, treatment, histopathology and outcome. Data management and descriptive analysis were performed using SPSS 16.0.Results: A total of 58 patients were included in the study. 87% of girls were postmenarchal, (7%) were hypothyroid and 57 were elective admissions. The most frequent symptoms were abdominal pain (82%), swelling (16%) and menstrual disorders (2%).Tumour markers -either LDH, CA -125 , CEA or βhCG were abnormal in 12%. Size of tumour varied from 5-35 cm. The origin of adnexal mass was ovarian in 92% and paraovarian in 8%. The operations included laparoscopy in 13 cases and laparotomy in 45 cases. The type of surgery performed was ovarian cystectomy (15%), paraovarian cystectomy (8%), oophorectomy (35%) and salpingoopherectomy (38%). 2 girls had bilateral masses -frozen section showed immature teratoma, one underwent TAH+BSO and other girl had bilateral ovariotomy done. Ovarian torsion was seen in 25% of cases. Histopathological examination revealed 23 functional lesions, 33 benign and 2 malignant masses. One girl was diagnosed with hydatid cyst intraoperatively and was started on Albendazole. Postoperative course was uneventful in all cases. Conclusion:Adnexal masses are relatively uncommon in children and adolescents. Minimal invasive surgery targeting fertility preservation is recommended in managing these adnexal masses.
Abstract:Context: Metformin therapy for treatment of GDM (Gestational Diabetes Mellitus) is not yet approved by FDA.Objectives: To assess the glycaemic control in women with GDM who received metformin therapy and to know the maternal side-effects and effects on the fetus-neonate. Material and Methods:A preliminary retrospective cohort analysis of 38 women with GDM who received metformin along with dietary advice for control of GDM. The maternal analysis included the time of initiation of metformin therapy, the glycaemic control, the need to add insulin and the side-effects. Fetal outcome analysis included Apgar score at birth, birth weight, neonatal hypoglycaemia, still birth rate and congenital malformations. The goals of glycaemic control were achieved by a pre-prandial Blood sugar of 60-70 mg%; post prandial blood sugar of 120-140mg%. Results:The mean age was 27.5 years and gestational age at diagnosis and initiation of metformin therapy was 24 weeks and 3 days. Twenty-four percent were diagnosed during first trimester. Ninety percent achieved glycaemic control with a dose of 1500 mg of metformin. Ten percent required an increment in dose up to 2250 mg and an addition of small dose of insulin only after 35 weeks of gestation. The mean birth weight was 3.12 kg and 13% were LGA. There were no cases of maternal or neonatal hypoglycaemia and no stillbirths, congenital anomalies or neonatal deaths. Conclusion:Metformin therapy resulted in optimum control of blood sugar in most of the women with GDM without any significant side-effects in the mother or in the fetus-neonate.
DOICC By 025Citation: Haritha S, Kumar S, Lakshminarayanan S, Dasari P (2017) Human Papilloma Virus vaccine -awareness and acceptability amongst medical students in a tertiary teaching hospital in South India. J Gynecol Res Obstet 3(2): 025-028. Clinical Group AbstractObjectives: To evaluate awareness and acceptability of HPV vaccine amongst medical students in a tertiary teaching hospital. Materials and methods:This was a cross sectional descriptive study carried out in a tertiary hospital in South India in January 2015. A self-administered questionnaire in English was given to 310 undergraduate medical students after obtaining consent. Parameters studied included awareness and acceptability of HPV vaccine. Data was analysed using SPSS 16 software.Results: Response rate in this study was 100%.40% of students were <20 years of age, while the remaining were between 21-25 years, while gender distribution was equal (50%). 92% felt that HPV is preventable. 89% were aware of HPV vaccine and in 74% the source of information was medical books/ classes. 81% knew of barrier contraceptive as method of HPV prevention. 54% thought that the vaccine is approved for the age group 10-20 years. 50% didn't know that that the vaccine could be administered to males and 60% felt that screening for cervical cancer is necessary prior to vaccination. Need for cervical cancer screening post vaccination was supported by 80% of students. Approximately 50% of the students were not aware of the types, route, doses and 76% were not aware of the contraindications of HPV vaccine. 40% felt that it is protective only against cervical cancer and were unsure of the effi cacy. 68% didn't know the duration of protection and 78% had no idea about the cost. Overall 40% said that they would have the vaccine, 41% were not sure and 18% didn't want to have the vaccine. 50% of the students felt that HPV vaccine should be incorporated in National Immunisation programme. Conclusion:There is a lack of adequate knowledge regarding HPV prevention even among medical students. Health education and awareness campaigns on HPV prevention with more attention to the benefi ts of vaccination are necessary in order to improve acceptance of vaccination thereby preventing cervical cancer in future.
Context General practitioners as well as obstetricians are coming across a large number of pregnant women whose conceptions are following a period of infertility or treatment for the same. There is a controversy in the literature regarding the occurrence of adverse outcomes of pregnancy in such women. Aims To assess the maternal and perinatal outcome in pregnancies that occurred after a period of infertility and to compare the outcome in spontaneous conceptions with the conceptions following treatment for infertility Settings and Design Retrospective analysis of hospital records of 200 pregnancies following infertility during the year 2009 in a tertiary care center in South India. Material and Methods All the women were divided into two groups, viz: Group 1—those who had history of infertility but conceived spontaneously and Group 2—those with history of infertility and conceived only after treatment for infertility. The main outcome measures were antenatal complications and adverse neonatal complications. Statistical analysis The statistical package SSPS version 15.0. Chi-square and student ‘t’ test was used for nonparametric and parametric variables. Results The incidence of hypertension was 60% and that of gestational diabetes was 7%. Obstetric complications included increased incidence of preterm labor (23.5%) and premature rupture of membranes (38%). There was no statistically significant difference in both groups though the medical complications especially hypertension was high in the pregnancies following spontaneous conceptions, i.e. untreated group. There was a greater demand for the NICU care mainly because of prematurity. The PNMR was (40/1000) less than the institutional rate of 72/1000 births. Conclusions There is increased incidence of hypertension premature rupture of membranes and preterm delivery in pregnancies following infertility. There is no significant statistical difference in the adverse pregnancy outcomes between spontaneous conception and those treated for infertility. Key Messages Pregnancies following infertility are at increased risk of developing hypertension and preterm labor and hence these women should be screened for the same and preventive measures to be undertaken to achieve good maternal and perinatal outcome.
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