Garima Kachhawa

Effect of vitamin D supplementation on insulin kinetics and cardiovascular risk factors in polycystic ovarian syndrome: a pilot study

To assess the effect of vitamin D supplementation on parameters of insulin sensitivity/resistance (IS/IR) and insulin secretion in subjects with polycystic ovarian syndrome (PCOS). A prospective double-blind randomized control trial was conducted to assess the effect of vitamin D on insulin kinetics in women with PCOS. The trial was conducted in a tertiary care research hospital. A total of 36 subjects with PCOS, aged 18–35 years, were included in this study. Vitamin D3 4000 IU/day versus placebo was given once a month for 6 months and both groups received metformin. IS (by whole-body IS index or Matsuda index), IR (by homeostasis model assessment IR (HOMA-IR)), and insulin secretion (by insulinogenic index; II30) were the main outcome measures. Secondary outcome included blood pressure (BP), lipid profile, disposition index (DI), and vascular stiffness. Out of 36 subjects who consented, 32 completed the study. Subjects were randomized into two groups: group A (n=15; metformin and vitamin D 4000 IU/day) or group B (n=17; metformin and placebo). Oral glucose tolerance tests with 75 g glucose were carried out at baseline and 6 months after supplementation. Hypovitaminosis D was observed in 93.8% of all subjects with mean serum 25 hydroxy vitamin D level of 7.30±4.45 ng/ml. After 6 months of vitamin D supplementation, there was no significant difference in any of the parameters of IS/IR (area under curve (AUC)–glucose, AUC–insulin, insulin:glucose ratio, HOMA-IR, Matsuda index, insulinogenic index, and DI), II30, and cardiovascular risk factors between the two groups. Supplementation of vitamin D, at a dose of 4000 IU/day for 6 months, did not have any significant effect on parameters of IS/IR and insulin secretion in subjects with PCOS.

Prediction of gestational diabetes mellitus at 24 to 28 weeks of gestation by using first-trimester insulin sensitivity indices in Asian Indian subjects

The aim of the present study was to predict the development of gestational diabetes mellitus (GDM) after 24 weeks of gestation by using first-trimester insulin indices. A total of 298 nondiabetic pregnant women underwent 3-hour oral glucose tolerance test (OGTT) in the first trimester of pregnancy. The normoglycemic women underwent second OGTT between 24 and 28 weeks. Insulin sensitivity and resistance indices were calculated by using the Matsuda index (composite insulin sensitivity from OGTT), quantitative insulin sensitivity check index, and homeostasis model assessment for insulin resistance and sensitivity by using the results of the first-trimester OGTT. These indices were compared between subjects who were diagnosed as having GDM and subjects with normal glucose tolerance in the second OGTT. The overall prevalence of GDM was 15.49% (24 in the first trimester and 16 between 24 and 28 weeks). First-trimester fasting plasma insulin greater than 7.45 μU/mL was able to predict GDM with sensitivity and specificity of 80% and 57.4%, respectively. The negative predictive value for this parameter was 0.97. Values of first-trimester composite insulin sensitivity from OGTT less than 5.5 had sensitivity and specificity of 71.4% and 62.5% for the prediction of GDM. First-trimester hyperinsulinemia preceded the onset of hyperglycemia between 24 and 28 weeks of gestation and would predict the development of GDM with limited sensitivity and specificity.

Laparoscopic-Assisted Uterovaginal Anastomosis in Congenital Atresia of Uterine Cervix: Follow-up Study

STUDY OBJECTIVE To study the efficacy, safety, and functional outcomes of laparoscopic-assisted uterovaginal anastomosis with placement of a silicone tube as stent in congenital cervical atresia. DESIGN Descriptive study (Canadian Task Force classification II-3). SETTING Tertiary care referral hospital. PATIENTS Fourteen consecutive patients (mean [SD] age, 15.2 [2.0] years) with congenital absence of a uterine cervix, associated with partial or complete vaginal aplasia. INTERVENTIONS Laparoscopic-assisted uterovaginal anastomosis with placement of a silicone stent was performed to treat cervical agenesis. In cases with associated vaginal aplasia, modified McIndoe vaginoplasty was performed concomitantly. Follow-up assessment was performed at 1, 3, and 6 months, and then yearly. MEASUREMENTS AND MAIN RESULTS Of 14 patients with congenital cervical anomalies, cervical dysgenesis was observed in 5 (35.7%), and cervical agenesis in 9 (64.2%). All patients with cervical agenesis also had a partial or complete noncanalized vagina. The procedure was successfully completed in all patients. Main outcome measures were functional capability and postoperative complications. Mean (SD) follow-up after surgery was 3.8 (1.2) years. Postoperatively, all but 1 patient (92.8%) experienced regular menses, with complete relief of cyclical abdominal pain. One patient underwent hysterectomy because of genital infection and re-stenosis. Concomitant vaginoplasty was performed in 9 patients (64.2%) with associated vaginal aplasia, and vaginal length was 6.5 (1.2) cm at 6-month follow-up. Five patients (35.7%) are sexually active, and report it to be satisfactory. Pregnancy has been achieved in 3 of the 5 patients (60%). CONCLUSIONS Laparoscopic-assisted uterovaginal anastomosis may be considered the treatment of choice in patients with cervical agenesis, and radical treatment such as hysterectomy can be averted. The procedure is successful insofar as resumption of menstrual function. However, long-term reproductive outcome in these young girls will require further follow-up.

Severe hydrops in the infant of a Rhesus D-positive mother due to anti-c antibodies diagnosed antenatally: a case report

IntroductionRhesus haemolytic disease of the newborn is a prototype of maternal isoimmunisation and fetal haemolytic disease. There are other rare blood group antigens capable of causing alloimmunisation and haemolytic disease such as c, C, E, Kell and Duffy. In India, after the confirmation of a newborns blood group, antibodies are screened only if the mother is Rehsus D-negative negative and the father is Rhesus D-positive. Hydrops in Rhesus positive women are investigated along the lines of non-immune hydrops.Case presentationWe report the case of a patient from India where irregular antibodies were requested for an O-positive 26-year-old mother in order to investigate fetal hydrops. Anti-c antibody was revealed and the fetus was treated successfully with compatible O negative and c negative intrauterine blood transfusions. The baby was treated postnatally with double volume exchange transfusion with the same compatible blood, and was discharged 30 days after birth.ConclusionWe highlight the importance of conducting irregular antibody screening for women with significant obstetric history and fetal hydrops. This could assist in diagnosing and successfully treating the fetus with appropriate antigen negative cross-matched compatible blood. We note, however, that anti-c immunoglobulin is not yet readily available.

Randomized controlled trial comparing ferric carboxymaltose and iron sucrose for treatment of iron deficiency anemia due to abnormal uterine bleeding

To evaluate the efficacy and safety of intravenous ferric carboxymaltose (FCM) in comparison with intravenous iron sucrose (ISC) in the treatment of anemia due to abnormal uterine bleeding (AUB).

Successful Outcome in a Rare Case of Large Adrenal Myelolipoma duringPregnancy Complicated by Uterine Inversion

Primary adrenal tumours are often functioning, and include adrenal cortical adenomas or phaeochromocytomas. With advances in imaging, uncommon tumours are more frequently reported. These are myelolipoma, lipoma, teratoma, angiomyolipoma and liposarcoma. Adrenal myelolipoma are rare tumors with few cases reported during pregnancy.

Maternal and perinatal outcome in gestational diabetes mellitus in a Tertiary Care Hospital in Delhi

Background: Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance first diagnosed in pregnancy and may be associated with adverse maternal and perinatal outcome. Aim: The aim of the study was to determine the maternal and perinatal outcome in GDM during pregnancy. Materials and Methods: It is a retrospective analysis of women diagnosed with GDM who got antenatal care and delivered in our hospital in previous 5 years. Another 191 women with normal pregnancy without GDM and other medical conditions were taken as control. The baseline characteristics (age, body mass index, religion, and socioeconomic status) were noted in all cases. Diagnosis of GDM was made using oral glucose tolerance test with 75 g glucose. GDM patients were started on diet following which insulin or oral hypoglycemic agents were given if required. Maternal and perinatal outcome was noted in all women.Results: The prevalence of GDM was 5.72% (170/2970). Most patients (79.41%) could be controlled on diet alone. However, 21 (12.35%) needed insulin and 14 (8.23%) needed oral hypoglycemic agents. Middle socioeconomic status was more common in GDM than control and pregnancy-induced hypertension was more common in GDM (13.5%) than in control (6.3%) (P = 0.019). Mode of delivery was not different in two groups. Instrumental deliveries and postpartum hemorrhage were also similar. However, mean birth weight was significantly higher in GDM (2848 ± 539 g) than in control (2707 ± 641 g) (P = 0.004). Incidence of large-for-date babies was also higher (28.2%) in GDM than control (19.4%) (P = 0.005). In neonatal complication, hypoglycemia was significantly higher in GDM (20.6%) than in control (5.2%) (P = 0.001). However, the incidence of hyperbilirubinemia and congenital malformations was not significantly different in two groups. Conclusion: The prevalence of GDM was 5.72% in this study. Adequate treatment of GDM on diet, oral hypoglycemic agents, or insulin to achieve euglycemia can achieve near-normal maternal and neonatal outcome.

The temporal trend of vascular function in women with gestational diabetes

The objective of the study was to assess the temporal changes in vascular function during pregnancy in healthy women and in those with gestational diabetes mellitus (GDM). Assessment of vascular function was done at three time points, 11–13+6 weeks+days, 20–22+6 weeks+days and 30–32+6 weeks+days, by flow-mediated dilatation (FMD), augmentation index (AIx) and carotid-radial pulse wave velocity (crPWV) in women (n=100) with singleton pregnancies. Out of the 100 women, 20 developed GDM, who were compared with 20 healthy, age-matched pregnant women in a nested case-control design. Women with GDM had lower FMD% in the third compared to the first trimester (6.77 (4.36–9.96) vs 9.76 (6.66–16.61)%; p = 0.026); however, FMD% was similar on inter-group comparison between GDM and healthy pregnancies. AIx was significantly higher in GDM than healthy pregnancies at both first (15.35 ± 10.57 vs 6.45 ± 9.81%; p<0.05) and second trimesters (15.00 ± 8.44 vs 2.50 ± 9.01%; p<0.05). A higher AIx in early pregnancy differentiates women with GDM from those with healthy pregnancies.

A Comparison of the Strength of Association of Reid Colposcopic Index and Swede Score With Cervical Histology.

Objective Colposcopic scoring systems provide an objective diagnosis and select patients who require treatment. A new scoring system, Swede score, has added lesion size as a parameter. This study aimed to compare the strength of association of Reid colposcopic index versus Swede score and assess their utility in low-resource settings. Methods In this prospective study, 150 women aged 30 to 59 years with abnormal screening result were enrolled. All women underwent colposcopy; the findings were scored by both Reid colposcopic index and Swede score, biopsy taken from all abnormal areas. Performances of both the scores were calculated. Results A total of 33 (22%) CIN 2+ lesions were detected. Reid colposcopic index at a cutoff of 5 had sensitivity, specificity, positive predictive value, and negative predictive value for detecting CIN2+ lesions of 96.97%, 95.35%, 88.89%, and 98.8%, respectively. Using Swede score at a cutoff of 8, sensitivity, specificity, positive predictive value, and negative predictive value were 42.42%, 100%, 100%, and 81.9%, and with a cutoff of 5, these were 100%, 88.37%, 76.74%, and 100%, respectively. The correlation coefficient (R2) was 0.919. By Spearman rank correlation coefficient, the strength of correlation between Swede score and RCI was 0.937 (p < .001). Conclusions Swede score can be used flexibly depending on the setting. The lower threshold (5) with high sensitivity can be used for screening, whereas the higher threshold (8) with high specificity can be used for screen-and-treat selection to decrease the overtreatment rate. Thus, it is a more attractive option for cancer prevention programs in low-resource settings.

Management of narrow introitus with Fenton's operation followed by successful pregnancy in a woman with repaired bladder exstrophy

Bladder exstrophy is a rare congenital anomaly, with incidence varying from 1:30,000 – 1:50,000 live births; involvement of females being rarer (Giron et al. 2011). It involves maldevelopment of the infraumbilical anterior abdominal wall, urinary tract, external genitalia and pelvis. Th e quality of life of these individuals is considerably aff ected with an array of problems, such as urinary incontinence, prolapse, problems in social integration, psycho-sexual life, pregnancy complications, newborn care, etc. Pregnancies have been reported in these women (Sayeeda et al. 2012; Sharma et al. 1998; Ikeme 1981; Mariona and Evans 1982; Mathews et al. 2003). Managing pregnancy is unique in these women, despite repair due to deformities of external genitalia, pelvic fl oor defects, expected post-surgical dense lower abdominal adhesions involving the bladder and absence of anterior pelvis.