Shaily Agarwal

Pattern of sexually transmitted infections and reproductive tract infections in women of reproductive age group attending sexually transmitted infections clinic at a tertiary care hospital

Background: Sexually transmitted infections are public health problems, which significantly increase the risk of HIV transmission. A proper understanding of pattern of STIs in different socio demographical areas is important for proper planning of STI control. Reproductive tract infection is caused by sexually transmitted disease and other routes and they are being recognized as a serious public health problem. RTIs cause suffering to both men and women, but their consequences are far more devastating and widespread among women. To describe socio demographic factors related to reproductive tract infections in females of reproductive age group attending STI clinic at obstetrics and gynecology department, GSVM medical college Kanpur. Methods: A cross sectional study was carried out at STI clinic of Department of Obstetrics and Gynecology from 1 January 15-31 December 2016. Data on variables like age, socioeconomic status, habitat, marital status was collected and all symptomatic and asymptomatic women were counselled for examination and investigations and were given syndromic treatment. Results: Out of the 4963 women surveyed, 69% were married, 76% belong to 25-35 age group. Laboratory diagnosed RTI were HIV 1.52%, candidiasis 14.65%, chlamydial infections 27.32%, PID 31.50%, syphilis 0.02%. After syndromic management, prevalence of RTI has significantly reduced Conclusions: Syndromic treatment and health education can definitely reduce STIs and RTIs.

A study to assess knowledge and attitude of antenatal women about maternal nutrition attending a tertiary care centre

Background: Nutrition is the fundamental pillar of human life. All human beings need a balanced amount of nutrients for proper functioning of body system. Inadequate nutrition during pregnancy has a negative impact on the pregnant mother as well as short and long term consequences on the newborn. This study aims to assess knowledge and attitude of antenatal women about maternal nutrition in pregnancy and highlights the need of interventions aimed at promoting awareness about healthy diet during pregnancy in association with various socio demographic factors. Methods: This study was conducted on 850 antenatal women attending the antenatal clinic of UISEMH, Kanpur, Uttar Pradesh, India from August 2015 to February 2016. A 25 point- 10 minute questionnaire was designed to collect information about awareness and myths associated with nutrition in pregnancy from antenatal women. Results: Only 22 % of the women had good knowledge about nutrition during pregnancy and 82% showed willingness to acquire more information about maternal nutrition. Source of information for most pregnant women were immediate family members (41%). Most women were lacking in their knowledge about common local sources of nutrition, adequate weight gain during pregnancy and effects of over and under nutrition. Conclusions: There is need to impart more knowledge to pregnant women about nutrition in pregnancy. More attention should be paid on nutritional guidance among pregnant women especially in young and less well educated women for healthy outcome of mother and babies. This study emphasizes the importance of dietary counselling by attending doctors as an integral part of antenatal care.

Visual inspection with acetic acid for cervical cancer screening in a tertiary health care centre

Background: Cervical cancer is one of the most prevalent malignant neoplasms among women in developing countries. Invasive cervical cancer is preceded by a long premalignant phase known as cervical intraepithelial neoplasia (CIN). The goal of cervical cancer screening is the detection and treatment of precancereous lesions before cancer develops. The objective of the study was to assess visual inspection with acetic acid (VIA) as a screening tool for use in a well-equipped health center , to evaluate VIA as an alternative or adjunct to the Papanicolaou (Pap) smear, and to determine if VIA can play a role in settings other than low resource ones. Methods: This was a prospective study of 1520 asymptomatic women, carried out in 2014-2015. The study was performed at a tertiary care center equipped with the latest-generation technology and highly trained oncologists. The women underwent a complete clinical evaluation, including a Pap smear and VIA. Participants with any positive test were referred for colposcopy and biopsy. Results: More women tested positive by VIA than on the Pap smear (6.9% vs. 4.2%; P =0.0001). There were 27 women with histologic cervical intraepithelial neoplasia grade 1 (CIN1); of these, 12 were detected by Pap and 15 by VIA (P = 0.4). A diagnosis of CIN 2 or 3 (CIN2–3) was confirmed in a total of 11 cases; Pap detected 4 of the cases and VIA 9 of the cases (P = 0.06). The positive predictive value for detection of CIN 2+ was 8.5% for VIA and 6.2% for Pap (P = 0.5). Most importantly, while only 2.8% of patients with a positive VIA were lost to follow-up before colposcopy that was true for 26.5% of the women with a positive Pap smear (P < 0.0001). Conclusions: VIA is useful for detection of precursor lesions of cervical cancer not only in low-resource settings but also in well-equipped health centers and cancer centers. In these non low-resource settings, VIA has a positive predictive value comparable to the conventional Pap smear, but it is more likely to achieve earlier diagnosis, follow-up, and treatment than cytology based screening.

Life-threatening severe sepsis following stapled hemorrhoidopexy

In our case, the problem was in the loose connection between the ETT and the standard connector. With patient taking a deep breath at the same time, there was a strong intrathoracic pressure pulling the un-cuffed ETT into the trachea. Postpartum patients who were on prolonged endotracheal intubation are more likely to develop subglottic stenosis.[3] A high index of suspicion is warranted with the onset of respiratory symptoms following a history of intubation, regardless of the duration of intubation. This case highlights the fact that subglottic stenosis can present as acute airway obstruction.