Many countries across the world have made newborn screening (NBS) mandatory. It is a laboratory test which screens the newborns for metabolic & genetic disorders, some of which can be treated or modified if detected early in life, and thereby preventing potentially disastrous consequences and saving the baby’s life. The last four decades have witnessed rapid evolution in implementation & strategies used for NBS in US, Europe, Japan & other industrialised nations where NBS is well accepted public health policy. India is going through a progressive transitional phase of control over infant mortality & morbidity due to infections and emergence of genetic conditions. This is the right time to review NBS program in totality considering the global scenario of its initiation, growth, advances in technologies & its transfer from conventional to mass spectrometry techniques, as well as selection & nature of candidate NBS disorders. Nevertheless, the impact of this worldwide movement of NBS is inadequate in India; this review article discusses the various efforts required to successfully introduce this significant health service for population benefits as well as the lacunae & limitations still exist in 21st century in India. Based on the high-risk screening of congenital metabolic conditions using mass spectrometry in India, the first hand experience of more than a decade is shared here to provide better opportunities & guidelines to those who have serious urge to pursue NBS as an important preventive public health program, be it at government, public or private level for the masses of India.
Objectives: To evaluate the feasibility, simplicity, effectiveness of meshplasty procedure using polypropylene mesh in the management of female stress urinary incontinence (SUI).
Methods: A total of 75 patients in the age group of 35 to 70 years having clinical evidence of stress urinary incontinence with or without various degrees of genital prolapse were included in the study. Patients were evaluated preoperatively by history taking, detailed general and systemic examinations, various clinical tests and investigations including urodynamic studies in some. A polypropylene mesh of appropriate length was placed at mid-urethral level. Simultaneous repair of pelvic floor defect and/or vaginal hysterectomy was performed in the same sitting. Postoperative follow up included physical examination and assessing patient’s level of satisfaction. In some cases urodynamic studies were carried out.
Results: None of the patients had intraoperative or postoperative complications.
Conclusions: Our meshplasty for the correction of stress urinary incontinence is simple, quick, easy to perform, and cost effective.
stress urinary incontinence, meshplasty, polypropylene meshObjective(s): To study the epidemiology and outcome of pregnancy complicated by obstetric cholestasis (OC).
Methods(s): Retrospective case control study of 45 women with OC at a tertiary private hospital from November 2003 to November 2006. Statistical analysis was performed using the z test when appropriate. A p value <0.05 was considered statistically significant.
Results: The incidence of OC was 8.2%. The most common symptom was generalized pruritus which appeared after 28 weeks in 73.3% cases. The cesarean section rate was 93.3%. A higher incidence of meconium staining in amniotic fluid at delivery (17.1% vs 1.1%, p<0.005) and preterm premature rupture of membranes (8.9% vs 1.1%, p<0.01) was noted without an increase in preterm delivery rate (24.4% vs 15.6%, not significant). There was no statistically significant difference in the following parameter - pathological cardiotocography, 1-5 minuteApgar score <7, intrauterine growth restriction, neonatal intensive care admission or perinatal mortality. There was no case of postpartum hemorrhage.
Conclusion: The incidence of OC is high in the Indian population. Perinatal outcome is good in actively managed women, although at the cost of a high intervention rate.
obstetric cholestasis, perinatal outcome, meconiumObjectives: To create awareness, lay down a new criterion to pick up probable cases, and draw a proper management protocol for hypothyroidism in pregnancy.
Methods: Inclusion criteria – All normal pregnant women and those with thyroid problems were included in the study. Exclusion criteria –All others who had diabetes, collagen disease, heart disease with pregnancy were excluded from the study. Eighty two women were screened for hypothyroidism in pregnancy using T3, T4, TSH and FT4.Anew screening criterion was followed [TSH value – 0.5-1.5 mIU/ml i.e biological range].Women with TSH in pregnancy were followed up.Women with TSH value above 3mIU/ml, were considered hypothyroid and received treatment with L-Thyroxin. The group with a TSH value 2-3 mIU/ml was assessed with FT4. Those with low values or those with increasing TSH value on subsequent follow up received treatment.
Results: Study group consisted of 62 primigravidae and 20 multigravidae. A. 40[32P + 8M] > 3 TSH value, these women received treatment with L-Thyroxin B. 24[16P + 8M] 2-3 TSH value, C. 18[14P + 4M] <2 TSH value. According to thyroid status, they were categorized into euthyroid – [27 true euthyroid + 4 potential hypothyroid] and overt hypothyroid – [43 adequately treated and 6 inadequately treated], two were untreated. Inadequately treated and potential hypothyroid pregnant women landed with miscarriages or pregnancy inducted hypertension, oligohydramnios and IUGR.
Conclusions: Potential and inadequately treated hypothyroid patients present with problems in pregnancy, while adequately treated hypothyroid and true euthyroid women get normal ongoing pregnancies. So to identify these potential or overt hypothyroid women, thyroid screening with T3, T4, TSH and FT4 must be done during prenatal period, at first booking, and repeated at 8 weeks interval thereafter, in pregnancy. TSH value should be kept below 2mIU/ml to get adequate control.
screening in pregnancy, thyroid and pregnancy, hypothyroidismObjective(s): To evaluate the efficacy of single dose nevirapine in the prevention of mother to child transmission of HIV-1 in 30 HIV-1 infected parturients. Material and
Method(s): This study was necessary since any study has not been conducted in an Indian population, were usually women are not offered antiretroviral therapy during pregnancy but only peripartum. East Godavari District of Andhra Pradesh, India, has the highest prevalence (2.5%) of HIV-1 positive antenatal women, according to NACO estimations. Therefore, the study was conducted in Lutheran General Hospital, Rajahmundry, East Godavari District, Andhra Pradesh, India, at a 50- bedded hospital offering health care to people living with HIV/AIDS. One year prospective study with 30 primigravidae infected with HIV-1, were planned for elective cesarean section. Single dose 200mg tablet was administered two hours prior to the cesarean section and all babies were given nevirapine syrup 2mg/kg within 72 hours of birth. Babies were tested for HIV-1 at one and two weeks of birth.
Result(s):All the women were primigravidae. Nineteen babies born to these mothers tested positive for HIV-1 after two weeks, confirming the transmission rate to be 63.33% (95% CI of proportion 45.36% - 78.15%). Thus, the efficacy of single dose nevirapine in preventing mother to child transmission was found to be 36.67%. Neonatal morbidity was more in those babies that were HIV positive. Two neonatal deaths occurred in two weeks and both babies were HIV-1 positive.
Conclusion(s): Single dose nevirapine is associated with a lower efficacy in preventing mother to child transmission of HIV-1.
HIV, mother to child transmission, prevention, single dose nevirapne