Writing a paper for publication in a medical Journal is more of a science than an art. Every author who sends a paper for publication confidently believes that his paper is very good and unquestionably merits publication. He is surprised and disappointed to find the paper rejected as happens very often.
An essential attribute of a good paper is that the topic or subject of the paper should be of interest to the reader of the concerned journal. Ideally the paper should provide good new information to the readers or throw light on those aspects of the subject which are controversial. Repeating studies already done time and again makes no sense and wastes time, energy, money and manpower. The study must have a definite aim directed to acquire new knowledge. You must study the subjects scientifically by applying modern methods of conducting research. The study must be planned meticulously well before the first participant is enrolled. Ethical conduct of research is mandatory today. No harm should be done to the subjects voluntarily participating in the research. They should be subjected to the least inconvenience. Their informed consent must be obtained in writing. No journal would publish a paper unless the research study is approved by the ethics committee.
The purpose of the ethics committee is to protect the interests of the study subjects. The study in all detail must be approved by the ethics committee before it starts. The ethics committee also ensures periodically that the study is actually being conducted as per the plan approved by the committee. The goal of every study is to be able to draw universally applicable valid conclusions. In other words the study must have good power. Although 90% power is desirable a minimum power of 80% is obligatory. The number of subjects needed to be studied for achieving this power is arrived at with the help of a biostatistician. An underpowered study is unlikely to be accepted by the editors. Studying a number larger than necessary amounts to waste of precious resources.
We are living in an era in which we must practice evidence based medicine and this evidence must be tested on the touchstone of statistics. This inevitably means that a biostatistician must be a part of any good research study. He helps in planning the study besides analyzing the results and evaluating them statistically.
Women with polycystic ovaries (PCOS) frequently present with reproductive dysfunction. However, when these women do finally achieve pregnancy, after intensive treatment, they are faced with a substantially high risk of miscarriage in the first trimester. This review deals with the pathophysiology and management of pregnancy loss in women with PCOS.
Recurrent miscarriage, described as the loss of three or more consecutive pregnancies, affects 1% of couples trying to conceive. Amongst the various causes , PCOS is the most commonly identified ultrasound abnormality amongst women with recurrent pregnancy loss 1. Its incidence ranges from 40 to 56% of women with recurrent pregnancy loss. Conversely, rate of early pregnancy loss is reported to be 30 to 50% in women with PCOS, which is 3 fold higher than the rate of 10 to 15% in normal women 2.
It is clear that a fully functional CL is an important prerequisite for both nidation and the normal progress of early pregnancy. Normal formation and function of the CL and optimal endometrial preparation for implantation of the conceptus depend on a number of factors, a deficiency of any one of which may result in luteal phase inadequacy and thereby predispose to early pregnancy wastage.
The duration of luteal function in the nonfertile menstrual cycle is limited to no more than 10 to 15 days 3. Theoretically, each menstrual cycle is potentially a fertile one. The mechanism responsible for spontaneous luteolysis, viz., the timely and inevitable demise of the CL when pregnancy fails to occur, remains unknown despite considerable investigations. An important feature of the endocrinology of the early pregnancy is the prolongation or maintenance of luteal function, a process commonly known as CL rescue. Luteal support remains essential until approximately the seventh week of gestation, presumably the time when the trophoblast has acquired sufficient steroidogenic capacity to support the pregnancy by itself. Lutectomy induces abortion in most women if performed prior to 7 weeks of gestation whereas removal of the CL after that time has no effect.
OBJECTIVE(S) : To review trends in maternal mortality in apex hospitals of western Maharashtra.
METHOD(S) : Data on maternal deaths were collected from our institute (KIMS) and Satara district health unit for the last 5 years. Maternal mortality data from three apex hospitals for the last four decades were reviewed for comparison of trends in maternal mortality rates (MMR) and causes of maternal death.
RESULTS : Maternal deaths from KIMS and Satara district health unit were reported to be 191 during the years 2000 to 2005 giving maternal mortality rate (MMR) of 32 per 10,000 births. Except for 51 deaths all were attributed to hemorrhage and pregnancy induced hypertention (PIH). In a review of data over last four decades MMR has declined from 210 (1967) to 37 (2005). There is a marked decline in MMR related to intrapartum complications, abortions and sepsis.
CONCLUSION(S) : MMR for all causes of maternal deaths declined significantly from 1966 to 1998. It has remained steady at 32 to 40 per 10000 births thereafter. Hemorrhage and PIH have emerged as greatest killers.
OBJECTIVE(S) : To assess ascorbic acid and uric acid levels in GDM.
METHOD(S) : Plasma vitamin C and serum uric acid levels were analysed in 25 patients of GDM and 25 normotensive pregnant women who served as controls.
RESULTS : Significantly low vitamin C levels were observed in GDM as compared to those in controls (P<0.05). Significantly high serum uric acid levels were observed in GDM as compared to those in controls (P<0.05).Vitamin C and uric acid levels showed a significant negative correlation (r = 0.25,P<0.05).
CONCLUSION(S) : These findings indicate decreased detoxification or free radical scavenging capacity in GDM and compensatory elevation of uric acid confers protection in pregnancies complicated by diabetes.
OBJECTIVE(S) : To assess the safety and efficacy, complete abortion rate, induction abortion interval (IAI), and side effects of misoprostol for voluntary termination of second trimester pregnancy.
METHOD(S) : Fifty selected women admitted for second trimester (13-22 weeks) abortion from January 2005 to November 2005 were administered 800 mg misoprostol intravaginally followed by 300 mg sublingually every 3 hours upto a maximum of 3 doses or till abortion if it occured earlier. They were observed for 24 hours. Main outcome measures were IAI, success rate, complete abortion rate, mean blood loss and side effects.
RESULTS : Of the 50 women, 49 aborted within 24 hours of administration of vaginal misoprostol giving a success rate of 98%. The complete abortion rate was 88%. Mean IAI was 9.36 ± 3.50 hours and mean dose of misoprostol required was 1485.63 ± 219.25 mg. The mean blood loss was 60.2 ± 2.01 mL. The main side effects were vomiting, diarrhea and fever in 12% each.
CONCLUSION(S) : Intravaginal misoprostol (800 mg) followed by sublingual (300 mg x 3 hourly) misoprostol is a safe, effective, cheap and acceptable method for the second trimester pregnancy termination.
OBJECTIVE(S) : To study the rubella seroprevalance rates in children, in newborns with congenital anomalies, and in women with bad obstetric history.
METHOD(S) : A total of 489 blood samples were collected by veinous puncture from both women, and children attending out patient departments of pediatrics, and obstetrics and gynecology. Samples were tested for the presence of rubella specific IgM antibody by ELISA.
RESULTS : Fifteen out of 334 women (4.49%) and 11 out of 155 children (7.9%) were positive for rubella specific IgM antibodies.
CONCLUSION(S) : The prevalence of rubella specific IgM antibodies in women with affected children and newborns (7.09%) with congenital anomalies was higher than that in women with bad obstetric history (4.9%). There is a need to screen all the women attending antenatal clinic for the presence of rubella specific IgM antibodies which indicates recent infection with rubella virus. This would prevent pregnancy wastage and congenital anomalies in the newborns.
OBJECTIVE(S) : To study the role of trace elements in anemic pregnant women in their second and third trimester.
METHOD(S) : One hundred and fortyfive pregnant women in their second and third trimester were enrolled in this prospective study and serum trace elements estimation for iron, copper and zinc was done using atomic absorption spectrophotometry.
RESULTS : There were significantly lower levels of serum iron and zinc (P<0.001) in anemic women as compared to those in nonanemic pregnant women in second and third trimester. Copper and hemoglobin levels were found inversely correlated and serum copper was significantly higher (P<0.001) in anemic pregnant women than in nonanemic ones in second and third trimester.
CONCLUSION(S) : There appears to be an intriguing interrelation between iron, copper and zinc in absorption and utilization. Therefore combined zinc and iron supplementation should be recommended to pregnant women, especially those with anemia.
OBJECTIVE(S) : TO determine the prevalence of bacterial vaginosis in pregnant women and its role in causing preterm labor and to determine the most significant test of Amsel’s criteria.
METHOD(S) : A prospective study of laboratory diagnosis of bacterial vaginosis by applying Amsel’s criteria to 100 subjects between 28 to 37 weeks of gestational age with preterm labor and 100 controls with same gestational age. The accuracy of different tests of bacterial vaginosis were also compared.
RESULTS : Bacterial vaginosis was associated with 44% cases of preterm labor, wherein other causes of preterm labor were excluded, compared to 23% of controls. The reletive risk of preterm labor due to bacterial vaginosis was 1.9 and P value was 0.0016. The detection of clue cells in vaginal smear and Whiff test, when applied independently, had high sensitivity and high positive and negative predictive values.
CONCLUSION(S) : Bacterial vaginosis is an important cause of preterm labor. The detection of clue cells in vaginal smear is the most accurate laboratory test and Whiff test is the most accurate bed side test, when applied independently for diagnosis of bacterial vaginosis.
OBJECTIVE(S) : To find the incidence of different nonpelvic causes of menorrhagia with special emphasis on careful history taking, clinical examination and inclusion of simple blood tests to diagnose hemostatic disorders.
METHOD(S) : Fifty women of 15-45 years age, having menorrhagia without any pelvic cause and treated from 1st June, 2004 to 31st May, 2005 were selected for this retrospective study. After a detailed history and general examination all patients were subjected to blood tests for complete blood count, bleeding time, prothrombin time, activated partial thromboplastin time (aPTT) and serum T3, T4, TSH levels. Special tests were reserved, wherever applicable, to diagnose the cause of menorrhagia. Results were analyzed statistically by 2 x 2 chi square test with Yate’s correction.
RESULTS : Hypothyroidism (20%) and inherited coagulopathy (18%) were the two most common nonpelvic causes of menorrhagia. Menorrhagia from menarche (P<0.001), bleeding from other sites (P=0.007), history of previous operative bleeding (P<0.001), and history of postpartum bleeding (P<0.001) were statistically significant in patients with underlying hemostatic disorders.
CONCLUSION(S) : A detailed history, clinical examination and simple blood tests can detect various nonpelvic causes of menorrhagia.
OBJECTIVE(S): To find which of the two risk factors - age and parity, play dominant role in cervical carcinogenesis.
METHOD(S): Detailed information regarding age and parity has been available in 12,456 women registered for cervical cytology between January 1992 and May 2005 at our gynecological out patient department. Critical analysis was carried out in these women categorizing them into two groups viz., women of different age groups with varying parity and women of different parity groups with varying age.
RESULTS: The incidence of squamous intraepithelial lesion (SIL) in the present series was 10.5% (1314 /12456) while squamous cell carcinoma was 0.8% (109 /12456). The incidence of SIL and carcinoma cervix showed progressive rise with increasing age and parity. The detailed analysis of the two groups defined above revealed SIL incidence rising with increasing parity in nearly all age groups and with increasing age in nearly all parity groups but the corresponding figures were much higher in women of high age and high parity. The SIL rate was found to be maximum in women of high age with high parity. Similar trend was also seen in case of carcinoma cervix.
CONCLUSION(S): Women of high age with high parity are at very high risk of developing carcinoma cervix and this may be due to cumulative effect of both these risk factors. Hence women of this category need special attention for mandatory cytological screening.
OBJECTIVE(S): To explore the effect of extracellular products of cervical isolates from the cases of unexplained infertility on spermatozoa.
METHODS(S): Thirty endocervical isolates obtained from 11 cases of unexplained primary infertility were studied for the effect of culture supernatants on motility and decapitation of human spermatozoa. Effect on rat, cow bull and buffalo bull spermatozoa was similarly studied.
RESULTS: Sixteen isolates showed significant decrease in motility of spermatozoa. Out of 16 isolates, 5 isolates not only showed a decreased the motility of spermatozoa but also decapitated a few spermatozoa. This effect was more pronounced on rat spermatozoa where 100% decapitation could be observed whereas in humans only 14-17% spermatozoa were decapitated. There was no prominent effect on cow bull and buffalo bull spermatozoa.
CONCLUSION(S): Decapitation of spermatozoa occurred with supernatants of Bacillus sp. and Pseudomonas sp.
OBJECTIVE(S) : To determine the risk fators of induced abortion in relation to contraceptive behaviour
METHOD(S) : A matched case control study was undertaken to investigate the possible association of induced abortion (MTP) and contraceptive behavior. Data were collected from 80 married abortion seekers attending family welfare clinic attached to Medical College, 80 pregnant controls who wanted to continue pregnancy, and 80 nonpregnant controls receiving service at the study hospital. Conditional logistic regression analysis was done for predicting risk factors.
RESULTS : Bivariate analysis showed a strong association between induced abortion and contraceptive use. Using only natural methods of contraception is found to be a significant predictor for induced abortion (OR 5.2; P = 0.0002). Mean frequency of intercourse per month was higher in subjects than in pregnant controls (3.7 vs 2.8; P = 0.018) and in nonpregnant controls (3.7 vs 2.2, P = 0.005). Women who communicate rarely with their partners about contraception have a high risk of induced abortion (OR; 2.57, P = 0.028). Attitude towards induced abortion was also found to be significant (OR 30; P <0.001) for pregnant controls and (OR 10.33; P < 0.001) for nonpregnant controls. Multivariate analysis showed three statistically significant variables (P < 0.05) using only natural methods of contraception, rare discussion about contraception with partners, and frequent intercourse.
CONCLUSION(S) : Natural methods of contraception, increased frequency of sexual intercourse, and rare communication with partners about contraception were found to be significant predictors for seeking abortion.
OBJECTIVE(S) : To find out the efficacy and safety of intravaginal misoprostol insertion for second trimester termination of pregnancy.
METHOD(S) : One hundred and forty cases of second trimester termination of pregnancy done from September 2001 to August 2004 using intravaginal misoprostol 600 mg followed by 400 mg every 4 hourly till abortion or a maximum of 2600 mg over 24 hours were analyzed.
RESULTS : A majority of the women was married, the mean gestational age was 26.42 years, and the mean gravidity 2.96 ± 1.56. The success rate was 99.26%. The mean induction abortion interval was 12.27± 5.71 hours. However, it was more in primigravidas as compared to that in multigravidas. The mean dose of misoprostol required was 1638.57 ± 322.67 mg. The side effects observed were nausea, vomiting, diarrhea and fever.
CONCLUSION(S) : Intravaginal misoprostol is a safe, effective, cheap and acceptable method for second trimester termination of pregnancy.
