Browsing by Author "Madhu Jain"

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A case of endometriosis in episiotomy scar with anal sphincter involvement and extension into ischiorectal fossa
(Jaypee Brothers Medical Publishers (P) Ltd, 2014) Shuchi Jain; Soma Ghoshal; Mohan Kumar; Madhu Jain
Episiotomy scar endometriosis is characterized by presence of endometrial tissue (glands and stroma) and is a rare condition. It may also extend and involve the anal sphincter. The ideal treatment is wide excision to prevent recurrence but it may cause fecal incontinence, if the anal sphincter is involved. We describe here a case with much deeper extension into ischiorectal fossa. She was treated with wide local excision and primary sphincteroplasty. She has remained free of recurrence up to 12 months follow-up. © 2014, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.
A Correlation between Antral Follicle Count and Anti-Müllerian Hormone in Healthy Indian Women of Reproductive Age
(Jaypee Brothers Medical Publishers (P) Ltd, 2022) Shivi Jain; Ram C. Shukla; Madhu Jain; Usha Singh; Tej B. Singh
Aim: To determine which of the two parameters between antral follicle count (AFC) and anti-Müllerian hormone (AMH) had better correlation with age in healthy females, and also to estimate the strength of correlation between AMH and AFC. Materials and methods: This was a prospective, cross-sectional study comprising 1,181 fertile women of age 20–40 years, who were divided into four age groups, i.e., group I (20–24 years), group II (25–29 years), group III (30–34 years), and group IV (35–40 years). AFC and AMH were measured on third day of menstrual cycle. Pearson correlation and linear regression analysis were used. Statistical Package for Social Sciences, trial version 20, was used for the statistical analysis. A p-value of <0.05 was considered statistically significant. Results: The correlation coefficients between AFC and age, AMH and age, AMH and AFC were r = −0.403, r = −0.824 and r = 0.328; p <0.001, respectively. A strong positive correlation (r = 0.986, p <0.001) was noted between AMH and age in group I, while strong negative correlations (p <0.001) were noted in other groups. The correlations between AFC and age (r = −0.177) and AMH and AFC (r = 0.175) were significant (p <0.05) only in group IV. Age accounted for 16.3% variation in AFC and 67.8% variation in AMH. Conclusion: AMH correlated better with age than AFC. There was a weak correlation between AMH and AFC. Clinical significance: The counselling of a woman about her reproductive potential should be based on both AFC and AMH taken together, apart from chronological age, to avoid false sense of security or unnecessary alarm. © The Author(s). 2022.
A Prospective Observational Study Comparing Contrast-Enhanced Ultrasonography (CEUS) and Magnetic Resonance Imaging (MRI) in Evaluating Adnexal Lesions
(Springer, 2025) Roshni Mandal; Shuchi Jain; Shivi Jain; Madhu Jain
Aim: To study and compare the number, size, location, and character of adnexal lesions identified by CEUS and MRI and correlate the results with gross intra-operative and histopathological findings. Background: CEUS is a newly emerging diagnostic modality. It involves the administration of intravenous contrast agents consisting of microbubbles. The distinguished acoustic properties of the gas in the microbubble enable it to produce high-frequency harmonics that enhance the ultrasound images. CEUS provides the ability to detect intralesional microvascularity. It can produce real time imaging and thus can be used during interventional procedures. Methods: It was a prospective observational study with a sample size of 150 study subjects. The contrast agent used in our study is commercially known as Sonovue, which is made of Sulphur hexafluoride microbubbles. Results: 150 cases of adnexal masses were studied. There was no significant difference between CEUS and MRI reports with respect to the size of the lesions as shown by a t-test (t = 0.06, p = 0.53) and Pearson correlation coefficient (r = 0.96, p = 0.001). Disagreement regarding character of the lesion was seen only in a few number of cases. Gross per-operative findings and histopathology reports showed 100% concordance with the investigative results. Conclusion: 150 subjects with adnexal masses were evaluated. No statistically significant difference was found between CEUS and MRI findings with regard to size, character, location, intra-operative appearance and histopathological results of the lesions. Thus we can conclude that CEUS can be considered an effective alternative to MRI for the evaluation of adnexal lesions. © The Author(s) 2025.
Age-Specific Nomograms for Antral Follicle Count in Fertile and Infertile Indian Women: A Comparative Study
(Thieme Medical Publishers, Inc., 2023) Shivi Jain; Ram Chandra Shukla; Madhu Jain; Rabindra Nath Mishra
Objectives: The aim of this study was to develop age-specific nomograms for antral follicle count (AFC) in fertile and infertile Indian women and (2) to compare the influence of age on AFC in both groups. Setting and Design: It is a prospective cross-sectional study in a tertiary-care hospital in north-central India. Methods and Material: One-thousand four-hundred seventy-eight fertile and 1,447 infertile women (primary infertility) of reproductive age (18-49 years) were recruited. One-thousand one-hundred eighty-one fertile and 1,083 infertile women fulfilled the selection criteria for the study. Transvaginal ultrasonography was done on the second or third day of the menstrual cycle. Statistical Analysis: Age-specific nomograms for AFC were built for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles in both groups. Correlation and regression analysis was done to estimate the relationship between the study variables. Statistical analysis was done by using IBM SPSS Statistics for Windows, version 20. Results: At every age, each percentile value of AFC was lower in infertile than in fertile women. The decline of AFC with increasing age was linear in both fertile (r = - 0.431, p < 0.001) and infertile (r = - 0.520, p < 0.001) women; however, the rate was higher in the latter (0.50 follicle/year) than in former (0.44 follicle/year) group. The variation in AFC explained by age was 16.3% in fertile and 22.7% in infertile women. Conclusion: AFC decreased linearly with advancing age in both fertile and infertile women, but more rapidly in the latter. The age only modestly explained the decline of AFC. The age-specific percentile thresholds for AFC should be used instead of age-independent constant thresholds in infertility counselling. © 2023. Indian Radiological Association. All rights reserved.
Antral follicle count in normal (fertility-proven) and infertile Indian women
(Georg Thieme Verlag, 2014) Arjit Agarwal; Ashish Verma; Shubhra Agarwal; Ram Chandra Shukla; Madhu Jain; Arvind Srivastava
Background: Antral follicle count (AFC) has been labeled as the most accurate biomarker to assess female fecundity. Unfortunately, no baseline Indian data exists, and we continue using surrogate values from the Western literature (inferred from studies on women, grossly different than Indian women in morphology and genetic makeup). Aims: (1) To establish the role of AFC as a function of ovarian reserve in fertility-proven and in subfertile Indian women. (2) To establish baseline cut-off AFC values for Indian women. Settings and Design: Prospective observational case-control study. Materials and Methods: Thirty patients undergoing workup for infertility were included and compared to equal number of controls (women with proven fertility). The basal ovarian volume and AFC were measured by endovaginal. USG the relevant clinical data and hormonal assays were charted for every patient. Statistical Analysis Used: SPSS platform was used to perform the Student's t-test and Mann-Whitney U-test for intergroup comparisons. Correlations were determined by Pearson's ranked correlation coefficient. Results: Regression analysis revealed the highest correlation of AFC and age in fertile and infertile patients with difference in mean AFC of both the groups. Comparison of the data recorded for cases and controls showed no significant difference in the mean ovarian volume. Conclusions: AFC has the closest association with chronological age in normal and infertile Indian women. The same is lower in infertile women than in matched controls. Baseline and cut-off values in Indian women are lower than that mentioned in the Western literature.
Assessment of clinical outcomes and prescribing behavior among inpatients with severe preeclampsia and eclampsia: An Indian experience
(2014) Shefalika Kumar; Dipika Bansal; Debasish Hota; Madhu Jain; Pawan Singh; Bl Pandey
Objectives: The study aims to evaluate the management, maternal-fetal outcomes, and prescription behavior among inpatients with severe preeclampsia and eclampsia. Materials and Methods: This prospective cohort study in a tertiary referral center was conducted in 164 inpatient pregnant women who fulfilled the inclusion criteria. The study was conducted between November 2005 and February 2007. The patients were followed-up till delivery. Antepartum and intrapartum care and maternal and perinatal outcome were noted. Chief outcome measures were maternal and perinatal mortality and drug use indicators. Results: Median age at delivery of the women was 25 (22-28) years. Majority were suffering from antepartum eclampsia (52.5%), followed by preeclampsia (31%) and postpartum eclampsia (16.5%). Nulliparity (61.6%) was more common in eclampsia, while multiparity in preclamptic group. A total of 48% had preterm delivery. Most presented with headache (50%) and hyperreflexia (29%). Only 15% presented with all three prodromal symptoms and 86% had hypertension. There was increased morbidity, operative intervention, and admission to intensive care unit. Most babies (67%) weighed <2.5 kg and had poor outcome. The maternal mortality was 0.4/1000. Average number of drugs prescribed in patients of preeclampsia, antepartum eclampsia, and postpartum eclampsia were 13.2, 14.9, and 14.2, respectively. Antibiotics (24.6%) were the most common class of the drugs prescribed in all the groups, followed by vitamin and calcium supplements (22.7%) and antihypertensives (13.5%). Most common antihypertensive used were calcium channel blockers and anticonvulsant magnesium sulphate. Conclusions: There was increased maternal and perinatal morbidity. Protocols for the management of eclampsia, including antihypertensive and anticonvulsant therapies, should be available and reviewed regularly to improve the standard of care and reduce the prevalence of this dangerous condition.
Capillary Hemangioma of the fallopian tube
(Journal of Clinical and Diagnostic Research, 2016) Richa Katiyar; Shashikant C. U. Patne; Shreekant Bharti; Madhu Jain
Neoplastic lesions of the fallopian tube are rarely seen by surgical pathologists. Haemangioma of the fallopian tube is an extremely rare benign neoplasm. A 30-year-old lady with polymenorrhea and dysmenorrhea underwent hysterectomy and bilateral salpingo-oophorectomy. Her left fallopian tube showed a 2mm sized solid nodule in the wall. Histopathological examination revealed a well-defined vascular lesion in the left fallopian tube, consistent with capillary haemangioma. The vascular endothelium was highlighted by CD34 immunostaining. Our literature review has identified 10 cases of cavernous haemangioma of the fallopian tube. To the best of our knowledge, we report the first ever case of capillary haemangioma of the fallopian tube. This is also the smallest detected haemangioma in the fallopian tube. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.
Chemical Shift Artifact on Steady-State MRI Sequences for Detection of Vesical Wall Invasion in Placenta Percreta
(Federation of Obstetric and Gynecologycal Societies of India, 2016) Ishan Kumar; Ashish Verma; Shivi Jain; Madhu Jain; R.C. Shukla; Arvind Srivastava
Background: Antenatal diagnosis of the invasiveness of a placenta percreta helps in planning the surgical approach, reducing blood loss and morbidity. Doppler sonography is the mainstay diagnostic modality with a sensitivity of 80–95 %. With the advent of high magnetic field MRI techniques, there has been recent interest in evaluation of placenta by MRI. On an extensive PUBMED search, we could not find any citations describing imaging, ultrasound, or MRI features to evaluate vesical wall invasion by placenta percreta. Purpose: We attempt to evaluate transmyometrial vesical wall invasion by placenta percreta using chemical shift artifact as a marker of intact bladder-myometrial interface on steady-state MRI sequences. Materials and Methods: This is a prospective observational study, conducted at a university hospital. We have compiled clinico-radiological criteria for diagnosis of invasive placentae based on the existing body of evidences, in four patients. We further go on to analyze a specific proposed sign on a newly introduced MR imaging sequence i.e., loss of chemical shift artifact (India ink line) on steady-state GRE sequence (TrueFISP), to diagnose transmyometrial vesical invasion in placenta percreta. Results: Though the sample size is small, the sensitivity, specificity, positive, and negative predictive value of the proposed sign for the purpose was 100 %. Conclusions(s): Loss of chemical shift artifact (India ink line) on steady-state GRE sequences at the vesico-myometrial junction in case of invasive placentae confirms vesical wall invasion, a prospective diagnoses of which can help in planning the surgical protocol and preventing potentially fatal blood loss. © 2015, Federation of Obstetric & Gynecological Societies of India.
Clinical Profile of Obstetric Patients Getting Admitted to ICU in a Tertiary Care Center Having HDU Facility: A Retrospective Analysis
(Federation of Obstetric and Gynecologycal Societies of India, 2018) Soumya Ranjan Panda; Madhu Jain; Shuchi Jain
Background: The critically ill obstetric patient represents a challenge that usually requires a multidisciplinary approach. Lack of awareness and the absence of regular antenatal care make the critically ill patients to be referred late and sometimes in moribund conditions. The objective of the present study is to determine the incidence, predictors and outcome of obstetric ICU admissions. Methods: This retrospective study was conducted over a period of 2 year from July 2015 to June 2017 in Department of Obstetrics and Gynecology at Institute of Medical Sciences, BHU, Varanasi, India. Results: Out of a total of 4986 deliveries, 756 patients underwent HDU admission, while 92 obstetric patients were admitted to ICU during this study period. Maximum number of patients (73.91%) were in the age-group of 20–35 years, 64.13% of patients constitute lower socioeconomic status group, 68.47% of patients reside in rural area and there was inadequacy in receiving antenatal care in case of 60.86% of patients. Maximum number of patients were admitted for a period of 4–7 days. Blood transfusion (64.1%), the use of inotropic drugs (45.6%), central line placement (44.5%) and mechanical ventilation (26.08%) were the major interventions performed in ICU. Obstetric hemorrhage was found to be the most frequent clinical diagnosis leading to ICU admission (31.5%) followed by hypertensive disorders (25%). Conclusion: In addition to timely referral, health education and training of health professionals may improve clinical outcome and better obstetric practice, especially in countries like India. Obstetric ICU dedicated for the management of only obstetric patients should be constructed in order to compensate for heavy burden critically ill women. © 2017, Federation of Obstetric & Gynecological Societies of India.
Complement component 5a receptor 1 and leukotriene B4 receptor 1 regulate neutrophil extracellular trap (NET) formation through Rap1a/B-Raf/ERK signaling pathway and their deficiency in term low birth weight newborns leads to deficient NETosis
(Elsevier B.V., 2024) Doli Das; Hiral Thacker; Khushbu Priya; Madhu Jain; Shambhavi Singh; Geeta Rai
Background: Neutrophil extracellular traps (NETs) being one of the predominant activities of neutrophils has become its key defense mechanism owing to its extensive role in inflammation and infection. However, the mechanisms regulating NET formation or NETosis still remains to be better understood. Our earlier whole genome transcriptomic data revealed two G-protein couple receptors (GPCRs) − complement component 5a receptor 1 (C5aR1) and leukotriene B4 receptor 1 (LTB4R1) were downregulated in term low birth weight (tLBW) newborns with deficient NET formation abilities. Neutrophils employ C5aR1 and LTB4R1 for mediating their immune responses, inflammation and antimicrobial activity. Hence, this study was aimed to explore the role of two GPCRs, C5aR1 and LTB4R1 including their downstream signaling molecules in NETs induction and regulation. Methods: The validation of the transcriptomic data for C5aR1 and LTB4R1 was done using quantitative real time PCR. Pharmacological inhibition of C5aR1 and LTB4R1 using W-54011 and LY223982 on neutrophils of adults and newborns’ was done to study their impact on NETosis. Extracellular DNA release, Reactive oxygen species (ROS) generation, expression of NET proteins, and signaling molecules downstream to C5aR1 and LTB4R1 were quantified using plate reader based assay, immunofluorescence, and western blotting. Myeloperoxidase (MPO)-DNA quantified by flow cytometry. Knockdown studies using siRNA against C5aR1 and LTB4R1 were done in HL-60 cells derived surrogate neutrophils and expression of downstream molecules of the two GPCRs, C5aR1 and LTB4R1 signaling axis along with NET proteins was quantified by western blotting. Results: The expression of C5aR1 and LTB4R1, extracellular DNA, ROS and NET associated proteins (NE, CitH3, PAD4 and MPO) was notably increased upon NET induction in healthy adults and normal birth weight (NBW) newborns’ neutrophils. Pharmacological inhibition of these two GPCRs led to substantial reduction in NETosis, extracellular DNA, ROS generation, and expression of NET associated proteins like CitH3, NE, PAD4, MPO along with downstream signaling molecules Rap1a, B-Raf and pERK. Our observations suggest a precise role of C5aR1 and LTB4R1 on induction of NETs via Rap1a/B-Raf/ERK signaling axis. Conclusion: The C5aR1 and LTB4R1 signaling via Rap1a/B-Raf/ERK axis acts as a signal-relay mechanism to regulate NET formation in neutrophils. Further, C5aR1 and LTB4R1 signaling cascade along with NET-associated proteins are remarkably downregulated in tLBW newborns’ neutrophils leading to impaired NETosis in them. Therefore, C5aR1 and LTB4R1 and their signaling molecules could provide an effective therapeutic target for compromised NETosis like tLBW newborns. © 2024
Correlation between antral follicle count and anti-Mullerian hormone in infertile Indian women
(Regional Institute of Medical Sciences, 2021) Shivi Jain; Ram Chandra Shukla; Madhu Jain; Usha Singh; Tej Bali Singh
Background: Antral follicle count (AFC) and anti-Mullerian hormone (AMH) have been used as indicators of ovarian reserve in infertile women. There still exists a debate about the association between the two parameters. Objective: The objective of the study was to find out the relationship between AFC and AMH in infertile women. Methods: This was a prospective, hospital-based, cross-sectional study, in which 1083 infertile women (aged 20– 40 years) with primary infertility were included. They were divided into four age groups, i.e., Group I (20–24 years), Group II (25–29 years), Group III (30–34 years), and Group IV (35–40 years). AMH and AFC were measured on 3rd day of menstrual cycle. Pearson correlation and linear regression analysis were done to find out the relationship between age, AFC, and AMH. Statistical analysis was done using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA). A P < 0.05 was considered statistically significant. Results: There was modest negative correlation of AFC with age (r = −0.476, P < 0.001). AMH showed strong negative correlation with age (r = −0.844, P < 0.001) and modest positive correlation with AFC (r = 0.400, P < 0.001). For separate age groups also, statistically significant correlations (P < 0.05–P < 0.001) were noted between age, AFC, and AMH. Age explained 22.7% variation in AFC and 71.2% variation in AMH. Conclusion: There was a significant correlation between AMH and AFC in infertile women. AFC showed a continuous decline with increasing age. However, AMH increased with age till third decade of life and showed negative correlation with AFC. Thereafter, AMH started decreasing with age and showed positive correlation with AFC. © The Authors.
Correlation of Clinical, Hormonal, Biochemical and Ultrasound Parameters Between Adult and Adolescent Polycystic Ovarian Syndrome: Adult and Adolescent PCOS
(Springer, 2022) Shivi Jain; Madhu Jain; R.C. Shukla
Purpose: To correlate the clinical, hormonal, biochemical and ultrasound parameters in adolescent patients with polycystic ovarian syndrome (PCOS) and to compare them with adult patients. Methods: This was a prospective, correlational study. 50 adult (20–35 years) and 50 adolescent patients (15–19 years) who had features of PCOS (Rotterdam Criteria, 2003) were selected. The control group comprised of 50 women of same age in each group with normal parameters. Pelvic ultrasound was done in early follicular phase (3–5th day of menstrual cycle). Assessment of hormonal and biochemical parameters (LH/FSH ratio, free testosterone level, lipid profile and fasting glucose/insulin ratio) and grey-scale ultrasound was done. Results: No significant difference was observed in menstrual pattern in adults and adolescents with PCOS. The mean values of serum LH/FSH ratio and free testosterone were significantly higher in both adult and adolescent PCOS patients as compared to their controls (p < 0.001). The mean value of serum insulin was significantly higher (p < 0.001) with positive correlation (adult: r = 0.655, p < 0.01; adolescent: r = 0.451, p < 0.01) of serum insulin with free testosterone. Hyperandrogenemia without hyperinsulinemia was found in 56% adolescent and 60% adult PCOS patients. 82% adolescent and 88% adult PCOS patients showed multiple follicles (> 5) on ultrasound. The ovarian morphology had positive correlation with serum LH and free testosterone. The mean ovarian volume was significantly higher in adult (10.48 ± 4.38 vs. 4.17 ± 0.91) and adolescent (11.08 ± 5.82 vs. 4.23 ± 0.89) PCOS patients, when compared with controls, respectively. Conclusion: No statistically significant difference was noted in PCOS between adults and adolescents. © 2021, Federation of Obstetric & Gynecological Societies of India.
Diagnosis of Genital Tuberculosis in Infertile Women by Using the Composite Reference Standard
(Hindawi Limited, 2022) Riden Saxena; Kriti Shrinet; Sachchida Nand Rai; Kamal Singh; Shivi Jain; Shuchi Jain; Deeksha Singh; Shampa Anupurba; Madhu Jain
Female genital tuberculosis (FGTB) can be asymptomatic or even masquerade as other gynecological conditions. Conventional methods of FGTB diagnosis include various imaging, bacteriological, molecular, and pathological techniques that are only positive in a small percentage of patients, leaving many cases with undiagnosed condition. In the absence of a perfect diagnostic method, composite reference standards (CRSs) have been advocated in this diagnostic study. This study assesses the agreement between traditional diagnostic modalities using CRS and prevalent TB groups among different fallopian tube infertility manifestations. A total of 86 women with primary and secondary infertility were included in the study and subjected to bacteriological, pathological, and radiological examination for the diagnosis of FGTB. Results were evaluated statistically for concordance of the diagnostic tests to the CRS by sensitivity and specificity, while PPV and NPV were calculated for the performance of diagnostic tests of FGTB. We observed that 11.2% of women were found to be true positives by means of CRS. The positive findings by CRS were as follows: ultrasonography (13.9%), laparoscopy (14%), hysteroscopy (12%), GeneXpert (4.8%), culture (4.8%), polymerase chain reaction (4.8%), and histopathology (6.4%). GeneXpert and culture were found to have a perfect agreement with CRS. Hysterosalpingography, laparoscopy, and hysteroscopy have a fair agreement with CRS. Out of 43 women with tubal factor infertility, 6 women were found in the definitive TB group with mixed conditions of tubal manifestations. This study evaluates and demonstrates the reliability of the collective assessment of various diagnostic methods with CRS findings that help in identifying different TB groups of genital tuberculosis patients from all infertile patients by applying the criteria of CRS. © 2022 Riden Saxena et al.
Diagnostic Role of Transvaginal Sonography and Magnetic Resonance Imaging in Adenomyosis of the Uterus and its Correlation with Histopathology
(Wolters Kluwer Medknow Publications, 2023) Shivi Jain; Kamlesh Kumar; Ram Chandra Shukla; Madhu Jain
Background and Objective: The prevalence of adenomyosis of the uterus varies from 5% to 70%, and there is no clear consensus on its imaging diagnostic criteria. The objective of this study was to evaluate the role of transvaginal sonography (TVS), combined TVS and color Doppler (TVS-CD), and magnetic resonance imaging (MRI) in the diagnosis of adenomyosis. Materials and Methods: This was a tertiary care hospital-based prospective study, in which 365 clinically suspected cases of adenomyosis were enrolled. All three types of imaging (TVS, TVS-CD, and MRI) were done in 233/365 patients, followed by hysterectomy in 50. Imaging features were correlated with the histopathological examination (HPE), which was taken as the gold standard for the diagnosis. The diagnostic performance of each imaging modality was assessed. Results: Among patients who underwent hysterectomy, 36/50 (72%) had adenomyosis on HPE, with or without associated benign gynecological abnormalities. Sensitivity, specificity, positive predictive value (PPV), negative PV (NPV), and diagnostic accuracy (DA) of MRI were higher than that of TVS-CD (91.67% vs. 77.78%, 85.71% vs. 78.57%, 94.29% vs. 90.32%, 80% vs. 57.89%, and 90% vs. 78%, respectively). TVS alone had lower diagnostic performance (specificity: 64.29%, PPV 84.85%, NPV 52.94%, and DA74%) than TVS-CD, but equal sensitivity (77.78%). Heterogeneous myometrium was the most sensitive (80.56%), while myometrial cyst was the most specific (92.86%) TVS feature. The maximum junctional zone thickness ≥12 mm was the most sensitive (97.22%), while the hyperintense myometrial focus was the most specific (100%) MRI feature. Conclusion: TVS-CD should be used as an initial diagnostic imaging modality in clinically suspected cases of adenomyosis; however, MRI due to better diagnostic efficacy should be the imaging modality of choice before subjecting such patients to hysterectomy. © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
Does preoperative urodynamic testing improve surgical outcomes in patients undergoing the transobturator tape procedure for stress urinary incontinence? a prospective randomized trial
(Korean Urological Association, 2014) Abhinav Agarwal; Sudheer Rathi; Pranab Patnaik; Dipak Shaw; Madhu Jain; Sameer Trivedi; Udai Shankar Dwivedi
Purpose: Urodynamic studies are commonly performed as part of the preoperative work-up of patients undergoing surgery for stress urinary incontinence (SUI). We aimed to assess the extent to which these urodynamic parameters influence patient selection and postoperative outcomes.; Materials and Methods: Patients presenting with SUI were randomly assigned to two groups: one undergoing office evaluation only and the other with a preoperative urodynamic work-up. Patients with unfavorable urodynamic parameters (detrusor overactivity [DO] and/or Valsalva leak point pressure [VLPP] < 60 cm H2O and/or maximum urethral closure pressure [MUCP] < 20 cm H2O) were excluded from the urodynamic testing group. All patients in both groups underwent the transobturator midurethral sling procedure. Evaluation for treatment success (reductions in urogenital distress inventory and incontinence impact questionnaire scoring along with absent positive stress test) was done at 6 months and 1 year postoperatively.; Results: A total of 72 patients were evaluated. After 12 patients with any one or more of the abnormal urodynamic parameters were excluded, 30 patients were finally recruited in each of the “urodynamic testing” and “office evaluation only” groups. At both the 6- and the 12-month follow-ups, treatment outcomes (reduction in scores and positive provocative stress test) were significantly better in the urodynamic testing group than in the office evaluation only group (p-values significant for all outcomes).; Conclusions: Our findings showed statistically significantly better treatment outcomes in the urodynamic group (after excluding those with poor prognostic indicators such as DO, low VLPP, and MUCP) than in the office evaluation only group. We recommend exploiting the prognostic value of these urodynamic parameters for patient counseling and treatment decisions. © The Korean Urological Association, 2014.
Effect of Orlistat Versus Metformin in Various Aspects of Polycystic Ovarian Syndrome: A Systematic Review of Randomized Control Trials
(Federation of Obstetric and Gynecologycal Societies of India, 2018) Soumya Ranjan Panda; Madhu Jain; Shuchi Jain; Riden Saxena; Smrutismita Hota
Background: Polycystic ovarian syndrome (PCOS), a commonly prevalent endocrinopathy among reproductive age group women, is most often associated with obesity. Increased insulin resistance appears to be the central pathophysiologic mechanism responsible for various complications of PCOS. This makes ‘weight loss’ as the first-line treatment approach in PCOS. So various trials have tried to compare metformin (an insulin-sensitizing agent) and orlistat (an anti-obesity drug) aiming to achieve weight loss and hence higher ovulation rate for the group of obese PCOS patients. Keeping an eye on all these background facts, we designed this systematic review and metaanalysis to compare the effects of metformin and orlistat on various aspects of PCOS and to pick the better among the two drugs. Materials and Methods: This is a systemic review of randomized control trials that studied the effectiveness of orlistat versus metformin in terms of improvement in ovulation rate, weight loss, lipid profile, etc. Systematic literature search over the period January 2000–December 2016 was performed in the following electronic databases: Medline, embase, google scholar, pubmed and The Cochrane Library and only randomized controlled clinical trials were included in our study. All authors carefully went through all sources of information independently. Results: According to this study, weight loss, testosterone level after 4 weeks of treatment, total serum cholesterol and triglyceride level showed significant fall in orlistat-treated group. Conclusion: Our review shows that orlistat is a more effective drug than metformin and should be the preferred drug in obese PCOS in combination with weight loss. © 2018, Federation of Obstetric & Gynecological Societies of India.
Evaluating the effects of back massage during labour on delivery outcomes: A prospective study on primigravida mothers
(IP Innovative Publication Pvt. Ltd., 2024) Anitha Moncy; Madhu Jain; Ashok Kumar; Shuchi Jain; Akash Mishra; Sangeeta Kansal
Background and Objectives: The labor and delivery process can be stressful for parturient women, especially for primigravida mothers. Birth companions providing massage and emotional support can help make more pleasant birthing experience. This study aimed to assess the impact of back massage by trained birth companions on reducing analgesic use, pain intensity scores, and labor duration. Materials and Methods: The study was conducted on primigravida women. During antenatal care visits, companions in the intervention group were trained in massage techniques, while no training was imparted to companions in the control group. Data were collected using a pre-tested questionnaire during antenatal clinic visits and delivery A multivariable logistic regression model was used to assess the impact of massage on delivery outcomes while adjusting for significant confounding variables. Results: The study demonstrated a positive impact of back massaging on labor and delivery outcomes. Mothers in the massaged group were 2.27 times less likely to receive analgesics and 3.71 times more likely to experience a reduction in pain intensity scores of > 2 compared to those receiving usual care. Additionally, the massaged group had a 2.24 times higher likelihood of reducing labor duration to < 12 hours compared to the usual care group. Conclusion: Back massaging by trained birth companions is an effective intervention for reducing the use of analgesics, pain intensity scores, and the length of labor in primigravida women. © 2024 Author(s).
Fetomaternal outcome among women with mitral stenosis after balloon mitral valvotomy
(John Wiley and Sons Ltd, 2013) Shuchi Jain; Tapan K. Maiti; Madhu Jain
Objective To compare pregnancy outcomes among patients with non-operated mitral stenosis and those who had balloon mitral valvotomy before pregnancy. Methods In a study at a tertiary-care referral hospital in Kolkata, India, 48 women with mitral stenosis who delivered between July 2007 and June 2008 were separated into 2 groups according to whether they had cardiac surgery before pregnancy. Eighteen women in the test group had balloon mitral valvotomy before pregnancy, whereas 30 women in the control group had no cardiac surgery. Fetomaternal outcomes were compared between the 2 groups. Results In the control group, significantly more patients had palpitations (P = 0.032) and severe dyspnea (P = 0.017) than in the test group. The incidence of preterm labor in the test group (1/18) was lower than that in the control group (10/30) (P = 0.035). However, the groups did not differ in mode of delivery, mean birth weight, or neonatal complications. Conclusion Balloon mitral valvotomy improved maternal symptoms and should be done to prevent maternal morbidity and to reduce the incidence and complications of preterm labor. © 2013 International Federation of Gynecology and Obstetrics.
Folic acid, total antioxidant and malondialdehyde in fetal cord blood of preeclamptic pregnancy
(2011) Abha Sinha; Mandavi Singh; H.D. Khanna; Madhu Jain
The present study was' designed to evaluate the folic acid, total antioxidant and malondialdehyde (MDA) status in fetuses of Pre-eclamptic pregnancy.52 cases were studied of which 26 were from normal pregnancy (controls) and 26 were from Preeclamptic pregnancy. Fetal cord blood (10 mil) was collected from the umbilical vein in heparinised tubes. It was centrifuged for ten minutes and the plasma collected. Folic acid was estimated by ELISA method, total antioxidant (TAS) was determined by Rondox kit and level of Malondialdehyde (MDA) was estimated by thiobarbituric acid (TBARS) assay from the collected plasma. In pre-eclampsia, the folic acid and total antioxidant was significantly decreased as compared to those in normal subjects, whereas Malondialdehyde was significantly increased. A significant negative correlation was detected between folic acid, total antioxidant and lipid peroxidation in pre-eclampsia. Our study clearly indicates a relationship between decreased folic acid, total antioxidant and elevated lipid peroxidation in pregnancy with preeclampsia.
Fuzzy metrics and cost optimization of a fault-tolerant system with vacationing and unreliable server
(Springer Science and Business Media Deutschland GmbH, 2020) Madhu Jain; Pankaj Kumar; Rakesh Kumar Meena
A finite population fuzzy model for the fault-tolerant system (FTS) is studied by considering the general distributed repair time, server vacation, and server breakdown. The concept of imperfect recovery, along with reboot process, is considered for the evaluation of fuzzy performance indices of an FTS supported by warm standbys. If the faults in the system are not detected successfully, then FTS reconfigures itself automatically by rebooting. When the system becomes free from the assigned repair jobs, the idle server can take a vacation and returns from the vacation in case a machine fails and requires repair. The single failure-prone server can provide the repair of failed machines with a slower rate in the breakdown state also. The parametric non-linear programming approach is implemented for the evaluation of performance metrics in a fuzzified environment using system parameters as a trapezoidal fuzzy number. The supplementary variable and recursive approaches are employed to obtain the system size distribution of the M/G/1 model by taking remaining repair time as a supplementary variable. The cost analysis is performed in order to determine the suitable control parameters using harmony search approach. The impacts of the sensitive system parameters on the performance of FTS are explored by evaluating numerical results for specific distributions of repair time. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.