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Background: Antiphospholipid Syndrome (APS) is a systemic autoimmune thrombophilic condition characterized by obstetric manifestations, including pregnancy loss, preeclampsia and fetal growth restriction. Early diagnosis and management are key to improve maternal and neonatal outcomes. Objective: The aim of this study is to assess the perinatal outcomes in APS, the development of various adverse pregnancy outcomes (APO), and their association with specific antibody profiles. Material methods: This observational study was carried out on booked cases of singleton pregnancy and diagnosed cases of primary APS in our High-Risk Pregnancy (HRP) clinic from January 2018 to December 2022 after approval from institutional ethics committee. Forty-three confirmed cases of primary APS were enrolled and started on low-dose aspirin and low-molecular-weight heparin (LMWH) as per the patient's body weight after confirmation of fetal heart activity radiologically until 36 weeks of gestation as a standard of care. Results: Forty patients (93 %) had obstetric APS, and three patients (7 %) had thrombotic APS. During the course of the current pregnancy, adverse pregnancy outcomes (APO) developed in 12 (30 %) out of 40 cases of obstetric APS and in all 3 patients with thrombotic APS. Preeclampsia was seen in 11 (25.5 %), FGR in 12 (27.9 %), and preterm birth in 7 (16.2 %) cases. Patients with an antibody profile showing the presence of Anti-β2 GP-I positivity and ACL positivity had fewer APOs (20 % and 29 %) in comparison to patients with a LA and triple positive antibody profile (55 % and 50 %). Conclusion: Treatment of pregnant women with APS causes significant improvement in the live birth rate. The late pregnancy complications like preeclampsia, FGR, and premature birth, occurring despite treatment still remains a challenge and emphasizes the need for stringent antepartum surveillance and timely delivery.

Background: Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around. Aim: A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries. Materials and Methods: The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist – Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery. Results: The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P < 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P < 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P < 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P < 0.05). Conclusion: There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events.

Isolated elephantiasis of the vulva refers to a gigantic swelling of the vulva without concomitant swelling of the lower limbs. It is a rarely reported entity and its occurrence during pregnancy has been reported only once. We report a case of an isolated vulval elephantiasis during pregnancy and we discuss the possible etiologies and management issues. Our patient had a successful vaginal delivery followed by a satisfactory genital reconstruction at eight months postpartum and no recurrence thereafter.

Introduction: Obstetrics teleconsultation is a new concept to enable health-care services in the COVID pandemic by limiting in-person visits. This study describes the methodology of mobile-based teleconsultation, preliminary findings, and the experience of the obstetricians. Material and Methods: The data of pregnant women who got registered for teleconsultation in early phase of COVID pandemic lockdown were reviewed and analyzed. A qualitative analysis was performed to assess the experience of obstetricians (consultants, senior residents, and junior residents) via an online electronic survey. Results: The majority of obstetrics teleconsultations were for routine antenatal care (75%) and fetal medicine consultation (12.3%). Out of 187 women, 29.9% were advised to continue antenatal care at local hospitals, whereas 33.6% were asked to follow up via teleconsultation. Most of the obstetricians (73.68%) felt that they were able to satisfy the pregnant women and rated the teleconsultation satisfactory. Conclusion: Obstetrics telemedicine found to be beneficial for providing routine antenatal care services via reducing physical visits and overcrowding in outpatient departments, promoting antenatal care at local hospitals, and making specialized (maternal–fetal medicine) care accessible even during COVID-19 pandemic.

Agriculture is the primary sector of Indian economy contributing substantially towards GDP of the country. Qualified and quality human resources contribute significantly towards agricultural sector in the economy. The present study (2021) attempts to analyze the human resource development in terms of enrollment pattern of students in undergraduate (UG) course of agriculture and allied sciences and reflects on evolving strategies for attracting talented students in this sector. Present study shows that there is a close correlation with State Value of Output in agricultural sector and number of students enrolled in higher agricultural and allied studies. Presently, there are 74 agricultural universities (AUs) under the National Agricultural Research Education System and the present study attempts to analyze the student enrollment patterns of under-graduate students in agricultural universities of India for meeting the scientific manpower needs towards achieving targeted agricultural growth. Five years of enrollment data (2015–20) across AUs was considered. Human resource development in terms of enrolment in the higher agricultural education of agricultural universities is quite low when compared to enrolment of students overall in higher education and pattern of enrollment of girls varied in different regions of the country. This study has brought out an important aspect linked to higher agricultural education that the State Value of Output in agriculture has a positive association with enrollment of the students in higher agricultural education from the state in agricultural sector. It is important to assess the future human resource needs for the various sub-sectors of agriculture.

Introduction: Covid 19 pandemic has taken the world by storm. As far as maternal health is concerned, it has been affected both directly and indirectly. Not only are the women getting affected by COVID disease but also the health services are suffering in terms of availability, approachability and access. The study aimed to analyze the change in the trends of maternal near and maternal mortality comprising severe maternal outcome (SMO) between 2019 and 2020 in the department of obstetrics and gynaecology of our hospital due to COVID pandemic. Methods: This retrospective study was conducted in the Obstetrics and Gynaecology department of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. The maternal death review data and maternal near miss statistics were analysed. This included assessing the change in the number of maternal deaths and obstetric near miss, their respective causes, and case fatality rate specific to COVID during pregnancy. Results: The total births decreased from 6056 in 2019–4140 in 2020 whereas women with severe maternal outcomes increased from 4.6% in 2019 to 6.5% in 2020(p value

Objective: The objective is to compare endothelial dysfunction measured by brachial artery flow-mediated dilation (BAFMD) in nonobese, nondiabetic post-menopausal women with their age-matched menstruating controls and to identify the correlation of BAFMD with Framingham risk score (FRS) and with the individual parameters of FRS in low-risk women. Methods: This study was done in the department of Obstetrics and Gynaecology, Chandigarh, India, for 1 year. Fifty postmenopausal and 50 menstruating females aged 45–55 years who were nondiabetic and nonobese and were low risk according to FRS were selected as cases and controls, respectively. All cases and controls were age-matched. The diameter of the brachial artery and the blood flow in it was measured at rest. Ischemia was produced and released after 5 min. The maximum blood flow velocity diameter of the brachial artery was measured. After 10 min of reactive hyperemia, 400 μg of sublingual nitrate was given, and vasodilatation mediated by nitroglycerine was subsequently measured. Results: Menopause did not have any significant effect on the endothelial dysfunction as measured by the brachial artery flow-mediated dilatation (P = 0.74) but did influence vascular smooth muscle as measured by nitroglycerine-mediated dilatation (P = 0.028). A significant correlation was found between flow-mediated dilatation with FRS helps us conclude that flow-mediated dilation is a reliable tool to estimate the cardiovascular risk (P < 0.001). A strong correlation was found between nitroglycerine-mediated dilatation and flow-mediated dilatation, demonstrating that both endothelial dysfunction and vascular smooth muscle are interrelated (P < 0.001). Conclusion: Menopause did not affect endothelial function, but it has a significant effect on vascular smooth muscle function. To know the effect of longer duration of menopause on vascular function in elderly women further studies with large number of postmenopausal women of different duration of menopause, may be needed.

Context: Primary Amenorrhea is worrisome for the adolescent as well as their guardian. It is essential to be able to identify the underlying pathology and initiate appropriate management strategies, well in time. Aims: To study the clinical features, with an aim to identify discriminatory clinical features to indicate a most probable diagnosis. Design: A prospective, observational study. Setting: The Gynecologic Endocrinology Clinic of Department of Obstetrics and Gynecology and Endocrinology Outpatient Department of a tertiary centre in North India. Methodology: In total 328 women with primary amenorrhea, registered during a duration of 10 years (January 2008 to December 2017), were enrolled for the study and a proforma was filled with their medical details. Results: It was observed that patients with normal stature and underdeveloped breasts were likely to be hypogonadotropic hypogonadism, whereas those with short stature and underdeveloped breasts were more likely to be gonadal failure with underlying chromosomal abnormality. The three most common causes of primary amenorrhea in the index population were hypogonadotropic hypogonadism (117/328 = 35.1%), gonadal dysgenesis (99/328 = 30.2%) and mullerian agenesis (53/328 = 16.2%). Conclusion: Age, height, and Tanner staging at presentation can provide a clue toward diagnosis, even before confirmatory tests are available. One of the largest studies reported on primary amenorrhea, we found hypogonadotropic hypogonadism to be the commonest cause, in contrast to previous studies.

Pyoderma gangrenosum (PG) is an ulcerative, neutrophil-predominant inflammatory disease of the skin that commonly presents as painful ulcers. PG during pregnancy is extremely rare. We report the case of a 28-year-old woman with a painful, rapidly progressive ulcerative lesion at an episiotomy site presenting 16 days following a vaginal delivery. No systemic association was found after an exhaustive work-up and the patient was successfully managed with the help of oral prednisolone. It should be noted that when a postoperative ulcerative wound defect is not healing despite standard wound care, antibiotic treatment, and negative cultures, the possibility of PG should be considered. We conclude that early diagnosis of PG is essential because this condition is usually misdiagnosed and surgical intervention may lead to deterioration of lesions. The case highlights the uncommon presentation of PG at a rare site, thereby calling for a high index of suspicion in order to arrive at the diagnosis.

Background and Aims: Dexamethasone has been increasingly used as an adjuvant to local anesthetics in peripheral nerve blocks with various studies showing an opioid sparing the effect of intravenous (IV) dexamethasone as well in a multimodal analgesia technique. It is not clear whether this effect of dexamethasone is because of its peripheral action or because of its systemic absorption. In our study, we compared the effectiveness of dexamethasone on duration of analgesia when used as an adjuvant with local anesthetic in transverse abdominis plane block (TAP) versus when given systemically by IV route along with block only, in patients undergoing laparoscopic gynecological procedures under general anesthesia (GA). Material and Methods: This is a prospective, randomized, parallel treatment, double-blinded study. The primary outcome of our study was the time to administration of first rescue analgesia. Forty patients were randomly assigned to perineural (PN) and IV Group using a computer-generated random numbers table and allocated using sealed opaque envelopes technique. After induction of GA, PN group received ultrasound guided TAP block with 15 ml of 0.25% levobupivacaine plus 4 mg (1 ml) dexamethasone on each side. Patients in IV group received TAP block on both sides with 15 ml of 0.25% levobupivacaine and 8 mg IV dexamethasone. Results: Time to request for first rescue analgesia was 6.63 ± 1.5 h in PN group and 5.04 ± 1.7 h in IV group. Pain scores were comparable in both the groups. Conclusion: Dexamethasone administered in either of the routes has comparative effect on quality of analgesia of TAP block with 0.25% levobupivacaine.

Aim: To compare the efficacy of pre-incision intravenous single doses of cefazolin versus cefazolin plus azithromycin as an antibiotic prophylaxis in cesarean delivery (CD). Methods: This was a single-center, double blind, randomized controlled trial conducted in the PGIMER, Chandigarh. 200 women undergoing elective/emergency cesarean section were randomized. Group A received single dose of cefazolin plus placebo while Group B received single dose of cefazolin plus azithromycin. Primary outcome evaluated was occurrence of surgical site infections (SSI); secondary outcomes included incidence of febrile morbidity, UTI, endometritis, neonatal outcome, total cost of antibiotics, and duration of hospital stay in both the study arms. Descriptive statistics and χ2 tests were used for analysis of the data. Result: There was an overall significant reduction in the incidence of SSI (15% vs 3%; P = 0.03), endometritis (8% vs 2%; P = 0.048), and post-operative febrile morbidity (17% vs 3%; P = 0.001) with the addition of azithromycin to cefazolin. Duration of hospital stay was almost two days lesser for the cefazolin plus azithromycin group. Subgroup analysis of patients with SSI showed the age, duration of ruptured membranes, and type of anesthesia as important predictors of infection rate. Study observed statistically significant reduction in requirement of additional post operative antibiotics, phototherapy for neonates, hospital stay and cost of therapy in cefazolin plus azithromycin group (P < 0.05). Conclusion: Tertiary care hospitals in developing countries such as India can opt for the cefazolin plus azithromycin as antimicrobial prophylaxis during CD to maximize the efficacy as well as for decreasing the cost burden of postoperative infections.

This paper proposes a novel feature selection method for Sentiment Classification. UCI ML Dataset is selected having a textual review from three domains (IMDB Movie, AMAZON Product, and YELP restaurant). Text pre -processing and feature selection technique is applied to the dataset. A Novel Feature Selection approach using Association Rule Mining is presented in which Sentence is converted in binary form and Apriori Algorithm is applied to reduce the dataset. Four Machine Learning algorithms: Naïve Bayes, Support Vector Machine, Random Forest & Logistic Regression to implement experiment. The proposed approach shows an accuracy improvement of 4.2%, 4.9% & 5.9% for IMDB, Amazon & Yelp domain datasets, respectively. Compared with the Genetic Algorithm, Principal Component Analysis, Chi-Square, and Relief based feature selection, the proposed method shows an accuracy improvement of 9.8%, 0.4%, 0.6% & 1.9%, respectively.

Nitrogen (N) remobilization during grain filling from pre-anthesis N uptake and stored in different tissues of crop N use efficiency (NUE). N is remobilized from to sink (young leaves or grains) with the help of nitrate/amino acid transporters. Nearly 80% of grain N in cereals is derived from N remobilized from vegetative tissues. Remobilization of N within the plant takes place from older leaves to young leaves, leaves to grains, senescing organs to grains, from storage parts to grains. Enzymes involved in N remobilization include glutamine synthetase (GS), glutamate dehydrogenase (GDH), asparagine synthetase (AS) and proteases. Among them, cytosolic GS plays a key role during N remobilization in cereals. There are various senescence-associated genes (SAG) involved in N remobilization from older degrading leaves to younger leaves and grains. Autophagy (ATG) is an important mechanism involved in the degradation of stored N in the form of various proteins to amino acids, which are transported to long-distance in the form of glutamine and asparagine via phloem tissue. There is a complex network of genes, mechanisms, and factors associated with N remobilization, which needs to be considered for improving NUE of crops.

Background and Aims: Fetuses with abnormal umbilical blood flow are at a higher risk of adverse perinatal outcome than those with normal flow. Epidural analgesia (EA) has shown to decrease villous vascular resistance in preeclamptic women during labor. The present study evaluates the effects of epidural ropivacaine and intramuscular (IM) tramadol on Doppler blood flow in parturients with fetal growth restriction and raised umbilical artery (UmA) blood flow. Material and Methods: In this prospective nonrandomized comparative study, 36 term parturients with sonographic evidence of UmA systolic-diastolic (S-D) ratio ≥3 were enrolled. Parturients received either continuous epidural ropivacaine 0.2% or 1 mg/kg IM tramadol 4–6 hourly. Doppler flow parameters of UmA and bilateral uterine arteries (UtAs) were measured at 0, 1, and 6 h of labor analgesia. Doppler indices change with time during labor analgesia was assessed as the primary outcome. Change of Doppler indices of UtAs, Apgar score, and cord blood gases was considered as secondary measures. Results: Data from thirty laboring women who completed the study were analyzed. The pulsatility index, resistance index, and S-D ratio in UmA and right UtA reduced significantly with continuous epidural infusion during first 6 h of labor. However, these values increased or unchanged with tramadol administration. Better neonatal pH and base deficit (P = 0.039) were observed with EA. Conclusions: Continuous epidural ropivacaine causes improved fetoplacental circulation in parturients with growth-restricted fetuses having raised Doppler indices during labor analgesia. We also found better neonatal outcome with continuous infusion of epidural ropivacaine as compared to IM tramadol.

Context: Vulvar cancer is one of the uncommon gynecological malignancies. Multimodality treatment with surgery, radiotherapy, and chemotherapy are required for treatment of the disease. Aims: The aim of the study was to evaluate clinical outcome in patients of carcinoma vulva, treated at our institution. Subjects and Methods: This was a retrospective-cohort study done in 50 patients with squamous cell carcinoma of the vulva, treated at our institution from January 2008 to December 2014. Data were analyzed on the basis of age, stage, type of treatment received, and treatment-related toxicity. Disease-free survival and overall survival were estimated. Statistical Analysis Used: Kaplan–Meier survival analysis and Chi-square test were used for statistical analysis. Results: Majority of the patients (52%) had presented with Stage III disease. Thirty-six of 50 patients underwent surgery: simple vulvectomy – 2, radical vulvectomy – 34, bilateral inguinal lymph node dissection was done in 32 patients, and 1 patient underwent ipsilateral-inguinal lymph node dissection. Among 40 patients who received radiotherapy and eight patients received palliative radiotherapy. Seventeen patients underwent intensity-modulated radiotherapy (IMRT) and 15 patients received conventional radiotherapy. Significantly less Grade 2 or more skin toxicity (P = 0.003) observed in patients who underwent IMRT. Among non-IMRT group, eight patients required treatment break during radiation. At a median follow-up time of 25.5 months, median overall survival was 31 months and median disease-free survival was 25 months. About 42% patients were alive and free of disease at last follow-up. Conclusions: Modified radical vulvectomy with inguinal lymph node dissection followed by radiotherapy is the mainstay of management of locally advanced carcinoma vulva. Using IMRT, we could minimize the treatment related radiation toxicity and treatment breaks.

Sirenomelia is a rare congenital anomaly characterized by the presence of a median single lower appendage. The affected fetus is popularly referred to as a “Mermaid baby,” due to the uncanny resemblance to the fictious fable character. The manifestation is a result of the merger of the lower limbs with variable fusion or complete absence of bones. Sirenomelia is universally fatal due to the associated lethal anomalies involving the internal organs, which are usually part of the VACTER or VACTERL complex. However, this sirenomelia-afflicted fetus is unique in being associated with VACTERL as well as congenital hydrocephalus.

Background and Aims: Peripartum hysterectomy is associated with significant maternal morbidity and mortality. We reviewed all peripartum hysterectomies at our institute over a 1-year period. The aim of this study was to determine the incidence, surgery and anesthesia-related issues of peripartum hysterectomies and to compare outcomes of emergency and electively planned peripartum hysterectomies. Material and Methods: This was a retrospective analysis of records of women who underwent emergency or elective peripartum hysterectomy in a tertiary care hospital. The study included all women who underwent peripartum hysterectomy in a teaching hospital and referral institute in North India over a span of 1 year (April 1, 2014, to March 31, 2015). Association of variables was based on Chi-square test, Fisher's exact test, and comparison on “t” statistics (normal distribution) and Mann–Whitney (nonnormal distribution). Results: Forty women underwent peripartum hysterectomy during the study period. The incidence was 6.9/1000 deliveries. In 16 (40%) cases, peripartum hysterectomy was planned electively while emergency hysterectomy was done in 24 (60%) cases. Main indications of peripartum hysterectomies were placenta accreta (60%), atonic postpartum hemorrhage (PPH) (27.5%), and uterine rupture (7.5%). Intensive care management was required in 35% women postoperatively. The common maternal complications were febrile morbidity, bladder injury, disseminated intravascular coagulation, and wound infection. There were 4 maternal deaths following emergency peripartum hysterectomy done for atonic PPH whereas no mortality occurred in elective hysterectomy group. Conclusions: The most common indication for peripartum hysterectomy was placenta accrete. Electively planned peripartum hysterectomies with a multidisciplinary team approach had better outcomes and no mortality as compared to emergency peripartum hysterectomies.

Postmenopausal bleeding may be a presenting complaint for genital tract malignancy. Benign uterine causes predominate while endometrial cancer contributes 10% of symptomatic cases. Extra-uterine causes are rare and include carcinoma cervix or hormone secreting tumours of the ovary. We report a case of 50-year-old postmenopausal lady that presented with postmenopausal bleeding. On evaluation, she was found to have a complex adnexal mass, normal ovarian tumour markers and endometrial histology was normal on biopsy. She underwent exploratory laparotomy and total abdominal hysterectomy with bilateral salpingooophorectomy. The postoperative diagnosis was cystadenofibroma of ovary. We reported this case because of its rare incidence and varied symptomatology and presentation on imaging. One should consider diagnosis of a cystadenofibroma of ovary when a postmenopausal lady presents with a triad of an adnexal mass, postmenopausal bleeding with normal endometrial evaluation.

Struma ovarii is a rare ovarian teratoma of monodermal variant constituting 1-4% of all benign ovarian teratoma. Any ovarian teratoma is called struma ovarii only when it consists of at least 50% thyroid tissue. Only about 8% of struma ovarii cases present with clinical and biochemical features of thyrotoxicosis which is presumed to be due to ectopic production of thyroid hormone and only 0.5 to 5% undergo malignant transformation. We report seven cases of varied clinical presentations of struma ovarii operated at a single centre over four years duration, from January 2014 to December 2017, and endeavor to define the clinical features of this neoplasm as regards to ultrasonographic findings, histological features and ideal management. The clinical presentation, laboratory findings and imaging of these patients are very diverse. Pathologic findings confirm the diagnosis. Due to its rarity, there is no consensus on the best management of Struma ovarii and each case must be individualised. A review of the literature finds that most authors recommend surgical treatment. For malignant struma ovarii, surgery should be followed by postoperative total-body scinti-scanning with I131 to evaluate for residual disease. Many studies recommend adjunct thyroidectomy with I131 therapy to be considered first line management following surgery.

Background and Aims: Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. Methods: Forty-eight parturients with sonographic evidence of foetal weight

Objective: Induction of labor (IOL), using intravenous oxytocin, is the artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Although there are various studies looking at dosages of oxytocin, only a few have addressed the issue of discontinuation of oxytocin in the active stage of labor. Thus, our study was conducted to evaluate the need for continuation versus discontinuation of oxytocin during active labor. Methods: This prospective, randomized controlled trial included 106 women who needed IOL. Oxytocin infusion was initiated at a rate of 3mIU/min and was incremental until 4–6cm cervical dilation. At this point the patients were randomly assigned into one of two groups. In group one, oxytocin was discontinued, and infusion was continued with 0.9% sodium chloride solution. In group two, oxytocin was continued at the same dose until delivery. Results: The duration of oxytocin infusion was 5.5 hours in the oxytocin discontinuation group and 11.0 hours in oxytocin continuation group (p

Cesarean scar pregnancy (CSP) and cesarean scar dehiscence (CSD) are the most dreaded complications of cesarean scar (CS). As the incidence of CS is increasing worldwide, so is the incidence of CSP, especially in cases with assisted reproduction techniques. It is of utmost importance to diagnose CSP in the early first trimester, as it can lead to myometrial rupture with fatal outcome. On the other hand, CSD may be encountered during pregnancy or in the postpartum period. CSD in the postpartum period is very rare and can cause secondary postpartum hemorrhage (PPH) leading to increased maternal morbidity or even death if not diagnosed and managed promptly. Both complications can be diagnosed on ultrasonography (USG) and confirmed on magnetic resonance imaging (MRI). These two conditions carry high morbidity and mortality. In this article, we highlight the role of imaging in the early diagnosis and management of these conditions.

There has been worldwide changes in seasonal patterns, weather events, temperature ranges, and other related phenomena and all have been analyzed in partial, reported and attributed to global climate change. The negative impacts of climate change will become much more intense and frequent in the future—particularly if environmentally destructive human activities continue unabated, warned categorically by a number of experts in a wide range of scientific disciplines and interests. Medicinal and aromatic plants (MAPs) are not immune to the effects of climate change like all other living members of the biosphere. Clear signals are coming on climate change impact which is causing noticeable effects on the lifecycles and distributions of the world’s vegetation, including wild MAPs across the world. This in turn causing some MAPs endemic to geographic regions or ecosystems which could put them at risk and are particularly vulnerable to climate change. Such serious issues and challenges are a continuous concern with regard to the survival and genetic integrity of some MAPs and are being discussed within various forum and platform. Further, such issues of climate change will definitely pose a more prominent or immediate threat to MAP species than other threats, however, scientists do not know whether climate change has the potential to exert increasing pressures upon MAP species and populations. Climate change impact may have a tremendous possible effect on MAPs particularly significant due to their value within traditional systems of medicine and as economically useful plants. At this stage, the future effects of climate change are largely uncertain more so with MAPs, but current evidence suggests that these phenomena are having an impact on MAPs and that there are some potential threats worthy of concern and discussion.

Introduction: Thyroid autoimmunity can have an adverse impact on the outcome of the pregnancy. Although the adverse effects of antithyroid antibodies have been well studied in hypothyroid women, their effects in euthyroid women are not well evaluated. Aim: The study was conducted to assess the overall prevalence of anti-Thyroid Peroxidase (anti-TPO) antibodies in pregnant women and the effect of anti-TPO positivity on the outcome of pregnancy in euthyroid women. Materials and Methods: One thousand Indian women, in their first trimester were screened for anti-TPO antibodies to know the prevalence. Of this, euthyroid women who were positive for the presence of anti-TPO antibody were selected and their obstetric history was recorded. These women were followed up and the incidences of maternal and foetal complications were recorded. The complications were compared with the past obstetric history and outcomes in parity and gestation matched controls (anti-TPO negative). Results: The prevalence of anti-TPO positivity was 11% (n=110). Out of the positives, those with elevated Thyroid Stimulating Hormone (TSH) were 6.5%. The prevalence of euthyroid women who were anti-TPO positive was 4% (n=40). Anti-TPO positive, euthyroid females had a higher prevalence of infertility, anaemia and preterm delivery as compared to the controls (p

Growth under elevated CO2 (EC) conditions inhibits nitrate (NO3-) assimilation in crop plants, hence ammonium (NH4+) nutrition is beneficial compared to NO3– nutrition under EC conditions. In the present study, an attempt was made to compare the suitability NH4 + vs mixed NH4 + + NO3 – nutrition in wheat (Triticum aestivum L.). Wheat seedlings supplied with NH4+ alone or with both NH4+ + NO3– as nitrogen (N) source and grown under ambient (380 μl/l, AC) or elevated (600±50 μl/l, EC) CO2 conditions were analyzed for growth and biochemical parameters. Plants receiving only NH4+ as N source showed significant reduction in growth parameters. The negative effects of NH4+ nutrition were manifested in form of reduced root length, root surface area and thinner leaves under EC. Negative effects of NH4+ nutrition were ameliorated in plants receiving mixed NH4 + + NO3 – nutrition. Supplementing NO3 – -N with NH4+ -N led to the enhancement of various morphological and biochemical parameters in EC grown plants. Activity and gene expression of the enzymes, nitrate reductase and glutamine synthetase was significantly higher in plants supplied with both NH4+ + NO3– ions and grown in EC, as compared to plants grown in AC, resulting in lesser reduction in N content of the EC grown plants. Our study indicates that mixed NH4+ + NO3– nutrition will be more suitable for wheat cultivation under high CO2 conditions in future.

Multidrug-resistant tuberculosis (MDR-TB) is identified from the time of introduction of antituberculosis treatment and is a known worldwide public health crisis affecting women of reproductive age group. Management issues raised by pregnant women with MDR tuberculosis are challenging due to the limited clinical experience available with the use of second line drugs. We hereby report two cases of MDR-TB during pregnancy: one patient was on second line drugs, while another one was evaluated and diagnosed to have MDR-TB in last trimester. At 6 months of follow-up both mothers and babies are doing well. The approach to such cases along with review of the literature is discussed.

OBJECTIVE: To validate the verbal autopsy tool for stillbirths of the World Health Organization (WHO) by using hospital diagnosis of the underlying cause of stillbirth (the gold standard) and to compare the fraction of stillbirths attributed to various specific causes through hospital assessment versus verbal autopsy. METHODS: In a hospital in Chandigarh, we prospectively studied all stillbirths occurring from 15 April 2006 to 31 March 2008 whose cause was diagnosed within 2 days. All mothers had to be at least 24 weeks pregnant and live within 100 km of the hospital. For verbal autopsy, field workers visited mothers 4 to 6 weeks after the stillbirth. Autopsy results were reviewed by two independent obstetricians and disagreements were resolved by engaging a third expert. Causes of stillbirths as determined by hospital assessment and verbal autopsy were compared in frequency. FINDINGS: Hospital assessment and verbal autopsy yielded the same top five underlying causes of stillbirth: pregnancy-induced hypertension (30%), antepartum haemorrhage (16%), underlying maternal illness (12%), congenital malformations (12%) and obstetric complications (10%). Overall diagnostic accuracy of verbal autopsy diagnosis versus hospital-based diagnosis for all five top causes of stillbirth was 64%. The areas under the receiver operator characteristic curve (ROC) were, for congenital malformations, 0.91 (95% confidence interval, CI: 0.83-0.97); pre-gestational maternal illness, 0.75 (95% CI: 0.65-0.84); pregnancy-induced hypertension, 0.76 (95% CI: 0.69-0.81); antepartum haemorrhage, 0.76 (95% CI: 0.67-0.84) and obstetric complication, 0.82 (95% CI: 0.71-0.93). CONCLUSION: The WHO verbal autopsy tool for stillbirth can provide reasonably good estimates of common underlying causes of stillbirth in resource-limited settings where a medically certified cause of stillbirth may not be available.