Uterine Life Research Articles

Nesting Technique : It’s Effects on Preterm Cardiorespiratory Indicators

Background: Premature infant born with immature body system, their organs are not ready for extra uterine life, and they are unable to deal with external stress, which could alter body functions such as cardio-respiratory function. In addition, poor muscle tone increases the chance of developing an abnormal posture. To reduce this instability, applying developmental care such as nesting is vital to promote cardio-respiratory stability, maintain position, and reduce stress in preterm. Objectives: The study aims to assess the impact of the nesting technique on preterm cardio-respiratory parameters in various positions (supine, prone, and right lateral). Methodology: The research used randomized controlled trial design. By simple random sampling technique was choose 60 preterm infant, and they were divided into four groups equally (supine, prone, right lateral, and control group). The cardio-respiratory parameters (heart rate, respiratory rate, and oxygen saturation) were measured before and after applying the nesting and positioning techniques for 3 consecutive days. Data were analyzed by Statistical Package for Social Sciences (SPSS) program. Results: The study results showed a significant difference in the mean score of cardio-respiratory after three days of nesting technique with lateral, supine, and prone position groups at p= 0.000. While the control group showed there was non-significant change in the mean score of HR, RR, and Spo2 at p > 0.05. Conclusion: The Study concluded that the nesting technique was effective for stabilizing the cardio-respiratory parameters of preterm infants. The authors recommended routinely using nesting with the ideal position technique in preterm as a part of developmental care at the neonatal intensive care unit

A REVIEW ON ROLE OF TRIDOSHA IN HEALTH AND DISEASES

Healthy and unhealthy state of a human being depends on normal and abnormal functional state of Tridosha, considering the physiological importance of Dosha in maintenance of homeostasis of the body. Tridosha have been called as root (Dosha Dhatu Mala Moolam hi Shariram) of the body. All the functions of the body could be explained in terms of Dosha, Dhatu, and Mala. Panchamahabhuta are chief controllers of universe. By Loka purusha saamyavaada existence of entities in universe and living body is similar. Hence controllers in human body must also be Panchabhoutika. Since Dosha are functional representatives of Panchamahabhuta, they are controllers of body functions. They are structurally Panchabhoutika in nature. Synthesis of Dosha is brought about in two stages. Those synthesized in unicellular zygote and impress every cell after differentiation are Prakruta Dosha, which are decisive factors for body characteristics. Those synthesized from food material which control routine body metabolism are called Vaikrata Dosha, which are decisive factors for homeostasis. Both stages are observed in intra uterine as well as extra uterine life. Both these kinds of Dosha work in synergism to carry out all bodily functions. Vatadosha is divided into five types and These types are according to function, chief location etc. Similarly, Pitta as well as Kaphadosha are also divided into five types. Within limits Doshas are maintaining living body, as they maintain homeostasis. Doshas are only and direct responsible factors for genesis of diseases. Even though there are exogenous and endogenous etiological factors in pathogenesis, Ayurveda suggests that any cause leads to vitiation of Dosha in the first place and then next events start for generation of diseases. Doshas control other two entities namely Dhatu and Mala. Aim & Objectives: Observing the role of Doshas in health and disease conditions Materials and Methods: All the classical texts of Ayurveda with available commentaries, published research papers, PUB med, Google scholar, research Gate, subject related data on Internet and other sources were reviewed for the present study Results and Conclusion: The Doshas having the primary role in maintaining health and any disturbance in Doshas will causes disease KEY WORDS: Doshas, Ahara, vihara, Vikruti, vyadhi

Asuhan Kebidanan Pada Bayi Baru Lahir dengan Perawatan Tali Pusat Di Klinik Pratama Medical Center Kota Batam

Newborns also called neonates are individuals who are growing and have just experienced birth trauma and must be able to make adjustments from intra uterine life to extra uterine life. A normal newborn is a baby born at 37-42 weeks gestation and weighs 2,500-4,000 grams. Care taken of newborns is care of hair, eyes, nose, mouth, ears and one of them is umbilical cord care. Umbilical cord care is needed to prevent the umbilical cord from becoming a breeding medium for pathogenic microorganisms: Incorrect care techniques can lead to tetanus neonatorum infection which can affect the length of cord detachment. This type of research is descriptive by applying a case study approach. The implementation of this study was carried out at the Pratama Medical Center Clinic on Mrs. W's baby by providing umbilical cord care to her baby.

Review of Teratogenic Effects of Leflunomide, Accutane, Thalidomide, Warfarin, Tetracycline, and Angiotensin-Converting Enzyme Inhibitors.

Teratogenic agents have been shown to have drastic and detrimental effects on fetuses if exposed to the agent during uterine life. The most sensitive time for a developing fetus is during the first trimester, and teratogenic exposure during this time can lead to severe deformities in the fetus. The Food and Drug Administration has categorized teratogenic agents based on the severity of their effecton the fetus; these categories include A, B, C, D, and X. Category A is the safest, with the most dangerous, and highly contraindicated in pregnant patients being Category X. This review article will discuss the teratogenic agents leflunomide, isotretinoin, thalidomide, warfarin, tetracycline, and angiotensinogen-converting enzyme inhibitors. Leflunomide can cause cranioschisis, exencephaly, and vertebral, head, and limb malformations. Isotretinoin's main teratogenic effects include central nervous system malformations, hydrocephalus, eye abnormalities, cardiac septal defects, thymus abnormalities, spontaneous abortions, and external ear abnormalities. Thalidomide has been shown to cause limb deformities, bowel atresia, and heart defects when the embryo is exposed to the agent during development.Warfarin can lead to spontaneous abortion and intrauterine death, as well as nasal hypoplasia, hypoplasia of extremities, cardiac defects, scoliosis, and mental retardation when exposed in utero. Tetracycline's teratogenic effects include gastrointestinal distress, esophageal ulceration and strictures, teeth discoloration, hepatotoxicity, and calcifications. Angiotensinogen-converting enzyme inhibitors can cause skull hyperplasia, anuria, hypotension, renal failure, lung hypoplasia, skeletal deformation, oligohydramnios, and fetal death. Teratogenic effects can be avoided if the pregnant patient is educated on the teratogenic effects of these agents.

Self-Efficacy and the Digit Ratio in a Group of Sports University Students.

Self-efficacy is one's awareness of being able to cope optimally with different situations. Perceived self-efficacy is a belief that closely involves emotional and personological functioning. In fact, when one perceives oneself as capable, the likelihood of success increases significantly. The aim of this research was to verify a possible correlation between self-efficacy and the Digit Ratio (2D:4D), referred to as prenatal androgen levels, and whether these correlate with some psychological variables, considering possible gender differences. This study involved 56 sports university students, whose 2D:4D ratio was calculated. Moreover, self-assessment questionnaires: the Self-efficacy Scale (SES), the Big Five Questionnaire-2 (BFQ-2), the Profile of Mood State (POMS), the State-Trait Anxiety Inventory Form Y (STAI-Y) and the Emotional Regulation Questionnaire (ERQ) were administered. The data show that the perceived levels of self-efficacy seem to be influenced by an innate predisposition linked to prenatal androgen values to which the subjects were exposed during uterine life (2D:4D). This negative correlation indicates that the higher the value of the digit ratio, the more likely it is that the level of perceived self-efficacy will be lower. Finally, the degree of perceived self-efficacy also seems to depend on the levels of subjective anxiety, understood both as a personological disposition and a contingent condition, and the latter also seems to be influenced by prenatal androgen levels, particularly in women.

Age Related Histoarchitectural Studies on the Adrenal Gland of Goat (Capra hircus)

Background: Adrenal gland is an important endocrine gland that secrets several hormones that play a key role in the adaptation of the newborn to extra uterine life. The study was conducted to explore the histomorphological development of adrenal glands in Gohilwadi Goat (Capra hircus). Methods: The research work was carried out on twenty pair of goat adrenal gland collected from local abattoir. The animals were divided into three age groups, viz. group- I (day old to 1 month), group- II ( greater than 1 month to 6 months) and group- III ( greater than 6 months). Result: Histological observations revealed that the gland was fully differentiated into cortex and medulla, completely surrounded by a dense fibrous capsule in the day old goats. In group- I, adrenal cortex was made up of definite and foetal cortex, whereas former one comprised of zona glomerulosa and zona fasciculata only. Small to elongate foetal cortical cells were characterized by eosinophilic cytoplasm and arranged into irregular cords. In group II, the foetal cortex disappeared and only definite cortex was present with well-developed three zones i.e. Zona glomerulosa, zona fasciculata and Zona reticularis. Zona glomerulosa was the smallest of the three cortical zones and thickness increased from group-I to group-III. The zona fasciculata was the largest among the three cortical zones in all the age groups and thickness increased from group-I to group-III. Zona reticularis was well organized in the adrenal gland of adult Gohilwadi goat. Medulla occupied greater proportion of the gland and inner medullary cells were the main cellular constituent of medulla. Thickness of medulla increased from group-I to group-III.

Effectiveness of Planned Teaching Programme on Knowledge Regarding Prevention of Hypothermia in Neonates among Mothers of Neonates at Selected Hospitals of Pune City

A newborn baby is a god’s divine precious gift given to a mother. Hence the birth of an newborn is one of the most awe inspiring and marvellous joyful events that occurs in every women’s life time. The WHO stated that approximately 125 million infant born every year, 8 million die before reaching one year of life due to various complications among that about 2.5% newborn die due to hypothermia. The cry of newborn is the only means of communication and brings a message that, I need care. The newborn babies need special care to meet the basic physiological and psychological needs. This also aims at keeping the newborn safe from the environmental and practical harm such as maintaining the normal body temperature. One of the most critical factors in the survival of newborn babies is the satisfactory maintenance of their body temperature. Birth is a major challenge to the newborn to negotiate successfully from Intrauterine to extra uterine life. At birth, the newborn must adopt to transition from warm uterine environment to the cooler extra uterine environment to maintain stable body temperature. Dr. Abdul Kalam says, Today’s children are tomorrow’s citizens and leaders. The resources spent on the care and health of the young are an investment for the future.

Neonatal perioperative resuscitation (NePOR) protocol-An update.

Unexpected cardiac arrest in the perioperative period is a devastating complication. Owing to immaturity of organ systems, and presence of congenital malformations, morbidity and mortality are higher in neonates. There is abundant literature about early recognition and management of perioperative adverse events in children, but similar data and guidelines for surgical neonates is lacking. The current neonatal resuscitation guidelines cater to a newborn requiring resuscitation at the time of birth in the delivery room. The concerns in a newborn undergoing transition from intrauterine to extra uterine life is significantly different from a neonate undergoing surgery. This review highlights the causes and factors responsible for peri-arrest situations in neonates in the perioperative period, suggests preoperative surveillance for prevention of these conditions, and finally presents the resuscitation protocol of the surgical neonate. All these are comprehensively proposed as Neonatal Peri-operative Resuscitation (NePOR) protocol.

Hypoglycemia in breastfed neonates: a hospital-based study

Background: Neonates has well-coordinated adaptation system which maintains the blood sugar at certain safe level in extra uterine life. However certain intrauterine risk factors alter this adaptation system leading to hypoglycemia in early post-natal period. Most of the time hypoglycemic episodes are transient but sometimes there may be recurrent or prolonged hypoglycemia leading to permanent insult in brain and neurological deficit in post-natal life. Aims and objective of the study was to find out incidence of hypoglycemia in exclusively breastfeed neonates and the risk factors associated with this in the post-natal ward of a tertiary care centre in North-East India. Methods: This is a prospective study conducted for a period of six month, where 112 exclusively breastfeed neonates who were shifted immediately to post-natal ward were included. Capillary blood sugar was checked at 1, 3, 6, 12, 24, 48 and 72 hours of life. Neonates with capillary blood glucose less than 40 were considered hypoglycemic. All the hypoglycemic babies were extensively evaluated for different intrauterine and post-natal risk factors. Results: Incidence of hypoglycemia was 16% (18 out of 112 babies). Significant numbers (30.5%) of LBW babies had hypoglycemia, where as 6.5% of normal birth weight babies had hypoglycemia. 38.8% of preterm babies had hypoglycemia where as 11.95% of term babies had hypoglycemic episodes. 71.4% (5 out of 7 babies) of neonates born from diabetic mother. All the large for date infants of diabetic mother had hypoglycemia. Conclusions: Our study came to a conclusion that incidence of hypoglycemia is not very uncommon finding in exclusively breastfeed neonates especially those with risk factors. Routine capillary blood glucose screening is utmost important to pick up the babies with hypoglycemia to prevent immediate and long-term complication.

Perinatal Psychoactive Substances Use: A Rising Perinatal Mental Health Concern.

A significant increase in psychoactive drugs use was observed in women of childbearing age and during the perinatal period worldwide. Yet, the use of illicit drugs, alcohol and tobacco during pregnancy is a serious health risk for the mother, developing fetus and newborn. This review of current trends and consequences of psychoactive substance use in the general population and in pregnant women was conducted using the English and French literature published during the years 2000 to 2022, supplemented by guidelines, meta-analyses and reviews. According to current rates of prenatal substances use, it was calculated that 380,000 offspring were exposed to illicit substances, more than 500,000 to alcohol and over one million to tobacco during uterine life. Alarmingly, drug-related pregnancy-associated mortality has shown a staggering 190% rise between 2010 and 2019 in the USA. Different drugs of abuse, when used during pregnancy, increase the risk of stillbirth, neonatal abstinence syndrome and sudden infant death. Adverse effects on pregnancy include premature rupture of membranes, placental abruption, preterm birth, low birth space? weight and small-for-gestational-age infants. There is also an increased risk of morbidity and mortality for the pregnant women. Long-term negative adverse effects of perinatal exposure to substances also include a number of neurocognitive, behavioral and emotional dysfunctions in infants. Each type of substance has its own specificities, which will be briefly summarized. All childbearing age women must be informed about the potential harm of the prenatal use of psychoactive substances and should be encouraged to stop their use when pregnancy is planned and, at least, when pregnancy is known. Questioning women about their alcohol consumption should be systematic at the first prenatal visit and then at every prenatal visit until delivery. Multidisciplinary prevention approaches as well as intervention measures targeted to each type of psychoactive substance can save mothers' lives and mitigate serious adversities to the offspring.

Exercise in Pregnancy: It’s Effect on Maternal and Fetal Health an Evidence Based Findings

Introduction: Exercise in pregnancy is one of the important contributors which also has a direct link between healthy mothers and healthy fetus. The purpose of this study is to review the published articles and recommend the information regarding benefit of exercise in pregnancy on maternal and fetal health.
 Methods: Systematic search of peer- review publications had been done through Google Scholar, Medline, Pubmed and Scopus. Among the 32 relevant articles on this topic has been selected and reviewed ,analyzed and significant findings have been concluded. Pregnant mothers who do not have obstetric or medical contraindications should be encouraged to exercise during pregnancy. Observational studies of women who exercise during pregnancy have shown benefits such as decreased gestational diabetes mellitus, cesarean birth and operative vaginal delivery. It is related with the course of a healthy pregnancy, since it can increase physical fitness, lower the risk of excessive gestational weight gain, gestational diabetes, pre-eclampsia, macrosomia, and stillbirth. Exercises during pregnancy advances neuro-behavioral relaxation in the fetus.
 Conclusion: Regular exercise is are recommended for pregnant women, for overall health benefits of maternal and fetal health. Evidences supported that moderate level exercise during pregnancy is safe for the fetus during intra uterine life.

Efficacy of body position on gastric residual in preterm infant: a systematic review and meta-analysis.

Preterm babies are born before completion of 37 weeks of gestational. Compared to term neonates, preterm babies are difficult to adjust to extra uterine life and 15 million babies (11%) born before 37 weeks of gestation. This systematic review and meta-analysis aimed to evaluate evidence concerning the efficacy of body position on gastric residual volume among preterm infants. We conducted a systematic search of studies trials published in PubMed, MEDLINE, CINHAL, Clinical Key, Cochrane Library, and Google scholar. Two authors independently appraised the selected randomized control trials for evaluating the effectiveness of body position on gastric emptying. This systematic review and meta-analysis was conducted based on the Cochrane risk bias assessment tool using Revman 5.3 software. On assessment this systematic review and meta-analysis comprised 289 preterm infants from the included 7 trials, with the sample size ranging from 20-63. The gestational age ranged from 28-37 weeks, with an average gestational age of 31.7 weeks. The age of the participants postnatal ranged from 6.6 days to 33.4 days, with an average age of 18±6 days. The weight of the participants during data collection ranged from 1,272-2,683 g, with an average of 1,795 g. This systematic review and meta-analysis revealed that right lateral and prone position lesser gastric residual volume in comparison to preterm infants placed in supine and left lateral position.

Effects of fetal famine exposure on the cardiovascular disease risk in the metabolic syndrome individuals

BackgroundPatients with metabolic syndrome (MS) have a higher incidence of cardiovascular disease (CVD), but the possible mechanisms are not fully understood and further exploration of the possible factors influencing the high incidence of CVD in patients with MS is still needed.ObjectivesThis study aims to examine the association between fetal famine exposure and the risk of CVD in adulthood with MS.MethodsOf 13,744 MS patients free of CVD selected from the Kailuan Study in 2006 (referred as the baseline survey) were included in the study. China suffered a severe famine from 1959 to 1962, so the participants born during this period were classified as the uterine famine exposed group. All patients were born between January 1, 1949, and December 31, 1974. Based on the date of birth, all patients were divided into the no-exposed group (born between January 1, 1963, and December 31, 1974), uterine famine exposed group (born between January 1, 1959 and December 31, 1962), and childhood famine exposed group (born between January 1, 1949 and December 31, 1958). After following up to December 31, 2019, the weighted Cox regression analysis model was used to calculate the effect of early life famine exposure in MS individuals on the risk of CVD in adulthood.ResultsDuring the 12.12 years of follow-up, the incidence of CVD was 5.87%, 10.13%, and 10.90% in the no-exposed group, uterine famine exposed group, and childhood famine exposed group, respectively. Compared with participants in the no-exposed group, the CVD risk and stroke risk increased in participants in the uterine famine exposed group (for CVD, HR: 1.32, 95% CI 1.04–1.67; for stroke, HR:1.37, 95% CI 1.05–1.79), but not in childhood famine exposed group. However, the increased CVD risks were only observed in females or smokers. No increased MI risks were observed for participants in the uterine famine exposed group or childhood famine exposed group.ConclusionsOur findings suggested that exposure to famine during uterine life might increase the risk of CVD in adulthood in participants with MS.

Future in Pediatrics: prevention in maternal child chronic diseases in the first 1000 days

Abstract Introduction The screening and management of obesity, metabolic chronic conditions conditions and genetic predisposition, before and during pregnancy, improve the effects of therapies and reduce the rate congenital diseases, metabolic fetal disorders and early chronic diseases during first 1000days. The maternal child health promotion program ‘Future in Pediatrics’ is dedicated to women in preconception and in early pregnancy, with three steps: 1) a specific survey, 2) a personalisated plan 3) the management of chronic conditions (diabetes, hypertension, overweight, metabolic disorders) and surveillance during the first maternal child 1000 days. Encouraged results Methods In 2019-2021, FUTURA project involved 460 women (before,during and after pregnancy) into 2 groups: group 1 of 280 women, with overweight/ obesity, metabolic conditions, malnutrition, and hypovitaminosis, group 2 of 180 women without chronic conditions, but physical inactivity, high level of homocysteine (60 to 100 μmol/L) and with predisposition for cardiovascular diseases. We have involved the patients in a survey of 100 questions about health, lifestyle, habits, sleep and in a daily diary. In the second time we have realized a personalised and educational program for diet, supplementations sleep, physical activities, health routine. Results The 2 groups of women improved the quality of their health and the management of weight, chronic and metabolic conditions, with impact on reproductive and perinatal health, reduction of inflammatory status and metabolic parameters.We have observed a great influence on cardiovascular health in both groups and decreased of homocysteine levels in the 2nd group. During first 1000 days 393 women, involved into the program, continued with the healthy and preventive routine with zero cases of weight and metabolic chronic disorder in their children. Conclusions This research that the prevention in perinatal health influences the children's health. Key messages • The origins of chronic and metabolic conditions are in uterine life before the conception. The unhealthy lifestyle influenced fertility, cardiovascular health and child health. • The cardiovascular health and metabolic chronic conditions are influenced by first 1000 days health and habits.

A case of global developmental delay (GDD) responding positively to homoeopathic treatment

Global developmental delay (GDD) is a delay in two or more developmental domains of gross/fine motor, speech/language, cognition, social/personal and activities of daily living. Poverty, the root cause of the existence of slums or settlement colonies in urban areas has a great impact on almost all aspects of life of the urban poor, especially the all-round development of children. It is observed 2.5% prevalence of developmental delay in the less than 2 year olds of deprived urban settlements, and the risk factors are low birth weight, birth asphyxia, coupled with poor environment of home and lack of awareness of child care services. Management of GDD involves sophisticated and expensive diagnostic and therapeutic measures which is again unaffordable by this class of patients. Here is a case report of a child 2 years 7 months old with GDD born in a urban poor colony, due to lack of awareness of child care services was deprived from treatment. Clinically the child was assessed for all the areas of developmental delay. After analyzing and individualizing the case a totality was framed on the intra uterine life events, observatory symptoms, observed by the physician and the child’s mother. Sanicula 1M covered the totality which was prescribed in infrequent doses, also silica 6x was given. The follow up assessments were done using Gross motor function measures (GMFM) and WHO recommended growth chart. The Gross Motor Function Measure (GMFM) scale has been one of the most chosen to quantify the evolution of patients after the intervention, because it allows evaluating children with CP from 5 months to 16 years. It is a numerical rating scale, in which a higher score implies better gross motor function. WHO growth chart (0-5) years is applied for the assessment of height, weight, head circumstances (cms) assessed in 4 subsequent follow ups, a linear catch up growth observed with homoeopathic medicine. During the period of treatment from 9th July 2018 to January 2019 the child showed marked improvement in gross motor/fine motor functions, cognition, social and daily activities. The child is still under treatment.

A prospective follow-up study on how long newborns are fasting in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2020.

BackgroundAt birth, continuous flow of nutrients to the fetus in utero interrupted due to cut of the route /umbilical cord/. Instead of the cord, breast-mouth connection will be the next route in the extra uterine life. Nevertheless, limited data in our locality show the duration for how long immediate newborns are fasting.ObjectiveThis study aimed to assess time to initiation of breastfeeding and its predictors among postnatal mothers within 12 hours of birth in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia, 2020.MethodsA Facility based prospective follow-up study was conducted among 475 participants who were selected using systematic random sampling techniques. To collect the data, techniques including interview, chart review and observation were used. Data was entered to Epi-data version 3.1 and analyzed by STATA 14 software. A cox proportional hazards regression model was fitted to identify predictors for survival time. Results of the final model were expressed in terms of adjusted hazard ratio (AHR) with 95% confidence interval, statistical significance was declared with P-value is less than 0.05.ResultsNewborns were fasting breast-milk for the median time of 2 hours. In this study, 25% of participants initiated breastfeeding within 1 hour, pre-lacteal while 75% initiated within 3 hours. Gave birth to multiple babies (AHR 0.37, 95% CI (0.19, 0.69)), operative delivery (AHR 0.77, 95% CI (0.62, 0.96)), got advice on timely initiation of breastfeeding immediately after delivery (AHR 0.79, 95% CI (0.63, 0.97)), pre-lacteal feeding initiation (AHR 10.41, 95% CI (2.82, 38.47)) and neonatal sickness (AHR 0.08, 95% CI (0.03–0.19)) were statistically significant predictors for time to initiation of breastfeeding.ConclusionFifty percent of mothers initiated breastfeeding within 2 hours. Most of them didn’t initiate breastfeeding based on world health organization’s recommendation, within one hour after delivery. Multiple birth, operative delivery, getting advice on timely initiation of breastfeeding immediately after delivery, giving pre-lacteal feeding and neonatal sickness were found to be predictors of time to initiation of breastfeeding.

Accessory tongue — A case report

Congenital anomalies of tongue happen as a result of disturbances in the embryological development of tongue which starts at fourth month of intra uterine life. Anomalies of tongue are very common and it appears as isolated lesion or as part of any syndrome. Accessory tongue is one of the rarest developmental disorders of tongue. Here is the case report of a non-syndromic accessory tongue in female patient

Evaluation of bovhyaluronidase azoxymer efficacy in combined treatment of patients with endometriosis based on the results of multicenter prospective non-interventional study (ISLAND)

Background. Endometriosis is a chronic progressive recurrent disease associated with pelvis pain, menses disorders and infertility. The prevalence of endometriosis (EGE) tends to increase steadily and reaches 15% among women of reproductive age. Endometriosis-associated pain can persist despite surgical and drug treatment of this disease, resulting in a significant decrease in the quality of life of patients. The main causes of EGE-associated pain are local inflammatory, adhesive, neuro- and angiogenic processes. Currently, the search for alternative methods of pathogenesis-based therapy of the disease is one of the priority tasks. Given its anti-inflammatory, enzymatic, antioxidant effects and anti-adhesion mechanism of action, bovhyaluronidase azoximer, an enzyme agent with hyaluronidase activity, is a promising drug in the complex therapy of EGE.
 Aim. To compare bovhyaluronidase azoxymer efficacy in complex therapy of patients with EGE using dienogest (2 mg) versus monotherapy with this progestogen in real clinical practice.
 Materials and methods. 149 female patients of reproductive age were enrolled in the study after surgical treatment for EGE. The patients were divided into two groups: the first group (n=94) was treated with complex therapy by dienogest (2 mg) daily within 6 months in combination with suppositories containing bovhyaluronidase azoxymer (3000 IU): 1 suppositorium once within 3 days,10 administrations; and then 1 suppositorium once in 7 days, 17 administrations, within 120 days; the second group (n=55) received monotherapy with dienogest (2 mg) daily up to 6 months. EGE-associated pelvic pain intensity, uterine bleeding severity and life quality were assessed during the study, after 30, 90, 150 and 180 days with regard to the basic values.
 Results. There was a statistically significant reduction of pain intensity observed in both groups compared to the basic level, using visual analogue scale of pain (VAS), the Biberoglu and Berman scale, but there was a distinct trend towards a more significant decrease in pelvic pain score basing on VAS in patients received complex therapy versus monotherapy with dienogest 2 mg after 30 days of treatment (p=0.051). Life quality assessment of patients in both groups revealed statistically significant increase in scores for all values of the SF-36 life quality scale just after the second follow-up visit. More significant life quality improvement in patients was observed with complex therapy with regard to such descriptors of the SF-36 Questionnaire as Physical functioning, Role-physical functioning, Pain intensity (p0.05).
 Conclusion. Bovhyaluronidase azoxymer in combination with dienogest (2 mg) improves the overall therapy effectiveness for EGE and is associated with more significant reduction in pelvic pain intensity, inflammatory and adhesive processes in the pelvis, and significant life quality improvement compared to monotherapy with 2 mg dienogest.

STUDY OF FINGERPRINT PATTERN IN RELATION TO GENDER AND BLOOD GROUP IN JHALAWAR REGION

Dermatoglyphics, the study of epidermal ridges on palm, sole, and digits, is considered as most effective and reliable evidence of identification. Finger prints are the impressions made by fine ridges present on finger tips which are highly individualistic. The fingerprint ridges develop between 2nd and 3rd months of intra uterine life and remain unchanged in an individual throughout life. Out of many blood grouping systems available, ABO and Rh systems are the most important and are considered for the present study. Due to the immense potential of fingerprints as an effective method of identification an attempt has been made in the present work to analyse their correlation with gender and blood group of an individual. This study is carried out on 100 subjects (50 male and 50 female) having different ABO blood groups and belonging to different age groups. All the 10 fingerprints are taken and divided into loops, whorls, arches and composite. The results show that majority of the subjects belonged to blood group O. The fingerprint pattern of loops is most commonly found followed by whorls, arches and composite. Loops are higher in males whereas whorls and arches are found more in females. Composites are being in same proportion in both sexes. Highest frequency of loops is seen in O positive blood group followed by B positive. Among loops ulnar loops are predominant.
 Keywords: Fingerprints, Loops, Whorls, Arches, Blood Group, Pattern, Gender.

Minimally invasive permanent pacemaker implantation immediately after birth: from delivery room to heart surgery.

Congenital atrioventricular block is diagnosed in uterine life, at birth, or early in life. Atrioventricular blocks can be life threatening immediately at birth so urgent pacemaker implantation techniques are requested. Reasons can be cardiac or non-cardiac, but regardless of the reason, operations are challenging. We aimed to present technical procedure and operative results of pacemaker implantation in neonates. Between June 2014 and February 2021, 10 neonates who had congenital atrioventricular block underwent surgical operation to implant permanent epicardial pacemaker by using minimally invasive technique. Six of the patients were female and four of them were male. Mean age was 4.3 days (0-11), while three of them were operated on the day of birth. Mean weight was 2533 g (1200-3300). Operations were achieved through subxiphoidal minimally skin incision. Epicardial 25 mm length dual leads were implanted on right ventricular surface and generators were fixed on the right (seven patients) or left (three patients) diaphragmatic surface by incising pleura. There were no complication, morbidity, and mortality related to surgery. Few studies have characterised the surgical outcomes following epicardial permanent pacemaker implantation in neonates. The surgical approach is attractive and compelling among professionals so we aimed to present the techniques and results in patients who required permanent pacemaker implantation in the first month of life.