Objective: To identify the prevalence, determinants of reproductive tract infection, and healthcare seeking behavior among ever married women of reproductive age residing in an urban slum of Faridabad, Haryana, North India. Methods: This community based cross-sectional study was conducted among ever married women aged between 15 and 49 years insured under employees state insurance scheme and residing in an urban slum of Faridabad. Simple random sampling technique was used to interview 149 eligible women using a predesigned structured questionnaire. Study variables included sociodemographic profile, family planning methods, menstrual absorbent usage, and symptoms of reproductive tract infection. Binary logistic regression was used to investigate the determinants of reproductive tract infection. Results: Of the women, 46.3% had at least one reproductive tract infection or sexually transmitted infection symptom and 28.9% among them sought treatment for the symptom. Vaginal discharge, itching (14.1%) and lower abdominal pain (30.2%) were the major symptoms reported. Non-usage of condoms as contraceptive was significantly associated with a higher rate of symptoms (50.4% vs. 20.0%). Abortion had a significantly high odds of having reproductive tract infection symptoms (aOR 3.71, 95% CI 1.59-8.62; P<0.01). Less frequent change in absorbent during menstruation was also reported to have a higher rate of symptoms. The majority of those who took treatment sought it from government or employees state insurance dispensary. 2% also went to faith healers. Conclusions: Nearly half of the study population have reproductive tract infection symptom. Abortions and non-usage of condom increase the risk of reproductive tract infection. Menstrual hygiene and condom usage are the significant interventions, which may reduce the prevalence of these symptoms.

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Objective: To detect effect of removing cervical mucus before performing intrauterine insemination (IUI) on pregnancy rate in patients with unexplained infertility. Methods: The randomized controlled trial was conducted in Infertility Division of Department of Obstetrics and Gynaecology of a tertiary care hospital. Totally 80 patients of unexplained infertility were recruited. By computer generated block randomization in block size of 4 and 6, patients were randomly allocated at time of starting ovarian stimulation into the cervical mucus removal group or the non-removal of cervical mucus group before IUI, 40 in each group. Ovarian stimulation with clomiphene 100 mg from day 2-6 of menstrual cycle along with human menopausal gonadotropin 150 IU was given alternate day starting from day 7. Follicular monitoring was done and further doses given as per response; trigger was planned when 1-3 follicle reach a diameter of >18 mm. IUI was planned after trigger. IUI was done as per the group allocated. Mucus cleaning was done in the cervical mucus removal group by aspirating mucus with IUI syringe and sterile cotton swab before IUI. The primary outcome was clinical pregnancy rate. Number of difficult IUIs and cycle cancellation due to ovarian hyperstimulation were also noted. Results: IUI was not done in 4 patients due to hyperstimulation. Pregnancies per IUI cycle occurred in 7.9% (3/38) in the cervical mucus removal group and 21.1% (8/38) in the non-removal of cervical mucus group. There was no statistically significant difference in clinical pregnancy rate between two groups (P=0.19). Conclusions: There is a trend towards a lower clinical pregnancy rate with removal of cervical mucus before IUI in women of unexplained infertility though the difference is not statistically significant. Further studies with large sample size need to be done on this intervention. Trial registration: The trial registration was done with Clinical Trial Registry-India (Registration number: CTRI/2019/03/018326).

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Objective: To evaluate the levels of estrogen, albumin and gonadotropins (luteinizing hormone, follicle-stimulating hormone) as well as the activity of dopamine beta hydroxylase (DAß H) in aged female rats treated with nitric oxide precursor L-arginine and neuronal nitric oxide synthase antagonist L-NAME. Methods: A total of 224 Wistar rats (36 weeks old, weighing 250 g) based on a random sampling were divided into the control and experimental groups after Pap smear test. The control group received only saline (1 mL/kg) intraperitoneally (i.p.). The experiential groups were treated with L-arginine (5, 25 and 50 mg/kg, i.p.) and L-NAME (5 and 25 mg/kg, i.p.) for 3 to 21 days, once a day. Blood samples were taken from the rats and the levels of estrogen and albumin and gonadotropins in the serum were monitored by enzyme-linked immunosorbent assay kit, and the ovaries were examined immunohistopathologically for DAßH activity. Results: L-arginine (5 mg/kg) significantly increased estrogen level (P<0.05), which was associated with DAßH activation in the ovaries. L-NAME reduced this effect when administered prior to L-arginine dose. L-arginine caused no significant change in the levels of luteinizing hormone and follicle-stimulating hormone. Except for the lowest dose of L-arginine in the shortest period, albumin levels significantly decreased in other treatments compared to the control group (P<0.05). Conclusions: L-arginine is likely to reduce postmenopausal problems due to an increased nitric oxide level.

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Objective: To study the knowledge, attitude, and practice of pregnant women regarding transmission and preventive measures of COVID-19 from mother to child and to determine the reasons for vaccine hesitancy. Methods: This observational cross-sectional knowledge, attitude, and practice study was conducted among pregnant women of any trimester, attending the antenatal care out-patient department of a tertiary care hospital in Lucknow from October 2020 to March 2021. All the participants were interviewed using a pretested semi­structured questionnaire for desired information. Reasons for vaccine hesitancy were also asked to assess their unwillingness to get vaccinated. Results: Totally 652 pregnant women were included and 91.3% were aware that COVID-19 spread through contact with an infected person and 85.3% knew that COVID-19 spread by respiratory droplets. Of pregnant women, 95.7% perceived that social distancing and wearing a proper mask were effective ways to prevent SARS-CoV-2 infection and 96.8% of the pregnant women wore masks regularly when going out. Of pregnant women, 79.0% were hesitant to get vaccinated. The most common reason was that COVID-19 vaccine can harm the developing fetus (77.5%) and was not very safe in pregnancy (75.0%). Conclusions: Of the pregnant women, 22.92% have unsatisfactory knowledge regarding COVID-19, 35.63% have negative attitude and 19.93% have poor practices, indicating that there are still gaps in awareness, and majority of them are unwilling to get vaccinated. Good awareness will help prevent the occurrence of future COVID-19 waves in India.

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Objective: To determine the predictive role of stress, self-efficacy, and perceived social support on readiness for discharge in mothers of preterm infants. Methods: The present cross-sectional, descriptive-analytical study was conducted on 120 mothers of preterm infants admitted to hospitals affiliated to Lorestan University of Medical Sciences, Iran in 2019. Participants were selected by a convenience sampling method and based on inclusion criteria. Data collection tools included the demographic questionnaire of mothers and infants, parent perceptions of their child's hospital discharge, parental stressor scale: neonatal intensive care unit, perceived maternal parenting, and multidimensional scale of perceived social support. Data were analyzed using Pearson correlation and stepwise regression at the significance level of 0.05. Results: Infant behavior and appearance, situational belief, and family support achieved the highest mean score from parents' stress, self-efficacy, and perceived social support dimensions, respectively. There was a significant relationship between stress, self-efficacy, and perceived social support with readiness for discharge in mothers of preterm infants (P<0.001). The score of mothers' readiness for discharge decreased by 0.07 per 1-point increase in stress score, and the score of readiness for discharge in mothers of preterm infants rose by 0.35 and 0.43, respectively, for a unit increase in the scores of self-efficacy and perceived social support. Conclusions: Stress, self-efficacy, and perceived social support can be considered as predictors of readiness for discharge in mothers of preterm infants. It is suggested that nurses in neonatal intensive care units provide a better platform for the readiness for discharge in mothers of preterm infants by reducing stressors and increasing maternal self-efficacy and social support.

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Objective: To assess the effect of exogenous gonadotropin releasing hormone (GnRH) in libido, scrotal and testicular biometrics, endocrinological and heamatological profiles of Ganjam goat buck during winter and pre-monsoon seasons. Methods: Forty eight healty Ganjam goat bucks of 3-4 years old were equally divided into the control and treatment groups. The control group received distilled water as placebo, while the treatment group received GnRH injection (4 μg Buserelin acetate/mL) once a week for four months. Body weight, scrotal circumference and testicular parameters (testicular volume, testicular weight and testis index), endocrinological profiles [follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone], sex behavioural profiles (libido score, mating ability score, and sex behavioural score) and heamatological profiles (red blood cells, white blood cells, haemoglobin, and packed cell volume) were estimated. Results: The libido, scrotal and testicular biometrics, and endocrinological profiles significantly differed between the control and GnRH-treated bucks within and between the seasons within the two groups (P<0.05). Body weight, scrotal circumference, testicular volume, testicular weight, testis index, FSH, LH, testosterone, libido score, mating ability score, sex behavioural score, red blood cells, haemoglobin and packed cell volume were significantly higher in the GnRH-treated bucks compared to the control bucks in pre-monsoon and winter seasons (P<0.05). Body weight, scrotal circumference, testicular volume, testicular weight, testis index, FSH, LH, testosterone, libido score, mating ability score, sex behavioural score, red blood cell counts (in treatment), and haemoglobin were significantly higher in pre-monsoon compared to winter season in the experimental groups (P<0.05). The white blood cell counts neither differed between seasons nor between the two groups. Conclusions: Exogenous GnRH supplementation and pre-monsoon season have higher beneficial effects in improvement of endocrinological profiles with cascading beneficial effects on scrotal circumference, testicular volume, testicular weight, and sex behavioural profiles, which in turn will improve the sperm production and its cryo-survivability and fertility rate in Ganjam goat.

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Rationale: The current literature has a surprising controversy regarding the use of low-dose human chorionic gonadotropin (hCG) for luteal support as an explanation for the development of ovarian hyperstimulation syndrome, and this is because of the gap in the listing of the predisposing factors that put women at an increased risk of ovarian hyperstimulation syndrome. Patient concerns: A case of 25-year-old woman presented with abdominal pain, distention, dyspnea, and nausea with a 6.5 kg increase in weight from baseline. Ultrasonographic examination showed bilaterally enlarged multicystic ovaries after gonadotropin-releasing hormone (GnRH) agonist triggering and cycle segmentation with no hCG rescue administration. Diagnosis: Moderate/severe ovarian hyperstimulation syndrome. Interventions: The woman was admitted to the hospital for medical management of moderate/severe ovarian hyperstimulation syndrome, and pain management was advanced to patient-controlled anesthesia with the start of low molecular weight heparin. On day 2, albumin therapy followed by a furosemide chase was started due to an increase in abdominal girth. On day 1, Cabergoline was maintained, and on day 2 the GnRH antagonist Cetrorelix was started. Outcomes: The woman’s clinical condition improved, and a clinical pregnancy was eventually achieved during the first cryo-warmed blastocyst cycle. Lessons: Ovarian hyperstimulation syndrome can still happen even after the use of GnRH agonist and avoidance of hCG support. Segmentation of in vitro fertilization with complete avoidance of hCG for luteal support remains the best approach.

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