Background: Depomedroxyprogesterone acetate (DMPA) administered through injection stands out as a remarkably safe, convenient, highly effective, reversible, and long-acting method of postpartum contraception, all while having no adverse impact on lactation. Methods: This prospective study involved 60 women who received intramuscular Depomedroxyprogesterone acetate (DMPA) every three months starting six weeks postpartum.  Results: In the study, 43.33% of participants fell into the 21-25 age group, while 33.33% were in the 26-30 age bracket. Of the participants, 53.34% were primiparous. The most prevalent side effect was irregular bleeding, affecting 36.67% of individuals, followed by secondary amenorrhea in 20%, weight gain in 7.5%, headaches in 5.83%, and acne in 1.67%. The majority (61.66%) discontinued DMPA after the first and second injections, with 20.84% and 17.5% discontinuing after the third and fourth doses, respectively. The primary reason for discontinuation was side effects, accounting for 68.34%. A notable 16.66% were lost to follow-up, while 15% transitioned to another form of contraception. Despite these findings, the majority of users expressed satisfaction with lactation. No significant blood pressure alterations were observed among DMPA users, and no serious adverse reactions were reported, with none of the women becoming pregnant during DMPA use.  Conclusion: The study concluded that Injectable Depomedroxyprogesterone acetate (DMPA) proves to be a secure and highly efficient postpartum contraceptive method without negatively impacting lactation. The importance of pre-use counseling regarding anticipated side effects, coupled with consistent follow-up, emerged as a key factor in enhancing acceptance and continuation rates among users.

Aim: A Clinical Study of Menstrual Patterns in Women Presenting with Ovarian Masses in a Tertiary Care Hospital Material and Methods: A prospective, randomized study was conducted in the Department of Obstetrics and Gynaecology after obtaining approval from the protocol review committee and institutional ethics committee. A total of 110 patients presenting with palpable abdominal or pelvic adnexal masses of ovarian origin were included in the study. Patients with uterine-origin masses or other non-ovarian were excluded. A detailed history, including age, socioeconomic status, menstrual history, and associated symptoms like abdominal pain, abdominal mass, gastrointestinal symptoms, and pelvic pain, was documented. Special emphasis was given to menstrual patterns, including cycle regularity, duration, flow, and intermenstrual bleeding. Results: The demographic analysis revealed that the majority of patients (36.36%) were in the 30–40 years age group, with 31.82% aged 20–30 years. Most patients (45.45%) belonged to the low socioeconomic group, and 63.64% had a normal BMI, while 36.36% were overweight. The incidence of ovarian tumors was higher among married women (81.82%) compared to unmarried women (18.18%). Regarding menstrual patterns, regular menstruation was the most common, observed in 36.36% of cases. Irregularities such as secondary amenorrhea (9.09%), menorrhagia (7.27%), and polymenorrhagia (4.55%) were also noted. Other patterns included amenorrhea of pregnancy (7.27%), oligomenorrhea (5.45%), and physiological menopause (6.36%). Less frequent presentations included metrorrhagia (2.73%), continuous bleeding per vagina (1.82%), primary amenorrhea (1.82%), and polymenorrhea (0.91%). Conclusion: Women with ovarian masses present with a wide spectrum of menstrual patterns, with regular menstruation being the most common. Irregular patterns, such as secondary amenorrhea, menorrhagia, and polymenorrhagia, reflect the hormonal or mechanical effects of ovarian masses. Early identification of menstrual disturbances, particularly when associated with other symptoms, is essential for timely diagnosis and management of ovarian masses, improving overall patient outcomes.

Background and aim of the study: The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend a three-month administration of warfarin following bioprosthetic valve replacement (BVR). However, strong evidence supporting this recommendation is lacking, making process variation likely.

Methods: In the ANSWER Registry, a total of 386 patients who had received either Epic or Biocor BVRs between May 2007 and August 2008 at 40 centers was enrolled. Patterns of discharge anticoagulation and outpatient International Normalized Ratio (INR) values were collected. Mortality, embolic, and bleeding events were assessed up to six months after BVR.

Results: The median patient age was 74 years (interquartile range (IQR): 67-80 years), 39% of patients were female, and 65% were classified as a high thromboembolic risk. Warfarin was prescribed in 38% of all BVR patients, and in 49% of those at high risk of thromboembolism. The median time to therapeutic INR was nine days (IQR: 1 to 18 days), and 20% of patients failed to reach therapeutic levels. Among those patients achieving a therapeutic INR, 78% and 57% respectively had at least one subtherapeutic or supratherapeutic INR during the subsequent follow up to three months. During the follow up, patients treated with warfarin had similar rates of embolic events (2.8% versus 3.1%, p = 0.884), but a substantially higher incidence of bleeding than those not treated with warfarin (12% versus 3%, p = 0.0012). Among patients who were anticoagulated, those with supratherapeutic INR-values had a seven-fold higher risk for overt bleeding events (26% versus 3%).

Conclusion: Anticoagulation strategies after BVR are highly variable. In this population, challenges in achieving and maintaining therapeutic warfarin anticoagulation are common, and are associated with an increased risk of bleeding. Further studies are required to clarify the optimal post-BVR anticoagulation strategy.

Background and aim of the study: Aortic regurgitation (AR) is a disease for which there is currently no effective medical treatment. It has been shown previously in an experimental model of AR that the renin-angiotensin-aldosterone system (RAAS) plays a major role, and that medications blocking the RAAS are effective to protect against left ventricular (LV) hypertrophy and also help to maintain a normal systolic function. The role of aldosterone receptor blockers in this disease has never been evaluated. Thus, the effects were studied of the aldosterone receptor blocking agent spironolactone in a model of chronic AR in rats.

Methods: The effects of a six-month treatment with spironolactone were evaluated in adult Wistar rats with severe AR, compared to sham-operated and untreated AR animals.

Results: Spironolactone treatment decreased the total heart weight. In addition, the LV expression of atrial natriuretic peptide mRNA was decreased by spironolactone treatment, as was the expression of collagen 1 and LOX1 mRNAs. Left ventricular fibrosis was decreased by spironolactone treatment.

Conclusion: Spironolactone protected against volume-overload cardiomyopathy in this model of aortic valve regurgitation. The predominant protective effect was a decrease in myocardial fibrosis.

Background and aim of the study: Aortic valve stenosis (AS) is an important cardiovascular disease that affects between 2% and 7% of the elderly population in industrialized countries. AS often coexists with asymmetric septal hypertrophy (ASH), which is generally caused by a protrusion of the hypertrophied left ventricular outflow tract (LVOT) just below the aortic valve. The study aim was to determine, based on measurement of the aortic valve effective orifice area (EOA), if ASH might potentially interfere with the assessment of AS severity.

Methods: The effects of different levels of ASH (from normal to 90%) on the EOA measured from orifices mimicking different AS severities, and from a home-built AS model constructed from a bioprosthetic aortic valve, were examined in a pulsatile flow in-vitro model.

Results: For the most severe AS, the level of ASH had no impact on the measured EOA. In contrast, for the less severe AS, beyond an ASH level of 50% the AS severity was progressively overestimated, and reached a reduction of about 60% of EOA for a ASH level of 90%.

Conclusion: The presence of concomitant ASH may cause an overestimation of the hemodynamic severity of AS. The extent of overestimation is more important in less-severe AS. Hence, the presence of ASH may lead the clinician to conclude, erroneously, that the AS is severe and that aortic valve replacement is indicated. However, beyond an ASH level of 50% the AS severity can be accurately determined.

Background and aim of the study: Intraoperative real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to examine the geometric changes that occur in the mitral annulus immediately after aortic valve replacement (AVR).

Methods: A total of 35 patients undergoing elective surgical AVR under cardiopulmonary bypass was enrolled in the study. Intraoperative RT-3D TEE was used prospectively to acquire volumetric echocardiographic datasets immediately before and after AVR. The 3D echocardiographic data were analyzed offline using TomTec Mitral Valve Assessment software to assess changes in specific mitral annular geometric parameters.

Results: Datasets were successfully acquired and analyzed for all patients. A significant reduction was noted in the mitral annular area (-16.3%, p < 0.001), circumference (-8.9%, p < 0.001) and the anteroposterior (-6.3%, p = 0.019) and anterolateral-posteromedial (-10.5%, p < 0.001) diameters. A greater reduction was noted in the anterior annulus length compared to the posterior annulus length (10.5% versus 6.2%, p < 0.05) after AVR. No significant change was seen in the non-planarity angle, coaptation depth, and closure line length. During the period of data acquisition before and after AVR, no significant change was noted in the central venous pressure or left ventricular end-diastolic diameter.

Conclusion: The mitral annulus undergoes significant geometric changes immediately after AVR. Notably, a 16.3% reduction was observed in the mitral annular area. The anterior annulus underwent a greater reduction in length compared to the posterior annulus, which suggested the existence of a mechanical compression by the prosthetic valve.

Background and aim of the study: Calcific aortic valve stenosis (AS) affects 2-5% of the population aged > 65 years. Functional DNA variants at the NOTCH1 locus result in bicuspid aortic valve (BAV) and severe valve calcification. The contribution of these variants to AS in the population with tricuspid aortic valve (TAV) remains to be determined.

Methods: Fourteen genetic variants surrounding the NOTCH1 gene were genotyped, including rare mutations previously reported, and common polymorphisms. The study involved 457 French Canadian patients with severe tricuspid AS. Genotyping was carried out using the Illumina BeadXpress platform. Allele frequencies of common single nucleotide polymorphisms (SNPs) for patients with AS were compared to a shared control group of European ancestry (n = 3,294). In total, 88 ancestry-informative markers were used to correct for population stratification.

Results: The mutation R1107X, previously associated with AS and BAV, was identified in a relatively young patient (aged 58 years). The mutations R1279H and V2285I were detected in 18 and 14 heterozygotes, respectively. A common polymorphism (rs13290979) located in intron 2 was significantly associated with AS (p = 0.003), which remained significant after correction for multiple testing. However, this association was no longer significant after accounting for population stratification (p = 0.088).

Conclusion: In this study, rare functional variants were found in the NOTCH1 gene in a French Canadian population of patients with severe tricuspid AS. This also suggests, for the first time, the presence of a common polymorphism in this gene conferring susceptibility to AS.

Background: A supracondylar fracture of the humerus is a type of break in the bone located just above the elbow, involving the distal humerus (the lower end of the upper arm bone). The present study was conducted to comparative study of crossed pinning v/s lateral pinning in supracondylar humerus fractures. Materials & Methods: 68 cases of supracondylar fracture of humerus of both genders were divided into 2 groups of 34 each. Group I were treated with crossed pin and group II with lateral pins. Parameters such as the mode of injury, the affected side and complications were recorded.  Results: Out of 68 patients, males were 30 and females were 38. In group Iand group II, side was right in 18 and 17 and left in 16 and 17. Mode of injury was fall in 25 and 29, RTA in 7 and 3 and violence in 2 each. Complications were radial nerve palsy in 1 and 2, ulnar nerve palsy in 3 and 5, pin tract infection in 0 and 2 and cubitus varus deformity in 1 each. Outcome was excellent in 30 and 26, good in 4 and 6 and fair in 0 and 2 patients respectively. The difference was significant (P< 0.05). Conclusion: Because crossover pinning was more stable than two parallel lateral pinning, it was judged to be superior.