Tools to Facilitate Event-Driven Program Design in Introductory Courses

Widespread acceptance of the Windows environment has increased the popularity of application development tools that facilitate creation of Windows programs. In response, many universities are starting to teach introductory programming courses using these new software development tools. However, the event-driven nature of these new tools requires a design change to the traditional methods of teaching introductory programming. Unfortunately, most programming textbooks that employ the new tools neglect to provide a suitable framework for designing programs for this new event-driven software paradigm. This paper will present the key differences between event-driven and conventional programming, particularly as it affects teaching programming development concepts to beginning students. It will also describe how a new design tool (Object-Event Diagram) can be used to promote student understanding of event-driven programs

A prospective comparative study to evaluate the efficacy of ultrasonography and hysteroscopy and their correlation with the histopathology of endometrium in a case of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is one of the most common complaints that brings a woman to the gynecologist. Key to successful clinical management of AUB is to identify the cause behind it for which proper evaluation of the case is required. In current scenario of increasing cost awareness and taking risk related to invasive procedure hysteroscopy, a balance has to be achieved between the practices of randomly doing all investigation versus a condition appropriate approach. This study was done to compare efficacy of pelvic ultrasonography & hysteroscopy in cases of AUB and their correlation with the histopathology of endometrium.Methods: In this study 70 women with AUB were selected as they presented in OPD. After evaluation of clinical presentation, general, systemic and local examination, ultrasonography and hysteroscopy were performed on every patient and endometrial curetting were sent for histopathology.Results: We concluded that ultrasonography has a better efficacy to detect uterine cause of AUB and hysteroscopy is better for detecting intracavitary lesions.Conclusions: Ultrasonography has a better efficacy to detect uterine cause of AUB. However a thorough history and detailed clinical examination plays a very important role in narrowing the differential diagnosis of AUB. We have developed an algorithmic approach and guidelines for selective use of hysteroscopy in cases of AUB after evaluating the results

Comparative study of patients undergoing check curettage for first trimester incomplete and inevitable abortion under paracervical block versus no anesthesia

Background: The pain experienced during check curettage is due to the dilatation of the cervix, hence it can be hypothesized that in patients with a dilated internal os there should be no need for anesthesia. If it can be proven, then it would prove useful in cases where access to anesthesia is not available, such as primitive hospital set up, while also reducing the cost and complications of anesthesia.Methods: This study was a prospective randomized single blinded control trial conducted in a tertiary care centre over a period of 15 months with a sample size of 80 patients, 40 in group receiving paracervical block and 40 in group receiving no anesthesia. All patients with spontaneous first trimester incomplete and inevitable abortion were included and randomized in the two groups. Intraoperative vital parameters, vocalization, limb movement and demand for higher anesthesia were noted. Postoperative pain score was obtained based on the numeric rating scale.Results: The demand for higher anesthesia and satisfaction with procedure was comparable between the two groups (P> 0.05).The average pain score for patients receiving paracervical block was 1.13 and that for patients receiving no anesthesia was 1.79 (P<0.05).Conclusions: The mean pain scores of both the groups were on the lower spectrum of the pain scale with no difference in demand for higher anesthesia. In primary set ups where facilities of anesthesia are not available, curettage can be performed safely without anesthesia, which can prove to be life-saving

An observational study to determine accuracy of various methods used to assign gestational age and correlate with outcome

Background: Appropriate estimation of gestational age is paramount in obstetric care. Uncertain gestational age may lead to adverse pregnancy outcome like low birth weight, spontaneous or iatrogenic preterm delivery and perinatal mortality independent of maternal characteristics. In India, seeking of early medical attention in pregnancy is still not the norm. Three methods to estimate the estimated date of delivery are available, namely, menstrual history, clinical examination and by ultrasound.  This study attempts to analyse the accuracy of the three methods used and their correlation with maternal and fetal outcome.Methods: 260 patients presenting to the outpatient department were enrolled irrespective of the gestational age but as soon as they got registered. Ultrasonography was advised if the patient did not have one. EDD was calculated by various methods and was recorded. If significant discrepancy existed, EDD was reassigned. Patients were followed up till the time of their delivery. After the delivery of the baby gestational age was assessed by the neonatologist and was compared with the gestational age at the time of delivery by the three methods. Maternal and fetal outcomes were compared in the form of avoided inductions and maturity of the baby at the time of delivery by all the three methods.Results: The kappa coefficient for the agreement between dating by ultrasound scan and neonatologist was 0.415 whereas for menstrual dates and clinical examination it was 0.197 and 0.369 respectively thus it can be interpreted that the accuracy of ultrasonography may be slightly better than menstrual dates and clinical examination. 75 patients required reassigning of EDD, Induction of labor for supposed post-term pregnancy was avoided in 13% of the patients.Conclusions: Ultrasonography was found to be accurate for determination of term /preterm/ post-term births followed by clinical examination and then the menstrual EDD. Induction of labor for supposed post-term pregnancy was avoided in 13% of the patients in whom EDD was ”assigned” thus stressing that EDD should be reassigned when there is discrepancy between menstrual EDD, Ultrasonography EDD and EDD by clinical examination

Maternal outcome of caesarean section with or without eventration of the uterus: a prospective observational study

Background: Caesarean section is a commonest surgical procedure performed by an obstetrician. Many variations in technique of caesarean section have been devised with the intent of shortening the operating time, making the operation easier, safer and more efficient; and to decrease the blood loss, postoperative morbidity, other complications as well as to shorten the period of hospitalization. One such variation is in the technique of repair of the uterus, whether it is repaired in situ or taken out from the incision and repaired outside the abdomen before replacing it back in place. This study was designed to compare two techniques of uterine closure and determine the benefit of using one technique over the other.Methods: A prospective observational study on 100 women who underwent caesarean section. Technique of uterine repair was surgeon dependent and was not influenced by investigator.  Based on this, patients were assigned into two separate groups (exteriorised group and in situ repair group). Observation was made and recorded regarding the various preoperative, intraoperative parameters and the surgeon`s technique of uterine closure. The patients were then followed up and various postoperative outcome variables were recorded.Results: There were no statistically significant differences between the two groups with regards to any of the intraoperative or postoperative parameters except that there was a rise in diastolic pressure in exteriorization group during eventration which gradually came down during the suturing and reposition (P < 0.05).Conclusions: With this study, it can be concluded that clinical outcomes remain unaffected by any of the two methods of uterine repair. Both are equally safe. However, a caution must be exercised in intraoperative blood pressure monitoring, especially when the uterus is being exteriorized for repair as there is a statistically significant rise in diastolic blood pressure during eventration

Prevalence and assessment of the risk factors of stress urinary incontinence in gynaecology out patients in a tertiary care centre

Background: Stress urinary incontinence (SUI) is the complaint of involuntary leakage of urine during increased abdominal pressure in the absence of detrusor contraction. Although not a life-threatening condition, stress urinary incontinence causes various physical, psychological, and sexual problems for millions of women and their families. Although these conditions are highly prevalent, they are not often reported by patients. This was the reason for the study; to find out the prevalence and the associated risk factors.Methods: A total of 400 patients presenting in the gynaecology outpatient department with various complaints were studied. A detailed history was taken, and examination was done. Urine microscopy and culture studies were done and whenever found positive; the infection was treated. Bonney’s test was done on full bladder.Results: Stress urinary incontinence was diagnosed in 41 (10.30%) of the women. The most common co morbidity was found to be tuberculosis and other lung diseases. Among the study population, 4% of women had culture positive urinary tract infection.Conclusions: Stress urinary incontinence was seen in 10.30% of the study population. It was seen more commonly among the elderly. Urine routine and microscopy was done for all patients complaining of leakage of urine or any other urinary complaints

Comparative study to evaluate efficacy of 30 mg of ormeloxifene to 60 mg of ormeloxifene in cases of dysfunctional uterine bleeding

Background: Dysfunctional uterine bleeding is most common menstrual disorder. Third generation selective estrogen receptor modulator ormeloxifene is relatively recent modality of treatment for this condition. Conventionally ormeloxifene in dose of 60 mg is used to treat this condition. In this study 30 mg of ormeloxifene was used for treatment of DUB and its efficacy was compared with 60 mg dose. Objective was to evaluate whether 30 mg of ormeloxifene will be as efficacious as 60mg of ormeloxifene in the treatment of dysfunctional uterine bleeding.Methods: In this study patients presenting to the outpatient department or emergency with clinical features suggestive of dysfunctional uterine bleeding were included. Random number table was used and 60 patients assigned in two groups with 30 patients in each group. Study group and control group patients were administered T. ormeloxifene 30 mg and 60 mg respectively. Both groups received it twice week for 12 weeks and weekly for next 12 weeks. Patients followed up 4 weekly and efficacy of treatment assessed in terms of decrease pictorial blood assessment chart (PBAC) score, rise in hemoglobin and reduction in endometrial thickness.Results: Treatment efficacy in terms of hemoglobin rise, decrease in PBAC score and reduction in endometrial thickness was assessed and it was found that ormeloxifene in dose of 30 mg as well as in 60 mg was equally efficacious.Conclusions: Patients treated with 30mg dose of ormeloxifene showed efficacy of treatment comparable to 60 mg dose. Patients receiving 30 mg dose showed significant increase in mean hemoglobin, significant fall in mean endometrial thickness and also significant reduction in menstrual blood loss. 30 mg can be used as the optimum dose for the treatment of DUB with similar efficacy of treatment and more cost effectiveness

A comparative study of two different techniques of subcutaneous tissue closure in abdominal surgery

Background: Surgical access to abdomen is required for many operative procedures. The subcutaneous tissue of the anterior abdominal wall can either be sutured or left unsutured with drain in situ. The purpose of this study was to compare the two methods of closure of the subcutaneous tissue and determine the benefit of one over the other.Methods: The study was conducted in a tertiary care centre with sample size of 30 each in study and control group. Patients fulfilling the inclusion criteria were selected and depending on the randomisation the closure of subcutaneous tissue was done either by polyglactin 910, 2-0 or left unsutured with indigenously designed syringe suction drain kept in situ. The patients were followed up till the day of suture removal and further in case of any complications.Results: Total duration taken for the procedure was significantly increased in the study group. There was a significant level of discomfort among the participants due to drain. The rate of surgical site infection, hospital readmission morbidity was significantly higher in the study group.Conclusions: The type of drain studied was indigenously designed where the closed system was not maintained during charging the drain, hence further studies need to be conducted which will compare this with the other closed suction drains to determine the difference in the risk of wound complications

Clinical presentation of autoimmune disorders in pregnancy

Background: Autoimmune disorders have a significant impact over the health of an individual. This heterogenous group of disorders affects pregnancy in a multitude of ways. Pregnancies with autoimmune disorders are usually cared for by a multidisciplinary team of doctors.Methods: Pregnancies with autoimmune disorders were studied over a one-year period in one unit of a medical college teaching hospital set up. Obstetric and neonatal outcomes were studied.Results: Ten patients were studied. Average age was 29.9 years. Majority presented in early second trimester. Eight patients were ANA positive. Two patients had antiphospholipid antibody syndrome, for whom low molecular weight heparin was helpful. Hypothyroidism was seen in two patients. Bad obstetric history was seen in most patients. Successful neonatal outcome was seen in six patients. One patient had Evans syndrome. There were no maternal mortalities. There was one perinatal mortality.Conclusions: Autoimmune disorders in pregnancy when managed in a tertiary care centre with multidisciplinary approach can result in good obstetric and neonatal outcomes