Why women with advanced carcinoma cervix do not seek medical help early: a tertiary hospital based Indian study

Background: Cervical cancer is a disease which claims maximum number of deaths in developing countries. Objective of this study was to understand the reason for delayed approach to medical help in women with advanced carcinoma cervix.Methods: It was a cross-sectional study. Information obtained from women with carcinoma cervix clinical stage IIb and above with proven histopathological diagnosis was recorded in the predetermined format.Results: Almost all the subjects were illiterate and were from lower socioeconomic strata and rural areas. None of them knew about the disease and its symptomatology. About 82% of the patients were symptomatic since 5-10 years however took no medical care during the period and 2/3rd of them even did not reveal their problem to any of the family members. About 79% of the subjects had never used any contraception and none had knowledge about its role in preventing infection. Majority of them (98%) had no idea about the role of PAP smear in screening carcinoma cervix. All of them said if they had knowledge about the disease, they would have sought medical help much earlier.Conclusions: The most important reason for delayed approach in our study was found to be lack of knowledge about the disease. Therefore, till such time that we have national screening program in place, these women who are at high risk of developing carcinoma of cervix should be targeted and educated through mass media so that these women could seek medical help in early stages

Tramadol versus placebo for labor analgesia in low risk women: a randomized controlled trial

Background: In low- and middle-income countries epidural analgesia is generally not available and practically no form of labor analgesia is given to the majority of the parturient. The purpose of study was to evaluate the safety and efficacy of tramadol as a labor analgesic during first stage of labor.Methods: Pregnant women admitted in the labor room satisfying the eligibility criteria were randomized to receive intramuscular injection of either 100 mg tramadol or 2 ml distilled water. Visual analogue score (VAS) was assessed at the beginning and every hour till 4 hours. Pain satisfaction, duration of second stage of labor, fetal heart rate, mode of delivery, and any maternal side effects of the study drug were recorded. Neonatal evaluation using Apgar score at 1 and 5 minutes was done. For statistical analysis Student t-test, Chi Square test and Fisher’s exact test were used.Results: Total of 86 women were included in the study. The VAS scores were significantly lower in the tramadol group at 1, 2 and 3 hours after the administration. Pain relief satisfaction was significantly higher in the tramadol group. Rate of cervical dilatation, duration of the second and the third stage, need for instrumental delivery or lower segment caesarean section, rate of fetal distress and Apgar score at one and five minutes were comparable in both the groups. Nausea was significantly higher in tramadol group.Conclusions: Tramadol is a safe and efficacious drug which is inexpensive, easily available and easy to administer with few minor side effects. It can be used as a labour analgesic as an alternative to epidural analgesia in settings where epidural analgesia is not available. Trial registration: Clinicaltrials.gov PRS registration number: NCT02999594.

Antibiotic prophylaxis in cesarean sections: a tertiary care hospital based survey

Background: The objective of the study was to study the pattern of prophylactic antibiotics usage in caesarean sections in Indian settings.Methods: A cross-sectional observational study was done on women undergoing elective and emergency caesarean sections in the Department of obstetrics and gynecology who were given antibiotics according to the existing trends in the hospital.Results: Almost 72% women received prophylactic antibiotics within 30-60 minutes of skin incision while rest 28% received it before 60 minutes. In post-operative period around 80% of the women received injectable antibiotics for 48 hours, 12% for 72 hours and rest 8% received antibiotics for more than 72 hours. 90% of the patients received injections ceftriaxone 1 gm IV BD, gentamycin 80 mg IV BD metronidazole 400 mg iv TDS while 10% received injection Ampicillin 500 mg QID along with Injection Metronidazole 400 mg iv TDS and injection gentamycin 80 mg IV BD. Two percent of the cases developed wound sepsis and required change to higher antibiotics.Conclusions: In spite of recommendations by International Guidelines for single dose of prophylactic antibiotics, multiple doses are being given. There are no Indian guidelines for antibiotic prophylaxis in cesarean sections and as a result, various combinations of antibiotics are being given for variable duration leading to antibiotic resistance and increased cost of treatment

Prevalence and causes of blindness in patients coming to a tertiary eye care centre in western Uttar Pradesh

Background: Objective of the research was to study the prevalence of blindness in adult patients coming to a tertiary eye care centre in Western Uttar Pradesh and assess their causes. Methods: A cross-sectional study was conducted on adult patients coming to the outpatient department of a tertiary eye care centre over a period of 3 months and 375 patients were identified as having blindness. Complete ophthalmological examination was conducted to find out the cause for the same. Results: The prevalence of blindness was found out to be 4.096%. The major causes for blindness in adults were identified as cataract (33.06%), glaucoma (13.6%), ARMD (5.6%), diabetic retinopathy (5.06%), corneal scar/opacity/dystrophy (26.93%), amblyopia (3.2%) and trauma (2.13%). Conclusions: Knowledge of prevalence of blindness in a region is important in developing and implementing eye care services. Avoidable blindness needs to be identified and treated as soon as possible

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Background: Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. Methods: We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. Results: 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. Conclusions: In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care