Comparison between intramuscular oxytocin versus oxytocin with sublingual misoprostol in blood loss reduction among risk of postpartum hemorrhage vaginal deliveries

Background: This study compares the efficacy of intramuscular oxytocin and oxytocin with sublingual misoprostol administration among the primary postpartum hemorrhage (PPH) mothers of vaginal deliveries. The aim is to compare the effectiveness of intramuscular oxytocin versus oxytocin with sublingual misoprostol in blood loss reduction among women at risk of PPH undergoing vaginal deliveries.Methods: Each group, 50 mothers were selected from the risk of PPH vaginal mothers in the labour ward of the study area.Results: The two groups’ mothers were not statistically significantly differed (P>0.05) in respect of their demographic and clinical variables such as age, gravida, risk factors, the onset of labour and type of delivery. The mean blood loss of group I was 315.4±111.4 ml and group II mean blood loss was 241.4±191.2 ml. The difference between the two groups’ blood losses was statistically significant (P<0.05).Conclusions: Oxytocin with sublingual misoprostol significantly reduced the blood loss during 3rd stage labour than only oxytocin administration

Functional outcome of unstable intertrochanteric fractures managed with proximal femoral nail: a prospective analysis

Background: Hip fractures are a growing concern for the orthopedic surgeons all over the world because the incidence of hip fractures is increasing dramatically and these fractures impose a significant challenge in their efficient management. The aim of the study was to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with ‘proximal femoral nail’.Methods: In our institution, we have selected 24 cases of unstable intertrochanteric fractures for this prospective study. All cases enrolled were managed with the proximal femoral nail. These cases were studied from the mechanism of injury, classification, and treatment with the proximal femoral nail and their surgical and functional outcome with or without residual comp.Results: Patients were followed up for an average period of 8.58 months. The mean Harris hip score was 88.75 at 6th month. The score was excellent in 12 patients, good in 10 patients, fair in 1 patient and poor in 1 patient. In our study of 24 patients with unstable intertrochanteric fracture, the average age incidence was 54.64 years. In the present study male: female was 5:3.Conclusions: In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work

Wilsons disease and autoimmune liver disease overlap syndrome: a clinical study

Background: The coexistence of Wilson’s disease and autoimmune liver disease in a same patient is a rare entity. Combined treatment with steroid and D-penicillamine may be effective. Aim of the study was analyse the clinical, histological, laboratory profile for patients with chronic liver disease with aim of finding the etiology of the disease.Methods: It is an observational study. Common clinical presentations were evaluated. Laboratory investigations done include complete blood count, renal and liver function tests, prothrombin time, viral markers for hepatitis A, B, C and E, USG abdomen and pelvis, portal Doppler studies and upper GI endoscopy. Specific tests include ANA, AMA, ASMA, Anti LKM-1Ab, serum ceruloplasmin and 24hrs urinary copper were done. Liver biopsy was done in selected patients.Results: Commonest clinical presentation was abdominal distension (80%), abdominal pain (30%), pedal edema (60%), splenomegaly (40%) and upper GI bleed (40%). Laboratory investigation revealed anemia (50%), thrombocytopenia (70%), prothrombin time prolongation in (60%), normal liver function in 60%, abnormal liver function in (40%). Autoimmune markers revealed ANA strong positivity in (40%), mild positivity in (60%). AMA, ASMA, Anti-LKM-1 were negative in all cases (100%). Liver biopsy showed features of autoimmune liver disease and Periportal copper deposition in 80% of cases.Conclusions: Coexistence of Wilson’s disease and autoimmune liver disease is a rare entity and medical treatment with steroids and D-penicillamine simultaneously to be started in these patients

Original Article Section: Surgery A Study of 100 Cases of Malignant Tumours of the Breast

ABSTRACT Background: Breast cancer is the commonest malignancy in women worldwide. It cause about 20% of cancer deaths among females and has rightly been called the 'foremost cancer' in women. A high incidence of locally advanced disease and recurrent disease is reported in our institution. Aim: To characterize the clinical features and pattern of presentation of malignant tumors of the breast and to study the accuracy of FNAC and its Histopathological correlation. Methods: 100 cases of malignant tumor diseases of the breast admitted in the various surgical units of Tirunelveli Medical College Hospital, Tirunelveli. Results: The mean age of the patients in our study is 48.3 years. Majority of our cases belong to the locally advanced group (Stage III). FNAC was found to be 90.3% sensitive for carcinoma breast and accurate in 90% of cases. Invasive Ductal Carcinoma NOS type was the commonest (82%). Simple mastectomy with axillary dissection was the commonest surgery performed. All cases were followed up at regular intervals (3 -4 months).Conclusion: Majority of our patients belongs to the post menopausal group and is locally advanced (Stage III -51%). FNAC was found to be accurate in more than 90% of cases. To improve the disease free survival rate early detection of cases is needed. The high rate of recurrence (9%) can be reduced by good local control by surgery and post operative radiotherapy with systemic therapy for all node positive cases

Clinical Spectrum of Central Nervous System Tuberculosis and the Efficacy of Revised National Tuberculosis Control Program in its Management

Introduction: Tuberculosis (TB) is a major global problem and poses a threat which is of considerable magnitude, with an estimated one-third of the population infected with TB bacillus. Aim: The aim of this study is to study the treatment outcomes in patients with various forms of neurological TB treated with the standardized Revised National TB Control Program (RNTCP), directly observed treatment short-course (DOTS). Materials and Methods: Patients diagnosed to have TBM, tuberculoma with or without spinal arachnoiditis (central nervous system tuberculosis-TB [CNS-TB]) were categorized as per the RNTCP guidelines and received DOTS Category I or Category II thrice-weekly intermittent treatment as deemed appropriate. Results: The outcome of management with the standard RNTCP DOTS regimen was that a success rate (treatment completed) of 75%, the default rate of 6.6%, and a mortality of 3.3%. The target fixed by the RNTCP is to achieve a cure rate of 85%. We were able to document successful completion of treatment in 75% which is close to the target fixed by RNTCP. The default rate is 6.6% which quite negligible when compared to the unsupervised therapy which has a default rate of 50%. Conclusion: The most important factor in predicting the outcome of treatment in CNS-TB is early diagnosis and the timing of initiation of antituberculous treatment. Early initiation of treatment is associated with better treatment outcomes