Minimally invasive surgical approach to retrieve migrated intrauterine contraceptive device

Background: To present experience with clinical presentation, diagnosis and minimally invasive removal of migrated intrauterine contraceptive device (IUD).Methods: A total of 6 patients were included in retrospective study. Diagnosis was based on clinical presentation, TVS and Abdominopelvic X- ray. Minimally invasive approach was utilized to remove migrated IUD.Results: The mean (range) age of the patient was 36.6 (26-55) years. The mean (range) of parity was 3.5 (2-6). The mean (range) duration of IUD use was 8.1 (3-25) years. Five patients had TCu380A IUD. One patient had Lippes loop type of IUD. Three patients underwent laparoscopy, two had hysteroscopy and one had cystoscopy, for removal of IUD. The mean (range) operative time was 40.8 (18-76) mins. No anesthesia or surgery related complications were observed intraoperatively. The mean (range) duration of hospital stay was 34 (24-48) hours. The postoperative course was uneventful and all the patients were followed for 3-6 months period of time with no complaints.Conclusion: Removal of migrated IUDs is recommended in symptomatic and asymptomatic patients using minimally invasive approach.

Glyceryl trinitrate patch versus intravenous ritodrine for tocolysis in pre-term labour

Background: Preterm birth is the single most important determinant of adverse infant outcome. Tocolytic therapy has shown beneficial effect in certain selected patients. The present study was conducted to evaluate the efficacy, maternal and fetal outcome with the use of Transdermal Glyceryl nitrate patches versus Intravenous Ritodrine tocolytic agents.Methods: Study included 50 patients of gestation 24-34 weeks in preterm labor. Group I: Glyceryl trinitrate patch releasing 10mg/24 hours (0.4mg/ hour) was applied transdermally and repeated after 2 hours if no reduction in contractions was seen. Group II: Intravenous Ritodrine infusion prepared by adding 50mg to a bottle of 5% dextrose or ringer lactate solution and infusion started at an initial rate of 0.05mg/min which was increased by 50 micrograms per minute every 15 min until contractions ceased.Results: 22 patients in group I treated with GTN and 19 patients in group II treated with Ritodrine achieved successful tocolysis. The difference was statistically insignificant (P value - 0.23). Mean Gestational age at delivery was 34.97 in GTN Group as compared to 33.24 weeks in Ritodrine Group ; difference which is statistically significant (P = 0.0004). Very few adverse effects were observed in the GTN Group. Comparatively, the Ritodrine Group had severe adverse effects requiring discontinuation of therapy. Fetal outcome was satisfactory in both groups.Conclusions: The effects of Glyceryl trinitrate and Ritodrine in the treatment of preterm labor were essentially similar. Glyceryl trinitrate is associated with lesser maternal and fetal adverse effects and appears to be a very viable, inexpensive and safer alternative to Ritodrine

A rare case of subacute uterine inversion managed by Haultain’s repair

Uterine inversion is a rare but serious obstetrical emergency which usually occurs due to mismanagement of third stage of labour. If the condition is promptly recognized before incarceration, manual repositioning of the uterus may be successful. However in neglected uterine inversion, incarceration may occur due to constriction ring formation, necessitating surgical intervention. We present a case of neglected uterine inversion managed by Haultain`s repair

Tourism, Energy Consumption and Climate Change in OECD Countries

The study analyzed dynamics of the relationship between tourism, energy consumption, and climate change for 25 OECD countries during 1995-2005. For the analysis, Panel VAR (PVAR) model was used. Results of panel unit root-tests show that tourism is nonstationary in the level form but stationary in first difference form and energy consumption and climate change are stationary variables in the level form. Analysis of bivariate model shows that results are sensitive with change in the measurement of the tourism variable, change in order of variable and inclusion of the third variable. However, results of our trivariate model are found to be insensitive with either the change in the measurement of our tourism variable or change in the ordering of the variables. Our results of IRFs shows that response of tourism in one SD shock in climate change and energy consumption and response of climate change emissions to tourism is marginally positive. Further, we find that response of climate change in one SD shock in energy consumption and response of energy consumption in one SD shock in tourism and climate change is zero. Keywords: Tourism; energy consumption; climate change; OECD countries; panel VAR JEL Classifications: L83; O13; Q4; Q

Reliability Analysis of Radiation Tolerant Low Voltage CCCII Circuit For Space Applications

In this paper, the impact of radiation on the MOS devices is investigated on recently reported programmablesecond generation Current Controlled Conveyor (CCCII) wherein some updates are suggested to take Hot Carrier Injection, Bias Temperature Instability, and Time Dependent Dielectric Breakdown into account. As radiation is yet another important factor that causes change in threshold voltage, the transistors which are amenable to larger threshold shift and may lead to functional failure are identified first. Subsequently, three possibilities; uses of all thin oxide devices, all thick oxide devices, and mixed devices are being investigate and it is found that while using mixed devices, the circuit becomes functional at lower voltage without any effective increase in leakage current. Architecture is updated to enhance the performance of circuits under time-based ageing and radiation environment. The major challenge is to control dynamic leakage and radiative noise due to imposed radiation. All simulations are carried out using 28nm CMOS technology models in Cadence Virtuoso environment using ±1.0V supply voltage and results have been verified with post layout netlist. Proposed circuit can function at low voltage with the reduced degradation for 8 years at 25 °C consumes less area as compared to the existing CCCII circuit with 0.008 FIT value

PAP Smear versus Colposcopy in the Absence of HPV-DNA Testing for the Screening of Pre-malignant and Malignant Cervical Lesions

Introduction: The incidence of cervical cancer is very high in developing countries. The extensive use of cervical screening with PAP smear and colposcopy has considerably increased the detection of premalignant and malignant cervical lesions. Methods: This was a hospital-based study conducted over a period of three months. All the patients underwent gynecological examination, PAP smear and colposcopy. In case of abnormal findings in colposcopy or follow-up cytology, patients were advised for cervical biopsy. With reference to the histopathological reports, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PAP smear and colposcopy were evaluated. Results: The most common cytological result was Negative for Intraepithelial Lesion or Malignancy (NILM, 60%) followed by Atypical Squamous Cells of Undetermined Significance (ASCUS, 10%), Atypical Squamous Cells- cannot exclude High grade lesion (ASC-H, 6%), Low grade Squamous Intraepithelial Lesion (LSIL,10%) and High grade Squamous Intraepithelial Lesion (HSIL, 11%). In colposcopy, 60% of the patients were normal and 40% showed atypical transition zone. Histo-pathological findings among 53 patients were NILM (13.2%), cervicitis (13.2%), Cervical Intraepithelial Neoplasia I (CIN I, 28.3%), CIN II and CIN III (39.6%) and invasive carcinoma (5.66%). The sensitivity, specificity, PPV and NPV of PAP smear were 63.6%, 66.6%, 33.3%, and 87.5% respectively. Similarly sensitivity, specificity, PPV, NPV of colposcopy for abnormal cervical lesions were 87.56%, 15.38%, 76.09% and 28.57% respectively. Conclusion: In the absence of HPV-DNA testing, the combined use of PAP smear and colposcopy to detect premalignant and malignant cervical lesions increases early detection and treatment