Successful laparoscopic assisted myomectomy of a gigantic 9.4 kg uterine parasitic myoma: a case report and review of literature

Uterine leiomyomas are the most common benign tumours of the female pelvis affecting around 25-30% women of reproductive age. A case of successful laparoscopic assisted myomectomy in a giant uterine parasitic myoma is presented. A 42-year nulliparous morbidly obese lady presented with an Ultrasound diagnosis of a large uterine mass, detected during routine health check-up. MRI revealed a giant uterine pedunculated myoma of size 35 × 28 × 18 cm arising from the fundus and a 6 × 7 cm posterior wall myoma. After counselling the patient regarding surgical and anaesthesia risk, need of hysterectomy and laparotomy, laparoscopic myomectomy was planned. Laparoscopic findings revealed an exceptionally large parasitic fundal myoma filling the whole abdominal cavity and another 7 × 6 cm subserous myoma. main technical challenge was to tackle the big feeding vessels from the omentum providing massive blood supply to the gigantic tumor. Laparoscopic myomectomy was completed successfully using harmonic ace for coagulating the giant feeding vessels from the omentum. As the size of myoma was too big to put in the morcellation bag, so specimen retrieval was done through small incision and manual morcellation. The weight of the specimen was 9.4 Kg. This case emphasizes that size does not pose a limit to removing these gigantic myomas laparoscopically when surgical expertise and good anaesthesia facility is available. This is the case of largest myoma managed laparoscopically

Rural Nonfarm Employment and Incomes in the Eastern Himalayas

Nonfarm activities generate on average about 60 percent of rural households? incomes in the eastern Himalayan region of India. This paper analyzes the determinants of participation in nonfarm activities and of nonfarm incomes across rural households. We present and explore an analytical framework that yields different activity choices as optimal solutions to a simple utility maximization problem. A unique data set collected in the eastern Himalayas allows us to closely examine the implications of the analytical framework. We conduct an empirical inquiry that reveals that education plays a major role in accessing more remunerative nonfarm employment. Other household assets and characteristics such as land, social status, geographical location, and credit access also play a role

Refractive indices, density and order parameter of some technologically important liquid crystalline mixtures

Temperature variation of the refractive indices, birefringence, density and order parameter of liquid crystalline mixtures E7, E8, N10 and PCH-1132 are reported. The birefringence of PCH-1132 is found to be abnormally low compared to other mixtures

Refractive indices, density and order parameter of some liquid crystals

The temperature variation of the refractive indices (no, ne) and density are reported for two liquid crystals. The order parameter is evaluated by both Vuks' and Neugebauer's approaches. The possible sources of error in evaluating the order parameter from refractive indices measurements have been discussed. The contradictory behavior of Δ n and ΔX during the nematic-smectic B phase transition of HBT has been explained on the basis of polydomain formation and the order parameter in the SB phase is estimated. The order parameter of two liquid crystals, HBT and OBT, is also evaluated by NMR measurements, confirming the polydomain formation in the SB phase of HBT

Refractive indices, density and order parameter of two liquid crystals HBT and OBT

The temperature variation of refractive indices (ne ne), birefringence (δn), density (ρ) and order parameter (S) of two liquid crystals, namely, N-(p-hexyloxybenzylidene)-p-toluidine (HBT) and N-(p-octyloxybenzylidene)-p-toluidine (OBT) are reported in the smectic (SA in OBT and SB in HBT), nematic and isotropic phases. For accurate measurement of δn, the wedge method was modified to eliminate the need to measure the wedge angle. Density measurements indicate that the smectic-nematic and nematic-isotropic phase transitions in these materials are of first order. Using refractive index values and the density data, the internal field factors (γe, γo), the ratio of principal polarizabilities f(=αeαo) and the order parameter, S, have been evaluated and their temperature dependence discussed in the light of molecular geometry. The order parameter has been determined using the isotropic internal field model (Vuks approach) and the anisotropic internal field model (Neugebauer's approach). The S values determined using these two models agree in the nematic phase but differ considerably in the smectic phase

1,5-Dimethyl-3-oxo-2-phenyl-2,3-di­hy­dro-1H-pyrazol-4-aminium 2-hydroxy­benzoate

In the title salt, C11H14N3O+·C7H5O3 −, the phenyl ring of the cation is oriented at an angle of 67.0 (1)° with respect to the five-membered pyrazolone ring. The carboxyl­ate plane of the anion is twisted out from the plane of the aromatic ring at an angle of 13.7 (3)°. In the crystal, the cations form hydrogen-bonded dimers with an R 2 2(10) ring motif. The salicylate anion has an intra­molecular O—H⋯O hydrogen bond

Study of outcome of obstetric emergencies admitted to intensive care unit

Background: Critically ill obstetric patients pose challenges to the intensive care unit team due to their altered physiology as well as due the presence of the foetus and safety of both the mother and the foetus is of paramount importance.Methods: All antenatal and postnatal cases within 42days of delivery requiring ICU admission from October 2014 to September 2016. Detailed history taken and outcome noted. Results were subjected to statistical evaluation using SSP software.Results: (n=75): obstetric reasons (n=51, 68%) of which 21(28%) had PPH and 17(22.6) had hypertensive disorders of pregnancy. Non-obstetric reasons (n=24, 32%) of which 7(9.3%) cases had jaundice and 4(5.3%) had malaria. Mechanical ventilation was needed in the majority of cases (n=44, 58.7%) followed by inotropic support (n=30, 40%).Maternal mortality was 16%. Mortality was higher (n=8, 66.6%) among patients admitted for obstetric reasons as opposed to non-obstetric indications (n=4, 33.3%).Conclusions: Early detection and prompt referral to the tertiary centre with intensive care facilities should be promoted among the medical fraternity to reduce the incidence of ICU admissions and maternal mortality. All residents of obstetrics and gynaecology should have short mandatory training phase in critical care. Multicentre randomised studies are required for formulating evidence-based national guidelines

Post operative wound infection: a descriptive study

Background: Surgical site infections is the third most commonly reported nosocomial infection which has an adverse impact on the hospital as well as the patient. This study was designed to evaluate the frequency, clinical presentation, common risk factors and different organisms involved. Methods: This study was performed at NRI Medical college, Chinnakakani. This is an Observational descriptive study over a period of one year from September 2022 to September 2023. Biodata of the patients together with their clinical features, diagnosis, type of surgery performed and the development of any complications including wound infection was noted and the data analyzed. Results: Out of 1509 patients in the study, 1101 belonged to obstetrics and 408 to gynaecology surgery. The overall incidence of surgical site infection in the study was 7.9%; 86 (7.8%) in obstetrics group and 33 (8%) in gynaecology group developed infection. Age more than 50 years was found to be a risk factor for postoperative wound infection. Obesity is known to be a well-established risk factor for postoperative wound infection. It was noted that surgical site infection was more common in patients that had low haemoglobin levels pre-operatively.  The increased susceptibility to infection in diabetics is an established risk factor. Conclusions: Meticulous surgical technique, proper sterilization, judicious use of antibiotics, improvement of ward environments, control of malnutrition and obesity, treatment of infective foci and diseases like diabetes helps control the morbidity of surgical wound infections

Instrumental deliveries and its outcome in tertiary care center

Background: Objective of the study was to determine the incidence and indication of assisted vaginal deliveries and to compare the fetal and maternal outcome of vacuum and forceps deliveries. Methods: This study done over a period of one and half year from March 2022 to August 2023 at NRI Medical College, Chinnakakani. Total number of vaginal deliveries are 1617, out of which 33 had a successful assisted vaginal delivery and studied in terms of maternal and fetal outcome. Verbal consent was taken, indication for instrumental application documented and pre requisites fulfilled before instrument application. Results: Out of 1617 vaginal deliveries in our institute, 33 cases successful underwent assisted vaginal deliveries in which 49% were vacuum assisted, 51% were forceps assisted deliveries. Most common indication for instrument application were fetal distress (51%), failure of maternal forces followed by maternal exhaustion (30%). We had 2nd degree perineal tear - 2 (11.76%), cervical tear - 1 (5.88%), PPH-1 (5.88%), 1- vaginal laceration (6.25%) as maternal complications. Out of 16 vacuum and 17 forceps deliveries, 5/16 (31.25%) and 8/17 (47.06%) were admitted in NICU respectively. Conclusions: In the present study showed that most common indication for assisted vaginal deliveries are fetal distress and maternal exhaustion. Maternal complications are seen more in forceps deliveries when compared to vaccum. There is no significant difference between vaccum and forceps deliveries in neonatal complications when compared