Study of comparison of transvaginal cervical length and Bishop score in predicting successful labour induction- a prospective study from a tertiary care hospital of Rajasthan

Background: Labor induction is one of the common interventions in obstetric practice. Assessment of cervix has been used as a predictor of the successful vaginal delivery. The traditional method of predicting whether an induced labour will result in successful vaginal delivery is based on the pre induction favourability of cervix as assessed by the Bishop score. Now we used transvaginal sonography (TVS) as an objective method of assessment of cervical length to evaluate the role of the pre-induction transvaginal ultrasonographic (TVS) cervical length in predicting labour outcome and comparing it to the Bishop score in patients undergoing induction of labour. Methods: This observational prospective study included 100 pregnant women in which induction of labour was performed at 37-42 weeks of gestation. Cervical length on transvaginal ultrasound and bishop score by digital examination is assessed prior to induction in cases according to standard protocol. Results: In our study though the sensitivity of the Bishop score in predicting the successful labour induction was higher (75.6%) compared with that of cervical length measured trans vaginally (69.35%). The specificity and positive predictive value for the cervical length (2.7 cm) was 77.78% and 91.49% compared with the Bishop score (4) 55.55% and 81.82% respectively. Conclusions: Bishop score and transvaginal cervical length both are good predictors of successful induction of labour. Transvaginal cervical length provides a better prediction of the likelihood of vaginal delivery within 24 hours of induction

Unipolar pedicled latissimus dorsi transfer for elbow reanimation in traumatic brachial plexus injuries

Background: Brachial plexus injuries are troubling for the patients socially, economically and emotionally. Elbow joint being a large and vital joint needs to be reanimated so that the patient can carry out his routine work and bring the hand to the mouth. Number of procedures have been defined but latissimus dorsi being a large muscle is the muscle of choice for transfer in cases who present late. Bipolar latissimus dorsi transfers have often been reported but unipolar latissimus dorsi transfer has also been described. Authors have studied the unipolar muscle transfer, it’s surgical technique and results.Methods: In this study 18 patients were studied for demographic data, pre- and post-operative flexion of the elbow and the MRC grade of the corresponding movements. Diagnostic work up in the form of nerve conduction velocity, electromyography and magnetic resonance imaging were carried out and evaluated for their significance in traumatic brachial plexus injuries.Results: In this study 13 patients had avulsion of the C5-6 roots on magnetic resonance imaging. The patients presented after a period of 128.83±56.76 days. Substantial time elapsed and ruled out primary brachial plexus reconstruction or nerve transfers. The average elbow flexion improved from 6.67±5.69 degrees (range: 0-20 degrees) to 86.94±12.38 degrees (range: 65-110 degrees) following unipolar latissimus dorsi transfer. 12 patients (66.67%) developed M4 or M4+ power.Conclusions: Unipolar latissimus dorsi muscle transfer is a reliable method and most of the patients develop adequate strength and satisfactory function at the elbow joint

Tissue expansion as an aesthetic alternative for facial resurfacing: a single centre series of 92 patients

Background: The visibility, vulnerability and social stigmata of facial scars whether by burn, nevi or trauma can be compelling for the patient as well as challenging for the surgeon. Restoration to normal form and aesthetics require tissue replacement which has good colour and texture match and produce minimal visible scarring.  Although many other options are available for a given defect, tissue expansion offers the best alternative which meets almost all the criteria of an ideal procedure.Methods: Among 92 patients with deformities over various facial subunits were operated and expanders 50 ml to 300 ml inserted subcutaneously adjacent to the scar. Prior planning, accurate measurement and choice of ideal expander is extremely important. A precise and practical method of calculation for determination of amount and duration of expander was used. Any secondary deformity to adjoining vital structures was avoided.Results: Results were meticulously and critically analyzed. Different shapes, dimensions and volume of expanders were used depending on the anatomical site which was to be expanded. A total of 118 expanders were inserted in 92 patients. The average volume of tissue expanders used was 170.33 ml. Majority of the expanders used had volume of 200 ml (62.71%). Post-expansion volume was 240.67 ml and the over expansion done was 41.3% over the pre-expansion volume of 170.33 ml. Surgical outcome and cosmesis was assessed by the patient’s perspective and was considered fair by 57.61% patients.Conclusions: The study underlines the clinical application, reasons for overexpansion as well as shortcomings and complications of tissue expansion

ROLE OF PLATELET-RICH PLASMA INJECTIONS IN TENNIS ELBOW; A PROSPECTIVE STUDY

Aims and Objectives: The aim of this study is to evaluate the efficacy of platelet-rich plasma (PRP) injections in chronic/recalcitrant cases of lateral epicondylitis in comparison to steroid injections and their role in averting surgical procedures. Methods: A prospective study was carried out in the Post Graduate Department of Orthopaedics, Government Medical College and Hospital, Jammu, from July 21 to June 22. Results: The patients managed with PRP injections tend to have a better outcome in long-term follow-up than the steroid group and the results in our study have been found to be statistically significant (p<0.05). Conclusion: We consider PRP injection for intractable lateral epicondylitis of the elbow, not only a safe but also very effective tool in reducing symptoms as well as averting the need for surgical intervention in this difficult cohort of patients

Correlation of non-stress test with fetal outcome in term of Apgar score- a prospective observation study

Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. The objectives of antepartum fetal surveillance are to prevent fetal death and avoidance of unnecessary intervention. This study using NST as a tool for routine antepartum fetal surveillance was trying to catch up those fetuses who might be at risk in womb and provide prompt intervention in otherwise considered normal pregnancies without any obvious high risk factor thus giving the best outcome in mothers.Methods: The objective of this study was to evaluate the correlation of the non-stress test with fetal outcome in pregnancies from 37-42 weeks of gestation.  This was a prospective observational study at Pannadhaya Rajkiya Mahila Chikitsalya Udaipur (Rajasthan) from February 2022 to July 2022. This study included 100 normal pregnant mothers from 37 weeks to 42 weeks who were subjected to NST.Results: The parameters of poor fetal outcome like Apgar score <7 at 5 minutes had increased incidences in the non reactive group.Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. So This study suggested that the NST was found to be a good predictor of the healthy foetus even in normal pregnancies between 37-42 weeks of gestation and the probability of an adverse outcome such as poor Apgar score increases with a non reactive strip

Paediatric lateral humeral condyle fractures managed by k-wire fixation, should the wires be buried or left exposed: a dilemma

Background: Fractures of the lateral condyle of the humerus in children are common injuries. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). These may be passed through the skin and left exposed or buried subcutaneously.Methods: A prospective study was carried out in department of orthopaedics at my college from January 2019 to March 2020.  A total number of 37 subjects were included in the study.Results: Patients were followed for a period of 3 months and results were drawn on basis of union, infection, carrying angle at the elbow, and range of motion (ROM) which was assessed by clinico-radiological means.Conclusions: Buried wire group has shown better union rate than exposed group, wires could be removed under local anaesthesia thereby avoiding any major procedure and also the risk of infection is low making this a better option than the exposed cohort

Association of colposcopy with pap smear in evaluation of unhealthy cervix- a prospective study

Background: Unhealthy cervix is a very common finding in our country due to poor genital hygiene, malnutrition and multiparity. The cervix is the commonest site for female genital cancer. Gynaecologists who work in tertiary care institutes in the developing countries to get referrals from practitioners and peripheral health centres for patients with a clinical diagnosis of an “unhealthy cervix. An “unhealthy cervix” or grossly abnormal cervix can harbour premalignant cervical lesions or invasive carcinoma. That’s why present study was planned to evaluate colposcopy role in relation to PAP smear in symptomatic patients. Methods: The present study was a prospective, analytical study. After institutional committee approval this study was conducted from January 2021 to January 2022 in department of obstetrics and gynecology at RNT Medical college, Udaipur. Total 140 women were assessed for this study. Results: Our study results based on combined cytology and colposcopy with histopathology- sensitivity =100%, specificity =87.03%, PPV=84.09%, NPV=100%, accuracy =92.30%. The result of current study supports that, PAP smear demonstrates premalignant and malignant lesions, whereas colposcopy shows the exact site for biopsy for histopathological diagnosis and for further management. Conclusions: Colposcopy and cytology are complementary to each other. Best result in early detection of pre-invasive carcinomas could be obtained by combined use of cytology, colposcopy and colposcopy guided biopsy. So, use of ‘single visit approach’ in which cytology, colposcopy and guided biopsy all are done in one setting and treated accordingly in resource poor countries will enable maximum utilization of scarce medical resources

Evaluation of Guava (Psidium guajava L.) Varieties and Standardization of Recipe for Nectar Preparation

The nectar prepared from guava variety L-49 had highest ascorbic acid, pH and non-reducing sugar. The recipe with 20 per cent pulp, 0.3 per cent acidity and 17°Brix (TSS) recorded highest organoleptic score. The acidity, TSS, total and reducing sugar of nectar showed an increasing trend during the progress of storage upto five months under ambient conditions. However, these chemical constituents did not change markedly until five months of storage as compared to fresh nectar at the time of preparation

A rare case of giant condyloma acuminata during pregnancy

Genital warts (Condyloma acuminata) are a benign lesion caused by human papillomavirus (HPV) type-6 or type-11 and are usually transmitted sexually. During pregnancy, condyloma has a tendency to proliferate and may have recurrence. We have a case of G2P1L1 38 weeks previously normal vaginal delivered patient in our hospital with extensive genital warts. Patient was successfully managed by surgical excision and after that in follow up after 2 months for podophyllin resin application on remaining lesions. HPV infection presentation can range from asymptomatic to cervical cancer. Small genital wart lesion may become extensive and cumbersome during pregnancy and again regress after delivery in due course of time. HPV vaccination, sex education and early treatment of condyloma lesions should prevent and, in any case, improve the prognosis of this disease

Study of maternal and perinatal outcome in twin pregnancy at a tertiary care hospital

Background: Twin pregnancy refers to the presence of two fetuses in the uterus. The phenomenon of twinning has fascinated mankind throughout its recorded history. The major problems occurring in twin pregnancy are prematurity, Lbw, IUGR, birth trauma, birth asphyxia and congenital anomalies. The most serious risk is preterm delivery, which accounts for most of the increased perinatal mortality, neonatal morbidity, and long-term morbidity of twins. Methods: This prospective observational study included analysis of 250 women with twin pregnancies, over a period from 01st November 2021 to 31st October 2022 with 28 completed weeks of gestation, admitted at PDMC, Udaipur, Rajasthan. Results: In our study 250 twin pregnancies delivered Out of total 15209 deliveries were studied in our institute. incidence of twin pregnancy was 1.64%. The majority of study participants were in the age group 20 to 29 year and delivered between the gestation age 34-37week, multigravida was 51.2% and in primi it was 48.8%. The 4% patients underwent caesarean section and 48% delivered by vaginal delivery. Conclusions: Twin pregnancy is a great challenge to the concerned obstetricians. Complications associated with twin pregnancies cannot be prevented but can be detected early and controlled adequately by proper and prompt management. Timely diagnosis and treatment of nutritional anaemia and pre-eclampsia helps in preventing additional complications. Hence the need for better obstetric care, neonatal care, health services to get a better fruitful outcome