Study the cases of rupture uterus in a tertiary care teaching hospital, Jharkhand, India and its maternal and perinatal outcome

Background: Rupture of a pregnant uterus is a serious obstetric emergency and a common cause of maternal death. Study was done to evaluate the incidence, risk factors, management, maternal and fetal outcome of rupture uterus at RIMS.Methods: The present study was carried out in 80 cases of rupture uterus admitted in labour room in the department of Obstetrics and Gynaecology, RIMS, Ranchi, India from March 2014 to September 2015.Results: It was observed that the incidence rate of 0.763%. About 53.75% of ruptures of uterus were noted after 38 weeks of pregnancy. The cause of rupture uterus during labour in most of the cases was spontaneous (49.34%). scar rupture was the next frequent cause (45.33%) and traumatic rupture were 5.33%. Malpresentation and malposition contributed the most important aetiological factors causing spontaneous rupture during labour (43.24%). Hysterectomy was performed in 53.75% (subtotal, 32 cases i.e. 40% and total, 11 cases i.e. 13.75%).Conclusions: Rupture uterus is a serious and life threatening complication for both mother and the fetus. The leading cause of uterine rupture was found to be neglected and obstructed labor due to mismanagement by local untrained birth attendants. Timely recognition and referral to higher centers can reduce the maternal and fetal morbidity and mortality due to uterine rupture. Education and proper care especially of high risk patients like previous caesarean by competent personnel, proper use of oxytocin and early referral may help to reduce the incidence of rupture uterus

The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine

Background: Spinal anesthesia for cesarean section is not a 100% successful technique. At times, despite straightforward insertion and drug administration, intrathecal anaesthesia for cesarean section fails to obtain any sensory or motor block.Methods: This study is aimed at comparing the incidence of hypotension and the need for vasopressors in patients submitted to caesarean section under spinal anaesthesia following preload with either crystalloid or colloid. This study was carried out on 100 healthy pregnant women with single term foetus and not in labor admitted at the labor room of Gynecological department of RIMS. Blood pressure, Pulse rate, O2 Saturation and episodes of hypotension were recorded every 5 minutes from the spinal block.Results: The study showed that maximum number of caesarean sections here performed for the indication of foetal distress which is seen in 44%, 48%, 52%, and 48% in Group A, Group B, Group C and Group D respectively. This is followed by scar tenderness and obstructed labour. In Group A maximum number of patients developed hypotension during 11-20 minutes duration which is 13 (61.9%) followed by 5 (23.8%) patients during first 10 minutes.Conclusions: The study concludes that the combined use of volume preloading to compensate for vasodilatation and vasopressor to counteract arterial dilatation is a very effective method in reducing the incidence, severity and duration of spiral hypotension. The combination group with decreased volume of preload and reduced dose of vasoconstrictor provides better haemodynamic stability when compared to preloading of vasoconstrictors alone

Clinicopathological observations on incidental appendicectomy in a tertiary care teaching hospital, Ranchi

Background: Incidental appendectomy is defined as the removal of a clinically normal appendix during non-appendiceal surgery.  This study was conducted at RIMS, Ranchi to document effects of incidental appendicectomy on overall morbidity and mortality while performing the intra-abdominal operation and also to study the frequency of pathological findings in incidentally removed appendices and the correlation between the pathology in the appendix with known aetiological factors for acute appendicitis. Materials & Methods: The diagnosis of the primary intra-abdominal pathology was made on the basis of a detailed history through clinical examination, supported by laboratory investigations and confirmed during operation besides, the patients. The clinical setting-emergency or elective laparotomy in which the appendix was removed was noted. Laparotomy incision used was noted with regard to the case with which the appendix could be approached. The naked eye examination of the appendix was noted. A piece of appendix was collected for histopathological examination. Results: About 42% of patients were below 30 years of age. Approximately 68% of female patients were below 40 years of age. Diseases of the extra-hepatic biliary tree were the most frequent indications for operation in female patients (91%).  Contaminated operations formed 88% of abdominal operations. Appendix could be easily approached and removed in 90% of the laparotomies. Operative time (length of anaesthesia) was increased by an average of 7.7 minutes. Retrocaecal position was the commonest site of appendix (68%). Length of appendices varied between 2.5-15 cms, majority being about 5-10 cms in length. Fibrotic changes with luminal obliteration were observed in 15% of appendices. Faecoliths alone or with bands, kings, adhesions or thickening of wall of appendix were present in 12% cases. Evidence of focal or catarrhal appendicitis was evident in 3% cases. Post-operative hospital stay was 12 days or less in the majority of patients (93%). Conclusion: An incidental appendicectoy should be performed when operating in abdomen for the surgical treatment of some other diseases, where no contraindication exists. The added procedure does not increase either intra-operative risk or post-operative complications and spares the patient from the possible subsequent development of acute appendicitis

Study the antimicrobial agents sensitivity of methicillin resistant Staphylococcus aureus isolated from patients admitted in RIMS, Ranchi

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospital-acquired infections that are becoming increasingly difficult to combat because of emerging resistance to all current antibiotic classes. For this, study of MRSA isolated from admitted patients were carried out. These strains were separately tested for their sensitivity to different antibiotics to know which group of antibiotics are most effective particularly for cases of RIMS, Ranchi. Material & Methods: The present study was carried out in the Department of Microbiology, Rajendra Institute of Medical Sciences (RIMS), Ranchi clinical isolates of MRSA strains were obtained from admitted patients of RIMS, Ranchi. The sources of isolate included pus from infected surgical wounds, infected burn wounds, conjunctival swab, aural swab, throat swab, vaginal swab, urine etc for microbiological analysis and antimicrobial sensitivity of MRSA. Disc diffusion method was employed. Results: All the 264 cases of staphylococcal species isolated from different clinical specimens were subjected to coagulase test. It was observed that out of 264 strains of staphylococci isolated from different sites 165 strains (62.5%) were coagulase positive and 99 strains (37.5%) were coagulase negative by tube method. It was observed that out of 165 strains of staph. aureus isolated from different clinical samples 64 strains of staph. aureus were resistant to methicillin (38.78%). Maximum isolation of MRSA were from pus 38 (51.35%), followed by throat swab 19 (36.36%), aural swab (14.28%) and conjunctival swab (44.44%). It was observed that out of 165 strains of s. aureus isolated only 64 strains were resistant to methicillin. All strains of MRSA were 100% sensitive to Vancomycin & linezolid. Similarly 92.3% were sensitive to netilmicin, 89.7% to clindamycin, 82.1% to ciprofloxacin, 74.4% to cephotaxime, 69.2% to azithromycin, 56.4% to roxithromycin & clarithromycin, 17.9% to piperacillin/tazobactam. The most effective antibiotic against MRSA was vancomycin, linezolid, netilmicin & clindamycin. Conclusion: After comparing the effectiveness of antibiotics against MRSA infection it can be concluded that piperacillin/tazobactam, clarithromycin, roxithromycin azithromycin, cefotaxime & ciprofloxacin are of little value in treating the MRSA infection. They should not be used indiscriminately and in a haphazard manner otherwise increment in emergence of resistant strains may not be checked

Comparison of proximal femur locking compression plate with dynamic hip screw in management of inter-trochanteric fracture

Background: Intertrochanteric fractures are common in elderly population and pose a significant financial burden to the patients and family. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition to deal with these fractures, which creates an angular stable construct. It will theoretically lessen the risk of failure by screw cut-out and varus collapse, the common mode of DHS failure. Materials & Methods: This study was done to prospectively compare, the rate of union, complications, operative risks and functional outcomes in inter-trochanteric fractures treated with dynamic hip screw [DHS] and Proximal femur locking compression plate [PFLCP]. It also determined the effectiveness of PF-LCP in comparison to DHS in treatment of inter-trochanteric fractures. The data collected during the study of 30 cases of inter-trochanteric fractures, 15 cases were treated using PFLCP and other 15 group of cases were treated using DHS in the Department of Orthopaedics in Rajendra Institute of Medical Sciences, Ranchi from December 2012 to December 2014.Results: The functional outcome was measured with Harris Hip Score. In PFLCP group 7 (46.67%) cases had excellent result, 5 (33.33%) cases had good result, and 3 (20%) cases had fair result with no poor result. The mean score in PFLCP group was 86.4. In DHS group 7 (46.67%) cases had excellent result, 4 (26.67%) cases had good result, 2 (13.33%) cases had fair result and 2 (13.33%) cases had poor result. Conclusion: PFLCP is a good option for the management of inter-trochanteric fracture with high union rate and low rate of complication with high functional outcome and with a possibility that it can be done without C-Arm

Study the cases of rupture uterus in a tertiary care teaching hospital, Jharkhand, India and its maternal and perinatal outcome

Background: Rupture of a pregnant uterus is a serious obstetric emergency and a common cause of maternal death. Study was done to evaluate the incidence, risk factors, management, maternal and fetal outcome of rupture uterus at RIMS.Methods: The present study was carried out in 80 cases of rupture uterus admitted in labour room in the department of Obstetrics and Gynaecology, RIMS, Ranchi, India from March 2014 to September 2015.Results: It was observed that the incidence rate of 0.763%. About 53.75% of ruptures of uterus were noted after 38 weeks of pregnancy. The cause of rupture uterus during labour in most of the cases was spontaneous (49.34%). scar rupture was the next frequent cause (45.33%) and traumatic rupture were 5.33%. Malpresentation and malposition contributed the most important aetiological factors causing spontaneous rupture during labour (43.24%). Hysterectomy was performed in 53.75% (subtotal, 32 cases i.e. 40% and total, 11 cases i.e. 13.75%).Conclusions: Rupture uterus is a serious and life threatening complication for both mother and the fetus. The leading cause of uterine rupture was found to be neglected and obstructed labor due to mismanagement by local untrained birth attendants. Timely recognition and referral to higher centers can reduce the maternal and fetal morbidity and mortality due to uterine rupture. Education and proper care especially of high risk patients like previous caesarean by competent personnel, proper use of oxytocin and early referral may help to reduce the incidence of rupture uterus

Antenatal blood pressure for prediction of gestational hypertension: A prospective observational study

Background: Hypertensive disorders during pregnancy occur in women with preexisting primary or secondary chronic hypertension, and in women who develop new-onset hypertension in the second half of pregnancy. Early detection of preeclampsia will help reduce the morbidities and mortalities associated with the disorder. The study aims to evaluate the clinical utility of second trimester MAP in the prediction of preeclampsia or gestational hypertension. Methods: This was a prospective cohort study of 200 normotensive, nonproteinuric pregnant women without prior history of gestational hypertension. The women were booked patients attending the antenatal clinic at a tertiary care teaching Hospital, Haldia and were all in their second trimesters of pregnancy. The outcome measures were systolic blood pressure, diastolic blood pressure, and MAP. The end point of the study was the development of preeclampsia or gestational hypertension. The diagnosis of preeclampsia was made by the attending obstetrician. Results: A prospective observational study was carried out on 200 pregnant women between 16-26 weeks of gestation during the time period of 1st Jan 2016- 30th Dec 2016 and results were analyzed. The maximum number of subjects (51.5%) were in the peak reproductive age group of 26-30 years followed by 21.5% and 18% from (21-25 yrs) and 31-35 yrs respectively. The mean age of the study cases was 27.90 years with a SD of ±7.24. The youngest in the study was 19 years of age and eldest was 42 years of age. The parity distribution of the study population was primigravida (39.5%) and 60.5% were multigravida. The development of gestational hypertension among the subjects was 11.5%. Rest of the pregnant women were normotensive. The maximum number of subjects in the gestational hypertension group was in the age group of 26-30 years (n=23, 34.8%) followed by 21-25 yrs age group (30.4%) and 31-35 yrs age group (17.4%). Conclusions: Accurate measurement of blood pressure (BP) is crucial to the diagnosis and management of hypertensive disorders in pregnancy

Effect of nigella sativa on bone mass density (BMD) in albino rats

Abstract Background: Osteoporosis may be diagnosed in postmenopausal women and in men aged 50 years and older if the measurement of bone mineral density in the lumbar spine, total hip or femoral neck is at least 2.5 standard deviations below that of a young control (T score –2.5 or less). Based on current guidelines, a diagnosis of osteoporosis relies on a history of fragility fracture or the result of bone mineral density (BMD) evaluation. Nigella sativa seeds (NS) has been used traditionally for various illnesses. The most abundant and active component of NS is thymoquinone (TQ). However paucity of data is available in this regard especially in animal model mimicking postmenopausal osteoporosis. Materials & Methods: A total 42 female rats were selected and divided in to seven groups of six in each. Pregnant rats excluded, only non-pregnant rats were used (confirmed by the Veterinary Surgeon attached to the Department). Firstly, the rats were immobilized using ether anaesthesia at a minimal dose following which, a freshly prepared suspension of thiopentone sodium i.v. was given through the dorsal tail vein cannulation at a dose of 10mg/kg. The left hind legs of all the rats were immobilized using plaster casts so as to promote the process of osteoporosis. Results: It is evident from measurement of dry bone weight that there is significant bone loss in the ovariectomised rats in comparison to sham rats. Treatment with Nigella sativa extract significantly improved the bone weight, though there is no dose related improvement. There is a significant change in raloxifene treated as well as in combination treated groups in comparison to all the doses of test drug showing the better effectiveness of raloxifene. Conclusion: The histopathological studies as well as radiographic finding of bone showing high osteoblastic activity and minimum osteoclastic activity indicating bone formation, also supports its anti-osteoporotic activity. Based upon the results of the present study in animal model, it is quite justified that this indigenous drug may be tried as an adjunct therapy in the treatment as well as prevention of osteoporosis. Keywords: Osteoporosis, Nigella sativa (NS), raloxifene, albino rats, bone mineral density (BMD), anti-osteoporotic activity, histopathology, radiological change

Study of the incidence of different types of tuberculous lesion in association with diabetes mellitus in Indian patients

Background: Tuberculosis (TB) is one of the most common infectious diseases worldwide.  It is well known that diabetes mellitus (DM) impairs the immunity of patients and therefore is an independent risk factor for infections such as TB. Hence keeping all above things in mind we had undertaken this study with following aims and objectives: to find out the incidence of different types of tuberculosis in patients suffering from diabetes mellitus; to prevent early mortality and morbidity caused by tuberculosis and early diagnosis and treatment of diabetes mellitus in patients of tuberculosis and vice-versa. Materials & Methods: In the present work a total number of 100 (hundred) patient were selected in which patients had history of diabetes mellitus and having complaints of cough with productive sputum for more than four weeks. Sputum examination for A.F.B, sputum culture examination, Skiagram of the chest PA view, tuberculin skin test, ELISA for mycobacterium tuberculosis, biochemical, cytological examination and culture of ascitic, pleural, pericardial and cerebrospinal fluid. Others supportive investigations  were complete blood examination, ESR, USG of abdomen, echocardiography, C.T. Scan of Brain, Spine, Abdomen etc. and tissue biopsy – by fine needle aspiration of affected side was taken and cultured. Results: About 100 cases of diabetes mellitus were taken from indoor and outdoors in Rajendra Institute of Medical Sciences, Ranchi of these patients 20 were found with tuberculous lesion. In 20 diabetic tuberculosis patients, 11 were male and 9 were female. In these patients, 16 were belonging to rural area and 4 were from urban area. Extra pulmonary tuberculosis was found in 14 patients and pulmonary tuberculosis in 6 patients. The incidence of tuberculous infection is associated with more in type 2 diabetes mellitus than type 1 diabetes mellitus, 17 & 3 cases respectively. The most common clinical feature was cough with or without expectoration, than fever and weakness. Pleural effusion is the most common extra pulmonary tuberculous lesion. Most of the tuberculous lesions are diagnosed by Chest X-Ray PA-view. In diabetic pulmonary tuberculous lesion, 45% cases are found in advanced stage.  Conclusion: This study shows the incidence of tubercolous infection in diabetes mellitus in gradually increasing. Extra pulmonary types of tuberculosis are more in diabetic patients. Rural populations are more prone to be infected with tuberculosis. The future studies will within corborate or contradict the present finding and thereby strengthen the observation made in the present study. Keywords: Pulmonary and extra pulmonary tuberculosis, diabetes mellitus, association, incidence, diagnostic tests, mortalit