Surveillance of congenital malformations and their possible risk factors in a teaching hospital in Punjab

Background: Congenital malformations (CMF) are third most common cause of perinatal mortality in India making their prediction and prevention highly eminent. The present study was designed to analyze the frequency, distribution and patterns of CMF among babies born in a teaching hospital in Punjab, along-with factors contributing towards their occurrence.Methods: This was a prospective study in which the incidence of CMF was determined in 1554 consecutive deliveries conducted at Gian Sagar Medical College, Banur, from July 2010 - June 2011. Diagnosis of CMF was based on prenatal ultrasound or clinical evaluation of the newborn by the neonatologist. Various risk factors associated with occurrence of CMF were studied.Results: The incidence of CMF was 4.44% (n=69). Out of the babies born with CMF, 49 (71.01%) were still born, and major defects were present in 68.11%. CNS and urogenital system were most commonly involved, while 8.6% babies had multiple anomalies. High age and parity, parental consanguinity, bad obstetrical history, inadvertent drug ingestion enhanced risk; with no effect of radiation exposure and antenatal infections.Conclusions: Incidence of CMF in our population was 4.44%: frequently associated with increasing age, parity, consanguineous marriage, maternal disease and drug ingestion

Comparative study of feto-maternal outcome in clinical and subclinical hypothyroidism

Background: Thyroid diseases are the one of commonest endocrine disorders affecting women of reproductive age group, and hence constitute the commonest endocrine disorder complicating pregnancy. Maternal thyroid function changes during pregnancy and inadequate adaptation to these changes results in thyroid dysfunction. The objective of this study was to determine the prevalence of clinical and subclinical hypothyroidism and to study the fetal and maternal complications associated with hypothyroidism.Methods: A prospective and observational study undertaken over a period of 2 years from 1st October 2009 onwards. Pregnant women were screened for thyroid dysfunction irrespective of gestational age. Patients were divided into two group; Group I (subclinical hypothyroidism)- all pregnant patients with serum TSH ≥ 3 mu/l up to 6 mu/l and normal free T4 levels. Group II (clinical hypothyroidism)- all pregnant patients with serum TSH level ≥ 6 mu/l OR on thyroxine pre-pregnancy.Results: In the present study, prevalence of thyroid disorder was 6.22%, subclinical hypothyroidism and clinical hypothyroidism being 3.77% and 2.45% respectively. In subclinical group and clinical group, we found, preeclampsia, preterm labour, first trimester abortions and oligohydramnios in 13.75% versus 19.23%, 13.75% versus 36.54%, 11.25% versus 11.53%, and 16.25% versus 23.02% respectively. Subclinical hypothyroidism was more prevalent and hidden leading to the poor obstetrical outcome and fetal complications like low birth weight, prematurity and intrauterine growth restriction. There was higher incidence of caesarean deliveries in both groups more in clinical hypothyroid cases.Conclusions: Due to the adverse effect of maternal thyroid disorder on maternal and fetal outcome, timely diagnosis and initiation of treatment of hypothyroid disorders is essential

Palonosetron: A novel approach to control postoperative nausea and vomiting in day care surgery

Background: Postoperative nausea and vomiting (PONV) is one of the complications which hamper the successful implementation of day care surgical procedure in spite of the availability of so many antiemetic drugs and regimens for its prevention. The aim was to compare the prophylactic effects of intravenously (IV) administered ondansetron and palonosetron on PONV prevention in patients undergoing laparoscopic gynecological surgery under general anesthesia. Methods: A prospective double-blind study comprised of 60 ASAI/II female patients between the age group of 25 and 40 years was carried out in the Departments of Anesthesiology and Obstetrics and Gynecology of our institute. Patients were randomly divided into two groups of 30 patients each in a double-blind manner. Group I received 8 mg of inj. ondansetron IV while group II received inj. palonosetron 0.075 mg IV 5 minutes before the induction of anesthesia. The need for rescue antiemetics, episodes of PONV and other side effects were observed for 6 hours in the postanesthesia care unit and thereafter complaints were received on phone after the discharge. At the end of study, results were compiled and statistical data was subjected to statistical analysis using Student two-tailed ′t′ and c2 test and value of P<0.05 was considered significant. Results: The demographical profile of the patients was comparable. Twenty and 13.33% of the patients in group I had nausea and vomiting episodes postoperatively as compared to 6.67% and 3.33%, respectively, in group II which was statistically significant (P<0.05). Twenty percent of the patients in group I experienced significant post-op headache as compared to 6.67% in group II. The mean rescue dose of antiemetic was significantly higher (10.6 mg) in the group I as compared to group II (6.4 mg) (P=0.036). The rest of parameters were comparable and statistically nonsignificant. Conclusions: Palonosetron is a comparatively better drug to prevent the PONV in patients undergoing day care surgical procedures as compared to ondansetron as it has got a prolonged duration of action and favorable side-effects profile

Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation

Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists) ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD) and ropivacaine + clonidine (RC), comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS) version 10.0 for windows and value of P < 0.05 was considered significant and P < 0.0001 as highly significant. The demographic profile, initial and post-operative block characteristics and cardio-respiratory parameters were comparable and statistically non-significant in both the groups. However, sedation scores with dexmedetomidine were better than clonidine and turned out to be statistically significant (P < 0.05). The side effect profile was also comparable with a little higher incidence of nausea and dry mouth in both the groups which was again a non-significant entity (P > 0.05). Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia