Comparing role of laparoscopy, ultrasound and clinical examination in pelvic pain

Background: Pelvic pain is a frequent and poorly understood complaint in women of reproductive age group, which is one of the most perplexing problems faced by the gynaecologist. This study was conducted to detect the cause of pelvic pain and to correlate clinical diagnosis, ultrasound, and laparoscopic di-agnosis and formulate treatment modalities.Methods: This study was conducted in the Department of Obstetrics and Gynecology, JLN Hospital and RC, Bhilai, Chattisgarh during the one year period from September 2014 to August 2015. 97 women belonging age 15 to 65 years with history of pelvic pain (acute / chronic) were admitted after excluding history of acute abdominal trauma, diagnosed gynaecological malignant disorder, severe cardiac/respiratory disease or signs of peritonitis. A detailed history was taken and clinical examination was done.Results: The age group in the present study was between 15 to 65 years. Among them, 36% cases belonged to 20-30 years age group. Clinically the most common sign was abdominal tenderness (59.89%). Clinically 47 cases (48.45%) had abnormal findings, on ultrasonography 61 cases (62.88%) had abnormal findings as compared to laparoscopy which could detect 75 cases (77.32%) showing abnormality. Most common pelvic pathology was adhesions (17.52%) followed by PID (14.43%). None of the cases of adhesions, fimbrial cyst, pelvic congestion syndrome and appendicitis were diagnosed clinically or ultrasonographically, all cases were diagnosed on laparoscopy. The sensitivity and specificity of clinical examination is 54% and 49% as compared to laparoscopy respectively. The PPV and NPV of clinical examination is 24% and 78% respectively. The sensitivity and specificity of ultrasonography is 59% and 69% as compared to laparoscopy respectively. The PPV and NPV of Ultrasonography is 36% and 85% respectively. Appropriate surgical intervention like salphingooopherectomy, adhesiolysis, myomectomy, hysterectomy was carried out laparoscopically.Conclusions: Laparoscopy eliminates the diagnostic error and corrects the wrong diagnosis. Laparoscopy is a more sensitive and superior method for evaluation of pelvic pain as compared to Ultrasonography. Laparoscope has definitive place in evaluating patients with pelvic pain and often a definitive procedure can be undertaken with the laparoscope without subjecting the patient to laparotomy

Partograph versus no partograph: effect on labour progress and delivery outcome: a comparative study

Background: Abnormal labour which includes prolonged labour and obstructed labour remain major causes of maternal morbidity. The major reason for neonatal mortality, birth asphyxia and subsequent morbidity is essentially the repercussion which occurs when a complicated labour is not intervened at the right time. A Partograph provides a graphic overview of the progress of labour and records information about maternal and fetal condition during labour. It is considered to be a very effective tool to monitor labour progress and prevent prolonged and obstructed labour.Methods: This prospective randomised comparative study was conducted in the Department of Obstetrics and Gynaecology, JLN Hospital and RC, Bhilai, Chattisgarh, from January 2015 to June 2016. Pregnant women were randomly assigned to two groups, of 200 each, after satisfying the inclusion and exclusion criteria. Women assigned to Group 1 had their active labour modified using modified WHO partograph whereas those assigned to Group 2 were not monitored using the partograph.Results: Use of Partograph (group 1) significantly reduced the duration of active phase of labour (p 0.05).Conclusions: The use of Partograph, when compared to no Partograph plotting in active labour, is associated with better monitoring of labour progress as well as delivery outcome in the form of a healthy mother and a healthy child

Laboratory and clinical profile of dengue: a study from coaching city, Kota, India

Background: Dengue, an endemic disease in most subtropical and tropical regions of the world and it causes severe epidemics in India. Dengue is one of the most common acute viral illness associated with considerable morbidity and mortality. The objective of this study was to study laboratory findings and clinical profile of patients with dengue fever at a tertiary care hospital of coaching city Kota.Methods: This study was cross sectional study. The patients were examined at one point of time and later they were never followed which is similar to the cross-sectional study design. A total of 100 patients of dengue fever who were NS1 Antigen or IgM dengue positive, admitted to department of medicine of government medical college, Kota included in the study. Through clinical examination and relevant laboratory investigations performed in all patients.Results: In the present study, there were 74 males and 26 females. The sex ratio was 2.8:1. Maximum number of males (50%) was in the age group of 15-25 Years. Among females the maximum (42.3%) were in the age group of 15-25 years. The most common presenting symptom was fever in all cases followed by headache in 96%. Among bleeding manifestation, Epistaxis, gum bleeding and melena (24%) were the common symptom. 47% patients showed hepatomegaly and 38% showed splenomegaly. 12% patients were anemic and 51% showed leucopenia while 93% showed thrombocytopenia.Conclusions: Males were commonly affected. Young age group of 15-25 was more commonly affected. Fever and headache were the most common presenting symptom. As dengue causes increased morbidity and mortality and requires prompt diagnosis and treatment for the proper management of these cases, this study helps physicians in early diagnosis of dengue by suspecting the features as of dengue and can prevent morbidity and mortality associated with dengue

Severe acute malnutrition: seasonal variations in Southern Rajasthan, India

Background: Malnutrition is India’s one of the biggest health care challenge. India has some of the highest rates of child malnutrition. We performed a retrospective study of children admitted in Malnutrition Treatment Centre to find out any seasonal variations in the prevalence of severe acute malnutrition (SAM) in Southern Rajasthan, India.Methods: In this hospital based retrospective study, data were analysed for all children admitted at malnutrition treatment centre of a tertiary level hospital attached to a medical college from April 2014 to March 2016 to study the seasonal variations in the prevalence of SAM.Results: A total of 30,140 children were admitted during the last two years, out of which under five children other than new born were 4,942 in 2014-15 and 5,972 in year 2015-16. Total 1915 SAM children were admitted in our malnutrition treatment centre (MTC) in last 2 years. Among the under five children 840 (17%) children were admitted with SAM in 2014-2015 and 1075 (18%) in year 2015-2016. The number of SAM admission has increased in 2015-16 from the previous year (p0.05).Conclusions: The prevalence of SAM in admitted patients was high as compared to national and state data and this has increased over the year, but there are no month wise seasonal variations in prevalence of SAM in our children representing Southern Rajasthan, India.

Effect of pre-harvest spray of calcium nitrate, boric acid and zinc sulphate on storability of Nagpur mandarin (Citrus reticulata Blanco)

An investigation was carried out at Fruit Research Farm, Department of Fruit Science at College of Horticulture and Forestry, Jhalawar during 16 September, 2014 to 1 March, 2015 to study the individual effect of Pre-harvest spray of Calcium nitrate, Zinc sulphate and Boric acid as well as their interaction on Storability of Nagpur mandarin (Citrus reticulata Blanco) after fruit set stage. Among different pre-harvest treatments, T27 treatment (Ca 3.0% + B 0.6% + Zn 0.6%) treated fruits had the longest shelf-life of 15 days at ambient conditions with lowest PLW (9.27 %), decay per cent (15.23 %) and better organoleptic ratting (8.41/10) and higher retention of juice percent (39.12 %) till end of storage period

Role of serum anti mullerian hormone as a predictor for miscarriage

Background: Recurrent Miscarriage is defined as three or more failed clinical pregnancies at less than 20 weeks of gestation or fetal weight less than 500 grams that ends spontaneously. Ovarian reserve demonstrates reproductive potential and includes FSH, estradiol, inhibin B, and S. AMH levels. Women with very low AMH levels may have altered folliculogenesis that may influence early implantation to increase the risk of miscarriage. This study aimed to determine the serum AMH levels in patients with recurrent miscarriage and pregnancy outcomes in low (3.5 ng/ml) AMH groups and to evaluate the role of serum ovarian biomarkers in prediction of miscarriages.Methods: This was a case-control study conducted over a time period of 1 year, on 120 women attending the antenatal clinic in department of obstetrics and gynecology, Swaroop Rani Nehru Hospital, Prayagraj. The patients were divided into two groups, Group 1 (n=80) included women with previous history of abortions and Group 2 (n=40) included women with no history of abortions. S. AMH levels were analyzed and compared in both the groups.Results: In the present study, a significant negative correlation was seen between S. AMH and rate of miscarriages (p <0.05). Low AMH values were observed in patients with history of previous pregnancy loss.Conclusions: Diminished ovarian reserve contributes to recurrent pregnancy loss and should be considered part of the work-up for RPL. AMH levels in recurrent miscarriage patients were lower than those in a normal population

Kinetic study of Oxidation of some Monosaccharides by Chloramine-T induced by Visible light source

Abstract The kinetics of photochemical oxidation of glucose and fructose by chloramine-T in acidic medium has been studied

Schools as opportunity for oral health promotion: Existing status in India

Childhood is a significant stage in people’s lives where they are more receptive toward behavior shaping; thus, schools have been&nbsp;considered important foundation in addressing the health and social issues. School oral health education programs have produced&nbsp;affirmative results in improving the overall health of the child. The aim of the current review was to explore the history of school&nbsp;health, models of school health and existing efforts of School Oral Health Programs (SOHP) in India. The review identified&nbsp;five existing SOHP (Indian Dental Association - Colgate’s “Young India” Bright Smiles, Bright Futures, Chacha Nehru Sehat&nbsp;Yojna - School health scheme [Government of Delhi], Neev - SOHP, Intensive Dental Health Care Program - Punjab, Trinity CareFoundation - Bengaluru, National Oral Health Program, AIIMS) which is either running or proposed. It is recommended that the&nbsp;upcoming SOHP should be crafted on the existing evidence-based guidelines and theoretical models of school health. Prompt&nbsp;execution of proposed programs should be the priority to target the optimum oral health of the children.&nbsp

An evaluation of comparative treatment effects with high and low dose fluticasone propionate/formoterol combination in asthma.

Abstract Background Despite extensive use of inhaled corticosteroid/long-acting β2-agonist combinations in asthma, limited data evaluating dose–response for this combination class are available. The benefits of dose escalation and nature of patient subgroups likely to benefit are thus ill-defined. Method In this randomised, double-blind, 8-week study the effects of two dose levels (100/10 and 500/20 μg b.i.d.) of a fixed combination of fluticasone/formoterol (flutiform®) were compared in 309 patients. Treatment effects upon spirometric and symptom-based endpoints were examined in the overall population and in two subgroups defined a priori by % predicted FEV1 at baseline (≥40–≤60% ["severe" airways obstruction] and >60–≤80% ["moderate" airways obstruction]). Results No dose–response was evident for spirometric outcomes (FEV1, FEV1 AUC0–12, PEFR) either overall or in either subgroup. At variance with the spirometric data, statistically significant dose-dependent differences were seen for nocturnal outcomes and consistent numerical differences were found across multiple symptom-based outcomes (symptom scores, sleep scores, rescue medication use, asthma control days, AQLQ scores, exacerbations); greater effects were noted with the higher dose of fluticasone/formoterol. Between-group differences for the overall population were driven by treatment effect differences in the "severe" subgroup. Conclusion In this exploratory comparison a high dose of fluticasone/formoterol in asthmatic patients appears to provide additional improvement in symptom-based rather than spirometric outcomes. Additional benefits from high versus low dose treatment are most likely in patients with severe airway obstruction, although the doses at which ceiling effects are attained may vary between individuals. Trial registration ClinicalTrials.gov identifier: NCT00734318 ; EudraCT number: 2007-001633-34

Acute intermittent porphyria and pregnancy: an obstetric challenge

Acute intermittent porphyria is a rare autosomal dominant disease caused by a mutation in the gene coding for the porphobillinogen deaminase enzymes in heam biosynthesis. The disease manifests as acute attacks of neuropsychiatric dysfunction and neurovisceral manifestations presenting as acute abdomen. In pregnancy, 54% patient has exacerbation of attacks in the form of seizures and acute abdomen occurs due to hormonal changes. Prevalence of acute intermittent porphyria is 1-2/200000 in general. Here we report a case of 36 year old women, G4P1L2A2 presenting at 10+4 weeks of gestation requesting pregnancy termination. Patient was diagnosed as case of acute intermittent porphyria with porphyic polyneuropathy 6 months back. At that time her main symptoms were acute pain abdomen with numbness and weakness in all four limbs. Her urinary porphobillinogen and 5 ALA raised. Her CECT of brain and nerve conduction studies were normal. Since then she is on Tablet Gabapentin 300 mg H.S. She underwent successful pregnancy termination by suction and evacuation under spinal anesthesia and she refused for copper-T insertion. Only safe drugs were used for procedure and she was discharged with advice of barrier contraception