Comparison of intravenous paracetamol vs. intramuscular diclofenac for postoperative pain control in abdominal hysterectomy

Background: Abdominal hysterectomy is one of the most common gynaecological surgery conducted worldwide. It is commonly associated with post operative pain. The aim of this study was Comparison of intravenous Paracetamol versus intramuscular Diclofenac for postoperative pain control in abdominal hysterectomy. Objectives of this study were to compare the effectiveness of intravenous Paracetamol and intramuscular Diclofenac when used for post-operative pain control in abdominal hysterectomy patients and to compare the need for rescue analgesia in both the groups.Methods: It’s a prospective observational and clinically randomized study conducted in Department of Obstetrics and Gynaecology, Government Medical College Haldwani and associated Dr. Shushila Tiwari Government Hospital, Haldwani consisting of 120 patients undergoing abdominal hysterectomy. 60 patients in group A received Paracetamol 1000 mg (100ml infusion) intravenous followed by subsequent doses of 1000 mg every 8 hourly for 48 hrs and another 60 patients in group B received injection Diclofenac 75 mg intramuscular every 8 hourly for 48hrs. Pain intensity of patients was noted 2 hourly for 6 hours after giving the first dose of the drug and then at every 8 hour for next 48 hours, using VAS scoring. Patient’s hemodynamics in form of respiratory rate, heart rate, mean arterial pressure (MAP), oxygen saturation (sPO2) were monitored as per pain monitoring protocol.Results: Post-op mean VAS score at different point of time among the two treatment groups was lower for Paracetamol group as compared to Diclofenac group. The difference was found to be statistically significant at all point of time post op. Adverse effect like nausea, vomiting and dizziness was seen more among Diclofenac group as compared to Paracetamol group.Conclusions: Intravenous Paracetamol use was found to be associated with better postoperative pain relief and reduced need for rescue analgesia consumption in the postoperative period

Study of menstrual pattern changes in patients accepting injection depo-medroxyprogesterone acetate versus levonorgestrel intrauterine system

Background: Changes in menstrual bleeding patterns are a major cause of hormonal contraceptive discontinuation. DMPA and LNG IUS both are hormonal contraceptives and are used by most of the women worldwide for various gynaecological conditions. The aim of the present study was to compare menstrual pattern changes in patients accepting injection DMPA and LNG-IUS for various gynaecological indications.Methods: This randomized controlled trial was conducted among 70 women aged 18 years or older with heavy menstrual bleeding in the department of Obstetrics and Gynaecology, Chhatrapati Shivaji Subharti Medical College, Meerut. The study comprised of two groups having 35 patients each i.e. Group 1 (patient who opted for LNG IUS) and Group 2 (patient who opted injection DMPA). The menstrual pattern changes were assessed at 1month, 3month and 6th month interval. Patient were asked to maintain a menstrual calendar wherein she would keep a record of the no. of days along with dates when she has spotting per vaginum/bleeding per vaginum and the amount of blood loss explained to her through the pictorial blood assessment chart.Results: Reduction in median menstrual blood loss was significantly greater in the LNG IUS group (-128.12mL, range -393.6 to 328.5 mL) than in the DMPA group arm -17.8 mL, range -271.5 to+78.6 mL, p<0.001).Conclusions: LNG IUS reduces menstrual blood loss more effectively than DMPA

Association of early neonatal-maternal outcomes with timing of elective caesarean section at term gestation

Background: The decision for optimal time for elective caesarean section (ECS) should be taken considering the minimum risk to the newborn as well as to the mother. This prospective observational study aimed to investigate the effect of gestation of ECS, on neonatal and maternal outcomes.Methods: All the pregnant term mothers admitted to our hospital for ECS and fulfilling the inclusion criteria were enrolled and divided into 2 groups, early term and full term. Patients having high-risk factors like intrauterine growth restriction, amniotic fluid disorders, multiple pregnancies, placenta previa, abruption placenta and medical co-morbidities were excluded. Early neonatal and maternal outcomes were compared between the 2 groups.Results: 244 mothers were eligible for ECS, 183 (75%) women underwent ECS in the early term and 61 (25%) at full term as per the decision of obstetricians of various units. The incidence of neonatal respiratory morbidity (NRM) was 2 percent in our study. Out of 244 newborns, 4 developed NRM in the form of delayed adaption in 3 and respiratory distress in 1. The incidence of respiratory distress was comparable in both groups. The incidence of NNJ, MSL and sepsis was higher in the early term but it was not significant statistically. Maternal outcomes like postpartum haemorrhage, the need for blood transfusion, bladder injury, thin scar, adhesions poorly formed LUS were observed in the early term but the difference was not significant.Conclusions: More research needs to be done for optimization of timing of ECS

Endometrial stromal sarcoma together with leiomyosarcoma in a single patient: a rare case report

Uterine sarcomas are relatively rare tumors of mesodermal origin. The three most common histological variants of uterine sarcoma are Leiomyosarcomas, Endometrial stromal sarcomas, and Carcinosarcomas. It is extremely uncommon to find the 2 variants in a single patient. Given the rarity of these tumors there are limited reports in the literature referring to the clinical management and final outcome of these cases. Our patient was a 60 year old post-menopausal women presented in the opd with post-menopausal bleeding. Ultrasound report showed a fibroid of around 8 by 8 cm fundal fibroid. Endometrial biopsy report showed low grade endometrial sarcoma while the CECT report showed leiomyosarcoma creating a dilemma in the diagnosis. Patient was then taken up for surgical exploration. The biopsy report confirmed the existence of both the types of tumor, a very rare finding

Pattern and management of penetrating and nonpenetrating thoracic injuries

Background: Chest trauma constitutes a major public health problem which  includes the injuries to chest wall, pleura, tracheobronchial tree, lungs, diaphragm, oesophagus, heart and great vessels. It consist of more than ten percent of all traumas and twenty five percent of death due to trauma occurs because of chest injury. Chest trauma is increasing in frequency in urban hospitals. Penetrating and nonpenetrating thoracic injuries the most serious injuries leading to significant morbidity and mortality.Methods: This study was prospective observational study of 220 patients of thoracic trauma both penetrating and non-penetrating. These patients admitted in general surgical units from August 2017 to May 2018  of Pandit Bhagwat Dayal  Sharma,  PGIMS  Rohtak Haryana India. The study was pertaining to both penetrating  and non-penetrating chest trauma.Results: Out of 220 chest injury patients who were studied during the said period, Males were 203 and females 17 by a ratio of 12:1 and age ranged from lowest 18 years to 85 years of age. Majority of the patients (90.45%) sustained blunt injuries. RTA was the common mechanism of blunt injury affecting (50.45%) of patients. Multiple Rib fractures was the commonest type of chest injury (21.36%) followed by head injury (17.27%). Head injury was the commonest associated injury seen in our patients. Conclusions: Chest trauma resulting from road traffic accident remains a major mechanism of chest injury. The  measures to decrease the trauma are, educating people about traffic rules and regulations and strictly implementing them is necessary to reduce incidence of chest injuries

Study of sociodemographic factors of women undergoing caesarean section in tertiary care centre of rural area of central India

Background: Many studies have attempted to examine and evaluate the changes in population characteristics that may have contributed to the observed increase in CS rate. The aim of this study was to determine the caesarean section rate and demographic characteristics of women undergoing caesarean section in our rural tertiary health centre of central India.Methods: This prospective study was conducted in department of obstetrics and gynecology. The study instrument comprised a pre-structured data collection proforma which had various sections; social demographic characteristics, obstetric history and gestation details.Results: The overall caesarean section rate (CSR) was 36.88%. Maximum women (39.62%) who underwent Caesarean section were of age group 25-29 years. 58.05% from rural while 41.95% from urban area. CS was more in women of lower middle (22.80%) and upper lower (20.80%) class. Majority of women who had caesarean section were educated till higher school (31.87%) or were graduate (22.61%), 5.85% were illiterate. Majority of women (56.40%) were housewives. CSR was 70.83% in referred and 28.31% in booked. 52.86% women were nulliparous. Caesarean section was maximum (83%) in term, 16.92% preterm women and 0.08% post term women. 38.69% were referred from other health facilities. Maximum referrals 43.21% were from the district hospital.Conclusions: It was noted that the preference for caesarean section is more in women of 25-29 years, lower middle and upper middle class, rural women, educated upto high school and housewives at our centre. This hospital also serves as referral centre from surrounding health facilities increasing the caesarean section rate of the institute

Potentials and limitations of microorganisms as renal failure biotherapeutics

Renal insufficiency leads to uremia, a complicated syndrome. It thus becomes vital to reduce waste metabolites and regulate water and electrolytes in kidney failure. The most common treatment of this disease is either dialysis or transplantation. Although these treatments are very effective, they are extremely costly. Recently artificial cells, microencapsulated live bacterial cells, and other cells have been studied to manage renal failure metabolic wastes. The procedure for microencapsulation of biologically active material is well documented and offers many biomedical applications. Microencapsulated bacteria have been documented to efficiently remove urea and several uremic markers such as ammonia, creatinine, uric acid, phosphate, potassium, magnesium, sodium, and chloride. These bacteria also have further potential as biotherapeutic agents because they can be engineered to remove selected unwanted waste. This application has enormous potential for removal of waste metabolites and electrolytes in renal failure as well as other diseases such as liver failure, phenylketonuria, and Crohn’s disease, to name a few. This paper discusses the various options available to date to manage renal failure metabolites and focuses on the potential of using encapsulated live cells as biotherapeutic agents to control renal failure waste metabolites and electrolytes

Knowledge, stress and adopted coping strategies of parents of children having congenital adrenal hyperplasia: An exploratory survey

Background: Congenital adrenal hyperplasia (CAH) is an inherited disorder of adrenal glands, the most common type being due to a deficiency of the enzyme 21-α-hydroxylase. Girls affected with it are virilized to a variable extent. The taboo associated with ambiguous genitalia in female babies poses an immense societal pressure on parents for keeping the disease a secret. Objective: The aim of the study was to generate the evidence on the knowledge, stress, and coping strategies used by the parents of CAH children. Methodology: In a cross-sectional descriptive survey using mixed methods approach, 30 parents of children with CAH attending the outdoor department of pediatric medicine and surgery in a tertiary care hospital were enrolled. The CAH knowledge questionnaire, parental stress scale (PSS), and COPE inventory were the standardized tools used along with demographic profile sheet to assess the knowledge of parents related to CAH, stress, and coping strategies used by them. Results: Majority of the parents (67%) had poor knowledge (&lt;7) and moderate stress (42-65) scores. Knowledge and stress were negatively correlated (r=−0.39, p=0.035). Coping strategies used by the parents in dealing with stress in moderate amount were mainly problem-focused (active coping [60%] and planning [60%], instrumental social support [53%], suppression of competing activities [50%]), and emotion-focused (positive reinterpretation [60%], emotional social support [67%], acceptance [53%], and religious coping [50%]). Less useful coping strategies such as focus on and venting of emotions, behavioral disengagement, mental disengagement, humor, and substance abuse were not used by the majority parents. Conclusion: Parents of children with CAH had poor knowledge and moderate stress related to the disease condition of their children and were using problem focused and emotion focused coping strategies to reduce their stress

Synthesis of AgInS2 nanoparticles Directly in Poly (3-hexyl thiophene) (P3HT) Matrix: Photoluminescence quenching studies

Inorganic semiconductor AgInS, nanoparticles and P3HT/AgInS2 composite was synthesized by decomposition of silver indium xanthate. The synthesized nanoparticles and composite were characterized by XRD and UV-Vis spectroscopy. PL quenching of the composite demonstrate that the electron transfer from polymer to inorganic NPs through ex-situ solution blending is less efficient in PL quenching as compared to in-situ synthesis

A clinical audit and confidential enquiry of caesarean section indications at rural tertiary health care centre

Background: Worldwide CSR has been steadily increasing beyond recommended level of 15 %by WHO. High CSR have been reported in developed and developing countries. Reasons for increase in CSR are not obvious and somewhat complex. Thus, present study was undertaken to analyze various indications for CS performed at rural tertiary health care centre Sewagram, M.S.Methods: This was prospective study included all women who underwent CS from 1st January 2015 till 30th June 2016. Data was entered in MS excel sheet analyzed with percentage and chi square test using SPSS ver.17.Results: CSR was 36 .88% in present study. As per NICE guidelines CS were classified in four categories based on urgency, women were distributed in each category. Category I had 22.62%, category II -38.61%, category III - 28.37% and Category IV - 10.40% women. In CAT I common indication was foetal bradycardia (71.53%). In CAT II CS, common indication was non reassuring foetal status (38.82%).  Breech presentation (14.74%) and previous scar with doubtfull scar integrity (14.33) were next common indications. In CAT III (43.43%), IV (41.13%) previous LSCS with inadequate pelvis was the common indication. Confidential enquiry revealed that 26.17% (28/107), 20.3% (40/197), 23.17%, (35/151) and 8.3 % (5/60) of CAT I, II, III and IV CS had questionable indications.Conclusions: In this study, CSR was higher than WHO standard. Common indications in primipara was foetal distress while in multiparas primary indication previous LSC