Magnesium sulphate versus Phenytoin in eclampsia - Maternal and Foetal outcome – A comparative study

BackgroundEclampsia manifests as seizures and is unique to the pregnant state. It remains an important cause of maternal mortality especially in resource-challenged countries that lack access to prenatal care. AimsThe aim of our study was to compare maternal and foetal outcomes in mothers with eclampsia with the administration of either magnesium sulphate or phenytoin in a resource- challenged situation. MethodThe work was conducted from January 2012 to December 2012. A total of 80 patients were assigned alternately to two groups – one group was treated with magnesium sulphate (Group-M; n=40), and the other treated with phenytoin (Group-P; n=40) (Figure 1). The magnesium sulphate was administered according to the Pritchard’s regimen; phenytoin administered according to Ryan’s regimen. With either regimen, anticonvulsant therapy was continued for 24 hours postpartum or 24 hours after the last convulsion, whichever was later.ResultsFifty-four percent of patients regained consciousness within 8 hours of treatment onsetin Group-P compared to 5.3 percent in Group-M (p=0.0001, χ2=19.24). Seven patients in Group-P had recurrence of convulsions as compared to none of the 40 women assigned to Group-M (p=0.032, χ2=4.62). The incidence of Caesarean section was greater (62.5 per cent) in Group-M compared to Group-P (25 per cent; p=0.001, χ2= 9.96). No statistically significant differences were found in the foetal outcomes between the two groups.ConclusionPhenytoin use may be reconsidered in selective cases in low and middle income countries (LMIC) as it has been found simpler to use, has several benefits and also curtails treatment cost. Magnesium sulphate is substantially more effective than phenytoin with regard to recurrence of convulsions. Proper training in the management of eclampsia should be given to all health care workers to ensure appropriate management of eclamptic mothers. Thus, the treatment of this disease calls for more research work especially in the resource challenged settings

Incidence of Ovarian Pregnancy is in the increasing trend? Two case reports

Ovarian pregnancy is a rare event occurring in 1-3% of all ectopic pregnancies. Increased reporting might be due to the wider use of intra-uterine devices, ovulatory drugs and assisted reproductive techniques. Though ovarian pregnancy has a distinct pathology, it can be a source of clinical and intraoperative diagnostic difficulty. We report two cases of ovarian pregnancy – one primary and one secondary – that came to our notice within six months span. Unlike tubal ectopic and secondary ovarian pregnancies, patients with primary ovarian pregnancy are likely to experience success in future intra-uterine conception and negligible risk

Vasopressin: Its current role in anesthetic practice

Vasopressin or antidiuretic hormone is a potent endogenous hormone, which is responsible for regulating plasma osmolality and volume. In high concentrations, it also raises blood pressure by inducing moderate vasoconstriction. It acts as a neurotransmitter in the brain to control circadian rhythm, thermoregulation and adrenocorticotropic hormone release. The therapeutic use of vasopressin has become increasingly important in the critical care environment in the management of cranial diabetes insipidus, bleeding abnormalities, esophageal variceal hemorrhage, asystolic cardiac arrest and septic shock. After 10 years of ongoing research, vasopressin has grown to a potential component as a vasopressor agent of the anesthesiologist's armamentarium in the treatment of cardiac arrest and severe shock states

Influence of Exteriorised versus Intra-abdominal Uterine Repair Caesarean Delivery under Spinal Anaesthesia on Intraoperative and Postoperative Complications

Introduction: Caesarean techniques have evolved over time to increase their safety. Intra-abdominal closure of uterine incision seems more physiological. Exteriorisation makes repair easier with a better exposure. But this causes tension to the supporting structures attached to uterus and stretching of vasculature with the risk of intraoperative haematoma or aneurysm later on. Aim: To compare the in-situ repair Group and exteriorised repair group caesarean delivery under spinal anaesthesia regarding occurrence of intraoperative and postoperative complications of interest. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at College of Medicine and Jawaharlal Nehru Memorial Hospital, West Bengal, India, over a period of two years from April 2014 to March 2016. Four hundred women undergoing caesarean section who fulfilled the inclusion and exclusion criteria were recruited in the study. They were randomly allocated into two study groups as per a computer generated random allocation table. In Group A (n=200) uterine incision was closed after uterus was exteriorised and in Group B (n=200) uterine incision was closed keeping it inside the abdomen. Intraoperative and postoperative parameters of interest such as nausea-vomiting, drop in pulse rate, incision closure time, drop in haemoglobin, blood transfusion rate, return of bowel sounds, febrile morbidity, surgical site infection, hospital stay etc., were noted and compared between the two groups. Numerical variables were expressed as mean and standard deviation and analysed using independent sample t-test. For qualitative variables frequency and percentage were calculated and analysed using Chi-square. Collected data was transferred and analysed using Statistical Package for Social Sciences (SPSS) version25. The p-value ≤0.05 was considered significant. Results: The demographic profiles like age, parity, gestational age etc. of both the groups were similar. There was a significant difference in uterine closure time (9±2.5 minutes in in-situ repair group vs. 10±2 minutes in exteriorisation and repair groups, respectively (p0.05). Mean drop of haemoglobin was more in the intraabdominal closure group (1.5±1.3 gm/dL) as compared to the group of closure after exteriorisation (1.4±1.3 gm/dL) though the difference was not significant statistically (p=0.44). Postpartum blood transfusion rate was 6.5% in exteriorised repair group and 9% in in-situ repair group (p=0.35). Postoperative morbidity like fever, surgical site infection, length of hospital stay was similar in both the groups. Conclusion: Choice of uterine closure method is operator dependent and either method of uterine closure is acceptable when practiced and skill is gained. Exteriorisation is advantageous when excessive bleeding is encountered. Though time taken for closure in in-situ group is statistically more it is similar practically. Bowel sounds returned earlier postoperatively in in-situ group

Comparison of Attendance of Patients Pre-lockdown and during Lockdown in Gynaecology and Antenatal Outpatient Department in a Tertiary Care Hospital of Nadia, West Bengal, India

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has brought about a paramount change in the life. This has lead to a reduction in the number of routine patients visiting the Outpatient Department (OPD) of various hospitals and this department was no exception. Aim: To compare the attendance of patient in Antenatal Care (ANC) and Gynaecology Out Patient Department (GOPD) between pre-lockdown and lockdown period due to COVID-19 pandemic. Materials and Methods: The study was conducted among patients attending the OPD in ANC and Gynaecology for 70 days lockdown from 23rd March to 31st May and 70 days immediate pre-lockdown period from 12th January to 22nd March 2020. Daily attendance was noted and types of patient attending in different sub clinics in Gynaecology OPD compared. Enrolment of new ANC patient and old booked cases was compared during both periods. Descriptive statistics were used and displayed as percentages. Results: There was a significant reduction in number of patients attending OPD in lockdown period. There was a total of 6088 (87.3%) reduction in number of patients in Gynaecology OPD and 2235 (69.6%) reduction of patients in ANC OPD which was found to be significant with p-value <0.001. Reduction of patient in lockdown days among new ANC was 574 while it was 1661 in case of old patients. The different sub clinics of GOPD like infertility (704), endocrine (1450), uro-gynaecology (656), STD/ PID (732), postpartum (597), cancer detection (316), abortion and medical termination of pregnancy (MTP) (330), others (1303) also witnessed a diminution of attendance. Conclusion: COVID-19 caused a significant decrease in footfall of patients in outpatient department due to lockdown, though the percentage of types of patient attending Gynaecology OPD was almost same

Evaluation of the effect of COVID-19 infection in pregnancy and puerperium in a suburban medical college in West Bengal, India

Background: The pandemic of SARS-CoV-2 was a novel situation, there was no conclusive knowledge, particularly concerning its effect on pregnant women and infants. Eminent obstetric organizations have introduced an array of guidelines to assist clinicians in countering this prior unknown outbreak. The primary objective of this study was to summarize the clinical characteristics, complications, and maternal and neonatal outcomes of COVID-19 during pregnancy and puerperium. Methods: This was a cross-sectional observational study conducted in the Outpatient/Emergency/Inpatient or COVID ward in the Department of Obstetrics and Gynaecology, of a tertiary hospital in Nadia district, West Bengal, India, from 1.7.2020 to 30.6.2021 including 104 pregnant or puerperal mothers with laboratory-confirmed, i.e., RT-PCR or Rapid Antigen Test positive reports after informed consent. The obstetric outcome, modes of delivery, and neonatal status including any complications or SNCU admission within six weeks postpartum were recorded. Results: The majority were in the ≥ 20–24 years age group, primigravida, residents of Nadia with no significant travel or contact history. 73.08% were affected in the third trimester and the comorbidities detected were chiefly anemia (15.38%), hypertensive or chronic liver diseases, and hypothyroidism. 45.19% of the mothers were asymptomatic while the other complaints were fever (18.27%), cough (11.55%), anosmia and/or ageusia (10.58%), sore throat (9.61%), respiratory distress, loose stools, and chest pain. The medical complications were predominantly low SpO2, convulsions, pneumonitis, and two maternal deaths. The obstetric complications were preterm birth (26.9%), pre-eclampsia/eclampsia (17.3%), antepartum (3.9%) and postpartum hemorrhage (4.4%), and sepsis (5.8%). Fourteen mothers had first-trimester termination, 63 had vaginal deliveries, and the rest had cesarean section. Out of 90 neonates, most were in the range of ≥ 2–2.5 kg birth weight and normal 1-min APGAR score. None tested positive for COVID-19 RTPCR and no detectable congenital anomaly or neonatal death was recorded

Biostimulation of indigenous microbial community for bioremediation of petroleum refinery sludge.

Nutrient deficiency severely impairs the catabolic activity of indigenous microorganisms in hydrocarbon rich environments (HREs) and limits the rate of intrinsic bioremediation. The present study aimed to characterize the microbial community in refinery waste and evaluate the scope for biostimulation based in situ bioremediation. Samples recovered from the wastewater lagoon of Guwahati refinery revealed a hydrocarbon enriched high total petroleum hydrocarbon (TPH), oxygen-, moisture-limited, reducing environment. Intrinsic biodegradation ability of the indigenous microorganisms was enhanced significantly (>80% reduction in TPH by 90 days) with nitrate amendment. Preferred utilization of both higher- (>C30) and middle- chain (C20-30) length hydrocarbons were evident from GC-MS analysis. Denaturing gradient gel electrophoresis (DGGE) and community level physiological profiling (CLPP) analyses indicated distinct shift in community’s composition and metabolic abilities following nitrogen (N) amendment. High throughput deep sequencing of 16S rRNA gene showed that the native community was mainly composed of hydrocarbon degrading, syntrophic, methanogenic, nitrate/iron/sulfur reducing facultative anaerobic bacteria and archaebacteria, affiliated to γ- and δ-Proteobacteria and Euryarchaeota respectively. Genes for aerobic and anaerobic alkane metabolism (alkB and bssA), methanogenesis (mcrA), denitrification (nirS and narG) and N2 fixation (nifH) were detected. Concomitant to hydrocarbon degradation, lowering of dissolve O2 and increase in oxidation-reduction potential (ORP) marked with an enrichment of N2 fixing, nitrate reducing aerobic/facultative anaerobic members e.g., Azovibrio, Pseudoxanthomonas and Commamonadaceae members was evident in N amended microcosm. This study highlighted that indigenous community of refinery sludge was intrinsically diverse, yet appreciable rate of in situ bioremediation could be achieved by supplying adequate N sources