Case series on uterine rupture depicting the atypical presentations in the labour room

Uterine rupture is the complete division of all the three layers of uterus. Most uterine ruptures occur during labor in pregnant women, most commonly seen in previously scarred myometrium. Consequences of uterine rupture depend on the time between diagnosis of uterine rupture and intervention, and can be as grave as fetal and maternal death. Vigilance and avid action by the obstetrician can lead to better outcomes. Case 1 represented a 28-year-old moderately anemic G4P2L2A1 having previous 2 LSCS at POG 39 weeks 1 day presented in COVID emergency in active labour and was found to have a uterine scar rupture (5 cm rent) extending towards bladder wall with shoulder presenting on rent. A live female baby with thick meconium staining was delivered and uterine repair along with bilateral tubectomy was performed. Case 2 represented a 21-year-old primigravida with breech presentation at a gestation of 34 weeks 6 days with preterm labour pains who had been referred to our centre. Decision for LSCS was taken and on entering the abdomen rupture uterus with an inverted T-shaped rent in the upper segment extending up to the fundus was seen. A stillborn male fetus was delivered through the rent, followed by successful uterine repair. In spite of massive blood loss, the mother had survived. Case 3 represented a 30-year-old grand multipara at a gestation of 38 weeks 3 days with ultrasound documented fetal demise with fetal hydrocephalus and holoprosencephaly with labour pains was taken up for laparotomy due to suspicion of uterine rupture based on examination findings. Intra-operatively, baby was found lying in the peritoneal cavity with an unsalvageable uterus with a rupture in lower uterine segment and left lateral wall extending upto round ligament above and cervix below. A stillborn male fetus was delivered and peripartum subtotal hysterectomy with left salpingoophorectomy and right salpingectomy was done with a good maternal outcome. The above series suggest that the signs and symptoms of uterine rupture are usually variable and nonspecific, hence posing a challenge for the diagnosis. Early diagnosis and timely intervention by the obstetrician, can help us to improve the fetal and maternal outcome drastically

A prospective study of predictors of metabolic syndrome in women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is a well-known gynecological hormonal imbalance. The consequences of PCOS pose a substantial risk for the development of metabolic and cardiovascular abnormalities similar to those that make up metabolic syndrome (MBS). Therefore, there was a need to identify predictors for MBS in PCOS subjects and study their strength of association.Methods: A prospective observational study was carried on 100 PCOS subjects for having features of MBS. MBS was diagnosed by National cholesterol education program’s adult treatment panel III 2001 criteria. Student’s independent t test, Chi square test and Fisher’s exact test were used for statistical analysis.Results: The present study estimated the prevalence of MBS in women with PCOS to be 31%. MBS in PCOS was more prevalent in non-vegetarians (51.6%). The individual components of MBS criterion had a statistically significant p value (p=0.001 to 0.008) for development of PCOS. Raised levels of triglycerides, fasting blood sugars and fasting insulin tests were related directly to MBS development, with statistically significant p values (<0.001, <0.001 and 0.005), respectively.Conclusions: Women with PCOS have a high prevalence of MBS and its individual components, particularly raised laboratory values of triglycerides, fasting blood sugars and fasting insulin. MBS in PCOS women is associated with advancing age and obesity

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

Comparative evaluation of abdominal hysterectomy by ligasure and conventional method

Background: Hysterectomy is the 2nd most common surgical procedure performed in women and is associated with various complications like any other major surgical procedure. The objectives and aims of this study was to compare the effects of ligasure and conventional clamping and suturing in abdominal hysterectomy.Methods: A randomized controlled trial was performed by randomizing the patients in 2 groups - ligasure (A) and conventional hysterectomy (B). Operative time, no. of sutures, blood loss, hospital stay and cost factor to patient were studied as its main outcomes. A total of 100 patients were studied.Results: 66% of patients in group A had duration of surgery that was less than an hour in spite of associated co-morbidities. More no (76%) of patients in Group A had significantly less blood loss (<50 ml) as compared to 60% of patients in Group B. Only one suture was used in 80% of patients in Group A while in group B all of the patients required more than one suture from stumps to vault. There by reducing the cost of surgery.Conclusion: Apparently ligasure group seems to have less time for surgery and less blood loss and more intraoperative and postoperative complications, but to prove one ligasure group superior or inferior over conventional method we need to have more studies. But yes, Ligasure group reduces the cost of surgery to patient by reducing suture consumption as compared to conventional group.

Effect of pomegranate polyphenols on lipids metabolism in patients with myocardial infarction: a double-blind placebo controlled trial

Background: Myocardial Infarction (MI) is a leading disease globally. Major risk factors for MI are smoking, hypertension, diabetes mellitus, reactive oxygen species (ROS), obesity, coronary artery disease (CAD) and abnormally altered blood lipid levels. It is recommended that for healthy living the risk factors for CAD and ROS should be less. Consumption of natural food supplements rich in antioxidants and polyphenols reduce the risk of MI. One herb is Pomegranate. Pomegranate is polyphenols and antioxidants rich fruit. This prompted us to find out whether the presence of antioxidants in pomegranate offers any prognostic benefits in patients with MI?.Methods: Pomegranate Extract of Whole Fruit (PEWF) was prepared as tablet of 300mg to investigate its effects in patients with MI. Total 100 participants were included in the trial. Participants were assigned to two groups of 50 each. One group received “Add On” PEWF and other got matching placebo of same colour, shape and size as comparator agent in the dose of 300mg BD for 1 month.Results: Results were compared by Z test, Chi square test and coefficient of variations. Statistical analysis proves the prognostic effect after active medication (p<0.05). Study results indicate the rejection of Null Hypothesis (H0) and acceptance of Alternative Hypothesis (H1).Conclusions: Our findings suggest that consumption of antioxidant and polyphenols rich food supplements such as PEWFs for one month reduces the risk factors for CAD

Assessment of Indian Medical Graduate (IMG)’s knowledge about emergency contraception (EC) in a medical college of Himachal Pradesh

Background: Undergraduate curriculum of the medicine is created to ensure achievement of goal of “health for all” in India. In addition, it aspires graduates to meet or exceed global benchmark in knowledge, attitude, skills and communication (1). Objectives: 1) To assess undergraduates’ knowledge regarding the types and correct usage of available Emergency Contraceptives. 2) To utilize the data base for capacity building by focusing on the Core Competency of Emergency Contraceptives. Methods: This cross-sectional study was done among 442 undergraduates of all the Profs in our college in September 2017 after approval from Institutional Ethical Committee (17/66) and informed verbal consent from the participants. This pretested, pre-designed and self-administered 11-questionnaire proforma in English was used as a tool of investigation. Results: Maximum participation was from 3rd and 4th year. 7.2 % had a very poor knowledge, attempted 3 or less questions correctly.  Only 14.5% attempted 8 or more questions correctly. Conclusion:  Young population of our country forms the broad base of the pyramid, they should be provided with correct knowledge about EC for improving their reproductive health.  Since these graduates are going to serve the community, their knowledge and skill in this core competency is going to help the community

What is better: cryocautery or electrocautery for cervical erosion?

Background: Present study was conducted with a background in mind to compare the efficacy of electrocautery and cryocautery for the management of cervical erosion. Aim of this study was to compare the efficacy of electrocautery and cryocautery for the treatment of cervical erosion and to check cost effectiveness.Methods: A comparative study was conducted at Maharishi Markandeshwar medical college and hospital, Kumarhatti (Solan) between July’13 to June’14 among 100 patients of reproductive age group with cervical erosion. They were grouped into 2 groups A (Electrocautery) & B (Cryocautery) and data obtained was analysed by paired t-test.Results: Though in short- term follow-up at 4-6 weeks after cautery, apparently electrocautery was superior to cryocautery in terms of erosion healing rate 92% vs. 76% as P value (0.4557) is not statistically significant, but in long-term follow-up at 12-14 weeks there was no significant difference in erosion healing but electrocautery was cost effective.Conclusions: Both types of cautery were equally good for treatment of cervical erosion in long-term follow-up. But electrocautery occupies less space and there is no chance of gas leakage in electrocautery, so electrocautery is more cost effective.

Role of positron emission tomography-computed tomography in bronchial mucoepidermoid carcinomas: a case series and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Mucoepidermoid carcinoma of the tracheobronchial tree is rare. Such tumors usually present with signs and symptoms of bronchial obstruction. Histologically, they can be classified as high-grade or low-grade tumors. Experience of imaging these tumors with ¹⁸fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET-CT) is limited. We present three cases of this rare tumor, describe the functional imaging results, and review the available literature.</p> <p>Case presentation</p> <p>Three Caucasian patients, two men (21 and 24 years of age) and one woman (14 years of age), with bronchial masses were evaluated by us. All three patients were symptomatic, and underwent a thorough clinical examination, bronchoscopy and biopsy, plain computed tomography, ¹⁸F-FDG PET-CT and ⁶⁸Gallium 1,4,7,10-Tetraazacyclododecane-N^I,N^II,N^III,N^IIII,- tetra acetic acid (D) - Phel¹-Tyr³-octreotide positron emission tomography-computed tomography (⁶⁸Ga-DOTATOC PET-CT). ¹⁸F-FDG PET-CT revealed mild uptake in all three patients, whereas ⁶⁸Ga-DOTATOC PET-CT revealed no significant uptake in any patient, making carcinoid tumor unlikely. Results of histopathological examination were consistent with low-grade mucoepidermoid carcinoma in all patients.</p> <p>Conclusion</p> <p>Our study reveals that functional imaging may be helpful in the initial investigation of patients with mucoepidermoid carcinoma. ¹⁸F-FDG PET-CT may have a prognostic relevance by predicting the histopathologic differentiation of the tumor.</p

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good