Use of intramyometrial carbetocin in caesarean myomectomy to reduce hemorrhage

Traditionally myomectomy is avoided during caesarean delivery because of potential excessive blood loss. As the size increases, blood supply of leiomyomas also increases in pregnancy, and specifically at term due to the effect of human chorionic gonadotropin. Carbetocin is an oxytocin analog. It is long acting and is effective in preventing blood loss. It has been used in myomectomy to prevent blood loss in non-pregnant uterus. We present a case report where it is used intramyometrial route during caesarean section. A 30-year-old multigravida of 38 weeks period of gestation with previous caesarean section, presented in labor. Her recent ultra sound report showed single live intrauterine fetus of 35 weeks 3 days with a single posterior wall fibroid. The woman requested for myomectomy along with caesarean delivery as she had heavy menstrual bleeding caesarean section was done and myomectomy was planned along with the caesarean section. Intramyometrial carbetocin 100 mcg was used to prevent excessive blood loss. The patient had an uneventful post-operative period. Intramyometrial carbetocin is an effective method to reduce blood loss in myomectomy during caesarean delivery

The efficacy of transvaginal ultrasonography and office hysteroscopy in evaluation of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a prevalent issue in women of child bearing age group. AUB can be uncomfortable and have a considerable impact on health-related quality of life. AUB is reported to occur in 9 to 14% women between menarche and menopause and reported prevalence in India is around 17.9%. Methods: It is a prospective observational study done in 75 patients with abnormal uterine bleeding attending the gynaecology outpatient department (OPD) at Shri B. M. Patil Medical College, Vijayapura, Karnataka. Patient was thoroughly examined and then transvaginal sonography (TVS) was done after obtaining consent. This was followed by office hysteroscopy(OH) and endometrial biopsy was taken for histopathological examination. Data were gathered and examined and cost analysis of each procedure was done. Results: The most frequent presenting symptom was heavy menstrual bleeding (49.3%). For proliferative and secretory endometrium, the sensitivity of TVS was 81.48% and for the detection of polyps, endometrial hyperplasia, and submucous fibroid it was 45.45%, 42.86%, 100% respectively. The sensitivity of OH for detection of polyps, endometrial hyperplasia, and submucous fibroid which was 46.15%, 100%, 100% respectively. The p value was <0.05 which shows the statistical significance of both tests. TVS demonstrated low correlation for intracavitary diseases. OH was costlier when compared to TVS. Conclusions: TVS has more sensitivity and accuracy in detecting intramural pathologies. OH had showed greater diagnostic accuracy in identifying intra cavitary pathologies of uterus and doing intervention in the same setting

Why do mothers die? A retrospective analysis of maternal mortality over 7 years in a tertiary care teaching Hospital in North Karnataka, India

 Background: Maternal mortality ratio (MMR) is still high in many developing countries. In Southern India, the maternal mortality is highest in the state of Karnataka. Therefore, a study was conducted at BLDE (DU) Shri BM Patil medical college, hospital and research centre to study the causes of maternal deaths, and to make recommendation to reduce the maternal mortality.Methods: A retrospective analysis of all the maternal deaths between 2012 to 2019 was done.Results: A total of 58 women died due to pregnancy and its complications during the period of 2012-2019. Average age of death was 25.42 years. It was noted that 70.7% of the patients travelled over 30 km to reach Vijayapura city. The predisposing causes of death were post-partum haemorrhage (44.8%) eclampsia (18.9%), anaemia (17.2%), pulmonary or amniotic fluid embolism (12.1%), sepsis (10.3%) antepartum haemorrhage (3.4%) and cardiac disease (6.9%). A death each occurred in patients suffering cholestasis and adult respiratory distress syndrome. A majority of the deaths were post-partum deaths (84%). Most of the deaths of the occurred during the first 12 hours of admission (82.76). A total of 11 patients received blood and blood components. Of the 58 deaths, 56(96%) required ventilatory support., 47 (81%) patients received ionotropic support. 11 (19%) patients underwent peripartum hysterectomy.Conclusions: Timely intervention can save maternal lives. Services of well-equipped hospitals with obstetric intensive care units having a dedicated team of well-trained obstetricians, intensivists and anaesthesiologist are recommended in a facility which is near the residence of the pregnant women. Facilities for quick transfer of the cases who are high risk are required

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Statistics of one-minute rain rate distributions in India

66-69Conversion of hourly rain rate data to one-minute integration time is of immense importance. In this paper an attempt has been made to derive one-minute rain rate data from the hourly values obtained from India Meteorological Department for 11 stations over India.</span

Study of effective path length and path reduction factor over some stations in India

66-70Path reduction factor and effective path length, the two factors necessary to predict attenuation of millimetre waves by rain have been estimated for ten stations in India by using rain rate data obtained from India Meteorological Department. Cumulative distributions and variations of these two factors with rain rate have been deduced. The power law relations have been derived relating these two parameters with rain rate and percentage of time

Study of TRMM estimated freezing level height in the 36N – 36S region

1071-1095In this paper the freezing level height (HFL), a very important parameter in cloud physics has been studied in the latitudinal belt 36N-36S, during the period 1999-2002 and 2007-2008. Present study shows that the latitude is the major controlling factor of the HFL, rather than LH or temperature. Further, it is seen that the HFL depends on season. The study also reveals that the HFL responds in a different manner over the continental and the oceanic sites. Functional relationship between the HFL and latitude shows seasonal dependence. It also presents the range of the HFL, its maximum and minimum values and the months of occurrence of the maxima/minima over few selected locations, including India