Comparison of analgesic efficacy of diclofenac suppository with intramuscular diclofenac sodium in post-operative pain relief after cesarean delivery in the first 24 hours

Background About 80% of the patients experience enough post-operative pain to require analgesia. Adequate pain relief  is needed after caesarean section to assist ambulation , mother / baby bonding & above all, a  pleasant experience of being a mother. Different analgesics with  various routes of administrations are available for pain relief which include opioids and NSAIDS. Opiods are known for their undesireable side effects . Diclofenac sodium is an NSAID & acts via blocking prostaglandin production. The WHO recommends diclofenac as a first line drug in pain relief. It  is available in various preparations which include injections, tablets and suppositories. We  compared the mean pain experienced by the women after use of diclofenac suppositories and intramuscular diclofenac sodium after elective cesarean section in first 24 hours. Methodology This RCT was done in  the department of Obstetrics and Gynecology, --removed for blind review---from 1st March 2018 till 30th August 2018. Total of 100  antenatal women already planned for elective caesarean section ,who fulfilled inclusion criteria were selected after taking  informed consent & ethical approval by employing non probability consecutive sampling . The age , parity ,gestational age, weight  ,BMI & ASA status of all women was documented. 50 women were randomly assigned to the each group A & B. Group A was given 75 mg intramuscular diclofenac injection  immediately & then 8 hrly for the first 24 hrs after caesarean section while group B was given  100 mg rectal diclofenac suppository immediately & then  after 12 hrs  post caesarean for the first 24 hrs. if needed ,50 mg tramadol I/V was given to the women as rescue analgesia, Visual analogue pain  (VAS) score was used to assess the pain intensity of post operative  women after 24 hrs of caesarean and poltted  in the proforma. The number  of women needing rescue analgesia  in each group was also documented. & compared between the two groups. RESULTS:             Data was analyzed on the SPSS version 23.  In group A; mean age was 26.34 years with STD of 3.69. Mean gestational age was 37.82 weeks with STD of 1.79. In group B; mean age was 25.3 years with STD of 3.47. Mean gestational age was 37.70 weeks with STD of 1.59. In group A; mean weight was 84.62 kgs with STD of 5.76 and mean BMI was 32.18 with STD of 3.16. In group B; mean weight was 84.84 kgs with STD of 7.27 and mean BMI was 31.13 with STD of 3.57. In group A (intramuscular diclofenic injection group) the mean score of pain was 3.72 with STD of 0.57.  In group B (Diclofenic Suppository Group) the mean score of pain was 1.84 with STD of 0.68. P-value was significant. 26 women (52%) in group A (I/M diclofenac group) and 20 women (40%) in group B (rectal diclofenac suppository group) needed rescue analgesia with I/V Tramadol .P value was not significant.     CONCLUSION:             Dicolofenac is an effective post caesarean analgesic . Rectal route of diclofenac  is more effective than the intramuscular route as post caesarean analgesia . Almost less than half number of post caesarean women needed rescue analgesia after using diclofenac suppository

Comparison of Materials used in Facilitating External Cephalic Version

Background External cephalic version (ECV) is a procedure to manipulate a fetus with breech presentation to cephalic presentation through maternal abdomen under ultrasound guidance. It is done to reduce number of assisted breech deliveries and caesarean sections for breech presentation . Talcum powder or aqueous gel is frequently used to facilitate ECV. We  compared powder with gel in attaining successful version and  level of practitioner satisfaction with powder versus gel use. Methodology This retrospective descriptive study was conducted by –removed for blind review---10th Oct 2015- 10th Oct 2019 . Total of 56  low risk gravid women underwent ECV after selection on the basis of inclusion and exclusion criteria. By using  convenient consecutive sampling, powder or gel during ECV was allocated accordingly . ECV was performed by the  single experienced practitioner in labour room with  cardiotocograph and emergency caesarean facilities . Powder and gel use was compared in attaining successful version . ECV was declared successful on confirming head of fetus in lower uterine segment on ultrasound. Unsuccessful ECV’s were reattempted with crossover use to the other aid. Practitioner satisfaction  was defined  as, ease experienced by the practitioner in performing ECV. It was graded as high, medium and low on the base of ease or difficulty experienced by the practitioner while  using powder or gel during ECV. The data was recorded  & analysed using SPSS software. Descriptive statistics with Chi-square test is applied to find out the association between successful version & practitioner satisfaction level with powder versus gel use.  Results In powder use group , 9  ECV’s were successful and 19 ECV’s  were unsuccessful. In gel use group , 12  ECV’s were successful and 16 were unsuccessful .There were more successful ECV’s in gel group but the association was not significant (P value .408). Practitioner satisfaction was  significantly high with gel than  the powder use(Pvalue .<.001). Conclusion Powder or gel is not superior over the other as an aid for achieving successful ECV though gel use is more satisfying for the provider than the powder use in performing ECV. More studies are required regarding aids used in performing ECV for recommendations in clinical practice

Regulatory Network in Plant under Abiotic Stress

Abiotic stress is one of the primary causes of crop yield loss worldwide; it contributes to a nearly 50% reduction in crop production. Anti-oxidants are produced in plants to scavenge ROS that causes cellular damage during abiotic stress. The plant stress response is a complex mechanism that involves protein initiation pathways, abscisic acid signaling, transcriptional and post-transcriptional modifications. Abiotic stress-inducible genes are divided into two groups based on protein products, one is for signal transduction and other is for expressing resistance. Transcriptional factors bind to the promoter of the target gene at specific DNA sequences thus regulating the gene expression, so different kinds of transcriptional factors known as regulons are involved in regulation of genes during drought, salinity and cold stress

Comparison of Materials used in Facilitating External Cephalic Version

Background External cephalic version (ECV) is a procedure to manipulate a fetus with breech presentation to cephalic presentation through maternal abdomen under ultrasound guidance. It is done to reduce number of assisted breech deliveries and caesarean sections for breech presentation . Talcum powder or aqueous gel is frequently used to facilitate ECV. We  compared powder with gel in attaining successful version and  level of practitioner satisfaction with powder versus gel use. Methodology This retrospective descriptive study was conducted by –removed for blind review---10th Oct 2015- 10th Oct 2019 . Total of 56  low risk gravid women underwent ECV after selection on the basis of inclusion and exclusion criteria. By using  convenient consecutive sampling, powder or gel during ECV was allocated accordingly . ECV was performed by the  single experienced practitioner in labour room with  cardiotocograph and emergency caesarean facilities . Powder and gel use was compared in attaining successful version . ECV was declared successful on confirming head of fetus in lower uterine segment on ultrasound. Unsuccessful ECV’s were reattempted with crossover use to the other aid. Practitioner satisfaction  was defined  as, ease experienced by the practitioner in performing ECV. It was graded as high, medium and low on the base of ease or difficulty experienced by the practitioner while  using powder or gel during ECV. The data was recorded  & analysed using SPSS software. Descriptive statistics with Chi-square test is applied to find out the association between successful version & practitioner satisfaction level with powder versus gel use.  Results In powder use group , 9  ECV’s were successful and 19 ECV’s  were unsuccessful. In gel use group , 12  ECV’s were successful and 16 were unsuccessful .There were more successful ECV’s in gel group but the association was not significant (P value .408). Practitioner satisfaction was  significantly high with gel than  the powder use(Pvalue .<.001). Conclusion Powder or gel is not superior over the other as an aid for achieving successful ECV though gel use is more satisfying for the provider than the powder use in performing ECV. More studies are required regarding aids used in performing ECV for recommendations in clinical practice

Pre-Natal Diagnosis of beta – Thalassemia by Chorionic Villous Sampling

Background: To promote the utility of Chorionic Villous Sampling (CVS) for pre-natal diagnosis of beta thalassemia in at risk population and to highlight its demographic area distribution and effect of consanguinity. Method: This Cross Sectional Study was conducted in the Department of Gyne/Obstet-I, Holy Family Hospital, Rawalpindi, Pakistan, from June 1997 to June 2009. All 137 couples having either a previously affected conceptus/child with thalassemia or having strong family history of thalassemia, were recruited for the test. Samples collected by standard procedure were sent to Armed Forces Institute of Pathology, Rawalpindi for thalassemia detection. Results: In 12 yrs 137 mothers underwent CVS. Mean gestational age at the time of procedure was 12.6 weeks. Consanguineous marriage was seen in 119 cases. Largest group was ‘Punjabis’. 126 couples had a previously affected child with homozygous beta thalassemia and 11 had heterozygous beta thalassemia in their children. 95 cases had a family history of the disease. After DNA analysis, 30 cases (22%) were diagnosed to have homozygous beta thalassemia while 77(56%) were having heterozygous beta thalassemia. Report was normal in remaining 30 cases (22%). Early spontaneous pregnancy loss was seen in only 02 cases. Conclusion: Thalassemia is one of the commonly inherited crippling disorders. Its familial transmission must be checked by effective public awareness programme, pre marital screening, genetic counseling and pre-natal diagnosis by CVS

Hematological Profile of Patients with Dementia in South Punjab

Objectives:  A case-control study was conducted to find the prevalence of abnormal blood indices and electrolytes in patients with dementia. Material & Methods:  The levels of erythrocytes, leukocytes, platelets, electrolytes, and ESR were determined from the biochemistry lab. A t-test was applied to see the significance of the difference between each dementia patient group (Alzheimer Disease-AD, Parkinson’s Disease-PD, and Frontotemporal Dementia-FTD) with the control group for each CBC and electrolyte parameter Results:  In each patients’ groups (AD, PD, and FTD), the mean value of every erythrocyte was lower than the normal range. A significant difference existed for each erythrocyte between dementia patients and controls, except MCHC. Low levels were observed in neutrophils in all groups of dementia including control group. Very high levels were observed in ESR in all groups of dementia. Significant differences existed in the WBC levels between controls and AD as well as PD patients, in platelets between the control group and FTD patients, and in ESR in each group of dementia patients vs. control group. Normal values observed in all groups of dementia patients as well as in the control group.  Conclusion:  We found low levels in erythrocytes in cases of Alzheimer disease, Parkinson’s disease, and frontotemporal dementia. Age-related changes to hematological indices especially related to RBCs, and inflammatory mediators like cytokines, hamper the microcirculation in the cerebral tissue leading to micro-infarcts or microbleeds which cause neuronal insults and parenchymal damage

To determine the rate of success of external cephalic version in low risk breech presentations and possible factors affecting its success in POF hospital, Wah Cantt.

Abstract   Background The caesarean section rate  is on the rise for various reasons. One of the reason is breech presentation . External cephalic version is a procedure to manipulate the baby from breech to cephalic presentation externally through the maternal abdomen under USG guidance . Success in ECV decreases the breech presentation and  hence caesarean section rate . Methods This retrospective study was conducted by Wah Medical College in POF hospital from10 Oct 2015- 10 Oct 2019 after approval from the ethical committee .  It included 56 low risk singleton  breech presentations from 36 wks- 40 wks after taking their informed consent  While those with < than 36 wks (primis) and >40 wks gestation, refusal to ECV , with absolute contraindication to ECV& with medical and obstetric complications (ie scarred uterus, liquor <than 8 cm & > than 17 cm, fetal growth restriction, preclampsia, gestational diabetes & abnormal cardiotocography) were excluded  from the study. ECV was performed by single obstetrician in labour room with facilities  of cardiotocograph and emergency caesarean section. Cardiotocography of the fetus  for 30-40 min was done just before & after the procedure of ECV. ECV was declared successful on cofirming head of the fetus occupying the lower uterine segment on ultrasound.  .Number  of successful ECVs & specific factors  of the women & the baby (age . parity, amniotic fluid index ,type of breech, engagement of breech, position of back of baby)  were chosen to observe their effect on success of  ECV. Results External cephalic version was successful in 27 (48.2%)  & unsuccessful in 29 (51.8%)of women .Multiparity , unengaged breech & type of breech (complete flexed) ( with p values .001, .000 & .001 respectively) had statistically significant positive association with successful external cephalic version. Conclusion ECV should be offered to all  women with low risk breech presentations. Knowledge of factors predictive of ECV success can be utilized in selecting cases for ECV &counselling the women regarding the success and failure of ECV.   &nbsp

Comparison of efficacy and safety of zinc gluconate versus placebo for treatment of Primary Dysmenorrhea

Background & Objectives: Dysmenorrhea is a common gynecological complaint in women of reproductive age. Primary dysmenorrhea is defined as painful menstruation in the absence of any pelvic pathology and occurs in response to increased prostaglandin release from the ischemic endometrium. Conventional treatments include NSAIDs and oral contraceptive pills.  Zinc is an essential micronutrient with anti-inflammatory properties. We conducted this study to evaluate the efficacy and safety of zinc supplementation in treatment of primary dysmenorrhea in our target population as it presents as very common gynaecological issue in young adolescents females.   Methods: 100 participants with primary dysmenorrhea were enrolled in study from outpatient department via non-probability consecutive sampling. They were randomized into two groups. The intervention group (Group A) received zinc gluconate 50mg once daily and the control group (Group B) received placebo drug once daily, for 5 days before and 2 days after onset of menstruation. After three and six months of treatment severity of primary dysmenorrhea was assessed and compared in both groups using visual analogue scale for pain, along with side effect profile. Results: The treatment with Zinc gluconate reduced the mean pain score in females with primary dysmenorrhea after 3months with a further reduction after 6 months of treatment (P<0.001) as compared to placebo. Very few (4% after 3 months & 6% after 6 months) participants experienced the side effects of Zinc supplementation. Conclusion: zinc gluconate 50mg daily for 5 days before and 2 days after onset of menstruation can effectively treat the primary dysmenorrhea. The drug has very few side effects at this dose and duration of use. Key words: Primary dysmenorrhea, zinc gluconate, pain severity, visual analogue scale. &nbsp

One-Year Review Of Reduced Fetal Movements In Izzat Ali Shah MCH Center: A Predictor Of Poor Perinatal Outcome

Objectives: To find out common causes of reduced fetal movements. The purpose is to reduce perinatal morbidity and mortality. Methodology: This Prospective, Observational study was conducted at Izzat Ali Shah Maternal and child health center, unit III Gynae, Wah medical college Wah Cantt, from January 2019 to December 2019. A total of participants 160, who presented in the antenatal outpatient or emergency department with reduced fetal movements, were included in the study. Patients in the active phase of labor were excluded from the study. Patients were followed up till delivery. All necessary information, investigations, and examination points were noted on the predesigned proforma. Data were analyzed by using SPSS version 22. Results: Out of a total of 160 patients, 144 had alive and stable babies. Regarding the age group, out of 160, six patients were teenagers (3.75%), 98 (61.25%) were between 20-30 years, and 55(34.3%) were in the age group of 30-40 years. Regarding gestational age at presentation, 27 out of 160(16.8%) were between 30-35 weeks, 133(83.12%) was at 36-40 weeks. None of the patients presented below 30 weeks. Concerning the number of pregnancy, primigravida 82(51.25%), 60(37.5%) were multigravida, and 18 (11.25%) was grand multipara. Regarding medical history, anemia was seen in 31 patients (19.37%), pregnancy-induced hypertension in 20(12.5%), and 65 %( 104) has no significant medical history. Concerning past obstetrical history, 107(66.8%) fell under low-risk pregnancies, 18(11.25%) had previously normal deliveries but 08(05%) patients had H/O still births. Regarding placental position, 71(44.37%) had anterior, 71(44.37%) had posterior, and 18 (11.25) had fundal placenta. Regarding UAD, 136(85%) had normal umbilical artery Doppler, 13(8.12%) had altered, 06(3.75%) were Absent and 05 (3.12%) has reversed end diastolic flow. During study, 78(48.7%) had normal AFI, 69(43.12%) has Oligohydramnios, 10(6.25%) anhydramnios, while only 03(1.87%) had polyhydramnios.  Regarding birth weight, 122(76.25%) had average weight, 32(20%) were low birth weight and 05(3.12%) were very low birth weight. 61(38.12%) went into NICU, while 99(61.8%) no admission required. Conclusion: Most common risk factor or cause of reduced fetal movements was reduced liquor, (79). Out of which 69 remained alive and stable after birth, while 15 had early neonatal deaths. The second cause found was abnormal umbilical artery Doppler,(24). Out of which, 14 had early neonatal deaths and intrauterine deaths. This study showed the increased obligation of care required by patients with decreased fetal movement. Although the number of live births is more as compared to demise, it results in increased neonatal unit admission rates, higher induction and cesarean section rates, higher surveillance demands, and an increased financial burden on parents. It signifies the need for more vigilance in this area of practice. But we can’t neglect the perception of a mother. Mother’s feelings are more important than any other test

Feto-maternal Outcome of Reverse Breech Extraction versus Dis-impaction of Fetal Head in Caesarean Section for Obstructed Labour

Objectives: Obstructed labour is an obstetrical emergency with adverse feto-maternal consequences and caesarean delivery in such cases requires skillful handling of impacted fetal head. Objective of our study was to guide clinician about caesarean technique that facilitates the delivery with least complications for mother and baby. Methods: It was a randomized clinical trial with non-probability consecutive sampling conducted at –removed for blind review---from 1st july 2018 – 30th june 2020. Patients who underwent emergency cesarean section were randomized to undergo either push technique for delivery of impacted fetal head (Group A) or reverse breech extraction method (Group B) via lottery method. The data of 60 patients who fulfilled the inclusion criteria was analyzed using SPSS version 19. Maternal outcome measured were extension of uterine incision, blood transfusion, postpartum pyrexia, wound infection, postpartum hemorrhage and length of hospital stay. Fetal outcome measured were 5 minutes Apgar score, birth weight and NICU admission. Results: The results of our study showed statistically significant difference between extension of uterine incision(p-value=0.015), blood transfusion during surgery (p-value=0.021) and postpartum hemorrhage (p-value=0.020) in two groups with pull technique associated with less traumatic extension of uterine incision, less intraoperative transfusion and less PPH than push technique of fetal delivery. Length of hospital stay was also significantly less in reverse breech extraction group(p-value=0.001).More patients had postpartum pyrexia, wound infection, low 5-min Apgar score and NICU admissions in cephalic delivery group but results were not statistically significant. Conclusion: The results of our study recommend reverse breech extraction technique to be a safe alternative to conventional vaginal pushing of fetal head especially regarding maternal outcomes during caesarean section of patients with obstructed labour for fetal delivery. Key words: Obstructed labour, impacted fetal head, reverse breech extraction, caesarean sectio