Caesarean Section on Maternal Request (CDMR)

A maternal request for caesarean delivery in the absence of medical indication raises several ethical issues. Those who favour women’s autonomy in childbirth may advocate CDMR however at present there is no strong evidence to favour caesarean section over vaginal delivery in terms of both maternal and neonatal morbidity and mortality. Every effort must be made to reduce the incidence of caesarean on demand by focussing on providing correct information on the relative risk and benefit associated with vaginal delivery VS caesarean section

A randomised controlled trial of oral misoprostol vs injection methylergometrine for prevention of post partum hemorrhage

Background: To compare the efficacy of 600mcg of oral misoprostol with 0.2mg of injection methylergometrine for the prevention of post partum hemorrhage.Methods: 200 apparently normal pregnant women were randomized to receive either 600mcg of oral misoprostol (study group) after delivery of baby or 0.2 mg of methylergometrine intravenously (control group) after delivery of placenta. Primary outcome was to know the incidence of post partum hemorrhage in both the groups. Secondary outcome measures were to look for mean blood loss, need for any other uterotonic agents, need for blood transfusion, need for surgical intervention, mean duration of third stage and side effects of both the drugs.Results: Out of 200 cases, two cases were excluded for the final analysis. Incidence of PPH was 9% in misoprostol group & 6% in methylergometrine group which was not significant (p >0.05). There were no significant differences among both the groups in mean blood loss, duration of bleeding, need for further oxytocics and duration of third stage. Shivering was significantly more common in misoprostol group (36% Vs 2% p< 0.0027). Conclusion: Efficacy of 600mcg of oral misoprostol is comparable to injection methylergometrine 0.2 mg intravenously for prevention of post partum hemorrhage. So, in settings where methylergometrine is used routinely for prophylaxis, oral misoprostol can be used with more ease & other advantages over injectables. Significantly more number of patients in misoprostol will have shivering as a major side effect, which should be kept in mind

Left ventricular mass - a facade for left ventricular calcification

Calcification overlying the left side of the heart on a chest radiograph may involve either the pericardium or, alternatively, the myocardium in association with a left ventricular aneurysm. Pericardial calcification was found primarily over the right-sided cardiac chambers and in the atrioventricular grooves, infrequently over the base of the left ventricle, and rarely over the apex of the left ventricle. When the left ventricle was involved, there was always more extensive calcification elsewhere in the pericardium. Myocardial calcification occurred predominantly in the apex of the left ventricle, although it was rarely confined to the posterior wall of the left ventricle. Isolated calcification in the region of the left ventricular apex, therefore, strongly suggests left ventricular aneurysm. Isolated idiopathic left ventricular calcification without any detectable abnormality is a rare phenomenon and found to be worth reporting

Overview of Iron Deficiency and Iron Deficiency Anemia in Women and Girls of Reproductive Age

Over 50% of pregnant women are anemic and the majority of these are iron deficient. Micronutrient deficiency, the symptom of heavy menstrual bleeding in nonpregnant individuals, and loss of blood associated with pregnancy and obstetric delivery contribute to iron deficiency (ID). Poor outcomes with low maternal iron can affect not only the pregnancy but can also have major bearings on the offspring. Correction of ID and iron deficiency anemia (IDA) in pregnant and prepregnant populations with single-dose intravenous iron supplementation may offer improved outcomes. A harmonization process that incorporates all major randomized controlled trials studying the use of single-dose IV iron compared with oral iron may suggest actions for changing the global trajectory of ID/IDA for women and girls of reproductive age

Antipsychotics in schizophrenia: a retrospective study of drug utilization pattern in outpatient department of psychiatry at a tertiary care hospital

Background: Psychiatric disorders are one of the major causes of morbidity and the burden of illness is enormous and remains grossly under represented. Psychotropic drugs have had a remarkable impact in psychiatric practice. Currently a large number of atypical antipsychotics available in the market are endorsed as better options for treating schizophrenia than the typical antipsychotics. The main objective of the study was to find the commonly prescribed antipsychotics in schizophrenia patients in a tertiary care center.Methods: After Institutional Ethics Committee approval, a retrospective cross-sectional drug utilization study of 400 prescriptions was under taken from 1st July 2015 to 30th July 2016 in the outpatient department of psychiatry of a tertiary care hospital. The prescribing pattern of antipsychotics in schizophrenia patients (N=107) was measured.Results: Out of 400 cases in the outpatient department, schizophrenia cases were predominant (N=107 i.e. 27%) out of which 42.1% were females and 57.9% were males. This was followed by mood disorders and neurotic & somatoform disorders. The most common antipsychotic used was olanzapine followed by risperidone. Least commonly used antipsychotic was haloperidol. Most of the patients who received risperidone also received an anticholinergic trihexyphenidyl (91.8%).Conclusions: Olanzapine and risperidone are the most commonly used antipsychotics. Anticholinergics should be used only in selected patients on antipsychotics as tolerance develops to extrapyramidal side effects. Anticholinergics are unnecessary after 3-6 months in all except 10% of patients. Moreover, it has its own side effects and adversely interacts with antipsychotics