Ultrasound guided detection of position of post partum intra uterine contraceptive device and its relation to complications

Background: Worldwide, Intrauterine Contraceptive Device (IUCD) is one of the most commonly used reversible methods of contraception among married women of reproductive age. It is the second most commonly used forms of contraception, ranking second only to female sterilization. Proper positioning of Copper containing IUCD is of utmost importance for efficacy and safety. The immediate postpartum period, after a birth but prior to discharge from the hospital is an important but under utilized time frame to initiate contraceptives, specially long acting contraceptives such as intrauterine contraceptive device (IUCD). To study the location of Copper IUCD by ultrasound, relationship between position and complaints, failure rate and expulsion rate in post-partum IUCD cases.Methods: The study was prospective, analytical study conducted on 200 women for one year.  IUCD insertion was done in two groups; group A (normal delivery, postplacental) and group B (caesarean section, intracaesarean). On ultrasonography, position and distance of IUCD from fundus of uterus was measured. Outcome measures were expulsion, complication and failure rate upto six months. Informed consent was taken from each participant and ethical justification for the study was sought.Results: Majority of the patients were in age group of 21-25 years. Multigravidae patients had more acceptability of IUCD than primigravidae. More than half of IUCD insertion was done by senior residents (56%). Malpositions were more common in vaginal delivery (62%) than caesarean section (28%). Most common malposition was mid cavity and least common was oblique. Most common complaint was pain abdomen and least common was expulsion.Conclusions: Sonography can be used as an adjunct to clinical examination to examine the position of the IUCD. Ultrasonography done after PPIUCD insertion helps in determining, whether PPIUCDs are placed in normal position or malposition. Malpositioned PPIUCDs have more complications as compared to normally placed IUCD

Green Tobacco Sickness: A Review

It is still an unknown fact among many that tobacco harvesters are at a potential at a risk of suffering from “Green Tobacco Sickness (GTS)”, with its prevalence seen mostly among Asian and South American tobacco harvesters. These harvesters working in hot, wet conditions are likely to develop GTS,  as in such climatic conditions, the wetness and high humidity causes nicotine to reside on the surfaces of the leaves, while the high ambient temperature increases skin absorption, thereby increasing plasma nicotine concentrations by 30-45%. Patients suffering from GTS report nausea, vomiting, pallor, dizziness, headaches, increased perspiration, chills, abdominal pain, diarrhea, increased salivation, prostration, weakness, cough with or without expectoration, breathlessness and occasional reduction in blood pressure or heart rate. GTS is self-limiting and of short duration and hence treatment is not always necessary and not often sought by the harvesters. This review educates readers about GTS as well as encourages their participation in making tougher regulations in their respective countries for the control of this disease

Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study

Background: Laryngoscopy and tracheal intubation lead to sympathetic stimulation resulting in hemodynamic fluctuations. We compared local anesthetic ropivacaine 0.75% with alpha agonist dexmedetomidine through ultrasonic nebulization for direct local action of the drug in the airway. Methods: In our randomized study, 180 patients were prospectively assigned to three groups of 60 each: group R (0.75%), group D (1 microgram/kg), and group C (control). The primary objective was to determine whether nebulized ropivacaine or nebulized dexmedetomidine can cause a reduction in stress response to laryngoscopy and intubation. The secondary objectives were to compare the hemodynamic parameters at extubation, cough response at extubation, and postoperative sore throat. Results: A total of 165 patients were analyzed. Demographically, all the groups were similar. Group R and group D were found to significantly attenuate the heart rate (HR) at intubation and extubation when compared to group C (P < 0.05). A significant reduction in mean arterial pressure (MAP) was seen (P < 0.05; group D: 90 ± 18.4 mmHg, group C: 99.5 ± 15.9 mmHg, group R: 92.4 ± 16.1 mmHg). There was a significant reduction in cough response in both groups in comparison with group C at 0 minutes (P value; group C vs group D: <.0001; group C vs group R:.01) and 5 minutes (P value; group C vs group D: <.0001; group C vs group R: <.0001). Conclusion: Preinduction topical use of ropivacaine or dexmedetomidine, through the nebulization route, effectively attenuated the pressor responses when compared to placebo

Immediate Dental Implants Enriched with L-PRF in the Esthetic Zone

The aim of this article is to present the clinical application of immediate implant placement with L-PRF and immediate prosthetic loading in anterior esthetic region. A 24-year-old healthy female patient reported with a chief complaint of poor esthetics in the upper front tooth region with retained deciduous teeth. On oral examination, there were retained deciduous teeth (52, 53, and 63) with congenitally missing permanent successors. The retained deciduous teeth were extracted, and immediate implant placement was done in the extraction sockets along with L-PRF membranes in one surgical session under local anesthesia. Immediate temporization was performed with composite crowns on immediately placed dental implants. After 3 months of the healing period, the final implant-level impressions were made and the temporary composite crowns were replaced with the final zirconia porcelain crowns. A 12-month follow-up was made, and satisfactory esthetic and functional results were obtained