Comparison of efficacy and safety of ketoprofen patch versus diclofenac patch as post-operative analgesic in hysterectomy patients

Background: The objective of the study was to compare the efficacy and safety of ketoprofen patch versus diclofenac patch as post-operative analgesic in hysterectomy patients.Methods: The study was a prospective, single blind, randomized, comparative interventional clinical study conducted in a tertiary care hospital. Sixty female patients were randomly allocated to receive either ketoprofen or diclofenac patch 1 hour prior to the hysterectomy. Pain was assessed postoperatively after an interval of every four hours for 24 hours using visual analogue scale (VAS) and verbal rating scale (VRS).Results: In ketoprofen group, mean VAS was (2.92±0.11) significantly low as compared to diclofenac group (3.25±0.14). The mean VRS score in group ketoprofen (1.62±0.22) was low as compared to group diclofenac (1.83±0.16). Safety analysis revealed no apparent serious adverse events. Inj. Paracetamol 1 gm i.v was given as rescue analgesic to the patients in whom VRS >2 and VAS >5 was noted. Data were analysed using unpaired student’s t-test.Conclusions: Transdermal patches are very convenient to use and causes less discomfort as compared to traditional routes of drug delivery. Ketoprofen patch was found better in providing analgesia after hysterectomy as compared to diclofenac patch with lesser side effects.

Introduction of near peer assisted learning approach in teaching proper hand scrub technique among undergraduate students

Introduction: In near peer assisted learning (NPAL)tutor is of the same level of education as with one to two years senior but within the same broad grade. Literature suggests that it fosters qualities like leadership, self-confidence and mentoring in tutors with simultaneous provision of a cordial learning environment to tutees. With this study we introduced NPAL in our newly established institute and assessed its feasibility, student’s perception, future applicability.Method: After having ethical clearance from institution, the students and faculty of Department of Obstetrics and Gynaecology were sensitized. The interns posted in labor room were designated as tutors and maternity students were included as tutees. The surgical hand scrub was the topic of teaching. The faculty taught interns and assessed, then interns taught maternity students and they were assessed by faculty members. The interns were again assessed by faculty. Afterwards both these interns and maternity students supposed to work together in labor room, the feedback was taken from all with a structured questionnaire using Likert scale.Result: The results were encouraging from all the corners, the tutors, tutees and faculty agreed that NPAL is a better method of teaching strongly enhancing the learning of tutors and their communication skills and develops positive attitude towards teaching as a part of their profession. The tutees found a cordial learning environment with a cognitive congruence with their tutors and felt very comfortable while working with them. Faculty also showed a positive attitude towards NPAL.Conclusion: NPAL is a good adjunct to standard teaching but could not substitute standard teaching

Tuberculosis masquerading carcinoma cervix and carcinoma endometrium: 2 case reports

Tuberculosis is a common infection in developing countries but genital tuberculosis is less common, confused with malignancy and difficult to diagnose at times. We present 2 cases of genital tuberculosis where a clinical diagnosis of malignancy was made and tuberculosis surprised us once again. This case report is intended to emphasize to suspect tuberculosis in young patients on the basis of history and examination to be later supported by investigations.

Outcome of gestational trophoblastic disease in a rural tertiary centre of Haryana, India

Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases

Experience of hysteroscopy in a rural tertiary care center of Haryana, India

Background: During the last few decades hysteroscopy has become a tool of choice for evaluation of uterine cavity due to its “see and treat “benefits. It is more accurate and less invasive. Introduction of hysteroscopy in gynecological practice is the need of time. Aim of our study is to share the experience of hysteroscopy, its learning curve and limitations in a rural tertiary care center of Haryana.Methods: We retrospectively analyzed all the hysteroscopy procedure done from January 2016 to December 2018 from the hospital records.Results: Total 118 hysteroscopy were done but record of only 110 was available. Out of 110, 37(33%) were operative and 73(67%) were diagnostic. 36% were done for AUB, 33%  for infertility, 15% for misplaced cu t, 6% for amenorrhea, 2% in cases of RPL and rest for some less common indications. Out of operative hysteroscopy major procedures done were polypectomy and removal of misplaced Cu-T. Septal resection was also done in 3 cases. Number of operative hysteroscopy has increased over the time period of study.Conclusions: Hysteroscopic evaluation of uterine cavity is a reliable method for both diagnostic and treatment purpose. Proportion of hysteroscopy procedures and its learning curve will improve with persistent effort