Over the counter sale of abortion pills - time to act now

Background: Government of India has approved abortion pill for termination of early pregnancy. But over the counter availability of this drug instead has earned a bad name for this miracle drug. The aim of this study was to find out the incidence of over the counter availability of abortion pills, the outcome associated with this practice and what cost society has ultimately to pay for this unethical practice.Methods: This is a retrospective observational study. Among 200 patients who reported to Gynecology emergency with signs and symptoms suggestive of abortion process, those with history of abortion pill intake without prescription were included in the study group and their records were evaluated.Results: 70 patients who bought abortion pills over the counter were included in the study group. 90% (63/70) patients were not using any kind of contraceptive method. Only 55.71% (39/70) patients took the abortion pills as per the recommended standard protocol. Gestational age was < 8 weeks in 45.71% (32/70) patients only. Most common presenting complaint was varying amount of bleeding per vaginum followed by abdominal pain met in 97.14% (68/70) and 30% (21/70) patients respectively. 7.14% (5/70) patients presented to emergency in shock. Final diagnosis was complete abortion in 21.42% (15/70) patients, incomplete abortion in 47.14% (33/70), missed abortion in 11.42% ( 8/70), septic abortion in 7.14% ( 5/70) , threatened abortion in 5.71% ( 4/70), ectopic pregnancy in 5.71% ( 4/70) and molar pregnancy in 1.42% ( 1/70) patients and they were managed accordingly as per standard guidelines.Conclusion: The women in India should be aware of their legal right to safe abortion. They should stop buying the drug without prescription as medical abortion facilities are being made easily available, accessible and affordable to all. However strict ban on over the counter availability of abortion pills can make the situation worse

A Study of Comparison of Post-Operative Analgesia after Single-Shot Caudal Epidural Block Using Bupivacaine with or without Clonidine in Children

Introduction: Lower abdominal surgeries are one of the most frequently performed surgeries in the pediatric age group. A large number of these operations are done as day-care procedures.Caudal block is one of the most common regional anesthetic techniques in children being used to supplement general anesthesia for a wide variety of sacral-segment surgery. The local anesthetics currently in use are safe and their pharmacological effects have been well evaluated. There is no fear of neurological sequelaeas in the past.Several studies have demonstrated that Clonidine added to the local anesthetic in caudal block both enhances and prolongs the analgesia produced by the block without the unpleasant or hazardous sideeffects associated with the use of other adjuvant drugs like opioids, epinephrine and some newer adjuvants like neostigmine and dexmedetomidine. Our study aimed to evaluate the efficacy of single-dose caudal epidural Clonidine in prolonging the post-operative analgesia when mixed with Bupivacaine in children.Materials and MethodsSixty children of ASA I and ASA II physical status, between 1 and 12 years of age, who underwent elective lower abdominal surgeries, were randomly divided into two groups B (N=30) and C (N=30). All the children were administered general anesthesia. After induction, a single-shot caudal block was administered using 0.25% Bupivacaine (group B) and 1.5 mg/kg of Clonidine hydrochloride (group C). Vital monitoring was done intraoperatively as per institutional protocol. Post-operative monitoring was done in the post-anesthesia care unit (PACU) for 2–3 hours and in the ward for next 24 hours. Data with respect to duration of surgery, duration of pain-free period, time to void and any other complications was compiled. The final results of the study were tabulated and analyzed for significance using standard statistical techniques (unpaired t-test).ResultsThis study was undertaken to evaluate the efficacy of Clonidine in prolonging post-operative analgesia of Bupivacaine when given caudally in 60 children undergoing lower abdominal surgeries. The duration of pain-free period with caudal Bupivacaine with Clonidine (group C) is significantly longer than caudalBupivacaine (group B). The duration of pain relief was 20.4 hours in group C as compared to 14.2 hours in group B. This is statistically significant (p<0.05).ConclusionWe conclude that adding Clonidine 1.5 mg/kg to Bupivacaine 0.25% for caudal anesthesia in children undergoing lower abdominal surgeries enhances and prolongs postoperative analgesia compared to caudal Bupivacaine 0.25% alone. Clonidine may be the drug of choice to prolong the duration of caudal anesthesiaprovided by a single injection in children

A rare case of fourth consecutive fallopian tube ectopic pregnancy

We present a case of consecutive fourth tubal ectopic in a patient which was managed by emergency laparotomy and salpingectomy. The first two tubal ectopic pregnancies occurred on the right side while the subsequent two occurred on the contralateral side. The patient was planned for IVF-ET

Clinical study comparing outcome of post in vitro fertilisation triplet pregnancy reduced to twins versus non reduced in vitro fertilisation triplet pregnancies

Background: There has been an upsurge in the number of multiple pregnancies with its attributability to increasing use of artificial reproductive techniques. To study clinical outcome of post IVF triplet pregnancy reduced to twin pregnancies   compared to those without triplet reduction.Methods: Hospital designed comparative study. 31 subjects were studied for comparative study design with triplets obtained after infertility treatment (assisted post-IVF). Out of 31, 15 subjects were expectantly managed who refused reduction while 16 subjects chose reduction to twins. Outcomes like prematurity, complications in neonate, birth weight discordance, neonatal mortality and maternal complications were studied.Results: The fetal (triplet) reduction group was associated with significant (p<0.002) higher neonatal birth weight as compared to non-reduced group. The fetal reduction group had significantly lower incidence of prematurity and neonatal complications like hyperbilirubinemia, respiratory distress syndrome and neonatal sepsis. The maternal complications were also higher in nonreduced in terms of PPROM, gestational hypertension, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy and gestational hypertension.Conclusions: It is indicated that the reduction of triplet to twins is effective considering more complications with non-reduced group and hence reduction improves favorable pregnancy outcomes

Ranking very young Pinus radiata families for acoustic stiffness and validation by microfibril angle

International audienceAbstractKey messageAcoustic techniques can be utilised to rank a large population of young trees for stiffness and stability for breeding purposes.IntroductionThis study sought to validate new approaches to rapid, very early screening and selection of radiata pine families, using microfibril angle (MFA) as a reference for comparative purposes.MethodA key feature was tilting the trees at an angle of ∼30° after the initial 12 months of growth in order to force production of opposite wood (OW) and compression wood (CW) and prevent the co-mingling of the two distinctive wood types as occurs ‘at random’ within vertical stems. After 34 months, OW and CW materials were characterised independently for acoustic velocity (V), dynamic modulus of elasticity (MOEdynamic), basic density and longitudinal shrinkage. Finally, MFA were determined with X-ray diffraction.ResultNo phenotypic correlation was observed between OW and CW wood properties. The Spearman ranking correlation between V2 and MFA values in OW was 0.81.ConclusionWe show that families or individual trees with superior wood properties can be screened at this young age using acoustics. Further, the same outcomes can be achieved as with X-ray diffraction (MFA) but more cheaply and rapidly