Misplaced intrauterine contraceptive devices: a case report

Contraception is a new topic gaining attention in country like India and a new proposed area of research. Intrauterine contraceptive devices (IUCDs) are one contraceptive method requiring less efforts and having more efficacy. ‘Misplaced IUCD’ is one of the rare and the most dreadful complication of IUCD insertion. Clinically, it can present as having pain, bleeding, recurrent pregnancy loss or can be asymptomatic. This is a case report of a 40 year old P4A1L4 female who presented to us with suspicion of misplaced IUCD without clinical symptoms. Clinical examination and radiological investigations made a diagnosis of misplaced IUCD and laparoscopy confirmed it. Laparoscopically misplaced IUCD was removed.

Sublingual misoprostol to reduce blood loss at caesarean delivery

Background: Caesarean section is the most common obstetrical procedure performed worldwide. Sometimes oxytocin alone is not sufficient to prevent postpartum haemorrhage and additional uterotonics may be required. We attempted an additional uterotonic misoprostol by sublingual route to evaluate the role of it to reduce blood loss at caesarean delivery.Methods: This prospective clinical study was done on patients of S. S. G. Hospital, Baroda; 138 patients who underwent lower segment caesarean section (elective or emergency). The primary outcome was less intra/peri operative blood loss, need for additional uterotonic agents and perioperative haemoglobin (Hb) fall. The secondary outcomes studied were incidence of shivering, pyrexia, nausea, vomiting, operating time, blood transfusion, endomyometritis and hospitalization period. Average blood loss after normal vaginal delivery is 500 ml and after caesarean delivery is around 1000 ml.Results: Mean postoperative Hb was high with misoprostol group and perioperative Hb fall was less. Perioperative Hb fall of 1 g or more was lesser in this group.Conclusions: Sublingual misoprostol reduces intraoperative blood loss, perioperative blood loss and the need for additional uterotonic agents and blood transfusions at caesarean delivery.

Reynolds number dependence of the near-wall flow over irregular rough surfaces

The database contains representations of the two surfaces studied, a graphite and a gritblasted surface, and the corresponding time-averaged velocity data for Reynolds numbers Re� = 90; 120; 180; 240; 360; 540, and 720

Reynolds number dependence of the near-wall flow over irregular rough surfaces

The database contains representations of the two surfaces studied, a graphite and a gritblasted surface, and the corresponding time-averaged velocity data for Reynolds numbers Re� = 90; 120; 180; 240; 360; 540, and 720

Understanding the degree of awareness among medical professionals regarding the ethics of pharmaceutical marketing activities in context of revised medical council of India code of ethics

Background: Pharmaceutical marketing activities are regarded as ethically challenging by most medical professionals. This study was planned to understand the extent of the interaction of pharmaceutical companies with healthcare providers & to determine the level of awareness about the ‘Medical Council of India (MCI) Code of Ethics’.Methods: A questionnaire based survey was conducted among 100 consultants and residents. The questionnaire mainly dealt with ethical issues about accepting free gifts, medicines and other sponsorships from pharmaceutical representatives, interactions and expectations from representatives of pharmaceutical companies by doctors and ascertaining among them the level of awareness about the MCI’s code of ethics.Results: 59.4% residents and 58.8% consultants do not consider small gifts (stationery/books/drug samples) as ethically problematic. 88% residents and 85% consultants felt that offers should be limited. 72% of consultants were aware of the revised MCI code of ethics as compared to 28% of residents.Conclusions: Most physicians do maintain a code of ethics with regards to accepting gifts and they felt that inexpensive gifts do not influence clinical judgment. Consultants were of the view that amended MCI code of ethics would not affect their clinical practice significantly

Seismic Behaviour of Bridges Considering Soil-Structure Interaction

The soil-structure interaction has significant effect on seismic response of bridges in many situations. The choice of soil springs for response determination is an important consideration. This paper presents a comparative assessment of the seismic response of bridge substructure by four different types of frequency independent soil springs namely, Beredugo-Novak, Wolf, Bycroft-Parmelee and Terzaghi. The variation of equivalent weighted damping and equivalent seismic coefficient is also studied. The Terzaghi\u27s soil springs obtained by modulus of subgrade reaction approach are most flexible as compared to others. The responses are seen to be comparable with springs other than Terzaghi. The equivalent damping in higher modes is increased due to energy dissipation in soil. The codal provisions of equivalent seismic coefficient variation below scour level are generally unconservative

Assessment of quality of life in Indian patients with vitiligo, an observational study

Background: Vitiligo is the most common hypopigmentary disorder. In India, the incidence of vitiligo is 0.25-2.5%. It considerably influences the patient’s quality‑of‑life (QoL) and psychological well‑being.Methods: A prospective, observational study was conducted from April 2016 to September 2016 in dermatology outpatient department. Patients clinical characteristic were noted and Quality of life was assessed by using Vitiligo Quality of Life Questionnaires [VQLQ]. During item development, none of the questions were changed according to the results of cognitive and understand ability testing. The scale consisted of 25 questions. The answer to each question was scored as ‘never = 1’, ‘sometimes = 2’, ‘often = 3’ and ‘all the time = 4’, so the total score ranged between 25 and 100. Higher scores represented more severely impaired quality of life.Results: We enrolled 78 Vitiligo patients who were attending dermatology department for phototherapy. Out of them 53 were female. Mean age was 37.12±12.270. Most common age group was 31-40 years. Mean VLQL score 40.92±6.081. Patients were divided based on VQLQ score in Moderate (50-75) and Low score group (25-50). Vitiligo patients presented with symptoms of pain, irritation and itching (P<0.0001). Vitiligo patients when assessed for feeling domain were significantly embarrassed for their overall look and appearance. (P < 0.0001). When Personal relationship domain was analysed physical contact was a major concern (P <0.002). Patients suffering from Vitiligo were significantly worried about spread of vitiligo and occurrence of cancer (P<0.0001). Therapy for Vitiligo was time consuming time and was a work place challenge for the patients (P <0.0001). The reliability of VQLQ in our study was Cronbach’s α coefficient was 0.876.Conclusions: QoL impairment was relatively high in vitiligo patients. Medical intervention and counselling should focus to improve feelings, personal relationship, anxiety, school/work, leisure and symptom domains

Complications as indicators of quality assurance after 401 consecutive colorectal cancer resections: the importance of surgeon volume in developing colorectal cancer units in India

<p>Abstract</p> <p>Background</p> <p>The low incidence of colorectal cancer in India, coupled with absence of specialized units, contribute to lack of relevant data arising from the subcontinent. We evaluated the data of the senior author to better define the requirements that would enable development of specialized units in a country where colorectal cancer burden is increasing.</p> <p>Methods</p> <p>We retrospectively analyzed data of 401 consecutive colorectal resections from a prospective database of the senior author. In addition to patient demographics and types of resections, perioperative data like intraoperative blood loss, duration of surgery, complications, re-operation rates and hospital stay were recorded and analyzed.</p> <p>Results</p> <p>The median age was 52 years (10-86 years). 279 were males and 122 were females. The average duration of surgery was 220.32 minutes (range 50 - 480 min). The overall complication rate was 12.2% (49/401) with a 1.2% (5/401) mortality rate. The patients having complications had an increase in their median hospital stay (from 10.5 days to 23.4 days) and the re-operation rate in them was 51%. The major complications were anastomotic leaks (2.5%) and stoma related complications (2.7%).</p> <p>Conclusions</p> <p>This largest ever series from India compares favorably with global standards. In a nation where colorectal cancer is on the rise, it is imperative that high volume centers develop specialized units to train future specialist colorectal surgeons. This would ensure improved quality assurance and delivery of health care even to outreach, low volume centers.</p

Disparities in Survival with Bystander CPR following Cardiopulmonary Arrest Based on Neighborhood Characteristics

The American Heart Association reports the annual incidence of out-of-hospital cardiopulmonary arrests (OHCA) is greater than 300,000 with a survival rate of 9.5%. Bystander cardiopulmonary resuscitation (CPR) saves one life for every 30, with a 10% decrease in survival associated with every minute of delay in CPR initiation. Bystander CPR and training vary widely by region. We conducted a retrospective study of 320 persons who suffered OHCA in South Florida over 25 months. Increased survival, overall and with bystander CPR, was seen with increasing income (p = 0.05), with a stronger disparity between low- and high-income neighborhoods (p = 0.01 and p = 0.03, resp.). Survival with bystander CPR was statistically greater in white- versus black-predominant neighborhoods (p = 0.04). Increased survival, overall and with bystander CPR, was seen with high- versus low-education neighborhoods (p = 0.03). Neighborhoods with more high school age persons displayed the lowest survival. We discovered a significant disparity in OHCA survival within neighborhoods of low-income, black-predominance, and low-education. Reduced survival was seen in neighborhoods with larger populations of high school students. This group is a potential target for training, and instruction can conceivably change survival outcomes in these neighborhoods, closing the gap, thus improving survival for all