Efficacy of Intra Vaginal Misoprostol as Various Doses versus Intra cervical Dinoprostone in Cervical Ripening and Induction of Labor

Objective: To compare the efficacy of intra vaginal misoprostol as various doses versus intra cervical dinoprostone in cervical ripening and induction of labor.Study Design: A Prospective Randomized Controlled Trial.Place and Duration of Study: Obstetrics and Gynecology Department of Nishtar Medical University and Hospital, Multan from May 2016 to July 2018.Methodology: We divided 168 patients into three groups; Group M1 and M2 were given 25µg and 50µg misoprostol, respectively; Group D was given 0.5mg dinoprostone. Complete history was followed by complete examination. Outcome variables, age, parity, gestational age, indications for the induction of labor and initial Bishop Score were compared. Data was put in SPSS 23 and analyzed by applying one way ANOVA and Chi-square tests, as appropriate considering p≤0.05 statistically significant.Results: Induction to vaginal delivery interval was 15.51±6.18min in Group-M1, 12.14±4.65min in Group-M2 and 13.43±6.96min in Group-D (p=0.008). The women who need oxytocin supplementation were 30.6%, 17.7% and 41.9% from Group M1, M2 and D, respectively (p=0.013). Bishop Score after 6 hours of delivery was 3.45±1.2, 4.41±1.5 and 4.21±1.3 in group M1, M2 and D, respectively, and the difference was highly statistically significant (p<0.001). All other variables were comparable among the groups (p>0.05).Conclusion: Higher dose of misoprostol i.e. 50µg misoprostol is higher in efficacy than 0.5mg dinoprostone which is in turn better than 25µg misoprostol. But 50µg misoprostol can cause hyper-stimulation and dinoprostone needs oxytocin augmentation. Misoprostol is a good and cheap agent for the induction of vaginal delivery. Keywords: misoprostol, dinoprostone, cervical ripening, induction of labor.

Association of Peripheral Neuropathy in Chronic Kidney Disease (CKD)

Objective: To study the prevalence of peripheral neuropathy and evaluate the clinical nerve dysfunction in patients with chronic kidney disease. Study Design: Prospective study Place and duration: Medical ward Mayo hospital, Lady Wllingdon Hospital and Nishtar Hospital Multan from  March 2018 to  May 2019. Methodology: Eighty patients of clinically and biochemically proven chronic kidney disease were selected for study. Non probability consecutive sampling was used. Patients were assessed or both sensory and motor nerve dysfunction. SPSS software was used for data analysis. Main variables of study were creatinine clearance and neuropathy of peripheral nerves. Results: Affected patients percentage with reference to overt and subclinical neuropathy was noted as 67.5%. Overt neuropathy and subclinical neuropathy observed as 35.2% and 64.8%, respectively. Patients affected with percentage with reference to the type of peripheral neuropathy were noted 67.5%. Sensory-motor, sensory and motor was observed as 31.5%, 14.8% and 53.7%, respectively. Conclusion: Peripheral neuropathy is highly associated with chronic kidney disease and severity and prevalence of neuropathy increases with worsening in renal failure. Early diagnosis and strict compliance required to overcome this condition. Keywords: Chronic Kidney disease, Peripheral neuropathy, Hemodialysis, Sensory nerve, Motor nerve. DOI: 10.7176/JMPB/60-03 Publication date:October 31st 201