Comparative evaluation of low dose-vaginal misoprostol and intra-cervical dinoprostone for cervical ripening and induction of labour in term pregnancy

Background: Induction of labour is one of the most common obstetric interventions worldwide. The study was conducted to compare the efficacy and safety of 25µg (low dose) vaginal Misoprostol with intracervical Dinoprostone for cervical ripening and induction of labour in term pregnancy.Methods: The study was conducted on 200 eligible term gravidas admitted for the purpose of labour induction. Subjects were randomly allotted to two groups. Group A (100 patients) received 25µg vaginal Misoprostol 6 hourly, while Group B (100 patients) received intracervical Dinoprostone 6 hourly for a maximum of 3 doses each, for cervical ripening and induction of labour. The main outcomes analysed were the induction-to-vaginal delivery interval, number of vaginal deliveries within 24 hours, dose of prostaglandin required, need for oxytocin augmentation and incidence of operative or caesarean delivery and rates of hyper stimulation, maternal complications and neonatal outcome.Results: Misoprostol use was associated with shorter induction-to-vaginal delivery interval (1165.60+306.28 minutes v/s 1369.80+286.96 minutes, p= <0.001), a greater proportion of patients delivering vaginally within 24 hours (67% v/s 46%, p=0.001) and lesser need for oxytocin augmentation to achieve vaginal delivery (25.3% v/s 54.7%, p<0.001).The mean change in Bishop’s score was greater with Misoprostol, although the difference was not statistically significant. The rates of operative and caesarean deliveries, and indications for caesarean were similar in both groups. The rates of uterine hyper stimulation, maternal and neonatal outcomes were similar.Conclusions: Vaginal Misoprostol is more efficacious than intracervical Dinoprostone for induction of labour in term gravidas

Role of risk of malignancy index 4 in evaluation of adnexal masses

Background: The discrimination between benign and malignant adnexal masses is important for clinical management and surgical planning in such patients. Various combined methods of evaluation adnexal mass have also been proposed. Risk of malignancy index (RMI) is a combined parameter which is simple, preclinical and highly sensitive, and more specific. Risk of malignancy index 4 (RMI 4) is calculated as a product of ultrasound score (U)×menopausal score (M)×CA 125×tumor size. Objective of this study was to determine if the RMI (RMI 4) can distinguish between benign and malignant adnexal masses.Methods: A prospective study was conducted on 30 women with an adnexal mass presenting in the OPD and emergency and RMI-4 calculated. Cut off level of 450 was set to differentiate between benign and malignant mass.Results: In this study, the value of RMI-4 is less than 450 in 17 patients with benign disease and 3 patients with malignant disease. The value is more than 450 in 2 patients with benign disease and 8 patients with malignant disease. RMI-4 >450 had a sensitivity of 72.73% and specificity is 89.47%. The positive predictive value is 80% and negative predictive value is 85%. The p-value for RMI-4 in this study is 0.001 which is highly significant.Conclusions: RMI is a reliable, simple, easy to use and cost-effective method in differentiating benign from malignant adnexal masses

Schwannoma in oropharynx: a rare site posing diagnostic challenge

Schwannomas are benign nerve sheath tumors. These arise from Schwann cells of the neural sheath. Intra oral region is a relatively uncommon site of these tumors. They are solitary, slow growing, smooth surfaced, usually asymptomatic, and encapsulated tumors, about 25% of all schwannomas are located in the head and neck, but only 1% show intraoral origin. A 22-year-old female came with dysphagia since, 3 years. FNAC was not feasible and so excision biopsy of the lesion was performed. Histopathology revealed schwannoma like picture and it was confirmed with diffuse S-100 positivity on immunohistochemistry. Hence, finally confirming schwannoma of the oropharyngeal region. Schwannomas can be found anywhere in the body but a quarter of all occur in the head and neck region. Intraorally its percentage is only 1% with tongue being the commonest. Pharyngeal presentations of schwannoma are rare. Schwannomas are benign tumors having excellent prognosis. Basically, this case report is important as these very rarely occur in the oropharyngeal region and it’s a must to consider them in the differential diagnosis of lesions at this site

Comparative Insight of Regulatory Guidelines for Probiotics in USA, India and Malaysia: A Critical Review

Probiotics have always been a unique category of natural products due to established evidences of their applications in wellness of human beings. Inspite of being based on live microorganisms, commercial exploration of probiotics as biologics, pharmaceuticals, food and nutritional supplements has witnessed a tremendous increase due to their potential of providing health benefits. Currently different regulatory bodies across the globe consider probiotics under several categories depending upon their intended use. In order to clear the ambiguity related to regulatory specifications, assurance of quality and premarketing safety assessment for drafting of comprehensive guidelines with global acceptance is need of the hour. The aim of this paper is to compare existing regulations in countries like United States, India and Malaysia to develop harmonized guidelines for approval of probiotics

Comparative evaluation of composite and simplified who partograms in a tertiary care centre in North India

Background: Early detection of abnormal progress and prevention of prolonged labour can significantly improve the outcome of labour. Partograph is an inexpensive tool which can provide a continuous pictorial overview of labour and is essential to monitor and manage labour. The objectives were to study the course of normal and abnormal labour and to evaluate the maternal and perinatal outcome using simple and composite WHO partogram.Methods: This was a randomized study conducted at Department of Obstetrics and Gynaecology, Government Medical College, Amritsar, a tertiary care centre in North India. 200 women with term, singleton, vertex gestation, in spontaneous labor were included in the study. In 100 cases composite partograph was plotted and in rest 100 cases simple partograph was plotted. The following outcomes were compared: labor crossing the alert and action line, augmentation of labor, rate of cesarean section, perinatal and maternal outcome.Results: The partogram crossed the alert line (p 0.008) and action lines (p 0.017), causing increased need for augmentation (p 0.034) in the composite partogram which was statistically significant. The numbers of vaginal deliveries were high (p<0.001) and decrease number of cesarean sections (p 0.007) and instrumental deliveries (p 0.009) in the simplified group. NICU admissions were also higher in the composite group (p<0.05), though most of the NICU admissions were due to hyperbilirubinemia and low birth weight and was not directly related to monitoring of labour.Conclusions: It was observed in the present study that labour can be managed without the latent phase being plotted on the partograph. The interventions were higher when the latent phase was included, with increased number of labours crossing the alert and action lines, increased no. of augmentations and larger number of caesarean sections. Our study favours the use of the WHO modified partograph, which should become routine practice in monitoring labour for better maternal and perinatal outcome

Maternal mortality in a tertiary care centre in North India: a retrospective study

Background: The World Health Organization (WHO) estimates that, of 536,000 maternal deaths occurring globally each year, 136,000 take places in India. Maternal death has serious implications to the family, the society and the nation. It deprives the surviving infant of mother's care. This study was done to assess maternal mortality in a tertiary care centre in north India where large numbers of patients are referred from the peripheral centers and the rural parts. This study was done to assess the causes of maternal mortality and suggest remedial measures to reduce the same. Objective of present study was to assess the causes of maternal death over a period of one year at G.M.C Amritsar, India.Methods: A retrospective hospital based study of 22 maternal deaths over a period of 1 year from June 2012 to June 2013. The information regarding demographic profile and reproductive parameters were collected and results were analyzed.Results: Over the study period, there were 22 deaths and 7272 live births (Majority were referral from other districts all over Punjab). Most common direct cause of maternal mortality was haemorrhage and anemia was the most common indirect cause. Most maternal deaths were seen in patients from rural areas, unbooked, illiterate patients and patients from low socioeconomic status.Conclusions: Proper health education should be given to the women; early registration of antenatal cases should be done which allows for rapid diagnosis and treatment of high risk cases. Also constructing a well equipped health care facility with trained staff and prompt transport facilities for early referral can bring down the maternal mortality rate in our country

Scaling Laws for Spreading of a Liquid Under Pressure

We study squeeze flow of two different fluids (castor oil and ethylene glycol) between a pair of glass plates and a pair of perspex plates, under an applied load. The film thickness is found to vary with time as a power-law, where the exponent increases with load. After a certain time interval the area of fluid-solid contact saturates to a constant value. This saturation area, increases with load at different rates for different fluid-solid combinations.Comment: 10 pages, 5 figure

CLINICAL STUDY OF LAGHUPANCHMOOLA SADHIT COW’S MILK IN COW’S MILK PROTEIN ALLERGY

In Ayurveda classics it is pointed out that cow’s milk have Vamaka, Virechaka, Sarama and Abhisyandi properties. In classics, it has been mentioned that cow milk should always be processed with Laghupanchmoola before it is consumed. Aims and Objectives of the study: To study Aetiopathogensis of cow milk protein allergy and to evaluate the efficacy of Laghupanchmoola sadhit cow milk in CMPA. Material &amp; Methods: To fulfill the above Aims and Objectives: Total 35 patients were selected between the age group of 0-3 years of age with symptoms of CMPA. Hb%, complete history and elimination-challenge test were used for evaluation of the patients. Laghupanchmoola granules dose depend upon age and duration of trial was 60 days. Results: After analyzing the data statistically in 30 patients, statistically highly significant improvements were found in diarrhea, abdominal pain, respiratory difficulty and vomiting. Significant improvements were found in dermatitis. No improvement was found in anemia and nausea. Statistically highly significant improvement was found in weight, height, mid arm circumference, chest circumference and head circumference. After full observation of treatment modules, it was found that: Number of patient with complete improvement was 0, Number of patient unchanged was 2 (6.5%), Mild improvement was observed in 05 patients (16.6%), and Moderate improvement was observed in 21 patients (70%), where marked improvement was observed in 2 patients (6.7%). Conclusion: Laghupanchmoola proved quite effective in managing the patients of CMPA due to its Tridoṣahar, Deepana, Aamdoshanasaka, Balya and Brahmanna properties