bluuebunny/crossref_metadata_2025 huggingface dataset:
Descriptive analysis of theory examination question papers of 2nd MBBS pharmacology of Krantiguru Shamji Krishna Verma Kachchh University (Gujarat)
Authors: Khuteta Neelesh K. , Saurabh Manoj K.
Published: December 2016

Background: The Question Paper is the most important tool of theory exam examination. An attempt was made to assess the pharmacology question papers of university examination in accordance with their guidelines. To assess the pharmacology theory question papers for content validity, area of importance and to test the level of cognitive domain.Methods: Twenty four papers of university comprising 695 questions after preparing 520 learning objective were analysed. All questions were analysed for coverage of different subdivision of Pharmacology and marks allotted to them, type of taxonomic level of each question asked on the basis of verb use and percentage of question asked from area of importance.Results: It was observed that 18.40% weightage of marks given to general pharmacology and least .67% for immunosuppressant in paper I whereas in paper II, 34.90% for antimicrobial agents. About 84% questions were asked from must know area, 8.07% from nice to know area and 7.90 from desirable to know area. In paper I, 92.08% of the questions were to test factual recall (Bloom level I), remaining 07.93% were reasoning type but in other paper verbs were used to test only lower cognitive domain.Conclusions: All the sub-divisions of pharmacology were not covered in each theory assessment. Majority of questions were asked to test lower level of cognitive domain. Theory question papers should be designed to give proper weightage to whole subject area. Blue printing of theory question papers is absolutely necessary.
Socio-economics: a propensity of self-medication among OPD patients of a teaching hospital
Authors: Chattopadhyay Subha Sankar , Datta Angana , Ghosh Aritra , Biswas Suvadip , Mandal Krishnendu , Biswas Supreeti
Published: December 2016

Background: Use of over the counter (OTC) drug is very much common in India. Not only medical professionals or educated urban population but also it is common in rural area and low educated person. This study was done to assess the extent of knowledge and practices of OTC drugs among OPD patients of a tertiary care hospital.Methods: A questionnaire based study was conducted among 1680 Medicine OPD (outpatient department) patients.Results: Among the participants, 62% patients taking OTC drugs at least once in their life. Most common symptoms for self-medication were fever (89%), cough and cold (78%), headache (67%), pain (53%), diarrhea (10%), vomiting (10%), indigestion (20%). Antipyretics (65%), analgesics (35%) among NSAIDs which were common used as OTC drugs. Others drugs were antacids (50%), cough and cold preparations (50%), Vitamins (30%), antiemetics (5%).Conclusions: Awareness is necessary to use drugs rationally with proper prescription and know about harmful effects of OTC drugs.
Study to monitor the adverse effects by different HAART regimens in HIV patients with tuberculosis
Authors: Shyam Radhey , Singh Arpita , Singh Dheeraj Kumar , Verma Ajay Kumar , Shankar Pratap , Tutu Sachin , Dixit Rakesh Kumar
Published: December 2016

Background: In the modern era, AIDS is not less than a disaster for the human race. More than two-third of HIV-infected individuals have an associated infectious pulmonary disease. Mycobacterium tuberculosis is more virulent than most of other opportunistic pathogen causing latent infection. HIV is characterized by a profound immunodeficiency resulting from a progressive, quantitative and qualitative deficiency of the subset of CD4 T lymphocytes referred to as helper T cells leading to the patient at high risk of developing a variety of opportunistic infections. At present AIDS is incurable but some of the drugs have shown to decrease the mortality and morbidity of the disease. These are called as Highly Active Anti-Retroviral Therapy (HAART). However, these drugs are associated with a significant number of side effects. This work has been conducted in order to study the demographic profile of HIV patients with TB and monitor the adverse effects of different HAART regimens among them.Methods: A total of 3078 patients screened for the study. Those who were diagnosed with HIV were enrolled. Pretreatment parameters like, CD4, CD8 + lymphocyte count and their ratio, haemogram etc. were recorded. Patients were divided into four groups and were started with different HAART regimens. They were monitored regularly for the appearance of any adverse effects.Results: The prevalence of HIV sero-positivity was found to be 3.60%. Out of them, 71.18% were males and 28.82% were females. The highest prevalence (43.29%) was in the age group of 21-50 years. The sero-positive rate was found more in married males as compared to married females and unmarried cases. Side effects were present in all the groups. The most common side effect was GI intolerance and was most frequent in Group I. Anemia and neutropenia occurred in the Zidovudine containing groups (group I, III and IV). Peripheral neuropathy occurred most commonly in cases of Group II. Rashes occurred in nevirapine containing groups. Liver function derangement was noticed more in group I and II. 71.4% of patients on HAART regimen showed improvement in symptoms while 28.57% did not show any improvement.Conclusions: The prevalence of HIV sero-positivity in our study was 3.60%. The rate of sero-positivity was more in males as compared to females while it was highest in the individuals of 21-50 years of age. The most common side effect was GI intolerance and was most frequent in Group I. Anemia and neutropenia occurred most frequently in Zidovudine containing groups. Peripheral neuropathy occurred most commonly in cases of Group II (Stavudine + Lamivudine + Nevirapine). Deranged lipid profile was found to occur due to indinavir in patients of Group IV. After starting on HAART regimens, 74.4% showed significant improvement in symptoms.
Assessment of drug utilization pattern and rationality of drug use in treatment of dilated cardiomyopathy in a tertiary care teaching hospital of rural Bengal
Authors: Banerjee Prasun , Mandal Ananya , Mukhopadhyay Dipankar , Gangopadhyay Tanmoy , Mandal Sonai , Das Abhijit
Published: December 2016

Background: Dilated cardiomyopathy (DCM) is an important underlying cause of congestive heart failure and/or arrhythmias. The introduction of therapy combining diuretics, digoxin and angiotensin converting enzyme inhibitors (ACEI) has significantly decreased mortality and morbidity. The aim of the study was undertaken to identify the pattern of drugs most commonly prescribed for DCM and to assess the rationality behind such use.Methods: This was a prospective study undertaken between 1st July and 31st August 2015. Prescriptions were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Rationality and cost of therapy per prescription was also evaluated.Results: We encountered 78 patients of DCM in the OPD of Cardiology (prevalence of 4.94%). The average number of drugs per prescription was 6.64. Generic prescriptions were made in 90% encounters. As part of therapy, diuretics and ACE inhibitors or angiotensin receptor blockers, were prescribed in all cases. Our results show a distinctive drug use pattern where beta blockers were used more commonly than digoxin. Other commonly prescribed agents were antiplatelet drugs and statins. Antibiotics were prescribed in 8.7% cases and no injectable drug was prescribed. Average drug cost per encounter was 10.63 INR.Conclusions: To conclude, we found a typical and rational pattern of drug use. Diuretics, ACEI and beta blockers were found to be most commonly used agents. This study provides a clear picture of drug use in this special clinical condition in rural Bengal and paves the way for larger and long term studies.
Preclinical study comparing the antidotal effect of clonidine with atropine for the treatment of acute malathion poisoning in the albino rats
Authors: K. R. Suresha , M. SantoshKumar , Nagashayana .
Published: December 2016

Background: In developing countries 2–3 million people are acutely poisoned by organophosphorus (OP) pesticides every year. There is a pressing need for new affordable antidotes and in this context clonidine which has central effect (α2 agonist) has been evaluated in the albino rats presenting with signs or symptoms of acute malathion poisoning. And compared with atropine for the acte malathion poisoning in albino rats.Methods: This was a preclinical study conducted on albino rats of either sex weighing 100-150 grams were randomly divided into 4 groups (6/group). Malathion was given at the lethal dose of 54 mg/kg body weight (BW) by gavage to each group. Group 1: normal saline intraperioneal (i.p). Group 2: Post treated with atropine 1.5 mg/kg BW (i.p). Group 3: Pre treated with clonidine 1mg/ kg BW (i.p), 10 minutes priore malathion. Group 4: Pre treated with clonidine and post treated with atropine. The above groups were observed for straub tail, muscle fasciculation, piloerection, lacrimation, defecation/ urination; salivation, tremors, gasping and convulsion and were recorded at time 0, 15, 30, 45 and 60 minutes after poisoning. The latency of onset of tremors, loss of righting reflex and tremors were recorded. Results were presented as percentage occurrence and Mean ± SEM. Repeated measure one way ANOVA and Fisher’s Least Significant Difference post hoc test for comparison between groups. P-value of 0.05 or less was considered for statistical significance.Results: The central effects namely straubs tail and whole body tremors are significantly improved compared to control and atropine with clonidine group (p<0.05). However convulsion shows improve in atropine alone and atropine with clonidine groups. The overall survival time has significantly increased compared to control and atropine and atropine with clonidine (P<0.05).Clonidine has not shown any effect on survival time.Conclusions: Clonidine has some central protective effect in malathion poisoning. And it has not shown any effect on survival time. This issue needs further controlled studies.
Medication package inserts: how far do they adhere to the guidelines?
Authors: Deep Neha , Jose Roslin , Chakrabo Ananya
Published: December 2016

Background: Package Insert (PI) is a document that is provided with the package of a drug. It is chiefly directed at the prescribers and is set to provide information for the safe and effective use of the respective drug. This study was conducted to assess the completeness of clinical information provided in the currently available PIs.Methods: PIs were collected from pharmacies located at various parts of Bangalore over three months. A total of 310 drugs were checked for package inserts (PI) and 192 PI’s were collected. They were analysed based on the criteria mentioned in Schedule D of Drug and Cosmetic act 1945.Results: Out of 192 PIs, 33 were repeated and so were not taken into account. Hence, 159 PIs were analysed. Among 159 PIs, 43 (27.04%) were of Cancer chemotherapy drugs; 19 (11.94%) of antibiotics, 18 of anti-diabetic drugs, 13 (8.17%) of Vitamins and minerals, 10 (6.28%) of Cardiac drugs, 9 (5.66%) of Respiratory drugs, 6 (3.77%) of CNS drugs, 5 (3.14%) of Ophthalmic eye solutions, 4 (2.51%) of Hormones and reproductive system, 4 (2.51%) of GIT, 4 (2.51%) of Antifungals, 3 (1.88%) of steroids, and 21 (13.20%) of miscellaneous drugs respectively. Out of them, the PIs that belonged to “A”, “B”, and “C” categories were 5 (3.14%), 150 (94.33%), and 4 (2.51%) respectively. It was observed that the PIs were inadequate in many aspects. Majority of the PIs had unclear instructions about drug usage, special precautions, ability to drive and use machines and adverse effects to name a few.Conclusions: This study showed that many of the drugs now days come without PI. Also of the available ones, very few fulfil all the criteria mentioned in the guidelines. With the growing sales of over the counter drugs in India, it is important for companies to dispense PIs with all the drugs. PIs oriented toward educating the patient are the need of the hour.
Study of diuretic activity of aqueous extract of amaranthus spinosus linn on rats
Authors: Potllapalli Shravani , Narumalla Jagannath , Pavani A. Naga Teja , Govindadas Damodaram , Chikkannasetty Somashekar S.
Published: December 2016

Background: Traditional Siddha medicine literature claims that the Amaranthus spinosus Linn. Whole plant possesses diuretic property. The aim of the present study is to investigate the diuretic activity of aqueous extract of amaranthus spinosus linn on rats.Methods: The rats were randomly divided into four groups of six animals each and deprived of food for 18 hours before the experiments. Control (Group I) rats were treated with Normal saline (5ml/Kg,) and Standard (Group II) rats were administered furosemide 15mg/Kg, I.P. Group III and IV were treated with Aqueous extract of Amaranthus spinosus Linn (AEAS) 250 and 500 mg/kg in normal saline respectively, The urine was collected after 5 and 24 hours. The urine volume and the total concentration of Na+, K+, and Cl- in the urine were estimated. The data were presented as mean ± standard deviation and analyzed using one-way analysis of variance and Student's "t"-test. P <0.05 was considered statistically significant. Conventional windows software was used for statistical analysis.Results: Urine analysis showed that Na+, K+, and Cl- levels were significantly (p<0.05) increased with AEAS 250 and 500 mg/kg as rats treated with furosemide 15mg/kg. Urine volume is significantly (p<0.05) increased in rats treated with drugs (AEAS 500 mg/kg and furosemide 15mg/kg) compared to normal saline 25ml/Kg, treated rats at 5 and 24 hours.Conclusions: These data suggest that AEAS has produced notable diuretic effect which appeared to be comparable to that produced by the standard diuretic furosemide.
A prospective assessment of antimicrobial agents utilization pattern in a tertiary care hospital
Authors: Hussain Sartaj , Sawlani Kamal K. , Yadav Suraj S. , Khattri Sanjay
Published: December 2016

Background: The antimicrobial resistance is increasing globally and, concurrently, downward trend in development of newer antibiotics is leading to a serious public health problem and economic consequences.Methods: Prescriptions with at least one antimicrobial were included in the study. A total of 242 prescriptions were included in the study. The antimicrobials were classified into different classes based on WHO-ATC classification.Results: A total of 281 antimicrobials prescribed in 242 prescriptions with an average of 1.16 per prescription. In most of the prescriptions, 1 antimicrobial were prescribed (88.43%). The routes of the antimicrobial administration were mostly oral 268 (95.37%) followed by injectable 13 (4.63%). The most commonly prescribed classes of antimicrobial in this study were antibacterials for systemic use (J01) (74.02%) followed by antimycobacterials (J04) (13.88%), antiparasitic drugs (P) (8.19%), antimycotics for systemic use (J02) (2.49%) and antivirals for systemic use (J05) (1.42%). Among antibacterials, the most commonly prescribed classes of antibacterial was various antibacterial FDCs (19.22%), followed by quinolones (18.86%), macrolides (18.15%), β-lactams (11.03%) cephalosporins (6.76%), penicillins (4.27%), aminoglycosides (2.84%), metronidazole (1.78%), clindamycin (1.78%) and tetracycline (0.36%). The total percentage of antimicrobials prescribed as Fixed Dose Combinations (FDCs) were 32.38%.Conclusions: The present study has reported that most commonly prescribed antimicrobials were quinolones followed by macrolides and β-lactams. Recommendations to change the ongoing prescribing practices should be based on the Standard Treatment Guidelines, EDL and Antibiotic policy or by following the information, education, and communication (IEC) interventions.
Determinants, characteristics and treatment of neck pain in a tertiary care hospital in Kerala
Authors: Joseph Liya Roslin
Published: December 2016

Background: This study was undertaken to study the determinants, clinical characteristics and treatment pattern of neck pain in patients attending outpatient department of Physical medicine and Rehabilitation in a tertiary care hospital.Methods: Study comprehended single patient visit. Data regarding patient demographics, characteristics of neck pain and clinical diagnosis, drugs prescribed to each patient were recorded in a pre prepared proforma. Clinician’s opinion about patient’s X-ray of cervical spine and the data regarding alternative treatment modalities were also noted. Data analysis was done with the help of excel 2007 and SPSS 16 statistical software.Results: Among 170 patients included in the study 38.8% of patients were in the age group of 40-49 years with M:F ratio-1:2.9. 98.8% of patients experienced radiation of neck pain to one or both arms. Neck pain also was associated with numbness in arm (82.4%), forearm (61.8%) or hand (59.4%) and neck stiffness (99.4%). Half of the study population were found to have neurological deficit. 98.2% of patients had positive radiological evidence for neck pain. Cervical spondylosis (85.9%) was the most commonly observed cause for neck pain. All patients received pharmacotherapy with NSAIDS and muscle relaxants. Diclofenac was the most commonly prescribed NSAID. 45% of the patients received alternative and complementary treatments for neck pain.Conclusions: NSAIDs and central skeletal muscle relaxants are the commonly prescribed medications and alternative treatments like spinal manipulation and physiotherapy appears to be beneficial in patients with neck pain.
A study on concept of P- drug selection among rural general practitioners
Authors: G. Priyadarshini Bai , P. Ravi Kumar
Published: December 2016

Background: The objective of the study was to assess the awareness of P- drug selection among rural general practitioners’s (GP) for common medical conditions.Methods: Fifty general practitioners in Tumakuru district were provided with proformas for selection of P- drugs for mild to moderate hypertension, diabetes, upper respiratory tract infections and acid peptic disease based on safety, affordability, need, and efficacy (SANE criteria).Results: Forty one GP’s responded by completing the proformas. Seventeen of them were aware of the concept of P- drug selection. In hypertension, beta blockers followed by Angiotensin Converting Enzyme (ACE) inhibitors were most commonly preferred. In diabetes, biguanides followed by sulfonylureas were preferred as oral hypoglycemic agents. Ampicillin, Ciprofloxacin and Cotrimoxazole were the commonly used antibiotics for upper respiratory tract infections. Ranitidine and antacids were preferred for acid peptic disease. Affordability followed by efficacy was the deciding criteria for P- drug selection.Conclusions: There is lack of awareness of P- drug selection among many rural GP’s. Therefore, there is necessity to create awareness about P- drug selection through continued medical education for rational use of drugs.
Comparison of intravenous Magnesium Sulphate with intrathecal Magnesium Sulphate for post- operative analgesia in orthopaedic patients undergoing extracapsular hip fracture surgery
Authors: Kumar Arvind , Chaudhary Usha Kumari , Kansal Dinesh , Rana Shelly , Sharma Vipin , Kumar Parbeen
Published: December 2016

Background: Magnesium sulphate (MgSO4) N methyl D aspartate receptor antagonist has the potential to be an ideal adjuvant for postoperative analgesia via intrathecal or intravenous route. The aim of the study was, we compared the efficacy of two routes of MgSO4 (Intravenous vs intrathecal) as an adjuvant to bupivacaine in subarachnoid block (SAB).Methods: Ninety, American Society of Anesthesiologists physical status 1 or 2 patients, aged 20-60 years, scheduled for hip surgeries under SAB were recruited in department of Anaesthesia and Dept. of Orthopaedics. Patients in group 1 (n=29) received intrathecal 0.5% (H) bupivacaine 15 mg with 0.1 ml of normal saline and 250 ml 0.9% normal saline intravenous 30 minutes before giving SAB. Group 2 (n=30) patients received intrathecal 0.5% bupivacaine 15mg with 0.1 ml of normal saline and 50mg/kg of magnesium sulphate in 250 ml normal saline intravenous 30minutes before giving SAB. In Group 3 (n=30) patients received intrathecal 0.5% (H) bupivacaine 15 mg with 50mg (0.1ml) magnesium sulphate and 250 ml 0.9% normal saline intravenous 30 minutes before giving SAB. They were evaluated for block characteristics, visual analogue scale at various time intervals up to 24 hours and total rescue analgesic and duration of postoperative analgesia were noted.Results: Intravenous magnesium sulphate had maximum pain free interval, lower pain scores, longer sensory and motor blockade and less requirement of rescue analgesia as compared to the patients in intrathecal group or control group (P<0.05).Conclusions: Intravenous magnesium sulphate was more effective as compared to intrathecal route with regards to the pain scores and in providing postoperative analgesia.
Role of betahistine in glycemic control of obese subjects: a placebo- controlled clinical trial
Authors: Al-Anbari Hayder H. , Sahib Ahmed S. , Al-Mukhtar Amer O.
Published: December 2016

Background: Poor glycemic control, insulin resistance and abnormal beta cell function are of the most important complications that associated with obesity, targeting of such complications with pharmacological agents depending on the already existing central mechanism may decrease the incidence of morbidity and mortality among obese subjects. Betahistine is an anti-vertigo drug, commonly prescribed to patients with balance disorders or to improve vertigo symptoms associated with Meniere's disease. The aim of this study was to investigate the effect of betahistine on glycemic status, insulin resistance and pancreatic function in obese subjects.Methods: A randomized, placebo controlled trial was carried out on 72 obese subjecta of both sexes with age range of 18-50 years who allocated into two groups: Group A: 48 patients treated with 144mg /day in three divided every eight hours for twelve weeks. Group B: 24 patients treated with placebo for twelve weeks to serve as control. For each group, demographic data, liver and renal function tests beside the studied parameters were investigated at baseline and after 12 weeks.Results: Administration of betahistine to obese subjects resulted in improvement in fasting blood glucose, glycosylated hemoglobin, insulin resistance and beta cell percent values after twelve weeks compared to baseline values and placebo treated group.Conclusions: Administration of betahistine in a dose of 144mg /day for twelve weeks to obese subjects effectively improve glycemic control, insulin resistance and beta cell functions in these subjects, indicating the beneficial effect of betahistine in slowing or reversing the long term progress of obesity complications without incidence of any serious adverse effects, indicating its efficacy and safety.
A clinical study on role of caroverine in the management of tinnitus
Authors: Kumari Abha , Kumar Sandeep
Published: December 2016

Background: Tinnitus is a perception of sound in the absence of sound stimulation and it continues to be a significant and costly health problem without a uniformly accepted treatment. The signals between the inner hair cells and the cochlear nerve fibres are most likely to be transmitted by glutamate. Hence, present study was undertaken to assess the role of caroverine which is a glutamate receptor antagonist in the management of sensory neural tinnitus.Methods: The present study was conducted among 50 adult patient with sensory neural tinnitus divided into two groups with 25 patients in each group. In group 1 caroverine 20 mg twice daily for a period of 90 days was administered and in group 2 placebos was given. The effect of caroverine and placebo on subjective relief and objective improvement was evaluated by using THI (Tinnitus Handicap, Inventory) scoring, Tinnitus frequency matching before and after the administration of caroverine and placebo.Results: In Group I reduction in tinnitus was seen in 16 patients (64%) in 90 days. In group II (placebo group) improvement was seen in 20% of the patient. Significant difference with respect to treatment was noted. In group 1, 8% of the patient showed complete relief from the tinnitus. 44% of the patient showed improvement below 50% whereas 12% of the patient showed improvement more than 50%.Conclusions: Carvoverine had shown a statistically significant improvement in tinnitus management.
A study of antinociceptive effect of venlafaxine in albino mice
Authors: Ramakrishna Santhosh , Gurusiddappa Shivashankaramurthy K. , Jambulingappa Kiran L.
Published: December 2016

Background: Serotonin and norepinephrine are important neurotransmitters involved in pain inhibition in descending pain inhibitory tracts. Venlafaxine being an antidepressant exerts its mechanism mainly by inhibiting reuptake of serotonin and norepinephrine like Tramadol. The objectives were to study the antinociceptive activity of Venlafaxine and its comparison with Pethidine.Methods: A total of 32 Swiss albino mice were divided into 4 groups with 8 animals in each group. Group 1 received normal saline as control in dose of 5ml/kg i.p, Group 2 received Pethidine as standard in dose of 30mg/kg s.c, Group 3 received Venlafaxine as in dose of 10mg/kg i.p and Group 4 received Venlafaxine in dose of 22.5mg/kg. Tail flick test and hot plate test were used for evaluating antinociceptive activity. All animals were subjected to the above mentioned tests before and 30 minutes after the administration of the drugs. Results were subjected to suitable statistical analysis.Results: The results from the above mentioned tests showed that Venlafaxine in dose of 10mg/kg showed significant antinociceptive activity as compared to normal saline (p <0.05) but was not comparable to Pethidine (p >0.05). Venlafaxine in dose of 22.5mg/kg showed significant antinociceptive activity as compared to normal saline (p <0.05) and activity was comparable to Pethidine.Conclusions: Venlafaxine in both the doses showed significant antinociceptive activity in acute models of pain in animals.
Stevens-Johnson syndrome induced by phenytoin: a case report
Authors: Bhanu Lalkota Prakash , M. Kumara Swamy , Nasiruddin Mohammed , H. D. Naveen , Venkataraman Rajesh
Published: December 2016

Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) are rare (one to two per 10,00,00 population per year) but life threatening adverse drug reactions. Antiepileptic drugs-induced Stevens-Johnson syndrome (SJS) is a life-threatening severe cutaneous adverse reaction, amongst anti-epileptics; carbamazepine and phenytoin are the major culprits. We report here a case of SJS due to phenytoin (CTC vs 2 Grade 3).
Comparative study of vectis versus manual method for extraction of fetal head during lower segment cesarean section
Authors: HK Priyanka , Yeddala Madhavi , KR Vimala , N. Shailaja , BS Bhat , L. Krishna
Published: December 2016

Background: Delivery of fetal head through uterine incision is often the major technical problem during low transverse cesarean section when the presenting part is unengaged. Techniques to deliver head under special circumstances are traumatic to both mother and fetus. This study aims to establish the role of vectis in extraction of fetal head during lower segment cesarean section (LSCS) and to assess associated difficulties or untoward effects of use of vectis over manual method.Methods: The study was undertaken in PESIMSR, Kuppam, Andhra Pradesh over two years. Vectis was used in extraction of fetal head in LSCS in 100 cases of full term pregnancy and maternal and neonatal outcomes were compared with 100 cases of manual extraction.Results: Incision-delivery time interval was similar in both vectis and manual extraction method (p value of 0.390). Vectis group did not require any fundal pressure for extraction of head where as 100% of women in manual extraction group required fundal pressure (p value: <0.001) which is statistically significant. The length of abdominal incision for majority of cases in vectis group was smaller and statistically significant compared to manual extraction group (p value of 0.001). Neonatal outcomes were similar in both the groups.Conclusions: As per our study, usage of vectis has shown significant advantage in reducing maternal discomfort caused due to fundal pressure and length of abdominal incision required, with negligible difference in neonatal and other maternal outcomes in comparison to manual method of extraction.
Post abortion care: experience of the gynecological and obstetrical service of Treichville university hospital center, Abidjan-Cote D’ivoire
Authors: Marc Dia Jean , Eric Bohoussou , Ignace Yao , Mouhideen Oyéladé , Gerard Okon , Privat Guié Beret , Simplice Anongba
Published: December 2016

Background: The objectives of our study were to determine the sociodemographic characteristics of the patients received in our service for abortion and to describe the Post Abortion Cares (PAC) that have been administered since the 2014 reorganization.Methods: This was a descriptive and prospective study over 12 months taking into account patients admitted to our department for abortion.Results: The frequency of abortions was 24%. The majority of patients were less than 25 years old (84.95%) and single (74.33%) had a low level of study (71.68%), an induced abortion history (73.75%) and a notion of contraceptive use (58%). On admission 15.48% of abortions were complicated. Patients mostly received, during their stay, abortion emergency cares (71.68%), contraception (81.25%) and HIV test (90.26%). They also benefited at 6 weeks from the cervical cancer screening (78.57%).Conclusions: The reorganization of the practice of abortion care permitted us to have the expected results.
Utility of amnioinfusion in deliveries complicated by meconium stained liquor: a randomized controlled trial
Authors: Elsersy Mervat A.
Published: December 2016

Background: Meconium stained amniotic fluid could be seen in 12-16 % of deliveries. Meconium is toxic to the newborn lung. Its presence during labour increases the risk to develop neonatal respiratory distress by about 100 times more. Meconium aspiration syndrome (MAS) occurs in about 5% of deliveries with meconium-stained amniotic fluid and death occurs in about 12% of infants with MAS. Intrapartum amnioinfusion was described as a way to dilute meconium or act as a mechanical cushioning of the umbilical cord to prevent its compression .The aim of this study is to perform a randomized controlled clinical trial to test the hypothesis that amnioinfusion can reduce the incidence of caesarean deliveries and perinatal morbidity associated with meconium stained amniotic fluid.Methods: An interventional randomized study was conducted in Hai Jamaa hospital. 360 patients were enrolled in the study. The patients were in labour with meconium stained liquor above 37 weeks. They were randomly allocated in two groups. Group 1: amnioinfusion group and Group 2: non amnioinfusion group.Results: Significant reduction of cesarean section rate due to fetal distress. Also significant reduction of prevalence of variable fetal heart rate decelerations, and significant reduction of incidence of MAS in patients received amnioinfusion.Conclusions: Amnioinfusion is an easy, safe and inexpensive procedure useful in patients with meconium stained liquor.
Perinatal outcome associated with oligohydramnios in third trimester
Authors: Chaudhari Kamlesh R. , Chaudhari Kushagra R. , Desai Omkar M.
Published: December 2016

Background: We aimed to evaluate the effect of Oligohydramnios on fetal outcome in terms of fetal distress, Meconium staining of amniotic fluid, birth weight, Apgar score of newborn babies, NICU admission, early neonatal morbidity and mortality.Methods: This was a prospective study of 156 antenatal patients booked at K. J. Somaiya medical college and research centre during the year January 2012 to December 2013 with gestational age between 30-40wks with AFI<5cms with intact membranes were analyzed for perinatal outcome.Results: The Caesarian section rate for fetal distress was 41% in patients with Oligohydramnios. Meconium staining of amniotic fluid was found in 30.7% patients. APGAR score at 5 minutes <7 was found in 6 patients (3.8%).Conclusions: Oligohydramnios has significant correlation with Caesarean section for fetal distress and low birth weight babies. Oligohydramnios is associated with high rate of pregnancy complication and increased perinatal morbidity and mortality. Oligohydramnios is a frequent occurrence demand careful evaluation, intensive parental counseling, fetal surveillance and proper antepartum and intrapartum care.
A study of vitamin D levels and associated deficiency in pregnancy and its effect on maternal and fetal outcome
Authors: Dave Anupama , Verma Monica , Jain Neelam , Dave Atisha
Published: December 2016

Background: From conception the embryo is dependent on the mother for all nutritional requirements until birth. Vitamin D deficiencies have adverse effect on pregnancy outcome result in poor growth, prematurity, NTD, even congenital anomalies. The aim and objectives of the study was to assess the prevalence of deficiencies among pregnant woman attending M.Y. Hospital and assess the correlation with the pregnancy complications.Methods: Total 110 patients were studied for vitamin d levels and associated obstetrical complications and risk factors over a period of six months. 53 pregnant women were found to be deficient with vitamin D.Results: 53 pregnant women out of total of 110 were deficient in vitamin D levels. Maximum patients belonged to group (21-30yr) of age. Vitamin D deficiency was more in housewives (65.3%) and in urban(86.8%). Low birth weight<2.5kg were born 50(45.5%) and 2 IUD. 2 were diagnosed NTD in USG reports. 80% low birth weight babies were born in vitamin D deficient women.Conclusions: Our study fails to show a causal relation between low vitamin D level and adverse maternal and fetal outcome in terms of preeclampsia, cesarean delivery, oligo and diabetes. There was a relation between vitamin D deficiency and low birth weight babies.
Study of congenital malformation in tertiary care centre, Mumbai, Maharashtra, India
Authors: Kokate Prasannajeet , Bang Roshni
Published: December 2016

Background: Birth defects are important cause of neonatal morbidity and mortality. Congenital anamolies are defined as structural and functional abnormalities including metabolic disorders present at birth. There are several known factors that are associated such as maternal infection like TORCH, genetic factors, drugs, maternal age, Consanguinity. Screening in late first and second trimester is important tool to reduce the prevalence.Methods: A retrospective study was done. Data was collected and analyzed. Fetal outcome was assessed. Variables like maternal age, parity, consanguinity, abortions, sibling with malformation, nutrition, smoking ,alcoholism, family history of congenital anomalies, conceived after infertility treatment, maternal diabetes, infections, fever, drugs, history of intrauterine deaths were critically evaluated.Results: Out of total 5020 deliveries, 50 babies with congenital anomalies identified. Incidence being 0.9%, commonest congenital anomalies involving craniospinal system (44%). Second most common is musculoskeletal system (30%). Consanguinity is single most important factor which was found to increase the risk of congenital anomalies in our study. In 40% of the cases consanguinity was noted. Most common perinatal risk factors are preterm labor (22%), polyhydramnios (8%) and breech (16%). The fetal outcome was 80% of the babies were compatible with life and 20% were non compatible.Conclusions: In the present study, most of the mothers who had anomalous fetuses had risk factors like consanguinity and previous history of abortions. Hence the need for focused screening in this high risk category. A level II targeted scan is done at 18-20 weeks and again at 24 weeks to exclude anomalies and reduce the prevalence. Once an anomaly is detected, various management options are to be discussed with the patients in consultation with neonatologist, pediatric surgeon and neurosurgeon when necessary. If parents are willing to continue the pregnancy with compatible congenital anamolies in baby then pregnancy may be continued. But if the congenital anamoly is imcompatible with life then pregnancy should be terminated. This study was conducted to study the incidence of various congenital anamolies in babies and their possible etiological factors in the population visiting to tertiary care hospital at Mumbai.
To study the effectiveness of self-instructional module on knowledge and selected outcome among women undergoing hysterectomy in a tertiary care hospital in South India
Authors: MC Elgi , Viswanath Lekha
Published: December 2016

Background: Hysterectomy is a one of the major operations of surgical treatment in Gynecology. The purpose of the study was to assess the effectiveness of Self -Instructional Module (SIM) on knowledge and selected outcome among women undergoing hysterectomy at a tertiary care hospital Kochi.Methods: An experimental approach with a pretest-posttest control group design was used for the study. Forty women posted for hysterectomy were selected by convenience sampling technique. First 20 samples were allotted to experimental group and second 20 to the control group to avoid data contamination. SIM was given to the women in the experimental group after the pretest and post-test of both group was done on the fourth post-operative day. The socio-demographic and clinical data were collected by a semi-structured interview. A semi structured questionnaire was used to assess the pretest and posttest knowledge. The selected outcomes were measured using a ten point visual analogue scale in the fourth postoperative day. Data analysis was done by using descriptive and inferential statistics.Results: The findings of the study revealed that the pre-test level of knowledge among experimental group was average for 13 (65%), and poor for seven (35%), whereas in post-test 12 (60%) subjects had good knowledge and eight (40%) had average knowledge. The mean post-test score of knowledge in the experimental group (19.95 + 3.268) is higher than the mean pre-test score of knowledge (10.80 + 3.847) and the post-test score of control group (9.5+4.2). These differences in the means were significant at P<0.001. The mean score of all the selected outcomes were less in the experimental group than the control group. The difference in mean score was significant at p <0.001 in variable like pain, head ache, abdominal discomfort, insomnia, fatigue, anxiety and at P <0.05 level in variables like pain on surgical site, pain on back, pain on abdomen.Conclusions: Based on the major findings of the study, it was concluded that the self-instructional module on hysterectomy was effective in improving the knowledge of subjects and they felt it more useful in identifying the possible post-operative problems like pain on abdomen, surgical site pain, head ache, abdominal discomfort, insomnia, fatigue and anxiety. And take necessary steps to prevent it. SIM was effective as they could read and clear their doubts at their own place. More over the subjects experienced minimal problems associated with the surgery and subjects verbalized that they felt more comfortable to ask their doubts during the time of post assessment.
Serum placental growth factor in late first trimester of pregnancy for prediction of preeclampsia in primigravida - a case control study
Authors: Agarwal Rachna , Chaudhary Shweta , Kar Rajarshi , Radhakrishnan Gita , Sharma Richa
Published: December 2016

Background: We studied the correlation of serum PLGF levels at 11-14 weeks in primigravida for prediction of future preeclampsia in a prospective nested case control study and estimated the critical levels of PLGF for possible use as screening test.Methods: Subjects with preeclampsia/gestational hypertension were taken as cases with an equal number of controls.Results: Out of 300 participants, final analysis was possible in 291 subjects. Thirty five were cases; two had early PE, 15 late PE and 18 had GH. PLGF level was lower in cases (20 pg/ml) compared to controls (79 pg/ml). PLGF was significantly lower in PE cases (15 pg/ml) compared to GH cases (34 pg/ml). PLGF had maximum area under the ROC curve (AUC) for PE with value of 0.867. Further, late PE had more AUC (0.853) as compared to GH (0.759). The cut off value for prediction of PE was found to be <30 pg/ml with 88.2% sensitivity and 71.4% specificity.Conclusions: PLGF levels were significantly lower in first trimester serum samples of subjects who later developed either preeclampsia or gestational hypertension. PLGF had better detection rate for PE and late PE as compared to GH.
Role of office hysteroscopy in gynecology: retrospective observational study at a tertiary care hospital
Authors: Tangri Manoj Kumar , Lele Prasad , Kapur Krishan , Kapur Anupam , Chhabra Neelam , Mitra Binay , Saraswat Monica
Published: December 2016

Background: Hysteroscopy being the gold standard for evaluation of uterine cavity can be utilized for varied gynaecological indications. Conventionally, hysteroscopy is performed under general anaesthesia but with technical advances over years, it is now possible to do the procedure in ambulatory office setting with same diagnostic accuracy. Aim of this study was to assess the role of hysteroscopy as a diagnostic tool in office setting, to evaluate various gynaecological conditions.Methods: Study performed retrospective analysis on 1920 patients who underwent office hysteroscopy between Jan 2011 to Apr 2015, at outpatient department of a tertiary care centre at Maharashtra, India. The procedure was done in office setting without any sedation or anaesthesia. Approach used was vaginoscopic free hand technique with minimal instrumentation and the findings were documented after evaluation of uterine cavity, ostea and endocervical canal.Results: Office hysteroscopy could be successfully performed in 1920 out of 1938 patients. Most common indications were primary infertility (38.0%), secondary infertility (11.2%), abnormal uterine bleeding (36.6%) and postmenopausal bleeding (8.3%). The procedure done in office setting was tolerated well. The procedure was also used for evaluation in patients with breast and endometrial carcinoma.Conclusions: Office hysteroscopy by vaginoscopic approach is a simple and convenient method for evaluation of uterine cavity and cervical canal. It has the potential to come out from formal operation theatre to more patient friendly outpatient department.
Ectopic pregnancy: a life threatening gynaecological emergency
Authors: Bhoosanoor Shruti R. , BK Sujani , Urvashi . , Sivasambu Gayatri Devi
Published: December 2016

Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality.Methods: This is a retrospective study of ectopic pregnancies managed at M. S. Ramaiah Medical College and Hospital, Bangalore, India over a period of 1 year from March 2015 to March 2016. The medical records of the patients managed for ectopic pregnancy during the period, under review were retrieved and data were collected from registers. There were 30 cases of ectopic pregnancies over one year.Results: Ectopic pregnancy constituted 3% of all gynecological admissions, and its incidence was 2.5%. The mean age of the patients was 26 ± 2 years, 21 of 30 (70%) had ruptured ectopic pregnancies, and the remaining nine (30%) were unruptured. The commonest (20 of 30, 66.6%) clinical presentation was abdominal pain, and the commonest (9 of 30, 30%) identified risk factor was a previous history of induced abortion.Conclusions: Ectopic pregnancy is a recognized cause of maternal morbidity and mortality and has remained a reproductive health challenge to manage.
Obesity in pregnancy: maternal and perinatal outcome
Authors: J. Prameela H. , S. Madhuri
Published: December 2016

Background: Obesity, the silent epidemic worldwide has reached a stage where approximately 2.3 billion adults will be overweight and more than 700 million adults will be obese by 2015, as projected by WHO. The objective of this study was to find out the incidence of the pregnancy complications due to maternal obesity and to assess the neonatal outcome.Methods: Retrospective study conducted in Cheluvamba Hospital, Mysore from September 2014 to September 2015. Subjects were categorized into 3 classes based on the BMI. Class 1:30-34.9 kg/m2, class 11:35-39.9 kg/m2, Class 111: >40 kg/m2. The maternal and perinatal outcome of the subjects evaluated in relation to body mass index.Results: A total of 56 women were included in the study, with 37 belonging to class I, 13 women class II, 6 women class III. Class III women were significantly more likely to have pre-eclampsia (83.3%, 69.2%, 27%) and post term pregnancy (50%, 38%, 16.2%) than class II and class I. The incidence of GDM (7.6%, 5.4%) and IUGR (7.6%, 2.7%) are more in class II compared to class I. Instrumental deliveries (10%, 28.5%) and LSCS (45.9%, 46.1%, 66.6%) rates increased as the BMI increased from class I to class III. Postpartum complications like PPH (5.4%, 7.6%, 33.3%) and wound gapping (7.6%, 16.6%) were on rise with increased BMI. Class III women were more likely to have macrosomic babies than class II and class III (33.3%, 15.3%, 18.9%).Conclusions: As the BMI increases pregnancy is more likely to get complicated. Interventions directed towards weight loss and prevention of excessive weight gain must begin in the pre-conception period. Obstetrical care providers must counsel their obese patients regarding the risks and complications conferred by obesity and the importance of weight loss.
A clinical study of fetomaternal outcome in pregnancy with polyhydramnios
Authors: Rajgire Aditi Anil , Borkar Kiran Rajendra , Gadge Amruta Madan
Published: December 2016

Background: Amniotic fluid not only provides protection to the fetus from traumatic forces, cord compression, and microbial pathogens, but also plays an integral role in the normal development of the fetal musculoskeletal, pulmonary, and gastrointestinal systems. Polyhydramnios, defined as an excessive amount of amniotic fluid, complicates approximately 0.4-3.3% of all pregnancies. Fetal conditions that are associated with polyhydramnios include major congenital anomalies and both the immunologic and non-immunologic forms of hydrops foetalis. Maternal medical conditions are also known to be associated with polyhydramnios and subsequently alter perinatal outcome. So by diagnosing these cases as early as possible, these maternal complications can be prevented and advise proper prenatal counseling in relevant cases.Methods: This study was conducted in obstetrics and gynaecology department at a tertiary care hospital, over the period of from September 2015 to September 2016. Prospective observational study.Results: Polyhydramnios is commoner in primigravida. Causative factor are mainly idiopathic after which the most important is fetal defects. Diabetes is also associated finding with polyhydramnios in 8.3% cases. The occurrence of fetal congenital abnormality was directly proportional to the gestational age of pregnancy. Incidence of congenital abnormality was found to be 1.25 %. Congenital heart disease and cleft lip and cleft palate (3%) were the commonest congenital abnormality associated with polyhydramnios followed by anencephaly and spina bifida (3.3%).Conclusions: In our study Idiopathic polyhydramnios was found to be the most common cause of polyhydramnios. A careful study must be done for detection of etiological factors in all cases of polyhydramnios, careful screening, prenatal and antenatal counseling will help to improve the foetal outcome as well as to prevent the maternal complication.