Effects of Nuchal Cord on Maternal & Foetal Outcome.

Umbilical cord is the connecting link between the foetus and the placenta through which foetal blood flows to and from the placenta. It extends from the foetal umbilicus to the foetal surface of the placenta. Excessively long cords are linked with cord entanglement. Nuchal cord occurs when umbilical cord gets wrapped around foetal neck 3600. Single loop around neck is reported in 20-34% cases. Cord compression is one of the postulated factors for birth asphyxia. It has become a cause of concern for rising primary C Section rate. We wanted to determine the actual threat nuchal cord poses to the mother as well as to the foetus and identify various factors which should be considered for safe delivery in these patients. METHODSThis study was conducted in the Department of Health and Medical Education, Sub-District Hospital, Akhnoor, J & K. We included 100 cases in the test group in which nuchal cord was identified during delivery, delivered either vaginally or by C section. These cases were compared with 100 controls delivered without nuchal cord. We had to observe 462 patients for finding out 100 cases. Incidence of nuchal cord in our study is 21.64%. Patients profile was noted on proforma and various variables were compared such as age, parity, gestational age, mode of delivery, duration of labour, length of cord, number of loops and prior USG detection of cord were noted in every case. Foetal outcome as observed in terms of gender, birth weight and Apgar score was recorded. RESULTSMost of the patients belonged to the age group 21-25 years with a mean age of 25.56 years. Incidence of nuchal cord is 21.64%. As the number of turns increased, incidence fell progressively, but as the number of loops increased length of cord also increased. Only 36 loops were pre detected on USG. Maximum number of patients had normal vaginal delivery in both groups, but the rate of C section was higher in test group and difference was statistically significant (0.028). When variables of newborn were compared, no significant difference was seen in sex and weight of the baby. Meconium stained liquor was more in nuchal cord group and although low Apgar score was more in nuchal cord group, the difference was not statistically significant. CONCLUSIONSNuchal cord is a common feature observed during delivery and is seen almost in 20-25% cases. Ante natal diagnosis of nuchal cord is possible with USG and colour doppler imaging. Elective C section for nuchal cord is a wrong practice. Patients should be assessed holistically including age, parity, gestational age, Bishop score and signs of foetal distress. Vigilant ante partum and intra partum monitoring is required in every case. Nuchal cord is potential cause of perinatal distress and rarely significant long-term neurodevelopmental consequences are seen in the foetus.

A Comparative Study of Different Modalities of Treatment of Anal Fissure: Glyceryl Trinitrate (Local Application) V/S Conventional Methods in the Management of Anal Fissure

Background: The majority of anal canal fissures heal spontaneously or withconservative treatment such as the use of anaesthetic cream to heal fissures, and high fibre diets or laxatives to reduce constipation. The aim of this study to comparative evaluation of the conventional treatment v/s 0.2% Glyceryltrinitrate ointment (local application). Methods: The present study included both out door and indoor patients who attended M.G. Hospital attached to Dr. S.N. Medical college, Jodhpur. Detailed history were taken and through physical examination was done. In this study 75 cases were divided in to three groups: Group I: Treated with Anal dilation under general anaesthesia, Group II : Treated with local anaesthetics, Diet, Hot Sitz bath and Group III: Topical application of 0.2% Glyceryltrinitrate. The comparison was done with respect to pre- treatment symptoms, post treatment symtoms and long term complications. Results: The maximum cases were seen in 30-50 years of age group and minimum was seen in below 20 years & above 60 years of age. The incidence of male patients were slightly more than females. Anorectal pain and constipation was most frequent symptoms. Streak of blood in stool was next common symptoms.By the end of 6th week with anal dilation, 80% respondent to this treatment. With local anaesthetic agent, 60% responded and 66% responded with 0.2% glyceryltrinitrate treatment modality. Conclusion: We concluded that GTN & local anaesthetics are both non surgical treatment modalities & thus avoids the risk & complications of surgery and anaesthesia

Comparative efficacy of two daily use mouthrinses: randomized clinical trial using an experimental gingivitis model

Two antimicrobial agents, a fixed combination of essential oils (EOs) and 0.07 percent cetylpyridinium chloride (CPC) are found in commercially available mouthrinses, Listerine® Antiseptic and Crest® Pro HealthTM, respectively. Both mouthrinses have been shown to control dental plaque and gingivitis in short and longer term studies. The aim of this study was to determine the comparative effectiveness of these two mouthrinses using a 2-week experimental gingivitis model. Qualified subjects were randomly assigned to one of three mouthrinse groups: a fixed combination of EOs, 0.07 percent CPC, or negative control (C) rinse. Following baseline clinical assessments and a dental prophylaxis, subjects began a two-week period in which they rinsed twice daily with their assigned rinse and abstained from any mechanical oral hygiene procedures or other oral care products. Subjects were reassessed at the end of the two-week period. One hundred and forty-seven subjects were randomized and 142 completed this study. After two weeks use, the EOs rinse was superior (p < 0.011) to the CPC rinse in inhibiting the development of gingivitis, plaque, and bleeding, with 9.4 percent and 6.6 percent reductions compared to CPC for gingivitis and plaque, respectively. Both rinses were superior to the negative control rinse (p < 0.001). This study demonstrates that the essential oil-containing mouthrinse has superior antiplaque/antigingivitis effectiveness compared to the 0.07 percent CPC-containing mouthrinse without mechanical oral hygiene influence.

Comparative antiplaque and antigingivitis efficacy of three antiseptic mouthrinses: a two week randomized clinical trial

The objective of this randomized, examiner blind, parallel group, controlled clinical trial was to compare the antiplaque and antigingivitis efficacy of an essential oil-containing mouthrinse (EO) to two mouthrinses containing 0.05 percent Cetylpyridinium Chloride (CPC), one with alcohol and one alcohol-free, using a two-week experimental gingivitis validated-model with a 5 percent hydroalcohol rinse serving as the negative control. One hundred and fifty-nine subjects, 56 males and 103 females; ranging in age from 18 to 58 years in good general health were assigned to one of the four treatment groups: EO (n = 40), 0.05 percent CPC with alcohol (CPCa, n = 39), 0.05 percent CPC alcohol-free (CPCna, n = 40), and 5 percent hydroalcohol negative control (n = 40). The Mean Turesky Modification of the Quigley-Hein Plaque Index (PI) and the Mean Modified Gingival Index (MGI) were the primary efficacy endpoints and were evaluated at baseline and at two weeks. Following baseline examinations, subjects received a complete dental prophylaxis and began supervised rinsing with their assigned mouthrinse twice daily for two weeks, as their sole oral hygiene measure; 151 subjects completed the trial. Two weeks after baseline the EO adjusted mean PI and MGI scores were significantly lower than those of both CPC rinses and negative control (p < 0.001). In conclusion, the EO mouthrinse demonstrated significantly greater antiplaque and antigingivitis efficacy than both CPC-containing mouthrinses and the negative control.