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The delivery of high-quality antenatal care is a perennial global concern for improving maternal and neonatal outcomes. Antenatal care is currently provided mainly on a one-to-one basis, but growing evidence has emerged to support the effectiveness of group antenatal care. Providing care in a small group gives expectant mothers the opportunity to have discussions with their peers about certain issues and concerns that are unique to them and to form a support system that will improve the quality and utilization of antenatal care services. The aim of this article is to promote group antenatal care as a means to increase utilization of healthcare.
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Objective@#To determine the frequency of premalignant and malignant lesions in cervical polyps in order to examine whether cervical polyps need to be removed routinely and also to appraise its association with cervical smear cytology and endometrial pathologies. @*Methods@#We retrospectively re-examined the hospital records of 299 cases over a period of 5 years. All patients were segregated into perimenopausal and postmenopausal groups according to their menopausal status. The groups were compared in terms of histological results of cervical polyp biopsy, endometrial pathologies, and cervical smear cytology. Pearson’s χ2 test and Fisher’s exact test were used for statistical analysis, and a P-value of <0.05 was accepted as statistically significant. @*Results@#In the histopathological reports of cervical polyps, premalignant lesions were found in 2% of cases, and only 0.3% of malignant lesion was observed in menopausal women. Subsequently, no malignancy was noted in cervical smear cytology for both groups. Premalignant and malignant lesions in endometrial histopathology findings were 1.33% and 0.66%, respectively. There was a statistically significant association between the menopausal status of the patient and cervical smear cytology and endometrial pathology, but the histological findings were not statistically significant in relation to the symptomatic status of the patients. @*Conclusion@#As per the results, we strongly suggest the removal of all cervical polyps with subsequent histological review. The evaluation of cervical smear cytology prior to polypectomy can provide information about its malignancy potential. We believe that along with cervical polypectomy, endometrial sampling should be recommended, especially for postmenopausal women.
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Objective@#To determine the frequency of premalignant and malignant lesions in cervical polyps in order to examine whether cervical polyps need to be removed routinely and also to appraise its association with cervical smear cytology and endometrial pathologies. @*Methods@#We retrospectively re-examined the hospital records of 299 cases over a period of 5 years. All patients were segregated into perimenopausal and postmenopausal groups according to their menopausal status. The groups were compared in terms of histological results of cervical polyp biopsy, endometrial pathologies, and cervical smear cytology. Pearson’s χ2 test and Fisher’s exact test were used for statistical analysis, and a P-value of <0.05 was accepted as statistically significant. @*Results@#In the histopathological reports of cervical polyps, premalignant lesions were found in 2% of cases, and only 0.3% of malignant lesion was observed in menopausal women. Subsequently, no malignancy was noted in cervical smear cytology for both groups. Premalignant and malignant lesions in endometrial histopathology findings were 1.33% and 0.66%, respectively. There was a statistically significant association between the menopausal status of the patient and cervical smear cytology and endometrial pathology, but the histological findings were not statistically significant in relation to the symptomatic status of the patients. @*Conclusion@#As per the results, we strongly suggest the removal of all cervical polyps with subsequent histological review. The evaluation of cervical smear cytology prior to polypectomy can provide information about its malignancy potential. We believe that along with cervical polypectomy, endometrial sampling should be recommended, especially for postmenopausal women.
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Background: The study was planned to detect an association of HIV infection and sub-clinical atherosclerosis in the form of increased carotid intima-media thickness (IMT) Methods: 50 HIVpatients and 50 matched healthy controls were studied. The HIVpatients were further sub classified into those on ARTor not on ART. All of them underwent carotid doppler to identify subclinical atherosclerosis in the form of presence of either pathological intima-media thickness (IMT) or atherosclerotic plaque. Mean IMTwas calculated in various groups and the statistical analysis done. Results: The mean IMT in the test group (HIV), ART, Non ART, control groups was 0.746 mm (SD 0.181), 0.817 mm (SD 0.167), 0.58 mm (SD 0.068) ,0.572 mm (SD 0.101) respectively. There is significant difference in the mean IMT of HIV Vs control groups, ART Vs Non ART sub groups. There is no significant difference in mean IMTof Non ARTVs Control group. Conclusion: HIV patients have higher prevalence of subclinical atherosclerosis and significantly higher mean IMT as compared to Healthy controls. The prevalence of subclinical atherosclerosis is even higher in ARTtreated HIVpatients.
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Meckel Gruber syndrome (MGS) is a rare lethal autosomal recessive disorder. It is characterized by triad of features having occipital meningoencephalocele, polycystic kidneys and post-axial polydactyly. We report an antenatal patient detected with occipital meningoencephalocele in foetus on early anomaly scan at 15 weeks of gestation followed by foetal MRI which revealed the typical triad features strongly suggestive of MGS. The patient opted for medical termination of pregnancy and the abortus was autopsied, with the permission of the patient, for detailed evaluation of anomalies which were consistent with MGS. This case highlights the importance of a detailed foetal evaluation antenatally to detect anomalies which are incompatible with life and proper diagnosis as it has bearing on patient’s future obstetric outcome.
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Background: Dexmedetomidine is a highly selective α2adrenergic agonist with an affinity of 8 times greater thanclonidine and hence allows the use of higher doses with lessα1 effect. Hence; the present study was undertaken forassessing the efficacy of Dexmedetomidine under combinedspinal epidural anesthesia.Materials and Methods: A total of 100 patients were enrolledin the present study. All the patients received isobariclevobupivacaine intrathecally and dexmedetomidine in normalsaline epidurally. Complete demographic details and clinicalhistory of all the patients was obtained. Preoperativehematological and biochemical profile of all the patients wasobtained. All the anesthetic procedures were carried out underthe hands of skilled and experienced anesthetists. Incidenceof intra-operative and postoperative adverse events wasrecorded separately. All the results were recorded in Microsoftexcel sheet and were analyzed by SPSS software. Chi- squaretest was used for assessment of level of significance.Results: Mean time taken for sensory regression to S1 was356.12 minutes. Mean time taken for rescue analgesia was362.55 minutes. In the present study, hypotension was foundto be present in 4 patients, bradycardia was found to bepresent in 3 patients and nausea and vomiting was found to bepresent in 5 patients.Conclusion: Dexmedetomidine is an effective agent undercombined spinal epidural anesthesia in patients undergoingelective surgical procedures.
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Background: Diabetes mellitus is a metabolic disorder with common denominator of hyperglycemia, arising from a variety of pathogenic mechanisms. The aim of the study was to evaluate the drug utilization pattern of anti-diabetic drugs in diabetic patients and observe adverse drug events (ADEs) associated with anti-diabetic therapy in a prospective way.Methods: A prospective study was carried out in diabetic patients visiting the Departments of General Medicine in a tertiary care teaching hospital. Demographic data, drug utilization pattern and ADEs due to Anti-diabetic drugs were summarized.Results: In the present study, 153 (54%) of the 282 diabetic patients were males and 129 (46%) were females. Majority of patients were in the age group of 51-60 years (31.20%) and most of the patients (31.56%) had a diabetic history of 11-15 years. Metformin was the most commonly prescribed drug (64.89%). Majority of the patients (36.87%) were on multidrug therapy. Co-morbid condition was found in 232 patients (82.26%) where hypertension (22.69%) being the most common co-morbid condition. 32 ADRs were observed with Nausea being the most common ADR reported.Conclusions: The present study helps to find out current prescribing pattern of oral diabetic medications with different co-morbidities with respect to diagnosis, cost of treatment and it also highlight the need for comprehensive management of diabetic patients, including life style changes, dietary control, hypoglycemic agents, cardiovascular prevention, treatment of complications and co-morbidity. Therefore, through the existing prescribing patterns, attempts can be made to improve the quality and efficiency of drug therapy.
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Background: The purpose of this study was to evaluate role of Posteromedial Plating in condylar fractures of Tibia, especially patients with posterior tibial shear fractures. Materials and methods: This prospective study included 12 patients with mean age 40 years (range 30 to 50 years) who sustained high velocity posterior tibial plateau fracture-subluxations with/ without associated Bicondylar fractures (Moore I & II Types, Schatzker’s Groups – IV, V and VI). Surgical management included stabilisation plating through a posteromedial/ posterior approach and additional postero lateral or antero lateral approach as needed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Oxford Knee Score and Lyshom Score. Results: The mean OKS score was 40 (range 36 to 44) at the end of one year. The main clinical measures were early post-operative non weight bearing ROM, post-operative complication and functional outcome. The time to full weight bearing, the rate of post-operative complications and functional outcome was significantly better as evident by over 94 % showing good to excellent OKS and Lyshom scores. Conclusion: A posterior/ postero medial approach for posterior tibial plateau shear fractures (which are otherwise irreducible by conventional approaches) and buttress/ antiglide plate are usually needed to reduce the fractures anatomically, achieving absolute stability and mobilize early NWB, ROM of the knee joint to optimize the functional outcomes and minimize the complications, without the need for revision surgery.
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Background: Problematic Internet use (PIU) has become a global social issue and can be regarded as an individual’s inability to control Internet usage which results in negative impact in daily life. Individuals who spent more time on surfing the Internet are likely to sleep late night and this further increases the level of tiredness. The present study was commenced to determine relationship between Internet uses and sleep patterns among medical college students. Methods: The present study was commenced among 149 undergraduate students studying at Sikkim Manipal Medical College. The severity of addiction to Internet was measured using Young’s Internet addiction test. Epworth Sleepiness Scale (ESS) which consists of subjective sleepiness scale comprising of eight items was used to measure daytime sleepiness. Significance of association of Internet addiction and sleep disturbance was done by Fisher’s 2 sample t- test and a value of less than 0.05 was considered as significant value. Results: The proportions of boys who were pathological Internet addicts (moderate to severe) were 9.5%. For girls, the corresponding proportions were 7.5%. The prevalence of Excessive daytime sleepiness (EDS) was 20.1%. This study estimated the prevalence of pathological Internet using was 8.05%. Present study found an association between problematic Internet use and excessive daytime sleepiness. The association was statistically significant (p= 0.016). Conclusion: The present study shows that Internet overuse was strongly associated with EDS and other sleep problems in adolescents. Because the number of Internet addicts will continue to grow, clinicians should consider examining Internet addiction in adolescent cases of EDS.
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Background: The paring of tympanic membrane is usually done by doing myringoplasty with temporal is fascia graft. Methods: A newer technique of butterfly cartilage underlay grafting has been used in 50 patients with small to moderate size safe perforation. Results: The result of the study would be analysed for hearing improvement and graft uptake. Hearing gain of 0-5 dB was observed in 4 patients, 6-10 dB in 3 patients, 11-15 dB in 14 patients, 16-20 dB in 22 patients and 21-25 dB in 7 patients. Conclusion: Butterfly cartilage myringoplasty is a very good technique for closure of small to moderate size central perforations.
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Background: Objectives of current study were (i) To find out the pattern of cervical smear in females having risk factors. (ii) To observe the relationship between abnormal cervical smear with high risk factors. Methods: A cross-sectional descriptive study was carried out in the department of obstetrics and gynecology, Guwahati medical college & hospital from July 2009 to August 2010 with the help of Pathology department. 200 women attending gynecological OPD with associated risk factors were selected at random. Detailed history, demographic information, contraceptive history and coital history were taken. Smear was taken from endocervix with the help of Ayer’s spatula or cytobrush. Results: Out of 200 cases, in 110 (55%) the smear was reported negative for malignancy. 73(36.5%) had an inflammatory smear, 11 (5.5%) had CIN, 1(0.5%) had malignancy and 5(2.5%) the smear was inadequate for cytological examination. In the study mean age of Cervical Intraepithelial Neoplasia (CIN) was 42.64 ± 6.34 years. Low socio-economic status, high parity & the use of oral contraceptive pills were major risk factors. Conclusion: Cervical smear should be routinely used as a reliable diagnostic aid for early detection carcinoma cervix especially in high risk cases. The need of the hour is to create awareness and easy accessibility to proper screening.