A Study of Outcome of Induction of Labor: Medical Versus Surgical.

The aim of this article is to study the outcome of induction of labor using medical and surgical methods. Two hundred and twelve patients with >28 weeks pregnancy requiring induction of labor were studied for a period of 1 year in the Government Medical College and Rajindra Hospital, Patiala, Punjab. In 25 patients (Group 1), artificial rupture of membranes was done to induce labor, 52 patients were induced with oxytocin, and 83 patients were induced with misoprostol (Group 2). In 52 patients (Group 3), medical and surgical methods were used in combination. The incidence of labor induction came out to be 13.86%. The induction delivery interval was shortest in Group 3 (85.42% delivered within 12 h) compared to 62.72% and 64.60% in Groups 1 and 2, respectively. The lower segment cesarean section rate was least in Group 3 (7.69% vs 12% and 16.30%, respectively). Postpartum hemorrhage and maternal pyrexia were observed more in Group 1 (20% and 8%) than in Group 2 (2.96% and 0.74%) and Group 3 (5.77% and 3.85%). All methods were equally effective in induction of labor in terms of induction delivery interval and mode of delivery.

Cesarean scar endometriosis--report of two cases.

Endometriosis is presence of functioning endometrial tissue outside the uterine cavity. Endometriosis can sometimes occur in a previous surgical scar. Scar endometriosis is rare and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. This condition is often confused with other surgical conditions. We are reporting two cases of scar endometriosis following cesarean section, which were misdiagnosed as stitch granuloma initially. Medical treatment was not helpful. Both the patients required wide surgical excision of the lesion. The pathogenesis, diagnosis and treatment of this condition are being discussed.

Premature coronary artery disease in North India: an angiography study of 1971 patients.

BACKGROUND: South Asians, specially Indians, show increased risk for atherosclerosis and have the highest mortality rates due to coronary artery disease amongst all ethnic groups studied so far. We aimed to find out the differences in clinical-biochemical and angiographic profile of young patients versus older patients with angiographically proven atherosclerotic coronary artery disease. METHODS AND RESULTS: Group I (n=828) consisted of patients with age above 55 years (mean age: 63.15 +/- 5.76 years), group II (n=924, mean age: 49.13 +/- 4.25 years) consisted of patients between age 41-55 years and group III (n=219) consisted of patients with age < or = 40 years (mean age: 37.37 +/- 2.92 years). Among the conventional risk factors, smoking was significantly more frequent in group III, while diabetes mellitus and systemic hypertension were more prevalent in groups II and I. Q wave myocardial infarction was more frequently present in groups II and III. Only about one-third of the entire patient population in the myocardial infarction group received thrombolytic therapy. Total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were significantly higher in younger patients (groups II and III), while high-density lipoprotein cholesterol was significantly low in whole cohort but more so in older patients. Single vessel involvement was more common in group III, while multi-vessel involvement, diffuse disease and fluoroscopic calcium were more common in groups I and II. CONCLUSIONS: Significant differences were observed in the clinical, biochemical and angiographic profile of young patients with coronary artery disease as compared to elderly patients. The younger cohort had more atherogenic lipid profile, higher prevalence of smoking and more frequent single vessel disease. We observed that total cholesterol/high-density lipoprotein cholesterol ratio was a better predictor of coronary artery disease as compared to individual lipid levels.

Contraceptive practices and awareness of emergency contraception in educated working women.

BACKGROUND: Regular contraceptive use and emergency contraception are tools to prevent pregnancies. AIMS: This study was designed to investigate knowledge and use of contraceptive methods and awareness of emergency contraception among women working in the hospital. SETTINGS: Educated workingwomen in a medical college hospital. DESIGN: Cross-sectional study. MATERIALS AND METHODS: The study was carried out among women belonging to three categories: staff nurses, ministerial staff and others. Married as well as unmarried employees in the reproductive age group were interviewed. A pretested mixed questionnaire containing open as well as closed ended questions was administered. The women were asked questions concerning knowledge and use of contraceptive methods and awareness of emergency or postcoital contraception. RESULTS: Of the 284 employees 258 women consented for the interview. All the subjects were literate and majority (97.2%) had an urban background. Of the 190 married women, 154 (81.1%) practiced contraception, among them (73.3%) were regular users. Eighty respondents underwent abortions of which 46 had spontaneous and 34 had induced abortions. Among the available contraceptive methods, condom was the most popular method in 89 (57.8%) followed by Copper T in 38 women (24.7%). The use of hormonal contraception was very low 2.6%. Print and electronic media were the common source of public awareness in 149 subjects (57.7%). Twenty-nine women (11.2%) were aware and only three women used emergency contraception. CONCLUSIONS: A high percentage of females in this literate workingwomen population used contraception; however, the awareness of emergency contraception was low.

Effects of passive smoking on outcome in pregnancy.

BACKGROUND: Adverse health effects of exposure to environmental tobacco smoke (ETS) among non-smokers have been studied occasionally in developing countries. AIMS: To study the effects of exposure to ETS on outcome in pregnancy SETTINGS AND DESIGN: A cross-sectional study at a secondary level teaching hospital Material and Methods: Consecutive 576 non-smoking women delivering a singleton live baby were studied. A pre-designed structured questionnaire was used to record the details of exposure to ETS at home. The maternal and foetal variables were compared among those who were exposed to ETS vis-à-vis not exposed. Unpaired Student t-test was used for the comparison of continuous variables and Fisher's Exact test was used for categorical variables. Multiple logistic regression analysis was performed after including all variables found to have significant differences on univariate analysis. RESULTS: Of the 576 women studied 141 (24%) were exposed to ETS. In the mothers exposed to ETS, there was a significantly higher incidence of pre-term birth (24.1% vs. 16.1%; P = 0.027) and small-for-gestation babies (31.9% vs.17.2%; p<0.001) as compared to unexposed mothers. The mean birth weight of the babies born to the mothers exposed to ETS was 138 g less than that of babies in the unexposed group (2632 -/+577 g vs. 2770 -/+562 g respectively, p = 0.014). The multiple logistic regression analyses showed that ETS exposure during pregnancy was significantly associated with a higher risk of small-for-gestation babies (OR 2.10; 95% CI: 1.27-3.48). CONCLUSION: Exposure to ETS during pregnancy is associated with higher risk of having a small-for-gestation baby.

Multifocal cardiac myxoma: report of a rare clinical entity.

Primary tumors of the heart and pericardium are rare, with myxomas representing the majority. Myxomas, if multiple, are mostly biatrial in location. We report a case with four tumors in three chambers of the heart, including both ventricles, which were identified by transthoracic echocardiography and successfully operated.

Double right coronary artery with anomalous left main and septal arteries originating from the right coronary sinus.

Anomalies of the coronary artery are often asymptomatic and are uncommon in the general population. We present a case of a double right coronary artery along with anomalous origin of the left main coronary artery and first septal perforator, all originating from the right coronary sinus.

Umbilical Cord Haematoma : A rare cause of fetal death

We report an unusual case of spontaneous umbilical cord haematoma resulting in intrauterine fetal death.

Role of thrombolytic therapy for stuck prosthetic valves: a serial echocardiographic study.

BACKGROUND: Thrombotic occlusion of a prosthetic valve continues to be an uncommon but serious complication. Intravenous thrombolytic therapy has been proposed as an alternative to surgical treatment, but only in critically ill patients. METHODS AND RESULTS: Forty-one consecutive patients presenting with 48 episodes of prosthetic valve thrombosis (44 mitral and 4 aortic) were treated with thrombolytic therapy under serial echocardiographic guidance. There were 14 male and 27 female patients. The anticoagulation status was inadequate in 89.6% of episodes. Atrial fibrillation was present in 47.9% of episodes. The prostheses involved in these episodes were tilting disc in 45, bileaflet in 2, and ball and cage type in 1. The Sorin prosthetic valve was the most commonly involved. The time interval between valve replacement and thrombosis ranged from 1 month to 108 months (mean 20.4+/-20.6 months). Patients were in New York Heart Association functional class III in 47.9% and in class II in 43.9% of episodes. Thrombolytic agents used were streptokinase and urokinase in 44 and 4 episodes, respectively. The mean duration of thrombolytic therapy was 27.9+/-15.0 hours and the overall success rate was 87.5%. Patients developed peripheral embolism with almost complete recovery in 5 episodes while significant bleeding that required termination of thrombolytic therapy was observed in 2 episodes. Redo valve replacement was done in 3 episodes because these patients did not improve on thrombolytic therapy (all 3 cases were of recurrent prosthetic valve thrombosis and were found to have pannus peroperatively). Three patients died during thrombolytic therapy because of persistent heart failure. Six patients experienced a total of 13 epidoses of recurrent prosthetic valve thrombosis including index episodes (rethrombosis in 5, re-rethrombosis in 1). They were treated with repeated thrombolysis with a success rate of 76.92%. The mean duration of thrombolytic therapy in these episodes was 36.1+/-14.0 hours. CONCLUSIONS: In patients with prosthetic valve thrombosis, intravenous thrombolysis guided by echocardiography is a safe and effective method that may expand the indications for nonsurgical treatment of prosthetic valve thrombosis. By using serial echocardiography, the duration of thrombolytic therapy can be tailored to the patient's requirement for normalization of valve hemodynamics.

Ross procedure in an infant.

The Ross procedure is gaining acceptance as the procedure of choice for aortic valve replacement in children. We present the case of a 4-month-old child (weight 3.2 kg) suffering from congenital valvar aortic stenosis who underwent a Ross procedure. We believe that this is the youngest patient to have undergone this procedure successfully in the Indian subcontinent.

"Concertina" effect during angioplasty of tortuous right and left coronary arteries and importance of using over-the-wire system: a case report.

A case wherein "Concertina" effect appeared during angioplasty of both right and left coronary arteries is described. Also, the advantages of using an over-the-wire system in such cases are stressed especially when extreme tortuosity and total occlusion are present together.

Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi, India.

All 64 dentists working in a teaching hospital of New Delhi participated in a survey. A pre-tested self-administered questionnaire was used to assess knowledge and practices of biomedical waste management and infection control among these dentists. The results show that not all dentists were aware of the risks they were exposed to and only half of them observed infection control practices. In addition to this, majority of them were not aware of proper hospital waste management. The dentists need to be educated on Biomedical Waste (Management & Handling) Rules, 1998 through extensive training programme.

Prevalence of dental disease amongst 5-6 and 12-13 year old school children of Puttur municipality, Karnataka State-India.

A survey was conducted among 5-6 and 12-13 years old school children of Puttur municipality, Karnataka State, India, to assess the prevalence of dental caries, malocclusion and dental calculus. A sample size of 200 subjects was taken for each age group and cluster-sampling method was used to select those schools which were to be included in the sample frame. Data collection was done using the Basic Oral Health Survey (WHO) form. The deciduous dentition alone was considered for 5-6 year old subjects while the permanent dentition alone was considered for those aged 12-13 years. A total of 427 subjects from 7 schools were studied. Results indicated that 81.25% of 5-6 year old subjects had dental caries (mean dmft = 4.86 +/- 4.16 S.D.) as compared to 59.6% of 12-13 year old (mean DMFT = 1.87 +/- 2.01 S.D.). The prevalence of malocclusion was 1.79% and 36.95% among those aged 5-6 year and 12-13 year, respectively. None of the 5-6 years old subjects had calculus on their teeth while 47.78% of 12-13 year old subjects exhibited the presence of dental calculus. Overall the prevalence of dental caries was found to be significantly higher among 5-6 year old subjects compared to 12-13 year old subjects. The prevalence of malocclusion and dental calculus was significantly higher among 12-13 year old subjects compared to 5-6 year old subjects.

Knowledge, attitude and practice of dental caries and periodontal disease prevention among primary school teachers in Udupi municipality.

Primary school teachers of Udupi municipal corporation were surveyed to determine their knowledge, attitude and practice toward dental caries and periodontal disease prevention. Fourteen schools were selected by cluster sampling and the teachers working in these schools were included in the sample. The questionnaires were completed by one hundred teachers. The results showed that school dental health services must compulsorily hold demonstrations or lectures on prevention of oral diseases during school feasts and parent teacher meetings, in order to involve the teachers and parents in oral health promotion of the child.

In-hospital results of radiofrequency ablation of supraventricular tachycardia.

Two hundred and one consecutive patients with symptomatic paroxysmal supraventricular tachycardia (PSVT) underwent a diagnostic electrophysiological test and catheter ablation with radiofrequency (RF) current. In 102 (51%) patients, the mechanism of PSVT was found to be atrioventricular nodal reentry (AVNRT, typical in 101, atypical in 1). Atrioventricular reentrant tachycardia (AVRT) involving accessory pathway was present in 94 (47%) and ectopic atrial tachycardia in 5 patients. A successful outcome was achieved in 100 of 102 patients (98%) with AVNRT and in 85 of 94 patients (90%) with AVRT. The anatomical approach was used for ablation in patients with AVNRT. The focus was ablated in 4 patients with ectopic atrial tachycardia whereas it was modified in the remaining one patient. Procedure-related complications occurred in 4 patients (2 AVNRT, 2 AVRT). One patient each developed haemothorax, pericardial effusion, mitral valve endocarditis and high-grade AV block requiring permanent pacemaker implantation. The electrode and ablation catheters were repeatedly used after ethylene oxide sterilisation to reduce the cost of the procedure. RF ablation is an effective, safe and curative modality of treatment for patients with symptomatic PSVT due to AVNRT and AVRT. The experience with this modality in patients with ectopic atrial tachycardia is limited.