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Abstract Background: Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS. Objectives: To determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender. Material and methods: This was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson's chi-square test followed by univariate and multivariate analysis. Results: The prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN. Study limitations: The small sample size and single-center data are the limitations of the present study. Conclusion: AN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.
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Purpose: To evaluate the determinants affecting the quality of life in monocular glaucoma patients using the Indian vision function questionnaire. Methods: In this prospective cross?sectional study, total of 196 patients were divided into two groups: cases and controls. Indian Vision Function Questionnaire (IND?VFQ) was administered and analyzed. One hundred twenty?nine (58.6%) patients who had lost their vision in one eye due to glaucoma were included as cases and 67 (30.4%) patients who had lost their vision due to other causes were taken as controls. Results: Median composite score of subscales was 54.62 (29.7–74.7) in group 1 and 45.38 (23.7–76.7) in group 2. The psychosocial impact scale was the most affected scale, the median scores were 33.02 (0 to 60.0) and 19.07 (0 to 53.0) in groups 1 and 2, respectively. Among all dimensions of IND?VFQ, the highest score was for color vision 100.0 (0–100.0) and 100.0 (0–100.0), and the lowest median score was found in mental health and dependency in both the groups. Multiple linear regression analysis demonstrated that visual acuity was associated with a low score (P < 0.001). Female gender was significantly associated with the overall score in the univariate model (P = 0.006). Conclusion: Monocular glaucoma patients have a poor general and vision?related quality of life. Depression associated with monocularity and the perception of dependency and being a burden on their family members greatly impacted the mental health of the participants
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Background- Patients with psychiatric illnesses require support from family, peers, and care-givers to overcome the difficulties and manage their health. Caregivers are hence at a risk themselves to develop anxiety and depression, or related symptoms, due to the emotionally challenging and draining experience. Aim – To evaluate and assess anxiety and depression of caregivers to the patients admitted to the Psychiatry department of a tertiary care centre located in Rajasthan. Materials and Methods- Our assessment relied on data collection that followed cross-sectional observational analysis. We performed the study post approval of the ethical clearance by the respective committee at the university and an informed decision was consented to in written by 50 caregivers taking part in the study. These included caregivers to 25 patients with disorders due to substance use (Group A) and 25 patients with other psychiatric diagnosis (Group B). We also filled in socio-demographic details and performed scoring as administered by the HAM-D and HAM-A scales. ResultsGroup A comprised of more females (64%) than males in contrast to Group B participants. HAM-D score analysis showed that depression was present in Group A (52%) as compared to Group B participants (40%). HAM-A analysis of score showed anxiety in 34% of caregivers and was higher among Group A participants and among female caregivers. Conclusions- The results of the study can be used to plan for early interventions, to reduce stress among caregivers of patients with psychiatric illness
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Purpose: To evaluate the effectiveness of repeat deep anterior lamellar keratoplasty (DALK) in patients of previous failed DALK. Methods: A retrospective analysis of records of seven patients who had undergone repeat DALK following the failure of the primary DALK was done. The indications for repeat surgery, time elapsed since the first surgery, and pre? & postoperative best?corrected visual acuity (BCVA) were noted for all the patients. Results: The follow?up period ranged between one? to four?year post repeat DALK. The indication of primary DALK was keratoconus with vernal keratoconjunctivitis (VKC) (n = 3), corneal amyloidosis (n = 2), Salzman nodular keratopathy (n = 1), and healed keratitis (n = 1). The need for repeat surgery arose when the BSCVA dropped to less than 20/200. The time interval elapsed since the first surgery ranged from two months to four years. Postoperatively, the BSCVA improved from 20/120 to 20/30 at the end of one?year post repeat DALK in all except one patient. All regrafts were clear at the most recent examination, performed after a mean period of 18 months after the secondary graft. No complication was encountered during the resurgery. The dissection of the host bed was easier in the second surgery owing to weaker adhesions. Conclusion: The prognosis for repeat DALK for failed DALK is excellent, and the outcomes of secondary grafts were comparable to those of primary DALK grafts. Re DALK offers the advantage of an easier dissection and lower chances of graft rejection compared to penetrating keratoplasty.
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Learning about human eye movements broadens our comprehension of the visuomotor system and aids in the effective management of strabismus. One’s clinical practice is improved by a dynamic simulation of human eye movements using physical models of the extraocular muscles (EOMs). We use our eyeball model to teach the basics of strabismus to undergraduate students and ophthalmology residents. In Listing’s plane, extraocular movements of each muscle and the angle demonstration are being used to familiarize students with their knowledge. The degree of the residents’ understanding of strabismus is significantly influenced by the eyeball strabismus simulator. This model is an inexpensive, Do It Yourself (DIY) model that is simple to build.
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For beginner surgeons, it is difficult to recognize the posterior capsule during cataract surgery. In the case of brown cataracts with a thin posterior capsule and in cataracts with asteroid hyalosis, it is difficult to identify the capsule before intraocular lens (IOL) implantation even for expert surgeons. Here we illustrate five important signs, which can be practiced in routine cases to make sure the posterior capsule is intact, before IOL implantation.
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The rise in cases of antibiotic resistance can be mainly attributed to the overuse and misuse of antibiotics. To address this issue, the WHO launched Access, Watch, and Reserve (AWaRe) classification of antibiotics in 2017 as a surveillance tool. Many countries have adopted it to monitor and optimize their antibiotic usage. However, implementation of it is yet not seen at a very appreciable level. Through this survey, we tried to explore the prescribing pattern of antibiotics based on the WHO AWaRe classification in selected secondary and tertiary care health facilities of Tamil Nadu. In-patient case sheets were audited in selected departments across 18 health facilities in six districts. Proportionately higher use of the watch group of antibiotics was found in all the districts. A lower access–watch ratio suggests the need for judicious implementation of such tools to safeguard this life-saving good and ensuring its sustainability.
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Salt stress is a major abiotic stress that limits rice productivity worldwide including India. As modern rice varieties are salt sensitive, infusing salt tolerance through breeding is a viable farmer-friendly approach. Breeding salt tolerant rice varieties has been slow due to complexity of the trait and high Genotype x Environment interaction in the salt affected field. Selection practiced in such a situation using conventional selection method, in the presence of competition, would be misleading. On the otherhand, selection is effective in the absence of competition in honeycomb selection and counteracts the disturbing effects of competition on effectiveness of selection. The present study was conducted to test the efficiency of honeycomb selection design in early generation of a rice cross to study genetics of yield and practice selection. All the characters studied in both the design showed non normal distribution except for panicle length in CSD. All the characters studied in both the design had lower coefficient of variation, high mean and high standard deviation in the HSD compared to CSD. Large number of genes with duplicate epistasis governs days to flowering whereas panicle length and single plant yield are governed by few number of genes with complimentary epistasis. Twenty nine F2 plants each in CSD and HSD were selected based on mean and plant index (SPY), respectively. Plants selected in HSD recorded higher percentage of increase over base population compared to CSD and found HSD to be superior to CSD because of enhanced phenotypic expression in the former by eliminating confounding effects of negative correlation between yielding and competitive ability.
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A patient with multiple myeloma usually presents with pathologic fractures, renal failure, anemia, and recurrent bacterial infections. Instead, this patient presented with acute ischemic stroke, dyspnea, and abdominal pain. The following case could be of immense clinical significance due to the unorthodox presenting features of the patient. A 55-year-old Indian male, a known hypertensive with a history of COVID-19, presented with features of acute ischemic stroke, breathlessness, and moderate abdominal pain. After treating the stroke, USG abdomen and pelvis were done which showed aortic, splenic, and right renal arterial thrombosis. Following suspicious laboratory results, a bone marrow biopsy was performed which revealed 12–15% plasmacytosis. Serum electrophoresis showed a band of M-protein suggestive of multiple myeloma. Multiple myeloma is rare and the aforementioned symptoms are even rarer which could pose a diagnostic challenge to clinicians. Clinicians should consider the possibility of multiple myeloma in similar cases in the future.
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Objective: Herbal shampoo is gaining immense popularity among all consumer groups due to rising awareness about the side effects of chemical formulations. It was also observed that not many marketed shampoos incorporated excellent hair nurturing properties of curry leaves. The aim of the study was to formulate and evaluate herbal shampoo using Murraya koenigii, Phyllanthus emblica, Acacia concinna Linn., Trigonella foenum-graecum, Sapindus mukorossi and perform a comparative analysis with marketed formulation. Method: Three formulations were prepared using extracts of Murraya koenigii, Phyllanthus emblica, Acacia concinna, Trigonella foenum-graecum and Sapindus mukorossi in definite proportions. Decyl Glucoside and Sodium Lauryl Sulphate were added as surfactant in adequate amount. The formulated shampoo was evaluated for organoleptic properties (colour and odour), pH, surface tension, viscosity, dirt dispersion, cleansing action, foaming ability and stability studies. Results: The formulated shampoos were brown in colour with good acceptable fragrance. All the formulations showed good cleansing and detergency power with stable foam. F1 showed comparatively better foaming ability. All the formulations had neutral pH and low surface tension (21-25 dyn/cm). The solid content was found to be in the range of 23-27 % and viscosity 4885 cP- 4903 cP. The results of the prepared formulations were compared with a marketed formulation and were found that F1 formulation was on par with marketed formulation. Conclusion: The prepared shampoo had good characteristics. It was further inferred that it is possible to develop safer and equally effective shampoo using ingredients of plant origin.
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Purpose: To compare the costs associated with medications and travel of patients with smear?proven bacterial keratitis and fungal keratitis in a tertiary care center in India. Methods: Retrospective analysis of case records of a cohort of patients who presented between April 2017 and March 2018 to a tertiary care center in India, with infectious keratitis who were smear?positive for bacteria or fungi, and whose costs of treatment and travel were supported by a philanthropic program. Results: In total, 672 case records of 177 smear?positive bacterial keratitis (BK) and 495 smear?positive fungal keratitis (FK) were included in the study. Further, 62% of BK and 75% of FK received more than one antimicrobial drug (P < 0.001). The mean total medication cost (INR) was significantly more in FK (959.1 � 675.2) compared to BK (674.9 � 463.7) (P < 0.0001). The mean medication cost (INR) per visit was also more for FK (201.1 � 109.4) compared to BK (155.2 � 84.1) (P < 0.0001). The mean total medication cost was significantly more for FK for both patients who healed with medical treatment (611.6 � 395.6 for BK, 801.5 � 599.9 for FK, P = 0.0005) and for patients who required TPK (953.7 � 653.1 for BK, 1374.6 � 701.5 for FK, P = 0.0023) compared to their respective counterparts in BK. Conclusion: Patients with fungal keratitis incurred significantly more on medications compared to patients with bacterial keratitis irrespective of whether they had healed with successful medical treatment or required therapeutic keratoplasty. Prolonged duration of treatment and the high costs of antifungal medications account for the significant economic burden of fungal keratitis.
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Objective@#To study the effect of time on shift on the opioid prescribing practices of emergency physicians among patients without chronic opioid use. @*Methods@#We analyzed pain-related visits for five painful conditions from 2010 to 2017 at a single academic hospital in Boston. Visits were categorized according to national guidelines as conditions for which opioids are “sometimes indicated” (fracture and renal colic) or “usually not indicated” (headache, low back pain, and fibromyalgia). Using conditional logistic regression with fixed effects for clinicians, we estimated the probability of opioid prescribing for pain-related visits as a function of shift hour at discharge, time of day, and patient-level confounders (age, sex, and pain score). @*Results@#Among 16,115 visits for which opioids were sometimes indicated, opioid prescribing increased over the course of a shift (28% in the first hour compared with 40% in the last hour; adjusted odds ratio, 1.06; 95% confidence interval, 1.02–1.10; adjusted P-trend <0.01). However, among visits for which opioids are usually not indicated, relative to the first hour, opioid prescriptions progressively fell (40% in the first hour compared with 23% in the last hour; adjusted odds ratio, 0.93; 95% confidence interval, 0.91–0.96; adjusted P-trend <0.01). @*Conclusion@#As shift hour progressed, emergency physicians became more likely to prescribe opioids for conditions that are sometimes indicated, and less likely to prescribe opioids for nonindicated conditions. Our study suggests that clinical decision making in the emergency department can be substantially influenced by external factors such as clinician shift hour.
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Abstract Introduction Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. Objective The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. Methods We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS-CoV-2, COVID-19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. Results The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. Conclusion In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.
Resumo Introdução A maioria dos procedimentos rinológicos, principalmente os procedimentos endoscópicos nasossinusais, é suscetível à produção de aerossóis. A síndrome respiratória aguda grave coronavírus-2 (SARS-CoV-2) é transmitida através de gotículas respiratórias, mas o grau de sua disseminação através de aerossóis por via aérea não é claro. Objetivos Orientar os rinologistas sobre como modificar sua prática convencional durante a pandemia de Covid-19, priorizar a necessidade de procedimentos, identificar procedimentos geradores de aerossol e usar equipamento de proteção individual de precisão para vários procedimentos endonasais. Método Fizemos uma revisão de artigos indexados na Medline por meio das bases de dados PubMed, ENT Cochrane, DOAJ e Web of Science, com as palavras-chave nasal endoscopy, SARS-CoV-2, Covid-19, aerosol-generating medical procedures e rhinology para formular diretrizes para a segurança dos profissionais de saúde. Resultados A revisão incluiu evidências de 28 artigos de otorrinolaringologia, cirurgia, doenças infecciosas, cirurgia de cabeça e pescoço e biologia do câncer. Fornecemos recomendações e informações relevantes para rinologistas durante a pandemia de Covid-19, com base nos estudos e dados disponíveis, para garantir atendimento de alta qualidade ao paciente e níveis necessários de prevenção da infecção durante procedimentos de rinologia. Conclusões Em rinologia, recomenda-se cuidado acentuado durante o tamponamento nasal, eletrocauterização e uso de dispositivos rotativos de alta velocidade em tecidos potencialmente infectados, pois esses procedimentos são consideráveis produtores de aerossóis. A escolha do equipamento de proteção individual é baseada no risco de exposição e nos possíveis modos de geração de aerossol.
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Pandemics , COVID-19/diagnosis , COVID-19/therapy , Aerosols , Personal Protective Equipment , SARS-CoV-2ABSTRACT
Hyperinflammation and cytokine storm has been noted as a poor prognostic factor in patients with severe pneumonia related to coronavirus disease 2019 (COVID-19). In COVID-19, pathogenic myeloid cell overactivation is found to be a vital mediator of damage to tissues, hypercoagulability, and the cytokine storm. These cytokines unselectively infiltrate various tissues, such as the lungs and heart, and nervous system. This cytokine storm can hence cause multi-organ dysfunction and life-threatening complications. Mavrilimumab is a monoclonal antibody (mAb) that may be helpful in some cases with COVID-19. During an inflammation, Granulocyte-macrophage colony-stimulating factor (GM-CSF) release is crucial to driving both innate and adaptive immune responses. The GM-CSF immune response is triggered when an antigen attaches to the host cell and induces the signaling pathway. Mavrilimumab antagonizes the action of GM-CSF and decreases the hyperinflammation associated with pneumonia in COVID-19, therefore strengthening the rationale that mavrilimumab when added to the standard protocol of treatment could improve the clinical outcomes in COVID-19 patients, specifically those patients with pneumonia. With this review paper, we aim to demonstrate the inhibitory effect of mavrilimumab on cytokine storms in patients with COVID-19 by reviewing published clinical trials and emphasize the importance of extensive future trials.
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Hyperinflammation and cytokine storm has been noted as a poor prognostic factor in patients with severe pneumonia related to coronavirus disease 2019 (COVID-19). In COVID-19, pathogenic myeloid cell overactivation is found to be a vital mediator of damage to tissues, hypercoagulability, and the cytokine storm. These cytokines unselectively infiltrate various tissues, such as the lungs and heart, and nervous system. This cytokine storm can hence cause multi-organ dysfunction and life-threatening complications. Mavrilimumab is a monoclonal antibody (mAb) that may be helpful in some cases with COVID-19. During an inflammation, Granulocyte-macrophage colony-stimulating factor (GM-CSF) release is crucial to driving both innate and adaptive immune responses. The GM-CSF immune response is triggered when an antigen attaches to the host cell and induces the signaling pathway. Mavrilimumab antagonizes the action of GM-CSF and decreases the hyperinflammation associated with pneumonia in COVID-19, therefore strengthening the rationale that mavrilimumab when added to the standard protocol of treatment could improve the clinical outcomes in COVID-19 patients, specifically those patients with pneumonia. With this review paper, we aim to demonstrate the inhibitory effect of mavrilimumab on cytokine storms in patients with COVID-19 by reviewing published clinical trials and emphasize the importance of extensive future trials.
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Self-medication practice involves consumption of medicines by one’s own initiative or on the consultation of others without the guidance of a doctor. Self-medication and use of over-the-counter drugs, are worldwide health concerns. This study evaluated the prevalence, behavioural patterns, knowledge of self-medication, and the attitudes toward this practice among medical and nonmedical university students. METHODSThis is a cross-sectional descriptive study conducted among students with medical and non-medical backgrounds. A semi-structured questionnaire was constructed after reviewing literature to capture data regarding socio-demographic background, practice and knowledge of self-medication. RESULTSOut of a total of 98 students, 79.6 % of students practiced self-medication (medical - 77.5 % and non-medical - 85.2 %). The main reason for self-medication was convenience (50.8 %) and the choice of self-medication was based on their own experience (30.4 %) and previous doctors’ prescription (20.2 %). Community pharmacies (64.0 %) were the most common source of acquiring the drugs in both groups. It was observed that 53.1 % students think self-medication is an acceptable practice. 28.6% were confident of treating infectious diseases through self-medication. CONCLUSIONSThe present study shows a higher prevalence of self-medication among students. It also indicates a critical need for the implementation of quality education programs in order to prevent the self-medication among students.
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Background: Various endometrial pathologies contribute to a large proportion of cases of abnormal uterine bleeding (AUB) during the reproductive years as well as after menopause.Methods: This is a retrospective observational study conducted in department of Obstetrics and Gynaecology at SMGS Hospital, Jammu. 200 patients between 20-70 years age presenting to gynaecology OPD with abnormal uterine bleeding between January 2019 to December 2019 were studied. All patients were subjected to thorough clinical evaluation followed by hysteroscopy. Data collected from medical records, analysed and various intrauterine causes of AUB were studied. Hysteroscopy directed biopsies were taken in the same sitting and sent for histopathology and culture. Results: Mean age of patients in our study was 45 years with majority of patients in 40-50-year age group (69%). Most common symptom reported was menorrhagia (48%) followed by menometrorrhagia (18%) and polymenorrhea (10%). Hysteroscopy detected intrauterine abnormality in 59% cases. Most common being hyperplastic endometrium in 52 patients (26%) followed by polyp (20%). 14 (7%) had sub mucous fibroid, 8 (4%) had atrophic endometrium and 2 (1%) had intrauterine adhesions.Conclusion: Hysteroscopy provides a simple & easy method for visualization of the cervical canal & uterine cavity for the evaluation of AUB. Hysteroscopic pattern recognition is a useful concept to triage women who require sampling for histopathological diagnosis.
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Background: The advents of new technologies are providing a variety of effective learning environment. However, many adult students still prefer traditional, academic settings and do not want to take online or hybrid classes.Methods: Present study included cross sectional descriptive survey design which was carried out on 394 undergraduate nursing students. Convenient sampling technique was chosen for selection of samples. A five-point Likert self-structured scale was used for data collection. Descriptive and inferential statistics were used to analyze the data in SPSS.Results: Study findings showed that there were 209 (53%) female participants. Significant difference (p=0.05) was found among participants’ gender and year of study, area of residence, father education, family income and whether they had ever attended online classes. Lack of control over the group was top perceived barrier with highest score (261 marks). Majority of participants (61%) perceived barriers encountered during online classes. Mann Whitney U test showed the significant differences of participants’ perceived barriers among male and female participants by their age, year of study, fathers’ education and family income (p<0.05).Conclusions: As more students are growing up familiar with internet-based learning, many students were still opposing to go with online classes. Barriers explored in the study can limit the acceptance of online classes among undergraduate nursing students. Higher authorities must find the ways for making online education user friendly.
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Immature teratomas are usually derived from a malignant transformation of mature teratoma. The pure immature teratoma accounts for less than 1% of all ovarian cancers. It is the second most common germ cell malignancy and accounts for 10-20% of all ovarian malignancies seen in women younger than 20 years of age. Extragonadal origin are extremely rare and the most common extragonadal site of these teratomas is the omentum. We hereby describe a case report of a 29-year-old lady who presented with abdominal pain and her imaging with an ultrasound revealed a mass with features suggestive of a subserosal fibroid. She underwent a laproscopic myomectomy. A histopathologic diagnosis of Immature teratoma was made following her primary surgery. She subsequently underwent a staging laparotomy which was followed by chemotherapy. Immature teratomas predominantly occur in young patients, and preservation of fertility is an important factor in its management. Treatment should be initiated as soon as possible after surgery, preferably within 7-10 days, in those patients who require chemotherapy.
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Background: The objective of this present study was to compare the efficacy of oral mifepristone and balloon catheter for cervical ripening and induction of labour in women with previous caesarean section.Methods: This prospective study was conducted on 130 pregnant women with previous 1 caesarean section and term singleton pregnancy admitted for induction of labour. Sixty-five patients were induced with oral mifepristone (Group 1) and in another 65 transcervical balloon catheter (Group 2) was inserted for induction of labour. Both groups were than compared with respect to change in bishop score, induction to active phase interval, induction to delivery interval, dose of oxytocin in milliunits, mode of delivery, maternal complication and fetal outcomes.Results: Change in bishop score after induction was more in mifepristone group than balloon catheter group (p=0.002). Favorable bishop score was more in Group 1 (83.07%) than Group 2 (66%), p=0.05. There was significant difference in mode of delivery between two groups, 61.53% in Group 1, and 32.3% in Group 2 delivered vaginally (p<0.001).Conclusions: Present study showed that mifepristone is an alternative to balloon catheter for induction of labour in women with previous one caesarean section with poor bishop score.