Efficacy of internal iliac artery ligation for control of post-partum haemorrhage

Background: Pelvic hemorrhage is associated with a great degree of morbidity and mortality and has to be controlled immediately. Ligation of the internal iliac arteries is a method to achieve the goal. We conducted this study to assess the outcome, effectiveness and complications of internal iliac artery ligation (IIAL) in controlling postpartum haemorrhage.Methods: This study was a retrospective study conducted in a rural tertiary referral centre from April 2015 to March 2018. IIAL was performed in women with PPH either at caesarean section or at laparotomy performed at a variable time after vaginal or caesarean delivery.Results: Over the study period of 3 years, 29 cases of IIAL were performed. The most common indication for IIAL was atonic PPH. Uterine salvagability was 62% in this study.Conclusions: All obstetric surgeons should be fully aware of the indications, timing and technical aspects of IIAL. Bilateral internal iliac artery ligation remains a safe, fast, effective and life saving salvage procedure which should be encouraged and used routinely by obstetricians when faced with cases of severe obstetric hemorrhage, especially in young women of low parity.

Evaluation of 303 Cases of Thrombocytopenia

Thrombocytopenia is a common clinical problem with many etiological causes. Although transient bone marrow suppression and marrow infiltration by malignancies are important causes, certain non-malignant conditions such as nutritional causes and infections are equally important as the treatment is simple and cure is possible. Depending on the aetiology, the clinical presentation may vary. Knowing the exact aetiology is important for specific treatment and prognostication. A total of 303 cases of thrombocytopenia were studied out of which males were 44% and females were 56%. The patients’ age ranged from 5 months to 84 yrs. The commonest presenting symptom was fever with bleeding manifestations and jaundice. 14% of cases are of Grade 1, 20% of the cases of Grade 2, 5% of cases of Grade 3 and 31% of cases had counts less than 25000/cu.mm i.e. of Grade 4. 50% of cases in Grade 4 had a decreased number of megakaryocytes in the bone marrow. The most common cause of thrombocytopenia in our study was megaloblastic anaemia (48.6%), ITP (20%), post-viral (10.9%) followed by leukaemia, aplastic anaemia and others. Thrombocytopenia has a spectrum of causes which can be diagnosed by detailed history and peripheral smear examination supported by bone marrow examination. Megaloblastic anaemia was the commonest cause of thrombocytopenia followed by immune thrombocytopenia. Unlike in the western India megaloblastic anemia is highly prevalent and is the leading correctable cause of thrombocytopenia. Most of the patients with Grade 4 thrombocytopenia had a decreased number of megakaryocytes in the bone marrow suggesting a production defect.

Comparative evaluation of bovine derived hydroxyapatite and synthetic hydroxyapatite graft in bone regeneration of human maxillary cystic defects: A clinico-radiological study.

Introduction: Bone grafts are frequently used in the treatment of bone defects. Bone harvesting can cause postoperative complications and sometimes does not provide a sufficient quantity of bone. Therefore, synthetic biomaterials have been investigated as an alternative to autogenous bone grafts. Aim and Objectives: The aim of this study was to evaluate and compare bovine derived hydroxyapatite (BHA) and synthetic hydroxyapatite (SHA) graft material as bone graft substitute in maxillary cystic bony defects. Patients were analyzed by computerized densitometric study and digital radiography. Materials and Methods: In this study, 12 patients in each group were included randomly after clinical and radiological evaluation. The integration of hydroxyapatite was assessed with mean bone density, surgical site margin, and radiological bone formation characteristics, of the successful graft cases using computer densitometry and radio-visiograph. Statistical analysis was carried out using Mann-Whitney U-test, Wilcoxon matched pairs test and paired t-test. Results: By the end of 24 th week, the grafted defects radiologically and statistically showed similar volumes of bone formation. However, the significant changes observed in the formation of bone and merging of material and surgical site margin at 1 st week to 1 st month. The results were significant and correlating with all the parameters showing the necessity of the grafting for early bone formation. However, the bone formation pattern is different in both BHA and SHA group at 3 rd month interval with significant P value. Conclusion: Both BHA and SHA graft materials are biocompatible for filling bone defects, showing less resorption and enhanced bone formation with similar efficacy. Our study showed maximum bone healing within 12 weeks of grafting of defects. The BHA is economical; however, price difference between the two is very nominal.

A radiographic correlation between systemic disorders and pulp stones.

Aim: The purpose of this study was to determine the correlation between pulp stones and cardiovascular disorders, Type II diabetes mellitus, autoimmune disorders and dental wear defects. This study also aims to evaluate the frequency of pulp stone in population of Dakshina Kannada district (Karnataka, India) and to determine association of pulp stones in different sexes, tooth type, dental arches and sides. Patients and Methods: A total of 1432 teeth of five groups were examined, comprising of patients with C.V.S. disorders; Type II diabetes mellitus, autoimmune disorders, dental wear defects and control group. Teeth were examined under 2Χ magnification on radio visiograph (RVG) and conventional intra-oral periapical radiograph. The presence or absence of pulp stones were recorded. Statistical Analysis Used: Chi-square analysis was used to compare the frequency of occurrence of pulp stones between sexes, tooth type, dental arches and sides. Results: Pulp stones were found in 134 (9.35%) of 1432 teeth detected. Significantly, higher numbers of pulp stones were recorded in patients with cardiovascular disorder (15.86%) than other groups. The occurrence of pulp stones were significantly higher in molars (18.29%) than premolars (6.6%) and in maxillary arch (12.36%) than in mandibular arch (5.95%). No significant difference was found between sexes and sides. Conclusion: Positive correlation was found between systemic disorder and pulp stones. Cardiovascular patients had maximum number of pulp stones followed by dental-wear defects and least number of pulp stones were evident in control group.

Protective effect of Zuroor-e-Qula' against gastric mucosal damage: an ultrastructural study

The gastro-protective activity of the PHF [Zuroor-e-qula'] and its extracts was assessed in three different models of experimentally induced gastric ulcers in rats. In case of both preventive and curative treatments at 400 mg/kg dose the PHF and the aqueous and alcoholic extracts reduced gastric lesions significantly which were induced by HCl/ethanol. Significant changes in gastric parameters such as pH, volume of gastric juice and gastric acidity after oral administration of the samples under ligated pylorus [Shay] conditions. Also, in this paper, we report the ultrastructural observations of gastric mucosa. The ultrastructural changes were observed by Scanning Electron Microscopy [SEM]. The preventive as well as curative treatments in rats revealed a protective action against HCl/ethanol induced gastric mucosal damage. Probably, polyphenols, flavonoids, essential and fixed oils of the formulation were involved