Comparison of misoprostol in conjunction with oxytocin and oxytocin alone for the prevention of postpartum hemorrhage during active management of the third stage of labor

Background: When it occurs after a cesarean section or a normal vaginal delivery, postpartum hemorrhage (PPH) is a potentially fatal obstetric emergency. Aims and objectives: The aim of the study was to compare the efficacy and safety of oxytocin against oxytocin plus misoprostol in avoiding PPH during active management of the third stage of labor (AMTSL). Materials and Methods: Using simple randomization, 150 women from the labor ward of the Department of Obstetrics and Gynaecology at the Indore Medical College were recruited and randomly allocated to either test Group A or test Group B. Standard pharmacological treatment, including intramuscular injection of 10 IU of oxytocin and other components of AMTSL criteria, was administered to patients in Group A. In addition to the other components of the AMTSL criteria, Group B patients got the usual pharmacological treatment of 10 IU of oxytocin through the injectable route and 600 g of misoprostol through the oral route. Various characteristics of both groups were compared, including parity, gravida, delivery style, PPH etiology, blood transfusion, and surgical intervention. Results: Mode of delivery was vaginally seen in 85% and 92% and cesarean in 15% and 8%. Etiology was uterine atony in 54% and 64%, retained tissue in 26% and 12%, laceration in 11% and 18%, and coagulopathy in 9% and 6%. Blood transfusion was needed in 27% and 57% and surgical intervention in 82% and 68% in Groups A and B, respectively. A statistically significant difference was observed (P ? 0.05). Conclusion: The results of this study support the use of misoprostol in hospital settings as an adjunct to oxytocin since it reduces the incidence of PPH, eliminates the need for intrusive interventions, and ultimately reduces maternal mortality.

Tribal Odisha Eye Disease Study Report # 6. Opportunistic screening of vitamin A deficiency through School Sight Program in tribal Odisha (India)

Purpose: To explore the possibility of vitamin A deficiency (VAD) detection through School Sight Program (SSP) in a tribal district of Odisha, India. Methods: In a cross-sectional observational study, we tracked school children with ocular signs/symptoms of VAD to their villages. The ophthalmologist examined their under-5 siblings and other under-5 children in the village. Information pertaining to family belief and practices of food, water, sanitation, and the socioeconomic status of the family were collected. Results: The ocular features of VAD were detected in 207 of 4801 (4.3%) examined children. This included 70 children (mean age 11 ± 2.6 years) detected in the school, 22 siblings (mean age 3.2 ± 1.2 years) of these children detected at their home, and 115 children (mean age 3 ± 1.5 years) detected in their habitat. The average family size was 5.8 ± 2.02 and the birth order of the child with VAD was 2.3 ± 1.25. Most parents were farmer, living in asbestos-roofed house, depended on public underground water, and practiced open-air defecation. The distribution of VAD in 207 children was conjunctival xerosis (X1A = 207; 100% of VAD and 4.3% of all children), Bitot's spot (X1B = 169; 81.6% of VAD and 3.5% of all children), corneal scar (XS = 3; 1.4% of VAD and 0.06% of all children), and night blindness (XN = 35; 16.9% of VAD and 0.72% of all children). Conclusion: An opportunistic screening for detection of VAD through a SSP could be cost-effective and complement the existing strategy.

Pediatric idiopathic macular hole � A case report and review of literature

Macular hole in the pediatric age group is usually post-traumatic unlike, the adult counterpart. Herein we describe a case of idiopathic macular hole occurring in a 9-year-old male who presented to us with complaints of diminution of vision in OD (oculus dextrus) for 2 months. The child underwent 25-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. On follow-up his best-corrected visual acuity improved with type 1 closure of macular hole.

Frequent plateletpheresis donations & its effect on haematological parameters: An observational study

Background & objectives: The well-being of donors undergoing frequent plateletpheresis has been a matter of concern. The aim of this study was to analyze the effect of frequent plateletpheresis on the haematological parameters (HP) of repeat donors. Methods: The study was conducted during February 2016 to March 2017 on all the repeat plateletpheresis donors undergoing the 2nd plateletpheresis within a month of the first in a tertiary care centre. Donors repeating plateletpheresis 3rd and 4th times were also studied. The values of the HP observed on follow up after plateletpheresis done on three different separators were compared. Results: HPs of the 98 donors were similar at follow up except mean platelet volume (P <0.05). Of the 98 donors, 35 were followed up within a week and 63 were followed up within 8-30 days. No significant alteration was found in the HPs except a significant difference in the variation of platelet counts of the two groups (P=0.025). In 34 donors who presented 3rd time for plateletpheresis (mean gap between 1st and 3rd plateletpheresis=31 days), no significant differences in the HPs were found except the platelet distribution width (P <0.05). Minimal difference in the HP was found in the baseline and the follow up of 3rd plateletpheresis i.e., at 4th plateletpheresis donation. Plateletpheresis through all the three cell separators used had similar effects on the follow up HPs. Interpretation & conclusions: Repeated plateletpheresis can be done without any detrimental effects on the cell counts of the plateletpheresis donors. The three cell separators yielded similar post-donation follow up haematological parameters.

Morphological and toxigenic study of Aspergillus flavus from indoor air

Aim: In the current investigation thirty four A. flavus cultures were isolated from indoor air samples of some farmers' house in coastal region of Odisha. Production of aflatoxin B1 and the pattern of formation of sclerotia by the isolates were studied in vitro. Methodology: Morphological study and production of sclerotia were carried out by observing fungal colonies on culture media. Conidiophores were identified under Phase contrast microscope. Detection of aflatoxin B1 was done by Thin Layer Chromatography technique. Results: The isolates exhibited variation in their colony characteristics and pattern of sclerotia formation. Overall 44% A. flavus isolates produced stable aflatoxin B1 and 41% were producers of sclerotia. About 32% A. flavus isolates produced both sclerotia and aflatoxin B1. Most of the non toxigenic isolates failed to form thick mycelia mat on β-CD-PDA media. Aflatoxin and sclerotia producing isolates were found more in coastal districts than inter-coastal regions. No significant variation in the pattern of sclerotia production was observed among isolates in less aerobic (sealed plates) and aerobic (unsealed plates) condition, however isolates had slightly more preference towards less aerobic environment for sclerotia production. The size of sclerotia was found to be inversely related to number of sclerotia. Interpretation: The presence of diverse A. flavus strains in farmers' indoor air, having the ability to produce either aflatoxin or sclerotia or both, may lead to serious health implications. This issue need to be addressed and a suitable way for proper management of indoor environment of farmers' need to be designed.

Tribal Odisha Eye Disease Study (TOES) report # 5: Comparison of prevalence and causes of visual impairment among tribal children in native and urban schools of Odisha (India)

Purpose: To compare the prevalence and causes of blindness and visual impairment in tribal school students in the rural day-care and in a residential urban school. Methods: This was a cross-sectional comparative study. The 4-Stage screening in the native habitat of the tribal students performed in the school and hospital involved the trained school teachers, optometrists, comprehensive ophthalmologist, and pediatric ophthalmologist. The 2-Stage screening in the urban school involved only the optometrists and pediatric ophthalmologist. In both instances, vision (presenting and best corrected) was recorded and refraction performed. In addition, fundus photo was taken in all students in the urban school using a non-mydriatic fundus camera. Results: The comparison of blindness, visual impairment, and ocular anomalies were between tribal children (153,107 children; mean age 9.3 ± 2.7 years) examined in the native school and tribal children (10,038 children; mean age 8.8 + 1.64 years) in an urban residential school. Mild and moderate visual impairment was higher in the urban settings (P < 0.05), but severe visual impairment and blindness were similar in both settings. Refractive error, amblyopia, and posterior segment anomaly were detected more often in an urban settings (P < 0.05). Vitamin A deficiency (Bitot's spot) was detected only in children studying in the native schools (P < 0.05). Conclusion: The location, urban or rural, did not influence the visual impairment profile of tribal children. The food habit and environment seem to impact nutritional status.

Population Structure Of Kaempferia Galanga L. From Eastern India

Objective: India has been a producer of a large number of aromatic medicinal plants which serves as a valuable genetic resource for future quality improvement to meet the ever-growing demand of human essential products. Thus, an urgent need arises for germplasm conservation of these high yielding varieties to help the pharmaceutical and other industries. For this understanding, the population structure is essential in order to explore their genetic identification by fingerprinting and molecular characterization. Methods: In the present study DNA was isolated using modified Cetyl Trimethyl Ammonium Bromide (CTAB) method and Polymerase Chain Reaction (PCR) was performed according to standardized method along with its data analysis. This study was undertaken to characterize the highly medicinal Kaempferia galanga collected from 4 different populations of Odisha using the molecular markers as Random Amplified Polymorphic DNA and Inter-Simple Sequence Repeats for the first time. Results: A dendrogram constructed through Sequential Agglomerative Hierarchical and Nested (SAHN) clustering and Unweighted Pair Group Method with Arithmetic mean (UPGMA) analysis showed an average similarity of 0.993 ranging between 0.967 to 1.000. Jaccard’s similarity coefficient of combined markers segregated the genotypes into two main clusters, 1 with six samples and the others at 0.98 similarity coefficient. Conclusion: Hence, the molecular analysis could be further used for the identification of important novel gene present in Kaempferia galanga which can be utilized for future crop improvement as well as pharmacological activities.

Tribal Odisha Eye Disease Study # 4: Accuracy and utility of photorefraction for refractive error correction in tribal Odisha (India) school screening

Purpose: To compare the photorefraction system (Welch Allyn Spot™) performance with subjective refraction in school sight program in one Odisha (India) tribal district. Methods: In a cross-sectional study school students, aged 5–15 years, referred after the preliminary screening by trained school teachers received photoscreening and subjective correction. The photoscreener was compared to subjective refraction in the range of +2D to ?7.5D. Statistical analysis included Friedman nonparametric test, Wilcoxon signed-rank test, linear regression, and Bland–Altman plotting. Results: The photoscreener was used in 5990 children. This analysis included 443 children (187 males, 256 females, and the mean age was 12.43 ± 2.5 years) who received both photorefraction and subjective correction, and vision improved to 6/6 in either eye. The median spherical equivalent (SE) with spot photorefraction was 0.00 D (minimum ?5.0D; maximum +1.6 D), and with subjective correction was 0.00D (minimum ?6.00 D; maximum +1.5 D). The difference in the SE between the two methods was statistically significant (P < 0.001) using Friedman nonparametric test; it was not significant for J 45 and J 180 (P = 0.39 and P = 0.17, respectively). There was a good correlation in linear regression analysis (R2 = 0.84) and Bland–Altman showed a good agreement between photorefraction and subjective correction in the tested range. Conclusion: Photorefraction may be recommended for autorefraction in school screening with reasonable accuracy if verified with a satisfactory subjective correction. The added advantages include its speed, need of less expensive eye care personnel, ability to refract both eyes together, and examination possibility in the native surrounding.

Intern’s Perception Regarding Learning Educational Environment At Rural Health Training Centre.

Abstracts: Background and Objectives: Internship is ideal period to train the medical graduates and apply their knowledge for benefit of society. It is mandatory for interns to undergo three months training in rural area where they have to learn some basic skills as given my Medical council of India. It is important to assess the learning environment in rural health centres for effective learning. Methodology: Interns posted in year 2014-2015 were given the structured questionnaire to rate learning environment in terms of physical, intellectual and emotional plane. Results: Interns were not satisfied with physical environment. The emotional support and supervision was appreciated by interns but it did not sensitized them to work in rural area. They also had good hand on experience but the orientation programme was poorly conducted. Conclusion: The learning environment was very poor specially in terms of infrastructure.

In Vitro α-Amylase Inhibition and Antioxidant potential of Chloroform Fraction of Hydroalcoholic Extract Obtained from Hyptis Suaveolens.

The plant Hyptis is an effective medicinal herb and a well known medicinal plant in herbal world. The present study was aimed to investigate the α-amylase inhibition and antioxidant activities of chloroform fraction of H. suaveolens. Chloroform fraction of H. suaveolens was screened for α-amylase inhibition activity by 3, 5- dinitrosalicylic acid (DNSA) method respectively. and antioxidant activity was evaluated by 1,1-diphenyl-2- picryl-hydrazile (DPPH) free radical scavenging, Super oxide radical Scavenging, nitric oxide (NO) radical scavenging, and 2.2’-azinobis-3-ethylbenzothiazole-6-sulfonic acid (ABTS) radical scavenging assays. The chloroform fraction of H. suaveolens showed effective α-amylase inhibition activity (IC50 57.34μg/ml). Chloroform fraction demonstrated significant antioxidant activity in all the in vitro antioxidant models. Moreover, the chloroform fraction was found to be extremely effective in scavenging DPPH (IC50 57.51 μg/ml) while compared to super oxide (IC50 61.36 μg/ml), NO (IC5076.3 μg/ml) and ABTS radical (IC50 93.16 μg/ml) scavenging activity. In conclusion, from the results of present study it is established that antioxidant and alphaamylase inhibitory activity of chloroform fraction of H. suaveolens may contribute in its earlier observed antidiabetic potential.

Prevalence and distribution of dental anomalies in 500 Indian school children.

Objective: Developmental disturbances of teeth contribute to dental problems encountered in general practice. These are a group of disorders where prevention is not possible, with the exception of environmental enamel hypoplasia. Surveys done on various populations have found prevalence of dental anomalies to be 5.46%. Knowledge of common dental anomalies when available can be a useful tool for forensic dentistry. Since such epidemiological data is not available for the Jodhpur population in Rajasthan, this study was conducted to determine the prevalence of developmental dental anomalies in 500 school going children. Methodology & Result: A total of 500 school children (290 male & 210 female) of age ranging between 6 - 15 years were examined clinically for developmental anomalies of teeth. Prevalence of Peg lateral, supernumerary teeth & Talon’s cusp was 0.4%, 0.6% & 0.2% respectively while 18.8% showed fluorosis induced enamel hypoplasia.

Synthesis, anti-oxidant and anti-bacterial properties of diethyl (4-flouro-3-nitro phenylamino) (substituted phenyl) methyl phosphonates.

A new class of α–aminophosphoantes 4a-j have been synthesized by condensation of imines 3a-j with dialkyl phosphite under catalyst free conditions in dry toluene at reflux conditions via pudovik reaction in high yields. All the title compounds were confirmed by physico-spectral analysis. All the title compounds were screened for antioxidant properties by radical scavenging methods such as 1,1-diphenyl-2-picryl hydrazyl (DPPH), hydroxyl radical scavenging method and lipid peroxidation. They exhibited potent in vitro antioxidant activity dose dependently. Their bioassay showed them to possess significant antibacterial activity.

Oral manifestations associated with human immunodeficiency virus infection in 200 Indian patients..

Objective: To determine the pattern and prevalence of oral lesions in HIV infected 200 costal Andhra Pradesh patients. Patients and methods: the study population comprised 200 consecutive HIV seropositive patients presented to regional ART center at Andhra Pradesh, India. The oral lesions were diagnosed based on clinical appearance and were entered in to the database for analysis. Results: 30-39 yrs age group was most commonly affected and 87% of the patients had acquired infection via heterosexual contact. Oral lesions were seen in 66% of the patients. Gingivitis (36.7% males & 33.9% females) was the most common lesion followed by candidiasis (21% males & 26.4% females), periodontitis (6.8% males & 7.5% females), pigmentation (36.7% males & 33.9% females), ulcers (2.7% males & 0% females) and leukoplakia (1.3% males & 0% females). Conclusion: The pattern of oral lesions associated with HIV infection was not markedly different form those reported in the literature, the prevalence of each type of lesion differ slightly.

Accessory Head of Flexor Pollicis Longus Muscle and its Significance in Anterior Interosseous Nerve Syndrome: Case Report and Review / Cabeza Accesoria del Músculo Flexor Largo del Pulgar y su Significancia en el Síndrome del Nervio Interóseo Anterior: Reporte de Caso y Revisión

During the laboratory dissection of the fore arm, an accessory head of flexor pollicis longus muscle has been observed unilaterally in the right upper limb of a male cadaver. It took its origin from the under surface of flexor digitorum superficialis muscle just distal to the origin of this muscle from medial epicondyle. On further dissection we have noticed that, the accessory belly was running downwards to the medial aspect of the tendon of flexor pollicis longus muscle for its insertion. Its possible role in anterior interosseous syndrome is discussed in detail with a brief review.

Durante una disección en el laboratorio se encontró en el antebrazo derecho de un cadáver de sexo masculino una cabeza accesoria del músculo flexor largo del pulgar. Ésta se originaba de la superficie profunda del músculo flexor superficial de los dedos, inmediatamente distal al origen de este músculo en el epicónddilo medial. El vientre accesorio se dirigía hacia abajo medial al tendón del músculo flexor largo del pulgar hasta su inserción. Se discute detalladamente su posible rol en el síndrome interóseo anterior.

Uveitis following anti-snake venom therapy

Snakebite is a common medical emergency in the tropics, causing multisystemic involvement. Ophthalmic manifestations after snakebite have included ptosis and ophthalmoplegia. Uveitis as an immunological complication following therapy with anti-snake venom (ASV) serum has been rarely reported in literature. We reported two patients who developed uveitis and acute renal failure following snakebite treatment with ASV serum. Both patients recovered uneventfully with appropriate therapy.(AU)

Anaesthesia-related maternal mortality.

Complications of anaesthesia leading to death in young pregnant women might be prevented if more experienced personnel could be entrusted with the job. The contribution of anaesthesia to maternal mortality in the United Kingdom is 1.7 per million pregnancies with almost similar incidence from United States. The commonest single factor responsible for anaesthesia-related death is difficult or failed intubation. A pregnant woman with a potentially difficult airway should receive aspiration prophylaxis (mechanical or pharmacological) as soon as operative delivery is anticipated. Anaesthetists should make a plan that comes into effect as soon as failure to view the larynx or to intubate the trachea becomes evident. Unsuspected difficult airway can be managed if the skill of the anaesthetists is of high standard. Pulmonary aspiration is one cause of death in obstetric anaesthesia. Regurgitation and vomiting prevention can minimise pulmonary aspiration. In regional anaesthesia, local anaesthetics toxicity is another cause of concern. This should be tackled with some safe local anaesthetics. Preventing a high spinal or epidural block involves ways to detect inadvertent injection of local anaesthetic into the cerebrospinal fluid. Postoperative care after anaesthesia in obstetric cases is very important.

Non-Hodgkin's lymphoma of the brainstem with atrial septal mass.

Simultaneous occurrence of cardiac and central nervous system tumors have been rarely reported. A 23 years male presented to us with right cerebello-pontine (CP) angle symptoms and signs. Cranial imaging showed a mass lesion in the right pons infiltrating into the right and middle cerebellar peduncles. There was also a cardiac-atrial septal mass. The brainstem lesion was found to be a non-Hodgkin's lymphoma where as the cardiac lesion was not accessible. Central nervous system lymphomas are reported rarely and the prognosis is poor. The chances of the cardiac lesion in this patient also being a lymphoma are high, as it was a infiltrative cardiac mass, infiltrating the atrial septum.