Comparative maternal outcomes of oral nifedipine and intravenous labetalol for severe hypertension during pregnancy: an open label randomized controlled trial

Background: Hypertensive diseases are commonly seen during pregnancy and remain one of the leading causes of maternal morbidity and mortality. Mostly commonly preferred drugs by health care providers for treatment of severe hypertension during pregnancy are labetalol and hydralazine. However, they require proper storage, intravenous access, and adequately trained staff for usage. Oral nifedipine in contrast is easier to use and widely available.  Objective of this study was to report the efficacy and safety of oral nifedipine as compared to intravenous labetalol for treatment of severe hypertension during pregnancy.Methods: It was an open label randomized controlled trial in which 100 women with severe hypertension during pregnancy were enrolled. They were randomized to receive either incremental doses of intravenous labetalol every 20 minutes (total 300 mg) or 10 mg oral nifedipine every 20 minutes (up to 50 mg) to lower the blood pressure to safer levels.Results: Women receiving oral nifedipine took significantly less time to achieve target blood pressure [(37.6±23.3) minutes (SD) as compared to those receiving intravenous labetalol (52.0 minutes±27.95 (SD)]. Women receiving nifedipine for treatment also required significantly lesser doses to control the blood pressure [mean dose 1.8±1.1 (SD) versus 2.6±1.2 (SD) p=0.006]. There were two failures in labetalol group and one failure in nifedipine group. No serious adverse events were reported in either group.Conclusions: Oral nifedipine is equally efficacious to I.V. labetalol for treatment of severe hypertension during pregnancy and is easier to use in low resource settings.

Comparative study of sublingual versus vaginal misoprostol for induction of labor

Background: Induction of labor done, when the benefits to either mother or fetus outweighs those of continuing pregnancy. Pharmacological methods used for induction includes oxytocin, prostaglandin (E1, E2) and mifepristone. However the ideal dose, route and frequency of administration of misoprostol are still under investigation. Hence we plan to do a comparative study between sublingual and vaginal misoprostol for inducing labor.Methods: A prospective randomized interventional study was conducted on seventy pregnant women who met the inclusion criteria. They were explained about the study on admission and were randomized into two groups: Group I (sublingual) and Group II (vaginal). Bishop score at start of induction, number of pelvic examinations, doses required, mode of delivery, induction to delivery interval, duration of different stages of labor and perinatal outcome of the women were recorded followed by statistical analysis.Results: Patients in both the groups were comparable with respect to demographic data, period of gestation, gravidity and parity. There was no significant difference with regard to number of doses, p/v examinations and number of patients required augmentation. Mean induction to delivery interval, average duration of first, second and third stage was almost comparable. Out of 35 women in each group, 29 women (82.8%) in both groups had normal vaginal delivery, one woman in Group I and three women in Group II had instrumental delivery. Emergency LSCS was done in 5 women (14.28%) in Group I and 3 women (8.57%) in Group II.Conclusions: Sublingual misoprostol seems as effective as vaginal misoprostol for induction of labor at term. Sublingual route represents a valid alternative to vaginal route with the advantage of convenience of administration. In view of limited sample size, we cannot reach definitive conclusions in regard to the preference of sublingual or vaginal route of misoprostol for induction of labor.

Assessment of Satisfaction and Quality of Life using Patient-reported Outcome Measures after Perineal Urethrostomy: A Prospective Analysis

Introduction: Conventionally, success after urethroplasty has focused on objective measures such as urinary flow rates, postvoid residual (PVR) volumes, and appearance of the urethra on cystoscopy and/or retrograde urethrogram. The objective ofthis study was to prospectively analyze the pre- and post-operative patient-reported outcome measures describing patients’satisfaction and quality of life (QoL) after perineal urethrostomy and to compare these results with objective data.Materials and Methods: We prospectively collected data from 30 consecutive patients who underwent perineal urethrostomyfor complex anterior urethral stricture from April 2017 to January 2019. Patient demographics, International Prostate SymptomScore (IPSS), QoL score, urethral stricture surgery patient-reported outcome measure (USS-PROM), maximum flow rate, andPVR urine were collected before, and 2 and 8 months after surgery. General estimation equation was used to compare theresults and linear regression analysis to correlate both questionnaires with objective data.Results: Mean age was 63 years. All patients had undergone previous urethral surgery in the form of multiple DVIU, urethraldilatation, substitution, or augmentation urethroplasties. The mean USS-PROM score improved from 13.4 preoperatively to 3.10after surgery (P < 0.001) and 85.6% of patients were satisfied or very satisfied with surgical results. Strong negative correlationwas found, respectively, between flow rate and USS-PROM and with IPSS.Conclusion: Significant improvements in urinary symptoms and in QoL are expected after perineal urethrostomy for complexanterior urethral stricture and they are correlated with objective measures.

Preoperative Dexmedetomidine Prevents Tourniquet Induced Hypertension In Upper Limb Orthopaedic Surgeries During General Anaesthesia

Introduction: During limb operations tourniquets are widely used to minimize surgical bleeding and to maintain a relatively bloodless field. Tourniquet induced hypertension occurs more frequently under general anaesthesia than spinal anaesthesia and more with lower limb tourniquet than with upper limb tourniquet and can be serious in patients with cardiopulmonary diseases, neurological disease and glaucoma. This study was designed to investigate the hemodynamic effects of dexmedetomidine on prolonged tourniquet inflation. Material and Methods: Sixty patients scheduled for elective orthopaedic surgery of the upper limb under general anaesthesia were recruited. They were randomly assigned to receive intravenous dexmedetomidine (0.5 mcg/kg; n=30) or normal saline (NS group; n = 30) before tourniquet inflation. Arterial blood pressure and heart rate were recorded every 10 minutes until 90 minutes after the start of tourniquet inflation and again immediately after deflation. Result: In the dexmedetomidine group, arterial pressure was not significantly changed, but in the Control group arterial pressure was significantly increased at 90 minutes after the start of tourniquet inflation. Development of more than 30% increase in arterial pressure during tourniquet inflation was more frequent in the Control group than in the dexmedetomidine group. Conclusion: Preoperative intravenous dexmedetomidine could therefore prevent tourniquet-induced hypertension in patients undergoing general anaesthesia.

Co-existence of Riche-Cannieu communications and Berretinni communications.

Median nerve is formed by union of lateral and medial roots arising from the corresponding cords of the brachial plexus. Ulnar nerve arises from the medial cord of brachial plexus itself. Only few communications between the median and ulnar nerve have been reported and described in the available literature. During routine dissection of the upper limb of a male cadaver for teaching undergraduate medical students, a variation was observed in the course of median nerve and ulnar nerve communications in palm. A very rare communication was found in which there is superficial and deep communication between ulnar and median nerve was observed only in one male cadaver (1.25%). This type of communication was not found in any other cadaver so far. This dual ansa formation between branches of ulnar and median nerve by communicating branches at superficial and deep levels in palm is rare to observe in which there is co-existence of Berretini Communications and Riche-Cannieu Communications is found in one hand only.

Indoor air pollution and respiratory illness in children from rural India a pilot study.

Objective. Indoor air pollution measured in terms of particulate matter <2.5μm in diameter (PM2.5), is an important cause of respiratory illness in children. Therefore, PM2.5 levels in rural households and its correlation with respiratory illness-related symptoms in children were studied. Methods. A questionnaire-based survey of children for respiratory illness-related symptoms was conducted in 37 households of a village (Khanpurjupti, Delhi-NCR, India) from September 2011 to October 2011. Assessment of 24-hour PM2.5 level was done using University of California-Berkeley Particle and Temperature Sensor (UCB-PATS). Results. Thirty-seven households in a rural area were studied. These were divided into 20 respiratory households, i.e. those with children with respiratory illness-related symptoms and 17 control households. The 24-hour PM2.5 was measured in all the houses. The average minimum and maximum PM2.5 levels were 7.24mg/m3 and 22.70mg/m3, respectively (mean=10.47mg/m3) among the 20 respiratory households. The average minimum and maximum PM2.5 levels were 1.10mg/m3 and 18.17mg/m3, respectively (mean=4.99mg/m3) in the 17 control households. The PM2.5 levels were significantly greater (p<0.05) in houses where children had respiratory symptoms compared to the control households. Further, biomass fuel use and number of family members were significantly associated with respiratory illness in children. Conclusion. Increased PM2.5 levels, biomass fuel use and number of family members were found to be associated with increased occurrence of respiratory illness in children.

Purification, characterization and properties of phytase from Shigella sp. CD2.

Phytases catalyze the release of phosphate from phytic acid. In this study, a phytase producing bacterial strain Shigella sp. CD2 was isolated from the wheat rhizosphere. Phytase production started from the exponential phase of bacterial growth, showing the highest activity during the stationary phase. The enzyme activity was detected in both periplasmic and intracellular fractions. The enzyme was purified by about 133-fold with specific activity 780 U mg-1 protein. The optimum pH and temperature of the enzyme was 5.5 and 60oC, respectively. The enzyme was thermostable and retained 100% and 75% of its activity on pre-incubation at 70o and 80oC for 30 min, respectively. The Km value for the substrate sodium phytate was 0.25 mM. The enzyme was highly specific to substrate phytate, and no activity was detected in presence of other phosphorylated substrates, such as ATP, ADP, glucose 6-phosphate, fructose 6-phosphate and p-nirophenyl phosphate. The activity declined dramatically in presence of Cu2+, Zn2+ and Fe2+ and SDS, whereas Mg2+ and Co2+ slightly enhanced the enzyme activity. The addition of other metal ions or chemicals had little or no effect on phytase activity. The enzyme was resistant to both pepsin and trypsin. Due to high specific activity, substrate specificity, good pH profile, protease insensitivity and thermostability, phytase encoding gene from Shigella sp. CD2 could be an interesting candidate for industrial applications. Further studies on cloning and expression of Shigella phytase gene are currently in progress.

Serum ferritin in renal cell carcinoma: effect of tumor size, volume grade, and stage.

AIM: To study the levels of serum ferritin in patients of renal cell carcinoma (RCC). PATIENTS AND METHODS: Serum ferritin levels were measured preoperatively in 32 patients with radiological evidence of RCC using an enzyme immunoassay. The largest diameter of the primary tumor was measured in the pathological specimens in patients undergoing radical nephrectomy while in patients with non-operable tumor maximum tumor dimension was taken from CT scan. Pathological staging was done according TNM-1997. RESULTS: Mean serum ferritin value in patients of RCC was 283.23+/-77.38 ng/ml while in controls the mean value was 79.98+/-32.96 ng/ml (P CONCLUSIONS: Serum ferritin levels are elevated in patients with RCC although its actual source is unclear. Further studies are needed to establish the role of ferritin in RCC.