A comparative study of low dose magnesium sulphate therapy with Pritchard’s regime in management of Eclampsia

Background: Eclampsia is one of the most common causes of maternal and perinatal mortality and morbidity in India. Amongst the principles of management of eclampsia, the first is the control of convulsions. Magnesium sulphate is the main stay of treatment in eclampsia and imminent eclampsia. Average weight of Indian women is less than the western women due to which lower dose of magnesium sulphate can be used.  The aim of the study was to compare the efficacy of low dose magnesium sulphate regimen with standard Pritchard regimen in control of eclampsia.Methods: The study was carried out at emergency labour room, GMERS Sola Civil Hospital Ahmedabad. 120 patients of eclampsia were divided randomly into study group (n=60) receiving low dose MgSO4 and control group (n=60) receiving Pritchard regimen. The recurrence of convulsion, toxicity of MgSO4 and maternal and fetal outcome was studied.Results: It was observed that with low dose MgSO4 regime, convulsions were controlled in 91.7% of the cases. With standard Pritchard’s regime convulsions were controlled in 95% of patients. The maternal and perinatal mortality and morbidity were comparable in both groups.Conclusions: Low dose magnesium sulphate therapy is as effective as Pritchard’s regime for controlling convulsions in eclampsia and can be safely given in Indian women.

Sudden, new-onset aortic regurgitation during off pump coronary bypass surgery

During off pump coronary artery bypass grafting surgery, it is common to observe mitral or tricuspid regurgitation due to heart displacement. But it's very unusual to notice new onset aortic regurgitation in OPCABG.

Experimental evaluation of analgesic activity of PPAR γ agonists: pioglitazone and rosiglitazone.

Background: To evaluate analgesic activity of pioglitazone and rosiglitazone by tail flick method in rats and acetic acid induced writhing method in mice. Methods: Albino wistar rats of either sex weighing 180-200 g and Swiss mice weighing 25-30 g were used. Study was conducted after approval from the Institutional Animal Ethics Committee. The tail flick method in rats described by D’Amour and Smith (1941) and acetic acid induced writhing in mice were used. The dose of pioglitazone and rosiglitazone were 20 mg/kg and 10 mg/kg respectively. Results: In tail flick method of analgesia, both, pioglitazone and rosiglitazone have analgesic activity which was statistically comparable to aspirin. In acetic acid induced writhing model of analgesia, the action of pioglitazone and rosiglitazone was significantly greater than the control group but it was less when compared to aspirin. Conclusions: Analgesic activity of pioglitazone and rosiglitazone was comparable to aspirin in tail flick model of analgesia in rats while it was significantly less when compared to tramadol. Analgesic activity of pioglitazone and rosiglitazone was significantly less than aspirin in acetic acid induced writhing method.

Palliative chemotherapy in carcinoma penis: does platinum and taxane combination holds a promise?

To report safety and efficacy of chemotherapy incorporating the combination of paclitaxel and platinum in patients with advanced penile carcinoma. Retrospective analysis of patient with advanced penile carcinoma undergoing palliative chemotherapy with paclitaxel and platinum combination. The demographic profile, indication of treatment, chemotherapy details, toxicity and survival outcome were noted. Statistical analysis was done for estimation of progression free survival and overall survival. Factors affecting these outcomes were sought for. Eighteen patients with a median age of 47.5 years [31-68 years] were offered palliative intent chemotherapy over a period of 2.5 years. ECOG performance was 1 in 12 patients [66.7%] and 2 in 6 patients [33.3%].The grade of tumor was poorly differentiated in 8 patients [44.4%], moderately differentiated in 5 [27.8%] and we1l differentiated in 5 patients [27.8%]. Twelve patients had previous surgical treatment [66.7%], with 2 of them having received groin radiation in past. The indication for treatment was metastatic disease in 7 patients [38.9%] and locally advanced disease in 11 patients [61.1%]. Out of 18 patients 13 received chemotherapy. Paclitaxel and carboplatin combination was given in 10 patients [76.9%] while paclitaxel and cisplatin was received by 3 patients [23.1%]. The median numbers of cycles received were 3 [1-6 cycles]. Response rate was 30.8%. The median estimated progression free survival [PFS] and overall survival [OS] for patients receiving atleast one cycle of chemotherapy [n = 13] were 96 days and 246 days respectively. Among tested variables the median OS in patients who had received 2 or more cycles was 351 days versus 55 days in those who received less than 2 cycles [P = 0.025]. However, after applying Bonferroni correction, the difference was no longer significant. There was no toxicity related death or life threatening complication. Our institutional protocol of platinum-based doublet with paclitaxel is effective, well-tolerated and has the advantage being delivered on an outpatient basis alone. Overall, we believe that paclitaxel-platinum is an effective regimen that needs to be investigated further in larger studies

Study of prescribing practices of injections in outpatients of a rural tertiary care teaching hospital.

Background: Injections are probably the most common of all medical procedures. The combination of injection overuse and unsafe practices creates a major route of transmission of blood borne pathogenic infections. Unnecessary use of injections can also lead to unnecessary burden on the institution in terms of efficiency, infrastructure, staff requirement and poor utilization of resources. Monitoring and analysis of prescribing practices can help to achieve rational use of injections. The present study was carried out to study the injection prescription patterns in outpatients of a rural tertiary care teaching hospital, Ambajogai, Maharashtra, India. Methods: A cross sectional descriptive study was conducted for duration of two months and 744 prescriptions were randomly collected and analyzed. Results: The total number of injections prescribed in 744 prescriptions was 205. Most (71.70%) of the patients receiving them were above 35 years of age. The most common complaint for which the injections were prescribed was musculoskeletal pain (45.36%) followed by fever. About 155 (75.60%) prescriptions contained injection diclofenac which was the most commonly used drug followed by injection paracetamol (11.21%). There was a high tendency of using brand names in prescriptions (89.30%). Conclusion: The study revealed high proportion of use of injectable drugs. There was overuse of analgesic injections like diclofenac, most of which were unnecessary and irrational. This leads to unnecessary burden on the institution in terms of efficiency, infrastructure, staff requirement and poor utilization of resources. There is a need to develop local guidelines for injection usage along with educational sessions for prescribing doctors.

A review of objective structured practical examination (OSPE) in pharmacology at a rural medical college.

Background: 1. To evaluate the attitudes of undergraduate medical students towards objectively structured practical examination (OSPE) component of Pharmacology practical examination. 2. To investigate any gender differences and any influence of medium of instruction in school on these attitudes. Methods: The scores of 40 undergraduate medical students were analysed at S R T R Government Medical College, Ambajogai, Maharashtra, India. A Likert scale containing 9 items was used to assess the attitudes of students towards OSPE in Pharmacology. Student perspectives regarding the OSPE were obtained by asking them to respond to a questionnaire. Results: The study revealed that the OSPE was an acceptable tool in Pharmacology practical examination. The overall mean attitude score was 3.99. The response of male students towards OSPE (4.2) was more favourable as compared to that of female students (3.9) Students strongly agreed that OPSE covers wide range of skills and it is a good form of examination and learning experience. Majority of students were in favour of continuing OSPE as a method for examination in Pharmacology. Conclusions: OSPE was found to be a valuable tool to check the depth of understanding of undergraduate students. OSPE can be used as an index of the learning attitude of students. The present study is a small step in a direction of changing the traditional patterns of practical examination to a more objective and reliable way of evaluation in Pharmacology. It will help in modifying teaching-learning strategies so that both, the teachers as well as the students can gain maximum advantage.

Genito-urinary tuberculosis revisited - 13 years' experience of a single centre.

Background: Tuberculosis had been declared by the World Health Organization (WHO) as ‘public health emergency’ in 1993. Extra pulmonary tuberculosis (E.P.T.B.) comprises 20-25% total burden of the disease in which genitourinary tuberculosis (G.U.T.B.) is 4%. Timely diagnosis and treatment will prevent the sequelae of this disease. Aims: To know the varied clinical presentations, diagnostic modalities and management of G.U.T.B. Methods: During a 13-year-period, 117 retrospective cases of GUTB were admitted in the tertiary care centre. They were analyzed for clinical presentation, diagnostic modalities and management. Results: Young patients mainly in third decade of life were commonly affected with higher incidence in females. In our study, the most common presentation was irritative voiding symptoms (66.47%) followed by haematuria (47.60%). Although it can affect the entire organ in genito-urinary system but, in the present study, kidney was the most affected organ (64.9%) following ureter (27.35%), urinary bladder (17.09%), prostate (3.4%) and epididymis (5.19%). In this study, we had not encountered any case of testicular and penile tuberculosis. Among the different diagnostic modalities in this study, the diagnostic positivity rate was 41.6% for the urine AFB test, 55.4% for the urine M. tuberculosis culture test and 67.7% for PCR. Chest x-ray was positive in 25.6% (30). ESR was raised in 62.5% and Mantoux test was positive in 61.2% patients. Conclusion: A high index of suspicion and a wide range of investigations may be required to achieve a complete diagnosis of genitourinary tuberculosis. Though short course chemotherapy with four-drug-regimen for sixmonth- duration is the mainstay of treatment, surgical interventions were required in 60% of cases of this study.

Newer drugs in the management of diabetes mellitus.

Modern life style with present days technological advances have made human life sedentary. This is causing increasing prevalence of obesity and physical inactivity amongst population. The number of cases of diabetes worldwide in the year 2000 among adults 20 years of age is estimated to be 171 million in recent reports and is said to rise to more than 300 million by 2025. The raised plasma glucose levels give rise to complications in the form of microvascular and macrovascular complications diminished quality of life with reduced life expectancy. The currently available drugs used in the management of type II DM are not completely satisfactory in regard of controlling blood glucose level, many of the times they are associated with undesirable side effects. Hence there is continuous ongoing work in development of newer drugs, which are safe, efficacious and potent as well as free of undesirable effects such as sustained hypoglycaemia. Fortunately there are newer drug, few of them approved while other still knocking the door from the classes of drug such as GLP-1Mimetic, DPP-4 Inhibitors and others. Here we have tried to cover them in brief.

Inverted papilloma of the urinary bladder: Rigorous surveillance needed: An Indian experience.

Aims: Inverted papilloma (IP) is an uncommon benign neoplasm of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) leads to conflicting clinical conclusions regarding its biological behavior, and hence, the need for rigorous follow-up protocols. In this study, we review all cases of urinary bladder IP in our institution and determine the need for strict follow-up. Materials and Methods :0 We included consecutive patients from August 2004 to August 2008 with IP of the urinary bladder in this study who did not have prior or concurrent urothelial carcinoma. A single pathologist performed the histologic review. The patients had undergone strict a follow-up schedule every 6 months. Results: In our study of the 24 patients, the mean age at presentation was 53.5 (range 22-81) years. The mean follow-up period was 25.8 months (range 6-58 months). Of the 24 patients, 21 were men and 3 were women. No patient had a synchronous or previous bladder tumor. The most common presenting symptoms were macroscopic hematuria and dysuria. All were solitary tumors except one, most commonly found at the bladder neck and trigone. The average follow-up period was 2.5 years without any evidence of recurrence. Conclusions: We conclude that when diagnosed by strictly defined criteria, IP as benign urothelial neoplasm was with extremely low incidence of recurrence and good prognosis. It does not seem to be a risk factor for TCC, especially if located in the bladder. Therefore, a good transurethral resection is adequate therapy and follow-up protocol as rigorous as those for TCC may not be necessary.

Computed tomography [CT] versus magnetic resonance imaging [MRI] in differentiation between neoplastic orbital lesions

To compare between the role of CT and MRI in diagnosis of neoplastic orbital lesions. The study included 126 patients proved to have orbital neoplasm and were subjected to CT and MRI. The study included. 59 males and 67 females with age ranged from 12 days to 91 years. The orbital lesions were bilateral in 16 patients. The lesions were distributed according to their location in one or more of the five orbital compartments including optic nerve, globe, conal intraconal, extra-conal and preseptal space. The most frequent encountered lesion was lymphoma followed by following order: uveal melanoma, optic nerve glioma, juxtaorbital meningioma, retinoblastoma, optic nerve meningioma, rhabdomyosarcoma, metastases, pleomorphic carcinoma, leukemia, aneurysmal bone cyst, schwannoma, neurofibroma, capillary hemangioma, basal cell fibroma, lacrimal gland carcinoma, malignant fibrous histiocytoma, malignant teratoma, osteoma, assifying fibroma and esthesioneuroblastoma. CT assessed the attenuation values of the lesion, presence of enhancement, bony changes and calc/lcations. MRJ assessed signal changes on T1 and T2WI and enhancement. CT and MRI are complimentary studies for imaging of orbital neoplasm

Safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma.

PURPOSE: To establish the safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma. METHODS: We studied 109 consecutive patients who underwent planned simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma by a single surgeon from January 1990 through December 1999. The main outcome measures were postoperative intraocular pressure (IOP), corneal clarity and diameter, visual acuity, bleb characteristics, time of surgical failure and complications. Postoperative complications including endophthalmitis and anaesthetic morbidity and mortality were also analysed. RESULTS: The series consisted of 218 primary combined trabeculotomy-trabeculectomy surgeries during 109 anaesthesias. The mean follow-up period was 16.33 +/- 16.22 months. The IOP reduced from 26.4 +/- 5.9 mmHg to 13.5 +/- 4.5 mmHg, with a mean percentage reduction of 46.2 +/- 23.7 (P < 0.0001). The success (IOP < 16 mmHg) probabilities were 90.9%, 88.0% and 69.3% at first, second and third year respectively (Kaplan-Meier analysis). The success probability of 69.3% obtained at third year was maintained till 6 years of follow-up. One hundred and sixty six (76.1%) eyes had significant corneal oedema. Postoperatively, the cornea cleared in 93 (57.8%) eyes. Clinically, well functioning blebs were present in 114 of 171 eyes (66.6%). Postoperatively, 18 (8.3%) eyes developed shallow anterior chamber and 6 (33.3%) of them required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Of the anesthetic complications, apnea occurred in 17 (15.6%) patients and all were successfully resuscitated. The most serious post-anaesthetic complication was cardio-pulmonary arrest that occurred 5 hours postoperatively following aspiration during feeding in one child; this child could not be resuscitated. Two children had delayed recovery (2 and 4 hours respectively). The child who had delayed recovery by 2 hours survived and has completed 3 years of follow-up while the other child expired 48 hours later. CONCLUSION: Simultaneous bilateral primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma. It obviates the need for long second anaesthesia with its attendant risks. It offers several other benefits to the patients and families.