Acute hepatitis E in pregnancy--study of 16 cases.

This retrospective study was done at Tribhuvan University Teaching Hospital between April 1999 to April 2003, to asses the maternal and perinatal outcome of acute hepatitis E in pregnancy. During this period a total of 19 patients presented with jaundice. Out of 19 cases, 16 suffered from acute hepatitis due to hepatitis E. Acute hepatitis was diagnosed by presence of prodromal symptoms and anti HEV IgM in the body. Hepatitis B and C were ruled out in all these cases. Out of 16, 15 delivered in the hospital. Average age of the patients was 24 years. 81.2% (13/16) presented during the third trimester of pregnancy. There were 3 maternal deaths (20%). Other complications were; Preterm delivery 53.3% (8/15), post partum haemorrhage 26.7% (4/15), low birth weight in 33.3% (5/15). This analysis showed increased maternal and perinatal complications of hepatitis E contracted during pregnancy, especially so in those with fulminant hepatitis.

Tramadol along with local anaesthetics in the penile block for the children undergoing circumcision.

OBJECTIVE: This study was to find out the total duration of postoperative analgesia following circumcision in children when Tramadol was used as an adjunct to local anaesthetics in penile block. METHODS: Forty children of age 5 - 13 yrs, ASA I & II were enrolled in this study. Patients were premedicated with ketamine and atropine intramuscularly prior to separation from their parents and IV cannulation. Penile block was then performed under strict aseptic precautions with paramedian approach by 3 cm long 23 g ordinary needle where 4 ml of mixture of local anaesthetics and tramadol was given on each side of the base of penis at 11 and 2 o clock positions. Duration of analgesia was recorded from the time of completion of surgery till the patients' first complain of pain and when additional analgesic was given. Intraoperative analgesia duration achieved by the penile block was not included in this study due to unavoidable overlapping of sedation and analgesia produced by the premedicated IM Ketamine (4-5 mg/kg) ,which lasts for 25 minutes to 30 minutes. Unless complicated, this is the usual surgery time in our hospital for this procedure. Because of this reason, the sedation score was not used in this study. Moreover, paediatric sedation score remains too impractical and unreliable in our context. RESULTS: Addition of Tramadol with local anaesthetics in penile block prolonged the postoperative analgesia even up to 40 hours. CONCLUSION: Tramadol as an adjunct with Local Anaesthetics extends the duration of postoperative analgesia and can be used safely for this purpose in the children.