Comparison of oral misoprostol versus intramuscular oxytocin for active management of third stage of labour: a single centre randomised controlled study

Background: This study was conducted to compare the efficacy and safety of oral misoprostol against intramuscular oxytocin in the active management of the third stage of labour, so that it can be widely used in the areas of limited resources to contribute in preventing post-partum haemorrhage and thus decreasing maternal mortality ratio.Methods: This was a prospective randomised controlled clinical study. Two hundred patients fulfilling inclusion criteria were randomized to receive either oral misoprostol (600 mcg) or intramuscular oxytocin (10 IU) in the active management of third stage of labour. Primary outcome measured was mean blood loss and incidence of primary PPH.Results: The mean blood loss during third stage of labour in oral misoprostol group and oxytocin group was 239.16�.78 ml and 240.19�.70 ml respectively with p value-0.7331 which was insignificant. Similarly mean fall in haemoglobin was also not significant. There was no significant differences between the two groups with regard to the incidence of PPH (3% vs. 2% respectively; p=0.651). Women experiencing side effects like shivering and fever were significantly higher among misoprostol group than in oxytocin group.Conclusions: In this study, oral misoprostol was found to be comparable to intramuscular oxytocin regimen, in terms of amount of blood loss, occurrence of postpartum hemorrhage, duration of third stage of labour, fall in hemoglobin and fall in blood pressure. However, shivering and fever were more common with misoprostol, but no other serious side effects were noted.

Study of pattern and management strategies of solid visceral injuries in blunt trauma abdomen in tertiary care centre

Background: Blunt trauma abdomen is a leading cause of morbidity and mortality among all age groups. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality still remain large. The aim was to evaluate pattern and management strategies of solid visceral injuries in blunt trauma abdomen patients.Methods: This was a prospective study on 100 consecutive patients admitted in Department of General Surgery at a tertiary care center with an antecedent history of blunt abdominal injury. All patients proven to have penetrating injury and hollow viscus injury were excluded. The pattern of injury, presentation and parameters associated with management strategies were evaluated.Results: In the present study, solid viscera injury in blunt trauma abdomen is more common in age group 21-30 years (43%) with male predominance (92%). RTA (75%) were the most common mode of injury followed by fall. Most common clinical presentation was abdominal pain (86%) followed by tachycardia (34%) and hypotension (6%). Most common viscera injured is liver (48.2%) followed by spleen (36.7%), kidney (12.3%) and pancreas (2.8%). Majority of patients were managed conservatively (84%).Conclusions: It was concluded from the study that irrespective of the solid organ injury in blunt trauma abdomen, patients can be managed conservatively due to aggressive resuscitation with supplement drug therapy, use of analgesia or sedation in ICU setup and close monitoring. Patients are grossly hemodynamically unstable at presentation do require intervention either immediate or in due course of time.

Rebuilding Confident Smile by Restoring the Pink Component by Zucchellie’s Technique in Multiple Gingival Recession

Background:Gingival recession in anterior teeth results in a smile that is likely to be perceived as unaesthetic. It is defined as the location of marginal tissue, apical to cementoenamel junction with exposure of root surface. The most common reason for recession in the adult individual is the loss of periodontal support due to plaque-associated conditions. Abnormal tooth morphology, faulty restorations, and traumatic oral hygiene practices may also negatively influence the position of the interdental soft tissues. Numerous surgical techniques have been proposed for gingival recession correction. Zucchelli modified coronally advanced flap is the technique which avoids vertical releasing incisions. It has advantage of adequate coronal advancement, good anchorage, ample blood supply to the surgical interdental papilla and no unaesthetic scars along incision lines. This case report demonstrates multiple recession coverage in maxillary anterior buccal segment by Zucchelli’s technique of coronally advanced flap.

To Determine the Bacteriological Profile and Antibiotic Sensitivity Pattern of the Isolates Causing Ventilator Associated Pneumonia in ICU Patients

Background: Ventilator associated pneumonia (VAP) is a type of nosocomial pneumonia occurring in patients who are mechanically ventilated for more than 48 hours. VAP is the most common nosocomial infection occurring in the intensive care units and its incidence varies from 8% to 28%. AIMS & OBJECTIVES- This study was done to determine the bacteriological profile and antibiotic sensitivity pattern of the isolates obtained from the endotracheal aspirates of the clinically suspected patients of VAP in ICU.  Materials & Methods: Ventilator associated pneumonia (VAP) is a type of nosocomial pneumonia occurring in patients who are mechanically ventilated for more than 48 hours. VAP is the most common nosocomial infection occurring in the intensive care units and its incidence varies from 8% to 28%. AIMS & OBJECTIVES- This study was done to determine the bacteriological profile and antibiotic sensitivity pattern of the isolates obtained from the endotracheal aspirates of the clinically suspected patients of VAP in ICU. Results: Out of 110 patients included in the study, only 85 patients were diagnosed as VAP patients based on clinical and microbiological criteria. Pseudomonas aeruginosa (35.55%) was the most common gram-negative isolate obtained in VAP cases followed by Escherichia coli (27.77%) and Acinetobacter baumanni (16.66%). Among Gram positive bacteria, Staphylococcus aureus 40 (80%) was the most common isolate. The most active antibiotic against the gram-negative isolates was imipenem (82.2%), followed by piperacillin-tazobactum (77.7%) and amikacin (63.3%). All the Gram-positive isolates were susceptible to vancomycin and linezolid. Conclusion: Due to the increasing incidence of multi drug resistant pathogens in ICU, early and correct diagnosis of VAP is an important challenge for critical care physicians. Hence, knowing the bacteriological profile causing VAP and their routine antibiotic susceptibility pattern can improve the patient’s clinical outcome.

Clinical profile and factors associated with microalbuminuria in type 1 diabetes mellitus in children and adolescents.

Background: The aim of this study was to determine the pattern of clinical presentation and factor associated with microalbuminuria. Methods: Urinary albumin excretion of children and adolescents diagnosed with type 1 diabetes mellitus attending diabetic clinic of Katihar medical college hospital over a period of one year. Collected blood and urine samples were analysed for glycated haemoglobin, cholesterol, triglycerides, and for 12 hour urinary albumin concentration. Blood pressures were recorded and clinical data collected. Results: During the study period 215 patients were diagnosed with type1 DM. Out of 215, fourty-three patients (20%) had persistent microalbuminuria. Factor associated with microalbuminuria in diabetic patients include duration of diabetes mellitus, higher blood pressure, higher cholesterol and triglyceride levels. Conclusion: Type 1 DM is treatable and testing is acceptable and accessible to the patients. As microalbuminuria is an early microvascular complications, it is highly recommended to screen all diabetic patients for the incidence of microalbuminuria and modifiable risk factors like dyslipidemia at the onset and then yearly assessment. Efforts need to be intensified in education of health workers and population at large for quick presentation and prompt diagnosis in order to predict overt diabetic nephropathy and also to prevent its progression.

Childhood Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a common condition in childhood and can result in severe complications if left untreated. It is showing a rising trend in India. A significant association with obesity has been observed; however, some children with enlarged tonsils and/or adenoids may even be underweight. The patient usually presents with snoring and other respiratory problems like mouth breathing, choking and gasping episodes in night. Poor school performance and neurocognitive deficits have been reported. Pulmonary hypertension and cor pulmonale are seen in severe cases. Besides the history and clinical examination, for definitive diagnosis an overnight polysomnographic evaluation is the gold standard. In all cases, the specific treatment ranges from simple lifestyle modifications and medications to surgeries like adenotonsillectomy. Early diagnosis is vital.