Functional independence measure (WeeFIM) reference values in Indian children aged 3–7 years: A cross-sectional study

Background. We sought to establish reference values of the functional independence measure (WeeFIM; Unified Data System for Medical Rehabilitation, Buffalo, NY, USA) for children aged 3–7 years in India using this cross-sectional study. Methods. We obtained permission from the Unified Data System for Medical Rehabilitation, a non-profit organization to use the WeeFIM instrument. Participants were recruited randomly from schools. After obtaining written informed consent, direct interviews for WeeFIM II Clinical Guide (version 6.0) were conducted for parent/guardian/teacher of 182 typically developing children. Results. There was a progressive increase of functional independence with increasing chronological age across all WeeFIM domains. Total score of the WeeFIM instrument showed a similar performance between boys and girls. At the beginning of 3 years, children were at WeeFIM level 3 that is moderate assistance stage in their functional independence, but by the age of 7 years, they became completely independent on all the three domains of WeeFIM functional scale. Conclusions. We have provided reference values for WeeFIM in children of India aged 3–7 years (35–84 months). There were no differences between boys and girls regarding WeeFIM performance. Children in private schools showed better performance versus children in government schools in the early age ranges. We could not find any effect of socioeconomic status on WeeFIM raw rating or functional independence level.

Knowledge about menstrual cup and its usage among medical students

Background: Menstrual cups have been available for decades, but their use in India is limited because of lack of awareness and popularity of sanitary pads. Since they are reusable, they reduce solid waste and are environment friendly. The need of the hour is education, awareness, and availability of the eco-friendly practices when it comes to managing menstrual waste effectively. Once that is taken care of, it will be easy for anyone to make a green switch.Methods: A total 400 medical undergraduate students (females) were given a questionnaire. The objective of the study was to assess knowledge about the menstrual cup among students.Results: Among 400 medical students, 28(7%) of them dint know what a menstrual cup was! 262(70.4%) students were for usage of menstrual cup in virgins. There was no clear picture among students regarding material used in cup manufacture, its emptying time and sterilisation technique. Among 372 students, none of them used a menstrual cup.Conclusions: All the students in the study used sanitary pads, owing to its popularity and promotion. There was lack of awareness about the cup. So, we conclude that menstrual cup needs promotion in India. To boost the adoption rate of menstrual cups, youth should be targeted, who are more open to the idea of environment-friendly products. The Government must conduct awareness programs in the rural areas and work constantly spreading the message across all socio-economic sectors so that we can make the dream of a “pad free country”, a reality soon.

A clinical study of trends of ectopic pregnancy and its management in a tertiary care hospital

Background: Ectopic gestation is a gynaecological emergency which culminates in pregnancy loss and causes significant maternal morbidity, mortality besides jeopardizing future conception. The study discusses the incidence, risk factors, symptomatology and management of ectopic pregnancy in a tertiary care teaching hospital.Methods: This was a prospective study of 45 cases of ectopic pregnancies at a tertiary care teaching hospital from January 2012 to December 2013. Information was collected in a structured proforma, tabulated and descriptive analysis was carried out.Results: The incidence of ectopic pregnancy was 1.17%. Majority of the patients (80%) belonged to 20-30 yrs age group. Second gravidas predominated (42.2%). Fallopian tube was the most common site (95.5%). Rudimentary horn ectopic accounted for 4.65%. Previous abdominopelvic surgery (31.1%), IUCD usage (22.2%), PID (20%), abortions (20%), tubectomy (15.5%) were the principal risk factors. 42% of the patients had no risk factor. The triad of amenorrhea, bleeding per vaginum and abdominal pain was seen in 51.1% of cases. Ultrasound, UPT, β-hCG estimation were the diagnostic tools. Ruptured ectopic pregnancy accounted for 64.4%. Nearly 95.5% of patients underwent surgery; salpingectomy (76%). Methotrexate was successful in 4.44%. There was no maternal mortality.Conclusions: Mostly diagnosis, prompt surgical or medical management is cornerstone of treatment. Primary prevention such as improved access to family planning services, sex education, treatment of STI, PID, surgical asepsis  and haemostasis, implementing legislation for dispensing MTP drugs ameliorate risk factors and hence reduce ectopic pregnancy.

Prospective study of primary amenorrhoea and its management in a rural tertiary centre

Background: Amenorrhoea (absence of menstruation) is a symptom of varied causes. It results from dysfunction of hypothalamic-pituitary ovarian axis, uterus and vagina. It is a major concern for pubertal girls and their family members. It has a major impact on the physical, mental, psychological and social life of the girl and her family. The objective of the present study was to evaluate the aetiology and management of primary amenorrhoea in young adolescent girls.Methods: It was a prospective study conducted for a period of 2 years from August 2016 to July 2018 at Rajarajeswari medical college and hospital. Patients presenting with history of amenorrhoea that is, absence of menses by the age of 13 years with no visible development of secondary sexual characteristics or by 15 years of age with the presence of normal secondary sexual characteristics were included in our study. Cases of secondary amenorrhoea were excluded. Detailed history, examination, investigations and management was documented and analysed.Results: A total of 25 patients of primary amenorrhea were studied during the study period. In our study outflow tract anomalies were the commonest cause of amenorrhoea accounting for 84%, of which imperforate hymen (32%) and Mayer Rokitansky Küster Hauser syndrome (MRKH) 36% were the two most common Mullerian anomaly causing primary amenorrhoea. Gonadal dysgenesis accounted for 12% of the cases. Amenorrhoea was the commonest complaint patients presented with accounting to 76%, followed by cyclical pain abdomen accounting for 16% of cases.Conclusions: Primary amenorrhoea is multifactorial and is of major concern among adolescent girls. Early diagnosis and intervention has an impact on the physical and psychological wellbeing of the girl.

A Clinical Audit: Intrapartum Care in Third Stage of Labor

Introduction: The third stage of labor is the time from the birth of the baby to the expulsion of the placenta and membranes.Management is normally categorized into two types; active management and physiological management. Active managementof the third stage involves a package of care comprising the following components: Routine use of uterotonic drugs, deferredclamping, and cutting of the cord controlled cord traction after signs of separation of the placenta. Most common complicationsof the third stage of labor are postpartum hemorrhage and retained placenta.Aims and Objectives: The present clinical audit aims to improve the care of healthy women and their babies during the thirdstage of child and to review the practices regarding the third stage of labor and to develop and implement action plan regardingmanagement strategies.Materials And Methodology: The audit was carried out on 218 pregnant women admitted in Rajarajeswari Medical Collegeand Hospital from April 2018 to September 2018. The inclusion criteria, exclusion criteria, and data collection on the excel sheetwere based on the National Institute for Health and Care Excellence (NICE) guidelines.Results: Among 218 cases, vaginal blood loss was recorded in 181 (83%) cases whereas the color, respiration, and generalcondition were recorded in all 218 cases. In all 218 cases, active management of the third stage was carried out, and decisionregarding the same was recorded. The time of cord clamping was recorded in only 6% of the cases. The management ofpostpartum hemorrhage and retained placenta met audit standard in all 218 cases.Conclusion and Recommendations: The present clinical audit suggests that there is a need to follow specific guidelines andtreatment strategies to avert the complications. Recording of vaginal blood loss in all cases, instructions for the compulsoryrecording of the cord clamping time following the birth of a baby and continue to follow the remaining steps according to theNICE guidelines to reduce the complications of the third stage of labor.

Maternal and Perinatal Outcome in Severe Pre-eclampsia and Eclampsia in Rajarajeswari Medical College, Bangalore

Introduction: Eclampsia and pre-eclampsia is an acute life threatening complication of pregnancy. They are the leading causeof maternal and perinatal morbidity and mortality.Aim: To study the maternal and perinatal outcome in severe pre-eclampsia and eclampsia.Methods: A prospective study carried on 50 pregnant women admitted with severe pre-eclampsia and eclampsia in RajarajeswariMedical College and Hospital.Results: Out of the 50 cases, majority of the cases were transferred cases (56%) and 80% of the cases belonged to the agegroup of 20 to 30 years. Majority of the cases were seen in primigravida (58%). There was high incidence of PPH (70%), abruptioplacenta (4%), HELLP syndrome (6%). Perinatal complication were also high, 60% were low birth weight, 20% were preterm,16% were IUFD, three cases had doppler changes and three neonates had to be ventilated.Conclusion: There is high maternal and perinatal morbidity and mortality. Good and regular antenatal care can help preventpre-eclampsia and eclampsia. Therefore, proper and frequent antenatal care id needed for high risk pregnant women.

Post hysterectomy fallopian tube prolapse: a rare case

Fallopian tube prolapse into the vaginal vault is a very complication of hysterectomy where the adnexa is preserved. The overall occurrence after all routes of hysterectomy is 0.01-0.05%. Several factors have been suggested to contribute to the condition such as vault hematoma, improper closure of vault, early resumption of sexual activity. Due to the misdiagnosis, there is often delay in the diagnosis and its management. The only means of definitive diagnosis is histopathology. A 30-year-old P2l2 presented to us after 3 years of post-hysterectomy with abdominal pain and bleeding pv on and off. On examination prolapsed fallopian tube was found in the vaginal vault on speculum. Biopsy was done in the outside hospital and was confirmed to be the tube. Patient underwent combined laparoscopic and vaginal method. Vaginal excision of the tube was done. Prevention by prophylactic salpingectomy and by suturing the adnexa high up in the pelvis in abdominal hysterectomy.

Provocative poliomyelitis causing postpolio residual paralysis among select communities of two remote villages of North Karnataka in India: A community survey.

Intramuscular injections can provoke muscular paralysis especially, if the child has had exposure to polio virus. The purpose of the study was to determine the association with known risk factors for motor disabilities in two remote villages of North Karnataka (India), where an increased number of disabled people among select communities had been reported. A community based survey was conducted. The selection of study subjects was done through screening, history related with occurrence of musculoskeletal disability, screening and general examination of the affected joints and muscles. Data analysis was done by estimation of percentages. Among the physical disabilities identified, the most common was post-polio residual paralysis. 35.65% (n = 41) subjects had developed paralysis following the administration of an intramuscular injection when they had acute viremia in childhood, indicating that (probably) muscle paralysis would have been provoked by intramuscular injections, resulting in provocative poliomyelitis. Unnecessary injection must be avoided in children during acute viremia state and use of oral polio vaccine should be encouraged.