Comparative study of intra and post-operative complications between total abdominal hysterectomy and laparoscopic assisted vaginal hysterectomy

Background: Vaginal hysterectomy is preferable due to faster recovery, decreased morbidity and absence of an abdominal incision. The aim was to compare the risks and complications of laparoscopy assisted vaginal hysterectomy and total abdominal hysterectomy in terms of intra-operative and post-operative complications.Methods: A retrospective observational study was conducted in the Gynaecology ward at Vinakaya Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India. The data for the past 1-year record was taken for analysis. A total of 80 subjects were included in the study and were divided into two groups with 40 patients under TAH (total abdominal hysterectomy) group and 40 under LAVH (Laproscopic assisted vaginal hysterectomy) group. The primary outcome of the present analysis was incidence of perioperative complications like blood loss and the secondary outcomes were operating time, blood loss, urinary tract injury, rate of conversion to laparotomy, postoperative pain, and length of postoperative stay.Results: The mean intra-operative blood loss was measured among both the groups and it was found to be very high among TAH group (201 ml) compared to LAVH group (149.8 ml) and the difference was found to be statistically significant (p <0.05). Similarly, the duration of operative procedure was found to be less in LAVH group (57.9 mins) compared to TAH group (72.6 mins) and the difference was found to be statistically significant (p <0.05). Post-operative wound infection (14 vs 0) was found to be more among the patients in TAH group than that of the LAVH group and the difference was found to be statistically significant (p <0.05).Conclusions: LAVH is a safe and effective surgical treatment for benign gynaecological diseases and should be offered whenever possible, taking into account the low rate of complications and cost-effectiveness.

Validity of leukocyte esterase reagent (LER) strip in diagnosing infectious pleural effusion

Background: Pleural fluid sampling and analysis are essential to confirm an infection. In a resource-limited health care setting or if biochemistries of the aspirated fluid are not available on an emergency basis, urine reagent strips applied to pleural fluid may expedite diagnostic information. Present study was aimed to evaluate the effectiveness of leukocyte esterase reagent (LER) strip in diagnosing infectious pleural effusion and to correlate the reaction of LER strip with various stages of infectious effusions.Methods: A prospective longitudinal study was conducted in the medical ward of Government Mohan Kumaramangalam Medical College Hospital for a period of one year. Pleural effusion patients with associated immuno-compromised conditions like diabetes mellitus, patients on steroids, HIV reactive patients, chronic obstructive lung disease were included for the study. A totalof 84 patients were included for the study. Exploratory thoracocentesis was done with an 8 mm needle and pleural fluid was obtained and sent for cell count and biochemical testing. The pleural fluid was also tested using the leukocyte esterase reagent strip. The results were recorded as 0, 1+, 2+, 3+ based on the density of violet colour.Results: The leukocyte esterase reagent strip test showed totally negative results in all patients with transudative pleural effusion and also in patients with tuberculous pleural effusion, whereas among patients with infectious pleural effusion other than tuberculosis LER strip test showed negative to only 15% of the patients and for remaining it ranged from 1+ to 3+. The validity of leukocyte esterase strip test was tested in comparison with the gold standard culture test. The accuracy of LER strip test was found to be 88.6%, and the sensitivity and specificity was 90.2% and 66.2% respectively.Conclusions: Reagent strips may speed up the bedside diagnosis of infectious effusions. However, where access to standard biochemical pleural fluid analysis is not available this dipstick tests would add value to the management of the patients.

The Physiochemical, Biological Quality and Seasonal Variability of River Ganges in Varanasi, Uttar Pradesh, India

Background: The Ganga River is a life-line, a symbol of purity and virtue for countless people of India. Nearly all the sewage, industrial effluent, runoff from chemical fertilizers and pesticides used in agriculture within the basin, and large quantities of solid waste, including thousands of animals carcasses and hundreds of human corpses are dumped in the river everyday which posed a considerable public health threat to the religious bathers and a large number of people living along the river who uses Ganges water for drinking and other household purposes. Objective: To assess the physiochemical and biological quality of river Ganges water and to study the seasonality pattern of pollution of River Ganges. Materials and Methods: Two points namely Samne ghat and Rajghat (entry and exit point of Ganga into the city) were selected as the first and the last sampling stations, beside 8 other intermediate sampling stations to assess the physiochemical and biological quality of River Ganga water. The study was conducted from April 2013 to March 2014 and this period was crudely divided into three seasons viz Winter, Summer and Rainy season for the purpose of studying seasonality pattern of pollution. Results: As the river progress through city of Varanasi, Total dissolved solids (TDS), Chloride, Conductivity, Biochemical Oxygen Demand (BOD), Nitrate, Nitrite and Most Probable Number (MPN) increases, DO decreases progressively and Temperature and pH remain same. Conclusion: As far as quality of water with regard to recreational and industrial purposes are concerned, Ganges water may be considered useful but most of the parameters observed across different seasons indicates that it may not be used as potable water.

Maternal and Foetal Outcomes of Gestational Diabetes Mothers Treated with Human Insulin

Background: The most common adverse event that is associated with GDM is that it has led to higher incidence of maternal diabetes mellitus later in life and the major morbidities among the infants born to the diabetic mothers include respiratory distress, macrosomia, polycythaemia, hypoglycaemia, hypocalcaemia, hypomagnesemia, and congenital malformations. As most of the oral hypoglycaemic agents is prone to cause teratogenic effects the most preferred was the insulin therapy and the subcutaneous insulin therapy has been considered as the standard therapy in the management of GDM. Aim: To assess the factors associated in the incidence of diabetes among the gestational diabetes mothers and to assess the effect of insulin on them in terms of maternal and foetal outcome. Methodology: A prospective study was undertaken among the gestational mothers with diabetes for a period of one year during Jan 2015 – Dec 2015 at the Government Medical College Hospital, Salem. A total of 150 maternal mothers with more than 24 weeks of gestation were included in the study and who had been diagnosed as gestational diabetes mellitus. The insulin used for majority of the patients was novo rapid and it was used four times a day. The outcome parameters which were used for antenatal mothers were their weight gain and the type of complications at the time of delivery whereas for the neonates their birth weight and the necessity for NICU admission were considered as the outcome parameters. Results: the risk factors found to be associated with the gestational diabetes among the study population were age more than 30 years, BMI of more than 25, family history both father and mother being diabetic, having a bad obstetric history, primigravida and the mothers who had gained more than 7 kgs in the first two trimesters. majority of the mothers delivered macrosomia babies (29.3%), hypoglycaemia and hypothyroidism was found only in 6% and 5.3% of the new-born babies and 4 were still births and 15 babies were got admitted to NICU for respiratory distress. The pearson’s correlation had shown a strong positive correlation between the dose of the insulin given to the antenatal mother and their increase in the weight (r=0.819) and a strong negative correlation with the weight of the neonate (r= -0.532). Conclusions: Gestational diabetes mellitus being associated with maternal and neonatal adverse outcomes, so maintaining adequate blood glucose levels in GDM helps in reducing the morbidity for both the mother and baby. Insulin would be a right choice for treating GDM and when initiated early it prevents most of the complications due to GDM both in the mother and the neonate.

Prevalence of fungal infections among diabetic foot ulcer patients in a rural area in south India.

Introduction: Infections among the diabetic patients play a vital role in the morbidity and to an extent mortality of the diabetic patients. Among the bacteriology of diabetic foot ulcers which had been documented by various researchers mixed aerobic - anaerobic microbes seems to be more common. Fungal infections among immunocompromised patient’s particularly diabetic patients are one of the major health concern in the world today. Very few studies in India was previously done on assessing the magnitude of fungal infections in diabetic foot ulcers particularly among the rural patients. This study was undertaken to assess the prevalence of infections among the diabetic patients with foot ulcers and see for the presence of fungal infections and to describe the spectrum of those fungal infections. Material and Methods: A prospective study was carried out on diabetic patients with foot ulcer during the period of 1 year from June 2014 – May 2015 at Thanjavur medical college. A total of 100 cases with diabetic foot ulcers were included for the study. The power of the study was kept as 89.7%, which was calculated by using the formula of Z power = test statistics/ S.E – 1.96. Where the test statistics was taken as 0.2and the SE was taken as square root of 0.5/n and where n= 100. Specimens (pus, wound, exudates or tissue biopsy) for microbiological studies were obtained from the ulcer region. All the 100 specimens were immediately transported to the microlab for further processing, culture and isolation. Identification of the microorganisms were done according to the standard microbiological procedures. Results: Among the study subjects males constitutes to 83% and females 17%. The mean random blood sugar among the subjects was 316.35±54 mgs/dl. The average duration of the foot ulcer among the study subjects was 13±7.58 months. Of the various microorganisms which was found in the foot ulcer bacterial agents were present in almost 100% of the patients. The fungal growth was seen in 29% of the patients with foot ulcers. The most common fungus identified were Aspergillus flavus (17%), Aspergillus fumigates (5%), Candida albicans (6%) and Mucor (1%). Conclusions: The present study insists on the evaluation of fungal pathogen for long standing diabetic foot ulcers even after effective treatment with antibacterial agents.

Fasciolopsiasis: Endemic focus of a neglected parasitic disease in Bihar.

Purpose: To describe a newly discovered, previously unreported endemic focus of fasciolopsiasis in the Phulwaria village, under tehsil Sugauli, East Champaran, Bihar. Materials and Methods: A study was conducted at village Phulwaria, following diagnosis of fasciolopsiasis in three children from the village. A total of 120 individuals, including all the children and adults who gave history of recent passage of red fleshy masses in their stool, were included in the study. The cases of fasciolopsiasis were treated with Praziquantel 25 mg/kg, three doses a day. Risk factors for the transmission of the parasite in the village were also studied. Results: Questionnaire revealed majority of the population suffering from abdominal discomfort and passage of red fleshy masses in stool. These fleshy masses were identified as Fasciolopsis buski. One hundred and eighteen individuals were presumably considered as cases of the parasitic infection. After treatment with Praziquantel, all of them passed the parasite in their stool for the next 2–3 days. On investigating, it was observed that all the conditions required for effective continuation of the life cycle of the parasite were present in this village. Conclusion: This study draws attention to a new endemic focus of fasciolopsiasis in Bihar, with a very high prevalence due to poverty, the lack of awareness about the parasite in villagers as well as ignorance among local medical practitioners. There is an urgent need for mass campaign around the region for its effective control.

Clinical and Laboratory Evaluation of Patients with Fever with Thrombocytopenia.

Aims: To evaluate clinical profile of fever with thrombocytopenia. To identify the causes of fever with thrombocytopenia. To assess the clinical complications associated with fever and thrombocytopenia. Material and methods: This study was done on patients, who were admitted to Sir T. Hospital and Government Medical College, Bhavnagar, Gujarat. We prospectively collected a series of 100 patients with fever and thrombocytopenia. Results: Age and sex distribution; In this study male out numbered female. Platelet count and bleeding; Of 100 patients four had bleeding manifestations. There is no correlation between platelet count and bleeding. Degree of thrombocytopenia in various diseases; (1) Viremia; Among infectious cases viremia including dengue accounted for the vast majority. In this study out of 100 cases viremia including dengue accounts for 52 cases. (2) Dengue; In our study dengue caused severe thrombocytopenia. Twenty patients out of 40 cases had count <50,000/mm3. (3) Malaria; In our study malaria caused mild-to-moderate thrombocytopenia with counts remaining between 50,000 to 1 lacs in most cases. Bleeding manifestations; In our study, out of 100 patients only four patients presented with bleeding manifestations. Three patients of mixed Plasmodium vivax with Plasmodium falciparum malaria presented with petechie, purpura and hematuria. One patient of dengue presented with gum bleeding. Platelet count and fever; In this study, shortest duration of fever is three days and longest is 10 days. Platelet count started increasing from 2nd day of admission to 8th day of admission with relative treatment. Enteric fever; In our study out of 100 patients three had fever with thrombocytopenia without any bleeding manifestations.

Improving access to innovative medicines in emerging markets: evidence and diplomacy as alternatives to the unsustainable status quo

Introduction: Access to medicines is a substantial component of universal health coverage. However, the current dynamics between the innovative pharmaceuticals industry and governments in emerging markets are adversarial and may be counterproductive to sustainably increasing access to current and future patented medicines. Methods: This work is a review of public sources including white papers, news and peer-reviewed literature with a focus on mainstream approaches used by the pharmaceutical industry (such as unaffordable price premiums for innovative medicines) and governments (such as denial of intellectual property rights) to support their interests. We assess the need for consensus-based approaches as alternatives to the above policies and review country cases with supporting evidence. We also explore the implications of possible approaches on pharmaceutical policy in the context of global health diplomacy. The latter is a requirement for universal health coverage given the increasing power of state and non-state actors in emerging markets. Results: We conclude that evidence and due processes, through inclusive and transparent priority-setting mechanisms, offer a reconciliatory way forward for both parties. Value-based pricing, underpinned by Health Technology Assessment (HTA), could leverage global health diplomacy to set priorities and resolve the perhaps unsustainable status quo. HTA is itself a diplomatic, consensus building and evidence-based approach that can help diffuse the current tension, enhance mutual understanding and perhaps help strengthen (or even mend) the current model of product development. Discussion: Value-based pricing and HTA offer a potential priority setting mechanism that can serve as a transparent, non-adversarial platform for governments and the pharmaceutical industry to engage with each other and work towards enhancing access to medicines. Further quantitative research, exploring the impact of different policy-setting approaches by governments on medicine access using HTA, would strengthen this discourse.

Health status of elderly population in rural area of Varanasi district.

In order to assess the health problems of the elderly people and its relationship with advancement of age, a field based cross sectional study was carried out in two selected villages in the rural field practices area in Varanasi district. 88.8 % were found to suffer from one or more illness at the time of study. This resulted in the morbidity load of 1.93 illnesses per person. The morbidity was directly proportional to the age. The most common morbidity was arthritis with overall prevalence of 57.08% followed by cataract (48.33%), hypertension (11.25%). But the prevalence of old age related morbidities increased with advancing age (p<0.008). Compared to married people higher percentage of widow / widower (91.5%) suffered from old age related morbidities (p<0.01).

Effect of the 5-HT3 receptor antagonist ondansetron on amphetamine-induced hyperactivity and stereotypy in rats.

The effects of different doses of ondansetron (0.1, 0.5, 1, 2 mg/kg) administered intra-peritoneally were studied on amphetamine-induced hyperactivity and stereotypy in wistar rats. Ondansetron was administered 30 minutes prior to d-amphetamine (3 mg/kg, i.p.). Ondansetron in doses of 0.5 and 1 mg/kg significantly decreased the mean number of head dippings and crossings in the hole board test and in doses of 0.1 and 0.5 mg/kg significantly decreased the average stereotypic score. Since the hyperactivity and stereotypy are dopamine mediated, the effect of ondansetron to reduce these states suggests a potential role for ondansetron in conditions with dopamine excess.

Effects of long-term thyroid hormone suppressive treatment on the cardiac functions.

Long-term effects of thyroid hormone suppressive therapy on the heart were evaluated in 45 patients by non-invasive techniques. Fifteen patients were athyreotic after surgery for differentiated thyroid cancer and 30 had diffuse or nodular goiter. Mean age of the group was 42 +/- 12 years. Twenty-four age- and sex-matched subjects were taken as controls. Mean daily dose of levothyroxine was 158 +/- 36 micrograms. Plasma thyroid stimulating hormone (TSH) levels were within normal range. Mean serum T4 and free T4 were significantly higher (p < 0.001) whereas mean serum T3 and free T3 did not differ from the control levels. Non-invasive cardiac assessment was done by a standard 12 lead electrocardiogram (ECG), ambulatory electrocardiographic (Holter) monitoring and echocardiographic study. Six patients had left ventricular hypertrophy in ECG. Holter monitoring demonstrated a higher average heart rate in patients compared to controls (86 +/- 10 vs 72 +/- 6 beats/min; p < 0.001). Supraventricular premature beats were more frequent in patients than in the control group (98% vs 60%; p < 0.06). Echocardiogram showed an increased left ventricular (LV) mass index in patient group (98 +/- 28 vs 78 +/- 16 gm/m2; p < 0.02). LV systolic function was increased with higher values of fractional shortening (40 +/- 8% vs 34 +/- 6%; p < 0.05) and rate-adjusted velocity of shortening (1.4 +/- 0.12 vs 1.02 +/- 0.16 circumferences/sec; p < 0.01). It is concluded that long-term levothyroxine suppressive therapy has significant effects on the cardiac functions.

Effect of haloperidol on phospholipid biosynthesis in rat brain.

Haloperidol, a butyrophenone used in the treatment of various psychoses has been clinically used and studied extensively. At the molecular level it is known to preferentially block D2 type of dopamine receptors but its other effects are unknown. We studied the effect of this drug on phospholipid biosynthesis in vitro by following incorporation of 32P into individual classes of phospholipids. It was observed that haloperidol inhibits the biosynthesis of almost all major phospholipids including phosphatidyl inositol at fairly low concentrations. It cannot be concluded from the present experiment which step the inhibition may be taking place but acyl transfer reaction is likely to be involved because the drug effects almost all the phospholipids. It is suggested that long-term use of the drug can effect the organization of synaptic membrane.

Effect of birth asphyxia on serum calcium levels in neonates.

Serum calcium and phosphorus levels were measured at birth, 6 hours, 24 hours, and on 5th day of life in 35 neonates with birth asphyxia (one-minute Apgar score of 6 or less), and in 37 neonates without asphyxia (one-minute Apgar score of 7 or more). Infants were divided into three groups: FT-AGA (n = 30, asphyxia = 15), FT-IUGR (n = 20, asphyxia = 10) and PT-AGA (n = 22, asphyxia = 10). Asphyxiated infants--FT-AGA as well as FT-IUGR--had significantly lower serum calcium levels than control infants during each of the time period studied. In PT-AGA infants with asphyxia, the serum calcium was significantly low only on 5th day of life. Lack of calcium intake, and hyperphosphatemia were identified as possible risk factors for low serum calcium in asphyxiated infants. No change in serum calcium levels was found in bicarbonate-treated asphyxiated infants in comparison to those who did not receive sodium bicarbonate. In view of the high incidence of low serum calcium in asphyxiated infants, serial monitoring of serum calcium levels is recommended in these infants.