Impact of increased rate of caesarean section on perinatal outcome: sociolegal evaluation.

Sharp rise in the caesarean section rate, over the past years has been causing lot of concerns. It is to be evaluated whether the decrease in perinatal mortality rate is due to the rising rate of caesarean section. Five hundred consecutive patients were selected on whom caesarean section had been performed. Both mother and baby were followed till they are discharged from the hospital. Foetal distress was the commonest indication in primigravidae who underwent caesarean section. The other indications of caesarean section in this study were breech, severe pre-eclampsia, eclampsia, cord prolapse, elderly primi, postdated, premature rupture of membrane, twin, compound presentation, meconium stained liquor. The occurrence of perinatal morbidity in caesarean section was 10% compared to 12% in vaginal delivery. Common causes of perinatal morbidity were asphyxia, prematurity, diarrhoea, septicaemia, jaundice, conjunctivitis and scalp injury. The occurrence of perinatal mortality in caesarean section was 3.8% compared to 3% in vaginal delivery. Causes of perinatal mortality were stillbirth, meconium aspiration syndrome, hypoxic ischaemic encephalopathy, prematurity and congenital malformation. In spite of safety of vaginal birth after caesarean section it continues to be underutilised. Good perinatal care proper screening and use of newer effective pharmacological agents improve the maternal progress as well as perinatal outcome without increasing the caesarean section rate.

Trends to access internet among medical students of a government medical college in West Bengal.

The use of computer and information technology is on an escalation. The internet, one of the key developments in this field, provides instant access to latest medical information. The present study was conducted (i) to estimate the extent and purpose of internet usage among undergraduate (UG) and postgraduate (PG) medical students, (ii) to identify factors that encourage the students to use internet for medical information, (iii) to assess the need for incorporating computer education in medical curriculum. A prospective, cross-sectional, questionnaire-based study was conducted on 150 students of Burdwan Medical College and Hospital between June 2009 and December 2009. Majority of the students accessed internet from their home PC (42% UGs and 52% PGs).Common search engines browsed commonly by both UGs and PGs include Google and yahoo. Regarding principles of telemedicine and evidence-based medicine, majority of the PGs are well versed while UGs are not (p-value 0.0001). Almost all students agreed to incorporate computer education in medical curriculum. Primary source of medical information was textbook for UGs (62%) and internet for the PGs (48%). Majority of UGs (48%) used internet as a ready source of information thus saving time while PGs (68%) primarily relied on internet for recent advances in their disciplines. The primary purposes of internet use are educational for both UGs and PGs. The data obtained indicates that majority of the medical students participating in the present study embrace and use internet to access medical information. It also justifies the need to incorporate internet and associated information technology into existing medical curriculum.

Isolated ascites in hypothyroidism: medical and ethical issues.

Hypothyroidism presenting as ascites is one of the rarest clinical scenarios encountered in medical practice. A case of a 65-year-old woman, presenting with progressive onset ascites, secondary to underlying hypothyroidism, which responded to thyroid hormone replacement therapy is reported. A feature of hypothyroidism Induced ascites is the high protein content of the ascitic fluid (> 2.5 g/dl), a high serum albumin ascites gradient (SAAG) and the consistent drastic response of ascites to thyroid hormone replacement. Hypothyroid ascites is thus a very rare manifestation of the primary disease, but should be borne in mind when other causes of ascites are ruled out and the ascitic fluid shows typical features.

Pharmaco-epidcemiology of drugs utilised for cataract surgery in a government medical college and hospital.

Prescription audit is a powerful tool for rational prescription. To evaluate pharmaco-epidemiology of drugs utilised for cataract surgery, a retrospective study was conducted in the department of pharmacology, RG Kar Medical College, Kolkata. Data from bed head tickets of one year, available in medical record section, were collected in case report forms and analysed. Utilisation pattern of drugs like dosage form, dose, route and frequency of administration and duration of therapy were audited. Drug prescription versus therapeutic indication was also evaluated. Price of the prescribed drugs was evaluated for rationality towards cost-effective prescription. For 848 cases of cataract surgery, drugs were prescribed pre-, per- and post-operatively. Different fluoroquinolone antibiotics, anti-inflammatory and mydriatic-cycloplegic agents were prescribed. High or low cost drugs were prescribed both in generic (52%) and brand (48%) names. Few Latin abbreviations were used in directions. Different parameters and study results were discussed from various aspects to explore their social impacts. Though prescription pattern was almost rational, some parts need improvement. Healthcare provider should be aware of cost-effectiveness of the prescribed drugs for the benefit of patients to provide a rational prescription.

Deep vein thrombosis.

Occlusive clot formation in the veins causes venous thrombosis, the site most common in the deep veins of leg, called deep vein thrombosis. The clot can block blood flow and when it breaks off, called an embolism which in turn can damage the vital organs. Venous thrombosis occurs via three mechanisms ie, Virchow's triad. The mechanisms are decreased flow rate of blood, damage to the blood vessel wall and an increased tendency of the blood to clot. There are several factors which can increase a person's risk for deep vein thrombosis. The symptoms of deep vein thrombosis in the legs are pain, swelling and redness of the part. One variety of venous thrombosis is phlegmasia alba dolens where the leg becomes pale and cool. Investigations include Doppler ultrasound examination of the limb, D-dimer blood test, plethysmography of the legs, x-rays to show vein in the affected area (venography). Hospitalisation is necessary in some cases with some risk factors. The mainstream of treatment is with anticoagulants, mostly low molecular weight heparin for 6 months. Deep venous thrombosis is a rising problem. Early diagnosis and treatment is associated with a good prognosis.

Study of victims of organophosphorus compound poisoning: evaluation after medicolegal autopsy.

Indiscriminate use of organophosphorus compounds (OPC) increases the potential threat of self-poisoning and death. To make a conclusive diagnosis on academic interest a retrospective record-based study was undertaken. Postautopsy studies were carried out on 100 victims of OPC poisoning by collecting data from following 3 sources: Medicolegal autopsy reports, inquest reports, and inpatient case sheets. Mode of ingestion of OPC was to commit suicide. Incidence was more in 20 to 30 years age group, in females and in urban area. Diagnosis was confirmed by history of poison exposure, clinically well-defined cholinergic effects, and characteristic autopsy findings. Early and correct identification of the cause of poisoning enables specific treatment. Restrictions on access of very toxic pesticides through national policies and enforcement, public education on storage and safe use, early recognition of poisoning, and appropriate medical management may reduce the incidence of poisoning and death.

Profile of postmortem cases conducted at a morgue of a tertiary care hospital in Kolkata.

A record based cross-sectional study of postmortems performed at the mortuary attached to the forensic medicine and toxicology department of RG Kar Medical College and Hospital from March 2008 to February 2009 comprising 1900 cases was conducted to determine the sociodemographic profile and to assess the nature and cause of such deaths. Bodies of 5 foetuses were decomposed which were excluded from the study. Out of a total of 1895 postmortems analysed, 23 autopsies were performed of limbs where the subjects were alive. Out of 1872 cases in 325 (17.4%) the manner of death was natural, whereas in 1547 cases (82.6%) it was unnatural. Accidents, suicides, homicides and undetermined deaths were 63.1%, 29.8%, 2.8% and 4.3% respectively. Among the natural deaths, evidence of pulmonary tuberculosis and coronary heart disease was found in 141 (43.4%) and 124 (38.2%) cases respectively. Burn injuries (22.6%) were the most common cause of unnatural deaths and occurred in 77.4% females. Rail track injuries and road traffic injuries were responsible for 21.9% and 14% of unnatural deaths. Hanging, poisoning and self-immolation were responsible for 48.4%, 28.9% and 19.7% of suicidal deaths respectively.

Recovery of a bundle of bones leading to unveiling of a murder mystery.

A bundle of bones, packed in a gunny bag, was detected by the villagers in a jungle situated in Bankura, West Bengal. After thorough autopsy, it revealed that the bones belonged to a male person aged 25 +/- 2 years of stature 167.5 +/- 5 cm. It also revealed that the person was a chronic smoker and his cause of death was head injury, probably homicidal in nature. Subsequent investigation by police unveiled a gruesome incidence of killing a man by his wife and her paramour.