Effect of a novel technique of posterior reconstruction of pubourethralis on 'early' return of continence after robot assisted radical prostatectomy (RARP): A comparative study.

OBJECTIVE: To study the effect of a novel technique of posterior reconstruction of pubourethralis on early return of continence after robot assisted radical prostatectomy (RARP). MATERIALS AND METHODS: The study included 206 patients of organ confined prostate cancer managed at our centre between March 2014 and December 2018.The patients were randomly distributed into two comparable groups with respect to age, height, weight and BMI, with 100 patients in control and 106 patients in study group. After standard excision of the specimen, the posterior reconstruction in the form of Rocco stitch was done in control group while in addition to Rocco stitch pubourethralis was approximated posteriorly in midline at the proposed site of vesicourethral anastomosis in study group. Continence was defined as the need to use 0-1 pad in 24 h. The data was collected on day 0, 3, 7, 15, 30, 90 and 180 after removal of catheter. RESULTS: At day zero, 3,7, 15, 30, 90 and 180 days after catheter removal continence rates (⩽1 pad usage per day) were observed to be 18.8% versus 0%, 22.6% versus 0%, 50.9% versus 5%, 72.6% versus 20%, 84.9 versus 32%, 97.1% versus 83%, and 97.1% versus 91% in the study and control group respectively. CONCLUSION: Despite small number of patients in this study the results with respect to early return of continence are encouraging in the reconstruction group and there by in favour of this technique .Furthermore the technique is easily reproducible and may be seen as one more additional step to be applied in order to enhance the recovery of continence after RARP. However it is necessary to further validate the efficacy of this procedure through multicenteric controlled trials.

Evaluation of paperless partogram as a bedside tool in the management of labor.

INTRODUCTION: The partogram has been heralded as one of the most important advances in modern obstetric care. However, some healthcare practitioners, especially in high-income countries, have questioned its effectiveness. The purpose of this study is to evaluate prospectively the use of a paperless partogram as a bedside tool in the management of labor. MATERIALS AND METHODS: Women were invited to participate in the trial if they were at 36 to 42 weeks of gestation, and carrying a singleton pregnancy, with a cephalic presentation. All women who met the criteria and gave informed consent were included in the study till the required sample size of 91 was obtained. Progress of labor was monitored on the basis of Alert estimated time of delivery (ETD) and Action ETD. At the time of the Action ETD, if woman had not yet delivered, a diagnosis of abnormal labor was made and arrangements were made for emergency obstetric care. RESULTS: Out of 91 women who participated in the study 55 (60%) were primigravida and 36 (40%) were multipara. The mean age of the participants was 25.36 years and the mean duration gestation was 281.9 days. The mean duration for delivery after Alert ETD was 4.3 hours. In our study, out of 91 participants, labor was induced only in 13% of the cases. The mean duration for delivery after Alert ETD was 4.7 ± 1.9 hours in the primigravida and 3.7 ± 1.8 hours in multipara, but these differences were not statistically significant. CONCLUSION: In our study, the paperless partogram was found to be convenient and effective in the management of labor. The mean duration for delivery after Alert ETD was 4.3 hours in our study, which was similar to the World Health Organization's (WHO) recommendation for partograms, with a four-hour action line, denoting the timing of intervention for prolonged labor.

Efficacy of single dose epidural morphine versus intermittent low-dose epidural morphine along with bupivacaine for postcaesarean section analgesia.

BACKGROUND: Obstetric anesthesia presents a challenge to the anesthesiologist. The effective pain management allows the partu-rient adequate degree of comfort and promotes physical reco-very and a sense of well being. MATERIALS AND METHODS: This randomized controlled study was designed to assess the analgesic efficacy and side effects of 1.20 mg single-dose epidural morphine (Group 1) versus intermittent 12 hourly epidural morphine (0.5 mg) with bupivacaine (Group2) for postoperative analgesia in lower segment caesarean section cases. RESULTS: Each group consisted of 36 patients. Demographic characteristics of two groups were comparable and differences among them were not statistically significant. Mean duration of analgesia was significantly longer in group one patients (16.5±2.5h) in comparison to group two patients (11.5±1.5h). Mean highest visual analog scales (VAS scale) was significantly lower (3.2±0.9) in group one patients in comparison of group two (6.7±0.8) patients. Only 43% patient in group one required supplementary perenteral analgesic (Paracetamole/Diclofenac) and 71% required epidural morphine/bupivacaine in group two. Mean number of supplementary perenteral analgesic required in group one was 0.7 and it was 1.8 in group two. There was no significant difference in nausea, vomiting, itching, and pruritis in two groups of patients. CONCLUSION: Our study showed that the use of single dose epidural morphine is associated with lower pain scores at rest and movement when compared to intermittent epidural morphine with bupivacaine in postcaesarean section analgesia.

Comparative analgesic efficacy of buprenorphine or clonidine with bupivacaine in the caesarean section.

The need for early ambulation for caring of the neonate by mothers makes postoperative pain management after cesarean delivery unique. Favorable results have been observed with buprenorphine, clonidine and bupivacaine as epidural analgesics. This prospective, randomised triple blind control study was carried out among 112 lower segment caesarean segment (LSCS) patients, divided into three groups, to assess the analgesic efficacy and side effects of epidural analgesia, with an intermittent top up of (i) bupivacaine (0.125%) and buprenorphine (0.075 mg) (ii) bupivacaine (0.125%) and clonidine (37.5 microgram) and (iii) bupivacaine (0.125%) alone, in LSCS cases. The demographic characteristics (age, weight and height) of the three groups were comparable and the differences were not statistically significant. The mean duration of the analgesia was significantly longer in the group one patients receiving buprenorphine plus bupivacaine (690 ± 35 minutes) and it was lowest in group three patients receiving bupivacaine (170 ± 31 minutes) alone. The mean highest pain score (VAS scale) was significantly lower (3.4 ± 0.6) in group one patients and it was highest in group three (6.7 ± 0.8) patients. Requirement of continuation of epidural analgesia after 15 hours of operation and requirement of diclonfenac injections as well as incidence of itching and pruritus was significantly lower in group one patients. Incidence of nausea and vomiting was the lowest in group one patients. Incidence of respiratory depression, sedation and hypotension were nil in all three group of patients. Epidural buprenorphine combined with bupivacaine produced significantly longer duration and better quality of analgesia than bupivacaine combined with clonidine or bupivacaine alone, and it was safe in LSCS patients, for post-operative analgesia.

Efficacy of imidacloprid and fipronil gels over synthetic pyrethroid and propoxur aerosols in control of German cockroaches (Dictyoptera: Blatellidae).

BACKGROUND & OBJECTIVES: Resistance amongst cockroaches has been reported to most of the spray insecticides apart from the problem of food contamination and inconvenience. Gel baits which can be selectively applied have been found effective in control of cockroaches in laboratory studies but very few field studies are available. This trial was planned to evaluate the efficacy of fipronil (0.01%) and imidacloprid (2.15%) gels over synthetic pyrethroid (0.02% deltamethrin + 0.13% allethrin) and propoxur (2%) aerosols in control of cockroaches in the field. METHODS: Survey was done to find out pre-treatment density in catering establishments and houses by visual count and sticky trap methods. A total of 10 catering establishments and 10 houses having high cockroach infestation were selected by sampling (two catering establishments and houses for each insecticidal treatment and two for control). Propoxur and synthetic pyrethroid aerosols were used for spraying the infested sites once only. Single application of fipronil and imidacloprid gels was used as crack and crevice treatment. Visual count method gave better indications of cockroach infestation as compared to sticky trap method, hence, the same was followed for post-treatment evaluation every week up to 12 weeks. RESULTS: Synthetic pyrethroid could not bring about the desired reduction in cockroach infestation in the present study. Single application of fipronil gel was able to reduce cockroach infestation up to 96.8% at the end of 12 weeks whereas imidacloprid application resulted in 90.9% reduction and propoxur resulted in 77.5%. However, propoxur was more effective in reducing the cockroach density by first week in comparison to imidacloprid and fipronil gels but its efficacy started declining after 8th week. Difference was found statistically significant by Kruskal-Wallis H-test. CONCLUSION: The study reports the efficacy of propoxur aerosol, imidacloprid gel and fipronil gel baits for control of cockroaches.