Progress of labor and obstetric outcome in parturients with combined spinal-epidural analgesia for labor: A comparative study.

Background: Alleviation of labour pain is known to improve maternal and fetal outcome. Combined Spinal-Epidural (CSE) analgesia is an excellent method. Aim and objectives: In view of reports of its concerns on labour, this study was conducted to evaluate the progress of labour, obstetric outcome in cases with and without CSE analgesia, the maternal pain relief and fetomaternal adverse effects. Materials and methods: In this comparative study, 60 parturients were allocated into case and control groups of 30 each. CSE analgesia was administered utilizing 0.5 ml of 0.125% Levobupivacaine / 0.2% Ropivacaine with 2 mcg/ml fentanyl. Progress of labour was recorded in partogram including duration of labour, mode of delivery, pain relief - Visual Analogue Scale (VAS) score, development of motor block, maternal satisfaction and Apgar score. Data was analyzed by Descriptive and Inferential statistics. Results: Mean duration of first and second stage of labour among cases was 530±44.1 minutes, 61.5±12.7 minutes respectively and that of control was 526.6±64.9 minutes, 60±10.8 minutes respectively with no prolongation of labour P > 0.05. CSE analgesia did not alter the mode of delivery P=0.145 with rapid onset of pain relief. Apgar score was normal in both groups. Total 29 (97%) parturients experienced effective labour analgesia following CSE analgesia with VAS score 0. Maternal adverse effects included pruritus, transient initial motor blockade and post spinal headache. Conclusion: CSE analgesia did not affect the duration of labour, mode of delivery with minimal fetomaternal adverse effects and provides rapid onset of pain relief . CSE analgesia can be considered for safe and effective labour analgesia.

RésuméContexte: Le soulagement de la douleur du travail est connu pour améliorer les résultats maternels et fœtaux. L'analgésie rachidienne-épidurale combinée (CSE) est une excellente méthode. But et objectifs: Au vu des rapports de ses préoccupations sur le travail, cette étude a été menée pour évaluer la progression du travail, les résultats obstétricaux dans les cas avec et sans analgésie CSE, le soulagement de la douleur maternelle et les effets indésirables fœto-maternels. Matériels et méthodes:Dans cette étude comparative, 60 parturientes ont été réparties dans des groupes cas et témoins de 30 chacun. L'analgésie CSE a été administrée en utilisant 0,5 ml de Lévobupivacaïne à 0,125 % / Ropivacaïne à 0,2 % avec 2 mcg/ml de fentanyl. La progression du travail a été enregistrée dans le partogramme, y compris la durée du travail, le mode d'accouchement, le soulagement de la douleur - le score de l'échelle visuelle analogique (EVA), le développement du bloc moteur, la satisfaction maternelle et le score d'Apgar. Les données ont été analysées par des statistiques descriptives et inférentielles. Résultats: La durée moyenne des premier et deuxième stades du travail parmi les cas était de 530 ± 44,1 minutes, 61,5 ± 12,7 minutes respectivement et celle du contrôle était de 526,6 ± 64,9 minutes, 60 ± 10,8 minutes respectivement sans prolongation du travail P > 0,05. L'analgésie CSE n'a pas modifié le mode d'accouchement P = 0,145 avec un soulagement rapide de la douleur. Le score d'Apgar était normal dans les deux groupes. Au total, 29 parturientes (97 %) ont subi une analgésie efficace du travail après une analgésie CSE avec un score EVA de 0. Les effets indésirables maternels comprenaient un prurit, un bloc moteur initial transitoire et une céphalée post-rachidienne. Conclusion: L'analgésie CSE n'a pas affecté la durée du travail, le mode d'accouchement avec des effets indésirables fœto-maternels minimes et procure un soulagement rapide de la douleur. L'analgésie CSE peut être envisagée pour une analgésie du travail sûre et efficace. Mots-clés: Césarienne, analgésie du travail, résultats du travail, parturition.

Bilateral Abducent Palsy in Leptospirosis- An Eye Opener to a Rare Neuro Ocular Manifestation: A Case Report.

Leptospirosis, a disease of great significance in tropical countries, presents commonly as a biphasic illness with acute febrile episode in the first phase followed by a brief afebrile period and then by the second phase of fever with or without jaundice and renal failure. However, it has varied manifestations and unusual clinical features ascribed to immunological phenomena can occur due to the additional involvement of pulmonary, cardiovascular, and neurological systems. Among the various neurological features, aseptic meningitis is the most common myeloradiculopathy, myelopathy, cerebellar dysfunction, transverse myelitis, Guillain-Barre syndrome, optic neuritis, peripheral neuropathy hare also described. Cranial neuropathy involving facial nerve is a rare, but known neurological manifestation. Sixth nerve palsy in neuroleptospirosis has so far not been reported. We hereby present the occurrence of bilateral abducent nerve palsy in a patient with leptospirosis.

A Comparative Study of Epicardial Fat Thickness and its Association with Abdominal Visceral Fat Thickness in Obese and Nonobese Type 2 Diabetes Subjects.

CONTEXT: The concept of visceral fat and its role in various metabolic disorders is well-known. Epicardial fat (EF) is also visceral fat, and very few studies are done, especially in the Indian subcontinent. AIMS: To study and establish the relationship of EF thickness (EFT) and abdominal visceral fat thickness (VAT) in obese and nonobese type 2 diabetics and to evaluate the usefulness of EFT as a marker of visceral adiposity. SETTINGS AND DESIGNS: This cross-sectional study was carried out in the Department of Medicine, JSS Hospital, Mysore, India, between October 2012 and October 2014. MATERIALS AND METHODS: A total of 68 patients were studied. Patients underwent transthoracic echocardiography and ultrasound abdomen. EFT and VAT were measured. STATISTICAL ANALYSIS: SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) was used. T-test used for comparing quantitative variables. Correlation analysis was done using Pearson correlation test. P ≤ 0.05 was considered statistically significant. Kruskal-Wallis and Mann-Whitney test were used for analysis. RESULTS: The mean value of EFT was 5.92 mm, 7.43 mm, 12.97 mm, 11.27 mm, and 13.8 mm for nonobese, obesity Grade I, II, III, and morbid, respectively (P < 0.0001). The mean EFT between nonobese and obese diabetics was 5.92 mm and 10.2 mm, respectively (P < 0.0001). The mean VAT between nonobese and obese diabetics was 16.58 mm and 38.53 mm, respectively. EFT was significantly correlating with VAT in obese diabetics. CONCLUSION: EFT and VAT were significantly correlated among obese diabetics while not significantly correlated among nonobese diabetics, suggesting obesity is an independent risk factor for visceral adipose tissue deposition both in abdomen as well as in epicardial surface.

A case of acute on chronic uterine inversion with fibroid polyp.

Chronic nonpuerperal inversion of the uterus is uncommon and is usually associated with a fundal submucous myoma extrusion. We report herewith the case of a young lady with hitherto asymptomatic long standing mass per vagina presenting acutely with vaginal bleeding and shock. The mass was a uterine myoma. She underwent hysterectomy in view of extensive necrosis.