Does Local Infiltration of Anesthesia Reduce Port-site Pain in Gynecological Laparoscopic Surgeries? A Pilot Study.

Objectives: The objectives of this study were to evaluate the visual analog scale (VAS) score in patients receiving port-site bupivacaine infiltration in gynecological laparoscopic surgeries and to compare it with those receiving placebo and to evaluate the additional analgesic requirement in the first 24 h after surgery. Materials and Methods: A prospective interventional study was conducted on 60 women scheduled for benign gynecological laparoscopic surgeries. Patients were randomized into two groups using an alternative sequential method of allocation. Approval from the Institute's Ethics Committee was sought. Informed written consent was taken from all the patients. All laparoscopic surgeries were performed under general anesthesia. Double-blinding was done. A VAS with a 10 cm vertical score ranging from "no pain" to "worst possible pain" was used to assess the postoperative pain when the patient awakened in the operating room (2 h after surgery), then after 6 and 24 h. The primary outcome measured was pain perception by the patient (as VAS scores), and the secondary outcome was the need for additional analgesia. Results: Comparison of both groups with the VAS score shows P > 0.001, i.e., nonsignificant in all the groups. Additional analgesics were required in 56% of the patients in the intervention group and 60% of the patients in the control group; however, 44% and 40% of the patients from the intervention and control groups, respectively, do not require any additional analgesic in the postoperative period. Conclusion: The local infiltration of bupivacaine does not significantly reduce the port-site postoperative pain in gynecological laparoscopic surgeries.

Choriocarcinoma of the Ovary Masquerading as Ectopic Pregnancy.

Choriocarcinoma of ovary is a rare aggressive tumor of ovary. It may be gestational or nongestational tumor. High index of suspicion is required for diagnosis in reproductive age group females. Here, we present a case report of a 30-year-old female who was operated for ectopic pregnancy but was diagnosed as ovarian choriocarcinoma on histopathology. The patient had abnormally high beta-human chorionic gonadotropin levels with history of amenorrhea and negative urine pregnancy test. On laparotomy, a mass of 8 cm × 10 cm was found which was confirmed as choriocarcinoma on histopathological examination. The patient was managed with chemotherapy and responded well to treatment.

Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation Score and BAP-65 Score, Tools for Prediction of Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Comparative Pilot Study.

INTRODUCTION: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) being common and often fatal, prognostic tools in AECOPD are lacking. MATERIALS AND METHODS: A prospective, observational study was carried out in fifty patients of AECOPD admitted in A and E department. Dyspnea, Eosinopenia, Consolidation, Acidemia and atrial Fibrillation (DECAF) score and elevated blood urea nitrogen, altered mental status, pulse >109, age >65 (BAP-65) score were calculated. Dyspnea was scored using extended Medical Research Council Dyspnoea score. Data were collected and analyzed using SPSS 17.0 software. RESULTS: Forty-one patients were discharged and 9 (18%) died during treatment. Patients who were discharged and patients who died during hospital stay were compared. There was no significant difference in terms of sociodemographic variables, presence of comorbidities, and other markers of disease severity. A significant difference was found in blood counts, blood urea, serum creatinine, acidotic respiratory failure, and atrial fibrillation. A higher value of DECAF score and BAP-65 score was found more commonly in patients who died. Sensitivity for prediction of mortality for DECAF score and BAP-65 score was 100% and specificity was 34.1% and 63.4%, respectively. Sensitivity for prediction of need for invasive ventilation for DECAF score and BAP-65 score was 80% and 100%, respectively, and specificity was 80% and 60%, respectively. CONCLUSION: Both DECAF and BAP-65 scores were found to be good predictors of mortality and need for ventilation in this pilot study.

Hypertension in Pregnancy.

Hypertensive disorders of pregnancy remain an unresolved and unpreventable problem in obstetrics. They remain one of the leading member of deadly triad causing maternal mortality, the other two being hemorrhage and sepsis which are preventable. The incidence of hypertensive disorders worldwide is 12 %. We have discussed various terminologies used to describe hypertension during pregnancy, risk factors, etiopathogenesis, pathophysiology, management guidelines, complications and long term consequences of hypertensive disorders of pregnancy in this chapter.

Association of early maternal hypertriglyceridemia with pregnancy-induced hypertension.

BACKGROUND: Hypertensive diseases are directly responsible for 24 % of maternal deaths in India. A screening method is yet to be discovered to reduce the morbidity and mortality related to it. Serum triglyceride (TG) levels are reported to increase in hypertensive pregnant women. AIM: To predict pregnancy-induced hypertension (PIH) by serum triglyceride values. METHOD: This study is a prospective cohort study that was conducted over three hundred normotensive, primigravida women with singleton pregnancy at 14-20 weeks of gestation. These were divided into two groups on the basis of their TG concentration estimated at 14-20 weeks of gestation. The pregnancy was then followed till delivery and, signs and symptoms of PIH were noted in both the groups. RESULTS: Out of 300 women, 210 women completed the study. Fifty-nine women developed PIH and 151 women remained normotensive. Among 59 women, 45 women had raised TG values i.e., ≥160 mg/dL and 14 women were with normal TG levels i.e., <160 mg/dL. A significant positive correlation was found between serum TG concentration and systolic and diastolic blood pressure. It was observed that a cutoff of 162.50 mg/dL for TG could reliably predict PIH with sensitivity of 76 % and specificity of 85 %. Also, the mothers with hypertriglyceridemia were found to be at higher risk of developing early-onset PIH. CONCLUSION: Our study supports the evidence that early pregnancy hypertriglyceridemia is associated with an increased risk of PIH.

Harlequin icthyosis: report of one case.

Harlequin icthyosis is a rare extremely severe autosomal recessive dermatosis. The appearance of newborn can be shocking to parents and health care providers. Prenatal diagnosis is possible only with great suspicion and can often be missed. To our knowledge only 100 cases have been reported so far, we report one case of harlequin icthyosis.