Perimortem caesarean delivery (PMCD)

When a woman in late pregnancy has cardiac arrest and resuscitation fails, should an attempt be made to deliver the baby by Caesarean section? Many obstetricians would hesitate to operate in these circumstances for fear of delivery a baby who survives but shows profound neurological handicap. Obstetricians need to have a clear view on whether and when to operate in such cases. Here we report two cases of PMCD.

Heritability variations of morphometric traits in West Bengal (India) children aged 4-19 years: a mixed-longitudinal growth study

BACKGROUND

Longitudinal and semi-longitudinal growth studies on siblings reflecting heritability changes during growth are very scarce. Moreover, studies of variables other than height, weight and BMI are virtually non-existent.

AIM

The study compared changes in the heritability of six body lengths, four body breadths, and three indices between ages 4 and 19 years on the basis of a mixed-longitudinal sample of siblings, and examined whether heritability estimates change during the growth period. The data consisted of 238 brothers and 214 sisters from 134 middle-class nuclear families living in Kolkata (India). The analysis of sibling correlation was performed by maximum likelihood. The age-related patterns of heritabilities of the various traits were described by a cubic spline.

RESULTS

The heritability was very high and significant in most traits, and at all considered ages. Mean heritability in the 10 morphometric traits was 69.3%, which was higher than the heritability values for the three indices.

CONCLUSIONS

These results confirmed the existence of age-related trends in heritability of the considered morphometric traits. The sharp decline of the heritabilities at adolescence in most of the morphometric traits, and the acromio-iliac index in particular, may be due to the large inter-individual variation in the age at which the adolescent growth spurt is reached in both sexes.

Patients choice for method of early abortion among comprehensive abortion care (CAC) clients at Kathmandu Medical College Teaching Hospital (KMCTH)

OBJECTIVE

The over all objective of the study was to determine different methods of abortion opted by CAC clients at KMCTH. The specific objective of the study was to know the reasons for pregnancy termination and to know the reasons opted for either medical or surgical method of abortion.

METHODOLOGY

A hospital based prospective study was carried out for a period of six months at KMCTH from 1st January 2006 to 31st June 2006. All the patient undergoing CAC services were included for the study. Clients were provided with written and verbal information regarding the methods of terminating early abortion and its associated complications. After that they were asked to give their informed choice and decision. All the pertinent information was entered on pre-structured questionnaire.

RESULTS

During the study period a total of 100 patients underwent CAC services. The commonest reason for termination pregnancy was no desire for additional children (60%) followed by youngest child too small or short spacing (21%). 74% of the patients opted for surgical abortion, 23% patient opted for medical abortion and 3% of the patient remain undecided. Reasons for favouring surgical method of abortion was that surgical abortion is complete (35), repeated visits are avoided (18), quick (10) would be with service provider and feel safe (5), lack of expectancy (2) side effect of medical treatment (1), twin pregnancy (1), easy (1), fear of pain (1). Medical method of abortion was favoured due to fear of surgery (9), easy and less painful (8) and maintains privacy (6).

CONCLUSION

Factors affecting the choice of abortion method appear to be numerous and complex. Providers need to be sensitive to differences in women's values and life circumstances when counselling them about an abortion method. In particular, providers should incorporate into their counselling sessions what women need to know about the characteristics of abortion methods and help women to identify what is the best option for them. Key words: Early abortion medical methods, surgical methods, choice.

Disseminated nodular granulomatous perifolliculitis

Nodular granulomatous perifolliculitis is a well-recognized infection of the dermal and subcutaneous tissue caused by dermatophytes, which normally do not invade beyond the epidermis. We report here one such case that occurred in an immunosuppressed individual. The patient was a 35-year-old farmer who presented with small pruritic eruption that had initially appeared on the lower leg and then had gradually spread to hair-bearing areas of the body, finally producing nodular and pustular inflammatory lesions with exacerbations and remissions. Fungal examination by direct potassium hydroxide mount and culture revealed Trichophyton rubrum. Granulomatous changes were seen on histopathological examination. The patient completely responded to systemic antifungal therapy.

Assessment of noise level in Burdwan town, West Bengal

Cities and towns of the world are now facing enormous rise of noise pollution problem due to very high population rise, transport congestion and associated commercial and industrial activities. Burdwan, a district headquarter (100 km away from Kolkata) is one such town where noise pollution is very frequent. In order to assess noise level, noise data were collected from various places of the town by sound level meter with a duration of 30 minutes/location during specified time like 6.00 am, 10.00 am, 1.00 pm, 4.00 pm and 6.00 pm. Most of the monitoring places either belongs to silence category or commercial category areas. From the tabulated data, it was found that sound level lies within the range of 64-85 dB or above in different time at different places. The locations that belong to the silence zone have the noise level up to 90 dB. Statistically noise level in all these zones differ significantly at their peak hours. Noise pollution adversely affects our environment as well as human beings. Sound causes both pathological and psychological disorders in human beings. Implementation of rules and regulations under section 20, 21J, 41, 68(I), 70, 90, 111A of Environment Protection Act, 1986 and of course various technological methods and public awareness are very essential to check noise pollution in Burdwan town.

The impact of an IEC campaign on tuberculosis awareness and health seeking behaviour in Delhi, India

OBJECTIVE

To study the impact of an intensive IEC campaign regarding the Revised National Tuberculosis Control Programme launched by the Government of Delhi on awareness generation among the general population and improvement in self-reporting by symptomatic cases in Delhi, India.

DESIGN

Cross-sectional study.

RESULTS

A pilot study wherein 1008 persons selected by systematic random sampling from the general population and 1012 patients selected from symptomatic cases reporting to DOTS centres were interviewed. Among the general population, 716 (71.0%) had been exposed to one or more IEC message through the media. The core message regarding symptoms, diagnosis, treatment centre and free treatment was recalled correctly by 144 (14.3%), 449 (44.5%), 659 (65.4%) and 900 (89.2%), respectively. In the post IEC period, a significant increase (P < 0.01) was seen in individuals self-reporting with symptoms to DOTS centres: the media message reportedly encouraged 36.3% of these to self-report. Prior to the IEC campaign only 49 (9.8%) patients had chosen a DOTS centre as first source of treatment, which increased significantly (P < 0.0001) to 104 (20.4%) post IEC.

CONCLUSION

The IEC campaign launched by the Government of Delhi has been effective in raising awareness and improving self-reporting, but it requires intensification with suitable modification to reach all sectors.

B-Lynch brace suture simple surgical technique for managing post-partum haemorrhage - report of three cases

Post-partum haemorrhage is a major contributor to maternal morbidity and mortality. Numerous medical and surgical therapies have been used but none has been uniformly successful. Three cases which were managed successfully with brace suture following failure of medical management for post-partum haemorrhage are being presented. The ease and usefulness of this procedure as a life saving measure, its relative safety and its capacity for preserving the uterus and thus fertility is high lighted.

Correlation of cervical cytology with cervical histology

OBJECTIVE

To correlate cervical cytology with Cervical histology.

METHODOLOGY

A hospital based prospective study was carried out in consecutive total forty-three patient attending oncology clinic of Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal from 1st Bhadra 2061 to end of Falgun 2061 (18th August 2004-12th February 2005) during authors posting in this clinic. All patients who underwent cervical biopsy on either indication of clinically suspected lesions or abnormal cytology were correlated with Pap smear report. Pap smear was carried out in conventional technique using Ayre's spatula. Cervical biopsy was carried out with help of punch biopsy forceps in operation Theatre without the guidance of colposcopy. All pertinent information regarding patient profile in terms of their age, parity, age at marriage, age at 1st child birth, smoking habit, contraceptive use, and symptom of vaginal discharge was taken. Reports of Pap smear and cervical biopsy of these patients were collected from oncology clinic during their follow up visit and all these information and finding were entered in structured questionnaire. The reporting of Pap smear was done in Bethesda system. The average duration between performing Pap smear and biopsy was of one month. Statistical analysis was carried out by EPI-INFOS6 system.

RESULT

Of forty three patients who underwent cervical cytology 22 cases were of Benign lesion, 8 cases of LSIL, 9 cases of HSIL, 3 cases of invasive carcinoma and 1 of ASCUS. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in benign grade was 76%, 83.3%, 86.4%, 71.4%, 79.1%, 0.0004 respectively. Similarly sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and p-value in LSIL was 60%, 93.9%, 75%, 88.6%, 86%,0 .0008 respectively. For HSIL it was 100%, 89.5%, 55.6%, 100%, 90.7 0.0001 respectively. Respectively for carcinoma it was 100% for sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy p-value was 0.00008.

CONCLUSION

Pap smear significantly correlated with cervical histology.

Comprehensive abortion care service at Kathmandu Medical College--an experience

INTRODUCTION

His Majesty's Government amended the Nepal Criminal Code (Muluki Ain)--for Liberalising abortion law in the month of Chaitra 2058 (March 2002) and Royal Assent was given on 10th Asoj 2059 (27th September 2002). Accordingly Comprehensive Abortion Care (CAC) Services was initiated in the country. Kathmandu Medical College after enlisting with Ministry of Health started this service from June 2004.

OBJECTIVE

This study was carried out to know--1. Reasons for undergoing CAC service. 2. The complications after the CAC services. 3. The various contraceptive methods adopted by the client following CAC.

METHODOLOGY

Hospital based prospective study was carried out in Department of Obstetrics & Gynaecology at KMCTH from the period July 2004 to April 2005. Total 160 patients who asked for CAC were enrolled in the study. Counselling, history taking and general examination and per vaginal examination was carried out at the visit. CAC was performed with premedication with Doxycycline 100 mg and Ibuprofen 400 mg half an hour before the procedure. Paracervical block was also given with 1% xylocaine. MVA was performed as described in standard techniques. Patient was discharged after 1-2 hours of observation and with contraception opted by the clients.

RESULTS

Main reason for performing CAC was unwanted pregnancy in 66.75%. Complication following CAC was 1.25%. Post CAC contraception was adopted by 93%. Most preferred method was Inj. Depoprovera

CONCLUSION

The reason for CAC service asked by the patients was unwanted pregnancy. CAC service performed had minimal complication and also gave the opportunity for contraception.

[When mothers get cancer: psychological effects on children and needs for prevention]

Children having a parent who suffers from a serious somatic disease are at increased risk for mental health problems. Mainly due to the high prevalence of breast cancer diseases children of mothers with cancer are the most studied subgroup of this risk population. In this review the sequelae of a cancer diagnosis on a patient's female identity with respect to the maternal role are illuminated. Then, children's fears, conflicts and stressors that may be typically associated with maternal cancer are differentiated by age groups from a developmental perspective. In several controlled studies children of cancer patients had increased scores in symptom scales. If there are psychic symptoms, these are likely to manifest themselves as anxiety, depression, psychosomatic complaints or social withdrawal. Adolescent daughters of mothers having cancer had an especially increased risk to develop symptoms. The possible impact of a maternal cancer disease on a developing girl's puberty is discussed. In addition, a case vignette of a nine-year-old daughter of a breast cancer patient illustrates psychotherapeutic procedures in a brief intervention, the goal of which was to facilitate talking about fears between mother and daughter. Perspectives of family oriented mental health prevention in the context of gynaecological care are discussed.

Knowledge about tetanus immunization among doctors in Delhi

BACKGROUND

In spite of the clear-cut guidelines regarding tetanus immunization, we have observed that tetanus toxoid injection is often given after injury without considering previous immunization status. One of the reasons for this could be that the doctors themselves are not aware of the correct immunization schedules against tetanus.

AIMS

1. To assess the knowledge about tetanus immunization in relation to injuries among doctors. 2. To assess their knowledge about tetanus immunization schedules in children, pregnant women and adults.

SETTING AND DESIGN

It was a cross-sectional study conducted in Delhi.

MATERIALS AND METHODS

After complete enlisting of all the government allopathic hospitals and dispensaries, a representative sample (including private practitioners from the nearby area of selected dispensaries) of doctors was selected. All the doctors were personally contacted and information was collected through a pre-structured self-administered proforma.

STATISTICAL ANALYSIS

Data was analyzed using a computer and wherever applicable Chi-square test/Z test or Fishers' Exact test was applied.

RESULTS AND CONCLUSION

As many as 38.3% of doctors favored tetanus toxoid injection after every injury. The correct knowledge of immunization against tetanus in children, pregnant women and adults was 75%, 90.8% and 35.8% respectively. The knowledge regarding when to give boosters was even poorer. The present study showed that doctors had poor knowledge about tetanus immunization that needs to be improved.

Mental health status of runaway adolescents

There are 47.22 million homeless and runaway adolescents roaming on the streets of our country (Voluntary Health Association of India - VHAI) of which one lakh are in Delhi.1 Very little is known about them, their needs or their experiences.

OBJECTIVE

(1). To assess the psychological problems amongst the runaway adolescent boys. (2). To determine possible risk factors.

METHODS

This study was cross-sectional in design and done at a child observation home for boys in Delhi. All runaway boys aged 10 to 16 years of age were included in the study. The study was conducted from 15th June to 15th July 2001. A comprehensive schedule consisting of five parts, viz identification data, hopelessness scale for children by Kazdin, Beck depression inventory, Psychological survey questionnaire and RUTTER-B2 scale were used to assess various mental health problems.

RESULTS

20.7% of children were found to have high hopelessness and 8% of children had depression. 2% of children revealed that they had attempted suicide at any point of time in life. Among children with high hopelessness, 3.2% had ever attempted suicide. 8.3% of the depressed children gave history of suicidal attempts. 38% of children gave history of physical abuse, 14.6% of sexual abuse and a large number reported substance abuse. 69.33% were found to have behavioral problems (i.e. scored above the recommended cut off score of 9). 81% of children had antisocial behavior, 7.8% were neurotic and 10.5% remained undifferentiated.

CONCLUSION

Runaway adolescents suffer from a wide array of mental health problems and there is a need for a broad based psychosocial intervention programme.

Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair

BACKGROUND

Whereas open anterior inguinal herniorrhaphy is a time-tested, safe, and well-understood operation with a high success rate, laparoscopic techniques of inguinal hernia repair are fairly recent. Consequently, short- and long-term outcomes are still being evaluated. Few studies have compared laparoscopic extraperitoneal inguinal hernia repair with tension-free open hernia repair. The current study was conducted to compare complications, operative time, postoperative pain, length of hospital stay, and return to work between open tension-free mesh Lichtenstein (open) repair and laparoscopic total extraperitoneal (TEP) repair.

METHODS

In a prospective randomized study, open hernia repair was performed in one group (n = 25), and TEP repair using a large mesh was performed in another (n = 25). Then intraoperative and postoperative complications and results were compared.

RESULTS

The mean operative time in the TEP group was 75.72 +/- 31.6 min, which was significantly longer than the mean operative time in the open group (54 +/- 15) min (p <0.001). The mean pain scores in the TEP group were 2.64 +/- 1.4 at 12 h and 1.76 +/- 1.4 at 24 h. These scores were significantly lower than the corresponding scores of 3.52 +/- 1.7 (p <0.04) and 2.74 +/- 1.5 (p <0.01) in the open repair group. The mean postoperative analgesic dose was 2.6 +/- 2.3 in the TEP group, which was significantly lower than in the open group 5.76 +/- 3.5 (p <0.001). There was no major complication in either group. The time until return to work was significantly lower in the TEP group (12.8 +/- 7.1) days versus 19.3 +/- 4.3 days; than in the open group (p <0.001). In terms of cosmetics, all 25 patients (100%) in TEP group rated themselves as "highly satisfied," as compared with 7 patients (28%) in the open group (p <0.001). After a mean follow-up period of 13 months (range, 9-18 months), no recurrence was seen in either of the two groups.

CONCLUSION

In terms of complications and short-term recurrence, TEP repair is comparable with open repair. Moreover, TEP is significantly less painful in the early postoperative period, leading to earlier ambulation than open repair. Additionally, TEP results in significantly earlier return to work and better cosmetic results. Currently, TEP seems to be a better alternative than the existing open repair, provided the long-term recurrence rates are comparable. Despite the fact that TEP was a new procedure for the surgeon and the study was conducted during the learning phase, the results are comparable with those in the world literature.

Formulation and Evaluation of Parenteral Sustained Release Microspheres of Diclofenac Sodium

The aim of this study was to formulate and evaluate microsphere based depot type parenteral sustained release formulation of diclofenac sodium (DFS). Drug was formulated in the form of microspheres, using varying proportion of ethylcellulose (EC) as the retardant material to extend the release, by phase separation-coacervation technique. The in vitro release pattern of the designed formulations was studied using modified Franz diffusion cell. In vivo pharmacodynamic study was carried out by determining the index of analgesia (increase in response time to thermal stress as percentage of basal response time). Tail flick method was employed to measure both the degree of analgesia and its duration of action. The prepared microspheres were white, free flowing, and spherical in shape with a mean particle size of 50 μm. In vitro release study of the micro-spheres in aqueous media was found to extend the release of DFS beyond 24 hours with DFS and EC ratio 1:3. The plot of log percentage remaining to be released vs. time gave a linear relationship indicating first-order release kinetics. The in vitro release rate constant (Kr) for different microspheres varied between 0.1448 hr-1 and 0.0256 hr-1. A good correlation was obtained between K, and proportion of EC in the microspheres. In vivo pharmacodynamic studies indicated that the duration of analgesic action is prolonged beyond 24 hrs in case of microsphere products of 1:3 ratio of DFS to EC, whereas administration of marketed parenteral preparation showed activity only up to 11hrs. Also, a good correlation was obtained between analgesic activity in vivo and cumulative percentage of drug release from the formulations.

Hysterectomy: an analysis of perioperative and post operative complication

OBJECTIVE

To document peri operative and post operative complication observed after hysterectomy, regardless of route on the operator.

MATERIAL AND METHODS

A hospital based prospective study was carried out in department of obstetrics and gynaecology, KMCTH Sinamangal for six months. The study was carried out in patients undergoing hysterectomy who were followed from the time of admission to the time of discharge and two weeks thereafter. And followings were noted--Indication; route of hysterectomy, intraoperative and postoperative morbidities during hospital stay and after two weeks of discharge was noted.

RESULT

Total number of hysterectomy carried out was 50. 31 (62%) were Total abdominal hysterectomy, and 19 (38%) were vaginal hysterectomy. Indication for total abdominal hysterectomy were fibroid uterus 12 (24%), DUB 8 (16%), CIN 4 (8%), chronic cervicitis 1 (2%). II U-V prolapse with previous LSCS 1 (2%), endometriosis 1 (2%). Prophylactic for Ca breast 1 (2%), Postmenopausal bleeding 1 (2%). All cases of vaginal hysterectomy were performed for 2nd degree U-V prolapse. Intra operative complication during surgery were two cases of haemorrhage (4%) each in both total abdominal hysterectomy and vaginal hysterectomy. There was one case of bladder injury during abdominal hysterectomy. Postoperative complication noted were febrile morbidity 1 (2%) in abdominal hysterectomy. Urinary tract infection remains the single most common febrile morbidity. There was one case of secondary haemorrhage in both type of hysterectomy. One was managed conservatively and other required laparotomy. There were three (6%) cases of wound infection in abdominal hysterectomy of two which were sanguineous discharge and one was frank pus which required secondary suture.

Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh

OBJECTIVE

To investigate the extent of tobacco expenditures in Bangladesh and to compare those costs with potential investment in food and other essential items.

DESIGN

Review of available statistics and calculations based thereon.

RESULTS

Expenditure on tobacco, particularly cigarettes, represents a major burden for impoverished Bangladeshis. The poorest (household income of less than $24/month) are twice as likely to smoke as the wealthiest (household income of more than $118/month). Average male cigarette smokers spend more than twice as much on cigarettes as per capita expenditure on clothing, housing, health and education combined. The typical poor smoker could easily add over 500 calories to the diet of one or two children with his or her daily tobacco expenditure. An estimated 10.5 million people currently malnourished could have an adequate diet if money on tobacco were spent on food instead. The lives of 350 children could be saved each day.

CONCLUSION

Tobacco expenditures exacerbate the effects of poverty and cause significant deterioration in living standards among the poor. This aspect of tobacco use has been largely neglected by those working in poverty and tobacco control. Strong tobacco control measures could have immediate impact on the health of the poor by decreasing tobacco expenditures and thus significantly increasing the resources of the poor. Addressing the issue of tobacco and poverty together could make tobacco control a higher priority for poor countries.

Prognostic significance of apoptosis in squamous cell carcinoma of oral cavity with special reference to TNM stage, histological grade and survival

Apoptotic count was assessed in 38 cases of squamous cell carcinoma of oral cavity by light microscopy and correlated with TNM stage, histological grade and survival. A direct correlation with the TNM stage (p = 0.0166) and an inverse correlation with the histological grade (p = 0.03) was found, however no correlation was found with the survival. Apoptotic count was significantly different between well and moderately differentiated carcinoma (p = 0.347) and well and poorly differentiated carcinoma (p = 0.0190). Thus apoptotic count may have prognostic value particularly in combination with staging and histological grade.

Hepatitis G virus (HGV) infection in voluntary and commercial blood donors in India

The prevalence of hepatitis G virus (HGV) has been determined in commercial as well as voluntary blood donors from India by detecting viral RNA genome using reverse transcription polymerase chain reaction (RT-PCR) assay. 45 professional blood donors from private blood banks and 50 healthy controls who opted for voluntary blood donation were recruited for the study. Both the groups were also screened serologically for HBV and HCV infection. The prevalence of HGV in the general population in India was found to be 4% but significantly a higher frequency (46.6%; p<0.001) of HGV was observed in commercial blood donors.