scholarly journals Vaginal progesterone after tocolytic therapy in threatened preterm labour

Author(s):  
Aparajita Ashok Mishra ◽  
Shilpa N. Chaudhari

Background: Currently preterm labour is one of the most challenging problem faced by both obstetricians and perinatologists, this episode in the course of woman’s pregnancy takes a heavy tool for perinatal mortality which accounts for approximately 50-75%. The incidence of preterm labour is estimated to be 5-10% of all pregnancies.Methods: It was a prospective randomize control trail over a period of 3 year at department of obstetrics and gynecology, tertiary care hospital Pune, Maharashtra, India. Total 100 subjects were randomized into two groups with group one receiving vaginal micronized progesterone and group two control group receiving only tocolytics and steroids. Subsequently authors compared the safety and efficacy of vaginal micronized progesterone versus placebo as a maintenance therapy in preventing preterm labour.Results: This analysis showed that women who randomized to progesterone prophylaxis had a significantly increase in duration of pregnancy. The mean of birthweight in Group A and Group B was 2963±36 gm and 2567±49 gm and respectively which confirmed the positive effects of progesterone on increasing infants’ weights at birth.Conclusions: Authors concluded that progesterone therapy had acceptable efficacy in the prevention of preterm labor in terms of prolongation of delivery and by increasing gestational age at delivery.

2021 ◽  
Vol 8 (4) ◽  
pp. 541-547
Author(s):  
Shilpa Chaudhari ◽  
Aparajita Mishra ◽  
Kishor Hol ◽  
Shraddha Shastri

Currently preterm labour is one of the most challenging problem faced by both obstetricians and perinatologists, this episode in the course of woman’s pregnancy takes a heavy tool for perinatal mortality which accounts for approximately 50-75%. The incidence of preterm labour is estimated to be 5-10% of all pregnancies. It was a prospective randomize control study. All the cases with inclusion and exclusion criteria were selected during the study period. The subjects were randomized into two groups with group A received vaginal micronized progesteron and group B intramuscular 17a hydroxyprogesteron caproate. Total of 100 cases were included in this study. All preterm pregnancy of more than 20 weeks were considered in this study. Initial nefidipine 10 mg, 4 tablets 15 min apart was given for tocolytic activity for 48 hours. Injection bethamethasone 12 mg I.M 2 doses in a duration of 24 hours apart is given for fetal lung maturity. One group will receive weekly intramuscular 17a hydroxyprogesteron (250 mg) injection while other group will receive daily micronized vaginal progesteron suppository (200mg). Subsequently compare the safety and efficacy of intramuscular progesterone versus micronized progesterone as a maintenance therapy in preventing preterm labour and analyse maternal and fetal factors.Subsequently compared the safety and efficacy of intramuscular progesterone versus micronized progesterone as a maintenance therapy in preventing preterm labour.This analysis showed that women who randomized to progesterone prophylaxis had a significantly increase in duration of pregnancy. The mean ± SD of birthweight in Group A and Group B was 2784.2 ± 490.7 gm and 2813.9 ± 363.3 gm respectively which confirmed the positive effects of progesterone on increasing infants’ weights at birth. Authors concluded that progesterone therapy had acceptable efficacy in the prevention of preterm labor in terms of prolongation of delivery and by increasing gestational age at delivery.


1996 ◽  
Vol 3 (3) ◽  
pp. 176-180
Author(s):  
RC Balkissoon ◽  
L Clelland ◽  
L Whitehead ◽  
MT Newhouse

OBJECTIVE:To compare the safety and efficacy of a new spacer-oral nasal mask device with those of the standard needle nozzle spray method for the delivery of aerosolized lidocaine to the upper airway for pre-bronchoscopic anaesthesia in a tertiary care hospital.DESIGN:Single-blind randomized control trial.SETTING:University affiliated tertiary care hospital, ambulatory care bronchoscopy unit.SUBJECTS:Thirty consecutive consenting patients referred for fibreoptic bronchoscopy for various indications.INTERVENTION:Thirty randomized subjects received 150 mg of topical 1% aerosolized lidocaine via standard long needle nosed applicator (group A) or via a new oral/ nasal mask with spacer device (group B). Bronchoscopists, blinded as to the preprocedure topical anaesthetic method used, gave additional topical lidocaine at their discretion.MEASUREMENTS:The study nurse recorded the total dose of lidocaine (mg), timing of the procedure (s), cough frequency expressed as coughs per minute (c/min), vital signs, time for return of gag reflex and patients' subjective comments.RESULTS:Fifteen patients were randomized to each group. The lidocaine dose required for insertion through the vocal cords (mean ± SD) was 282.6±66.3 mg in group A and 203.3±70.6 mg in group B (PÃ0.005). Total lidocaine dose required for the procedure was 330.6±70.2 mg in group A and 256.6±75 mg in group B (PÃ0.01). The mean time for passage of the bronchoscope from mouth entry to through the vocal cords was 82.7±54.5 s in group A and 110.5±64.4 s in group B (P>0.1). The mean total time for the procedure was 699.7±377.5 s in group A and 697.2±409.1 s in group B (not significant). The mean cough frequency was 8.2±6.1 c/min in group A and 7.0±5.7 c/min in group B (not significant). There were no statistically significant differences in heart rate, in return of gag reflex time or in complication rate between the two groups.CONCLUSIONS:A statistically significant reduction in the dose of lidocaine is required to achieve equivalent topical anaesthetic for bronchoscopy with a new mask and spacer device compared with a more conventional method. Since no other variables related to the procedure showed a significant difference, the new method appears to be superior to the previous method.


2021 ◽  
Vol 29 (02) ◽  
Author(s):  
Zahidullah Khan ◽  
Ahmar Rashid ◽  
Iqbal Haider ◽  
Shams Suleman ◽  
Aliena Badshah ◽  
...  

Spontaneous Bacterial Peritonitis (SBP), a known complication of cirrhosis Liver is an acute bacterial infection of the peritoneum. Usually no source of infection is easily identifiable. Objective: To compare the efficacy of Ciprofloxacin and Cefotaxime in Cirrhosis Liver patients with SBP. Material and Methods: This prospective, comparative, single center study was conducted in the Department of Medicine, Khyber Teaching Hospital Peshawar from 1st October 2017 to 31st December 2018. A total of 300 admitted patients having Cirrhosis Liver with SBP were included in this study. The patients were randomized into Group A and Group B. Group A was treated with Intravenous Ciprofloxacin and Group B was treated with Intravenous Cefotaxime given twice daily for a period of 5 days. Diagnostic peritoneal paracentesis was done before the start of the treatment and repeated after 5 days therapy. Patients who were either non cirrhotic or had secondary bacterial peritonitis were excluded from the study. Results: A total of 300 Cirrhosis Liver patients with SBP were studied in two equal randomized groups. Out of these 168 were male and 132 were female. The mean age of patients in study was 51.14±11.9 years. The age ranged between 15-75 years. In Group A, 82 percent responded to ciprofloxacin and in group B, 86 percent responded to cefotaxime. Conclusion: Both intravenous ciprofloxacin and cefotaxime are effective in treating spontaneous bacterial peritonitis in patients with Cirrhosis Liver. Key Words: Ciprofloxacin, Cefotaxime, Spontaneous bacterial peritonitis, Efficacy.


2021 ◽  
Vol 71 (5) ◽  
pp. 1553-58
Author(s):  
Sana Abbas ◽  
Saquib Naeem ◽  
Amjad Akram ◽  
Beenish Abbas ◽  
Rashid Iqbal

Objective: To evaluate the analgesic potential of pregabalin in ambulatory dacryocystorhinostomy surgeries under general anaesthesia. Study Design: Quasi-experimental study. Place and Duration of Study: Tertiary Care Hospital Rawalpindi, from Nov 2019 to Sep 2020. Methodology: A total of 110 patients undergoing ambulatory dacryocystorhinostomy surgery at our hospital were included in the study. Participants were divided into two groups, group A (n=55) were administered 150 mg oral pregabalin, while a placebo was given to participants of group B (n=55). Post-operative pain was assessed at recovery, four and eight hours after surgery with the help of the visual analogue scale. Results: Mean age of participants was 43.05 ± 7.5 years. Gender wise distribution showed 62 (56.4%) males and 48 (43.6%) females. At recovery, four and eight hours after surgery the mean pain scores in group A (pregabalin) vs group B (placebo) were (2.98 ± 0.8 vs 4.98 ± 0.8, p<0.001, 2.67 ± 0.6 vs 5.02 ± 0.8, p<0.001 and 1.49 ± 2.9 vs 2.95 ± 0.8, p<0.001 respectively). Opioid administration frequency in trial versus placebo group was [11 (20%) vs 32 (58.2%), p<0.001]. Conclusion: Pregabalin has analgesic potential moreover decreased postoperative consumption of opioids and associated adverse effects such as nausea and vomiting. Hence making it a suitable agent for pain relief in ambulatory surgeries.


2021 ◽  
Vol 9 (06) ◽  
pp. 307-314
Author(s):  
Nidhi Singh ◽  
◽  
Yogesh Goel ◽  
Ritu Agarwal ◽  
◽  
...  

Background: In December 2019, the infection caused by 2019 novel coronavirus led to an outbreak in Wuhan, situated in the Hubei Province of China. The number of studies on children with COVID-19 is limited. We reviewed that COVID-19 does indeed affect children the same way as any other age group. Children can act as carriers of the virus and can endanger the lives of other individuals. Aim: In this Prospective study a combination of Ivermectin, Doxycycline along with supportive care was evaluated therapeutically to treat COVID-19 children (> 9 year) and adolescent age group. Method: Study was performed on pediatric COVID-19 patient who were enrolled in this study with a predefined inclusion and exclusion criteria. RT- PCR of the SERS-CoV-2 was done. The clinical features and response to treatment were noted according to protocol. Patients were divided in 2 groups.Combination of Ivermectin, Doxycycline and supportive treatment were given in one group and other group acted as control. Retesting was done between 5 to 25 days of starting medication. Result: In the study after excluding 50 patients, out of remaining 110 patients, males and females were 67 and 43 respectively, the age ranged between 9-18 years (Mean age was 10.88 ± 2.39 year). Retesting was done between 5 to 25 days of starting medication. Symptomatic improvement was noticed after 2-3 days of starting medication. Mean recovery time in Ivermectin-Doxycycline-supportive care group (Group B) was 10.28±4.72 versus 14.92±8.40 in control group. Hence, using Ivermectin along with Doxycycline reduced mean time to recovery up to 4.64 days. By analyzing the mean time to recovery in mild, moderate and severe patients in each group, it was shown that the mean time to recovery in Group B was 6.88±1.84,11.78±1.81, 21.28±1.79 days, respectively vs 8.375±1.25, 12.76±1.73, 23.16±1.47 days respectively in Group A. All patients symptomatically improved and tested negative. No death was noted in either group. Conclusion: Most of the cases of SARS-CoV-2 were mild and did not require specific treatment but combination of Ivermectin and Doxycycline along with supportive care was found to be effective in early viral clearance and helped the patients to overcome the disease early. Early improvement of symptoms and early discharge were noted in patients whom we gave combination of medicines. Over all it is a very cheap combination, save a lot of lives, and very helpful for resource-poor settings. This study has limitations as our number of patients was small.


2019 ◽  
Vol 26 (08) ◽  
pp. 1306-1310
Author(s):  
Muhammad Ghayasuddin ◽  
Fareya Usmani ◽  
Amtullah Sheikh ◽  
Hamid Raza

The aim of our study is to assess the surgical outcome of healing by primary intention and compare it with primary repair for the treatment of pilonidal sinus. Study Design: Randomized controlled trial. Setting: Tertiary Care Center in Karachi Pakistan. Period: Two years from April 2015 to April 2017. Materials and Methods: 60 patients were divided into two groups by utilizing a Random Allocation Software. All the patients involved in the study signed a duly informed consent. The inclusion criteria were patients who presented to us with a pilonidal sinus and agreed to participate in the study. All the procedures were performed by the same team of surgeons. Patient follow up was bi-weekly at the outpatient. Data were collected in a predesigned proforma with various variables such as patient demographics, clinical findings, treatment option used, postoperative results, complications (if any), healing time, length of hospital stay and time for a return to function among others. The data were analyzed using IBM SPSS version 21.0. A p value of less than 0.05 was considered to be statistically significant. Results: N= 60 patients were included in the study. There were n= 51 men (85%) and n= 9 women (15%). The mean age of patients in group A was 26.45 +/- 5.81 years and the mean age of participants in group B was 27.10 +/- 5.75 years. Symptoms lasted for 6.52 +/- 2.03 days, the most common presenting complaint was pain in 51.66% of patients followed by discharge in 40% and swelling in 33.33% respectively. The mean length of stay at the hospital for both the groups was 4.40 +/- 2.11 days (4.09 +/- 1.96 days in group A and 4.85 +/- 2.33 days in group B), mean time to return to normal functioning was 17.88 +/- 8.46 days (14.50 +/- 7.30 days in group A and 23.80 +/- 6.50 days in group B). The mean healing time postoperatively for both the groups was 39.98 +/- 24.46 days (21.90 +/- 10.15 days in group A and 67.30 +/- 9.09 days in group B. Early postoperative infection was found in n=7 (11.66%) patients, wound necrosis was found in n= 2 (3.33%) patients, and recurrence of the pilonidal sinus was found in n= 3 (5%) of the patients respectively. Conclusion: According to the results of our study primary closure technique provides better outcomes in terms of early return to functioning, shorter duration of wound healing and lower rates of wound infection as compared to excision and healing by secondary intention.


Esculapio ◽  
2020 ◽  
Vol 16 (03, july 2020-Septmber 2020) ◽  
Author(s):  
Shamila Ijaz Munir ◽  
Falak Naseer ◽  
Amna Ahsan ◽  
Mahnaz Gondal, ◽  
Nazia Khalil ◽  
...  

Objective: To determine the relationship between periodontitis and preterm labour in pregnant women presenting to a tertiary care hospital in Lahore. Methods: This case control study was conducted at Obstetrics & Gynecology Unit 4 of Sir Ganga Ram Hospital, Lahore for six months. The delivering women, who consented to participate, were divided into two case and control groups. For each case one control was enrolled who met the inclusion criteria, so total sample size was 380 women. Women delivered before 37 weeks of gestation were case group and those delivered after 37 weeks were control group. A patient was considered having periodontitis if she had probing pocket depth of ≥3mm in at least 3 sites. Data was collected and analyzed on SPSS version 21. Results: In this study the mean age of the case group patients was 28.52±6.45 years while of the control group was 28.67±6.35 years. The mean value of probing depth pocket in the case group was 3.872±1.37 while the mean value probing depth pocket of the control group was 3.58±1.52. Out of 380 patients the periodontitis was found in 275 patients. The odds of having periodontitis in case group was 1.85 times higher than control group i.e. OR=1.85[1.17-2.92]. Conclusion: Periodontitis is a preventable risk factor of preterm labour in women presenting at a tertiary care hospital. Keywords: Preterm Labour, Periodontitis, dental hygiene, preterm delivery


2021 ◽  
Vol 64 ◽  
pp. 298-302
Author(s):  
Ritika Singla ◽  
Neetu Sharma

Objectives: Until 2012, zidovudine+lamivudine+nevirapine (ZLN) was the first line treatment for human immunodeficiency virus (HIV)-positive patients, whereas in 2013, tenofovir+lamivudine+efavirenz (TLE) was recommended as a preferred regimen due to less adverse drug reactions and better virological response. The present study was done to compare the change in CD4 count and emergence of opportunistic infections (OIs) in HIV-positive patients on ZLN and TLE regimens. Materials and Methods: This retrospective record-based study was conducted at anti-retroviral therapy (ART) center of a tertiary care hospital on 150 charts of patients on ZLN (Group A) and TLE (Group B) regimens each for 1 year. Data were analyzed using GraphPad Prism version 6. Results: The mean age of patients in Group A was 38.72 (±10.5) years and Group B 37.75 (±11.57) years (P = 0.4460). After 1 year of ART, the mean CD4 count (cells/mm3) increased in both groups (Group A: 223.51 [±111.21] to 415.37 [±218.16] [P = 0.0001] vs. Group B: 255.05 [±164.50] to 433.12 [±247.66] [P = 0.0001]). With the baseline counts being comparable (P = 0.0527), the difference in mean CD4 counts between the groups post-ART was not statistically significant (P = 0.5105). The incidence of OI was 45% in Group A as compared to 25% in Group B. Overall, the most prevalent OI was tuberculosis (TB) (13.33%). Conclusion: Both ZLN and TLE regimens are equally effective in improving the immunological status of HIV-positive patients. Patients on ZLN have higher incidence of OI than those on TLE. However, therapy should be individualized as per patient’s suitability.


2017 ◽  
Vol 4 (4) ◽  
pp. 998
Author(s):  
Raju H. Badiger ◽  
Santosh B. Desai ◽  
Ravindra Kantamanenin ◽  
Chetana K. Kavatkopp ◽  
Joel George ◽  
...  

Background: Potassium is an extremely crucial element in maintaining the normal charge between intracellular and extracellular space. Normal cellular function is maintained through potassium homeostasis. The normal range of plasma potassium is 3.5 to 5.1 mmol/L. The deviation both hypo and hyperkalaemia are associated with cardiovascular diseases especially cardiac arrhythmia. The objective was to study the association of hypokalaemia on cardiovascular diseases.Methods: During this one year of retrospective study socio-demographic profile of the patients were collected from the medical record section of hospital. The participants were grouped into four classes based on the serum potassium levels as, Group A: < 2 mmol/L, group B: 2-2.49 mmol/l, group C: 2.5 - 2.9 mmol/L, group D: 3 - 3.49 mmol/L and group E (control group) 3.5 to 5.1 mmol/L. The participants were also grouped as those suffering from cardiovascular diseases and those with non-cardiovascular diseases.Results: In our study 4818 records were categorized into 5 groups including control group. Males (61.35%) were slightly more than female (38.65%). The mean age group was 43±4 years. Results revealed that there was positive association between the sexes. Females were more commonly associated as compared to males. Hypokalaemia among cardiovascular diseases was only 22.2% as compared to non-cardiovascular diseases. The mean systolic (142±8) and diastolic Blood pressure (92±2) among cardiovascular diseases was slightly higher as compared with the non-cardiovascular diseases.Conclusions: Hypokalaemia is significantly associated with myocardial infarction when compared with other disorders. Hypokalaemia was more commonly associated with cardiovascular diseases as compared with non-cardiovascular diseases.  


2018 ◽  
Vol 10 (1) ◽  
pp. 23-27
Author(s):  
Nirupama Saha ◽  
Nadiuzzaman Khan ◽  
Mirza Kamrul Zahid ◽  
Shah Alam Talukder ◽  
ASM Meftahuzzaman

Background: Post-operative outcomes of a major abdominal surgery depend on careful & effective post-operative management. But it is a critical job especially in children. Obtaining adequate analgesia after major surgery is a problematic issue and postoperative pain still imposes a major burden of suffering in surgical patients.Objectives: The principle objectives of the study is to evaluate the effects of intravenous lidocaine infusion in pain management of pediatric population undergone in major abdominal surgery; to reduce post-operative morbidity & enhance better surgical outcome in children.Methodology: This is a randomized control trial carried out from January 2015-June2015,in a tertiary care hospital among 60 cases of 4 to 14 years children with major abdominal surgery without having any pulmonary, cardiac, hepatic or renal insufficiency. Grouping of patients that is lidocaine infusion group (Group A) and control group (Group B) was made among admitted cases for elective abdominal surgery by simple random technique by means of lottery. For assessment of postoperative pain FLACC Scale was used in both groups. Clinical examination findings & specifically designed data collection sheet with a set questionnaire were used as research instruments. Formulated data was analyzed by SPSS version 17, taking p value <0.05 as significant.Results: It is noted that, after 24 hours of operation most of the patients 56.7% of group A had mild pain whereas 90% patients of group B had moderate pain (p<0.001)& during that time there was no patient with severe pain in group A whereas in group B 10% patients were with severe pain. At 48 hours, pain was absent in 13.3% children of group A and 6.7% in group B. In group A most of the children 76.7%had mild pain compared to moderate pain 18 (60%) in group B children at that hours (P<0.001). Again, regarding required amount of analgesics, patients received I/V lidocaine required less amount of analgesics than its counterpart. In present study, complications was noted only 3.3% patien in group A, where as in the opposite group it was found in 23.3% & p was <0.05. In group A, in 50% patients post operative bowel sound was returned within 72 hours, compared to 73.3% patients in group B. The p value was 0.001. About post-operative hospital stay, 83.3% children of the group A were released from hospital after 5th P.O.D whereas, in group B, only 50% children were released after 7th P.O.D of operation. The P value was 0.03 that is also significant.Conclusion: Intravenous lidocaine could improve immediate and late post-operative pain with early recovery after major abdominal surgery in children & it can contribute to rapid postoperative rehabilitation programs.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 23-27


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