Second trimester termination of pregnancy with misoprostol alone and misoprostol with isosorbide mononitrate: a comparative study

Background: Aim of the study was to compare the efficacy of misoprostol alone and misoprostol with isosorbide mononitrate in reducing the induction abortion time interval in second trimester termination of pregnancy.Methods: A randomized control prospective study was conducted. Patients seeking second trimester abortions were randomized in to two groups. Group A received 400 ugm of misoprostol per vaginum every 4 hours up to maximum of 5 doses. Group B patients received 400 ugm of misoprostol and 40mg of isosorbide nitrate intravaginally. Repeat dose of 400 ugm misoprostol and 20 mg of isosorbide mononitrate was given every 4 hours up to a maximum of 5 doses. The induction to abortion interval and side effects of the drugs used were noted.Results: A total 71 women seeking second trimester termination between 12 to 20 weeks gestation were recruited for the study. In group A, there were 36 patients and in group B there were 35 patients. In group A the mean induction abortion interval was 14.8±4.16 hours while in group B the mean induction-abortion interval was 12.45±3.9 hours. Patients treated with isosorbide mononitrate and misoprostol combination had statistically significantly lower induction abortion time interval when compared with misoprostol alone (p value 0.018).Conclusions: The study demonstrates that the combination of isosorbide mononitrate and misoprostol is more effective for termination of second trimester pregnancy than misoprostol alone.

Transient Vision Restoration Training Using a Unique Virtual Reality Platform in Glaucoma

Background To evaluate the efficacy of transient vision restoration training (tVRT) with an augmented virtual reality platform in glaucoma patients. Design: A self-control, prospective study. Methods This study recruited subjects with glaucoma. All participants were treated with tVRT which based on an augmented virtual reality platform for 20 minutes. The intraocular pressure (IOP), the best-corrected visual acuity (BCVA), global mean defect (MD) values, global indices mean sensitivity (MS) were evaluated and compared before and after treatment. Results While the IOP and BCVA after tVRT did not change obviously compared to baseline. However, the global MD significantly reduced, consistently the global MS changed better in the treated patients. Conclusions The glaucomatous optic neuropathy remains potentially neuroplasticity. And the training based on an augmented virtual reality platform may have a positive impact on vision restoration.

TO FIND THE INCIDENCE OF TYPE OF POST OPERATIVE WOUND INFECTION IN UNCOMPLICATED ACUTE APPENDICITIS CASES USING PROPHYLACTIC POST OPERATIVE ANTIBIOTICS

Background: The efficacy of antibiotic prophylaxis in patients undergoing appendectomy has been examined in several randomized and observational studies showing that appropriate use of antibiotics reduces the risk of SSI following appendectomy by 40-60%. These antibiotics are continued in postoperative period with different courses and combinations according to each case. Methods: This randomized control prospective study was conducted in IGMC SHIMLA from August 2017 to July 2018. Cases of uncomplicated acute appendicitis undergoing emergency open appendectomy were included in this study. Results: All the 9 patients who had wound infection developed superficial surgical site infection. None of the patients developed deep surgical site or intra abdominal infections in either of the two groups. Conclusion: Frequency of post operative wound infection is generally very low in uncomplicated appendicitis. The prolonged use of antibiotics post operatively is unnecessary, can increase antibiotic resistance, can produce side effects and increase cost of treatment. Keywords: Wound infection, Antibiotic, Acute appendicitis.

Cognitive Function in Children With Idiopathic Subclinical Hypothyroidism: Effects of 2 Years of Levothyroxine Therapy

Background Long-term consequences of mild subclinical hypothyroidism (SH) in children are still unclear, and the need for levothyroxine (L-T4) supplementation remains controversial. We designed a 2-year, case-control, prospective study of a cohort of children with SH to evaluate the effects of L-T4 therapy on neurocognitive outcome. Methods Thirty-four children, age 9.1 ± 2.6 years, with long-lasting, idiopathic, and mild SH, and 34 healthy matched controls, were enrolled. Twenty SH children underwent a 2-year L-T4 treatment (group A), whereas 14 refused treatment and were reevaluated after a 2-year-follow-up (group B). IQ and specific cognitive domains were evaluated in all children at study entry and after 2 years of therapy (group A) or observation (group B) in SH individuals. Results In SH children baseline IQ scores were normal and comparable to controls (full-scale IQ [FSIQ] 100.4 ± 11.3 vs 101.8 ± 14.2, verbal IQ [VIQ] 99.7 ± 13.7 vs 98.3 ± 14.9 and performance IQ [PIQ] 101.2 ± 10.4 vs 105 ± 10.4). In group A, L-T4 treatment was associated with normalization of thyrotropin (6.3 ± 1.0 mIU/L at baseline vs 2.8 ± 1.4 mIU/L at 2 years, P < .001). However, 2-year L-T4 therapy was not associated with a change in IQ scores (FSIQ 104.4 ± 13.8 vs 102.7 ± 11.0; VIQ 101.8 ± 14.9 vs 102.3 ± 11.9; and PIQ 106.5 ± 13.9 vs 102.7 ± 10.7) or in verbal or performance subtest scores. No significant differences were found in IQ scores after 2 years of treatment in group A compared to group B after a 2-year follow-up. Conclusions Our data suggest neurocognitive function in children is not impaired by persistent, mild, untreated SH and is not significantly modified by 2-year L-T4 supplementation.