Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Cardiac diseases comprise almost 4% of pregnancies in women in India. There is a risk ... more BACKGROUND Cardiac diseases comprise almost 4% of pregnancies in women in India. There is a risk of pregnant women with both congenital and acquired heart diseases to develop a variety of adverse foetomaternal adverse events which can compromise the health of both mother and baby. Objective-Our study was aimed at identifying pregnancies with congenital and acquired heart diseases, to assess the effect of heart diseases on maternal, foetal and neonatal health. MATERIALS AND METHODS The study was a prospective observational study carried out on 40 patients in IPGMER over a one-year period. All patients were subjected to detailed history taking and clinical examination and investigations. The mode of delivery, period of gestation, antenatal, intranatal and postnatal complications were calculated as well as the detailed history of delivery of the baby and neonatal parameters like birth weight, and APGAR score were assessed. RESULTS 29 patients had acquired heart disease while 11 had congenital heart disease. Among the CHD group 7 developed heart failure. Cardiological complications as well as maternal mortality were higher in the AHD group than CHD group. LBW and preterm delivery were more common among AHD group but congenital heart lesion was more common among CHD patients. Mode of delivery did not differ in the two groups. CONCLUSION A high index of suspicion and vigilant interdisciplinary approach can optimise the foetomaternal outcome in pregnant women with heart disease.
A collision tumor is one where histology shows the presence of two distinct primaries involving t... more A collision tumor is one where histology shows the presence of two distinct primaries involving the same organ without intermixture of individual cell types, ie, a side by side pattern. Here we present three rare cases of collision tumors involving the stomach and transverse colon. There were two cases of collision tumors involving the stomach, one of which was a combination of adenocarcinoma and low-grade non-Hodgkin's (mucosa-associated lymphoid tissue) lymphoma, and the other showed the presence of non-Hodgkin's lymphoma involving the entire stomach wall along with adenocarcinoma infiltrating the muscle layer. The third case comprised a mucinous adenocarcinoma and carcinoid tumor in the large gut.
INTRODUCTION & OBJECTIVES: Postpartum depression (PPD) is a common disorder and social debilitati... more INTRODUCTION & OBJECTIVES: Postpartum depression (PPD) is a common disorder and social debilitating that has adverse effects on the mother, child and family. Pica is an eating disorder characterized by persistent ingestion of substances that the consumer does not define as food. The aim of this study was to investigate the association of postpartum depression with pica during pregnancy. METHOD: This is case-control study was carried out in health centers in west Tehran. 152 depressed women (case group) and 148 non-depressed women (control group) were selected randomly from these health care centers. In addition to collecting demographic and pica data, the Edinburgh Depression Scale was used. The data was analyzed by both descriptive and analytic analyses such as chi-squared and logistic regression in SPSS version 16. RESULT: In this study, there wasn’t a significant association between PPD and pica during pregnancy (P=0.153, OR=2.043, CI=0.767, 5.438), but, postpartum depression has...
Journal of clinical and diagnostic research : JCDR, 2017
Malaria occurring in pregnancy is associated with considerable maternal and perinatal morbidity. ... more Malaria occurring in pregnancy is associated with considerable maternal and perinatal morbidity. In India, the problem is compounded by dual parasitological aetiology of Plasmodiumvivax (P.vivax) and Plasmodium falciparum (P.falciparum). To compare the outcome of infections by P. vivax and P.falciparum species among pregnant women in a hospital setting. Pregnant women who tested positive for malaria either by microscopy of peripheral blood smear or ELISA test for double antigen were enrolled in the study. They were followed up till their delivery and discharge from hospital. Demographic, clinical and laboratory data was collected at enrolment, on event of complication and at delivery. Data was analyzed for univariate and multivariate associations. There were 64 pregnant women diagnosed with malaria. A total of 76.6% study subjects had vivax infection rest were infected with p. falciparum. Anaemia (84%) was the commonest complication. A total of 60.9% women had pathological placenta....
Aim: The present study aimed to compare the efficacy of injectable diclofenac intramuscularly (IM... more Aim: The present study aimed to compare the efficacy of injectable diclofenac intramuscularly (IM), injection paracetamol intravenously (IV), or a combination of both to provide post-operative analgesia in patients undergoing lower abdominal gynecological surgeries. Materials and Methods: A total of 90 female patients (American Society of Anesthesiologists I and II), aged 20-50 years, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized to receive 75 mg diclofenac IM 8 hourly (Group D) or 1 g paracetamol IV 8 hourly (Group P) or a combination of both 8 hourly (Group PD) for 24 h post-operative period from the start of surgery. The primary outcome measured was the requirement of rescue analgesic (tramadol), the secondary outcomes measured included visual analog score (VAS) for pain, time until first rescue analgesic administration, patient satisfaction score and any side effects. Results: The requirement of rescue analgesic was significantly lower in Groups D and PD compared to Group P. Mean (standard deviation) tramadol requirement during 24 h was 56.67 (62.60) mg, 20.00 (40.68) mg and 20.00 (40.68) mg in the Groups P, D and PD respectively. Less number of patients in Groups D and PD (20% in both the groups) required rescue analgesic compared to Group P (50%). The VAS showed a significant decrease in Groups D and PD compared to Group P between 4 and 12 h post-operatively. However, Group PD showed no significant difference when compared to Group D alone. Conclusion: Injection diclofenac IM is more effective than paracetamol IV in terms of rescue analgesic requirement, but the combination of diclofenac IM and paracetamol IV provides no added advantage over diclofenac IM alone.
International Journal of Gynecology & Obstetrics, 2013
Background & Objective: Postoperative hemorrhage is one of the most frequently cited complication... more Background & Objective: Postoperative hemorrhage is one of the most frequently cited complications of total abdominal hysterectomy (TAH). This study aimed to investigate the effect of a single preoperative dose of sublingual misoprostol on reducing blood loss during total abdominal hysterectomies. Materials & Methods: This study was a single-blind randomized controlled trial (RCT). The statistical population included all women who were candidates of hysterectomy in 2017 and 2018. A total of 132 patients were randomly selected and classified into two groups of misoprostol (N=66) and placebo (N=66). Examining intraoperative blood loss was considered a primary outcome. Moreover, levels of hemoglobin before and 24 hours after the surgery, the need for a blood transfusion, febrile morbidity, and the duration of hospitalization were regarded as secondary outcomes. The means of bleeding in the two groups were compared using a t-test. Results: There were no significant differences between the two groups in the baseline characteristics (P<0.05). After the surgery, the mean of hemoglobin values was lower in the placebo group compared to the misoprostol one, and this difference was statistically significant (P<0.001). There was a significant difference in intraoperative blood loss between the two groups, and it was significantly higher in the placebo group (P<0.001). Conclusion: Taking a single preoperative dose of sublingual misoprostol is effective in reducing intraoperative blood loss after total abdominal hysterectomies. Additionally, this intervention led to a decline in hemoglobin.
International Journal of Gynecology & Obstetrics, 2011
Objective: To compare sublingual misoprostol with intramuscular oxytocin for prevention of postpa... more Objective: To compare sublingual misoprostol with intramuscular oxytocin for prevention of postpartum hemorrhage (PPH) in low-risk vaginal birth. Methods: In a prospective, randomized, double-blind trial, 530 women without risk of PPH were randomly allocated to receive either 400 μg of misoprostol sublingually or 10 units of oxytocin intramuscularly within 1 minute of delivery. The outcome measures were incidence of PPH, postpartum blood loss, drop in hemoglobin level in 24 hours, need for additional uterotonic drug, incidence of adverse effects, and need for blood transfusion. Student t, χ 2 , Mann-Whitney U, and Fisher exact tests were used for comparison. Results: Incidence of postpartum hemorrhage (≥ 500 mL) and postpartum blood loss in the misoprostol group were similar to those in the oxytocin group (6% versus 5.7%, P = 0.85; 153 mL versus 146 mL, P = 0.36). Shivering and pyrexia were encountered more often in the misoprostol than in the oxytocin group (shivering: 19% versus 0.8%, P b 0.001, relative risk [RR] 0.86, 95% confidence interval [CI] 0.82-0.90; pyrexia: 2.3% versus 0%, P = 0.03, RR 0.97, 95% CI 0.95-0.99). Conclusion: The efficacy of 400 μg of misoprostol administered sublingually was equivalent to that of 10 units of oxytocin given intramuscularly for prevention of PPH in low-risk vaginal delivery.
Postdural puncture headache (PDPH) is a distressing complication of the subarachnoid block. The p... more Postdural puncture headache (PDPH) is a distressing complication of the subarachnoid block. The previous studies conducted, including the recent ones, do not conclusively prove that pencil-point spinal needles decrease the incidence of PDPH. In this study, we have tried to find out whether a pencil-point Whitacre needle is a better alternative than the classic cutting beveled, commonly used, Quincke spinal needle, in patients at risk of PDPH. Three hundred and twenty obstetric patients, 20-36 years of age, ASA I and II, posted for Cesarean section under subarachnoid block, were randomly assigned into two groups W and Q, where 25G Whitacre and 25G Quincke spinal needles were used, respectively. The primary objective of the study was to find out the difference in incidence of PDPH, if any, between the two groups, by using the t test and Chi square test. The incidence of PDPH was 5% in group W and 28.12% in group Q, and the difference in incidence was statistically significant (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The pencil-point 25G Whitacre spinal needle causes less incidence of PDPH compared to the classic 25G Quincke needle, and is recommended for use in patients at risk of PDPH.
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Cardiac diseases comprise almost 4% of pregnancies in women in India. There is a risk ... more BACKGROUND Cardiac diseases comprise almost 4% of pregnancies in women in India. There is a risk of pregnant women with both congenital and acquired heart diseases to develop a variety of adverse foetomaternal adverse events which can compromise the health of both mother and baby. Objective-Our study was aimed at identifying pregnancies with congenital and acquired heart diseases, to assess the effect of heart diseases on maternal, foetal and neonatal health. MATERIALS AND METHODS The study was a prospective observational study carried out on 40 patients in IPGMER over a one-year period. All patients were subjected to detailed history taking and clinical examination and investigations. The mode of delivery, period of gestation, antenatal, intranatal and postnatal complications were calculated as well as the detailed history of delivery of the baby and neonatal parameters like birth weight, and APGAR score were assessed. RESULTS 29 patients had acquired heart disease while 11 had congenital heart disease. Among the CHD group 7 developed heart failure. Cardiological complications as well as maternal mortality were higher in the AHD group than CHD group. LBW and preterm delivery were more common among AHD group but congenital heart lesion was more common among CHD patients. Mode of delivery did not differ in the two groups. CONCLUSION A high index of suspicion and vigilant interdisciplinary approach can optimise the foetomaternal outcome in pregnant women with heart disease.
A collision tumor is one where histology shows the presence of two distinct primaries involving t... more A collision tumor is one where histology shows the presence of two distinct primaries involving the same organ without intermixture of individual cell types, ie, a side by side pattern. Here we present three rare cases of collision tumors involving the stomach and transverse colon. There were two cases of collision tumors involving the stomach, one of which was a combination of adenocarcinoma and low-grade non-Hodgkin's (mucosa-associated lymphoid tissue) lymphoma, and the other showed the presence of non-Hodgkin's lymphoma involving the entire stomach wall along with adenocarcinoma infiltrating the muscle layer. The third case comprised a mucinous adenocarcinoma and carcinoid tumor in the large gut.
INTRODUCTION & OBJECTIVES: Postpartum depression (PPD) is a common disorder and social debilitati... more INTRODUCTION & OBJECTIVES: Postpartum depression (PPD) is a common disorder and social debilitating that has adverse effects on the mother, child and family. Pica is an eating disorder characterized by persistent ingestion of substances that the consumer does not define as food. The aim of this study was to investigate the association of postpartum depression with pica during pregnancy. METHOD: This is case-control study was carried out in health centers in west Tehran. 152 depressed women (case group) and 148 non-depressed women (control group) were selected randomly from these health care centers. In addition to collecting demographic and pica data, the Edinburgh Depression Scale was used. The data was analyzed by both descriptive and analytic analyses such as chi-squared and logistic regression in SPSS version 16. RESULT: In this study, there wasn’t a significant association between PPD and pica during pregnancy (P=0.153, OR=2.043, CI=0.767, 5.438), but, postpartum depression has...
Journal of clinical and diagnostic research : JCDR, 2017
Malaria occurring in pregnancy is associated with considerable maternal and perinatal morbidity. ... more Malaria occurring in pregnancy is associated with considerable maternal and perinatal morbidity. In India, the problem is compounded by dual parasitological aetiology of Plasmodiumvivax (P.vivax) and Plasmodium falciparum (P.falciparum). To compare the outcome of infections by P. vivax and P.falciparum species among pregnant women in a hospital setting. Pregnant women who tested positive for malaria either by microscopy of peripheral blood smear or ELISA test for double antigen were enrolled in the study. They were followed up till their delivery and discharge from hospital. Demographic, clinical and laboratory data was collected at enrolment, on event of complication and at delivery. Data was analyzed for univariate and multivariate associations. There were 64 pregnant women diagnosed with malaria. A total of 76.6% study subjects had vivax infection rest were infected with p. falciparum. Anaemia (84%) was the commonest complication. A total of 60.9% women had pathological placenta....
Aim: The present study aimed to compare the efficacy of injectable diclofenac intramuscularly (IM... more Aim: The present study aimed to compare the efficacy of injectable diclofenac intramuscularly (IM), injection paracetamol intravenously (IV), or a combination of both to provide post-operative analgesia in patients undergoing lower abdominal gynecological surgeries. Materials and Methods: A total of 90 female patients (American Society of Anesthesiologists I and II), aged 20-50 years, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized to receive 75 mg diclofenac IM 8 hourly (Group D) or 1 g paracetamol IV 8 hourly (Group P) or a combination of both 8 hourly (Group PD) for 24 h post-operative period from the start of surgery. The primary outcome measured was the requirement of rescue analgesic (tramadol), the secondary outcomes measured included visual analog score (VAS) for pain, time until first rescue analgesic administration, patient satisfaction score and any side effects. Results: The requirement of rescue analgesic was significantly lower in Groups D and PD compared to Group P. Mean (standard deviation) tramadol requirement during 24 h was 56.67 (62.60) mg, 20.00 (40.68) mg and 20.00 (40.68) mg in the Groups P, D and PD respectively. Less number of patients in Groups D and PD (20% in both the groups) required rescue analgesic compared to Group P (50%). The VAS showed a significant decrease in Groups D and PD compared to Group P between 4 and 12 h post-operatively. However, Group PD showed no significant difference when compared to Group D alone. Conclusion: Injection diclofenac IM is more effective than paracetamol IV in terms of rescue analgesic requirement, but the combination of diclofenac IM and paracetamol IV provides no added advantage over diclofenac IM alone.
International Journal of Gynecology & Obstetrics, 2013
Background & Objective: Postoperative hemorrhage is one of the most frequently cited complication... more Background & Objective: Postoperative hemorrhage is one of the most frequently cited complications of total abdominal hysterectomy (TAH). This study aimed to investigate the effect of a single preoperative dose of sublingual misoprostol on reducing blood loss during total abdominal hysterectomies. Materials & Methods: This study was a single-blind randomized controlled trial (RCT). The statistical population included all women who were candidates of hysterectomy in 2017 and 2018. A total of 132 patients were randomly selected and classified into two groups of misoprostol (N=66) and placebo (N=66). Examining intraoperative blood loss was considered a primary outcome. Moreover, levels of hemoglobin before and 24 hours after the surgery, the need for a blood transfusion, febrile morbidity, and the duration of hospitalization were regarded as secondary outcomes. The means of bleeding in the two groups were compared using a t-test. Results: There were no significant differences between the two groups in the baseline characteristics (P<0.05). After the surgery, the mean of hemoglobin values was lower in the placebo group compared to the misoprostol one, and this difference was statistically significant (P<0.001). There was a significant difference in intraoperative blood loss between the two groups, and it was significantly higher in the placebo group (P<0.001). Conclusion: Taking a single preoperative dose of sublingual misoprostol is effective in reducing intraoperative blood loss after total abdominal hysterectomies. Additionally, this intervention led to a decline in hemoglobin.
International Journal of Gynecology & Obstetrics, 2011
Objective: To compare sublingual misoprostol with intramuscular oxytocin for prevention of postpa... more Objective: To compare sublingual misoprostol with intramuscular oxytocin for prevention of postpartum hemorrhage (PPH) in low-risk vaginal birth. Methods: In a prospective, randomized, double-blind trial, 530 women without risk of PPH were randomly allocated to receive either 400 μg of misoprostol sublingually or 10 units of oxytocin intramuscularly within 1 minute of delivery. The outcome measures were incidence of PPH, postpartum blood loss, drop in hemoglobin level in 24 hours, need for additional uterotonic drug, incidence of adverse effects, and need for blood transfusion. Student t, χ 2 , Mann-Whitney U, and Fisher exact tests were used for comparison. Results: Incidence of postpartum hemorrhage (≥ 500 mL) and postpartum blood loss in the misoprostol group were similar to those in the oxytocin group (6% versus 5.7%, P = 0.85; 153 mL versus 146 mL, P = 0.36). Shivering and pyrexia were encountered more often in the misoprostol than in the oxytocin group (shivering: 19% versus 0.8%, P b 0.001, relative risk [RR] 0.86, 95% confidence interval [CI] 0.82-0.90; pyrexia: 2.3% versus 0%, P = 0.03, RR 0.97, 95% CI 0.95-0.99). Conclusion: The efficacy of 400 μg of misoprostol administered sublingually was equivalent to that of 10 units of oxytocin given intramuscularly for prevention of PPH in low-risk vaginal delivery.
Postdural puncture headache (PDPH) is a distressing complication of the subarachnoid block. The p... more Postdural puncture headache (PDPH) is a distressing complication of the subarachnoid block. The previous studies conducted, including the recent ones, do not conclusively prove that pencil-point spinal needles decrease the incidence of PDPH. In this study, we have tried to find out whether a pencil-point Whitacre needle is a better alternative than the classic cutting beveled, commonly used, Quincke spinal needle, in patients at risk of PDPH. Three hundred and twenty obstetric patients, 20-36 years of age, ASA I and II, posted for Cesarean section under subarachnoid block, were randomly assigned into two groups W and Q, where 25G Whitacre and 25G Quincke spinal needles were used, respectively. The primary objective of the study was to find out the difference in incidence of PDPH, if any, between the two groups, by using the t test and Chi square test. The incidence of PDPH was 5% in group W and 28.12% in group Q, and the difference in incidence was statistically significant (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The pencil-point 25G Whitacre spinal needle causes less incidence of PDPH compared to the classic 25G Quincke needle, and is recommended for use in patients at risk of PDPH.
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