A Hospital-Based Randomized Controlled Trial—Comparing the Outcome of Normal Delivery Between Squatting and Lying Down Positions During Labour

BackgroundLabour is a physiological process. Before the seventeenth century, the upright birthing position was common in western countries. The supine position became popular because of the convenience for health professionals rather than the benefits for women.Aims and ObjectivesTo compare the outcomes of normal deliveries between squatting and lying down positions and to assess the risks and benefits of squatting position during the second and third stages of labour and its comparison with the lying down position.MethodologyA hospital-based prospective randomized controlled study was conducted in the Department of Obstetrics and Gynaecology in tertiary care centre carried over a period of 18 months among 212 female patients in labour assigned in Group A squatting position and Group B lying down position.ResultsThe mean age of patients in Group A was 23.30 ± 4.30 years and Group B was 23.81 ± 4.13 years. The mean duration of second and third stages of labour in both multigravida and primigravida patients was significantly lower in Group A (p < 0.05). The mean amount of blood loss in Group A was significantly higher compared to Group B (p < 0.05). The mean VAS score assessing severity of pain at second stage and third stage of labour was significantly lower in Group A compared to Group B (p < 0.05).ConclusionSquatting position was found much convenient for mothers in terms of less duration of second stage of labour, less number of patients administered oxytocin, lesser extension of episiotomy and greater maternal satisfaction on severity of pain.     

Another simple regimen for perioperative management of diabetes mellitus

Persons with diabetes who require surgical procedures are increasing day by day.Many of the regimens available to manage patients with diabetes perioperatively are complex. Hence, the junior doctors and the paramedics(Primary care providers on a 24/7 basis) find it difficult to execute them. We need a simple regimen that can be executed in a primary care setting/general floor as it is becoming difficult to accommodate the patients in a sophisticated setting because of the increasing burden of the disease. We suggest a simple regimen in this article(Ram's regimen) which we believe safer, economical and more effective than few simple regimens available to date. Moreover, this regimen does not require any additional equipment such as syringe pumps, measured-volume set,etc. Hence, this regimen can be implemented in a primary care setting/general floor easily and we hope that it will be useful for doctors of various specialties and their patients.     

Analysis of Clinical Profile,Investigation, and Management of Ocular Cysticercosis Seen at a Tertiary Referral Centre

Aim: To analyze the demographic profile, clinical presentation, diagnosis, management, and outcome of ocular cysticercosis (OC) seen at a tertiary referral center.

Design: Retrospective case series.

Material and methods: Records of patients with diagnosis of OC from January 2000 to September 2015 were retrieved and the data was analyzed.

Results: 102 eyes of OC were seen. 72(71%) eyes had extraocular cysticercosis (EC) and 30(29%) eyes had intraocular cysticercosis (IC). EC was located in the orbit in 69/72 (96%) eyes. Symptoms of extraocular cysticercosis were restriction of ocular movement in 33 eyes (46%). IC was located in vitreous 17 eyes (57%). Symptom of IC was drop in vision in 26/30 eyes (87%). EC was managed medically with albendazole and steroid. Surgical excision was done for IC.

Conclusion: EC was more common than IC. Prompt and appropriate management of OC results in good visual outcome.     

Plasma homocysteine: an independent or an interactive risk factor for coronary artery disease

BACKGROUND: Coronary artery disease (CAD) is emerging as a major public health concern in most developing countries. Further conventional risk factors for CAD do not solely account for the increased mortality, particularly in Asians. Recently, increased plasma homocysteine is being considered as a risk factor, but the strength of relationship and interaction of plasma homocysteine with other risk factors is yet obscure. In this study, the association of plasma homocysteine with CAD and other risk factors was estimated. METHODS: In the present study, 100 patients of CAD and 50 controls of both sexes were included. Plasma total homocysteine (tHcy) concentrations were measured using reverse phase high-performance liquid chromatography. RESULTS: Plasma homocysteine concentrations were significantly raised in cases as compared to age-matched controls (16.57+/-6.86 and 11.47+/-5.19 micromol/l, p<0.001). On calculating relative risk (RR) of each factor by univariate analysis smoking, hypertension, plasma cholesterol and homocysteine appeared to be significant risk factors. However, on applying multiple logistic regression only the latter three emerged as independent risk factors (p<0.005). Further, strong interactive effects were observed between homocysteine levels and increasing age, hypertension and smoking. CONCLUSION: An increase in plasma homocysteine concentration confers an independent risk for CAD. It further increases the risk associated with increasing age, smoking and hypertension. Thus, increased homocysteine concentrations are a significant medical problem and effective strategies are urgently required to counter this challenge.     

Thyroarytenoid muscle responses to air pressure stimulation of the laryngeal mucosa in humans

Others have observed glottic adduction in response to air puff stimuli and suggested that this is a reliable indicator of laryngeal sensation. We undertook to determine whether the same thresholds are found if one uses either thyroarytenoid (TA) muscle responses or subjects' reports of laryngeal sensation. We also studied the characteristics of TA responses to unilateral air pressure stimulation of the mucosa overlying the arytenoid cartilages. Ten normal volunteers provided button press responses to air pressure stimuli during bilateral TA electromyography. Similar thresholds were determined by reports of sensation as by electromyographic responses (p < .0005). The early TA responses occurred either around 80 ms or around 125 ms after onset of the air puff, with equal frequency on the ipsilateral and contralateral sides. The TA muscle responses to air pressure stimulation differ in physiological characteristics from the laryngeal adductor reflex that occurs in response to electrical stimulation of the superior laryngeal nerve.     

Fraser-Cryptophthalmos syndrome with cardiovascular malformations: a rare association

Fraser-Cryptophthalmos syndrome is a multiple malformation disorder associated variably with cryptophthalmos (hidden eye), anomalies of the head, nose and ears; syndactyly, renal and genital malformations. In this report, we describe a case of Fraser syndrome with cardiovascular malformations: coarctation of aorta, an association not previously described.     

Corticosteroid physiology and principles of therapy

The adrenal cortex secretes glucocorticoids (GC), mineralocorticoids (MC) and androgens. GC maintain homeostasis, MC regulate fluid and electrolyte balance and adrenal androgens contribute to development of secondary sexual characteristics. Pharmacologic GC therapy is frequently indicated in the pediatric age group. Besides having many important side effects, prolonged high dose systemic GC therapy has a suppressive effect on endogenous steroid production. Therefore, GC therapy should be withdrawn gradually and stopped based on assessment of hypothalamo-pituitary-adrenal (HPA) axis recovery. Patients with HPA axis suppression require physiological replacement of GC along with enhancement of doses during periods of stress. Due to its immunosuppressive effects, issues about safety and efficacy of live virus vaccines in patients receiving systemic high dose GC therapy must be borne in mind.