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   2004| February  | Volume 58 | Issue 2  
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Sublingual misoprostol before first trimester abortion: A comparative study using two dose regimens
N Vimala, S Mittal, Sunesh Kumar
February 2004, 58(2):54-61
Various methods have been described for preoperative cervical priming prior to vacuum aspiration (VA) in first trimester pregnancy termination, to facilitate cervical dilatation and shorten the abortion procedure. Recently misoprostol a prostaglandin E1 analogue has been shown to be effective in facilitating cervical dilatation prior to VA. Misoprostol offers several advantages over the other prostagland in analogues including stability at room temparature, ease of administration and minimal side effects. OBJECTIVE: To determine the optimal dosage and dosing interval for the use of misoprostol administered sublingually for pre-abortion cervical dilatation. Setting & Design: This was a prospective randomised study conducted at Comprehensive Rural Health Project, Ballabgarh the rural health centre under Centre for Community Medicine, AIIMS, New Delhi. MATERIAL AND METHODS: One hundred and twenty pregnant women between 6-11 weeks of gestation opting for voluntary medical termination of pregnancy were (MTP) randomly allocated to either 200 g or the 400 g misoprostol group. Vacuum aspiration was performed either two or three hours after administration of sublingual misoprostol. Using Hegar's dilators, degree of cervical dilatation before vacuum aspiration was measured. Other parameters assessed included the amount of additional dilatation required, intra-operative blood loss and associated side effects. STATISTICS: Statistical analysis was conducted using chisquare, the student's t and the Mann-Whitney U tests to examine the difference between the two groups. Results: In the 200 g misoprostol group 33% achieved a dilatation of > 8 mm compared with 71% of women in the 400 g misoprostol group. The odds ratio was 95.8 (95% CI 10.2-842.9) for 400 g misoprostol for successful preoperative cervical dilatation of > 8 mm. The mean baseline cervical dilatation for 400 g and 200 g misoprostol was 8.2 mm and 6.0 mm respectively (P<0.001). The use of 400 g misoprostol with an evacuation interval of two hours appears to be the optimal dosage and evacuation interval. Increasing the time interval beyond two hours did not confer any additional advantage on the rate of successful cervical dilatation but was instead associated with an increased incidence of side effects such as preoperative vaginal bleeding, abdominal pain and shivering. CONCLUSION: Our study has shown that Sublingual administration of 400 g of misoprostol at least two hours before procedure is effective for preoperative cervical dilatation before vacuum aspiration in first trimester pregnancy termination. There is no additional advantages of increasing the dosing interval upto three hours.
  12,010 352 6
Evaluation of diarrhea: The challenge continues! Part-I
Sundeep Shah
February 2004, 58(2):75-78
  10,568 346 1
Iron deficiency anemia - Part-I
Asha Shah
February 2004, 58(2):79-81
  9,106 459 1
Rapid diagnosis of meningitis using reagent strips
Ramesh C Parmar, Swapna Warke, Poonam Sira, Jaishree R Kamat
February 2004, 58(2):62-66
OBJECTIVES: Identification of causative agent with estimation of cerebrospinal fluid (CSF) glucose, protein, cells is necessary for accurate diagnosis of meningitis. Unfortunately, even these facilities are not available in many areas. Reagent strips that measure glucose and protein in blood and urine can serve this task but have been used with varying results in the past. This study was carried out to evaluate the utility and efficacy of Combur 10 strips in the diagnosis of meningitis. DESIGN, SETTINGS AND METHODS: A prospective clinical single blinded study of 63 children suspected to have meningitis undergoing CSF analysis. Each CSF sample was divided in to two and was utilised for reagent strip analysis in addition to standard laboratory evaluation and a correlation analysis were made. Statistical Method used: Results were analysed using standard statistical tests. Accuracy of the reagent strips as a screening tool was established using Godyn's test. RESULTS: The sensitivity, specificity of the reagent strips for the diagnosis of meningitis was 97.14%, 96.42%. The sensitivity, specificity for tuberculous meningitis and bacterial meningitis were 100%, and 96.55%. That for the aseptic meningitis was 70% and 96.55%. Accuracy for the diagnosis of meningitis as a whole, bacterial meningitis, tuberculous meningitis, and aseptic meningitis were 96.78%, 98.2%, 98.27% and 83.0% respectively. CONCLUSION: Combur10 strips thus can be used for the rapid CSF analysis and screening with good accuracy. In situations where facilities of routine laboratory testing are not available this can be of an immense help.
  6,681 410 3
Outbreak of measles amongst vaccinated children in a slum of Chandigarh
Munesh K Sharma, Vikas Bhatia, HM Swami
February 2004, 58(2):47-53
BACKGROUND: An outbreak of measles was reported from a slum, UT, Chandigarh in April 2003. Similar outbreak was also reported in less than three years from the same and adjoining areas. The present study was conducted to investigate and assess various epidemiological features associated with measles outbreak. MATERIAL AND METHODS: Three cases of measles were admitted in Deptt. of Paediatrics, Govt. Medical College & Hospital, Chandigarh and were reported to the Deptt. of Community Medicine for an outbreak investigation. A trained team investigated the slum having a population of 25,000 and studied various features associated with epidemic between the period of April 22 to May 10, 2003. RESULTS: The study covered 484 houses having 1130 children. Among the children who developed measles 32.76% were vaccinated ones. In them attack rate was 3%. Attack rate in vaccinated children went on increasing as age increased. An overall attack rate of 5.13% (Peak incidence 6% in 1-4 years age group) was recorded. Among measles cases, one-fifth had post measles complications. As much as 32.76% children with measles had received measles vaccination in the past. Therefore something more than immunization by single dose of vaccine is required. Measles was reported to be higher amongst the children without Vitamin A supplementation (P<0.001). CONCLUSION: There is need to store vaccine properly and to strengthen routine immunization coverage, Vitamin A supplementation and health infrastructure in underprivileged population. Serological studies among vaccinated children against measles should be undertaken to explore the possibility of second dose of measles in older children.
  6,218 343 15
Arthritis in lymphomatoid granulomatosis: Report of a case and review of literature
Vikas Agarwal, Amita Aggarwal, Lily Pal, Ramnath Misra
February 2004, 58(2):67-71
Lymphomatoid granulomatosis (LG) is a rare systemic vasculitis caused by Epstein Barr virus induced transformation of the B-cells in a T-cell rich environment. The predominant clinical presentations are confined to the pulmonary system however; extra-pulmonary manifestations can sometimes be the main feature of the disease. Here in we describe a 52-year-old female who presented with symmetric polyarthritis and generalized stiffness for 7 months and papular lesions over extremities for 3 months duration. She in addition had generalized lymphadenopathy. Histopathological examination of the cutaneous lesions confirmed LG. Patient died despite therapy with cyclophosphamide and prednisolone. This is the first report of LG mimicking rheumatoid arthritis from India.
  6,205 304 1
Ceftriaxone induced cholestasis in a neonate: A case report
MS Ravisha, SV Godambe
February 2004, 58(2):73-74
  5,347 239 2
Wilms' tumor arising in a horseshoe kidney
Sashidhar V Yeluri, Dipesh D Duttaroy, Pranav Ghodgaonkar, Siddharth Karanth
February 2004, 58(2):72-73
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2004 - Indian Journal of Medical Sciences
Published by Wolters Kluwer - Medknow
Online since 15th December '04