Abstract
Background: Pre-eclampsia is a pregnancy specific disorder which constitutes hypertension after 20 weeks of gestation and proteinuria. It is being speculated that associated subclinical left ventricular dysfunction may contribute to cardiac mortality and morbidity. This prospective study on left ventricular systolic function by echocardiography was undertaken in normal and pre-eclamptic pregnancies. Methodology: This prospective study was carried in Rajah Muthiah Medical College and Hospital, Chidambaram. Forty subjects were enrolled of which 20 had pre-eclampsia and 20 were normotensive. All were subjected to echocardiography.Results: Echocardiography reveals no significant systolic dysfunction was noted in pre-eclamptic patients and normotensive patients.

2016040219.SYSTOLIC FUNCTION IN PRE ECLAMPSIA pdf.

Abstract
Objective
To compare the Transvaginal cervical length with modified Bishop’s score for cervical assessment in women undergoing labour induction at term to predict the need for caesarean delivery and to estimate the cut-off points for cervical length measured by TVS and modified bishop’s score in successful induction.
Methods: A prospective study was performed on One hundred and twenty five nulliparous women admitted for induction of labour. The cervical length was measured by TVS in cm followed by Digital vaginal examination done to record the modified Bishop’s score. Dinoprostone gel (0.5mg) was kept in the endocervical canal for inducing labour.
Results: Bishop’s score of 4 and cervical length by transvaginal ultrasound of 2.6cm are considered as cutoff values. Patients with TVS Cervical length of (2.54±0.50) cm delivered vaginally, whereas patients with TVS Cervical length of (3.26±0.45) cm delivered by caesarean section. A total of 32 (61.5%) of the patients delivered vaginally, and 3 (4.1%) of the patients delivered by caesarean section had cervical length ≤2.6 cm. Patients with modified Bishop’s score around (4.9±3.1) delivered vaginally, whereas patients delivered by caesarean section had modified Bishop’s score around (3.1±1.1). Moreover, 39 (75%) of the patients delivered vaginally, and 20(28.7%) of the patients delivered by caesarean section had modified Bishop’s score ≥4.
Conclusions: Both TVS cervical length and modified Bishop’s score are useful predictors of the need for caesarean delivery following labour induction.

2016040218.Study of comparison on transvaginal cervical length and modified Bishop’s score pdf.

Abstract
Post partum hemorrhage (PPH) is an important cause of maternal mortality accounting for nearly 25% of maternal deaths worldwide. Atonic PPH is the most common cause of PPH. PPH is a preventable condition. Third stage of labour is indeed a unforgiving stage of labour where normal case can become abnormal within a minute and successful delivery can turn into a disaster. This paper represent a case of atonic PPH as well as literature review.

2016040217.CHALLENGING CASE OF POSTPARTUM HEMORRHAGE – A CASE REPORT pdf.

Abstract
Introduction: Gestational diabetes mellitus (GDM) according to ACOG is any degree of glucose intolerance that either commences or is first diagnosed in pregnancy.
Babies of GDM mothers are regarded as a major risk factor for birth trauma, respiratory distress syndrome, birth asphyxia, transient tachypnea of the newborn and jaundice. These babies are also at a risk for microvascular (e.g., ocular and renal complications) and macrovascular complications (e.g., cerebrovascular accident, atherosclerosis and cardiovascular insult). The neonatal mortality rate is over five times higher than that of infants of normal mothers. In this study, therefore we aimed to assess the effect of maternal diabetes on cord serum lipid profile.
Objective: The aim is to analyse the impact of gestational diabetes mellitus (GDM) on cord serum lipid profile.
Methods: Study group included 30 babies of GDM women and control group included 30 equal cohort babies of normal pregnant women. Cord blood was collected at the time of delivery and lipid profile which includes serum cholesterol, serum triglycerides, serum low density lipoprotein and serum high density lipoprotein were estimated by autoanalyser.
Result: There was a significantly higher value of total cholesterol (75.45mg/dl vs 62.48mg/dl) and HDL (27.17mg/dl vs 24.55mg/dl) in babies of GDM women compared to babies of normal pregnant women. On the other hand slightly lower LDL (29.14mg/dl vs 30.16mg/dl) and triglycerides (56.44mg/dl vs 58.41mg/dl) were noted in babies of GDM women.
Conclusion: Total cholesterol and high density lipoprotein were significantly higher in babies of GDM women whereas LDL and TG were slightly lower compared to babies of normal women.

2016040216,IMPACT OF GESTATIONAL DIABETES MELLITUS ON CORD SERUM LIPIDS pdf.

Abstract
Back ground and objective
Cancer of cervix is a leading cause of morbidity and mortality in women world wide. So there is a need to develop an effective screening test to curb the disease, which should have good sensitivity and specificity. The present study is to compare the effectiveness of visual inspection after acetic acid and visual inspection after Lugol’s iodine as an adjunct test for Pap smear to improve its sensitivity and specificity.
Material and methods
This is a prospective study in which 50 women were screened. First Pap smear was taken followed by VIA, VILI. If positive in visual inspection methods, cervical biopsy is taken.
Results
Of 50 women, 21 had Pap as normal. Of 21, 19 were
negative for VIA, VILI. 2 women positive for both VIA,VILI. 27 had inflammatory smear. Of these 12 were positive for VIA, VILI.one shows dysplasia in Pap and histology shows chronic nonspecific cervicitis. two women who showed dysplasia in histology of these one had inflammatory smear in Pap and 1 had dysplasia in Pap also. These two were positive for VILI but one negative in VIA. Sensitivity of Pap, VIA, VILI individually were 58.6%, 38.46%, 42.85% respectively. Specificity of these 3 tests individually is 93.3%, 71.3%, 86.36% respectively. But sensitivity of Pap when combined with VIA, VILI is 100% and specificity is 80%.
Conclusion
The present study showed that Pap smear when combined with VIA, VILI had 100% sensitivity but with no improvement in specificity.

2016040215,Comparative study of Visual Inspection after acetic acid and Lugol’s iodine (VIA, VILI) versus combined Pap smear…pdf.

Abstract
Introduction: Various modalities have been tried for the management of postoperative pain. Clonidine is an alpha-2 receptor agonist. Dexmedetomidine is a super selective alpha–2 agonist made up of medetomidine’s dextrogyrous enatiomer. They produce analgesia with haemodynamic changes and minimum side effects.
Methods: A clinical study of 70 cases of ASA grade 1 & 2 between the age group 25-65yrs undergoing abdominal, obstetrical, gynaecological and orthopaedic surgeries under epidural anaesthesia. . At the end of surgery patients were allocated to receive either of Group – C Clonidine 2 g /kg with 5 ml of Normal saline. (No = 35) or Group – D Dexmeditomidine 1g /kg with 5 ml of Normal saline. (No = 35). Cardio-respiratory effects like Pulse rate, blood pressure, respiratory rate and side effects like nausea, vomiting, pruritus, hypotension, sedation, respiratory depression were studied. Continuous data was analyzed by student’s “t”-test and categorical data by Chi-square test and possible significance has been determined considering it statistically significant if it’s P < 0.05 level of significance. Results: In comparison of Group C and Group D , by highly significant difference in systolic blood pressure was seen from 0 min till 6 hrs in both the groups. Diastolic blood pressure was seen from 0 min till 6hrs and the difference was found to be statistically highly significant. Highly significant difference in pulse rate was seen from 15 min till 120 min in both the groups. Highly significant difference in respiratory rate was seen from 0 min till 6 hrs in both groups. It is observed that the incidence of nausea vomiting was comparable in both groups (5.71% in Group C as compared to 2.85% in Group D). 3 patients in Group C out of 35 had shivering (8.57%) while no shivering was observed in Group D. Conclusion: In our study, post operative arterial pressure and heart rate were slightly lower in both clonidine and dexmedetomidine group but the onset of fall and duration was longer in dexmedetomidine group. Although the incidence of nausea and vomiting were less in dexmedetomidine groups, the difference was not statistically significant between both groups. 2016040214,HAEMODYNAMIC CHANGES AND SIDE EFFECTS WHEN CLONIDINE AND DEXMEDETOMIDINE ADDED AS AN ADJUVANT TO BUPIVACAINE…pdf.

Abstract
Objective: To compare the efficacy of Bupivacaine 0.5% with Midazolam & Bupivacaine 0.5% used for supraclavicular approach to brachial plexus block in adult patients postoperatively.
Study Design: Randomized controlled clinical trial.
Place and Duration of Study: Rajah Muthiah Medical College and Hospital, Chidambaram, from April 2015 to August 2016.
Methodology: A randomized controlled clinical trial was conducted on 60 ASA- 1 or 2 adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into 2 groups of 30 each. Patients in group M were administered 27.5 ml of 0.5 % Bupivacaine with 2.5 ml of Midazolam (0.05 mg/kg) and those in group B were administered 27.5 ml of 0.5% Bupivacaine with 2.5 ml of distilled water. Hemodynamic varaiables (heart rate, blood pressure), pain scores and rescue analgesic requirements were recorded for 24 hours postoperatively, and compared using unpaired student’s t- test with significance at p < 0.05. Results: The duration of sensory and motor block was significantly longer in group M compared to group B (p < 0.05). Duration of analgesia was prolonged in group M compared to group B. Hemodynamics did not differ between the groups in the studied period. Conclusion: Bupivacaine (0.5%) in combination with Midazolam (0.05 mg/kg) prolonged the duration of motor and sensory blockade and duration of analgesia of brachial plexus block for upper limb surgery. 2016040212dr.MIDAZOLAM WITH BUPIVACAINE 0.5% IMPROVES ANALGESIA QUALITY IN BRACHIAL PLEXUS BLOCK BY SUPRACLAVICULAR APPROACH IN POSTOPERATIVE PERIOD pdf

Abstract
Background: The study was conducted with an aim to estimate the prevalence of central obesity in newly diagnosed type 2 diabetics.

Materials and Methods: A cross-sectional study was carried out to estimate the prevalence of central obesity in patients who have been newly diagnosed with type 2 diabetes in the past 3 months. 100 patients participated in our study, in whom waist circumference was measured as a surrogate for visceral adipose tissue by measuring at the horizontal plane above the iliac crest1. Cut-off values for waist circumference were derived from Modified NCEP:ATP III (National Cholesterol Education Programme: ATP III Control Panel) criteria.
Results: Among the 100 study participants, the maximum number of participants belonged to the age group 40-50 years (53%). 24% of participants were obese with a BMI ≥30 and 32% were overweight with a BMI of 25-29.9. 69% of participants had high waist circumference according to the modified NCEP ATP III criteria whereas 31% of the participants had a normal waist circumference. Among the 69 participants who had high waist circumference, 43(62%) were females and 26 (38%) were males.
Conclusion: There was higher prevalence of central obesity in females who were newly diagnosed diabetics. Waist circumference is a better measure of central obesity than BMI.

2016040211.A CROSS-SECTIONAL STUDY OF THE PREVALENCE OF CENTRAL OBESITY IN NEWLY DIAGNOSED TYPE 2 DIABETICS

Abstract
Spinal anaesthesia is effective in the management of perioperative pain which extends into the initial post-operative period. In order to maximize intraoperative pain free period numerous techniques and newer drugs have been tried. In this study, the anesthetic properties of 12.5 mg of 0.5% hyperbaric bupivacaine with 0.4 ml of normal saline and 12.5 mg of 0.5% hyperbaric bupivacaine with 2 mg of midazolam given intrathecally were compared. A hundred ASA physical status I and II patients, posted for various elective lower limb and lower abdominal surgeries were studied. The patients were divided into two groups of fifty each:
Group A – Received 0.5% hyperbaric bupivacaine 12.5 mg + 0.4 ml of Normal saline
Group B – Received 0.5% hyperbaric bupivacaine 12.5 mg + 2 mg of midazolam.
Addition of 2 mg of midazolam to hyperbaric bupivacaine does not alter the onset and level of sensory and motor block. The time taken for two segment regression was significantly prolonged in Group B (Group A – 78.9; Group B 87.2min).The time taken for maximum sensory blockade was significantly prolonged in Group B(Group A –7.4min; Group B – 5.5min). More number of the mean arterial pressure changes from baseline values varied from 6.76% for patients in group B compared with 5.41% group A. there was 8% fall in the mean pulse rate from the baseline in group B compared to 9.7% in group A.
With the above findings it is evident that the use of 2mg of intrathecal midazolam as an adjuvant to hyperbaric bupivacaine in lower limb and lower abdominal surgeries is beneficial in several aspects and scored over the use of hyperbaric bupivacaine alone without side effects.

2016040210.INTRA OPERATIVE EFFECT OF INTRATHECAL HYPERBARIC BUPIVACAINE WITH MIDAZOLAM AND HYPERBARIC BUPIVACAINE ALONE IN LOWER LIMB