Next-Generation Sequencing (NGS): Platforms and Applications.

The demand for accurate, faster, and inexpensive sequencing of deoxyribonucleic acid (DNA) is increasing and is driving the emergence of next-generation sequencing (NGS) technologies. NGS can provide useful insights to help researchers and clinicians to develop the right treatment options. NGS has wide applications in novel fields in biology and medicine. These technologies are of great aid to decode mysteries of life, to improve the quality of crops to detect the pathogens, and also useful in improving life qualities. Thousands to millions of molecules can be sequenced simultaneously in parallel using various NGS methods. NGS can identify and characterize the microbial species more comprehensively than culture-based methods. Recently, the NGS approach has been used for oral microbial analysis.

To Determine the Quality of Life in Indian Women After Peripartum Hysterectomy Using a Hindi Version of the SF-36 Questionnaire.

Objective: The objective of the study was to determine the quality of life in women after peripartum hysterectomy using a Hindi version of the SF-36 questionnaire. Background: There are long-term effects on quality of life in women after peripartum hysterectomy. The effects on physical, mental, and social functioning have a prolonged recovery. No studies have been done in Indian women after peripartum hysterectomy to evaluate quality of life. Methods: Patients who underwent peripartum hysterectomy from January 2017 to May 2021 were contacted to participate in the study. To determine the quality of life post-surgery, a Hindi version of the 36-item Short-Form Health Survey (SF-36) was used for a face-to-face personal interview-based assessment. The participants were divided into two groups based on the duration between surgery and the interview. The aggregate scores for the eight components of SF-36 were calculated, and responses were analyzed. Results: Out of the 138 post-hysterectomy women, 118 were enrolled in the study. Women who could not be contacted [14 (10.14%)] and those who died post-procedure [6 (4.35%)] were excluded. Out of the total, 43 assessed participants were within 2 years of surgery, and 75 were after 2 years of surgery. The group that was assessed after 2 years of surgery had a significantly lower quality of life in six, out of the eight aspects of SF-36 domains. Conclusion: Women after peripartum hysterectomy undergo a prolonged recovery phase with effects on physical, mental, and social functioning. A multi-disciplinary long-term follow-up including physiotherapy and psychotherapy is required and that should be guided by a dedicated clinical team.

Efficacy of Infraclavicular Brachial Plexus Block Alone Versus Combination With Suprascapular Nerve Block in Patients Undergoing Shoulder Surgeries: A Single-Blind, Randomized Trial.

Background and aim The regional anesthesia technique is commonly used for upper extremity surgery as an alternative to general anesthesia. The study aimed to compare the efficacy of infraclavicular brachial plexus block (BPB) and a combination of infraclavicular brachial plexus block with suprascapular nerve block for postoperative analgesia in patients undergoing shoulder surgeries. Method A total of 62 patients of both sexes with the American Society of Anaesthesiologists (ASA) physical status I/II/III, aged between 18 and 65 years, and undergoing shoulder surgery, were included in this prospective, single-blinded, randomized controlled trial. Patients were equally allocated into two groups: 31 in group A and 31 in group B. After pre-anesthetic evaluation, the purpose and protocol of the study were explained to patients, and informed consent was obtained. Thirty-one patients in group A were given infraclavicular brachial plexus block using 30 ml 0.375% bupivacaine while 31 patients in group B were given a combination of infraclavicular brachial plexus block using 30 ml 0.375% bupivacaine and suprascapular nerve block using 5 ml 0.375% bupivacaine. Blocks were given using ultrasound guidance and a peripheral nerve stimulator; the suprascapular block was given in the sitting position while the infraclavicular block was provided in the supine position. General anesthesia was administered in the operation theatre in the supine position after the administration of blocks. The pain was assessed using the visual analog scale (VAS) and the satisfaction score was assessed by the numeric rating scale (NRS). The Mann-Whitney U test was applied for comparison of pain between the two groups. The chi-square test was utilized for comparing the categorical variables. Result The postoperative pain was significantly lower (p<0.001) in group B as compared to group A at all the periods of observation, i.e., 0h (2.77±0.72 vs. 5.42±0.77), 6h (3.89±0.70 vs. 5.94±0.73), 12h (5.66±0.93 vs. 6.58±0.88), and 24h (6.16±0.80 vs. 6.74±0.90). These findings illustrate that group B patients who received a combination of infraclavicular brachial plexus block and suprascapular nerve block for shoulder surgeries had better pain relief than group A patients who received only the infraclavicular approach. The mean NRS score of patient satisfaction in group B (7.26±0.58) was significantly higher (p<0.001) in comparison to group A (6.16±0.64). Diaphragmatic palsy was observed in only one case in group A and none in group B. No other complication was observed in any of the patients during the study period. Conclusion The combination of infraclavicular brachial plexus block and suprascapular nerve block displays a positive postoperative analgesic profile with less usage of rescue analgesic doses and better patient satisfaction after shoulder surgery.

Effect of remineralizing agent on laser and nonlaser bleached enamel surfaces subjected to erosion: An in vitro study.

Aim: Assessment of remineralizing agent's effect on laser and nonlaser bleached enamel surfaces subjected to erosion. Materials and Methods: In this study, 80 extracted human permanent anteriors were collected and divided into 4 groups with 20 teeth per sample. Enamel specimen of 3 mm × 3 mm were made using polyvinyl chloride rings and acrylic and randomly divided into four groups. Then the specimens were subjected to initial microhardness test using Vicker's hardness tester (AVK-CO, Mitutoyo, Japan). Two indentations were placed at 100 mm from one another in the center of all the samples. Bleaching with laser and without laser using hydrogen peroxide was performed followed by remineralization in the groups (Groups 1a and 2a) and then were subjected to erosion. The final hardness was measured using the above method used for initial microhardness. Results: Microhardness in the remineralized groups showed least variation. The group in which laser bleaching was performed along with remineralization as compared with nonlaser bleaching group with remineralization showed improvement in microhardness but the data was not statistically significant. A significant difference was noted between the laser and remineralization group when compared with the groups in which no remineralization was done. Conclusion: After bleaching the enamel surface is more prone to erosion, so to improve the microhardness of bleached enamel a remineralizing agent should be used. A combination of diode laser bleaching and remineralizing agents leads to improved microhardness of the bleached enamel thus proving this combination to be efficacious.

Comparison of single and multiple file rotary endodontic instruments for debris and irrigant extrusion: An in vitro study.

Aim: The aim of this study was to assess and compare the quantity of apically debris which was extruded apically by TruNatomy (TN), ProTaper Next (PTN), HyFlex electric discharge machining (EDM), and HyFlex controlled memory (CM), following root canal preparation. Materials and Methods: Sixty extracted single-canal mandibular premolars were used. The root canal preparation was done with TN, HyFlex EDM, PTN, or HyFlex CM files. The preweight debris, which was extruded apically, was collected in the Eppendorf tube and later on incubated at 670°C for 3 days and weighed again to record the extruded debris. Results: The result showed that there was a significant reduction in debris extrusion by TN system, followed by PTN system, HyFlex EDM, and maximum extrusion in HyFlex CM (P < 0.05). Between the PTN and TN groups as well as between the HyFlex EDM and HyFlex CM groups, statistically significant difference was not observed (P > 0.05). Conclusion: Apical debris extrusion is the inherent nature of the all file systems. Nevertheless, the TN file system produced substantially minimum debris extrusion among other systems compared in the study.

Evaluating the Efficacy of Certain Intermediate Irrigants in Preventing Precipitate Formed Due to Sodium Hypochlorite and Chlorhexidine Within the Root Canal System: An In Vitro Study.

AIM: Root canal irrigation using a mixture of sodium hypochlorite (NaOCL) and chlorhexidine gluconate (CHX) might cause a precipitate to develop. This study aims to check the efficacy of sodium thiosulfate and normal saline as irrigating solutions. MATERIALS AND METHODS: Roots of 45 teeth were biomechanically prepared, and the teeth were then tested. A size 15k file was introduced to the point where the apical foramen could be visible in order to provide an accurate reading of the working length. As a precaution against irrigating solutions leaking out, the specimens' tips were sealed with modeling wax before being instrumented. Each group's root canals were instrumented with #F4 hand Protaper (Dentsply Sirona, USA) as recommended by the manufacturer. Between instrumentation, The canals were lubricated with ethylenediamine tetraacetic acid (EDTA) and irrigated with 2.5% sodium hypochlorite (RC Help, Prime Dental, Mumbai, India). Fifteen samples were randomly assigned to one of three experimental categories based on the middle watering arrangement used: Group 1 (control), Group 2 (saline irrigant), and Group 3 (3.86% sodium thiosulfate). The jewel plate was submerged in water to cool it down, while two longitudinal scores were made on the root's buccal and lingual surfaces. We used a stereomicroscope to examine the exposed surfaces of the root trench in the coronal, middle, and apical thirds for the orange-earthy colored material (Stereozoom Nikon magnifying lens under 20X amplification), and we used the Mann-Whitney U test and the Kruskal Wallis test during our thorough analysis. RESULTS: The precipitation generated in the coronal, middle, and apical thirds had significantly different thicknesses. While precipitation did occur in all three regions, it was at a much lower rate in the apical third compared to the coronal and middle regions. In Group 1, the control group, the precipitate was thicker than in Groups 2 (saline irrigant) and 3 (3.86% sodium thiosulfate). CONCLUSION: Sodium thiosulfate, which is a biocompatible solution, can be used as an intermediate irrigant as it shows less precipitate as compared to saline.

Intrinsic insights to antimicrobial effects of Nitrofurantoin to multi drug resistant Salmonella enterica serovar Typhimurium ms202.

Emerging multidrug resistant (MDR) serovar of Salmonella has raised the concern of their impactful effect on pathogenic infection and mortality in human lead by the enteric diseases. In order to combat the battle against these MDR Salmonella pathogen, new drug molecules need to be evaluated for their potent antibacterial application. This study evaluates the mechanistic antimicrobial effect of nitrofurantoin against a MDR strain of Salmonella named S. enterica Typhimurium ms202. The antimicrobial effect of nitrofurantoin was studied through experimental and computational approach using standard microbiological and molecular techniques like growth curve analysis, live-dead analysis, oxidative stress evaluation using high throughput techniques like flow cytometry and fluorescent microscopy. The result showed a potent dose dependent antibacterial effect of nitrofurantoin against S. enterica Typhimurium ms202 with a MIC value of 64 µg/ml. Moreover, the mechanistic excavation of the phenomenon described the mechanism as an effect of molecular interaction of nitrofurantoin molecule with membrane receptor proteins OmpC of S. enterica Typhimurium ms202 leading to internalization of the nitrofurantoin heading towards the occurrence of cellular physiological disturbances through oxidative stress impeded by nitrofurantoin-Sod1 C protein interaction. The results indicated towards a synergistic effect of membrane damage, oxidative stress and genotoxicity for the antibacterial effect of nitrofurantoin against S. enterica Typhimurium ms202. The study described the potent dose-dependent application of nitrofurantoin molecule against MDR strains of Salmonella and guided towards their use in further discovered MDR strains.

Biofilm modifiers: The disparity in paradigm of oral biofilm ecosystem.

A biofilm is a population of sessile microorganisms that has a distinct organized structure and characteristics like channels and projections. Good oral hygiene and reduction in the prevalence of periodontal diseases arise from minimal biofilm accumulation in the mouth, however, studies focusing on modifying the ecology of oral biofilms have not yet been consistently effective. The self-produced matrix of extracellular polymeric substances and greater antibiotic resistance make it difficult to target and eliminate biofilm infections, which lead to serious clinical consequences that are often lethal. Therefore, a better understanding is required to target and modify the ecology of biofilms in order to eradicate the infection, not only in instances of oral disorders but also in terms of nosocomial infections. The review focuses on several biofilm ecology modifiers to prevent biofilm infections, as well as the involvement of biofilm in antibiotic resistance, implants or in-dwelling device contamination, dental caries, and other periodontal disorders. It also discusses recent advances in nanotechnology that may lead to novel strategies for preventing and treating infections caused by biofilms as well as a novel outlook to infection control.

Effect of Erector Spinae Block and Pectoralis Block on Quality of Recovery and Analgesia After Modified Radical Mastectomy: A randomised controlled study.

Objectives: Post-operative pain after a modified radical mastectomy ranges from moderate to severe. Pectoralis (PECS) block has been found to be more effective than erector spinae block in reducing pain and the consumption of rescue analgesia in the post-operative period. This study aimed to compare the effect of erector spinae block and PECS block on the quality of recovery after modified radical mastectomy using the quality of recovery (QoR-40) score. Methods: This randomised controlled study was conducted at King George's Medical University, Lucknow, India, from 9th October 2020 to 9th October 2021. After general anaesthesia, patients were given blocks according to computer-generated randomisation: Group I: PEC I and PEC II (PECS) blocks; Group II: erector spinae plane (ESP) block; and Group III: control group (no intervention). The QoR-40 score was observed on the morning of the surgery and after 24 hours. Time to rescue analgesia and the total consumption of rescue analgesia in the first 24 hours were also observed. Results: A total of 90 patients were included (30 in each group). In the post-operative period after 24 hours, global QoR-40 scores were 183.64 ± 6.36, 179.68 ± 6.38 and 171.37 ± 6.88 in the PECS, ESP and control groups (P <0.0001). But there was no statistically significant difference between the QoR scores of PECS and ESP group patients (P = 0.0551). The total requirement of rescue analgesic was significantly lower in the PECS group (137.28 ± 31.46 mg) than in the ESP (189.46 ± 42.98 mg) and control (229.57 ± 46.80 mg) groups (P <0.0001). Time to first rescue analgesia was significantly higher in the PECS group (6.53 ± 2.78 hours) than in the ESP (4.05 ± 2.91 hours) and control (2.15 ± 1.51 hours) groups (P <0.0001). Conclusion: Both ESP and PECS blocks were effective in improving the QoR score and in reducing the consumption of rescue analgesia after modified radical mastectomy.

Synthesis of 6-alkoxy and 6-hydroxy-alkyl amine derivatives of braylin as vasorelaxing agents.

Braylin (10b) is a 8,8-dimethyl chromenocoumarin present in the plants of the family Rutaceae and Meliaceae and possesses vasorelaxing and anti-inflammatory activities. In this study, six 6-alkoxy (10b, 15-19), and twelve 6-hydroxy-alkyl amine (20a-20l) derivatives of braylin (11 and 12) were synthesized to delineate its structural requirement for vasorelaxing activity. The synthesized compounds were evaluated for vasorelaxation response in preconstricted intact rat Main Mesenteric Artery (MMA). The compounds showed l-type VDCC channel blockade depended and endothelium-independent vasorelaxation within the range of Emax < 50.00-96.70 % at 30 µM. Amongst all, 6-alkoxy derivatives were more active than 6-hydroxy-alkyl amine derivatives. The structural refinements about braylin showed that deletion of its methoxy group or homologation beyond ethoxy group presented deleterious effect on vasorelaxation response of braylin. Interestingly, substituting the ethoxy group in 10b presented the best activity and selectivity towards l-type VDCC channel blockade, a specific target cardiovascular function.

Synthesis of amide derivatives of 3-aryl-3H-benzopyrans as osteogenic agent concomitant with anticancer activity.

The present study reports a series of 3-aryl-3H-benzopyran-based amide derivatives as osteogenic agents concomitant with anticancer activity. Six target compounds viz 22e, 22f, 23i, and 24b-d showed good osteogenic activity at 1 pM and 100 pM concentrations. One of the potential molecules, 24b, effectively induced ALP activity and mRNA expression of osteogenic marker genes at 1 pM and bone mineralization at 100 pM concentrations. These molecules also presented significant growth inhibition of osteosarcoma (MG63) and estrogen-dependent and -independent (MCF-7 and MDA-MB-231) breast cancer cells. The most active compound, 24b, inhibited the growth of all the cancer cells within the IC50 10.45-12.66 µM. The mechanistic studies about 24b showed that 24b induced apoptosis via activation of the Caspase-3 enzyme and inhibited cancer cell migration. In silico molecular docking performed for 24b revealed its interaction with estrogen receptor-ß (ER-ß) preferentially.

Congenital anterior urethral valves and diverticula.

AIMS OF STUDY: Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. The present study highlights the clinical approach in identifying the condition and its treatment options. METHOD: Single centre, retrospective study of children. RESULT: Over a 16 year duration, 14 children were diagnosed with AUVs and diverticula with a mean age of 15 months. Clinical features included straining at micturation and a palpable penile swelling. Diagnosis was confirmed with voiding cystourethrogram and cystoscopy. An open surgical procedure was performed in 12 cases and endoscopic intervention done in one. On follow up 13 patients showed restoration of a normal voiding stream and normal renal function. One child died of chronic renal failure due to a delayed presentation, severe back-pressure changes, urinary ascites, and urosepsis. One patient developed a small urethrocutaneous fistula that healed spontaneously. CONCLUSION: AUV, though rare, should be recognizable due to the combination of a poor urinary stream and visible swelling in the ventral aspect of penis. Open surgical excision is the method of choice, and the outcome is excellent. LEVEL OF EVIDENCE: Level IV.

Short-Term Adverse Drug Reactions to Antiretroviral Therapy in Children with HIV: A Cohort Study.

OBJECTIVES: To carry out an active surveillance for adverse drug reactions (ADRs) in children with HIV infection newly initiated on antiretroviral therapy (ART), determine risk factors for their occurrence, and assess their influence on adherence to ART. METHODS: All children newly initiated on ART from 1st March 2014 to 30th June 2019 at a tertiary care children's hospital in New Delhi, were actively monitored for ADRs to ART for a period of 6 mo after ART initiation. The frequency, spectrum, and severity of ADRs, their influence on adherence, and risk factors for their occurrence were analyzed. RESULTS: Among the 174 enrolled children, ADRs were observed in 78 (44.8%) children during the first 6 mo after ART initiation. Total numbers of episodes of ADR observed were 108 (0.62 episodes of ADR/child). Sixty percent of events were of grade 1 severity, 19.4% events were of grade 2 and 3 each, while 1 (0.9%) event was of grade 4 severity. Adherence to ART was adversely affected in 21.8% of ADRs. Gastrointestinal symptoms (49.1%) were most frequent among all the events observed. Zidovudine, lopinavir/ritonavir, efavirenz and nevirapine based regimes were significantly associated with hematological, gastrointestinal, neurological, and dermatological ADRs, respectively. Children with immunological suppression were at a higher risk of developing ADRs as compared to those without it [RR 1.9 (95% CI (1.1-3.2)]. CONCLUSIONS: ADRs to ART are very frequent; most of them are mild and self-limiting. However, they can adversely impact adherence to ART. Anticipatory guidance, ongoing monitoring, and provision of symptomatic treatment will help tide over most ADRs and reduce their adverse impact upon ART adherence.

A systematic review and quality analysis of cancer pain guidelines.

Background and Aims: Cancer pain guidelines remain confined due to implementation barriers, preventing them from attaining a global perspective. The guidelines must be robust in development and inculcate high-quality content to achieve practical utility. Quality indicators related to safe opioid practice empower effective guideline implementation. Methods: The protocol was registered prospectively in PROSPERO (CRD42021244823). Guidelines published over the last decade providing insights into cancer pain management and incorporating safe opioid practice were evaluated. The review's primary outcome was to evaluate the quality of cancer pain guidelines. Appraisal of guidelines for research and evaluation II (AGREE II) instrument was used to assess a guideline's quality. The ADAPTE collaboration-guideline adaptation resource tool kit (ADAPTE) provided insights into its adaptation based on specific questions within the guideline. Results: Fourteen cancer pain guidelines met the eligibility criteria and were included for quality evaluation. Eight guidelines were evaluated with combined AGREE II and ADAPTE process, attaining >66.7% in the rigour of development domain score, summated scaled domain score, and specific ADAPTE tools to evaluate the quality of each guideline. The intra-class correlation coefficient was utilised for resolving inter-rater agreement. 'Safe opioid practice' within a guideline was assessed for quality content implementation. Conclusion: Combined AGREE II and ADAPTE identified four cancer pain guidelines, namely Ministry of Health Malaysia, National Comprehensive Cancer Network, NCEC-National Clinical Guideline, and World Health Organization, which were of the highest quality and incorporated safe opioid practice effectively.

Assessment of Role of Complete Dentures in Improving the Chewing Efficiency of Edentulous Patients.

Introduction: The loss of teeth leads to difficulty in chewing and smiling and an unesthetic appearance. The present study assessed the role of complete dentures in improving the chewing efficiency of edentulous patients. Materials and Methods: Eighty-two complete denture wearers of age group 40-75 years of both genders were enrolled in the study. The chewing efficiency of denture was determined by VMM machine. Patients were provided with the self- administered questionnaire and were advised to answer. Results: Out of 82 patients, there were 42 (51.2%) males and 40 (48.8%) females. The mean ± SD particle size was found to be 0.12 ± 0.07 mm in males and 0.13 ± 0.06 mm in females. A non-significant difference was observed (P > 0.05). The mean ± SD satisfaction level value was 1.28 ± 0.07. Conclusion: There was improved chewing efficiency with the complete denture, and the patient satisfaction level was high among patients.

Lupus Erythematosus Tumidus Associated With Hemophagocytosis.

ABSTRACT: A case of lupus erythematosus tumidus (LET), a subtype of chronic cutaneous lupus erythematosus, in an 85-year-old woman who presented with discrete indurated erythematous plaques over the face and upper chest is described. A skin biopsy showed features in keeping with a diagnosis of LET. Unusually however, the lymphocytic infiltrate contained frequent macrophages that demonstrated hemophagocytosis. Most of the phagocytosed cells were lymphocytes, but there was also evidence of erythrophagocytosis. The presence of conspicuous hemophagocytosis has only rarely been reported in skin biopsies of patients with autoimmune conditions. These include systemic lupus, neonatal lupus and dermatomyositis, and on 2 occasions in cases of nonspecified cutaneous lupus erythematosus. To the best of our knowledge, hemophagocytosis as a feature of LET has not been previously described in the literature.

Evaluation of apical leakage after immediate and delayed postspace preparation using different root canal sealers: An in vitro study.

BACKGROUND: Endodontically treated teeth with extensive loss of tooth structure lacks sufficient support for a permanent restoration. While restoring them with post and core it is important not to disrupt the apical seal. AIM: Evaluation of apical leakage after immediate and delayed postspace preparation using two root canal sealers. MATERIALS AND METHODS: Sixty single-rooted teeth were decoronated and roots were biomechanically prepared and obturated with gutta-percha and 2 sealers: AH Plus (Group A, n = 30) and Sure-Seal root canal sealer (Group B, n = 30). Groups A and B were subdivided into A1, A2 and B1, B2. Postspace was prepared immediately for A1 and B1. For A2 and B2 post space was prepared after storage in physiologic saline for 1 week. The samples were kept in Rhodamine B dye for 72 h and then sectioned longitudinally to observe dye penetration along the root canal wall under Stereomicroscope. The dye penetration was measured linearly and the values were subjected for statistical analysis using one-way analysis of variance and t-test. RESULTS: Statistically significant difference between Group A (1.00 mm) and B (2.71 mm) was observed (P < 0.001). However, the subgroups for immediate and delayed post space preparation did not show statistically significant difference (A1 = 0.947; A2 = 1.043; B1 = 2.306 and B2 = 3.120, P < 0.001). CONCLUSION: AH plus sealer showed lesser leakage compared to Sure-Seal Root canal sealer. The difference in leakage values was not statistically significant in delayed and immediate post space preparation groups, Time of postspace preparation has no influence on apical leakage.

Effectiveness of Manual Vacuum Aspiration (MVA) Device in the Management of Intrauterine Copper Devices (IUCD) with Missing Strings: A Prospective Interventional Study.

BACKGROUND: The cases of intrauterine contraceptive device (IUCD) with missing strings have risen due to increasing popularity of postpartum IUCD in Indian women. This has lead to increase in the burden of referral cases in tertiary care centres. Manual vacuum aspiration (MVA) device is a cheap and non-invasive method, well established for surgical abortion in first trimester of pregnancy. This study was undertaken to assess if MVA device can be used in retrieving IUCD in low resource setting, hence, reducing the need for referral or need of expensive and invasive techniques. METHOD: A prospective interventional study was conducted over a period of 6 months. A total of 50 women who were desirous of IUCD removal with non-visibility of strings at the external cervical os were included in the study. All cases were more than 12 weeks postpartum and had an ultrasound confirmed intrauterine location of IUCD. Women with pregnancy, extrauterine location of IUCD, active pelvic infection and cervical cancer were excluded. RESULTS: The incidence of IUCD with missing strings was 19.4%. Almost a third of the cases (36%) were referred from outside Delhi for IUCD removal to our centre. In 30% cases IUCD could successfully be removed using the MVA device. Majority of the IUCDs were inserted in hospital by a gynaecologist (90%), and most of the insertions were post-placental (62%). CONCLUSION: Retrieval of IUCD with missing strings with MVA device is a novel method and can be an initial approach in low resource setting before referral to a higher centre for management.

Bacterial Colonization of Vagina in Indian Women During Labor and Its Association With Puerperal and Neonatal Sepsis: A Tertiary Hospital Study.

Objective The aim was to find the prevalence of colonization of vagina with aerobic bacteria among low-risk Indian women in active labor and its association with early-onset neonatal sepsis (EONS) and puerperal sepsis. Methods The study was conducted prospectively from October 2018 to March 2020 in a tertiary hospital in New Delhi, India. Low-risk pregnant women (N=920) in active labor with intact membranes were recruited. High vaginal swabs were collected, cultured by standard methods to detect aerobic bacteria. The primary outcomes were the development of puerperal sepsis and EONS. Results In a total of 920 low-risk subjects, vaginal colonization was found in 484 (52.6%), coagulase-negative Staphylococcus being the predominant colonizer (13.2%) followed by Escherichia coli (8.9%). Multigravida women were at 1.4 times higher risk of colonization than primigravida (odds ratio [OR] 1.399; 95% CI 1.064, 1.84). Women whose sample was collected at the first vaginal examination were at 0.34 times lower risk of colonization as compared to women with more than one vaginal examination (OR 0.34; 95% CI 0.241, 0.481). The incidence of colonization increased with progressive vaginal examinations (p<0.001). None of the colonized women and their neonates developed puerperal sepsis or EONS, respectively. Conclusion Vaginal colonization of aerobic bacteria in active labor is not associated with an increased risk of puerperal sepsis or EONS.

The Most Comfortable Posture at First Postnatal Day in Women With Episiotomy for Breastfeeding and Routine Activities.

BACKGROUND: Episiotomy is a common procedure in vaginal deliveries. It was thought that episiotomy reduces the risk of severe perineal injuries, but now in various studies it has been observed that it is associated with increased perineal pain, sexual problems, and incontinence in the postpartum period. PURPOSE: This study was carried out to assess pain score on first postnatal day in women with episiotomy during breastfeeding and daily activities. METHOD: The consecutive patients who underwent normal vaginal delivery with episiotomy from November 1, 2020 to December 1, 2020 in the Department of Obstetrics and Gynecology at Safdarjung Hospital were evaluated. The patients with vulval edema; vulval hematoma; instrumental delivery; and cervical, vaginal, and perineal tear were excluded from the study. The episiotomy pain during routine activities and breastfeeding was assessed at first postnatal day by Visual Analogue Scale (VAS) pain score. The analysis of variance (ANOVA) was used to compare the VAS score in different positions for breastfeeding and routine activities. The most comfortable posture was with lowest VAS pain score. RESULTS AND CONCLUSION: Overall 73 patients were enrolled in the study, mean age was 23.48 ± 2.49 years, 47/73 (64.38%) were primigravida, and mean birth weight of neonate was 2.79 ± 0.43 kg. The mean VAS pain score during breastfeeding in crossed-leg position was 74.82 ± 28.33, and in left lateral position, the score was 14.51 ± 11.65 (p [U1] = 0.0001). The mean VAS pain score during resting position in sitting with leg down was 56.52 ± 21.23, and in left lateral position, the score was 21.25 ± 13.95 (p= 0.0001). The VAS score was increased as the birth weight (p= 0.302), and the duration of second stage of labor was increased (p = 0.047). The severe pain was in 5/73 patients using Western toilet and in 46/73 Indian toilet (p≤ 0.0001). CONCLUSION: The left lateral position for breastfeeding and resting supine are least painful positions. The Western-style toilets are more comfortable than Indian-style toilets.