Peripartum interventions resulting in reduced perinatal mortality rates, and birth asphyxia rates, over 18 years in a tertiary centre in South India: a retrospective study.

OBJECTIVE: To study the changes in the rates of perinatal mortality, birth asphyxia, and caesarean sections in relation to interventions implemented over the past 18 years, in a tertiary centre in South India. DESIGN: Retrospective study. SETTING: Labour and maternity unit of a tertiary centre in South India. POPULATION OR SAMPLE: Women who gave birth between 2000 and 2018. METHODS: Information from perinatal audits, chart reviews, and data retrieved from the electronic database were used. Interventions implemented during this time period were audits and training, obstetric re-organisation, and minor changes in staffing and infrastructure. MAIN OUTCOME MEASURES: Main outcome measures were perinatal mortality rate, birth asphyxia rate, and caesarean section rate. RESULTS: Perinatal mortality rate decreased from 44 per 1000 births in 2000 to 16.4 per 1000 births in 2018 (P < 0.001). The rates of babies born with birth asphyxia requiring admission to the neonatal unit decreased from 24 per 1000 births in 2001 to 0.7 per 1000 births in 2018 (P < 0.00001). The overall caesarean section rate was maintained close to 30%. CONCLUSION: In a large tertiary hospital in South India, with 14 000 deliveries per year, a policy of rigorous audits of stillbirths and birth asphyxia, electronic fetal monitoring, and the introduction of standardised criteria for trial of scar, reduced the perinatal mortality and the rate of babies born with birth asphyxia over the past 18 years, without an increase in the caesarean section rate. TWEETABLE ABSTRACT: Rigorous perinatal audits with training in fetal cardiotocography, decreased birth asphyxia, without a major increase in caesarean rates.

Symptomatic unilateral pleural effusion: A rare presentation of ovarian hyperstimulation syndrome.

Isolated pleural effusion is a rare presentation of ovarian hyperstimulation syndrome. The pathogenesis of this disorder has not been fully elucidated. It supports the role of systemic factors rather than transudation of fluid from the surface of enlarged ovaries. This article describes a rare case of isolated pleural effusion following controlled ovarian hyperstimulation during an in-vitro fertilization cycle.

Gastrointestinal histoplasmosis mimicking abdominal tuberculosis.

We report an elderly male who presented with history of chronic diarrhoea. The patient underwent colonoscopy and CT scan of the abdomen which strongly suggested tuberculosis; however histopathology showed presence of budding forms of Histoplasma capsulatum. The patient was started on oral itraconazole on which he improved remarkably.

Kerosene poisoning--varied systemic manifestations.

We report here unusual clinical manifestations in a case of kerosene poisoning. The patient presented with encephalopathy and in the course of stay in the hospital developed renal tubular acidosis, delayed first-degree burns and myocarditis. With supportivetherapy the patient recovered completely and was discharged without any sequelae.

Comparative evaluation of immunogenicity, reactogenecity and safety of purified chick embryo cell rabies vaccine and neural tissue rabies vaccine.

OBJECTIVES: 1. To compare the protective antibody titres on day 14, 30 and 90 after giving intramuscular (IM) injections of PCECV and subcutaneous injections of Nervous Tissue Vaccine. 2. To compare the immunogenicity and safety of PCECV and NTV. METHODS AND MATERIALS: The study enrolled cases in three groups. Group 'C' or control group: (n = 38) : This group comprised of 38 normal healthy volunteers without dog-bite. Group 'A' (n = 102): This group included cases of dog-bite fulfilling inclusion/exclusion criteria. Each one of Group A and C were given PCECV as post exposure treatment (PET) on day 0-3-7-14-30 and 90. Group 'B' (n = 50): This group included 50 cases of dog-bite who received NTV. The rabies virus neutralizing antibody titres were estimated by RFFIT (Rapid Fluorescent Focus Inhibition Test) on day 0, 14, 30 and 90 days. 45 recipients of PCECV were re-tested for persistence of Protective Antibodies at the end of 1 year. RESULTS: Of these 37, 91 and 45 cases were evaluable in Groups C, A and B respectively. The antibody titres in Groups A, B, C were 13.4, 3.2, 22.8 IU/ml respectively; the protective titre being 0.5 IU/ml.5% PCECV recepients had delayed response on day 30.14% of NTV recepients did not seroconvert. CONCLUSIONS: The Immunogenicity, Reactogenicity and safety of PCECV is well established. 5% of PCECV receipients showed a delayed sero conversion. 14% of NTV receipients did not sero convert at all. Therefore it is desirable to estimate antibody titres on day 14 after vaccination. If difficult, then all the cases of animal bite must receive passive immunization with rabies immunoglobulins.

Preparation and evaluation of a liposomal formulation of sodium cromoglicate.

Sodium cromoglicate (SCG) is given by inhalation in prophylactic control of asthma. It was encapsulated in liposomes with a view to improve utilization of the drug when given via pulmonary route. The liposomes were characterized for encapsulation efficiency, shape, size and release rate. Liposomal dispersions were freeze-dried using a cryoprotectant. Freeze-dried liposomal dispersion retained 60% of drug upon reconstitution but increase in size of liposomes was noted. Liposomes exhibited good keeping properties when stored at 4 degrees C. In vivo performance of liposomal SCG was evaluated in sensitized guinea pigs. In one of the studies, differential leukocyte count and total leukocyte count in bronchoalveolar lavage fluid was measured. Liposomal dispersion showed significant inhibition of influx of neutrophils as compared with drug solution at 24 h. However, in the second study, when recovery period required by animal to revert back to normal respiratory pattern from the onset or preconvulsion time was measured, no significant difference was found between drug solution and liposomal dispersion when administered 2 h before allergen challenge.

Preparation and evaluation of liposomal formulations of tropicamide for ocular delivery.

Tropicamide, a mydriatic, cycloplegic drug was entrapped in liposomes. Liposomes were investigated by laser counting studies, transmission electron microscopy and differential scanning calorimetry for characterization. The precorneal clearance of liposomes was compared with solution by gamma-scintigraphy in the rabbit. The neutral liposomes failed to demonstrate significant enhancement in precorneal retention in comparison with aqueous solution. The potential of liposomes as an ophthalmic drug delivery system was investigated by comparing pupil dilatory effect of tropicamide by topical instillation, in the rabbit eye, of the solution and various drug-loaded liposomal forms, i.e. neutral liposomes, positively charged liposomes and neutral liposomes dispersed in 0.25% (w/v) polycarbophil gel. The positively charged liposomal formulation and liposomes dispersed in polycarbophil gel were found to be more effective than neutral liposomal dispersion when data were statistically treated at the 5% level of significance.