Biomedical subjects
Publications and source records attributed to M Malhotra.
A case of unilateral phylloides tumor of breast with sudden enlargement during pregnancy has been presented with successful pregnancy outcome followed by complete surgical excision (simple mastectomy) in the puerperium.
METHODS: We describe a prospective study, done over a 2-year period in which a total of 958 women having a vaginal delivery were randomised to the drainage method (478 women) or controlled cord traction method (480 women) for placental delivery. RESULTS: The mean age, parity, gestation and birth weight were similar in the two groups. The mean duration of third stage of labor was 3.24 min and 3.2 min in the placental drainage group in contrast to 8.57 min and 6.20 min in controlled cord traction method in primigravida and multigravida respectively. CONCLUSION: Placental drainage significantly reduces the duration of third stage of labour in vaginal deliveries.
CASE REPORT: A 60-year-old female, para 1, menopausal for last 12 years was admitted with complaints of distention and pain abdomen for last 2 months. There was no history of postmenopausal bleeding. On abdominal examination there was a vague mass in lower abdomen reaching upto umbilicus. On vaginal examination, uterus was eight weeks size and a vague mass was felt around it through all fornices. On exploratory laparotomy uterus was studded with multiple friable hemorrhagic growths perforating from fundus and filling the peritoneal cavity. TREATMENT: Total abdominal hysterectomy with bilateral salpingo-oophorectomy with debulking of tumour and omentectomy was performed followed by postoperative adjuvant radiotherapy. CONCLUSION: Histopathology report confirmed it to be uterine myxoid leiomyosarcoma which is an extremely rare variant of uterine sarcoma with poor prognosis exhibiting malignant biologic behaviour.
OBJECTIVES: To compare the pregnancy outcomes of women having valvular heart disease with the pregnancy outcomes of healthy women. METHODS: A retrospective comparison of the maternal and fetal pregnancy outcomes of 312 women with valvular heart disease and 321 healthy women cared for at a tertiary care hospital during the same period. Statistical analysis was done using the chi(2)-test, with significance fixed at 0.05. RESULTS: Women with valvular heart disease had a significantly higher incidence of surgical interventions during pregnancy than women in the control group [13.4% (balloon mitral valvotomy) vs. 0.6% (ovarian cystectomy)], congestive heart failure (5.1% vs. 0%, P<0.001), and mortality [0.64% (two women) vs. 0%]. Perinatal outcome was also more adverse in the valvular heart disease group than in the control group, with increased preterm delivery rate (48.3% vs. 20.5%), reduced birth weight (2434+/-599 g vs. 2653+/-542 g; P<0.001), and a higher incidence of APGAR scores less than 8 (8.3% vs. 4%; P<0.01). There was also a higher rate of instrumental delivery (9.9% vs. 3.4%). However, the rate of cesarean deliveries was similar in the two groups. CONCLUSIONS: Pregnancy in women with valvular heart disease is associated with significantly higher maternal morbidity and adverse fetal outcomes and requires a team approach for optimal management.
BACKGROUND: Pelvic pain is common in adolescent girls in day-to-day practice. Severity, Affect, Family and Environment (SAFE) is a recent interview strategy to approach these patients and their families. AIM: 1. To find the prevalence of pelvic pain in adolescent girls. 2. To find out the feasibility and acceptability of "SAFE" approach in evaluating chronic pelvic pain in adolescent girls. SETTINGS & DESIGN: 200 adolescent girls aged 13-23 years were selected at random from school and colleges nearby hospital campus. METHOD: A questionnaire method was adopted. Adolescent girls selected were divided into two groups, group I (with pain) and group II (without pain). STATISTICAL ANALYSIS: It was performed using chi-square and Fischer tests with significance of p value being taken at 0.05. RESULTS: Out of 200 adolescent girls selected for interview, prevalence of pelvic pain was found to be 37.0%. Dysmenorrhoea was also found to have significant relationship with pelvic pain. Depression and anxiety, school absences and loss of weight were found to have significant association with pain. Pelvic pain was found to be more in adolescent girls with large family size (> 4 members), single parent, both parents working, ongoing marital problems at home and was less reported when there was good parent-child communication about sex and when the teenager was well prepared for menarche by the parents and the association with the above mentioned factors was found to be significant. CONCLUSION: "SAFE" approach contributes in identifying health problems in adolescent girls with chronic pelvic pain.
A questionnaire-study was undertaken among 50 women to take note of their views on awareness, information, choices and expectations on various aspects of hysterectomy performed on them. Most women (92%) did not know the type of hysterectomy and none of them was offered the alternative treatment, various types of hysterectomy done, type of anaesthesia used and hormone replacement therapy. A total of 96% wanted the surgeon to spend time with them explaining to them about various aspects of surgery and 46% thought the staff was sympathetic to them. A total of 26 women (52%) preferred to solve their problems with self-help groups (association of women with similar problems) and 84% wanted a leaflet to be distributed to them about various aspects of hysterectomy. This study concluded that Indian women to be involved in the decision making about their healthcare.
OBJECTIVES: To compare maternal and fetal outcomes in patients with non-operated valvular heart disease and patients who had surgery before or during pregnancy. METHODS: The 308 women with valvular heart disease who delivered in this hospital in the last 8 years were divided into three groups. The 218 (70.7%) women in group 1 had no surgical intervention; the 42 (13.6%) women in group 2 underwent balloon mitral valvotomy during pregnancy; and the 48 (15.5%) women in group 3 had surgical intervention before pregnancy (35 had balloon mitral valvotomy, eight had mitral valve replacement, and five had mitral valve repair). Maternal and fetal outcomes were compared for these three groups. RESULTS: The antenatal events differed significantly: 175 (80.3%), 40 (94.2%), and 46 (95.8%) patients in groups 1, 2 and 3, respectively, had uneventful pregnancies. In group 1, 14 (6.4%) patients had congestive heart failure (P>0.05) and 24 (11%) patients had cardiac arrhythmias, which was statistically significant. The rate of preterm deliveries did not differ significantly among the three groups. The groups did not differ in mean birth weight, mode of delivery, low birth weight, Apgar scores less than 8, stillbirths, neonatal death, or congenital anomalies. CONCLUSIONS: Mitral valve surgery before or during pregnancy did not significantly improve maternal and fetal outcomes but decreased adverse events such as congestive heart failure and cardiac arrhythmias. It should be therefore performed only in selected cases.
OBJECTIVES: To observe the effect of the antioxidant lycopene on the occurrence of pre-eclampsia and intrauterine growth retardation in primigravida women. METHODS: A total of 251 primigravida women were enrolled in this prospective, randomized controlled study in the second trimester. A total of 116 women were given oral lycopene (Group I) in a dose of 2 mg twice daily while 135 women were given a placebo (Group II) in the same dose until delivery. The criteria for recruitment included gestational age of 16-20 weeks, singleton pregnancy, absence of any medical complication and willingness on the part of the women to participate in the study. The women were followed-up until delivery for development of pre-eclampsia, mode of delivery and fetal outcome. RESULTS: The two groups were comparable in their maternal characteristics. Pre-eclampsia developed in significantly less women in the lycopene group than in the placebo group (8.6% vs. 17.7%, P=0.043 by chi-square test). Mean diastolic blood pressure was significantly higher in the placebo group (92.2+/-5.98 mmHg vs. 86.7+/-3.80 mmHg, P=0.012). Mean fetal weight was significantly higher in the lycopene group (2751.17+/-315.76 g vs. 2657+/-444.30 g, P=0.049). The incidence of intrauterine growth retardation was significantly lower in the lycopene group than in the placebo group (12% vs. 23.7%, P=0.033). CONCLUSIONS: The results of the present study suggest that the antioxidant lycopene reduces the development of pre-eclampsia and intrauterine growth retardation in primigravida women.
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OBJECTIVES: To test the efficacy and safety of laparoscopic oxidized cellulose application at the uterine perforation site. METHODS: In a prospective study over a 3.5-year period a total of 30 women undergoing combined surgical termination of pregnancy and laparoscopic sterilization who had a small uterine perforation were recruited. Oxidized cellulose (Surgicel) was inserted and attached to the perforation site with a laparoscope. The end point was sealing of the perforation and complete hemostasis. Laparotomy was performed if hemostasis was not achieved. RESULTS: The mean age, parity and gestation were 31.4 years, 3.8 and 9.3 weeks. The perforations occurred in the fundal region (60%), anterior wall (16.7%), posterior wall (13.3%), upper lateral wall (3.3%) and lower lateral wall (6.7%). Mean size of perforations, respectively according to site were 4.3 mm, 3.2 mm, 3.4 mm, 3 mm and 3.5 mm in the five groups. Laparoscopic oxidized cellulose application was successful in all women with fundal, anterior, posterior and upper lateral uterine wall perforations. In two women with perforations on the lower lateral wall, due to excessive blood loss, oxidized cellulose fell off; laparotomy was performed and hemostasis was achieved with sutures. All 28 laparoscopically-treated women were discharged on the next day in good condition with no complications. CONCLUSIONS: Laparoscopic oxidized cellulose application appears to be a safe and effective treatment for small uterine perforations that are bleeding moderately.
BACKGROUND: As ectopic pregnancy is associated with significant maternal mortality and morbidity it may be worthwhile to find alternative surgical method to traditional laparotomy. AIMS: To compare the efficacy, safety and cost effectiveness of minilaparotomy surgery for ectopic pregnancy cases with standard laparotomy method. SETTING AND DESIGN: A total of 60 patients of ectopic pregnancy were randomized for minilaparotomy and laparotomy (30 cases each) for three years from January. 1998 to March 2001 in a medical college hospital. MATERIAL AND METHODS: Patients history, clinical examination, intraoperative, preoperative and postoperative data were recorded and compared in minilaparotomy and laparotomy groups. STATISTICAL ANALYSIS USED: Chi-square and Fischer chi-square test is used using P value of less than 0.05 as level of significance. RESULTS: Mean operative time was significantly less in minilaparotomy (38 minutes) than in laparotomy group (54 minutes). Postoperative complications were fever in 4(13.33%) and 6(20%) cases, paralytic ileus in 3(10%) and 8(26.66%) cases, urinary tract infection in 2(6.66%) and 3(10%) cases and wound infection in 1(3.33%) and 5(16.66%) cases respectively in the two groups and were significantly less in the minilaparotomy cases. Mean day of mobility, starting normal diet and discharge from the hospital were 10 hours and 24 hours, 1.5 days and 3.1 days and 3.4 days and 6.9 days respectively in the two groups and were significantly less in the minilaparotomy group than the laparotomy group. CONCLUSIONS: Surgery by minilaparotomy technique in ectopic pregnancy cases appears to be a safe and feasible method and is superior to conventional laparotomy as there are minimum perioperative and postoperative complications and patients can be discharged early from the hospital without the need of expensive equipment.
We herein report a case of a pregnant woman with previous cesarean section whose uterus herniated in an incisional hernia of the anterior abdominal wall at 34 weeks of pregnancy. Incarceration of the pregnant uterus in an incisional hernia is a rare but serious obstetric situation. Treatment is conservative till term followed by delivery and herniorrhaphy as was done in our case and it was associated with successful outcome.
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BACKGROUND: Pelvic inflammatory disease is a common problem faced by the gynecologists in there out patient department. AIM: The aim of the study was to evaluate the efficacy of three treatment combinations in the syndromic management of pelvic inflammatory disease in the out patient setting. SETTING DESIGN: In the medical college hospital patients presenting in gynecology out patient department were enrolled. MATERIAL AND METHODS: One hundred and sixty five women with diagnosis of pelvic inflammatory disease were randomized into three equal groups getting ciprofloxacin (500 mg) and tinidazole (600 mg) combination twice daily for 7 days (Group 1), a kit containing fluconazole (150 mg), azithromycin (1 gm) and secnidazole (2 mg) as one time dose (Group 2) and Doxycycline 100mg twice daily and metronidazole 200 mg thrice daily for seven days (Group 3). Severity score was determined on first visit and after 1 week and 4 weeks when patients were called for follow up. STATISTICAL ANALYSIS: Chisqare test, Krusker wallis test and Mann Whitney test. RESULTS: There was significant reduction in severity score after 1 week of treatment, which was further reduced after 4 weeks in all the three groups. Cure rate was highest in-group 1 (96%) followed by group 2 (93.5) and group 3 (91.3%) but the difference was not statistically significant. Resolution of inflammatory mass was highest in group 1. The incidence of side effects was highest and compliance was lowest in the doxycycline -metronidazole group, but the difference was not statistically significant. CONCLUSION: All the three treatment combinations were found to be equally effective in the syndromic management of pelvic inflammatory disease.
OBJECTIVES: To assess the prevalence of incidental Fitz-Hugh-Curtis syndrome in women undergoing diagnostic laparoscopy for sterilization, infertility or chronic pelvic pain. METHODS: This was a prospective study over a 4-year period in which a total of 320 women undergoing diagnostic laparoscopy for sterilization [Group I, 200 women (62.5%)], infertility [Group II, 60 women (18.7%)], or chronic pelvic pain [Group III, 60 women (18.7%)] were enrolled. After examination of the pelvic area and abdominal cavity, the liver area was visualized in all cases for evidence of perihepatitis and adhesions between liver and anterior abdominal wall or diaphragm (Fitz-Hugh-Curtis syndrome). Statistical analysis was performed using the chi-square test, with a P-value set at 0.05 for significance. RESULTS: The mean age was similar in the three groups, while mean parity was obviously less in the infertility group. Fitz-Hugh-Curtis syndrome was observed in 16 women (8%) in Group I, 10 women (16.6%) in Group II, and 18 women (30%) in Group III. The prevalence was highest in Group III and the difference was statistically highly significant in Group III vs. Group I (P<0.001), and in Group III vs. Group II (P<0.01). It was higher in the infertility group than in the sterilization group (P<0.05 in Group II vs. Group I). CONCLUSIONS: There was a very high prevalence of incidental Fitz-Hugh-Curtis syndrome in the chronic pelvic pain and infertility groups, and even in the sterilization group.
The permeability of the cornea to drugs is clinically important because it is the major factor determining the efficacy of topically applied ophthalmic preparations. With this perspective, the present article gives a brief update and overview of corneal structure and proposed mechanisms of permeation. Physiological, physicochemical and formulation factors affecting drug permeation through cornea are highlighted. Influence of ocular penetration enhancers on drug permeation is also discussed.
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In vitro testing is useful for detecting pollen and fungal-allergen sensitivities in nasobronchial-allergy patients. However, allergen-coated discs or solid-phases supplied in kits do not contain all the relevant extracts. The present study was aimed to develop a safe and credible procedure of allergen coating on paper discs for allergy diagnosis by ELISA. Paper discs were coated with indigenous allergens using poly(vinyl alcohol) and glutaraldehyde. ELISAs were carried out to standardize the allergen-coated discs using skin-test-positive-patients' sera. The cut-off value (A) for ELISA was worked out by analysing normal human sera (NHS) and is based on the mean+/-2 S.D. for the NHS value. The allergen-coated discs, i.e. Centre for Biochemical Technology (CBT) discs, demonstrated excellent comparison with plate-binding method and Pharmacia discs [Prosopis juliflora (mesquite), critical value 0.879 at 5% probability+/-0.599, n=11, is significant]. Inter- and Intra-assay coefficients of variations ranged from 2.5-14.05% to 4. 8-11.5% with different allergens. Results of skin tests and ELISA with CBT discs showed 60-70% correlation.