Kuldip Pratap Patel

Abstract

Background: Sigmoid volvulus is a condition in which the torsion of the sigmoid colon around its mesenteric axis leads to acute colonic obstruction that is not timely and properly treated, leading to life-threatening and morbid complications such as bowel ischemia, gangrene and perforation. The aim of the study is to analyze the risk factor of SV, clinical signs and symptoms, treatment, complications and outcomes when it presents as a surgical emergency in a tribal area in central India. Materials and Methods: This is a prospective, single-center, cohort study of 24 patients presenting to the government with features of SV. medical college Shahdol [tribal area of ??central India] from June 2022 to November 2022. All data formulated in frequency charts. Results: We develop a prediction model for the high incidence of SV, its presentation and treatment in patients from the trunk region. 21 patients (87.5%) were male and 3 patients (12.5%) were female. The age of the patients varied between 30-80 years, most of them between 50-70 years. The main risk factors were [1] old age, [2] male gender, [3] rural residence, [4] low socioeconomic status, [5] pure vegetarian diet, [6] abuse [mc-alcohol], [7] chronic constipation, [8] chronic pain medication user [9] associated comorbidity [mc-hypertension] [10] high fiber diet, have a higher chance of this. The most common symptoms were absolute constipation and generalized abdominal distension followed by abdominal pain. The most common symptoms were tenderness followed by tachycardia and then fever. All patients were examined by clinical symptoms, plain X-ray of the upright abdomen and blood tests. Vomiting, the most common postoperative complication, followed paralytic ileus. Among the patients, 6 had distended gangrenous SV, 15 patients were found to have distended non-gangrenous, and 3 patients had perforated gangrenous sigmoid colon volvulus. Mostly treated with sigmoidectomy with stoma followed by resection with colorectal anastomosis with flatus bypass. Most patients were discharged, only 3 [12.8%] patients died. Conclusions: SV predominates in older men. Most patients with SV have a history of alcohol abuse, a high-fiber diet, and low socioeconomic status. Keywords: Sigmoid colon, Strangulation, Volvulus

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Background: PPH is most significant and common cause of maternal morbidity and mortality in developing and developed countries both due to uncontrolled bleeding. It is responsible for 30% of maternal death. Around, two-thirds of the obstetric morbidity is related to haemorrhage. From many studies, found that PPH 50 times increases the risk of the morbidity and 5 times higher morbidity than mortality. Materials and Methods: This is a prospective cohort study, which is done in the Department of Obstetrics & Gynaecology of MGM Medical College and M.Y. Hospital, Indore over a period of one year in 60 patients. All the patients who developed PPH with failed medical management and give proper consent for application of clamp included. Patients with cervical cancer and patients who do not give consent are excluded. Statistical Test: All the data analysis was performed using IBM SPSS ver. 20 software. Frequency tables and cross tabulation is used to prepare the tables. Categorical data was expressed as number and percentages whereas quantitative data was expressed as mean and standard deviation. Categorical data was compared using chi square test whereas means were compared using one-way Anova. Microsoft word and excel used to generate graph, table etc. P value of less than 0.05 was considered as significant. In our study, more than half (56.7%) clamping were successful. In this study, more than half (56.7%) clamping were successful. Patients with lower parity had more chances of successful clamp as compared with those with higher parity. Blood loss was significantly less in those with successful clamp (1127.94) as compared to without successful clamp (1384.62) as revealed by the highly significant p value of Results: In the present study, we evaluated requirement of further surgical procedure and clamp success rate and results showed that majority of the patients who had successful clamp does not require further surgical procedure to undergo as compared to those without successful clamp. Blood loss was significantly less in those with successful clamp as compared to without successful clamp.   Keywords: Postpartum haemorrhage, Clamp.

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Introduction: Thyroid dysfunction is a common disorder in pregnancy which affects both maternal and fetal outcomes. There are very less and limited data on prevalence of hypothyroidism during pregnancy from India because no such big study done till now. This study done to define cut off value of serum TSH level in Indian pregnant women as hypothyroid and maternal and fetal outcomes. This study was planned to establish a lower cut off value for serum TSH to diagnose hypothyroidism in Indian pregnant women. Materials and Methods: This is a prospective and retrospective cohort study conducted in a period of 1.5 years between September 2021 to April 2023, in the department of Obstetrics & Gynecology GMC Shahdol in 1000 pregnant women’s who comes in antenatal checkup in OPD.All healthy pregnant women with singleton pregnancy willing to participate in the study were enrolled. Women which have multiple pregnancy, known chronic medical disorder like diabetes, hypertension, any autoimmune disorder with hyperthyroidism or known hypothyroidism, bad obstetric history with a known cause are excluded from study. However, there are few limitations of this study. We have not assessed trimester specific ranges. Follow up beyond newborn period was not possible because after discharge most infants either did not come for follow up or they were seen in pediatric clinic. We did not carry out thyroid examination using ultrasound, and we have not evaluated other causes of hypothyroidism in these women. All pregnant women underwent ELISA TSH assay. Women with serum TSH >6.2mIU/L underwent Free Thyroxin (FT4) estimation and labelled as overt hypothyroid (OH) (group I) or subclinical hypothyroid (SCH) (group II). Women with serum TSH between 3-6.2mIU/L & 0.4-3mIU/L were labelled as group III & control. Foeto-maternal outcomes were compared between group I, II,III & controls. Result: The prevalence of SCH & OH was 6.4% and 3.8%. Pre-eclampsia, gestational DM & IUFD in group I and foetal distress in group II developed in significantly higher number of women (p=0.009, p=0.002, p=0.002 & p=0.004 respectively) Foeto-maternal variables assessed in group III none was significantly different from control group. Conclusion: There is a high prevalence of hypothyroidism and adverse foeto-maternal outcome is more commonly associated with OH as compared to SCH. TSH 3-6.2mIU/L may be taken as normal during pregnancy in the Indian population. We recommend a higher cut off for serum TSH to diagnose hypothyroidism ie >6.2mIU/L in Indian pregnant women. The strong point of this study is that we have included large number of subjects from India. From this study we know the level of thyroid cut off level in Indian pregnant women’s which can be used for diagnosis and treatment of this disorder. Keywords: Hypothyroidism, Pregnant women, Cut-off for diagnosis

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