Objective: To compare efficacy and safety of 50 μg misoprostol administered vaginally, with oral route for induction of labor at term. Materials and methods: One hundred women at term gestation, Bishop score 4, with various indications for labor induction were randomized. Fifty women received 50 ƒÊg misoprostol orally and 50 women received 50 ƒÊg vaginally, fourth hourly (maximum six doses) or till the women went into active labor. Results: In vaginal misoprostol group, induction delivery interval was significantly less (8.70 vs 17.47 hours) and successful induction was significantly higher (70 vs 60%) than oral group, within 24 hours of induction. In vaginal group, 46% women needed two doses for delivery compared with 8% in oral group. A maximum of six doses were required. Conclusion: Vaginal route of misoprostol is more effective in inducing labor than oral administration.

Introduction: Cardiovascular causes contribute toward a large proportion of increased morbidity and mortality in patients with chronic kidney disease (CKD). Cardiac disease is the major cause of death in the CKD population. Materials and methods: The present study was undertaken for documentation of various cardiovascular abnormalities in 50 patients with CKD at RajaRajeswari Medical College & Hospital, Bengaluru, Karnataka, India, using electrocardiography (ECG) and echocardiography as investigation procedures. The present study is a descriptive crosssectional study and data collected were analyzed by frequency, percentage, chisquared test, and pvalue which is the left ventricular (LV) diastolic dysfunction. Pericardial effusion and conduction abnormalities are more common in patients of CKD. Results: The ECG was normal in 12 out of 50 cases of CKD (24%), left ventricular hypertrophy (LVH) present in 14 out of 50 (28%), left axis deviation in 8 out of 50 (16%), conduction disturbances in 11 out of 50 (22%), ischemia in 10 out of 50 (20%), arrhythmias in 1 out of 50 (2%), and P mitrale was found in 3 out of 50 cases (6%). The most common ECG change associated with cases with CKD was LVH (28%). The most common abnormality found on echocardiography in CKD cases under the study was LVH (56%) followed by diastolic dysfunction (38%). Conclusion: The LVH is the commonest abnormality observed in CKD both on ECG and echocardiography. Echocardiography is a more sensitive diagnostic procedure to detect LVH. Af ter LVH other most common abnormalities found on Echocardiography in CKD patients on haemodialysis were pericardial effusion and conduction abnormalities.

Aim: To study the effect of levothyroxine treatment on lipid profile in patients with subclinical hypothyroidism. Materials and methods: This study was a randomized controlled trial, prospective study conducted on 22 cases of subclinical hypothyroidism with 22 controls at Down Town Hospital, Guwahati, Assam, India. Inclusion and exclusion criteria were undertaken. Levothyroxine therapy was given and follow-up was done after 3 months with thyroid and lipid profile tests. Pretreatment and posttreatment values were compared using paired t-test using Statistical Package for the Social Sciences (SPSS), version 19. Results: Statistical significance between pretreatment and posttreatment values was found to be in values of thyroidstimulating hormone (TSH), cholesterol high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (p < 0.05). There was no significant difference in the pretreatment and posttreatment triiodothyronine (T3) and thyroxine (T4) values. There was mild increase in value of HDL, and significant decrease in value of TSH, cholesterol, very low density lipoprotein (VLDL), and triglycerides. Conclusion: Lipid profiles are altered in patients with subclinical hypothyroidism compared with controls. Levothyroxine therapy has beneficial effect on lipid profile in patients with subclinical hypothyroidism. Clinical significance: Levothyroxine therapy in patients of subclinical hypothyroidism reduces TSH levels and thus prevents conversion to overt hypothyroidism and also reduces cardiac morbidity.

Synchronous tumors of different histological types involving the salivary gland are rare. There have been cases reported in the literature of such tumors occurring in the parotid gland. Head and neck surgeons frequently request nasotracheal intubation for their surgical procedures. Complications of nasal intubation include epistaxis, sinusitis, bacteremia, or dislodgement of adenoids from trauma of the intubation. We describe a case report of accidental removal of the inferior turbinate with nearly complete airway obstruction, during nasotracheal intubation. This case report demonstrates the importance of early detection and management of this potentially dangerous complication.

Postoperative pain after radical retropubic prostatectomy can be severe unless adequately treated, with potential implications for the quality of recovery and length of hospital stay. Ultrasonography-guided quadrates lumborum block (QLB) involves the injection of local anaesthetic solution adjacent to the anterolateral aspect of the quadrates lumborum muscle. QLB is used for postoperative pain relief in abdominal surgeries. We report here a case of 65yr old male with adenocarcinoma of the prostate gland. He underwent radical retropubic prostatectomy under General anaesthesia with QLB. Post operative analgesia was optimal

Pelvic chondrosarcomas (CHSs) are malignant cartilaginous tumors. Due to their slow growth, CHSs tend to cause symptoms over a prolonged period of time, and their diagnosis might be delayed. Since radiotherapy and chemotherapy have proved ineffective in the treatment of CHSs, wide surgical excision remains the treatment of choice. Although CHSs rarely metastasize and have a very good prognosis after surgery, local recurrence is a quite common occurrence especially following inadequate excision. In this report, we present a case of pelvic CHS mistaken for an abscess.

Ebstein's anomaly is an abnormality of the tricuspid valve in which valve leaflets are malformed or displaced downwards into the right ventricle. Patient may develop supraventricular dysrhythmias leading to syncope, cyanosis, congestive heart failure and sudden death. The choice of anaesthesia is individualized and remains a challenge. We managed one such patient under Epidural Anesthesia successfully. Epidural Anesthesia in a fractionated and graded manner provides a hemodynamically stable patient with adequate intra and post-operative analgesia

We present here a case of pseudocyst of spleen, a rare entity. In our case, the patient presented with pain abdomen since 5 to 6 months. She gave the history of abdominal trauma 2 years ago. Ultrasonography (USG) and computed tomography (CT) of abdomen and pelvis showed a well-defined cyst arising in spleen. Open splenectomy was followed. Histopathology of the splenectomy specimen showed features of pseudocyst.

Introduction: High-flow oxygen therapy through nasal cannula is a technique whereby heated and humidified oxygen is delivered to nose at high flow rates and this generates low levels of positive pressure in upper airways. This may decrease physiological dead space by flushing expired CO₂ from the upper airway, a process that explains the decrease in the work of breathing. With this we determine whether high-flow oxygen therapy as compared with standard oxygen therapy alone could reduce the rate of endotracheal intubation and outcomes. Materials and methods: We performed a prospective randomized trial in our intensive care unit (ICU), in which we randomly assigned patients with acute hypoxemic respiratory failure without hypercapnia into two groups. A total 30 patients were taken in our study and were randomly allocated to groups I and II (15 in each group) with type I r espiratory failure. • Group I: Received high-flow oxygen therapy using nasal cannula • Group II: Treated with standard oxygen mask therapy The outcome of two groups was compared in terms of PaO2 and the proportion of patients who needed reintubation. Results: Demographic data (Table 1) were not significant between the two groups. Arterial blood gas (ABG) analysis (Table 2) showed PaO2 of 92 + 32 mm Hg in high-flow nasal oxygen (group I) receiving patients compared with PaO2 of 85 ± 31 mm Hg in standard oxygen therapy patients (group II). The intubation rate (Table 2) was 46% (7/15) in highflow nasal oxygen group (I) and 66% (10/15) in the standard oxygen therapy group (II). Conclusion: Patients with nonhypercapnic acute hypoxemic respiratory failure treatment with high-flow nasal oxygen have significantly better outcome compared with oxygen therapy with the standard oxygen therapy with face mask.