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Jyoti Rokade

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Papers by Jyoti Rokade

Management of Postpartum Hemorrhage in Case of Bicornuate Uterus

PARIPEX INDIAN JOURNAL OF RESEARCH, Mar 15, 2024

Bicornuate uterus can lead to early miscarriages, preterm labor, foetal growth retardation, conge... more Bicornuate uterus can lead to early miscarriages, preterm labor, foetal growth retardation, congenital malformation, placenta previa and postpartum hemorrhage. It is unsual to manage a case of PPH in a bicornuate uterus with one horn well developed and the other horn an accessory. As it may be associated with vascular malformations, Urinary tract malformations. Systemic approach and identification of anatomy before ligating any vessel is of at most important in such cases.

Incidental adnexal masses during caesarean section: a case series

International journal of reproduction, contraception, obstetrics and gynecology, Oct 28, 2022

This case series included 7 cases of adnexal masses of 4 different types which were detected inci... more This case series included 7 cases of adnexal masses of 4 different types which were detected incidentally during caesarean section and had no prior diagnosis on ultrasound. These cases were recorded over a period of 6 months at our tertiary care center. Case 1: Dermoid cyst A 26-year-old G3P2L2 with 39 weeks of gestation with previous 2 LSCS came to ANC ward with complaints of pain at scar site. She was an unbooked case and did not

Bell's Palsy in Pregnancy and Puerperium: A Case Report

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

Bell's Palsy is an idiopathic facial nerve palsy and also the most common cause of facial ner... more Bell's Palsy is an idiopathic facial nerve palsy and also the most common cause of facial nerve palsy. It's incidence is 17/100,000 population per year in women of child bearing age group(WCBA). We, hereby present a case of 26 year old gravida 2, para 1, living 1 with 35 weeks of gestation who presented with gradual onset of facial weakness and few other complaints which after thorough examination were suggestive of Bell's palsy in a case of pre eclampsia. Patient was later posted for C-section at 36 weeks for scar tenderness. In the post operative period patient was on steroids for persistent facial nerve palsy but the patient landed in an unusual complication due to on going steroids as she had failed to follow up. Patient was taken up for exploratory laparotomy, patient tolerated the procedure well and went home on POD-42. Amongst the medications used in this patient for Bell's palsy, we saw that steroids could thus act as a double edged sword and thus close monit...

Female sterilization failure: Review over a decade and its clinicopathological correlation

International journal of applied & basic medical research, 2014

Objectives: The primary objective of the following study is to determine the demographic patterns... more Objectives: The primary objective of the following study is to determine the demographic patterns of women presenting as sterilization-failure and secondary is to evaluate possible etiological factors for failure and lay standard guidelines to reduce failure rate. Materials and Methods: The present study is retrospective study conducted in Department of Obstetrics and Gynecology, Government Medical College and Hospital-based on the case records maintained in our institution over a decade (April 2002-March 2012). Results: Over a decade, 140 cases of sterilization-failure with longest interval of 20 years have been documented out of 80 (57.14%) cases were of minilaparotomy (minilap), 53 (37.86%) laparoscopic tubal ligation and 5 (3.57%) were lower segment cesarean section. In 84 cases (60%) sterilization were performed in Primary Health Centre (PHC). Only 58 (41.43%) patients reported failure in 1 st trimester (<12 weeks). 14 cases (10%) were of ectopic pregnancy. There were 25 cases (17.86%) of spontaneous recanalization. In 27 cases (19.29%) failure was due to improper surgical procedure and rest 54 (38.57%) have conceived due to tuboperitoneal fistula. Conclusion: Female sterilization even though considered as permanent method of contraception, recanalization is possible even 20 years after procedure. Maximum cases of failure were with minilap and those were performed at PHC. The most common cause of failure was tuboperitoneal fistula. Ectopic pregnancies were seen in 10% of cases. Proper counseling of patient is must. There is a need to stick to standards of sterilization procedure to prevent future failure.

IGBT based Single Phase AC Drive

Paripex Indian Journal of Research, May 1, 2015

This paper presents a design and implementation of single phase AC Drive to drive and speed contr... more This paper presents a design and implementation of single phase AC Drive to drive and speed control of an 1-phase induction motor using the PIC 16F72 Microcontroller. The use of this PIC microcontroller yields enhanced operations, fewer system components, lower system cost and increased efficiency. The control algorithm is based on the constant volts-perhertz principle because the exact speed control is needed. Reflective object sensors which are mounted on concrete frame are used to detect accurate edge position of revolving stage. The PWM control signals are generated by the PIC16F72 controller to drive the IGBT based single phase AC Drive. The power section in this includes rectifier (converter) and filter which provide dc output with less distortion from single phase ac input supply. Then the main stage comes is inverter where by controlling the firing of power devices(e.g. IGBT) by pulse width modulation produced by the PIC controller using the control algorithm based on the constant volts-per-hertz principle, the motor is rotated with the load maintaining the volt-hertz ratio constant.[9] I.INTRODUCTION Any collection of mechanical and electro-mechanical components, which when connected together will move a load, as a "drive". When speaking to these people, an AC drive may be considered by them as the variable frequency inverter and motor combination.

A study of perinatal outcome in meconium stained amniotic fluid

International Journal of Clinical Obstetrics and Gynaecology, 2020

Objective: To study the fetal outcome and mode of delivery in patients with meconium stained amni... more Objective: To study the fetal outcome and mode of delivery in patients with meconium stained amniotic fluid. Material and methods :This is a prospective observational study carried out in department of obstetric and gynaec at P.V.P.G.H.sangli. over a period of 6 months.Total 200 cases of more than 37 weeks of gestation with singleton pregnancies and cephalic presentation were included in the study with thin or thick meconium stained liquor during labour. The data was collected on predesigned proforma and analysed using SPSS version 10. Chisquare test was applied with 95% interval and P value less than 0.05 was considered significant. Result: Among 200 cases 60% were not booked and came as emergency.Primigravida constituted 62% ,with PIH being 28% and postdate 21%. APGAR score was > 7 for 82 % of babies and only 18 % had APGAR score <7. At 1 minute .111 patients (56%) delivered by L.S.C.S., 49 patients(24%) had instrumental delivery (more with forceps 18% and vaccume 6%), and 40 patients (20 %) delivered normally. Conclusion: Meconium stained amniotic fluid has importance both for obstretician and paediatrician point of view.It increases the casarean section rate causes birth asphyxia and increases NICU admission rate.

Incidental adnexal masses during caesarean section: a case series

International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Adnexal masses originate in the ovaries, fallopian tubes or surrounding tissue. Adnexal masses ca... more Adnexal masses originate in the ovaries, fallopian tubes or surrounding tissue. Adnexal masses can be found in women of any age and pregnancy is no exception. Reasons for adnexal masses going undiagnosed in antenatal period are asymptomatic and small (≤5 cm) mass size; the pregnant patients refused a pelvic examination and a transvaginal USG examination for the fear of abortion during early pregnancy. In 3rd trimester ultrasound, a gravid uterus may obscure the correct visualization and detection of an adnexal mass or it is often missed when we keep our focus on the baby and placenta. As there is also increase in caesarean section rate, the incidence has also increased. Here we presented a case series of 4 different cases, we had described variety of adnexal masses which were diagnosed accidentally during caesarean section and also about their management. Case 1-dermoid cyst, case 2-para ovarian cyst, case 3-complex cyst, case 4-includes 3 cases of simple cyst. Adnexal masses arisin...

Study of awareness of contraception in postnatal women

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Background: This study was undertaken to know the awareness of contraception in postnatal women i... more Background: This study was undertaken to know the awareness of contraception in postnatal women in a Government Hospital in Maharashtra.Methods: Authors conducted a prospective study in Department of Obstetrics and Gynecology at Government hospital, Miraj between January 2015 to September 2016. All postnatal patients in this hospital, willing to participate in the study were included in the study after a thorough written informed consent. Patients were given pre decided questions for answering. Answers were noted, counselling was done.Results: Out of 4860 women, 97% of the women were aware of at least 1 contraceptive method, the highest being of female sterilization (91%) 20.8% of women had ever used the contraception before and most of them used it in between pregnancies (64.4%). 79.2% had not used any contraception before and main reason for not using was found to be, they wanted to conceive (46%) followed by fear of side effects (24.7%) Regarding willingness to use the contracept...

The Study of Fetomaternal Outcome in Obese Pregnant Females

Introduction: Obesity in pregnancy puts the mother and the fetus at risk of several complications... more Introduction: Obesity in pregnancy puts the mother and the fetus at risk of several complications such as gestational diabetes mellitus, preeclampsia, preterm labour, dusfunctional labour, caesarean section, postpartum infections, post delivery deep vein thrombosis. The study finds the incidence of pregnancy complications and neonatal outcome due to maternal obesity. Material methods: It is a prospective study carried out at P.V.P.G.H. sangli over 100 obese pregnant with BMI more than 30 kg /m patients, control being 100 patients with normal BMI. Different risk factors developed during antenatal period like preeclampsia, gestational diabetes mellitus, postdatism and postpartum performance of patient and risk factors like DVT were studied. The neonatal outcome in test and controls were studied. Results: The development of risk factors in antenatal period was directly proportional to the degree of obesity. Incidence of L.S.C.S, instrumental delivery, postpartum haemorrhge and macrosom...

Study of ectopic pregnancy at tertiary care center

International journal of scientific research, 2018

Vacuum Assisted Delivery in Caesarean Section- a Safe and Useful Technique

Indian journal of applied research, 2018

Increased use of caesarean section and a lower willingness about vaginal birth post caesarean has... more Increased use of caesarean section and a lower willingness about vaginal birth post caesarean has prompted the need of alternate delivery techniques. We assess vacuum assisted delivery (of fetal head) for a sample group of 300 patients delivered with LSCS using vacuum, compared against a control group of 300 patients with the fetal head delivered manually or by forceps/ extending uterine incision. In our data, subjects were full term, with 64 % of vacuum assisted group and 69 % in manual extraction were in labour. Incision to delivery interval was 10-30 seconds (average 18 seconds). In comparison to cases with traumatic extension of angle, 9% patients from control and only 1% from sample group had extension. Mean blood loss in control and sample group was 700 ml and 400 ml respectively. None of the babies in sample group had vacuum related scalp injuries. We conrm vacuum assisted LSCS is safe, atraumatic with obstetrician's well familiarity with the technique as a prerequisite.

Strengthening health systems response to violence against women: protocol to test approaches to train health workers in India

Pilot and Feasibility Studies, 2020

Background Globally, including in low- and middle-income [LMIC] countries, there is increased att... more Background Globally, including in low- and middle-income [LMIC] countries, there is increased attention to and investment in interventions to prevent and respond to violence against women; however, most of these approaches are delivered outside of formal or informal health systems. The World Health Organization published clinical and policy guidelines Responding to intimate partner violence and sexual violence against women in 2013. Further evidence is needed concerning implementation of the Guidelines, including how health care providers perceive training interventions, if the training approach meets their needs and is of relevance to them and how to ensure sustainability of changes in practice due to training. This manuscript describes a study protocol for a mixed methods study of the implementation of the Guidelines and related tools in tertiary hospitals in two districts in Maharashtra, India. Methods The study will employ a mixed-methods study design. A quantitative assessment ...

Study the acceptance, compliance and efficacy of injection depot medroxy progesterone acetate as contraception: a prospective observational study

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020

Background: India was the first country in the world to launch a family planning programme, as ea... more Background: India was the first country in the world to launch a family planning programme, as early as 1952, with the main aim of controlling its population. Depot medroxy progesterone acetate, or DMPA is a progestin-only method of contraception. It is a 3-monthly intramuscular injectable that delivers 150 mg of medroxyprogesterone acetate in microcrystalline suspension form that delays absorption of the hormone after the injection. It provides long acting, effective and reversible contraception. In this study, we evaluated patients in reproductive age group 18-35 years who were willing to use injectable DMPA as a method of contraception to study the acceptance, compliance and efficacy of injection depot medroxyprogesterone acetate as contraception.Methods: It is a prospective observational study carried out at Government medical college Miraj on 150 patients who fulfil the inclusion criteria. The postpartum, interval and postabortal categorisation of patients done and they are cou...

Codesigning discharge communication interventions with healthcare providers, youth and parents for emergency practice settings: EDUCATE study protocol

BMJ Open, 2020

IntroductionDischarge communication is an important aspect of patient care but frequently has sho... more IntroductionDischarge communication is an important aspect of patient care but frequently has shortcomings in emergency departments (EDs). In a paediatric context, youth or parents with young children often leave the ED with minimal opportunity to ask questions or to ensure comprehension of important information. Strategies for improving discharge communication have primarily targeted patients and/or parents, although neither group has been engaged in intervention design or implementation. Furthermore, ED healthcare providers (HCPs), important actors in discharge communication practice, are rarely consulted regarding intervention design decisions. We will generate evidence to enhance discharge communication by engaging youth, parents and HCPs in the codesign of ED discharge communication strategies (EDUCATE) for asthma and minor head injury.Methods and analysisThis mixed methods study will take place at two academic paediatric EDs in Canada. The study will occur in two phases: (A) c...

Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale

Pain, Jan 30, 2018

Appropriate pain measurement relies on the use of valid, reliable tools. The aim of this study wa... more Appropriate pain measurement relies on the use of valid, reliable tools. The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED). The inclusion criteria were children aged 6 to 17 years presenting to the ED with a musculoskeletal injury and self-reported pain scores ≥30 mm on the mechanical Visual Analogue Scale (VAS). Self-reported pain intensity was assessed using the mechanical VAS, Faces Pain Scale-Revised (FPS-R), and Colour Analogue Scale (CAS). Convergent validity was assessed by Pearson correlations and the Bland-Altman method; responsiveness to change was assessed using paired sample t tests and standardized mean responses; and reliability was estimated using relative and absolute indices. A total of 456 participants were included, with a mean age of 11.9 years ± 2.7 and a majority were boys (252/456, 55.3%). Correlations between each pair of scales were 0.78 (VAS/...

PL002: A randomized controlled trial on oral analgesic utilization for children presenting with a musculoskeletal trauma in the emergency department

CJEM, 2016

Introduction: Background: A single-agent approach to children’s moderate to severe pain is often ... more Introduction: Background: A single-agent approach to children’s moderate to severe pain is often inadequate. To date, no studies have evaluated the combined use of oral morphine and ibuprofen for optimal pain management of children presenting to an Emergency Department (ED) for musculoskeletal (MSK) trauma. Objective: To assess the efficacy of a combination of oral morphine and ibuprofen for pain management in children with MSK trauma in the ED. Methods: A double-blind, placebo-controlled, multi-centered, three-arm, randomized clinical trial of 500 patients was conducted at three pediatric tertiary care EDs. Patients 6 to 17 years of age, who presented to the ED with a MSK trauma, and a score >30 mm on the 100 mm Visual Analogue Scale were eligible to participate. Patients were randomized (in a 2:1:1 ratio) to receive (orally): (a) morphine (0.2mg/kg) + ibuprofen (10mg/kg) (Group MOR + IBU) or (b) morphine (0.2 mg/kg) + placebo (Group MOR) or (c) ibuprofen (10mg/kg) + placebo (Gr...

The Extent and Nature of Head Injury Secondary to Child Maltreatment in Canada: a 3 Year Surveillance Study

Paediatrics & Child Health, 2009

Poster sessioN séaNce de résuMés Par affiches 14 the eXteNt aNd Nature of head iNJury secoNdary t... more Poster sessioN séaNce de résuMés Par affiches 14 the eXteNt aNd Nature of head iNJury secoNdary to child MaltreatMeNt iN caNada: a 3 year surVeillaNce study *s Bennett, M Ward, G fortin, a Plint, t clifford, J King, M Mackay university of ottawa cheo, ottawa, ontario Cases of inflicted head injury in children, although thankfully reasonably rare, are of great clinical importance, as a large proportion of them result in death or permanent neurological deficits. Attempts have been made to quantify the issue in Canada; however, the information is limited. The objectives of the study were to: 1) Describe the incidence of head injury secondary to suspected child maltreatment among Canadian children in the general population and among high risk groups. 2) Identify the presentation, patterns and burden of head injury secondary to suspected child maltreatment. 3) Inform strategies to improve protection of children and youth and provide an opportunity to educate health care professionals. The study was conducted through the Canadian Paediatric Surveillance Program (CPSP) from March 1st 2005 to 29th February 2008. The case definition for all new cases for the study was for a child aged < or = 14 years, who had any mechanism of head or brain injury consistent with abuse (e.g. shaking, impact or suffocation) and that had been reported to a provincial/territorial child welfare agency. Check off forms for all new cases were mailed monthly to all Canadian practicing paediatricians during the study period. If cases were identified, a detailed questionnaire form was sent out for completion and then forwarded to the investigator for analysis. The results of the study showed that head injury, secondary to suspected child maltreatment, in children up to 14 years of age inclusively, continues to be prevalent in our society. There were a total of 215 cases and 64% were diagnosed as suspected Shaken Baby Syndrome. There was significant mortality and morbidity among confirmed cases; 40% of cases showed moderate to severe neurological sequelae at time of hospital discharge and 13% of cases died from their injuries. CONCLUSION: The results of the study show that it is important for all health care providers to keep a high index of suspicion to diagnose affected children. With as many as 75% of reported cases presenting to an emergency department there is a need to adequately educate health care providers in how to identify these cases. The findings confirm that this study will provide data that can inform educational efforts to support health care professionals in recognizing these cases. This will, ideally, also lead to more effective prevention efforts.

Are we Training Canadian Pediatric Residents in Child Protection Issues?

Paediatrics & Child Health, 2002

OBJECTIVES: We examined the training and experience that pediatric residents receive in the evalu... more OBJECTIVES: We examined the training and experience that pediatric residents receive in the evaluation and management of child abuse and neglect. METHODS: Structured questionnaires were developed, pilot-tested and distributed to the child protection program directors (CPPDs), pediatric program directors (PPDs) and pediatric residents at the 16 Canadian pediatric tertiary care centres. Data, entered into a SPSS-PC database, were analyzed using descriptive statistics for all categorical variables. Chi-square analyses were used to look for associations between variables. RESULTS: Responses were obtained from all 16 PPDs, 15 of 16 CPPDs, and 189 of 360 (53%) of residents. All programs had child protection specialists who participated in teaching residents. Teaching was provided to residents through grand rounds, formal sessions by staff, and bedside teaching by staff in 50%, 56% and 50% of programs respectively. Only 3 programs had mandatory training in child protection with 2 of these programs offering 1 month and the other offering 1 afternoon. Although 9 programs offered elective rotations, only 27% of residents had ever done a rotation in child protection. 92% of residents stated that they felt more competent in dealing with child abuse after the rotation. Overall, 50% of residents had seen 5 or fewer cases of suspected maltreatment in their training and only 20% had seen more than 10 cases. 67% of residents had never contacted a child welfare agency to report a case. Residents rated their competency on the initial evaluation of abuse cases as 62% of a maximal competency score, and 57% on the management of these cases. The only variable associated with this score was the number of cases seen. Residency training in child protection was rated by the residents as 'no training' or 'poor and inadequate' by 20%, 'somewhat adequate' by 51% and 'good' or 'excellent' by 28%. In comparison, 35% of CPPDs felt that the training was 'poor and inadequate' and only 14% felt that the training was 'good' or 'excellent'. 92% of residents felt that they needed further training in child protection issues, including 85% of 4th year residents. CONCLUSION: This study demonstrates that Canadian pediatric residency programs provide minimal training in child abuse and neglect with limited exposure to maltreatment cases. As a result, even senior pediatric residents feel poorly trained to evaluate and manage cases of suspected abuse. These results highlight the need to establish a standard educational curriculum and effective training programs for pediatric residents in the field of child abuse and neglect. Further study to explore the competency of practising pediatricians in the evaluation and management of child maltreatment is encouraged.

LO063: Adverse events in a pediatric emergency department: a prospective, cohort study

CJEM, 2016

Introduction: Data regarding adverse events (AEs) (unintended harm to a patient related to health... more Introduction: Data regarding adverse events (AEs) (unintended harm to a patient related to health care provided) among children treated in the emergency department (ED) have not been collected despite identification of the setting and population as high risk. The objective of our study was to estimate the risk and type of AEs, as well as their preventability and severity, for children seen in a pediatric ED. Methods: This prospective cohort study examined outcomes of patients presenting to a paediatric ED. Research assistants (RA) recruited patients < 18 yrs old during 28 randomized 8-hr shifts (over 1 yr). Exclusion criteria included unavailability for follow-up and insurmountable language barrier. RAs collected demographics, medical history, ED course, and systems level data. A RA administered a structured telephone interview to all patients at day 7, 14, and 21 to identify flagged outcomes (such as repeat ED visits, worsening/new symptoms, etc). Admitted patients' health r...

Use of personal protective equipment in Canadian pediatric emergency departments

CJEM, 2011

Management of Postpartum Hemorrhage in Case of Bicornuate Uterus

PARIPEX INDIAN JOURNAL OF RESEARCH, Mar 15, 2024

Bicornuate uterus can lead to early miscarriages, preterm labor, foetal growth retardation, conge... more Bicornuate uterus can lead to early miscarriages, preterm labor, foetal growth retardation, congenital malformation, placenta previa and postpartum hemorrhage. It is unsual to manage a case of PPH in a bicornuate uterus with one horn well developed and the other horn an accessory. As it may be associated with vascular malformations, Urinary tract malformations. Systemic approach and identification of anatomy before ligating any vessel is of at most important in such cases.

Incidental adnexal masses during caesarean section: a case series

International journal of reproduction, contraception, obstetrics and gynecology, Oct 28, 2022

This case series included 7 cases of adnexal masses of 4 different types which were detected inci... more This case series included 7 cases of adnexal masses of 4 different types which were detected incidentally during caesarean section and had no prior diagnosis on ultrasound. These cases were recorded over a period of 6 months at our tertiary care center. Case 1: Dermoid cyst A 26-year-old G3P2L2 with 39 weeks of gestation with previous 2 LSCS came to ANC ward with complaints of pain at scar site. She was an unbooked case and did not

Bell's Palsy in Pregnancy and Puerperium: A Case Report

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

Bell's Palsy is an idiopathic facial nerve palsy and also the most common cause of facial ner... more Bell's Palsy is an idiopathic facial nerve palsy and also the most common cause of facial nerve palsy. It's incidence is 17/100,000 population per year in women of child bearing age group(WCBA). We, hereby present a case of 26 year old gravida 2, para 1, living 1 with 35 weeks of gestation who presented with gradual onset of facial weakness and few other complaints which after thorough examination were suggestive of Bell's palsy in a case of pre eclampsia. Patient was later posted for C-section at 36 weeks for scar tenderness. In the post operative period patient was on steroids for persistent facial nerve palsy but the patient landed in an unusual complication due to on going steroids as she had failed to follow up. Patient was taken up for exploratory laparotomy, patient tolerated the procedure well and went home on POD-42. Amongst the medications used in this patient for Bell's palsy, we saw that steroids could thus act as a double edged sword and thus close monit...

Female sterilization failure: Review over a decade and its clinicopathological correlation

International journal of applied & basic medical research, 2014

Objectives: The primary objective of the following study is to determine the demographic patterns... more Objectives: The primary objective of the following study is to determine the demographic patterns of women presenting as sterilization-failure and secondary is to evaluate possible etiological factors for failure and lay standard guidelines to reduce failure rate. Materials and Methods: The present study is retrospective study conducted in Department of Obstetrics and Gynecology, Government Medical College and Hospital-based on the case records maintained in our institution over a decade (April 2002-March 2012). Results: Over a decade, 140 cases of sterilization-failure with longest interval of 20 years have been documented out of 80 (57.14%) cases were of minilaparotomy (minilap), 53 (37.86%) laparoscopic tubal ligation and 5 (3.57%) were lower segment cesarean section. In 84 cases (60%) sterilization were performed in Primary Health Centre (PHC). Only 58 (41.43%) patients reported failure in 1 st trimester (<12 weeks). 14 cases (10%) were of ectopic pregnancy. There were 25 cases (17.86%) of spontaneous recanalization. In 27 cases (19.29%) failure was due to improper surgical procedure and rest 54 (38.57%) have conceived due to tuboperitoneal fistula. Conclusion: Female sterilization even though considered as permanent method of contraception, recanalization is possible even 20 years after procedure. Maximum cases of failure were with minilap and those were performed at PHC. The most common cause of failure was tuboperitoneal fistula. Ectopic pregnancies were seen in 10% of cases. Proper counseling of patient is must. There is a need to stick to standards of sterilization procedure to prevent future failure.

IGBT based Single Phase AC Drive

Paripex Indian Journal of Research, May 1, 2015

This paper presents a design and implementation of single phase AC Drive to drive and speed contr... more This paper presents a design and implementation of single phase AC Drive to drive and speed control of an 1-phase induction motor using the PIC 16F72 Microcontroller. The use of this PIC microcontroller yields enhanced operations, fewer system components, lower system cost and increased efficiency. The control algorithm is based on the constant volts-perhertz principle because the exact speed control is needed. Reflective object sensors which are mounted on concrete frame are used to detect accurate edge position of revolving stage. The PWM control signals are generated by the PIC16F72 controller to drive the IGBT based single phase AC Drive. The power section in this includes rectifier (converter) and filter which provide dc output with less distortion from single phase ac input supply. Then the main stage comes is inverter where by controlling the firing of power devices(e.g. IGBT) by pulse width modulation produced by the PIC controller using the control algorithm based on the constant volts-per-hertz principle, the motor is rotated with the load maintaining the volt-hertz ratio constant.[9] I.INTRODUCTION Any collection of mechanical and electro-mechanical components, which when connected together will move a load, as a "drive". When speaking to these people, an AC drive may be considered by them as the variable frequency inverter and motor combination.

A study of perinatal outcome in meconium stained amniotic fluid

International Journal of Clinical Obstetrics and Gynaecology, 2020

Objective: To study the fetal outcome and mode of delivery in patients with meconium stained amni... more Objective: To study the fetal outcome and mode of delivery in patients with meconium stained amniotic fluid. Material and methods :This is a prospective observational study carried out in department of obstetric and gynaec at P.V.P.G.H.sangli. over a period of 6 months.Total 200 cases of more than 37 weeks of gestation with singleton pregnancies and cephalic presentation were included in the study with thin or thick meconium stained liquor during labour. The data was collected on predesigned proforma and analysed using SPSS version 10. Chisquare test was applied with 95% interval and P value less than 0.05 was considered significant. Result: Among 200 cases 60% were not booked and came as emergency.Primigravida constituted 62% ,with PIH being 28% and postdate 21%. APGAR score was > 7 for 82 % of babies and only 18 % had APGAR score <7. At 1 minute .111 patients (56%) delivered by L.S.C.S., 49 patients(24%) had instrumental delivery (more with forceps 18% and vaccume 6%), and 40 patients (20 %) delivered normally. Conclusion: Meconium stained amniotic fluid has importance both for obstretician and paediatrician point of view.It increases the casarean section rate causes birth asphyxia and increases NICU admission rate.

Incidental adnexal masses during caesarean section: a case series

International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Adnexal masses originate in the ovaries, fallopian tubes or surrounding tissue. Adnexal masses ca... more Adnexal masses originate in the ovaries, fallopian tubes or surrounding tissue. Adnexal masses can be found in women of any age and pregnancy is no exception. Reasons for adnexal masses going undiagnosed in antenatal period are asymptomatic and small (≤5 cm) mass size; the pregnant patients refused a pelvic examination and a transvaginal USG examination for the fear of abortion during early pregnancy. In 3rd trimester ultrasound, a gravid uterus may obscure the correct visualization and detection of an adnexal mass or it is often missed when we keep our focus on the baby and placenta. As there is also increase in caesarean section rate, the incidence has also increased. Here we presented a case series of 4 different cases, we had described variety of adnexal masses which were diagnosed accidentally during caesarean section and also about their management. Case 1-dermoid cyst, case 2-para ovarian cyst, case 3-complex cyst, case 4-includes 3 cases of simple cyst. Adnexal masses arisin...

Study of awareness of contraception in postnatal women

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Background: This study was undertaken to know the awareness of contraception in postnatal women i... more Background: This study was undertaken to know the awareness of contraception in postnatal women in a Government Hospital in Maharashtra.Methods: Authors conducted a prospective study in Department of Obstetrics and Gynecology at Government hospital, Miraj between January 2015 to September 2016. All postnatal patients in this hospital, willing to participate in the study were included in the study after a thorough written informed consent. Patients were given pre decided questions for answering. Answers were noted, counselling was done.Results: Out of 4860 women, 97% of the women were aware of at least 1 contraceptive method, the highest being of female sterilization (91%) 20.8% of women had ever used the contraception before and most of them used it in between pregnancies (64.4%). 79.2% had not used any contraception before and main reason for not using was found to be, they wanted to conceive (46%) followed by fear of side effects (24.7%) Regarding willingness to use the contracept...

The Study of Fetomaternal Outcome in Obese Pregnant Females

Introduction: Obesity in pregnancy puts the mother and the fetus at risk of several complications... more Introduction: Obesity in pregnancy puts the mother and the fetus at risk of several complications such as gestational diabetes mellitus, preeclampsia, preterm labour, dusfunctional labour, caesarean section, postpartum infections, post delivery deep vein thrombosis. The study finds the incidence of pregnancy complications and neonatal outcome due to maternal obesity. Material methods: It is a prospective study carried out at P.V.P.G.H. sangli over 100 obese pregnant with BMI more than 30 kg /m patients, control being 100 patients with normal BMI. Different risk factors developed during antenatal period like preeclampsia, gestational diabetes mellitus, postdatism and postpartum performance of patient and risk factors like DVT were studied. The neonatal outcome in test and controls were studied. Results: The development of risk factors in antenatal period was directly proportional to the degree of obesity. Incidence of L.S.C.S, instrumental delivery, postpartum haemorrhge and macrosom...

Study of ectopic pregnancy at tertiary care center

International journal of scientific research, 2018

Vacuum Assisted Delivery in Caesarean Section- a Safe and Useful Technique

Indian journal of applied research, 2018

Increased use of caesarean section and a lower willingness about vaginal birth post caesarean has... more Increased use of caesarean section and a lower willingness about vaginal birth post caesarean has prompted the need of alternate delivery techniques. We assess vacuum assisted delivery (of fetal head) for a sample group of 300 patients delivered with LSCS using vacuum, compared against a control group of 300 patients with the fetal head delivered manually or by forceps/ extending uterine incision. In our data, subjects were full term, with 64 % of vacuum assisted group and 69 % in manual extraction were in labour. Incision to delivery interval was 10-30 seconds (average 18 seconds). In comparison to cases with traumatic extension of angle, 9% patients from control and only 1% from sample group had extension. Mean blood loss in control and sample group was 700 ml and 400 ml respectively. None of the babies in sample group had vacuum related scalp injuries. We conrm vacuum assisted LSCS is safe, atraumatic with obstetrician's well familiarity with the technique as a prerequisite.

Strengthening health systems response to violence against women: protocol to test approaches to train health workers in India

Pilot and Feasibility Studies, 2020

Background Globally, including in low- and middle-income [LMIC] countries, there is increased att... more Background Globally, including in low- and middle-income [LMIC] countries, there is increased attention to and investment in interventions to prevent and respond to violence against women; however, most of these approaches are delivered outside of formal or informal health systems. The World Health Organization published clinical and policy guidelines Responding to intimate partner violence and sexual violence against women in 2013. Further evidence is needed concerning implementation of the Guidelines, including how health care providers perceive training interventions, if the training approach meets their needs and is of relevance to them and how to ensure sustainability of changes in practice due to training. This manuscript describes a study protocol for a mixed methods study of the implementation of the Guidelines and related tools in tertiary hospitals in two districts in Maharashtra, India. Methods The study will employ a mixed-methods study design. A quantitative assessment ...

Study the acceptance, compliance and efficacy of injection depot medroxy progesterone acetate as contraception: a prospective observational study

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020

Background: India was the first country in the world to launch a family planning programme, as ea... more Background: India was the first country in the world to launch a family planning programme, as early as 1952, with the main aim of controlling its population. Depot medroxy progesterone acetate, or DMPA is a progestin-only method of contraception. It is a 3-monthly intramuscular injectable that delivers 150 mg of medroxyprogesterone acetate in microcrystalline suspension form that delays absorption of the hormone after the injection. It provides long acting, effective and reversible contraception. In this study, we evaluated patients in reproductive age group 18-35 years who were willing to use injectable DMPA as a method of contraception to study the acceptance, compliance and efficacy of injection depot medroxyprogesterone acetate as contraception.Methods: It is a prospective observational study carried out at Government medical college Miraj on 150 patients who fulfil the inclusion criteria. The postpartum, interval and postabortal categorisation of patients done and they are cou...

Codesigning discharge communication interventions with healthcare providers, youth and parents for emergency practice settings: EDUCATE study protocol

BMJ Open, 2020

IntroductionDischarge communication is an important aspect of patient care but frequently has sho... more IntroductionDischarge communication is an important aspect of patient care but frequently has shortcomings in emergency departments (EDs). In a paediatric context, youth or parents with young children often leave the ED with minimal opportunity to ask questions or to ensure comprehension of important information. Strategies for improving discharge communication have primarily targeted patients and/or parents, although neither group has been engaged in intervention design or implementation. Furthermore, ED healthcare providers (HCPs), important actors in discharge communication practice, are rarely consulted regarding intervention design decisions. We will generate evidence to enhance discharge communication by engaging youth, parents and HCPs in the codesign of ED discharge communication strategies (EDUCATE) for asthma and minor head injury.Methods and analysisThis mixed methods study will take place at two academic paediatric EDs in Canada. The study will occur in two phases: (A) c...

Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale

Pain, Jan 30, 2018

Appropriate pain measurement relies on the use of valid, reliable tools. The aim of this study wa... more Appropriate pain measurement relies on the use of valid, reliable tools. The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED). The inclusion criteria were children aged 6 to 17 years presenting to the ED with a musculoskeletal injury and self-reported pain scores ≥30 mm on the mechanical Visual Analogue Scale (VAS). Self-reported pain intensity was assessed using the mechanical VAS, Faces Pain Scale-Revised (FPS-R), and Colour Analogue Scale (CAS). Convergent validity was assessed by Pearson correlations and the Bland-Altman method; responsiveness to change was assessed using paired sample t tests and standardized mean responses; and reliability was estimated using relative and absolute indices. A total of 456 participants were included, with a mean age of 11.9 years ± 2.7 and a majority were boys (252/456, 55.3%). Correlations between each pair of scales were 0.78 (VAS/...

PL002: A randomized controlled trial on oral analgesic utilization for children presenting with a musculoskeletal trauma in the emergency department

CJEM, 2016

Introduction: Background: A single-agent approach to children’s moderate to severe pain is often ... more Introduction: Background: A single-agent approach to children’s moderate to severe pain is often inadequate. To date, no studies have evaluated the combined use of oral morphine and ibuprofen for optimal pain management of children presenting to an Emergency Department (ED) for musculoskeletal (MSK) trauma. Objective: To assess the efficacy of a combination of oral morphine and ibuprofen for pain management in children with MSK trauma in the ED. Methods: A double-blind, placebo-controlled, multi-centered, three-arm, randomized clinical trial of 500 patients was conducted at three pediatric tertiary care EDs. Patients 6 to 17 years of age, who presented to the ED with a MSK trauma, and a score >30 mm on the 100 mm Visual Analogue Scale were eligible to participate. Patients were randomized (in a 2:1:1 ratio) to receive (orally): (a) morphine (0.2mg/kg) + ibuprofen (10mg/kg) (Group MOR + IBU) or (b) morphine (0.2 mg/kg) + placebo (Group MOR) or (c) ibuprofen (10mg/kg) + placebo (Gr...

The Extent and Nature of Head Injury Secondary to Child Maltreatment in Canada: a 3 Year Surveillance Study

Paediatrics & Child Health, 2009

Poster sessioN séaNce de résuMés Par affiches 14 the eXteNt aNd Nature of head iNJury secoNdary t... more Poster sessioN séaNce de résuMés Par affiches 14 the eXteNt aNd Nature of head iNJury secoNdary to child MaltreatMeNt iN caNada: a 3 year surVeillaNce study *s Bennett, M Ward, G fortin, a Plint, t clifford, J King, M Mackay university of ottawa cheo, ottawa, ontario Cases of inflicted head injury in children, although thankfully reasonably rare, are of great clinical importance, as a large proportion of them result in death or permanent neurological deficits. Attempts have been made to quantify the issue in Canada; however, the information is limited. The objectives of the study were to: 1) Describe the incidence of head injury secondary to suspected child maltreatment among Canadian children in the general population and among high risk groups. 2) Identify the presentation, patterns and burden of head injury secondary to suspected child maltreatment. 3) Inform strategies to improve protection of children and youth and provide an opportunity to educate health care professionals. The study was conducted through the Canadian Paediatric Surveillance Program (CPSP) from March 1st 2005 to 29th February 2008. The case definition for all new cases for the study was for a child aged < or = 14 years, who had any mechanism of head or brain injury consistent with abuse (e.g. shaking, impact or suffocation) and that had been reported to a provincial/territorial child welfare agency. Check off forms for all new cases were mailed monthly to all Canadian practicing paediatricians during the study period. If cases were identified, a detailed questionnaire form was sent out for completion and then forwarded to the investigator for analysis. The results of the study showed that head injury, secondary to suspected child maltreatment, in children up to 14 years of age inclusively, continues to be prevalent in our society. There were a total of 215 cases and 64% were diagnosed as suspected Shaken Baby Syndrome. There was significant mortality and morbidity among confirmed cases; 40% of cases showed moderate to severe neurological sequelae at time of hospital discharge and 13% of cases died from their injuries. CONCLUSION: The results of the study show that it is important for all health care providers to keep a high index of suspicion to diagnose affected children. With as many as 75% of reported cases presenting to an emergency department there is a need to adequately educate health care providers in how to identify these cases. The findings confirm that this study will provide data that can inform educational efforts to support health care professionals in recognizing these cases. This will, ideally, also lead to more effective prevention efforts.

Are we Training Canadian Pediatric Residents in Child Protection Issues?

Paediatrics & Child Health, 2002

OBJECTIVES: We examined the training and experience that pediatric residents receive in the evalu... more OBJECTIVES: We examined the training and experience that pediatric residents receive in the evaluation and management of child abuse and neglect. METHODS: Structured questionnaires were developed, pilot-tested and distributed to the child protection program directors (CPPDs), pediatric program directors (PPDs) and pediatric residents at the 16 Canadian pediatric tertiary care centres. Data, entered into a SPSS-PC database, were analyzed using descriptive statistics for all categorical variables. Chi-square analyses were used to look for associations between variables. RESULTS: Responses were obtained from all 16 PPDs, 15 of 16 CPPDs, and 189 of 360 (53%) of residents. All programs had child protection specialists who participated in teaching residents. Teaching was provided to residents through grand rounds, formal sessions by staff, and bedside teaching by staff in 50%, 56% and 50% of programs respectively. Only 3 programs had mandatory training in child protection with 2 of these programs offering 1 month and the other offering 1 afternoon. Although 9 programs offered elective rotations, only 27% of residents had ever done a rotation in child protection. 92% of residents stated that they felt more competent in dealing with child abuse after the rotation. Overall, 50% of residents had seen 5 or fewer cases of suspected maltreatment in their training and only 20% had seen more than 10 cases. 67% of residents had never contacted a child welfare agency to report a case. Residents rated their competency on the initial evaluation of abuse cases as 62% of a maximal competency score, and 57% on the management of these cases. The only variable associated with this score was the number of cases seen. Residency training in child protection was rated by the residents as 'no training' or 'poor and inadequate' by 20%, 'somewhat adequate' by 51% and 'good' or 'excellent' by 28%. In comparison, 35% of CPPDs felt that the training was 'poor and inadequate' and only 14% felt that the training was 'good' or 'excellent'. 92% of residents felt that they needed further training in child protection issues, including 85% of 4th year residents. CONCLUSION: This study demonstrates that Canadian pediatric residency programs provide minimal training in child abuse and neglect with limited exposure to maltreatment cases. As a result, even senior pediatric residents feel poorly trained to evaluate and manage cases of suspected abuse. These results highlight the need to establish a standard educational curriculum and effective training programs for pediatric residents in the field of child abuse and neglect. Further study to explore the competency of practising pediatricians in the evaluation and management of child maltreatment is encouraged.

LO063: Adverse events in a pediatric emergency department: a prospective, cohort study

CJEM, 2016

Introduction: Data regarding adverse events (AEs) (unintended harm to a patient related to health... more Introduction: Data regarding adverse events (AEs) (unintended harm to a patient related to health care provided) among children treated in the emergency department (ED) have not been collected despite identification of the setting and population as high risk. The objective of our study was to estimate the risk and type of AEs, as well as their preventability and severity, for children seen in a pediatric ED. Methods: This prospective cohort study examined outcomes of patients presenting to a paediatric ED. Research assistants (RA) recruited patients < 18 yrs old during 28 randomized 8-hr shifts (over 1 yr). Exclusion criteria included unavailability for follow-up and insurmountable language barrier. RAs collected demographics, medical history, ED course, and systems level data. A RA administered a structured telephone interview to all patients at day 7, 14, and 21 to identify flagged outcomes (such as repeat ED visits, worsening/new symptoms, etc). Admitted patients' health r...

Use of personal protective equipment in Canadian pediatric emergency departments

CJEM, 2011