Introduction: Misoprostol is a synthetic prostaglandin E1 analogue widely used for cervical ripening and labour induction. However, misoprostol optimal dose required to induce labour is still controversial. Aim: To determine the efficacy and safety of 25 µg and 50 µg of intravaginal misoprostol for induction of labour at term and to evaluate maternal and neonatal complications. Materials and Methods: The present study was a prospective, randomised, double blind, single centre study carried out during March 2019 to December 2020. All the selected participants were randomised (1:1) to group 1 which received 25 µg of intravaginal misoprostol (n=70) and group 2 received 50 µg of intravaginal misoprostol (n=70). Based on the Bishop’s score, misoprostol was chosen as labour inducing agent. Number of misoprostol doses, mode of delivery, vaginal delivery duration, maternal and neonatal complications was recorded. Statistical significance among study groups were analyzed by using Chi-square test. Results: Postdatism was most frequently reported indication in both the study groups (57.1% and 52.9%). A total of 14 and 4 participants in group 2 and group 1 received only single dose of misoprostol (p<0.01). Participants who received misoprostol 50 µg (n=60, 85.7%) has slightly showed higher vaginal deliveries compared to misoprostol 25 µg (n=57, 81.4%). The mean duration of induction time in group 2 was 10.12 hours and group 1 women showed 13.56 hours (p<0.0001). Maternal and neonatal complications were slightly higher in 50 µg misoprostol group. Maternal complications such as uterine tachysystole (n=4), Postpartum Haemorrhage (PPH) (n=3) and uterine hyperstimulation syndrome (n=2). Neonatal complications with 50 µg misoprostol were Apgar <7 at 1 min (n=4), Apgar <7 at 5 min (n=3), Special Care Baby Unit (SCBU) admissions (n=2) and severe birth asphyxia (n=1). Misoprostol with 25 µg has showed Apgar <7 at 1 min (n=2), Apgar <7 at 5 min (n=2), SCBU admissions (n=1). Conclusion: The efficacy and safety results of 25 µg intravaginal misoprostol were comparable with 50 µg of intravaginal misoprostol for labour induction. The advantages of 50 µg misoprostol were it favours the vaginal deliveries, lesser active induction time and decrease number of misoprostol doses required to induce labour. However, higher dose of misoprostol showed higher frequencies of both maternal and neonatal complications.

Introduction: Tuberculosis is a major public health problem in majority of the developing countries. Pleural effusion develops when fluid accumulates between the parietal and visceral pleura. Aim: To evaluate the efficiency of corticosteroids in rapid clinical and radiological resolution of TPE. Also to study the recurrence of pleural effusion and find incidence of pleural fibrosis in patients treated with corticosteroids. Materials and Methods: This prospective interventional study was conducted at Government Chest Diseases and TB hospital (tertiary care teaching hospital), Telangana, India, from October 2014 to October 2016. Total 80 patients with TPE were divided into two groups. Steroid group (n=40), patients received standard Antitubercular Treatment (ATT) that was alternate day regimen along with prednisolone 0.75 mg/kg body weight per day for 2 weeks there after tapering of the dose done every 2nd weekly in next 4 weeks. Non steroid group (n=40), patients received standard ATT alone that was alternate day regimen under Directly Observed Treatment Short course (DOTS) therapy based on Revised National TB Control Programme (RNTCP) guidelines respectively. All patients were followed in the Outpatient Department at the end of second, fourth, sixth, 24th week. At every follow-up visit, history obtained from patients regarding symptoms and chest radiographs for comparison of reabsorption of pleural fluid between two groups. At the end of treatment ultrasound of the chest was performed to confirm the presence of pleural thickening seen on chest radiograph. Descriptive measures obtained included as mean and standard deviation. The association between two categorical variables done by using Chi-square test. The p-values<0.05 was considered as statistically significant. Results: There was early initiation of symptomatic relief in patients treated with steroid group as compared to non steroid group (p-value <0.001). Average duration for symptomatic relief in steroid group was 3.42 days (range 1-7 days) and in non steroid group 8.3 days (range 1-42 days). There was significant difference between two groups in duration taken for symptomatic relief (p-value <0.001). Conclusion: Results of the present study suggest that corticosteroids still play some role in the treatment of TPE. Addition of the corticosteroids to the standard ATT exerts more rapid relief of clinical symptoms. The rapidity in pleural fluid absorption is not influenced significantly by adding corticosteroids to the ATT. There was no recurrence of pleural effusion after addition of corticosteroids to ATT. The incidence of pleural thickening was not influenced by steroids.