Background and Aims: Acute rheumatic fever and rheumatic heart disease constitute an important public health problem in the developing countries. The disease results from an abnormal autoimmune response to a group A streptococcal infection in a susceptible host. We aim to describe the pattern of valvular involvement in patients taking Injection Benzathine Penicillin.Methods: All the patients, who were taking injection Benzathine penicillin during 15th April to 14th July, 2013 at our Centre, were included in this study. Demographic features like age, sex, echocardiographic diagnosis along with any adverse effects of Benzathine penicillin were collected.Results: A total of 661 patients were included in our study, out of which female predominated in numbers. Rheumatic heart disease rather than rheumatic fever was the cause for Penicillin injection. Mitral valve was the most common valve involved and it was more common in female.Pure mitral stenosis was the most common valvular involvement. Forty two percent patients underwent intervention; among them Percutaneous transluminal mitral commisuorotomy was the most common. There was no adverse event during the study time following penicillin injection.Conclusions: Women are more commonly affected than male. Mitral valve is the most common valve involved. Nepalese Heart Journal 2016; 13(2): 25-27

Introduction Managing second stage of labour is very crucial. Emergency Cesarean Section (CS) or Instrumental Delivery (ID) is the only choices although complications might occur in both modes of deliveries. The rate of CS is at rise and the fear of failed ID followed by emergency CS with added complications makes the choice more difficult amongst the obstetricians. MethodsA retrospective study done to assess the maternal and fetal outcome in second stage of labour following ID and emergency CS from April 2018 to March 2019 among the pregnant women having completed 34 weeks of gestations and beyond. ResultsOf 4761 deliveries, 2537 (53.2%) were vaginal and 2224 (46.7%) CS, and amongst all, 133 (2.7%) were second stage interventions. Out of 133, 78 had ID, 76 were successful and 2 failed. Fifty seven (2.6%) were second stage CS. Nulliparas (65.8%) needed more ID, teenage pregnancy (6.5%) (p=0.04) and heart disease (18.4%) (p=0.002) were high risk for ID. Complications were more in CS, uterine extensions, (29.8%) (p<0.001), urinary complications, (43.9%) (p<0.001) and blood loss (p<0.001). Neonatal admission too was higher in CS (n=29) and more so due to respiratory distress (16/29). ConclusionDespite of few failed attempted ID, it still proved to be better choice for delivery during second stage, as both maternal and neonatal complications were higher following the second stage CS. Hence, the correct and timely decision for ID addressing the associated risk factors could lead to favorable outcome.