Background:Bispectral index (BIS) used for intra-operative depth assessment under general anesthesia (GA) can be altered by different factors. This study was designed to detect the alteration in BIS reading with two different Trendelenburg (TBG) tilt in laparoscopically assisted vaginal hysterectomy (LAVH) procedure.Materials and Methods:A prospective, double-blinded, randomized controlled study was designed involving 40 American Society of Anesthesiologists Grade I and II female patients, aged 35-60 years, scheduled to undergo LAVH under GA. Patients were divided into two groups with TBG >30° and TBG <30°. BIS readings; systolic and diastolic blood pressure, heart rate were recorded in supine position. Patients were then shifted to desired TBG position either (>30°) or (<30°) as per group allotment. Data were recorded at 30 min intervals and all the patients were followed upto 24 h postoperatively for any recall.Results:A rise in BIS value was noticed, when position was changed from supine to head down in both groups. During comparison between two groups with different angulations, TBG >30° showed a higher BIS value than TBG <30°. This statistically significant (P < 0.05) trend was observed at all the 30, 60, 90, and 120th min interval. Interestingly, BIS values returned to preoperative levels following adopting final supine position. No incidence of awareness was reported in both the series throughout the study.Conclusion:Though awareness remains unaltered BIS value gets increased with higher angle of inclination in TBG position during LAVH operation.

Caesarean scar pregnancy is one of the rarest forms of ectopic pregnancies. But, with the increasing Caesarean section rates, its incidence is on the rise. Its diagnosis and treatment is a challenge specially as standard protocols are not available and treatment aims not only to spare the patient's life, but also to preserve her fertility.The case reported here had initially been managed as an antenatal with intra-uterine pregnancy and had undergone an MTP. She presented with hypovolaemic shock and after resuscitation, was diagnosed as a patient with a Caesarean scar pregnancy. She underwent laparotomy with resection of the mass. Post-operative recovery was uneventful and she was discharged without complications.

Two cases of tuberculosis of the penis are presented because of the rarity of the disease. Stress is laid on the histopathological confirmation of the diagnosis of all penile ulcers before contemplating the line of treatment.

This randomized controlled trial (RCT) was undertaken to evaluate the effect of vibroacoustic stimulation (VAS) on the fetal heart rate tracing, mode of delivery and perinatal outcomes, when cardiotocographs (CTG) showed non-reassuring features during labour. In this RCT, 60 women beyond 30 weeks' gestation in labour having non reassuring CTG for 20 min were recruited in either study group (VAS group) or control group (non-VAS group). Women in the study group received VAS for 3 sec up to 3 occasions at an interval of 1 to 3 min while the control group received no VAS. There were significant improvement of baseline variability and acceleration in both VAS and control group during second 20 min (P<0.001). Although these improvements were more evident in VAS group, the difference between the two groups were not statistically significant (P>0.05). However, in VAS group, there was 3 min less testing time required to achieve reassuring CTG features (2.6 versus 5.6 min), and a tendency to have less cesarean delivery (60% versus 55.2%; p>0.05). Perinatal outcomes were similar in both groups. There is a trend toward less number of caesarean section in VAS group, probably because of early and more acquisition of reassuring CTG features. Therefore, this study suggests that VAS is potentially beneficial in women with suspicious CTG. Considering the procedure simple, safe and less expensive, it would be prudent to use VAS during CTG monitoring, especially in low resource countries, where facilities for fetal blood sampling is not widely available.