INTRODUCTIONGiving birth is a painful process. Any intervention that leads to improvement in pain relief is worthy of investigation 1 . Opioid as well as epidural analgesia is effective means for pain relief in labour, notwithstanding their shortcomings. Data regarding Entonox (50% Nitrous Oxide and 50% Oxygen mixture) for labour analgesia is not available in current Indian literature. Use of Entonox offers many apparent advantages over the ABSTRACT Background:Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation. Entonox, opioids as well as epidural analgesia are effective means for pain relief in labour, notwithstanding their shortcomings. The objectives of study are to compare the effectiveness of intermittent inhalational Entonox for labour analgesia with intramuscular opioid (Tramadol) and to compare the effects of Entonox and Tramadol as labour analgesia on the maternal and fetal outcome of labour. Methods:The study was a prospective randomized, comparative study of two established techniques of labour analgesia. The study was carried out in 100 subjects. These subjects are divided into two groups. Group A -Tramadol Group: 50 women in active labour who received 100 mg tramadol intramuscularly with repeat dose of 50mg tramadol 4 hourly. Group B -Entonox Group: 50 women in active labour who received entonox for labour analgesia. Results:The mean VAS (visual analogue score) i.e. the pain score in group I (Tramadol) was 4.58±1.54 and Group II (Entonox) was 4.02±1.99 which is significantly low when compared to Group I (Tramadol) p<0.001. Study also showed that both the analgesics Entonox as well as Tramadol does not cause any significant change when compared for duration of labor. The rate of instrumental assisted vaginal deliveries and normal vaginal deliveries were almost equal in both the groups. In our study, the mean overall satisfaction level of the parturients in group II (Entonox) at 1 hr post delivery was (5.06±1.42) and 24 hr post delivery was (6.64±1.66) which was more when compared with tramadol group. The difference was statistically significant (p value was <0.001). This indicates that overall satisfaction level of the parturients is more with the use of Entonox when compared with Tramadol. Conclusions: Therefore, it is concluded that intermittent inhalational Entonox provides better labour analgesia then intramuscular opioid Tramadol.

INTRODUCTIONKnee pain is one of the most common musculoskeletal complaints that bring people to their physician and the most common cause of knee pain is osteoarthritis. 1 Especially in females, knee osteoarthritis is the major cause of mobility impairment.2,3 Nearly, 45% of women over the age of 65 years have symptomatic findings of knee osteoarthritis while radiological evidence is found in 70% of those over 65 years.2-4 In India, average menopausal age in women is 46.3 years as compared to 54 years in western countries. 5,6 This predisposes Indian women at higher risk of developing osteoarthritis in earlier age as compared to their western counterparts. It could be due to loss of estrogen especially close to menopausal years at this time. 7,8ABSTRACT Background: Knee osteoarthritis is the most common form of joint disorder and a leading cause of pain and functional disability among elderly female population. Type 2-diabetes is frequently reported comorbidity in elderly female patients with knee osteoarthritis. VCAM-1 is emerging as a strong and independent predictor for severe osteoarthritis. VCAM-1 is an inducible cell surface sialo glycoprotein and mediates heterotypic cellular aggregation. Therefore, the aim of this study is to assess the role of soluble vascular cell adhesion molecule-1 at the onset of knee osteoarthritis among type 2 diabetic postmenopausal women. Methods: The present study includes 100 type 2-diabetic female subjects of age above 50 years as cases and 100 normal healthy female age matched individuals as controls. Osteoarthritis of knee was ascertained using the American college of rheumatology classification criteria. Serum soluble VCAM-1 concentration was measured by ELISA method in all 200 subjects. Biochemical parameters-Fasting blood sugar and lipid profile were measured using Mind ray BS-400 and HbA1c was measured by turbidimetric immunoassay method. Statistical analysis was made by student independent sample t-test. Correlation was determined by using spearman's rank correlation coefficient. Results: Serum level of soluble VCAM-1 was found statistically highly significant (p<0.001) in type 2 diabetic postmenopausal women having early stage of knee osteoarthritis as compared to control healthy subjects. The mean levels of fasting blood sugar, HbA1c, total cholesterol, TG, LDL-C and VLDL-C were also found significantly increased while HDL-C was found significantly decreased in cases as compared to controls. Conclusions: The increased level of soluble VCAM-1 in type 2 diabetic subjects shows active inflammation or cartilage damage. Therefore, it can be used as an early biomarker for osteoarthritis among type 2 diabetic postmenopausal women.