ABSTRACT
Abstract: Background and Aim: Comparison of the efficacy of epidural labour analgesia and programmed labour analgesia in controlling labour pain. Objectives: Primary objectives are VAS score, vitals and any untoward effects. Effect on ambulation, APGAR score and incidence of intervention as secondary objectives. Methods: A total of 80 parturients in active labour were allocated into two equal groups by using random allocation software.Group (G1) was given epidural injection of 15 ml of ropivacaine 0.2% with 2mcg/ml fentanyl. Top up was given with same dose regimen in graded manner.Group (G2) was given programmed labour analgesia with Inj. Pentazocine 6mg IV+Inj. Diazepam 2mg IV+Inj. Tramadol 1mg/kg deep i.m and thereafter Inj. Drotaverine 40mg IV half hourly (maximum of 3 doses). Inj. Ketamine 0.25-0.5 mg/kg IV was given as resque analgesia. Quality of pain relief was assessed with VAS score. Results: Labour analgesia was better in epidural group (G1) with VAS decreased significantly at 5 min (p <.00001). It was<3 till end of delivery in group (G1).In Group (G2) VAS was mostly>3 and they required resque analgesia with ketamine. There were no significant changes in hemodynamics. Side effects were mild without needing any intervention.There was no effect on ambulation in group (G1). Local anaesthetics were needed for episiotomy in all cases in group (G2). No adverse effects were seen on neonate in either group. Conclusion: Epidural labour analgesia with 0.2% ropivacaine plus fentanyl 2mcg/ml is better for labour analgesia in terms of VAS score, safety profile and side effects. There was no increase in duration of labour with epidural labour analgesia.

ABSTRACT
Abstract: COVID-19 associated Multisystem inflammatory syndrome in adults (MIS-A) can present with varied cardiac manifestations like ST segment changes, wall motion abnormalities, arrythmias and valvular abnormalities. Although the CDC has released criteria for diagnosis in July 2020, there is still a lack of clarity due to the varied presentation of cases and overlap of symptoms with other common disease conditions. A delay in diagnosis due to time taken to rule out other conditions can delay appropriate treatment. We present a case of an adult male who presented with fever, chest discomfort and abdominal symptoms with a history of previous COVID-19 infection. His vitals were stable without any signs of cardiac failure. We tested for COVID-19 antigen, antibody, and inflammatory markers. ECG and CT-chest and abdomen showed ST-T changes and a significant pericardial effusion. Though there were no cardiac symptoms, he was monitored with serial Troponin T and transthoracic ECHO cardiography which helped us to pick up deterioration of cardiac function. An immediate coronary angiogram was done which was normal. He was treated with corticosteroids, diuretics and colchicine and with daily monitoring his cardiac function improved. The pathophysiology of MIS-A is currently not well understood and a pericardial effusion without any significant cardiac symptoms as a presentation of MIS-A has not been reported previously. A multi-disciplinary approach and a high index of suspicion was required along with vigilant monitoring in an intensive care setup to recognise and treat this patient who had a good recovery with supportive care.