Analysing trends in caesarean sections at a tertiary care teaching hospital in South India: findings from a clinical audit using Robson criteria

Background: Caesarean section (CS) is a potentially life-saving surgery when performed for indicated reasons. The rates of CS deliveries have sky rocketed in the last few years. A CS does not come without complications and risk and therefore its trends in all institutes should be audited for ensuring optimization of obstetric care standards.Methods: The study was conducted as a retrospective analysis of all the CS deliveries for 12 months and their categorization using the WHO recommended Robson ten group classification system; with an aim to evaluate and understand the indication for each CS performed in the institute. The Robson was further subclassified to closely understand the circumstances in which the CS was performed in each group.Results: In this study evaluated a total of 2831 deliveries out of which 1557 (55%) were CS births. Out of these CS births, 48.5% were indicated for emergency indications. Class 5, 1 and 10 were the main contributors to the CS rate with 50.6%, 19.3% and 10% contributions respectively. From a total of 799 patients with previous CS, only 12.1% could have a successful trial of scar. The most common indications documented for Group 1 was foetal distress, cephalo pelvic disproportion and prolonged labour, in decreasing order. Among the singleton pre-terms who had a CS, a majority (92.3%) were operated before the onset of labour.Conclusions: The audit helped to understand the trends of CS in the institute and helped in the realizing that all the CS in the institute has questionable indications. This led to implementation of clinical and administrative reforms to ensure a reduction in unnecessary CS being performed.

Image segmentation and particles classification using texture analysis method

Introduction: Ingredients of oily fish include a large amount of polyunsaturated fatty acids, which are important elements in various metabolic processes of humans, and have also been used to prevent diseases. However, in an attempt to reduce cost, recent developments are starting a replace the ingredients of fish oil with products of microalgae, that also produce polyunsaturated fatty acids. To do so, it is important to closely monitor morphological changes in algae cells and monitor their age in order to achieve the best results. This paper aims to describe an advanced vision-based system to automatically detect, classify, and track the organic cells using a recently developed SOPAT-System (Smart On-line Particle Analysis Technology), a photo-optical image acquisition device combined with innovative image analysis software. Methods The proposed method includes image de-noising, binarization and Enhancement, as well as object recognition, localization and classification based on the analysis of particles’ size and texture. Results The methods allowed for correctly computing cell’s size for each particle separately. By computing an area histogram for the input images (1h, 18h, and 42h), the variation could be observed showing a clear increase in cell. Conclusion The proposed method allows for algae particles to be correctly identified with accuracies up to 99% and classified correctly with accuracies up to 100%.

Evaluation of Gallbladder Diseases

Gallbladder diseases are very common entities with diverse features of presentation at clinical, radiological and pathological settings with variable morbidities and mortalities. It implies an altered hepatobiliary function. A majority of gallbladder diseases involve gallstones, which form about 95% of all gallbladder diseases. The noncalculus disease forms only about 4–5% of the cases. Inflammations of gallbladder, either acute or chronic, are commonly seen in association with calculus gallbladder. Benign neoplasms are very rare compared to malignant neoplasms that are more common but uncommon compared to inflammatory conditions. Gallbladder diseases are very common and it is appropriate to emphasise that knowledge of these diseases is imperative. In the present study of 50 patients an attempt was made to correlate the clinical, radiological and pathological features of gallbladder diseases and to ascertain the sensitivity of ultrasound in the evaluation of gallbladder diseases. The radiological diagnosis in gallbladder diseases had favourable results against the clinical diagnosis and has also been shown to be impressive against the pathological diagnosis. In our study the radiological diagnosis of gallbladder diseases is shown with reference to most of the disease conditions.

Role of Sildenafil in ovulation induction A comparative study of outcomes with Sildenafil in ovulation induction cycles with Clomiphene Citrate

Background: Intraperitoneal instillations of local anaesthetic agents alone or in combination dexmedetomidine have been found to reduce post-operative pain following laparoscopic cholecystectomy. Aim: Comparing antinociceptive effects of intraperitoneal instillation of bupivacaine plain and bupivacaine with dexmedetomidine in patients undergoing laparoscopic cholecystectomy. Materials and methods: Study was conducted on 100 adult patients of ASA physical status 1 and 2 in the age group of 18 years to 60 years, posted for elective laparoscopic cholecystectomy under general anaesthesia. Patients were randomly divided on an alternate basis into two groups of 50 each. Group B: (n=50) patients received Intraperitoneal bupivacaine 50 ml 0.25% + 5 ml normal saline. Group DB: (n=50) Intraperitoneal bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg with normal saline 5 ml. Results: Mean pain scores were significantly lower in the group BD when compared to group B during the entire duration of the study. There was statistically significant difference in VAS pain score at 6, 8, 12, 18, 24 hours after surgery. Mean pain scores were significantly lower in the group BD Srinivas Rapolu, K Anil Kumar, Syed Ali Aasim. A comparative study on intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy. IAIM, 2016; 3(12): 33-40. Page 34 when compared to group B during the entire duration of the study. There was statistically significant difference in VAS pain score at 6, 8, 12, 18, 24 hours after surgery. There was statistically significant difference between two groups of patients in terms of heart rate, systolic and diastolic blood pressure from 1 hour to 12 hours. 4 patients (8%) of group B and only 5 (10%) patients of groups B + D had postoperative nausea/vomiting, and 7 (14%) patients of group B and 2 (4%) patients of groups B+D had postoperative shoulder pain. Conclusion: Intraperitoneal instillation of dexmedetomidine with bupivacaine prolongs the duration of postoperative analgesia as compared to that with bupivacaine alone.

Isolation and characterization of marine-derived actinomycetes with cytotoxic activity from the Red Sea coast

Objective: To isolate and evaluate the cytotoxic activity of different actinomycetes species isolated from the Red Sea coast in Sharm el-Sheikh, Egypt. Methods: Forty actinomycetes strains were isolated from different sediments and seawater samples collected from the Red Sea coast in Egypt. Actinomycetes were recognized by morphological and microscopic examinations. Cell viability and cytotoxicity induced by the crude extracts on breast cancer cell lines MDA-MB-231 were assessed using methylene blue assay. The strains with promising cytotoxic activity were identified by sequencing and amplifying the 16S rRNA genes. The antibacterial activities of the crude extracts were performed using Kirby-Bauer disc diffusion method. Results: The results indicated that five ethyl acetate extracts exhibited cytotoxicity towards breast cancer cell lines MDA-MB-231. The highest cytotoxic activity was found for the ethyl acetate extracts of EGY2 and EGY39. The isolate EGY3 was identified as a new Streptomyces species, while the actinomycete EGY22 was found to be a member of the genus Nocardiopsis sp. The crude extract of the isolate EGY8 showed slightly high antimicrobial activity against different test microorganisms. Conclusions: The results of the present study reveal that marine sediments of the Red Sea are a potent source of novel species of actinomycetes. The isolates may be useful in discovery of novel bioactive compounds and an important step in the development of microbial natural product research.

Ultrasound Evaluation of Thyroid Lesions

This study was done at Santhiram general hospital. 57 patients with thyroid swelling were examined with ultrasound and followed up with FNAC. Findings were analyzed which showed that 14 were cystic, 27 solid and 16 were mixed lesions; 93% of cystic lesions were benign (Table 2). Among solid lesions 83% were benign rest malignant. Among mixed lesions 87.75% benign and only 12.25% were malignant (Table 3). Ninty two per cent of goiter showed calicification papillary; carcinoma case showed calicification. Hypoechoic hallow showed 88% benign lesions and 12% of malignant lesions; hence US has a definete role in charecterising thyroid lesions. It is being cheap and readily available. The characterisation of perilesion halo is whether irregular or smooth which helps in differentiating benign and malignant nature of lesion. It helps in FNAC for exact localisation.

The Role of Umbilical Artery Doppler in Predicting the Fetal Out Come in Cases of Pregnancy Induced Hypertension

Purpose To determine and compare the diagnostic performance of Doppler sonography of fetal umbilical artery (UA) for prediction of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and pre eclampsia. Materials and Methods 100 women with singleton pregnancy between 26 to 30 weeks of gestation were studied in this prospective study over a period of one and half years with color Doppler. UA flow velocity form was studied. In UA systolic/diastolic (S/D) ratio, pulsatility index (PI) and Resistance index (RI) were studied. In UA absent diastolic flow or reversed diastolic flow is noted. Results Out of 50 clinically suspected pregnancy induced hypertension (PIH) cases, 31 (62%) cases show abnormal PI, 40 (80%) cases show abnormal RI values and 45 (90%) cases show abnormal S/D Ratio's. Sensitivity and specificity of the S/D ratio in predicting PIH are 90% and 88% respectively followed by positive and Negative predictive value (PPV & NPV) of 88% and 89% whereas sensitivity, Specificity, PPV and NPV of RI & PI are lower than S/D ratio. This shows that S/D ratio has more Sensitivity, Specificity and Predictive values. Sensitivity of PI value in predicting fetal outcome is 75%. 22% (11 out of 50 cases) cases show absent/reversal of end diastolic velocities, of these four are reversal of end diastolic velocity (RDEV). All four cases of REDV died before 32 weeks of gestation. Absent diastolic flow is seen in 7 cases, 4 cases died and three cases admitted in NICU with severe respiratory distress. Our study shows absent or reversal of end diastolic velocity is more sensitive in predicting adverse fetal outcome. There was no case of eclampsia or maternal death. Conclusion UA flow velocity waveforms abnormality is more predictive for preeclampsia and IUGR. Hence Doppler is a promising tools in prediction of PIH and IUGR

Non-traumatic Acute Abdomen Evaluation

The term “acute abdomen” defines a clinical syndrome characterized by the sudden onset of severe abdominal pain requiring emergency medical or surgical treatment. A prompt and accurate diagnosis is essential to minimize morbidity and mortality. The differential diagnosis includes an enormous spectrum of disorders ranging from benign self-limiting diseases to conditions that require emergency surgery. The clinical diagnosis of acute abdomen can be challenging because physical examination clinical presentation and laboratory examination are often non specific and non diagnostic. It is often difficult based on history and physical examination alone to separate these patients from those who require immediate surgery. The increased availability and use of computed tomography (CT) and Ultrasonography (US) have dramatically changed the clinical examination and treatment of patients who present with acute abdominal pain. These noninvasive imaging techniques have effectively replaced exploratory as the primarymeans of examiningpatientswho present with what was formerly known asa surgical abdomen.

Magnetic Resonance Imaging of the Lumbar Spine in Young Arabs with Low Back Pain

STUDY DESIGN: A prospective study. PURPOSE: To Investigate the prevalence of magnetic resonance imaging (MRI) changes of the lumbar spine in low back pain (LBP) and the associated risk factors in young Arab population. OVERVIEW OF LITERATURE: Studies on the prevalence of MRI findings and their relationship with LBP have been conducted; these have occurred in adult populations in developed countries. The prevalence of MRI changes in the young Arab population with LBP is not known. METHODS: Two hundred and fourteen patients of Arab origin in the 16 to 29 year age group with LBP symptoms underwent MRI examinations. The prevalence of MRI changes in the lumbar spine and associated risk factors were determined and compared to age, race, and gender-matched controls. RESULTS: A majority (64%) of the patients with LBP (138 out of 214) were found to have MRI evidence of degenerative disc disease (DD) compared to 10% (22 out of 214) in the control group. The majority (61%) of patients had multiple level disease, most commonly involving the lowest 2 disc levels. Reduced signal of the disc followed by disc bulge was the most common MRI features seen in the symptomatic subjects. Obesity correlated with MRI prevalence of abnormalities, while activity demonstrated a positive trend. CONCLUSIONS: The MRI prevalence of DD among the young Arab patients with LBP is high when compared to other reports in literature. Obesity correlated with MRI prevalence of abnormalities while activity demonstrated a positive trend.

Unusual complication of cervical tuberculous lymphadenopathy.

Lymphadenopathy is the most common form of extrapulmonary tuberculosis; cervical region being the most frequent site. Yet, tuberculous cervical lymphadenopathy is rarely associated with Internal Jugular Vein (IJV) thrombosis. We report right IJV thrombosis with isolated cervical tuberculous lymphadenopathy in a 22-year-old woman. Anti-tuberculous treatment resulted in complete regression of lymphadenopathy but anticoagulation treatment failed to restore the caliber of thrombosed IJV to normal. Thrombosis of adjacent IJV is a potential complication of delay in diagnosis and treatment of cervical lymphnode tuberculosis.

Role of aqueous humor matrix metalloproteinase-2 and its inhibitor and connective tissue growth factor in the pathogenesis of primary open angle glaucoma and pseudoexfolliative glaucoma

To study the presence and possible quantitative differences of matrix metalloproteinase-2 [MMP2] and its endogenous inhibitor, tissue inhibitor metalloproteinase-2 [TIMP2] and connective tissue growth factor [CTGF] in aqueous humor of patients with pseudoexfoliative glaucoma [PEXG], primary open angle glaucoma [POAG] and cataract patients [serving as controls] and to determine the potential role of these elements in the pathogenesis of glaucomas. Aqueous humor samples were collected from 75 patients [25 patients with PEXG, 25 with POAG and 25 with senile cataract, who served as controls]. Glaucoma and cataract subjects underwent routine glaucoma trabeculectomy and cataract extraction surgeries respectively. MMP2, TIMP2 and CTGF levels were measured using specific enzyme immunoassay [ELISA]. Total MMP2 was detected in significantly higher concentration in aqueous samples from PEXG eyes and POAG eyes compared to control eyes. The ratio of MMP2 to its principle inhibitor TIMP2 was balanced in cataract samples as well as in samples from PEXG glaucoma patients but increased in POAG samples. The CTGF concentration in PEXG group was significantly higher compared to POAG and cataract groups. Complex changes in MMP2- TIMP2 balance in aqueous humor may promote the abnormal matrix accumulation [in PEXG] and matrix degeneration [in POAG] which may be causally involved in the pathogenesis of both glucomas. The increased CTGF concentration supports the proposed fibrotic pathology of glaucoma. Regulation of MMP2/ TIMP2 expression and anti-CTGF therapy may offer potential therapeutic avenues for controlling glaucoma

Synthesis and antimicrobial activity of some new quinoline and 1h-pyrazolo[3,4-b]quinoline derivatives

Vilsmeier formylation of acetanilide I followed by treatment with hydroxylamine produced 2-chloroquinoline-3-carbonitrile II that was condensed with different amines to give 2- substituted aminoquinolines-3-carbonitriles III. Treatment of II with thiourea yielded 2- mercaptoquinoline-3-carbonitrile IV, which was converted to its potassium salt V that was condensed with some chloroacetate esters to produce 2-substituted thioquinoline-3- carbonitriles VI. Hydrazinolysis of II or IV gave 1H-pyrazolo[3,4-b]quinolin-3-ylamine VII. Condensation of VII with different aryl aldehydes resulted in the corresponding imines VIII. Treatment of VII with p-chloro-benzoyl chloride afforded the amide IX. Some of the synthesized compounds were evaluated for their antibacterial and antifungal activity

Spinal tuberculosis: CT and MRI features

Spinal tuberculosis [TB] is perhaps the most clinically important extrapulmonary form of the disease. Early recognition is therefore necessary to minimize residual spinal deformity and/or permanent neurological deficit. We defined the CT and MRI image morphology of spinal TB and correlated the imaging features of these two modalities. CT [29 patients] and MRI [11 patients] images were retrospectively analyzed in 30 patients with proved spinal TB. CT and MRI findings were compared in cases with both imaging tests [10 cases]. The parameters assessed were the type and extent of bone and soft tissue involvement. The majority of the 30 patients were males [n=18] in the 30-49 year age group [43%]. The most common clinical presentation was backache [73.3%] followed by fever [63.3%] and malaise [36.6%]. The lumbar spine was the commonest site of the disease [43.3%] followed by the thoracic region [36.6%]. A fragmentary type of bone destruction was the most frequent CT feature of the disease [48.2%] followed by the lytic type [24.1%]. Intervertebral disc destruction [72%] and paravertebral mass/abscess [65.5%] were other features. Of the 11 patients who had an MRI, contiguous vertebral disease with disc destruction was seen in 10 cases. In 4 patients, there was distant vertebral disease in addition to the disease at the symptomatic site. MRI offers excellent visualization of the bone and soft tissue components of spinal tuberculosis and helps to identify disease at distant asymptomatic sites. CT is useful in assessing bone destruction, but is less accurate in defining the epidural extension of the disease and therefore its effect on neural structures. MR imaging clearly demonstrated the extent of soft tissue disease and its effect on the theca/cord and foramen in cases with doubtful CT findings

Pattern of dermatoses among inmates of district prison--Mangalore.

The present paper studies the pattern of dermatoses among 225 inmates of a jail, over a period of 6 months (Feb- July' 99). 63.6% inmates screened had dermatoses. Among those with dermatoses 63.3% were infectious and 36.4% were non-infectious. Among the infections, fungal infections (51.3%) constituted the maximum. Pediculosis copitis was found in 6.6% of inmates. in the non-infectious group, pigmentary changes (21%) and dandruff (21%) were noted. Overcrowding prevalent in jail (73% excess inmates) could be contributory factor for the high incidence of infections.