A prospective randomized comparative study of the efficacy of sustained release vaginal insert versus intracervical gel in primigravidae at term pregnancy

vBackground: Induction of labour is the intentional initiation of labour before spontaneous onset for the purpose of delivery of fetoplacental unit. Failure of induction is responsible for increased incidence of caesarean delivery. This study performed to assess and compare the clinical effects of sustained release vaginal insert versus intracervical gel in primiparous women with term pregnancy in terms of improvement of Bishop’s score, Induction delivery interval, incidence of hyperstimulation, maternal and neonatal outcomes.Methods: A total 100 consecutive term pregnant women who underwent labor induction for fetal or maternal indications were divided randomly into two groups. Group A - sustained release Vaginal insert and Group B - Intracervical gel. Informed consent was taken from each patient.Results: Statistically significant increase in final Bishop’s score (p=0.008) and hyperstimulation (p=0.04) was seen in Vaginal insert group as compared to Intracervical gel group, while there were no statistically significant differences in maternal outcomes, neonatal outcomes and need for oxytocin augmentation in both groups.Conclusions: In this study we found that insert did not improve the induction delivery interval or rate of successful induction, nor did it have any advantage in terms of neonatal outcome although it did improve the Bishops score – Its advantage was in terms of single application, few prevaginal examinations, longer duration of action and immediate retrieval in case of hyperstimulation. Its main drawback remained the maintenance of cold chain without which its efficacy decreases. Another significant observation was the dropout rate of insert (16%).

A clinical study of impact of anaemia in pregnancy on maternal and neonatal outcome

Background: The aim is to study effect of anaemia in obstetrics patients during antepartum, intrapartum and postpartum and to find the incidence of maternal and neonatal morbidity and mortality in those patients.Methods: A prospective clinical study was conducted on patients receiving obstetric care at Basaveshwara Medical College and Hospital from July 2016 to July 2018.Pregnant women with Hb less than 8g were included in the study to determine the outcome of pregnancy in severe anaemia and determine the causes of anaemia. Acute cases of obstetrical haemorrhages as in antepartum and postpartum haemorrhages and all medical and surgical high-risk factors except anaemia, were excluded from the study.Results: A total of 200 pregnant anaemic patients with haemoglobin less than 8g/dl were included in the study. The patients were divided into two groups based on haemoglobin concentration at first presentation. Patients with haemoglobin level less than 5g/dl were included in group A (N=44, 22%), and rest of the patients were included in group B (N=156, 78%). Most commonly observed complications in the study were preeclampsia and eclampsia (46 cases), preterm labour (46 cases) and IUGR (30 cases). In both group of patients, the commonest cause of anaemia in pregnancy was iron deficiency. The greater the severity of anaemia in pregnancy, greater was the risk of preeclampsia, preterm delivery, low birth weight and stillbirth.Conclusions: This study reveals that severe anaemia which is commonly observed in the pregnancy in our country, gives rise to maternal and perinatal morbidities and mortalities.

Foreigners To Pulp And Periodontium - Report Of 2 Cases

Presence of a foreign object embedded in and around a tooth is unusual. Such object may get lodged and become a source of pain and infection, causing the patient to present to the dentist. This paper present two such case reports of foreign body imbedded within or around the tooth. One of the reported cases is the first case in which staple pin is present in primary molar. Present article emphasizes upon maintenance of oral hygiene and regular dental check up can prevent such undesirable situation.

Management Of Open Apex In A Patient With Sickle Cell Anemia: A 6year Long Follow Up Case

Sickle cell anaemia is one of most common genetic disorder world wide, with estimated 70 million people carrying the sickle genes. Most dental procedure present some form of bacteremia. Preventive dental therapy is an ideal approach for treatment of SCA patient. The goal of pediatric dentist is to improve oral health of patient and to decrease possibility of oral infections. Infected immature permanent teeth could be source of infection in such patient. Present case shows conservative management of immature permanent teeth with a 6 year long follow up

Understanding Singaporean medical students' stress and coping

Medical school is intrinsically stressful, and high levels of stress have untoward effects. Although surveys have revealed some sources of stress among medical students, little is known about the qualitative aspects of these stressors and their associated coping behaviours, particularly among medical students in Singapore. Our exploratory pilot study found that relationship issues and examinations were the major sources of stress for medical students. The respondents described multiple context-sensitive coping styles, as well as reported 'avoidance' or 'wishful thinking' coping strategies as ineffective. Their stress-and-coping process suggests the influence of Asian culture and medical school culture. Our findings thus indicate the need for further research, potentially using new methodologies such as the critical incident analysis technique, and thoughtful consideration of culture when implementing programmes in Singapore medical schools to improve the students' stress-and-coping responses.

Increased Cellular NAD⁺ Level through NQO1 Enzymatic Action Has Protective Effects on Bleomycin-Induced Lung Fibrosis in Mice / 결핵및호흡기질환

BACKGROUND: Idiopathic pulmonary fibrosis is a common interstitial lung disease; it is a chronic, progressive, and fatal lung disease of unknown etiology. Over the last two decades, knowledge about the underlying mechanisms of pulmonary fibrosis has improved markedly and facilitated the identification of potential targets for novel therapies. However, despite the large number of antifibrotic drugs being described in experimental pre-clinical studies, the translation of these findings into clinical practices has not been accomplished yet. NADH:quinone oxidoreductase 1 (NQO1) is a homodimeric enzyme that catalyzes the oxidation of NADH to NAD+ by various quinones and thereby elevates the intracellular NAD⁺ levels. In this study, we examined the effect of increase in cellular NAD⁺ levels on bleomycin-induced lung fibrosis in mice. METHODS: C57BL/6 mice were treated with intratracheal instillation of bleomycin. The mice were orally administered with β-lapachone from 3 days before exposure to bleomycin to 1-3 weeks after exposure to bleomycin. Bronchoalveolar lavage fluid (BALF) was collected for analyzing the infiltration of immune cells. In vitro, A549 cells were treated with transforming growth factor β1 (TGF-β1) and β-lapachone to analyze the extracellular matrix (ECM) and epithelial-mesenchymal transition (EMT). RESULTS: β-Lapachone strongly attenuated bleomycin-induced lung inflammation and fibrosis, characterized by histological staining, infiltrated immune cells in BALF, inflammatory cytokines, fibrotic score, and TGF-β1, α-smooth muscle actin accumulation. In addition, β-lapachone showed a protective role in TGF-β1–induced ECM expression and EMT in A549 cells. CONCLUSION: Our results suggest that β-lapachone can protect against bleomycin-induced lung inflammation and fibrosis in mice and TGF-β1–induced EMT in vitro, by elevating the NAD+/NADH ratio through NQO1 activation.

A review of global initiatives to fight antibiotic resistance and recent antibiotics׳ discovery

Data from across the world have shown an overall decline in the antibiotic pipeline and continually rising resistance to all first-line and last-resort antibiotics. The gaps in our knowledge of existing prevalence and mechanisms of antibiotic resistance (ABR) are all too well known. Several decades of antibiotic abuse in humans, animals, and agricultural practices have created health emergency situations and huge socio-economic impact. This paper discusses key findings of the studies conducted by several national and international collaborative organizations on the current state of affairs in ABR. Alongside, a brief overview of the antibacterial agents׳ discovery in recent years approved by the US FDA is discussed.

Anaesthetic management of a patient with severe aortic stenosis for caesarean section: a case report.

Aortic stenosis (AS) is an uncommon valvular heart disease presenting during pregnancy. Mild to moderate AS is associated with favorable pregnancy outcome but severe AS can worsen the hemodynamics during the peripartum period and precipitate heart failure, pulmonary edema, thus carrying significant maternal and fetal morbidity and mortality. Percutaneous balloon valvuloplasty can be used as a palliative procedure that allows for completion of pregnancy before definitive repair. We present a case of severe AS posted for caesarean section who was successfully managed under general anaesthesia and had an uneventful recovery.

Cisplatin-induced Kidney Dysfunction and Perspectives on Improving Treatment Strategies

Cisplatin is one of the most widely used and highly effective drug for the treatment of various solid tumors; however, it has dose-dependent side effects on the kidney, cochlear, and nerves. Nephrotoxicity is the most well-known and clinically important toxicity. Numerous studies have demonstrated that several mechanisms, including oxidative stress, DNA damage, and inflammatory responses, are closely associated with cisplatin-induced nephrotoxicity. Even though the establishment of cisplatin-induced nephrotoxicity can be alleviated by diuretics and pre-hydration of patients, the prevalence of cisplatin nephrotoxicity is still high, occurring in approximately one-third of patients who have undergone cisplatin therapy. Therefore it is imperative to develop treatments that will ameliorate cisplatin-nephrotoxicity. In this review, we discuss the mechanisms of cisplatin-induced renal toxicity and the new strategies for protecting the kidneys from the toxic effects without lowering the tumoricidal activity.

Lytic bacteriophages specific to Flavobacterium columnare rescue catfish, Clarias batrachus (Linn.) from columnaris disease.

This investigation was aimed to find out appropriate strategy against antibiotic resistant bacterial fish pathogen, F. columnare. This pathogen was found persistently associated with fishes causing columnaris disease and ensuing mass mortality in hatchery and culture system of Sub - Himalayan region. Nine lytic F. columnare phages (FCP1 – FCP9) specific to its fifteen isolates were isolated from the water and bottom sediments of various geo-climatic regions of North India. The F. columnare phage FCP1 (made of hexagonal head and non contractile long tail belonging to family Podovariedae, a member of DNA virus) exhibited broader host range to lyse 9 out of 15 isolates of F. columnare. Therapeutic ability of FCP1 phage was assessed in C. batrachus inoculated intramuscularly (im) with virulent bacterial isolate FC8 and post inoculated (PI) with FCP1phage (@ 108 : 106 :: cfu : pfu) through intramuscular (im), immersion (bath) and oral (phage impregnated feed) treatment. Significant (p<0.001) reduction (less than 10-3 cfu ml-1) in host bacterium in the sera, gill, liver and kidney of challenged fishes was noted after 6 hr of phage treatment. Quantum of phage played a significant role in bringing down bacterial population as in the sera of dose 1 (@ 4.55 X 106 pfu ml-1) and dose 2 (@ 9.15 X 106 pfu ml-1) treated fishes mean log10 cfu value reduced by 3 logs (58.39%) and 5 logs (73.77%) at 96 hr, respectively. Phage treatment led to disappearance of gross symptoms, negative bacteriological test, detectable phage and 100% survival in experimentally infected C. batrachus. Result of this study provides evidence of profound lytic impact of FCP1 phage and represents its interesting therapeutic importance against antibiotic resistant F. columnare.

Antagonistic effect of polyamines on ABA-induced suppression of mitosis in Allium cepa L.

Effect of abscisic acid (ABA) and polyamines (PAs) [putrescine (Put), spermidine (Spd) and spermine (Spm)] on mitosis in root tips of A. cepa was studied. Treatment with ABA (0.1 to 100 microM) for 24 hr suppressed the mitosis, measured as mitotic index (MI), in a concentration-dependent manner with approx. 50% suppression at 10 microM of ABA. Treatment with different PAs (1 to 100 microM) had differential mitosis suppression effect. Spm was most inhibitory followed by Spd and Put, respectively. The higher concentrations of PAs (1 mM Put; 0.1 and 1 mM Spd or Spm) caused cell distortion. Remarkably, a 24 hr pretreatment of root tips with PAs prior to ABA (100 microM) treatment resulted in a general concentration-dependent reversal of ABA-induced suppression of MI. Catalase (CAT) activity in the root tips, an indicator of redox metabolism, increased due to ABA treatment in a concentration-dependent manner, remained unaltered in response to Put and declined due to Spd and Spm (> or = 0.1 mM). However, all PAs, irrespective of their individual effects, generally antagonized the ABA-dependent increase in CAT activity. Data indicate the possibility of ABA-PA interaction in the regulation of mitosis.

Atypical varicella zoster as SJS-TEN overlap syndrome with involvement of palm and sole.

A 14-month-old boy presented with generalised vesicular eruption involving the face, trunk and extremities accompanied by high grade fever. He had associated redness and purulent discharge from both eyes. Examination revealed erosions on the tongue, soft palate and genitalia with haemorrhagic crusts on the lips and nasal orifices. All laboratory investigations were within normal limits except leucocytosis. Chest x-ray showed left middle zone pneumonitis. Treatment was by paracetamol, antibiotics and oral acyclovir. Desquamation started from the eighth day. Our purpose in reporting this case is to highlight the fact that varicella can be atypical with distal involvement and can present as SJS-TEN overlap syndrome.

Cyclosporine in steroid dependent and resistant childhood nephrotic syndrome.

OBJECTIVE: To evaluate the efficacy of cyclosporine (CyA) monotherapy in steroid resistant (SRNS) and steroid dependent (SDNS) nephrotic syndrome in children. DESIGN: A retrospective study. SETTING: Tertiary kidney care center for children at Bangalore. METHODS: Forty-one children with SDNS and SRNS with normal renal functions were treated with CyA at a dose of 6 mg/kg/day initially and maintained at 3 to 4 mg/kg/day if remission was sustained. The dosage was adjusted according to the CyA blood levels in non-responders. RESULTS: The median age of patients was 93 months (range 48-936) months. Thirteen children had minimal change disease (MCNS), 10 had mesangial proliferative glomerulonephritis (GN). Ten had membrano-proliferative (GN) (MPGN) and 8 had focal segmental glomerulosclerosis (FSGS). Median age at onset of disease and median time for CyA usage from disease onset was 22 months and 16 months respectively. Median duration of CyA therapy was 24 months (range 6-72) months. The data was analyzed to determine significance of variables on the outcome. Median follow up was 71 months (range 20-205) months. Eleven children were CyA resistant. Of the remaining 30 who were CyA responders, 22 (73.33%) were CyA dependent. Seven children developed chronic renal failure (CRF). CONCLUSIONS: The predictors for CyA non-responsiveness were steroid resistance, non MCNS on biopsy and longer duration between onset of nephrotic syndrome and CyA usage, irrespective of the age of onset of the disease. There was a higher incidence of CyA dependence among young responders. Patients with CyA resistance are at high risk for significant infections and CRF.

Pediatric renal transplantation: the Bangalore experience.

A retrospective analysis was done on 47 pediatric renal transplants performed over last 16 years at Bangalore, Karnataka. The median age and weight of the recipients at transplantation were 120 months and 21 kg respectively; male to female ratio was 30 to 17. Twenty two children had underlying glomerular disease and 23 had tubulointerstitial disease. Preemptive transplantation was done in 33.3% of patients, 57.2% received hemodialysis and 9.5% received peritoneal dialysis prior to transplantation. The mean duration of dialysis was 2.6 months.The most common source of donor organ was the mother. Immunosuppression medications included cyclosporine, azathioprine, and corticosteroids. Graft survival at 1 year, 5 years, and 10 years was 80%, 45.8% and 37.5% respectively. Renal transplantation is the most optimal way to manage children with ESRD with satisfactory long term results.

Prevalence of hepatits B and C among blood donors in Dhahira region, Oman

To determine the prevalence of Hepatitis B surface antigen and anti-hepatitis C virus [HCV] antibodies among blood donors and to compare the prevalence between Omani and non Omani population The study was conducted from January 2001 to December 2002. This is a hospital based study conducted in two major hospitals [Regional hospital and Wilayat hospital] having a blood bank facility in the Dhahira region, Oman. All those who donated blood during the study period were included in this study. The HBsAg was performed using IMX system [Abbott, Microparticle Enzyme Immunoassay [MEIA] technology]. The blood was screened for hepatitis C by the same system using recombinant HCV antigen. A total of 4,472 blood donors were tested during the study period, out of whom 68.4% were voluntary donors and 31.6% were family replacement donors. Approximately 85% of the donors were local Omanis and 15% were nonOmanis. The prevalence rate of HBsAg and HCV Positive was found to be 4.29 and 0.96% respectively. The Male:Female ratio was found to be 9.3:1.0. The prevalence of hepatitis B among males was higher compared to females but the difference was not statistically significant [p=0.68]. However, there was a significantly higher prevalence of hepatitis B among Omanis compared to non-Omanis [p=0.0004]. No significant difference was observed despite the higher number of hepatitis C positives in males than in females [p=0.16] and non-Omanis compared to Omanis [p=0.22]. The prevalence of hepatitis B and C among Omani population of Dhahira region was moderate and low, respectively. The prevalence of hepatitis B was higher among Omanis and conversely hepatitis C prevalence was higher among non-Omanis