Unravelling the oxygen factor - An investigation of transcriptional activation of hypoxia associated placental angiogenesis in recurrent pregnancy loss (RPL) patients from Assam, India.

INTRODUCTION: Recurrent pregnancy loss (RPL) is defined as the spontaneous loss of two or more consecutive pregnancies before 20 weeks of gestation, and affects 7.46 % of the Indian population. About 40-50 % of RPL cases are idiopathic making it a therapeutic challenge for clinicians. This study focuses on elucidating the role of hypoxia-associated placental angiogenesis in these idiopathic RPL cases. METHODS: Whole blood and product of conception (POCs) were collected from RPL patients (N = 87) and cases of voluntary abortions (medically terminated pregnancy, MTP; n = 110) as controls with informed consent. Serum separated from whole blood was used to study the ROS-antioxidant status in the cases and controls through colorimetric assays and ELISA. The mRNA extracted from placental tissue samples were used to determine the hypoxic and angiogenic status in cases and controls through real time PCR. Statistical analysis was also carried out to correlate the differential hypoxic status between RPL and MTP cohorts with the expression of angiogenic factors (VEGFA, VEGFR1 and VEGFR2). RESULTS: HIF1α mRNA expression was found to be upregulated in the RPL cases. While the serum levels of H2O2 (p = 0.012), guanine oxides and lipid hydroperoxides (LPO) were increased in the RPL cases, reduced glutathione (GSH) was found to be significantly decreased (p = 0.012). Additionally, AUROC analysis also shows an excellent discriminatory ability of 0.850 for serum H2O2 levels. VEGF-A and VEGF-R1 mRNA expression was also found to be downregulated in the RPL cases compared to MTP. DISCUSSION: This study indicates that increased oxidative stress may lead to aberrations in the VEGF pathway resulting in improper placentation in RPL cases, and subsequently, pregnancy loss.

Conversion of Laparoscopic to Open Cholecystectomy: Experience in A Tertiary Care Hospital.

Now-a-days Laparoscopic cholecystectomy is regarded as the gold standard treatment for benign gallbladder disease but in certain situations conversion to open cholecystectomy is extremely important for the safety of the patient. The objective of this study was to evaluate the reason for conversion of this operation to open surgery. This prospective study was carried out on 392 patients in a single unit of Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh and in a private hospital from July 2013 to December 2018. Maximum (28.3%) patients were 31-40 years age group. Majority (75.3%) was female and 24.7% were male. It was observed that only 2.1% were converted due to dense adhesion (n=3), severe inflammation (n=2), difficult to define anatomy of Calot's triangle (n=2) and Mirizzi syndrome (n=1). Meticulous dissection and proper case selection can reduce the rate of conversion to open surgery.

Role of Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Pancreatic Lesions.

To evaluate the diagnostic utility of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of pancreatic lesions, EUS-FNA was carried out on a total of 28 cases at the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2015 to August 2016. Clinical impression was compared with the final cytological diagnosis and the percentage of non diagnostic smears was calculated. The lesions were categorized according to cytological report. Out of 28 cases, 3(10.71%) cases were normal, 6 cases (21.43%) were reported as inconclusive while a definite diagnosis was given in 19 cases (67.85%). The mean patient age was 47.82 years. There were 16(57.1%) males and 12(42.9%) females. The most common site biopsied was pancreatic head in 21cases (75%) followed by tail in 5 cases (17.9%) & body in 2(7.1%) cases. The average number of passes made was two. Endoscopic Ultrasound Guided Fine-Needle Aspiration in the diagnosis of pancreatic lesion is a useful procedure.

Lower Genital Tract Trauma in A Tertiary Care Centre in Mid-Western Nepal.

INTRODUCTION: The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. METHODS: Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. RESULTS: These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. CONCLUSIONS: Appropriate surgical intervention can avert morbidity and mortality.

Assessment of indoor pollutants generated from bio and synthetic fuels in selected villages of Burdwan, West Bengal.

The objective of the present study was to access the pollutant generated from bio-fuels like bamboo sticks, cow dung, paddy straw, carbon dust cake, gobar gas, jute stick, and mustard stick and synthetic fuel like LPG during cooking in rural villages of Burdwan, West Bengal, India and its fluctuation in living room. The average SO2 released from the fuels was found in the following order: bamboo stick > cow dung > paddy straw > carbon cake > gobar gas > jute stick > LPG > mustard stick; NO2 emission was in the following order : mustard stick > carbon dust cake > paddy straw > cow dung cake > LPG, jute stick > gobar gas > bamboo stick > and SPM was obtained in the following sequence: cow dung cake > bamboo stick > carbon dust cake > gobar gas > LPG > mustard stick > paddy straw > jute stick, respectively. The highest living room to kitchen room (L/K) ratio of SO2, NO, and SPM was found in LPG, gobar gas, jute stick respectively in 2009 and followed by bamboo stick > paddy straw > jute stick > cow dung cake, respectively in 2010. Results of this study suggest that different fuels released different amount of air pollutants, but more extensive study is needed to confirm the relationship between fuels and released air pollutants.

Vaginal hysterectomy for pelvic organ prolapse in Nepal.

BACKGROUND: UVP is a significant Public Health Problem in Nepal. This problem is mainly prevalent in rural areas where the women are socio--economically less privileged and cannot afford the costs of treatment. OBJECTIVE: An analysis of peri operative and post operative complications of vaginal hysterectomies for pelvic organ prolapse. MATERIALS AND METHODS: A hospital based prospective study was carried out in the department of obstetrics and gynaecology, NGMC followed up from the time of operation to time of discharge. RESULTS: 632 cases underwent vaginal hysterectomy with financial support from UNFPA. There were no operative complications. The most common post operative complications as noted were retention of urine, pelvic infection & pelvic abscess. In two cases laparotomy was done for haemoperitoneum. Pelvic abscess was drained vaginally. Mortality was nil. CONCLUSION: Proper screening before operation is the key to reduce operative as well as peri operative complications.

A probabilistic model for the fault tolerance of multilayer perceptrons.

This paper presents a theoretical approach to determine the probability of misclassification of the multilayer perceptron (MLP) neural model, subject to weight errors. The type of applications considered are classification/recognition tasks involving binary input-output mappings. The analytical models are validated via simulation of a small illustrative example. The theoretical results, in agreement with simulation results, show that, for the example considered, Gaussian weight errors of standard deviation up to 22% of the weight value can be tolerated. The theoretical method developed here adds predictability to the fault tolerance capability of neural nets and shows that this capability is heavily dependent on the problem data.

Study of side-effects of Cu-T as intra-uterine contraceptive device in post medical termination of pregnancy and interval cases.

Follow-up study of 60 cases (group B) of post medical termination of pregnancy Cu-T insertion and 100 cases (group A) of interval Cu-T insertion revealed that menstrual complaints like dysmenorrhoea and menorrhagia were more prevalent in the 1st 3 months. These were more frequently found in group B cases. After one year the incidence reduced to almost nil in both the groups. Pain in lower abdomen and backache, a more frequent complaint in group B in 1st 3 months were also reduced remarkably after one year. Two expulsions in group B and one expulsion in group A had occurred during the 1st 3 postinsertion cycles along with menstrual flow. Failure has occurred in only one case in group B. For some reason or other Cu-T was removed in 11 cases in group A and 5 cases in group B. Desire for another pregnancy was the prime cause of removal of Cu-T in group A and along with this cause menstrual trouble was equally responsible for its removal in group B cases. There was no case of perforation, displacement or ectopic pregnancy reported in the present study, though for a short period.

PIP: A 12-month comparative study conducted at a medical center in Burla, India, failed to detect significant differences in side effects between 60 women who had a Copper-T 200 IUD inserted after induced abortion and 100 women with interval IUD insertion. Most insertions involved women in the 21-30 year age group. Menorrhagia was reported by 8% of women in the postabortion insertion group and 8.5% of those in the interval insertion group after 1 month and by 5% and 10%, respectively, after 3 months; its incidence was negligible thereafter. Dysmenorrhea was experienced by 20% of postabortion insertion cases and 7% of interval cases at 1 month and by 15% and 7%, respectively, at 3 months, at which point it, too, decreased. Women with postabortion IUD insertion reported more lower abdominal pain and back ache in the first 3 months, presumably because of the operative trauma and chance of pelvic inflammation. Expulsion occurred in 2 women in the postabortion insertion group and in 1 woman in the interval group. The single pregnancy reported during the study period involved a woman from the postabortion insertion group (1.6%). The removal rate was 8.3% in the postabortion group and 11% in the interval group; requests were due to a desire for pregnancy or discomfort with menstruation disturbances. These findings refute the commonly held belief that postabortal IUD insertion is associated with an increased risk of infection, spontaneous expulsion, and unacceptable menstrual disturbances.