Prevalence of Repeat Cesarean Section in a Tertiary Care Hospital.

INTRODUCTION: Cesarean section is the surgical delivery of a baby through an incision made in the mother's abdomen and uterus. Repeat cesarean section has recently increased, partly because of concern about increased risk of uterine rupture in women attempting vaginal birth after cesarean delivery. Among the women who underwent cesarean section in their first delivery, 80-96% had a second surgical delivery. Therefore, the present study aimed to describe the prevalence of repeat cesarean section among Nepali women presented at Kathmandu Medical College and Teaching Hospital who had a previous cesarean section. METHODS: This was a descriptive cross-sectional study conducted in Kathmandu Medical College and Teaching Hospital from 1st of February to 31st of May 2020. Ethical approval was taken from the Institutional Review Committee of the Kathmandu Medical College. Convenient sampling was done. All pregnant patients between gestational ages of 37-40 weeks with previous cesarean section admitted for safe confinement were included in the study. RESULTS: Among the 104 women, who had prior cesarean section, 99 (95.19%) had second cesarean section and 5 (4.81%) had vaginal birth after cesarean. The most common indication for the first cesarean section was fetal distress 31 (29.81%) while the indication for the second cesarean section among previously cesarean section women was cephalo pelvic disproportion 39 (39.40%). CONCLUSIONS: The proportion of cesarean section in both first and subsequent delivery is quite high. This high rate may compromise the reproductive future of the women who underwent consecutive cesarean section with possible consequent complications.

Pattern of Body Mass Index and Common Health Problems in Women of Reproductive Age Group in a Private Clinic in Kathmandu.

INTRODUCTION: High Body Mass Index is one of the risk factors for many chronic diseases and adverse health outcomes. It is associated with an increased risk of coronary heart disease, ischemic stroke, high blood pressure and type 2 diabetes mellitus. It also have many adverse effect on reproductive health of the women like sub fertility, polycystic ovarian disease, menstrual abnormality etc. The purpose of this study is to find Basal Metabolic Rate and the diseases pattern of reproductive age woman in Nepal. METHODS: This is a descriptive study of women of reproductive age (15 to 49 years) attending a private gynaecology clinic in Kathmandu Valley from October 2016 to June 2017. Six hundred and eight women of current reproductive age group participated in this study. Women's particulars and complaints were noted down. Detailed history was taken. Height, weight and blood pressure were recorded and general examination was done. BMI was calculated as BMI is weight in kilogram divided by height in meter square, and it was interpreted as per WHO guidelines. RESULTS: Out of the total 608 participants, 243 (40%) were overweight, 96 (15.8%) were obese. Regarding the common health problems, 154 (25.3%) have sub fertility and 199 (32%) had genitourinary infection. Similarly, 90 (14.8%) had menstrual problems. CONCLUSIONS: Prevalence of overweight and obesity has risen significantly comparing to the study done decade ago in same setting. Similarly, sub fertility rate has also risen whereas the prevalence of genitourinary infections has decreased.

Gelatinase B (-1562C/T) polymorphism in tumor progression and invasion of breast cancer.

Matrix metalloproteinases (MMPs) play an important role in breast cancer tumor invasion and progression. MMP-9 is a member of the MMP family and is also known as Gelatinase B or type IV collagenases (92 kDa) and possesses proteolytic activity against type IV collagen, a major component of the basement membrane. Our study aims to examine the association of Gelatinase B (-1562C > T) promoter polymorphism with breast cancer invasion and progression. The study involves 200 breast cancer patients and age-matched 191 healthy controls. The SNP-1562C > T (rs3918242) in MMP-9 promoter region was examined by allele-specific polymerase chain reaction and gel electrophoresis. The genotypes were determined and compared between patients and controls, and the influence of the polymorphism on clinicopathological data was analyzed. The T allele of the -1562C > T MMP-9 polymorphism was detected more frequently in breast cancer patients than controls (p < 0.001). Our results suggest the clinical importance of MMP-9 gene polymorphism (-1562C > T) in breast cancer patients. The study may also help in identifying individuals at risk of developing breast cancer.

5-Isothiocyanonicotine: a high-affinity irreversible ligand for brain nicotinic receptors.

A newly synthesized affinity ligand, (R,S)-5-isothiocyanonicotine (ISCN-N) was found to inhibit irreversibly the binding of [3H]methylcarbamylcholine (a specific nicotinic receptor ligand) to brain membranes. Plots of percent inhibition versus ligand concentration yielded an IC50 of 7 x 10(-8) M for SCN-N and Ki values of 6 x 10(-9) and 2 x 10(-9) M for (R,S)-5-aminonicotine and (S)-nicotine, respectively. The IC50 value for irreversible inhibition of [3H]methylcarbamylcholine by SCN-N was 2 x 10(-7) M. The affinity ligand irreversibly inhibited brain nicotinic receptors in vivo in a dose-dependent manner, the inhibition being 49% at a dose of 20 mumol/kg. Behavioral studies in mice revealed that SCN-N had less than one-fifth the potency of nicotine in producing muscle weakness and seizures, whereas 5-aminonicotine was without significant behavioral effects at doses up to 20 mumol/kg.

Affinity ligands and related agents for brain muscarinic and nicotinic cholinergic receptors.

This study describes the chemical synthesis and receptor binding characteristics of various affinity ligands and related ligands for brain muscarinic and nicotinic cholinergic receptors, including the 4-bromoacetamidobenzoic acid esters of dimethylaminoethanol (DMBAB) and choline (BABC) and 4-iodoacetamidobenzoylcholine (IABC). The reversible binding of [3H]3-quinuclidinylbenzilate ([3H]QNB) to calf brain membranes was inhibited in a concentration-dependent and saturable manner by DMBAB, BABC, and IABC with Ki values of 8 x 10(-7), 3 x 10(-7) and 8 x 10(-7) M, respectively; the Ki values for inhibition of reversible binding of the nicotinic ligand, [3H]methylcarbamylcholine ([3H]-MCC), were 1 x 10(-6), 6 x 10(-8), and 1 x 10(-6) M, respectively. The Ki values for irreversible inhibition of [3H]QNB binding were 8 x 10(-7), 1 x 10(-7), and 2 x 10(-7) M for DMBAB, BABC, and IABC, respectively, and for [3H]MCC binding, 8 x 10(-5), 1 x 10(-5), and 2 x 10(-5) M, respectively. Although DMBAB was found to inhibit the QNB-induced hyperactivity in mice, it did not antagonize the toxic or other pharmacologic effects of oxotremorine. Structure-activity studies with various non-affinity analogues of the 4-aminobenzoate ester of dimethylaminoethanol and choline revealed that removal of the NH2 moiety from the phenyl group increased affinity for the muscarinic but not the nicotinic cholinergic site, and quaternization of the ester side chain greatly increased affinity for the muscarinic site. Dimethylation of NH2 in 4-aminobenzoylcholine decreased the affinity for both cholinergic sites. Replacement of NH2 by NO2 increased affinity for the muscarinic but not the nicotinic site, whereas quaternization of the 4-nitrobenzoyl ester markedly increased affinity for the nicotinic site while diminishing affinity for the muscarinic site. The findings indicate that DMBAB and its analogues are useful affinity ligands for examining the biochemical and functional characteristics of brain cholinergic receptors, particularly the muscarinic which has an affinity near the nanomolar concentration range.

4-Bromoacetamidoprocaine: an affinity ligand for brain muscarinic and nicotinic cholinergic receptors.

This study describes the synthesis, receptor binding characteristics, and some behavioral effects of p-bromoacetamidoprocaine (BAP), a new affinity ligand for brain muscarinic and nicotinic cholinergic receptors. The reversible binding of [3H]QNB to rat brain membranes was inhibited in a concentration dependent and saturable manner by both procaine and BAP, with Ki values of 4 x 10(-6) and 3 x 10(-7) M, respectively, and complete inhibition at 1 x 10(-5) M. Both procaine and BAP, although at much concentrations, inhibited the binding of [3H]methylcarbamylcholine in a concentration dependent manner, with Ki values of 5 x 10(-5) and 1 x 10(-5) M, respectively, and complete inhibition for both at 1 x 10(-3) M. Plots of the % irreversible inhibition of [3H]QNB, [3H]nicotine, and [3H]MCC vs [BAP] yielded Ki values of 7 x 10(-8), 1 x 10(-4), and 6 x 10(-5) M, respectively. In behavioral studies BAP was able to antagonize the QNB-induced hyperactivity in mice; however, BAP did not appear to alter nicotine-induced seizure activity or other behavioral effects in mice. A plot of the time course of inhibition by BAP for [3H]QNB binding revealed that the inhibition was almost complete within 10 min exposure at 37 degrees. The findings indicate that BAP is a useful affinity ligand for examining the biochemical and functional characteristics of brain cholinergic receptors, particularly the muscarinic which has an affinity near the nM concentration range.

Effect of centrally administered enkephalins on carrageenin-induced paw oedema in rats.

Intracerebroventricularly (icv) administered met-enkephalin, leu-enkephalin, and morphine induced dose-related attenuation of carrageenin-induced acute paw oedema in rats. Naloxone (10 micrograms, icv) antagonized the anti-inflammatory effects of the enkephalins (20 micrograms) and morphine (20 micrograms), but itself induced an anti-inflammatory effect at a higher dose (50 micrograms, icv). The anti-inflammatory effects of the enkephalins, morphine, and the higher dose of naloxone were significantly inhibited by metyrapone, an inhibitor of endogenous corticoid synthesis. The icv-administered doses of the enkephalins and morphine induced insignificant inflammation-attenuating effects when administered i.p. Results suggest that the anti-inflammatory effects of the enkephalins and morphine are exerted through central opiate receptors. Furthermore, the inflammation-attenuating effects of these drugs and the higher dose of naloxone appear to be dependent upon endogenous corticoids, suggesting that activation of the hypothalamo-pituitary-adrenocortical axis may be involved.

Effect of intracerebroventricularly administered insulin on brain monoamines and acetylcholine in euglycaemic and alloxan-induced hyperglycaemic rats.

There is now conclusive evidence for the presence of insulin and insulin receptors in the mammalian CNS and it has been postulated that they can modulate peripheral glucose homeostasis. Since a number of central neurotransmitters are also known to influence glucose levels and it is likely that CNS insulin receptors act through neurotransmitter mediation, the present study was conducted to investigate the effect of intracerebroventricularly (icv) administered insulin on rat brain dopamine (DA), noradrenaline (NA), serotonin and acetylcholine (ACh) activity in normal and alloxan-induced hyperglycaemic animals. Insulin was administered in doses (50 and 100 microU) which induced minimal hypoglycaemia, so as to obviate the likely effects of hypoglycaemia on neurotransmitter function. DA was estimated in midbrain-diencephalon (MD) and caudate nucleus (CN), NA and serotonin in MD and pons-medulla (PM), while ACh was estimated in all the three areas, namely, MD, CN and PM. The regional brain concentrations of DA, NA and serotonin were more in the hyperglycaemic rats as compared to their euglycaemic counterparts. However, the reverse was noted in case of ACh. Insulin induced a decrease in rat brain DA and NA levels, which was more marked in the hyperglycaemic animals. Conversely, insulin induced an increase in rat brain serotonin concentration which was not significantly different in normal and hyperglycaemic rats. Insulin induced marked increase in rat brain ACh levels, which was accentuated in hyperglycaemic animals. The present study reports for the first time the likely interaction between CNS insulin receptors and brain monoamines, and ACh, in euglycaemic and hyperglycaemic states.(ABSTRACT TRUNCATED AT 250 WORDS)